Short-course radiotherapy and chemotherapy for conversion surgery in patients with unresectable metastatic rectal cancer: a preliminary case series study

Purpose@#Curative treatment is challenging in patients with locally advanced rectal cancer and unresectable metastases. The aim of this study was to evaluate the clinical outcomes of short-course radiotherapy (RT) followed by systemic chemotherapy for patients with rectal cancer with mesorectal fascia (MRF) involvement and unresectable distant metastases. @*Methods@#The study included consecutive patients diagnosed as having metastatic mid-to-low rectal cancer treated with short-course RT followed by systemic chemotherapy for conversion radical or palliative surgery between 2014 and 2019 at Gil Medical Center. The patients had primary rectal tumors involving the MRF and unresectable distant metastases. The treatment strategies were determined in a multidisciplinary team discussion. @*Results@#Seven patients (five men and two women) underwent short-course RT (5 × 5 Gy) and preoperative systemic chemotherapy. The median age was 68 years (range, 46–84 years), and the median distance from the anal verge to the primary tumor was 6.0 cm (range, 2.0–9.0 cm). During the median follow-up period of 29.4 months, three patients underwent conversion radical surgery with R0 resection, two underwent palliative surgery, and two could not undergo surgery. No postoperative major morbidity or mortality occurred. The patients who underwent conversion complete radical surgery showed good long-term survival outcomes, with an overall survival time of 29.4–48.8 months and progression-free survival time of 14.7–41.1 months. @*Conclusion@#Short-course RT followed by systemic chemotherapy could provide patients with unresectable stage IV rectal cancer a chance to undergo to conversion radical surgery with good long-term survival outcomes.

The Prognostic Impact of the Number of Metastatic Lymph Nodes and a New Prognostic Scoring System for Recurrence in Early-Stage Cervical Cancer with High Risk Factors: A Multicenter Cohort Study (KROG 15-04) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence. MATERIALS AND METHODS: A multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pNstage, number of mPLN, lymph node (LN)ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)). RESULTS: In univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs (≤ 3 vs. > 3), LN ratio (≤ 17% vs. > 17%), and log odds of mPLNs (≤ -0.58 vs. > -0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.

The influence of number of high risk factors on clinical outcomes in patients with early-stage cervical cancer after radical hysterectomy and adjuvant chemoradiation

OBJECTIVE: The purpose of this study was to evaluate the prognosis according to the number of high risk factors in patients with high risk factors after radical hysterectomy and adjuvant chemoradiation therapy for early stage cervical cancer. METHODS: Clinicopathological variables and clinical outcomes of patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB1 to IIA cervical cancer who had one or more high risk factors after radical hysterectomy and adjuvant chemoradiation therapy were retrospectively analyzed. Patients were divided into two groups according to the number of high risk factors (group 1, single high risk factor; group 2, two or more high risk factors). RESULTS: A total of 93 patients were enrolled in the present study. Forty nine out of 93 (52.7%) patients had a single high risk factor, and 44 (47.3%) had two or more high risk factors. Statistically significant differences in stage and stromal invasion were observed between group 1 and group 2. However, age, histology, tumor size, and lymphovascular space invasion did not differ significantly between the groups. Distant recurrence occurred more frequently in group 2, and the probability of recurrence and death was higher in group 2. CONCLUSION: Patients with two or more high risk factors had worse prognosis in early stage cervical cancer. For these patients, consideration of new strategies to improve survival may be worthwhile. Conduct of further clinical trials is warranted for development of adjuvant treatment strategies individualized to each risk group.

Failed septal extension graft in a patient with a history of radiotherapy / 대한악안면성형재건외과학회지

BACKGROUND: This report describes the authors’ experience of “melting” septal cartilage after placement of a septal extension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, and provides a review of the literature. METHODS: Electronic medical records were used to obtain details of the patient's clinical history. RESULTS: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited our department to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip (first operation). Five days after surgery, it was found that the septal extension graft was melting without any signs of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without any sign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Five months after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, and thus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tip augmentation (third operation). CONCLUSIONS: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Further studies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.

Cardiac dose reduction with breathing adapted radiotherapy using self respiration monitoring system for left-sided breast cancer

PURPOSE: To quantify the cardiac dose reduction during breathing adapted radiotherapy using Real-time Position Management (RPM) system in the treatment of left-sided breast cancer. MATERIALS AND METHODS: Twenty-two patients with left-sided breast cancer underwent CT scans during breathing maneuvers including free breathing (FB), deep inspiration breath-hold (DIBH), and end inspiration breath-hold (EIBH). The RPM system was used to monitor respiratory motion, and the in-house self respiration monitoring (SRM) system was used for visual feedback. For each scan, treatment plans were generated and dosimetric parameters from DIBH and EIBH plans were compared to those of FB plans. RESULTS: All patients completed CT scans with different breathing maneuvers. When compared with FB plans, DIBH plans demonstrated significant reductions in irradiated heart volume and the heart V25, with the relative reduction of 71% and 70%, respectively (p < 0.001). EIBH plans also resulted in significantly smaller irradiated heart volume and lower heart V25 than FB plans, with the relative reduction of 39% and 37%, respectively (p = 0.002). Despite of significant expansion of lung volume using inspiration breath-hold, there were no significant differences in left lung V25 among the three plans. CONCLUSION: In comparison with FB, both DIBH and EIBH plans demonstrated a significant reduction of radiation dose to the heart. In the training course, SRM system was useful and effective in terms of positional reproducibility and patient compliance.

Superior Mesenteric Artery Syndrome in Patient with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder that causes progressive muscular weakness, severe weight loss, and ultimately death. Gastrostomy or nasogastric tube is beneficial for ALS patients with severe weight loss and dysphagia. However, the development of superior mesenteric artery (SMA) syndrome in ALS patients when the enteral feeding time is delayed is rarely reported. We report herein the first case of SMA syndrome in a Korean ALS patient who showed improvement after percutaneous endoscopic gastrojejunostomy(PEGJ).

Establishment of linear accelerator-based image guided radiotherapy for orthotopic 4T1 mouse mammary tumor model / 한국실험동물학회지

This study was conducted to assess the feasibility of image guided radiotherapy (IGRT) for orthotopic 4T1 mouse mammary tumor using linear accelerator (LINAC). Eighteen Balb/C mice were inoculated with 4T1 cells on left mammary fat pad and nine of them were irradiated using LINAC. Tumors, planning target volumes (PTV), bowels adjacent to tumors, bones and lungs were delineated on planning CT images. IGRT plans were generated to irradiate prescription dose to at least 90% of the PTV and then compared with conventional 2-dimensional plans with anterior-posterior and posterior-anterior beams with 5 mm margins (2D AP/PA plan). Homemade dose-build-up-cradle was designed to encompass mouse bed for homogeneous dose build up. To confirm the irradiated dose, tumor doses were measured using diode detector placed on the surface of tumors. Plan comparison demonstrated equivalent doses to PTV while sparing more doses to normal tissues including bowel (from 90.9% to 40.5%, median value of mean doses) and bone marrow (from 12.9% to 4.7%, median value of mean doses) than 2D AP/PA plan. Quality assurance using diode detector confirmed that IGRT could deliver 95.3-105.3% of the planned doses to PTV. Tumors grew 505.2-1185.8% (mean 873.3%) in the control group and 436.1-771.8% (mean 615.5%) in the irradiated group. These results demonstrate that LINAC-based IGRT provides a reliable approach with accurate dose delivery in the radiobiological study for orthotropic tumor model maintaining tumor microenvironment.

Clinical application of RapidArc volumetric modulated arc therapy as a component in whole brain radiation therapy for poor prognostic, four or more multiple brain metastases

PURPOSE: To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases. MATERIALS AND METHODS: Nine patients with multiple (> or =4) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10-12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions. RESULTS: The median biologically effective dose to metastatic tumors was 68.1 Gy10 and 67.2 Gy10 and the median brain volume irradiated more than 100 Gy3 were 1.9% (24 cm3) and 0.8% (13 cm3) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively. CONCLUSION: RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.

Radiation therapy with chemotherapy for patients with cervical cancer and supraclavicular lymph node involvement / 부인종양

OBJECTIVE: We wanted to evaluate the outcomes of cervical cancer patients with supraclavicular lymph node (SCLN) involvement and who received radiation therapy (RT) combined with chemotherapy. METHODS: From August 2001 to April 2009, nine cervical cancer patients with SCLN involvement were treated by RT and cisplatin-based chemotherapy. Most of the patients (8/9, 88.9%) also had a positive para-aortic lymph node (PALN). The RT field was designed to include the whole pelvis, the involved PALNs and the SCLN area. The median SCLN RT dose was 66.6 Gy (range, 60 to 70 Gy). RESULTS: The median follow-up period was 61 months (range, 13 to 98 months). The 3- and 5-year overall survival rates were 66.7% and 55.6%, respectively and the 3- and 5-year progression-free survival rates were 66.7% and 44.4%, respectively. The acute hematologic toxicities according to the criteria of Radiation Therapy of Oncology Group (RTOG) were G1/2 leucopenia in 3 (33.3%), G3/4 leukopenia in 6 (66.7%), G1/2 anemia in 7 (77.8%), G3 anemia in 1 (11.1%), G2 thrombocytopenia in 2 (22.2%), and G3/4 thrombocytopenia in 2 (22.2%). Within 6 months after RT, most of the patients (5/6, 83.3%) recovered from the G3/4 leukopenia, except for 1 patient who received chemotherapy after completing RT due to subsequent bone metastasis. CONCLUSION: For patients with advanced cervix cancer and SCLN involvement, RT with chemotherapy as active therapy can be expected to provide favorable results, although there is an increased risk of G3/4 hematologic toxicity.

Irinotecan and Cisplatin Combination Chemotherapy Plus Concurrent Thoracic Irradiation for Patients with Limited Disease Small Cell Lung Cancer

PURPOSE: To evaluate the antitumor activity and safety of irinotecan plus cisplatin combination chemotherapy with concurrent thoracic radiotherapy (TRT) in patients with limited disease (LD) small cell lung cancer (SCLC). MATERIALS AND METHODS: Patients with pathologically-confirmed LD SCLC with the following inclusion criteria were retrospectively analyzed: age > or =18 years; measurable lesion; Eastern Cooperative Oncology Group Performance Status 0~2; chemotherapy naive; and adequate bone marrow and organ function. Patients received an intravenous (IV) infusion of irinotecan (35 mg/m2 on days 1, 8, and 15) and cisplatin (60 mg/m2 on day 1), which was repeated every 4 weeks for up to 6 cycles. Concurrent TRT was administered with the beginning of chemotherapy. Irinotecan was increased to 60 mg/m2 after completion of TRT. Patients with a complete response (CR) subsequently received prophylactic cranial irradiation. RESULTS: Nineteen patients were analyzed. There were 8 patients (42.1%) with CR, 9 patients (47.4%) with partial response, and 1 patient each (5.3%) with stable disease and progressive disease (PD). The overall response rate was 89.5%. The median progression-free survival was 7.6 months (95% confidence interval [CI], 1.3~14.0 months) and the median overall survival was 12.4 months (95% CI, 0.5~24.2 months). The 2-year survival rate of the CR patients was 75.0%. No grade 4 hematologic toxicity was reported. Frequently reported toxicities were nausea (10 patients), radiation-induced pneumonitis (10 patients), and neutropenia (6 patients). Radiation-related severe toxicities were frequently reported. Three patients had treatment-related deaths. CONCLUSION: This study supports the activity and tolerability of irinotecan plus cisplatin with concurrent TRT in patients with LD SCLC.

Additional rituximab-CHOP (R-CHOP) versus involved-field radiotherapy after a brief course of R-CHOP in limited, non-bulky diffuse large B-cell lymphoma: a retrospective analysis / 대한혈액학회지

BACKGROUND: Standard treatment for stage I or non-bulky stage II diffuse large B-cell lymphoma (DLBCL) has been either a brief course of chemotherapy plus involved-field radiotherapy (IFRT) or prolonged cycles of chemotherapy. The introduction of rituximab has necessitated re-evaluation of the treatment for limited disease (LD) DLBCL. METHODS: Thirty-nine LD DLBCL patients (median age, 52 years; range, 24-85) treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) were retrospectively analyzed. Treatment outcomes were evaluated, and toxicity, event-free survival (EFS), and overall survival (OS) were compared according to the treatment and risk factors. RESULTS: The median follow-up duration was 34.6 months (range, 9.1-65.4). The 3-year EFS and OS were 76.0% and 86.0%, respectively. Among the 36 patients who underwent either 3-4 cycles of R-CHOP followed by IFRT (N=22) or 6-8 cycles of R-CHOP (N=14), there was no difference in the 3-year EFS (79.4% vs. 71.6%, P=0.638) and 3-year OS (85.7% vs. 92.9%, P=0.732). Severe neutropenia and neutropenic fever were more frequent in patients treated with R-CHOP alone, with 1 treatment-related mortality. Among the IFRT patients, 1 required hospital admission for IFRT-related complications. No events or deaths were reported among patients without adverse risk factors. CONCLUSION: The difference in outcomes between the 2 treatment options was not significant. Analysis of treatment outcomes suggested that baseline characteristics and expected toxicities should be considered in LD DLBCL treatment. Further studies are needed to define the optimal treatment in the rituximab era.

Analysis of the Radiation Therapy Outcomes and Prognostic Factors of Thymoma / 대한방사선종양학회지

PURPOSE: This retrospective study was performed to evaluate the efficacy of radiation therapy (RT) and to investigate the prognostic factors for thymoma when treated with RT. MATERIALS AND METHODS: We analyzed 21 patients with thymoma and also received RT from March 2002 to January 2008. The median follow-up time was 37 months (range, 3 to 89 months). The median patient age was 57 years (range, 24 to 77 years) and the gender ratio of males to females was 4:3. Of the 21 patients, complete resections (trans-sternal thymectomy) and R2 resections were performed in 14 and 1 patient, respectively. A biopsy was performed in 6 patients (28.7%). The WHO cell types in the 21 patients were as follows: 1 patient (4.8%) had type A, 10 patients (47.6%) had type B1-3, and 10 patients (47.6%) had type C. Based on Masaoka staging, 10 patients (47.6%) were stage II, 7 patients (33.3%) were stage III, and 4 patients (19.1%) were stage IVa. Three-dimensional RT was adminstered to the tumor volume (planned target volume), including the anterior mediastinum and the residual disease. The total RT dose ranged from 52.0 to 70.2 Gy (median dose, 54 Gy). Consistent with the WHO criteria, the response rate was only analyzed for the 6 patients who received a biopsy only. The prognostic factors analyzed for an estimate of survival included age, gender, tumor size, tumor pathology, Masaoka stage, the possibility of treatment by performing surgery, the presence of myasthenia gravis, and RT dose. RESULTS: The 3-year overall survival rate (OS) and the progression free survival rate (PFS) were 80.7% and 78.2%, respectively. Among the 10 patients with WHO cell type C, 3 of 4 patients (75%) who underwent a complete resection and 3 of 6 patients (50%) who underwent a biopsy survived. Distant metastasis developed in 4 patients (19.1%). The overall response rate in the 6 patients who received biopsy only were as follows: partial remission in 4 patients (66.7%), stable disease in 1 patient (16.6%), and progressive disease in 1 patient (16.6%). Acute RTOG radiation pneumonitis occurred in 1 patient (4.8%), grade 2 occurred in 2 patients (9.5%), grade 3 occurred in 1 patient (4.8%), and grade 4 occurred in 1 patient (4.8%). A univariate analysis revealed that the significant prognostic factors for OS were age (> or =60, 58.3%; <60, 100%; p=0.0194), pathology (WHO cell type A-B3, 100%; C, 58.3%; p=0.0194) and, whether the patient underwent surgery (yes, 93.3%; no, 50%; p=0.0096). CONCLUSION: For the 15 patients who received surgery, there was no local failure within the radiation field. In patients with WHO cell type C, surgical procedures could have resulted in a more favorable outcome than biopsy alone. We report here our clinical experience in 21 patients with thymoma who were treated by radiation therapy.

Pseudohyponatremia After Intravenous Immunoglobulin Therapy in a Patient With Guillain-Barre Syndrome

No abstract available.

Analysis of Outcomes and Prognostic Factors Associated with Surgical Treatment Plus Postoperative Radiation Therapy for Stage II/III Pancreatic Cancer

PURPOSE: To evaluate treatment outcomes for patients with stage II/III pancreatic cancer who are treated with radiation therapy (RT) with or without chemotherapy (CTx) following surgery. METHODS: We retrospectively analyzed data from 17 patients who underwent surgery and post-operative RT with or without CTx between January 2000 and December 2008. Seven patients (41%) had stage II cancer and 10 (59%) had stage III cancer. Most were male (13 of 17; 76.5%). Age at diagnosis ranged from 42 to 82 (median 69) years. Whipple's operation was done in 9 patients (53%), distal pancreatectomy in 7 (41%), and subtotal pancreatectomy in 1 (6%). All patients received RT using a three-dimensional RT technique to spare critical normal structures. Median radiation dose was 54 Gy (range, 50.4~55.8 Gy). Variable CTx regimens were combined in 10 patients (58.8%); 5-FU in 4, UFTE-G in 4, gemcitabine in 1, and xeloda in 1. Acute toxicity was evaluated according to RTOG toxicity criteria. Survival analysis was done using the Kaplan-Meyer method. Univariate and multivariate prognostic factor analysis were done, respectively, using a log-rank test and Cox's proportional hazards model. RESULTS: The median follow-up period was 12.6 months. Locoregional and distant failures occurred in 8 (47.1%) and 8 patients (47.1%), respectively. Five patients (29.4%) developed both loco-regional recurrence and distant metastasis. The metastatic sites were liver in 4 patients, lung in 3, peritoneum in 1, and kidney in 1. Median overall survival (OS) was 12.6 months. The 1- and 2-year OS rates were, respectively, 58.8% and 24.5%. Median disease-free survival (DFS) was 8.3 months and the 1- and 2-year DFS rates were 46.3% and 30.9%, respectively. The 2-year OS was not different between RT and RT with CTx : survival rates were 28.6% and 17.5%, respectively (p=0.764). T stage and a postoperative CA 19-9 level of > or =180 U/ml were significant prognostic factors for OS in both univariate and multivariate analysis: the 2-year OS for T3 and T4 were 34.1% and 16.7%, respectively (p=0.0022), the 2-year OS for or =180 U/ml were 32.5% and 0%, respectively (p=0.0142) Acute toxicities were RTOG grade 1 (G1) nausea in 1 patient (5.9%), G1 vomiting in 2 (11.8%), and G1-2 enteritis in 5 (29.4%). The hematologic toxicities were G1 leukopenia in 5 patients (29.4%), G2 leukopenia 1 (5.9%), G1 thrombocytopenia in 1 (5.9%), and G1~2 anemia in 6 (35.3%). CONCLUSION: Survival results of the present study are comparable to those in other reports with acceptable toxicity. Significant prognostic factors for overall survival in pancreatic cancer are tumor stage and postoperative CA 19-9 level.

Guillain-Barre Syndrome Presenting With Bilateral Ptosis

No abstract available.

Prospective Study on the Efficiency of Neurophysiological Index Applicated at Posterior Tibial Nerve/Abductor Pollicis Longus in Patients With Amyotrophic Lateral Sclerosis

BACKGROUND: Neurophysiological Index (NI) is a sensitive measure of changes during the course of amyotrophic lateral sclerosis (ALS). However, NI applied at the ulnar nerve has limitation in that the initial manifestation of ALS is different among individual patients. This study was aimed to evaluate the efficiency of NI applied to the posterior tibial nerve system in a prospective study of progression in ALS patients. METHODS: The subjects of the study were 22 patients with definite or probable ALS based on revised EL Escorial criteria. NI applied to the ulnar nerve/abductor digiti minimi muscle and the posterior tibial nerve/abductor hallucis muslce, revised ALS functional rating scale, Norris scale, and grip power were obtained at four and eight months of the follow-up. RESULTS: Overall, NI at both ulnar and posterior tibial nerve systems showed a significant interval change at 4 and 8 months. Although NI in both nerve systems showed significant changes at an interval of 4 months in patients with upper limb onset, NI obtained from the ulnar nerve did not show a difference from the baseline in the lower limb onset patients. Moreover, there was a significant change of NI in the early stage ALS patients, compared to the late stage patients. CONCLUSIONS: In the lower limb onset patients, NI obtained from the posterior tibial nerve is more useful in evaluating the disease progression pattern. Moreover, NI is more effective in the evaluation of the patients in the early stage.

Facioscapulohumeral Muscular Dystrophy Confirmedby D4Z4 Analysis

No abstract available.

Radiation Therapy and Chemotherapy after Breast Conserving Surgery for Invasive Breast Cancer: An Intermediate Result / 대한방사선종양학회지

PURPOSE: Breast conserving surgery (BCS) followed by chemotherapy (CTx.) and radiation therapy (RT) is widely performed for the treatment of early breast cancer. This retrospective study was undertaken to evaluate our interim results in terms of failure patterns, survival and relative risk factors. MATERIALS AND METHODS: From January 1999 through December 2003, 129 patients diagnosed with invasive breast cancer and treated with BCS followed by RT were subject to retrospective review. The median age of the patients was 45 years (age distribution, 27~76 years). The proportions of patients according to their tumor, nodes, and metastases (TNM) stage were 65 (50.4%) in stage I, 41 (31.7%) in stage IIa, 13 (10.1%) in stage IIb, 9 (7.0%) in stage III, and 1 patient (0.8%) in stage IIIc. For 32 patients (24.8%), axillary node metastasis was found after dissection. BCS consisted of quadrantectomy in 115 patients (89.1%) and lumpectomy in 14 patients (10.6%). Axillary node dissection at axillary level I and II was performed for 120 patients (93%). For 7 patients (5.4%), only sentinel node dissection was performed with BCS. For 2 patients (1.6%) axillary dissection of any type was not performed. Postoperative RT was given with 6 MV X-rays. A tumor dose of 50.4 Gy was delivered to the entire breast area using a tangential field with a wedge compensator. An aditional dose of 9~16 Gy was given to the primary tumor bed areas with electron beams. In 30 patients (23.3%), RT was delivered to the supraclavicular node. Most patients had adjuvant CTx. with 4~6 cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens. The median follow-up period was 50 months (range: 17~93 months). RESULTS: The actuarial 5 year survival rate (5Y-OSR) was 96.9%, and the 5 year disease free survival rate (5Y-DFSR) was 93.7%. Local recurrences were noted in 2 patients (true: 2, regional node: 1) as the first sign of recurrence at a mean time of 29.3 months after surgery. Five patients developed distant metastases as the first sign of recurrence at 6~33 months (mean 21 months). Sites of distant metastatic sites were bone in 3 patients, liver in 1 patient and systemic lesions in 1 patient. Among the patients with distant metastatic sites, two patients died at 17 and 25 months during the follow-up period. According to stage, the 5Y-OSR was 95.5%, 100%, 84.6%, and 100% for stage I, IIa, IIb, and III respectively. The 5Y-DFSR was 96.8%, 92.7%, 76.9%, and 100% for stage I, IIa, IIb, and III respectively. Stage was the only risk factor for local recurrence based on univariate analysis. Ten stage III patients included in this analysis had a primary tumor size of less than 3 cm and had more than 4 axillary lymph node metastases. The 10 stage III patients received not only breast RT but also received posterior axillary boost RT to the supraclavicular node. During the median 53.3 months follow-up period, no any local or distant failure was found. Complications were asymptomatic radiation pneumonitis in 10 patients, symptomatic pneumonitis in 1 patient and lymphedema in 8 patients. CONCLUSION: Although our follow up period is short, we had excellent local control and survival results and reaffirmed that BCS followed by RT and CTx. appears to be an adequate treatment method. These results also provide evidence that distant failure occurrs earlier and more frequent as compared with local failure. Further studies and a longer follow-up period are needed to assess the effectiveness of BCS followed by RT for the patients with less than a 3 cm primary tumor and more than 4 axillary node metastases.

Concurrent chemoradiation therapy in cervical cancer with para-aortic lymph node involvement / 부인종양

OBJECTIVE: This study was undertaken to evaluate the therapeutic results and complications after concurrent chemoradiation therapy and to investigate the prognostic factors for cervical cancer with para-aortic lymph node involvement. METHODS: From May 1999 to August 2005, thirty eight patients with cervical cancer, treated by combined platinum base chemotherapy and extended field radiation therapy in Gachon University Gil medical center. All patients were diagnosed as paraaortic lymphnode involvement with imaging studies. The radiation dose of external beam was 34.2-64.4 Gy to whole pelvis and 32.4-59.4 Gy to paraaortic area. Cisplatin based chemotherapy was done simultaneously. We evaluated the prognostic factors such as stage, tumor size, inguinal and supraclavicular lymphnode status, and radiation doses. RESULTS: Median follow-up period is 34 months (7-85 months). The 3 year overall and disease free survival rates were 63.6% and 56.4%, respectively. There was no case of recurrence after 3 years of treatment. In 2 patients, the treatment was not completed because of Grade III or IV gastroenteral complications; abdominal pain and diarrhea. Grade III or IV hematologic complications were occurred in fifteen patients, but all patients were recovered without serious complications. We could not find any significant prognostic factors in this study. CONCLUSION: Concurrent chemoradiation therapy for cervical cancer with paraaortic lymph node involvement is well tolerable and effective treatment.

Effect of concurrent chemoradiotherapy with cisplatin and 5-fluorouracil for FIGO stage IIB of the uterine cervix / 부인종양

OBJECTIVE: To determine effect of concurrent chemoradiotherapy (CCRT) in treatment of FIGO stage IIB cervical cancer the uterus and of consolidation chemotherapy using same chemotherpeutic regimens. METHODS: The study population consisted of total number of 41 patients diagnosed as having cervical cancer FIGO stage IIB between January 1999 and December 2003 and treated with CCRT. We were divided into 2 groups according to number of cycles of chemotherapy received [e.g., 3 (n=22, controls) cycles]. Both groups had received the chemotherapeutic regimens which consist of cisplatin 60 mg/m2 followed by five consecutive daily infusions of 5-fluorouracil (5-FU) 1,000 mg/m2 every 3 weeks. RESULTS: 5 years survival rate and 3 years progression free survival are 80.1% and 60.6% in 45 months median follow up duration (range 6-81 months). The median duration of follow up for case and control is 42 months (range 6-81 months) and 52.5 months (range 11-74 months) respectively (p=0.89). Both progression free survival rate (p=0.77) and survival rate (p=0.39) of the groups were revealed to be without statistical significance. CONCLUSION: This study shows similar results to compare with previous CCRT reports and that CCRT is primary treatment of cervical cancer IIB.We may not improve remarkably survival with many chemotherapy cycles. But because of small population and retrospective study, further study of a large number of patients,prospective and long term follow up will be necessary to test the efficacy of the consolidation chemotherapy.