Radiation therapy for angiosarcoma of the scalp: treatment outcomes of total scalp irradiation with X-rays and electrons.

BACKGROUND AND PURPOSE: Wide surgical excision is the standard treatment for angiosarcoma of the scalp, but many patients are inoperable. Therefore, we investigated the outcome of radiation therapy for angiosarcoma of the scalp. PATIENTS AND METHODS: Seventeen patients with angiosarcoma of the scalp underwent radiation therapy with total scalp irradiation. Four patients had cervical lymph node metastases, but none had distant metastases. A median initial dose of 50 Gy in 25 fractions was delivered to the entire scalp. Subsequently, local radiation boost to the tumor sites achieved a median total dose of 70 Gy in 35 fractions. RESULTS: Fourteen of the 17 patients developed recurrences during the median follow-up period of 14 months after radiation therapy; 7 had recurrences in the scalp, including primary tumor progression in 2 patients and new disease in 5, and 12 patients developed distant metastases. The primary progression-free, scalp relapse-free, and distant metastasis-free rates were 86, 67, and 38 % at 1 year and 86, 38, and 16 % at 3 years, respectively. Thirteen patients died; the overall and cause-specific survival rates were both 73 % at 1 year and 23 and 44 % at 3 years, respectively. The median survival time was 16 months. There were no therapy-related toxicities ≥ grade 3. CONCLUSION: Total scalp irradiation is safe and effective for local tumor control, but a dose of ≤ 50 Gy in conventional fractions may be insufficient to eradicate microscopic tumors. For gross tumors, a total dose of 70 Gy, and > 70 Gy for tumors with deep invasion, is recommended.

Long-term Outcomes of Early-stage Non-stomach Gastrointestinal Mucosa-associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy.

BACKGROUND/AIM: Non-stomach gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphoma is rare, and there are only a few reports regarding radiation therapy (RT) for non-stomach gastrointestinal MALT lymphoma. There has been no established cure and no reports on RT use with long-term follow-up. Herein, we report a retrospective long-term investigation of early-stage non-stomach gastrointestinal MALT lymphoma. Our aim was to evaluate whether RT is a valid treatment option for this disease. PATIENTS AND METHODS: We retrospectively analyzed 6 patients who were diagnosed with early-stage non-stomach gastrointestinal MALT lymphoma and received RT. The median age was 66 years (range=38-89 years). The primary tumor originated from the duodenum in 2 patients and from the rectum in 4 patients. The RT dose was 30-34 Gy in 15-20 fractions to the involved site or field, depending on the case. RESULTS: The median follow-up time was 89.5 months (range=6-170). All patients had complete remission within 3 months after RT. The 5-year overall survival and progression-free survival rates were 83.3% and 100%, respectively. During the observation period, no patient had a confirmed recurrence. One patient died of causes unrelated to cancer or treatment. There were no late toxicities by RT. CONCLUSION: Our results show good long-term local control and no late toxicities requiring treatment. Moderate-dose RT was appropriate and well tolerated for early-stage non-stomach gastrointestinal MALT lymphoma.

The role of radiation therapy for uterine cervical cancer with distant metastasis.

OBJECTIVE: We carried out a review to determine the role of radiation therapy in uterine cervical cancer with distant metastasis. METHODS: Forty-four patients with uterine cervical cancer with distant metastasis underwent radiation therapy; 29 of these also underwent chemotherapy. A total dose of 19.8-90.4 Gy (median 62.9 Gy) was delivered to the cervical tumors. RESULTS: Thirty-three patients died during the follow-up period of 1-94 months (median 10 months) after irradiation. The overall survival rate at 3 years was 20%, and the estimated median survival time was 15 months. Ten patients developed primary tumor progression, and the primary tumor control rate at 3 years was 49%. A distant metastatic site and primary tumor size were significant prognostic factors for their survival. Total radiation dose was considered a significant and useful variable for primary tumor control. With the exception of transient hematologic reactions and hemorrhagic cystitis, there were no therapy-related toxicities of grade 3 or greater. CONCLUSIONS: Radiation therapy was safe and effective for local control in patients with uterine cervical cancer with distant metastasis. More aggressive treatment, including radiation therapy with a curative radiation dose, should be considered for patients with favorable prognostic factors for survival.

Clinical evaluation of the effect of attenuation correction technique on 18F-fluoride PET images.

OBJECTIVE: The purpose of this study is to evaluate effect of attenuation correction technique on 18F-fluoride positron emission tomography (PET). METHODS: We performed PET scans after the injection of 185 MBq 18F-fluoride on 32 patients from October 20th, 2004 to April 13th, 2005. We calculated bone-to-muscle ratios for the images with and without attenuation correction. We placed regions of interest (ROIs) on normal bone accumulation in 22 patients. The exclusion criteria were bone metastasis, Paget's disease, and rheumatoid arthritis. Several regions were chosen for ROI placement: skull, cervical vertebra, mandible, scapula, thoracic vertebra, rib, humerus, lumbar vertebra, radius, ulna, pelvis, femoral head, femoral shaft, tibia, and fibula. The count ratios of normal bones to gluteus muscle were calculated as bone-to-muscle ratios. The count ratios of abnormal skeletal lesions to gluteus muscles were calculated as bone-to-muscle ratios, while the count ratios of abnormal skeletal lesions to normal bones were calculated as bone-to-bone ratios. RESULTS: PET images without attenuation correction showed significantly higher mean bone-to-muscle ratios than those with attenuation correction (p < 0.05) for all normal bones except the femoral head and lumbar vertebrae. For abnormal bones, bone-to-muscle ratios without attenuation correction were significantly higher than those with attenuation correction (p < 0.005). The same statistical significance was found for bone-to-bone ratios (p < 0.005). CONCLUSIONS: The attenuation correction technique is not necessary to conduct the visual interpretation of 18F-fluoride PET images. The bone-to-muscle ratio analysis without attenuation correction may be of use to differentiate malignant from benign disease processes.

CT assessment of breast cancer for pathological involvement of four or more axillary nodes.

BACKGROUND: To predict the likelihood of ≥4 pathologically positive axillary nodes in breast cancer patients by computed tomography (CT) before neoadjuvant chemotherapy (NAC). METHODS: Inclusion criteria for the 97 patients reviewed were lymph nodes (LNs) pathologically proved positive with standard level I-II axillary dissection, contrast-enhanced CT was performed before surgery, contralateral breast cancer was not present, and NAC was not given before surgery. The size, number, and level of both ipsilateral and contralateral axillary LNs were studied by contrast-enhanced high-resolution CT for pathologically positive LNs in breast cancer patients. RESULTS: Level III LN was only detected in ipsilateral axilla of patients with ≥4 pathologically involved nodes. The number of ipsilateral level I-II LNs is the only factor significantly related to the pathological involvement of ≥4 axillary nodes. Increasing numbers of contralateral level I-II LNs are significantly related to increasing numbers of ipsilateral level I-II LNs. For the criterion of maximal LN size ≥5 mm, if contralateral level I-II LNs were negative and the cutoff points for ipsilateral level I-II LNs were 0-2 and ≥3, the sensitivity and specificity for ≥4 pathologically involved nodes would be 84.6 and 73.3%. If contralateral I-II LNs were positive, the negative predictive value was 80.0%. CONCLUSION: Level III LN detection in ipsilateral axilla and the number of level I-II LNs in bilateral axilla will be helpful to predict ≥4 pathologically positive axillary nodes.

Role of radiotherapy as curative treatment of extramammary Paget's disease.

PURPOSE: Extramammary Paget's disease (EMPD) is a relatively rare malignancy that usually arises in the genital areas. Wide surgical excision remains the standard and most reliable curative treatment of EMPD. However, surgery is sometimes not possible, because many patients are elderly, and complete excision can be difficult owing to the tumor location. We, therefore, performed a review to determine the role of radiotherapy (RT) for EMPD. METHODS AND MATERIALS: A total of 22 patients with EMPD in their external genitalia (4 men and 18 women, age 52-94 years at RT) underwent RT with curative intent. Nine patients had regional lymph node metastases. A total dose of 45-70.2 Gy (median, 60) was delivered to the pelvis, including the tumors, in 25-39 fractions (median, 33). RESULTS: In all but 3 patients, the irradiated tumors were controlled during a follow-up period of 8-133 months (median, 42). Of the 22 patients, 13 developed recurrences, including local progression within the radiation field in 3 and lymph node and/or distant metastases outside the radiation field in 10, at 3-43 months after treatment. The 2- and 5-year local progression-free rates were 91% and 84%, respectively. Of the 22 patients, 7 patients had died at 33-73 months after RT. The cause of death was tumor progression in 4, infectious pneumonia in 2, and renal failure in 1 patient. The overall and cause-specific survival rates were 100% for both at 2 years and 53% and 73% at 5 years, respectively. No therapy-related Grade 3 or greater toxicity was observed. CONCLUSIONS: RT is safe and effective for patients with EMPD. It appears to contribute to prolonged survival as a result of good tumor control.

Treatment effects and sequelae of radiation therapy for orbital mucosa-associated lymphoid tissue lymphoma.

PURPOSE: Among extranodal lymphomas, orbital mucosa-associated lymphoid tissue (MALT) lymphoma is a relatively rare presentation. We performed a review to ascertain treatment efficacy and toxicity of radiation therapy for orbital MALT lymphoma. We also evaluated changes in visual acuity after irradiation. METHODS AND MATERIALS: Thirty patients with orbital MALT lymphoma underwent radiation therapy with curative intent. Clinical stages at diagnosis were stage IEA in 29 patients and stage IIEA in 1 patient. Total doses of 28.8 to 45.8 Gy (median, 30 Gy) in 15 to 26 fractions (median, 16 fractions) were delivered to the tumors. RESULTS: All irradiated tumors were controlled during the follow-up period of 2 to 157 months (median, 35 months) after treatment. Two patients had relapses that arose in the cervical lymph node and the ipsilateral palpebral conjunctiva outside the radiation field at 15 and 67 months after treatment, respectively. The 5-year local progression-free and relapse-free rates were 100% and 96%, respectively. All 30 patients are presently alive; the overall and relapse-free survival rates at 5 years were 100% and 96%, respectively. Although 5 patients developed cataracts of grade 2 at 8 to 45 months after irradiation, they underwent intraocular lens implantation, and their eyesight recovered. Additionally, there was no marked deterioration in the visual acuity of patients due to irradiation, with the exception of cataracts. No therapy-related toxicity of grade 3 or greater was observed. CONCLUSIONS: Radiation therapy was effective and safe for patients with orbital MALT lymphoma. Although some patients developed cataracts after irradiation, visual acuity was well preserved.

F-18 FDG PET/CT evaluation of radiotherapy response in rare case of mucosa-associated lymphoid tissue lymphoma.

We experienced two cases of mucosa-associated lymphoid tissue (MALT) lymphoma arising at unusual locations and used F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to evaluate their response to radiation therapy (RT). A 62-year-old male with proven prostatic MALT lymphoma and a 43-year-old woman with proven duodenal MALT lymphoma had diffuse FDG uptake in the lesion. Both cases were treated with RT; following FDG, PET/CT showed decreased FDG uptake in each lesion. Neither patient had evidence of recurrence at more than 18 months after RT. FDG PET/CT is useful for indicating the treatment site in MALT lymphoma and in evaluation of therapeutic response following RT.