Five-year Local Control Rates Research Articles

Radiotherapy With or Without Surgery for Maxillary Sinus Squamous Cell Carcinoma

Maxillary sinus squamous cell carcinoma is commonly diagnosed at an advanced stage and treated using radiotherapy, with or without surgical resection. Fifty-four patients with maxillary sinus squamous cell carcinoma were treated from 1969 to 2006, using radiotherapy, with or without surgical resection. Fifty-two (96%) patients had American Joint Committee on Cancer stages III to IV disease, and 45 (83%) patients had N0 neck disease. Five-year local control (LC) rates by T-stage were 63% for T2/T3; and 43% for T4. Five-year LC rates for patients treated with radiotherapy preoperatively, postoperatively, and definitively were 61%, 65%, and 37%, respectively. Initially, overall 5-year LC, neck control, and local-regional control were 49%, 82%, and 45%, respectively. The ultimate 5-year LC, neck control, and local regional control after salvage of failures were 51%, 87%, and 50%, respectively. The overall 5-year cause-specific survival was 41%. Thirty-three percent of patients had a severe complication. Radiotherapy, with or without surgical resection, remains an effective tool in treating patients with this disease. LC, cause-specific survival, and complication rates need significant improvement. Treatment details and recommendations are discussed herein.

Outcomes by breast cancer subtype in patients treated with accelerated partial breast irradiation.

83 Background: To determine clinical outcomes for patients treated with accelerated partial breast irradiation (APBI) based on breast cancer subtype. Methods: We evaluated 516 consecutive patients who received APBI with a minimum follow-up of 6 months. Methods of APBI delivery included interstitial brachytherapy (n=221), balloon-based brachytherapy (n=201), and 3D-CRT (n=106). Women were assigned a breast cancer subtype (BCST) based on results of testing for estrogen (ER), progesterone (PR), and human epidermal growth factor (HER2/neu) receptors. Those without test results for all three receptors were excluded. 278 patients were eligible and submitted for analysis. Receptor subtypes were approximated as follows: ER+, PR+/–, and HER-2 negative [luminal A (LA), 164 pts.]; ER+, PR+/–, and HER-2 positive [luminal B (LB), 81 pts.]; ER/PR–, HER-2+ [HER-2 (H2), 5 pts.], and ER/PR/HER-2 negative [basal (B), 28 pts.]. An analysis was then performed to estimate IBTR, RNF, DM, DFS, CSS, and OS. Results: Mean age was 66 years, median follow-up was 4.9 yrs. Basal and H2 subtype patients had higher histologic grades (Gr. 3 = 75% vs. 10% LA/LB, p<0.001), larger tumors (13.0mm vs. 10.7mm LA/LB, p=0.05), and were more likely to receive chemotherapy (68% vs. 15% LA/LB, p<0.001). Basal subtype patients were also more likely to be African American (18% vs. 4% LA/LB, p=0.002). Margin and nodal status were similar between all BCSTs. At five years, IBTR rates were 2.9%, 3.2%, 0%, and 4.8% for LA, LB, H2, and B subtypes, respectively (p=0.75). The IBTR within the B subtype group was due to a single elsewhere failure, the rate of which was not statistically different than that for the LA subtype (2.9%, p=0.30). DM was only seen in LA (2.5%) and LB (1.4%) (p=0.87). Disease-free survival (95-100%), CSS (97%-100%), and OS (80-100%) (Table) were also not statistically different (p=0.98, 0.85, 0.24, respectively) between BCST categories. Conclusions: Five-year local control rates after treatment with APBI are excellent for luminal, HER2, and triple-negative phenotypes of early-stage breast cancer. Further study of BCST is important and may be useful when counseling patients on adjuvant treatment options following breast-conserving surgery.

Management of Ductal Carcinoma In Situ Patients Receiving Postoperative Radiotherapy after Breast Conserving Surgery: Hacettepe Experience

We retrospectively evaluated our therapetic results in ductal carcinoma in situ (DCIS) patients treated with postoperative radiotherapy following breast-conserving surgery (BCS). Sixty-seven DCIS patients were treated with curative radiotherapy (RT) after BCS, in our department from December 1998 to January 2008. All patients have been treated with 6 MV photon energy on lineer accelerator machine. Radiotherapy treatment fields were opposed tangential to the whole breast. A total dose of median 50 Gy (48-50 Gy) was delivered in five fractions in a week. In twenty patients, boost dose to the tumour region was applied. Fifty patients received systemic hormonotherapy. Median follow-up time was 44 moths (range 12-122 months). Five-year OS, DFS and local control rates were found as 96%, 97% and 97%, respectively. There was only one ipsilateral breast recurrence in our study (2%). Two patients died due to other causes except disease (3%). Grade III dermatitis was seen in only one patient (2%), and there was no serious acute side effects in 41 patients (63%). There was no late side effect in our patients. Sixty-two patients were alive without evidence of tumour recurrence, with their intact breast and with good cosmesis. Our survival rates and side effects were in consistent with literature, and RT is an effective option for DCIS patients following BCS.

Role of radiation therapy in the multidisciplinary management of Ewing's Sarcoma of bone in pediatric patients: An effective treatment for local control

Background Radiotherapy (RT) plays an important role in the multidisciplinary management of Ewing's Sarcoma (ES), especially in unresectable cases. Aim Assessment of efficacy of RT in terms of local control in pediatric patients with primary ES of bone. Materials and methods Thirty-six patients younger than 17 years old with ES treated with combined RT and chemotherapy with ( N = 14) or without ( N = 22) prior surgery from 1981 to 2008 were retrospectively reviewed. Since 1995, they were all treated according to the Spanish Society of Pediatric Oncology protocol (55.5% cases). Those patients received vincristine, ifosfamide, doxorubicin and etoposide. The TNM classification was as follows: 17 T1, 18 T2 and 1 T3; 36 N0; 29 M0, 5 M1a and 2 M1b. Analysis was stratified by treatment: definitive RT or pre/postoperative RT. Results The 36 patients (21 male; 15 female) had a median age of 10 years (range 2–17 years). Median follow-up of living patients was 105 months. The 2-year local control (LC) rate for all patients was 88%. Five-year LC rates for patients treated with definitive and pre/postoperative RT were 91% and 86%, respectively. Two-year overall survival and disease-free survival rates for all patients were 68% and 66%, respectively. Low phosphatase alkaline levels and local and distant recurrences were significantly predictive of worse prognosis ( P = 0.021, P = 0.011, P = 0.007, respectively). Conclusion Radiotherapy with and without surgery is a highly effective local treatment option in the multidisciplinary management of ES in pediatric patients.

Oncologic Outcomes after Supracricoid Partial Laryngectomy

To review the oncologic outcomes of a series of supracricoid partial laryngectomy. Case series with chart review. La Paz University Hospital, Madrid, Spain. Forty-one patients with glottic or supraglottic squamous cell carcinoma who underwent supracricoid partial laryngectomy between 1998 and 2008 at the authors' institution. Local control rate, specific-disease survival rate, and overall survival rate. All patients were male, with a mean age of 56 years (range, 38-71 years). Forty-one percent of tumors were classified as locally advanced carcinomas (T3-T4). Thirty-three patients (80%) underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Epiglottis was resected in the remaining 8 patients. One patient died in the immediate postoperative period because of cardiac tamponade, 6 developed pneumonia, 2 had a postoperative bleeding that required reintervention, and 2 developed pharyngocutaneous fistula. The median follow-up period was 43 months. More than 85% of the patients completed more than 2 years of follow-up. Five-year actuarial local control rate was 80%, being 92% for T1-T2 tumors and 67% for locally advanced tumors. Thirty-five patients (85%) preserved their larynx. The 6 patients who underwent total laryngectomy had a local recurrence or a regional recurrence that infiltrated the larynx. No laryngectomy was performed for functional reasons. Supracricoid partial laryngectomy is an oncologically safe procedure to preserve laryngeal functions in selected patients with glottic and supraglottic carcinomas.

Risk factors for survival and local recurrence after particle radiotherapy for single small hepatocellular carcinoma

Particle radiotherapy is a novel treatment for malignant tumours. The present study aimed to evaluate risk factors for overall survival and local control after particle radiotherapy of single small hepatocellular carcinoma (HCC), and to identify suitable candidates for this treatment. All patients with a single HCC smaller than 5 cm in diameter treated by particle radiotherapy between 2001 and 2008 were identified retrospectively from a prospectively collected database. Clinical outcomes and prognostic factors were analysed. A total of 150 patients were included. Five-year overall survival and local control rates were 50.9 and 92.3 per cent respectively. Multivariable analysis revealed that several factors, including age and Child-Pugh classification, significantly influenced overall survival. Proximity to the digestive tract and Child-Pugh classification were independent risk factors for local recurrence. Other tumour factors including size, gross classification, previous treatment, macroscopic vascular invasion, and tumour location in relation to the diaphragm and large vessels did not influence local control rate. Particle radiotherapy seems safe and effective, and may be a novel treatment for small HCC. Recurrences are more frequent when the tumour is located close to the gut.

Limited Chemotherapy and Shrinking Field Radiotherapy for Osteolymphoma (Primary Bone Lymphoma): Results From the Trans-Tasman Radiation Oncology Group 99.04 and Australasian Leukaemia and Lymphoma Group LY02 Prospective Trial

To establish benchmark outcomes for combined modality treatment to be used in future prospective studies of osteolymphoma (primary bone lymphoma). In 1999, the Trans-Tasman Radiation Oncology Group (TROG) invited the Australasian Leukemia and Lymphoma Group (ALLG) to collaborate on a prospective study of limited chemotherapy and radiotherapy for osteolymphoma. The treatment was designed to maintain efficacy but limit the risk of subsequent pathological fractures. Patient assessment included both functional imaging and isotope bone scanning. Treatment included three cycles of CHOP chemotherapy and radiation to a dose of 45 Gy in 25 fractions using a shrinking field technique. The trial closed because of slow accrual after 33 patients had been entered. Accrual was noted to slow down after Rituximab became readily available in Australia. After a median follow-up of 4.3 years, the five-year overall survival and local control rates are estimated at 90% and 72% respectively. Three patients had fractures at presentation that persisted after treatment, one with recurrent lymphoma. Relatively high rates of survival were achieved but the number of local failures suggests that the dose of radiotherapy should remain higher than it is for other types of lymphoma. Disability after treatment due to pathological fracture was not seen.

Abstract 5639: Preoperative concurrent paclitaxel and radiation in locally advanced breast cancer (LABC): Five-year outcomes on 105 patients

Abstract Purpose: A prospective trial of preoperative concurrent paclitaxel and radiation for patients with LABC was conducted at three academic institutions. Five-year local and systemic control rates are reported. Patients and Methods: 105 patients with LABC were treated with concurrent neoadjuvant paclitaxel and radiation. Paclitaxel was administered at 30 mg/m2 intravenously twice a week for 10-12 weeks. Daily radiotherapy was delivered to the breast, axillary and supraclavicular lymph nodes during weeks 2-7, at 1.8 Gy per fraction to a total dose of 45 Gy followed by a boost of 14 Gy at 2 Gy per fraction to the originally palpable tumor. Weekly trastuzumab (2mg/kg) was added for 8 more recent patients whose tumor over-expressed Her-2/neu. At one of the three institutions preoperative paclitaxel (3 cycles of 175 mg/m2 q 3 weeks) was also administered prior to chemo-radiation to 36 patients. Pathologic response was defined as complete response (pCR) in the absence of invasive cancer in breast or lymph nodes; partial response (pPR) as the persistence of < 10 microscopic foci of invasive carcinoma in breast or lymph nodes. After surgery additional systemic therapy was left to the discretion of the treating physician. Results: Pathological response (pCR and pPR) after neoadjuvant chemo-radiation was achieved in 36/105 patients (34.3%, 95% confidence interval: 25.3% - 44.2%). 30/105 patients underwent breast-conserving surgery after neoadjuvant chemo-radiation (28.6%), while 74 underwent mastectomy. One patient progressed during therapy and did not undergo surgery. With a median follow up of 60 months and a maximum of 137 months, the median survival has not been reached. The estimated 5-year overall cumulative survival (OS) is 71.6% (95% confidence interval: 60.5% - 80.1%). Local recurrence occurred in 4/105 patients (3.8%): in 3/4 synchronously with or following systemic recurrence. Five patients (4.8%) developed contra-lateral breast cancer. Patients without a pathologic response had a higher risk of recurrence or death than patients who had a pathologic response (hazard ratio = 2.86, logrank p-value=0.009); similarly, survival was shorter (hazard ratio = 4.28, logrank p-value=0.003). The 5-year estimated OS for non-responders was 61.6% compared with 87.9% for responders. A separate analysis of patients who received additional preoperative paclitaxel before chemo-radiation showed a pathologic response rate of 41.7% (15/36 patients, 95% confidence interval: 25.5% to 59.2%); with an estimated 5-year OS of 63.9% (95% confidence interval: 46.1% - 77.2%). Conclusion: This series of 105 patients with LABC treated with concurrent paclitaxel and radiation demonstrated a 71.6% 5-year OS and 96% local control rate. Pathological response to concurrent paclitaxel and radiation was associated with a significantly better 5-year survival. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5639.

Oligometastases confined one organ from colorectal cancer treated by SBRT

To determine the feasibility and efficacy of stereotactic body radiotherapy (SBRT) for oligometastases from colorectal cancer (CRC). Total of 59 patients with 78 lesions confined to one organ and treated from 2001 to 2006 were involved in this retrospective review. These patients presented with 1-4 metastatic lesions of largest diameter of <7 cm, progressed after chemotherapy, and were amenable to local treatment. The median radiation dose administered was 42 Gy, which was delivered in 3 fractions. Lymph node lesions were most frequent, followed in order by the lung and liver. Five-year overall survival and local control rates were 29 and 19%, respectively. Cumulative gross tumor volume, site of metastasis, and SBRT dose were found to be significantly associated with overall survival. In terms of local control, a cumulative GTV below 23 ml was found to be a significantly favorable prognostic factor. Acute grade 1-2 toxicities occurred in 24 of the 59 patients, and a late grade 4 complication occurred in 2 (3%), and these were relieved by bypass surgery. CRC patients with oligometastases generally fare well after SBRT. In particular, the survival rates of patients with a pelvic LN or a small tumor are promising.

T1N0 to T2N0 Squamous Cell Carcinoma of the Glottic Larynx Treated With Definitive Radiotherapy

To report the treatment outcomes of definitive radiotherapy (RT) for early-stage squamous cell carcinoma (SCCA) of the glottic larynx. We retrospectively reviewed the medical records of 585 patients with T1N0 to T2N0 invasive SCCA of the glottic larynx treated between 1964 and 2006 with RT alone. All patients had at least 2 years of follow-up, had histologic diagnosis of invasive SCCA, and received continuous-course RT. None of these patients received chemotherapy or had elective nodal RT. The probabilities of local control (LC), ultimate LC, ultimate LC with larynx preservation, neck control, cause-specific survival (CSS), and overall survival (OS) were calculated by the Kaplan-Meier product-limit method. The median follow-up for survivors was 12 years. Five-year LC rates were as follows: T1A, 94%; T1B, 93%; T2A, 80%; and T2B, 70%. Multivariate analysis revealed that overall treatment time greater than 41 days (p = 0.001) and poorly differentiated histology (p = 0.016) adversely affected LC. Five-year rates of ultimate LC with laryngeal preservation were: T1A, 95%; T1B, 94%, T2A, 81%; and T2B, 74%. Twenty-four (4%) of 585 patients failed in the neck; only 7 neck failures (1%) were isolated. Five-year CSS and OS rates were as follows: T1A, 97% and 82%; T1B, 99% and 83%; T2A, 94% and 76%; and T2B, 90% and 78%, respectively. Ten (1.7%) patients had severe and/or fatal complications. One patient died of a radiation-induced carotid artery angiosarcoma. Based on our study results, RT cures a high proportion of patients with T1N0 to T2N0 glottic SCCAs and has a low rate of severe complications.

Elective re-irradiation and hyperthermia following resection of persistent locoregional recurrent breast cancer: A retrospective study

Purpose: To analyse the therapeutic effect and toxicity of re-irradiation (re-RT) combined with hyperthermia (HT) following resection or clinically complete remission (CR) of persistent locoregional recurrent breast cancer in previously irradiated area.Methods and materials: Between 1988 and 2001, 78 patients with high risk recurrent breast cancer underwent elective re-RT and HT. All patients received extensive previous treatments, including surgery and high-dose irradiation (≥50Gy). Most had received one or more lines of systemic therapy; 44% had been treated for ≥ one previous locoregional recurrences. At start of re-RT + HT there was no macroscopically detectable tumour following surgery (96%) or chemotherapy (CT). Re-RT typically consisted of eight fractions of 4Gy, given twice weekly. Hyperthermia was added once a week.Results: After a median follow up of 64.2 months, three-year survival was 66%. Three- and five-year local control rates were 78% and 65%. Acute grade 3 toxicity occurred in 32% of patients. The risk of late ≥ grade 3 toxicity was 40% after three years. Time interval to the current recurrence was found to be most predictive for local control in univariate and multivariate analysis. The extensiveness of current surgery was the most relevant treatment related factor associated with toxicity.Conclusions: For patients experiencing local recurrence in a previously radiated area, re-irradiation plus hyperthermia following minimisation of tumour burden leads to a high rate of local control, albeit with significant toxicity. The latter might be reduced by a more fractionated re-RT schedule.

Malignant neoplasms of the sinonasal tract: report of 71 patients and literature review and analysis

The present study aimed to report the characteristics, prognostic factors, and treatment outcomes of 71 cases of malignant neoplasms of the sinonasal tract and literature review and analysis of major report series. Seventy-one consecutive patients diagnosed with primary malignant neoplasm of the sinonasal tract that were treated and followed up at a university hospital between May 2000 and March 2008 were selected for the present study. Thirty-four patients were treated with surgery followed by a combination of chemotherapy and radiotherapy, 15 with surgery alone, 14 with combined radiotherapy and chemotherapy, six with radiotherapy alone, and two with surgery followed by radiotherapy. To find out the major series of related studies over the last 20 years, a literature review of PubMed was performed. In all, we found 42 major series including 8,164 patients with malignant neoplasms of the sinonasal tract. There were 35 women and 36 men ranging in age from 5 to 80 years, with a median age of 55 years at diagnosis. The primary sites included were paranasal sinuses in 51 and nasal cavity in 20. There were one case of stage I, 20 of stage II, 27 of stage III, and 23 of stage IV. Epithelial tumors constituted 65% of all neoplasms. After a median follow-up of 39 months for surviving patients, 33 patients are alive and without disease, eight are alive with disease, and 30 patients died due to disease. Local recurrence was the most frequent treatment failure. The 5-year disease-free, local control, and overall survival rates were 42.1%, 59.5%, and 54.5%, respectively. On univariate analysis, cervical lymph nodes involvement, primary tumor size, histologic type, response to therapy, and stage of disease were independent prognostic factors for overall survival. In the literature review and by analyzing the data collection from 42 major reported series, the median age was 57 years and male/female ratio was 1.8. Epithelial tumors consisted of 69% of all malignant neoplasms of sinonasal tract and stages III and IV disease constituted 74.7% of all stages. Local recurrence was the dominant treatment failure in nearly all series. Five-year local control and overall survival rates were 56% and 45.5%, respectively. In this review and by analyzing the large data collection of recent major reported series, we found that malignant neoplasms of the sinonasal tract tend to present at locally advanced stage, with a high frequency of local failure and a moderate to poor outcome. More effective local treatment for improving the local control and overall survival is needed.

Assessment of Influence of Smoking, Drinking, Leukoplakia and Dental Irritation on Local Control of Early Oral Tongue Carcinoma Treated with Brachytherapy: Age and Dental Factors are Potential Prognostic Factors

To examine the background characteristics of elderly patients (65 years or older) with node-negative mobile tongue cancer (T1-2N0M0) who showed worse local control than a younger group. We retrospectively analyzed background data for 265 patients treated with brachytherapy with or without external radiotherapy between 1967 and 1999. We examined dental factors (such as irritation by prosthesis), leukoplakia, tobacco smoking and alcohol consumption for comparisons between the elderly (age > or = 65 years; n = 83) and a control group (64 years or younger; n = 182). The elderly patients showed a worse outcome than the control group (respectively 86% and 70% at 5 years; P < 0.05). Incidence of dental factors tended to be higher for elderly patients (53%) than the control group (40%, P = 0.07). Dental factors proved to have prognostic importance for local control. Five-year local control rate was 85% for patients with and 76% for patients without dental factors (P = 0.04). The elderly group positive for dental factors showed a lower 5-year local control rate (61%) than the other three groups [(elderly without the dental factor (-) group (80%), control with the dental factor (+) group (84%), and control without the dental factor (-) group (87%)] (P < 0.05). Leukoplakia was found more frequently in the control (23%) than in the elderly group (5%) (P = 0.006) but had no effect on treatment outcome. Age and dental factors (including prosthesis irritation) are potentially important prognostic factors for local control of oral tongue cancer treated with brachytherapy, especially for elderly patients.

Brachytherapy boost for T1/T2 nasopharyngeal carcinoma

The aim of this study was to review our experience and demonstrate the safety of intracavitary brachytherapy (ICB) in patients with nasopharyngeal carcinoma (NPC). Hundred seventy-eight patients with early T1-2b disease underwent radical external beam radiation therapy (EBRT) followed by ICB boost. The primary tumor received 66 Gy of EBRT over 33 fractions using 6 or 10 MV photons. ICB insertions were performed 1 week later, delivering 10 Gy in 2 fractions over 8 days. Kaplan-Meier survival analyses were used to calculate the actuarial 5-year overall survival (OS), cause-specific survival, local control, and disease-free survival (DFS). Five-year local control rates were 91.6%. OS, DFS, and cause-specific survival were estimated to be 85.25%, 81.7%, and 87.9%, respectively. Median follow-up was 86 months. There were no documented serious complications noted with ICB. ICB boost supplementing radical EBRT is an excellent method of enhancing local control for patients with NPC with early T1-2b disease.

Reirradiation of Locally Recurrent Nasopharynx Cancer With External Beam Radiotherapy With or Without Brachytherapy

To determine survival rates of patients with locally recurrent nasopharynx cancer (LRNPC) treated with modern therapeutic modalities. From July 1996 to March 2008, 29 patients were reirradiated for LRNPC. Thirteen patients received combined-modality treatment (CMT), consisting of external beam radiotherapy (EBRT) followed by intracavitary brachytherapy, whereas 16 received EBRT alone. The median age was 50 years, 59% were male, 38% were Asian, 69% had World Health Organization Class III histology, and 86% were treated for their first recurrence. Nine, 6, 8, and 6 patients had recurrent Stage I, II, III, and IV disease, respectively. Patients in the EBRT-alone group had more advanced disease. Median time to reirradiation was 3.9 years. In total, 93% underwent imaging with positron emission tomography and/or magnetic resonance imaging before reirradiation, 83% received intensity-modulated radiotherapy, and 93% received chemotherapy, which was platinum-based in 85% of cases. The median follow-up for all patients was 45 months and for surviving patients was 54 months. Five-year actuarial local control, event-free survival, and overall survival rates were 52%, 44%, and 60%, respectively. No difference was observed between patients treated with EBRT or CMT. Overall survival was superior in patients who achieved local control (p = 0.0003). The incidence of late Grade > or =3 events in patients re-treated with EBRT alone was significantly increased compared with those receiving CMT (73% vs. 8%; p = 0.005). In this modern reirradiation series of patients with LRNPC, favorable overall survival compared with historical series was achieved. Patients treated with CMT experienced significantly fewer severe late effects compared with those treated with EBRT.

Surgical treatment of sacrum-involved tumors.

Objective To discuss the approaches of resection and reconstruction of sacrum-involved tumors. Methods Based on a review of records in 61 patients (27 females and 34 males) with tumors involved sacrum, who underwent operations between January 2000 and December 2005 in Department of Orthopaedics or General Surgery of Changhai Hospital, a retrospective study was to review the authors experience with surgical treatment of these patients. Evaluations for the various patient characteristics, clinical manifestation, histological findings, complications as well as the type of surgical treatment used, and the outcomes were reported. Average age at surgery was 48.5 years (range, 18-71 years). 9 patients received tumor resection by single anterior approach, 22 patients by single posterior approach and 30 patients by anterior combined posterior approaches. There were 25 (41.0%) patients received spinal-pelvic reconstruction, while 36 (59.0%) cases did not. Results 49 patients were successfully followed up, the average time was 20.5 months (range, 3-72 months). Up to data, no perioperative death occurred. One patient received vascular tran- splantation and Miles procedure because of tumor erosion. No other major complications occurred. 4 patients died of distant metastasis and 4 had a second operation due to local recurrence. The other 41 patients (83.7%) were well under local controlled within one year and the five-year local control rate is 69.4%. Conchlsion 1) For large tumors violating sacrum, surgery of resection is very complicated. So it should be emphasized that the surgical strategy must be designed individually according to each patient's condition. Surgery should strive to achieve cn bloc resection by multi-discipline cooperation and a harmonious referral system is necessary; 2) The choice of surgical approach is important. For large-size tumors, anterior combined posterior approaches is recommended; 3)Wound infection is a common complication, one must be very cautious to prevent this condition in perioperative period; 4) Tumors involving the sacroiliac joints require to be reconstructed the stability between the lumbar spine and pelvis. Key words: Sacrococcygeal region; Neoplasms; Surgical procedures,operative

Supraglottic carcinoma treatment results analysed by therapeutic approach

This study reviewed 161 patients with supraglottic squamous cell carcinoma who underwent radical therapy at Kurume University Hospital between 1989 and 2003. The five-year survival rate was 89 per cent in patients with stage III disease and 75 per cent in stage IV patients, thus demonstrating favourable results even for patients with advanced cancer. The five-year local control rate and the laryngeal preservation rate were poor in patients with T3 tumours (being 75 per cent for both), but the overall five-year local control rate for all patients was 86 per cent. Laser surgery plus chemo-radiotherapy was the most frequently used treatment. The local control rates and laryngeal preservation rates were poor in patients with tumour infiltration to the glottis and the laryngeal ventricle. In conclusion, the indications for combination laser therapy for supraglottic carcinoma should in future be extended, and the type and number of chemotherapy courses for this cancer should be further clarified.

Stage III-IV Sinonasal and Nasal Cavity Carcinoma Treated with Three-Dimensional Conformal Radiotherapy

To report the dosimetric data and clinical outcomes of patients with advanced neoplasm of the paranasal sinuses and nasal cavity, treated by three-dimensional conformal radiotherapy. Between 2000 and 2005, 31 consecutive patients were treated for locally advanced tumors of paranasal sinuses and nasal cavity. The primary tumor was located as follows: maxillary sinus 15 (48.4%); ethmoid sinus 10 (32.3%); nasal cavity 6 (19.3%). The patients were separated in two groups according to the modality of treatment: group A included 21 patients treated with postoperative three-dimensional conformal radiotherapy with or without chemotherapy; group B included 10 patients treated with radical three-dimensional conformal radiotherapy with or without chemotherapy. The median radiation dose to the planning target volume was 60 Gy (range, 56-63) for patients who underwent complete surgical resection and 68 Gy (range, 64-70) for those who did not have tumor resection or patients with residual disease. The median follow-up was 42 months. Five-year local tumor control and overall survival actuarial rates were 74% and 72%, respectively, in the postoperative setting, 20% and 25%, respectively, with the primary radiotherapy. Local recurrence was the most common site of failure. No patient developed radio-induced blindness; 4 patients underwent enucleation as part of radical surgery. Dosimetric data are reported. The local control rate for these tumors remains low. The prognosis depends on localization, tumor stage and treatment modality. Three-dimensional conformal radiotherapy reduces the risk on optical pathways but does not modify outcome.

Malignant Phyllodes Tumor of the Breast: Local Control Rates With Surgery Alone

Patients with malignant phyllodes tumors of the breast (MPTB) are routinely treated with surgery alone. We performed a retrospective study to determine local control rates based on tumor size and type of surgery performed. We reviewed records of 478 patients with MPTB treated between March 1964, and August 2005. The data were extracted from the IMPAC National Oncology Database consisting of merged tumor registries from 130 hospitals. Median follow-up was 64 months (range, 0-410 months). Actuarial 5-year local control rates were 79.4% for 169 lumpectomy patients and 91.2% for 207 mastectomy patients treated by surgery alone. Five-year local control rates for lumpectomy based on tumor size were 91% for 0-2 cm tumors, 85% for 2-5 cm tumors, and 59% for 5-10 cm tumors. For mastectomy patients, 5-year local control rates were 100% for 0-2 cm tumors, 95% for 2-5 cm tumors, 88% for 5-10 cm tumors, and 85% for 10-20 cm tumors. Multivariate analysis of overall survival found several factors to be significant including advancing age with each decade after 50 years of age, appearance of distant metastases, larger primary tumor size, and local control vs. local recurrence (Hazard Ratio [HR] 2.5, p < 0.05). Malignant phyllodes tumors of the breast local recurrence rates are 15% or greater for patients with tumors >2 cm treated by lumpectomy alone and tumors >10 cm treated by mastectomy alone. Adjuvant radiation therapy should be evaluated for these patients. This may be especially important because our study showed that local recurrence impacted on survival rates.

Résultats à long terme d'une série de 89 patients suivis pour un sarcome des tissus mous traités par chirurgie conservatrice et trois modalités d'irradiation postopératoire

Purpose To evaluate the outcome of patients treated for soft tissue sarcoma using three different post-operative radiotherapy schedules. Methods and materials Between 1990 and 2003, 89 patients (median age 50.8 years) presenting with soft tissue sarcoma (located to the limbs for 66 of them) underwent post-conservative–surgery radiotherapy. Pathology was liposarcoma in 35 cases and 54 others tumors. Tumors grades (FNCLCC classification) were 1, 2, 3 or unknown in 29, 32, 19 and 9 cases, respectively. Surgery was considered as complete in 68 patients. Irradiation was normofractionated (NF) in 62 cases, hyperfractionated (BF) in 19 cases and hypofractionated (HF) in 8 cases. For all the patients, median delivered dose was 61 Gy [34–76 Gy]. Results Median follow-up of alive patients was 73,8 months [3–184]. Five-year local control (LC) and overall survival (OS) rates were 85.5 and 71.2% respectively. According to multifactorial analysis, favourable prognostic factors were for local control, complete surgery ( P = 0.0075) and for overall survival, complete surgery ( P = 0.0267), grade 1 tumor ( P = 0.012) and absence of distant recurrence ( P = 0.0488). There was no statistical evidence of difference for the five-year LC and OS rates between the patients who received NF, BF or HF. There were few complications and there were comparable in the three groups. Conclusions This retrospective serie showed similar results for all the schedules. There is no evidence to recommend bifractionation. Hypofractionation should be used only in selected patients with poor performans status.