Accelerated whole breast irradiation with intensity-modulated radiotherapy to the prone breast.

PURPOSE: Whole breast irradiation (WBI) is the standard of care for patients with early-stage breast cancer who opt for breast conservation. After a randomized trial demonstrated equivalent cosmesis and disease control with accelerated WBI (AWBI), our institution began to offer AWBI to appropriate patients. The aim of this study was to examine our unique experience with AWBI using prone positioning and simplified intensity-modulated radiotherapy (IMRT) planning with a sequential boost to the tumor bed. METHODS AND MATERIALS: We identified 356 patients who had been treated with prone WBI using IMRT in our department between January 2004 and December 2006. Of these, 128 (36%) patients had received AWBI (representing 131 treated breasts), consisting of 16 daily fractions of 265 cGy to a total dose of 4,240 cGy followed by a conventionally fractionated boost. RESULTS: Patients who opted for AWBI were similar demographically to the patients undergoing conventional WBI. In the AWBI cohort, 83% of the patients had Stage T1 disease and 22% had nodal involvement (N1). The tumors were estrogen receptor-positive, progesterone receptor-positive and Her-2/Neu-amplified in 82%, 69%, and 11%, respectively. The median duration of AWBI plus a boost was 29 days, and no patient required a toxicity-related treatment break. No Grade 3 or greater acute toxicity developed. At a median follow-up of 18 months, one ipsilateral breast recurrence developed that was salvaged with mastectomy and immediate reconstruction. CONCLUSION: AWBI to the prone breast using simplified IMRT with a sequential boost offers women requiring breast-only adjuvant radiotherapy an abbreviated treatment with early tumor control and cosmesis comparable to that with standard fractionation.

Primary adenocarcinoma of the anus treated with combined modality therapy.

PURPOSE: The purpose of this study was to determine the local control and survival of patients with adenocarcinoma of the anus who received combined modality therapy as a component of their treatment. METHODS: Thirteen patients with primary anal adenocarcinoma (T1: 1, T2: 4, T3: 3, T4: 5; and N0: 9, N1: 2, N2: 2) were treated between 1989 and 2001 in the Department of Radiation Oncology at Memorial Sloan Kettering Cancer Center. Three general treatment approaches were used that were based on physician and patient preference as well as tumor stage. These included preoperative combined modality therapy followed by abdominoperineal resection (n = 5), with four of the five receiving postoperative chemotherapy; local excision followed by postoperative radiation alone or combined modality therapy (n = 5); and abdominoperineal resection followed by postoperative combined modality therapy (n = 3). Two patients received brachytherapy. RESULTS: With a median follow-up of 19 months, the median survival was 26 months, the local failure rate was 37 percent, and the two-year actuarial survival was 62 percent. In the subset of eight patients treated with abdominoperineal resection and preoperative or postoperative radiation or combined modality therapy, local control was 63 percent, and three of eight are without evidence of disease. Of the five patients who underwent a local excision followed by postoperative radiation or combined modality therapy, the local control rate was 60 percent, with one of the local failures salvaged by abdominoperineal resection and one of five patients without evidence of disease. CONCLUSION: Although the experience is limited, our data suggest that the combination of abdominoperineal resection and combined modality therapy is a reasonable approach for this rare tumor.

Radiation-induced salivary gland tumors: a report of 18 cases and a review of the literature.

PURPOSE: The purpose of this study was to examine the relationship between radiation exposure and subsequent development of salivary gland tumors (SGTs). MATERIALS AND METHODS: Eighteen patients with SGTs as second cancers after head and neck irradiation were identified from chart review of institutional databases of 3025 patients with SGTs evaluated between 1986 and 2001. RESULTS: The median age at the time of initial radiation therapy was 22 years (range, 5-74 years). The median age of the group at the time of their diagnosis of a SGT was 54 years (range, 21-79 years). The median interval between radiation exposure and diagnosis of the SGT was 21 years (range, 4-64 years). The most common initial diagnosis for which patients received radiation therapy was Hodgkin's disease. Histology of the secondary SGT was varied, but most were malignant (N = 15), and mucoepidermoid carcinoma was the most common histology (N = 9). CONCLUSION: There is an association between radiation exposure and the risk of developing an SGT. There was a wide range in the dose of radiation and the age at exposure, suggesting that exposure to head and neck radiation at any age and dose may increase the risk for SGT. This series also suggests an increased risk for developing malignant (versus benign) SGT after radiation exposure.