Objective Measurement of Cosmetic Outcomes of Breast Conserving Therapy Using BCCT.core / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate objective cosmetic outcomes and factors related to breast-conserving therapy (BCT) using the BCCT.core software. MATERIALS AND METHODS: Fifty-one patients who received BCT with informed consent were evaluated using the BCCT.core software. Patients were divided into two groups based on the BCCT score: excellent or good (n=42) vs. fair or poor (n=9). Analysis of clinical factors was performed to determine factors affecting cosmetic outcomes. RESULTS: The objective cosmetic outcome of BCT measured using the BCCT.core software was excellent in 10% of patients, good in 72%, and fair in 18%. None of the patients were classified as poor outcome. Tumor characteristics, systemic adjuvant therapy (chemotherapy and hormonal therapy), and radiation dose or energy of electron boost did not show correlation with the score measured by the BCCT.core program (p > 0.05). In univariate analysis, maximum dose within the breast (Dmax), width of tangential field, and excised tumor volume were smaller in patients with excellent or good by the BCCT.core compared to those with fair or poor (Dmax, 110.2±1.5% vs. 111.6±1.7%, p=0.019; width of tangential field, 8.0±1.1 cm vs. 8.6±0.7 cm, p=0.034; excised tumor volume, 64.0±35.8 cm3 vs. 95.3±54.4 cm3, p=0.067). In multivariate analysis, only Dmax was a significant factor for breast cosmetic outcome with a risk ratio of 1.697 (95% confidence interval, 1.006 to 2.863; p=0.047). CONCLUSION: Objective measurement of cosmetic outcome of BCT using the BCCT.core software was feasible. The cosmetic outcome of BCT may be affected by the maximum dose within the breast.

High-Dose Involved Field Radiotherapy and Concurrent Chemotherapy for Limited-Disease Small Cell Lung Cancer

PURPOSE: We wanted to evaluate the effect of high dose involved field radiotherapy and concurrent chemotherapy for treating patients with limited disease, small cell lung cancer. MATERIALS AND METHODS: We reviewed the medical records of 37 patients who had a limited stage of small cell lung cancer. All the patients were treated with induction chemotherapy followed by definitive radiotherapy and concurrent chemotherapy. The radiation dose was 60 Gy for 31 patients and 50~58 Gy for 6 patients with once-daily 2 Gy fractions. Elective nodal irradiation was not performed. The chemotherapy regimen was either combinations of etoposide and cisplatin or irinotecan and cisplatin. Prophylactic cranial irradiation of 25 Gy at 2.5 Gy per fraction was administered to the patients who had a complete or near complete response. The median follow-up period was 17 months (range, 5~57). RESULTS: The 2-year overall survival and locoregional control rates were both 55%. A complete response was achieved in 17 patients (46%), a partial response was achieved in 19 patients (51%) and 1 patient (3%) had progressive disease. Seven patients experienced tumor recurrence in the radiation field and four of those recurrences were isolated local recurrences. There was only one isolated regional recurrence outside the radiation field. Grade 3 treatment-related esophageal toxicity occurred in 2 patients. Two patients died of treatment-related pulmonary complications. CONCLUSION: Involved field radiotherapy of 60 Gy can achieve favorable survival and a low rate of isolated nodal failure outside the radiation field. However, a considerable number of patients still experienced in-field failure. Further studies to establish the optimal radiation doses and fractionation are needed in the future.

Postoperative External Beam Radiotherapy for Retroperitoneal Soft Tissue Sarcoma / 대한방사선종양학회지

PURPOSE: To evaluate the clinical outcomes and prognostic factors in retroperitoneal soft tissue sarcomas treated by postoperative radiotherapy. MATERIALS AND METHODS: The records of 23 patients with retroperitoneal soft tissue sarcomas, who underwent postoperative radiotherapy between 1985 and 2003, were analyzed. The median follow-up period was 77 months (range, 8~240 months). A total of 21 patients presented with primary disease, and two patients presented with recurrent disease. Liposarcomas and leiomyosarcomas represented 78% of the diagnosed tumor cases. Moreover, 17 cases were of high grade (grade 2 or 3). The median tumor size was 13 cm (range, 3~50 cm). Complete excision was achieved in 65% of patients. The median radiation dose was 50.4 Gy (range, 45.0 to 59.4 Gy), with conventional fractionation. RESULTS: The 5-year overall, local recurrence-free, and distant metastasis-free survival rates were 68%, 58%, and 71%, respectively. Eleven patients experienced local recurrence, while 9 patients experienced distant metastasis. The most common site for distant metastasis was the liver. A univariate analysis revealed that adjacent organ invasion and age (> 60 years) as the significant risk factors contributing to the prediction of poor overall survival. Moreover, multivariate analyses indicated that adjacent organ invasion remained significantly associated with a higher risk of death. In addition, patient age (> 60 years) was the other identified risk factor for local recurrence by univariate and multivariate analyses. Except for one case of grade 3 diarrhea, no patient suffered grade 3 or higher complications. CONCLUSION: Our results were comparable to previous reports in that adjacent organ invasion and patient age (> 60 years) were significant predictors of poor survival and tumor recurrence, respectively.

Results of Breast Conserving Surgery and Subsequent Postoperative Radiotherapy for Cases of Breast Cancer / 대한방사선종양학회지

PURPOSE: We analyzed the treatment outcomes and prognostic factors of breast conserving surgery, followed by postoperative radiotherapy. MATERIALS AND METHODS: A total of 424 breast cancer patients treated with breast conserving surgery and postoperative radiotherapy between February 1992 and January 2001 were retrospectively analyzed. A quadrantectomy and axillary lymph node dissection was performed in 396 patients. A total of 302 patients had T1 disease, and 122 patients had T2 disease. Lymph node involvement was confirmed in 107 patients. Whole breast irradiation was administered at up to 50.4 Gy in 28 fractions, followed by a 10 Gy boost in 5 fractions to the tumor bed. In addition, 57 patients underwent regional lymph node irradiation. Moreover, chemotherapy was administered in 231 patients. A regimen consisting of cyclophosphamide, methotrexate, and 5-fluorouracil was most frequently used with 170 patients. The median follow-up time was 64 months. RESULTS: The 5-year local control rate was 95.6%. During the follow-up period, local tumor recurrence was observed in 15 patients. The 5-year overall and disease-free survival rates were 93.1% and 88.7%, respectively. The 5-year overall survival rates, by stage, were 94.8% for stage I, 95.0% for stage IIA, 91.1% for stage IIB, 75.9% for stage IIIA, and 57.1% for stage IIIC. As for disease-free survival, the corresponding figures, by stage (in the same order), were 93.1%, 89.4%, 82.8%, 62.0%, and 28.6%, respectively. The advanced N stage (p=0.0483) was found to be a significant prognostic factor in predicting poor overall survival, while the N stage (p=0.0284) and age at diagnosis (p=0.0001) were associated with disease-free survival. CONCLUSION: This study has shown that breast conserving surgery and postoperative radiotherapy for early breast cancer results was excellent for local control and survival.