Radiation and depression associated with complications of tissue expander reconstruction.

PURPOSE: Rates of implant failure, wound healing delay, and infection are higher in patients having radiation therapy (RT) after tissue expander (TE) and permanent implant reconstruction. We investigated pretreatment risk factors for TE implant complications. PATIENTS AND METHODS: 127 breast cancer patients had TE reconstruction and radiation. For 85 cases of bilateral TE reconstruction, the non-irradiated breast provided an internal control. Comparison of differences in means for continuous variables used analysis of variance, then multiple pairwise comparisons with Bonferroni correction of p value. RESULTS: Mean age was 53 ± 10.1 years with 14.6% African-American. Twelve (9.4%) were BRCA positive (9 BRCA1, 4 BRCA2, 1 Both). Complications were: Grade 0 (no complication; 43.9%), Grade 1 (tightness and/or drifting of implant or Baker Grade II capsular contracture; 30.9%), Grade 2 (infection, hypertrophic scarring, or incisional necrosis; 9.8%), Grade 3 (Baker Grade III capsular contracture, wound dehiscence, or impending exposure of implant; 5.7%), Grade 4 (implant failure, exchange of implant, or Baker Grade IV capsular contracture; 9.8%). 15.3% (19 cases) experienced Grade 3 or 4 complication and 9.8% (12 cases) had Grade 4 complication. Considering non-irradiated breasts, there were two (1.6%) Grade 3-4 complications. For BMI, there was no significant difference by category as defined by the CDC (p = 0.91). Patients with depression were more likely to experience Grade 3 or 4 complication (29.4 vs 13.2%; p = 0.01). Using multiple logistic regression to predict the probability of a Grade 3 or 4 complications in patients with depression were found to be 4.2 times more likely to have a Grade 3 or 4 complication (OR = 4.2, p = 0.03). CONCLUSIONS: Higher rates of TE reconstruction complications are expected in patients receiving radiotherapy. An unexpected finding was that patients reporting medical history of depression showed statistically significant increase in complication rates.

Definitive radiotherapy for squamous cell carcinoma of the anal canal.

PURPOSE: To review the outcomes of definitive radiotherapy (RT) alone or combined with chemotherapy (CT) in the treatment of squamous cell carcinoma of the anal canal. METHODS: Between November 1968 and June 2005, 69 patients were treated with curative intent at the University of Florida. Distribution according to T stage was: T1, 11 (16%); T2, 29 (42%); T3, 21 (30%); and T4, 8 (12%). Distribution according to N stage was: N0, 53 (77%); N1, 3 (4%); N2, 7 (10%); and N3, 6 (9%). RT consisted of external beam RT (EBRT) in 30 patients (43%) and EBRT plus brachytherapy in 39 patients (57%). Thirty-eight patients (55%) received adjuvant CT: mitomycin C and fluorouracil, 21 patients (30%); cisplatin plus fluorouracil, 16 patients (23%); and other, 1 patient (1%). Median follow-up for all patients was 7.9 years (range: 0.1-17.3 years). One patient who was disease-free was lost to follow-up at 129 months. RESULTS: The 5-year local control rates were: T1, 100%; T2, 93%; T3, 70%; T4, 88%; and overall, 86%. The 5-year regional control rates were: N0, 96%; N1 and N2, 89%; N3, 100%; and overall, 96%. The 5-year colostomy-free survival rates were: T1, 82%; T2, 89%; T3, 65%; T4, 38%; and overall, 74%. The 5-year cause-specific and overall survival rates were: stage I, 100% and 64%; stage II, 86% and 70%; stage III, 80% and 76%; and overall, 87% and 71%, respectively. Seven patients (10%) developed Radiation Therapy Oncology Group grade 3 late complications and 4 additional patients (6%) experienced grade 4 late complications. A fatal acute complication occurred in 1 patient (1%). CONCLUSION: The likelihood of cure and colostomy-free survival after EBRT alone or combined with brachytherapy is relatively high and likely improved by adjuvant CT. The acute toxicity of treatment is significant; the major risk is neutropenia and sepsis. Patients with advanced T4 cancers that result in sphincter dysfunction requiring a pretreatment colostomy will usually have a permanent colostomy.

Definitive radiotherapy for T1-T2 squamous cell carcinoma of pyriform sinus.

PURPOSE: To report the long-term results after definitive radiotherapy (RT) for T1-T2 pyriform sinus squamous cell carcinoma. PATIENTS AND METHODS: The data from 123 patients with T1-T2 pyriform sinus squamous cell carcinoma treated with RT with or without neck dissection between November 1964 and June 2003 were analyzed. The median follow-up for all patients was 3.2 years, and the median follow-up for living patients was 10.7 years. RESULTS: The 5-year local control, locoregional control, freedom from distant metastasis, cause-specific survival, and overall survival rate was 85%, 70%, 75%, 61%, and 35%, respectively. The ultimate local control rate, including successful salvage of RT failure, for T1 and T2 cancer patients was 96% and 94%, respectively. The overall local control rate with a functional larynx was 83%. Pretreatment computed tomography tumor volume data were available for 55 patients. The median computed tomography tumor volume was 4.2 cm(3) (range, 0-22.4). Local control was worse for patients with a tumor volume >6.5 cm(3) compared with those with a smaller tumor volume. Of the 123 patients, 16% developed moderate to severe acute (2%), late (9%), or postoperative (5%) complications. CONCLUSIONS: Local control with larynx preservation after definitive RT for T1-T2 pyriform sinus squamous cell carcinoma likely results in local control and survival similar to that after total laryngectomy or larynx-conserving surgery. Two-thirds of our living patients retained a functional larynx.

Radiotherapy and concomitant intraarterial cisplatin (RADPLAT) for advanced squamous cell carcinomas of the head and neck.

PURPOSE: Review of the University of Florida experience in treating advanced squamous cell carcinomas of the head and neck with concurrent intraarterial cisplatin and radiotherapy (RADPLAT). PATIENTS AND METHODS: Thirty-five patients with Stage III or IV head and neck squamous cell carcinomas were treated between November 2000 and October 2001 with 3 to 4 cycles of weekly intraarterial cisplatin (150 mg/m2) and a rapid infusion of the neutralizing agent sodium thiosulfate (9 g/m2), followed by a continuous infusion of sodium thiosulfate (12 g/m2), with concomitant radiotherapy (RT). The primary site was treated with 70 Gy in 35 fractions with 6 MV photons, and the low neck received 50 to 70 Gy depending on nodal involvement. Median follow-up for all patients was 4.06 years; median follow-up for living patients was 4.34 years. RESULTS: The 4-year outcomes were: local-regional control, 78%; distant metastasis-free survival, 83%; cause-specific survival, 65%; and survival, 57%. The majority of patients with recurrent disease failed at the primary site (73%); the remaining 27% of patients with recurrent disease failed only in distant sites. Nine patients required a neck dissection after chemoradiation because of suspected residual disease; 2 of 9 patients had residual tumor in the neck nodes. Severe osteoradionecrosis occurred in 26% of patients, and 9 of 35 patients (26%) required a permanent gastrostomy. CONCLUSIONS: RADPLAT results in excellent local-regional control and survival in patients with advanced squamous cell carcinomas of the head and neck. Outcomes from the University of Florida are comparable to those reported by other institutions. However, in our limited experience, the likelihood of osteoradionecrosis and permanent gastrostomy may be higher than what might be anticipated after RT alone or combined with intravenous chemotherapy.