Hyaluronic acid spacer in focal prostate reirradiation: A single centre experience.

PURPOSE: The optimal management of locally recurrent prostate cancer after curative radiotherapy is still unknown. In this study, we evaluated the preliminary results of reirradiation using stereotactic body radiotherapy for locally recurrent prostate cancer after initial definitive local radiotherapy. MATERIALS AND METHODS: Between April 2016 and February 2019, 11 patients with recurrent disease at the previously irradiated prostate were treated. Local recurrence was detected by radiological with or without functional imaging modalities including prostate multiparametric/pelvic MRI or positron-emission tomography-computerised tomography with (68Ga)-labelled prostate-specific membrane antigen performed after rising prostate specific antigen serum level during follow-up. All patients received stereotactic body radiotherapy to the recurrent nodule to a total dose of 30Gy in five fractions. Hyaluronic acid spacer was injected between prostate and rectum in seven patients to decrease the rectal dose. Acute toxicity was evaluated by using Common Terminology Criteria for Adverse Events version 4.0, and late toxicity was evaluated by using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer late radiation morbidity scoring schema. RESULTS: At the diagnosis, the median age was 64 years, and the mean prostate specific antigen serum concentration was 17.7ng/mL. The median interval time between local recurrence and initial definitive radiotherapy was 63 months. Mean prostate specific antigen concentration nadir value during follow-up was 0.43ng/mL. With a median follow up of 19 months, three patients developed either local or distant relapse. One patient had grade 3 acute rectal toxicity, and one patient had grade 2 late urinary toxicity. We did not observe any acute or late toxicity due to hyaluronic acid spacer injection. CONCLUSION: Reirradiation after local recurrence following initial definitive radiotherapy together with hyaluronic acid spacer use seems to be effective and safe.

Concomitant trastuzumab with thoracic radiotherapy: a morphological and functional study.

BACKGROUND: The purpose of this study is to elucidate if there is an additive or supra-additive toxic effects of radiotherapy (RT) and trastuzumab (T) on vascular structures when used concomitantly. METHODS: Female Wistar albino rats were treated with either 8 or 15 Gy of thoracic RT. T was applied i.p. with a dose of 6 mg/kg 2 h before RT. Four rats in each arm were killed at 6th h, 21st and 70th days after irradiation and thoracic aorta of each animal was dissected for electron microscopy. In addition, functional studies for evaluating the relaxation and contraction were carried out 21 days after RT. RESULTS: Only 15-Gy RT dose groups showed significant difference in terms of functional deterioration as more contraction than the others (P < 0.05) without any difference between RT and RT + T. However, T produced additional deficit in relaxation when added to RT, which was considered near significant (P: 0.0502). Electron microscopy showed endothelial and subendotelial damage signs in 15-Gy dose groups. T + 15-Gy arm showed more pronounced endothelial cell damage than 15-Gy RT-only arm, 70 days after RT. CONCLUSION: T and high-dose RT may lead to vascular damage that seems at least additive.

High-dose-rate mold brachytherapy of early gingival carcinoma: a clinical report.

Two elderly edentulous patients with the diagnosis of early stage cancer of the upper gingiva were treated by customized dental mold brachytherapy. Locoregional tumor control was achieved in both patients. One patient is alive without any evidence of disease 36 months after treatment, the other patient died of distant metastasis shortly after brachytherapy. Brachytherapy, being easy to apply with short treatment time and good acute tolerance, is a good choice and effective modality for the management of early stage gingival cancer, particularly in elderly patients.

Comparison of AJCC 1988 and 1997 classifications for nasopharyngeal carcinoma. American Joint Committee on Cancer.

PURPOSE: A comparison of American Joint Committee on Cancer (AJCC) 1988 and 1997 nasopharyngeal carcinoma (NPC) classifications was made in terms of patient distribution and efficacy in predicting prognosis. METHODS AND MATERIALS: Between 1993-1997, 90 patients (64 M, 26 F) with non-metastatic NPC were treated. The mean age was 42.02 (range: 9-82) years old. Histopathological diagnosis was WHO 2 and 3 in 83 (92.2%) patients. All patients were prospectively staged using AJCC 1988 and modified Ho's classifications (1989) and these data were stored in a computer database. Retrieval of this information enabled us to restage patients according to the AJCC 1997. Median follow-up was 38 months. RESULTS: According to the AJCC 1988 there were 2 (2.2%), 6 (6.7%), 13 (14.4%), and 69 (76.7%) patients in Stage I, II, III and IV, respectively. Same figures were 8 (8.8%), 21 (23.3%), 26 (28.9%), and 35 (38.8%), according to AJCC 1997. Three year overall survival (OS) rates were 100%, 100%, 67%, and 62% for patients Stage I, II, III, and IV according to the AJCC 1988 and 100%, 72%, 65%, and 55%, (I vs. IV; p = 0.03, I vs. III; p = 0.05) respectively, according to the AJCC 1997. Three year loco-regional relapse free survival (LRRFS) rates were 50%, 100%, 100%, and 83% (I vs. III; p = 0.03) for patients in Stage I, II, III, and IV according to the AJCC 1988. Same figures were 88%, 90%, 89%, and 85% according to the AJCC 1997. Three year distant metastasis free survival (DMFS) rates were 100%, 100%, 82%, and 67% for patients in Stage I, II, III, and IV according to the AJCC 1988. Same figures were 100%, 74%, 80%, and 57% (I vs. IV; p = 0.03) according to the AJCC 1997. We did not observe any significant difference in LRRFS among T stages for both staging system and the N stage was the primary determinant for DMFS in both systems. CONCLUSIONS: We observed a better patient distribution with AJCC 1997 comparing to AJCC 1988. The new classification also attained better statistical significances among stages in the OS and DMFS rates.

Colonic anastomotic healing after preoperative chemo-radiotherapy in rat.

PURPOSE: To prevent micrometastasis at an earlier stage and to increase the lateral or circumferential tumor free margins, there is a rationale for neo-adjuvant chemo-radiotherapy in patients with colorectal cancer. In order to investigate the effects of such a protocol on colonic anastomotic healing, an experimental study resembling the clinical use of neo-adjuvant concomitant 5-FU+ irradiation treatment of colorectal cancer was conducted. MATERIALS AND METHODS: Seventy-one male Wistar rats were divided into three groups: a control group (I) underwent left colon resection and primary anastomosis (n = 20); a sham-treated group (II, n = 20); and a study group (III) which received fractionated irradiation to the whole pelvis to a total dose of 22 Gy, 5.5 Gy per fraction, in four consecutive days with linear accelerator and concomitant intra-peritoneal 5-FU (20 mg/kg/day) for five consecutive days. The last fraction of irradiation and the last injection were given four and three days before colonic resection and anastomosis, respectively. Within each group one-half of the animals were anesthetized on the third postoperative day and one-half on the seventh postoperative day. Abdominal wound healing, intraperitoneal adhesions, anastomotic complications, and anastomotic bursting pressure measurements were recorded. Following these measurements the anastomotic segment was resected for hydroxyproline content, myeloperoxidase activity, and histopathological evaluation. RESULTS: There were no differences in the abdominal wound healing, intraperitoneal adhesions, and anastomotic complications between groups. At three and seven days, the mean bursting pressures of the anastomoses were 36.5 mm Hg and 208 mm Hg in group I, 34.5 and 228 in group II, and 27 and 167 in group III, respectively (p < 0.01, group III vs both groups I and II on day seven). The burst occurred at the anastomosis in all animals tested on the third postoperative day, and one in group I (10%), none in group II, and four in group III (40%) on the seventh postoperative day. CONCLUSION: Preoperative pelvic fractionated irradiation and concomitant 5-FU delays anastomotic healing.

Histological evaluation of colonic anastomotic healing in the rat following preoperative 5-fluorouracil, fractionated irradiation, and combined treatment.

There is a growing interest in neoadjuvant chemo- and radiotherapy as a treatment modality for colorectal cancer which could affect mechanical and biochemical parameters of anastomotic healing. This study investigated the effect of such protocols on colonic anastomotic healing by evaluating the histopathological parameters. One hundred and sixty male Wistar rats were divided into six groups: a control group (I, n = 20), a saline group (II, n = 30) which received 1 ml NaC1 intraperitoneally, a sham-irradiated group (III, n = 20), a 5-fluorouracil (5-FU) group (IV, n = 30), which received 5-FU (20 mg/kg) intraperitoneally for 5 consecutive days, an irradiated group (V, n = 40) which received fractionated irradiation to the whole pelvis to a total dose of 22 Gy, 5.5 Gy per fraction on 4 consecutive days, and a concomitant 5-FU + irradiation group (VI, n = 20) which received 5-FU as in group IV and irradiated as in group V. All groups underwent left colonic resection with primary anastomosis, and the last fraction of irradiation and the last injection were given 4 and 3 days before the operation, respectively. Within each group one half of the animals were killed on the third postoperative day and the other half on the seventh postoperative day. After the resection of the anastomotic segments, histopathological examination was evaluated. Apposition of the wound edges of the mucosa and the muscularis were not affected by the therapy. The level of granulocytes was high, inflammatory exudate and necrosis persisted, granulation tissue formation was delayed, and the levels of macrophages and fibroblasts were low. We conclude that colonic anastomotic healing can be affected by the administration of preoperative chemotherapy, irradiation, and chemoirradiation.

Effects of preoperative fractionated irradiation on left colonic anastomoses in the rat.

PURPOSE: Radiotherapy is frequently used as a (neo)adjuvant to surgery in colorectal cancer patients, and because such therapy could influence the integrity of the anastomosis, we decided to investigate the effect of preoperative irradiation on colonic anastomosis. METHODS: Seventy-two male Wistar rats, weighing 200 to 348 g, were divided into three groups: a control group (I) underwent left colon resection and primary anastomosis (n = 20); a sham irradiated group (II, n = 20); a study group (III) that received fractionated irradiation to the whole pelvis (anterior-posterior pelvic field), for a total dose of 22 Gy, 5.5 Gy per fraction, on four consecutive days with linear accelerator (n = 32). Four days after irradiation, both Groups II and III underwent the same operation as performed in Group I. Within each group, one-half of the animals were anesthetized on the third postoperative day and one-half on the seventh postoperative day. Abdominal wound-healing, anastomotic complications, and anastomotic bursting pressure measurements were recorded. Following these measurements, the anastomotic segment was resected for hydroxyproline content and myeloperoxidase activity. RESULTS: Irradiated animals had more pronounced weight loss during therapy. There were no differences with abdominal wound-healing, intraperitoneal adhesions, and anastomotic complications between groups. At days 3 and 7, mean bursting pressures of the anastomosis were determined at 36.5 and 208 mmHg in Group I, 34.5 and 228 mmHg in Group II, and 25 and 150 mmHg in Group III, respectively (P < 0.01 Group III vs. both Groups I and II on days 3 and 7). The burst occurred at the anastomosis in all animals tested on the third postoperative day and one in Group I (10 percent), none in Group II, and six in Group III (37.5 percent) on the seventh postoperative day. In addition, hydroxyproline content and myeloperoxidase activity was significantly lower in Group III. CONCLUSION: Although preoperative fractionated irradiation significantly decreased the anastomotic bursting pressure and more burst occurred in the anastomotic line on postoperative day 7, the clinical outcome was similar among the groups.

Intracranial ependymomas: treatment results and prognostic factors.

Forty-nine intracranial ependymoma patients were postoperatively irradiated with craniospinal, cranial, or wide local fields. Thirty-two patients received an adjuvant chemotherapy regimen of vincristine and CCNU with or without procarbazine. The 10-year actuarial overall and progression-free survival rates were 57% and 57%, respectively. Age was the only significant prognostic factor in favor of adults (p = 0.01).

Cranial nerve involvement in nasopharyngeal carcinoma: its prognostic role and response to radiotherapy.

Between 1975 and 1989, 23 nasopharyngeal carcinoma patients presenting with cranial nerve involvement (CNI) of one or more nerves at the time of diagnosis were treated and followed-up in our department. All patients were irradiated with curative intent, and total doses of 50 to 70 Gy (median 65 Gy) were delivered to the nasopharynx. Cranial nerves VI, III, V, IV, IX, and XII were the most commonly involved nerves. The total response rate of cranial nerves was 74% in a median follow-up time of 2 years, with the highest rate observed in the third and sixth cranial nerves. All complete responses except two were observed in the first month after radiotherapy.

Results of radiotherapy in craniopharyngiomas analysed by the linear quadratic model.

In 23 craniopharyngioma patients treated by limited surgery and external radiotherapy, the results concerning local control were analysed by linear quadratic formula. A biologically effective dose (BED) of 55 Gy, calculated with time factor and an alpha/beta value of 10 Gy, seemed to be adequate for local control.

Results of post-operative or exclusive radiotherapy in grade I and grade II cerebellar astrocytoma patients.

43 Patients with the diagnosis of cerebellar astrocytoma were post-operatively treated, between 1 January 1976 and 31 December 1985. Their age ranged between 2 and 51 years with a median of 13. There were 22 males and 21 females. The tumours were reported as grade I in 18, and grade II in 25 patients. The primary surgical intervention was in the form of biopsy in 3, subtotal excision in 24 and macroscopic total excision in 16. All patients were treated with cobalt-60 teletherapy unit, to a total tumour dose of 4500-5500 cGy in 6-7 weeks. The obtained 5 and 10 year actuarial survival rates are 78% and 78%. Our study gives the impression that, age, sex and tumour grade are not determining factors in survival and post-operative radiotherapy improves prognosis in cases treated by subtotal excision while it remains unnecessary in those who had undergone total surgical removal.

Post-irradiation osteosarcoma of the iliac bone: a case report.

A case of osteosarcoma of the iliac bone developing 12 years after the successful management of childhood rhabdomyosarcoma is presented. The frequency of secondary tumors, mainly bone malignancies, following therapeutic irradiation in the pediatric age-group, and the criteria for the diagnosis of radiation-induced bone sarcoma are discussed.