Hypofractionated conformal irradiation of patients with malignant glioma.

PURPOSE: The aim of the study is to evaluate the effect of a conformal irradiation in short fractionation scheme of 49.5Gy in 15 fractions in an overall time of 3 weeks, in terms of overall survival (OAS) and progression free survival (PFS) rates in brain glioma patients. PATIENTS AND METHODS: A prospective study was conducted on 54 brain glioma patients and was carried out in the Radiation Oncology Department, South Egypt Cancer Institute, Assiut University during the period from April 2006 till June 2009. Patients were treated by hypofractionated conformal irradiation (49.5 Gy/15 fractions/3 weeks). RESULTS: The median follow up was 23 months (range: 9-39 months). Two-year OAS and PFS rates were 68% and 60%, respectively. In univariate analysis, age >50 years, poor performance status [Karnofasky score of ≥40-≤70%], poor neuroperformance status of score III, high-grade tumor [glioblastoma multiforme], and biopsy were all associated with statistically significant reduction in OAS and PFS rates. Multivariate analysis, showed that age >50 years and glioblastoma pathology were the only independent prognostic factors that were associated with poor OAS (p=0.003 and p=0.004, respectively), and PFS (p=0.027 and p=0.011, respectively). CONCLUSION: Hypofractionated conformal radiotherapy was as effective as the conventional radiotherapy, with time sparing for patients, and for radiation oncology centers. Hypofractionated radiotherapy may be considered the radiotherapy regimen of choice in clinical practice for patients with gliomas.

Esthesioneuroblastoma: is there a need for elective neck treatment?

PURPOSE: To assess the risk of cervical lymph node metastases after definitive treatment for esthesioneuroblastoma (ENB) that did not include elective neck therapy. METHODS AND MATERIALS: This was a retrospective analysis of 26 ENB patients treated at the University of Michigan between 1995 and 2007. Tumor stage was Kadish A in 1 patient, B in 19, C in 5, and unknown in 1. Craniofacial or subcranial resection was performed in 24 patients (92%), with negative margins in 22 (92%). Postoperative radiotherapy (RT) to the primary site was given in 12 patients (46%), and 14 patients (54%) had surgery alone. All patients had clinically N0 disease, and no patient underwent elective neck dissection or radiation. Median follow-up was 72 months. RESULTS: Local relapse-free survival was significantly better for patients who received postoperative RT compared with those who had surgery alone: 100% vs. 29% at 5 years, respectively (p = 0.005). Five-year disease-free survival was 87.5% in the RT group vs. 31% in the surgery-alone group (p = 0.05). Regional failure was observed in 7 patients (27%), 6 with Kadish Stage B and 1 with Stage C disease. The most common site of nodal failure was Level II, and 3 patients failed in the contralateral neck. Only 3 patients with regional failure were successfully salvaged. CONCLUSION: The high rate of regional failures when the neck is not electively treated justifies elective nodal RT in patients with both Kadish Stages B and C. In addition, our experience confirms the beneficial effect on local control of adjuvant RT to the tumor bed.

Feasibility of breast conservation after neoadjuvant taxene based chemotherapy in locally advanced breast cancer: a Prospective Phase I trial.

BACKGROUND: Neoadjuvant chemotherapy is the standard care for locally advanced breast cancer. Our study aimed at evaluating the feasibility of breast conversation surgery (BCS) after neoadjuvant chemotherapy. PATIENTS AND METHODS: Forty five patients had stage IIB (except those with T2N1 disease) and stage IIIA were selected to 3 cycles taxane-based neoadjuvant chemotherapy. Patient who had tumours ≤5 cm underwent a tentative BCS while patients who had tumour size >5 cm underwent radical surgery. Negative margin is essential for BCS. Adjuvant chemotherapy and 3-D radiotherapy ± hormonal treatment were given to all patients. RESULTS: Thirty four patients had BCS. Response to chemotherapy was the only statistically significant factor which influences the BCS. Incidence of local recurrence was 5.9% for patients who had BCS at a median follow up 24 months. CONCLUSION: Breast conservation is feasible in selected cases of locally advanced, non metastatic cancer breast. We recommend that patients who have tumour size ≤4 cm after chemotherapy are the best candidates for BCS.

Esthesioneuroblastoma: the role of post-operative irradiation after complete surgical resection.

BACKGROUND: Esthesioneuroblastoma is a rare tumor and this retrospective report was done to evaluate the role of post-operative radiotherapy after complete surgical resection of the tumor. PATIENTS AND METHODS: Twenty nine patients with Esthesioneuroblastoma of Kadish stages A (1), B (19), C (6) and unknown (3) were retrospectively identified through the hospital data-base, patients charts, imaging studies and computerized notes between 1995 to 2007 at Department of Radiation Oncology, University of Michigan, U.S.A. RESULTS: After complete surgical resection (mostly craniofacial resection) of the tumor, 13 (44.8%) patients received post-operative radiotherapy to the tumor bed and 16 (45.2%) patients did not receive. Only one patient received adjuvant nodal irradiation. At a median followup 80 months, local recurrence developed in 11 of 16 (68.7%) patients in the group which did not receive postoperative radiotherapy, compared with 2 of 13 (15.3%) patients in the group which received. Disease free cumulative survival rate at 5-years was 88% for the group which received post-operative radiotherapy compared with 35% for the group which did not receive (p=0.02). Lymph node recurrence in retropharyngeal and level II nodes was observed in 7 (24%) patients of whole group. CONCLUSION: Adjuvant radiotherapy to the tumor bed after craniofacial resection improves significantly local control and disease free survival. Our results suggest that in addition to the tumor bed, prophylactic irradiation of the upper neck is necessary in patients with Kadish stages B and C. KEY WORDS: Esthesioneuroblastoma - Radiotherapy - Surgery.

Initial results of bladder preserving approach by chemo-radiotherapy in patients with muscle invading transitional cell carcinoma.

BACKGROUND: This study was conducted to test the efficacy and tolerability of trimodality treatment for invasive bladder cancer and to test the possibility of bladder sparing. METHODS: This study had been carried out on 50 patients with transitional cell carcinoma (TCC) stage T2- T3 tumors with adequate performance status and renal function. All patients were subjected to maximum transurethral resection of bladder tumors (TURBT). Patients were then subjected to chemo-radiation that was executed in two treatment phases. Phase I was external radiotherapy in the form of 46 Gy /23 fractions /5 weeks to whole pelvis with concurrent cisplatin 40 mg/m2 weekly. Phase II was 20 Gy /10 fractions /2 weeks to the bladder tumor with concurrent cisplatin 40 mg/m2 weekly. After phase I, patients who had complete response (CR) or partial response (PR) were subjected to phase II and patients who had stationary disease (SD) were subjected to salvage cystectomy. After the end of treatment, patients who had CR were subjected to bladder preservation. Radiological and cystoscopic reevaluation was done to assess the tumor response after phase I and phase II. After completion of the scheduled treatment, patients were under follow up for clinical examination, radiological, and cystoscopic assessment. RESULTS: The treatment schedule was tolerable and was associated with infrequent incidence of moderate toxicity that was easily controlled without interruption of treatment. Bladder preservation was achieved in 72%of patients. The actuarial relapse free survival and overall survival at a median follow up 18 months for patients who were candidate for bladder preservation were 81% and 100%; respectively. Invasive recurrence (16%) salvaged with cystectomy and superficial recurrence (6%) successfully treated with Bacilles bilie de CalmetteGuerin. CONCLUSIONS: This study indicates that in spite of a relatively small number of patients and short follow-up period; the trimodality treatment could be an effective way to achieve a high response rate in the treatment of invasive TCC of the bladder with good tolerance.