NED Survival Rates Research Articles

Tumour infiltrating lymphocytes in squamous cell carcinoma of the oro- and hypopharynx: Prognostic impact may depend on type of treatment and stage of disease

he purpose of this study was to evaluate the prognostic influence of various subtypes of tumour infiltrating lymphocytes (TIL) in head and neck cancer, in particular the potential influence of regulatory T cells (Treg) in relation to different treatment modalities was addressed. A total of 115 patients with squamous cell carcinoma of the oro- and hypopharynx were selected. A low-risk group of 62 patients with early disease was treated by primary surgery followed by external radiotherapy. A high-risk group of 53 inoperable patients with advanced disease was treated by primary radiochemotherapy. Two-hundred and forty biopsy samples were evaluated by use of the tissue-micro-array technique employing the following markers: CD3, CD4, CD8, CD20, CD68, FOXP3, Granzyme B. In the low-risk group high CD20+ infiltration was associated with a significantly better NED-survival rate (p=0.02). Contrary, among high-risk patients low CD20+ counts indicated significantly better survival (p=0.03). Additionally, in the low-risk group higher numbers of intraepithelial CD8+ TIL (>66.6 per thousand) led to improved NED-survival of 95% vs. 52% (p=0.005). The impact of TIL on prognosis in patients with head and neck cancer may be affected by type of treatment and stage of disease. This finding will influence future studies on the role of TIL in human cancers.

Cancers de prostate non métastatiques traités par radiothérapie exclusive : devenir des patients selon la méthode d'évaluation ganglionnaire radiologique ou chirurgicale. Une analyse rétrospective multivariée

Purpose : To compare retrospectively the outcome of localized prostate cancers treated by curative external radiotherapy in which the negative lymphatic status was either surgically or radiologically assessed. Methods and materials : From January 1986 to December 1995, 112 patients with localized prostate cancers were found to have no evidence of lymphatic disease in the pelvis. N0 status was assessed either surgically (61 patients, group pN-) or after a CT scan procedure (51 patients, group cN0). The treatment consisted of conventional external radiotherapy using a four-fields box technique to a total dose of 65 Gy. The pelvis was never irradiated. Results : The two groups did not statisticaly differ according to age, PSA level, Gleason score, T stage and hormonal therapy. Actuarial NED survival rates were 80% and 60% at five and ten years respectively. At ten years, the actuarial NED survival rates were 78% and 34% in the pN- and cN0 groups respectively ( p=0.003). The multivariate analysis corroborated the positive impact of lymphatic dissection before radiotherapy on disease free survival of T1-T2 patients, but not for T3 stages. Conclusions : This retrospective study suggests the inability of CT scan to accurately evaluate the lymph node status in carcinoma of the prostate. Systematic ilio-obturator nodal dissection is strongly recommended in early stages before curative radiotherapy. Only pN- patients should be included in high dose conformal irradiation trials.

Bilateral breast carcinoma

The aim of this study was to compare the outcomes of bilateral breast carcinoma (BBC) patients with those of patients who had unilateral disease. From 1960 to 1995, 1465 Stage 0-III patients with primary breast carcinoma were treated with either mastectomy or breast conservation therapy at the Kimmel Cancer Center of Jefferson Medical College and Thomas Jefferson University Hospital. There were 1315 (89.9%) unilateral, 103 (7.1%) metachronous, and 47 (3.0%) synchronous breast carcinoma patients. Patients with synchronous breast carcinoma were defined as having a contralateral cancer diagnosed within 1 year of initial diagnosis. The percentage of patients with Stage 0-I disease at initial diagnosis was 49.4%, whereas 68% had Stage 0-I disease at subsequent diagnosis. For patients with metachronous breast carcinomas, the median interval between the first and second diagnosis was 44 months (range, 13-287 months). The median follow-up time was 58 months (range, 12-229 months) for patients with synchronous cancers and 87 months (range, 0.25-414 months) for those with metachronous cancers. Rates of overall survival and survival with no evidence of disease (NED survival), local control, and distant metastasis from the time of the second diagnosis were calculated for patients with synchronous and metachronous disease. These figures were then compared with each other and also with those for unilateral breast carcinoma patients. Patients with synchronous and metachronous breast carcinoma had worse 5- and 8-year NED survival rates compared with unilateral breast carcinoma patients, as well as an increased risk of distant metastasis. In multivariate analysis, differences in local control and overall survival were not statistically significant for patients who had bilateral disease compared with those who had unilateral disease. There was no difference when patients with metachronous and unilateral breast carcinoma were compared with respect to local control and overall survival. Patients with bilateral breast carcinoma who present with synchronous disease are at greater risk for distant metastasis than women with unilateral or metachronous breast tumors. There was a trend toward decreased overall survival and local control for patients with synchronous bilateral breast carcinoma compared with patients who had either metachronous or unilateral disease.

Radiation therapy for prostate cancer long-term results and implications for future advances

There are surprisingly few studies that concurrently report the 10-year overall survival (OS) rate, 10-year adjusted survival (AS) rate, 10-year recurrence free (NED) survival rate, and 10-year local tumor control (LC) rate using external beam radiation therapy (RT) for Stages A2, B, and C prostate cancer. A simultaneous analysis of OS, AS, NED survival, and LC rates is useful in terms of establishing priorities for future research efforts. Actuarial LC, NED survival, AS, and OS rates were analyzed for 289 patients with Stages A2, B, and C prostate cancer treated with RT between 1975 and 1990 in the Department of Therapeutic Radiology, Yale University School of Medicine. The 10-year LC, NED survival, AS, and OS rates for 168 patients with Stage A2 and B disease were 88% (standard error [SE], 5%), 50% (SE, 10%), 70% (SE, 7%), and 38% (SE, 7%), respectively. The 10-year LC, NED survival, AS, and OS rates for 121 patients with Stage C disease were 82% (SE, 6%), 41% (SE, 6%), 25% (SE, 7%), and 21% (SE, 6%), respectively. External beam radiation provides excellent local clinical tumor control for early prostate cancer. However, 60% of all prostate cancer deaths of patients with Stage A2 and B disease and 76% of all prostate cancer deaths of patients with Stage C disease were attributable to metastatic disease without clinical local failure. The major obstacle in improving the death rate associated with Stages A2, B, and C prostate cancer remains the inability to control metastatic disease; research efforts must concentrate on overcoming this problem.

Combined radiation and chemotherapy for epidermoid carcinoma of the anal canal.

Between 1985 and 1992, 46 patients with epidermoid carcinoma of the anal canal were treated prospectively by a protocol of combined radiation and chemotherapy with 5-Fluorouracil and Mitomycin C. The survival rate, NED-survival rate and local tumour control rate were 84%, 71% and 83% at 5 years. Anorectal function was retained in 33 of 41 patients (80%). We observed severe acute toxicity including three deaths, but very little late morbidity. The only marginally significant prognostic factor (P = 0.06) for local tumour control was T-stage. NED-survival was significantly affected (P = 0.02) by reduction of chemotherapy during the second course.

Conservative treatment for breast cancer: long-term results (15 years)

From 1961 to 1974, 245 patients with unilateral “operable” breast cancer (25% T 1, 56% T 2, 119% T 3) were treated with breast conservation and irradiation at the Gustave Roussy Institute (1961–1969) or at the Henri Mondor Hospital (1970–1974). The minimum follow-up is 15 years. Most patients with T > 3 cm underwent radiation therapy with the tumor in place, while the greater part of patients with T < 3 cm received radiation therapy after tumorectomy. The breast and draining lymph node areas received widefield telecobalt irradiation to 45 Gy. The dose to the tumor site was boosted using iridium-192 implantation. Additional irradiation was given to the internal mammary and lower axillary nodes using an electron beam. The 15 years NED survival rate was 63%, 51% and 26% for T 1, T 2 and T 3 tumors, respectively. The NED survival for T ⩽ 1 cm was 86%. The local recurrence rate was 8, 12 and 19% for T 1, T 2 and T 3 tumors, respectively. Of the patients with local recurrence, 85% underwent surgical salvage. Complications were rare. Cosmetic results were satisfactory in most patients including the T3 group. The proportion of breasts conserved among patients living NED at 15 years, was 97, 88 and 93% for T 1, T 2 and T 3 tumors, respectively. In 1980, after almost 20 years experience using breast conserving techniques, we modified our treatment policies in close collaboration with our surgical team, hel cbye extending the indications for tumorectomy and associating routine surgical exploration of the lower axilla.

Iodine-125 implants versus external beam therapy for stages A2, B, and C prostate cancer

From 1974 to 1984, 307 patients with local prostate cancer (Stage A2, B, or C) were referred to the Hunter Radiation Therapy Center, Yale-New Haven Hospital for definitive radiation therapy. One hundred forty-one patients underwent an interstitial Iodine-125 implant (IMP) and 166 patients received external beam irradiations (EB). For IMP patients with Stage A2, B, and C tumors, the actuarial 5-year disease-free survival (NED) rates were 88%, 84%, and 38% and the 9-year NED survival rates were 88%, 62%, and 30%, respectively. For EB patients with Stage A2, B, and C tumors, the 5-year NED survival rates were 88%, 77%, and 43% and the 9-year NED survival rates were 74%, 63%, and 37%, respectively. The NED survival rates by histologic grade were equivalent for the IMP and EB patients. The absolute local control rate (LCR) was 77% for all of the IMP patients but if one excludes patients who were inadequately treated, the LCR was 82%. LCR in the EB patients was 86%. The LCR for Stage A2, B, and C patients treated with EB was 100%, 94%, and 82%, respectively. The LCR for Stage A2, B, and C patients treated with an adequate IMP was 100%, 83%, and 71%, respectively. The complication rate was 8.5% in the IMP patients (with 0% severe complications) and 14% in the EB patients (with 3% severe complications). Our results indicate that a carefully selected group of IMP patients (Stage A2, B) will have an equivalent NED survival rate and an excellent LCR compared to EB patients but with fewer and less severe side effects.

Definitive irradiation for early stage breast cancer: The University of Pennsylvania experience

From 1977 to 1984, 552 breast cancers in 548 women were treated with definitive irradiation following breast-conserving surgery at the Hospital of the University of Pennsylvania and the Fox Chase Cancer Center. All patients had invasive carcinoma and were AJC clinical Stage I or 11. Pathologic axillary lymph node staging was known for all cases. The 5-year actuarial survival for the entire group was 93% with an NED survival of 81%. The 5-year survival for clinical Stage I and 11 patients was 97 and 87%, respectively, with a corresponding NED survival of 87 and 73%, respectively. For pathologic Stage I and II patients, the corresponding survival figures were 97 and 89%, respectively, with NED survival rates of 86 and 76%, respectively. The overall 5-year actuarial local failure rate was 6%, and the rate of local only as the first failure was 3%. The overall local-regional failure rate was 13% with a local-regional only first failure rate of 8%. These results compare favorably with other reported series and contribute a substantial number of patients to the increasing experience with definitive irradiation following breast-conserving procedures. The relatively low incidence of breast recurrence may be related to the emphasis on integrating the surgical, pathologic, and radiotherapeutic aspects of treatment, as well as the emergence of a re-excision policy for patients at high risk to have residual tumor.

Metastatic carcinoma of the neck from an unknown primary

From 1974 to 1984, 31 patients with metastatic carcinoma to the neck from an unknown primary were treated with radiation therapy. On review, three groups were identified based on presentation and treatment. Group I consists of 19 patients treated with curative intent. They all presented with cervical adenopathy, I I patients with N 1 disease, 2 with Stage N 2A disease, 1 with Stage N 2B disease, 4 with N 3A disease, and 1 with unknown stage. The majority of patients were treated with portals encompassing the nasopharynx, oropharynx, hypopharynx, and neck to a dose of 5000 rad followed by boosts of 1000–1500 rad. The overall 2-year NED survival in this group was 63% ( 12 19 ). The most significant prognostic factor was the stage of the metastatic nodes. The NED survival rate for the 14 patients with Stage N 1 and N 2 was 86% ( 12 14 ). Histology of the lesions was not an important factor in the outcome. In Group 11 there are six patients who received palliative treatment because of large, fixed, cervical nodes. Three of these patients (50%) died within 2 months of completion of treatment. Group III consists of six patients who presented with supraclavicular adenopathy. All had persistent or recurrent disease within 19 months. We have concluded that in patients with metastatic carcinoma to the cervical nodes from an unknown primary, radiation therapy to the neck and suspected areas of primary disease may play an important role in cure, particularly in early stage disease.

Carcinoma of the nasopharynx: survival and patterns of recurrence.

We have analyzed survival, disease-free (NED) survival, and patterns of recurrence for 76 patients with carcinoma of the nasopharynx treated from June 1964 through July 1979. Patients with Stages I through IV, who were treated for cure, comprise the study group. Megavoltage teletherapy treatment was delivered to the primary bilateral neck and supraclavicular areas. Dose to the nasopharynx ranged from less than 55 Gy to 70 Gy with several patients receiving higher doses. The observed 5 year NED survival rates were: Stage I, 75%; Stage II, 20%; Stage III, 42%; and Stage IV, 31%. During a 5-year minimum follow-up for all patients, 46 or 60.5% failed. Ninety-five percent of these failures occurred within 3 years; only two patients relapsed after more than 5 years.

The management of parotid lymph node metastases by irradiation.

An analysis of 28 patients with parotid nodal metastases from carcinomas treated by radiation therapy at the Massachusetts General Hospital was made. Of 24 patients treated more than 24 months previously, the NED survival and local tumor control rates were 54% and 75%, respectively. For the early lesions with disease limited to the parotid nodes, the local control rate was 83% following radiation therapy. A modified staging system for nodal metastases to this particular site is presented.