Definitive and palliative radiotherapy for cervix cancer in the elderly.

The elderly population is increasing in number. Aggressive therapeutic intervention in this patient group may not always be possible because of age, the presence of co-morbidity, and poor functional status. Hence, individualized management of cervix cancer (CC) in the elderly is often practiced. Because of the preceding consideration, the cases of 79 women 65 years of age and older with CC treated with radiation over the last 20 years were reviewed. The cases were classified into two groups--those who were aggressively irradiated (group 1: 43 patients) and those managed less intensively for palliation (group 2: 36 patients). Local tumor control, complications, and survival were assessed. There were fewer extremely aged (> or = 75 years of age) women (p = 0.006) with advanced stage disease (p = 0.012) in group 1 than in group 2. Also, group 1 women experienced fewer treatment failures (p < 0.0003) and more of them were alive and well at last follow-up (p < 0.005) than those from group 2. The median survival periods for groups 1 and 2 were 60 months and 11 months, respectively (p < 0.0001); the corresponding 5-year crude survival rates were 54% and 19%, respectively (p = 0.002). Two women required remedial surgery for bowel obstruction/perforation after irradiation, and one patient sustained chronic radiation cystitis.

Thoracic metastases from breast cancer: a single-institution's experience.

OBJECTIVE: Thoracic metastasis from breast cancer (TMBC) is a relatively uncommon condition, and few reports of its therapeutic palliation and patient outcomes exist. We therefore reviewed retrospectively our radiotherapeutic experience of TMBC. METHODS: Between 1981 and 2003, 19 patients were treated with radiation (with doses raging from 10 Gy to 50 Gy) for palliation of TMBC. RESULTS: The mean age was 55.4 years. Mediastinal lymph node disease was the most common form of TMBC. TMBC developed within five years of breast cancer diagnoses in 11 patients (58%). Among the evaluable symptomatic individuals, subjective palliation was complete in 78% of the cases. The complete objective response (e.g., complete resolution of clinically manifested superior vena caval obstruction or imaging-demonstrated atelectasis) rate was 50%. There was no significant difference in survival between patients presenting with airway obstruction and women who were not in respiratory distress, asymptomatic and symptomatic patients, and women with and without concurrent extrathoracic metastases. CONCLUSION: Although the prognosis of women with TMBC was quite ominous, radiotherapy should be considered in very symptomatic patients because justifiable palliation can be effected in some individuals.

Breast cancer metastasis to the medulla oblongata: a case report.

Breast cancer metastasis to the brain stem is uncommon. Because of the rarity of the condition, the clinical course of such patients is not known. The case of a 41-year-old woman with advanced-stage carcinoma of the breast involving the medulla oblongata is presented and the literature concerning management, including patient outcome, is reviewed.

Cancer of the cervix with endometrial extension treated by radiotherapy: a retrospective case-control study.

BACKGROUND: Studies determining prognosis of cancer of the cervix with endometrial extension (CCEE) in a case-control fashion are scant. METHODS: A case-control retrospective study of 20 women with CCEE and 16 patients with cervical cancer not extending to the endometrium (CCNEE) treated by radiation was undertaken. The patient groups were matched for age, disease stage, the presence of bulky/barrel-shaped tumor in the cervix, intercurrent illness, total radiation dose, and hemoglobin level. The overall mean follow-up was 54 months (range 8 to 218 months). RESULTS: The numerical rates of local and systemic failure as well as 5-year survival were worse for patients with CCEE versus CCNEE. However, the observed differences were not statistically significant. CONCLUSION: Involvement of the endometrium by cancer of the cervix seems to confer a worse outcome among cervical cancer patients treated by radiation alone.

Supraclavicular nodal relapse of breast cancer: prevalence, palliation, and prognosis.

PURPOSE: To determine the frequency, palliative effects of radiotherapy (RT) and survival of patients developing supraclavicular nodal relapse (SNR) after definitive surgery for non-disseminated breast cancer (BCa). METHODS: A retrospective study of individuals treated by breast conserving surgery or modified radical mastectomy for Stage I to III BCa at a single institution during a 17-year period (1980-96) was undertaken. RESULTS: Of the 536 patients studied, 22 (4%) developed SNR. Among the seven symptomatic women, the complete subjective response rate after RT was 71%. Of the 18 evaluable patients with manifest SNRs, tumor regression was complete in 12 (66.6%), partial in one (5.6%), and absent in five (27.8%). The overall median survival was 11.5 months; five patients (23%) survived for at least two years. CONCLUSION: Supraclavicular nodal relapse in breast cancer patients occurs infrequently. The application of radiotherapy for palliation of SNR was fully justified by the perceived results even though long-term survival was not often observed.

Synchronous and metachronous extrapelvic metastases of cancer of the cervix: a study of prognosis and palliation.

Thirty-eight women with cancer of the cervix and extrapelvic metastases (EPM) were retrospectively reviewed with respect to prognosis and responses to palliative radiotherapy. Seventeen patients had synchronous EPM and 21 individuals displayed metachronous metastatic disease outside of the pelvic cavity. A meaningful difference was not revealed (p = 0.11) in the comparison of the two groups' 2-year survival rates. However, this small retrospective review highlighted the efficacy of radiotherapy administered for palliation to this cohort of patients.

Cauda equina compression in breast cancer--incidence and treatment outcome.

PURPOSE: To determine the incidence and treatment outcome of compression of the cauda equina by metastatic disease in patients with breast cancer. METHODS: A retrospective study of individuals diagnosed with breast cancer at a single institution during a 16-year period was undertaken. RESULTS: Of the 1,283 patients studied, 15 (1.2%) developed cauda equina syndrome from metastatic disease. The median survival was eight months; ten (67%) survived for at least six months. Among the evaluable patients, pain was completely relieved in eight of ten women; complete resolution of neurologic deficits was observed in five of nine patients. CONCLUSION: Metastatic breast cancer compression of the cauda equina and long-term survival of patients are infrequent occurrences. Beneficial responses can be mediated by radiotherapy.

Can intermediate-risk node-negative patients with stage I corpus cancer do without posthysterectomy radiotherapy? Review of a 13-year experience.

A retrospective comparative study of 41 patients with stage I corpus cancer, negative surgical staging, and adverse pathological features either treated or untreated by posthysterectomy radiotherapy (PHR) during a 13-year period was undertaken. The patients were matched for age, intermediate-risk classification, number of sampled nodes and the presence of coexisting illness. After complete follow-up, there was no significant difference in outcome between the patient groups. Unless it can be shown definitely that PHR is beneficial, its use in intermediate-risk node-negative stage I corpus cancer patients must be seriously questioned.

Palliative radiotherapy for synchronous bilateral lung cancers.

Scant information is available about the outcomes of patients with synchronous bilateral lung cancers (SBLC) treated with radiation. We report on 32 patients with SBLC who were treated for palliation by external beam irradiation during a 19-year period. The overall median survival was 7 months; 20 individuals (63%) survived at least 6 months. Among the evaluable patients, the complete/partial subjective and objective response rates were 100% and 60%, respectively. Survival was not significantly influenced by the total dose applied. Radiotherapy is effective for palliation of symptoms associated with SBLC. However, the dismal prognosis of SBLC managed by nonradical radiotherapy alone warrants investigation of treatment using curative doses of radiotherapy or chemotherapy with radiotherapy.

Computed tomographic staging of esophageal cancer and prognosis.

The purpose of this retrospective study was to examine whether computed tomography (CT)-determined staging of esophageal cancer (EC) has prognostic correlation. The results showed a strong relevance of staging of EC by CT to survival (p<0.01).

Palliative management of metastatic tumors involving the psoas muscle: case reports and review of the literature.

Seven case reports of patients with metastatic tumors in the psoas muscle are described. Reasons for the rarity of this neoplastic disease complication are considered. The efficacy of radiotherapy in providing palliation of symptomatic patients is examined.

Prophylactic and therapeutic fixation of weight-bearing long bones with metastatic cancer.

BACKGROUND: We retrospectively studied the duration of operations and the hospitalizations for impending and manifest fractures of weight-bearing long bones with metastatic disease, which has rarely been done. METHODS: The duration of operative fixation and the hospital stay in patients with an impending (n = 7) or actual (n = 15) fracture in a weight-bearing long bone with metastatic tumor were assessed, including symptomatic response, posttreatment mobility, and survival rate. RESULTS: Most patients had significant relief of pain. More than half of patients with impending fracture and 80% with actual fracture were ambulatory after therapy; 3-year survival rates were 29% and 13%, respectively. Corresponding mean durations for the operations were 175 minutes and 185 minutes, respectively; mean durations of hospitalization were 22 days and 16 days, respectively. CONCLUSION: Surgical fixation of fractures in weight-bearing long bones with metastatic cancer does not require excessive operative time as compared with that of impending fractures, does not extend hospitalization, and has an acceptable risk-reward ratio.

Radical combined treatment of locally extensive head and neck cancer in the elderly.

PURPOSE: Few studies have described the effects of aggressive combined therapy for locally extensive head and neck cancer in the elderly. Our study evaluated the outcome of this particular cohort of patients after such treatments. METHODS: Survival, failure, morbidity, and complication rates were determined retrospectively in 43 elderly patients with stage III or IV head and neck cancer who underwent curative surgery and postoperative radiotherapy (n = 33) or neoadjuvant, 3-drug chemotherapy plus radiotherapy (n = 10) between the years 1977 and 1992. RESULTS: The crude survival rate at 3 years was 27% in patients managed by surgery plus radiotherapy, and 30% in individuals treated with chemoradiation; the corresponding locoregional failure rates were 23% and 30%; and the distant failure rates were 13% and 0%, respectively. The acute toxicity rate was 12% in the surgery plus radiotherapy group and 30% in the chemoradiation patients; the corresponding late complication rates were 0% and 10%. There were no toxic deaths. CONCLUSION: Radical combined treatments can be performed safely and achieve long-term, disease-free survival in selected elderly patients with locally extensive head and neck cancer.

Maxillary sinus cancer and metastatic compression of the cauda equina: report of two cases.

Maxillary sinus cancer with metastasis outside of the head and neck is a relatively rare occurrence. We describe two cases of carcinoma of the maxillary sinus that metastasized to the spine and compressed the cauda equina. In the first case, the neurological complication happened synchronously with the primary malignant neoplasm, while in the second instance, cauda equina compression occurred several months later. The treatment of metastatic compression of the cauda equina consisted mainly of radiotherapy, with palliation being achieved in one patient. Survival was expectedly short (3 months) for both individuals.

"Routine" weekly blood counts during breast irradiation for early stage cancer: are they really necessary?

The present investigation analyzed the weekly blood count assays of 73 women receiving breast irradiation after organ-preserving surgery for early stage cancer. With regard to leucopenia and anemia, grade 1 toxicity occurred in 26% and 21%, respectively, of the cases. Thrombocytopenia of any degree and grades 2-4 leucopenia or anemia were either not seen or were minimally observed. Most of the patients who experienced grade 1 or grade 2 toxicity had received preirradiation chemotherapy. We stress the importance of a baseline blood count recording prior to breast irradiation and the need for further study to define better the population for whom continuous weekly blood count determinations might prove to be useful.

Involvement of the cavernous sinus by malignant (extracranial) tumour: palliation in six cases without surgery.

Involvement of the cavernous sinus region due to haematogenous spread or by local extension of a malignant head and neck tumour does not occur frequently. Six patients were treated by external beam radiation with (n=3) or without neoadjuvant chemotherapy between December 1989 and February 1996. Manifestations of the condition mainly consisted of fifth and sixth cranial nerve deficits (n=4). Complete resolution of cranial nerve deficits after therapy occurred in two of the four patients with only three individuals having been evaluable. Three of the six patients survived for more than 3 years. Thus, palliation can be achieved by chemoradiation or radiotherapy alone, and long term survival is not precluded.

Radiotherapy for cancer of the cervix in morbidly obese women: preliminary results.

A retrospective four-year review showed that six morbidly obese (> or = 40 kg/m2) women, two of whom underwent pre-irradiation simple hysterectomy, were definitively treated with radiation for cancer of the cervix. All cases were FIGO stage IB. The average age was 49 years and average body mass index 49 kg/m2. Radiotherapy consisted of external beam pelvic irradiation and low-dose rate or high-dose rate brachytherapy applications. During a follow-up period ranging from 9 to 46 months, all women were alive and free of neoplastic disease as well as complications. Albeit long-term outcome data are not yet available, we believe that morbidly obese women with early stage cervical cancer who are not suitable candidates for curative surgery may derive beneficial effects from appropriately applied definitive radiotherapy.