Soft X-Ray Therapy of Recurrent Pterygium – an Alternative to 90Sr Eye Applicators

BACKGROUND: Analysis of effectiveness of perioperative 20 kV soft X-ray irradiation in recurrent pterygium as an alternative to postoperative 90Sr beta irradiation. PATIENTS AND METHODS: Between 1987 and 2000 a total of 65 patients with 81 pterygia were treated with 20 kV X-ray therapy in the course of surgical treatment of recurrent pterygium. Until 1995 simple excision (bare sclera technique) followed by postoperative irradiation (generally four fractions of 5 Gy) was applied, with radiation starting on mean 4 days following surgery (34 cases, mean follow-up 52 months). Since 1995 we have changed our policy to a perioperative regimen starting with a single dose of 7 Gy prior to microsurgical excision with conjunctival autograft and proceeding within 24 hours with 5 Gy single dose to the surgical bed and then every other day to a total dose of 27 Gy (47 cases, mean follow-up 31 months). Recurrence rate was calculated by Kaplan Meier method. A multivariate Cox regression analysis of prognostic factors for recurrence was performed. RESULTS: A total of 19 recurrences were observed, 15 in the historical postoperative group and four in the perioperative group. Actuarial 2- and 5-year recurrence rate is 9% in the "new treatment group" compared to 34% and 56% in the historical group (p = 0.001). Only one of the four recurrences among the pre- and postoperatively irradiated group required a new surgical procedure. In this case radiation had been terminated at 17 Gy. Actuarial rate of surgical reintervention was only 2% at 2 and 5 years compared to 28% and 36% in the historical group. In multivariate Cox regression analysis only the new treatment strategy was found to influence control rate significantly. Until now no case of severe side effects like scleral necrosis or thinning, symble-pharon, radiation-induced cataract or glaucoma were observed in both groups. CONCLUSION: The combination of pre- and postoperative 20 kV X-ray therapy and microsurgical excision combined with conjunctival autograft is a highly effective treatment to prevent recurrence in the high-risk group of recurrent pterygia and can be recommended as an alternative to postoperative 90Sr beta irradiation.     

Prospective Study on Exclusive, Nonsurgical Strontium-/Yttrium-90 Irradiation of Pterygia

PURPOSE: Prospective study to evaluate consecutive treatment results and to demonstrate safety and efficacy of nonsurgical, exclusive strontium-/yttrium-90 beta-irradiation of nonoperated pterygia. PATIENTS AND METHODS: Between November 1999 and March 2002, 20 patients with 21 primary pterygia and six patients with recurrent pterygia after former surgery were treated with exclusive strontium-/yttrium-90 irradiation up to a total dose of 3,600 cGy (six fractions) and 4,800 cGy (eight fractions), respectively. All patients were referred from a single institution. The mean follow-up is 35.6 +/- 7.3 months (range 24-48 months). RESULTS: Prior to irradiation the mean horizontal diameter of all pterygia was 2.6 mm and shrank to a mean diameter of 1.6 mm after treatment (p = 0.0011, Student's t-test). The treatment led to a reduction in size of all 21 primary and all six recurrent pterygia. Visual acuity reached a value of 0.73 before and 0.82 after treatment. This improvement was not significant in Student's t-test (p = 0.12). The visual acuity did not decrease in any patient, complications were not observed, and in none of the 27 pterygia a recurrence developed CONCLUSION: Exclusive strontium-/yttrium-90 irradiation of the early and moderately advanced pterygium is a very efficient and very well-tolerated method of treatment. As to the therapeutic management, it is suggested to apply beta-irradiation prior to the development of an astigmatism-relevant pterygium, which requires excision.     

脑动静脉畸形的X刀治疗

目的　探讨立体定向放射外科治疗脑动静脉畸形的临床效果。方法　对 87例脑动静脉畸形患者采用X刀治疗 ,畸形团大小大小 5～ 4 0mm。单独接受X刀治疗 5 5例 ,联合血管内栓塞治疗32例。治疗周边剂量 17～ 30Gy ,平均 2 2 .6Gy ,等剂量曲线 70 %～ 90 %。随访时间 6～ 96个月 ,平均 5 3.4个月。结果　单独应用X刀治疗的脑动静脉畸形患者 ,完全闭塞 4 1例 ,部分闭塞 9例 ,无变化 5例 ;联合血管内栓塞治疗患者 ,完全闭塞 2 6例 ,部分闭塞 3例 ,无变化 3例。全组完全闭塞 6 7例 (77.0 % )。癫痫完全缓解 7例 (2 6 .2 % ) ,头痛头昏症状缓解 18例 (38.3% )。并发症 :再出血 2例 ,症状性放射性脑水肿 6例 ,经治疗后 ,完全缓解 2例 ,遗留神经功能障碍 4例。结论　立体定向放射外科是脑动静脉畸形的安全而有效的治疗方法之一。     

Lymphoepithelioma-like carcinoma of salivary glands: treatment results and failure patterns

The purpose of this study was to evaluate the treatment results and failure patterns of lymphoepithelioma-like carcinoma (LELC) of salivary glands. From June 1987 to May 2001, nine patients with LELC of salivary glands were treated at our hospital. One patient was excluded due to the loss of clinical follow-up after surgery. For the remaining eight patients, the primary tumour sites were parotid glands (4 patients), submandibular glands (3), and the minor salivary glands in right cheek (1), respectively. Seven patients underwent surgical treatment and post-operative radiotherapy, while the other one patient was treated with surgery only. The total radiation dose to the salivary tumour bed ranged from 39.6 Gy to 67.6 Gy (mean dose: 58.3 Gy and median dose: 59 Gy). The treatment results and failure patterns were analysed. The survival time ranged from 21.4 months to 145.2 months (mean: 69.1 months, median: 54.5 months). At the end of follow-up, six patients were still alive and two died. One patient died of distant metastases 21.5 months after the surgical treatment of LELC. The other case died of intercurrent disease (pontine haemorrhage) 53 months after surgery. No patient had local or regional failure after the treatments. Distant failure was noted in two patients. The patients with LELC of salivary glands were shown to have favourable prognoses. No local or regional failure was noted. However, distant failure developed in two patients. The risk of distant metastasis should be carefully monitored, especially for those patients with more advanced neck node involvement.     

Die rolle der strahlentherapie in der behandlung maligner meningiome

PURPOSE: Most malignant meningiomas will recur following surgical resection only. The role of irradiation and radiation dose levels is poorly defined. This study reviews a single institution experience using both, conventional and high doses > or = 60 Gy/CGE radiation regimen. PATIENTS AND METHODS: Between 1974 and 1995 16 patients with histologically proven malignant meningioma underwent radiation therapy (RT). Age at diagnosis ranged between 6 and 79 years (median: 49 years). Three patients reported previous irradiation to the head at least 14 years prior to diagnosis. Ten patients were treated for primary, and 6 patients for recurrent disease. Six patients underwent gross total and 10 patients subtotal resection (Table 1). RT was delivered using conventional, megavoltage photons or combined 160 MeV proton and photon irradiation. Except 1 patient, who died during RT, the radiation doses ranged between 40 and 70 Gy/CGE (= Cobalt Gray Equivalent) (median: 58 Gy/CGE, Table 2). RESULTS: With median observation time of 59 months (range: 10 to 155 months), actuarial local control rates at 5 and 8 years were 52% and 17%, respectively. Target doses > or = Gy/CGE resulted in significantly improved tumor control (100%) compared to < 60 Gy/CGE (17%) (p = 0.0006, Table 3 and Figure 1). Improved local control translated also in increased overall survival: 87% (> or = 60 Gy/CGE) versus 15% (< 60 Gy/CGE) at 5 years (p = 0.025, Figure 2). At time of analysis, 6/16 patients (38%) were alive. Two patients developed symptomatic brain damage at doses of 59.3 and 72 Gy/CGE. CONCLUSION: Conformal, radiation therapy with target doses > or = 60 Gy/CGE, in this study by use of combined proton and photon irradiation, can significantly improve chances of long-term local control and survival for patients diagnosed with these challenging tumors.     

Postoperative Irradiation for Pterygium

BACKGROUND AND PURPOSE: Irradiation of ocular pterygium is considered a valuable treatment supplementation after surgical therapy. Since prospective randomized trials are scare and only limited patient data are available, the aim of this study was to evaluate the patient population treated with fractioned 90Sr irradiation after surgical pterygium resection. PATIENTS AND METHODS: Between September 1993 and March 2001, 1,147 patients with pterygium lesions (1,320 lesions) were treated surgically and with 90Sr postoperative beta-irradiation. A total dose of 30 Gy was used for patients treated within 48 h after surgery, while those treated>48 h postoperatively received a total dose of 35 Gy. A minimum follow-up period of 3 months was required for inclusion in the analysis, and 1,253 lesions were ultimately analyzed. RESULTS: Recurrence of the pterygium after postoperative 90Sr irradiation was observed in 97 of 1,253 cases (7.7%). Statistical analysis (uni- and multivariate) revealed, that male gender, younger age (<40 years), prior treatment (surgery and radiotherapy) and immediate irradiation (<2 h after surgery) were negative predictors for local recurrence. Temporary radiotherapy-induced side effects were observed in 15.2% of patients, including moderate conjunctivitis, local pain, visual disturbance and photophobia or an increase in tear flow. However, no long-term serious side effects were documented. CONCLUSION: 90Sr irradiation of pterygium after surgery represents a safe and effective treatment option to prevent disease recurrence. The data obtained in this study indicate that a certain interval after surgery might improve therapy outcome.     

Radiation-induced brain disorders in patients with pituitary tumours

Radiation-induced brain disorders (RIBD) are uncommon and they are grave sequelae of conventional radiotherapy. In the present report, we describe the clinical spectrum of RIBD in 11 patients who received post-surgery conventional megavoltage irradiation for residual pituitary tumours. Of these 11 patients (nine men, two women), seven had been treated for non-functioning pituitary tumours and four for somatotropinomas. At the time of irradiation the age of these patients ranged from 30 to 59 years (mean, 39.4 +/- 8.3; median, 36) with a follow-up period of 6-96 months (mean, 18.3 +/- 26.4; median, 11). The dose of radiation ranged from 45 to 90 Gy (mean, 51.3 +/- 13.4; median, 45), which was given in 15-30 fractions (mean, 18.6 +/- 5.0; median, 15) with 2.8 +/- 0.3 Gy (median, 3) per fraction. The biological effective dose calculated for late complications in these patients ranged from 78.7 to 180 Gy (mean, 99.1 +/- 27.5; median, 90). The lag time between tumour irradiation and the onset of symptoms ranged from 6 to 168 months (mean, 46.3 +/- 57.0; median, 57). The clinical spectrum of RIBD included new-onset visual abnormalities in five, cerebral radionecrosis in the form of altered sensorium in four, generalized seizures in four, cognitive dysfunction in five, dementia in three and motor deficits in two patients. Magnetic resonance imaging (MRI)/CT of the brain was suggestive of radionecrosis in eight, cerebral oedema in three, cerebral atrophy in two and second neoplasia in one patient. Associated hormone deficiencies at presentation were hypogonadism in eight, hypoadrenalism in six, hypothyroidism in four and diabetes insipidus in one patient. Autopsy in two patients showed primitive neuroectodermal tumour (PNET) and brainstem radionecrosis in one, and a cystic lesion in the left frontal lobe following radionecrosis in the other. We conclude that RIBD have distinctive but varying clinical and radiological presentations. Diabetes insipidus and PNET as a second neoplastic disorder in adults following pituitary irradiation have not been reported previously.     

Giant cell tumors of bone: treatment with radiation therapy

Records of 15 patients with giant cell tumor of bone treated with radiation therapy over a 35-year period were reviewed; ten patients for whom follow-up information was available constituted the study group. One patient was treated by means of orthovoltage equipment only, a second, by both orthovoltage and megavoltage equipment (cobalt 60). The remaining eight were all treated with megavoltage to doses of 40-52 Gy in 24-30 fractions. Seven patients are alive without disease, with an average survival of 192 months (range, 48-360 months). Three patients died of uncontrolled local and distant disease (average survival, 52 months; range, 23-99 months): one with metastasis in the lungs at time of treatment and two after treatment. Although incidence of lung metastasis appears high, it may be due to patient selection because chemotherapy had failed in all three. Complications from irradiation in one surviving patient required surgical closure of a dural fistula 19 years after treatment. No radiation-induced sarcomatous transformations of controlled tumors were noted. These data suggest that giant cell tumor of bone can be well controlled by radiation therapy. Megavoltage irradiation should be considered in treating local disease not easily controlled by surgery in the axial skeleton. Complications are minimal, and normal function can be preserved in the treated areas.     

Soft X-Ray Therapy of Recurrent Pterygium - an Alternative to 90Sr Eye Applicators

Background: Analysis of effectiveness of perioperative 20 kV soft X-ray irradiation in recurrent pterygium as an alternative to postoperative ⁹⁰Sr beta irradiation. Patients and Methods: Between 1987 and 2000 a total of 65 patients with 81 pterygia were treated with 20 kV X-ray therapy in the course of surgical treatment of recurrent pterygium. Until 1995 simple excision (bare sclera technique) followed by postoperative irradiation (generally four fractions of 5 Gy) was applied, with radiation starting on mean 4 days following surgery (34 cases, mean follow up 52 months). Since 1995 we have changed our policy to a perioperative regimen starting with a single dose of 7 Gy prior to microsurgical excision with conjunctival autograft and proceeding within 24 hours with 5 Gy single dose to the surgical bed and then every other day to a total dose of 27 Gy (47 cases, mean follow-up 31 months). Recurrence rate was calculated by Kaplan Meier method. A multivariate Cox regression analysis of prognostic factors for recurrence was performed. Results: A total of 19 recurrences were observed, 15 in the historical postoperative group and four in the perioperative group. Actuarial 2- and 5-year recurrence rate is 9% in the "new treatment group" compared to 34% and 56% in the historical group (p = 0,001). Only one of the four recurrences among the pre- and postoperatively irradiated group required a new surgical procedure. In this case radiation had been terminated at 17 Gy. Actuarial rate of surgical reintervention was only 2% at 2 and 5 years compared to 28% and 36% in the historical group. In multivariate Cox regression analysis only the new treatment strategy was found to influence control rate significantly. Until now no case of severe side effects like scleral necrosis or thinning, symblepharon, radiation-induced cataract or glaucoma were observed in both groups. Conclusion: The combination of pre- and postoperative 20 kV X-ray therapy and microsurgical excision combined with conjunctival autograft is a highly effective treatment to prevent recurrence in the high-risk group of recurrent pterygia and can be recommended as an alternative to postoperative ⁹⁰Sr beta irradiation. Hintergrund: Analyse der Wirksamkeit einer perioperativen Röntgennahbestrahlung beim rezidivierenden Pterygium als Alternative zu postoperativer ⁹⁰Sr-Betastrahlung mit Augenapplikatoren. Patienten und Methode: Zwischen 1987 und 2000 wurde bei 65 Patienten mit 81 rezidivierenden Pterygien im Rahmen der Reoperation eine Röntgennahbestrahlung mit 20 kV durchgeführt. Bis 1995 wurde nach einfacher Exzision ein ausschließlich postoperatives Konzept verfolgt (meist 4 2 5,0 Gy), wobei die Bestrahlung im Mittel erst 4 Tage postoperativ nach Epithelialisierung der Kornea begann (34 Fälle, mittlere Nachbeobachtungszeit 52 Monate); seit 1995 erfolgte eine Konzeptumstellung auf prä- und postoperative (1 2 7 Gy + 4 2 5,0 Gy) Bestrahlung (47 Fälle, mittlere Nachbeobachtungszeit 31 Monate), wobei die erste Bestrahlung mit 7,0 Gy unmittelbar vor der Operation und die zweite Bestrahlung mit einer Einzeldosis von 5,0 Gy innerhalb von 24 Stunden postoperativ durchgeführt wurden. Die Rezidivraten wurden aktuarisch berechnet und Prognosefaktoren in multivariater Cox-Regression analysiert. Ergebnisse: Im Gesamtkollektiv traten 19 lokale Rezidive auf, 15 in der historischen postoperativ behandelten Gruppe und vier in der Gruppe mit prä- und postoperativer Bestrahlung. Im "neuen" Behandlungsregime beträgt die aktuarische 2- und 5-Jahres-Rezidivrate nur 9% im Vergleich zu 34% und 56% in der historischen postoperativen Gruppe. Bei nur einem Rezidiv bei dem neuen Konzept war eine erneute Operation notwendig. In diesem Fall lag eine Unterdosierung vor (Gesamtdosis 17 Gy). Die aktuarische Rate an erneuten operativen Interventionen lag bei dem neuen Behandlungskonzept bei 2 und 5 Jahren bei lediglich 2% im Vergleich zu 28% und 36% im historischen Kollektiv. In der multivariaten Rezidivanalyse zeigte nur das neue Behandlungskonzept einen signifikanten Einfluss auf die Kontrollrate. Bislang wurden keinerlei Spätfolgen wie Iris- und Skleraatrophie, Symblepharon, radiogener Katarakt oder Glaukom beobachtet. Schlussfolgerung: Das vorgestellte Konzept der prä- und postoperativen Röntgennahbestrahlung im Zusammenhang mit mikrochirurgischer Exzision und Einnähen eines freien Bindehauttransplantats führt zu einer hervorragenden lokalen Kontrolle im Risikokollektiv der rezidivierenden Pterygien. Die Röntgennahbestrahlung ist eine wirksame Alternative zu ⁹⁰Sr-Augenapplikatoren.     

Pterygia: single-fraction postoperative beta irradiation

A retrospective evaluation was performed with records of 128 patients with 146 eyes that underwent applications of strontium-90 after pterygium excisions performed between 1982 and 1988. With a median follow-up of 13 months, 135 eyes were evaluable. Most pterygia (127 of 135) were treated with a single postoperative application of Sr-90 that delivered 3,000 cGy of beta radiation in one fraction. The actuarial freedom from relapse was 87%; all recurrences occurred within the first 18 months, and 46% of these within the first 3 months. Of the 13 recurrences, 10 have been re-treated with surgery and a second course of beta irradiation with excellent results. All eight eyes for which follow-up was available had no evidence of disease. The ultimate control rate was 96.3% for the series. Correlation of various treatment parameters, including age, bilaterality, prior recurrence, and interval from surgery to irradiation, was performed, and no statistically significant difference was seen. No serious complications have developed. Transient conjunctivitis and photophobia were almost universally seen, with five cases lasting beyond 5 months. The authors conclude that a single application of Sr-90 after surgery is effective and safe in managing pterygia.     

Radical radiation therapy of carcinoma of the rhinopharynx: analysis of 80 cases

From 1976 to 1987, 98 patients affected with nasopharyngeal carcinoma were observed at the Oncology Center, Trento, Italy. Eighty of them were treated with radical radiation therapy (average total dose: 6432 Gy, range: 5500-7400 Gy) on primary tumor and positive neck nodes. The clinically negative neck received 5000 Gy. Each dose ranged from 180 to 250 Gy. Fifty-nine patients were treated with the split-course technique with an interval of about 15 days after receiving 4000 cGy. The patients were 60 males and 20 females, their age ranging 17-81 years (mean: 57 years). Histology diagnosed squamous cell carcinoma in 15 cases and undifferentiated carcinoma in 65 cases. All patients were staged according to TNM (UICC, 1978) criteria. Ten patients were stage I/II. Complete local control was obtained in 81.3% of cases. Actuarial global survival at 10 years was 52%, actuarial relapse-free survival was 49%. Mean follow-up is 33 months (range: 4-122 months). Squamous cell carcinoma at histology and advanced nodal involvement (N2-N3) were negative prognostic factors. Six patients had a relapse in the nasopharynx and 5 in the neck; the incidence of distant failures was 20%. The most frequent mid-/long-term side-effect was xerostomia.     

Clinical Assessment Of Stereotactic IGRT: Spinal Radiosurgery

The role of stereotactic radiosurgery for the treatment of intracranial lesions is well established. Its use for the treatment of spinal lesions has been limited because of the availability of effective target immobilization devices. Recent advances in stereotactic IGRT have allowed for spinal applications. Large clinical experience with spinal radiosurgery to properly assess clinical outcomes has previously been limited. At our institution, we have developed a successful multidisciplinary spinal radiosurgery program in which 542 spinal lesions (486 malignant and 56 benign lesions) were treated with a single-fraction radiosurgery technique. Patient ages ranged from 18 to 85 years (mean 56 years). Lesion location included 92 cervical, 234 thoracic, 130 lumbar, and 86 sacral. The most common metastatic tumors were renal cell (89 cases), breast (74 cases), and lung (71 cases). The most common benign tumors were neurofibroma (24 cases), schwannoma (13 cases), and meningioma (7 cases). Eighty-nine cervical lesions were treated using skull tracking. Thoracic, lumbar, and sacral tumors were tracked relative to either gold or stainless steel fiducial markers. The maximum intratumoral dose ranged from 12.5 to 30 Gy (mean 20 Gy). Tumor volume ranged from 0.16 to 298 mL (mean 47 mL). Three hundred thirty-seven lesions had received prior external beam irradiation with spinal cord doses precluding further conventional irradiation. The primary indication for radiosurgery was pain in 326 cases, as a primary treatment modality in 70 cases, for tumor radiographic tumor progression in 65 cases, for post-surgical treatment in 38 cases, for progressive neurological deficit in 35 cases, and as a radiation boost in 8 cases. Follow-up period was at least 3 to 49 months. Axial and/or radicular pain improved in 300 of 326 cases (92%). Long-term tumor control was demonstrated in 90% of lesions treated with radiosurgery as a primary treatment modality and in 88% of lesions treated for radiographic tumor progression. Thirty of 35 patients (85%) with progressive neurological deficits experienced at least some improvement after treatment. Spinal stereotactic radiosurgery is now a feasible, safe, and clinically effective technique for the treatment of a variety of spinal lesions. The potential benefits of radiosurgical ablation of spinal lesions are short treatment time in an outpatient setting with essentially no recovery time and excellent symptomatic response. This technique offers a new therapeutic modality for the primary treatment of a variety of spinal lesions, including the treatment of neoplasms in medically inoperable patients, previously irradiated sites, for lesions not amenable to open surgical techniques, and as an adjunct to surgery.     

Stage I and II non-Hodgkin's lymphoma: results of combined of THP-COP chemotherapy and radiotherapy

PURPOSE: We evaluated the usefulness of radiotherapy plus THP-COP chemotherapy consisting of cyclophosphamide, vincristine, pirarubicin (tetrahydropyranyl adriamycin, THP), and prednisone for stage I and II non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS: Between October 1998 and October 2001, 32 patients with Stage I or II NHL were treated with THP-COP plus radiotherapy. The patients consisted of 19 men and 13 women with a median age of 60 years (range, 23-81 years). The histological type was intermediate grade in 29, high in one, and unclassified in two. The number of cycles of THP-COP ranged from three to six (median, three cycles). Doses of irradiation ranged from 18.0 to 46.5 Gy (median, 40.0 Gy). The median length of follow-up was 19 months (range, 1-47 months). RESULTS: The 3-year overall survival rate and progression-free survival rate were 81.3% and 74.9%, respectively. Leukopenia of grade 3-4 was documented in 24 patients (75%) and thrombopenia of grade 3-4 in four (12.5%). CONCLUSION: THP-COP plus radiotherapy appeared to be feasible for stage I and II NHL patients. However, further evaluation is needed to determine the usefulness of this treatment.     

Outcomes of radiation therapy for maxillary sinus carcinoma

PURPOSE: We evaluated the outcome of radiation therapy for maxillary sinus carcinoma treated in our institution. MATERIALS AND METHODS: From 1984 to 2001, 48 patients with maxillary sinus carcinoma were irradiated with or without chemotherapy and surgery. Patients ranged from 20-89 years of age (median, 68 years) and included 29 men and 19 women. The clinical T factors for these patients, according to the UICC classification (1997), were T2(n = 2), T3(n = 13), and T4(n = 29). Lymph node involvement was observed in 13 patients. The follow-upperiod ranged from 2.5 to 150 months (median, 25 months). The total radiotherapy dose ranged from 40 Gy to 72.8 Gy. Forty-three patients underwent surgery. Intra-arterial chemotherapy was delivered in 39 patients, and systemic chemotherapy was delivered in 7 patients. Fourteen patients were classified as "unresected" (radiation therapy with or without antrostomy), and 34 patients as "resected" (partial, total, or extended total maxillectomy with pre- or postoperativeirradiation). RESULTS: The 5-year overall survival rate(OS), cause-specific survival rate(CSS), and local control rate(LC) of all patients were 52%, 64%, and 75%, respectively. There was no significant difference between the "uaresected" and "resected" groups in OS, CSS, or LC. Local recurrence was observed in 12 patients. In the "resected" group, for local control, it was important to reduce viable tumor before maxillectomy. Preoperative > or = 60 Gy irradiation was considered to be effective to reduce tumor viability. CONCLUSION: There was no significant difference between the "unresected" and "resected" groups in OS, CSS, or LC. In the "resected" group, preoperative irradiation > or = 60 Gy was considered to be effective for local control. In radical treatment of maxillary sinus carcinoma, maxillectomy is not always necessary. Concurrent chemoradiation therapy with or without antrostomy is a reasonable treatment strategy.     

五例皮肤蕈样霉菌病的全身电子线照射随访结果

目的 报道皮肤蕈样霉菌病的全身电子线照射技术、治疗并发症及近远期疗效。方法 回顾性分析5例皮肤蕈样霉菌病患者的临床资料,并作长期随访。男4例,女1例,中位年龄51岁(14~56岁)。4例患者8周接受30~31.25 Gy/30次的全身电子线照射,另1例患者之前接受了6个周期化疗,后接受8周全身电子线照射31 Gy/31次,残留病灶局部补充电子线剂量至36 Gy。皮肤剂量约为处方剂量的90%,照射野内剂量均匀性控制在处方剂量的±10%以内。结果 放疗后6个月,4例患者疗效评价均为完全缓解,1例为近期治疗,放疗结束时评价为接近完全缓解。急性不良反应可以耐受。2例患者分别于全身电子线治疗后3年和1年死于内脏受累,死亡前皮肤无复发表现,2例患者至随访17年及15年时仍健康存活,1例近期治疗患者放疗结束后2个月仍健康存活。结论 全身电子线照射皮肤蕈样霉菌病局部疗效确切,不良反应可以耐受,脏器侵犯是主要的失败原因。     

Merkel Cell Carcinoma: The Role of Radiation Therapy in General Management

BACKGROUND: Merkel cell carcinoma (MCC) is a rare malignant, locally aggressive tumor of the skin. Because few data exist about the clinical course of irradiated patients, we reviewed the 17 patients treated at our institution since 1982. PATIENTS AND METHODS: The median age at diagnosis was 71 years (range 47 to 88 years). Twelve patients presented with lymph node involvement (Stage II), 5 patients with negative lymph nodes (Stage I). Five patients were irradiated immediately after initial surgical excision of the primary tumor. Eleven patients underwent a surgical treatment of recurrence prior to the first irradiation. Only 1 patient received primary radiotherapy. A median dose of 52.8 Gy (range 40 to 60 Gy) in the region of the primary tumor and a median dose of 49.5 Gy (range 30 to 54 Gy) in the regional lymph nodes were delivered. RESULTS: The median overall survival after first diagnosis was 45 months. Three-year overall survival was 57%, 5-year cause-specific survival was 73% (Kaplan Meier). Local control could be achieved in the 5 patients irradiated immediately after surgical treatment of the primary tumor. In contrast, an in-field recurrence occurred in 5 of 12 patients irradiated after surgical excision of relapsed disease. Five patients developed distant metastases. None of these patients was irradiated immediately after surgical excision of the primary tumor. CONCLUSIONS: With respect to our experience, a local control can be achieved with an immediate postoperative radiotherapy of the primary tumor site and the adjacent lymph nodes.     

Radiotherapy of carcinoma of the gallbladder

Thirteen patients with carcinoma of the gallbladder were treated with radiation therapy using Cobalt-60 or 10 MV X-ray. The total dosage ranged from 16 Gy to 54 Gy. Eight patients were treated for palliation, three patients had post-operative irradiation and two patients were treated for recurrence after surgery. Palliation was achieved in six of the eight patients (75%). The results of our series of tests together with other reports suggest radiotherapy can contribute to palliation and post-operative irradiation as an adjunctive treatment.     

Prospective assessment of patient-reported long-term urinary morbidity and associated quality of life changes after 125I prostate brachytherapy

PURPOSE: Prostate brachytherapy has been reported to have less morbidity for patients than radical prostatectomy or external beam irradiation. However, to date there have been no long-term data to support these claims. With radiation doses in excess of 140 Gy required to control the tumor, disabling chronic urinary symptoms and associated quality of life (QOL) changes might be expected to occur. This study prospectively assessed the long-term effects of (125)I prostate brachytherapy on urinary morbidity. METHODS AND MATERIALS: A total of 248 patients with a median age of 67 years (range, 43-83 years) who presented with T1-T2 prostate cancer were treated with (125)I seed implantation and followed up for a minimum of 18 months after treatment (range, 18 to 108 months; median, 31 months). There were 177 T1b-T2a cases and 41 patients with prostate-specific antigen >10 ng/ml; 20.2% were treated with hormonal therapy. All patients prospectively reported their urinary symptoms and QOL assessment on American Urological Association symptom score records before treatment and at each follow-up visit. Urinary symptoms at last follow-up were compared with pretreatment scores. Radiation doses to the prostate (dose delivered to 90% of the gland; D(90)) and urethra (D(30)) were determined by CT-based dosimetry. RESULTS: The median prostate D(90) was 165 Gy (range, 16.5-260 Gy), and the median urethra D(30) was 192 Gy (range, 23.5-306 Gy). Mean individual scores and QOL ranged from 0.31 to 1.65 before implantation and 0.39 to 1.73 afterward. There were no significant differences between pretreatment and last mean scores for any of the categories except for a small but significant increase in urgency (p=0.01) and weak stream (p=0.03). The cohort of patients who initially presented with marked urinary symptoms (initial score >or=3) had improvement in individual scores by 31.4% to 58.2%, total score by 31.1% (p=0.0005), and QOL by 40.6% (p<0.0001). CONCLUSIONS: This study suggests that prostate brachytherapy is associated with minimal long-term urinary morbidity. The subgroup of patients who present with marked urinary symptoms before implantation has improvement in symptoms and QOL after implantation. These data substantiate the favorable long-term QOL outcomes associated with modern brachytherapy techniques.     

Management of epidural cauda equina disease of prostate cancer by radiotherapy

OBJECTIVE: Secondary prostate cancer affection of the cauda equina (SPCCE) can be an ultimate cause of morbidity and mortality. Since the results of management of this particular disease condition remain largely unknown, a retrospective case review was undertaken to determine the effects of treatment by radiation in SPCCE patients. METHODS: The records of 12 patients with SPCCE treated at the Division of Therapeutic Radiology during the period 1984 to 1998 were reviewed. The administered total radiation dosage ranged from 6 Gy to 32 Gy (average, 26.6 +/- 2.0 Gy). Two individuals underwent decompressive laminectomy and bilateral orchiectomy at the time of SPCCE and prostate cancer diagnoses. Ten patients had prior hormonal manipulative treatment (orchiectomy, estrogen, or Flutamide therapy). RESULTS: Pain was relieved in three of four symptomatic patients (75%). Five of nine patients unable to walk before therapy could walk after treatment. One of two individuals with anal or bladder sphincter dysfunction improved following irradiation. The overall mean duration of survival was five months. With treatment, survival was approximately three times as long for ambulatory versus non-ambulatory patients. CONCLUSION: We conclude that radiation treatment is efficacious in promoting palliation of SPCCE, although it may not prolong life.     

旋转式伽玛刀治疗脑动静脉畸形

目的：评估旋转式伽玛刀对脑动静脉畸形的治疗效果及术后并发症。方法：1996年11月－2000年5月以旋转式伽玛刀治疗脑动静脉畸形。脑动静脉畸形平均直径23mm。脑动静脉畸形周边平均照射剂量19．2Gy(13-25Gy),中心平均照射剂量37．6Gy(32.5-50Gy）。结果：106例病人有完整的随访资料，平均随访18．4个月（5－44个月）。5例病人（4．2％）伽玛刀治疗后5－13个月发生再出血，无死亡。78例病人治疗后行CT或MR检查，19例（22％）出现放射性水肿，多发生在治疗后6－18个月，一般经类固醇激素治疗，数月可消退，无遗留永久并发症。68例病人随访超过1年，其中57例在治疗后1年行脑血管造影复查，24例（42％）畸形血管完全闭塞。27例随访超过2年，其中23例行脑血管造影检查，18例（78％）完全闭塞。结论：旋转式伽玛刀是一种新的可靠的立体定向治疗设备，对脑动静脉畸形具有较高的治愈率，治疗后并并发症少且极少出现永久性并发症。