ABSTRACT
INTRODUCTION: To report a single-institutional experience with the use of Superficial X-Ray Therapy (SXRT) for head and neck non-melanoma skin cancer (N-MSC) and to compare outcomes by prescribed fractionation schedules. MATERIALS AND METHODS: The medical records of 597 patients with 1021 lesions (720 BCC, 242 SCC, 59 SCC in situ) treated with kilovoltage radiation from 1979-2013 were retrospectively reviewed. The majority of patients were treated according to 1 of 3 institutional protocols based on the discretion of the radiation oncologist: 1) 22 x 2.5 Gy; 2) 20 x 2.5 Gy; 3) 30 x 2.0 Gy. "T" stage at first presentation was as follows: Tis (59); T1 (765); T2 (175); T3 (6), T4 (9); Tx, (7). All patients were clinical N0 and M0 at presentation. Chi-square test was used to evaluate any potential association between variables. The Kaplan-Meier method was used to analyze survival with the Log Rank test used for comparison. A Cox Regression analysis was performed for multivariate analysis. RESULTS: The median follow up was 44 months. No significant difference was observed among the 3 prescribed fractionation schemes (p = 0.78) in terms of RTOG toxicity. There were no failures among SCC in situ, 37 local failures (23 BCC, 14 SCC), 5 regional failures (all SCC) and 2 distant failures (both SCC). For BCC, the 5-year LC was 96% and the 10-year LC was 94%. For SCC the corresponding rates of local control were 92% and 87%, respectively (p = 0.03). The use of >2.0 Gy daily was significantly associated with improved LC on multivariate analysis (HR: 0.17; CI 95%: 0.05-0.59). CONCLUSION: SXRT for N-MSC of the head and neck is well tolerated, achieves excellent local control, and should continue to be recommended in the management of this disease. Fractionation schedules using >2.0 Gy daily appear to be associated with improved LC.
Subject(s)
Head and Neck Neoplasms/radiotherapy , Skin Neoplasms/radiotherapy , X-Ray Therapy , Adult , Aged , Dose Fractionation, Radiation , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment FailureABSTRACT
Patients with rapid-onset obesity, hypothalamic dysfunction, hypoventilation, autonomic dysregulation, and neural crest tumor syndrome have poor long-term outcomes. We report a patient who was treated successfully with high-dose cyclophosphamide immunoablation. This experience offers a novel therapeutic approach and an indirect insight into the underlying pathogenesis of this syndrome.
Subject(s)
Autonomic Nervous System Diseases/drug therapy , Cyclophosphamide/administration & dosage , Hypothalamic Diseases/drug therapy , Obesity Hypoventilation Syndrome/drug therapy , Obesity/drug therapy , Acute Disease , Adrenal Gland Neoplasms/complications , Adrenal Gland Neoplasms/diagnosis , Adrenal Gland Neoplasms/drug therapy , Autonomic Nervous System Diseases/complications , Autonomic Nervous System Diseases/diagnosis , Child, Preschool , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Hypothalamic Diseases/complications , Hypothalamic Diseases/diagnosis , Immunosuppressive Agents/administration & dosage , Obesity/complications , Obesity/diagnosis , Obesity Hypoventilation Syndrome/complications , Obesity Hypoventilation Syndrome/diagnosis , Pulse Therapy, Drug , Severity of Illness Index , Syndrome , Treatment OutcomeABSTRACT
OBJECTIVES: African-Caribbean men have a risk of prostate cancer comparable to that of African-American men. To begin exploring potential risk factors for prostate cancer in these high-risk black subgroups, we conducted a pilot study in Brooklyn, New York, a community with large numbers of African-Americans and immigrants from Jamaica and Haiti. METHODS: Black men, 35 to 65 years of age, who were born in the United States, Jamaica, or Haiti were recruited in Brooklyn. The subjects' serum samples were analyzed for prostate-specific antigen (PSA) and the following hormones, which may be related to prostate cancer: testosterone, sex hormone-binding globulin, 3alpha-androstanediol glucuronide, insulin-like growth factor-1 (IGF-1), and IGF-binding protein-3 (IGFBP-3). Subgroup differences in PSA and hormonal levels, adjusted for relevant covariates, were explored using analysis of variance techniques. RESULTS: For 3 months, we recruited 21 U.S.-born, 20 Jamaican-born, and 24 Haitian-born black men using various methods. The mean age-adjusted PSA level was 1.04 ng/mL in the U.S.-born men, 1.09 ng/mL in the Jamaican-born men, and 0.85 ng/mL in the Haitian-born men (P = 0.55). The mean age-adjusted hormone levels, as well as testosterone/sex hormone-binding globulin and IGF-1/IGFBP-3 ratios, also were not significantly different statistically across the subgroups. CONCLUSIONS: It is feasible to conduct epidemiologic studies of prostate cancer in these high-risk black subgroups in Brooklyn. Our preliminary data suggest that the serum levels of PSA and potential hormonal risk factors are similar among U.S.-born, Jamaican-born, and Haitian-born black men. Larger follow-up studies are being planned to confirm these findings.