Course Of External Radiotherapy Research Articles

Circulating Cell Free DNA as Predictive Biomarker in Cervical Cancer Patients Treated with Radical Chemo-Radiation

<h3>Purpose/Objective(s)</h3> Liquid biopsy is a new technique for cancer detection. Evaluation of circulating cell-free DNA (ccfDNA) through liquid biopsy is a minimally invasive and cost-effective method that may serve as a potential biomarker for early detection, treatment monitoring, status of residual disease, and distant tumor metastasis in cervical cancer patients. We evaluated plasma ccfDNA levels in patients of cervical cancer undergoing chemo-radiation and correlated their levels with treatment response and short-term clinical outcome. <h3>Materials/Methods</h3> This prospective, single arm, open–label, observational pilot study included patients of cervical cancer, being radically treated with three-dimensional conformal radiotherapy or intensity modulated radiotherapy to a dose of 46Gy/23 fractions over 4.5weeks followed by high dose rate (HDR) brachytherapy to deliver EQD2 of >80Gy. Concurrent weekly cisplatin 40mg/m² was administered weekly throughout the course of external radiotherapy. Peripheral blood samples were collected in EDTA tubes before starting treatment and at 6months after completion of treatment. On the same day, tubes were centrifuged at 800g for 10 minutes. The supernatant was transferred to 10ml tubes and centrifuged at 1600g for 10 minutes to remove debris. Plasma supernatants were transferred in 1mL aliquots and stored at -80°C. Total genomic DNA of plasma aliquots were extracted using the commercially available Circulating Nucleic Acid Kits. Categorical variables were tested using the chi-square test. Univariate analysis was done to analyze the factors affecting ccfDNA levels and if found significant, multivariate analysis was used. <h3>Results</h3> Of 22 patients of histologically confirmed cervical cancer, 11 (50%) were of stage II disease followed by 7 (31.8%) with stage III disease. The median age was 53.5 years (range 39-70 years). The baseline mean ccfDNA levels was 69.68±58.335 ng/μL which was significantly reduced post-treatment to 0.452±0.199 ng/μL (p<0.001). The stage of the disease significantly affected the baseline ccfDNA levels (p=0.029). Positive pelvic and para-aortic lymph nodes showed a trend towards higher baseline ccfDNA levels (p=0.068 and 0.38 respectively). Patients with progressive disease had a trend towards higher post-treatment ccfDNA levels (p=0.19). <h3>Conclusion</h3> Our study revealed the role of ccfDNA as a potential biomarker in cervical cancer, which, however requires further longitudinal studies for confirmation.

Interstitial high dose rate brachytherapy boost in early-stage breast cancer: deformable image registration for defining target volume

Purpose: optimization of the technique of additional irradiation of the removed tumor bed using high-dose brachytherapy for breast cancer. Material and Methods: the results of treatment of 28 patients diagnosed with breast cancer were analyzed. After surgical treatment and a course of external radiation therapy, all patients underwent additional irradiation of the removed tumor bed using high-dose brachytherapy. The assessment of the operation protocols, the data of the pathomorphological conclusion was carried out, and on the basis of pre- and postoperative CT images, the formation of irradiation fields for high-dose brachytherapy was carried out. Results: After deformable (nonrigid) registration of pre- and postoperative CT images of 28 patients, it was revealed that in 18 women (64.3% of cases) the location of interstitial markers and the primary tumor focus does not match topographically, which can cause incorrect formation of borders irradiation. In 35.7% of cases, radiopaque markers were located on the chest wall (on the pectoralis major muscle) when the primary tumor was located in the breast tissue. In 25% of cases, the markers were located cranial or caudal to the topography of the primary tumor focus. Label migration occurred in 3.6% of cases. In 35.7% of cases, the topography of the primary tumor node and marks completely coincided. Conclusions: The use of deformable (non-rigid) registration of pre- and postoperative CT images is a simpler method to determine the topography of the removed tumor bed, which subsequently leads to a more accurate formation of the clinical volume of irradiation.

Breast Cancer Case Using Tamoxifen during Pregnancy: A Case Report and Literature Review

&lt;p&gt;This is a case of 32 years old nulliparous female who was diagnosed in November 2004 as a case of carcinoma of the right breast , luminal A , (Estrogen Receptor positive Progesterone receptor negative, Her 2 negative, Ki67 10 %), poorly differentiated invasive ductal cancer, TNM stage,T2 N0 MO. She had a wide local excision and axillary clearance. As she is a case of low risk early stage luminal A breast cancer; she was not given chemotherapy, instead she had a course of external irradiation and was put on Tamoxifen (Astra Zeneca, 20 mg daily), and was advised not to get pregnant during this treatment,but she got pregnant and delivered normally a healthy infant, although Tamoxifen is potentially teratogenic.&lt;/p&gt;

Impact of Treatment Time on Chemoradiotherapy in Locally Advanced Cervical Carcinoma.

Adverse effects of treatment prolongation beyond 8 weeks with radiotherapy for cervical cancer have been established. Clinical data also show that cisplatin increases the biologically effective dose of radiotherapy. However, there are no data on the effect of overall treatment time in patients with locally advanced cervical cancer treated with concomitant chemo-radiotherapy (CCRT) in an Indian population. The present study concerned the feasibility of concurrent chemotherapy and interspacing brachytherapy during the course of external radiotherapy to reduce the overall treatment time and compare the normal tissue toxicity and loco- regional control with a conventional schedule. Between January 2009 and March 2012 fifty patients registered in the Gynaecologic Oncology Clinic of Institute Rotary Cancer Hospital with locally advanced cervical cancer (FIGO stage IIB-IIIB) were enrolled. The patients were randomly allocated to treatment arms based on a computer generated random number. Arm I (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions, and weekly cisplatin 40 mg/m2. High dose rate intra-cavitary brachytherapy (HDR-ICBT) was performed after one week of completion of external beam radiotherapy (EBRT). The prescribed dose for each session was 7 Gy to point A for three insertions at one week intervals. Arm II (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions. Mention HDR-ICBT ICRT was performed after 40Gy and 7 Gy was delivered to point A for three insertions (days 23, 30, 37) at one week intervals. Cisplatin 20 mg/m2/day was administered from D1-5 and D24-28. Overall treatment time was taken from first day of EBRT to last day of HDR brachytherapy. The overall loco-regional response rate (ORR) was determined at 3 and 6 months. A total of 46 patients completed the planned treatment. The overall treatment times in arm I and arm II were 65±12 and 48±4 days, respectively (p=0.001). At three and six months of follow-up the ORR for arm I was 96% while that for arm II was 88%. No statistically significant difference was apparent between the two arms. The overall rate of grade≥3 toxicity was numerically higher in arm I (n=7) than in arm II (n=4) though statistical significance was not reached. None of the predefined prognostic factors like age, performance status, baseline haemoglobin level, tumour size, lymph node involvement, stage or histopathological subtype showed any impact on outcome. In the setting of concurrent chemo- radiotherapy a shorter treatment schedule of 48 days may be feasible by interspacing brachytherapy during external irradiation. The response rates and toxicities were comparable.

Intraoperatory radiotherapy (IORT) during breast cancer surgery: Acute cardiac safety tested by troponin

Intraoperatory radiotherapy (IORT) during breast cancer surgery: Acute cardiac safety tested by troponin

Exclusive chemoradiotherapy without TURBT for frail and elderly patients with an invasive bladder cancer: Which platin fits better?

279 Background: Frail and elderly patients (pts) with invasive bladder carcinoma (BC) are often unfit for surgery. Whether exclusive concomitant chemoradiotherapy (cCRT) without TURBT could be performed in a curative-intent remains uncertain. Methods: From 1996 to 2007, 68 pts were treated with exclusive cCRT. Median age was 77.5 years (70-91). WHO performance status (PS) at baseline were: PS 0: 27 pts; PS 1: 36 pts; PS 2; 4 pts; PS 3: 1 pt. 31 pts (45.5%) had a Charlson's score ≥ 5. Tumors were staged T1 (5 pts), T2 (44 pts), T3 (13 pts) and T4 (6 pts). 87.5% of the pts were clinically staged N0. Transuretral resection bladder tumor (TURBT) was incomplete and thus done for a diagnostic purpose only. 58 pts had an urothelial tumor (85.29%). External radiotherapy (ERT) was delivered with 1.8-2.0 daily fractions: median total dose of 63Gy [18Gy-69.4Gy] to the bladder and 92% of the pts had a whole pelvic ERT: median dose: 37.2Gy [18Gy-46Gy]. Drug was either cisplatin (CDDP) for 40 pts or carboplatin (CBDCA) for 28 pts. Overall survival (OS) and progression-free survival (PFS) rates were evaluated. Results: The rate of compliant pts with the full course of cCRT was 77.9% (53 pts). 5 pts stopped cCRT for acute urinary adverse events (AE) whereas 8 pts stopped chemotherapy only for hematological or renal biochemical AE. For late toxicity, 5 pts had a G3/4 toxicity (1 rectal bleeding, 1 urinary bleeding, 1 recto-urinary fistula, 1 urinary incontinence and 1 urinary retention). Median follow-up was 4.6 years [CI95%: 3.43-5.93]. Of the 68 pts, 14 are alive (13 recurrence-free) amongst the 61 evaluable pts and 47 have died (24 recurrence-free). OS rates at 2 and 5 years were 50% (CI95%: [37.45%-61.44%]) and 31% (CI95%: [13.67%-38.43%]). PFS rates at 2 and 5 years were 37.4% [CI95%: 25.89%-48.82%] and 22% [CI95%: 12.25%- 33.61%], respectively. OS and PFS rates were worse for pts treated with CBDCA in comparison with those treated with CDDP (p= 0.01 for OS and p= 0.03 for PFS). Combined 5-FU did not impact either OS or PFS. Conclusions: cCRT for elderly pts with a BC was feasible. For selected pts with a good PS, the adequate drug that should be combined with a conventional full course of ERT remains CDDP. No significant financial relationships to disclose.

Radiotherapy in congenital vulvar lymphangioma circumscriptum

Congenital lymphangioma circumscriptum (LC) of the vulva is a rare disorder with unknown etiology. Treatment options include ablative approaches such as laser therapy, sclerotherapy, and surgery. Radiotherapy has been shown to be effective in the management of congenital lymphangioma especially in the thoracic and abdominal lesions. In this report, we describe a patient with persistent vulvar LC despite sclerosing therapy and several surgical excisions. She was treated with a course of external radiotherapy and showed a dramatic objective response with relief of all symptoms.

Survival and Compliance with the Use of Radiation Therapy for Anaplastic Thyroid Carcinoma

†Purpose: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. Materials and Methods: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from 6∼ 70 Gy (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from 1∼104 months (median, 5 months; mean, 20 months). Results: Five patients started the ERT without the presence of a gross mass and all of the patients completed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median surviv al was five months (range, 1∼104 months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. Conclusion: This study suggests that patients with a small initial tumor (≤5 cm), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (＞5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.

Tumor motion and deformation during external radiotherapy of bladder cancer

First, to quantify bladder-tumor motion in 3 dimensions during a 4-week to 5-week course of external radiotherapy. Second, to relate the motion to the tumor location on the bladder wall. Third, to extensively evaluate gross tumor volume (GTV) shape and volume changes during the course of the treatment. Multiple repeat computed tomography (CT) images were obtained for 21 bladder cancer patients. These scans were matched to the rigid bony anatomy. For each patient, the main direction and magnitude of the tumor movement was determined by use of principle-component analysis. To study GTV shape changes, all GTVs were registered to the GTV in the planning CT scan, and the residual shape errors were determined by measurement of edge variations perpendicular to the median surface. Gross tumor volume translations were largest in cranial-caudal and anterior-posterior direction (SD, 0.1 to approximately 0.9 cm). The translations were strongly correlated with the tumor location on the bladder wall. The average value of the local standard deviations of the GTV shape ranged from 0.1 to approximately 0.35 cm. Despite large differences in bladder filling, variations in GTV shape were small compared with variations in GTV position. Geometric uncertainties in the GTV position depended strongly on the tumor location on the bladder wall.

Adenocarcinoma arising in a vaginal müllerian cyst: A case report

Background. We report a case of adenocarcinoma arising in a vaginal müllerian cyst. Although the most common pathological type of vaginal cysts is müllerian cyst, malignant change of a müllerian cyst has not been reported before. Case. A 48-year-old woman presented with a 3 cm-sized ruptured vaginal cyst. The cyst had been asymptomatic for 20 years, but ruptured 2 months before her visit. After the diagnosis of atypical glands was made on punch biopsy of cyst wall, she underwent an operative excision and the final histopathologic examination revealed an adenocarcinoma arising in the müllerian cyst. After the surgery, she received a course of external radiation therapy followed by brachytherapy. At 6 months following treatment, the patient remained without evidence of disease. Conclusion. To our knowledge, this is the first case report of an adenocarcinoma arising from a müllerian cyst. The possibility of malignant transformation should be considered and careful follow-up is warranted even in cases of asymptomatic vaginal cysts.

Radiation therapy induced micronuclei in cervical cancer—does it have a predictive value for local disease control?

Objective To evaluate the predictive value of serial changes in micronuclei induction during external radiotherapy (EXRT) in cervical cancer with respect to local response at the end of EXRT and local disease free survival (LDFS). Methods Twenty-five patients of squamous cell cancer of the cervix were treated by 50 Gy of EXRT delivered over 5 weeks followed by intracavitary brachytherapy. Serial cytological smears were taken from cervical growth at weekly intervals during the course of EXRT and stained by Giemsa and May-Grunwald's stain. Micronuclei induction were scored as (a) number of cells expressing micronuclei (MN), and (b) total number of micronuclei (TMN) in 1000 tumor cells from each of the serial smears. Results A significant rise in micronuclei count was seen for both MN and TMN from pretreatment (week 0) to successive weeks of EXRT. For those having a near total tumor regression by end of EXRT, a significant rise in micronuclei was evident even at the end of first week of EXRT (MN: P = 0.05, TMN: P = 0.04). A superior LDFS was observed in patients showing greater than 50% increment in MN value in the first week (median survival for <50% vs. ≥50% rise: 5 months vs. not reached, P = 0.21), while it reached significance for a similar rise of TMN (median survival <50% vs. ≥50% rise: 5 months vs. not reached, P = 0.04). Conclusions The significant rise of micronuclei at the end of first week of EXRT in cervical cancers as observed from serial cytological smears could predict for a better local response and LDFS.

Variations in clinical estimates of tumor volume regression parameters and time factor during external radiotherapy in cancer cervix: Does it mimic the linear-quadratic model of cell survival?

Tumor regression parameters and time factor during external radiotherapy (EXTRT) are of paramount importance. To quantify the parameters of tumor regression and time factor during EXTRT in cancer cervix. Patients, treated solely with radiotherapy and enrolled for other prospective studies having weekly tumor regressions recorded were considered. Seventy-seven patients received 50 Gy of EXTRT followed by intracavitary brachytherapy. Loco-regional regressions were assessed clinically and regression fraction (RF) was represented as RF=c + a 1D + a 2 D2 sub - a 3T, with c, D and T as constant, cumulative EXTRT dose and treatment time respectively. Step wise linear regression was performed for RF. Scatter plots were fitted using linear-quadratic fit. Coefficients of parameters D, D2 sub and T were computed for various dose intervals, namely 0--20 Gy, 0--30 Gy, 0--40 Gy and 0--50 Gy. At 0--20 Gy and 0--30 Gy, only the coefficient of D2 was significant (P 2 sub and T turned significant (P 2 sub and T showed significance, leading to an estimate of 26 Gy for a1/a2 and 0.96 Gy/day for a3/a1. As with alpha/beta and gamma/alpha of post-irradiation cell survival curves, a1/a2 and a3/a1 represents the cumulative effect of various radiobiological factors influencing clinical regression of tumor during the course of EXTRT. The dynamic changes in the coefficients of D, D2 sub and T, indicate their relative importance during various phases of EXTRT.

The long-term follow-up on local control of breast carcinoma treated by external beam irradiation plus iridium 192 implant

The long-term follow-up on local control of breast carcinoma treated by external beam irradiation plus iridium 192 implant

Daily megavoltage CT image guidance in the treatment of localized prostate cancer

Daily megavoltage CT image guidance in the treatment of localized prostate cancer

Stromal invasion of the cervix can be excluded from the criteria for using adjuvant radiotherapy following radical surgery for patients with cervical cancer

Background. Regarding complications of radiotherapy, the indications for adjuvant radiotherapy should be restricted. We conducted the present study to determine whether deep stromal invasion of the cervix could be excluded from the criteria used to identify patients for this treatment surgery. Methods. This study included 115 patients with FIGO stage Ib to IIb cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. Patients had the following tumors: 61 nonkeratinizing squamous cell carcinoma, 21 keratinizing squamous cell carcinoma, 26 adenocarcinoma, and 7 adenosquamous cell carcinoma. Our study criteria for using adjuvant radiotherapy included positive lymph node involvement, a compromised surgical margin, or parametrial extension. Deep stromal invasion of the cervix was excluded from the criteria in this study. Results. Seventy-two of the 115 patients (62.6%) underwent radical surgery only and all were alive. The remaining 43 patients received a complete course of external irradiation following radical surgery. The estimated 5-year survival rate is 100% for patients with stage Ib, 93.3% for stage IIa, and 52.7% for stage IIb. Fifty-five patients (47.8%) had deep stromal invasion. The prognosis for patients with deep stromal invasion was significantly worse than that for patients without deep stromal invasion (5-year survival rate, 69.8% vs. 98.0%). However, 21 patients (18.3%) with deep stromal invasion, but without positive lymph node involvement, compromised surgical margin, or parametrial extension, were alive without recurrence. Multivariate analysis showed that lymph node involvement and parametrial extension were independent prognostic factors, but that deep stromal invasion was not. Conclusion. Deep stromal invasion of the cervix can be excluded from the list of criteria for selecting patients with cervical cancer who would benefit from adjuvant radiotherapy following radical surgery.

Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery.

The current standard treatment for early breast cancer includes conservative surgery followed by entire breast radiotherapy (RT). Recent study findings show that most local recurrences are in the scar tissue area suggesting that whole-breast RT may not always be necessary. If the volume of breast tissue to be irradiated is limited, RT may be performed intraoperatively. Intraoperative RT delivered with electrons at the total isodose of 2100 rad (21 Gy) could in principle substitute the currently used radiation course of external RT after breast-conserving surgery in selected cases. We report our findings on intraoperative RT using a specially designed mobile linear accelerator delivering 4 energy levels of electrons (3, 5, 7, and 9 MeV) via a head maneuvered by a robot arm. We applied this technique to 237 patients with breast cancer (mean age, 59 years; age range, 33-80 years) with tumors smaller than 2 cm in maximum diameter (T1); most underwent wide resection and an axillary sentinel node biopsy. After a median follow-up of 19 months (range, 7-33 months), the rate of posttreatment complications is very low. Four patients (1.7%) developed breast fibrosis-mild in 3 patients and severe in 1 patient-that resolved in 24 months. Three patients (1.4%) developed ipsilateral breast cancer-2 (1.0%) contralateral breast cancer, 1 (0.5%) supraclavicular node metastasis, and 1 (0.5%) distant metastases. Intraoperative RT with electron beams reduces irradiation to the skin, subcutaneous tissue, and contralateral breast and lung. It appears to be a promising method for irradiating conservatively treated breasts and it avoids the long period of postoperative RT that may not be easily accessible to all patients.

Skin markings in external radiotherapy by temporary tattooing with henna: Improvement of accuracy and increased patient comfort

Purpose: To guarantee invariable skin markings in patients undergoing a course of external radiotherapy, especially using conformal techniques. Cutaneous markings with henna also increase patient comfort, because washing and showering are allowed. Methods and Materials: Henna, a completely natural product, is a skin colorant with a history of 5,000 years. It is applied to the skin in the form of a paste. While drying, henna stains the superficial skin layers for several weeks, and the marked area can be exposed to water arbitrarily. In case of fading of the stain before the end of radiotherapy, the marking procedure can be repeated. From November 1998 until March 2000, we performed skin markings with henna in 158 patients with different tumor sites. The majority of patients received conformal radiotherapy techniques. All patients have been evaluated concerning durability of the markings, the required number of marking procedures per treatment course, and possible related side effects. Results: The median durability of henna staining is 23 days (range 12–48 days). On average, two marking procedures (range 1–4) are necessary for a patient treated with curative intent. Although washing and showering are freely permitted, no adverse cutaneous side effects (e.g., erythema, allergic reactions) have been observed. Conclusions: Skin marking by temporary tattooing with henna increases the accuracy of external radiotherapy. It yields stable and invariable markings for the entire course of radiotherapy and also increases the comfort of patients.

Total biological effect on late reactive tissues following reirradiation for recurrent nasopharyngeal carcinoma

Purpose: To assess the additional damage of normal tissues attributable to reirradiation and the magnitude of partial recovery following the initial course. Methods and Materials: Symptomatic late complication rates (excluding xerostomia) in 3635 patients receiving one course (Group 1) and 487 patients receiving two courses of external radiotherapy (Group 2) for nasopharyngeal carcinoma were retrospectively analyzed and compared. Results: Group 2 had significantly lower actuarial complication-free survival rates than Group 1: 48% versus 81% at 5 years. The post-retreatment incidence was significantly affected by biologically effective dose (BED) (assuming an α/β ratio of 3 Gy) of the first course: hazard ratio (HR) = 1.04 per Gy 3 ( p = 0.01), but only marginally by that of the second course: HR = 1.01 per Gy 3 ( p = 0.06). If the summated BED was taken as the dose unit, it was estimated that a total BED of 143 Gy 3 would induce a 20% incidence at 5 years, while the corresponding dose projected from Group 1 was 111 Gy 3. The gap effect was insignificant in the overall analyses, but a trend of decreasing risk with increasing interval was observed in patients with gap ≥ 2 years: HR = 0.86 per year ( p = 0.07). Conclusion: The major determinant of post-retreatment complication is the severity of damage during the initial course. The sum of total doses tolerated is higher than that expected with a single-course treatment, suggesting occurrence of partial recovery (particularly in those reirradiated after an interval of 2 years or more).

A randomized, controlled clinical trial to evaluate the effects of zinc sulfate on cancer patients with taste alterations caused by head and neck irradiation

In uncontrolled clinical trials, the administration of oral zinc sulfate has been reported both to prevent and correct taste abnormalities in cancer patients receiving external radiotherapy (ERT) to the head and neck region. Eighteen patients were randomized to receive either zinc sulfate tablets (a dose of 45 mg) or placebo tablets three times a day at the onset of subjective perception of taste alterations during the course of ERT and up to 1 month after ERT termination. Taste acuity was determined by measuring detection and recognition thresholds for four taste qualities. Intolerance of zinc sulfate or placebo administration was investigated, and the oral cavity was examined. All the evaluations were studied prior to, at weekly intervals during, and 1 month after ERT administration. Taste acuity for one or more taste qualities was already impaired before ERT. During ERT treatment, taste alterations were experienced at least once for a minimum of 3 of the 8 measured thresholds by 100% of the patients, and 33.3% of the patients became aware of some alteration within the first week of treatment. The patients treated with placebo experienced a greater worsenning of taste acuity during ERT treatment compared with those treated with zinc sulfate. One month after ERT was terminated, the patients receiving zinc sulfate had a quicker recovery of taste acuity than those receiving placebo. Statistically significant differences between the two groups emerged for urea detection and sodium chloride recognition thresholds during ERT treatment and for sodium chloride, saccharose, and hydrogen chloride recognition thresholds after the termination of ERT treatment. This pharmacologic therapy is effective and well tolerated; it could become a routine in clinical practice to improve the supportive care of patients with taste alterations resulting from head and neck cancer. H. Tideman

The role of brachytherapy in early-stage nasopharyngeal carcinoma

Purpose: To present the treatment results and assess the optimal radiation dose and the role of brachytherapy in early stage nasopharyngeal cancer (NPC).Methods and Materials: One hundred eighty-three patients with Stage I and II (American Joint Committee on Cancer Staging System, 1987) NPC completed the planned radiotherapy in our institution from 1979 to 1991. In 133 patients, radiotherapy was given to the nasopharynx by external beam to 64.8–68.4 Gy. Further boost was done by high dose rate (HDR) brachytherapy for 5–16.5 Gy in one to three fractions. For the remaining 50 patients, a course of external radiotherapy to the nasopharynx for 68.4–72 Gy was given to nasopharynx. Age (>40 or not) sex, neck boost or not, brachytherapy, and irradiation dose were analyzed to determine significant factors that influence the probabilities of local control and actuarial survival.Results: The 5-year disease-specific survival was 85.8% and local control was 83%. Only the brachytherapy and irradiation dose significantly affected the results. The use of the brachytherapy had significant impact on overall survival and local control. Furthermore, we compared the prognostic effect of various radiation dosage among Group I of 50 patients (<72.5 Gy, no brachytherapy, excluding four patients who received brachytherapy), Group II of 71 patients (72.5–75 Gy; one to two fractions of brachytherapy), and Group III of 58 patients (>75 Gy; three fractions of brachytherapy). Five-year disease-specific survival rates of Group I, Group II, and Group III were 77, 95.5, and 82.4%, respectively. Five-year local control rates were: 73.7, 93.9, and 79.5%. We found that the Group II had the best actuarial survival and local control rate (log-rank test, p < 0.05). Most patients receiving brachytherapy encountered foul odor because of nasopharynx crust; 12 of them had palate or sphenoid sinus floor perforation or nasopharynx necrosis. None of the patients without brachytherapy experienced the same complications.Conclusions: The optimal radiotherapy dose to the nasopharnyx area in early stage NPC may be within 72.5 to 75 Gy by our treatment protocol. A dose of more than 75 Gy did not have significant local control or survival advantage. The use of brachytherapy to elevate radiation dose had significant local control and survival benefit for early stage NPC patients, but the fractionation size should be decreased to reduce the complications.