Development of paraaortic lymph nodes metastases in carcinoma of the cervix: analysis of treatment outcome.

PURPOSE: To evaluate treatment outcomes in patients with cervical cancer and paraaortic lymph nodes metastases using radiotherapy (RT), chemotherapy (CT), or chemo/radiotherapy (CT/RT). PATIENTS AND METHODS: From 184 stage IIB-IVA patients with cervical cancer who were randomly treated with RT or CT/RT, 15 relapsed after the initial therapy only in the paraaortic lymph nodes. The median age of these 15 patients was 53 years (range 30-69). Fourteen patients had squamous cell carcinoma and one adenocarcinoma. The initial stage was IIB (n=3), and IIIB (n=12). The treatment consisted of RT to the paraaortic region (3 patients), CT (4 patients 4-6 cycles) and CT/RT sequentially (8 patients 1-2 cycles of CT before RT and 4 cycles after RT). RT was delivered as external beam radiotherapy (EBRT), total dose 45 Gy, 24 fractions, antero-posterior (AP)/postero-anterior (PA) field technique. RESULTS: With median follow up of 7 months (range 4-24), the 2-year overall survival (OS) was 17%. There was no difference in OS between therapy groups. CT/RT had not significant impact on OS. There were 7 (46.6%) objective responses (complete response-CR-5/15 and partial response-PR-2/15 patients; the best response was seen in the CT/RT group (5/8 patients). Treatments were well tolerated, while 40% of the 15 patients experienced late complications. There was no significant correlation between the initial patient therapy (RT vs. concurrent CT/RT) and the development of metastases in the paraaortic region (median time to relapse 5 vs. 6 months, respectively). CONCLUSION: Development of metastatic disease of cervical carcinoma to the paraaortic lymph nodes is associated with poor prognosis and the treatment has palliative aim. The use of different therapy approaches didn't improve the therapeutic ratio. The sequential use of CT/RT might improve results but further studies are needed.

[Radiotherapy of locally advanced breast carcinoma in elderly female patients]. / Radioterapija lokalno odmaklog karcinoma dojke kod bolesnica starije zivotne dobi.

INTRODUCTION: Breast cancer is the most frequent cancer in elderly patients (over 65 years). The recent data indicate that in women aged over 72 years the incidence of breast cancer is twice greater than in women aged 45 years. As more and more women are getting older, the total incidence of breast cancer can be expected to increase. The treatment of these patients is complicated by many other diseases including cardiovascular and pulmonary disorders associated with aging, and because chemotherapy and radical surgery are often contraindicated. MATERIAL AND METHODS: In an one year period in the Institute of Oncology and Radiology of Serbia a group of 53 elderly (65 years and more) patients with locally advanced breast cancer were treated. Twenty four patients (group A) were treated with hypofractionated (concentrated) radiotherapy. The irradiation was delivered to the breast with TD24-26 Gy with two tangentional portals and 19 Gy to regional lymphatics with anterior fields owner 8 fractions, breast and lymphatics alternatively. The same treatment plan was repeated after 28 days (split course). Co60 was used. Twenty nine patients (group B) were treated with conventional fractionated radiotherapy. Irradiation was delivered to the breast with 51 Gy tumour dose in 16 fractions and to the lymphatics with 45 Gy in 15 fractions. Breast and lymphatics were irradiated alternatively, during 31 working days. After 51 Gy the whole breast was boosted with 20 Gy tumour dose and axilla with TD 12 Gy. The concentrated radiotherapy is, in fact, an alternative for radical--conventional or protracted radiotherapy according to the so-called hypofractionated split course technique. Both techniques have very similar TDF factors. The aim of such a plan is the achievement of adequate tumour dose adapted to the age of patients (the patients should be treated in a smaller number of fractions). All patients were aged 65 years or were older. The median age in group A was 72 years and in group B 68 years. Also in all patients breast cancer was locally advanced (stadium III). In group A median follow-up was 29.79 months and in group B 23.62 months. RESULTS: All patients had acute skin reactions. In group A (irradiated with concentrated technique) 91.7% of patients had erythema, 8.3% dry desquamation, but moist desquamation was not observed. In group B (irradiated with conventional technique) 27.6% of patients had erythema, 55.2% dry desquamation and 17.2% moist desquamation. Delayed radiation changes manifested as fibrosis of the breast and region of axilla were noted in 29.24% of patients in group A and 13.8% in group B. The relapse in group A was 41.7% with median relapse free interval of 13.9 months and in group B 48.2% with relapse free interval of 15.6 months. There was no significant statistical difference between the two groups according to standard statistical methods (chi 2 = 0.96; DF = 3; p > 0.05). After approximately 30 months of follow-up, 50% of patients in group A are alive without signs of disease; 16.7% are alive with disease, and 16.7% are dead due to primary disease. In group B 24.1% of patients are alive without signs of disease; 24.1% are alive with disease; and 20.7% are dead due to primary disease. There was no significant statistical difference between the two groups (chi 2 = 4.09; DF = 4; p > 0.05). The overall survival rate in group A was 67% after 4 years and 53% in group B. Relapse free survival was 53% in group A after 4 years and 36% in group B. In conclusion, according to our study there was no statistically significant difference in local control between conventional and hypofractionated radiotherapy in the treatment in elderly patients. The main advantage of concentrated schedule is shortening of duration of irradiation, but the main disadvantage is a high incidence of fibrosis which makes difficult the evaluation of local control. Consensus about treatment of breast cancer in elderly women has not yet been clearly established. Our data suggest that hypofractionated schedule is an effective, suitable and comfortable therapeutic approach in the management of breast cancer in elderly women.

[Radiotherapy of malignant tumors of the uterine cervix: results of therapy]. / Radioterapija malignih tumora grlica materice: rezultati lecenja.

From February 25, 1974 to April 30, 1976 at the Institute for Oncology and Radiology of the University Clinical Center in Belgrade 138 patients with cervical carcinoma stage I, II and III were radical irradiated by Cathetron (HDR Co-60 sources and remote afterloading technique) and 42 MeV Betatron. The 5-year and 10-year survival of these patients was: stage I--90.9% and 81.8%, stage II--65.1% and 46.0%, stage III--32.8% and 23.0% and III stages--52.5% and 39.1%. Local recurrences, distant metastases and late postirradiation sequelae were: 26.8%, 5.8% and 22.7%.

[Stomatologic preparation of patients with malignancies of the maxillofacial region for radiation therapy]. / Stomatoloska priprema pacijenata sa malignomima maksilofacijalnog predela za zracnu terapiju.

A series of 3456 patients with malignant tumours of the maxillofacial region have been treated at the Clinic for Maxillofacial and Oral Surgery of the Military Medical Academy, Stomatological Clinic of the M.M.A. and Radiological Institute of Medical Faculty in Belgrade. The most frequent localization was lips and mucosa of the oral cavity, 77,9%. The irradiation therapy was applied in 42,3% of the patients and combined surgery and irradiation therapy in 28,6% Postirradiation changes of the oral cavity mucosa were found in 25% of the patients, teeth changes in 50% and Candida albicans was found in 56% of the patients. In order to prevent irradiation and postirradiation complications, all the patients with malignant tumours foressen for irradiation therapy should undergo a detailed stomatological examination and sanation of the oral cavity and teeth. The authors advocate team work in establishing the diagnosis and treating in which an important place should have stomatologist.