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Radiotherapy in Small Cell Carcinoma of the Uterine Cervix .

Eun Ji CHUNG ; Yong Hee LEE ; Gwi Eon KIM ; Chang Ok SUH

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):369-378.

PURPOSE: This study was performed to identify the histopathologic feature by the reevaluation of the pathologic specimen of the cervical tumors and to evaluate the clinical findings and the treatment results of the patients with small cell carcinoma of the cervix treated by radiotherapy. MATERIALS AND METHODS: 2890 patients with cervical carcinoma received radiotherapy at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine between October 1981 and April 1995. Of the 2890 patients in this data base, sixty were found to have small cell carcinomas (2.08%). Among them thirty six patients were transferred from other hospitals, the biopsy specimens of those patients were not available. So we could review the slides of the other twenty four patients who were diagnosed at our hospital. Twenty four patients with small cell carcinoma of the cervix were analyzed retrospectively based on the assessment of H & E staining and other four immunohistochemical stains for neuroendocrine differentiation (neuron specific enolase, chromogranin, synaptophysin and Grimelius stain). And we also evaluate the patients and tumor characteristics, response to radiation, patterns of failures, 5 year overall and disease free survival rates. RESULTS: Thirteen tumors were neuroendocrine carcinomas (13/24=54.2%) and eleven tumors were squamous carcinomas, small cell type (11/24= 47.8%) based on the assessment of H & E staining and other four neuroendocrine marker studies. So we classified the patients two groups as neuroendocrine carcinoma and small cell type of squamous carcinoma. Among the 13 neuroendocrine carcinomas, five were well to moderately differentiated tumors and the other eight were poorly differentiated or undifferentiated ones. The median age was 54 years old (range 23-79 years). Eight patients had FIGO stage IB disease, 12 had stage II, 3 had stage III and one had stage IV disease. Pelvic lymph node metastases were found in five patients(20.8%), three of them were diagnosed by surgical histologic examination and the other two were diagnosed by CT scan. There was no difference between two histopathologic groups in terms of patients and tumor characteristics, response to radiation, 5 year overall and disease free survival rates. However the distant metastases rate was higher in neuroendocrine carcinoma patients (6/13:46.2%) than in small cell type of squamous carcinoma patients (2/11:18.2%), but there was no statistically significant difference because of the small number of patients (P>0.05). CONCLUSION: More than half of the small cell carcinoma of the cervix patients were neuroendocrine carcinoma (13/24 : 54.1%) by reevaluation of the biopsy specimen of the cervical tumors. The tendency of distant metastases of the neuroendocrine carcinoma was greater than those of the small cell type of squamous carcinoma (46.2% vs. 18.2%). But there were no differences in the patients and tumor characteristics and other clinical treatment results in both groups. These data suggest that radical local treatment such as radiotherapy or radical surgery combined with combination systemic cytotoxic chemotherapy might provide these patients with the best chance for cure.
Biopsy ; Carcinoma, Neuroendocrine ; Carcinoma, Small Cell* ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Coloring Agents ; Disease-Free Survival ; Drug Therapy ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Phosphopyruvate Hydratase ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Synaptophysin ; Tomography, X-Ray Computed

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Adjuvant Radiotherapy Following Radical Hysterectomy and Bilateral Pelvic Lymph Node Dissection for the Uterine Cervical Cancer: Prognostic Factors and Failure Patterns.

Doo Ho CHOI

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):357-368.

PURPOSE: To identify variable prognostic factors and analyse failure patterns in the uterine cervix cancer after radical operation and adjuvant radiotherapy, a retrospective analysis was undertaken. MATERIALS AND METHODS: I analysed one hundred and twenty four patients with uterine cervix cancer, FIGO stage IB, IIA and IIB, treated with radical hysterectomy and pelvic lymph node dissection followed by adjuvant radiotherapy between May 1985 and May 1994. Minimum follow up period was 24 months. All of them were treated with full dose external radiotherapy with linear accelerator and/or high dose rate intracavitary radiation. RESULTS: Overall 5 year survival rate and relapse free survival rate were 75.4%, 73.5%, respectively. Significant prognostic factors by relapse free survival were wall involvement thickness, lymph node location and number, parametrium involvement, tumor size, stage, uterine body involvement, vaginal resection margin involvement. By multivariate analysis, lymph node metastasis, tumor size and vaginal resection margin involvement were significant prognostic factors.Treatment related failure were 33 cases. Locoregional failure were more likely in the stage IIB, lymph node positive or vaginal resection margin positive patients whereas distant failures were relatively more frequent in stage IB, IIA and lymph node, vaginal resection negative patients. In stage IIB, 5 year relapse free survival rate was only 56% and nine of twenty two patients recurred. CONCLUSION: Postoperative radiotherapy results are good for patients with relatively low risk factor. But the results are poor for patients with multiple, high risk factors or stage IIB. To control recurrence for patients with high risk factors, postoperative adjuvant radiotherapy is not sufficient treatment method. To raise control rate, adding other methods such as radiosensitizing agent or chemotherapy is necessary and prospectively randomized study is needed for evaluation of postoperative radiotherapy efficacy and /or othermethods. And it is reasonable to treat primary radical radiotherapy for patients with stage IIB cervical cancer instead of radical operation and adjuvant radiotherapy and/or chemotherapy regimen.
Cervix Uteri ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Hysterectomy* ; Lymph Node Excision* ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Particle Accelerators ; Radiotherapy ; Radiotherapy, Adjuvant* ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate ; Uterine Cervical Neoplasms*

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Results of Hyperfractionated Radiation Therapy in Bulky Stage Ib, IIa, and IIb Uterine Cervical Cancer.

Jin Hee KIM ; Ok Bae KIM

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):349-356.

PURPOSE: To evaluate the efficacy of hyperfractionated radiation therapy in carcinoma of the cervix, especially on huge exophytic and endophytic stage Ib, IIa and IIb. METHODS AND MATERIAl: Fourty one patients with carcinoma of the cervix treated with hyperfractionated radiation therapy at the Department of Therapeutic Radiology, Dongsan Hospital, Keimyung University, School of Medicine from Jul, 1991 to Apr, 1994. According to FIGO staging system, there were stage Ib (3 patients), IIa (6 patients) with exophytic (> or = 5cm in diameter) and huge endophytic mass, and IIb (32 patients) with median age of 55 years old. Radiation therapy consisted of hyperfractionated external irradition to the whole pelvis (120cGy/fraction, 2 fraction/day (minimum interval of 6 hours), 3600-5520cGy) and boost parametrial doses (for a total of 4480-6480cGy) with midline shield (4x10cm), and combined with intracavitary irradiation (up to 7480-8520cGy in Ib, IIa and 8480-9980cGy in IIb to point A). The maximum and mean follow up durations were 70 and 47 months respectively. RESULTS: Five year local control rate was 78% and the actuarial overall five year survival rate was 66.1% for all patients, 44.4% for stage Ib, IIa and 71.4% for stage IIb. In bulky IIb (above 5cm in tumor size, 11 patients) five year local control rate and five year survival rate was 88.9%, 73% respectively. Pelvic lymph node status (negative : 74%, positive:25%, P= 0.0015) was significant prognostic factor affecting to five year survival rate. There was marginally significant survival difference by total dose to A point (>84Gy : 70%, <84Gy : 42.8%, P=0.1). We consider that the difference of total dose to A point by stage (mean Ib,IIa : 79Gy, IIb : 89Gy P=0.001) is one of the causes in worse local control and survival of Ib,IIa than IIb.The overall recurrence rate was 39% (16/41). The rates of local failure alone, distant failure alone, and combined local and distant failure were 9.7%, 19.5%, and 9.7%, respectively. Two patients developed leukopenia (>; or =grade 3) and Three patients developed grade 3 gastrointestinal complication. Above grade 3 complication was not noted. There was no treatment related death noted. CONCLUSION: We thought that it may be necessary to increase A point dose to more than 85Gy in hyperfractionated radiotherapy of huge exophytic and endophytic stage Ib,IIa. We considered that hyperfractionated radiation therapy may be tolerable in huge exophytic and endophytic stage IIb cervical carcinoma with acceptable morbidity and possible survival gain but this was results in small patient group and will be confirmed by long term follow up in many patients.
Cervix Uteri ; Female ; Follow-Up Studies ; Humans ; Leukopenia ; Lymph Nodes ; Middle Aged ; Pelvis ; Radiation Oncology ; Radiotherapy ; Recurrence ; Survival Rate ; Uterine Cervical Neoplasms*

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The Role of Adjuvant Postoperative Radiotherapy in Curative Resectable Sigmoid Colon Carcinoma.

Won PARK ; Jinsil SEONG ; Ki Chang KEUM ; Chang Ok SUH ; Sang Wook LEE ; Ji Hoon LIM ; Jin Sik MIN ; Jae Kyung ROH ; Joo Hang KIM ; Hyun Cheol CHUNG ; Kang Kyu LEE ; Gwi Eon KIM

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):339-348.

PURPOSE: To evaluate the role of postoperative radiation therapy after curative resection of sigmoid colon cancer MATERIALS AND METHODS: From 1988 to 1993, a total of 93 patients with curative resectable sigmoid colon cancer of modified Astler-Coller (MAC) stage B2, B3, C2, C3 was divided into two groups on the basis of those who received radiation treatment and those who did not. Forty-three patients who treated by surgery alone were classified as postop RT ( group. The remaining 50 patients who underwent postoperative radiotherapy were classified as postop RT (+) group. In all patients in postop RT (+) group, radiation therapy was delivered using 4 or 10 MV linear accelerators to treat the tumor bed with approximately 5cm margin to a total dose 50.4-61Gy (median 54Gy) in 1.8Gy per fraction. Thirty-two patients were treated with 5- Fluorouracil based adjuvant chemotherapy at least 3 cycles, but these was no significant difference between two groups. Treatment failure pattern, 5-year local failure-free survival rates (LFFS), and 5-year disease-free survival rates (DFS) were compared between two groups. RESULTS: Five year LFFS and DFS were 85.1%, 68.5%, respectively. In postop RT (-) group, LFFS was 76.2%, compared with 91.7% in postop RT (+) group. Improved LFFS and DFS were seen for patients with stage C3 sigmoid colon carcinoma with postoperative radiation therapy compared with postop RT (-) group (P=0.01, P=0.06 respectively). In stage B3, LFFS washigher in postop RT (+) group than that in postop RT (-) group, although it was not significant. Especially, local control was higher in stage T4 in postop RT (+) group than that in postop RT (-) group. CONCLUSION: This study showed significantly improved LFFS and DFS in MAC Stage C3 and improved tendency of LFFS and DFS in MAC Stage B3 disease. Large scale prospective study is required to verify the role of adjuvant radiation therapy in resectable sigmoid colon cancer.
Chemotherapy, Adjuvant ; Colon, Sigmoid* ; Disease-Free Survival ; Fluorouracil ; Humans ; Particle Accelerators ; Radiotherapy* ; Sigmoid Neoplasms ; Survival Rate ; Treatment Failure

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Risk Factors for Recurrence after Conservative Treatment in Early Breast Cancer: Preliminary Report.

Chang Ok SUH ; Eun Ji CHUNG ; Hy De LEE ; Kyong Sik LEE ; Ki Keun OH ; Gwi Eon KIM

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):331-338.

PURPOSE: To evaluate our experience in the breast-conserving treatment for early breast cancer with special regard to recurrence pattern and related risk factors. MATERIALS AND METHOD: Two hundred and sixteen patients with AJC stagei and ii breast cancer who received breast conserving treatment between January 1991 and December 1994 were evaluated. Age distribution ranged from 23-80 year old with a median age of 44. One hundred and seventeen patients had T1 lesions and 99 patients had T2 lesions. Axillary lymph nodes were involved in 73 patients. All patients received a breast conserving surgery (wide excision to quadrantectomy) and axillary node dissection followed by radiotherapy. Ninety six patients received chemotherapy before or after radiotherapy. RESULTS: During the follow-up period (3-60 months, median 30 months), local recurrences were noted in six patients (true; 3, elsewhere; 1, skin; 2). Sixteen patients developed distant metastases as the first sign of recurrence at 8-38 months (median 20 months) after surgery. Among them, three patients simultaneously developed local recurrence with distant metastases. Contralateral breast cancer developed in one patient and non-mammary cancers developed in three patients. The actuarial 5 year survival rate was 88.4% (stage i 96.7%, stage iia 95.2%, stage iib 69.9%). Age, T stage, number of involved axillary lymph nodes, and AJC stage were risk factors for distant metastases in univariate analysis. In the multivariate analysis, the number of involved axillary lymph nodes was the most significant risk factor for metastases. CONCLUSION: Local recurrence was not common in the early years after radiotherapy. Distant metastases occurred at a steady rate during the first three years and was more common in the patients with larger tumors, highernumber of involved axillary nodes, and younger age.
Age Distribution ; Breast Neoplasms* ; Breast* ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mastectomy, Segmental ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy ; Recurrence* ; Risk Factors* ; Skin ; Survival Rate

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Nodal Status of the Head and Neck Cancer Patients.

Dae Sik YANG ; Myung Sun CHOI ; Jong Ouck CHOI

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):321-330.

PURPOSE: It is well known that the risk of lymph nodes metastases to head and neck cancers are influenced by the location and size of the primary tumor, as well as the degree and types of histological differentiation. However, data on the statistical analyses of lymph node metastases from the head and neck cancers among Korean population are not available at present. In order to obtain current status of such data, we have analyzed cancer patients at the department of radiation oncology, Korea university hospital for radiation treatment. MATERIALS AND METHODS: We have evaluated nine-hundred and ninetyseven (997) head and neck cancer patients who visited to the Department of radiation oncology, between November 1981 to December 1995. After careful physical examinations and CAT scan, patients were divided into two groups, those with positive lymph node metastases and with negative lymph node metastases. The nodal status were classified according to the TNM system of American Joint Committee on Cancer (AJCC) RESULTS: Four-hundred and sixteen patients out of the 997 patients were lymph node positive (42%) and 581 patients were lymph node negative (58%) when they were first presented at the department of radiation oncology. According to the AJCC classification, the distribution of positive lymph node is as follow:N1:106 (25.5%), N2a:100 (24%), N2b:68 (16.4%), N2c: 69 (16.6%), N3:73 (15%), respectively. The frequency of lymph node metastases according to the primary sites is as follow : larynx : 283 (28.5%), paranasal sinuses:182 (18%), oropharynx:144 (14.5%), nasopharynx:122 (12%), oral cavity:92 (9%), hypopharynx:71 (7%), salivary gland:58 (6%), unknown primary:31(3%), skin:14(2%). The most frequent primary site for the positive lymph node metastases was nasopharynx (71%) followed by hypopharynx (69%), oropharynx (64%), oral cavity (39%). The most commonhistologic type was squamous cell carcinoma (652/997: 65.4%), followed by malignant lymphoma (109/997:11%). CONCLUSION: Statistical results of lymph node metastases from head and neck cancer at our department were very similar to those obtained from other countries. It is concluded that the location of primary cancer influences sites of metastases on head and neck, and stage of the primary cancer also influences the development of metastatic lesions. Since the present study is limited on the data collected from one institute, further statistical analyses on Korean cancer patients are warrented.
Animals ; Carcinoma, Squamous Cell ; Cats ; Classification ; Head and Neck Neoplasms* ; Head* ; Humans ; Hypopharynx ; Joints ; Korea ; Larynx ; Lymph Nodes ; Lymphoma ; Mouth ; Nasopharynx ; Neck ; Neoplasm Metastasis ; Oropharynx ; Physical Examination ; Radiation Oncology

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Radiotherapy of Early Stage Glottic Cancer.

Yong Ho KIM ; Gyu Young CHAI

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):315-320.

PURPOSE: To evaluate the role of curative radiotherapy and salvage surgery in patients with T1,T2 glottic cancer. MATERIALS AND METHOD: Between June 1989 and December 1994, 23 patients with early glottic cancer, 18 with T1N0M0 and 5 with T2N0M0, were treated with radiotherapy at Gyeongsang National University Hospital. All patients were male. Median follow-up period was 46 months, and 100% were observed for at least 3 years. RESULTS: Actuarial survival rates at 5 years were 84.3% for 23 patients. The 5-year actuarial survival rates were 94.4% for T1 and 53.3% for T2 (P=0.05). The 5-year local control rates was 70.0% for T1 and 60.0% for T2 (P=0.44). Of 8 patients with treatment failure, 6 patients (75.0%) were salvaged with surgery. After surgical salvage, the 5-year local control rates were 87.2% for T1 and 80.0% for T2(p=0.55). CONCLUSION: In early stage (Stage I and II) glottic cancer, curative radiotherapy can be a treatment of choice and surgery reserved for salvage of radiotherapy failure.
Follow-Up Studies ; Humans ; Male ; Radiotherapy* ; Survival Rate ; Treatment Failure

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Radiation Therapy of Nasopharyngeal Carcinoma.

Young Ju NHO ; Jeong Gill CHO ; Seung Do AHN ; Eun Kyung CHOI ; Jong Hoon KIM ; One Chul KANG ; Hyesook CHANG

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):305-314.

PURPOSE: This is a retrospective study to evaluate the results of radiation therapy and prognostic factors influencing the results in nasopharyngeal carcinoma. MATERIALS AND METHODS: From October 1989 to May 1996, 56 patients were treated for nasopharyngeal carcinoma at Department of Radiation Oncology. According to stage, patients were distributed as follows: stage I (2), II (13), III (11), IV (30). Twenty-eight patients were treated with radiation therapy only, 7 patients were treated with neoadjuvant chemotherapy followed by radiation therapy. Twenty-one patients were treated with radiation therapy and weekly CDDP. After external beam radiotherapy of 60Gy, 46 patients received boost dose with intracavitary radiation and 9 patients with 3D conformal therapy. One patient received boost dose with 2 dimensional photon beam therapy. The tumor dose ranged from 69.4Gy to 86.2Gy with median dose of 74.4Gy. The follow-up period ranged from 5 months to 92 months with a median of 34 months. RESULTS: Forty-seven patients achieved complete response and 8 patients showed partial response. One patient showed minimal response. Patterns of failure were as follows : locoregional recurrence (8) and distant metastasis (18). Among these patients, 2 patients failed locoregionally and distantly. The sites of distant metastasis were bone (8), lung (8) and liver (4). Five years survival rate was 67.2% and 5 years disease-free survival rate was 53.6%. KPS (P=0.005) and response of radiation therapy (P=0.0001) were significant prognostic factors for overall survival. KPS (P=0.02) and response of radiation therapy (P=0.005) were significant prognostic factors for disease-free survival. CONCLUSION: This retrospective study showed that distant metastasis was the predominant pattern of relapse in nasopharyngeal cancer. Neoadjuvantchemotherapy or weekly CDDP did not influence the distant metastasis-free survival. For advanced T stage, 3D conformal therapy provided an improved dose coverage compared to ICR. But further follow-up was needed in patients with 3D conformal therapy to assess the efficacy of this therapy. Development of techniques of radiation therapy to improve locoregional control and of more effective systemic chemotherapy regimen are needed.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Liver ; Lung ; Nasopharyngeal Neoplasms ; Neoplasm Metastasis ; Radiation Oncology ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate

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The Result of Radiotherapy for Pituitary Adenoma.

Hyun Joo LEE ; Kwang Mo YANG ; Heung lae CHO ; Seung Chang SHON ; Hyun Suk SUH

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):297-304.

PURPOSE: To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. METHODS AND MATERIALS: The study involved a retrospective review of outcome in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median : 97 months). Seventeen were men and 10 were women. The numbers of functioning and non-functioning pituitary adenoma were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy (median : 5040cGy) were deliverd over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. RESULTS: For radiation therapy alone, the 5YSR was 100% and progression free survival rate was 85.8%. The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy, the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose, radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statistically significant (P > 0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluable patients with hyperprolactinoma achived normalization in 4 and decrement in 5 patients. Only 2 patients developed mild degree of panhypopituitarism. CONCLUSION: The radiotherapy appears to be effective in controlling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherapy was comparable. There was a trend toward high recurrence rate in patients with nonfunctioning or prolactin secreting tumor and larger radiation field sizes.
Disease-Free Survival ; Female ; Humans ; Male ; Multivariate Analysis ; Pituitary Neoplasms* ; Prolactin ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Visual Fields

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Clinical Application of 3-D Conformal Radiotherapy for Carcinoma of the Ethmoid Sinus: I. Comparative Analysis Between Conventional 2-D and 3-D Conformal Plans.

Sangwook LEE ; Gwi Eon KIM ; K Chang KEUM ; Hee Chul PARK ; Jae Ho CHO ; Soung Uk HAN ; Kang Kyu LEE ; Chang Ok SUH ; Won Pyo HONG ; In Yong PARK

Journal of the Korean Society for Therapeutic Radiology.1997;15(4):287-296.

PURPOSE: This is study of whether 3-D conformal radiotherapy for carcinomas of the ethmoid sinus were better than those treated with conventional 2-D plan. MATERIALS AND METHODS: The 3-D conformal treatment plans were compared with conventional 2-D plans in 4 patients with malignancy of the ethmoid sinus. Isodose distribution, dose statistics, and dose volume histogram of the planning target volume were used to evaluate differences between 2-D and 3-D plans. In addition, the risk of radiation exposure of surrounding normal critical organs are evaluated by means of point dose calculation and dose volume histogram. RESULTS : 3-D conformal treatment plans for each patient that the better tumor coverages by the planning target volume with improved dose homogeneity, compared to 2-D conventional treatment plans in the same patient. On the other hand, the radiation dose distributions to the surrounding normal tissue organs, such as the orbit and optic nerves are not significantly reduced with our technique, but a substantial sparing in the brain stem and optic chiasm for each patient. CONCLUSION : Our findings represented the potential advantage of 3-D treatment planning for dose homogeniety as well as sparing of the normal tissue surrounding the tumor. However, further investigational studies are required to define the clinical benefit.
Brain Stem ; Ethmoid Sinus* ; Hand ; Humans ; Optic Chiasm ; Optic Nerve ; Orbit ; Radiotherapy, Conformal*

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