Previous Radiation Field Research Articles

Злокачественные глиомы, последовавшие за лечением новообразований у детей

Multimodal therapy has improved survival for most childhood tumours. The development of neoplasms subsequent to therapeutic cranial irradiation is a rare but serious and potentially fatal complication. The analysis included 16 patients (pts.) with subsequent glioblastoma (SG) from several institutions in Russia who underwent cranial or neck irradiation (1 case) to treat their primary disease (acute lymphoblastic leukaemia – 12 pts., medulloblastoma – 2 pts., choroid plexus papilloma – 1 pts., lymphoma – 1 pts.). All gliomas arose within the previous radiation fields and satisfied the widely used criteria for the definition of radiation induced neoplasms. The median RT dose administered was 18 Gy with the dosage ranges being 12–55 Gy. TBI was used in one patient with Ph-positive ALL during bone marrow transplantation. Median latency period was 6 years until diagnosis of SG. The majority of SG (14 of 16) occurred during the initial 9 years of follow-up. Patients underwent surgery resection followed by standard fractionated local radiation and chemotherapy. A Kaplan–Meier analysis was used to illustrate the overall survival (OS) curves. OS rate was 34.4 ± 12.3% and 13,6 ± 9.0% at 1 and 2 years respectively with median 11 months. In case that paediatric neoplasms are treated by standard fractionated radiation or TBI is used, radiation-induced gliomas should be considered as possible long-term side effect. And the patients should be followed for a long term, even long after the period of risk for relapse of the primary cancer has passed.

Thoracic reirradiation with SBRT for residual/recurrent and new primary NSCLC within or immediately adjacent to a prior high-dose radiation field

PurposeLocal failure following concurrent chemoradiation and in-lobe failures following stereotactic body radiation therapy (SBRT) are common. We evaluated our institutional experience using SBRT as salvage in this setting. Methods and materialsSeventy-two patients were reirradiated with SBRT for residual, locally recurrent, or new primary non-small cell lung cancer within or adjacent to a high-dose external beam radiation therapy or SBRT field. Kaplan-Meier analysis with log-rank test were used to estimate endpoints and differentiate cohorts. ResultsMedian follow-up was 17.9 months. Patients had residual or recurrent disease (54.2%); 45.8% had new lung primaries. Median reirradiated T size was 2.5 cm (range, 0.8-7.8 cm). Median pre-retreatment maximum standardized uptake value (SUVmax) was 7.15 (range, 1.2-37.6). The most common SBRT reirradiation regimen was 48 Gy in 4 fractions (range, 17-60 Gy in 1-5 fractions). Median progression-free survival was 15.2 months, and median overall survival was 20.8 months. Two-year local failure was 21.6%. Patients with SUVmax at reirradiation <7.0 had a 2-year local control of 93.1% versus 61.1% above the median (P < .001). The 2-year rate of distant metastases was 10.4% versus 54.1% in patients treated for a new primary versus residual or recurrent disease (P < .001). Median progression-free survival was 31.9 months versus 8.4 months, respectively (P = .037). Median survival of patients treated for new primary was 25.2 months versus 16.2 months with residual or recurrent disease (P = .049), and median survival for patients with reirradiation SUVmax below the median was 42.0 months versus 9.8 months above the median (P < .001). Acute any-grade toxicity was seen in 29.2% of patients, acute grade 3 toxicity in 11.1%, and late grade 3 toxicity in 1.4% with no treatment-related deaths. ConclusionsSBRT appears to be a safe and effective means of salvaging recurrent, residual, or new primary NSCLC in or adjacent to a previous high-dose radiation field.

Radiation recall dermatitis triggered by sorafenib after radiation therapy for hepatocellular carcinoma.

Sorafenib is widely used for unresectable and metastatic hepatocellular carcinomas. Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin that occurs after the administration of certain drugs. RRD after sorafenib treatment is rare; five cases have been reported thus far. We describe a 44-year-old man irradiated for chest wall bone metastasis from hepatocellular carcinoma. Eight days after radiotherapy completion, systemic therapy for metastatic hepatocellular carcinoma was initiated with sorafenib treatment. Eleven days after starting sorafenib, the patient complained of erythematous rash with pruritus in the chest wall, in a location consistent with the previous radiation field. Sorafenib was continued at the same dose, despite the RRD. The skin reaction subsided over the next 2 weeks without any medical intervention.

Radical chest wall resection and hyperfractionated accelerated radiotherapy for radiation-associated angiosarcoma of the breast: A safe and effective treatment strategy.

Radiation-associated angiosarcomas (RAS) of the breast are vascular tumors arising in a previous radiation field for primary breast cancer. They occur rarely but confer a high probability of local recurrence (LR) and poor prognosis. A wide range of treatment strategies exists due to limited evidence, and although resection is the definitive treatment, LR rates remain high. It has been suggested hyperfractionated accelerated radiotherapy (HART) has the potential to prevent LR. The sarcoma group at the Juravinski Cancer Centre (JCC) reports our experience of nine patients treated with radical resection and adjuvant HART. This is one of the largest reported cohorts we are aware of to receive this treatment. The JCC pathologic data base was reviewed between the year 2006-2015 for patients with RAS. Patients who received radical surgery and immediate HART were eligible. Patients underwent radical chest wall resection and en bloc mastectomy. Radiotherapy was then delivered to 4500 cGy in 45 fractions three times daily using parallel opposed photon beams and electron patching, or volumetric modulated arc therapy. Primary outcome was recurrence-free survival in months, and records were reviewed for descriptive reports of toxicity. We compared our results to other institutions experience with surgery alone or other adjuvant therapies. Median follow-up was 19 months (range 3-41 months). One of nine patients developed LR and developed metastasis, one died of other causes, and seven are alive with no recurrent disease. There were seven reports of mild skin toxicity during treatment. One patient developed chronic wound healing complications which eventually resolved and one patient developed asymptomatic radiation osteitis of a rib. On the basis of our experience at the JCC, we recommend treatment with radical chest wall resection and adjuvant HART to prevent recurrence in RAS patients. As demonstrated in our patients, the large normal tissue volume irradiated is tolerable with in combination with small fraction sizes, and no major toxicities were seen. Further investigation into adjuvant therapy regimens and prospective studies are required to reach consensus on optimal treatment for this disease.

Development of Malignant Melanoma of the Orbit in Previous Radiation Field

We present a case of a 40-year-old woman with a history of retinoblastoma in the left eye treated with enucleation and radiation therapy as an infant who recently developed worsening pain and exophthalmos in her right eye. Multimodality imaging demonstrated an enhancing, FDG-avid mass in the medial right orbit with associated bone destruction and extension into the ethmoid sinus. Pathologic analysis after excision showed a highly undifferentiated tumor consistent with melanoma. Although development of malignant melanoma in an irradiated field is rare, it should be considered in the differential, especially in childhood cancer survivors at increased risk of second malignant neoplasms.

Response to chemotherapy in patients with recurrent rectal cancer in previously irradiated area.

BackgroundTumor lesions in previously irradiated area may have a less favorable response to chemotherapy compared to tumor sites outside the radiation field. The aim of the present study was to evaluate the response to chemotherapy of locally recurrent rectal cancer (LRRC) within the previous radiation field compared to the response of distant metastases outside the radiation field.Patients and methodsAll patients with LRRC referred between 2000 and 2012 to our tertiary university hospital were reviewed. The response to chemotherapy of LRRC within previously irradiated area was compared to the response of synchronous distant metastases outside the radiation field according to the Response Evaluation Criteria in Solid Tumors (RECIST).ResultsOut of 363 cases with LRRC, 29 previously irradiated patients with distant metastases were treated with chemotherapy and eligible for analysis. Twenty-six patients (89 %) suffered a first recurrence and three patients (11 %) a second recurrence. These patients were followed with a median of 22 months (IQR, 9–40 months) and had a median survival of 33 months (IQR, 14–42). In 23 patients (79 %), the local recurrence showed stable disease, but the overall response rate of the local recurrences in the previously irradiated area was significantly lower than the response rate of distant metastases outside the radiation field (10 vs. 41 %,p = 0.034).ConclusionsPreviously irradiated patients with LRRC have a lower response rate to chemotherapy of the local recurrence within the radiation field compared to the response rate of distant metastases outside the radiation field. This suggests that chemotherapy for local palliation may not have the desired effect.

Never say never.

DOI: 10.1200/JCO.2014.58.7717 She was elderly, slightly confused, and very, very worried. I was not quite sure why. It was a minor procedure—a routine angiogram, one of a dozen to be performed that morning. The risks were so small that the job of admitting her had been handed to me, then a final-year medical student, with a simple onepage form to fill out. I took her history in 5 minutes, listed her current medications, completed the physical examination, and prepared to move on to the next patient. But she grabbed my arm and asked me if she would be all right; she was worried she was going to die. I was not quite sure what to say. We had been taught about informed consent, warning patients of all risks—even minor ones—that you can never say never in modern medical practice. Yet the consent had been signed, the risks had been explained, and the patient was now simply looking for reassurance, for comfort, for a human touch. “Don’t worry,” I reassured her. “You’ll be absolutely fine. There’s nothing to be concerned about; you’re not going to die.” She was not fine. An hour after the procedure, things started to go wrong. Her abdomen rapidly distended, her toes turned black, and she starting writhing in pain. The angiogram had triggered a shower of cholesterol emboli from the aorta, resulting in the infarction of most of her bowel. It was a rare but well recognized and potentially devastating complication. Within a short space of time, she had died. I berated myself for telling her she would be okay, for telling her she would not die, when I knew that it was always a risk—a small but tangible possibility. I did not feel that I had jinxed her, but I decided never to reassure a patient again that I had control of his or her destiny. I was left with a deep unease, unsure from that time of the best way to convey risks and prognoses to patients and at the same time provide a human touch. Is that not what patients are looking for in a physician? Someone they can trust with their life, someone they are confident will get them through? How can we balance a rational assessment of risk with our patients’ desire for hope and reassurance? We cannot predict the future, but is that not what our patients are asking us to do? These questions continued to puzzle me as I embarked on a career in pediatric oncology. Here the risks of my patients dying were much higher than for those undergoing a routine procedure, but I felt the parents looked at me with the same fears, the same worries, hoping that I could provide them with the same absolute reassurance—that I would ensure their child would survive. For the first 2 years, it went well. All my patients went into remission. Their prognoses were good, their adverse effects manageable, and their outlooks promising. I was optimistic with my patients—most had a good prognosis—and I felt my optimism was fully justified. Then my first patient relapsed. He had highrisk neuroblastoma, which is incurable after relapse. His parents knew this; they were understandably distraught but were still looking for hope. So was I. His tumor was a little different, I thought; there were some favorable prognostic features, and the relapse was localized and outside the previous radiation field. New drugs were available. Moreover, his parents insisted, even if there was only a 1% chance of cure, they could not give up; they needed to hope. We embarked on more treatments. Although the tumor responded, the results were short lived; the tumor recurred and grew with a galloping rapidity. His treatment focus turned to palliation, and he died a short time later. Although the parents were grateful that we had tried everything, I felt that I had failed, and I started to wonder: When does hope become false hope? Then another patient presented with a newly diagnosed osteosarcoma that should have been treatable and highly curable. But during her workup, the prognosis grew bleaker. Dozens of metastatic lesions appeared in lungs and bones. Her chance of cure was less than 10%, but again, I thought her case was a little different. Her lesions responded well to chemotherapy, and as prolific as they were, all the metastatic lesions were resectable. My colleagues disagreed. They suggested the hope I was offering really was false. After a heated discussion at a multidisciplinary meeting, I pulled her parents aside to tell them what my colleagues thought—to reinforce the poor prognosis and to make sure they understood the statistics. They wanted to continue treatment; JOURNAL OF CLINICAL ONCOLOGY A R T O F O N C O L O G Y VOLUME 33 NUMBER 5 FEBRUARY 1

24. Recurrent chordoma with rhabdoid and chondroid differentiation

Background Chordoma is a rare primary malignant bone tumour derived from remnants of the notochord, accounting for approximately 1–5% of all malignant bone tumours of adulthood affecting males more commonly. The majority of chordomas occur in the axial skeleton with rare extra axial examples reported. Histologically chordomas exhibit low grade features however clinically they are locally aggressive, recur, and metastasise in a significant proportion. Chordomas are classified into conventional, chordoid with similar biological behaviour as the conventional and dedifferentiated which is exceptionally rare and is composed of a high grade sarcoma in a background of conventional chordoma. It also shows poor response to systemic therapy and are resistant to conventional radiotherapy. The treatment of election is excision with wide margins combined with heavy particle or stereotactic photon radiation. Aim We present a case of recurrent chordoma and discus morphological changes in the context of multiple recurrences. Results A 76 year old man with conventional chordoma of the sacrum initially treated with excision and radiotherapy developed multiple recurrences at margins of previous radiotherapy field. Excision of the recurrence and adjuvant IMRT following failed brachytherapy was the elected treatment. In contrast to the presence of typical histological features of conventional chordoma in the previous excision the recurrent chordoma showed rhabdoid differentiation. Several months posterior to treatment he presented with history of progressive bilateral sciatic pain, constipation and diarrhoea. The latest recurrence in the right gluteus muscle showed a chordoma with prominent rhabdoid and chordoid differentiation with prominent nuclear atypia, vascular invasion and positive margins. However there were still no features of dedifferentiation.

Is elective neck dissection indicated during salvage surgery for head and neck squamous cell carcinoma?

Among patients with head and neck squamous cell carcinoma with a negative neck who are initially treated with (chemo)radiotherapy, a number of cases will recur locally without obvious neck recurrence. There is little information available as to the most efficacious management of the neck in these cases. We have reviewed the literature to see what conclusions can be drawn from previous reports. We conducted a bibliography search on MEDLINE and EMBASE databases. Studies published in the English language and those on squamous cell carcinoma of the oral cavity, nasopharynx, oropharynx, larynx and hypopharynx were included. Data related to neck management were extracted from the articles. Twelve studies satisfied the inclusion criteria. Five studies reported only one treatment plan (either neck dissection or observation), while the others compared neck dissection to observation. The rate of occult metastases ranged from 3.4 to 12 %. The studies included a variable distribution of primary sites and stages of the recurrent primary tumors. The risk of occult neck node metastasis in a clinically rN0 patient correlated with tumor site and T stage. Observation of the neck can be suggested for patients with T1-2 glottic tumors, who recurred with less advanced tumors (rT1-2). For patients with more advanced laryngeal recurrences or recurrence at other high-risk sites, neck dissection could be considered for the rN0 patient, particularly if the neck was not included in the previous radiation fields.

Guideline on the management of primary resistant and relapsed classical Hodgkin lymphoma

Summary of key recommendations ● Repeat biopsy is generally recommended in Hodgkinlymphoma (HL) patients thought to have relapsed, andshould be considered in those who have residual fluoro-deoxyglucose (FDG)-avid lesions post-therapy (1C).● Positron-emission tomography/computerized tomogra-phy (PET-CT) is the preferred restaging modality aftersalvage therapy (1B).● The aim of salvage treatment should be to achieve anFDG-PET-negative remission (1B).● The choice of a first-line salvage regimen in patients eli-gible for autologous stem cell transplantation (ASCT)should be based on patient factors and familiarity ofthe treatment centre with the regimen (2C).● Regimens containing stem cell toxic agents (such as car-mustine and melphalan) should be avoided if possibleuntil stem cells have been successfully collected andcryopreserved if ASCT is planned (1B).● There is currently no evidence to support intensivesequential induction/consolidation strategies prior toASCT (1B).● Consider switching to an alternative non-cross-resistantsalvage regimen if there are residual FDG-avid lesionsafter first line salvage treatment and the intent is toproceed to ASCT (2B).● In patients not eligible for ASCT, combined modalitytherapy should be considered especially in early stagerelapse and in patients who have not received priorradiotherapy or who have relapsed outside of the initialradiotherapy field (2B).● In patients unlikely to tolerate the toxicities associatedwith more intensive regimens, palliation with either a sin-gle agent or with a multi-agent oral regimen with or with-out intravenous vinblastine should be considered (2C).● Early consideration of involvement of palliative care ser-vices is recommended, particularly in those not eligiblefor high dose therapy (1C).● ASCT is the standard treatment for patients withrelapsed disease who achieve an adequate response tosalvage therapy (1A).● ASCT is also the standard treatment for patients withprimary resistant disease who achieve an adequateresponse to salvage therapy (1B).● ASCT is not recommended in those failing to achievean adequate response (1B).Guideline

Relapse in synovial sarcoma: what can be done for poor outcomes?

Improving patients’ chances of cure after their tumors have relapsed is one of the greatest challenges oncologists face, especially when it comes to patients whose front-line treatment had already included both chemotherapy and radiotherapy. It is almost as if oncologists had just one shot to fire in their battle against cancer, no second chances. Once standard chemotherapy has failed, cancer clone cells are likely to develop multidrug resistance, becoming insensitive to any further systemic therapy. Likewise, reirradiation after local relapse within previous radiation fields is rarely feasible and, even when it can be attempted, it is usually to no effect. Synovial sarcoma is a good example to discuss in this scenario. It is a typical tumor spanning the pediatric and adult age groups [1]. This highgrade soft tissue sarcoma carries a good overall prognosis – approximately three in four patients are cured nowadays – generally depending on the feasibility of surgical resection, the tumor’s size and site, and any presence of metastases [1–4]. As in other tumor types however, studies on synovial sarcoma have reported a narrow ‘salvage gap’, definable as the difference between event-free survival and overall survival. This is tantamount to saying that the chances of further treatments curing patients who progress or relapse are decidedly slim. A recent Italian pediatric study described the pattern of synovial sarcoma recurrence and the prognostic variables influencing survival with a view of finding a risk-adapted stratification procedure that could facilitate the planning of second-line therapies [5]. If we could distinguish between patients who have realistic prospects of cure with currently available treatment options and those unlikely to benefit from them, then the latter might, in principle, be offered experimental therapies. Most of the relapses in the pediatric sample considered were metastatic (particularly to the lung), and 10-year survival after relapsing was 21% [5]. The final outcome was influenced Andrea Ferrari* & Michela Casanova Editorial

Muir–Torre syndrome-associated pleomorphic liposarcoma arising in a previous radiation field

Muir-Torre syndrome is a variant of Lynch syndrome, characterised by sebaceous neoplasia and/or keratoacanthomas associated with visceral malignancies. Muir-Torre syndrome is caused by germline mutations of one of the mismatch repair genes, frequently MSH2 and less frequently MLH1 and MSH6. Visceral malignancies associated with Muir-Torre syndrome and Lynch syndrome include colorectal, endometrial and other gastrointestinal, urological and gynaecological malignancies. Small numbers of Lynch syndrome-associated soft tissue sarcomas have been reported, but there are no reported cases of soft tissue sarcomas in Muir-Torre syndrome. In this study, we report a 74-year-old man with known Muir-Torre syndrome with confirmed MSH2 germline mutation, diagnosed with pleomorphic liposarcoma of the right buttock in a previous radiation field. The tumour showed loss of expression of MSH2 and MSH6 on immunohistochemistry. Immunohistochemistry on another pleomorphic liposarcoma in a different patient with no previous history of Muir-Torre syndrome or Lynch syndrome showed no loss of expression of mismatch repair proteins. This is the first report of Muir-Torre syndrome-associated sarcoma and the first case of post-radiation sarcoma in Lynch syndrome.

Muir–torre syndrome-associated pleomorphic liposarcoma arising in a previous radiation field

Background Muir–Torre syndrome is a variant of Lynch syndrome, characterised by sebaceous neoplasia and/or keratoacan-thomas associated with visceral malignancies. Muir–Torre syndrome is caused by germline mutations of one of the mismatch repair genes, frequently MSH2 and less frequently MLH1 and MSH6. Visceral malignancies associated with Muir–Torre syndrome and Lynch syndrome include colorectal, endometrial and other gastrointestinal, urological and gynaecological malignancies. Small numbers of Lynch syndrome-associated soft tissue sarcomas have been reported but there are no reported cases of soft tissue sarcomas in Muir–Torre syndrome. Aim and Methods In this study, we report a 74-year-old man with known Muir–Torre syndrome with confirmed MSH2 germ-line mutation, diagnosed with pleomorphic liposarcoma of the right buttock in a previous radiation field. The tumour showed loss of expression of MSH2 and MSH6 on immunohistochemistry. Results Immunohistochemistry on another pleomorphic liposar-coma in a different patient with no previous history of Muir–Torre syndrome or Lynch syndrome showed no loss of expression of mismatch repair proteins. Discussion This is the first report of Muir–Torre syndrome-associated sarcoma and the first case of post-radiation sarcoma in Lynch syndrome.

Oral cancer: Current role of radiotherapy and chemotherapy

The term oral cavity cancer (OSCC) constitutes cancers of the mucosal surfaces of the lips, floor of mouth, oral tongue, buccal mucosa, lower and upper gingiva, hard palate and retromolar trigone. Treatment approaches for OSCC include single management with surgery, radiotherapy [external beam radiotherapy (EBRT) and/or brachytherapy], as well as adjuvant systemic therapy (chemotherapy and/or target agents); various combinations of these modalities may also be used depending on the disease presentation and pathological findings. The selection of sole or combined modality is based on various considerations that include disease control probability, the anticipated functional and cosmetic outcomes, tumor resectability, patient general condition, and availability of resources and expertise. For resectable OSCC, the mainstay of treatment is surgery, though same practitioners may advocate for the use of radiotherapy alone in selected “early” disease presentations or combined with chemotherapy in more locally advanced stage disease. In general, the latter is more commonly reserved for cases where surgery may be problematic. Thus, primary radiotherapy ± chemotherapy is usually reserved for patients unable to tolerate or who are otherwise unsuited for surgery. On the other hand, brachytherapy may be considered as a sole modality for early small primary tumor. It also has a role as an adjuvant to surgery in the setting of inadequate pathologically assessed resection margins, as does postoperative external beam radiotherapy ± chemotherapy, which is usually reserved for those with unfavorable pathological features. Brachytherapy can also be especially useful in the re-irradiation setting for persistent or recurrent disease or for a second primary arising within a previous radiation field. Biological agents targeting the epithelial growth factor receptor (EGFR) have emerged as a potential moda-lity in combination with radiotherapy or chemoradiotherpy and are currently under evaluation in clinical trials. Key words:Radiotherapy, chemoradiotherapy, oral cavity cancer, treatment.

AB 59. Re-irradiation with 3D-conformal radiotherapy in patients with lung cancer. Report in two cases

Background There are cases of patients with Lung cancer, which have received radiation therapy in mediastinum and the tumor mass (45-50 Gy) and after uncertain period in their life, they need re-irradiation due to recurrent tumor mass which is close to previous radiation field. 3D Conformal Radiotherapy, the last years, is used always and more, because of the minimal dangerous of radiation myelitis. Re-irradiation of patients with lung cancer and the role of 3D Conformal radiotherapy in the overall-survival and the quality of life in these patients.

Low-dose Gamma Knife surgery for nonfunctioning pituitary adenomas

The primary concern when performing Gamma Knife surgery for pituitary adenoma is preservation of vision and pituitary function while achieving tumor growth control. Higher prescribed radiation doses are typically correlated with higher incidences of postradiosurgical hormone deficiencies. The goal of the present study was to retrospectively analyze the feasibility of using a lower prescribed radiation dose in the treatment of nonfunctioning pituitary adenomas and the effect of this dose on vision, pituitary function, and tumor growth control. The study was conducted in 38 patients with nonfunctioning pituitary adenomas, who were treated between January 2002 and July 2008. Twenty-one patients were available for follow-up (13 men and 8 women). The mean follow-up period was 44 months (range 24-90 months). Nineteen patients had previously undergone surgery. Pituitary dysfunction developed after surgery in 3 patients. One patient had an abnormal pituitary hormone profile before radiosurgery due to an attack of pituitary apoplexy. Visual field defects were present in 12 patients. The prescribed radiation dose was 12 Gy in all patients. The tumor volume ranged from 0.5 to 11.8 cm(3) (mean 4.8 cm(3)). The maximum dose to the visual pathway was kept below 10 Gy. The mean maximum dose delivered to the visual pathway was 7.9 Gy. The patients were followed up for a period of 24 to 90 months (mean 44 months). The size of the tumor decreased in 11 patients (52%) and remained stable in 9 patients (43%). In 1 patient there was tumor growth outside the previous radiation field (on the contralateral side). Among the 12 patients with visual field defects, 9 (75%) experienced an improvement and the remaining patients' vision remained stable. In only 4 patients was the visual improvement associated with tumor shrinkage. The hormone profile remained normal in all patients except for the 4 patients who had pituitary dysfunction before radiosurgery. The 12-Gy prescribed dose used in this study seems to be sufficient for producing tumor control while sparing the patient from radiation-induced pituitary dysfunction. In addition, visual improvement was reported in a number of cases. A larger series and longer follow-up are required to confirm these results.

Involved Node Radiation Therapy: An Effective Alternative in Early-Stage Hodgkin Lymphoma

The involved node radiation therapy (INRT) strategy was introduced for patients with Hodgkin lymphoma (HL) to reduce the risk of late effects. With INRT, only the originally involved lymph nodes are irradiated. We present treatment outcome in a retrospective analysis using this strategy in a cohort of 97 clinical stage I-II HL patients. Patients were staged with positron emission tomography/computed tomography scans, treated with adriamycin, bleomycin, vinblastine, and dacarbazine chemotherapy, and given INRT (prechemotherapy involved nodes to 30 Gy, residual masses to 36 Gy). Patients attended regular follow-up visits until 5 years after therapy. The 4-year freedom from disease progression was 96.4% (95% confidence interval: 92.4%-100.4%), median follow-up of 50 months (range: 4-71 months). Three relapses occurred: 2 within the previous radiation field, and 1 in a previously uninvolved region. The 4-year overall survival was 94% (95% confidence interval: 88.8%-99.1%), median follow-up of 58 months (range: 4-91 months). Early radiation therapy toxicity was limited to grade 1 (23.4%) and grade 2 (13.8%). During follow-up, 8 patients died, none from HL, 7 malignancies were diagnosed, and 5 patients developed heart disease. INRT offers excellent tumor control and represents an effective alternative to moreextended radiation therapy in the combined modality treatment for early-stage HL.

Erlotinib-induced generalized eczema craquelé and follicular rash sparing the previous radiation field

Clinical and Experimental DermatologyVolume 37, Issue 8 p. 922-924 Viewpoints in dermatology •Correspondence Erlotinib-induced generalized eczema craquelé and follicular rash sparing the previous radiation field H. Y. Chiu, H. Y. Chiu Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, TaiwanE-mail: tftsai@yahoo.comSearch for more papers by this authorY. P. Cheng, Y. P. Cheng Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, TaiwanE-mail: tftsai@yahoo.comSearch for more papers by this authorS. H. Jee, S. H. Jee Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, TaiwanE-mail: tftsai@yahoo.comSearch for more papers by this authorT. F. Tsai, T. F. Tsai Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, TaiwanE-mail: tftsai@yahoo.comSearch for more papers by this author H. Y. Chiu, H. Y. Chiu Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, TaiwanE-mail: tftsai@yahoo.comSearch for more papers by this authorY. P. Cheng, Y. P. Cheng Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, TaiwanE-mail: tftsai@yahoo.comSearch for more papers by this authorS. H. Jee, S. H. Jee Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, TaiwanE-mail: tftsai@yahoo.comSearch for more papers by this authorT. F. Tsai, T. F. Tsai Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, TaiwanE-mail: tftsai@yahoo.comSearch for more papers by this author First published: 25 June 2012 https://doi.org/10.1111/j.1365-2230.2012.04415.xCitations: 3 Conflict of interest: none declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume37, Issue8December 2012Pages 922-924 RelatedInformation

Phase II study of low-dose paclitaxel and cisplatin in combination with split-course concomitant twice-daily reirradiation (XRT) in recurrent squamous cell carcinoma of the head and neck (SCCHN): Long-term follow-up of Radiation Therapy Oncology Group (RTOG) protocol 9911.

5583 Background: Loco-regionally recurrent SCCHN or new second primary tumor (SPT) in a previous radiation field, if not curable by surgery, is virtually always fatal. Chemotherapy alone yields a median survival time (MST) of no more than 10 to 11 months, 1- and 2- year overall survival (OS) rates of 35% and 10-15% at best. Concurrent re-irradiation and chemotherapy is an alternative strategy. Methods: Eligibility for RTOG protocol 9911 stipulated measurable, recurrent SCCHN or SPT in a previous radiation field, PS 0-1, and adequate end-organ indices. Patients (pts) received twice-daily XRT (1.5 Gy per fraction BID x 5 d every 2 weeks x4), plus cisplatin 15 mg/m2 IV QD x 5 and paclitaxel 20 mg/m2 IV QD x 5 every 2 weeks x 4. G-CSF was administered days 6 - 13 of each 2-week cycle. Primary endpoints were OS and progression-free survival PFS at 1 and 2 yrs. Secondary endpoints included acute/late toxicities and patterns of failure. Results: 105 patients were enrolled from March 2000 through June 2003. 100 patients were analyzable (76% male, med age 60 yrs). Oropharynx (41%) and oral cavity (27%) were the predominant primary sites. 23% had SPT. Median prior XRT dose was 65.7 Gy. 73% of pts completed all chemotherapy. Grade &gt; 4 acute toxicity occurred in 28%, grade &gt; 4 acute hematologic toxicity in 21%. 9 treatment-related deaths (9%) occurred: five in the acute setting, four late (including three carotid hemorrhages at 116, 427 and 2772 days). 1-, 2-, and 5-year OS rates were 50%, 27%, and 15% respectively. PFS at 1, 2, and 5 yrs were 35%, 18%, and 7%. 64.9% died from the incident cancer, 3.2% from SPT, and 21.2% from other, non-cancer causes. Estimated 10 yr survival is 5% with 6 pts still alive, including 2 free from relapse. Conclusions: Despite a high incidence of grade 5 toxicity, 1-, 2-, and 5- yr OS rates for split-course bid XRT and concurrent cisplatin/paclitaxel exceed results usually seen with chemotherapy alone. At 5-10 yrs, we have observed longterm survivors free of recurrence.

A Case of Radiation Recall Myositis Induced by 5-FU and Cisplatin

Radiation recall phenomenon is an inflammatory reaction which occurs at a previously irradiated area after the administration of causative agents, especially anticancer drugs. Radiation recall mostly involves skin and rarely affects internal organs. We, hereby, report a rare case of radiation recall myositis. A 51-years-old man visited the hospital due to pain and weakness of the left thigh. He had been diagnosed with a skin metastasis of pancreatic adenocarcinoma, at the left thigh and treated with radiotherapy and subsequent combination chemotherapy of 5-FU and cisplatin. After the 5th cycle of chemotherapy, the patient developed pain and weakness localized at the previous radiation field. An MRI revealed myositis of left gluteus medius muscle. Muscle biopsy showed no malignant cells or signs of infection. He was diagnosed as having radiation recall myositis and treated with steroid and NSAID. Soon after, pain and weakness gradually improved. Although rare, a possibility of radiation recall myositis should be considered when a patient with history of radiotherapy has a myopathy.