乳腺癌保乳术后放射治疗的疗效观察

目的观察乳腺癌保乳术后放射治疗的疗效和美观效果。方法109例保乳术后在我科接受全乳外照射和瘤床加量(boost)放疗,79例应用高剂量率插植技术,T1肿瘤用单排插植,针距为1.5cm,T2以上肿瘤用双排或三排插植。针距间单次剂量(DB)10～12Gy,靶区周边剂量为85%DB。30例采用电子线常规外照射15Gy。全乳照射应用6MV直线加速器,采用双切线半野照射技术,靶区剂量为45～52Gy(平均48.6Gy)。采用医生评分与患者问卷方法评价美观效果。结果全组109例应用KaplanMeier方法统计5年实际生存率为93.8%。局部复发率为6.5%。全组无放射性溃疡发生,5例出现位于插植针孔周围急性皮肤炎症。在经临床随访体检的75例中,医生打分和患者自评满意度为优的比例分别为87%和81%,无统计学意义(P>0.05)。48例经组织间插植加量放疗;27例经电子线外照加量放疗。两组满意度医生总评为优的患者比例分别为81.2%和85.2%,差异无统计学意义(P>0.05)。结论乳腺癌保乳术后放疗可降低局部复发率,并发症少。不同的瘤床加量放疗方法不影响美观效果。     

Therapeutic Outcome and Prognostic Factors in the Radiotherapy of Recurrences of Cervical Carcinoma Following Surgery

PURPOSE: To evaluate the efficacy of radiotherapy in patients with recurrences of cervical carcinoma. PATIENTS AND METHODS: 26 patients who underwent radiation therapy for recurrences of cervical carcinoma following surgery between 1989 and 1999 were retrospectively analyzed. 17 patients had inoperable or macroscopic residual tumor. Nine patients had a complete/microscopically incomplete tumor resection. Depending on tumor burden and location of the recurrence, external beam radiotherapy or a combination with brachytherapy was delivered to a total dose of 50-65 Gy. RESULTS: The 5-year overall survival was 28%, relapse-free survival 24%, pelvic control 48%. Therapeutic outcome was related to the margins of resection, location of recurrence and technique of radiotherapy. In case of surgery without residual or microscopic tumor, the 5-year survival rate was 67%, with macroscopic tumor no patient was alive after 37 months (p = 0.05). 5-year overall survival was 42% for central recurrences, 10% for recurrences with pelvic wall infiltration. Recurrences confined to the vagina or paravaginal tissue had a higher 5-year overall probability as compared to all other patients (57% vs. 14%). All patients treated with combined radiotherapy were alive, whereas all patients treated only with external radiotherapy were dead after 32 months (p = 0.01). CONCLUSION: The probability of controlling recurrence mostly depends on a small tumor burden with the possibility of brachytherapy and/or complete surgery. Aggressive treatment modalities like radiochemotherapy and/or higher radiation doses are needed, especially for recurrences with infiltration of the pelvic wall and/or with macroscopic tumor.     

Die postoperative Strahlentherapie beim Endometriumkarzinom Eine retrospektive Analyse von 541 Patienten

PURPOSE: This retrospective study was designed to evaluate the role of adjuvant radiotherapy for surgically treated endometrial carcinoma. PATIENTS AND METHODS: From 1980 through 1988, 541 patients were treated with either intravaginal cuff irradiation with a high-dose-rate (HDR) Iridium-192 remote afterloading technique (n = 294) or with combined HDR-brachytherapy and additional external pelvic irradiation to 54 Gy (n = 247) after surgery for endometrial cancer. Afterloading irradiation was administered in 4 fractions 4 to 6 weeks after surgery. A dose of 30 Gy was delivered at a depth of 0.5 cm from the vaginal mucosa. RESULTS: Patients with HDR-brachytherapy alone showed a 5-year survival of 94.3% for Stage I and 73.6% for Stage II (p = 0.0007). Patients who received both brachytherapy and additional external pelvic irradiation had a 5-year survival of 94.1% for Stage I, 81.1% for Stage II, 70.4% for Stage III and 46.9% for Stage IV (p = 0.0001). The main predictors for survival in a multivariate analysis were stage and grading. Patients with combined radiotherapy had a local recurrence rate of 3.2%, whereas patients with brachytherapy alone who were better selected and had more favorable prognostic factors showed a recurrence rate of 2%. Low-risk patients (Stage I, Grade 1, low infiltration) in the HDR-brachytherapy group had 6 relapses, mainly caused by insufficient treatment on the basis of papillary histology. High-risk patients with poorly differentiated tumors, which infiltrate more than half the myometrial wall might benefit from additional external radiotherapy in terms of reduction of local recurrence and better survival. Five-year actuarial survival rate was 93.6% after combined radiotherapy vs 86.7% after brachytherapy alone. Complications were graded according to the RTOG scoring system. Severe late complications were fistulas of bladder and/or bowel, which occurred in 2.8% in the combined radiotherapy group, and 0.7% in the HDR brachytherapy group. CONCLUSIONS: Low-risk patients should be generally treated postoperative with HDR-brachytherapy alone. Combined radiotherapy decreased pelvic relapses for high-risk patients with overall low complication rates. We conclude that an individually adjusted postoperative radiotherapy allows a well tolerated treatment with excellent results.     

Squamous cell carcinoma of the base of the tongue: results of treatment in 115 cases

Between 1976 and 1986, we treated 115 patients (mean age 53.8 years) with base of tongue carcinomas. The staging system used was the UICC TNM classification of 1979. Seventy per cent of the tumours were T3 or T4 and 42% had N2 or N3 lymph node. Locoregional treatment was irradiation alone (98/115) or surgery and post-operative radiotherapy (17/115). Sixty-seven patients received induction chemotherapy. Actuarial survival of the entire group at 3 and 5 years was 25 and 23%, respectively, and 3-year actuarial survival rates for T1, T2, T3 and T4 lesions were 42, 48, 20 and 17%, respectively. The local control rate at the primary site was 55% and 78% in the neck. Distant metastases occurred in 10% of patients and 8% had a second primary. Nodal status was the only other prognostic factor. The local control rate obtained with irradiation alone was not good. For limited T1 and T2 tumours, interstitial therapy or surgery should improve the local control rate.     

Microscopic Residual Disease Is a Risk Factor in the Primary Treatment of Breast Cancer

OBJECTIVES: In the primary treatment of breast cancer, postoperative radiotherapy is performed in high-risk patients after mastectomy and in patients who received breast conserving surgery. In a retrospective analysis, our mono-institutional results of postoperative irradiation have been evaluated. PATIENTS AND METHODS: Between 1992 and 1996, 500 patients have been irradiated after surgery for primary breast cancer. Of these, 489 patients had no initial metastases. 89 patients with loco-regional disease had a mastectomy, 400 patients were irradiated after breast conserving surgery. Radiotherapy at the chest wall was performed with 50 Gy and 2 Gy fractions. After microscopically incomplete resection, an electron boost of 10 Gy was given. The ipsilateral lymph nodes were irradiated with 50 Gy when there was extensive lymph node involvement or invasion of tumor in the axillary fat tissue. RESULTS: The 5-year local control rate after mastectomy was 97.4% and 91.2% after breast conserving surgery. The only statistically significant risk factor for local failure was microscopically incomplete resection. The corresponding 5-year local control rates for microscopically incomplete and complete resections were 76.4% and 92.7% (p = 0.01). The risk of local relapse was increased with both marginal invasive and marginal DCIS-tissue. 86.6% of local relapses were in the same quadrant. CONCLUSIONS: High-risk patients after mastectomy and patients with breast conserving surgery achieve a high local control rate with postoperative irradiation. After microscopically incomplete resection, there is an increased risk for local relapse.     

Treatment outcomes and prognostic factors in patients with supratentorial low-grade gliomas

Low-grade gliomas account for 10-15% of all adult primary intracranial tumours. Currently, there is no consensus on the treatment strategy for low-grade gliomas. This study was designed to evaluate the treatment outcomes, prognostic factors and radiation-related late complications, as well as to assess whether or not post-operative radiotherapy has benefit on local control and overall survival in this population. We retrospectively reviewed 93 consecutive adult patients with supratentorial low-grade gliomas diagnosed at our institution from July 1985 to December 1997. All patients underwent surgical intervention and 60 of them received post-operative radiotherapy. With a median follow-up of 110 months for surviving patients, the 5-year overall and progression-free survival rates were 57% and 47%, respectively. 46 patients experienced local progression of disease during the follow-up period. In multivariate analysis, age at diagnosis, extent of surgery and post-operative Karnofsky performance status showed independent prognostic significance for progression-free and overall survival rates. Post-operative radiotherapy had independent prognostic value for progression-free survival. This analysis has changed our practice and we suggest that aggressive surgical resection and post-operative radiotherapy might be considered for patients with low-grade gliomas. Further efforts should be made to optimize radiotherapy techniques and to integrate new therapeutic modalities.     

Treatment results of radiotherapy with or without surgery for posterior pharyngeal wall cancer of oropharynx and hypopharynx: prognostic value of tumor extension

PURPOSE: We have been treating posterior pharyngeal wall cancer of the oropharynx and hypopharynx with external radiotherapy according to our policy reported in the 1970s. MATERIALS AND METHODS: Between 1968 and 1995, 51 patients were treated. Treatment policy was decided on the basis of the treatment response after 40 Gy of radiotherapy. Thirty-six good responders were treated with radical radiotherapy, eight poor responders received radical surgery, and the other seven patients could not receive radical treatment because of tumor or patient factors. RESULTS: The 5-year local control and cause-specific survival rates were 56% and 48% for all 51 patients. The 5-year local control rate was 52% for radical radiotherapy. Tumors limited to the posterior wall showed better treatment results (76% for both local control and cause-specific survival) than tumors involving the postcricoid area (0% and 10%). CONCLUSION: Radiotherapy for carefully selected patients dependent on response after 40 Gy of radiotherapy is a useful policy. Tumor extension is an important prognostic factor.     

Effect of radiation therapy alone or in combination with surgery and/or chemotherapy on tumor and symptom control of recurrent rectal cancer

Purpose

To define the value of radiotherapy alone or in combination with other treatment modalities in salvage and/or palliation of locally recurrent rectal cancer with or without concomitant distant metastases.

Patients and Method

A series of 280 patients, treated between 1975 and 1990 was retrospectively reviewed. The patients were divided into 2 groups: 166 patients had a local recurrence only (group 1), 114 presented with simulteneously distant metastases (group 2). In group 1, 50 patients had only radiotherapy, 20 had radiation in combination with surgery, 68 patients had radiation and chemotherapy, and 28 patients had a combination of all 3 treatment modalities. In group 2 these numbers were 41, 7, 59 and 7, respectively. The median follow-up time was 11 months (1 to 118).

Results

The 2- and 5-year survival of group 1 were 33% and 12%. In group 2 the 2-year survival was 9%. The 2- and 5-year symptom-free survival for both groups were 18%/12% and 1%/0%, respectively. There was no significant difference in survival and symptom-free survival between treatment including concomitant 5-FU or 5-FU once a week and treatment without chemotherapy. In the combined treatments which included surgery there was a longer survival and symptom-free survival. In both groups a subanalysis of the patients who had radiation only showed a dose-response relationship for symptom-free survival. This was not the case for survival.

Conclusion

In local recurrence of rectal cancer without detectable distant metastases, radiotherapy and/or surgery have value toward survival and symptom-free survival. Further intense efforts in preventing the local recurrence by improving primary treatment are warranted.     

Surgical and radiotherapeutic treatment in stage I endometrial adenocarcinoma. Retrospective analysis of 218 patients

From April 1977 through April 1985, 218 stage I endometrial carcinomas were treated with radiosurgery or radiotherapy alone. Postoperative irradiation was external (60Co) in 131 and curietherapy in 27 patients. Twenty patients underwent preoperative curietherapy and 40 patients radiotherapy alone. Median follow-up was 5.6 years (range 3-11). The overall 5-year actuarial survival (Kaplan-Meier method) was 86.1% +/- 2.5. The 5-year D.F. actuarial survival was 95% +/- 4.9, 93.1% +/- 4.7, 88.4% +/- 2.9, respectively, for preoperative radiotherapy, postoperative curietherapy and postoperative external irradiation groups. The 5-year actuarial survival was 69.8% +/- 7.7 in the radiotherapy alone group. There was difference in survival among patients treated with radiotherapy alone as compared to those radiosurgically treated (P less than 0.001). Local and general recurrence rate was 8.2%; vaginal recurrences 2/218 (0.9%); pelvic recurrences 7/218 (3.3%); distant metastases 9/218 (4.1%). Overall side effects were observed in 20/218 patients (9.1%): grade I and II in 8.6% of cases, grade III in 0.9% of cases. The authors conclude that good results can be achieved with adjuvant radiotherapy both in high risk cases and in low risk cases, with minimal side effects.     

Intraoperative Radiotherapie (IORT) lokal ausgedehnter und rezidivierter Nierenzellkarzinome

Purpose

Renal cell carcinomas are relatively radioresistant. After macroscopically incomplete tumor resection conventional external beam radiotherapy is dose-limited and additional systemic treatment with chemotherapy ineffective to achieve local control. In a pilot study the role of intraoperative radiotherapy in the treatment of locally advanced or recurrent renal cell carcinomas was analysed.

Patients and Method s

From January 1992 to July 1994 11 patients with a primary (n=3) or recurrent renal cell carcinoma had IORT. One patient had complete resection and in 3 respectively 7 patients microscopically or macroscopically residual disease was left. Using 6 to 10 MeV, a single dose of 15 to 20 Gy was delivered to the fossa renalis and the corresponding paraaortic area. Based on three-dimensional treatment planning, additional external beam radiotherapy was given 3 to 4 weeks later (40) Gy, 2 Gy SD, 23 MV).

Results

After a mean follow-up of 24.3 months 5 patients had died of distant metastases (lung, liver, bone, mediastinum) with a mean survival time of 11.5 months. Mean disease-free interval was 6.4 months. One patient suffered from a second malignancy. Two patients are alive with distant metastases. Local tumor control in the entire group was 100%. The calculated 4-year overall and disease-free survival was 47% and 34%. The postoperative course was affected in 3 patients (abscess n=1, short dehiscence of the abdominal wound n=2). The gastrointestinal toxicity during external beam radiotherapy was low. No IORT-specific late adverse effects were observed.

Conclusion

After incomplete tumor resection local tumor control with minimal therapy related side effects could be achieved using intraoperative radiotherapy. With IORT the dose limitation in the radiotherapy of renal cell carcinoma could be overcome. The high distant metastases rate relativized overall prognosis. The low morbidity rate justifies further evaluation of this technique.     

A systematic radio-surgical combination in the treatment of sarcoma of soft tissues in adults. Results in 106 cases at the Centre Fran?ois Baclesse

Based on a series of 143 cases of soft tissue sarcomas, including 106 cases treated curatively, the author stresses the importance of surgical resection with frozen section histological control, systematically combined with radiotherapy. Even when resection is complete, the frequency of loco-regional recurrences in all published series shows that neoplastic cells were already present around the resection site. Consequently, since 1972 at the Centre Fran?ois Baclesse, whenever possible, surgery is preceded by concentrated regional irradiation (2 sessions of 6.50 Gy at 48 hour's interval) and postoperative complementary radiotherapy is always performed regardless of the quality of the resection 3 weeks after the preoperative irradiation. The dose is limited to a total of 50 Gy when the resection is complete and is increased to 60 to 70 Gy in the zones of doubtful or incomplete resection. This postoperative radiotherapy is associated with 5 injections of actinomycin D during the first sessions, but no adjuvant chemotherapy such as cyvadic is administered routinely. Under the conditions of treatment, the 5-year results obtained in 106 cases were as follows: local recurrences: 12.4%, metastases: 26%, survival rate: 76%. When the surgical resection was complete (62 cases), the 5-year local recurrence rate was 1.5% with 9% metastases and 92% survival. Metastases were related to factors of high malignancy which are beginning to be more clearly defined. These forms may benefit from intensive combination chemotherapy.     

Exclusive radiotherapy of locally advanced carcinoma of the larynx. Analysis of the caseload of Varese (1979-1986)

The authors analyse a retrospective series of 90 consecutive patients (pts) affected with locally advanced laryngeal carcinoma (T3-4, N0-3--TNM, UICC 1978) who were radically irradiated from November 1979 to December 1986 at the Radiotherapy Department of the General Hospital of Varese. All the patients were treated with 60Co and two opposed parallel lateral fields and progressive shrinkage: 66 with conventional fractionation (2 Gy once a day, 5 times a week), 24 with an accelerated hyperfractionated regimen (1.5 Gy twice a day, 5 times a week). The median total dose delivered to the tumor and clinically involved nodes was 64 Gy (1678 reu, CRE). Median follow-up was 21 months (range: 3-113). The 5-year overall survival (Kaplan-Meier) was 40.5%. The 5-year disease-free survival, for 47 patients in complete remission at the end of radiotherapy, was 51.9% after irradiation alone and 56.7% with salvage surgery. There were no statistically significant differences in survival according to local spread (T3 vs. T4), nodal status (N0 vs. N1-3) and dose fractionation regimen (conventional vs. accelerated hyperfractionated). Isoeffect (CRE) values above 1751 reu obtained a 3-year loco-regional control rate of 65%, while, for isoeffect values under 1600 reu, the 3-year loco-regional control rate was 33.3%. Relevant late sequelae were not observed. Our findings suggest that primary radiotherapy with salvage surgery in reserve could be considered as an effective choice for locally advanced laryngeal carcinoma, at least in selected groups of patients.     

Role of brachytherapy in post-operative cervical cancer patients with risk factors other than positive stump

OBJECTIVEThis study aimed to determine the effectiveness of brachytherapy in post-operative cervical cancer patients with risk factors other than positive stump, and to identify the candidates most likely to benefit.METHODSNewly diagnosed, non-metastatic cervical cancer patients treated in our hospital between January 2012 and November 2015 were retrospectively reviewed. Early stage patients receiving radical surgery and needing adjuvant external radiotherapy were included, but those with positive stump were excluded. All patients received external radiotherapy. They were divided into two groups: one group received vaginal brachytherapy and the other did not. The 5-year local-regional recurrence free survival (LRRFS) and overall survival (OS) rates in the two groups were compared.RESULTSTwo hundred and twenty-five patients were included in this study; while 99 received brachytherapy, 126 did not. The brachytherapy group had significantly superior 5-year LRRFS (87.7% vs. 72.5%, p = 0.004), but did not show a significant overall survival benefit (78.4% vs. 75.3%, p = 0.055). In multivariate analysis, brachytherapy, pathological type, high-risk factors, duration of radiotherapy, and transfusion were independent prognostic factors for 5-year LRRFS. In stratified analysis, the brachytherapy group showed superior LRRFS in those meeting Sedlis criteria (p = 0.017).CONCLUSIONThe combination of external beam radiation therapy and brachytherapy can improve LRRFS in post-operative cervical cancer patients with risk factors other than positive stump. Therefore, brachytherapy should be considered for these patients.     

Nasopharyngeal carcinoma: treatment of neck node recurrence by radiotherapy.

The records of 91 nasopharyngeal carcinoma patients who were treated with external radiotherapy for recurrent neck node disease were reviewed. All patients had received prior radiotherapy for cervical nodal disease or prophylactic neck irradiation. The node size (product of the greatest perpendicular diameters) at the time of treatment for nodal relapse ranged from 1cm2 to 35cm2 (median 2.25cm2). The radiation dose ranged from 823 RETs to 1949 RETs (median 1520 RETs). The recurrent node size and radiation dose were found significant prognostic factors for local control. The local tumour control for nodes 4cm2 or smaller was 51% at five years, for nodes greater than 4cm2 was 16% at 18 months (p = 0.01). The overall 5 year survival was 19.7%. Radiation dose greater than 1600 RETs was significantly associated with better survival for patients with recurrent nodes measured 4cm2 or smaller, but higher radiation dose did not improve the survival of patients with recurrent nodes greater than 4cm2. Because of the dilemma of suboptimal control resulting from inadequate radiation dose when compared with surgical treatment, and possible radiation complication from higher dose, surgery should be the treatment of choice for neck node recurrence after primary radiotherapy for nasopharyngeal carcinoma.     

早期乳腺癌根治术后辅助放疗指征探讨

目的 探讨腋窝淋巴结阳性数为1~3个的早期乳腺癌患者根治术后辅助放疗的指征。 方法 回顾性分析根治术后并经病理证实腋窝淋巴结阳性数为1~3个的早期乳腺癌患者92例,腋窝淋巴结阳性数为1、2、3个的患者数分别为40、30、22例。其中45例接受同侧胸壁、内乳区及锁骨上淋巴引流区放疗。定义预后指数≥4分者为高危患者, < 4分者为低危患者。采用Kaplan-Meier法计算生存率,并用Logrank法进行检验。 结果 放疗患者和未放疗患者的5年生存率分别为93.5%和86.4%(χ2=3.43,P＞0.05),10年生存率分别为73.0%和56.8%(χ2=2.82,P＞0.05),局部复发率为6.7%和19.1%(χ2=4.66,P＜0.05)。低危和高危患者中未放疗患者的10年生存率分别为73.0%和56.8%(χ2=3.45,P＞0.05),局部复发率分别为11.0%和24.0%(χ2=4.64,P＜0.05)。低危和高危患者中接受放疗患者的10年生存率分别为82.0%和72.3%(χ2=4.07,P＜0.05),局部复发率分别为11.0%和5.0%(χ2=5.64,P＜0.05)。 结论 对腋窝淋巴结阳性数为1~3个的早期乳腺癌根治术后且预后指数为高危的患者,建议术后行胸壁和同侧锁骨上淋巴结辅助放疗。     

Salvage treatment with sole high-dose-rate endobronchial interventional radiotherapy (brachytherapy) for isolated endobronchial tumor recurrence in non–small-cell lung cancer patients: a 20-year experience

PurposeThe purpose of this study was to report on the use of high-dose-rate (HDR) endobronchial interventional radiotherapy (brachytherapy) for isolated endobronchial tumor recurrence in patients with non–small-cell lung cancer, in whom a surgery or external radiation treatment is not possible.Methods and MaterialsA retrospective review of the patients with endobronchial tumors treated with HDR–endobronchial interventional radiotherapy at our institution (1995–2015) was performed. Treatment results and treatment-related toxicity were recorded. Clinical response was evaluated by bronchoscopy 3 months after treatment. Disease-free survival and overall survival were analyzed.ResultsOne hundred twenty-six patients were identified. The median age was 63 years, and median followup time was 67.2 months. Three-month complete local response was 86.5%. At 5 years, disease-free survival was 41.4% and overall survival was 23.6%. 12.7% of the patients died from massive hemoptysis.ConclusionHDR-endo brochial brachytherapy is an effective treatment option with acceptable toxicity for patients with endobronchial tumor recurrence in whom surgery and external beam radiotherapy are contraindicated.     

Post-operative adjuvant thoracic radiotherapy for patients with completely resected non-small cell lung cancer with nodal involvement: outcome and prognostic factors

The purpose of this study was to analyse the outcome and prognostic factors of non-small cell lung cancer (NSCLC) patients with nodal disease treated by complete tumour resection followed by radiotherapy alone. Between October 1990 and October 1999, 49 NSCLC patients with N1 or N2 stage were treated with complete resection of tumour followed by post-operative radiotherapy in our department. The radiation was delivered with 10 MV X-rays given 5 days per week at 1.8-2 Gy per fraction. Total doses ranged from 40 Gy to 64.8 Gy, with a median dose of 55.8 Gy. All patients had at least 30 months of follow-up. The 5 year overall survival rate (OS), local control rate (LC) and distant metastasis-free rate (DMF) were 34%, 52% and 29%, respectively. In multivariate analysis, stage and margin were found to influence OS. The total number of involved lymph nodes and positive margins were significant factors for LC. Only N stage was found to correlate with DMF. In conclusion, patients with multiple involved lymph nodes, advanced stage or positive surgical margins had a poor outcome even with post-operative radiotherapy. Based on these prognostic factors, new therapeutic regimens and modalities for NSCLC need to be further investigated.     

Supratentorial Low-Grade Glioma: Results and Prognostic Factors Following Postoperative Radiotherapy

BACKGROUND AND PURPOSE: To assess treatment outcome and prognostic factors following postoperative external radiotherapy in 77 patients with low-grade glioma. PATIENTS AND METHODS: Between 1977 and 1996, 45 patients with astrocytoma, 14 with oligodendroglioma and 18 with mixed glioma received postoperative radiotherapy with a median total dose of 52 Gy (range, 45 to 61 Gy). Sixty-seven patients were treated immediately following surgery, 10 patients with tumor progression. The influence of various factors including histology, gender, age, seizures, duration of symptoms (< or = 6 weeks vs > 6 weeks), CT pattern (enhancement vs no enhancement), type of surgery, total radiotherapy dose and timing of radiotherapy on relapse-free survival and overall survival was investigated. RESULTS: The median overall survival time was 81 months, the 5- and 10-year survival rates were 54% and 31%, respectively. The median time to progression was 56 months, while the 5- and 10-year progression-free survival rates were 45% and 24%. Univariate analyses identified the total radiotherapy dose (p = 0.01), duration of symptoms (p = 0.05), the presence of seizures (p = 0.04), and the CT pattern following intravenous contrast (p = 0.005) as significant prognostic factors for overall survival. Progression-free survival rates were influenced by the total dose (p = 0.04), the duration of symptoms (p = 0.01) and CT pattern (p = 0.006). On multivariate analysis, only the CT pattern (enhancement vs no enhancement) remained as independent prognostic factors for both progression-free survival and overall survival. CONCLUSIONS: A minimum total dose of 52 Gy is recommended for the postoperative radiotherapy in low-grade glioma. Tumors with CT enhancement seem to need further intensification of treatment.     

Current status of radiotherapy following ablative and breast-sparing treatment of breast cancer

After a total mastectomy in cases of a high risk of loco-regional recurrence the postoperative irradiation of the chest wall is indicated in the following situations: Inflammatory type of carcinoma, tumor stage T3-T4, extended multifocal and multicentric primary tumor. After radical axillary surgery even in patients with positive nodes irradiation is not necessary except in cases where all axillary nodes are involved or with invasion of the axillary tissue. The supra- and infraclavicular lymph drainage regions caudal to the operated area (clip) should be irradiated with 50 Gy providing both an enlarged or subtotal involvement can be diagnosed. The irradiation of the retrosternal lymph-drainage system with 45-50 Gy is indicated as follows: Medial or central tumor site, extensive involvement of the axillary nodes and advanced stages of the primary tumor (T2-T4). Axillary irradiation alone cannot serve as a substitute for surgery. After segmental mastectomy without postoperative radiotherapy a local failure rate of 30% is to be expected during a 5 year period. After surgery with adjuvant postoperative irradiation the local failure rate can be reduced to about 5%: 50-60 Gy should be applied. In case of an unfavourable histology an additional boost dose is recommended. The objective of breast cancer irradiation is to achieve freedom of loco-regional recurrence. The survival can be improved occasionally after local irradiation, theoretically improvement of survival can be achieved in 7-10% at the most.     

Prognostic factors and results after the combined surgical and radiotherapy treatment of ependymomas]

Between 1978 and 1991, 31 patients with primary (n = 28) and recurrent (n = 3) ependymoma received external radiation after initial surgery. There were 26 cases of intracranial and five cases of spinal ependymoma. Histological grading revealed low-grade in 23 and high-grade tumors in eight patients. Craniospinal irradiation was given to 13 of 28 patients, whole cranial radiation with boost to posterior fossa in three and local treatment to twelve patients. Six of 28 patients received chemotherapy. Dose to the primary, tumor localisation, grading and extend of surgery did not significantly impact on survival and relapse-free survival. Age was a marginally significant prognostic factor for survival. In patients with intracranial ependymoma (n = 24) survival and relapse-free survival at five years were 54% and 42%, respectively. Patterns of recurrence showed a local recurrence alone in eight, a CNS-relapse with local recurrence in four and local recurrence with distant metastases in one case. Spinal seeding occurred in two of 13 after craniospinal irradiation and two of twelve patients after local treatment. The main problem in the treatment of ependymoma remains local control, the use of spinal irradiation does not seem to improve treatment results.