(1/2084) Reirradiation combined with hyperthermia in recurrent breast cancer results in a worthwhile local palliation.
Both experimental and clinical research have shown that hyperthermia (HT) gives valuable additional effects when applied in combination with radiotherapy (RT). The purpose of this study was evaluation of results in patients with recurrent breast cancer, treated at the Daniel den Hoed Cancer Center (DHCC) with reirradiation (re-RT; eight fractions of 4 Gy twice weekly) combined with HT. All 134 patients for whom such treatment was planned were included in the analysis. The complete response rate in 119 patients with macroscopic tumour was 71%. Including the 15 patients with microscopic disease, the local control rate was 73%. The median duration of local control was 32 months, and toxicity was acceptable. The complete response (CR) rate was higher, and the toxicity was less with the later developed 433-MHz HT technique compared with the 2450-MHz technique used initially. With this relatively well-tolerated treatment, palliation by local tumour control of a worthwhile duration is achieved in the majority of patients. The technique used for hyperthermia appeared to influence the achieved results. The value of HT in addition to this re-RT schedule has been confirmed by a prospective randomized trial in a similar patient group. In The Netherlands, this combined treatment is offered as standard to patients with breast cancer recurring in previously irradiated areas. (+info)
(2/2084) When to consider radiation therapy for your patient.
Radiation therapy can be an effective treatment modality for both malignant and benign disease. While radiation can be given as primary treatment, it may also be used pre- or postoperatively, with or without other forms of therapy. Radiation therapy is often curative but is sometimes palliative. There are many methods of delivering radiation effectively. Often, patients tolerate irradiation well without significant complications, and organ function is preserved. To ensure that all patients with cancer have the opportunity to consider all treatment options, family physicians should be aware of the usefulness of radiation therapy. (+info)
(3/2084) Improved survival and reduction in local failure rates after preoperative radiotherapy: evidence for the generalizability of the results of Swedish Rectal Cancer Trial.
OBJECTIVE: The Swedish Rectal Cancer Trial (SRCT) demonstrated that a short-term regimen of high-dose preoperative radiotherapy (5 x 5 Gy) not only reduced the local recurrence rates but also improved the overall survival rate. This compelling evidence will have a significant impact on the primary treatment of rectal cancer. The authors' aim was to explore the representativeness of the study. SUMMARY BACKGROUND DATA: Until the SRCT was presented in 1997, no major trial had established that radiotherapy has a positive effect on the overall survival rate. METHODS: A review of all rectal cancer cases reported to the Swedish Cancer Registry during the same period that the SRCT accrued patients (1987 to 1990) was performed at 57 of 68 participating hospitals. At these 57 hospitals, there were 2366 patients with invasive rectal cancer, with 1664 of these patients fulfilling the criteria for inclusion in the SRCT. RESULTS: Fifty-two percent (866/1664) of eligible patients were included in the SRCT. The patients not included, of whom 8% (67/798) received adjuvant radiotherapy, had an overall 5-year survival rate of 48%, which was identical to the overall survival rate in the SRCT surgery-alone group (48%) but was inferior to the SRCT radiotherapy group (58%). The cancer-specific 5-year survival rates were 65% and 66% among the patients not included and the surgery-alone group, respectively. The local recurrence rates reached 27% in both groups. The results were still comparable when stratifying for curative surgery, tumor stage, and surgical procedure. CONCLUSIONS: The achieved inclusion level of 52% in a randomized multicenter trial is comparatively high. Because the population in the SRCT was representative, it was concluded that the study results are reliable. (+info)
(4/2084) Decreased BOLD functional MR activation of the motor and sensory cortices adjacent to a glioblastoma multiforme: implications for image-guided neurosurgery.
A patient with a glioblastoma multiforme and mild sensorimotor deficits had significantly less activation of the motor and sensory cortices on the side with the tumor than on the contralateral side on blood oxygen level-dependent (BOLD) functional MR images. This difference, which may be due to pressure effects or loss of vascular autoregulation, should be considered in preoperative planning in which BOLD functional MR imaging is used to identify eloquent cortices to be avoided during brain tumor surgery. (+info)
(5/2084) The influence of margin width on local control of ductal carcinoma in situ of the breast.
BACKGROUND: Ductal carcinoma in situ is a non-invasive carcinoma that is unlikely to recur if completely excised. Margin width, the distance between the boundary of the lesion and the edge of the excised specimen, may be an important determinant of local recurrence. METHODS: Margin widths, determined by direct measurement or ocular micrometry, and standardized evaluation of the tumor for nuclear grade, comedonecrosis, and size were performed on 469 specimens of ductal carcinoma in situ from patients who had been treated with breast-conserving surgery with or without postoperative radiation therapy, according to the choice of the patient or her physician. We analyzed the results in relation to margin width and whether the patient received postoperative radiation therapy. RESULTS: The mean (+/-SE) estimated probability of recurrence at eight years was 0.04+/-0.02 among 133 patients whose excised lesions had margin widths of 10 mm or more in every direction. Among these patients there was no benefit from postoperative radiation therapy. There was also no statistically significant benefit from postoperative radiation therapy among patients with margin widths of 1 to <10 mm. In contrast, there was a statistically significant benefit from radiation among patients in whom margin widths were less than 1 mm. CONCLUSIONS: Postoperative radiation therapy did not lower the recurrence rate among patients with ductal carcinoma in situ that was excised with margins of 10 mm or more. Patients in whom the margin width is less than 1 mm can benefit from postoperative radiation therapy. (+info)
(6/2084) Surgical management of esophageal carcinoma.
Surgical management of esophageal carcinoma is reviewed. The anatomy and biology are briefly mentioned, since these factors mitigate against the success of surgery. Staging, the key to proper treatment allocation and prognosis, is discussed, including the use of endoscopic ultrasonography, positron emission tomography, and thoracoscopy/laparoscopy. Patient selection and preparation for surgery are important considerations. Surgical techniques are then discussed, as are the advantages and disadvantages of various approaches, the morbidity of surgical resection, survival, and quality-of-life issues. Adjuvant treatment strategies (preoperative radiation, induction chemotherapy, induction chemoradiotherapy, and postoperative treatment) are summarized. (+info)
(7/2084) External beam radiotherapy for pelvic node recurrence after curative resection of colon cancer: report of a case.
The role of radiotherapy in locally advanced or recurrent colon cancer has not yet been determined. A 59-year-old man undergoing curative resection for advanced descending colon cancer had pelvic lymph node metastasis detected by computed tomography 5 months postoperatively. Intravenous chemotherapy using 5-fluorouracil and CDDP was repeated bimonthly for 7 months; however, his condition deteriorated progressively. External beam radiotherapy (50 Gy) was started thereafter. His serum carcinoembryonic antigen level decreased promptly and abdominal computed tomography showed apparent shrinkage of the metastatic pelvic node with calcification. The patient maintained a partial response for at least 12 months. Radiotherapy has a more crucial role in the treatment of a subgroup of recurrent colorectal tumors. (+info)
(8/2084) A randomised phase III trial comparing consolidation treatment with further chemotherapy to chest irradiation in patients with initially unresectable locoregional non-small-cell lung cancer responding to induction chemotherapy. European Lung Cancer Working Party.
PURPOSE: A phase III randomised trial was conducted in patients with non-metastatic unresectable non-small-cell lung cancer in order to compare, in responders to induction chemotherapy, consolidation treatment by further chemotherapy to chest irradiation. PATIENTS AND METHODS: A total of 462 untreated NSCLC patients were eligible for three courses of induction chemotherapy (MIP) consisting of cisplatin (50 mg/m2), ifosfamide (3 g/m2) and mitomycin C (6 mg/m2). It was proposed that objective responders be randomised to either three further courses of MIP or to chest irradiation (60 Gy; 2 Gy per fraction given over six weeks). RESULTS: An objective response rate of 35% was achieved; 115 patients (including 52% with initial stage IIIA and 44% with initial stage IIIB) were randomised to consolidation treatment, 60 of them to further chemotherapy and 55 to chest radiotherapy. There was no significant difference in survival between the two arms, with a respective median and two-year survival of 42 weeks (95% confidence intervals (95% CI: 35-51) and 18% (95% CI: 8-28) for chemotherapy and 54 weeks (95% CI: 43-73) and 22% (95% CI: 11-33) for irradiation. There was also no statistical difference for response duration between the two arms but chest irradiation was associated with a significantly greater duration of local control than chemotherapy (median duration times: 158 vs. 31 weeks, P = 0.0007). CONCLUSIONS: For non-metastatic unresectable NSCLC treated by an induction chemotherapy regimen containing cisplatin and ifosfamide, if an objective response is obtained, consolidation treatments by further chemotherapy or by chest irradiation result in non-statistically different survival distributions, although a better local control duration is observed with radiotherapy. (+info)