Supraclavicular Involvement Research Articles

Modern Radiotherapy Results with Bulky Stages II and III Seminoma

We treated 20 patients with stage II seminoma by primary radiotherapy from 1971 to 1982. Median patient age was 38 years (range 26 to 52 years) and median disease width in the transverse plane was 11cm. (range 5 to 25cm.). Four tumors were 5 to 9cm., 9 were 10 to 14cm. and 7 were 15cm. or more wide. Tumor was palpable in 13 patients. Generous radiation ports (such as wide hockey stick or whole abdomen) often followed by a boost to the area of bulky disease were used as primary therapy in all patients. Median tumor dose was 37.5Gy. (range 13.3 to 56.7Gy.). Supradiaphragmatic prophylactic radiation was given to 16 patients (median dose 26Gy., range 12 to 37.3Gy.). Median followup was 56 months, and all patients currently are free of disease except for 1 who died without disease more than 10 years after completion of all therapy. Mediastinal failure occurred in 2 of 4 patients without and 1 of 16 with mediastinal prophylaxis. All 4 patients with relapse are currently free of disease after salvage therapy.Five patients 16 to 42 years old (median age 30 years) received primary radiation therapy for stage III disease. The median size of abdominal disease was 10cm. (range 5 to 17cm.). Of the 5 stage III cancer patients 3 had supradiaphragmatic disease demonstrated only in supraclavicular lymph nodes and all 3 were continuously free of disease 115 to 136 months after therapy. The remaining 2 stage III cancer patients had supradiaphragmatic disease by virtue of bulky mediastinal disease with or without supraclavicular involvement. Both patients had relapse in-field and distantly, and they died of disease despite salvage chemotherapy. A total of 30 fields with bulky disease (greater than 5cm.) was treated either primarily or at relapse among the 25 stages II and III cancer patients. In-field relapse occurred in 3 of 21 patients receiving less than or equal to 36Gy. and 0 of 9 who received greater than 36Gy.These results justify radiation therapy as an acceptable initial primary treatment modality for typical bulky stage II seminoma. Disease greater than 5cm. should receive greater than 36Gy. Prophylactic radiation to the mediastinum is effective. However, patients who have mediastinal failure often can be salvaged with chemotherapy and/or radiation, and prophylactic mediastinal radiotherapy may be associated with poor tolerance to salvage chemotherapy and other significant late effects. Our series also confirms that subsets of stage III seminoma may do well with primary radiotherapy but mortality and distant metastasis occur frequently enough to warrant chemotherapy as initial therapy in stage III disease.

Radiation therapy for local-regional recurrent breast carcinoma

One hundred seven women with recurrent breast carcinoma involving the chest wall and/or regional lymph node regions were treated with radiotherapy between 1970 and 1979. Local-regional tumor was the initial and only evidence of recurrent breast carcinoma in all cases. Forty-seven patients had their disease confined to the chest wall alone and sixty (56%) patients had chest wall involvement as some component of their local-regional recurrent disease. Within five years after the initial mastectomy, 80.5% of recurrences were manifested. All patients had radiotherapy to at least the site of involvement. Eighty-four patients (78.5%) had a complete response. The absolute 5-year survival of all patients following local-regional recurrence was 34.6%. Five year survival was 29% in those patients who had recurrence within 5 years of the original mastectomy. For those patients whose local-regional regurrence occurred after a 5-year disease-free interval, the subsequent 5-year survival was 57%. For patients with recurrence confined to the chest wall, subsequent 5-year survival was 48.9%. Patients who had supraclavicular involvement as part of their local-regional recurrence had only a 16.1% 5-year survival. The majority of patients developed distant metastasis. Twenty-two patients developed carcinoma of the contralateral breast following local-regional recurrence. Five year survival following local-regional recurrence was only 4396 for patients whose initial treatment for their primary breast carcinoma was surgery and adjuvant chemotherapy. For those patients whose primary breast carcinoma was treated by surgery alone or surgery and post-operative radiotherapy, the 5-year survival following local-regional recurrence was over 40%.

The value of supraclavicular area treatment in radiotherapeutic management of lung cancer

Records of 295 patients treated for carcinoma of the lung have been reviewed. 64 patients (21.7%) had a supraclavicular involvement at initial presentation, local control was achieved in that region in 26 out of 27 (96%) patients who received a minimum dose of 5,000 rads in 25 treatments. „Local control”︁ applies to complete disappearance of disease in that area with no subsequent recurrence at any time or until death of the patient. One patient had persistent disease despite a dose of 7,000 rads in 35 treatments. Elective supraclavicular irradiation was given to 79 patients, one of whom subsequently developed clinically detectable disease there. One hundred fifty-three patients did not receive elective supraclavicular irradiation, and 21 (14%) subsequently developed supraclavicular disease, a statistically significant difference. Patients considered at higher risk for supraclavicular metastasis were selected for elective supraclavicular irradiation. Therefore, the markedly lower rate of involvement in the treated patients can be attributed to the irradiation given that group. Overall, supraclavicular nodes were present in 24.8%, 30.2%, 34.1%, and 31.5% of patients with squamous cell carcinoma, adenocarcinoma, and undifferentiated small and large cell carcinoma, respectively. Seventy-six of 85 patients (89.4%) with supraclavicular involvement had hilar and/or mediastinal involvement at initial presentation. No significant difference in survival was observed between patients receiving supraclavicular, irradiation and those not receiving treatment to that area. Of 64 patients with initial supraclavicular involvement, there were 14, 9, and 5 survivors at 12, 18, and 24 months, respectively, with four patients surviving beyond 36 months.