Low rates of local recurrence after surgical resection of rectal cancer suggest a selective policy for preoperative radiotherapy

Aim Preoperative short‐course radiotherapy (SCRT) is increasingly recommended to reduce local recurrence after surgery for rectal cancer. Its avoidance may be beneficial, however, if the risk of local recurrence is low. We report a single centre experience which suggests that selective rather than uniform use of SCRT may be the best approach. Method Analysis was carried out on a prospectively collected unselected series of 1606 patients with rectal cancer treated in one centre. Follow‐up was 97% complete. SCRT was performed selectively and all patients had a mesorectal excision. Results Among 940 patients undergoing a potentially curative major resection the operative mortality was 4.6%, the permanent stoma rate 23% and the crude 5‐year survival 61%. The local recurrence rate after curative anterior resection was 2.9% and 7.7% after abdominoperineal excision. The overall local recurrence rate after a potentially curative major resection was 4.0%. Conclusion The routine use of preoperative radiotherapy for rectal cancer is probably not justified where local recurrence after curative rectal resection is uncommon.     

Early glottic carcinoma: Treatment according patient's preference?

BACKGROUND: To analyze the results in early (stage I and II) glottic carcinoma of a single institution with a patient-oriented concept. METHODS: After diagnostic workup and multidisciplinary counseling, either radiotherapy or CO(2) laser surgery was chosen with respect to the patient's preference. RESULTS: Sixty-five patients underwent laser surgery and 75 had radiotherapy. For T1 tumors, the 5-year overall survival, disease-specific survival, and initial local control rate after laser surgery and radiotherapy were comparable (OS, 85% vs 88%; DSS, 96% vs 93%; LCR, 86% vs 85%). In contrast, initial local control for T2 tumors was significantly more favorable after surgery (OS, 83% vs 78%; DSS, 83% vs 88%; LCR, 89% vs 67%). Larynx preservation was significantly higher after surgery in T1 tumors (96% vs 82%) and in T2 tumors (89% vs 77%). CONCLUSIONS: Selection of the treatment modality according to patient's preference results in a comparable control of disease for T1 tumors. The initial local control for T2 tumors is significantly better after surgery. In both stages laser surgery warrants a better larynx preservation rate.     

Breast-conserving therapy with adjuvant paclitaxel and radiation therapy: feasibility of concurrent treatment

As commonly used, adjuvant paclitaxel after doxorubicin in high-risk breast cancer patients results in a prolonged delay of the onset of radiation therapy after breast-conserving surgery. Concurrent delivery of breast irradiation with paclitaxel would allow for earlier initiation of radiation. We report on the toxicity of concurrent paclitaxel and breast irradiation after doxorubicin and cyclophosphamide. Twenty-four patients were treated with concurrent breast radiation and paclitaxel. All patients received four cycles of doxorubicin and cyclophosphamide followed by four cycles of paclitaxel, 175 mg/m2 every 3 weeks. The radiation therapy started after the first cycle in 3 patients, after the second cycle in 16, and after the third in 5. The breast received 4680-5040 cGy external beam irradiation, followed by a boost of 1000-2000 cGy. Fifteen patients received supraclavicular irradiation, and a posterior axillary supplement was used in five patients. Median follow-up after completion of irradiation was 11.5 months (range 2-29 months) with 21 patients followed >or=6 months, 12 followed >or=12 months, and 7 followed >or=18 months. Using Radiation Therapy Oncology Group (RTOG) acute toxicity scoring criteria, 7 patients experienced grade 1 skin and/or soft tissue reactions and 17 patients had grade 2 reactions. The average total duration of radiation treatment was 49 days (range 41-57 days). Only eight patients had radiation therapy interruptions for a median of 3.5 days (range 2-8 days): two more than 5 days. None had a chemotherapy dose reduction. One patient discontinued paclitaxel after the third cycle due to bilateral upper extremity neuropathy. No cases of pneumonitis or brachial plexopathy were seen. Concurrent treatment with every 3-week paclitaxel and breast irradiation was well tolerated. Additional study is needed to determine optimal timing, long-term toxicity, and potential benefits of concurrent radiation therapy and paclitaxel.     

Distant metastases after definitive radiotherapy for squamous cell carcinoma of the head and neck

PURPOSE: To analyze parameters that influence the risk of distant metastases after definitive radiotherapy. METHODS: Between 1983 and 1997, 873 patients were treated with definitive radiotherapy and had follow-up for 2 years or more. Univariate and multivariate analyses were performed to evaluate risk factors that might influence the risk of distant metastases. RESULTS: The 5-year distant metastasis-free survival rate was 86%. Univariate analyses revealed that the risk of distant metastases was significantly influenced by gender (p =.0092), primary site (p =.0023), T stage (p <.0001), N stage (p <.0001), overall stage (p <.0001), level of nodal metastases in the neck (p <.0001), histologic differentiation (p =.0096), control above the clavicles (p <.0001), and time to locoregional recurrence (p <.0001). Multivariate analysis of freedom from distant metastases revealed that gender (p =.0390), T stage (p <.0001), N stage (p =.0060), nodal level (p <.0001), and locoregional control (p <.0001) significantly influenced this end point. Multivariate analysis revealed that gender (p =.0049), T stage (p <.0001), N stage (p <.0001), and locoregional control (p <.0001) significantly influenced cause-specific survival. CONCLUSIONS: The risk of distant metastases after definitive radiotherapy is 14% at 5 years and is significantly influenced by gender, T stage, N stage, nodal level, and locoregional control.     

Stereotactic radiosurgery for locally recurrent nasopharyngeal carcinoma

BACKGROUND: Stereotactic radiosurgery has been used to treat intracranial tumors. Recently, it has also been used for the treatment of head and neck tumors involving the base of skull, including recurrent NPC. METHODS: From October 1994 to April 1999, 36 patients with recurrent NPC, were retreated by stereotactic radiosurgery. These patients received radiosurgery as a boost treatment after reirradiation for recurrence. The external RT dose ranged from 20 to 60 Gy. The tumor volume ranged from 3.58 to 24.6 cc. The target surface dose ranged from 8 to 20 Gy. The median follow-up was 22.1 months. RESULTS: The 3-year local control rate was 56%. The 5-year overall survival was 49%. Persistence after radiosurgery had a worse survival than those who had secondary recurrence. Age and gender were marginally significant. No patient had new severe complications after retreatment. Four patients (11%) had nasopharyngeal necrosis after radiosurgery, none had nasal bleeding or headache, but a foul odor was present in one patient. CONCLUSIONS: Conformal radiotherapy and stereotactic radiotherapy provide good local control and survival without severe complications for patients with recurrent NPC.     

Prostate specific antigen bounce phenomenon after external beam radiation for clinically localized prostate cancer

PURPOSE: We characterize the prostate-specific antigen (PSA) bounce in patients who underwent external beam radiation therapy for prostate cancer and correlate the PSA bounce with the development of biochemical disease progression. MATERIALS AND METHODS: In this study 964 patients received full dose radiation therapy alone. Followup PSA values were obtained 3 months after completion of radiotherapy and every 3 to 6 months thereafter. Median followup of the entire study group was 48 months. All time intervals were calculated from the completion date of radiation therapy. PSA bounce was defined as an initial increase in serum PSA of at least 0.5 ng./ml., followed by a decrease to pre-bounce baseline serum PSA values no more than 60 months after external beam radiation therapy. RESULTS: Of the 964 patients 119 (12%) had a PSA bounce. PSA bounce was unrelated to age, race, pretreatment PSA, Gleason score, clinical T stage or radiation dose. Mean time to PSA bounce was 9 months from the time of therapy. The respective 1 and 5-year biochemical disease-free survival rates were 100% and 82.1% for patients with PSA bounce and 93.9% and 57.7% for those without PSA bounce (p = 0.0001). CONCLUSIONS: Of men with prostate cancer treated with external beam radiation therapy 12% experienced a transient increase in PSA (PSA bounce) followed by a return to pre-bounce levels after radiation. The PSA bounce phenomenon was not predictive of time to biochemical recurrence.     

Combined endoscopic laser and radiotherapy palliation of advanced rectal cancer

Background : In the palliative treatment of patients with advanced, inoperable rectal cancer, combined endoscopic laser and radiotherapy have been claimed to be more effective than laser therapy alone. The number of laser treatments, laser energy used, relapse rate, treatment of relapse, morbidity and survival in consecutive patients who were treated either by laser therapy alone or laser plus radiotherapy was compared. Methods : Prospective data were analysed with regard to number of treatments, laser energy used, relapse rate, morbidity and survival for 56 consecutive patients. Results : The crude relapse rate was significantly higher in the laser only group than in the laser plus radiotherapy group (58 and 15%, respectively; P = 0.002). There was no difference between the groups in the median total number of laser treatments or the mean total laser energy used. In patients experiencing a relapse, there was no difference in the median number of relapses, the number of laser treatments post‐relapse or the total energy used post‐relapse. Survival did not differ between the groups and there were no treatment‐related deaths. Conclusions : These findings demonstrate a clear reduction in relapse after using combined laser and radiotherapy to palliate patients with advanced rectal cancer with no appreciable additional morbidity and have encouraged continuing use of this treatment.     

Radiation-induced osteosarcoma of the chest wall

A case of radiation-induced sarcoma of the chest wall is reported. Twenty-seven years 11 months after orthovoltage radiotherapy of the right breast a 69-year-old woman developed a radiation-induced osteosarcoma of the right thoracic wall. Initial diagnosis has been T-cell lymphoma of the skin. The right breast was irradiated with tangential fields and a total dose of 40 Gy, 2 Gy/day, 5 days a week. Orthovoltage treatment was performed in two courses of 20 Gy, 3 months apart. The clinical appearance of the secondary sarcoma was a diffuse infiltrated area in the irradiated breast which seemed to be fixed to the chest wall. Magnetic resonance imaging (MRI) demonstrated a mass in the right anterior thoracic wall which destroyed the fourth to the sixth rib. The tumor infiltrated the thoracic wall, including subcutaneous tissue and pericardium, as well as extending into the subphrenic space. Biopsy of the lesion revealed a poorly differentiated osteosarcoma. The patient's general condition precluded surgical or chemotherapeutic intervention; she died due to a cerebral stroke 6 months later. This case fulfilled all criteria for radiation-induced sarcoma, as there was a prior history of radiotherapy, latency period of several years, development of sarcoma within the irradiated field, and histologic confirmation of sarcoma.     

3D腹腔镜联合杂交技术在腹壁巨大切口疝中的应用体会

目的:探讨3D腹腔镜联合杂交技术治疗腹壁巨大切口疝的临床效果。方法:回顾分析2012年5月至2016年4月为25例腹壁巨大切口疝患者行3D腹腔镜联合杂交技术腹壁切口疝无张力修补术的临床资料,记录围手术期情况,总结其治疗效果。结果:25例患者均顺利完成手术,手术时间平均(111.7±11.3)min,切口长度平均(7.1±3.5)cm,术中出血量平均(55.1±7.7)ml,术后平均住院(6.7±1.6)d;4例患者术后使用止痛剂。术中肠道浆膜损伤1例,未影响补片修补;术后切口轻度感染1例,积极治疗后痊愈,未取出补片,无血清肿、肠瘘等其他并发症发生。术后随访24个月,随访率100%,无一例复发。结论:3D腹腔镜联合杂交技术治疗腹壁巨大切口疝是安全、有效、可行、实用的,治疗效果较好,结合了腹腔镜与开放手术的优点,术后患者康复快,美容效果好,值得临床推广应用。     

宫颈癌放化疗患者生活质量及其影响因素的研究

目的了解宫颈癌患者的生活质量水平,并分析其影响因素。方法采用社会支持评定量表(SSRS),Zung抑郁自评量表(SDS)和癌症患者生活质量量表(QLQ-C30)对148例宫颈癌放化疗患者进行调查。结果患者生活质量得分(64.3±18.2)分;年龄、社会支持、家庭月收入、文化程度和抑郁是宫颈癌患者生活质量的影响因素(P0.05,P0.01)。结论护理人员应了解宫颈癌患者的生活质量水平及其影响因素,并提供有针对性的护理措施,以提高其生活质量。