125Ⅰ seed brachytherapy for recurrent salivary gland carcinoma after external radiotherapy / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinical application and efficacy of 125Ⅰ radioactive seeds implantation in the treatment of recurrent salivary gland carcinoma after external radiotherapy.@*METHODS@#From July 2004 to July 2016, 43 cases of recurrent salivary gland carcinoma of the neck after external radiotherapy or surgery combined with external radiotherapy were treated. According to the conventional segmentation radiotherapy for head and neck cancer (once a day, 1.8-2.0 Gy each time, 5 days per week), the cumulative radiation dose of the patients in this group was calculated. In the study, 26 patients received 50-60 Gy, 7 patients received less than 50 Gy, 4 patients received 60-70 Gy, and 6 patients received more than 80 Gy (range: 80-120 Gy). The interval between the last external irradiation and local recurrence was 4-204 months, and the median interval was 48 months. Among them, 25 cases were treated with 125Ⅰ radioactive seeds implantation only and 18 cases were treated with 125Ⅰ radioactive seeds implantation after operation. The prescription dose was 100-140 Gy. The control rate, survival rate and disease-free survival rate were recorded to evaluate the side effects.@*RESULTS@#The median follow-up time was 27 months (ranging from 2.5 to 149.0 months). Among them, the median follow-up time of adenoid cystic carcinoma patients was 31 months (range: 2.5-112.0 months), and the median follow-up time of mucoepidermoid carcinoma patients was 18 months (range: 5-149 months). The local control rates for 1, 3 and 5 years were 66.5%, 48.8% and 42.7%, respectively. The 1-, 3- and 5- year survival rates were 88.0%, 56.7% and 45.8%, respectively. The disease-free survival rates of 1, 3 and 5 years were 58.3%, 45.4% and 38.1%, respectively. There was no statistically significant difference in local control rate, survival rate, and disease-free survival between the radioactive seeds implantation group and the radioactive seeds implantation group after surgical resection. There were 2 cases of acute radiation reaction Ⅰ/Ⅱ and 3 cases of reaction Ⅲ or above. In the late stage of radiotherapy, there were 8 cases with Ⅰ/Ⅱ grade reaction and 3 cases with Ⅲ grade or above reaction. The incidence of radiation reactions of Grade Ⅲ and above was 7%.@*CONCLUSION@#125Ⅰ radioactive seeds implantation provides an alternative method for the treatment of recurrent salivary gland carcinoma after external radiotherapy. The local control rate and survival rate are improved on the premise of low incidence of side effects.

Salvage radiotherapy for biochemical recurrence after radical prostatectomy: does the outcome depend on the prostate cancer characteristics?

ABSTRACT Objective: To build a model to evaluate the impact of salvage radiotherapy (SRT) in men with PSA rise or persistent PSA after undergoing radical prostatectomy (RP). Materials and Methods: The study included 107 node-negative patients treated with SRT after RP at a single institution. Patients received SRT for either prostate-specific antigen (PSA) rising, or PSA persistence after RP. All patients received local radiation to the prostate / seminal vesicle bed. The primary measured outcome was the biochemical recurrence (BCR) free survival. Multivariable Cox regression analysis was used to develop a risk-stratification group to identify predictive factors associated with the probability of BCR at 5yr. Results: At a median follow-up of 52 months, the BCR free survival rate and overall survival in 5 years was 73% and 94%, respectively. At multivariable analysis, pre-SRT PSA level > 0.35ng / mL (p = 0.023), negative margins (p = 0.038), and seminal vesicles invasion (p = 0.001) were significantly associated with BCR free survival. Three risk groups using regression analysis for SRT administration was built. Low-, intermediate- and the high-risk groups had a BCR free survival in 5-years of 96%, 84%, and 44% (p = 0.0001), respectively. Conclusions: We developed a risk group stratification to show the impact of SRT based on prostate cancer characteristics. SRT showed to be extremely beneficial for patients with low- and intermediate-risk tumors. Moreover, the risk-group built could identify patients classified as high-risk who might benefit from more aggressive treatment for SRT.

Cervical cancer: what's new? / Câncer de colo do útero: o que há de novo?

SUMMARY Cervical cancer is the most common gynecological cancer in Brazil. Among women, it is the second most frequent, second only to breast cancer. It is the fourth leading cause of cancer death in the country, with estimated 15,590 new cases (2014) and 5,430 deaths (2013). In order to update information to improve outcomes, reduce morbidity and optimize the treatment of this cancer, this article will address the advancement of knowledge on cervical cancer. The topics covered include the role of surgery in different stages, treatment of locally advanced carcinomas, fertility preservation, the role of the sentinel lymph node technique, indications and techniques of radiotherapy and chemotherapy, and some special situations.

RESUMO O câncer de colo uterino é o câncer ginecológico mais frequente em nosso meio. Entre as mulheres, é o segundo mais frequente, atrás apenas do câncer de mama. É a quarta causa de morte por câncer no Brasil, com estimativa de 15.590 casos novos (2014) e com 5.430 mortes (2013). No intuito de atualizar informações para a melhora do prognóstico, redução da morbidade e otimização do tratamento dessa neoplasia, serão abordados neste artigo os avanços nos conhecimentos sobre o câncer cervical. Entre os temas apresentados, estão o papel da cirurgia nos diferentes estádios, o tratamento dos carcinomas localmente avançados, a preservação da fertilidade, o papel da técnica do linfonodo sentinela, indicações e técnicas da radio e quimioterapia, além de situações especiais.

Delayed postoperative radiation therapy in local control of squamous cell carcinoma of the tongue and floor of the mouth / Retardo da radioterapia pós-operatória no controle local do carcinoma epidermoide de língua e soalho de boca

Objective To evaluate the effect of time between surgery and postoperative radiation therapy on local recurrence of squamous cell carcinoma of the tongue and floor of the mouth. Methods A total of 154 patients treated between 1996 and 2007 were selected considering local recurrence rate and time of the adjuvant radiotherapy. Results Local recurrence was diagnosed in 54 (35%) patients. Radiation therapy reduced the rate of local recurrences, although with no statistical significance. The time between surgery and initiation of postoperative radiotherapy did not significantly influence the risk of local recurrence in patients referred to adjuvant treatment (p=0.49). Conclusion In the presence of risk factors for local recurrence, a short delay in starting the adjuvant radiation therapy does not contraindicate its performance. .

Objetivo Avaliar o efeito do tempo entre o tratamento cirúrgico e a radioterapia pós-operatória nas recidivas locais do carcinoma epidermoide de língua e soalho da boca. Métodos Foram selecionados 154 pacientes tratados entre 1996 e 2007, considerando a frequência das recidivas locais e o tempo para início da radioterapia adjuvante. Resultados As recidivas locais foram diagnosticadas em 54 (35%) pacientes. A radioterapia reduziu a frequência de recidivas locais, embora sem significância estatística. O tempo entre a cirurgia e o início da radioterapia pós-operatória não influenciaram, de forma significante, no risco de recidivas locais entre o pacientes que tinham indicação de tratamento adjuvante (p=0,49). Conclusão Na presença de fatores de risco para recidiva local, um pequeno atraso no início da radioterapia adjuvante não contra-indica sua realização. .

Efficacy of radical radiotherapy alone for functional preservation of larynx in laryngeal carcinoma: A retrospective analysis.

PURPOSE: Concurrent chemoradiation is the current standard of care in locally advanced head and neck cancer. But, in our setup, many patients of carcinoma larynx are treated with only radical radiotherapy because of poor general condition of the patients. This study was performed to assess the influence radical radiotherapy alone on functional preservation of larynx. MATERIALS AND METHODS: 110 previously untreated patients with invasive squamous cell carcinoma of larynx were treated with radical radiotherapy alone between January 2006 and June 2009. Conventional one daily fraction of 2 Gy with total doses of 60–66 Gy was used. Voice preservation and local control at median follow-up period of 2 years were analyzed. Several host, tumor, and treatment parameters were also analyzed. RESULTS: Among 110 patients, preservation of larynx was possible in 78 patients (71%). With radical radiotherapy alone, excellent preservation of larynx was achieved in stage I (88.9%) and stage II (75%) disease, while in advanced stages, results were not so encouraging. In stage III and stage IVA, larynx preservation was only 72.4% and 65.3%, respectively. Patients without any cartilage invasion had significantly better laryngeal preservation rate as compared to patients with cartilage invasion. (78.9% vs. 35.3%; P = 0.008). CONCLUSION: Though concurrent chemoradiation is the standard of care in preservation of voice in laryngeal cancer, definitive radiotherapy alone may also be a good option in terms of preservation of larynx in patients of laryngeal cancer in community practice in the developing world where most of the patients cannot tolerate concurrent chemoradiation.

High Dose Involved Field Radiation Therapy as Salvage for Loco-Regional Recurrence of Non-Small Cell Lung Cancer

PURPOSE: To determine the effectiveness of salvage radiation therapy (RT) in patients with loco-regional recurrences (LRR) following initial complete resection of non-small cell lung cancer (NSCLC) and assess prognostic factors affecting survivals. MATERIALS AND METHODS: Between 1994 and 2007, 64 patients with LRR after surgery of NSCLC were treated with high dose RT alone (78.1%) or concurrent chemo-radiation therapy (CCRT, 21.9%) at Samsung Medical Center. Twenty-nine patients (45.3%) had local recurrence, 26 patients (40.6%) had regional recurrence and 9 patients (14.1%) had recurrence of both components. The median RT dose was 54 Gy (range, 44-66 Gy). The radiation target volume included the recurrent lesions only. RESULTS: The median follow-up time from the start of RT in survivors was 32.0 months. The rates of in-field failure free survival, intra-thoracic failure free survival and extra-thoracic failure free survival at 2 years were 52.3%, 33.9% and 59.4%, respectively. The median survival after RT was 18.5 months, and 2-year overall survival (OS) rate was 47.9%. On both univariate and multivariate analysis, the interval from surgery till recurrence and CCRT were significant prognostic factors for OS. CONCLUSION: The current study demonstrates that involved field salvage RT is effective for LRR of NSCLC following surgery.

Radioterapia adjuvante no câncer de mama operável / Adjuvant radiotherapy in operable breast cancer

O tratamento do câncer de mama inicial começa com a obtenção do controle locorregional. A radioterapia adjuvante é uma modalidade de tratamento local utilizada no câncer de mama para reduzir a recidiva local após o tratamento cirúrgico. A associação entre um adequado controle local e o aumento de sobrevida tem sido frequentemente observada. Os mecanismos, entretanto, através dos quais a aplicação da radiação ionizante no sítio tumoral primário pode resultar em efeitos sistêmicos, são um grande motivo de debates. Este artigo revisa dados sobre o papel da radioterapia adjuvante no câncer de mama operável, tanto pós-cirurgia conservadora quanto pós- mastectomia, assim como seus resultados locais e sistêmicos

The treatment of early breast cancer begins with the locorregional control. Adjuvant radiotherapy is a local treatment modality employed in breast cancer to reduce the local recurrence following surgery. The association between optimal local control and improved survival has been commonly observed. The mechanisms however whereby the application of ionizing radiation to the primary tumor site can result in systemic effects is subject of much debate. This article reviews data about the role of adjuvant radiotherapy in operable breast cancer post-conservative surgery and post-mastectomy as well as its local and systemic results

Low risk stage I endometrial carcinoma: Prognostic factors and outcomes.

Objectives: The aim of the study is to evaluate clinical features of patients with low-risk stage I endometrium cancer, who received adjuvant therapy or followed with observation only and to analyse the effects of known prognostic factors in this group of patients. Materials and Methods: A total of 246 patients (median age: 53, range: 31-77) with low-risk stage I endometrial cancer, who were just followed postoperatively (156 patients) or received adjuvant radiotherapy (90 patients) between 1996 and 2007 were reviewed retrospectively. Results: Local recurrence was detected in four patients, distant metastasis occurred in seven patients, and two patients had both local recurrence and distant metastasis. The 83.3% of recurrences were on the vaginal stump. Five- and ten-year local control (LC) and overall survival (OS) rates are 97.6%, 97.6% and 96.4%, 93.5% in the observation and adjuvant therapy groups, respectively, whereas distant control rates are 96.7% and 96.3%. In multivariate analysis, only age and lymphovascular invasion (LVI) were found to affect OS and disease-free survival (DFS). Conclusions: LC and OS rates are high in the low-risk group of patients; however, current adjuvant therapies did not improve the outcomes. Age over 60 years and the presence of LVI have negative effects on outcomes in this group of patients.

Recovery of hormone sensitivity after salvage brachytherapy for hormone refractory localized prostate cancer

PURPOSE: Recent work has demonstrated the return of hormone sensitivity after palliative chemotherapy in androgen independent prostate cancer. We wished to establish whether a similar phenomenon existed in patients with no exposure to chemotherapy. MATERIALS AND METHODS: A review of “hormone resistant” patients who had received salvage brachytherapy for localized prostate cancer after previous external beam radiotherapy was undertaken. Three patients with subsequent biochemical relapse responded to the rechallenge with hormonal treatment. RESULTS: The series of patients presented here demonstrates this phenomenon occurs after salvage brachytherapy with no exposure to chemotherapy. Recovery of sensitivity is demonstrated both to androgen deprivation and to androgen receptor antagonism. The recovery of hormone sensitivity was surprisingly durable, ranging from eight months to over twenty-one months. CONCLUSIONS: Hormone sensitivity may be recovered after salvage brachytherapy. Potential mechanisms underlying these observations are discussed and the likely central role of the activity of the androgen receptor highlighted. The relevance of these findings to the management of advanced prostate cancer is considered including thoughts on the practice of intermittent anti-androgen therapy.

Tumor de vaina nerviosa periférica maligno asociado a neurofibromatosis tipo 1: informe de dos casos / Malignant peripheral nerve sheath tumors associated with neurofibromatosis type 1: report of two clinical cases

Introducción: El tumor de vaina nerviosa periférica maligno (TVNPM) es un sarcoma de alto grado de malignidad, originado de componentes de las vainas nerviosas, fibroblastos, células perineurales y células de Schwann, que se asocia a neurofibromatosis tipo 1 con un riesgo de 10 a 13 %. Casos clínicos: Se presentan dos casos de TVNPM asociado a neurofibromatosis tipo 1. El primero presentó dolor moderado sin causa aparente, además de lesión intrarraquídea en resonancia magnética nuclear, manejada quirúrgicamente en dos ocasiones. Histológicamente correspondió a lesión neurofibromatosa en transición con neoplasia maligna. El segundo se manifestó con cifoescoliosis torácica, dolor y aumento de volumen. Asociado a la deformidad, la resonancia magnética mostró tumor en la región torácica posterior (T1 a T8), que fue resecado; se identificó neoplasia sarcomatosa infiltrante, muy celular, con inmunopositividad para proteína S100 y vimentina. Conclusiones: Los TNVPM son sarcomas con alto índice de recurrencia, capaces de producir metástasis a distancia desde etapas tempranas. A pesar de la resección amplia, los pacientes descritos no sobrevivieron dado el avance y tamaño de las lesiones. Por el crecimiento progresivo de los TNVPM y la dificultad anatómica para su abordaje, deberá tenerse un control estrecho de los pacientes con neurofibromatosis tipo 1 a fin de identificar tempranamente la transformación maligna de las lesiones.

BACKGROUND: Malignant peripheral nerve sheath tumor (MPNST) is a sarcoma with a high grade of malignancy originating in the nerve sheath components, fibroblasts, perineural cells, and Schwann cells. It is associated with neurofibromatosis type 1 (NF-1) with a risk of 10-13%. CLINICAL CASES: We present two cases of NF-1-associated MPNST. The first patient presented moderate pain with no apparent cause, in addition to the presence of intraspinal lesion demonstrated by nuclear magnetic resonance imaging (NMRI), which was managed surgically on two occasions. Histologically, it corresponded to a neurofibromatosis lesion in transition with malignant neoplasm. The second case manifested with thoracic kyphoscoliosis, pain, and an increase in volume. Associated with the deformity, MRI showed a withering tumor in the posterior thoracic region (T1-T8), observing an infiltrating, cellular sarcomatous neoplasm with immunopositivity for S-100 protein and vimentin. CONCLUSIONS: MPNSTs are sarcomas with a high index of recurrence with the ability to produce distant metastasis during early stages. Despite wide resection, patients did not survive due to the advancement and size of the lesions (determining factors in the prognosis). Due to the progressive growth of MPNST and the anatomic difficulty for its approach, there should be strict surveillance of patients with NF-1 for early detection of malignant transformation in these lesions.

Exenteração pélvica para câncer do colo uterino recidivado pós-radioterapia: experiência de um centro terciário do Nordeste brasileiro / Post-radiotherapy pelvic exenteration in relapsed cervical cancer: experience of a tertiary health service in the northeast of Brazil

OBJETIVO: analisar complicações, morbidade, mortalidade e sobrevida num grupo de pacientes com câncer de colo uterino com recidiva pélvica central submetidas à exenteração pélvica pós-tratamento primário com radioterapia. MÉTODOS: estudo retrospectivo de uma série de 16 casos de exenteração pélvica pós-tratamento primário com radioterapia. Foi realizada estatística descritiva, curva de sobrevida pelo método de Kaplan-Meier e análise de regressão linear múltipla para avaliar fatores prognósticos. RESULTADOS: dezesseis pacientes foram submetidas à exenteração pélvica. O carcinoma epidermoide, o estádio IIb e o grau indiferenciado foram as condições mais frequentes. A recidiva tumoral pós-operatória ocorreu na metade dos casos. Onze pacientes apresentaram complicações perioperatórias ou pós-operatórias e as mais frequentes foram infecções pélvica e da ferida operatória e fístulas urinárias. A sobrevida global foi de 64,3 por cento, com um seguimento mediano de 11 meses. A análise de regressão linear múltipla não revelou fatores prognósticos significativos na sobrevida das pacientes. CONCLUSÕES: a taxa de sobrevida foi de 64,3 por cento. Nenhum fator associado a pior prognóstico foi encontrado nesta série.

PURPOSE: to analyze complications, morbidity, mortality and survival rate in a group of patients with cervical cancer with central pelvic relapse after primary radiotherapy treatment. METHODS: retrospective study of a series of 16 cases of pelvic exenteration after primary radiotherapy treatment. Descriptive statistics, survival curve through Kaplan-Meier's method, and regression analysis to evaluate prognosis were performed. RESULTS: sixteen patients have undergone pelvic exenteration. Epidermoid carcinoma, IIb stage and undifferentiated grade were the most frequent conditions. Post-operatory tumor relapse occurred in half the cases. Eleven patients presented peri or post-surgical complications, the most frequent being pelvic infection, that of the surgical wound, and urinary fistulae. Global survival rate was 64.3 percent, with average follow-up of 11 months. Regression analysis did not detect any significant prognosis factor for the patient survival. CONCLUSIONS: the survival rate was 64.3 percent. No particular factor associated to poor prognosis has been found in the present series of cases.

Reirradiation with high-dose-rate remote afterloading brachytherapy implant in patients with locally recurrent or residual cervical carcinoma.

PURPOSE: To assess the outcome for patients with postradiation locally recurrent or residual cervical malignancies treated with high-dose-rate (HDR) remote afterloading brachytherapy implant. This is a prospective study. MATERIALS AND METHODS: Twenty-two patients with postradiation recurrent cervical carcinomas were treated with HDR interstitial brachytherapy. All of these 22 patients had received some form of radiotherapy prior to implant placement and had biopsy-proven recurrence. Implant dose for these patients was in the range of 12-45 Gy, with a median dose of 25.80 Gy. RESULTS: Overall survival was better for patients in the 'no bad prognostic factor' (NBPF) group than for patients in the 'bad prognostic factor' (BPF) group and this difference was statistically significant. Overall survival was better for patients who had stage II disease before implant placement than for those who had stage III disease and also for patients who had relatively less parametrial disease. Grade 4 complications were seen only in four patients and were within acceptable limits. Multivariate analysis showed that only the BPF variable had a statistically significant effect on survival. CONCLUSION: We conclude that reirradiation with HDR brachytherapy implant in recurrent or residual carcinoma cervix can give a good chance of survival, with acceptable morbidity, if proper selection of patients is done. This treatment should not be done for palliative purposes.

Stereotactic Body Radiotherapy for Isolated Para-aortic Lymph Node Recurrence after Curative Resection in Gastric Cancer

The aim of this study was to investigate whether stereotactic body radiotherapy (SBRT) can salvage gastric cancer patients with para-aortic lymph node (PALN) recurrence. From January 2003 to December 2006, 7 patients were treated for isolated PALN recurrence from gastric cancer after curative resection. Follow up durations ranged from 19 to 33 months (median; 26 months), and SBRT doses from 45 Gy to 51 Gy (median 48 Gy) in 3 fractions. Disease progression-free and overall survivals and toxicities were recorded. Response to treatment was assessed by computed tomography. Final patient outcomes were as follows: 2 were alive without evidence of disease, 3 remained alive with disease, and 2 patients died of disease. Five of 7 patients showed complete response and 2 patients partial response between 3 and 11 months after SBRT. Three-year overall and disease progression-free survival rates post-SBRT were 43% and 29%, respectively. No severe complication was detected during follow-up. Selected patients with isolated PALN recurrence can be salvaged by SBRT without severe complications.

Stereotactic Body Radiotherapy for Isolated Para-aortic Lymph Node Recurrence after Curative Resection in Gastric Cancer

The aim of this study was to investigate whether stereotactic body radiotherapy (SBRT) can salvage gastric cancer patients with para-aortic lymph node (PALN) recurrence. From January 2003 to December 2006, 7 patients were treated for isolated PALN recurrence from gastric cancer after curative resection. Follow up durations ranged from 19 to 33 months (median; 26 months), and SBRT doses from 45 Gy to 51 Gy (median 48 Gy) in 3 fractions. Disease progression-free and overall survivals and toxicities were recorded. Response to treatment was assessed by computed tomography. Final patient outcomes were as follows: 2 were alive without evidence of disease, 3 remained alive with disease, and 2 patients died of disease. Five of 7 patients showed complete response and 2 patients partial response between 3 and 11 months after SBRT. Three-year overall and disease progression-free survival rates post-SBRT were 43% and 29%, respectively. No severe complication was detected during follow-up. Selected patients with isolated PALN recurrence can be salvaged by SBRT without severe complications.

Avaliação da sobrevida livre de doença de pacientes com recidiva loco-regional de carcinoma epidermóide de cavidade bucal e orofaringe submetidos a tratamento de resgate / Assessment of disease-free survival in patients with loco-regional recurrence of squamous cell carcinoma of the oral cavity and oropharynx submitted to salvage treatment

OBJETIVO: A cirurgia de resgate é primeira opção terapêutica, principalmente nas lesões de estadio clínico inicial. O objetivo do estudo é avaliação da sobrevida livre de doença após resgate cirúrgico de tumores de cavidade bucal e orofaringe. MÉTODOS: Estudo retrospectivo de 276 pacientes tratados com cirurgia, sendo que 127 desenvolveram recidiva loco-regional. Noventa e sete pacientes eram de estadiamento clínico inicial e 178 de estadiamento clínico avançado. Vinte e cinco casos de lábio, 173 cavidade bucal e 78 de orofaringe. A radioterapia pós-operatória foi realizada em 121 pacientes com dose média de 60,8 Gy. RESULTADOS: Oitenta e nove pacientes foram submetidos a tratamento de resgate, sendo que 76 destes foram à cirurgia. As recidivas loco-regionais de cavidade bucal foram submetidas ao resgate cirúrgico em 65 por cento casos. A sobrevida livre de doença pós-cirurgia de resgate foi de 13 por cento nas recidivas até seis meses e 48 por cento nas recidivas após 12 meses de seguimento (p=0,0009). O tipo de resgate e o intervalo livre de doença foram fatores independentes de sobrevida na análise multivariada. CONCLUSÃO: A sobrevida livre de doença pós-resgate nos estadios clínicos iniciais (I e II) foi de 70 por cento.

OBJECTIVE: Salvage surgery is the first therapeutic option for recurrent tumors of the mouth and oropharynx, mainly in early stage tumors. This study intends to evaluate the disease free survival interval after salvage treatment for recurrent tumors of the mouth and oropharynx. METHODS: Retrospective analysis of 276 patients with squamous cell carcinoma of the mouth and oropharynx treated with surgery. One hundred and twenty seven patients developed loco-regional recurrence. Ninety-seven were staged as early tumors and 178 as advanced ones. The tumor site was the lip in 25 cases, oral cavity in 173 and oropharynx in 78. Postoperative radiotherapy was indicated in 121 cases with a mean dose of 60.8Gy. RESULTS: Eighty-nine patients underwent salvage treatment (surgery in 76 patients). Loco-regional recurrences were treated with salvage surgery in 65 percent of cases. Disease free survival after salvage surgery was 13 percent in cases with recurrences diagnosed up to 6 months and 48 percent in those who recurred after 12 months of follow-up (p=0.0009). Modality of salvage treatment and the disease free interval were independent variables of survival in the multivariate analysis. CONCLUSION: In cases clinically staged as I and II, the disease free survival in five years after salvage treatment was 70 percent.

Second Line Palliative Endobronchial Radiotherapy with HDR Ir 192 in Recurrent Lung Carcinoma

PURPOSE: To observe the efficiency of reirradiation with high dose rate intraluminal brachytherapy in symptomatic palliation of recurrent endobronchial tumors. MATERIALS and METHODS: Between January 1994 and June 1998, 21 patients diagnosed with recurrent endobronchial tumors following external beam radiotherapy were treated palliatively with high dose rate intraluminal irradiation at Hacettepe University Oncology Institute. A single fraction of 10Gy was prescribed to the specified area in 9 patients and 15Gy to 12. RESULTS: Endobronchial treatment improved the performance and reduced symptomatology in 17 (81%) patients. Ten dyspneic patients (10/14, 71%) recovered clinically with an accompanying radiological downstaging. The median symptomatic palliation was 45 days (range, 0-9 months), and the overall median survival was 5.5 months (range, 4-12 months). The palliative intrabronchial brachytherapy was well tolerated, with the exception of in one patient with a fatal hemorrhage, and another with medically salvaged bronchospasm and intrabronchial edema. CONCLUSION: Recurrent patients with a history of previous thoracic external beam irradiation can be effectively palliated with high dose rate endobronchial reirradiation if the symptoms are directly related to the endobronchial tumor.

Tratamento da neoplasia trofoblástica gestacional de alto risco resistente à quimioterapia / Therapy of high risk gestational trophoblastic neoplasia resistant to chemotherapy

Neoplasia trofoblástica gestacional (NTG) de alto risco inclui os estadios I, II ou III: escore de risco sete ou mais ou estadio IV da classificação atual FIGO 2000. Embora bem estabelecidos os protocolos EMA-CO como primeira linha e EP-EMA como primeira ou segunda linha de tratamento, aproximadamente 30 porcento das pacientes com NTG de alto risco desenvolvem resistência ou apresentam recidiva seguindo a remissão. Ao constatar-se a resistência ou recidiva, deve-se proceder à reavaliação imediata da paciente, com base no Sistema de Estadiamento FIGO 2000, para clarear o tratamento de resgate em tempo hábil - poliquimioterapia e/ou cirurgia e/ou radioterapia. Não existe protocolo ideal para o tratamento de pacientes com NTG de alto risco resistente à quimioterapia. Assim sendo, o tratamento deve ser individualizado de acordo com a condição clínica da paciente e a experiência do centro especializado. Este estudo refere-se à NTG de alto risco resistente à quimioterapia, apresentando os principais regimes alternativos de poliquimioterapia, a quimioterapia de alta dose, o tratamento de consolidação, o papel da cirurgia e da radioterapia e o seguimento pós-remissão completa.

Radical radiotherapy treatment (EBRT + HDR-ICRT) of carcinoma of the uterine cervix: outcome in patients treated at a rural center in India.

AIM: To report the outcome of carcinoma of the uterine cervix patients treated radically by external beam radiotherapy (EBRT) and high-dose-rate (HDR) intracavitary radiotherapy (ICRT). MATERIALS AND METHODS: Between January 1997 to December 2001, a total of 550 newly diagnosed cases of carcinoma of the uterine cervix were reported in the department. All cases were staged according to the International Federation of Gynecologists and Oncologists (FIGO) staging system, but for analytical convenience, the staging was limited to stages I, II, III, and IV. Out of the 550 cases, 214 completed radical radiotherapy (EBRT + HDR-ICRT) and were retrospectively analyzed for presence of local residual disease, local recurrence, distant metastases, radiation reactions, and disease-free survival. RESULTS: There were 7 (3.27%), 88 (41.1%), 101 (47.1%), and 18 (8.4%) patients in stage I, II, III, and IV, respectively. The median follow-up time for all patients was 43 months (range: 3-93 months) and for patients who were disease free till the last follow-up it was 59 months (range: 24-93 months). The overall treatment time (OTT) ranged from 52 to 73 days (median 61 days). The 5-year disease-free mean survival rate was 58%, 44%, 33%, and 15%, with 95% confidence interval of 48 to 68, 37 to 51, 24 to 35, and 6 to 24 for stages I, II, III, and IV, respectively. There were 62 (28.97%) cases with local residual disease, 35 (16.3%) developed local recurrence/distant metastases, 17 (7.9%) developed distant metastases, and 9 (4.2%) had local recurrence as well. DISCUSSION AND CONCLUSION: The overall outcome was poor in advanced stage disease, but might be improved by increasing the total dose, decreasing overall duration of treatment, and by adding chemotherapy in patients with disease limited to the pelvis.

Prostatectomía radical en el tratamiento del cáncer de próstata / Radical prostatectomy for the treatment of prostate cancer

El cáncer de próstata es una patología prevalente que puede ser manejada con distintas modalidades de tratamiento. La prostatectomía radical es una de las más aceptadas y esta ampliamente validada. Se presenta una revisión retrospectiva de 141 pacientes sometidos a prostatectomía radical por nuestro equipo entre año 1997 y el 2003. Las edades de los pacientes fluctuaron entre 47 y 72 años con un promedio de 62,8. El seguimiento máximo fue de 80 meses con un promedio de 43,5 meses. De los pacientes operados, 104 (73 por ciento) se encuentran libres de enfermedad hasta la fecha. En 51 pacientes se decidió agregar radioterapia local por elevación del antígeno prostático o evidencia de compromiso de las vesículas seminales, de ellos 32 (62 por ciento) no han vuelto a demostrar actividad tumoral. Tomando en consideración que todos los pacientes tenían enfermedad órgano confinada al momento de diagnóstico, los parámetros que más influyeron en el resultado fueron tanto el score de Gleason como el valor preoperatorio del A.P.E.