To review the clinical characteristics and outcomes of adult patients with Ewing family of tumors treated with radiation at the University of Florida.
Clinical features, treatment, and outcomes of 47 ...patients older than 18 years with Ewing family of tumors treated with combined radiation therapy and chemotherapy from 1970 to 2005 were retrospectively reviewed. Analysis was stratified by age older or younger than 30 years. Patients with metastatic disease at the time of diagnosis were excluded from the study.
The 29 men and 18 women had a median age of 24 years. Thirty-three patients were 18-30 years old and 14 patients were older than 30 years. Median follow-up of living patients was 8.2 years. The 5-year overall survival rate for all patients was 43% (p = 0.8523). The 5-year local control rate for all patients was 75% (p = 0.9326). The 5-year rate of freedom from distant metastasis for all patients was 45% (p = 0.5471). There were no significant differences in 5-year overall survival, local control, and freedom from distant metastasis rates; patterns of distant failure; or toxicity profiles between older adult patients and younger adult patients.
We found that the natural history and treatment outcomes of the Ewing family of tumors were consistently similar in adults (young and old) and children. Thus, aggressive combined modality approaches should be considered for adult patients.
8 Other parallels, discussed below, include the relation between the version we are reading and its "original" sources. Since the middle of the nineteenth century, scholars have generally ...acknowledged that none of the gospel accounts is an eyewitness record of the life of Jesus.9 The contrast with Joan of Arcs firsthand account implies that any general questions that might be raised about de Conte's eyewitness narrative would be equally applicable to the second-hand gospel accounts.\n (This comment is a full-fledged expression of his lifelong, reflex Vorhabe, his hermeneutic circle; the question of whether he recognizes it as such is unanswerable.) On the piece of paper is written this chorus from the children's song about the tree: ... when in exile wand 'ring, we Shall fainting yearn for glimpse of thee, Oh, rise upon our sight! (957) De Conte immediately concludes, without evidence, that Joan's intention was to banish vain hopes from the minds of her family and friends (957).
Micropumps that utilize fixed-valves, i.e., valves having no moving parts, are relatively easy to fabricate and inherently reliable due to their simplicity. Since fixed-valves do not close, pumps ...based on them need to operate in a well-designed resonant mode in order to attain flow rates and pressures comparable with other designs. However, no methodology currently exists to efficiently investigate all the design parameters including valve size to achieve optimal resonant response. A methodology that addresses this problem is 1) the determination of optimal parameters including valve size with a low-order linear model capable of nonempirical prediction of resonant behavior, and 2) the independent determination of the best valve shape for maximal valve action over a target Reynolds number range. This study addresses the first of these two steps. The hypothesis of this study is that the resonant behavior of a fixed-valve micropump can be accurately predicted from first principles, i.e., with knowledge only of geometric parameters and physical constants. We utilized a new low-order model that treats the valves as straight rectangular channels, for which the unsteady solution to the Navier-Stokes equations is exact and with which the problem was linearized. Agreement with experiment using pump-like devices with valves replaced by straight channels was found to be excellent, thereby demonstrating the efficacy of the model for describing all aspects of the pump except actual valves. Agreement with experiment using pumps with Tesla-type valves was within 20 percent. With such accuracy and without the need for empirical data, the model makes possible reliable, efficient investigation and optimization of over 30 geometric and material parameters.
To evaluate the efficacy of radiotherapy (RT) alone or combined with surgery for the treatment of the nasal vestibule squamous cell carcinomas.
Seventy-one patients with squamous cell carcinoma of ...the nasal vestibule were treated with definitive RT at the University of Florida, and 8 patients with advanced T4 cancers were treated with combined surgery and RT. Patients were followed from 4 months to 27.7 years (mean 9.0 years, median 7.9 years). Follow-up on living patients ranged from 6 months to 27.7 years (mean 10.0 years, median 8.1 years).
The 5-year outcomes were: local control, 87%; local-regional control, 77%; freedom from distant metastases, 94%; cause-specific survival, 90%; and survival, 76%. The 5-year local control rates for patients treated with definitive RT were: T1-T2, 95%; T4, 71%; and overall, 86% (P = 0.0046). Local control was achieved in 8 of 8 patients treated with surgery and RT.
RT results in a high cure rate for T1-T2 and favorable T4 tumors. Surgery and RT result in an improved likelihood of cure for patients with extensive T4.
The purpose of this study was to report the outcomes after external-beam radiotherapy (RT) for selected T3 and T4 vocal cord squamous cell carcinomas.
One hundred nine patients with previously ...untreated T3 and T4 squamous cell carcinomas of the glottic larynx were treated with curative intent in this Institutional Review Board-approved outcome study using continuous-course RT alone (106 patients) or followed by a planned neck dissection (3 patients) between September 1966 and June 2002. Patients selected for such treatment had relatively low-volume, unilateral disease. Patients were staged according to the recommendations of the American Joint Committee on Cancer (AJCC) as follows: T3N0, 68 patients (62%); T3N1, 14 patients (13%); T3N2B, 5 patients (5%); T4N0, 17 patients (16%); T4N1, 4 patients (4%); and T4N2B, 1 patient.
The 5-year outcomes after treatment were: local control for stage T3 and T4, 78% and 81%; locoregional control for AJCC stage III and IVa, 62% and 78%; distant metastasis-free survival for AJCC stage III and IVa, 97% and 100%; cause-specific survival for AJCC stage III and IVa, 84% and 87%; and overall survival for AJCC stage III and IVa, 52% and 67%, respectively. Severe complications occurred in 13 patients (12%).
The results of this retrospective study compare favorably with those published elsewhere in the literature for T3 and T4 vocal cord carcinomas. Local control and ultimate cure probabilities will hopefully improve further with the addition of concomitant chemotherapy to RT for larger tumors.
To evaluate the prognostic factors, outcomes, and complications in patients aged ≤30 years with resectable nonrhabdomyosarcoma soft-tissue sarcoma treated at the University of Florida with ...radiotherapy (RT) during a 34-year period.
A total of 95 pediatric or young adult patients with nonrhabdomyosarcoma soft-tissue sarcoma were treated with curative intent with surgery and RT at the University of Florida between 1973 and 2007. The most common histologic tumor subtypes were synovial sarcoma in 22 patients, malignant fibrous histiocytoma in 19, and malignant peripheral nerve sheath tumor in 11 patients. The mean age at RT was 22 years (range, 6-30). Of the 95 patients, 73 had high-grade tumors; 45 had undergone preoperative RT and 50 postoperative RT. The prognostic factors for survival, local recurrence, and distant recurrence were analyzed.
The median follow-up was 7.2 years (range, 0.4-30.5). The actuarial 5-year local control rate was 88%. A microscopically negative margin was associated with superior local control. Although 83% of local recurrence cases initially developed in the absence of metastases, all patients with local failure ultimately died of their disease. The actuarial estimate of 5-year overall survival and disease-free survival was 65% and 63%, respectively. Of all the deaths, 92% were disease related. An early American Joint Committee on Cancer stage, tumor<8 cm, and the absence of neurovascular invasion were associated with superior disease-free survival. The National Cancer Institute Common Toxicity Criteria, version 3, Grade 3-4 treatment complication rate was 9%. No secondary malignancies were observed.
In the present large single-institution study, we found positive margins and locally advanced features to be poor prognostic factors for both local progression and survival. The results from the present study have helped to characterize the therapeutic ratio of RT in pediatric and young adult sarcoma patients and have provided a basis for identifying high-risk patients for whom treatment intensification might be justified.
To assess the potential benefit of proton therapy (PT) over photon therapy, we compared 3-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and PT plans in patients ...undergoing neoadjuvant chemoradiation for resectable rectal cancer at our institution.
Eight consecutive patients with resectable (T2-T3) rectal cancers underwent 3DCRT, IMRT, and 3-dimensional conformal PT treatment planning. Initial target volumes (PTV1) were contoured using the Radiation Therapy Oncology Group anorectal atlas guidelines. Boost target volumes (PTV2) consisted of the gross rectal tumor plus a uniform 2-cm expansion. Plans delivered 45 Gray (Gy) or Cobalt Gray Equivalent (CGE) to the PTV1 and a 5.4-Gy (CGE) boost to the PTV2. Ninety-five percent of the PTVs received 100% of the target dose and 100% of the PTVs received 95% of the target dose. Standard normal-tissue constraints were utilized. Wilcoxon paired t-tests were performed to compare various dosimetric points between the 3 plans for each patient.
All plans met all normal-tissue constraints and were isoeffective in terms of PTV coverage. The proton plans offered significantly reduced median normal-tissue exposure over the 3DCRT and IMRT plans with respect to pelvic bone marrow at the V5Gy, V10Gy, V15Gy, and V20Gy levels and the small bowel space at the V10Gy and V20Gy levels. The proton plans also offered significantly reduced median normal-tissue exposure over the 3DCRT plans with respect to the small bowel at the V30Gy and V40Gy levels and the urinary bladder at the V40Gy level.
By reducing bone marrow exposure, PT may reduce the acute hematologic toxicity of neoadjuvant chemoradiation and increase the likelihood of uninterrupted chemotherapy delivery. Bone marrow sparing may also facilitate the delivery of salvage chemotherapy for patients who subsequently develop hematogenous metastasis. Reduced small bowel exposure using PT may also reduce toxicity and possibly facilitate the use of more-aggressive chemotherapy with radiotherapy.
Purpose
: To review a large single-institution experience in the management of aggressive fibromatosis to determine the effectiveness of external beam radiotherapy (EBRT) and identify the ...presentation and treatment variables predictive of locoregional control.
Methods and Materials
: Between 1975 and 2000, 72 patients were treated with EBRT for a pathologically confirmed diagnosis of aggressive fibromatosis. Thirty patients were treated at the primary presentation and 42 at the time of a locoregional recurrence. Minimal 2-year follow-up data were available for 65 patients (median 6 years). Megavoltage irradiation with
60Co to 20 MV photons or electron therapy was used for all patients. Most patients were treated after attempted complete surgical resection; 16 patients underwent pretreatment biopsy alone. The prescribed treatment was standard (1.8 Gy) daily fractions in 42 cases and 1.2 Gy fractions b.i.d. in 23 cases. The median prescribed dose was 54 Gy. The prognostic variables and treatment results were evaluated by Kaplan-Meier actuarial analysis.
Results
: Locoregional control was achieved in 52 of 65 patients. The 5-year actuarial locoregional control was 83%. Locoregional failure occurred in 13 patients (11 in patients with recurrent tumors). Only two failures occurred within the irradiation fields; nine failures occurred at the field margins. Eleven patients were salvaged by surgery: wide excision in nine and amputation in two. The only prognostic factor significant for locoregional control was primary vs. recurrent presentation (
p = 0.0193). The 5-year locoregional control rates for irradiation at initial presentation and at recurrence were 96% and 75%, respectively. The variables without significance for locoregional control included primary tumor location, surgical procedures performed, resection margins, and gross vs. microscopic residual tumor at irradiation. Lymphedema was the most common late effect, occurring in 7 patients, 5 with prior treatment. Bone fracture occurred in 3 patients; all 3 had fibromatosis involving the bone at presentation but without recurrence at the time of fracture.
Conclusion
: EBRT is effective treatment for aggressive fibromatosis. The probability of locoregional control decreases with multiple prior recurrences.
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