A retrospective study to evaluate the outcome of salvage radiotherapy (RT) for clinically apparent, palpable prostate cancer recurrence after radical prostatectomy (RP).
Forty-two patients underwent ...RT for clinically apparent recurrent prostate cancer after RP between 1993 and 1999. The end points and treatment variables of biochemical disease-free survival were evaluated statistically.
The median follow-up was 4.3 years. All 42 patients experienced resolution of clinically detectable recurrence within 1 year after RT. The 5-year biochemical disease-free survival, local control, freedom from distant metastases, and overall survival rate was 27%, 94%, 82%, and 78%, respectively. The initial pathologic stage (T3 or T4;
p = 0.04) and interval (<2 years from RP to RT;
p = 0.01) were independent predictors of biochemical failure, and RT simulation without contrast (
p = 0.05) was nearly significant on multivariate analysis. Three patients (7%) experienced chronic Grade 3 or 4 RT-related toxicity.
Salvage prostate bed RT for clinically apparent locally recurrent prostate cancer after RP provides effective local tumor control with modest durable biochemical control. Patients irradiated with a better simulation technique were found to have a more favorable outcome. A consensus on a definition of biochemical disease-free survival after salvage RT is critical for meaningful comparison of the available data and to future progress in treating this disease process.
Purpose
: Patients with newly diagnosed brain metastases generally benefit from whole brain radiation therapy (WBRT). However, the role of reirradiation for patients who develop progressive bain ...metastases has been controversial. This retrospective study examines our experience with reirradiation of patients for progressive brain metastases after an initial course of WBRT.
Methods and Materials
: From 1975–1993, 2658 patients received WBRT for brain metastases at our institution. Eighty-six patients were subsequently reirradiated for progressive brain metastases. The median age of these patients was 58 (range: 31–81). The most common primary sites were breast and lung. Fifty patients had metastatic disease at other sites. Most patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 2 (40 patients) or 3 (38 patients). The median dose of the first course of irradiation was 30 Gy (range: 1.5–50.6 Gy). The median dose of the second course of irradiation was 20 Gy (range: 8.0–30.6 Gy).
Results
: Twenty-three patients (27%) had resolution of neurologic symptoms, 37 patients (43%) had partial improvement of neurologic symptoms, and 25 patients (29%) had either no change or worsened after reirradiation. The median survival following reirradiation was 4 months (range: 0.25–72 months). The majority of patients had no significant toxicity secondary to reirradiation. Five patients had radiographic abnormalities of their brain consistent with radiation-related changes. One patient had symptoms of dementia that was though to be caused by radiotherapy. Various potential prognostic factors were evaluated for possible associations with survival, including age, sex, primary site, ECOG performance status, RTOG neurologic functional class, absence of extracranial metastases, number of brain metastases, and dose of reirradiation. Absence of extracranial metastasis, solitary brain metastasis, and a retreatment dose > 20 Gy were associated with improved survival in univariate analysis (
p = 0.025, 0.033,
and 0.061,
respectively). The absence of extracranial disease was the only significant factor in multivariate analysis (
p = 0.05).
Conclusion
: The majority of patients in our series had favorable symptomatic responses. Clinically significant complications were minimal. Reirradiation should be offered to patients who develop progressive brain metastases.
Background To compare definitive radiochemotherapy with weekly administration of 30-40 mg/m.sup.2 of cisplatin to 100 mg/m.sup.2 of cisplatin on days 1, 22 and 43 for outcomes and toxicity in ...patients with squamous cell carcinoma of the head-and-neck. Methods Seventy-five patients receiving radiochemotherapy with weekly cisplatin (30-40 mg/m.sup.2) were compared to 58 patients receiving radiochemotherapy with 100 mg/m.sup.2 cisplatin on days 1, 22 and 43. Radiochemotherapy regimen plus seven characteristics (age, gender, performance score, tumor site, T-/N-category, histologic grading) were evaluated for locoregional control (LRC), metastases-free survival (MFS) and overall survival (OS). Radiochemotherapy groups were compared for toxicity. Results On multivariate analysis, improved LRC was associated with cisplatin 100 mg/m.sup.2 (hazard ratio HR 1.57; p = 0.008) and female gender (HR 4.37; p = 0.003). Radiochemotherapy regimen was not significantly associated with MFS on univariate analysis (p = 0.66). On multivariate analysis, better MFS was associated with ECOG performance score 0-1 (HR 5.63; p 0.001) and histological grade 1-2 (HR 1.81; p = 0.002). On multivariate analysis, improved OS was associated with cisplatin 100 mg/m.sup.2 (HR 1.33; p = 0.023), ECOG performance score 0-1 (HR 2.15; p = 0.029) and female gender (HR 1.98; p = 0.026). Cisplatin 100 mg/m.sup.2 was associated with higher rates of grade greater than or equai to3 hematotoxicity (p = 0.004), grade greater than or equai to2 renal failure (p = 0.004) and pneumonia/sepsis (p = 0.033). Conclusions Radiochemotherapy with 100 mg/m.sup.2 of cisplatin every 3 weeks resulted in better LRC and OS than weekly doses of 30-40 mg/m.sup.2. Given the limitations of a retrospective study, 100 mg/m.sup.2 of cisplatin appears preferable. Since this regimen was associated with considerable acute toxicity, patients require close monitoring. Keywords: Head-and-neck cancer, Definitive treatment, Radiochemotherapy, Cisplatin, Outcomes, Adverse events
Abstract Objectives Concurrent combined modality therapy is optimal treatment for patients with stage III non-small cell lung cancer (NSCLC) and is given with curative intent. However, elderly ...patients (≥ 75) are often undertreated, despite good performance status (PS). This study evaluated the treatment, outcomes and survival in elderly patients with stage III NSCLC versus patients < 75 years old. Materials and Methods A retrospective review of data from the Lung Cancer Registry at Mayo Clinic Arizona (MCA) was conducted. Patients with newly diagnosed stage III NSCLC from 1998 to 2006 were analyzed for type of therapy and outcomes. Results Three hundred and eighty-nine patients with newly diagnosed stage III NSCLC were identified from 1998 to 2006. Two hundred and forty-three (62%) patients were < 75 years old, and 146 patients (38%) were ≥ 75 years old. Among 374 eligible patients, 45% of patients < 75 years old received combined chemoradiation therapy vs. only 21% of patients ≥ 75 years old ( p < 0.0001). The median survival in the < 75 age group was 14.5 months vs. 10.1 months in the ≥ 75 age group ( p = 0.0014). In the < 75 age group, median survival was 15.0 months in patients who received combined modality treatment vs. 14.1 months in the other treatments group ( p = 0.02). In the elderly group, median survival was 19.9 months in the combined modality group vs. 7.8 months in the other treatments group ( p = 0.0048). Conclusion Our results confirm that older patients are less likely to receive optimal therapy, regardless of functional status. Prospective studies are desperately needed to help improve management of the burgeoning geriatric oncology population.
Urinary obstructive symptoms are the most common side effects of transperineal interstitial permanent prostate brachytherapy (TIPPB). Self-intermittent catheterization (SIC) can be used to relieve ...urinary retention. This study evaluated the factors associated with the probability of a patient performing SIC after TIPPB.
We prospectively evaluated 204 patients who underwent TIPPB at Mayo Clinic Scottsdale (MCS). All patients were taught to perform SIC before implant and were instructed to do so if they could not urinate at any time after the procedure.
Of the 204 patients, 22 patients (11%) received (103)Pd seeds and 182 patients (89%) received (125)I. Thirty-seven (18%) patients received external-beam radiotherapy (XRT) in addition to the TIPPB. SIC was performed by 69 (34%) of the 204 patients. Factors that were significantly associated with a lower frequency of SIC were prostate volumes < or = 34.2 cm(3) (p = 0.005), < or = 137 seeds implanted (p = 0.04), prostate-specific antigen (PSA) levels < or = 6.35 (p = 0.03), American Urological Association (AUA) score < or = 10 (p = 0.01), the use of (125)I (p = 0.03), and the addition of XRT to the implant (p = 0.02).
Significant associations were observed between the frequency of SIC and the number of seeds implanted, AUA scores, prostate volume, PSA levels, addition of XRT, and isotope used. Whereas the first four of these factors may be surrogates for prostate volume and obstructive symptoms in general, the last two factors are related to treatment decisions. These findings may aid in better patient selection and therapeutic decisions. Additionally, this information may provide a clearer understanding of the urinary side effects of TIBBP.
Background. Pineal parenchymal tumors are rare; therefore, only limited clinical data regarding their behavior is available. This study was performed to provide further information regarding the ...pathologic features, clinical behavior, and response to therapy of these tumors.
Methods. This study includes data concerning 30 patients (15 male and 15 female patients) with pineal parenchymal tumors (PPT) diagnosed between 1939 and 1991. Based on gross and microscopic features, tumors were divided into four groups: pineocytomas (9); PPT with intermediate differentiation (4); mixed PPT exhibiting elements of both pineocytoma and pineoblastoma (2); and pineoblastomas (15). At the time of diagnosis, four patients had evidence of spinal seeding (two with pineoblastoma, two with PPT with intermediate differentiation). Twenty‐two patients received radiation therapy (RT): 6 were treated to local fields, 7 to the whole brain, and 9 to the craniospinal axis.
Results. For patients who received RT and had a minimum follow‐up of 6 months, local failure occurred in one of four patients with pineocytomas, zero of four patients with PPT with intermediate differentiation, one of two with mixed PPT, and four of nine (44%) with pineoblastomas. In patients receiving ⩾ 50 Gy to the primary tumor, 0 of 12 had local failure compared with 6 of 7 (86%) patients receiving lesser doses. Leptomeningeal failure occurred in zero of four patients with pineocytomas, zero of four patients with PPT with intermediate differentiation, one of two with mixed PPT, and four of nine with pineoblastomas. All leptomeningeal failures occurred in patients with persistent primary tumor. Of the patients with seeding tumors (PPT other than pineocytomas) one of seven (14%) developed leptomeningeal failure when treated with craniospinal irradiation, compared with four of eight (50%) treated to lesser volumes. The projected 1‐year, 3‐year, and 5‐year survival rates of patients with pineocytomas were 100%, 100%, and 67%, and were 88%, 78%, and 58% for those with the other forms of PPT, respectively.
Conclusions. RT recommendations are described in detail and include the use of doses of ⩾ 50 Gy to areas of gross disease and the administration of craniospinal irradiation in patients with tumors prone to seeding. Surgical, chemotherapeutic, and pathologic considerations are discussed.
Whole brain radiotherapy (WBRT) is the most common treatment for brain metastases. Survival of patients with cancer of unknown primary (CUP) presenting with brain metastases is extremely poor. A ...radiation program with a short overall treatment time (short-course RT) would be preferable to longer programs if it provides similar outcomes. This study compares short-course RT with 20 Gy in 5 fractions (5 x 4 Gy) given over 5 days to longer programs in CUP patients.
Data regarding 101 CUP patients who received either short course WBRT (n=34) with 5 x 4 Gy or long-course WBRT (n=67) with 10 x 3 Gy given over 2 weeks or 20 x 2 Gy given over 4 weeks for brain metastases were analyzed retrospectively. Six additional potential prognostic factors were investigated: age, gender, Karnofsky performance score (KPS), number of brain metastases, extracranial metastases, RPA-(Recursive Partitioning Analysis-)class.
On univariate analysis, the radiation program was not associated with survival (p=0.88) nor intracerebral control (p=0.36). Improved survival was associated with KPS >or= 70 (p<0.001), absence of extracranial metastases (p<0.001), and RPA-class 1 (p<0.001). On multivariate analyses, KPS (risk ratio RR: 4.55; p<0.001), extracranial metastases (RR: 1.70; p=0.018), and RPA-class (RR: 2.86; p<0.001) maintained significance. On univariate analysis, KPS (p<0.001) and RPA-class (p<0.001) were significantly associated with intracerebral control. On multivariate analyses, KPS (RR: 2.72; p<0.001) and RPA-class (RR: 2.09; p<0.001) remained significant.
Short-course WBRT with 5 x 4 Gy provided similar intracerebral control and survival as longer programs for the treatment of brain metastases in CUP patients. 5 x 4 Gy appears preferable because it is more convenient for patients.
Lung cancer is the leading cause of cancer-related mortality not only in the United States but also around the world. In North America, lung cancer has become more predominant among former than ...current smokers. Yet in some countries, such as China, which has experienced a dramatic increase in the cigarette smoking rate during the past 2 decades, a peak in lung cancer incidence is still expected. Approximately two-thirds of adult Chinese men are smokers, representing one-third of all smokers worldwide. Non-small cell lung cancer accounts for 85% of all lung cancer cases in the United States. After the initial diagnosis, accurate staging of non-small cell lung cancer using computed tomography or positron emission tomography is crucial for determining appropriate therapy. When feasible, surgical resection remains the single most consistent and successful option for cure. However, close to 70% of patients with lung cancer present with locally advanced or metastatic disease at the time of diagnosis. Chemotherapy is beneficial for patients with metastatic disease, and the administration of concurrent chemotherapy and radiation is indicated for stage III lung cancer. The introduction of angiogenesis, epidermal growth factor receptor inhibitors, and other new anticancer agents is changing the present and future of this disease and will certainly increase the number of lung cancer survivors. We identified studies for this review by searching the MEDLINE and PubMed databases for English-language articles published from January 1, 1980, through January 31, 2008. Key terms used for this search included
non-small cell lung cancer, adenocarcinoma, squamous cell carcinoma, bronchioalveolar cell carcinoma, large cell carcinoma, lung cancer epidemiology, genetics, survivorship, surgery, radiation therapy, chemotherapy, targeted therapy, bevacizumab, erlotinib, and epidermal growth factor receptor.
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