Breast cancer in a male patient after treatment of acute lymphoblastic leukemia including total body irradiation and bone marrow transplantation.

BACKGROUND: With increasing numbers of patients subjected to total body irradiation and bone marrow transplantation for treatment of several systemic malignancies more and more patients with second malignancies were observed. CASE REPORT: We report the case of a 29- year-old man who developed breast cancer 13 years after treatment for acute lymphoblastic leukemia. Therapy for leukemia included total body irradiation (TBI) and bone marrow transplantation (BMT). Breast cancer was treated with mastectomy and irradiation of the left chest wall. 17 months later the patient developed malignant pleural effusion and died despite chemotherapy and hormonal therapy due to further tumor progression. CONCLUSION: The increased risk for secondary solid cancers after TBI and BMT and the greater risk among younger patients indicate the need for lifelong careful follow up.

Results of prophylactic irradiation in patients with resected keloids--a retrospective analysis.

The data of 139 patients with 166 keloids treated postoperatively between 1962 and 1996 were evaluated for prognostic factors and outcomes. Treatment commenced within 48 h after surgery. Radiotherapy was carried out as brachytherapy, using an integrated radionuclide 90 Sr-90Y surface applicator. The median dose delivered to the subcutis amounted to 14 Gy (range 7.5-28.5 Gy). The overall recurrence-free response rate was calculated to be 80% for all keloids. Response rates differed significantly (p < 0.001) between the different anatomical regions. The recurrence rate was lowest (2%) with keloids of the face and neck and highest with keloids of the thorax (49%). Outcome also differed significantly, depending on the etiology. Keloids following burns had a poorer success rate than those developing after surgery or mechanical trauma (p < 0.001). We were unable to demonstrate any significance in outcome related to gender, age or size. No direct correlation was found between total doses and response rates. In our patients there were no signs of secondary malignancies in the irradiation area within a median follow-up period of 12 years. Two new prognostic factors have been identified: keloid etiology and localization of the disorder.

Vulvar carcinoma: a retrospective analysis of 80 patients.

We evaluated the files of 80 women who were treated for vulvar carcinoma. In 13 women radiotherapy was used as primary treatment, in 45 cases postoperatively and in 22 women because of local recurrence. Patients older than 60 years had a significantly worse 5-year survival rate (39%) than younger women (57%) (p = 0.02). The 5-year survival rate for patients with negative nodes was 72% versus 46% for the N1- and 47% for the N2-status, respectively (p = 0.027). The 5-year actuarial survival rate for patients with tumor manifestation in the clitoris was 77.9% versus 26.1% for patients with tumors in the labia majora (p = 0.0044). There was no difference in survival in patients who had been treated with radical vulvectomy and bilateral groin dissection plus local radiotherapy when compared with patients who had been irradiated (whole pelvis) after tumor resection alone. The 5-year survival rates and the median survival time were identical in both groups (61%/62 months).

Treatment of irradiation-induced mucositis with growth factors (rhGM-CSF) in patients with head and neck cancer.

BACKGROUND: Mucositis is a frequent side-effect of radiotherapy which often causes interruption of therapy and consequently decreases the probability of remission or cure, rhGM-CSF may ameliorate symptoms of mucositis by increasing the immune response via macrophage activation and stimulation of secondary cytokines. PATIENTS AND METHODS: 32 patients with locally advanced head and neck cancer were treated with adjuvant local radiotherapy after surgery (60 Gy in 30 dose fractions). In a pilot study, 16 patients received rhGM-CSF for five days, starting after a radiation dose of 20 Gy. These patients were compared retrospectively with a control group of 16 matching patients. Patients were assessed according to the Oral Assessment Guide (OAG), the Composite Mucositis Score (CMS) and the Common Toxicity Criteria (CTC) for severity of mucositis and pain. RESULTS: When compared with controls, patients on rhGM-CSF treatment showed decreased OAG, CMS and CTC scores. During the following irradiation courses mucositis was less severe in patients previously treated with rhGM-CSF. With regard to pain relief, rhGM-CSF-treated patients demonstrated a statistically significant improvement (p = 0.011), compared with controls. CONCLUSION: rhGM-CSF affected the severity of oral mucositis and reduced the related pain. As rhGM-CSF was well tolerated, this effect will be further investigated in prospective, controlled study.

Modified neoadjuvant therapy regime with low dose irradiation in advanced head and neck cancer patients: preliminary results of a pilot study to minimize side effects.

We analysed the files of 52 patients with advanced head and neck tumors who were treated in a pilot phase. The therapy consisted of two courses of induction chemotherapy with ifosfamide and cisplatin followed by hyperfractionated-accelerated radiotherapy with a total dose of only 30 Gy. Surgery was performed within the following 7 days with tumor resection and neck dissection. Histologically we found in 50% of the specimens total necrosis of the tumor. The median survival time is calculated to be 22 months. The median follow-up time thus far is 36 months. Hence, therapy results are comparable to other therapy schedules. But side effects, especially late side effects had become minor. Therefore, our therapy regime results in augmentation of the quality of life of these patients.