Research progress on use of tissue equivalent filler in postmastectomy radiation therapy of breast cancer / 中华放射肿瘤学杂志

Although the use of postmastectomy radiation therapy (PMRT) has been proven to bring survival benefit to breast cancer patients, the use of chest wall tissue equivalent filler (bolus) remains controversial. In recent years, a large number of studies have shown that the use of bolus in PMRT does not significantly improve the local control rate, while it can significantly increase the acute skin toxicity, and even leads to more frequent and longer treatment interruption. Existing retrospective studies have indicated that for breast cancer patients undergoing mastectomy and systemic therapy, if there is no skin invasion, it is recommended not to routinely use bolus during radiotherapy. However, higher-level clinical studies are needed for further confirmation.

Analysis of the efficacy and safety of proton radiotherapy for primary hepatocellular carcinoma / 国际生物医学工程杂志

Objective:To study the efficacy, safety and prognostic factors affecting survival of proton radiation therapy for primary hepatocellular carcinoma (HCC).Methods:Forty-four patients with primary hepatocellular carcinoma treated at Zibo Wanjie Cancer Hospital in Shandong Province from June 15, 2005 to September 12, 2018 were enrolled and given proton radiation therapy with a single dose of 2-5 Gy and a total dose of 25-75 Gy. The overall and local control rates, factors influencing survival, and adverse effects were observed during a follow-up period of 12 to 120 months.Results:The overall survival rates of all patients were 79.5% at 1 year, 68.2% at 2 years, 50.0% at 3 years, and 45.5% at 5 years. The overall local control rate was 95.5%. Patients older than 50 years had a longer overall survival (Log Rank Chi-Square of 4.787, P = 0.029). Child-Pugh A classification had better overall survival compared with B classification (Log Rank Chi-Square 4.077, P = 0.043). The main adverse reactions were skin reactions and gastrointestinal reactions. Among the patients with adverse reactions, 23 patients had skin reactions and 9 patients had mild gastrointestinal reactions, and no serious adverse events were found. Conclusions:Proton radiation therapy has good efficacy and high safety in patients with HCC. Age and Child-Pugh classification are prognostic factors affecting survival after proton radiation therapy.

Outcome of Concurrent Chemoradiation in Inoperable Muscle Invasive Urothelial Carcinoma of Urinary Bladder in terms of Locoregional Response and Toxicities — A Longitudinal Study in a Tertiary Care Hospital

Background : The presenting study was performed to assess the efficacy in terms of tumour response and toxicity profile of a curative intent organ preservation approach in Inoperable Non-metastatic Muscle-Invasive Urinary Bladder Carcinoma. Materials and Methods : Prospective Interventional Single-Arm, Single Center study with a duration of one and half year in which 47 patients with Muscle-invaded Bladder Cancer were treated with Radiotherapy with 64 Gy in 32# along with Concurrent Chemotherapy with three weekly injection Cisplatin in dose of 70 mg/m2. Response evaluation was done using both Clinical and Radiological means and categorized using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. For adverse events measurement: NCI CTCAE (Common Terminology Criteria for Adverse Events, v4.1) and RTOG/EORTC Acute and Late Morbidity criteria was used. Results : Of the 47 patients who completed chemoradiation, complete treatment response was seen in 25 patients (53.2%), 17 patients (36.2%) had partial response on initial assessment and one patient had disease progression both in form of locoregional and distant (lung) metastasis. Stable disease found in (8.5%). Patients with residual disease were advised to undergo salvage treatment. Grade 3 Nephrotoxicity reported in one patient, Grade 2 Cystitis in 32 patients (68.1%), while Grade 2 Diarrhoea occurred in four patients (8.5%). Hematological toxicity attributable to Chemoradiotherapy included Grade 2, Grade 3 Neutropenia seen in 6.4% and 2.1% respectively and Grade 2 Anaemia in 4.3% patients. Conclusion : Concurrent Chemoradiotherapy is well-tolerated, effective and convenient curative treatment option for patients with Inoperable Non-metastatic Muscle Invasive Carcinoma of Urinary Bladder

Clinical efficacy of postoperative radiotherapy using shrinking field for patients with extremity soft tissue sarcoma / 中华放射肿瘤学杂志

Objective:To investigate the effectiveness of postoperative radiotherapy using shrinking field for patients with extremity soft tissue sarcoma (STS), mainly focusing on the local control rate and adverse events.Methods:Clinical data of 49 extremity STS patients who received postoperative intensity-modulated radiotherapy in the First Hospital of Tsinghua University from October 2017 to March 2021 were retrospectively analyzed. Target volumes were contoured on CT and MRI fusion images. The tumor bed was defined as GTV tb, with 3 cm expansion in the longitudinal direction and 1.5 cm expansion in the radial direction to construct CTV (the target volume should be properly repaired according to the anatomical barrier, and the edema area around the tumor should be included). GTV tb and CTV were expanded in all directions by 0.5 cm to construct PTV1 and PTV2 respectively, at a dose of 95%PTV1 63-66 Gy, 95%PTV2 50-56 Gy,1.8-2.0 Gy/f. The dose of surgical volume should be given at 70 Gy for patients who had a microscopic positive margin. Results:The median follow-up time was 32.1 months (7.9-45.6 months). The 3-year local failure-free survival (LFFS), overall survival (OS)and distant metastasis-free survival (DMFS) were 91.7%,77.6% and 71.5%, respectively. Univariate analysis showed that patients with a microscopic positive margin were more likely to develop local recurrence ( P<0.05). The incidence of grade 2 or above wound complications, joint stiffness, fracture, edema and skin fibrosis were 2%, 4.1%, 2%, 8.2% and 26.5%, respectively. Conclusion:Postoperative radiotherapy with shrinking field provides excellent local control rate and low incidence of late adverse events in patients with extremity STS.

Radioterapia en tumor de células gigantes tenosinovial (sinovitis villonodular pigmentada) / Radiation therapy in tenosynovial giant cell tumor (pigmented villonodular synovitis)

Presentar nuestra experiencia de 18 años en el tratamiento con radioterapia y evaluar cifras de control tumoral local en pacientes con diagnóstico de tumor de células gigantes tenosinovial difuso sinovitis villonodular pigmentada difusa. 33 pacientes, tratados durante el período 2000-2018. En 19 (57,6 %) se practicó sinovectomía parcial, 10 (30,3 %) fueron tratados con artroplastia y sinovectomía, 4 (12,2 %) con sinovectomía total. 32 pacientes recibieron radioterapia posoperatoria, 1 paciente preoperatoria. Técnica más empleada fue planificación 2D 51,5 % seguida de conformada con planificación 3D (RTC3D) 48,5 %. La dosis total promedio administrada 44 Gy (rango 10,5 - 50). Tiempo promedio de tratamiento radiante 28 días (8-35). Tiempo de seguimiento entre 0,7 - 240,8 meses, mediana 12 meses, promedio 52,1 meses. 26 pacientes (79 %) presentaron mejoría de la sintomatología inicial y 6 (18 %) refirieron estabilidad de los síntomas. La respuesta clínica al tratamiento en relación al tiempo de seguimiento, 12 pacientes (36,4 %) estaban asintomáticos, 10 con un seguimiento mayor a 60 meses; 14 (42,4 %) refieren respuesta clínica satisfactoria, (2 con un seguimiento mayor a 60 meses) 6 pacientes presentaban enfermedad estable, para un control local del 97 %. El 87,9 % presentaron dermatitis grado I, 1 desarrolló dermatitis grado II, 3 no presentaron efectos adversos. La radioterapia es una modalidad de tratamiento muy efectiva como adyuvante a la sinovectomía, observándose altas tasas de control local de la enfermedad con una baja morbilidad(AU)

To report our eighteen-year experience with radiation therapy in the treatment of diffuse tenosinovial giant cell tumor / diffuse pigmented villonodular synovitis and to assess local control of the disease. A review of 33 patients with treated with radiation therapy during the period 2000-2018 was done. 19 (57.6 %) partial synovectomy was performed, 10 (30.3 %) underwent arthroplasty plus synovectomy, 4 (12.2 %) total synovectomy. 32 patients received radiotherapy postoperative and 1 pre-operative. Most common technique employed was conventional (2D) in 51.5 % and 3D conformal (3DCRT) in 48.5 %. The average total dose was 44 Gy (range 10.5-50), with a mean treatment time of 28 days (8-35). Follow-up time ranged from 0.7- 240.8 months, median time and mean time of 12 and 52.1 months respectively After RT 26 (79 %) of the patients obtained improvement of the initial symptoms and 6 (18 %) were stable. 12 patients (36.4 %) were asymptomatic with follow-up time longer than 36 months (10 of 12 had follow-up time >60 months), 14 (42.4 %) had significant clinical improvement (2 of 14 had follow-up time >60 months), and 6 had stable disease, local control of 97 %. Complications were few, acute skin toxicity was grade I in 29 (87.9%) and grade II in 1 patient. There was no significant chronic toxicity. Radiation therapy is an effective adjuvant treatment modality after synovectomy in patients with high local control rates and low morbidity(AU)

Radioterapia intraoperatória com elétrons no tratamento do câncer colorretal localmente avançado submetido a ressecção incompleta: análise econômica sob a perspectiva do Sistema de Saúde Suplementar brasileiro / Intraoperative electron-beam radiotherapy in locally advanced rectal cancer, in patients submitted to suboptimal surgery: economic analysis on the Brazilian Private Health Care system perspective

Objetivo: Este estudo objetivou avaliar o custo-efetividade da aplicação da radioterapia intraoperatória com elétrons (RIOe) no paciente com câncer retal localmente avançado (CRLA) submetido a radio/quimioterapia neoadjuvante seguida de ressecção incompleta (margem comprometida ou doença grosseira residual). Métodos: Para tanto, foi elaborado um modelo de Markov. Os dados de eficácia, efeitos secundários, controle local e sobrevida global foram extraídos da literatura. A perspectiva considerada foi a do sistema de saúde privado brasileiro. Considerou-se, para o custo e para a efetividade, uma taxa de desconto anual de 5%. Resultados: A estratégia que continha a RIOe mostrou-se, nesse cenário, dominante em comparação à estratégia que não envolvia essa abordagem. Os resultados mostraram-se robustos após análises de sensibilidade uni e multivariadas. Conclusão: Concluiu-se que pode ser vantajosa, tanto para os pacientes com CRLA quanto para as operadoras de saúde do mercado privado brasileiro, a aplicação de RIOe na ocorrência de cirurgia subótima, ainda que se sugira que esses dados devem ser confirmados posteriormente, por meio da coleta de dados de mundo real, devido à ausência de níveis robustos de evidência, na literatura, para esse cenário clínico específico.

Objective: This study aimed to evaluate the cost-effectiveness of intraoperative electron radiotherapy (IOeRT) in patients with locally advanced rectal cancer (LARC) undergoing neoadjuvant radio-chemotherapy, followed by incomplete resection (compromised margin or gross residual disease). Methods: A Markov model was constructed. Data on efficacy, side effects, local control and overall survival were extracted from the literature. The perspective was that of the Brazilian private health system. For the cost and effectiveness, an annual discount rate of 5% was considered. Results: The strategy that contained IOeRT was, in this scenario, dominant, in comparison to standard of care. Results were considered robust, after univariate and multivariate sensitivity analyzes. Conclusions: We concluded that it can be advantageous, both for patients with LARC submitted to suboptimal surgery, as well as for Brazilian health insurance companies, the application of IOeRT. Although it is suggested that these results should be confirmed later, through the collection of real-world data, due to the absence of randomized controlled trials, in this specific clinical scenario.

Clinical observation of radiofrequency ablation in breast-conserving surgery after neoadjuvant chemotherapy / 国际外科学杂志

Objective@#To evaluate the efficacy of radiofrequency ablation in breast-conserving surgery followed neoadjuvant chemotherapy.@*Methods@#Retrospective analysis of 30 cases of breast cancer patients admitted to Beijing Friendship Hospital, Capital Medical University from April 2015 to September 2018. The average age was 54.3 years and the range was 28 to 70 years. For breast invasive ductal cancer, patients underwent breast-conserving surgery after neoadjuvant chemotherapy, and then received radiofrequency ablation. The clinical and pathological characteristics, postoperative complications, recurrence and metastasis, and cosmetic effects were observed.@*Results@#All 30 patients with breast-conserving surgery successfully completed radiofrequency ablation. The average outpatient follow-up was 22.5 months, ranging from 2 to 43 months, without local recurrence or metastasis; skin burns occurred in 2 cases (6.67%), and solid nodules formed in situ in 6 cases (20.00%); cosmetic satisfaction rate was 86.67% (26/30).@*Conclusions@#The radiofrequency ablation techniques applied in breast-conserving surgery have a high rate of technical success with relative low complication rates. And the radiofrequency ablation techniques may improve the cosmetic results after breast-conserving surgery and enhance local control.

Clinical observation of radiofrequency ablation in breast-conserving surgery after neoadjuvant chemotherapy / 国际外科学杂志

Objective To evaluate the efficacy of radiofrequency ablation in breast-conserving surgery followed neoadjuvant chemotherapy.Methods Retrospective analysis of 30 cases of breast cancer patients admitted to Beijing Friendship Hospital,Capital Medical University from April 2015 to September 2018.The average age was 54.3 years and the range was 28 to 70 years.For breast invasive ductal cancer,patients underwent breast-conserving surgery after neoadjuvant chemotherapy,and then received radiofrequency ablation.The clinical and pathological characteristics,postoperative complications,recurrence and metastasis,and cosmetic effects were observed.Results All 30 patients with breast-conserving surgery successfully completed radiofrequency ablation.The average outpatient follow-up was 22.5 months,ranging from 2 to 43 months,without local recurrence or metastasis;skin burns occurred in 2 cases (6.67％),and solid nodules formed in situ in 6 cases (20.00％);cosmetic satisfaction rate was 86.67％ (26/30).Conclusions The radiofrequency ablation techniques applied in breast-conserving surgery have a high rate of technical success with relative low complication rates.And the radiofrequency ablation techniques may improve the cosmetic results after breast-conserving surgery and enhance local control.

The impact of radiotherapy on clinical outcomes in parameningeal rhabdomyosarcoma

PURPOSE: Radiotherapy (RT) is considered a mainstay of treatment in parameningeal rhabdomyosarcoma (PM-RMS). We aim to determine the treatment outcomes and prognostic factors for PM-RMS patients who treated with RT. In addition, we tried to evaluate the adequate dose and timing of RT. MATERIALS AND METHODS: Twenty-two patients with PM-RMS from 1995 to 2013 were evaluated. Seven patients had intracranial extension (ICE) and 17 patients had skull base bony erosion (SBBE). Five patients showed distant metastases at the time of diagnosis. All patients underwent chemotherapy and RT. The median radiation dose was 50.4 Gy (range, 40.0 to 56.0 Gy). RESULTS: The median follow-up was 28.7 months. Twelve patients (54.5%) experienced failure after treatment; 4 local, 2 regional, and 6 distant failures. The 5-year local control (LC) and overall survival (OS) were 77.7% and 38.5%, respectively. The 5-year OS rate was 50.8% for patients without distant metastases and 0% for patients with metastases (p 22 weeks) of RT was related to a higher rate of local failure (40.0%). CONCLUSION: RT resulted in a higher rate of local control in PM-RMS. However, it was not extended to survival outcome. A more effective treatment for PM-RMS is warranted.

Association between obesity and local control of advanced rectal cancer after combined surgery and radiotherapy

PURPOSE: The association between metabolism and cancer has been recently emphasized. This study aimed to find the prognostic significance of obesity in advanced stage rectal cancer patients treated with surgery and radiotherapy (RT). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 111 patients who were treated with combined surgery and RT for clinical stage 2-3 (T3 or N+) rectal cancer between 2008 and 2014. The prognostic significance of obesity (body mass index [BMI] ≥25 kg/m²) in local control was evaluated. RESULTS: The median follow-up was 31.2 months (range, 4.1 to 85.7 months). Twenty-five patients (22.5%) were classified as obese. Treatment failure occurred in 33 patients (29.7%), including local failures in 13 patients (11.7%), regional lymph node failures in 5, and distant metastases in 24. The 3-year local control, recurrence-free survival, and overall survival rates were 88.7%, 73.6%, and 87.7%, respectively. Obesity (n = 25) significantly reduced the local control rate (p = 0.045; 3-year local control, 76.2%), especially in women (n = 37, p = 0.021). Segregation of local control was best achieved by BMI of 25.6 kg/m² as a cutoff value. CONCLUSION: Obese rectal cancer patients showed poor local control after combined surgery and RT. More effective local treatment strategies for obese patients are warranted.

Role of adjuvant radiation in the management of central neurocytoma: Experience from a tertiary cancer care center of India.

BACKGROUND AND OBJECTIVE: Neurocytoma (NC) is a rare benign neuronal tumor. A complete excision remains curative for most of these tumors, but atypical histology and extra‑ventricular location often necessitates adjuvant therapy. We intended to explore the clinico‑pathological features and treatment outcome in patients of NC in our institute. MATERIALS AND METHODS: Medical records were reviewed and data collected on NC over a 6‑year period (2006‑2012) from the departmental archives. Disease free survival (DFS) was analyzed by Kaplan‑Meier method. RESULTS: A total of 18 patients met the study criteria. Fourteen patients had intra‑ventricular neurocytoma (IVNC), right lateral ventricle being the most common site of origin. Gross total resection and near total resection were achieved in eight cases each whereas tumor decompression and biopsy could be done in two cases. On post‑operative histopathological examination, eight patients were found to have atypical NC while 10 patients had typical NC. All patients underwent adjuvant radiation. The median dose of post‑operative radiation was 56 Gy. All patients were alive at their final follow‑up. One patient had both clinical and radiological evidence of local relapse. In the evaluable patients (n = 18), after a median follow‑up of 35 months the DFS rate at 2 years and 3 years are 100% and 83% respectively. CONCLUSION: Use of adjuvant radiation to a total dose of 56 Gy enhances the local control and achieves superior survival in patients of NC. Use of 3D conformal planning techniques may help us to achieve better therapeutic ratio in patients with NC.

Clinical study on CO2 laser microsurgery for early glottic laryngeal carcinoma / 肿瘤研究与临床

Objective To study the efficacy and safety of CO2 laser microsurgery for early glottis carcinoma.Methods The data of 96 cases of early glottic laryngeal carcinoma treated with CO2 laser microsurgery were retrospectively analyzed.Surgical specimens were conventionally embedded with paraffin and serially sectioned.Sections were stained by using hematoxylin-eosin for pathologic examination.The local control rate was observed after operation.Results Among the 96 specimens,88 surgical margins were negative and 8 were positive.10 patients (10.4 ％) recurrenced followed up for 3 years.The recurrence rates of Tis,T1a,T1b and T2 were 0 (0/10),4.1％ (2/48),25.0 ％ (4/16) and 18.1％ (4/22),respectively,with significant differences among groups (X2 =6.105,P ＜ 0.05).All of 8 cases with positive margin and 2 cases with negative margin were recurrened.The recurrent rate of patients with involvement of the anterior commissure was 30.0 ％ (6/20),which was higher than that of patients with no tumor invasion [5.3 ％ (4/76)] (X2 =9.624,P ＜ 0.01).Conclusions The safe edges can be obtained by CO2 laser microsurgery for early stage of glottis carcinoma,which have advantages in local control rate,vocal function of the larynx and curative effect.

Stereotactic body radiotherapy for solitary spine metastasis

A clear consensus has not been established regarding the best treatment for solitary bone metastasis. Here, we reviewed the medical records of patients with a controlled primary malignancy who had only solitary spine metastasis without metastasis to the extraspinal bone or viscera and underwent treatment between April 2007 and December 2012 with stereotactic body radiosurgery using CyberKnife, with a total dose of 24 Gy in three to four fractions. During that time, there were only four cases. This was effective in each case, and all the four patients had no local failure and remained alive at a median follow-up of 68 months (range, 64 to 80 months). Although our experience is limited, this study suggests that stereotactic body radiotherapy could be a feasible, safe, effective, and noninvasive alternative treatment for solitary spine metastasis in patients who are medically inoperable or unsuitable for surgery.

Long-term results of forward intensity-modulated radiation therapy for patients with early-stage breast cancer

PURPOSE: To observe long-term clinical outcomes for patients with early-stage breast cancer treated with forward intensity-modulated radiation therapy (IMRT), including local control and clinical toxicities. MATERIALS AND METHODS: We retrospectively analyzed a total of 214 patients with stage I-II breast cancer who were treated with breast conserving surgery followed by adjuvant breast radiation therapy between 2001 and 2008. All patients were treated using forward IMRT. The whole breast was irradiated to a dose of 50 to 50.4 Gy followed by an 8 to 12 Gy electron boost to the surgical bed. RESULTS: The median age was 46 years (range, 21 to 82 years) and the medial follow-up time was 7.3 years (range, 2.4 to 11.7 years). Stage T1 was 139 (65%) and T2 was 75 (35%), respectively. Ipsilateral breast recurrence was observed in 3 patients. The 5- and 10-year local control rates were 99.1% and 97.8%, respectively. The cosmetic outcome was evaluated according to the Harvard scale and 89.4% of patients were scored as excellent or good. CONCLUSION: The whole breast radiation therapy as an adjuvant treatment using a forward IMRT technique showed excellent long-term local control as well as favorable outcomes of toxicity and cosmesis.

Therapeutic efficacy of stereotactic radiotherapy with gamma knife on early-stage non-small-cell lung cancer and life quality of patients / 中华放射医学与防护杂志

Objective To evaluate the therapeutic efficacy of stereotactic body radiotherapy (SBRT) with gamma knife on stage Ⅰ-Ⅱ non-small-cell lung cancer(NSCLC)and the quality of life of the patients undergoing this therapy.Methods Twenty NSCLC patients with the median age of 76,10 at stage Ⅰ and 10 at stage Ⅱ who were unable or unwilling to undergo surgery were given SBRT with gamma knife at the doses of 3-6 Gy in 8-15 fractions,finished within 2 to 3 weeks.The prescription isodose line was 50％,the marginal dose was 39-56 Gy,the central dose was 78-112 Gy,and the total biologically effective dose was 51-83 Gy.The patients were observed after admission and followed up by chest CT 1,3,6,and 12 months after treatment until progressive disease or death.EORTC QLQ-LC43 questionnaire was used to investigate the changes in quality of life.Results The 20 patients were followed up for 24 (12-46) months.At six months after the treatment,the overall response rate was 80％,and the complete response rate was 35％.The 1,2 and 3-year local control rates were 100％,95％ and 95％,respectively.The 1,2 and 3-year overall survival rates were 95％,80％ and 50％ respectively; The 1,2,and 3-year progression free survival rates were 85％,64％ and 33％,respectively.The failure rate was 20％ and the rate of progress within the planning target volume was 5％.No acute toxicity at grade 3 and over occurred in any patient during the treatment.15％ of the patients developed grade 1-2 radiation pneumonia.Age,gender,pathologic index or not were weakly correlated with the overall survival.The emotional function was improved significantly after treatment (P ＜ 0.05),dyspnea and cough were improved at different degrees,however,not significantly.There were no significant changes in the physical function and symptoms,such as fatigue,lack of appetite,insomnia,etc.Conclusions Significantly improving the motional function and maintaining the quality of life,SBRT with gamma knife is effective for elderly NSCLC patients with high local control rate fair overall survival rate and few side effects.

Role of radiotherapy in local control of non-AIDS associated Kaposi's sarcoma patients in Korea: a single institution experience

PURPOSE: There has been no definite consensus on standard treatment, either local or systemic, for the Kaposi's sarcoma (KS). Radiotherapy (RT) can be a good local therapeutic choice especially in non-AIDS associated KS (NAKS) for its indolent behavior. MATERIALS AND METHODS: Medical records of 17 KS patients treated with RT at the Seoul National University Hospital from February 1998 to January 2012 were retrospectively reviewed. One human immunodeficiency virus (HIV)+ patient with 3 lesions was excluded. The total number of the lesion was 23 among the 16 patients. The median follow-up period was 27.9 months. Correlation between response and variables was analyzed using the logistic regression model. Median age of the patients was 75 years. All the 23 lesions were located at the extremities. Fourteen (61%) of those had pain or local swelling as the initial presentation. Ten patients had possible causes of immunodeficiency and were regarded as iatrogenic, and other 6 were classic KS. Median dose of RT was 36 Gy. RESULTS: No KS-related death was observed. Excluding 2 with short-term follow-up only, complete response and partial response were obtained in 2 (9%) and 19 (73%) lesions, respectively. Of those, 3 lesions underwent local progression. Six had out-of-field recurrence after RT. Symptom improvement was achieved in 13 (93%) of 14 patients. Grade 2 skin toxicities were found in 9 lesions but all got improvement after treatment. When divided into responsive and progressive group, free from progression was not related to any of the possible variables. CONCLUSION: RT is effective in local control of NAKS resulting great response rate.

Role of radiotherapy in local control of non-AIDS associated Kaposi's sarcoma patients in Korea: a single institution experience

PURPOSE: There has been no definite consensus on standard treatment, either local or systemic, for the Kaposi's sarcoma (KS). Radiotherapy (RT) can be a good local therapeutic choice especially in non-AIDS associated KS (NAKS) for its indolent behavior. MATERIALS AND METHODS: Medical records of 17 KS patients treated with RT at the Seoul National University Hospital from February 1998 to January 2012 were retrospectively reviewed. One human immunodeficiency virus (HIV)+ patient with 3 lesions was excluded. The total number of the lesion was 23 among the 16 patients. The median follow-up period was 27.9 months. Correlation between response and variables was analyzed using the logistic regression model. Median age of the patients was 75 years. All the 23 lesions were located at the extremities. Fourteen (61%) of those had pain or local swelling as the initial presentation. Ten patients had possible causes of immunodeficiency and were regarded as iatrogenic, and other 6 were classic KS. Median dose of RT was 36 Gy. RESULTS: No KS-related death was observed. Excluding 2 with short-term follow-up only, complete response and partial response were obtained in 2 (9%) and 19 (73%) lesions, respectively. Of those, 3 lesions underwent local progression. Six had out-of-field recurrence after RT. Symptom improvement was achieved in 13 (93%) of 14 patients. Grade 2 skin toxicities were found in 9 lesions but all got improvement after treatment. When divided into responsive and progressive group, free from progression was not related to any of the possible variables. CONCLUSION: RT is effective in local control of NAKS resulting great response rate.

The Role of Stereotactic Radiosurgery in Metastasis to the Spine

OBJECTIVE: The incidence and prevalence of spinal metastases are increasing, and although the role of radiation therapy in the treatment of metastatic tumors of the spine has been well established, the same cannot be said about the role of stereotactic radiosurgery. Herein, the authors present a systematic review regarding the value of spinal stereotactic radiosurgery in the management of spinal metastasis. METHODS: A systematic literature search for stereotactic radiosurgery of spinal metastases was undertaken. Grades of Recommendation, Assessment, Development, and Education (GRADE) working group criteria was used to evaluate the qualities of study datasets. RESULTS: Thirty-one studies met the study inclusion criteria. Twenty-three studies were of low quality, and 8 were of very low quality according to the GRADE criteria. Stereotactic radiosurgery was reported to be highly effective in reducing pain, regardless of prior treatment. The overall local control rate was approximately 90%. Additional asymptomatic lesions may be treated by stereotactic radiosurgery to avoid further irradiation of neural elements and further bone-marrow suppression. Stereotactic radiosurgery may be preferred in previously irradiated patients when considering the radiation tolerance of the spinal cord. Furthermore, residual tumors after surgery can be safely treated by stereotactic radiosurgery, which decreases the likelihood of repeat surgery and accompanying surgical morbidities. Encompassing one vertebral body above and below the involved vertebrae is unnecessary. Complications associated with stereotactic radiosurgery are generally self-limited and mild. CONCLUSION: In the management of spinal metastasis, stereotactic radiosurgery appears to provide high rates of tumor control, regardless of histologic diagnosis, and can be used in previously irradiated patients. However, the quality of literature available on the subject is not sufficient.

Treatment Results of Major Salivary Gland Cancer by Surgery with or without Postoperative Radiation Therapy

OBJECTIVES: This is to report treatment results of major salivary gland cancer by surgery with or without postoperative radiation therapy (PORT). METHODS: Between March 1995 and January 2006, 94 patients with primary major salivary cancer underwent curative surgical resection at Samsung Medical Center. The parotid gland was the most commonly involved (73, 77.7%), followed by the submandibular and the sublingual. Neck dissection was added in 28 patients, and PORT was individually recommended to those with risk factors. Seventy-five (79.8%) patients received PORT. PORT volume included primary tumor bed and pathologically involved regional lymphatics, and no additional effort was made for elective nodal irradiation. The median total doses were 56.0 Gy to primary site and 58.7 Gy to regional lymphatics. RESULTS: After median follow-up of 49 months, 21 patients had relapsed: 20 in PORT; and one in surgery alone group. As the first site of failure, distant metastasis was the most common (17 patients). Local recurrence occurred in three, and regional relapse in one. The lung was the most common site (10 patients), followed by the bone, and the brain. Five-yr disease free survival (DFS), local control, and overall survival (OS) rates were 74.4% and 94.7%, 96.0% and 100%, and 78.2% and 100% in PORT and surgery alone groups, respectively. On multivariate analysis, DFS was significantly affected by pN+ (hazard ratio [HR], 3.624; P=0.0319), while OS was by pN+ (HR, 7.138; P=0.0034) and perineural invasion (HR, 5.073; P=0.0187). CONCLUSION: Based on our experience, the patients with early stage major salivary gland cancer with low risk can be effectively treated by surgery alone, and those who with risk factors can achieve excellent local and regional control by adding PORT. Omitting elective neck irradiation in patients with N0 disease seems a feasible strategy under accurate clinical evaluation. An effort is needed to decrease distant metastasis through further clinical trials.

Outcome of Atypical Meningioma

OBJECTIVE: Limited data are available concerning the outcome of the patients with atypical meningioma due to lack of the studies with large series. The authors review atypical meningioma retrospectively and analyzed various parameters concerning its outcome. METHODS: Of the 866 meningioma patients treated between 1990 and 2003, pathologically proven 54 atypical meningiomas were reviewed. Various factors of the patients were analyzed, and surgical specimens were re-examined blindly by neuropathologist without any patient information. Extent of surgical resection was determined according to Simpson's classification by reviewing the chart and postoperative scan if possible. RESULTS: Twenty-three (42.6%) had local recurrences during the follow-up, of which 13 (32.5%) of 40 complete excisions and 10 (71.4%) of 14 incomplete excisions. The median time to recurrence was 47 months, and the overall 3-, 5-, and 10-year local control rates were 62.4%, 41.5%, and 31.1%, respectively. Five (9.3%) died during follow-up period. The mean survival time was 123 months, and the overall 3-, 5-, and 10-year survival rates were 94.2%, 87.2%, and 78.5%, respectively. The extent of surgical excision was the most significant prognostic factor not for survival but for local control (p=0.2179 and 0.0005, respectively). Extracranial metastasis was not seen in our cases. CONCLUSION: Complete surgical excision is the most important factor in improving local control. Careful long-term follow-up is mandatory because atypical meningioma shows a broad range of aggressiveness and natural history.