Treatment results of carcinoma in situ of the glottic larynx: 61 patients treated with radiotherapy.

OBJECTIVES: To review the Notre-Dame Hospital experience in the treatment of carcinoma in situ of the glottis by radiotherapy and to evaluate the different factors affecting local control and survival. METHODS: Between January 1990 and June 2002, 61 patients presenting with carcinoma in situ of the glottis were treated with curative intent radiotherapy. No patients received either surgery or chemotherapy in the initial treatment of their cancer. RESULTS: The median follow-up for the entire population was 3.2 years. The local control rate was 96% and 94% at 2 and 5 years, respectively. Overall survival was 100% and 90% at 2 and 5 years, respectively. No statistically significant prognostic factor could be identified either for local control or survival. No patient experienced severe treatment complications or death. CONCLUSION: Radiotherapy offers excellent treatment results for carcinoma in situ of the glottic larynx, with few treatment complications. These results are comparable to those published in the literature and justify our choice of primary radiotherapy for carcinoma in situ of the glottis.

Phase II multicenter trial with carboplatin and gemcitabine induction chemotherapy followed by radiotherapy concomitantly with low-dose paclitaxel and gemcitabine for stage IIIA and IIIB non-small cell lung cancer.

INTRODUCTION: The optimal combination of concomitant radiotherapy (RT) and chemotherapy in stage III unresectable non-small cell lung cancer (NSCLC) remains unclear. The role of induction chemotherapy with carboplatin/gemcitabine regimen has not been established in stage III NSCLC. METHODS: Forty-two stage III NSCLC patients, 41 assessable, with a median age of 60 years and good performance status, entered this trial between January 2003 and November 2004. They received carboplatin area under the curve 5 on day 1 and gemcitabine 1000 mg/m2 on days 1 + 8 every 3 weeks for two cycles, followed on day 50 by RT 60 Gy, concomitantly with paclitaxel 50 mg/m2 and gemcitabine 100 mg/m2 on days 1 + 8 every 3 weeks for two cycles. RESULTS: After induction, the partial response (PR) was 73.1% and stable disease was 24.4%. Disease progressed in one patient. After RT and paclitaxel/gemcitabine, 22% achieved a complete response and 73% a PR, and 5% had disease progression. The median survival was 25 months, the 1-year survival rate was 73.2%, and the 2-year survival rate was 50.5%. During concomitant RT and chemotherapy, grade 3 neutropenia, thrombocytopenia, and anemia occurred in eight, three, and three patients, respectively, and grade 4 neutropenia and thrombocytopenia in one patient each. One patient developed an esophageal fistula and died shortly after, which was considered a grade 5 toxicity; one patient developed grade 4 interstitial pneumonitis, and three patients developed grade 3 esophagitis. CONCLUSION: This regimen appears to be effective and was well tolerated. Further studies using this approach are warranted in patients with stage III NSCLC.

Primary radiotherapy for tonsillar carcinoma: a good alternative to a surgical approach.

OBJECTIVES: To review the Notre-Dame hospital experience in the treatment of tonsillar carcinoma with primary radiotherapy and to evaluate the different factors affecting locoregional control (LRC) and survival. METHODS: We reviewed the records of 164 patients treated consecutively for squamous cell carcinoma of the tonsillar region between January 1990 and June 1999. Our study included 22 T1, 75 T2, 54 T3, and 12 T4 lesions; according to N stage, there were 48 N0, 50 N1, 51 N2, and 15 N3 disease. Overall staging was 6 stage I, 28 stage II, 62 stage III, and 67 stage IV disease. All patients received curative radiotherapy, and 31 patients received chemotherapy either prior to or during treatment with radiotherapy. No patient received surgery as a primary treatment modality. RESULTS: The median follow-up was 4.2 years for all patients and 5.4 years for alive patients. The overall LRC rate was 72% at 5 years. By T and N stage, local and regional control rates at 5 years were as follows: T1, 82%; T2, 74%; T3, 66%; T4, 65%; N0, 77%; N1, 83%; N2, 65%; and N3, 38%. Significant favourable prognostic factors for LRC on univariate analysis were N stage and global stage. On multivariate analysis, the single favourable prognostic factor was N stage. The overall survival (OS) rate was 57% at 5 years. By T and N stage, OS at 5 years was as follows: T1, 62%; T2, 67%; T3, 45%; T4, 22%; N0, 63%; N1, 70%; N2, 46%; and N3, 32%. Significant prognostic factors for OS on univariate analysis were T stage, N stage, and global stage. Favourable prognostic factors for OS on multivariate analysis were T stage and N stage. CONCLUSION: Lower N stage was a favourable prognostic factor for LRC and OS, whereas lower T stage was a favourable prognostic factor on OS. Our results compare favourably with other single-institution surgical series and justify the role of radiotherapy as a primary treatment modality in early tonsillar carcinoma. Concurrent chemotherapy and radiation therapy is currently our standard of care in advanced tonsillar carcinoma.

Retromolar trigone carcinoma treated by primary radiation therapy: an alternative to the primary surgical approach.

OBJECTIVES: To review our experience in the treatment of retromolar trigone carcinoma with radiotherapy as the primary modality and to evaluate the different factors affecting locoregional control and survival. DESIGN: We retrospectively examined 46 patients with squamous cell carcinoma of the retromolar trigone treated primarily with radiotherapy from January 1, 1973, to June 31, 2002. Four had T1, 21 had T2, 17 had T3, and 4 had T4 lesions; 25 had N0, 15 had N1, 5 had N2, and 1 had N3 disease. The overall stage was I in 3, II in 18, III in 18, and IV in 7 patients. All patients received conventional once-daily fraction radiotherapy as the primary modality of treatment. Three patients received chemotherapy. Overall survival, cause-specific survival, and locoregional control were estimated using the Kaplan-Meier method. Log-rank statistics were used to identify significant prognostic factors for overall survival and locoregional control. RESULTS: The median follow-up was 43 (range, 5-217) months overall and 78 (range, 26-188) months for living patients. The 5-year overall survival and cause-specific survival rates were 47% and 78%, respectively. Favorable prognostic factors for cause-specific survival were a lower tumor stage (univariate and multivariate analysis) and a lower nodal stage (multivariate analysis). The 5-year local control rate was 49% after radiotherapy and 67% after salvage surgery. The 5-year regional control rate was 88%. Favorable prognostic factors were a lower nodal stage and a lower overall stage (univariate analysis). The 5-year locoregional control rate for all patients was 42% after radiotherapy and 70% after salvage surgery. CONCLUSIONS: Given the surgical salvage rate in our series and previous published experience, radiation therapy can be used with curative intent for small retromolar trigone carcinomas (T1-T2 lesions). For advanced stages without bone invasion, consideration for concurrent chemotherapy and radiation therapy might increase previous historical locoregional and survival rates.

Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients.

PURPOSE: Many cancer patients take antioxidant vitamin supplements with the hope of improving the outcome of conventional therapies and of reducing the adverse effects of these treatments. A randomized trial was conducted to determine whether supplementation with antioxidant vitamins could reduce the occurrence and severity of acute adverse effects of radiation therapy and improve quality of life without compromising treatment efficacy. PATIENTS AND METHODS: We conducted a randomized, double-blind, placebo-controlled trial among 540 head and neck cancer patients treated with radiation therapy. Patients were randomly assigned into two arms. The supplementation with alpha-tocopherol (400 IU/d) and beta-carotene (30 mg/d) or placebos was administered during radiation therapy and for 3 years thereafter. During the course of the trial, supplementation with beta-carotene was discontinued because of ethical concerns. RESULTS: Patients randomly assigned in the supplement arm tended to have less severe acute adverse effects during radiation therapy (odds ratio [OR], 0.72; 95% CI, 0.52 to 1.02). The reduction was statistically significant when the supplementation combined alpha-tocopherol and beta-carotene for adverse effects to the larynx (OR, 0.38; 95% CI, 0.21 to 0.71) and overall at any site (OR, 0.38; 95% CI, 0.20 to 0.74). Quality of life was not improved by the supplementation. The rate of local recurrence of the head and neck tumor tended to be higher in the supplement arm of the trial (hazard ratio, 1.37; 95% CI, 0.93 to 2.02). CONCLUSION: Supplementation with high doses of alpha-tocopherol and beta-carotene during radiation therapy could reduce the severity of treatment adverse effects. However, this trial suggests that use of high doses of antioxidants as adjuvant therapy might compromise radiation treatment efficacy.

A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients.

BACKGROUND: Although low dietary intakes of antioxidant vitamins and minerals have been associated with higher risks of cancer, results of trials testing antioxidant supplementation for cancer chemoprevention have been equivocal. We assessed whether supplementation with antioxidant vitamins could reduce the incidence of second primary cancers among patients with head and neck cancer. METHODS: We conducted a multicenter, double-blind, placebo-controlled, randomized chemoprevention trial among 540 patients with stage I or II head and neck cancer treated by radiation therapy between October 1, 1994, and June 6, 2000. Supplementation with alpha-tocopherol (400 IU/day) and beta-carotene (30 mg/day) or placebo began on the first day of radiation therapy and continued for 3 years after the end of radiation therapy. In the course of the trial, beta-carotene supplementation was discontinued after 156 patients had enrolled because of ethical concerns. The remaining patients received alpha-tocopherol or placebo only. Survival was evaluated by Kaplan-Meier analysis. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). All statistical tests were two-sided. RESULTS: After a median follow-up of 52 months, second primary cancers and recurrences of the first tumor were diagnosed in 113 and 119 participants, respectively. The effect of supplementation on the incidence of second primary cancers varied over time. Compared with patients receiving placebo, patients receiving alpha-tocopherol supplements had a higher rate of second primary cancers during the supplementation period (HR = 2.88, 95% CI = 1.56 to 5.31) but a lower rate after supplementation was discontinued (HR = 0.41, 95% CI = 0.16 to 1.03). Similarly, the rate of having a recurrence or second primary cancer was higher during (HR = 1.86, 95% CI = 1.27 to 2.72) but lower after (HR = 0.71, 95% CI = 0.33 to 1.53) supplementation with alpha-tocopherol. The proportion of participants free of second primary cancer overall after 8 years of follow-up was similar in both arms. CONCLUSIONS: alpha-Tocopherol supplementation produced unexpected adverse effects on the occurrence of second primary cancers and on cancer-free survival.