Introduction: Initial surgical resection is considered the standard of care for patients diagnosed with tumours involving the salivary glands. We reviewed our institutional outcomes of patients ...treated with initial radiation therapy (RT) for diagnosed carcinoma of the parotid gland.
Methods: This review examined seventeen patients that received RT as initial therapy for tumours involving the parotid gland. Fifteen patients had primary salivary gland cancer, and two patients had metastatic carcinoma to the parotid gland. Sixteen patients (94.1%) following surgical evaluation had operative risk of facial nerve impairment or sacrifice with initial surgery, four (23.5%) had clinical objective evidence of nerve involvement at evaluation, five (29.4%) were poor surgical candidates and three (17.6%) refused initial surgery. Primary tumour stages ranged T2‐T4b, and disease stages ranged II‐IVb. RT median dose was 70 Gy, and median follow‐up was 12 months.
Results: Eleven patients (64.7%) achieved a clinical complete response (CR) to therapy. Of these CR patients eight (72.7%) received definitive RT and three (27.3%) underwent surgery following RT. Two surgical patients avoided facial nerve impairment while one required nerve sacrifice. The other six patients (35.3%) achieved an unfavourable response to RT and had unresectable or metastatic disease at follow‐up. No long‐term complications were reported.
Conclusion: Initial radiation therapy for tumours involving the parotid gland is effective to achieve clinical CR, eliminate surgical resection for many patients, and decrease risk of facial nerve impairment or sacrifice for those patients requiring surgery following RT.
Introduction: To review outcomes of patients treated with radiotherapy (RT) for T4 non‐melanoma skin cancer (NMSC).
Methods: A retrospective chart review was performed of 21 patients who received RT ...for T4 NMSC from 2004 to 2010. Outcomes of treatment efficacy, RT technique and patient morbidity were analysed. Twelve patients (57.1%) were treated definitively without prior treatment, five (23.8%) were recurrent lesions and four (19.1%) were treated postoperatively. Ten patients (47.6%) had evidence of bony erosion at presentation, and four (19.1%) had nodal disease. Intensity‐modulated radiotherapy (IMRT), three‐dimensional conformal RT and electron treatment were included RT techniques.
Results: Median follow‐up was 12 months (range, 5–48 months). Twelve patients (57.1%) following RT required no further treatment and had no disease recurrence. Three patients (14.3%) required salvage treatment and are disease‐free following all treatment. Tumours treated initially or postoperatively had improved control rates following RT compared with recurrent lesions (58.3% and 100% vs. 20%). Sixty percent of patients treated with IMRT achieved local control following RT, and 80% were disease‐free following surgical salvage treatment. Squamous cell carcinoma (SCC) histology, presence of bony erosion and/or nodal disease was associated with a higher incidence of disease recurrence.
Conclusions: Patients presenting with untreated lesions, smaller tumour volumes (<70 cm3) postoperatively, basal cell histology and absence of bone erosion or nodal disease have improved local control and outcomes. Basal cell carcinoma and SCC should be staged and treated as two separate disease entities. The use of IMRT for advanced skin cancer warrants further investigation.
To review our institutional outcomes of patients treated with radiation therapy (RT) for Graves' orbitopathy (GO), assess the role of orbital reirradiation, and identify prognostic factors of ...complete response (CR).
This is a retrospective review of 211 patients who presented with a diagnosis of GO and received RT between January 2000-2010. RT dose was 20 Gy in 10 fractions. Patient median age was 51 years (range, 15-84 years), median follow-up was 11 months (range, 1-88 months). Patient symptoms included any combination of proptosis (90.9%), extraocular muscle dysfunction (78.9%), soft tissue signs (68.4%), and diplopia (58.4%). Corticosteroids were used as first-line therapy in 20.6% of patients. Among those who achieved either CR or partial response (PR), prognostic factors were evaluated.
Stabilization of disease without recurrence was clinically achieved overall in 202 patients (96.7%). At the completion of RT, 176 patients (84.2%) reported a symptomatic improvement of pretreatment symptoms. CR of GO symptoms was achieved using multiple treatment modalities, including RT by 93 patients (44.5%), of which 32 patients received RT only. Corticosteroids were discontinued in 97.8% of patients who received them as initial therapy. Surgical intervention following radiotherapy was required for 144 (68.9%) of all patients. Fourteen patients received orbital reirradiation for persistent or recurrent symptoms. Five of these achieved a CR, and the other nine achieved disease stabilization but retained persistent ocular symptoms. Long-term side effects of RT included dry eyes (12%). Of the prognostic factors we investigated, only gender predicted CR, which was less common in men (33.9%) than in women (49.7%) p = 0.0471.
Orbital radiation for GO is an established treatment modality for patients. Orbital reirradiation is beneficial for patients who do not respond to initial RT or experience symptom recurrence without an apparent risk of increased morbidity.
To review institutional outcomes for patients treated with external-beam radiotherapy (EBRT) for orbital pseudotumor.
This is a single-institution retrospective review of 20 orbits in 16 patients ...diagnosed with orbital pseudotumor that received EBRT at the University of Oklahoma, Department of Radiation Oncology. Treated patients had a median follow-up of 16.5 months.
Fifteen patients (93.7%) were initially treated with corticosteroids. Eight had recurrence after steroid cessation, six were unable to taper corticosteroids completely or partially, and one experienced progression of symptoms despite corticosteroid therapy. Fourteen patients (87.5%) initially responded to radiotherapy indicated by clinical improvement of preradiation symptoms and/or tapering of corticosteroid dose. Mean EBRT dose was 20 Gy (range, 14-30 Gy). Thirteen patients (81.2%) continued to improve after radiation therapy. Patient outcomes were complete cessation of corticosteroid therapy in nine patients (56.3%) and reduced corticosteroid dose in four patients (25%). Radiotherapy did not achieve long-term control for three patients (18.7%), who still required preradiation corticosteroid dosages. Three patients received retreatment(s) of four orbits, of which two patients achieved long-term symptom control without corticosteroid dependence. One patient received retreatment to an orbit three times, achieving long-term control without corticosteroid dependence. No significant late effects have been observed in retreated patients.
Radiotherapy is an effective treatment for acute symptomatic improvement and long-term control of orbital pseudotumor. Orbital retreatment can be of clinical benefit, without apparent increase in morbidity, when initial irradiation fails to achieve complete response.
Tandem elution of technetium 99m generators Bogardus, Jr, C R; Levitt, S H; Ficken, V J
American journal of roentgenology, radium therapy, and nuclear medicine
97, Številka:
4
Journal Article
Review our institutional outcomes with linear accelerator based stereotactic radiation therapy at the University of Oklahoma.
We retrospectively reviewed all patients treated in our department with ...linear accelerator based stereotactic radiation therapy since we implemented this modality in 2008. Thirty-seven patients have been treated with a mean follow-up of 8.3 months. Seventeen patients had tumors near critical structures; ten had treatment sites not suited for gamma knife therapy. Outcomes are reviewed for efficacy and toxicity.
Acute and long term complications reported are minimal. Stabilization of treatment sites was achieved in 96% of patients on follow-up imaging. Thirteen patients (35%) have died, of which eleven died to systemic disease progression outside of the treatment site. No treatment related deaths occurred.
Stereotactic radiation therapy is a successful treatment modality to achieve local disease control with minimal toxicity. We plan to expand its use and applications in the future.
The value of radiotherapy to the chest (RC) in disseminated small cell lung carcinoma (SCLC) has been questioned. Two protocols for disseminated SCLC from the Southwest Oncology Group (SWOG) have ...been compared. They were developed four years apart. The first one included radiotherapy (RT), 3000 rad in two weeks, to the primary tumor, mediastinum and supraclavicular areas, while the second one deleted any RC. Multidrug chemotherapy (CT) and brain RT were used in both protocols. Nonresponders to CT were removed from the study. Our main findings are as follows: (1) Initial chest relapses (patients with no initial extrathoracic relapse) have increased from 24–55% when RC is not given (P = 0.0001). Overall chest relapse (adding those patients that relapsed simultaneously in the chest plus other sites) in the second protocol was 73%. (2) Amount of response to CT does not influence the chances for relapse. Even complete responders to CT have a high chance for chest relapse. (3) Sites of relapse without RC are mainly in the primary tumor, ipsilateral hilus and mediastinum. (4) With RC, relapses shift to the chest periphery, mostly to the lung outside the radiotherapy field and to the pleura. (5) The two very different CT regimens have produced similar percentages and duration of response. (6) CT schema with periodic reinductions prolongs duration of response and survival over schema with continuous maintenance. Hence, interruption of CT to allow RC does not seem to adversely influence CT efficacy. From our results and the review of the literature we conclude that: (1) patients with disseminated SCLC that respond to CT should be given RC to decrease chest relapses. (2) A dose of 3000 rad in two weeks seems to be enough to produce a low percentage of chest relapse in disseminated SCLC, as survival of these patients is short and many will die prior to developing chest relapse. However, according to the literature, 4000–4800 rad is probably a more effective dose. (3) More studies and guidelines are needed to outline proper boundaries of radiotherapy fields, to decrease chances of peripheral chest relapses. (4) Median survival might not be a good parameter to evaluate the impact of RC in disseminated SCLC. The study of long‐term survivors seems to be more important.
A case of angiosarcoma of the thumb, treated with radiation therapy alone, is described. The patient is alive and well at ten‐years post‐therapy, with no evidence of disease.
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