Four cases of hepatocellular carcinoma (HCC) were surgically resected following combined radiotherapy (RT) and hyperthermia (HT). Complete necrosis of the tumor without viable tumor cell was found in one case and extensive tumor necrosis was observed in the other three cases; the percentage of necrosis in the specimens were 40%, 70%, and 80%, respectively. Histologic assessment showed mainly coagulative necrosis in the tumor with focal liquefactive necrosis. Cystic dilatation of sinusoids was observed in both tumor and nontumorous normal liver tissue. Other changes in normal liver tissue were unremarkable except for infiltration of inflammatory cells, fatty change, and proliferation of the bile ducts which can usually be seen beyond the area where any space occupying lesions are present. It is concluded that combined radiotherapy and hyperthermia can significantly induce coagulative necrosis of hepatocellular carcinoma with nonsignificant minimal histologic changes in adjacent nontumorous liver tissue.
Carcinoma, Hepatocellular/*pathology/radiotherapy/surgery/*therapy ; Combined Modality Therapy ; Female ; Human ; *Hyperthermia, Induced ; *Liver Neoplasms/*pathology/radiotherapy/surgery/*therapy ; Male ; Middle Aged ; Necrosis

Because of its safety and treatment effectiveness, the popularity of radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC) has gradually increased. However, some serious complications of RFA such as hepatic infarction, bowel perforation, and tumor seeding have been reported. Recently, we experienced a case of diaphragmatic hernia after RFA for HCC. A 61-year-old man with alcoholic cirrhosis was diagnosed with a 1.0 cm sized HCC in segment (S) 5 and a 1.3 cm sized HCC in S 8 of the liver. He was treated by transarterial chemoembolization and RFA. After RFA, an abdominal CT revealed a diaphragmatic defect with herniating mesentery. Twenty-two months after the RFA, the chest CT showed the diaphragmatic defect with herniating colon and mesentery. Because he had no symptoms, and surgical repair for the diaphragmatic hernia would be a high risk operation for him, we decided to treat the patient conservatively. For its great rarity, we report this case with a review of the literature.
Carcinoma, Hepatocellular/*diagnosis/*radiotherapy/therapy ; Catheter Ablation/*adverse effects ; Chemoembolization, Therapeutic ; Hernia, Diaphragmatic/*etiology/surgery ; Humans ; Liver Cirrhosis, Alcoholic/complications/*diagnosis ; Liver Neoplasms/*diagnosis/*radiotherapy/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

Systemic chemotherapy is the basic palliative treatment for metastatic nasopharyngeal carcinoma (NPC); however, it is not known whether locoregional radiotherapy targeting the primary tumor and regional lymph nodes affects the survival of patients with metastatic NPC. Therefore, we aimed to retrospectively evaluate the benefits of locoregional radiotherapy. A total of 408 patients with metastatic NPC were included in this study. The mortality risks of the patients undergoing supportive treatment and those undergoing chemotherapy were compared with that of patients undergoing locoregional radiotherapy delivered alone or in combination with chemotherapy. Univariate and multivariate analyses were conducted. The contributions of independent factors were assessed after adjustment for covariates with significant prognostic associations (P < 0.05). Both locoregional radiotherapy and systemic chemotherapy were identified as significant independent prognostic factors of overall survival (OS). The mortality risk was similar in the group undergoing locoregional radiotherapy alone and the group undergoing systemic chemotherapy alone [multi-adjusted hazard ratio (HR) = 0.9, P = 0.529]; this risk was 60% lower than that of the group undergoing supportive treatment (HR = 0.4, P = 0.004) and 130% higher than that of the group undergoing both systemic chemotherapy and locoregional radiotherapy (HR = 2.3, P < 0.001). In conclusion, locoregional radiotherapy, particularly when combined with systemic chemotherapy, is associated with improved survival of patients with metastatic NPC.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bone Neoplasms ; drug therapy ; radiotherapy ; secondary ; surgery ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Cisplatin ; administration & dosage ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; drug therapy ; radiotherapy ; secondary ; surgery ; Lung Neoplasms ; drug therapy ; radiotherapy ; secondary ; surgery ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; drug therapy ; pathology ; radiotherapy ; Neoplasm Staging ; Paclitaxel ; administration & dosage ; Palliative Care ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Survival Rate ; Young Adult

In cases of large hepatocellular carcinoma (HCC), neoadjuvant treatment such as transarterial chemoembolization (TACE) and radiation therapy can be performed. The aim of this study was to evaluate the outcome of these treatments prior to hepatic resection. Between January 1994 and May 2007, 16 patients with HCC greater than 5 cm in size were treated with TACE and radiation therapy prior to hepatic resection. The clinicopathologic factors were reviewed retrospectively. Of the 16 patients, there were 14 men and two women, and the median age was 52.5 yr. TACE was performed three times in average, and the median radiation dosage was 45 Gy. The median diameter of tumor on specimen was 9.0 cm. The degree of tumor necrosis was more than 90% in 14 patients. The median survival time was 13.3 months. Five patients had survived more than 2 yr and there were two patients who had survived more than 5 yr. Although the prognosis of large HCC treated with neoadjuvant therapy is not satisfactory, some showed long-term survival loger than 5 yr. Further research will be required to examine the survival and disease control effect in a prospective randomized study.
Adult ; Aged ; Antineoplastic Agents/therapeutic use ; Carcinoma, Hepatocellular/radiotherapy/surgery/*therapy ; *Chemoembolization, Therapeutic ; Combined Modality Therapy ; Doxorubicin/therapeutic use ; Female ; Humans ; Liver/*surgery ; Liver Neoplasms/radiotherapy/surgery/*therapy ; Male ; Middle Aged ; Neoplasm Staging ; Preoperative Care ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Survival Rate

The purpose of this study was to compare the dose distribution of intensity-modulated radiotherapy (IMRT) in 7 and 5 fields as well as 3-D conformal radiotherapy (3D-CRT) plans for gastric cancer using dosimetric analysis. In 15 patients with gastric cancer after D1 resection, dosimetric parameters for IMRT (7 and 5 fields) and 3D-CRT were calculated with a total dose of 45 Gy (1.8 Gy/day). These parameters included the conformal index (CI), homogeneity index (HI), maximum dose spot for the planned target volume (PTV), dose-volume histogram (DVH) and dose distribution in the organs at risk (OAR), mean dose (Dmean), maximal dose (Dmax) in the spinal cord, percentage of the normal liver volume receiving more than 30 Gy (V30) and percentage of the normal kidney volume receiving more than 20 Gy (V20). IMRT (7 and 5 fields) and 3D-CRT achieved the PTV coverage. However, IMRT presented significantly higher CI and HI values and lower maximum dose spot distribution than 3D-CRT (P=0.001). For dose distribution of OAR, IMRT had a significantly lower Dmean and Dmax in spinal cord than 3D-CRT (P=0.009). There was no obvious difference in V30 of liver and V20 of kidney between IMRT and 3D-CRT, but 5-field IMRT showed lower Dmean in the normal liver than other two plans (P=0.001). IMRT revealed favorable tumor coverage as compared to 3D-CRT and IMRT plans. Specifically, 5-field IMRT plan was superior to 3D-CRT in protecting the spinal cord and liver, but this superiority was not observed in the kidney. Further studies are needed to compare differences among the three approaches.
Combined Modality Therapy ; Female ; Humans ; Kidney ; radiation effects ; Liver ; radiation effects ; Male ; Middle Aged ; Postoperative Period ; Radiation Injuries ; diagnosis ; prevention & control ; Radiation Monitoring ; methods ; Radiometry ; methods ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; methods ; Radiotherapy, Conformal ; methods ; Radiotherapy, Intensity-Modulated ; methods ; Spine ; radiation effects ; Stomach Neoplasms ; radiotherapy ; surgery

BACKGROUND AND AIMS: We investigated the five-year survival outcomes of a large cohort of hepatocellular carcinoma (HCC) patients who were treated at a single institute, and this is a follow-up study of a previous report. METHODS: Nine hundred four HCC patients who were treated at the National Cancer Center Korea were enrolled and they were followed till February 2007. RESULTS: The mean age of the patients was 56.0 years and 731 patients were male. Six hundred seventy-seven (74.9%) patients died and the overall 5-year survival rate (5-YSR) was 23.9%. The 5-YSRs of the patients with modified UICC stage I, II and III were 61.2%, 54.4% and 18.4%, respectively, and the median survival time was 4.3 and 3.7 months for the stage IVa and IVb patients, respectively. For the analysis of the treatment modality, surgical resection showed significantly better outcomes for the five-year survival as compared with transcatheter arterial chemoembolization (TACE) for Child-Pugh A patients with modified UICC stage I or II disease (80.1% vs 52.8%, respectively, P<.001), or stage III disease (60.7% vs 17.0%, respectively, P<.001). For patients with advanced stage IVb disease, TACE, systemic chemotherapy and radiotherapy increased the median survival period more than conservative management for the Child-Pugh class A patients. The serum alpha-fetoprotein level, portal vein tumor thrombosis, the Child-Pugh class, the tumor stage, the tumor type and symptoms were related to the prognosis. CONCLUSIONS: This study presented, for the first time, the 5-YSRs of a cohort of HCC patients.
Aged ; Carcinoma, Hepatocellular/etiology/*mortality/surgery ; Chemoembolization, Therapeutic ; Cohort Studies ; Combined Modality Therapy ; Female ; Humans ; Korea ; Liver Neoplasms/etiology/*mortality/surgery ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Staging ; Radiotherapy, Conformal ; Severity of Illness Index ; Survival Rate

For patients with unresectable pancreatic cancer, current chemotherapies have negligible survival benefits. Thus, developing effective minimally invasive therapies is currently underway. This study was conducted to evaluate the efficacy of transarterial chemoembolization plus radiofrequency ablation and/or 125I radioactive seed implantation on unresectable pancreatic cancer. We analyzed the outcome of 71 patients with unresectable pancreatic carcinoma who underwent chemoembolization plus radiofrequency ablation and/or radioactive seed implantation. Of the 71 patients, the median survival was 11 months, and the 1-, 2-, and 3-year overall survival rates were 32.4%, 9.9%, and 6.6%, respectively. Patients who had no metastasis, who had oligonodular liver metastases (≤3 lesions), and who had multinodular liver metastases (>3 lesions) had median survival of 12, 18, and 8 months, respectively, and 1-year overall survival rates of 50.0%, 68.8%, and 5.7%, respectively. Although the survival of patients without liver metastases was worse than that of patients with oligonodular liver metastasis, the result was not significant (P = 0.239). In contrast, the metastasis-negative patients had significantly better survival than did patients with multinodular liver metastases (P < 0.001). Patients with oligonodular liver lesions had a significant longer median survival than did patients with multinodular lesions (P < 0.001). In conclusion, combined minimally invasive therapies had good efficacy on unresectable pancreatic cancer and resulted in a good control of liver metastases. In addition, the number of liver metastases was a significant factor in predicting prognosis and response to treatment.
Antimetabolites, Antineoplastic ; administration & dosage ; Brachytherapy ; methods ; Catheter Ablation ; methods ; Chemoembolization, Therapeutic ; methods ; Deoxycytidine ; administration & dosage ; analogs & derivatives ; Female ; Follow-Up Studies ; Humans ; Iodine Radioisotopes ; Liver Neoplasms ; radiotherapy ; secondary ; surgery ; therapy ; Lymphatic Metastasis ; Male ; Middle Aged ; Pancreatic Neoplasms ; pathology ; radiotherapy ; surgery ; therapy ; Remission Induction ; Survival Rate

OBJECTIVETo investigate the histopathological features of basaloid squamous cell carcinoma of the esophagus, and to explore the ways of its diagnosis, differential diagnosis and treatment.

METHODSThe clinical data and pathological features of 23 cases of esophageal basaloid squamous cell carcinoma were reviewed and analyzed retrospectively.

RESULTSThe tumors were mainly located at the middle third segment of the esophagus. The 1-,2- and 3-year survival rates were 60.9%, 21.7% and 0, respectively.

CONCLUSIONThe basaloid squamous cell carcinoma of the esophagus is highly malignant with poor prognosis. Radical resection combined with radiotherapy and chemotherapy is required.

Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Carcinoma, Basosquamous ; diagnosis ; therapy ; Carcinoma, Squamous Cell ; diagnosis ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Diagnosis, Differential ; Esophageal Neoplasms ; diagnosis ; therapy ; Esophagectomy ; methods ; Esophagus ; pathology ; surgery ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Lung Neoplasms ; secondary ; Male ; Middle Aged ; Radiotherapy, High-Energy ; Retrospective Studies ; Survival Rate

Numerous studies have demonstrated the clinical activity of temozolomide, a second-generation alkylating agent, against malignant brain tumors, however, its activity has not been reported in an Asian population. This study analyzed the efficacy and toxicity of temozolomide in 25 adult patients with recurrent or progressive malignant gliomas after surgery and standard radiation therapy with or without chemotherapy, enrolled in our institution since July 2000. Sixteen patients had glioblastoma multiforme (GBM), six with anaplastic astrocytoma, and three with anaplastic oligodendroglioma. Of the 25 patients, 3 (12%) achieved a complete response (CR), 8 (32%) achieved a partial response (PR), 6 (24%) had stable disease (SD), and 8 (32%) had progressive disease (PD). Two patients achieved a CR, 4 patients achieved a PR, 3 patients had SD and 7 patients had PD in GBM, and 1 patient achieved a CR, 4 patients achieved a PR, 3 patients had SD, 1 patient had PD in the non-GBM patients. Median progression free survival was 8 weeks in GBM and 22 weeks in the non-GBM patients. The median overall survival of each group was 17 weeks and 28 weeks. Temozolomide demonstrated moderate activity in recurrent and progressive malignant gliomas without serious toxicity.
Vomiting/chemically induced ; Treatment Outcome ; Survival Analysis ; Neoplasm Recurrence, Local ; Nausea/chemically induced ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Liver Diseases/chemically induced ; Leukopenia/chemically induced ; Humans ; Glioma/*drug therapy/radiotherapy/surgery ; Female ; Drug Administration Schedule ; Dacarbazine/administration & dosage/adverse effects/*analogs & derivatives/therapeutic use ; Combined Modality Therapy ; Brain Neoplasms/*drug therapy/radiotherapy/surgery ; Brain/drug effects/pathology ; Antineoplastic Agents, Alkylating/administration & dosage/adverse effects/therapeutic use ; Adult ; Adolescent ; Administration, Oral