Definitive radiotherapy for early glottic carcinoma: Prognostic factors and implications for treatment

: Treatment and disease-related factors were analyzed for their influence on the outcome of patients treated definitively with irradiation (RT) for early glottic carcinoma.

: One hundre two patients with stage T1 or T2 glottic carcinomas were treated definitively with RT from December 1983 through September 1993. Median follow-up time was 63 months. Factors analyzed for each patients included age, sex, stage, anterior commissure involvement, surgical alternative, histologic differentiation, field size, total dose, fraction size, and total treatment time. Survival analysis methods were employed to assess the effects of these factors on local control and complication rates.

: The 5-year local control rates by stage were as follows: T1a, 92%, T1b, 80%, T2a, 94%; and T2b, 23%. by univariate analysis, factors found to have a significant impact on local control were stage, surgical alternative, fraction size, anterior commissure involvement, and overall treatment time. By multivariate analysis, stage, field size, and fraction size were the only significant factors that independently influenced local control.

: The inferior control rate for stage T2b lesions has implications for treatment. Our study supports the conclusion of reports in the literature showing that low fration size negatively influences outcome in patients with early glottic cancer.     

Prognostic factor of telecobalt therapy for early glottic carcinoma.

BACKGROUND. Local control rates of T1 and T2 glottic carcinoma treated with radiation alone were reported as 80-91% and 63-76%, respectively. The authors investigated the factors that affect the local control rate for early glottic carcinoma. METHODS. From 1967 through 1982, 330 patients with early glottic carcinoma (T1: 274 patients; T2: 56) were treated with telecobalt therapy at the Department of Radiology, Osaka University Hospital, Osaka, Japan. RESULTS. Five-year actuarial survival rates of patients with T1 and T2 were 79% and 80%, respectively. Five-year local disease control rates of patients with T1 and T2 disease were 81% and 67%, respectively. In 243 of 254 patients treated with 2 Gy a day, tumor response could be evaluated at the dose level of 40 Gy. For tumors treated with a daily dose of 2 Gy, local control rates of 153 tumors that disappeared at 40 Gy and 90 tumors that persisted at 40 Gy were 83% and 62%, respectively (P < 0.001). Field size and daily fraction size did not affect the local control rate. CONCLUSION. Evaluation of tumor response at 40 Gy was an important indicator of local disease control for early glottic cancers treated with 2 Gy a day.     

早期声门型喉癌放射治疗的预后因素分析

目的：分析单纯放射治疗早期声门型喉癌（TINOMO）的预后因素。方法：1958年8月至1994年12月，肿瘤医院共收治 行单纯放射治疗的TINOMO声门型喉鳞癌238例，其中男性220例，女性18例。用6、8MNVX射线或^60Co予平行对穿野放射治疗，中位放射总剂量为68Gy，中位治疗时间52d，中位放射野大小22．5cm^2。用Kaplan-Meier计算生存率和局部控制率，Logrank法做差异检验。Cox回归法统计影响局部控制率（LC）和总生存率（OS）的预后因素。结果：中位随访时间127个月（4－410 个月）。5、10年总生存率分别为84．0％和74．9％。5年局部控制率为82．1％。44例在随访过程中出现局部复发（41例为原发部位复发，2例为颈部淋巴结复发，1例因失访复发部位不祥），23例出现第二原发肿瘤。对LC不利的预后影响因素为局部大肿块、前联合受侵和治疗过程中血红蛋白下降。结论：单纯放射治疗TINOMO声门型喉癌可得到很好的局部控制率，但局部大肿块、前联合受侵和血红蛋白在治疗过程中下降是对局部控制不利的预后因素。     

Prognostic factors in early carcinoma of the endometrium

Two hundred forty-one patients with clinical-pathological Stage I and 58 patients with clinical-pathological Stage II carcinoma of the endometrium treated between January 1959 and December 1983 at the Ottawa General Hospital were analyzed. The adjusted survival rate at 5 years was 92% in patients with Stage I and 66% in patients with Stage II. In patients with Stage I, the most important prognostic factors were the histological grade of the tumor and the depth of myometrial invasion. In patients with Stage II, the single most important prognostic factor was the clinical extent of the disease. Grade and depth of myometrial invasion were also significant prognostic factors, particularly in patients with pathological Stage II. Combined surgery and radiation therapy was clearly superior to surgery alone in patients with Stage II but not in patients with Stage I, although, with long-term follow-up, our results may suggest improved survival in these patients as well.     

The efficacy of voice therapy in patients after treatment for early glottic carcinoma

BACKGROUND: After treatment for early glottic carcinoma, a considerable number of patients end up with voice problems that interfere with daily life activities. The objective of this randomized and controlled study was to assess the efficacy of voice therapy in these patients. METHODS: Of 177 patients, 6-120 months after treatment for early glottic carcinoma, 70 patients (40%) suffered from voice impairment based on a 5-item screening questionnaire. Approximately 60% of those 70 patients were not interested in participating in the current study. Twenty-three patients who were willing to participate were assigned randomly either to a voice therapy group (n = 12 patients) or to a control group (n = 11 patients). Multidimensional voice analyses (the self-reported Voice Handicap Index [VHI], acoustic and perceptual voice quality analysis, videolaryngostroboscopy, and the Voice Range Profile) were conducted twice: before and after voice therapy or with 3 months in between for the control group. RESULTS: Statistical analyses of the difference in scores (postmeasurement minus premeasurement) showed significant voice improvement after voice therapy on the total VHI score, percent jitter, and noise-to-harmonics ratio in the voice signal and on the perceptual rating of vocal fry. CONCLUSIONS: Voice therapy proved to be effective in patients who had voice problems after treatment for early glottic carcinoma. Improvement not only was noticed by the patients (VHI) but also was confirmed by objective voice parameters.     

Radiation therapy in early glottic carcinoma: significance of prognostic factors and dose fractionation

A retrospective analysis of 208 cases with early glottic cancers treated by radiation therapy is presented. Early T1 (156 cases) and T2 (52 cases) lesions accounted for only 43 per cent of all glottic tumours that presented at the Tata Memorial Hospital between 1975-80. A markedly predominant male to female ratio of 22:1 was noted with 66 percent presenting in the fifth and sixth decades of life. Radical Radiation therapy was delivered with two different regimens according to the then prevalent physician preference. Regimen 1 delivered 50 Gy/15 frs. in three weeks and regimen 2 with 60 Gy/24 frs./5 weeks. The actual total survival and disease free survival was 92 per cent and 85 percent for T1 lesions and 82 percent and 67 percent for T2 tumours respectively. Minimal tumour volume involving a unilateral mobile vocal cord had the best prognosis. With extension to more lengths of cord and/or involvement of the anterior commissure or with tethering or fixation of the cord the prognosis was adversely influenced. In T1 lesions, the shorter course with the higher fractionation dosage levels showed improved local controls. However, the results were not statistically significant. This was not so in the T2 lesions probably due to small number of cases. Treatment failure was recorded in 19 per cent cases of which 90 per cent was seen in the first two years after treatment. Persisting laryngeal oedema confirmed a high index of suspicion towards recurrent disease. A radiotherapeutic technique using proper patient positioning and accurate beam direction with total dosage level above 1850 rets and TDF between 101-106 values is the recommended optimal treatment. In conclusion, an understanding of the prognostic features and an appropriate dose fractionation schedule allows optimization to effectively control early glottic tumours and retain function in the majority of patients.     

早期声门型喉癌放疗与手术治疗的疗效分析

167 patients with early glottic carcinoma treated by surgery or radiotherapy in the past 25 years are analysed. Of these patients, 74 with T1 N0 M0 glottic carcinoma treated by surgery gave a 5-year survival rate of 93.2%. In these 74 patients, 5 who received total laryngectomy and 69, partial laryngectomy gave 5-year survival rates of 80% and 94.2%. In this series, 93 patients treated by radiotherapy gave a 5-year survival rate of 87.4%. There was no significant difference between the two groups (X2 test P greater than 0.05). The above results showed that the results of surgery and radiotherapy are similar. The authors suggest that radiotherapy be considered as the first choice for this type of cancer for its advantages over surgery.     

低温等离子射频消融术治疗早期声门型喉癌的疗效及影响因素分析

目的 探讨低温等离子射频消融术治疗早期声门型喉癌的疗效及相关影响因素.方法 根据手术方式的不同将120例早期声门型喉癌患者分为等离子组(n=86)和传统组(n=34),其中等离子组患者采用支撑喉镜下低温等离子射频消融术,传统组患者采用传统喉裂开声带切除术.所有患者手术结束后均采用门诊复查与电话随访相结合的方式进行3年随...     

Medullary thyroid carcinoma: Prognostic factors and treatment

Seventy-five patients with medullary thyroid carcinoma (MTC) have been treated at Institut Gustave-Roussy from 1932 to 1979. Of these, 13 patients had distant metastases and received palliative treatment, their median survival was 3 years. Sixty-two patients with WC limited to the neck received curative treatment: 6 had exclusive external radiotherapy for inoperable disease and 56 were surgically treated: 23 by total thyroidectomy and 33 by partial thyroidectomy. After surgery 29 patients received external radiotherapy for cervical lymph node involvement ($\text{25}\text{29}$) and/or incomplete surgical resection ($\text{12}\text{27}$). The survival rate was 69% at 5 years and 48% at 10 years. It was lower in patients with distant metastases at presentation (p < 10^?5), with tumoral infiltration of the posterior tissue planes (p < 0.025) and in patients in whom surgical excision bad not been satisfactory (p < 0.01). It was not correlated with cervical lymph node involvement probably because those patients with lymph node involvement had been irradiated. The 29 patients who received post-operative cervical radiotherapy had initially more extensive local disease (p < 0.05) than the 27 patients treated by surgery alone, nevertheless their survival was slightly higher. No difference in survival rate was observed between patients treated by total thyroidectomy or partial thyroidectomy, among whom only 4 local recurrences occurred. Three of the 6 patients treated with external radiotherapy alone experienced long survival (4, 7 and 10 years) and a fourth is still in clinical remission 4 years after treatment. The effectiveness of chemotherapy in patients with metastases was poor, only one patient out of 6 had a partial remission following a treatment by adriamycin. In the familial form and multiple endocrine neoplasia type II, total thyroidectomy appears to be indicated. In the sporadic cases, partial thyroidectomy is usually sufficient. External radiotherapy is effective in MTC and seem to be able to eradicate small foci of residual tumor; it is indicated when surgical excision is impossible or Incomplete.     

Prognostic factors and treatment effects for hepatocellular carcinoma in Child C cirrhosis

The aim of this study is to elucidate the prognostic factors and the treatment effect on survival in hepatocellular carcinoma (HCC) patients with Child C cirrhosis. Out of 3330 newly discovered HCC patients, 157 consecutive HCC individuals with Child C cirrhosis were enrolled. The prognostic factors were examined by Cox proportional hazards regression analysis and their survival was compared by propensity score-matched analysis. Multivariate analysis revealed that high serum bilirubin (>3 mg dl(-1)), the presence of uncontrollable ascites, and a high platelet count (>8 x 10(4) mm(-3)), so-called background liver factors, as well as multiple tumours, large tumours (>3 cm), high alpha-fetoprotein (>400 ng ml(-1)), and the presence of portal vein thrombus, so-called tumour factors, were factors of poor prognosis. While transcatheter arterial chemoembolisation (TACE) was a factor of good prognosis (relative risk=0.50, 95%CI=0.27-0.89, P=0.019), local ablation therapy and transcatheter arterial chemoinfusion (TAI) were not significant prognostic factors. The survival of patients who received TACE was superior to matched patients without active treatment (P=0.009); however, we did not observe survival benefit after local ablation therapy or TAI. These results suggested that tumour factors as well as background liver factors are prognostic factors of HCC even in patients with Child C cirrhosis, and selective use of TACE in these patients provides survival benefit.     

Prognostic factors for local control of early glottic cancer: the Rabin Medical Center retrospective study on 207 patients

Purpose: Different radiation therapy schedules and devices have been used over the last 20 years at Rabin Medical Center in patients with early glottic cancer. The aim of the present retrospective analysis was to identify the subgroup of patients at high risk of failure of radiation treatment.

Materials and Methods: Between 1974 and 1994, 207 patients with squamous cell carcinoma of the glottis, 182 Stage T1 and 25 Stage T2, underwent definitive radiation therapy. During this period, treatment was administered with different radiation devices (⁶⁰Co or 6-MV X ray), using different dose/fraction protocols (1.8 or 2 Gy per day, 5 or 6 fractions per week), total doses (42–77.4 Gy), overall radiation times, and delays. These treatment variables, in addition to certain patient and tumor characteristics, were correlated with local control at a median follow-up of 57 months (range 18–265 months).

Results: The 5-year local control rates for T1 and T2 tumors were 88% and 73%, respectively. Univariate analysis showed that smoking, diabetes mellitus, anterior commissure involvement, T stage, and extension of tumor to one third or more of the vocal cord were highly significantly correlated with decreased local control. None of the treatment variables, including dosage at which complete tumor regression was noted, were found to be predictive. By multivariate analysis, only anterior commissure involvement was found to be highly significant (risk ratio 1.9, 95% CI 1.2–3.0, p = 0.027), and T stage was borderline significant (risk ratio 1.6, 95% CI 1.0–2.5, p = 0.054).

Conclusion: This study suggests that only two tumor characteristics are predictive of local failure of early glottic cancer: anterior commissure involvement and T stage. Treatment variables apparently do not influence local control.     

Hypofractionation reduces the therapeutic ratio in early glottic carcinoma

From 1969-1985 two types of fractionation schedules with similar time, dose, and fractionation factor (TDF) values were used to treat 197 patients with Tis, T1, and T2 squamous cell carcinoma of the vocal cord. One hundred and thirty-one patients were treated with conventional daily 2.0 Gy fractions, and 66 patients were treated once per week with large (5.5-6.6 Gy) fractions (hypofractionated group); both groups were treated over a period of approximately 6 weeks. The local failure and complication rates for patients completing treatment in the two groups were compared; a patient was regarded as having suffered a serious complication of treatment if laryngectomy or tracheostomy had to be performed in the absence of active disease, or if antibiotics and/or corticosteroids had to be prescribed for laryngeal oedema and/or necrosis. In patients with Tis and T1 disease, the failure rate was worse in the hypofractionated group than in the conventionally treated group (p = 0.06). In the smaller group of T2 patients, no significant difference was found in the failure rates between the hypo- and conventionally fractionated groups. Complication rates were similar in Tis/T1 and T2 patients, but significantly higher in the hypofractionated group (p less than 0.001). Neither stage nor fractionation schedule had an effect on survival, but laryngectomy/tracheostomy free survival was significantly worse in Tis/T1 patients receiving hypofractionated treatment, (p = 0.008) although not in T2 patients. These results indicate that in Tis/T1 glottic cancer, hypofractionation of radiotherapy produces a reduction in the therapeutic ratio.     

Radiation therapy in the treatment of early glottic carcinoma: the experience of Villejuif

A retrospective analysis of 197 early glottic carcinoma treated with small field irradiation to a dose of 65 Gy is presented. The 5-year survival rate was 77.3%. Thirty-eight local failures have been observed, and the 5-year local control rate was 85.7%. Suspicion of extra glottic extension was the main prognostic factor. Final local control rate, taking into account the salvage treatment, was 90% at 5 years. Excellent functional results were observed.     

Risk factors for voice quality after radiotherapy for early glottic cancer

Background and purpose

In the majority of patients irradiated for early glottic cancer an abnormal voice was reported. The purpose of the study was to determine the factors influencing voice quality after radiotherapy for T1 glottic cancer.

Methods

The voices of 75 male patients irradiated for T1 glottic carcinoma were assessed subjectively and objectively by acoustic analyses and aerodynamic measurements. The laryngeal function and morphology were evaluated by videolaryngostroboscopy. The data on smoking habits, the associated diseases influencing voice quality, the extent of the tumor, the type of biopsy, and the irradiation technique were collected from the medical records. The data on the factors influencing voice quality were compared for patients with a normal/near-normal voice and those with a hoarse voice.

Results

Voice quality was at least slightly abnormal in 94.7% and 81.3% of patients, when assessed perceptively and objectively, respectively. Smoking after the completed treatment, more severe morphologic alterations of the vocal folds, dryness of the throat, incomplete closure of the vocal folds and functional voice disorders expressed as supraglottic activity adversely influenced the voice quality. A good correlation between the perceptive voice assessment and the acoustic analyses was established.

Conclusions

After the successful irradiation for T1 glottic carcinoma, the great majority of the patients have at least a slightly hoarse voice. A better voice outcome could be achieved if radiotherapy was followed by the patient’s cessation of smoking and the appropriate voice therapy.     

Prognostic factors for renal cell carcinoma

Renal cell carcinoma is a relatively uncommon tumour with a widely varying prognosis depending on several tumour and clinical factors. This review discusses these factors and critically appraises their value both as individual markers and when they are incorporated into scoring systems/models or algorithms. Disease stage (assessed pathologically and/or clinically) and performance status have the strongest evidence as helpful individual prognostic markers but a better discrimination is obtained by combining these and adding in various other indices. Prospective validation of such integrated prognostic models will be essential.     

Prognostic factors for lymphedema after primary treatment of breast carcinoma.

BACKGROUND: Lymphedema of the arm is a serious consequence of breast carcinoma treatment. Postmastectomy lymphedema of the upper limb usually is related to certain risk factors such as axillary surgery, radiotherapy, obesity, venous outflow obstruction, delayed wound healing, and infection. The objective of the current study was to identify the risk factors for secondary lymphedema after breast carcinoma treatment. METHODS: A total of 1278 breast carcinoma patients, all of whom were residents of Florence area, Italy at the time of diagnosis and who were operated on by the same surgeon between 1989 and 1997, were included in the current analysis. The circumference of the upper arm was measured and lymphedema was defined as being present when an increase of > 5% of the sum differences between the two arms was found. The observed cumulative probability of lymphedema occurrence was estimated using the Kaplan-Meier method. The Cox proportional hazards models were fitted to assess the relative excess risk of lymphedema and to check for confusing factors. All patients with lymphedema who were living in the Florence area were referred to a specialist for treatment. RESULTS: Two hundred three cases of lymphedema of the ipsilateral arm were found (15.9%). The right arm was affected in 44.5% of the cases and the left arm in 55.5%. The risk of developing late lymphedema was found to be significantly related to a pathologic T2 classification (hazards ratio [HR] = 1.44; 95% confidence interval [95% CI], 1.06-1.94) and postoperative radiotherapy (HR = 1.35; 95%CI, 1.00-1.83). Patients who had > 30 lymph nodes removed were found to have a borderline increased risk of lymphedema (HR = 1.64; 95% CI, 0.99-2.74). Multivariate analysis identified postoperative radiotherapy (HR = 1.38; 95% CI, 1.02-1.86) and the number of lymph nodes removed (HR = 1.29; 95% CI, 1.04-1.59) to be independent predictors of lymphedema. CONCLUSIONS: The results of the current study demonstrated that the risk of lymphedema was correlated with the use of postoperative radiotherapy and the number of lymph nodes removed.     

PROGNOSTIC FACTORS IN CERVICAL CARCINOMA

Carcinoma of the uterine cervix is the leadinggynecologic malignancy in developing country and is the third leading cause of cancer related death amongfemales. It is very important to explore prognosis factors of cervical carcinoma, however, there are many factors influencing prognosis and it would lead to great deviation to study prognosis only from clinic-pathologic parameters or single factor. Recent studies have focused on celldynamics and sporadic data showed that prognosis of cervical ca…     

Prognostic factors in endometrial carcinoma

From Apr. 1964 to Dec. 1985, the prognostic factors of 325 patients suffering from endometrial cancer treated by total hysterosalpingo-oophorectomy and bilateral pelvic lymph node dissection are analyzed. The results indicated that pelvic lymph node metastasis was related to the prognosis of this cancer, the 5-year survival rate was 86.56% in the negative group and 44.74% in the positive group (P less than 0.01). The factors leading to lymph node metastasis were: (1) The more advanced stage, the higher the pelvic lymph node metastatic rate (stage I 12.50%, II 27.16%, III 55.56%) (P less than 0.01); (2) The deeper the myometrial invasion, the higher the metastatic rate (no myometrial invasion 0%, superficial 8.25%, medium 36.96%, deep 40.74%) (P less than 0.01); (3) The higher the histological grade, the higher the metastatic rate (G1 12.50%, G2 21.57%, G3 30.00%) (P less than 0.05), implying that the histological grade is in direct proportion to the myometrial invasion and (4) The metastatic rate to pelvic lymph node is higher in the cervical invaded group than that without it (29.41% in the positive group and 15.42% in the negative group) (P less than 0.05). In this paper, the method of operation for endometrial cancer is discussed, suggesting that hysterosalpingo-oophorectomy be performed before opening the cavity of uterus. Should the cancer invades to a medium or deep degree in the myometrium, histological grade was high or the cervix was infiltrated pelvic lymph node dissection can be performed. After the operation, radiotherapy should be supplemented in those with positive lymph nodes.     

Prognostic factors in renal carcinoma

Identification of tumor-, patient-, or treatment-related prognostic factors in renal carcinoma (RC) would allow the most appropriate application of current and future therapy to patients with this poorly responsive malignancy. Stage, including degree of lymph node and venous involvement, and grade remain the most powerful predictors of patient outcome. Performance status (PS) of patients also influences prognosis, as it relates to tumor aggressiveness and ability to receive adequate treatment. Newer techniques of measuring tumor proliferation and the application of cytogenetics to RC are currently being explored and may add to prognostication. Lastly, characteristics of tumor metastases and the appropriate application of surgical and chemotherapeutic treatment modalities allow for identification of patient subgroups with different survival times. This review explores various characteristics as they impact on overall survival in patients with RC.