To identify the effect of post-operative irradiation to the thyroid gland in patients with breast carcinoma. Seventy seven patients with partial or total mastectomized breast carcinoma who received routine irradiation therapy (Hockey stick method: supraclavicular, internal mammary lymph nodes, and chest wall irradiation with 5, 040 rads, divided into 30 treatments) were reviewed in terms of their ipsilateral thyroid gland response. All patients had the bilateral thyroid sizes measured annually by ultrasonography before and after radiation therapy. In the one-year follow-up group (n=77), 32 patients (41.5%) demonstrated decreased ipsilateral thyroid gland size after Hockey Stick irradiation therapy (p=0.428), in the two-year follow-up group (n=37), 26 patients (70.3%) demonstrated decreased gland size after Hockey Stick irradiation (p=0.001), and in the three-year follow-up group (n=21), 15 patients (71.4%) showed a decreased thyroid gland size (p=0.005). Most the patients with breast carcinoma (32/77 at the one-year follow-up, 26/37 at the two-year follow-up, and 15/21 at the three-year follow-up) after post-operative Hockey Stick irradiation therapy showed reduced ipsilateral thyroid gland size. Routine en face treatment of the supraclavicular lymph nodes, using the Hockey Stick method, should be reconsidered.
Breast Neoplasms/*radiotherapy ; Female ; Follow-Up Studies ; Human ; Lymph Nodes/*radiation effects ; Radiotherapy/adverse effects ; Thyroid Gland/pathology/*radiation effects

OBJECTIVETo explore the value of color doppler ultrasound examination of thyroid in occupational health care of radiation-exposed physicians.

METHODSOne hundred and thirty-four radiation-exposed physicians (observation group) and sixty-eight non-radiation-exposed physicians (control group) received color doppler ultrasound examination of thyroid using ALOKA SSD-4000 color doppler ultrasonic diagnostic apparatus, and the results were compared between the two groups.

RESULTSThe anteroposterior diameters of the left lobe, right lobe, and isthmus of the thyroid in the observation group were significantly larger than those in the control group (P < 0.01). Compared with the control group, the observation group had significantly larger internal diameters and peak blood flow velocities during systole of the right superior thyroid artery (P < 0.05, P < 0.05). There were no significant differences in detection rates of thyroid nodules and lymph nodes between the observation group and the control group (18.7% vs 13.2%, P > 0.05; 6.7% vs 1.5%, P > 0.05). The radiation-exposed physicians were exposed to low-dose ionizing radiation with a dose between 0.14 and 1.67 mSv/a.

CONCLUSIONThe color doppler ultrasound examination of the thyroid can detect early changes in the thyroid of radiation-exposed physicians exposed to long-term and low-dose ionizing radiation.

Humans ; Lymph Nodes ; Occupational Exposure ; analysis ; Occupational Health ; Physicians ; Radiation Exposure ; analysis ; Radiation, Ionizing ; Thyroid Gland ; diagnostic imaging ; radiation effects ; Ultrasonography, Doppler, Color

OBJECTIVETo decrease lung and esophageal radiation injuries by reducing irradiation target volume of mediastinal lymph mode drainage in conformal radiotherapy (CRT) for patients with non-small cell lung cancer (NSCLC) after thoracic surgery.

METHODSFifty-three patients with NSCLC were randomized into groups A and B to receive 3D-CRT after thoracic surgery. Patients in group A, according to conventional therapy, received preventive nodal irradiation (PNI) of the mediastinal lymph node drainage, and those in group B, according to pathological nodal staging after operation, did not have PNI of the metastasis-free area to reduce the clinical target volume (CTV). Patients in both groups were treated with conventional fractionated radiotherapy (CFRT) at 2 Gy in each fraction, and 5 fractions each week. All patients were followed up for two years to record their 2-year survival rate, local relapse of lymph node drainage and lung and esophageal radiation injuries.

RESULTSThe total 2-year survival rate was 58.5%in these patients and comparable between the two groups. The rates of local regional relapse and recurrence out of the CTV were 13.8% and 3.4% in group A and 16.7% and 8.3% in group B, respectively (P=1 and P=0.571). The incidence of radiation pneumonia and lung fibrosis were 6.9% and 62.1% in group A and 0% and 58.3% in group B (P=0.459 and P=0.782), and that of radiation esogphagitis and esophagus stricture rates were 27.6% and 6.9% in group A and 12.5% and 4.2% in group B, respectively (P=0.039 and P=1).

CONCLUSIONReduced CTV does not warrant decrease in the local control but may lower the incidence of acute esophageal radiation injury in postoperative patients with NSCLC.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; radiotherapy ; surgery ; Drainage ; Esophagus ; pathology ; radiation effects ; Female ; Humans ; Lung ; pathology ; radiation effects ; Lung Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; surgery ; Lymph Nodes ; surgery ; Male ; Mediastinum ; Middle Aged ; Organ Size ; Radiation Injuries ; prevention & control ; Radiotherapy, Conformal ; adverse effects ; Recurrence ; Survival Rate ; Thoracic Surgery ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVEIt is controversial for the irradiation level and dose of the regional prevention for naspharyngeal cancer (NPC) with one or both cervical lymph node-negative neck. The study was to analyze the proophylactic irradiation of cervical lymph nodes for Stage -N0 NPC patients.

METHODSFrom January 2002 and December 2004, 205 NPC patients with negative lymphadenopathy diagnosed by imaging, were retrospectively analyzed. Before treatment, each patient underwent CT or MRI. Facial-cervical portals and 6-8 MV photons were used in radiotherapy. Doses applied were 60-80 Gy to the nasopharynx and 46-64 Gy to the neck without lymphadenopathy. Consecutive radiotherapy was performed employing conventional fractionation of 2 Gy/fraction, once a day, for a total of five fractions per week. Chemotherapy was administered to 60 patients. Median follow-up was 44 months. The survival function was calculated according to the Kaplan-Meier method. A log-rank test was used to compare the differences in survival. The Cox proportional hazards model was used for multivariate analysis. A total of 205 patients with stage-N0 NPC were divided into an upper-neck irradiation group and an entire-neck group.

RESULTSThe 3-year overall survival rate (OS) was 92.9% and the 3-year disease-free survival rate (DFS) was 91.9%. A total of 88 patients received irradiation to the upper neck and 117 to the entire neck. The rate of regional failure for the upper-neck group and the entire-neck group were 2.27% and 0%, respectively (P>0.05). The rates of regional failure in patients with T1-, T2-, T3- and T4-stage disease were 0, 3.08%, 0, and 0, respectively (P>0.05). The rates of regional failure in the patients both without and with local failure were 1.03% and 0, respectively (P>0.05). The 1-and 3-year OS for the upper-neck group were 97.7% and 94.2%, and the 1- and 3-year OS for the entire-neck group were 97.4% and 91.9% (P=0.950). The 1- and 3-year DFS for the upper-neck group were 96.6% and 92.9%, and the 1- and 3-year DFS for the entire-neck group were 95.6% and 90.9% (P= 0.730). In multivariate analysis, sex (P=0.039) and T stage (P=0.004) were independent prognosis factors for patients with stage-N0 NPC.

CONCLUSIONSProphylactic irradiation to the upper neck does not influence regional failure or long-term survival in the patients with stage-N0 NPC. Radiotherapy to the upper neck (levels II, III, VA) is recommended for the patients with stage-N0 NPC. Involvement of the parapharyngeal space, T stage, and the rates of local failure do not influence regional failure in these patients. Sex and T stage were independent prognosis factors of stage-N0 NPC patients.

Adult ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; pathology ; Lymphatic Irradiation ; Lymphatic Metastasis ; prevention & control ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; radiotherapy ; Nasopharynx ; radiation effects ; Neck ; radiation effects ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Particle Accelerators ; Proportional Hazards Models ; Radiotherapy Dosage ; Radiotherapy, High-Energy ; methods ; Retrospective Studies ; Sex Factors ; Survival Rate

OBJECTIVETo investigate the value of 18F-FDG PET-CT in detecting metastatic lymph node and radiation planning for patient with non-small-cell lung cancer (NSCLC).

METHODSThe data of 58 NSCLC patients were retrospectively analyzed. Preoperatively, Both 18F-FDG PET-CT and CT scan were performed for all patients. Blinded interpretation of these images was then carried out. The gross tumor volume defined by radiation oncologist based on imaging results of either PET-CT or CT alone was compared with pathological results eventually.

RESULTSThe sensitivity, specificity, accuracy, positive predictive value and negative predictive value of detecting metastatic lymph node in the mediastinum was 56.0%, 54.2%, 54.8%, 38.9%, 70.3% by CT alone, and 88.0%, 85.4%, 86.3%, 75.9%, 93.2% by PET-CT, respectively. There was a statisticalty significant difference between two methods(P < 0.05). However, statisticalty no significant difference in detecting hilar lymph nodes was observed. The radiation target volume defined by CT was identical to that by PET-CT in 31(53.5%) cases, but changed in the other 27 (46.5%) cases when 18F-FDG PET data was added. The accuracy was 75.9% in detecting metastatic lymph nodes in the radiation target volume defined by PET-CT, while it was much lower by CT alone (48.3%) with a statistically significant difference between two methods (P < 0.05).

CONCLUSION18F-FDG PET-CT is more accurate than CT alone in assessment of mediastinal lymph nodes for NSCLC patients. It may be recommended as a method in defining the radiation target volume.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; radiotherapy ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; Lymph Nodes ; diagnostic imaging ; pathology ; radiation effects ; Lymphatic Metastasis ; Male ; Mediastinum ; diagnostic imaging ; radiation effects ; Middle Aged ; Positron-Emission Tomography ; methods ; Radiopharmaceuticals ; Retrospective Studies ; Tomography, X-Ray Computed

The management of cervical lymph node metastases of squamous cell carcinoma from an unknown primary site is still a therapeutic challenge. We report here our experience in treating these patients with chemoradiotherapy as a curative approach. Data from 40 patients were reviewed. In total, 20 (50%) patients underwent excisional biopsy. All patients underwent radiotherapy, which was delivered to both sides of the neck and pharyngeal mucosa (extensive field), and concurrent chemotherapy consisting of weekly cisplatin at a dose of 40 mg/m(2). The clinical stage of the cervical nodes at presentation was N1 in 25%, N2 in 60%, and N3 in 15%. Most patients (75%) developed at least grade 3 mucositis. Eight patients (20%) had grade 3 xerostomia and 18 patients (45%) required esophageal dilation for stricture. The 5-year overall survival(OS) rate of all patients was 67.5%. The 5-year OS rates of patients with N1, N2, and N3 lesions were 100%, 67%, and 41%, respectively (P = 0.046). The 5-year progression-free survival rate was 62.5%. In multivariate analysis, only N stage significantly affected OS(P = 0.022). Emergence of the occult primary was very limited (1 patient only). Our results suggest that extensive irradiation of both sides of the neck and pharyngeal mucosa with concurrent chemotherapy results in a lower emergence of primary tumor. Because the survival of patients with unknown primary is comparable to that of patients with known primary, an attempt at cure should always be made.
Adult ; Aged ; Antineoplastic Agents ; therapeutic use ; Carcinoma, Squamous Cell ; pathology ; secondary ; therapy ; Chemoradiotherapy ; Cisplatin ; therapeutic use ; Disease-Free Survival ; Esophagitis ; etiology ; Female ; Follow-Up Studies ; Head and Neck Neoplasms ; pathology ; secondary ; therapy ; Humans ; Lymph Nodes ; radiation effects ; surgery ; Male ; Middle Aged ; Mucositis ; etiology ; Neck ; pathology ; Neck Dissection ; Neoplasms, Unknown Primary ; pathology ; therapy ; Pharynx ; pathology ; Survival Rate ; Xerostomia ; etiology ; Young Adult