The age-specific results of the adjuvant radiotherapy of breast carcinoma]

BACKGROUND: Aim of our work was to evaluate the standards of treatment in elder women with breast cancer and their results of radiation therapy. PATIENTS AND METHODS: In our hospital 218 breast cancer patients were treated in the years 1990 and 1991. Forty-three women were younger than 50 years of age (group I), 92 between 50 and 64 years (group II), 83 elder than 64 years (group III). One hundred and forty-nine patients underwent mastectomy, 65 patients had conservative treatment (Table 5). Four patients were not operable. All of the patients were irradiated uniformly loco-regionally with 50 Gy Co-60-photons, followed by a boost to the tumor bed with 10 Gy with 6- to 12-MeV electrons. Forty-four patients had an additional chemotherapy. RESULTS: The 5-year survival rate was 79.8% (n = 174), the disease free survival was 59.1% (n = 129) (Table 6). The mean rate of local recurrence was 3.6% (n = 8), 4% after mastectomy (n = 6) and 3% (n = 2) with breast conservation. Age group specific 5-year survival rates were 72% (I), 85.6% (II) and 77.1% (III), respectively, disease free survival rates were 48.8% (I), 65.2% (II) and 57.8% (III), respectively. The rates of local recurrence were 9.3% (I), 3.2% (II) and 1.2% (III), respectively. Significant age group specific differences in surgical and radiotherapeutical treatment could not be found. CONCLUSION: The curative chance of treatment has to be used in every age. A treatment of elder patients below the actual valid standards of treatment is not justified.     

The effectiveness of radiotherapy for Merkel cell carcinoma]

Merkel cell carcinoma is a high-grade malignant tumor of the skin that tends to extend locally and metastasize to regional lymph nodes. Surgical resection is the treatment of choice, and the effectiveness of radiotherapy for this disease has not yet been established. We report two cases of biopsy-proven Merkel cell carcinoma effectively treated with radiotherapy. Histopathological examination of the resected specimens after radiotherapy of 50 Gy and 38 Gy, respectively, using 6 approximately 15 MeV electrons showed no malignant cells in either case. No evidence of recurrence or metastasis has been noted in 11 to 21 months after radiotherapy. To our knowledge, no case of Merkel cell carcinoma in which complete cure was obtained by radiotherapy alone has been reported previously. It is considered that preoperative radiotherapy would contribute to the management of this locally invasive but radiosensitive tumor.     

Conformation radiotherapy of carcinoma of the prostate]

During the period from 1975 to 1989, 84 patients with carcinoma of the prostate were treated with conformation radiotherapy at Tokyo Metropolitan Komagome Hospital. The radiation field encompassed only the area of the prostate gland; it did not include the pelvic lymph nodes. The clinical stage of the 84 tumors was 22 in Stage A, 31 in Stage B, 15 in Stage C and 16 in Stage D. The average age of patients was 73.4 years, with range of 54 to 88 years. The average dose to the tumor was 65.7 Gy, with range of 60 Gy to 70 Gy. Hormone therapy was applied to 42 cases. The 5- and 10-year cumulative survival rates were 90.7% and 70.5% for Stage A, 41.7% and 26.7% for Stage B, 48.9% and 48.9% for Stage C, and 32.6% and 0% for Stage D, respectively. The 5-year cause-specific cumulative survival rates were 100% for Stage A, 92.3% for Stage B, 65.0% for Stage C and 40.3% for Stage D, respectively. Patients with poorly differentiated adenocarcinomas or undifferentiated carcinomas showed poorer survival than those with well-differentiated carcinoma. Only 7 cases suffered in-field recurrence, and 2 cases suffered recurrence at pelvic lymph nodes. Acute reactions were noted in 13 cases. Late complications following treatment were acceptable. Mild to moderate complications were recognized in 2 cases, but neither patient required surgery. In conclusion, our data suggest the advantage of the conformation technique applied to radiation therapy for carcinoma of the prostate.     

The late bladder reaction following radiotherapy of a cervix carcinoma]

This study presents the cystotonometric checks of trends in 102 patients with irradiated carcinoma of the cervix up to the time of the so-called five year survival recovery. As compared with a standard control group concerning the function of the urinary bladder a distinct tendency to hypertonia is realized and attributed as inevitable to radiotherapy. The moderate load being present before the onset of irradiation is mentioned, resulting from diagnostic operations and from the primary disease. Based on these observations, functional findings which allow objectivation appear to be indicated, the aim being to recognize, as early as possible, the increase of vesical reactions with regard to gynecologic radiotherapy and later follow-up care.     

鼻咽癌放疗后舌骨及喉室的运动学变化特征

目的 利用视频造影吞咽检查(VFSS)分析鼻咽癌患者放疗后舌骨运动学变化特征。方法 本试验为前瞻性临床研究,收集2014年10月至2015年5月在本院初治的25例鼻咽癌患者为研究对象,在放疗前后使用普通X射线模拟机采集吞咽视频,通过视频分析软件进行连续快速截图,对比放疗前后吞咽时间、舌骨移动度及平均移动速度。结果 25例受试者放疗后平均吞咽时间较放疗前延长[(1.38±0.23)s vs.(1.12±0.26)s,t=-9.53,P<0.05),舌骨水平方向移动度(HHD) 较放疗前降低［(0.78±0.24)cm vs.(1.01±0.25)cm,t=5.82,P<0.05),舌骨垂直方向移动度(HVD) 也较放疗前降低［(0.78±0.18)cm vs.(1.01±0.25)cm,t=2.56,P<0.05],舌骨平均移动速度放疗后明显降低[(0.83±0.19)cm/s vs.(1.31±0.45)cm/s,t=6.46,P<0.05]。喉室移动度放疗前后比较,差异无统计学意义(P>0.05)。结论 鼻咽癌患者放疗后吞咽时间较前延长,舌骨移动度及平均移动速度较前降低。临床试验注册 中国临床试验注册中心,ChiCTR-OOC-16007913。     

鼻咽癌病人放疗前后多种诱发电位的比较研究

目的：了解鼻咽癌（NPC）病人放疗,放疗后射线是否会引起多种诱发电位的改变。方法：对48例初次放疗的NPC病人在放疗前与放疗后各阶段进行脑干听觉诱发电位（BAEP）,短潜伏期体感诱发电位（SLSEP）,图形翻转视觉诱发电位（PRVEP）追踪研究。结果：与放疗前对比,本组病人放疗后不同的阶段BAEP、SLSEP、PRVEP某些波的伏期与波间潜伏期均值和放疗前的检测结果比较差异有显著性。结论：NPC病人接受放射治疗后,早期即可引起神经系统传导功能障碍,诱发电位技术可以反映这种传导功能障碍的存在,而BAEP、SLSEP、PRVEP3种诱发电位协同应用,可及时发现射线对听感觉、体感觉、视觉传导通路损伤。     

Intensity-modulated radiotherapy for laryngeal and hypopharyngeal cancer

Purpose

The purpose of this work was to retrospectively determine the value of intensity-modulated radiotherapy (IMRT) in patients with laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC), on outcome and treatment-related toxicity compared to 3-dimensional conformal radiotherapy (3D-CRT).

Materials and methods

A total of 175 consecutive patients were treated between 2007 and 2012 at our institution with curative intent RT and were included in this study: 90 were treated with 3D-CRT and 85 with IMRT. Oncologic outcomes were estimated using Kaplan–Meier statistics; acute and late toxicities were scored according to the Common Toxicity Criteria for Adverse Events scale v 3.0.

Results

Median follow-up was 35 months (range 32–42 months; 95% confidence interval 95?%). Two-year disease-free survival did not vary, regardless of the technique used (69?% for 3D-CRT vs. 72?%; for IMRT, p?=?0.16). Variables evaluated as severe late toxicities were all statistically lower with IMRT compared with 3D-CRT: xerostomia (0 vs. 12?%; p?<?0.0001), dysphagia (4 vs. 26?%; p?<?0.0001), and feeding-tube dependency (1 vs 13?%; p?=?0.0044). The rates of overall grade ≥?3 late toxicities for the IMRT and 3D-CRT groups were 4.1 vs. 41.4?%, respectively (p?<?0.0001).

Conclusion

IMRT for laryngeal and hypopharyngeal cancer minimizes late dysphagia without jeopardizing tumor control and outcome.

     

放疗前后喉癌组织中Bcl-2及Bax蛋白表达及其临床意义

目的　探讨放疗对喉癌组织中Bcl 2和Bax基因蛋白表达的影响及放疗后喉癌复发原因。方法　通过采用免疫组化SP法 ,测定 2 7例患者放疗前、放疗后和复发后喉癌组织中Bcl 2和Bax蛋白的表达。结果　与放疗前相比 ,放疗后喉癌组织中Bcl 2蛋白表达明显减少 (P <0 0 1) ,Bax蛋白表达明显增多 (P <0 0 5 )。喉癌放疗后局部组织中Bax蛋白表达与复发的时间长短有关 (P <0 0 5 )。结论　喉癌组织内Bcl 2和Bax蛋白表达参与了放疗引起的细胞凋亡过程 ,局部组织内Bax蛋白的表达水平与喉癌复发时间有关     

Results of treatment for laryngeal carcinoma in Würzburg]

From 1960 through 1972, altogether 418 patients with laryngeal carcinoma have been treated at Würzburg, 333 = 82% of these by primary radiation therapy with Co-60 gamma-rays. The results are reported and analyzed in dependence on prognostic factors as tumor site and extension, formation of metastases and age of the patient. Five-year survival of primarily irradiated cases from 1960 to 1967; Glottic T1 = 90%, T2 = 70%, T3 -31%. Supraglottic T2 = 51%, T3 =20%, T4 = 16%. Quota of cases with posterior surgical treatment: Glottic = 8% supraglottic = 28%. The attempt to preserve the larnyx function by means of radiation therapy as an initial measure does not bring along any risk for the patient. The incidence of recurrences with secondary surgical treatment is not smaller than with irradiation only.     

The radiotherapy of Castleman's lymphoma]

The angiofollicular lymphoid hyperplasia, first described by Castleman, is a benign lymphoma. The authors report a very rare case of Castleman lymphoma in the parotid gland. The tumor was successfully irradiated with 40 Gy fast electrons. Treatment planning and therapy monitoring were done by means of ultrasound and computed tomography.     

The contribution of CT to the T-staging of laryngeal carcinoma

A retrospective study of 35 cases of laryngeal carcinoma is presented. CT upstaging of the primary lesion was recorded in 12 of the cases. When analysing the process of upstaging, we found that cartilage destruction and deep (peri- and exolaryngeal) tumor spread are mainly responsible for this. We further observed a good correlation between CT and the pathological findings.     

Treatment results of radiotherapy for squamous cell carcinoma of the cheek mucosa]

The results of radiotherapeutic treatment in 71 patients with squamous cell carcinoma of the cheek mucosa were reviewed. The actuarial 5-year local control rate was 100% for T1 (8 patients), 62% for T2 (43), 65% for T3 (17) and 0% for T4 (3). The patients were divided into four groups according to treatment modality; group 1 was treated by radiotherapy alone (R), group 2 by radiotherapy combined with chemotherapy of BLM or PEP (R + C), group 3 by external radiotherapy followed by surgery (R + S) and group 4 by a combination of radiotherapy, chemotherapy and surgery (R + C + S). The 5-year local control rate was 44% for R (11 patients), 61% for R + C (39), 63% for R + S (6) and 80% for R + C + S (15). Nine of 14 cases or 64% of the surgical specimens in the R + C + S group showed no tumor cells microscopically, a rate comparable with the 5-year local control rate of the R + C group. Including the results of secondary treatment by surgery for recurrent cases, the ultimate local control rate was 83% in both the R and R + C groups. The local control rate was 88% for carcinoma located in the anterior half of the cheek and 53% for that in the posterior cheek. The results suggested that tumors extending to the bucco-alveolar sulci would be more difficult to control by radiotherapy alone, with or without chemotherapy.     

Results from 215 patients with laryngeal carcinoma treated with sole radiotherapy or with a combination of radiotherapy and operation (author's transl)]

Results of radiotherapy alone or in combination with surgery in 215 patients with laryngeal cancer are reported (treatment time between 1963 and 1976). In patients with glottic cancer, the cure rate is about 80% and surgical treatment for persistent/recurrent cancer was necessary only in a few cases. Analysis of tumor dose, tumor control rate and complication rate shows that in cases with glottic cancer a tumor dose between 1900 and 2000 ret is necessary and tolerable. In patients with supraglottic laryngeal cancer, the cure rate is about 55%. Early stages (T1N0M0) were mostly treated by radiotherapy alone, moderately advanced stages (T1N1,T2N0+1) mostly received radiotherapy as a primary treatment and were operated in case of irradiation failure. Advanced stages were primarily treated by a combined therapy, and by radiotherapy alone if they were inoperable. In early cases, who are to be treated by radiotherapy alone, the tumor dose should be about 1900 ret. In moderate cases, treatment by primary irradiation alone is possible, if the patient can be followed up regularly; surgery is indicated, if the patient cannot unequivocally be classified as symptomless. In some of these cases, there is no tumor demonstrable histologically in the excised larynx. In using this treatment policy, there is a better functional treatment result than in using primary combined treatment in moderately advanced cases with supraglottic laryngeal cancer.     

Combined intra-arterial chemotherapy and radiotherapy in inoperable non-small cell bronchial carcinoma]

The five years survival rates of patients with non-operable non-small cell lung carcinoma are between 6% and 9%. Multiple attempts have been made to improve the response rate and the survival of these patients with different chemo- and radiotherapy schemes. The systemic chemotherapy with cisplatin-vindesine is until now one of the most active treatments with a response rate of 40%, but it is limited because of its side effects and toxicity. Eleven patients are treated one to four times with an intraarterial infusion of 3 mg/m2 vindesine and 20 mg/m2 cisplatin into the tumor-feeding bronchial artery combined with a simultaneous radiotherapy (60 Gy). Until now no major side effects occurred and the systemic toxicity was insignificant. An objective tumor response was encountered in 7/11 patients. The intraarterial chemotherapy combined with radiotherapy is strictly local and therefore effective especially in patients with limited or locally advanced disease.