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Results for “inoperable local recurrence”

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PubMed1989

Neutron therapy of soft tissue sarcoma at Louvain-la-Neuve (interim results 1987).

The results of fast neutron therapy of soft tissue sarcoma at the cyclotron of Louvain-la-Neuve are reviewed. 75 patients were analysed, the follow-up ranged from six to 102 months (mean: 30.7 months). 47 patients were treated after radical surgery. A local control rate of 91.5% (43/47) was achieved, and 70% of the patients are alive. 28 patients were irradiated with gross tumour present at the time of neutron therapy (recurrence, incomplete resection, inoperable): a local control was achieved in 5/28 cases (18%), and 68% of the patients are alive. A complication rate of 16% was recorded which was directly related to the treatment volume.

Combined Modality Therapy↗

PubMed1985

Results of neutron therapy of locally advanced soft tissue sarcomas at Louvain-la-Neuve.

Between March 1978 and October 1983, 65 patients with locally advanced soft tissue sarcomas were treated at the cyclotron of Louvain-la-Neuve. 46 patients are analysed, 19 patients with intraabdominal or intrathoracic lesions are excluded. After "radical surgery" (no "gross tumour" present at the time of neutron therapy), a local control rate of 93% was achieved (25/27 patients) and the survival was 74%. In a second group of 19 patients with incompletely resected, or recurrent, or inoperable tumour, a local control was obtained in four cases (21%), and 13 patients were alive (69%). The follow-up ranged from three to 65 months (mean: 25,9 months). Ten severe complications were observed (22%); they were related to the field sizes, which reflected the local tumour extent.

Belgium↗

PubMed1997

[Recurrence after curative operation of non-small-cell bronchial carcinoma].

The poor prognosis of bronchial carcinoma is reflected among other things in a high recurrence rate. In general, recurrence is inoperable and only suitable for conservative/palliative management. The rate of curative surgical reintervention may be increased by early identification of recurrence. The value of tumour follow-up and the role of reoperation need to be assessed. 150 patients who underwent curative resection of non-small-cell lung cancer were followed-up for a mean of 4.5 years as part of a comprehensive after-care program. Fifty patients (33%) developed a recurrence at a mean of 13 months after operation. A second curative resection was possible in 9 patients (6%) with a mean survival of 22 months. Six of these patients had re-thoracotomy (completion pneumonectomy in 4 for local recurrence, mediastinal metastasectomy in 2), and in 3 patients a solitary cerebral metastasis was excised. Our results show that with focused, schematic tumour follow-up early recognition of recurrence is possible. Despite this, reoperation is only indicated in a selected group of patients because of multifocal recurrence, or local or functional inoperability. Further intensification of tumour follow-up is limited by personnel, logistical, and financial considerations. As an alternative, individualised, function-oriented tumour after-care could be considered.

Adult↗

PubMed1992

Mitomycin C, 5-fluorouracil and radiation in advanced, locally recurrent rectal cancer.

15 patients with inoperable presacral recurrent rectal cancer following surgery were treated with combined radiation and chemotherapy. Treatment consisted of split-course radiotherapy with 50 Gy in 25 fractions over 5 weeks and, after 4 weeks, an additional 20 Gy in 10 fractions over 2 weeks. At the start of treatment and following the split course, chemotherapy was administered. Mitomycin C was given on Day 1 (dose: 15 mg/m2 i.v. bolus) and 5-fluorouracil from Day 1 to Day 5 (dose: 750 mg/m2/24 h, continuous i.v. infusion). Owing to considerable, predominantly haematological and gastrointestinal toxicity, only six out of 15 patients received treatment according to the protocol. The symptomatic relief of symptoms was good. Pain was controlled in seven of eight symptomatic patients. Seven of the patients showed response according to computed tomography, but in none of these cases was a complete remission seen. After a follow-up of at least 30 months, only three patients are alive. The 1-, 2- and 3-year survival rates are 9/15, 6/15 and 3/12, respectively. The median survival is 14 months (range 4-60+ months). In comparison with historical data from the same institution, combined radio-chemotherapy did not show any prolongation of survival or increased response rate, but increased toxicity excessively, when compared with radiation alone.

Adenocarcinoma↗

PubMed1982

Lung cancer: retreatment of local recurrence after definitive irradiation.

Aggressive radiation therapy for the management of inoperable lung cancer has increased tumor control and survival. However, approximately 20% of patients continue to experience local recurrence as the sole manifestation of treatment failure. Seven hundred thirty-four patients were initially treated by radiation therapy for inoperable lung cancer, for recurrence after resection, or as adjunct postoperative therapy. Twenty-nine patients were referred for retreatment of cancer that recurred within the original treatment field. Following retreatment, 14 of 29 patients (48%) had a favorable subjective response, and 20 of 27 patients (74%) a favorable objective response. A favorable response was observed for all cell types and over a wide range of retreatment dosages. Symptomatic radiation pneumonitis developed in one patient, rib sclerosis and fracture developed in another. Th median survival after onset of retreatment was five months with a range of one month to 54 months. The clinically determined mechanisms of death were persistent intrathoracic disease in 14 of 25 patients (56%), intrathoracic disease and distant metastasis in 7 of 25 (28%), distant metastasis in 3 of 25 (12%), and unknown in 1 of 25 (4%).

Adult↗

PubMed1990

[Malignant hemangiopericytomas in the head and neck area].

Since 1975 we have treated nine patients with a malignant haemangiopericytoma. Three patients died 5, 9 and 14 years later of metastasis in the lung, liver, skeletal system and mastoid. However, five of the patients are still alive. Regular clinical and radiological follow-up is performed, the average period of follow-up being 8.2 years. Four patients suffered local recurrence within 1-5 years. Surgical resection was the primary therapy in five cases, supplemented in two cases by local radiation. Recurrences were treated by surgery on four occasions and six by radiation, but no complete remission was achieved. Chemotherapy (CyVADic regimen) was attempted in three patients with metastases and one patient with a huge local recurrence, but proved to be ineffective. A re-examination of the histological specimen of all primary tumours and recurrences did not reveal a correlation between histological appearance and clinical behaviour. Our experience in the treatment of malignant haemangiopericytoma and the data in the literature suggest that primary resection with a wide safety margin is the therapy of choice. Radiotherapy is recommended for incomplete resection, local recurrence, and metastases and inoperable tumours. Since recurrence and metastasis can occur after many years (up to 7 years in our patients) a lifelong regular follow-up is necessary.

Adult↗

PubMed2005

Extracranial stereotactic radiotherapy for primary and metastatic renal cell carcinoma.

BACKGROUND AND PURPOSE: We investigated the results of using stereotactic radiotherapy (SRT) for 58 patients with renal cell carcinomas (RCC) who were evaluated restrospectively for response rates, local control rates and side effects. PATIENTS AND METHODS: From October 1997 to January 2003, 50 patients suffering from metastatic RCC and eight patients with inoperable primary RCC received high-dose fraction SRT while placed in a stereotactic body-frame. The most common dose/fractionation schedules used were 8 Gyx4, 10 Gyx4 and 15 Gyx3 during approximately 1 week. RESULTS: SRT-treated tumor lesions regressed totally in 30% of the patients at 3-36 months, whereas 60% of the patients had a partial volume reduction or no change after a median follow-up of 37 months (SD 17.4) for censored and 13 months (SD 12.9) for uncensored patients. Side effects were generally mild. Of 162 treated tumors, only three recurred, yielding a local control rate of 90-98%, considering the 8% non-evaluable sites as defined here. For patients with one to three metastases, the time to new spread was 9 months. CONCLUSIONS: Our use of SRT for patients with primary and metastatic RCC yielded a high local control rate with low toxicity. Patients with one to three metastases, local recurrences after nephrectomy or inoperable primary tumors benefited the most, i.e. had fewer distant recurrences (13/23) and longer survival times compared to patients with >3 metastases (24/27 recurrences).

Aged↗

PubMed1985

Is dose/time fractionation important in treating rectal cancer?

In a study to evaluate the effect of increasing dose per fraction on radiation response in rectal cancer, two groups of 29 patients each, matched for extent and size of disease, were evaluated. Group A was treated with conventional dose/fraction (180-200 cGy) X 5 days/week and Group B was treated with 250 cGy/fraction X 4 days/week. Total dose was reduced by 10% in Group B patients to allow comparison of biologically equivalent doses. Two categories of patients were analyzed in each group: patients receiving planned high dose preoperative radiation (4000-4500 cGy); and patients receiving high dose radiation for post-surgical recurrent tumors or locally advanced inoperable tumors (5500-6000 cGy). Tumor regression was markedly better in patients treated with the 250 cGy/fraction. Overall response (greater than 50% regression) was 35% (10/29) in Group A and 62% (18/29) in Group B. Nine of 10 patients in Group B, treated preoperatively, had greater than 50% regression in tumor size, with two patients having no evidence of disease on surgico-pathological evaluation. Six of 10 similar patients in Group A had greater than 50% tumor regression.

Adenocarcinoma↗

PubMed1992

[Malignant melanoma of the skin in Denmark--epidemiology, diagnosis and treatment].

About 700 new cases of malignant melanoma of the skin are registered annually in Denmark. The incidence is increasing rapidly and the number of new cases increases by more than 5% per annum. The most important phenotypical risk factors are the number of acquired pigmented naevi and exposure to sunlight is the most important risk factor in the external environment so that severe sunburn in children and intermittent intense exposure to sunlight increase the risk of melanoma. The thickness of the tumour at the time of the diagnosis is the most important prognostic factor. The prognosis deteriorates with increasing thickness. Treatment is primarily surgical. In cases of inoperable local melanoma and regional recurrences, irradiation may be administered. Chemotherapy and/or immunotherapy are of experimental character. In the light of the rapidly increasing incidence, it is important that knowledge of risk factors for development of the disease and the clinical characteristics of early melanoma is spread to not only the medical profession but also to the general public.

Denmark↗

PubMedDate not supplied

Local effect of hyperthermia for superficial and shallow-seated tumors.

In approximately seven years, 134 patients with 161 tumors were treated by hyperthermia combined with radiation or chemotherapy at our department. The primary tumors were breast cancer, head and neck cancer, and soft tissue tumors in most patients. Adenocarcinoma was the most frequent, followed by squamous cell carcinoma and soft tissue sarcoma. The local response rates for primary inoperable advanced, metastatic, and local recurrence of breast cancer were 88% (7/8), 50% (10/15), and 86% (18/21), respectively. The local response rate of 39 tumors of neck lymph nodes was 49% (19/39). A total of 26 tumors of bone and soft tissue were treated. Five tumors showed CR and six PR, for a total response rate of 42%. Among 20 patients with malignant melanoma, CR and PR were 25% (5/20) and 30% (6/20), respectively. The local response rate for all patients with superficial and shallow-seated tumors was 58% (94/161). In some tumors classified as showing NR, complete disappearance of tumor cells was demonstrated by a post-treatment histological examination. The efficacy of hyperthermia, when evaluated solely on the basis of tumor size, is likely to be underestimated.

Adenocarcinoma↗

PubMed1986

[The use of artificial hyperglycemia in the radiotherapy of patients with rectal cancer].

A treatment modality employing radiotherapy with subsequent hyperglycemia induction was evolved in experiments on mice and then clinically tested in 32 cases of inoperable locally--extensive primary and recurrent cancer of the rectum. A 50% regression of tumor was registered in 14 (43.0%) out of 32 patients treated with radiotherapy in combination with hyperglycemia. Similar degree of regression was observed only in 6 (15.0%) out of 40 patients who received the same radiation treatment unaccompanied by hyperglycemia. The difference was statistically significant. No untoward side--effects developed. The results are encouraging and seem to open up new vistas of clinical research.

Adenocarcinoma↗

PubMed1986

Current results of neutron therapy at the UCL, for soft tissue sarcomas and prostatic adenocarcinomas. Université Catholique de Louvain.

From March 1978 to August 1985, 630 patients were treated with fast neutrons at the UCL cyclotron of Louvain-la-Neuve. Neutrons are produced by bombarding a beryllium target with 65 MeV protons. A CNPF of 2.8 was adopted. As far as soft tissue sarcomas are concerned, 32 patients were irradiated after "radical" surgery: only 2 local recurrences were observed (follow-up from 6 months to more that 5 years). On the other hand, in a group of 26 patients with large inoperable, recurrent of incompletely resected tumours, local control could not be achieved in 14 cases. In the whole group of these 58 patients, 12 severe complications were observed; their frequency increases with field size which in turn reflects tumour extent. Locally extended prostatic adenocarcinomas (stage C) were treated with mixed schedule irradiation (3 neutron and 2 photon fractions per week). A local control rate of 93% at 1 year, of 83% at 2 years, and 90% at 3 years was achieved (28, 23 and 10 patients respectively). The early and late tolerance was excellent; only one complication was observed.

Adenocarcinoma↗

PubMed2003

Early stage medically inoperable non-small cell lung cancer.

A nihilistic approach to the treatment of patients with medically inoperable, early stage non-small cell lung cancer (NSCLC) is not warranted. Despite the frequency of comorbid medical illness in patients with medically inoperable NSCLC, lung cancer progression is the major cause of morbidity and death. Although expectations for cure are reduced compared to good-risk patients (eg, adequate pulmonary reserve), modest long-term survival rates of patients have been reported, after definitive therapy. A comparison of radiotherapy and limited resection is difficult because of the lack of randomized data and the selection bias inherent in retrospective reports. For example, patients treated with surgery have peripheral lesions, undergoing rigorous staging compared to patients treated with radiotherapy. In a multidisciplinary thoracic program, patients are counseled on the options of sublobar resection and conformal radiotherapy. The efficacy of adjuvant radiotherapy, after limited resection, in reducing local recurrence in patients with medically inoperable NSCLC is unclear. However, adjuvant radiotherapy may be considered if a postoperative target volume can be defined, particularly if resection margins are narrow. Considering the benefit of chemoradiotherapy for patients with locally advanced disease, combination therapy is administered to patients with good performance status and large (eg, > 4 cm) primary lesions, although combined therapy may increase the potential for pulmonary toxicity in patients with baseline pulmonary dysfunction. Prospective data are becoming available to define the value of treatment alternatives for patients with medically inoperable NSCLC. The Cancer and Leukemia Group B completed a phase II study of thoracoscopic wedge resection and postoperative radiotherapy, whereas a phase I trial of dose-intensive accelerated conformal radiotherapy is ongoing. Trials involving systemic therapy for patients with medically inoperable NSCLC should be developed.

Carcinoma, Non-Small-Cell Lung↗

PubMed1994

Squamous cell carcinoma of the maxillary sinus and the oral part of the upper jaw. Comparison of treatment results.

The treatment results were compared in 77 patients with maxillary sinus squamous cell carcinoma (MC) and 53 patients with squamous cell carcinoma arising from the oral part of the upper jaw (OC). Both sets of patients received radiotherapy alone, or radiotherapy combined with surgery and/or chemotherapy. Computerized tomography was useful for the definition of the treatment volume. Intraarterial chemotherapy was given in 89 of 130 patients and in these patients the total radiation dose was reduced by about 10 Gy. No difference was found in the 5-year survival rate between the MC (65%) and the OC (66%) groups. The cumulative incidence of local failure was higher in MC (36%) than in OC (26%), whereas the ultimate incidence of neck node metastasis was higher in OC (43%) than in MC patients (18%). Half of the inoperable patients (9/18) were older than 80 years and had contraindications to anaesthesia and major surgery. The local recurrence rate was high in the inoperable MC patients (6/8). Contralateral sinus cancers occurred in 4 patients in the MC group.

Aged↗

PubMed1996

Radiotherapy vs. radiotherapy and razoxane in the treatment of soft tissue sarcomas: final results of a randomized study.

PURPOSE: The effect of the sensitizer razoxane on soft tissue sarcomas (STS) was prospectively evaluated in a randomized, controlled trial. The main purpose of the study was to determine the response rates and local control under the combined treatment compared to irradiation alone. METHODS AND MATERIALS: Between 1978 and 1988, 144 patients entered the study; 130 were evaluable for response, toxicity, or survival. The patients were randomized to receive radiotherapy alone or radiotherapy with razoxane. They were divided into postoperative cases and patients with gross disease (unresectable primaries, recurrent disease, or metastatic disease). The median radiation dose was 60 Gy postoperatively, and 56-58 Gy in patients with gross disease. The dose difference has palliative reasons. Razoxane was given orally at a daily dose of 150 mg/m2 during the time of the radiotherapy, starting 5 days before the first irradiation. In general, the groups were comparable as to their prognostic factors. There was some imbalance, however, in favor of the postoperative group reveiving radiotherapy alone. RESULTS: Between the patient groups treated postoperatively in an adjuvant form, there were no substantial differences in local control and survival. Among 82 patients with gross disease, the treatment with radiotherapy and razoxane led to an increased response rate compared to photon irradiation alone (74 vs. 49%). The local control rate was likewise improved (64 vs. 30%;p < 0.05). The acute toxicity was somewhat higher in the sensitizer arm, but there was no difference in the occurrence of late complications. CONCLUSIONS: Radiotherapy combined with razoxane seems to improve the local control in inoperable, residual, or recurrent STS compared to radiotherapy alone. The combined treatment is a fairly well tolerated procedure at low costs. It can be recommended for inoperable primary STS or gross disease after incomplete resection, conditions which are still associated with limited local control and a grave prognosis.

Adolescent↗

PubMed1995

A pilot study of concomitant protracted venous infusion 5-fluorouracil and hyperfractionated radiotherapy in rectal tumors.

It has recently been shown that postoperative radiotherapy combined with 5-fluorouracil (5FU) resulted in an increase of survival and local control in patients with rectal cancer. However, hematological and intestinal toxicity were also increased. Experimental and clinical studies showed an increased radiation effect with an acceptable toxicity by delivering 5FU via a continuous intravenous infusion. From July 1988, 38 patients radically operated on for stages B2-C rectal cancer were irradiated in our hospital with 3 fractions per day of 100 cGY to a total dose of 5,600 cGY. Of these 38 patients, 13 underwent postoperative radiotherapy alone, and 25 received postoperative radiotherapy combined with concomitant protracted infusion of 5FU at doses of 250 and 300 mg/m2 per day. In addition, 14 patients with inoperable, locally advanced tumors or postoperative recurrences, were treated with the same combination schedule of 5FU and radiotherapy to a total radiation dose of 6,500 cGy. After a median follow-up of 43 months, the actuarial 3-year overall and disease-free survival rates in the postoperative group of patients were 68% and 68%, respectively, in the combined modality group, as compared to 51% and 36%, respectively, in the radiation alone group. Patients with inoperable tumors exhibited 3-year overall and disease-free survival rates of 24% and 32%, respectively. The main toxicity was rectal tenesmus, diarrhea, dysuria, and, less frequently, leukopenia. These symptoms were responsible for a treatment delay of more than 5 days in 2 of 6 and in 7 of 33 patients who received 5FU doses of 300 and 250 mg/m2 per day, respectively, as compared to 2 of 13 patients treated with radiotherapy alone.

Adult↗

PubMed1988

[Chordomas].

Chordomas are slowly growing malignant tumors arising from notochordal rests. They are occurring in adults (50 to 60 year old) and are mainly (85%) located in sacrococcygeal or spheno-occipital regions; other main localization is cervical spine. Chordomas are usually discovered in patients with pain or symptoms due to compression of surrounding viscera. Radiologically it is characterized by association of osteolysis and soft tissues opacity. On macroscopic examination tumoral tissue has mucoid appearance; under microscope it is made up with lobules of epithelial-appearing cells surrounded by acid mucosubstances. Tumorous cells contain glycogen and neutral mucosubstances. They are surrounded by argyrophilic rim due to pericellular condensation of intercellular matrix, well viewed on electron microscope examination. When their cytoplasm is filled with vacuoles, cells take up typical physaliphorous appearance. Chordomas cells express epithelial differentiation antigens (low molecular weight cytokeratins, EMA, CAM 52, HFM 62, even CEA), Vimentin and S-100 Protein: this triple positivity allow differentiation between chordomas and numerous others tumors. Correct treatment of chordoma is achieved with an initially complete excision. Local recurrences are frequent and sometimes inoperable: in this cases radiotherapy alone may be performed (70 grays). Sarcomas (fibroblastic or Malignant fibrous histiocytoma) may occur after radiotherapy or without it. Hematogenous metastasis occur in 10% to 15% of patients. Survival rate at five years is included between 50% and 75%. Chondroid chordoma is a special entity occurring in younger patients (35 year old) and located in spheno-occipital region. In addition to chordomas it contain chondroid (benign or malignant) islands. Mean survival rate (16 years) is far better than for chordoma or chondrosarcoma.

Adult↗

PubMed2004

Paclitaxel and cisplatin in patients with recurrent and metastatic head and neck squamous cell carcinoma.

The purpose of this phase II trial was to investigate the use of paclitaxel and cisplatin in patients with recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC), to evaluate tumor response, time to progression, survival, and toxicity of this regimen. Patients with recurrent and/or metastatic HNSCC received 175 mg/mq paclitaxel (PTX) administered as a 3-h intravenous infusion on day 1 and 75 mg/mq cisplatin (CDDP) as a 30(') intravenous infusion on day 2; cycles were repeated every 21 days. From February 1997 to February 2000, 36 patients (18 with locoregionally recurrent disease, 8 with deemed inoperable locally advanced disease, and 8 with metastatic disease) with a median age of 60 years (range 38-73 years) were enrolled. The patients evaluable were 34 for toxic effects, length of survival, and tumor response. The overall response was 41.1%, with two (5.8%) complete responders (CR) and 12 (35.3%) partial responders (PR), 10 (29.4%) patients had stable disease and 10 (29.4%) progressed. The median time to progression (TTP) was 5 months (range 1-49 months), and the median overall survival was 11 months (range 1-53 months). The 1-year-, the 2-year-, and the 3-year-survival rate were 38.2, 17.6 and 14.6, respectively. Up to date of the statistical evaluation four patients were still alive. According to the World Health Organization (WHO) criteria, transient G3 neutropenia and anaemia occurred in seven (20.5%) and four (11.7%) patients, respectively. The predominant non-haematologic toxicities were alopecia and fatigue: Twenty-three (67.6%) patients had G3 alopecia, two patients (5.8%) G3 fatigue and 10 (29.4%) G2, eight (23.5%) G2 myalgia, eight (23.5%) G2 nausea/vomiting, and two (5.8%) G2 mucositis. There were no G4 toxicity and any treatment-related death. Paclitaxel plus cisplatin combination is an active regimen with an acceptable safety profile in recurrent/metastatic HNSCC. This regimen, according to our opinion, is a valid alternative to infusional fluorouracil (5FU)/cisplatin. In fact up to date we can confirm, in taxane era, that paclitaxel, as single agent or in combination, produce response rates similar to cisplatin/5FU regimen, but with more manageable toxicity, especially in the subset of patients with 0-1 ECOG-PS and incurable or locoregional recurrent HNSCC, with short outpatient administration too.

Adult↗