Clinical outcomes after sentinel lymph node biopsy in clinically node-negative breast cancer patients

PURPOSE: To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. MATERIALS AND METHODS: From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. RESULTS: The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. CONCLUSION: In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

Definitive Radiation Therapy for Early Glottic Cancer: Experience of Two Fractionation Schedules

OBJECTIVES: The authors would report the results of definitive radiation therapy (RT) for early glottic cancer by two different radiation dose schedules. METHODS: From February of 1995 till June of 2008, 157 patients with T1-2N0 glottic cancer were treated with curative RT at Samsung Medical Center. All patients had squamous cell carcinoma, and there were 89 patients (56.7%) with T1a, 36 (22.9%) with T1b, and 32 (20.4%) with T2. Two different radiation dose schedules were used: 70 Gy in 35 fractions to 64 patients (40.8%, group A); and 67.5 Gy in 30 fractions to 93 patients (59.2%, group B). The median treatment durations were 50 days (range, 44 to 59 days) and 44 days (range, 40 to 67 days) in the groups A and B, respectively. RESULTS: The median follow-up durations were 85 and 45 months for the groups A and B. No severe late complication of RTOG grade 3 or higher was observed, and there was no difference in acute or chronic complication between the groups. Twenty-four patients experienced treatment failure: local recurrence only in 19 patients; regional recurrence only in one; combined local and regional recurrence in four; and systemic metastasis in none. The overall 5-year disease-free survival and disease-specific survival rates were 84.7% and 94.8%. The disease-free survival rate in the group B was better (78.3% vs. 90.8%, P=0.031). This difference was significant only in T1 stage (83.4% vs. 94.6%, P=0.025), but not in T2 (62.7% vs. 60.6%, P=0.965). Univariate analysis showed that the tumor extent, cord mobility, T-stage, and the dose schedule had significant influence on the disease-free survival, and multivariate analysis showed that only the tumor extent and the dose schedule were associated with the disease-free survival. CONCLUSION: Superior disease-free survival could be achieved by 2.25 Gy per fraction without increased toxicity over shorter RT duration, when compared with 2.0 Gy per fraction.

The Significance of VEGF Expression in Stage II Carcinoma of Uterine Cervix Treated with Definitive Radiotherapy / 대한방사선종양학회지

PURPOSE: We wanted to determine the clinical characteristics and prognosis according to the VEGF expression in stage II cervical carcinoma patients treated with definitive radiotherapy. MATERIALS AND METHODS: We enrolled 31 patients who were diagnosed with cervical cancer from 1995 to 2003 at Samsung Medical Center and their paraffin block tissue samples were available for study. The median age of the patients was 65 years. The mean tumor size was 4.1 cm (range: 1.2~8.2 cm). Seven patients (22.6%) were suspected of having pelvic lymph node metastasis. An external beam irradiation dose of 45-56.4 Gy was administered to the whole pelvis with a 15 MV linear accelerator, and an additional 24 Gy was given to point A by HDR intracavitary brachytherapy. VEGF staining was defined as positive when more than 10% of the tumor cells were stained. The median follow-up duration was 58 months. RESULTS: A positive VEGF expression was observed in 21 patients (67.7%). There was no significant correlation between the VEGF expression and pelvic lymph node metastasis, tumor size and the response of radiotherapy. During follow-up, 7 patients had recurrence. The complete response rate was not significant between the VEGF (-) and VEGF (+) tumors. However, the VEGF (+) tumors showed a significantly higher recurrence rate in comparison with the VEGF (-) tumors (p=0.040). The three year disease-free survival rates were 100% and 66.7%, respectively, for patients with VEGF (-) or VEGF (+) tumor (p=0.047). CONCLUSION: The VEGF expression was a significant factor for recurrence and disease-free survival. However, the significance of the VEGF expression is still controversial because of the various definitions of VEGF expression and the mismatches of the clinical data in the previous studies.

Outcome of Glioblastoma Patients Treated with Surgery and Radiation Therapy / 대한방사선종양학회지

PURPOSE: To analyze the survival outcomes and prognostic factors in glioblastoma patients treated with surgery and radiation therapy. MATERIALS AND MEHTODS: One hundred twenty glioblastoma patients treated with postoperative radiation therapy from 1994 to 2003 at Samsung Medical Center were retrospectively reviewed. Surgical extents were gross total resection in 22 patients (18%), subtotal resection in 69 (58%), and biopsy only in 29 (24%). The median radiation dose was 60 Gy, ranging from 45 Gy to 72 Gy. The median follow-up period was 12 months ranging from 2 to 62 months. RESULTS: The overall 1- and 2-year survival rates were 52% and 14%, respectively, and the median survival duration was 13 months. Favorable prognostic factors by Uunivariate analyses of prognostic factors on 1-year survival rate wererevealed that age under 50 (p<0.01), ECOG performance status 0 or 1 (p=0.03), single lesion (p=0.02), and gross total resection (p=0.04), were the favorable prognostic factors. and by Mmultivariate analyses wererevealed that female (p<0.01), age under 50 (p<0.01), ECOG performance status 0 or 1 (p=0.05) and gross total resection (p=0.05) were the favorable prognostic factors. CONCLUSIONS: The results of our study were comparable with those previously reported. To improve treatment outcome, various modifications, including radiation dose escalation through newer radiation therapy techniques and use of effective chemotherapy regimen, should be further investigated. investigated. Also Furthermore, the application of individualized treatment strategy based on the patient's' prognostic factors might be needed.

Small Bowel Sparing Effect of Small Bowel Displacement System in 3D-CRT and IMRT for Cervix Cancer / 대한방사선종양학회지

PURPOSE: In radiotherapy for cervix cancer, both 3-dimensioal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) could reduce the dose to the small bowel (SB), while the small bowel displacement system (SBDS) could reduce the SB volume in the pelvic cavity. To evaluate the effect of the SBDS on the dose to the SB in 3D-CRT and IMRT plans, 3D-CRT and IMRT plans, with or without SBDS, were compared. MATERIALS AND MEHTODS: Ten consecutive uterine cervix cancer patients, receiving curative radiotherapy, were accrued. Ten pairs of computerized tomography (CT) scans were obtained in the prone position, with or without SBDS, which consisted of a Styrofoam compression device and an individualized custom-made abdominal immobilization device. Both 3D-CRT, using the 4-field box technique, and IMRT plans, with 7 portals of 15 MV X-ray, were generated for each CT image, and prescribed 50 Gy (25 fractions) to the isocenter. For the SB, the volume change due to the SBDS and the DVHs of the four different plans were analyzed using paired t-tests. RESULTS: The SBDS significantly reduced the mean SB volume from 522 to 262 cm3 (49.8% reduction). The SB volumes that received a dose of 10~50 Gy were significantly reduced in 3D-CRT (65~80% reduction) and IMRT plans (54~67% reduction) using the SBDS. When the SB volumes that received 20~50 Gy were compared between the 3D-CRT and IMRT plans, those of the IMRT without the SBDS were significantly less, by 6~7%, than those for the 3D-CRT without the SBDS, but the volume difference was less than 1% when using the SBDS. CONCLUSION: The SBDS reduced the radiation dose to the SB in both the 3D-CRT and IMRT plans, so could reduce the radiation injury of the SB.

Treatment Outcome and Analysis of the Prognostic Factors of Ductal Carcinoma in situ Treated with Breast Conserving Surgery and Radiotherapy / 대한방사선종양학회지

PURPOSE: To evaluate the survival rate, local failure rate and patterns of failure, and analyze the prognostic factors affecting local relapse of ductal carcinoma in situ treated with breast conserving surgery and radiotherapy Materials and Methods: From June 1995 to December 2001, 96 patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were retrospectively analyzed. The operations were either local or wide excision in all patients, with an axillary lymph node dissection performed in some patients. Radiation dose to the whole breast was 50.4 Gy, over 5 weeks, with 1.8 Gy daily fractions, with additional doses (10~14 Gy) administered to the primary tumor bed in some patients with close (< or =2 mm) or positive resection margin. The median follow-up period was 43 months (range 12~102 months). RESULTS: The 5-year local relapse free survival and overall survival rates were 91 and 100% respectively. Local relapse occurred in 6 patients (6.3%). Of the 6 recurrences, one was invasive ductal cell carcinoma. With the exception of one, all patients recurred 2 years after surgery. There was no regional recurrence or distant metastasis. Five patients with local recurrence were salvaged with total mastectomy, and are alive with no evidence of disease. One patient with recurrent invasive ductal cell carcinoma will receive salvage treatment. On analysis of the prognostic factors affecting local relapse, none of the factors among the age, status of resection margin, comedo type and nuclear grade affected local relapse. Operation extent also did not affect local control (p=0.30). In the patients with close resection margin, boost irradiation to the primary tumor bed did not affect local control (p=1.0). CONCLUSIONS: The survival rate and local control of the patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were excellent. Close resection margin and boost irradiation to the primary tumor bed did not affect local relapse, but further follow-up with much more patients is needed.

Preoperative Concurrent Radio-chemotherapy for Rectal Cancer: Report of Early Results / 대한방사선종양학회지

PURPOSE: To report the early results of preopeartive concurrent radio-chemotherapy (CRCT) for treating rectal cancer. MATERIALS AND METHODS: From June 1999 to April 2002, 40 rectal cancer patients who either had lesions with a questionable resectability or were candidates for sphincter-sacrificing surgery received preoperative CRCT. Thirty-seven patients completed the planned CRCT course. 45 Gy by 1.8 Gy daily fraction over 5 weeks was delivered to the whole pelvis in the prone position. The chemotherapy regimens were oral UFT plus oral leucovorin (LV) in 12 patients, intravenous bolus 5-FU plus LV in 10 patients, and intravenous 5-FU alone in 15 patients (bolus infusion in 10, continuous infusion in 5). Surgery was planned in 4~6 weeks of the completion of the preoperative CRCT course, and surgery was attempted in 35 patients. RESULTS: The compliance to the current preoperative CRCT protocol was excellent, where 92.5% (37/40) completed the planned treatment. Among 35 patients, in whom surgery was attempted after excluding two patients with new metastatic lesions in the liver and the lung, sphincter-preservation was achieved in 22 patients (62.9%), while resection was abandoned during laparotomy in two patients (5.7%). Gross complete resection was performed in 30 patients, gross incomplete resection was performed in one patient, and no detailed information on the extent of surgery was available in two patients. Based on the surgical and pathological findings, the down-staging rate was 45.5% (15/33), and the complete resection rate with the negative resection margin 78.8% (26/33). During the CRCT course, grade 3~4 neutropenia developed in four patients (10.8%). Local recurrence after surgical resection developed in 12.1% (4/33), and distant metastases after the preoperative CRCT start developed in 21.6% (8/37). The overall 3-years survival rate was 87%. CONCLUSION: Preoperative CRCT in locally advanced rectal cancer is well tolerated and can lead to high resection rate, down-staging rate, sphincter preservation rate, however, longer term follow-up will be necessary to confirm these results.

Results of Curative Treatment for Cancer of the Tonsil / 대한방사선종양학회지

PURPOSE: To report the results of curative treatment for patients with tonsil cancer by retrospective analysis. MATERIALS AND METHODS: From Jan. 1995 till Dec. 2000, 27 patients with squamous cell carcinoma of the tonsil received curative treatment at Samsung Medical Center. Therapeutic decision was made through multidisciplinary conference, and curative radiation therapy was favored when, (1) the patient's condition was not fit for general anesthesia and surgery, (2) the patient refused surgery, (3) complete resection was presumed impossible, or (4) too severe disability was expected after surgery. Surgery was the main local modality in 17 patients (S+/-RT group), and radiation therapy in 10 (RT+/-CT group). The median follow-up period was 41 months. RESULTS: AJCC stages were I/II in four, III in two, and Iv in 21 patients. The 5-year disease-free survival rate was 73.3% in all patients, 70.6% in the S+/-RT group, and 77.8% in the RT+/-CT group. Treatment failure occurred in seven patients, all with stage III/IV, and all the failures occurred within 24 months of the start of treatment. Five patients among the S CT group developed treatment failures; 2 local, 2 regional, and 1 distant (crude rate=29.4%). Two patients among the RT+/-CT group developed failures; 1 synchronous local and regional, and 1 distant (crude rate=20.0%). The 5-year overall survival rate was 77.0% in all patients, 80.9% in the S+/-RT group, and 70.0% in the RT+/-CT group. CONCLUSION: We could achieve favorable results that were comparable to previously reported data with respect to both the rates of local control and of survival by applying S+/-RT and RT+/-CT. RT+/-CT is judged to be an alternative option that can avoid the functional disability after surgical resection.

High Dose Radiation Therapy Concurrent with Chemotherapy in Locally Advanced Nasopharynx Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Here, our results from a prospective treatment protocol of concurrent radiochemotherapy (CRCT), which was conducted for locally advanced nasopharynx cancers, between April 1994 and May 2001, are reported. MATERIALS AND METHODS: A total of 52 consecutive eligible patients were accumulated for this protocol. The median radiation doses to the primary site, involved nodes and uninvolved neck were 72, 61.2 and 45 Gy, using a serial shrinking field technique. The boost techniques were 3-dimensional conformal radiation therapy in 45, intracavitary brachytherapy in 3 and 2-dimensional radiation therapy, with multiple small fields, in 2 patients. Two chemotherapy regimens were used: the first regimen, used in 8 patients during the earlier part of the study duration, consisted of 2 cycles of cisplatin plus 5- fluorouracil every 4 weeks, with concurrent radiation therapy, and 4 cycles with the same agents every 4 weeks, adjuvantly; the second regimen, used in 44 patients during the later part, consisted of 3 cycles of cisplatin every 3 weeks, with concurrent radiation therapy and 3 cycles of adjuvant cisplatin plus 5-fluorouracil every 3 weeks. RESULTS: The median follow-up period of the survivors was 32 months. The male to female ratio was 36/16, with a median age of 48 years. The stages, according to the new AJCC staging system (1997), were IIb in 6, III in 23, IVa in 14 and IVb in 9 patients. Fifty and 32 patients completed the planned radiation therapy and concurrent chemotherapy, respectively. Two patients died, 1 of septic shock during the CRCT and the other of malnutrition during the adjuvant chemotherapy. There were 12 failures in 11 patients: 7 locoregional recurrences, 1 within and 6 outside the radiation target volume, and 5 distant metastases. The locoregional control, disease-free survival and overall survival rates were 84.3, 78.8 and 92.8% at 3 years, respectively. CONCLUSION: High dose radiation therapy, coupled with concurrent chemotherapy, was judged a highly effective treatment for locally advanced nasopharynx cancers.