Evaluation of time, attendance of medical staff and resources for radiotherapy in pediatric and adolescent patients. The DEGRO-QUIRO trial.

BACKGROUND: The German Society of Radiation Oncology (DEGRO) initiated a multicenter trial to develop and evaluate adequate modules to assert core procedures in radiotherapy. The aim of this prospective evaluation was to methodical assess the required resources for radiotherapy in pediatric and adolescent patients. MATERIAL AND METHODS: At three radiotherapy centers of excellence (University Hospitals of Heidelberg and Münster, the Medical School of Hannover), the manpower and time required for radiotherapy in pediatric and adolescent patients was prospectively documented consistently over a 2-year period. The data were collected using specifically developed standard forms and were evaluated using specific process analysis tools. RESULTS: A total number of 1914 data sets were documented and carefully analyzed. The personnel time requirements for all occupational groups were calculated as total time needed for a specific procedure and mean time per person. Regarding radiotherapy in general anesthesia, the required manpower was higher. The personnel time requirements in these cases were also longer, mainly due to longer room occupancy. Overall, the required resources were remarkably similar between the three different departments and may, therefore, be considered as representative. CONCLUSION: For the first time, the personnel time requirements of a radiotherapy department for the maintenance, protection, and optimization of operational readiness for radiotherapy in pediatric and adolescent patients with and without general anesthesia were determined methodically.

Low skeletal muscle mass is predictive of dose-limiting toxicities in head and neck cancer patients undergoing low-dose weekly cisplatin chemoradiotherapy.

BACKGROUND: The dose-limiting effect of CT-assessed low skeletal muscle mass (LSMM) measured at the level of the third cervical vertebra has been found in head and neck cancer patients receiving high-dose cisplatin chemoradiotherapy. The aim of this study was to investigate the predictive factors for dose-limiting toxicities (DLTs) using low-dose weekly chemoradiotherapy. MATERIALS AND METHODS: Head and neck cancer patients receiving definite chemoradiotherapy with weekly 40 mg/m2 body surface area (BSA) cisplatin or paclitaxel 45 mg/m2 BSA and carboplatin AUC2 were consecutively included and retrospectively analysed. Skeletal muscle mass was assessed using the muscle surface at the level of the third cervical vertebra in pretherapeutic CT scans. After stratification for LSMM DLT, acute toxicities and feeding status during the treatment were examined. RESULTS: Dose-limiting toxicity was significantly higher in patients with LSMM receiving cisplatin weekly chemoradiotherapy. For paclitaxel/carboplatin, no significance regarding DLT and LSMM could be found. Patients with LSMM had significantly more dysphagia before treatment, although feeding tube placement before treatment was equal in patients with and without LSMM. CONCLUSIONS: LSMM is a predictive factor for DLT in head and neck patients treated with low-dose weekly chemoradiotherapy with cisplatin. For paclitaxel/carboplatin, further research must be carried out.

Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases.

BACKGROUND: Recently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information. METHODS: From 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months. RESULTS: At 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival. CONCLUSIONS: Moderate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information.

Comparison of avascular lymph node fragment transplantation techniques to optimize lymphangiogenesis in the minipig model.

BACKGROUND: Secondary lymphoedema is a challenging pandemic. This condition may arise after oncologic resection of tumor-draining lymph nodes and/or radiation. Plastic-surgical procedures for lymphoedema comprise transplantation of vascularized lymph node flaps, which are, however, technically challenging and difficult to implement on a global level due to the scarcity of microsurgery facilities in some countries. To improve this situation, comparative research in valid animal models is needed. METHODS: A total of 33 minipigs were subjected to lymphatic resection in the hind limbs. This large animal model was used in a first phase to compare different lymph node fragmentation methods and assess lymphatic regeneration after avascular transplantation. In a second phase, several stimulants were tested for their effect on lymphatic regeneration after fragment transplantation. In a third phase, animals additionally received irradiation of the groin. In this novel animal model, autologous avascular lymph node fragment transplantation was complemented by peripheral injections of vascular endothelial growth factor-C (VEGF-C). Finally, regeneration rates were quantified in relative numbers (percentage) in the irradiated tissue. RESULTS: In the first phase, transversal lymph node fragmentation under preservation of the nodal capsule showed the best percentage of regeneration (62.5%). Peripheral intradermal administration of VEGF-C enhanced lymph node fragment regeneration (70.8%) better than injections of tetanus toxoid (41.6%) or Streptococcus suis (62.5%). Lymph node fragment regeneration also occurred in an irradiated porcine model of lymphadenectomy under VEGF-C administration (66.6%). CONCLUSIONS: The present findings provide a pre-clinical proof-of-concept for a possible simplification strategy for current operative procedures of autologous lymph node transplantation.Level of evidence : Not gradable.

Lessons learned after one year of COVID-19 from a urologist and radiotherapist view: A German survey on prostate cancer diagnosis and treatment.

INTRODUCTION: Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines. MATERIALS AND METHODS: To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses. RESULTS: A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate. CONCLUSION: While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.

Radiotherapy of splenomegaly : a palliative treatment option for a benign phenomenon in malignant diseases.

PURPOSE: Since the 20(th) century, radiotherapy (RT) has been used for treatment of symptomatic splenomegaly (SM). SM occurs in association with hematologic disorders. The purpose of this analysis was to determine the indication, treatment concepts, and efficiency of RT. MATERIAL AND METHODS: Clinical features, treatment concepts, and outcome data during the past 20 years were analyzed. Endpoints were pain relief, symptomatic and hematological response, and treatment-related side effects. RESULTS: From 1989-2009, a total of 122 patients received 246 RT courses because of symptomatic SM. Overall 31 patients had chronic myelogenous leukemia (CML), 37 had chronic lymphocytic leukemia (CLL), 23 had osteomyelofibrosis (OMF), 17 had polycythemia vera (PV), 5 had acute myelogenous leukemia, 4 had idiopathic thrombocytopenic purpura (ITP), 3 had non-Hodgkin lymphoma (NHL), and 2 had multiple myeloma (MM). Patients were treated with (60)Co gamma rays or 5-15MV photons. The fraction size ranged from 10-200 cGy and the total dose per treatment course from 30-1600 cGy. Significant pain relief was achieved for 74.8% of the RT courses given for splenic pain. At least 50% regression was attained for 77% of the RT courses given for SM. 36 patients died within 2 months due to the terminal nature of their disease. Of the RT courses applied for cytopenia, 73.6% achieved a significant improvement of hematological parameters and reduction of transfusion need. Notable hematologic toxicities were reported < EORTC/RTOG II°. CONCLUSION: The present analysis documents the efficacy of RT. In addition, RT as a palliative treatment option for symptomatic SM should not be forgotten.

[The significance of radiation therapy for symptomatic vertebral hemangiomas (SVH)]. / Der Stellenwert der Strahlentherapie bei symptomatischen Wirbelkörperhämangiomen (sWKH).

PURPOSE: To evaluate the efficacy of radiation therapy (RT) for symptomatic vertebral hemangioma (SVH). MATERIAL AND METHODS: Based on the Registry for Rare Benign Disorders (RRBD) of the German Cooperative Group on Radiation Therapy for Benign Diseases (GCG-BD), the clinical information, treatment plans and outcome data from seven cooperating German RT institutions were analyzed retrospectively. RESULTS: Over a period of 39 years (1969-2008), a total of 84 patients with 96 symptomatic lesions underwent RT. The predominant indication was pain in 97.6%, and, in addition, 28.6% of patients had neurological deficits. The median total dose was 34 Gy (4.5-45 Gy), and the median single dose 2.0 Gy (0.5-3.0 Gy). After a median follow-up of 68 months (6-422 months), complete symptom relief (CR) occurred in 61.9% of patients, 28.6% had partial relief, and 9.5% had no relief (NR). The overall response rate (CR + PR) was 90.5%. In 26.2% of patients, radiologic signs of remineralization were noted. After a median follow-up of 70 months (8-124 months), symptom progression occurred in eight patients (9.5%). Therefore, the long-term rate of local control was 80.9%. Multivariate statistical analysis revealed a significantly higher rate of symptom relief and local control for total doses > or = 34 Gy. Side effects > RTOG/EORTC grade 2 were not observed. CONCLUSION: RT is a safe and effective for treatment of SVH. Total doses of at least 34 Gy are recommended to achieve optimal treatment response.

Effects of radiotherapy for brain metastases on quality of life (QoL). Prospective pilot study of the DEGRO QoL working party.

BACKGROUND: Prospective data on quality-of-life (QoL) effects of radiotherapy for brain metastases are currently lacking, but would be of great interest to guide therapeutic decisions. PATIENTS AND METHODS: From 01/2007 to 08/2007, 46 patients with previously untreated brain metastases were recruited at eight centers. QoL was measured at start of treatment (T(0)) and at 3 months (T(3mo)). In the pilot study, two combinations of QoL instruments could be used at the discretion of the centers (A: EORTC QLQ-C30 and B: EORTC QLQ-C15-PAL both with brain module BN20, assessment by proxies with A: Palliative Care Outcome Scale, B: self-constructed brain-specific instrument). RESULTS: All patients received whole-brain radiotherapy, four with an additional boost irradiation. At T(3mo), 26/46 patients (56.5%) had died. 17/20 survivors (85%) completed the questionnaires. In 3-month survivors, QoL deteriorated in most domains, significant in drowsiness, hair loss and weakness of legs. The scores for headaches and seizures were slightly better after 3 months. Assessment by proxies also suggested worsening of QoL. Initial QoL at T(0) was better in those alive than in those deceased at T(3mo), significant for physical function and for the symptom scales of fatigue and pain, motor dysfunction, communication deficit and weakness of legs. CONCLUSION: Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival.

Frequency and risk factors for arm lymphedema after multimodal breast-conserving treatment of nodal positive breast Cancer - a long-term observation.

BACKGROUND: Arm-lymphedema is a major complication after breast cancer. Recent studies demonstrate the validity of predicting Breast Cancer Related Lymphedema (BCRL) by self-reports. We aimed to investigate the rate of BCRL and its risk factors in the long-term using self-reported symptoms. METHODS: Data was collected from 385 patients who underwent multimodal therapy for nodal positive breast cancer, including breast conserving surgery, axillary dissection, and local or locoregional radiotherapy. Two validated questionnaires were used for the survey of BCRL (i.e. LBCQ-D and SDBC-D). These were analysed collectively with retrospective data of our medical records. RESULTS: 23.5% (n = 43) suffered a permanent BCRL (stage II-III) after a median follow-up time of 10.1 years (4.9-15.9 years); further 11.5% (n = 23) reported at least one episode of reversible BCRL (Stage 0-I) during the follow-up time. 87.1% of the patients with lymphedema developed this condition in the first two years. Adjuvant chemotherapy was a significant risk factor for the appearance of BCRL (p = 0.001; 95%-CI 7.7-10.2). CONCLUSIONS: Breast cancer survivors face a high risk of BCRL, particularly if axillary dissection was carried out. Almost 90% of BCRL occurred during the first two years after radiotherapy. Self-report of symptoms seems to be a suitable instrument of early detection of BCRL.

Definitive conformal radiotherapy for localized high-risk prostate cancer: a long-term follow-up study with PSA course.

BACKGROUND: The present study investigated the long-term outcome of patients with localized high-risk prostate cancer after definitive conformal radiotherapy. PATIENTS AND METHODS: Ninety-one consecutive patients with stage T1-T4 prostatic carcinoma were treated from 1996 through 2000. Each patient had at least one of the following risk factors: stage > T2b (UICC 1997; 55 patients), Gleason score > 7 (24 patients), or pre-treatment PSA > 20 ng/mL (40 patients). All patients received a conformal radiotherapy of the prostate (median dose, 70 Gy), eighty-three patients (91%) combined with temporary androgen deprivation (median duration, 4 months). All patients were followed continuously during a median of 5.2 years (range, 0.9 to 8.8 years). Biochemical failure after irradiation was defined as a PSA greater than 0.4 ng/mL and three consecutive serum PSA elevations. RESULTS: The 5- and 7-year overall survival rates were 86% and 74%, respectively. The 5- and 7-year biochemical disease-free survival (bDFS) rates were 78% and 66% respectively. The most important predictors of bDFS were Gleason score and central axis dose of 70 Gy or higher. PSA nadir (median, 0.1 ng/mL) was not predictive of subsequent biochemical disease-free survival. CONCLUSION: Our study confirms the findings of others and encourages us to proceed with this treatment policy for T1-T4 high-risk prostate cancer modified by using higher doses and long-term androgen deprivation.

Cortisol as a possible marker of metastatic adrenocortical carcinoma: a case report with 3-year follow-up.

BACKGROUND: Adrenocortical carcinoma (ACC) is a rare tumour, sometimes causing glucocorticoid hypersecretion. Treatment guidelines have not been established, but are currently under investigation. CASE REPORT: A 55-year-old Caucasian woman presented with adrenal Cushing's disease. Histological examination after a left adrenalectomy revealed a benign tumour. Postoperatively, elevated serum cortisol levels normalized. Hypercortisolism occurred again two years later. Diagnostic work-up revealed hepatic metastatic lesions of an ACC which were treated by right hemihepatectomy. Initial histological diagnosis was revised according to the increased proliferative changes. Postoperatively, cortisol declined to normal levels. Treatment with mitotane (o, p'-DDD) as a cytostatic agent was not tolerated. One year later, the patient was diagnosed with a solitary osseous metastasis at the left side of the sacrum because of back pain. Following curettage and stabilization, radiotherapy of this region with 37.5 Gy was performed, improving slightly elevated cortisol levels and neurological symptoms. CONCLUSION: Careful clinical and radiographic follow-up of patients with ACC are important. In this case of oligometastasizing ACC, serum cortisol values correlated with the clinical course. An aggressive multimodal treatment, including repeated surgical approach with consolidating radiotherapy in cases of incomplete resection, might be indicated to provide symptom control and possible long-term survival in oligometastatic disease of ACC.

Small cell cancer of the anal canal--case report of a rare tumor.

BACKGROUND: We report on a rare case of small cell cancer located at the anal canal. CASE REPORT: A 41-year old woman presented with locally advanced small cell anal cancer and simultaneous hepatic and pulmonal deposits. Due to metastatic disease, chemotherapy with etoposide and cisplatin was performed with mixed response after four cycles of chemotherapy. After application of two additional chemotherapy cycles, locally progressive disease occurred causing symptomatic bowel obstruction. Pelvic irradiation was started and, several days later, additional irradiation of cerebral metastases was initiated due to rapid progression of distant disease. Despite adequate local treatment the patient's condition further deteriorated and irradiation was stopped. The patient died 10 months after initial diagnosis due to rapid tumor progression. CONCLUSION: In patients with metastatic small cell anal cancer chemotherapy remains the mainstay of therapy. Radiotherapy exerts additional activity and remains a prime choice to gain local control and ameliorate symptoms. Careful histopathological examination, together with immunohistochemistry, is needed to determine the therapeutic strategy to be followed.

Influence of amifostine on late radiation-toxicity in head and neck cancer--a follow-up study.

AIM: The late toxicities due to multimodal therapy of advanced head and neck cancers were analysed. The impact of cytoprotection with amifostine is the specific objective of this report. PATIENTS AND METHODS: A total of 851 patients (717 men, 134 women) with head and neck cancer were included in this prospective study. Of these patients, 519/851 had received amifostine before radio(chemo)therapy, while 332 control patients had not received any kind of cytoprotection before irradiation. Primary radiochemotherapy was performed in 282 patients and adjuvant radiation was administered in 569. The follow-up examination was carried out at our outpatient department 21.4 months (median, range 2.3 to 149 months) after the primary therapy. RESULTS: Late xerostomia was seen in 765/851 patients (89.9%). Altered taste was reported by 284/851 (33.5%). These symptoms were reduced significantly by amifostine. No influence was seen on interstitial lymph edema (48.4%), or stenosis of the cervical esophagus (20.4%). Secondary symptoms such as dysphagia (78.8%) also had a trend for reduction. CONCLUSION: The administration of amifostine offers an opportunity to reduce selected long-term toxicities for survivors of head and neck cancer.

Zinc concentrations in serum during head and neck cancer progression.

UNLABELLED: Reduced serum-zinc concentrations are well known as typical laboratory characteristics in advanced head and neck cancer. Our aim was to follow the development of this phenomenon during the disease. PATIENTS AND METHODS: A total of 21 patients were included in this pilot-study (1 female, 20 male). The median age was 64 years, range 43-80 years. The following tumour localizations were registered: 11 larynx, 4 oropharynx, 2 hypopharynx and 4 other. Serum zinc levels were registered at baseline and during the follow-up investigations using flame atomic absorption spectrometry. RESULTS: The median follow-up time was 17 months, range 6-43 months. During the follow-up, 9/21 patients died tumour-dependently, 2 patients were living with cancer, 8 patients showed NED, and a further 2 patients died of non-cancer related causes. The zinc concentration decreased from 0.76 mmol/l (0.48-1.07 mmol/l) to 0.55 mmol/l (0.32-1.01 mmol/l). Nine of 11 patients with cancer developed extremely low serum zinc concentration 4-6 weeks before dying. CONCLUSION: The serum zinc concentration may be a marker for definitive palliative situations in head and neck cancer patients.

Clinical Value of Squamous Cell Carcinoma Antigen (SCCAg) in Anal Cancer - A Single-Center Retrospective Analysis.

AIM: To assess the clinical value of squamous cell carcinoma antigen (SCCAg) in anal cancer for chemoradiotherapy (CRT) patients. PATIENTS AND METHODS: In 24 patients with SCC of the anus, SCCAg was determined before CRT and at every follow-up visit. RESULTS: 16/24 (66.7%) had normal SCCAg and 11/16 (68.8%) achieved complete remission (CR), while 7/8 (87.5%) with elevated SCCAg achieved CR. In two patients, elevated SCCAg was observed after radiotherapy. One was false-positive and one was true-positive leading to diagnosis of metachronous recurrent and metastatic disease after interim CR. CONCLUSION: SCCAg was inappropriate to predict the clinical outcome but can provide additional information on the regular follow-up examinations to detect a relapse.

No predictive value of beta-hCG in patients with stage I seminoma--results of a long-term follow-up study after adjuvant radiotherapy.

BACKGROUND: Radical inguinal orchiectomy followed by adjuvant para-aortic radiotherapy has been the standard treatment in stage I seminoma. We have reviewed our experience with reduced total doses (less than 26 Gy) in stage I seminoma to investigate if patients with an elevated beta-human chorionic gonadotropin (beta-hCG) level before orchiectomy possibly require higher total doses of adjuvant radiotherapy (RT). PATIENTS AND METHODS: Two hundred and sixty-seven consecutive patients, with newly diagnosed pure seminoma of the testis, were treated with adjuvant RT between 1992 and 2000. All patients had stage I disease. Serum AFP and beta-hCG levels were analyzed prior to and after orchiectomy in case of an elevated beta-hCG level. The measurements were repeated after RT in routine follow-up at regular intervals. Serum beta-hCG was considered as elevated if the values exceeded the normal range (up to 5 U/L). A median total dose of 25.2 Gy (range, 19.8 to 26.0 Gy) was applied to the para-aortic region. RESULTS: Fourteen patients were excluded from this analysis because beta-hCG measurement was not available. Nineteen of the remaining 253 patients (7.5%) had an elevated serum beta-hCG, which returned to normal post-operatively by the start of adjuvant radiotherapy. Median serum beta-hCG level before orchiectomy was 27.7 U/L (range, 5.1 to 420 U/L) in the group of patients with initial elevation of serum beta-hCG. This did not correlate with tumor size or rete testis invasion. After a median follow-up of 6.1 years (range, 3.0 to 11.2 years), 11 out of 267 (4.1%) patients had developed lymph node recurrence, resulting in an actuarial 5-year relapse-free survival of 96%. Median time to relapse was 19 months (range, 11 to 47 months) after RT. Only one relapsing patient initially had an elevated serum beta-hCG level of 34.1 U/L. This patient had nodal relapse within the mediastinum without renewed elevation of the serum beta-hCG level. CONCLUSION: An elevated pre-treatment beta-hCG level appears to have neither importance nor a predictive value in stage I seminoma. Therefore, we recommend the current adjuvant standard treatment without any modification for all beta-hCG-positive stage I seminoma.

The impact of squamous cell carcinoma (SCC) antigen in patients with advanced cancer of uterine cervix treated with (chemo-)radiotherapy.

The impact of squamous cell carcinoma antigen (SCC) in the follow-up of patients with advanced cervical cancer treated with (chemo-) radiotherapy in primary and postoperative settings was evaluated. One hundred and forty-one patients with histologically proven squamous cell carcinoma of the uterine cervix were treated at the department of radiotherapy and radiation oncology. The serum level of SCC before treatment was elevated in 72% of the patients (cut-off level: 2.0 ng/ml). The course of SCC levels during (chemo-)radiotherapy reflects the tumor response: those patients, who had no significant decline of tumor marker values, had a lower response rate and worse outcome (p<0.001). Patients with a SCC level below the median of 7.2 U/ml had a significantly better prognosis and a better treatment response than those above the median (p=0.001). After treatment, 98% of patients with complete remission and 87% of patients with partial remission had a serum level below the cut-off In the case of recurrent disease, 82% of patients had a significant increase of SCC serum levels (p <0.001) before clinical manifestation of relapse. The lead- time ranged between one and 16 months (median: 4.5 months). We concluded that SCC is an essential tumor marker for monitoring treatment response and detecting recurrences in patients with squamous cell carcinoma of the uterine cervix undergoing (chemo-) radiotherapy. In this retrospective analysis, the value of SCC correlated with prognosis in patients with carcinoma of the cervix treated with (chemo-)radiotherapy.

Tumor markers and lymphatic metastasis in head and neck cancer patients.

OBJECTIVE: This study was conducted to evaluate the relationship between the lymph node status and tumor marker status in patients with histologically confirmed head and neck cancer. MATERIALS AND METHODS: 134 patients were included in this retrospective analysis. 33/134 were classified as NO and 101/134 as N+. The wall of the lymph node was ruptured by the metastasis in 70/134 patients (poor prognosis). We analyzed the sensitivity of squamous cell carcinoma antigen (SCC), carcinoembryotic antigen (CEA) and CYFRA 21-1 in the total population and in the subgroups. RESULTS: We observed elevated SCC levels in 21.6%, CEA levels in 23.9% and CYFRA 21-1 levels in 50.0% of all patients. If there was no lymphatic metastasis, the SCC sensitivity was 15.1%, the CEA sensitivity was 21.2% and the CYFRA 21-1 sensitivity was 36.4%. Lymph node-positive disease had increased SCC levels in 23.8% of the patients, increased CEA levels in 24.8% and increased CYFRA 21-1 levels in 54.5%. The subgroup of patients with ruptured lymph nodes had the following sensitivities: SCC 18.6% CEA 8.6%, and CYFRA 21-1 50.0%. CONCLUSION: No significant relationship between the lymph node metastasis and the elevation of tumor markers in patients with advanced head and neck cancer was found.

Results and follow-up of locally advanced cancer of the exocrine pancreas treated with radiochemotherapy.

UNLABELLED: In locally advanced carcinoma of the exocrine pancreas combined radiochemotherapy has been established as a standard treatment. MATERIALS AND METHODS: Two different treatment schemes have been consecutively used. Between 1/1994 and 12/2001, a total of 110 patients with locally advanced adenocarcinoma of the pancreas were treated with hyperfractionated accelerated radiotherapy to a total dose of 44.8 Gy combined with 5-fluorouracil (5-FU) (600 mg/m2) and folinic acid (FA) (300 mg/m2) injection. Chemotherapy was repeated monthly in non-progressive disease. From 1/2002 to 11/2003, in another 15 consecutive patients, chemotherapy was changed to gemcitabine (Gem) (300 mg/m2) and cisplatinum (Cis) (30 mg/m2), followed by gemcitabine (1000 mg/m2) every 2 weeks in non-progressive patients. RESULTS: Median survival in the 5-FU/FA group was 10.3 months with a 1-year survival of 46.6% and a 2-year survival of 20.1%. Median time to progression was 8.6 months. Treatment was well tolerated with nausea/vomiting grade I/II in 58.2%, grade III/IV in 14.5%, diarrhea grade I/II in 27.3%, leucopenia/thrombopenia grade I/II in 21.8%, grade III/IV in 7.2%, and mucositis grade III/IV in 7.2%. In the Gem/Cis group, median survival was 13.8 months with a 1-year survival of 54.9% and a 2-year survival of 24.4%. The toxicity data also revealed comparable feasibility: nausea/vomiting grade I/II in 46.7%, grade III/IV in 20%, diarrhea grade I/II in 20%, leucopenia/thrombopenia grade I/II in 26. 7%, and grade III/IV in 13.3%. CONCLUSION: Radiochemotherapy in locally advanced pancreatic cancer is an effective and well-tolerated treatment. The long-term efficacy concerning survival is limited. The integration of predictive factors and new chemotherapeutic agents like gemcitabine in the multimodality treatment may give a more promising perspective. Because of the narrow therapeutic index of gemcitabine-based radiochemotherapy schemes, a feasible combination of radiotherapy treatment volume and gemcitabine dose must be found.