Carcinoma, Hepatocellular ; pathology ; radiotherapy ; Humans ; Liver Neoplasms ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; radiotherapy

Radiotherapy is one of the most common treatments for oral cancer. However, in the clinic, recurrence and metastasis of oral cancer occur after radiotherapy, and the underlying mechanism remains unclear. Cancer stem cells (CSCs), considered the "seeds" of cancer, have been confirmed to be in a quiescent state in most established tumours, with their innate radioresistance helping them survive more easily when exposed to radiation than differentiated cancer cells. There is increasing evidence that CSCs play an important role in recurrence and metastasis post-radiotherapy in many cancers. However, little is known about how oral CSCs cause tumour recurrence and metastasis post-radiotherapy. In this review article, we will first summarise methods for the identification of oral CSCs and then focus on the characteristics of a CSC subpopulation induced by radiation, hereafter referred to as "awakened" CSCs, to highlight their response to radiotherapy and potential role in tumour recurrence and metastasis post-radiotherapy as well as potential therapeutics targeting CSCs. In addition, we explore potential therapeutic strategies targeting these "awakened" CSCs to solve the serious clinical challenges of recurrence and metastasis in oral cancer after radiotherapy.
Humans ; Mouth Neoplasms ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; radiotherapy ; Neoplastic Stem Cells ; pathology ; radiation effects ; Radiotherapy ; methods ; Recurrence

A patient with renal cell carcinoma (RCC) developed synchronous bone metastasis with metachronous relapses to the bone and renal fossa. The primary lesion was initially removed surgically, and the metastatic bone lesions and locally recurrent tumours were treated by a high-fractional dose and high-total-dose intensitymodulated radiotherapy (IMRT, 60 Gy at 2.5 Gy per fraction) without significant side effects. All the grossly relapsed tumors underwent complete remission (CR) within a short time after IMRT. To date, CR has been maintained for more than two years. This case study reports the successful treatment of radioresistant RCC using a new scheme that involves a fractionation regimen with a high precision radiotherapy.
Carcinoma, Renal Cell/pathology/*radiotherapy ; Dose Fractionation ; Female ; Humans ; Kidney Neoplasms/pathology/*radiotherapy ; Middle Aged ; Neoplasm Recurrence, Local/pathology/*radiotherapy ; Radiotherapy, Intensity-Modulated

OBJECTIVETo evaluate the feasibility, toxicity and tumor control of intensity modulated radiation therapy (IMRT) for recurrent nasopharyngeal carcinoma.

METHODSFourty-nine patients (Karnofsky performance status (KPS) >or= 80) with local-regional recurrence in the nasopharynx were treated with full course IMRT. Three patients with cervical lymph node metastasis (N1 2 and N3 1) were further supplemented with 5 to 6 courses of chemotherapy (Cisplatin + 5-Fu) after IMRT.

RESULTSThe results of treatment plan showed that the mean dose of covering gross tumor volume (GTV) (D(95)) in the nasopharynx was 68.09 Gy and the mean volume of GTV (V(95)) receiving the 95% dose was 98.46%. The mean dose of GTV, clinical target volume CTV1 and CTV2 in the targets were 71.40 Gy, 63.63 Gy and 59.81 Gy. The median follow-up time was 9 months (range 3 to 16 months). The local-regional progression-free survival was 100% with local-regional residual disease in 3 (6.1%) cases but was complicated with nasopharyngeal mucosa necrosis in 14 (28.6%) cases after IMRT.

CONCLUSIONIntensity modulated radiation therapy, as a re-treatment option for recurrent nasopharyngeal carcinoma, is able to improve the tumor target coverage and spare the adjacent critical structures. As high dose IMRT can result in radio-necrosis of nasopharyngeal mucosa, the prescription dose of GTV should be suitably decreased to 60 - 65 Gy.

Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; radiotherapy ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; pathology ; radiotherapy ; Neoplasm Recurrence, Local ; radiotherapy ; Neoplasm Staging ; Radiation Injuries ; pathology ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Conformal ; methods

Recently, the D'Amico classification system is widely used for the risk stratification of prostate cancer (PCa) , although no consensus has been reached for the definition of high-risk PCa. This system defines high-risk PCa as a prostate-specific antigen (PSA) level > 20 ng/ml, a Gleason score of 8-10, or a clinical stage ≥ T2c. Because high-risk PCa is prone to recurrence and metastasis after treatment, a proper initial therapy plays a crucial role. Currently, radical prostatectomy and radiation therapy are considered to be two most important options for the initial treatment of high-risk PCa although it remains controversial which is better.
Humans ; Male ; Neoplasm Grading ; Neoplasm Recurrence, Local ; Prostate-Specific Antigen ; blood ; Prostatectomy ; methods ; Prostatic Neoplasms ; blood ; pathology ; radiotherapy ; surgery ; Risk

Radiotherapy is the primary curative treatment of nasopharyngeal carcinoma (NPC) with the dose-response relationship. Local recurrence is one of the major treatment failure patterns. With high accuracy, high tumor dose, high therapeutic enhancement ratio and low normal tissue dose, stereotactic radiotherapy (SRT) is used as boost irradiation for residual lesions and is able to improve the local control rate. Residual lesions involving the carotid artery or cavernous sinus, or with tumor necrosis are treatment contraindications to SRT boost irradiation; while the old patients, patients with hypertension, diabetes mellitus, and severe nasopharyngeal infection are relative treatment contraindications to SRT boost irradiation. Fractionated SRT can spare vessels and nerves better than stereotactic radiosurgery (SRS). SRT can definitely improve the outcome for the boost of NPC residual lesions. Proper patient selection, individualized fractionated regimen, and balance of the benefit of tumor control and the risk of normal tissue damage are of paramount importance to ensure the satisfactory clinical outcome and quality of life.
Dose Fractionation ; Humans ; Nasopharyngeal Neoplasms ; pathology ; surgery ; Neoplasm Recurrence, Local ; Neoplasm, Residual ; Quality of Life ; Radiosurgery ; methods ; Radiotherapy Dosage ; Treatment Outcome

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; pathology ; radiotherapy ; Female ; Humans ; Lung Neoplasms ; pathology ; radiotherapy ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Radiotherapy, Conformal ; methods ; Remission Induction

Oral squamous cell carcinoma (OSCC) has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases (CLNM) in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy (aRT) and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.
Carcinoma, Squamous Cell ; pathology ; radiotherapy ; secondary ; surgery ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Mouth Floor ; pathology ; Mouth Neoplasms ; pathology ; radiotherapy ; surgery ; Neck ; pathology ; Neck Dissection ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Radiotherapy, Adjuvant

Retrospective analysis of two cases of advanced carcinoma of the middle ear. Two patients underwent operation and radiotherapy. A case developed extensive necrosis in ear and neck, which finally led to lethal hemorrhage. Multiple relapse with cranial fossa invasion and extensive necrosis was found in the other case.
Aged ; Ear Neoplasms ; pathology ; radiotherapy ; surgery ; Ear, Middle ; Female ; Humans ; Middle Aged ; Necrosis ; Neoplasm Recurrence, Local ; Retrospective Studies

OBJECTIVE: To evaluate the rate of occult metastases detected with elective neck dissection during salvage laryngectomy for patients of recurrence after radiotherapy. The relationship between occult metastases and tumor stage, complications and survival rate after operation was analyzed. METHOD: Retrospective review of 24 laryngo-carcinoma patients recurrent after radiotherapy treated with salvage surgery and 28 patients directly received laryngectomy in our hospital between 2005 and 2008. RESULT: A higher risk of occult metastases was noted in patients of recurrence after radiotherapy than those without radiation therapy. Cartilage invasion and perineural invasion in the larynx were associated with a higher risk of occult metastases. A statistically significant difference of survival advantage was not noted between these two groups. CONCLUSION We recommend bilateral neck dissection at the time of laryngectomy for recurrent staged T3/4 tumors and all patients with recurrent glottis and supraglottic cancers because of the higher rate of occult metastases.
Adult ; Aged ; Carcinoma, Squamous Cell ; pathology ; radiotherapy ; Female ; Humans ; Laryngeal Neoplasms ; pathology ; radiotherapy ; Male ; Middle Aged ; Neck Dissection ; Neoplasm Recurrence, Local ; surgery ; Retrospective Studies