BACKGROUND: Metastatic pathological fractures of the spine are a major problem for cancer patients; however, there is no consensus on treatment strategy. The purpose of this study was to evaluate various treatment options by analyzing their patterns for metastatic pathological fractures of the spine. METHODS: In this study, 54 patients (male:female = 36:18) who were diagnosed with metastatic pathological fractures of spine were recruited. Demographic data, origin of cancer, type of treatment, and results were obtained from electronic medical records. Treatment options were divided into radiotherapy (RT), vertebroplasty (VP) or kyphoplasty (KP), operation (OP), and other treatments. Treatment results were defined as aggravation, no response, fair response, good response, and unknown. The survival time after detection of pathologic fractures was analyzed with the Kaplan-Meier method. RESULTS: The mean age of the patients was 62.3 years. Hepatocellular carcinoma was the most common cancer of primary origin (n = 9), followed by multiple myeloma (n = 8). RT was the most common primary choice of treatment (n = 29, 53.7%), followed by OP (n = 13, 24.1%), and VP or KP (n = 10, 18.5%). Only 13 of 29 RT cases and 7 of 13 OP cases demonstrated a fair or good response. The mean survival time following detection of pathological spinal fractures was 11.1 months for 29 patients, who died during the study period. CONCLUSIONS: RT was the most common primary choice of treatment for metastatic pathological fractures of the spine. However, the response rate was suboptimal. Although OP should be considered for the relief of mechanical back pain or neurologic symptoms, care should be taken in determining the surgical indication. VP or KP could be considered for short-term control of localized pain, although the number of cases was too small to confirm the conclusion. It is difficult to determine the superiority of the treatment modalities, hence, a common guideline for the diagnosis and treatment of metastatic pathological fractures of the spine is required.
Carcinoma, Hepatocellular/mortality/pathology ; Female ; Humans ; Liver Neoplasms/mortality/pathology ; Male ; Middle Aged ; Multiple Myeloma/mortality/pathology ; Retrospective Studies ; Spinal Fractures/etiology/mortality/*radiotherapy/*surgery ; Spinal Neoplasms/*complications/secondary ; Spine ; Treatment Outcome

OBJECTIVETo compare the effectiveness of percutaneous microwave ablation ( MWA) versus hepatectomy for multifocal hepatocellular carcinoma.

METHODSFrom August 2002 to March 2012, one hundred and twenty-two patients with multifocal hepatocellular carcinoma (diameters 1 to 7 cm, 2 to 4 lesions) were treated by either complete MWA or radical hepatectomy, and their clinical data were collected and analyzed.The patients were divided into MWA group (n = 50) and resection group (n = 72), and the resection group was matched by MWA group based on clinical parameters. The survival and complications in the two groups were compared.

RESULTSThe overall 1-, 3- and 5-year survival rates were 100.0%, 73.0% and 62.0%, respectively, in the MWA group, and 80.0%, 56.0%, and 41.0%, respectively, in the resection group (P < 0.05). The corresponding recurrence-free survival rates were 88.0%, 63.0%, and 52.0% in the MWA group, and 68.0%, 45.0%, and 36.0%, respectively, in the resection group (P< 0.05). The multivariate Cox regression analysis indicated that albumin level, performance status, treatment modality, and tumor size were independent prognostic factors.

CONCLUSIONCompared with hepatectomy, percutaneous microwave ablation is a minimally invasive and reproducible procedure, and can improve the survival in patients with multifocal hepatocellular carcinoma.

Carcinoma, Hepatocellular ; mortality ; radiotherapy ; surgery ; Catheter Ablation ; Genetic Engineering ; Hepatectomy ; mortality ; Humans ; Liver Neoplasms ; mortality ; radiotherapy ; surgery ; Microwaves ; therapeutic use ; Regression Analysis ; Survival Rate ; Treatment Outcome

PURPOSE: The treatment of a clinically node-positive (cN+) neck is important in the management of oral cavity squamous cell carcinoma (OSCC). However, the extent of neck dissection (ND) remains controversial. The purpose of our study was to evaluate whether level IV or V can be excluded in therapeutic ND for cN+ OSCC patients. MATERIALS AND METHODS: We performed a retrospective chart review of 92 patients who underwent a comprehensive or selective ND as a therapeutic treatment of cN+ OSCC from January 1993 to February 2009. RESULTS: The incidence rate of metastasis to level IV or V was 22% (16 of 72) on the ipsilateral neck. Of 67 cases without clinically suspicious nodes at level IV or V, 11 cases (16%, 11 of 67) had pathologically proven lymphatic metastasis to level IV or V. Only a nodal staging above N2b was significantly relevant with the higher rate of level IV or V lymph node metastasis (p=0.025). In this series, selective ND, combined with proper adjuvant therapy, achieved regional control and survival rates comparable to comprehensive ND in patients under the N stage of cN2a OSCC. CONCLUSION: In conclusion, level IV and V patients can avoid recurrence under cN2a OSCC.
Adult ; Aged ; Carcinoma, Squamous Cell/mortality/*pathology/*surgery ; Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Mouth Neoplasms/mortality/*pathology/*surgery ; Neck/surgery ; *Neck Dissection ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome

PURPOSE: To determine the effectiveness of salvage radiation therapy (RT) in patients with loco-regional recurrences (LRR) following initial complete resection of non-small cell lung cancer (NSCLC) and assess prognostic factors affecting survivals. MATERIALS AND METHODS: Between 1994 and 2007, 64 patients with LRR after surgery of NSCLC were treated with high dose RT alone (78.1%) or concurrent chemo-radiation therapy (CCRT, 21.9%) at Samsung Medical Center. Twenty-nine patients (45.3%) had local recurrence, 26 patients (40.6%) had regional recurrence and 9 patients (14.1%) had recurrence of both components. The median RT dose was 54 Gy (range, 44-66 Gy). The radiation target volume included the recurrent lesions only. RESULTS: The median follow-up time from the start of RT in survivors was 32.0 months. The rates of in-field failure free survival, intra-thoracic failure free survival and extra-thoracic failure free survival at 2 years were 52.3%, 33.9% and 59.4%, respectively. The median survival after RT was 18.5 months, and 2-year overall survival (OS) rate was 47.9%. On both univariate and multivariate analysis, the interval from surgery till recurrence and CCRT were significant prognostic factors for OS. CONCLUSION: The current study demonstrates that involved field salvage RT is effective for LRR of NSCLC following surgery.
Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/mortality/*radiotherapy/surgery ; Female ; Humans ; Lung Neoplasms/mortality/*radiotherapy/surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*radiotherapy/surgery ; Survival Rate ; Treatment Outcome

OBJECTIVE: To investigate the clinical value that surgical treatment with comprehensive treatment in treating early stage nasopharyngeal carcinoma. METHOD: Based on the case selection criteria, patients with early nasopharyngeal carcinoma were divided into surgery group and the conventional group according to patients' wishes. Surgery group were treated with surgery plus Radiochemotherapy as a comprehensive treatment while conventional group were treated with Radiochemotherapy. Outcome indices: (1) 5-year survival rate and 5-year disease-free survival rate; (2) Radiation dose to the nasopharynx; (3) Incidence of xerostomia. RESULT: (1) The overall 5-year follow-up rate was 97.12%; 1 patient was lost to follow-up in surgical group, the 5-year follow-up rate was 96.77%; 2 patients were lost in conventional Group with 5-year rate of 97.26%. (2) The 5-year survival rate of 104 patients was 83.65% (87/104). (3) The 5-year survival rate and 5-year tumor-free survival rate were 96.77% (30/31) and 93.55% (29/31) in surgical group, 78.08% (57/73) and 73.97% (54/73) in conventional group. There were significant differences between the two groups (P < 0.05). (4) The radiation dose to the nasopharynx in surgery group and conventional group were (63.90 +/- 5.56) Gy and (71.48 +/- 4.18)Gy, respectively; the dose in surgical group was significantly less than the conventional group, there were statistical significance between the two groups. (5) The incidence of xerostomia was significantly less in surgical group (22.58%) than conventional group (65.75%), the difference was statistically significant. CONCLUSION The surgery combined with concurrent chemoradiotherapy is a effective comprehensive therapeutic interchange program for early stage nasopharyngeal carcinoma. These program can increase the long-term survival rate, but also reduce the radiation dose to the nasopharynx and the occurrence of radiation complications. A further aspect is worth consideration.
Aged ; Carcinoma ; Chemoradiotherapy ; Combined Modality Therapy ; methods ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Incidence ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; mortality ; pathology ; surgery ; therapy ; Nasopharynx ; radiation effects ; Neoplasm Staging ; Prospective Studies ; Radiotherapy Dosage ; Survival Rate ; Xerostomia ; epidemiology ; etiology

BACKGROUND AND OBJECTIVEThe efficacy of complete resection of the cancer for patients with stage IIIa non-small cell lung cancer (NSCLC) is limited. Synthetic therapy is taken the lead in advocating at present. However, the value of post-operative radiotherapy is not still clear. The aim of this study is to evaluate the survival time and side effects of postoperative chemotherapy or chemoradiotherapy in the treatment of stage IIIa NSCLC.

METHODSBetween December 2003 and June 2007, 52 cases that have completed followed-up data with stage IIIa of NSCLC received in the First Affiliated Hospital of Dahan Medical University. Twenty-three patients received postoperative chemoradiotherapy (group A) and 29 patients received postoperative chemotherapy combined with radiotherapy (group B). Group A adopted platinum-based combination chemotherapy for 4-6 cycles. The chemotherapeutics included gemcitabine, vinorelbine and docetaxel. Group B used chemotherapy for 2-4 cycles and then received 3-dimensional conformal radiotherapy (3D-CRT). The prescribe dose of target volume was 50 Gy. The chemotherapy was same as for group A and needed 4 cycles in all. The impact of postoperative adjuvant treatment on survival and toxicity was observed in patients with stage IIIa NSCLC and the reason of disease progression was analyzed.

RESULTSThe median survival was 32.5 months in group A and 31.9 months in group B (P = 0.371). Progression-free survival extended about 6 months (P = 0.044). The survival rate was 87% at 1 year, 0.1% at 2 year, 33% at 3 year for group A compared with 93%, 69%, 45% for group B. The major side effects were hematological and gastrointestinal toxicities, including nausea, vomiting and neutropenia. There was no significant difference in these toxicities between the two groups (P > 0.05). Radioactive esophageal infection occurred in 17.2% of the patients. Acute and late radioactive lung infection occurred in 13.8% and 27.6% of the patients. All these toxicities were below degree 2. Distant metastases were the main reason of disease progression. There was no significant difference in the rates of local recurrence and metastases between the two groups (P > 0.05).

CONCLUSIONCombined modality therapy should be the main therapy of stage IIIa NSCLC. The addition of radiotherapy can effectively prolong progression-free survival and don't highly increase the toxicities.

Carcinoma, Non-Small-Cell Lung ; drug therapy ; mortality ; radiotherapy ; surgery ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms ; drug therapy ; mortality ; radiotherapy ; surgery ; Male ; Middle Aged

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

OBJECTIVETo evaluate the treatment results of advanced pyriform sinus cancer according to therapy modalities.

METHODSTwo hundred and eighty seven patients with locally advanced pyriform sinus cancer were included in this retrospective analysis. One hundred and thirty four patients were treated with radiotherapy alone (Ra group) with 68.8 Gy. One hundred and twenty five patients were treated with preoperation radiotherapy with 45.5 Gy followed by surgery including 32 laryngeal function sparing surgery (R + S group). Thirteen patients were treated with surgery alone (Sa group). Fifteen patients were treated with surgery followed by post-operation radiotherapy with 56.3 Gy (S + R group) . There was no laryngeal function sparing surgery in the last two groups.

RESULTSSurvival rate and laryngeal sparing rate were calculated using Kaplan-Meier method. The overall 5-year survival rates were 23. 13% for Ra group, 46.51% for R + S group,18. 33% for Sa group and 44. 44% for S + R group, 46. 2% for combined therapy group ( R + S group and S + R group) and 22. 60% for single therapy group (Sa group and Ra group). There was statistical difference between combined therapy group and single therapy group (P = 0. 000 ) . Laryngeal sparing rate were 14. 08% ,13.61% , 0 and 0,respectively. R + S group showed superiority over Ra group, Sa group and S + R group in teams of both overall survival rate and laryngeal sparing rate. Laryngeal function spare was analyzed using Cox model. Therapy mode is the most important factor that contribute to laryngeal sparing. No significant differences were found in complication rate among the groups.

CONCLUSIONPreoperation radiotherapy conduce to preserve laryngeal function of patients with locally advanced pyriform sinus carcinoma.

Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; pathology ; radiotherapy ; surgery ; Combined Modality Therapy ; Female ; Humans ; Hypopharyngeal Neoplasms ; mortality ; pathology ; radiotherapy ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Survival Rate

OBJECTIVETo evaluate the efficacy of surgical treatment and combined therapy of advanced pyriform sinus cancer.

METHODSTotally 153 patients with locally advanced pyriform sinus cancer who received surgical treatment in our department from January 1974 to December 1999 were divided into three groups: preoperative radiotherapy with 45.5 Gy followed by surgery (R + S group, n = 125), including 32 laryngeal function sparing surgery; surgery alone (Sa group, n = 13); and surgery followed by postoperative radiotherapy with 56.3 Gy (S + R group, n = 15). Twenty-one patients received piriformectomy, 10 piriformectomy plus partial laryngectomy, and 1 total hypopharyngectomy and pharyngoesophagectomy with laryngeal spared and colon reconstruction. Among 121 patients who did not receive laryngeal function sparing surgery, 13 received near total laryngectomy, 55 total laryngectomy, and 53 total laryngectomy plus total hypopharyngectomy and pharyngoesophagectomy with reconstruction. Eight-six patients received radical neck dissection, 14 modified neck dissection, and 6 lateral neck dissection. Survival rate and laryngeal function sparing rate were analyzed using Kaplan-Meier and COX model respectively.

RESULTSThe overall 5-year survival rates were 46.51% in R + S group, 18.33% in Sa group, and 44.44% in S + R group. Laryngeal sparing rate were 13.61% (R + S group), 0 (Sa group), and 0 (S + R group), respectively. R + S group, S + R group and combined therapy group (R + S group plus S + R group) showed superiority over Sa group in teams of 5-year survival rate (P = 0.0364, P = 0.0462, P = 0.000). R + S group showed superiority over S + R group and Sa group in teams of laryngeal sparing rate. Therapy mode was the most important factor that contributed to 5-year survival rate and laryngeal sparing. No significant differences were found in complication rate among the groups.

CONCLUSIONPreoperative radiotherapy conduces to preserve laryngeal function of patients with locally advanced pyriform sinus carcinoma.

Adult ; Aged ; Carcinoma, Squamous Cell ; mortality ; radiotherapy ; surgery ; Female ; Humans ; Hypopharyngeal Neoplasms ; mortality ; radiotherapy ; surgery ; Laryngectomy ; methods ; Larynx ; physiopathology ; Lymph Node Excision ; Male ; Middle Aged ; Pharyngectomy ; methods ; Proportional Hazards Models ; Radiotherapy, Adjuvant ; Survival Rate

Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3, 088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8 cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n = 10), 2.1 months, Group 2 (n = 8) ; 3.6 months; Group 3 (n = 7), 3.0 months; Group 4 (n = 14), 3.5 months, Group 5 (n = 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.
Treatment Outcome ; Thyroid Neoplasms/mortality/surgery/*therapy ; Survival Analysis ; Radiotherapy, Adjuvant ; Neoplasm Metastasis ; Middle Aged ; Male ; Humans ; Female ; Combined Modality Therapy ; Chemotherapy, Adjuvant ; Carcinoma/mortality/surgery/*therapy ; Aged, 80 and over ; Aged ; Adult