OBJECTIVE: To study the assessed value of 64 slice spiral CT perfusion imaging (CTPI) in laryngeal squamous cell carcinoma after chemotherapy and radiotherapy. METHOD: Forty five patients diagnosed with local advanced laryngeal squamous cell carcinoma were selected. Conventional CT and CTPI were performed before treatment and at the time of radiation dose up to 40 Gy. Blood flow, blood volume, mean transit time and surface permeability were measured at the same time. According to the decrease of tumor volume in final examination, patients were divided into sensitive group and insensitive group. The tumor perfusion indexes were compared between groups. RESULT: Blood flow, blood volume, surface permeability after 40Gy treatment were lower than before treatment in both sensitive group and the insensitive group ascended(P<0. 05). The AUC of ROC of blood flow, blood volume, mean transit time and surface permeability were 0. 804, 0. 843, 0. 852 and 0. 826. The sensitivity, specificity and accuracy of blood flow was 89. 7%, 86.8% and 90. 9%. There were 100. 0%, 91. 4% and 93. 7% in blood volume; 100. 0%, 67. 7% and 88. 3% in mean transit time; 91. 2%, 69. 4% and 90. 6% in surface permeability(P<0. 01). CONCLUSION Sixty-four slice spiral CT perfusion imaging is able to assess tumor status of laryngeal squamous cell carcinoma after chemotherapy and radiotherapy effectively.
Carcinoma, Squamous Cell ; diagnosis ; drug therapy ; radiotherapy ; Head and Neck Neoplasms ; diagnosis ; drug therapy ; radiotherapy ; Humans ; Laryngeal Neoplasms ; diagnosis ; drug therapy ; radiotherapy ; Perfusion Imaging ; Sensitivity and Specificity ; Squamous Cell Carcinoma of Head and Neck ; Tomography, Spiral Computed ; Tumor Burden

Distant metastases from squamous cell carcinoma of the head and neck occur at many sites, most commonly lung and bone. Metastases to the skin are unusual, and account for fewer than 10% of all distant metastatic lesions. A 61-year-old man developed cutaneous metastasis two years later after the diagnosis of squamous cell carcinoma of the hypopharynx had been made. He was presented with asymptomatic multiple erythematous hard nodules with telangiectasia on the right shoulder. This lesion was diagnosed histologically as poorly differentiated squamous cell carcinoma. The skin metastases improved with radiotherapy and palliative chemotherapy, including cisplantin, 5-fluorouracil.
Carcinoma, Squamous Cell ; Diagnosis ; Drug Therapy ; Fluorouracil ; Head ; Humans ; Hypopharynx* ; Lung ; Middle Aged ; Neck ; Neoplasm Metastasis* ; Radiotherapy ; Shoulder ; Skin ; Telangiectasis

A total of 47 patients with a diagnosis of nasopharyngeal carcinoma was treated in Department of Therapeutic Radiology, Seoul National University Hospital during last 4 years. Of the 47 patients, 23(49%) had undifferentiated carcinoma, 20(43%) had squamous cell carcinoma, while 4(8%) had lymphoepithelioma. Most of the patients(71%) has Stage IV disease, cervical lymph node metastases were found in 36(77%) and distant metastasis was found in 1 at the time of diagnosis. Complete response rate after radiotherapy for 47 patients of nasopharyngeal carcinoma was 85.1%. The overall actuarial 3 year survival rates was 0.718 and the disease free actuarial 3 year survival rates was 0.468. Nodal involvement and symptom duration were statistically significiant influencing factors for actuarial survival rate. Treatment failures were found in 20 patients (42.6%), local recurrence only in 6(30%), local and neck recurrence in 3(15%), local recurrence with metastasis in 4(20%) and distant metastasis only in 7(35%). Local failures were more frequent in the patients with cranial nerve symptoms (P=0.032). Distant metastases were more frequent with T4 lesions (P=0.047), and with nodal involvement (P<0.01). Retreatment after the tumor recurrence was chemotherapy and/or radiotherapy, two patients refreated for local recurrence were alive without evidence of disease for more than 19 and 44 months after retreatment.
Carcinoma ; Carcinoma, Squamous Cell ; Cranial Nerves ; Diagnosis ; Drug Therapy ; Humans ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Radiation Oncology ; Radiotherapy* ; Recurrence ; Retreatment ; Seoul ; Survival Rate ; Treatment Failure

A 60-year-old female, who complained of delayed healing and swelling after extraction of left lower second molar during chemotherapy, visited our department. She had a history of a resection surgery of breast cancer and postoperative radiotherapy. The conventional radiographs showed diffuse permeative bone destruction in posterior mandibular body, which gave the first radiologic impression of osteonecrosis associated with radiotherapy or chemotherapy. And bone metastasis from the breast cancer was also considered in the differential diagnosis. On the enhanced computed tomography (ECT) the posterior mandibular body was occupied by a large expansile lesion showing central low attenuation with peripheral rim enhancement. Magnetic resonance images revealed that the low attenuated area on ECT did not show as high signal intensity as water on T2 weighted image and indicated solid component of a tumor. The final diagnosis was central squamous cell carcinoma. We present the diagnostic imaging features of the patient with special emphasis on the differential diagnosis.
Breast Neoplasms* ; Breast* ; Carcinoma, Squamous Cell ; Diagnosis* ; Diagnosis, Differential ; Diagnostic Imaging ; Drug Therapy* ; Female ; Humans ; Middle Aged ; Molar ; Neoplasm Metastasis ; Osteonecrosis ; Radiography ; Radiotherapy* ; Water

OBJECTIVETo observe the effect of traditional Chinese medicine (TCM) treatment according to syndrome differentiation on acute radio-reaction (ARR) in nasopharyngeal carcinoma (NPC) patients.

METHODSOne hundred and ninety-five NPC patients who received radiotherapy (RT) for the first time were randomly assigned to two groups: the control group (89 cases) was treated by RT alone for 7 weeks and the treatment group (106 cases) was treated by RT combined with oral taking TCM from starting of RT till 5 weeks after RT. The overall changes in total ARR score and ARR in different locations were observed weekly and compared.

RESULTSThe total ARR score in the treatment group was significantly lower than that in the control group (P<0.05). And the ARR scores of different organs, including skin, oropharyngeal mucosa, salivary glands, larynx, car, upper digestive tract, and central nervous system, in the treatment group were all lower than those of the corresponding organs in the control group. In addition, the ARR scores in both groups showed an ascending trend in the first 7 weeks and a descending trend from the 8th to the 10th week after beginning RT.

CONCLUSIONTCM treatment could relieve the ARR in the NPC patients without any affection on the efficacy of RT.

Adult ; Carcinoma, Squamous Cell ; drug therapy ; radiotherapy ; Combined Modality Therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Nasopharyngeal Neoplasms ; drug therapy ; radiotherapy ; Phytotherapy ; Radiation Injuries ; diagnosis ; prevention & control ; Syndrome ; Treatment Outcome

PURPOSE: In order to develop the national guide-lines for the standardization of radiotherapy we are planning to establish a web-based, on-line data-base system for laryngeal cancer. As a first step this study was performed to accumulate the basic clinical information of laryngeal cancer and to determine the items needed for the data-base system. MATERIALS AND METHODS: We analyzed the clinical data of patients who were treated under the diagnosis of laryngeal cancer from January 1998 through December 1999 in the South-west area of Korea. Eligibility criteria of the patients are as follows: 18 years or older, currently diagnosed with primary epithelial carcinoma of larynx, and no history of previous treatments for another cancers and the other laryngeal diseases. The items were developed and filled out by radiation oncologist who are members of Korean Southwest Radiation Oncology Group. SPSS v10.0 software was used for statistical analysis. RESULTS: Data of forty-five patients were collected. Age distribution of patients ranged from 28 to 88 years (median, 61). Laryngeal cancer occurred predominantly in males (10:1 sex ratio). Twenty-eight patients (62%) had primary cancers in the glottis and 17 (38%) in the supraglottis. Most of them were diagnosed pathologically as squamous cell carcinoma (44/45, 98%). Twenty-four of 28 glottic cancer patients (86%) had AJCC (American Joint Committee on Cancer) stage I/II, but 50% (8/16) had in supraglottic cancer patients (p=0.02). Most patients (89%) had the symptom of hoarseness. Indirect laryngoscopy was done in all patients and direct laryngoscopy was performed in 43 (98%) patients. Twenty-one of 28 (75%) glottic cancer cases and 6 of 17 (35%) supraglottic cancer cases were treated with radiation alone, respectively. The combined treatment of surgery and radiation was used in 5 (18%) glottic and 8 (47%) supraglottic patients. Chemotherapy and radiation was used in 2 (7%) glottic and 3 (18%) supraglottic patients. There was no statistically significant difference in the use of combined modality treatments between glottic and supraglottic cancers (p=0.20). In all patients, 6 MV X-ray was used with conventional fractionation. The fraction size was 2 Gy in 80% of glottic cancer patients compared with 1.8 Gy in 59% of the patients with supraglottic cancers. The mean total dose delivered to primary lesions were 65.98 Gy and 70.15 Gy in glottic and supraglottic patients treated, respectively, with radiation alone. Based on the collected data, 12 modules with 90 items were developed for the study of the patterns of care in laryngeal cancer. CONCLUSION: The study items for laryngeal cancer were developed. In the near future, a web system will be established based on the items investigated, and then a nation-wide analysis on laryngeal cancer will be processed for the standardization and optimization of radiotherapy.
Age Distribution ; Carcinoma, Squamous Cell ; Diagnosis ; Drug Therapy ; Glottis ; Hoarseness ; Humans ; Joints ; Korea ; Laryngeal Diseases ; Laryngeal Neoplasms* ; Laryngoscopy ; Larynx ; Male ; Radiation Oncology ; Radiotherapy*

The treatment of brain tumors metastasizing from lung cancer though the outcome has been unsatisfactory. Through an examination of the prognosis in patients treated with varying modalities, this study aims to determine which gives the best results. We analyzed 110 of 124 cases, histologically diagnosed between 1985 and 1994, in which lung cancer had meta-stasized to the brain. Radiotherapy, chemotherapy and conservative management had been implemented. The patients' mean age was 58(range 23 to 76) years: the M: F ratio was 74: 36. The histological diagnosis was squamous cell carcinoma in 25 cases, adenocarcinoma in 50, small cell carcinoma in 24, and large cell carcinoma in 11. The median metastatic period between the lung cancer and metastatic tumor was 11.5 months: the longest duration was 42 months(one case). In 63 cases primary lung cancer and brain metastasis were diagnosed simultaneously. Of the total cases, 47 involved solitary metastasis and 63, multiple. The chief complaints were headache in 38 cases, hemiparesis in 48, cognitive function defect in 16, and seizure in eight. Metastasis to other organs at the time of diagnosis was as follow: adrenal gland, 6: bone, 9: liver, 4: lung, 3: leptomeninges, 1. Four patients had undergone craniotomy, two, only chemotherapy; and 41, radiotherapy. Seven patients underwent gamma knife radiosurgery: 43 were treated with a single modality: and 53, by combined therapy. The median survival period in cases of surgery alone, radiotherapy, chemotherapy and gamma knife radiosurgery was 17 months, 5.7 months, 3.5 months and 8.0 months, respectively. In cases of combined therapy, this period was 19.2 months for conventional surgery and gamma knife radiosurgery, 14.0 months for surgery and radiotherapy, and 7.0 months for radiotherapy and chemotherapy. For those with adenocarcinoma, the median survival period was 7.7 months: those with large cell carcinoma had the shortest median survival period(4.6 months). Combined therapy proved most effective, but survival periods did not lengthen.
Adenocarcinoma ; Adrenal Glands ; Brain Neoplasms ; Brain* ; Carcinoma, Large Cell ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Craniotomy ; Diagnosis ; Drug Therapy ; Headache ; Humans ; Liver ; Lung Neoplasms ; Lung* ; Neoplasm Metastasis* ; Paresis ; Prognosis ; Radiosurgery ; Radiotherapy ; Seizures

OBJECTIVETo investigate the clinical application of diffusion weighted imaging (DWI) in uterine cervical cancer and the apparent diffusion coefficient (ADC) value in diagnosis and predicting treatment response.

METHODSTwenty-eight patients with advanced primary cervical cancer confirmed by pathology and 10 cases of normal uterine cervix as control were recruited in this prospective clinical trial. To analyze the correlation between tumor volume measured in DWI and tumor maximum diameter measured according to the RECIST criteria. To compare the ADC value differences among the uterine cervical cancer, uterine myometrium, and normal uterine cervix. To compare the ADC values in 17 cancer patients before and after treatment.

RESULTSThe illustration of tumor boundary in DWI was superior to conventional T2WI and post-enhancement T1WI. The DWI with higher b value (2000 s/mm(2)) had a better signal-to-noise ratio. The tumor volume measured in DWI has good correlation with tumor maximum diameter according to RECIST criteria (r = 0.759, P < 0.01). When b = 800 s/mm(2), the ADC values of the uterine cervical cancer, uterine myometrium, and normal uterine cervix were (9.85 ± 1.55)×10(-3) mm(2)/s, (14.20 ± 2.80)×10(-3) mm(2)/s, and (14.14 ± 0.45) ×10(-3) mm(2)/s. When b = 2000 s/mm(2), the ADC values of the uterine cervical cancer, uterine myometrium and normal uterine cervix were (7.38 ± 0.98)×10(-3) mm(2)/s, (8.52 ± 2.38)×10(-3) mm(2)/s, and (8.60 ± 0.63)×10(-3) mm(2)/s, respectively. There were significant differences between the cervical cancer and normal cervix or uterine myometrium (P < 0.001 for both). When b = 800 s/mm(2), the ADC value was (9.85 ± 1.55)×110(-3) mm(2)/s before and (13.41 ± 2.93)×10(-3) mm(2)/s after treatment (P < 0.001). When b = 2000 s/mm(2), the ADC value was (7.38 ± 0.98)×10(-3) mm(2)/s before and (8.93 ± 1.92)×10(-3) mm(2)/s after treatment (P = 0.008). Univariate logistic regression analysis showed that 25% ADC, 50%ADC, and 75%ADC in the tumor ADC value histogram before treatment were significantly correlated to the treatment outcome of cervical cancer (P < 0.05 for all). Multivariate regression analysis showed that 25%ADC, 50%ADC, and 75%ADC in the tumor ADC value histogram before treatment were not significantly correlated to the treatment outcome of cervical cancer (P > 0.05 for all). The values of ROC curves were 25%ADC = 0.818, 50%ADC = 0.775, and 75%ADC = 0.716 (P > 0.05), however, the 25% ADC showed a relatively stronger statistical power.

CONCLUSIONSDWI helps to confirm the morphology and exact target zone of the tumor for radiotherapy. DWI volume measurement is well correlated with RECIST criteria, particularly in volume measurement of irregular tumors. ADC value has a potential in quantitatively monitoring treatment response and predicting outcome of cervical cancers.

Adenocarcinoma ; diagnosis ; drug therapy ; pathology ; radiotherapy ; Antineoplastic Agents ; therapeutic use ; Carcinoma, Squamous Cell ; diagnosis ; drug therapy ; pathology ; radiotherapy ; Case-Control Studies ; Cervix Uteri ; pathology ; Cisplatin ; therapeutic use ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Middle Aged ; Myometrium ; pathology ; Prospective Studies ; ROC Curve ; Radiotherapy, Conformal ; Treatment Outcome ; Tumor Burden ; Uterine Cervical Neoplasms ; diagnosis ; drug therapy ; pathology ; radiotherapy

BACKGROUND: Lung cancer continues to increase worldwide. Also, the proportion of female patients incease and adenocarcinoma is the predominant histological type among lung cancer in many western countries. So, we studied these current trends of lung cancer by clinical approach of recent patients from our department. METHOD: We conducted a retrospective analysis on 212 subjects who were diagnosed with lung cancer at the department of chest medicine in National Medical Center between January 1990 and July 1996. The contents of analysis were patient's profile, clinical manifestation, smoking habits, accuracy of diagnostic methods, histological cell type, staging and treatment, etc. RESULTS: The results were as follows. 1) The ratio of male to female was 5.2:1. The peak incidence of age was 7th decade(35.4 %). 2) Chief complaints were cough, dyspnea and chest pain, etc. The most common duration of symptoms before the first admission was less than 3 months(57.7%). On the other side, duration more than 1 year represented 6.5%. The early diagnosed patients has been increased from the 1980s. 3) Smokers among the total patients were 77.2%. The proportion of smokers in sqamous cell carcinoma, small cell carcinoma and adenocarcinoma were 88.4%, 85.7% and 55.7%, respectively. Smoking history and histological cell type were correlated in squamous and small cell carcinoma. 4) Squamous cell carcinoma is still the predominant histological type(44.8%), but, adenocarcinoma increased more than the previous study(30.7%). The other histological types were small cell carcinoma(17.0%) and large cell carcinoma(3.8%) in order of their proportions. 5) The accuracy of diagnostic methods were as follows : sputum cytology 75.3%, bronchoscopic biopsy 65.7%, lymph node aspiration cytology 95.8%, percutaneous lung aspiration cytology 94.6% and open lung biopsy 100%. The general accuracies of diagnostic methods were improved than previous studies. 6) Performance status scales on admission were relatively good. After diagnosis, chemotherapy and/or radiotherapy were undertaken in 69.3% of the patients, and only 7.5% of the patients were operated. CONCLUSION: In our study, squamous cell carcinoma is still the predominant histological cell type, but, adenocarcinoma continues to increase. Because adenocarcinoma is less correlated with smoking habits, further evaluation of other carcinogens than smoking is requested. Screening and early diagnosis of lung cancer is important for good performance status scales in spite of advanced stages. But, we think that the prevention, for example, stop smokings is more important as because of no perfect treatment for lung cancer.
Adenocarcinoma ; Biopsy ; Carcinogens ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Pain ; Cough ; Diagnosis ; Drug Therapy ; Dyspnea ; Early Diagnosis ; Female ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Lymph Nodes ; Male ; Mass Screening ; Radiotherapy ; Retrospective Studies ; Smoke ; Smoking ; Sputum ; Thorax ; Weights and Measures

The prognostic value of T category for locoregional control in patients with nasopharyngeal carcinoma (NPC) has decreased with the extensive use of intensity-modulated radiotherapy (IMRT). We aimed to develop a prognostic scoring system (PSS) that incorporated tumor extension and clinical characteristics for locoregional control in NPC patients treated with IMRT. The magnetic resonance imaging scans and medical records of 717 patients with nonmetastatic NPC treated with IMRT at Sun Yat-sen University Cancer Center between January 2003 and January 2008 were reviewed. Age, pathologic classification, primary tumor extension, primary gross tumor volume (GTV-p), T and N categories, and baseline lactate dehydrogenase (LDH) level were analyzed. Hierarchical cluster analysis as well as univariate and multivariate analyses were used to develop the PSS. Independent prognostic factors for locoregional relapse included N2-3 stage, GTV-p ≥26.8 mL, and involvement of one or more structures within cluster 3. We calculated a risk score derived from the regression coefficient of each factor and classified patients into four groups: low risk (score 0), intermediate risk (score >0 and ≤1), high risk (score >1 and ≤2), and extremely high risk (score >2). The 5-year locoregional control rates for these groups were 97.4%, 93.6%, 85.2%, and 78.6%, respectively (P < 0.001). We have developed a PSS that can help identify NPC patients who are at high risk for locoregional relapse and can guide individualized treatments for NPC patients.
Adolescent ; Adult ; Aged ; Carcinoma ; Carcinoma, Squamous Cell ; diagnosis ; drug therapy ; metabolism ; pathology ; radiotherapy ; Chemoradiotherapy ; Female ; Humans ; Kaplan-Meier Estimate ; L-Lactate Dehydrogenase ; metabolism ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; drug therapy ; metabolism ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated ; methods ; Risk Assessment ; methods ; Tumor Burden ; Young Adult