Adjuvant radiotherapy after radical hysterectomy of the cervical cancer

Aim

To investigate prognostic factors and complications after radical hysterectomy followed by postoperative radiotherapy for carcinoma of the uterine cervix.

Patients and Methods

One hundred twenty-eight patients with Tlb-2b carcinoma of the uterine cervix following radical hysterectomy with bilateral pelvic lymphadenectomy and postoperative radiation therapy were reviewed. Pathologic and treatment variables were assessed by multivariate analysis for local recurrence, distant metastases and cause specific survival.

Results

The number of positive nodes (PN) in the pelvis was the strongest predictor of pelvic recurrence and distant metastases. These 2 failure patterns independently affect the cause specific survival. The 5-year cumulative local and distant failure were PN(0): 2% and 12%, PN(1–2): 23% and 25%, PN(2<): 32% and 57%, respectively (p=0.0029 and p=0.0051). The 5-year cause specific survival rates were PN(0): 90%, PN(1–2): 59% and PN(2<): 42% (p=0.0001). The most common complication was lymphedema of the foot experienced by one-half of the patients (5-year: 42%, 10-year: 49%).

Conclusion

These results suggest that patients with pathologic Tlb-T2b cervix cancer with pelvic lymph node metastases are at high risk of recurrence or metastases after radical hysterectomy with pelvic lymphadenectomy and postoperative irradiation.     

Intraoral ultrasound of the tongue tumor

Transcutaneous ultrasonography scanned through the submandibular triangle has been effectively utilized for the evaluation of tongue tumors. However, because of lacking an appropriate sonic window, tumors located in the anterior portion of the tongue can not be demonstrated on the transcutaneous ultrasonogram. Intraoral ultrasonography using an echoendoscopy was effective for evaluating neoplasms of the tongue, and could clearly demonstrate tongue tumors, which failed to be shown on the transcutaneous ultrasonograms. In addition, intraoral ultrasonograms could provide more accurate anatomical informations concerning the tumor extent than the transcutaneous ultrasonograms.     

Salvage radiotherapy in prostate cancer patients with biochemical relapse after radical prostatectomy

Background

In patients with prostate cancer (PCa) and biochemical progression (BP) after radical prostatectomy (RP), salvage radiotherapy (sRT) improves prostate cancer-specific survival (PCSS), but this evidence is based only on retrospective data.

Patients and methods

In addition to our previous study of 151 patients with PCa and BP after RP, we performed univariate analyses of prostate-specific antigen (PSA) kinetics during sRT. In 11 patients with BP or initiation of hormonal treatment (HT) within 180 days after sRT, risk factors were assessed using Mann–Whitney U tests. PSA doubling times (PSADT) before and after sRT in 82 patients with BP after sRT were compared by a Wilcoxon test.

Results

After a median follow-up of 82 months, analysis of PSA kinetics during sRT did not show a statistically significant impact on a subsequent BP, PCSS, or overall survival at an administered dose of 30 or 45?Gy. The subgroup analysis of patients with early BP or early HT revealed higher Gleason scores (p = 0.008) and preoperative PSA values (p = 0.005), shorter PSADT prior to sRT (p < 0.0005), and longer time intervals from RP until the start of sRT (p = 0.005) compared to all other patients. In patients with subsequent BP, PSADTs were significantly prolonged after sRT (median PSADT 4.5 months before and 9.9 months after sRT, p < 0.0005).

Conclusion

PSA monitoring during sRT did not predict the therapeutic success. Subgroup analysis suggests a lower probability of benefit for patients with the abovenamed risk factors . However, the prolonged PSADT after sRT reflects a benefit of sRT for the vast majority of patients.

     

Salvage radiotherapy in patients with prostate cancer and biochemical relapse after radical prostatectomy

Background and purpose

In patients with prostate cancer (PC) and biochemical relapse after radical prostatectomy, salvage radiotherapy (SRT) could improve PC-specific survival (PCSS) but the timing for initiation is still under discussion. We have demonstrated a low rate of biochemical relapses in a patient series with very low pre-SRT PSA levels after a median follow-up of 42 months. Here, we present an update of that study.

Patients and methods

Overall, 151 patients were analyzed. A biochemical relapse after SRT was diagnosed when the PSA exceeded the post-SRT nadir by 0.2 ng/ml with subsequent increase. Parameters with significant impact on biochemical progression-free survival (BPFS), PCSS, and overall survival (OS) in univariate analysis were included in a multiple Cox regression analysis.

Results

After a median follow-up of 82 months, 18 patients (12?%) had died with 10 (6.6?%) deaths being PC-related. A biochemical progression was diagnosed in 83 patients (55?%). Univariate analysis revealed a significant impact of pre-SRT PSA level, Gleason score, and PSA doubling time (PSADT) on BPFS and for initial tumor stage and Gleason score on OS. Multivariate analysis confirmed the impact of pre-SRT PSA level, Gleason score, and PSADT on BPFS and tumor stage on OS.

Conclusion

In this update, the rate of biochemical relapses increased compared with our previous data. Compared to similar studies, we found a remarkably low rate of PC-related deaths. Our data support early initiation of SRT. However, this treatment strategy, triggered by very low PSA levels, could carry the risk of overtreatment in at least a subset of patients.     

乳腺癌根治术后局部区域复发R0切除术后放疗110例分析

目的 探讨巩固放疗对根治术后局部区域复发接受R0切除手术的乳腺癌患者预后的影响。方法 回顾性分析2003年1月1日至2015年11月30日期间解放军307医院收治的110例仅局部区域复发后接受R0（切缘阴性）切除手术患者的临床资料,分析其预后因素。结果 74例（67.3%）接受巩固放疗的患者,其中位至局部区域进展时间优于未接受放疗的36例（32.7%）患者,差异有统计学意义（χ2=8.526,P〈0.05）;接受巩固放疗患者的局部复发后至无远处转移生存期、局部区域复发后总生存期与未接受放疗的患者差异无统计学意义（P〉0.05）。多因素分析结果显示内分泌治疗（χ2=7.541,95%CI：27.1%-80.4%,P〈0.05）、无病生存期（≥2年vs.〈2年,χ2=4.068,95%CI：101.4%-267%,P〈0.05）、巩固放疗（χ2=14.126,95%CI：21.7%-80.4%,P〈0.05）是局部区域复发R0术后患者局部复发后总生存期的独立预后因素。局部区域复发R0切除术后,同侧胸壁及锁骨上下淋巴引流区巩固照射组复发率低于未照射组。结论 局部区域复发乳腺癌患者R0切除术后需接受同侧锁骨上下区及胸壁巩固放疗。     

Change of sonographic findings on cervical lymph nodes before and after preoperative radiotherapy

The aim of this study was to assess the changes in the power Doppler sonographic findings in patients with oral cancer undergoing chemotherapy and radiotherapy. We performed US examinations on 187 cervical lymph nodes (71 metastatic and 116 reactive nodes) excised from 52 patients before and after preoperative therapy. On Power Doppler images, we calculated the vascular index (VI) and evaluated the vascular pattern. We also assessed the diagnostic power using receiver operating characteristic (ROC) curve analysis. Irradiation caused an increase of the VI and better visualization of the vessels within the lymph node in the reactive nodes; however, in the metastatic nodes, the VI was not significantly different between that before and after irradiation. When the reader observed the images before irradiation, the area under an ROC curve (Az values) observed by B-mode sonography were closely similar to those obtained by B-mode plus power Doppler sonography. With both images before and after irradiation, the Az value obtained by B-mode plus power Doppler sonography was higher than that by B-mode sonography alone. After irradiation, the enhanced Doppler signals contributed to a better visualization of the vessels and a better detection of any vascular abnormalities.     

Mammographic,sonographic and MR imaging features of invasive micropapillary breast cancer

Purpose

Describe mammographic, sonographic and MRI findings of invasive micropapillary carcinoma (IMPC) of the breast.

Materials and methods

Review of the pathology database identified 43 patients (mean age, 59.3 years) with the diagnosis of breast IMPC. Three patients had no available imaging studies. Mammograms (40), breast ultrasounds (33) and MRIs (8) were retrospectively evaluated by two radiologists in consensus following the BI-RADS Lexicon. Clinical, histopathologic features, as well as hormone status were recorded.

Results

Twenty patients presented with palpable abnormality (20/40, 50%). Thirty-five patients had an abnormal mammogram (87.5%, 35/40) showing 39 lesions, 29 corresponding to masses (29/39, 74.4%), 11 associated with microcalcifications and two associated with architectural distortion. Sonography identified 41 masses (in 33 patients) displaying an irregular shape (30/41, 73.2%), appearing hypoechoic (39/41, 95%), with spiculated or angular margins (26/41, 63.4%), non-parallel orientation (26/41, 63.4%) and combined acoustic posterior pattern (18/41, 44%). MRI identified 13 lesions (in eight patients), 12 as masses (12/13, 92.3%) with irregular or spiculated margins (12/12, 100%), eight displaying an irregular or lobulated shape (8/12, 66.7%), six with homogeneous internal enhancement (6/12, 50%) and eight with type 3 enhancement curve (8/12, 61.5%). Associated non-mass like enhancement was noted in two patients. Twenty-nine patients had associated lymphovascular invasion (29/40, 72.5%) and axillary lymph node metastases were present in 22 of the 39 patients (22/39, 56%).

Conclusion

Invasive ductal carcinoma with IMPC features display imaging findings highly suspicious of malignant lesions. They are associated with high lymphovascular invasion and lymph node metastases rates.     

Early mammographic and sonographic findings after intraoperative radiotherapy (IORT) as a boost in patients with breast cancer

The aim of this study was to evaluate mammographic and sonographic changes at the surgical site within the first 2 years after IORT as a boost followed by whole-breast radiotherapy (WBRT), compared with a control group treated with WBRT alone. All patients had breast-conserving surgery for early-stage breast cancer. Group A: n = 27, IORT (20 Gy) followed by WBRT (46 Gy). Group B (control group): n = 27, WBRT alone (56-66 Gy). Mammography: fat necrosis in 14 group A versus four group B patients (P < 0.001); parenchymal scarring classified as unorganized at the last follow-up in 16 vs seven cases, respectively (P = 0.03). Ultrasound: overall number of patients with circumscribed findings 27 vs 18 (P < 0.001); particular hematomas/seromas in 26 vs 13 patients (P < 0.001). Synopsis of mammography and ultrasound: overall postoperative changes were significantly higher classified in group A (P = 0.01), but not judged to have a significantly higher impact on interpretation. Additional diagnostic procedures, due to unclear findings at the surgical site, were performed on four patients of both groups. Within the first 2 years after IORT as a boost, therapy-induced changes at the original tumor site are significantly more pronounced compared with a control group. There is no evidence that the interpretation of findings is complicated after IORT.     

Pseudomembranous colitis: sonographic features

The sonographic features of pseudomembranous colitis (PMC) are described in 13 patients and correlated with clinical, radiologic, and pathologic findings. At sonography, the wall of the entire colon was moderately to markedly thickened in all patients. The enlarged colon wall was most commonly shown as a wide band of heterogeneous medium echogenicity surrounded by a narrow hypoechoic layer. Pathologic correlations proved that the wide inner stratum represented severely edematous submucosa and mucosa, while the outer layer depicted the muscularis propria. Almost complete effacement of the lumen of the colon occurred secondary to the mural edema in 69% of the cases. The dearth of intraluminal gas combined with thickening of the colon wall and ascites facilitated excellent sonographic evaluation. The diagnosis of PMC is strongly suggested by the presence of these sonographic features in a patient with watery diarrhea and a history of antibiotic therapy.     

CT and MR findings of denervated tongue after radical neck dissection.

PURPOSETo describe the CT and MR findings in the denervated tongue after a radical neck dissection.METHODSWe retrospectively evaluated the radiologic findings in seven patients who had hypoglossal paralysis following radical neck dissection. None of the patients had clinical or radiologic evidence of tumor recurrence.RESULTSThe side of the tongue operated on showed low density on CT scans. At MR imaging, denervated tongues were clearly seen as hyperintense relative to muscle on T2-weighted images; on T1-weighted images, the signal was hypointense to hyperintense, representing increased extracellular water or fatty degeneration.CONCLUSIONIn patients who have undergone a neck dissection for a malignant process, abnormal imaging findings in the tongue not only might indicate a recurrence of tumor involving the hypoglossal nerve but also suggest the possibility of postoperative change. Our findings emphasize the importance of the denervated tongue in differentiating inflammatory from neoplastic diseases of the the tongue.     

MR of denervated tongue: temporal changes after radical neck dissection.

PURPOSEThe purpose of this study was to evaluate the temporal changes of MR imaging in the denervated tongue after a radical neck dissection.METHODSOne hundred seventy-four consecutive MR studies in 116 patients with radical neck dissections for malignant tumors of the head and neck were evaluated retrospectively. Patients with tumors involving the tongue or hypoglossal nerve were not included in this study.RESULTSAbnormal signal intensity and/or hemiatrophy on the side of the tongue operated on was seen in 22 patients who had hypoglossal paralysis after radical neck dissection. The denervated side of the tongue appeared hypointense to hyperintense relative to the normal side on T1-weighted images and hyperintense on T2-weighted images. Signal intensity ratios of the abnormal to normal muscles were 0.9-1.6 on T1-weighted images and 1.3-2.8 on T2-weighted images. High signal intensity on T1-weighted images appeared 5 months or more after the dissection, whereas on T2-weighted images, the most prominent increases in signal intensity appeared in the first several months after denervation. Hemiatrophy of the tongue was observed on MR images obtained more than 6 months after surgery.CONCLUSIONMR findings in the denervated tongue are compatible with histologic changes and are characterized by an enlarged extracellular fluid space or fatty infiltration. The pattern of signal intensity and the degree of hemiatrophy suggest the duration of denervation.     

舌癌组织病理及增殖细胞核抗原表达与CT征象的对照研究

目的：评价舌癌CT征象与PCNA表达的关系。方法：39例舌癌术前行螺旋CT扫描。采用免疫组化方法，对病理标本行PCNA测定，统计学分析PCNA与CT征象的相关性。结果：舌癌的CT征象如肿瘤边界、大小、密度及增强情况与PCNA表达明显相关。结论：CT征象与舌癌PCNA表达有明显相关性，有助于对其预后进行评价。