PURPOSE: The aim of this study was to evaluate the efficacy of re-irradiation in patients with recurrent gliomas and to identify subgroups for whom re-irradiation for recurrent gliomas is most beneficial. MATERIALS AND METHODS: We retrospectively reviewed 36 patients with recurrent or progressive gliomas who received re-irradiation between January 1996 and December 2011. Re-irradiation was offered to recurrent glioma patients with good performance or at least 6 months had passed after initial radiotherapy (RT), with few exceptions. RESULTS: Median doses of re-irradiation and initial RT were 45.0 Gy and 59.4 Gy, respectively. The median time interval between initial RT and re-irradiation was 30.5 months. Median overall survival (OS) and the 12-month OS rate were 11 months and 41.7%, respectively. In univariate analysis, Karnofsky performance status (KPS) ≥70 (p<0.001), re-irradiation dose ≥45 Gy (p=0.040), and longer time interval between initial RT and re-irradiation (p=0.040) were associated with improved OS. In multivariate analysis, KPS (p=0.030) and length of time interval between initial RT and re-irradiation (p=0.048) were important predictors of OS. A radiographically suspected mixture of radiation necrosis and progression after re-irradiation was seen in 5 patients. CONCLUSION: Re-irradiation in conjunction with surgery could be a salvage treatment for selected recurrent glioma patients with good performance status and recurrence over a long time.
Adult ; Brain Neoplasms/mortality/*radiotherapy/surgery ; Female ; Glioma/mortality/*radiotherapy/surgery ; Humans ; Karnofsky Performance Status ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local/mortality/*radiotherapy/surgery ; *Re-Irradiation ; Retrospective Studies ; Salvage Therapy ; Treatment Outcome ; Young Adult

OBJECTIVE: To investigate the role of radiotherapy (RT) in patients who underwent hysterectomy for uterine carcinosarcoma (UCS). METHODS: Patients with the International Federation of Gynecology and Obstetrics stage I–IVa UCS who were treated between 1990 and 2012 were identified retrospectively in a multi-institutional database. Of 235 identified patients, 97 (41.3%) received adjuvant RT. Twenty-two patients with a history of previous pelvic RT were analyzed separately. Survival outcomes were assessed using the Kaplan-Meier method and Cox proportional hazards model. RESULTS: Patients with a previous history of pelvic RT had poor survival outcomes, and 72.6% of these patients experienced locoregional recurrence; however, none received RT after a diagnosis of UCS. Univariate analyses revealed that pelvic lymphadenectomy (PLND) and para-aortic lymph node sampling were significant factors for locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS). Among patients without previous pelvic RT, the percentage of locoregional failure was lower for those who received adjuvant RT than for those who did not (28.5% vs. 17.5%, p=0.107). Multivariate analysis revealed significant correlations between PLND and LRRFS, distant metastasis-free survival, and DFS. In subgroup analyses, RT significantly improved the 5-year LRRFS rate of patients who did not undergo PLND (52.7% vs. 18.7% for non-RT, p<0.001). CONCLUSION: Adjuvant RT decreased the risk of locoregional recurrence after hysterectomy for UCS, particularly in patients without surgical nodal staging. Given the poorer locoregional outcomes of patients previously subjected to pelvic RT, meticulous re-administration of RT might improve locoregional control while leading to less toxicity in these patients.
Adult ; Aged ; Aged, 80 and over ; Carcinosarcoma/mortality/*radiotherapy/surgery ; Chemotherapy, Adjuvant ; Female ; Humans ; *Hysterectomy ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local/prevention & control ; Proportional Hazards Models ; *Radiotherapy, Adjuvant/adverse effects ; Retrospective Studies ; Survival Rate ; Uterine Neoplasms/mortality/*radiotherapy/surgery

OBJECTIVE: The aim of this analysis was to examine the management of cervix cancer in elderly patients referred for radiotherapy and the results of treatment in terms of overall survival (OS), relapse-free survival (RFS), and treatment-related toxicities. METHODS: Patients were eligible if they were aged ≥75 years, newly diagnosed with cervix cancer and referred for radiotherapy as part of their treatment. Patient details were retrieved from the gynaecology service database where clinical, histopathological treatment and follow-up data were prospectively collected. RESULTS: From 1998 to 2010, 126 patients aged ≥75 years, met selection criteria. Median age was 81.5 years. Eighty-one patients had definitive radiotherapy, 10 received adjuvant radiotherapy and 35 had palliative radiotherapy. Seventy-one percent of patients had the International Federation of Gynecology and Obstetrics stage 1b–2b disease. Median follow-up was 37 months. OS and RFS at 3 years among those treated with curative intent were 66.6% and 75.9% respectively with majority of patients dying without any evidence of cervix cancer. Grade 2 or more late toxicities were: bladder 5%, bowel 11%, and vagina 27%. Eastern Cooperative Oncology Group (ECOG) status was a significant predictor of OS and RFS with each unit increment in ECOG score increased the risk of death by 1.69 times (p<0.001). CONCLUSION: Following appropriate patient selection, elderly patients treated curatively with radiotherapy for cervix cancer have good disease control. Palliative hypofractionated regimens are well tolerated in patients unsuitable for radical treatment.
Aged ; Aged, 80 and over ; Brachytherapy ; Female ; Humans ; Lymphatic Metastasis ; Neoplasm Recurrence, Local/prevention & control ; Neoplasm Staging ; Palliative Care ; Radiotherapy, Adjuvant/adverse effects ; Survival Rate ; *Treatment Outcome ; Uterine Cervical Neoplasms/mortality/pathology/*radiotherapy

PURPOSE: Few studies address independent prognostic factors after ipsilateral breast tumor recurrence (IBTR) following breast-conserving surgery (BCS). Locoregional recurrence is associated with distant metastases and increased mortality rates. Therefore anticipating prognoses after IBTR and evaluating risk factors for overall survival following a second salvage operation are important. We evaluated independent prognostic factors affecting overall survival after a second operation for IBTR. METHODS: We retrospectively identified 11,073 patients who underwent breast cancer surgery between November 1995 and December 2011. Locoregional recurrence occurred in 787 patients. Among them, IBTR developed in 165 patients selected for analysis. Excluding eight patients who refused further treatment, we analyzed 157 patients who underwent a second operation (partial mastectomy, 28 [17.8%]; total mastectomy, 129 [82.2%]) for IBTR. Excluding 26 patients with incomplete data, we evaluated the clinicopathol-ogical features influencing overall survival at the first and the second operation in the 131 patients who underwent a second operation. RESULTS: The median age of patients at the first operation was 43.6 years (range, 27-69 years). The median duration from the first to the second operation was 45.0 months (range, 2.5-164.6 months). The 5-year overall survival rate after IBTR was 87.1%. In the multivariable analyses, duration from the first to the second operation, histopathology, lymph node status, and adjuvant chemotherapy, radiotherapy, and endocrine therapy at the first operation were independent prognostic factors for overall survival. Positive estrogen receptor status and endocrine therapy at the second operation were also associated with increased overall survival following salvage operations for IBTR. CONCLUSION: The time interval to IBTR following BCS is related to overall survival after salvage operation for IBTR and it is important to undergo optimal adjuvant treatments according to risk factors after the first operation because those risk factors affect overall survival for IBTR following BCS.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Estrogens ; Humans ; Lymph Nodes ; Mastectomy ; Mastectomy, Segmental* ; Mastectomy, Simple ; Mortality ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Prognosis ; Radiotherapy ; Recurrence* ; Retrospective Studies ; Risk Factors ; Survival Rate

OBJECTIVE: To evaluate the prevalence and features of non-endometrial cancers in Thai endometrial cancer (EC) patients. METHODS: EC patients treated in our institution were identified and the following data were collected: age, EC stage, histopathology, adjuvant therapy, other cancers, living status, and cause of death. RESULTS: The mean age of the 344 patients was 56.8+/-10.8 years. Fifty (14.5%) had other synchronous and metachronous cancers. Mean ages of the patients with or without other cancers were not significantly different, 55.7+/-10.04 years versus 57.1+/-11.0 years, respectively (p=0.358). History of any cancer in the family and tumor in the lower uterine segment were more frequent among the patients with other cancers (6.0% vs. 1.7%, p=0.095; 12.0% vs. 1.0%, p<0.001; respectively). Six patients had > or =2 other cancers. Ovarian, breast, and colon were the three most common other cancers. After a median follow-up of 57.1 months, 18.3% of patients had died: 30.0% of patients with other cancers and 16.3% of those without other cancers. The corresponding EC deaths were 14.0% and 11.2%. The 5-year overall survival was significantly lower in patients who had other cancers: 79.3% (95% confidence interval [CI], 68.3 to 90.3) vs. 86.0% (95% CI, 81.7 to 90.3) than in those without (p=0.023). However, the corresponding disease-specific survival was not significantly different: 85.1% (95% CI, 75.5 to 94.7) compared with 89.0% (95% CI, 85.1 to 92.9), respectively (p=0.514). CONCLUSION: Thai EC patients had a high incidence of other cancers. Overall survival of EC patients who had other cancers was worse than those without, while disease-specific survival was not significantly different.
Breast Neoplasms/mortality/pathology/therapy ; Chemotherapy, Adjuvant/methods ; Colonic Neoplasms/mortality/pathology/therapy ; Disease-Free Survival ; Endometrial Neoplasms/mortality/*pathology/therapy ; Female ; Humans ; Kaplan-Meier Estimate ; Middle Aged ; Neoplasm Recurrence, Local/mortality ; Neoplasms, Multiple Primary/mortality/*pathology/therapy ; Neoplasms, Second Primary/mortality/*pathology/therapy ; Radiotherapy, Adjuvant/methods ; Tertiary Care Centers/statistics & numerical data ; Thailand/epidemiology

OBJECTIVETo evaluate the outcomes of T3a prostate cancer treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy, and analyse the influence of preoperative factors on prognosis.

METHODSFrom January 2003 to December 2008, 38 pactients with T3a prostate cancer aged from 48 to 81 years (mean: 71 years) were enrolled, with serum prostate specific antigen (PSA) levels ranged from 10.000 to 99.800 µg/L (mean: 56.300 µg/L), Gleason score from 5 to 9 (mean: 7.6) and percentage of positive biopsy cores from 10.0% to 100% (mean: 65.3%). All patients were treated by permanent interstitial brachytherapy combined with external radiotherapy and hormone therapy. Survival curves were calculated using the Kaplan-Meier method. The predictive factors including patient's age, prostate volume, serum pre-treatment PSA, Gleason score and percentage of positive biopsy cores were used for univariate analysis on biochemical failure-free, distant metastasis-free and overall survival.

RESULTSThe mean follow-up was 69 months (range: 9-109 months).Nineteen patients experienced biochemical failure. The average biochemical failure time was 13.4 months (range: 1-40 months). There were 13 patients developed as distant metastatic prostate cancer since average 19.7 months (range: 1-70 months) after brachytherapy. Of all patients, 9 died of prostate cancer recurrence, while 6 passed away because of other reasons, with an average of 52.2 months (range: 9.0- 98.5 months). The 5-year biochemical failure-free survival (BFFS), distant metastasis free survival (DMFS), cancer specific survival (CSS) and overall survival (OS) rate were 44.1%, 68.6%, 82.4 and 75.8%, respectively. Twenty-nine patients experienced grade 1-2 gastrointestinal toxicity and 18 patients experienced grade 1-2 genitourinary toxicity. In univariate analysis, the percentage of positive biopsy cores was significantly correlated with BFFS (χ(2) = 17.240, P = 0.000), DMFS (χ(2) = 18.641, P = 0.000) and OS (χ(2) = 8.970, P = 0.003); the Gleason score was significantly correlated with DMFS (χ(2) = 12.484, P = 0.000) and OS (χ(2) = 6.575, P = 0.010); and patient's age was significantly correlated with OS (χ(2) = 5.179, P = 0.023).

CONCLUSIONSPermanent interstitial brachytherapy combined with external radiotherapy and hormone therapy is alternative for T3a prostate cancer. The percentage of positive biopsy cores is correlated with BFFS, DMFS and OS.

Aged ; Aged, 80 and over ; Brachytherapy ; methods ; Combined Modality Therapy ; Hormones ; therapeutic use ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; drug therapy ; mortality ; radiotherapy ; Radiotherapy ; methods ; Survival Rate ; Treatment Outcome

PURPOSE: Although neoadjuvant therapy has been accepted as a treatment option in locally-advanced gastric cancer, its prognostic value has been difficult to evaluate. MATERIALS AND METHODS: Seventy-four gastric cancer patients who underwent gastrectomy after neoadjuvant treatment were divided into two groups according to the pathologic response: favorable (ypT0) and others (ypT1-4). The clinicopathologic characteristics, predictive factors for pathologic response, and oncologic outcome were evaluated. RESULTS: Eleven patients (14.8%) demonstrated ypT0 and the remaining 63 patients (85.2%) were ypT1-4. Chemoradiotherapy (CCRTx) rather than chemotherapy (CTx) was the only predictive factor for a favorable pathologic response. Chemotherapeutic factors and tumor marker levels did not predict pathologic response. The 1-, 2-, and 3-year disease-free survivals were 83.4%, 70%, and 52.2%. The 1-, 3-, 5-year overall survivals were 88.5%, 67.5%, and 51.2%, respectively. Although a complete pathologic response (ypT0N0M0) was achieved in 7 patients, 28.6% of them demonstrated recurrence of the tumor within 6 months after curative surgery. CONCLUSION: CCRTx rather than CTx appears to be more effective for achieving good pathologic response. Although favorable pathologic response has been achieved after neoadjuvant treatment, the survival benefit remains controversial.
Aged ; Chemoradiotherapy/*methods ; Disease-Free Survival ; Female ; Gastrectomy ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local/pathology ; Stomach Neoplasms/*drug therapy/mortality/pathology/*radiotherapy/surgery ; Treatment Outcome ; Tumor Markers, Biological

OBJECTIVE: To retrospectively analyze the long-term curative effects and prognostic factors of 137 cases of NPC patients treated with intensity modulated radiation therapy. METHOD: The three-dimensional conformal intensity modulated radiation therapy adopted for the design plan of 137 cases of newly diagnosed and no distant metastatic NPC patients. Evaluation of short-term clinical efficacy was made according to the efficacy evaluation criteria of WHO solid tumor one month after radiotherapy. During the 2 years after radiotherapy, re-examinations were made every 3 months. Two years later, re-examinations were made every 6 to 12 months, and the routine examinations included clinical body check, nasopharyngoscope, CT, B Chao, MRI, chest X-ray, bone scan, so as to understand the condition of cavum nasopharyngeum, cervical lymph nodes and cranial nerves. Life table method was adopted to calculate the overall survival rate, Kaplan-Meier method was used to calculate relapse-free survival rate, distant metasis-free survival rate and disease-free survival rate. Log-rank test was used for univariate analysis of 14 clinical factors which may exert influences on prognosis. Multivariate analysis was performed with the Cox regression model, P < 0.05 is of statistical significance. RESULT: (1) Of the 137 cases, the overall survival rates of 1-year, 3-year and 5-year were 98.5%, 90.3%, 74.6% respectively, relapse-free survival rates were 97.0%, 81.9%, 66.7% respectively; distant metasis-free survival rates were 96.3%, 80.5%, 56.0% respectively; disease free survival rates were 95.6%, 76.9%, 43.8% respectively. (2) Univariate analysis revealed that the influences of T-staging,N-staging, 92 Fuzhou clinical staging, combined chemotherapy, skull base bone destruction, injury of cranial nerve, retropharyngeal lymph node metastasis, residual disease, total time of IMRT on prognosis were of no statistical significance(with all the P values lower than 0.05) The influences of gender, nationality, age, pathological type and anemia or on prognosis were of no statistical significance(with all the P values higher than 0.05). (3) T-staging, skull base bone destruction, injury of cranial nerve, retropharyngeal lymph node metastasis, N-staging, combined chemotherapy, residual disease, total time of IMRT, and anemia were drawn into Cox model, and the results showed that N-staging, combined chemotherapy, injury of cranial nerve, residual disease, and total time of IMRT were independent factors that affect prognosis (with all P values lower than 0.05). CONCLUSION IMRT obviously has advantages than conventional radiotheraphy in treating NPC patients. N-staging, injury of cranial nerve, combined chemotherapy, residual disease, and total time of IMRT are the main factors that affect prognosis.
Adult ; Aged ; Carcinoma ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; mortality ; radiotherapy ; Neoplasm Recurrence, Local ; Prognosis ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Skull Base ; pathology ; Survival Rate

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

BACKGROUND/AIMS: The aim of this non-randomized study was to determine the role of photodynamic therapy (PDT) in a multimodal approach for the palliation of advanced esophageal carcinoma. METHODS: Twenty consecutive patients with obstructing esophageal cancer were enrolled in this study. Each subject had dysphagia, and nine could not swallow fluid. External beam radiotherapy or a self-expandable metal stent was used following PDT for dysphagia due to recurrence of the malignancy. RESULTS: At 4 weeks post-PDT, a significant improvement in the dysphagia score was observed in 90% of patients, from 2.75 +/- 0.91 to 1.05 +/- 0.83 (p < 0.05). Patients with recurrent dysphagia underwent stent insertion at an average of 63 days (range, 37 to 90). The rate of major complications was 10%. Two esophageal strictures occurred, which were treated by placement of a modified expandable stent across the stricture. The median survival in these cases was 7.0 +/- 0.6 months. One patient that was treated with PDT and radiotherapy is alive and showed a complete tumor response. CONCLUSIONS: PDT as a multimodality treatment is safe and effective for relieving malignant esophageal obstruction with minimal complications.
Adenocarcinoma/complications/mortality/*therapy ; Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Squamous Cell/complications/mortality/*therapy ; Deglutition Disorders/etiology/*therapy ; Esophageal Neoplasms/complications/mortality/*therapy ; Esophageal Stenosis/etiology/*therapy ; Esophagoscopy ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Metals ; Middle Aged ; *Neoplasm Recurrence, Local ; Palliative Care ; *Photochemotherapy/adverse effects ; Prospective Studies ; Prosthesis Design ; Radiotherapy, Adjuvant ; Stents ; Time Factors ; Treatment Outcome