ABSTRACT
BACKGROUND: In case of recurrent carcinoma of the head and neck region therapeutic options are often limited due to intensive prior therapy and/or reduced physical condition of the patient. Nevertheless there is a need for palliative treatment to control symptoms like pain, obstruction of the airways, dysphagia and for hygienic and cosmetic reasons. Side effects, treatment time and achievable results have to be adjusted to the needs of this patient subgroup. PATIENTS AND METHOD: 14 patients (13 male, one female) with recurrent squamous cell carcinoma of the head and neck region were studied. Average age was 56.1 years (range 42-76 years) (Table 1). Prior therapy: radiotherapy n = 14 (42-71.3 Gy), surgery: n = 10, chemotherapy: n = 13 (Table 2). Our patients received 100-150 mg/m2 Bendamustin i.v. (day 1 and 2) and involved field irradiation 15 Gy (daily dose 3 Gy, day 1-5) (Figure 1). Remission status, time to progression, side effects and survival were documented. RESULTS: Ten patients showed partial remissions, four patients had complete remissions of the treated lesion (Figure 2), amelioration of 70% of tumor symptoms was documented (Figure 3). Time to progression was 2-104 weeks. Side effects: 71% of patients had no significant side effects, CTC Grade 3 to 4 toxicity was seen in two patients (14%). CONCLUSION: The reported therapy regimen allows successful palliative treatment of intensively pretreated patients with progressive recurrent tumors of the head and neck. Side effects are tolerable even in patients with reduced physical condition.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/radiotherapy , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Nitrogen Mustard Compounds/therapeutic use , Palliative Care/methods , Adult , Aged , Antineoplastic Agents/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bendamustine Hydrochloride , Carcinoma, Squamous Cell/pathology , Chemotherapy, Adjuvant/adverse effects , Female , Head and Neck Neoplasms/pathology , Humans , Male , Middle Aged , Nitrogen Mustard Compounds/adverse effects , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study was the evaluation of the radiotherapy-induced psychological distress of patients and changes in psychological health during radiotherapy (RT). PATIENTS AND METHODS: 53 breast cancer patients undergoing irradiation after breast conserving surgery participated in this study. In the beginning and at the end of radiotherapy they answered a questionnaire asking for coping strategies, psychological distress with regard to irradiation and influence of surroundings. RESULTS: 92% stated to be well informed about radiotherapy. Coping strategies in order of importance: Talking to physician (94%) or partner (84%), 81% try to distract themselves, 56% repress thoughts about radiotherapy. 40% were anxious about RT and expected side effects (54%). At the end of therapy anxiety was reduced: 77% were anxious only initially or never. CONCLUSIONS: Patients are very interested in information about RT. Their experience of radiotherapy was more positive than initially expected. The relation to medical staff plays an important part in the reduction of irradiation-related psychological distress.
Subject(s)
Breast Neoplasms/psychology , Breast Neoplasms/radiotherapy , Anxiety/etiology , Breast Neoplasms/surgery , Female , HumansABSTRACT
PURPOSE: An individualized radiation treatment planning in patients with head and neck tumors requires an exact definition of tumorspread. Despite of high reliability of methods like computed tomography, sonography or magnetic resonance imaging used in daily routine, the correct diagnosis of lymphonodal tumor infiltration is often not possible. In a prospective trial, we examined whether an additional FDG-PET gives a relevant gain of information for radiation treatment planning. PATIENTS AND METHODS: We studied data of 34 patients with histologically confirmed squamous cell carcinoma of the head and neck who received a FDG-PET prior to treatment planning additionally to conventional staging procedures. The extent of changes of treatment strategy or target volume due to additional FDG-PET findings were analyzed. RESULTS: In 9/22 of patients with primary tumors and in 7/12 of patients with recurrent disease, FDG-PET detected additional tumor manifestations. In all cases, changes of treatment strategy or target volume were necessary. Regarding patients with primary tumors, the percentage of treatment modifications was highest in patients with large tumors (T3 and T4) and patients with advanced lymph node involvement (N2 and N3). CONCLUSIONS: Especially in patients with recurrent disease and patients with advanced tumor stages, FDG-PET is able to give clinically relevant information compared to conventional staging procedures. Therefore, in these group of patients a FDG-PET study prior to radiotherapy planning should be considered.
