Effect Of Adjuvant Radiation Therapy Research Articles

BENEFIT OF ADJUVANT RADIATION THERAPY FOR LOCALIZED PROSTATE CANCER WITH A POSITIVE SURGICAL MARGIN

Positive surgical margins are common after radical prostatectomy, and the role of adjuvant therapy in such cases is controversial. We determined the benefit of postoperative external beam radiation therapy in patients with margin positive prostate cancer with respect to biochemical progression or cancer recurrence. To decrease confounding factors that may affect the likelihood of biochemical progression our study was limited to men with organ confined cancer and a single positive margin. We retrospectively evaluated the records of a nested matched cohort of 76 patients with pathological stage T2N0 prostate cancer and a single positive margin who underwent adjuvant radiation therapy within 3 months of radical prostatectomy. There was a positive margin at the prostatic apex in 35 cases, prostatic base in 18, posterior prostate in 11, urethra in 7, and prostatic apex and urethra in 5. These patients were matched 1:1 with 76 controls who did not receive adjuvant radiation therapy. Neither group received androgen deprivation therapy. Patients and controls were matched exactly for the margin positive site, age at surgery, preoperative serum prostate specific antigen, Gleason score and DNA ploidy. Biochemical relapse was defined as posttreatment PSA greater than 0.2 ng./ml. Overall there was significant estimated improvement plus or minus standard error in 5-year clinical and biochemical progression-free survival in 88%+/-5% versus 59%+/-11% of patients treated with adjuvant radiation therapy versus no radiation therapy (p = 0.005). No patient who received radiation therapy had local or distant recurrence, while 16% of controls had recurrence (p = 0.015). When stratified by site of margin positivity, the 5-year estimated clinical and biochemical progression-free rate in 18 cases and controls with a positive base margin was 95%+/-15% and 65%+/-13%, respectively (p = 0.02). The rate in 35 cases and cases with a positive apex margin was 95%+/-5% and 64%+/-15%, respectively (p = 0.07). Limited sample size precluded analysis of the other sites. Patients with localized prostate cancer and a singe positive surgical margin appear to have a lower rate of biochemical relapse at 5 years when adjuvant radiation therapy is administered. Definitive evidence of the beneficial effect of adjuvant radiation therapy for patients with involved surgical margins awaits conclusion of randomized clinical trials.

The efficacy of early adjuvant radiation therapy for pt3n0 prostate cancer: a matched-pair analysis

Purpose: This study examines the effect of adjuvant radiation therapy (RT) on outcome in patients with pT3N0 prostate cancer and makes comparisons to a matched control group. Methods and Materials: At our center, 149 patients undergoing radical prostatectomy were found to have pT3N0 prostate cancer, had an undetectable postoperative prostate-specific antigen (PSA) level, and had no immediate hormonal therapy. Fifty-two patients received adjuvant RT within 3 to 6 months of surgery. Ninety-seven underwent radical prostatectomy alone and were observed until PSA failure. From these two cohorts, we matched patients 1:1 according to preoperative PSA (<10 ng/ml vs. >10 ng/ml), Gleason score (<7 vs. ≥7), seminal vesicle invasion, and surgical margin status. Seventy-two patients (36 pairs) were included in the analysis. Median follow-up time was 41 months. We calculated a matched-pairs risk ratio for cumulative risk of PSA relapse (a rise above 0.2 ng/ml). Results: After controlling for the prognostic factors by matching, there was an 88% reduction (95% confidence interval [CI]: 78–93%) in the risk of PSA relapse associated with adjuvant RT. The 5-year freedom from PSA relapse rate was 89% (95% CI: 76–100%) for patients receiving adjuvant RT as compared to 55% (95% CI: 34–79%) for those undergoing radical prostatectomy alone. Conclusions: These data suggest that adjuvant RT for pT3N0 prostate cancer may significantly reduce the risk of PSA failure as compared to radical prostatectomy alone. Its effect on clinical outcome awaits further follow-up.

Postmastectomy Radiation and Adjuvant Systemic Therapy: Outcomes in High-Risk Women with Stage II?III Breast Cancer and Assessment of Clinical, Pathologic, and Treatment-Related Factors Influencing Local-Regional Control

: Women with clinical T3 breast cancers, four or more positive axillary nodes, or both have a 25–35% risk of local-regional failure after mastectomy with or without adjuvant Tamoxifen or chemotherapy. We analyze the effectiveness of adjuvant radiation therapy in altering this pattern of failure. From 1984 to 1993, 80 women were treated with postmastectomy radiation. Twenty-three percent had operable T3 tumors and 71% were node positive (59%≥ 4 nodes). Sixty-nine percent received adjuvant chemotherapy ± Tamoxifen and 21% received Tamoxifen alone. Radiation was directed to the chest wall (median 50 Gy) in all patients, supraclavicular region (median 46 Gy) in 73%, axilla (median 46 Gy) in 54%, and internal mammary nodes (median 50Gy) in 5%. Median follow-up of surviving patients was 45 months (range 5–131 months). The 5-year actuarial local and regional control rates were 98% and 99%, respectively. There have been no local failures as an isolated first event. Two women with chest wall failures had simultaneous or antecedent distant metastases. There was 1 supraclavicular failure and no axillary or internal mammary node failures. The 5-year actuarial overall, cause-specific and relapse-free survival for women with clinical T3 tumors were 68%, 70%, and 68%, for women with 4–9 positive nodes were 66%, 80%, and 68%, and for women with ≥10 positive nodes were 49%, 56%, and 43%, respectively. Postmastectomy radiation was extremely effective in preventing local-regional recurrences in high-risk women. Overall and cause-specific survival were excellent with this combined modality approach.

Adjuvant radiation for vulvar carcinoma: Improved local control

Purpose : Local recurrence is a significant problem following primary surgery for advanced vulva carcinoma. The objectives of this study were to evaluate the impact of adjuvant vulval radiation on local control in high risk patients and the impact of local recurrence on overall survival. Methods and Materials : From 1980–1994, 62 patients with invasive vulva carcinoma and either positive or close (less 8 mm) margins of excision were retrospectively studied. Thirty-one patients were treated with adjuvant radiation therapy to the vulva and 31 patients were observed after surgery. Kaplan-Meier estimates and the Cox proportional hazard regression model were used to evaluate the effect of adjuvant radiation therapy on local recurrence and overall survival. Independent prognostic factors for local recurrence and survival were also assessed. Results : Local recurrence occurred in 58% of observed patients and 16% in patients treated with adjuvant radiation therapy. Adjuvant radiation therapy significantly reduced local recurrence rates in both the close margin and positive margin groups ( p = 0.036, p = 0.0048). On both univariate and multivariate analysis adjuvant radiation and margins of excision were significant prognostic predictors for local control. Significant determinants of actuarial survival included International Federation of Gynecologists and Obstetricians (FIGO) stage, percentage of pathologically positive inguinal nodes and margins of excision. The positive margin observed group had a significantly poorer actuarial 5 year survival than the other groups ( p = 0.0016) and adjuvant radiation significantly improved survival for this group. The 2 year actuarial survival after developing local recurrence was 25%. Local recurrence was a significant predictor for death from vulva carcinoma (risk ratio 3.54). Conclusion : Local recurrence is a common occurrence in high risk patients. In this study adjuvant radiation therapy significantly reduced local recurrence rates and may improve overall survival in certain subgroups. As salvage rates after developing local recurrence are poor adjuvant vulvar radiation should be considered for patients at risk after primary surgery.

Effect of Adjuvant Radiation Therapy on Prostate Specific Antigen Following Radical Prostatectomy

A total of 21 patients received adjuvant radiation therapy after radical prostatectomy for a persistently detectable prostate specific antigen value (more than 0.6 ng. per ml.) postoperatively. Adjuvant radiation therapy decreased serum prostate specific antigen values to the undetectable range in 6 of 21 patients (29%) all of whom have remained free of tumor recurrence with a mean followup of 12.6 months (range 6 to 30). Three patients initially showed a decrease in serum prostate specific antigen to undetectable levels but they subsequently demonstrated an increasing level within 12 months after adjuvant radiation therapy. Additionally, 7 of 13 patients whose prostate specific antigen values remained in the detectable range despite adjuvant radiation therapy have had clinical evidence of tumor recurrence. Further followup will be required to determine what ultimate impact adjuvant radiation therapy will have on survival free of tumor.

Local control in rectal cancer. A clinical review and meta-analysis.

We reviewed the factors influencing local control of potentially curable rectal cancer in 106 patients. There was improvement in stage-adjusted local control associated with increasing use of adjuvant radiation therapy. A meta-analysis of the English-language literature through 1988 also supported the effectiveness of adjuvant radiation therapy in all but the lowest-risk patients. No effect on survival was identified in either analysis, but a reduction of up to 40% in local recurrence rates may be achieved with doses of 3000 cGy or more.

The 5-year results of a randomized trial of adjuvant radiation therapy after chemotherapy in breast cancer patients treated with mastectomy.

The use of adjuvant radiation therapy in breast cancer patients treated with mastectomy and adjuvant chemotherapy has been controversial. In order to assess the necessity and effectiveness of adjuvant radiation therapy in this setting, we reviewed the results in 510 patients with T1-T3 tumors and pathologically positive nodes or tumors larger than 5 cm and negative nodes who were treated with adjuvant chemotherapy. Patients with four or more positive nodes or at least one positive apical node were randomized to receive either five or ten cycles of cyclophosphamide/Adriamycin (Adria Laboratories, Columbus, OH) (CA) and patients with one to three positive nodes or operable tumors larger than 5 cm and pathologically negative nodes were randomized to receive eight cycles of either cyclophosphamide, methotrexate, and 5-fluorouracil (5-FU) (CMF) or methotrexate and 5-FU (MF) chemotherapy. Two hundred six of these patients were subsequently rerandomized to receive either no further treatment or adjuvant radiotherapy. Thirty-five patients withdrew after randomization, including 34 who declined to receive radiotherapy. Radiation therapy consisted of 4,500 cGy in 5 weeks to the chest wall and appropriate draining lymph nodes. Median follow-up from chemotherapy randomization is 45 months for patients in the CA arm and 53 months for those in the CMF/MF arm. The crude rate of local failure (chest wall or draining lymph node areas) as first site of failure for patients randomized to receive chemotherapy only was 14%; for those randomized to receive both chemotherapy and radiotherapy it was 5% (P = .03). For patients in the CMF/MF arm, the rate of local failure as the first site of failure was nearly the same for patients randomized to chemotherapy only as for those randomized to adjuvant radiotherapy as well (5% v 2%). For patients in the CA arm, the crude rate of local failure was 20% for patients randomized to receive chemotherapy only, and 6% for those randomized to both types of adjuvant treatment (P = .03). Among the 43 patients treated with CA who actually received radiotherapy, there was only one local failure, compared with 12 local failures among the 59 patients (20%) who actually did not receive radiotherapy (P = .007). No significant difference was seen in disease-free survival or overall survival in either the CA or the CMF/MF arm between patients randomized to receive radiation therapy and those randomized to no further treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Surgery of the Bony and Cartilaginous Dorsum

Despite oversized latissimus dorsi free flap reconstruction in the head and neck area, esthetic and functional problems continue to exist due to the well-known occurrence of transplant shrinkage. The purpose of this study was to acquire an estimation of the volume and time of the shrinkage process.The assessment of volume loss was performed using a 3D evaluation of two postoperative CT scans. A retrospective review was conducted on all latissimus dorsi free flap reconstructions performed between 2004 and 2013. Inclusion criteria for the assessment were: resection of an oral carcinoma and microsurgical defect coverage with latissimus dorsi free flap; a first postoperative CT (CT1) performed between 3 weeks and a maximum of 3 months after reconstruction surgery; and an additional CT scan (CT2) performed at least one year postoperatively. The exclusion criterion was surgical intervention in the local area between the acquisition of CT1 and CT2. The effect of adjuvant radiation therapy was considered. Volume determination of the transplant was carried out in CT1 and CT2 by manual segmentation of the graft.Fifteen patients were recruited. 3D evaluation showed an average volume loss of 34.4%. In the consideration of postoperative radiotherapy the volume reduction was 39.2% in patients with radiotherapy and 31.3% in patients without radiotherapy.The reconstruction flap volume required for overcorrection of the surgical defect was investigated. This study indicates that a volume loss of more than 30% could be expected one or more years after latissimus dorsi free flap reconstruction.Clinical trial number DRKS00007534.