Use Of External Beam Radiotherapy Research Articles

51 20-year long-term results of the use of external beam radiotherapy for primary advanced, recurrent and metastatic malignant melanoma

M. Heinrich Seegenschmiedt “; Ludwig KeiIbok’* , Annelore Akendorf-Hofiinon *; Hermrnn SI Christian Wittekind 4; Rolf Seuer ’ Departments of ‘Radiation Oncology, *Surgery, 3Dermatology, 4Clinical Pathology, University Erlangen-Niimberg, Universit?s and ’ Department of Radiation Oncology, Therapeutic Radiology & Nuclear Medicine, Al&d-Kmpp Kraokenhaus, 45 117 Essen (Germany)

Papillary thyroid carcinoma associated with squamous cell carcinoma of the head and neck: Significance and treatment

Several studies in the recent literature would suggest that PTC found incidentally in the cervical lymphatics may be significant. By age alone, most of our head and neck cancer patients will fall into an intermediate risk group. There are also data to suggest that cervical metastasis from PTC may portend higher recurrence and mortality and that occult PTC may be a biologically significant situation. Many patients with cancer of the head and neck either have a good prognosis or don't follow the rules of their predicted prognosis, and for these patients living with the knowledge of an untreated thyroid, cancer may be an unnecessary concern. Other factors to be considered are that early PTC is probably curable disease and that there is real risk of transformation to higher grade or anaplastic cancer. Finally, there is no way to accurately predict the behavior of PTC. The decision to treat these cancers is ultimately made by the patient and the physician, and if there is a treatment with low morbidity that will alleviate concern of PTC recurrence, then this may outweigh the risk of treatment. Situations may exist when treating incidental PTC could be deferred. These include: a dismal prognosis for the head and neck primary when quality time outside of the hospital is the goal of the patient and the physician; or if the head and neck primary tumor requires external beam radiation therapy, because this may be adequate therapy for occult PTC. In summary, the scenario of PTC found incidentally in the neck treated for a head and neck SCC is unusual. Each patient will have a unique clinical situation based on the site and stage of the SCC, the age of the patient, and the treatment required for the SCC. Treatment options include total thyroidectomy, thyroid lobectomy, the administration of I131, and/or the use of external beam radiation, which must be weighed against the option of close clinical follow-up. In general, we recommend total thyroidectomy for PTC found incidentally in the cervical LNs for the reasons that have emerged from a recent review of the medical literature. We report 7 patients with synchronous head nad neck SCC and PTC who have all received surgical treatment for PTC (Table 1). In addition, we advocate postoperative radioiodine scanning with radioablation of metastatic or persistent PTC, or remnant ablation if uptake is greater than 2%. Our goal as head and neck surgeons should be to avoid inadequate therapy for incidental PTC.

Conversion of unresectable to resectable liver cancer: an approach and follow-up study.

In the last decade, significant improvement has been achieved in the treatment of hepatocellular cancer by combining therapies from different disciplines, and using effective biologic response modifiers to improve response to existing therapy. While operative resection remains the only curative modality, a select group of patients with unresectable fibrolamellar or nodular variant, can be converted from unresectable status to resectable by combining chemotherapy and radiotherapy. We reviewed the recent experience with intra-arterial chemotherapies and use of external beam radiotherapy and isotopic immunoglobulin-directed radiotherapy in the treatment of unresectable hepatocellular cancer. While significant tumor response can be achieved with these therapies they are short-lived, and long-term survival is poor. When combined with operative resection, however, a significant survival advantage is achieved. The expected survival of the unresectable patient is then altered from 18 to 24 months for chemotherapy or radiation alone, or when used in combination, to 44 months for patients converted to resectable status. We conclude that the need for more effective chemotherapy is imperative, and the major role for chemotherapy or radiotherapy in hepatocellular cancer is to convert an unresectable patient to resectable status.

Changing trends in the management of retinoblastoma: 1951-1965 vs 1966-1980.

A retrospective analysis of the records of 1253 retinoblastoma patients (567 females, 665 males, and sex of one unknown) seen in the years 1951-1965 (575 patients, Interval I) and 1966-1980 (678 patients, Interval II) was conducted to determine changes in the manner of presentation of the disease, the treatment modalities employed, and their subsequent outcomes following treatment. There was no significant difference between the two 15-year time intervals in the age at presentation (mean, range), laterality, gender, family history, laterality vs gender distribution, family history vs laterality, employment of chemotherapy in unilateral cases or the use of external beam radiation (EBR) in bilateral cases. Changing trends in the management of retinoblastoma were observed as a result of the introduction of new treatment modalities, such as cryotherapy, light coagulation, and radioactive plaque therapy. Bilateral patients have received chemotherapy less frequently in interval II. The use of photocoagulation, cryotherapy, and brachytherapy for bilaterals, and cryotherapy for unilaterals increased significantly during Interval II. During both time intervals, a significantly higher percentage of unilaterally affected eyes were enucleated compared with bilaterally affected eyes; in addition, there was a decrease in the percentage of enucleations performed on both unilaterally and bilaterally affected eyes. In Interval II, 87% of unilateral patients and 91% of the bilateral patients had an enucleation performed.