Purpose To investigate the results of postoperative radiotherapy (PORT) for the treatment of pathologic N2b/c squamous cell carcinoma of the oral cavity (OSCC). Materials and Methods This study ...reviewed cancer registry data collected in our hospital from 1998 to 2009 with the following inclusion criteria: primary OSCC, treatment with radical surgery, and multiple nodal metastases. Patients who had extracapsular spreading of the lymph node metastases or positive resection margins or who refused to undergo PORT were excluded. The prescribed dose of PORT was 60-66 Gy. Concurrent chemotherapy was optional. Patient characteristics, treatment parameters and clinical outcome were recorded. The primary end point was overall survival, and the secondary endpoint was disease status. Results There were 138 eligible cases, and the median follow-up period was 35 months. The 3-year overall survival rate was 56%. Univariate analysis revealed that pathologic T4 status (pT4), bone marrow invasion, and lymphatic invasion were significantly correlated with poor outcome (p<0.05). Multivariate analysis showed that pT4, lymphatic invasion, and the no concurrent chemotherapy were independent poor prognostic factors (p<0.05). Fifty-four patients had tumor recurrence. The 3-year recurrence-free survival rate was 59%. Skin invasion, pT4, and bone marrow invasion were correlated with poor prognosis in the univariate analysis (p<0.05). Only pT4 (p<0.01) and no concurrent chemotherapy (p = 0.03) were independently correlated with poor recurrence-free survival. Conclusion For OSCC patients with multiple-node metastases without extracapsular spreading or positive resection margins, PORT without concurrent chemotherapy correlated to inferior outcome. Multiple lymph node metastases might be considered an indication for concurrent chemotherapy.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This prospective study compares the efficacies of whole-body (18)F-FDG PET and a conventional work-up (CWU) in evaluating the treatment response for patients with locoregional advanced nasopharyngeal ...carcinoma (NPC) after primary curative therapy and investigates the impact of PET on patient management.
Patients who had locoregional advanced NPC (stages III and IVa-b, staged by (18)F-FDG PET and CWU) and who had completed primary curative therapy for 3 mo were enrolled. The curative therapy consisted of concurrent chemoradiotherapy with or without induction chemotherapy. All of the patients also underwent (18)F-FDG PET and CWU to evaluate the response. The criteria for final diagnosis were based on pathology or subsequent follow-up for at least 6 mo. Rates of detection by (18)F-FDG PET and CWU and the impact on management were determined on site and patient bases, respectively.
From January 2002 to August 2005, 131 patients with NPC were eligible, including 71 patients with stage III NPC (group A) and 60 patients with stage IVa-b NPC (group B). Twelve patients were proven to have residual tumors. (18)F-FDG PET had a higher overall sensitivity than CWU in group A (100% vs. 25%) and group B (91.7% vs. 58.3%). The overall specificity of PET was significantly higher than that of CWU in group B (97.6% vs. 91.7%; P = 0.019) but was slightly lower in group A (95.7% vs. 96.7%). The overall accuracy of PET also was significantly higher than that of CWU in group B (97.2% vs. 89.4%; P = 0.002) but was similar to that of CWU in group A (95.8% vs. 95.3%). PET resulted in management changes in 11 patients (15.4%; 11/71) in group A, with positive and negative impacts on 3 and 8 patients, respectively. In group B, the management of 26 of 60 patients (43%) was changed as a result of PET and included positive impacts on 23 patients and negative impacts on 3 patients.
(18)F-FDG PET plays differential roles in patients with stage III NPC and stage IVa-b NPC after primary curative therapy. PET has higher sensitivity and specificity in evaluating the response and results in better management of patients with stage IVa-b NPC. PET has a less prominent impact on patient management but higher sensitivity in patients with stage III NPC.
This article evaluates 18F fluorodeoxyglucose positron emission tomography (18F-FDG-PET) findings as a predictor for local responders (R) vs. nonresponders (NR) in nasopharyngeal carcinoma (NPC) ...patients with Stage T4 lesions, before and at 3 months after completion of concurrent chemotherapy and radiation therapy (CCRT).
From January 2002 to November 2003, 39 T4 NPC patients were enrolled. All had magnetic resonance imaging and 18F-FDG-PET, both before and 3 months after CCRT. Any residual/recurrent lesions were confirmed histopathologically.
Of the 39 eligible patients, after a follow-up of 24.2 +/- 9.5 months, 35 became disease-free and 4 had residual or recurrent disease. Marginal differences in standard uptake values (SUV) were observed (10.9 +/- 5.3 vs. 15.6 +/- 3.4, p = 0.058) between R and NR before treatment, and value changes of SUV before and after CCRT were not significantly different. However, highly significantly lower values of SUV were noted for R than for NR 3 months after completion of CCRT (2.1 +/- 0.8 vs. 5.5 +/- 3.2, p = 0.001). One hundred percent positive and negative predictive values were observed for SUV values of 4.0, set 3 months after completion of CCRT.
Neither the pretreatment SUV nor the changes of SUV between pretreatment and posttreatment were significant predictors for local response. SUV at 3 months after completion of CCRT was a significant determinator for local response. The cutoff of 4.0 for SUV at 3 months after completion of CCRT was useful to be offered as a diagnostic reference for recurrent or residual tumor for NPC treatment.
To review the initial treatment results of intensity-modulated radiotherapy (IMRT) for prostate cancer.
Ninety-two patients treated with IMRT before July 2003 were included in this study. The median ...follow-up was 32 months. The indications for IMRT included primary, adjuvant, and salvage treatment. Combined treatment with androgen suppression therapy was variable. The primary study endpoints were chronic adverse events which were subjectively reported. Only patients with an adenocarcinoma and who had been treated by primary radiotherapy were included in the analysis of disease relapse.
At the time of analysis, 89 patients were still alive, and only 2 patients had died of prostate cancer. In the survival analysis, the 30-month failure-free survival rates were 100%, 89.2%, and 67.3% for the low-, intermediate-, and high-risk groups of patients, respectively. Pretreatment PSA level, Gleason score, risk classification, and adjuvant hormone therapy were significantly associated with relapse according to the univariate analysis, while only risk classification remained significant in the multivariate analysis. During follow-up, 5 (6%) patients developed grade 2 gastrointestinal (GI) adverse events (AE). Sixteen (18%) and 7 (8%) patients developed grade 2 and 3 urinary AE, respectively. Development of severe urinary adverse events was closely related to previous surgical treatment. No factor was identified as being correlated with the GI adverse events. The preservation rate of sexual function was 25.7%.
Seventy-two Grays of irradiation, administered by IMRT, is a safe method as the primary treatment for prostate cancer. However, severe urinary toxicity was related to previous surgical treatment. There is a need for longer follow-up periods to verity the benetit of this dosage level.
Polarization splitters with zinc-nickel and gallium indiffusion optical waveguides fabricated on Z-cut lithium niobate substrates are presented. The device fabrication process needs only one ...diffusion step and, therefore, is greatly simplified. Experimental results show that, at 1.55-μm wavelength, the extinction ratios for the TE and TM modes are 27.8 and 24.5 dB, respectively.
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