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Initial Radiotherapy (initial + radiotherapy)
Selected AbstractsCase Report: Unusual solitary metastasis of the ciliary body in renal cell carcinomaINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2008Vito Mancini Abstract: Renal cell carcinoma (RCC) usually metastasizes to the lung, liver, bone; ocular metastasis is uncommon. We describe a rare case of metachronous ciliary RCC metastasis in a 42-year-old man who had undergone left radical nephrectomy for conventional RCC (pT3aN0M0, G2 Fuhrman) 6 years earlier. Solitary metastasis of the left eye presented with inflammatory symptoms, but examination of the fundus and bulbar ultrasound revealed a small mass of the ciliary body. Initial radiotherapy was unsuccessful and definitive treatment consisted of ocular enucleation with radical result and no further evidence of local and distant disease. Ocular metastasis of RCC is rare, can appear years after treating the primary tumor and should not be excluded in RCC follow-up. As for other RCC solitary metastasis, the best option remains the radical surgical approach. [source] Final report of RTOG 9610, a multi-institutional trial of reirradiation and chemotherapy for unresectable recurrent squamous cell carcinoma of the head and neck,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2008Sharon A. Spencer MD Abstract Background. Our objectives were to determine the incidence of acute and late toxicities and to estimate the 2-year overall survival for patients treated with reirradiation and chemotherapy for unresectable squamous cell carcinoma of the head and neck (SCCHN). Methods. Patients with recurrent squamous cell carcinoma or a second primary arising in a previously irradiated field were eligible. Four weekly cycles of 5-fluorouracil 300 mg/m2 IV bolus and hydroxyurea 1.5 g by mouth were used with 60 Gy at 1.5 Gy twice-daily fractions. Toxicity was scored according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results. Seventy-nine of the 86 patients enrolled were analyzable. The worst acute toxicity was grade 4 in 17.7% and grade 5 in 7.6%. Grade 3 and 4 late toxicities were found in 19.4% and 3.0%, respectively. The estimated cumulative incidence of grade 3 to 4 late effects occurring at >1 year was 9.4% (95% confidence interval [CI]: 0, 19.7) at 2 and 5 years. The 2- and 5-year cumulative incidence for grade 4 toxicity was 3.1% (95% CI: 0, 9.3). The estimated 2- and 5-year survival rates were 15.2% (95% CI: 7.3, 23.1) and 3.8% (95% CI: 0.8, 8.0), respectively. Patients who entered the study at >1 year from initial radiotherapy (RT) had better survival than did those who were <1 year from prior RT (median survival, 9.8 months vs 5.8 months; p = .036). No correlation was detected between dose received and overall survival. Three patients were alive at 5 years. Conclusion. This is the first prospective multi-institutional trial testing reirradiation plus chemotherapy for recurrent or second SCCHN. The approach is feasible with acceptable acute and late effects. The results serve as a benchmark for ongoing RTOG trials. © 2007 Wiley Periodicals, Inc. Head Neck 2008 [source] Factors influencing long-term survival following salvage total laryngectomy after initial radiotherapy or conservative surgery,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2006B. Zach Fowler MD Abstract Background. This retrospective study investigated survival outcomes of salvage total laryngectomy (STL) after initial radiation therapy (RT) or larynx conservation surgery (CS) at an academic center. Methods. A chart review yielded 64 patients with STL: 53 with RT failures, six with CS failures, and five after RT + CS. Median potential follow-up after STL was 9.4 years (mean, 9.2 years; range, 0.3,17.4 years). Results. Five- and 10-year actuarial overall survival (OS) after STL was 65.2% and 37.7%, respectively. Mean survival after STL was 7.2 years (median, 6.8 years; range, 0.2,17.4 years). No significant survival difference was found between the three treatment groups (p = .50). For 21 patients with nodes assessed at STL, 9-year OS was 45.4% for patients with N0 disease versus 26.7% for patients with N+ disease (p = .25). Conclusion. These data suggest that STL after radiation failure is associated with equivalent long-term survival as STL after RT + CS or after failure of CS alone. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Elective neck dissection during salvage surgery for locally recurrent head and neck squamous cell carcinoma after radiotherapy with elective nodal irradiation,THE LARYNGOSCOPE, Issue 5 2010Roi Dagan MD Abstract Objectives/Hypothesis: To define the role of elective neck dissection during salvage surgery for locally recurrent head and neck squamous cell carcinoma (SCCA) initially treated with elective nodal irradiation (ENI). Study Design: Retrospective chart review. Methods: We reviewed the medical records of patients treated with ENI at our institution from 1965 to 2006 for T1-4 N0 M0 SCCA of the oropharynx, hypopharynx, or larynx who developed an isolated local recurrence and remained N0. Fifty-seven patients were salvaged, 40 with neck dissection and 17 with neck observation. We then compared toxicity and actuarial outcomes between the two groups. Results were compared to the pertinent literature in a pooled analysis. Results: Four of 46 (9%) heminecks were found to have occult metastases in dissected specimens. The 5-year local-regional control rate was 75% for all patients. Neck dissection resulted in poorer outcomes compared with observation. In the dissected group, the 5-year local control, regional control, cause-specific survival, and overall survival rates were 71%, 87%, 60%, and 45%, respectively, compared to 82%, 94%, 92%, and 56%, respectively, for the observed group. Toxicity was more likely with dissection. In the pooled analysis totaling 230 patients, the overall pathologic positive rate of neck-dissection specimens was 9.6%; the compiled data showed no improvement in outcomes when salvage included neck dissection. Conclusions: Routine elective neck dissection should not be included during salvage surgery for locally recurrent head and neck SCCA if initial radiotherapy includes ENI. The risk of occult neck disease is low, outcomes do not improve, and the likelihood of toxicity increases. Laryngoscope, 2010 [source] Radiotherapy for extranodal, marginal zone, B-cell lymphoma of mucosa-associated lymphoid tissue originating in the ocular adnexaCANCER, Issue 4 2003A multiinstitutional, retrospective review of 50 patients Abstract BACKGROUND Due to the small number of patients and differences in the pathologic classification in most radiotherapy series, information regarding the adequacy of tumor control in patients with ocular-adnexal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is limited. METHODS A multiinstitutional, retrospective study was performed on 50 patients with Stage IE ocular-adnexal MALT lymphoma who were treated with radiotherapy between 1989 and 1999. The impact of patient characteristics and other variables on tumor control was analyzed. RESULTS Responses to radiotherapy include a complete response (CR) in 26 patients, a partial response (PR) in 20 patients, and no change in 4 patients. Forty-nine of 50 patients obtained tumor control in the ocular adnexa at 24 months. Overall, 6 patients exhibited disease recurrence at 4,97 months. Three patients developed recurrence in the ocular adnexa. Two patients had isolated extranodal failure involving the oral floor and the submandibular gland, and one patient experienced failure in the neck lymph node. The initial tumor response had a marginal impact on the development of recurrence. None of the 26 patients who achieved a CR experienced ocular-adnexal recurrence. All three patients who experienced local treatment failure belonged to the initial PR group. In total, five of six patients who developed recurrent disease had obtained a PR after initial radiotherapy. Age, gender, tumor location, and dose of radiotherapy did not influence the development of recurrence. There was only one death due to lymphoma. The 5-year overall survival rate was 91% with a median follow-up of 46 months. CONCLUSIONS Radiotherapy offers excellent local control with a prolonged clinical course for patients with MALT lymphoma in the ocular adnexa. The initial response to radiotherapy marginally influenced the probability of recurrence. Cancer 2003;98:865,71. © 2003 American Cancer Society. DOI 10.1002/cncr.11539 [source] | ||||||||||