Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck

From October 1977 through September 1986, a total of 77 patients (Stage I, 26; II, 35; and III-IV, 16) with primary non-Hodgkin's lymphoma (NHL) of the head and neck were treated with radiation therapy and chemotherapy (CVP or CHOP regimen) or radiation therapy alone. Actuarial 5-year survival rates by stage were 79% in Stage I, 35% in II, and 8% in III-IV. Significant prognostic factors were clinical stage (p = 0.0001), histological grade by the Working Formulation (p = 0.0089), and surface marker (T and B cell analysis) (p = 0.0001). In Stage II patients, the serum lactate dehydrogenase (LDH) level (p = 0.0286), the number of cervical lymph nodes involved (p less than 0.03), and maintenance chemotherapy after initial treatment (p = 0.0077) were significant prognostic factors. In conclusion, more intensive chemoradiotherapy is necessary as the first-line treatment in those with poor prognosis, especially those with T-cell type and high grade histology. In addition, maintenance chemotherapy after initial chemoradiotherapy is very important for Stage II NHL patients, especially those with a high LDH value or multiple cervical lymph node involvement.     

Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck in stage I-II

From September 1977 through January 1983, 34 previously untreated cases with primary non-Hodgkin's lymphoma of the head and neck in stage I-II were treated at our department. 16 cases were classified into stage I and 18 into stage II. Patients were treated with 4 MV X-ray (40 to 45 Gy) which encompassed Waldyer's ring and supraclavicular region with or without chemotherapy. The survival rates at three years were 93% and 50% in stage I and II, respectively. Stage, surface markers (T- and B-cell analysis) and initial primary site and the level of lymph node involvement were important prognostic factors. Chemotherapy in pre- or post-irradiation was essential, especially for cases in stage II. It was also indicated that the adequacy of radiation portal with special reference to anatomical consideration was necessary.     

Radiotherapy for head and neck cancer

Radiotherapy plays an important role in therapy for head and neck cancers from the aspect of functional and cosmetic conservation. In 2001, 130,000 patients underwent radiotherapy for the first time, and those with head and neck cancer accounted for 12.5% of this population. However, we cannot consider the management of head and neck cancer without understanding the similarities and differences among the primary sub-sites, because there is a significant difference in the natural history of cancer among these sub-sites. Treatment results are improving with the popularization of stereotactic radiotherapy and concurrent chemotherapy, in addition to traditional brachytherapy. Trends in radiotherapy for head and neck cancer are summarized in this article by discussing the specificities and similarities among sub-sites.     

Radiation therapy for primary non-Hodgkin's lymphoma of the head and neck in stages I and II

From January 1975 through December 1986, 58 previously untreated patients with primary non-Hodgkin's lymphoma of the head and neck in stages I and II were treated at our department. Thirty-seven patients were classified as stage I and 21 as stage II. Complete local remission was obtained in all cases. The 5-year survival rates were 68% and 79% in stages I and II, respectively. The 5-year survival rates according to site of origin were as follows: Waldeyer's ring 77% and neck lymph node 63%. The 5-year survival rates according to the histological classification of the Working Formulation were 73% intermediate grade malignancy and 63% for high grade malignancy. Chemotherapy combined with radiotherapy was essential, especially for cases in stage II. The 5-year survival rate was 100% for patients with chemotherapy and 71% without chemotherapy. The relapse-free 5-year survival rate was 67% with chemotherapy and 36% without chemotherapy. Most first failures were due to the development of generalized disease and the 5-year survival rate after salvage was 44%.     

Results of fast neutron therapy in advanced head and neck cancer

Eighty-nine patients with advanced head and neck cancer were treated with a fast neutron beam of mean energy 5.6 MeV. The standard tumour dose was 1320 cGyn, gamma in 20 fractions over 4 weeks, but 13 patients with laryngeal cancer received 1200 cGyn, gamma. Complete remission was achieved in 50 patients (56%). Fifteen patients (17%) survived 2 years, 14 of them being symptom-free. Survival correlated with the stage of disease. Encouraging results were obtained for cervical node metastases, oropharynx and salivary gland cancer. In laryngeal and hypopharyngeal cancer, neutron therapy seems to be disadvantageous. The main reason for treatment failure was local recurrence. Two patients died of complications.     

Serial FDG-PET on patients with head and neck cancer: Implications for radiation therapy

Purpose: To assess possible consequences for radiotherapy (RT) planning, e.g., reduction of treatment volume by a decreased tumour volume in Fluor-18-fluoro-deoxy-glucose-Positron emission tomography (FDG-PET) based on a close-meshed evaluation of FDG uptake in primary head and neck cancer (HNC) during RT.

Materials and method: PET data were analysed using a source-to-background based algorithm. The following parameters were obtained: max. standardised uptake value (SUVmax), PET-based gross tumour volume (GTV-PET) and metabolic volume (MV).

Results: While the median SUVmax decreased (initial: 15.2, 1st/2nd week: 10.2, 3rd/4th week: 6.5, 5th/6th week: 6.4), the median values of GTV-PET (9.3 cm³, 12.4 cm³, 14.0 cm³, 17.9 cm³) and MV (92.2 cm³, 61.7 cm³, 60.0 cm³, 71.3 cm³) seemed to increase during radiotherapy. The intra-individual development of SUVmax could be divided into two groups: group A having continuously decreasing values of SUVmax (n = 10 patients), and group B having a temporary increase of SUVmax (n = 13).

Conclusions: Data suggest that a reduction of treatment volume is not possible by an adaptive re-planning based on FDG-PET, e.g., at 50 Gy. This may be caused by a consecutive therapy associated inflammation. This limitation is probably related to the use of a source-to-background based algorithm.     

Radiation therapy for prostate cancer

In Japan, where the mortality rate of prostate cancer is lower than in Western countries, radical prostatectomy or hormonal therapy has been applied more frequently than radiation therapy. However, the number of patients with prostate cancer has been increasing recently and the importance of radiation therapy has rapidly been recognized. Although there have been no randomized trials, results from several institutions in Western countries suggest that similar results of cancer control are achieved with either radiation therapy or radical prostatectomy. For higher-risk cases, conformal high-dose therapy or adjuvant hormonal therapy is more appropriate. In this article, the results of radiation therapy for prostate cancer were reviewed, with a view to the appropriate choice of therapy in Japan.     

Hypoxia in head and neck cancer

A high level of hypoxia in solid tumours is an adverse prognostic factor for the poor outcome of cancer patients following treatment. This review describes the status of research into finding a practical method for measuring hypoxia and treating hypoxic tumours. The application of such methodology would enable the selection of head and neck cancer treatment based on an individual's tumour oxygenation status. This individualization would include the selection not only of surgery or radiotherapy, but also of novel hypoxia-modification strategies.     

Advanced head and neck cancer: response to and toxicity of multimodality therapy

This pilot study for resectable stage III and stage IV squamous cell carcinoma of the head and neck used a cytoreduction phase of preoperative radiation with cisplatin, followed by an eradicative treatment phase with radical surgery (group 1) or radical dose radiation and cisplatin (group 2), followed by adjuvant chemotherapy with 5-fluorouracil infusion and cisplatin delivered at 4-week intervals for six cycles following initial radiation therapy to the primary site. A total of 43 patients were treated between January 1984 and January 1987; 14 were classified with stage III carcinoma, 28 with stage IV, and one patient was not staged. Out of 43 patients, two did not complete therapy. Forty-one patients completed the eradicative phase of treatment. Complete tumor clearance at the end of the eradicative treatment phase was 88% (36 of 41 patients), 95% (18 of 19) in group 1 and 82% (18 of 22) in group 2. Actuarial recurrence-free survival was 61% at 3 years. Among 36 patients with complete tumor clearance after the eradicative treatment phase, there was no statistically significant difference for overall and recurrence-free survival between group 1 and group 2. In general, toxicity was not excessive, although mucositis, weight loss, and hematologic and neurologic toxicity were observed in varying degrees in these patients.     

Dysphagia after definitive radiotherapy for head and neck cancer

Background

Dysphagia is a complication of head and neck cancer patients undergoing radiotherapy (RT). We analysed frequency and severity of swallowing dysfunction and correlated these findings with dose–volume histograms (DVHs) of the pharyngeal constrictor muscles.

Methods

A total of 50 patients treated by radical RT were enrolled. DVHs of constrictor muscles were correlated with acute and late dysphagia and with the items of three quality of life questionnaires.

Results

Mean dose to superior and middle constrictor muscles (SCM, MCM), partial volume of SCM and MCM receiving a dose ≥?50 Gy dose to the whole constrictor muscles ≥?60 Gy and tumour location were associated to late dysphagia at univariate analysis. Mean dose to the MCM was the only statistically significant predictor of late dysphagia at the multivariable analysis.

Conclusion

The study shows a significant relationship between long-term dysphagia and mean doses to SCM, MCM, whole constrictor muscles, and oropharyngeal tumour. This finding suggests a potential advantage in reducing the RT dose to swallowing structures to avoid severe dysphagia.     

201TI SPECT for evaluating head and neck cancer

Background: Thallium-201 (²⁰¹Tl) has come to be widely used in the diagnosis of several kinds of malignant tumor, but its usefulness in diagnosing head and neck cancer has not been established. Purpose: This study investigated the usefulness of²⁰¹Tl SPECT imaging in patients with head and neck cancer histologically confirmed. Methods: Eighteen patients with histologically proven head and neck cancer were studied.²⁰¹Tl SPECT images were obtained both 15 min and 4 hours after intravenous injection of 148 MBq of²⁰¹Tl-chloride.²⁰¹Tl-indices were calculated semiquantitatively to assess the tracer uptake in relation to tumor size and histological type. Results: High²⁰¹Tl uptake was noted in all primary tumors and metastatic lymph nodes on the both early and delayed images, but²⁰¹Tl-indices did not show any correlation with tumor size or histological type. Conclusion: Primary head and neck cancer and lymph node metastasis can be effectively visualized with²⁰¹Tl SPECT. It may provide information in addition to morphological changes and may be a supplemental method to use in the evaluation of head and neck cancer.