ABSTRACT
Treatment for primary head and neck cancer has evolved from the use of radical approaches to therapies preserving important functions. Essential to this concept is the maintenance of therapeutic efficacy. The advances of organ-sparing surgery, improved radiation techniques and fractionation, and the addition of chemotherapy and targeted systemic agents, have added to the number of patients who undergo organ-preservation therapy. Crucial functions that can be spared include speech, swallowing, vision, salivation and cosmesis. This paper examines advances in therapy that allow the preservation of these important functions, scenarios where organ and function preservation is indicated, given current technology and agents, and where there might be future improvements.
Subject(s)
Carcinoma/therapy , Head and Neck Neoplasms/therapy , Postoperative Complications/prevention & control , Carcinoma/pathology , Carcinoma/radiotherapy , Carcinoma/surgery , Carcinoma in Situ/surgery , Deglutition Disorders/prevention & control , Disease Management , Head and Neck Neoplasms/surgery , Humans , Hypopharyngeal Neoplasms/radiotherapy , Hypopharyngeal Neoplasms/surgery , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/radiotherapy , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Minimally Invasive Surgical Procedures , Neoplasm Recurrence, Local , Neoplasm Staging , Organ Specificity , Quality of Life , Salvage Therapy , Speech Disorders/prevention & control , Tongue Neoplasms/surgery , Xerostomia/prevention & controlABSTRACT
We report outcomes on 23 patients with oligometastastic (1 or 2 sites) NSCLC treated with aggressive local, regional, and systemic treatment. The results suggest that this is a favorable subset of patients who may benefit from such an approach, with a 22% rate of long-term survival. This treatment strategy is a departure from the usual practice of palliative-only therapy for all NSCLC patients presenting with metastatic disease.
Subject(s)
Carcinoma, Non-Small-Cell Lung/therapy , Combined Modality Therapy/methods , Lung Neoplasms/therapy , Adult , Aged , Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/secondary , Disease-Free Survival , Female , Humans , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Metastasis , Treatment OutcomeABSTRACT
PURPOSE: Limited information is available comparing target volume and normal tissue dosimetry with the different techniques of partial breast irradiation (PBI). We present results of a dosimetric comparison of single catheter, balloon-based brachytherapy using the MammoSite catheter (BRT), 3D conformal radiation therapy (3DCRT), and intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS: Fifteen patients were treated using the BRT device. With the use of CT scans with balloons in inflated and deflated states, plans were developed for each patient using each of the methods of PBI, for a total of 45 plans. The plans were then compared using the below dosimetric parameters. RESULTS: The mean V100 was 95%, 92%, and 94% for the BRT, 3DCRT, and IMRT techniques, respectively. The mean ipsilateral breast V50 was 29%, 56%, and 46% (p < 0.0001) and the mean ipsilateral lung V30 was 5%, 7%, and 2% (p < 0.001 for IMRT vs. others) for the BRT, 3DCRT, and IMRT methods, respectively. For the 10 patients with left-sided breast tumors, the mean heart V5 was 12%, 4%, and 1% for the BRT, 3DCRT, and IMRT methods, respectively (p < 0.01). CONCLUSIONS: With increasing interest in PBI, our data may help clinicians individualize patient treatment decisions.
