Angiosarkom des rechten vorhofs: Lokale kontrolle durch niedrige strahlendosen und razoxan

BACKGROUND: Angiosarcomas of the heart are rare neoplasms bearing an unfavorable prognosis. In recent series, the median survival is about 5 months. The response to radiation therapy is uncertain. CASE REPORT: A 65-year-old copper smith with an angiosarcoma of the right atrium and metastases of the liver received a partial resection of the primary tumor in January 1992. This was followed by a polychemotherapy including ifosfamide, epirubicin and dacarbacin (DTIC). In April 1992, after 5 cycles of this treatment a large regrowth of the primary and multiple pulmonary metastases were observed. After a 4-day pretreatment with the radiosensitizer razoxane, the large tumor of the right heart was irradiated with 25 MV photons of a linear accelerator. Single doses of 200 cGy were given via parallel opposed fields. The total radiation dose at the tumor was 30 Gy. Concomitantly, razoxane was given at a dose of 125 mg twice daily during the radiation days until the end of the radiotherapy. The treatment was well tolerated and the patient went into a subtotal remission. Chest X-rays from September 1992 revealed a progression of the metastases in the lung and the liver, the recurrent tumor of the right atrium remained in a subtotal remission. The patient was retreated with ifosfamide, epirubicin and DTIC. No substantial remission of the metastases occurred and the patient died at the end of January 1993. At autopsy, the recurrent primary and the lung metastases within the region of the former radiation field remained locally controlled. CONCLUSION: Reviewing the literature and considering this case, irradiation seems to be a valid treatment option for the local control of cardiac angiosarcomas. The combination of radiotherapy with razoxane eventually allows a considerable reduction of the radiation dose.     

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.     

Radiochemotherapy in Combination with Regional Hyperthermia in Preirradiated Patients with Recurrent Rectal Cancer

BACKGROUND AND PURPOSE: Encouraging results of phase II studies combining chemotherapy with radiotherapy have been published. In this study, the results of a multimodal salvage therapy including radiochemotherapy (RCT) and regional hyperthermia (RHT) in preirradiated patients with recurrent rectal cancer are reported. PATIENTS AND METHODS: All patients enrolled had received previous pelvic irradiation (median dose 50.4 Gy). The median time interval between prior radiotherapy and the onset of local recurrence was 34 months. The combined treatment consisted of reirradiation with a median dose of 39.6 Gy (30.0-45.0 Gy), delivered in fractions of 1.8 Gy/day. 5-fluorouracil was given as continuous infusion 350 mg/m(2)/day five times weekly, and RHT (BSD-2000 system) was applied twice a week within 1 h after radiotherapy. The primary endpoint was local progression-free survival (LPFS); secondary endpoints were overall survival, symptom control, and toxicity. RESULTS: 24 patients (median age 59 years) with a previously irradiated locally recurrent adenocarcinoma of the rectum were enrolled. The median LPFS was 15 months (95% confidence interval 12-18 months] with a median follow-up of 27 months (16-37 months). The overall 1-year and 3-year survival rates were 87% and 30%, respectively. Pain was the main symptom in 17 patients. Release of pain was achieved in 12/17 patients (70%). No grade 3 or 4 hematologic or skin toxicity occurred. Grade 3 gastrointestinal acute toxicity was observed in 12.5% of the patients. Paratumoral thermometry revealed a homogeneous distribution of temperatures. CONCLUSION: RCT combined with RHT is an efficient salvage therapy showing high efficacy with acceptable toxicity and can be recommended as treatment option for this unfavorable group of preirradiated patients with local recurrence of rectal cancer.     

低强度He-Ne激光血管内照射配合放疗治疗鼻咽癌的临床研究

目的探讨低强度He-Ne激光血管内照射(intravascularlowlevellaserirradiation,ILLLI)配合放疗治疗鼻咽癌的放射反应及远期疗效。方法将122例接受放疗的鼻咽癌患者随机分为单纯放疗组(对照组)和放疗+ILLLI组(治疗组),比较两组患者的急性放射反应发生率,出现急性放射反应的放疗剂量,局部复发率,远处转移率及5年生存率。结果治疗组与对照组比较,中重度急性放射反应及并发症发生率明显减少(P<0.01),出现急性放射反应的剂量明显提高(P<0.01),局部复发率,远处转移率及5年生存率两组差异无显著意义(P>0.05)。结论ILLLI可提高鼻咽癌患者放疗耐受性,降低急性放射反应及并发症发生率,不增加远处转移,可作为鼻咽癌患者放疗的有效辅助治疗措施。     

Adding concurrent low dose continuous infusion of cisplatin to radiotherapy in locally advanced cervical carcinoma: a prospective randomized pilot study

The tolerability and efficacy of the continuous infusion of cisplatin during radiotherapy was studied by tumour response, survival and pelvic control, in carcinoma of the cervix. 44 patients with stage IIB-IIIB cervical carcinoma were prospectively randomized into two groups: radiation alone (control group) versus radiation plus cisplatin (study group). While there was no significant difference in diarrhoea and urinary complication scores, emesis and appetite changes were significantly greater in the study group. Tumour responses were no different at the end of the treatment and 3 months after completion of treatment. After 40 months median follow-up, 40/44 patients were assessed (one had a second primary tumour and three were lost to follow-up). Persistent disease was found in 3 patients: one in the study arm and two in the control arm. Recurrence was seen in 10 patients in the first 2 years. 5-year pelvic control rates were; 69.4% and 63.9% (p=0.7), survival rates were 52.0% and 48.9% (p=0.7) and disease-free survival rates were 67.5% and 58.7% (p=0.3) for the control and the study groups, respectively. Although the continuous infusion of cisplatin during radiotherapy was well tolerated, this additional treatment did not appear to show an improvement in pelvic control, survival, or disease-free survival.     

三维适形放疗结合化疗治疗直肠癌术后复发的临床研究

目的探讨三维适形放射治疗结合化疗治疗直肠癌术后复发的疗效.方法回顾性分析61例直肠癌术后复发患者采取首先给予常规放射治疗44 Gy/22次,再给予三维适形放射治疗加量3 Gy/次,共5～7次,肿瘤总量（DT）59～65 Gy/27～29次结合化疗（5-氟尿嘧啶0.75 g/m^2 ＋CF200 mg,d1～5和d29～33;顺铂40 mg/m^2,d1～3和d29～31）的疗效,生存分析采用Kaplan-Meier法.结果患者1、2、3年肿瘤局部控制率分别为86.9%、67.2%、37.7%;1、2、3年生存率分别为80.3%、62.3%、39.2%,中位生存期24.6个月;1、2、3年无瘤生存率分别为79.7%,52.5%、31.1%.急性放射反应主要是急性放射性肠炎和放射性膀胱炎,多为1～2级.结论三维适形放射治疗结合化疗可提高术后局部复发或转移直肠癌的控制率和生存率,改善其生存质量.     

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.     

Ergebnisse der Behandlung von Rektumkarzinomrezidiven mit schnellen Neutronen (d, T 14 MeV)

Purpose

In spite of improved surgical techniques and the use of multiple modality treatment schemes the local recurrence rate of colorectal carcinomas could not be successfully reduced up to now. Besides surgical treatment of local recurrences in some cases radiation therapy may be indicated.

Patients and Method

In the Department of Radiotherapy of the University of Münster 37 patients with recurrent rectal carcinoma were treated between the end of 1985 and September 1992 either with fast neutrons alone or with a combined photon-neutron therapy. Eighteen patients received radiotherapy with fast neutrons (14 MeV d,T) alone; the tumor dose was between 10 and 15 Gy neutrons. Nineteen patients were irradiated with a mixed-beam schedule consisting of 30 to 45 Gy photons (X 10 MV) and neutron doses ranging from 5 to 10 Gy.

Results

In 30 patients a good or complete pain relief could be observed immediately after the last irradiation. Sixteen out of 37 patients had local tumor regrowth during the follow-up period. The median survival for all 37 patients was 15.9 months. The probability for survival was 86% after 6 months and 61% after 12 months (Kaplan-Meier). The side effects were slight to moderate (EORTC/RTOG I-II).

Conclusions

This therapy showed good results concerning a fast and effective pain relief. Additionally the results seem to show a good effect concerning local control and overall survival in this negatively selected patients.     

A comparison of treatments of squamous cell carcinoma of the base of tongue: surgical resection combined with external radiation therapy, external radiation therapy alone, and external radiation therapy combined with interstitial radiation

PURPOSE: The outcomes of patients treated at a single institution over a specific time frame using three different therapeutic approaches for cancer of the base of tongue were reviewed. METHODS AND MATERIALS: Between 1992 and 1998, 53 patients were treated with curative intent for base of tongue cancer. Seventeen patients underwent surgical resection with postoperative radiation therapy, 16 patients received definitive external radiation therapy only, and 20 patients were treated with external and interstitial radiation, with neck dissection in 16 of those patients. Local control, survival, and functional status were assessed with each approach. RESULTS: The 5-year actuarial local control and survival for the surgically treated patients were 74% and 44%, respectively. The patients treated with external radiation therapy alone had local control of 28% and 5-year survival of 24%. The patients treated with external and interstitial radiation with neck dissection as indicated had 5-year actuarial local control of 87% and survival of 33%. Survival was not statistically different between the three treatment approaches (p=0.0995) but local control was worse in the definitive external radiation group (p < 0.0001). Speech and swallowing function among the long-term survivors was superior in the definitively irradiated patients compared with the operated patients. CONCLUSION: In this retrospective analysis, survival and local control was lowest in the patients treated with external radiation alone, however, patient selection likely played an important role. Local control was far better with surgical treatment and with external combined with interstitial radiation but survival remains less than 50% with each approach. Surgical treatment was superior for patients with T4 disease. Functional status was higher in the long-term survivors treated nonsurgically.     

High-dose-rate brachytherapy for previously irradiated patients with recurrent esophageal cancer

Purpose Our objective was to assess the feasibility, efficacy, and complications of high-dose-rate (HDR) brachytherapy for patients with recurrent esophageal cancer after external radiotherapy. Materials and methods Six patients with recurrent esophageal cancer after external radiotherapy were treated with HDR brachytherapy (Ir-192 source) from January 2003 to February 2004. The median age of the patients was 69 years. All patients had received external radiotherapy (median dose 60 Gy) before HDR brachytherapy. All patients underwent HDR brachytherapy once a week with a dose of 4 or 5 Gy per fraction in the esophageal mucosa (median total dose 20 Gy). The Kaplan-Meier method was used to calculate local control rates. Results The median overall survival period was 30.0 months. Local control was observed in five patients and residual tumor in one patient. Persistent local control was observed in two patients. No patient died of esophageal cancer, and all patients survived. We observed no severe late complications related to HDR brachytherapy. Conclusion These data suggest that HDR brachytherapy is an effective and safe treatment for patients with recurrent esophageal cancer after external radiotherapy.     

Intraarterial 5-FU-infusion and simultaneous radiotherapy as palliative treatment of recurrent rectal cancer.

Palliative treatment of recurrent rectal cancer remains to be a challenge. From 1989 to 1991 13 patients with recurrent rectal cancer were treated with intraarterial infusion of 5-Fluorouracil and simultaneous radiotherapy in a palliative intent. Seven patients had received postoperative adjuvant radiotherapy with 56 to 60 Gy. Three patients had been treated with systemic chemotherapy. Radiotherapy of the recurrence was performed with 19.8 to 30.6 Gy in the pre-irradiated patients and with 50.4 to 59.4 Gy in the others. One complete remission, three partial remissions and nine minor responses were observed. Three patients had complete pain relief after the treatment, in the remaining patients major pain reduction was achieved. Palliation lasted from three to twelve months (median: five months). Our results indicate that locoregional chemo- and radiotherapy are a effective modality in recurrent rectal cancer.     

A Small Prospective Study of Chordomas Treated with Radiotherapy and Razoxane

PURPOSE: To evaluate the local effect of conventional photon irradiation in chordomas if the radiosensitizing agent razoxane is added. The rationale for this procedure were improved results previously seen in soft tissue and chondrosarcomas with this combination. PATIENTS AND METHODS: Between 1988 and 1996, five patients with histologically confirmed chordomas of the skull base or the spine (three females, two males) were irradiated with 6- and 25-MeV photons under razoxane medication, one patient was treated with a telecobalt unit. Single doses of 180-200 cGy were given five times a week. The median total tumor dose was 63 Gy (range 54-67 Gy). Concomitantly, the radiosensitizer razoxane was administered at a dose of 125 mg twice daily p.o., median total dose 7.6 g. The drug was started 3-5 days before the first irradiation, and continued until the end of radiotherapy. RESULTS: After a potential median follow-up time of 10 years, three of the five patients are alive and show neither symptoms nor signs of recurrence in CT or MR images. One patient with persistent sacral chordoma died after 8 years from cardiac insufficiency, and another patient died after 6.5 years from a bleeding complication following surgery for recurrence. The patients remained locally controlled for 5, 5.5+, 6.4, 11+, and 13+ years, respectively. Objective tumor regressions were noted in three of four patients with measurable disease. Acute side effects included mucosal reactions, two of five patients developed a leukopenia WHO grade 3 due to razoxane. Serious long-term complications were not observed. CONCLUSIONS: Although the patient series is small, there is an interesting trend in local control and survival. The cases are unselected, and the follow-up time is of considerable duration. The treatment can easily be performed at any institution and is tolerated fairly well.     

立体定向放射治疗配合靶向药物索拉非尼治疗复发及转移性肾细胞癌的疗效分析

目的探讨γ-体部立体定向放射治疗（stereotactic body radiation therapy withγ-knife,γ-SBRT）配合靶向药物索拉非尼（sorafenib）治疗复发及转移性肾癌的效果。方法 2007-05至2009-05收治的肾癌术后复发及转移患者45例中,26例单纯行γ-SBRT,19例行γ-SBRT配合Sorafenib治疗,比较两组的有效率、局部控制率、生存率及生存质量改善情况。结果治疗后3个月总有效率为80.0%（36/45）。单纯γ-SBRT组的1年、2年局部控制率分别为42.3%（11/26）、19.2%（5/26）;中位生存12个月;1年、2年生存率分别为46.2%、19.2%。γ-SBRT＋Sorafenib组的1年、2年局部控制率分别为47.3%（18/19）、21.1%（4/19）,中位生存18个月;1年、2年生存率分别为57.9%、26.3%。结论采用γ-体部立体定向放疗结合靶向药物索拉非尼对复发及转移性肾癌进行治疗效果较好,不良反应轻微,多数患者能耐受治疗。     

Treatment of Solitary Brain Metastasis

BACKGROUND: Whole brain radiation therapy (WBRT) is reported to improve local control after resection of brain metastases. Improvement of survival was only observed in patients with controlled extracranial disease. The optimum radiation schedule has yet to be defined. The authors' experience with a postoperative approach including WBRT and a radiation boost to the metastatic site is presented. PATIENTS AND METHODS: Criteria for inclusion into this retrospective analysis were solitary brain metastasis, Karnofsky performance status > or = 70%, and controlled extracranial disease. Two therapies were compared for local control and survival: surgery followed by 40 Gy WBRT (group A) versus surgery followed by 40 Gy WBRT and a 10 Gy boost (group B). Statistical analysis was performed using the Kaplan-Meier method and log-rank test. RESULTS: 33 patients were included (17 group A, 16 group B). The results suggested better local control (p = 0.0087) and survival (p = 0.0023) for group B. 17/17 patients (100%) of group A and 13/16 patients (81%) of group B showed progression of brain metastasis, 8/17 and 3/16 patients in the area of metastatic surgery. Median time to progression was 7 (1-22) months in group A and 12 (3-42) months in group B. The number of cancer-related deaths amounted to 17/17 (100%) in group A after a median interval of 9 (3-26) months, and to 9/16 (56%) in group B after 14 (4-46) months. CONCLUSION: After resection of solitary brain metastasis, a radiation boost in addition to WBRT seems to improve local control and survival when compared to postoperative WBRT alone. The results should be confirmed in a larger prospective trial.     

Effects of low-dose cisplatin on 89Sr therapy for painful bone metastases from prostate cancer: a randomized clinical trial.

This study evaluated the effects of low-dose cisplatin plus 89Sr versus 89Sr alone in the treatment of painful bone metastases from prostate cancer, addressing both pain palliation and cytostatic effects. METHODS: Seventy patients with metastatic hormone-refractory prostate cancer were randomized into 2 groups: One group (arm A) received 148 MBq 89Sr plus 50 mg/m(2) cisplatin, and the other group (arm B) received 148 MBq 89Sr plus placebo. After treatment, the patients were followed up until death to evaluate the outcome variables: grade and duration of pain palliation, onset of new painful sites, changes in bone disease, global survival, serum prostate-specific antigen and alkaline phosphatase changes, and hematologic toxicity. RESULTS: Overall pain relief occurred in 91% of patients in arm A and 63% of patients in arm B (P < 0.01), with a median duration of 120 d in arm A and 60 d in arm B (P = 0.002). New painful sites on previously asymptomatic bone metastases appeared in 14% of patients in arm A and in 30% of patients in arm B (P = 0.18). The median survival without new painful sites was 4 mo in arm A and 2 mo in arm B (P = 0.04). Bone disease progression was observed in 27% of patients in arm A and in 64% of patients in arm B (P = 0.01). Median global survival after therapy was 9 mo in arm A and 6 mo in arm B (P = 0.30). Transient and moderate hematologic toxicity, as determined by World Health Organization criteria, was apparent in both arms without significant differences. CONCLUSION: The addition of a low dose of cisplatin enhances the effect of a standard dose of 89Sr without significant side effects, producing a significant improvement in pain palliation and a cytostatic effect on bone disease.     

Mammography in the pre-operative assessment and post-operative surveillance of patients treated by excision and radiotherapy for primary breast cancer

To evaluate the place of mammography in the selection of patients for excision and radiotherapy for primary breast cancer a detailed analysis of pre-operative mammograms was performed in (i) a study group of 37 patients who developed local recurrence; (ii) a matched control group with a median local recurrence free survival of 57 months. There were significantly more multifocal tumours in the study group. Tumours were significantly larger (P = 0.02) and closer to the nipple (P = 0.008) in the study group compared to the control group. Regular follow-up mammograms were available in 26 of the study group. Twenty-one patients had mammographic evidence of either residual or recurrent tumour. We conclude that pre-operative mammography is essential in the selection of patients for excision and radiotherapy. Following treatment, mammography is useful in detecting residual or recurrent disease.     

Ⅲ期非小细胞肺癌372例临床分析

目的　探讨不同治疗方法对Ⅲ期非小细胞肺癌生存率的影响。方法　Ⅲ期非小细胞肺癌 372例临床分别采用手术(单纯手术、手术 +放疗、手术 +放疗 +化疗 )及非手术 (单纯放疗、放疗 +化疗 )进行治疗。结果　Ⅲa期和Ⅲb期 1,3,5年生存率分别为 5 7.7%和 4 3.8% (P <0 .0 5 ) ,2 8.5 %和 10 .5 % (P <0 .0 1)、19.5 %和 0 % (P <0 .0 1)。手术组和非手术组的 1年生存率分别为 5 9.6 %和 5 1.8% (P >0 .0 5 ) ;3,5年生存率分别为 4 3.6 %和 16 .5 % (P <0 .0 1)、2 8.7%和 6 .8% (P <0 .0 1) ;术后辅助放疗者局部复发率 (2 1.5 % )与单纯手术和未手术者局部复发率 (4 4 .7% )比较P <0 .0 1。结论　Ⅲ期非小细胞肺癌的长期生存率与治疗方法有关 ,Ⅲa期优于Ⅲb期 ,手术优于非手术 ,放疗可减少术后局部复发率。     

Impact of CT-based brachytherapy in elderly patients with cervical cancer

PurposeThree-dimensional image-guided brachytherapy (3D-IGBT) has become the standard therapy for patients with cervical cancer. However, in this population, the impact of 3D-IGBT in elderly individuals remains unknown. This study assessed the efficacy of 3D-IGBT for elderly patients with cervical cancer.Methods and MaterialsWe performed a retrospective chart review of 105 consecutive patients with cervical squamous cell carcinoma aged ≥70 years who received radiotherapy alone between January 2001 and September 2014. All patients were treated with external beam radiotherapy and high-dose-rate intracavitary brachytherapy. We assessed the treatment outcomes in all patients. We then compared outcomes between two groups: patients treated by changing the Point A dose at brachytherapy (Group A, n = 71) and those treated with 3D-IGBT at least twice (Group B, n = 34).ResultsThe median followup period was 59 (range, 6–203) months; the median age was 77 years. The 5-year local control and cause-specific survival rates were 89% and 78%, respectively. The 5-year cumulative rates of late toxicities of the rectum and bladder of Grade ≥3 were 2.0% and 4.2%, respectively. No statistically significant differences were observed in the local control and cause-specific survival rates, or in the incidence of rectal toxicities between groups. The 3-year cumulative rates of urinary toxicity of Grade ≥1 were 20.4% and 6.9% in Group A and Group B, respectively (p = 0.035).ConclusionIn elderly patients with cervical cancer, 3D-IGBT could be performed safely and effectively and contributed to decreasing urinary toxicity incidence rates.     

立体定向放射治疗配合靶向药物索拉非尼治疗复发

 目的 探讨γ-体部立体定向放射治疗（stereotactic body radiation therapy with γ-knife,γ-SBRT)配合靶向药物索拉非尼 (sorafenib)治疗复发及转移性肾癌的效果。 方法 2007-05至2009-05收治的肾癌术后复发及转移患者45例中 ,26例单纯行γ-SBRT,19例行γ-SBRT配合Sorafenib治疗,比较两组的有效率、局部控制率、生存率及生存质量改善情况。 结果 治疗后3个月总有效率为80.0%(36/45)。单纯γ-SBRT组的1年、2年局部控制率分别为42.3%(11/26)、 19.2% (5/26);中位生存12个月;1年、2年生存率分别为46.2％、19.2％。γ-SBRT+Sorafenib组的1年、2年局部控制率分 别为47.3%(18/19)、21.1%(4/19),中位生存18个月;1年、2年生存率分别为57.9％、26.3％。 结论 采用γ- 体部立体定向放疗结合靶向药物索拉非尼对复发及转移性肾癌进行治疗效果较好,不良反应轻微,多数患者能耐受治疗。     

Timing of radiotherapy following breast-conserving surgery: outcome of 1393 patients at a single institution

Background

The role of postoperative radiotherapy in breast-conserving therapy is undisputed. However, optimal timing of adjuvant radiotherapy is an issue of ongoing debate. This retrospective clinical cohort study was performed to investigate the impact of a delay in surgery–radiotherapy intervals on local control and overall survival.

Patients and methods

Data from an unselected cohort of 1393 patients treated at a single institution over a 17-year period (1990–2006) were analyzed. Patients were assigned to two groups (CT+/CT?) according to chemotherapy status. A delay in the initiation of radiotherapy was defined as >?7 weeks (CT? group) and >?24 weeks (CT+ group).

Results

The 10-year regional recurrence-free survival for the CT? and CT+ groups were 95.6 and 86.0?%, respectively. A significant increase in the median surgery–radiotherapy interval was observed over time (CT? patients: median of 5 weeks in 1990–1992 to a median of 6 weeks in 2005–2006; CT+ patients: median of 5 weeks in 1990–1992 to a median of 21 weeks in 2005–2006). There was no association between a delay in radiotherapy and an increased local recurrence rate (CT? group: p?=?0.990 for intervals 0–6 weeks vs. ≥?7 weeks; CT+ group: p?=?0.644 for intervals 0–15 weeks vs. ≥?24 weeks) or decreased overall survival (CT? group: p?=?0.386 for intervals 0–6 weeks vs. ≥?7 weeks; CT+ group: p?=?0.305 for intervals 0–15 weeks vs. ≥?24 weeks).

Conclusion

In the present cohort, a delay of radiotherapy was not associated with decreased local control or overall survival in the two groups (CT?/CT+). However, in the absence of randomized evidence, delays in the initiation of radiotherapy should be avoided.