Results of Postoperative Radiation Therapy of Rectal Cancers: with the Emphasis of the Overall Treatment Time / 대한방사선종양학회지

PURPOSE: To evaluate the results of the treatment of locally advanced but resectable rectal cancers and to analyze prognostic factors, especially with the emphasis on the treatment time factor. MATERIALS AND METHODS: There were 71 patients with rectal cancer who had been treated by curative surgical procedure and postoperative radiotherapy from August 1989 to December 1993. The minimum follow up period was 24 months and the median follow-up was 35 months. Radiation therapy had been given by 6 MV linear accelerator by parallel opposing or four-box portals. Whole pelvis was treated up to 5040 cGy in most cases. Systemic chemotherapy had been given in 94% of the patients, mostly with 5-FU/ACNU regimen. Assessment for the overall and disease-free survival rates were done by life-table method and prognostic factors by Log-Rank tests. RESULTS: Five-year overall survival, disease-free survival were 58.8% and 57%, respectively. Two-year local control rate was 76.6%. Stage according to Modified Astler-Coller (MAC) system, over 4 positive lymph nodes, over 6weeks interval between definitive surgery and adjuvant radiotherapy and over 7 days of interruption during radiotherapy period were statistically significant, or borderline significant prognostic factors. CONCLUSION: The treatment results of patients with rectal cancers are comparable to those of other large institutes. The treatment results for the patients with bowel wall penetration and/or positive regional lymph nodes were still discouraging for their high local recurrence rate for the patients with MAC 'C' stage diseases and high distant metastases rate even for the patients with node-negative diseases. Maybe more effective regimen ofchemotherapy would be needed with proper route and schedule. To maximize postoperative adjuvant treatment, radiotherapy should be started at least within 6 weeks after surgery and preferably as soon as wound healing is completed. Interruption of treatment during radiotherapy course affects disease-free survival badly, especially if exceeds 7 days. So, the total treatment period from definitive surgery to the completion of radiotherapy should be kept as minimal as possiable.

Treatment Results for Supraglottic Cancer / 대한치료방사선과학회지

PURPOSE: In supraglottic cancer, radiation therapy is used to preserve the laryngeal function but combined surgery and radiation therapy is required in advanced stage. The authors present the results of radiation therapy alone and combined surgery plus postoperative radiation therapy for supraglottic cancer. METHODS AND MATERIALS: A retrospective analysis was done for 43 patients with squamous cell carcinoma of the supraglottic larynx who were treated from February 1982 to December 1991, in the Department of Radiation Oncology, Korea University Hospital. Patient distribution according to the AJCC staging system was as follows; I, 3(7.0%); II, 7(16.3%); III, 17(39.5%); IV, 16(37.2%). Patients' age ranged from 30 to 72 years(median 62). Follow up durations were from 21 to 137 months(median 27). Seventeen patients(39.5%) were treated by radiation therapy alone with radiation doses of 6840-7380 cGy and 26 patients(60.5%) were treated with surgery plus postoperative irradiation with doses of 5820-6660 cGy. RESULTS: Overall five-year survival rate for all stage was 51.8%, with 100% for Stage I and II, 47.3% for Stage III, and 29.2% for Stage IV. The difference of the survival rate by stage was statistically significant(p=0.0152). Five-year survival rates were 100% for locally confined tumor in the supraglottic larynx, 37.5% for transglottic extension, 26.7% for hypopharynx extension, and only two of 5 patients with both transglottic and hypopharynx extension were alive(p=0.0033). Five-year survival rates by neck node status were as follows: 55.0% for N0, 64.3% for N1, 50.0% for N2, and all 2 of N3 were died of disease. Overall survival rate for radiation therapy alone group was 42.8% and it was 56.7% for surgery plus postoperative radiation therapy group with no statistically significant difference(p=0.5215). In Stage I and II, all patients survived. In Stage III and IV, 5-year survival rate for radiation therapy alone group was 28.5% and 43.4% for surgery plus postoperative irradiation group(p=0.5103). Local control rate was 58.8%(10/17) for radiation therapy alone group and 73.1%(19/26) for surgery plus postoperative irradiation group. Three patients from surgery plus postoperative radiation therapy group developed distant metastasis in lungs. CONCLUSION: Treatment results of radiation therapy alone was excellent in early stage supraglottic cancer. In advanced stage, even the difference was statistically not significant, the result of postoperative radiation therapy group was superior compared with radiation therapy alone group. Since 1992, concomitant chemoradiotherapy with hyperfractionated radiotherapy is being used to improve the result of the treatment and preserve the laryngeal function in advanced stage supraglottic cancer.

Result of Radiation Therapy for Stage I, II Non-Hodgkin's Lymphoma / 대한치료방사선과학회지

A retrospective analysis was done for 69 patients with Stage I and II non-Hodgkin's lymphoma who were treated from May 1981 to December 1990, in the Department of Radiadtion Oncology, Korea University Hospital. We used Ann Arbor Staging system and Working Formulation for histological classification. Forty-three patients(43/69, 62.3%) were Stage I and 26 patients (26/69, 37.7%) were Stage II, and B symptom was found in 10.1%(7/69). Nodal lymphoma was 21.7%(15/69); 14 patients with supradiaphragmatic disease and 1 patient with infradiaphragmatic disease. Extranodal lymphoma was 78.3%(54/69); 64.8%(35/54) for head and neck, 25.9%(14/54) for gastrointestinal tract. Histologically, low grade consists of 8.7%(6/69), intermediate grade 84.2%(56/69), high grade 10.1%(7/69), and diffuse large cell type was the most frequent form with 36 patients (36/69, 52.2%). Eighteen patients(26.1%) were treated with radiation therapy alone, 20 patients(29.0%) with radiation therapy combined with chemotherapy, 15 patients(21.7%) with radiation therapy combined with surgery and chemotherapy. Median survival duration was 28 months, and the range of survival time was from 1 Month to 134 months. Overall five-year survival rate for Stage I and II disease was 54.2%, with 64.5% for Stage I and 37.1% for Stage II. For nodal lymphoma, 5-year survival rate was 45.9%, and 56.5% for extranodal lymphoma; 60.0% for head and neck, 52.5% for GI tract primary disease. Local control rate for all patients was 88.4%(61/69), with 80% (12/15) for nodal lymphoma and 90.7%(49/54) for extranodal lymphoma. The total failure rate was 34.8%(24/69). Five of 24 (20.8%) patients who were failed developed local failure only, 12.5%(3/24) local failure with distant failure, and distant failure only were found in 66.7%(16/24). Between nodal lymphoma and extranodal lymphoma, there was no significant survival difference, but extranodal lymphoma showed higher incidence.