Percent positive axillary involvement predicts for the development of brain metastasis in high-risk patients with nonmetastatic breast cancer receiving post-mastectomy radiotherapy.

We retrospectively assessed the predictive factors for brain metastasis in high-risk breast cancer patients receiving radiotherapy after mastectomy. Between January 1994 and 2002, the medical charts of nonmetastatic breast cancer patients receiving post-mastectomy radiotherapy were evaluated. The clinical and pathologic features of patients who developed brain metastasis as the first site metastatic disease were compared with nonmetastatic patients treated at the same time period. All eligible patients in this study were treated with postoperative radiotherapy +/- chemotherapy. Age, stage, percent positive lymph node involvement, number of lymph node metastasis, primary tumor size, grade, surgical margin status, estrogen receptor status, and perinodal fat tissue invasion were analyzed as predictive factors for brain metastasis. Statistical analyses were performed by using Log-rank test and Cox's regression analysis. Median follow-up-time was 61 months. In this period, 32 out of 957 patients (3.3%) developed brain metastasis. In univariate analysis percent positive axillary lymph node involvement (p < 0.001), primary tumor size (p < 0.001), number of lymph node metastasis (p = 0.01), and American Joint Committee on Cancer 2002 stage (p < 0.001) were found to be predictive for brain metastasis. Multivariate analysis revealed that only the primary tumor size and percent positive lymph node involvement were significant predictive factors for the development of brain metastasis. The primary tumor size and percent positive lymph node involvement increases the risk of brain metastasis in patients with nonmetastatic breast cancer receiving postoperative radiotherapy and chemotherapy.

Treatment results of 165 pediatric patients with non-metastatic nasopharyngeal carcinoma: a Rare Cancer Network study.

PURPOSE: This Rare Cancer Network (RCN) study was performed in pediatric nasopharyngeal carcinoma (PNPC) patients to evaluate the optimal dose of radiotherapy and to determine prognostic factors. PATIENTS AND METHODS: The study included 165 patients with the diagnosis of PNPC treated between 1978 and 2003. The median age was 14 years. There were 3 (1.8%) patients with stage I, 1 (0.6%) with IIA, 10 (6.1%) with IIB, 60 (36.4%) with III, 44 (26.7%) with IVA, and 47 (29%) with IVB disease. While 21 (12.7%) patients were treated with radiotherapy (RT) alone, 144 (87.3%) received chemotherapy and RT. The median follow-up time was 48 months. RESULTS: The actuarial 5-year overall survival (OS) was 77.4% (95% CI: 70.06-84.72), whereas the actuarial 5-year disease-free survival (DFS) rate was 68.8% (95% CI: 61.33-76.31). In multivariate analysis, unfavorable factors were age >14 years for LRC (p=0.04); male gender for DMFS (p=0.03); T3/T4 disease for LRFS (p=0.01); and N3 disease for DFS (p=0.002) and OS (p=0.002); EBRT dose of less than 66 Gy for LRFS (p=0.02) and LRRFS (p=0.0028); and patients treated with RT alone for LRFS (p=0.0001), LRRFS (p=0.007) and DFS (p=0.02). CONCLUSION: Our results support the current practice of using combined radiation and chemotherapy for optimal treatment of NPC. However, research should be encouraged in an attempt to reduce the potential for long-term sequelae in pediatric patients given their relatively favorable prognosis and potential for longevity.