Postoperative radiotherapy for locally advanced colon cancer.

BACKGROUND: The role of adjuvant postoperative radiotherapy for locally advanced colon cancer is not well documented. METHODS: Seventy-eight patients who underwent a complete resection of B2-C colon cancer received postoperative radiotherapy. Twenty-eight patients received < or = 45 Gy; 50 patients received 50-55 Gy. Twenty-seven patients received adjuvant fluorouracil-based chemotherapy. All patients were followed for a minimum of 3 years; no patients were lost to follow-up. RESULTS: The overall local control rate was 88%. The 5-year actuarial rate of local control was 96% after 50-55 Gy postoperative radiotherapy compared with 76% after < 50 Gy (p = 0.0095). Multivariate analysis of local control showed that only radiotherapy dose significantly influenced this end point. Cause-specific survival rates at 5 years were B2, 67%; B3, 90%; C1, 100%; C2, 61%; C3, 36%; and overall, 63%. Multivariate analysis of cause-specific survival showed that only stage significantly influenced this end point. Bowel obstruction caused by adhesions developed in three patients and required a laparotomy; radiation-induced sarcoma developed in one additional patient. CONCLUSIONS: Postoperative radiotherapy appears to reduce the risk of local recurrence in patients with locally advanced colon cancer. The optimal dose is probably 50-55 Gy at 1.8 Gy per fraction. Postoperative radiotherapy may improve cause-specific survival for patients with stages B3 and C2 cancers.

Conservative surgery and radiation therapy in early breast cancer: ten-year experience at the West Florida Cancer Institute.

Between July 1981 and December 1989, 143 patients received conservative surgery and radiation for 147 primary breast tumors. Ten lesions were staged as Tis, 122 as T1, and 15 as T2. N stages were NX in 15 cases, N0 in 93, and N1 in 39. All patients had lumpectomy, and 132 (89%) had axillary lymph node dissection. All had irradiation (45 to 50 Gy) to the entire breast. All received an electron boost to the primary site to a total dose of 60 Gy. Minimal follow-up was 18 months, and median follow-up was 56 months; 123 patients had at least 3 years of follow-up, and 59 patients had at least 5 years. The local control rates at 3 and 5 years were 96% and 97%, respectively. Tumor-free states at 3 and 5 years were 93% and 86%, respectively. Minor complications occurred in four patients. Approximately 90% of patients had good to excellent cosmetic results.

A technique for postoperative irradiation of carcinomas of the larynx and hypopharynx.

Postoperative radiation is commonly employed for advanced lesions of the larynx and hypopharynx which have undergone a laryngectomy. It is technically difficult to achieve a homogeneous distribution of irradiation throughout the treatment volume because of the marked variation in contour across the treated area. We have described a technique which employs a 15 degrees lateral kick-out of the treatment table and a 15 degrees gantry angle above the horizontal for each of two lateral fields. This technique has certain advantages over other techniques previously described in the literature. By adding a gantry angle of 15 degrees above the horizontal to the kick-out lateral position of the table, we have found that we were able to decrease the amount of irradiation to the shoulder, to improve the dose to the posterior superior mediastinum, to lower the applied dose, and to avoid a hot spot overlying the spinal cord in the superior posterior portion of the field. This technique is particularly useful in patients who lack the flexibility to move their shoulders posteriorly and inferiorly.