Control Of Squamous Cell Carcinoma Research Articles

Hypoxia inducible factor (HIF - 1 alpha) expression as an indicator of clinico-pathological characteristics & loco-regional control in squamous cell carcinoma of the Tongue.

Hypoxia inducible factor (HIF - 1 alpha) expression as an indicator of clinico-pathological characteristics & loco-regional control in squamous cell carcinoma of the Tongue.

Local Control of Squamous Cell Carcinoma of the Cervix Treated with CT-based Three-dimensional Image-Guided Brachytherapy with or without Central Shielding.

The purposes of this retrospective study were to analyze local control of squamous cell carcinoma of the cervix treated with computed tomography (CT)-based image-guided brachytherapy (IGBT), as well as the factors affecting local control. A total of 39 patients were analyzed. The prescribed dose to the pelvis was 45-50 Gy with or without central shielding (CS). IGBT was delivered in 1-5 fractions. The total dose for high-risk clinical target volume (HR-CTV) was calculated as the biologically equivalent dose in 2-Gy fractions. The median follow-up period was 29.3 months. The 2-year overall survival and local control rates were 97% and 91%, respectively. In univariate analysis, the dose covering 90% of the HR-CTV (D90) and tumor size were found to be significant factors for local control. The cutoff values of tumor size and D90 for local control were 4.3 cm (area under the curve [AUC] 0.75) and 67.7 Gy (AUC 0.84) in the CS group and 5.3 cm (AUC 0.75) and 73.7 Gy (AUC 0.78) in the group without CS, respectively. However, though the local control of CT-based IGBT was favorable, the results suggested that the dose required for tumor control may differ depending on the presence of CS.

Preradiotherapy Tumor Volume in Local Control of Squamous Cell Carcinoma of the Supraglottic Larynx

Examine the utility of pretreatment computed tomography in predicting local control (LC) in squamous cell carcinoma of the supraglottic larynx treated with primary radiotherapy (RT). In total, 167 patients treated between 1983 and 2013 were reviewed. Patients had received pretreatment diagnostic computed tomographic imaging of the larynx and neck from which primary tumor volume (PrTV) was delineated. LC, larynx function at last follow-up, and RT complications were recorded. PrTV was evaluated with respect to outcome. In this study, median age was 61 years, and mean follow-up was 96 months. In total, 43% had T1-T2, 46% had T3, and 11% had T4 disease; 49% had N0 disease. Median tumor volume, 5.1 cm (0.4 to 188 cm). Mean dose, 74 Gy; 20% received concurrent chemotherapy. Overall, 10-year LC was 78.9%. Ten-year LC stratified by tumor volume was: 0 to 4.9 cm, 90.8%; 5 to 8.9 cm, 67.3%; and >9 cm, 69.4%. Ten-year LC with preserved larynx function was: 0 to 4.9 cm, 76.7%; 5 to 8.9 cm, 61.5%; and >9 cm, 53.4%. LC and LC with preserved larynx function was significantly different between PrTV groups (P<0.001). On multivariate analysis, PrTV was a significant predictor of LC and LC with preserved larynx function (P<0.005). Six patients developed soft tissue necrosis; 2 suffered fatal carotid blowouts. Patients with grade 5 complications received concomitant chemotherapy. Four patients required total laryngectomy; 14 required permanent tracheostomy or gastrostomy tube. Pretreatment PrTV helps identify patients most likely to experience LC with primary RT alone or combined chemoradiation. LC for supraglottic larynx squamous cell carcinoma is optimal if the PrTV is <5.0 cm.

Pre-radiation Therapy Tumor Volume as a Predictor of Local Control in Squamous Cell Carcinoma of the Supraglottic Larynx: A 30-Year Experience

To examine the utility of pretreatment CT in predicting local control (LC) in patients with squamous cell carcinoma (SCC) of the supraglottic larynx treated with primary radiation therapy (RT). 167 patients treated with primary RT for supraglottic larynx SCC between 1983 and 2013 were reviewed. Patients had received pretreatment diagnostic CT imaging of the larynx and neck with intravenous contrast from which the primary tumor volume was delineated. The mean dose was 74 Gy; 20% received concurrent chemotherapy. LC, larynx function at last follow-up, and RT complications were recorded. Tumor volume was evaluated with respect to outcome. Median age, 61 years. Mean follow-up, 96 months. Of these, 43% had T1-T2, 46% had T3, and 11% had T4 disease; 49% had N0 disease. Median tumor volume, 5.1cm3 (0.4-188 cm3). The 10-year LC for the entire patient population was 78.9%. LC at 5 and 10 years was stratified by tumor volume: 0-4.9 cm3, 5-8.9 cm3, and 9 cm3 and greater. LC by tumor volume among all patients at 10 years were as follows: 0-4.9 cm3, 90.8%; 5-8.9 cm3, 67.3%; and 9 cm3 and greater, 69.4%. LC with preserved larynx function by tumor volume at 10 years was as follows: 0-4.9 cm3, 76.7%; 5-8.9 cm3, 61.5%; and 9 cm3 and greater, 53.4% LC and LC with preserved larynx function was significantly different between primary tumor volume groups (P < .001). On multivariate analysis, primary tumor volume was the only significant predictor of LC and LC with preserved larynx function (P < .005). T stage, N stage, pre-RT larynx dysfunction, chemotherapy, and RT dose did not significantly influence outcome. Six patients developed soft-tissue necrosis; 2 suffered fatal carotid blowouts. Patients with grade 5 complications were treated with concomitant chemotherapy. Four patients required total laryngectomy for a non-functional larynx; 14 required permanent tracheostomy or gastrostomy tube. Pretreatment primary tumor volume helps identify patients most likely to experience LC with primary RT alone or combined chemoradiation. LC for supraglottic larynx SCC is optimal if the primary tumor volume is <5.0cm3.

Preradiation Therapy Tumor Volume as a Predictor of Local Control in Squamous Cell Carcinoma of the Supraglottic Larynx: A 30-Year Experience

Examine the utility of pretreatment computed tomography (CT) in predicting local control at the primary site in patients with squamous cell carcinoma (SCC) of the supraglottic larynx treated with primary radiotherapy. The medical records of 167 patients treated with radiotherapy for SCC of the supraglottic larynx between March 1983 and September 2013 were reviewed. All patients had at least 2 years of follow-up. All patients reviewed received high-quality pretreatment diagnostic imaging, with dedicated CT of the neck with intravenous contrast, from which a pretreatment primary tumor volume was delineated with the aid of a neuroradiologist. All patients were treated with a continuous course of radiotherapy delivered in once- (16%) or twice- daily (84%) fractions to a total mean dose of 74 Gy. Thirty-three patients (20%) were treated with concurrent chemotherapy. Local control, larynx function at last follow up, and acute and late treatment complications were recorded. Tumor volume was evaluated with respect to clinical outcome. The median patient age was 61 years (range, 32 – 89 years); 79% were male. Mean follow-up was 96 months. Overall, 43% of patients had T1-T2 disease, 46% had T3, and 11% had T4 disease. Forty-nine percent of patients had N0 disease. The median tumor volume was 5.1 cm3 (range, 0.4 – 188 cm3). Local control was significantly improved in patients whose tumor volume was less than 5.0 cm3 (p = 0.001). This relationship was independent of T stage (p = 0.03) and did not vary by tumor subsite (p=0.08). For T1-2 tumors less than 5.0 cm3, 5- and 10-year local control rates were 98% and 90%, respectively. For T1-2 tumors greater than or equal to 5.0 cm3, 5- and 10-year local control rates were 77% and 64%, respectively. For T3 tumors, 5- and 10-year local control rate was 84% if less than 5.0 cm3 and 71% if greater than or equal to 5.0 cm3. Only 1 patient had a T4 tumor less than 5.0 cm3 who did not fail locally. T4 tumors greater than or equal to 5.0 cm3 achieved local control of 74% at both 5 and 10 years. Overall survival was not significantly different by tumor volume. Six patients developed soft tissue necrosis, and 2 patients suffered fatal carotid blowouts. All patients with severe complications, grade 5 CTCAE complications, were treated with concomitant chemotherapy. Four patients (2%) required total laryngectomy for a non-functional larynx, fourteen (8%) additional patients went on to require a permanent tracheostomy or permanent gastrostomy tube. Calculation of pretreatment primary tumor volumes, as defined on high-quality pretreatment CT imaging, can be useful in identifying patients most likely to experience local control with definitive radiotherapy or combined chemoradiation. Local control for SCC of supraglottic larynx is optimal if the primary tumor volume is less than 5.0 cm3.

Radiotherapy for early glottic cancer and salvage surgery after recurrence

Early glottic cancer can be effectively treated with radiation or surgery, but recurrence is a possibility when using any of the treatment modalities. AimTo assess the outcome of radiotherapy as initial treatment in the control of squamous cell carcinoma of vocal cord (T1) and the effectiveness of salvage surgery (endoscopic or open) after treatment failure. Materials and MethodsA retrospective study was based on the analysis of medical records from 43 patients with T1 squamous cell carcinoma of the glottis, radiotherapy as initial treatment and follow-up period of five years. ResultsThe rate of recurrence after radiotherapy was 30.2% of the cases, mean diagnosis interval was 29.5 months. As an option for salvage treatment, patients underwent open partial laryngectomy or endoscopic surgery with control rates of 77.7% and 25% respectively. ConclusionOur cases showed high rates of recurrence after radiotherapy and open partial laryngectomy was more effective for the salvage surgery.

Prospective randomized trial to compare the outcome and tolerability of delivering the same total dose of radiation in 61/2 weeks versus 51/2 weeks time in head and neck cancers.

Background:Concurrent chemoradiation is currently considered to be the standard of care in the treatment of head and neck cancer. In developing countries like ours, a good number of patients cannot tolerate chemoradiation because of the poor general condition and financial constraints. Those patients are treated with radiation alone. The optimum radiotherapy (RT) schedule for best local control and acceptable toxicity is not yet clear. We aimed to find out whether shortening of treatment time using six instead of five RT fractions per week improves the locoregional control in squamous cell carcinoma of head and neck.Materials and Methods:We conducted a prospective randomized study for a period of 2 years from September 2007 to August 2009 in 109 untreated patients of squamous cell carcinoma of head and neck with histologically confirmed diagnosis and no evidence of distant metastasis. Study group (55 patients) received accelerated RT with 6 fractions per week (66 Gy/33#/51/2 weeks). Control group (54 patients) received conventional RT with 5 fractions per week (66 Gy/33#/61/2 weeks). Tumor control, survival, acute and late toxicities were assessed.Results:At a median follow-up of 43 months, 29 patients (52.7%) in the 6 fractions group and 24 patients (44.4%) in the 5 fractions group were disease-free (P = 0.852). The benefit of shortening was higher for advanced disease control though it was not statistically significant. Grade 3 and 4 skin toxicity was significantly higher in the accelerated RT (70.9%) arm as compared to conventional (35.1%) arm (P = 0.04). Grade 3 mucositis was significantly higher in the accelerated RT arm (32.7% vs. 16.6%; P = 0.041). Those acute toxicities were managed conservatively. There was no difference in late toxicities between the two arms.Conclusion:Use of 6 fractions per week instead of 5 fractions per week is feasible, tolerable, and results in a better outcome in the patients of head and neck cancers.

OP083: Loco regional control of squamous cell carcinoma of oral cavity following marginal and segmental mandibulectomy

Purpose The treatment of oral squamous cell carcinoma may require mandibular resection to secure adequate margin. This bone resection often is segmental or marginal mandibulectomy. The purpose of this work was to evaluate the loco regional control and survival after surgical treatment of oral cancer, following marginal and segmental mandibulectomy. Material and methods The records of 81 consecutive patients of oral cancer undergoing marginal or segmental mandibulectomy were reviewed. All patients had a biopsy-confirmed diagnosis of squamous cell carcinoma involving either the buccal mucosa, lower GBS, RMT,upper alveolus, palate, oral tongue, FOM and lip. The type of mandibular resection and treatment outcome in the form of local or regional recurrence were compared to determine survival. Results Of 81 operated squamous cell carcinoma of oral cavity cases, there were 32 (39.50%) loco regional recurrences. 17 patients had local recurrences, nodal recurrences in 7, six patients had loco regional recurrences, and two patients had distant metastasis. Of the 24 patients where marginal mandibulectomy was done, four patients had local recurrences, one patient had locoregional recurrence, and one patient had distant metastasis. All relapses were within 6–12 months. Among the patients where marginal mandibulectomy was done, four patients were in stage I, and out of that one patient had local recurrence and 1 patient had loco regional recurrence. 10 patients were in stage II, out of which one had local recurrence and one had regional recurrence. Five patients were in stage III, out of which 1 had local recurrence. Another five patients were in stage IV, out of five, two had local recurrence. Conclusions Marginal mandibulectomy is a oncologically safe procedure, and even can be done in advance oral cancer where there is no paramandibular disease.

Does phase I radiotherapy dose of 30.6Gy in 17 fractions provide adequate microscopic nodal disease control in squamous cell carcinoma of the anus?

588 Background: Definitive chemoradiation has been established as the standard of care for patients with squamous cell carcinoma of the anus. The ACT II study recommends 30.6Gy in 17 fractions for Phase I to the lower pelvis with a superior border 2 cm above the inferior aspect of the sacro-illiac joints, then a Phase II boost of 19.8Gy in 11 fractions to the tumor and involved nodes. Our goal was to retrospectively evaluate patterns of failure in the volumes that received microscopic dose 30.6Gy. Methods: Between January 2002 and December 2008, 106 patients with non-metastatic squamous cell carcinoma of the anus were treated with definitive chemoradiation. 81 (76.45%) of these patients received Phase I dose of 30.6Gy.The tumor stage was Tx or T1 in 18 % , T2 in 36% , T3 in 29%, and T4 in 12% of patients. The nodal stage was N0 in 57%, N1 in 13%, N2 in 14% and N3 in 11% of patients. The median radiotherapy dose was 50.4 Gy (range 50.4Gy -60 Gy). Concurrent chemotherapy was given with 5-fluorouracil (5-FU) and cisplatin in 12%, 5-FU and mitomycin C in 34%, capecitabine and mitomycin C in 38% and other regimens in 8% of patients. The median follow-up interval was 43 months (range 3.2 - 112.9 months). Results: A total of 21 patients (19.8%) experienced persistent or progressive disease during follow up. Out of this total, 16 patients received 30.6Gy in Phase I. Of these, 5 patients (4.7%) had persistent disease at the end of chemo-radiation, 4 patients (3.7%) relapsed in the anal region, 2 patients (2.4%) relapsed in the 30.6Gy area and 5 patients (6.2%) developed metastases. 8 patients with local recurrence/persistent disease underwent salvage surgery. Estimated 3 year rates for locoregional control and overall survival were 78% and 82% respectively. Conclusions: The majority of locoregional failures involve the anus and mesorectum, while nodal recurrence occurs rarely supporting the use of 30.6Gy for microscopic nodal disease control. This makes the case for dose escalation of primary tumours in Phase II. Placing the superior border of the radiotherapy field at 2 cm above inferior sacroiliac joints for phase I could potentially spare bone marrow and small bowel toxicity with minimal risk of nodal relapse.

Determination of deep surgical margin based on anatomical architecture for local control of squamous cell carcinoma of the buccal mucosa

Of all oral squamous cell carcinomas, squamous cell carcinomas of the buccal mucosa (BSCC) are most associated with poorest prognosis. In particular, patients treated with surgery alone are reported to experience frequent local failures. This is considered to result from the surgeon's determination of the deep surgical margin for resection based on palpation alone when performing BSCC surgery. Therefore, an objective system for classifying the depth of invasion of a tumor appears to be necessary in order to improve the results of BSCC treatment. While current general practice is to treat based on tumor thickness, we would like to emphasize the importance of how far down the cheek wall layer the tumor has invaded. We performed surgery by classifying the depths of tumor invasion in relation to the buccinator. Depth of tumor invasion was assessed mainly using ultrasonography (US). The tumor was defined as D1 when it extended to the mucosal (m) and submucosal layers (sm). In these cases, the tumor was resected, while the buccinator was spared. The tumor was defined as D2 when it extended to the buccinator, but, based on US, muscle continuity was preserved, and the tumor was resected to include the buccinator and its overlying fascia. When the tumor had spread to the buccinator or invaded subcutaneous or cutaneous tissue it was classified as D3 and resection included the skin. The disease-specific survival rate of BSCC when treated based on our classification was 73.7% and the local control rate was 89.5%. These results are superior to those based on surgery alone and this therapeutic modality was considered to be useful.

Planned neck dissection after definitive radiotherapy or chemoradiation for base of tongue cancers

The study goal was to analyze the role of planned neck dissection for squamous cell carcinoma of the base of the tongue treated with definitive radiotherapy or chemoradiation. STUDY DESIGN, SETTING: We conducted a retrospective study of patients with squamous cell carcinoma of the base of the tongue undergoing planned neck dissection after definitive radiotherapy or chemoradiation. Twenty-two of 41 (53.7%) patients had one to six positive residual lymph nodes after receiving definitive radiotherapy or chemoradiation. Neck control rates were 92.3% and 88.3% at two and five years, respectively. Three of 22 (13.6%) patients with pathological residual nodal disease had regional or locoregional failures, compared with 1 of 19 (5.3%) patients with a pathologically complete response (P = 0.39). We observed a high incidence of pathologically residual lymph nodes after definitive radiotherapy or chemoradiation. Planned neck dissection following definitive radiotherapy or chemoradiation is highly effective in achieving regional control of squamous cell carcinoma of the base of the tongue.

Interobserver reliability of computed tomography‐derived primary tumor volume measurement in patients with supraglottic carcinoma

Prior studies have determined that macroscopic ("gross") tumor volume (GTV), as calculated from pretreatment computer tomography (CT), was capable of predicting local control in squamous cell carcinoma arising in different subsites in the head and neck in patients who were treated with nonsurgical organ-preservation therapy. The majority of these studies were single-institution, retrospective investigations. Consequently, there has been concern that GTV measurements may not be reproducible by different readers at different institutions. The objective of the current study was to measure the interobserver reliability for GTV measurements for squamous cell carcinoma of the supraglottic larynx (SGSCCA) performed by different readers at different institutions. Eight experienced readers (4 neuroradiologists and 4 radiation oncologists) from different institutions independently measured the pretreatment GTV of 20 patients with SGSCCA. The CT scans were obtained from patients entered into the definitive radiation therapy arm of Radiation Therapy Oncology Group protocol 91-11, who had supraglottic carcinoma and underwent pretreatment CT scans of the neck. Statistical analysis focused on interobserver reliability as measured by the intraclass correlation coefficient. The intraclass correlation coefficient was 0.81 (95% lower confidence bound, 0.71). This value was interpreted as "excellent." GTV measurements were reliable and reproducible when performed by neuroradiologists and radiation oncologists who were experienced in the interpretation of CT scans of the extracranial head and neck in patients with SGSCCA. The result implied that the correlation between GTV and local control should be reproducible across institutions.

The role of epidermal growth factor receptor and E-cadherin for the outcome of reduction in the overall treatment time of radiotherapy of supraglottic larynx squamous cell carcinoma

Reduction of the overall treatment time (OTT) of radiotherapy results in increased T-site control in squamous cell carcinomas of the head and neck (HNSCC). However, the response is heterogeneous and accelerated repopulation of clonogenic tumour cells during therapy may be one of the factors determining this response. The aim of the present study was to identify the influence of the epidermal growth factor receptor (EGFr) and E-cadherin for T-site control when the OTT was reduced and whether the markers add information to the histopathological grading in selecting patients for accelerated radiotherapy. A total of 209 patients from randomized DAHANCA-trials with supraglottic larynx squamous cell carcinomas treated with primary radiotherapy with different OTT of 9½, 6½, and 5½ weeks. Available formalin-fixed paraffin embedded tumour tissues were re-evaluated for histopathological characteristics and stained for EGFr and E-cadherin. Data were correlated with patient and tumour characteristics and 5-year T-site control. EGFr and E-cadherin were not associated with patient or tumour characteristics except that EGFr correlated to carcinomas with a well to moderate histopathological feature. Tumours with high EGFr or low E-cadherin did benefit from reduced OTT, and the combination of the two (high EGFr and low E-cadherin) had the most significant acceleration of treatment effect, compared with tumours with other combinations of EGFr and E-cadherin expression. Tumours with high expression of EGFr and low expression of E-cadherin showed the most significant increase in T-site control when the overall treatment time of radiotherapy was reduced, and the markers may be useful for selecting patients who will benefit from accelerated radiotherapy.

Tratamento cirúrgico do carcinoma epidermóide de língua e soalho de boca localmente avançado: efeito da radioterapia pós-operatória

Avaliar o resultado do tratamento cirúrgico do carcinoma epidermóide de língua e soalho de boca localmente avançado, considerando o efeito da radioterapia pós-operatória no controle da doença no sítio primário. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: série de casos, retrospectiva, envolvendo 72 pacientes com carcinoma epidermóide tratados com cirurgia e seguimento superior a 18 meses. Avaliado o efeito do estadiamento, margens cirúrgicas e radioterapia pós-operatória sobre as taxas de controle da doença no sítio primário. RESULTADOS: as recidivas locais foram diagnosticadas em 28 (38%) pacientes. Dentre as variáveis analisadas, apenas o estadiamento T e a presença de metástases linfáticas mostraram relação com a recidiva no sítio primário. O controle local foi alcançado em 80% dos pacientes pN0, não sendo afetado pela radioterapia pós-operatória. CONCLUSÃO: a doença localmente avançada, na ausência de metástases linfáticas, pode ser tratada com cirurgia exclusivamente.

Squamous carcinoma in an oesophageal foregut cyst

Cysts within the oesophageal wall may represent inclusion cysts, retention cysts or developmental cysts. Foregut duplications are developmental anomalies, which occur as a result of abnormal canalization of the foregut during intrauterine life. Malignant transformation is an extremely rare event occurring within oesophageal cysts, adenocarcinoma being the most common histology. We report a case of squamous cell carcinoma arising within an oesophageal cyst affecting the upper third of the oesophagus. The malignant cyst was not amenable to primary surgical resection and hence was treated using chemo-radiotherapy. The treatment gave good disease control, at the expense of a high oesophageal stricture. Chemo-radiotherapy is an alternative treatment modality to achieve long-term disease control in squamous cell carcinoma complicating oesophageal foregut cyst when primary surgical resection is not possible.

Postoperative radiotherapy for squamous cell carcinoma of the maxillary sinus: analysis of local control and late complications.

This retrospective study was conducted to analyze the local control and late complications in patients with squamous cell carcinoma of the maxillary sinus treated with postoperative radiation therapy following surgery. Between 1979 and 1998, 41 patients with squamous cell carcinoma of the maxillary sinus were treated with postoperative irradiation following partial or total maxillectomy. Tumor classification according to the TNM classification of the International Union Against Cancer (1997) was T2 in 6 patients, T3 in 21 patients, and T4 in 14 patients. Fourteen patients had negative surgical margins, 23 had microscopically positive margins, and 4 had grossly positive margins. Sixteen patients received preoperative intraarterial chemotherapy. The total dose to the primary tumor bed was 40-70 Gy (median: 54 Gy) with a fraction size of 2 Gy. The median follow-up time of the surviving patients was 93 months (range: 25-179 months). Local recurrence was observed in 17 patients (41%), and the 5-year actuarial overall survival and local control rates were 48% and 55%, respectively. In the univariate analysis, surgical margin status and total dose each had a statistically significant impact on local recurrence. For the patients with negative surgical margins, 8 of 9 (89%) patients achieved local control with a dose of 50-54 Gy, while 7 of 10 (70%) patients with microscopically positive margins achieved local control with a dose of 60-64 Gy. There were 11 late complications found in 9 patients; bone necrosis in 2, soft tissue necrosis in 2, trisumus: 2, cellulitis in 1, retinopathy in 1, and vision impairment in 3 patients. A total dose of 60 Gy or more was administered in all patients who suffered late complications except for 2 patients with vision impairment. These results indicated that an optimal dose of postoperative irradiation according to the surgical margin status was necessary to achieve local control for squamous cell carcinoma of the maxillary sinus following surgery. For patients with negative surgical margins, a total dose of 50-54 Gy in conventional fractionation was appropriate to achieve local control as well as to reduce late complications. On the other hand, a dose of 60 Gy or more was required for the patients with microscopic positive margins.

557Overall treatment time and tumor control in squamous cell carcinoma of the larynx

557Overall treatment time and tumor control in squamous cell carcinoma of the larynx

The absence of an adverse effect of prolongation of radiation treatment of primary rectal adenocarcinoma

Many reports have shown a deleterious effect from the prolongation of radiation treatment duration on local control of squamous cell carcinomas in a variety of sites. To study whether a similar effect was found in adenocarcinoma of the rectum, a retrospective review was performed of 353 patients treated by external beam radiation therapy for primary adenocarcinoma of the rectum. At 4 years, the local control rate for mobile tumours was 25%; for fixed tumours it was 7%. By multiple Cox regression analysis, the only factor statistically significant for local control was tumour fixation ( P=0.02). Neither treatment length ( P=0.44), nor the presence of an interruption in treatment ( P=0.41) was significant. The possible explanations for these observations are discussed.

Combined Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of the Bulbomembranous Urethra: A Case Report

Patients with locally advanced squamous cell carcinoma of the bulbomembranous urethra fare poorly whether they undergo surgery or primary radiotherapy. Combined chemoradiotherapy has been used with encouraging results in the treatment of squamous cell carcinoma of the anal canal and esophagus, and limited reports suggest that this management may show promise in the control of squamous cell carcinoma of the urethra. We report good results in a man with locally advanced squamous cell carcinoma of the bulbomembranous urethra who underwent concomitant radiotherapy, mitomycin C and 5-fluorouracil. We encourage the use of this regimen in patients with urethral squamous cell carcinoma as well as the reporting of results.

Local control of squamous cell carcinoma following marginal and segmental mandibulectomy: S. Dubner, K. S. HellerHead Neck 1993: 15: 29–32

Local control of squamous cell carcinoma following marginal and segmental mandibulectomy: S. Dubner, K. S. HellerHead Neck 1993: 15: 29–32