The value of postoperative radiotherapy in renal cell carcinoma: a single-institution experience.

AIM: To evaluate the efficacy of postoperative irradiation in renal cell carcinoma. PATIENTS AND METHODS: Forty patients with localized renal cell carcinoma admitted to our hospital between 1986 and 1999 were evaluated. All patients were initially treated with radical nephrectomy. Postoperative radiotherapy was given to 26 of 40 patients (65%). Fourteen patients (35%) received no adjuvant therapy. Median age was 55 years (range, 20-70 years). Twenty-four patients (60%) were men and 16 patients (40%) were women. Histopathological diagnosis was renal cell carcinoma in all of the patients. N+ disease was present in 3 patients (7%). Stage I and II disease was present in 25 patients (63%) and stage III and IV disease in 15 patients (37%). Two patients (5%) had T1a disease, 11 patients (27%) had T1b, 15 patients (38%) had T2, 11 patients (27%) had T3a and 1 (3%) patient had T3b. In the radiotherapy group, renal bed and regional lymphatic fields were irradiated with daily fractions of 180-200 cGy/fraction to a total dose of 46-50 Gy, using parallel opposing fields. RESULTS: The 5-year overall survival rates were 70% in the postoperative radiotherapy group and 20% in the no adjuvant treatment group, showing no significant difference (P = 0.1). The 5-year disease-free survival rates were 66% in the radiotherapy group and 16% in the no treatment group, with a significant difference in both univariate and multivariate analyses (P = 0.045 and P = 0.0007, respectively). Stage III and IV disease, tumor size 27 cm, presence of distant metastasis and lactate dehydrogenase level > 450 U/L were found to be adverse prognostic factors for overall survival in both univariate and multivariate analyses. Analyzing the factors affecting disease-free survival, absence of postoperative radiotherapy and tumor size > or = 7 cm were found to be adverse prognostic factors in univariate and multivariate analyses. CONCLUSION: Multi-institutional prospective randomized trials using modern radiotherapy techniques such as conformal radiotherapy and intensity-modulated radiotherapy are necessary to evaluate the real role of radiotherapy and its effect on survival in renal cell carcinoma, especially in selected patients with a high risk of local or regional failure.

Treatment of primary cutaneous B-cell lymphoma with radiotherapy.

Primary cutaneous B-cell lymphomas (PCBCL) are rare and constitute 5-10% of all cutaneous lymphomas. In patients with PCBCL presenting with solitary or localized skin lesions, radiotherapy is the preferred treatment. Two patients who were treated with 4 MeV electrons, both obtained remission for 51 months. Unfortunately, at the last visit one patient relapsed on the border of the radiotherapy field and was re-treated with a generous irradiation field in 2004. Complete response was obtained again. Thus, for localized PCBCL, radiotherapy alone is an effective treatment.

Megestrol acetate for cachexia and anorexia in advanced non-small cell lung cancer: a randomized study comparing two different doses.

BACKGROUND: The primary aim of the study was to compare two different dose levels of megestrol acetate, administered for cancer-related anorexia and cachexia for 3 months. METHODS: From August 1996 to December 2000, 119 patients with advanced non-small cell lung cancer were randomized to take 160 mg/day or 320 mg/day of megestrol acetate for 3 months at the Gülhane Military Medicine Academy of Ankara, Turkey. Patients were controlled at biweekly periods. RESULTS: There were 59 patients in the single dose arm (group 1) and 60 patients in the twice a day dose arm (group 2). The mean percentages of weight loss were 16.9% and 16.7% in group 1 and 2, respectively. In the first and the second month of weight gain, there were no significant differences in the two groups (P = 0.23 and P = 0.11). In the third month, weight gain was significantly higher in group 2 than in group 1 (P = 0.038). Toxicity was similar for both dose levels. CONCLUSIONS: Megestrol acetate can be safely and effectively given to patients with advanced non-small cell lung cancer. Although lower doses of megestrol acetate can be effective for anorexia and cachexia, the higher dose level seems to be more efficient.

Total skin electron beam therapy for cutaneous T-cell lymphoma: Turkish experience with translational technique.

Mycosis fungoides is the most common form of cutaneous T-cell lymphoma. In our department, between January 1995 to January 2001, we treated eleven patients with mycosis fungoides by total body skin electron irradiation to evaluate its influence. According to our knowledge, our department is the only center in Turkey capable of applying total skin electron beam therapy. Total skin electron beam therapy was applied by using the "translational technique". Daily doses (4 Gray) were given in a total of seven fractions according to the conventional fractionation scheme. There were 6 patients with stage I disease, 3 patients with stage II and 2 patients with stage IV disease. Except stage IV patients, we obtained good cutaneous results. According to our observation, in early stage mycosis fungoides total body skin electron irradiation can provide good cutaneous response, but for stage IV only moderate pallation can be obtained.