Efficacy of Dose-Escalated Radiotherapy for Recurrent Colorectal Cancer

PURPOSE: This study aimed to evaluate the effects of radiotherapy (RT) on progression-free survival (PFS) for patients with recurrent colorectal cancer. METHODS: We reviewed the records of 22 patients with recurrent colorectal cancer treated with RT between 2008 and 2014. The median radiation dose for recurrent disease was 57.6 Gy (range, 45-75.6 Gy). Patients were divided into 2 groups according to the type of RT: patients underwent RT without previous history of irradiation (n = 14) and those treated with secondary RT (reirradiation: n = 8) at the time of recurrence. RESULTS: The median follow-up period was 24.9 months (range, 4.5-66.6 months). Progression was observed in 14 patients (including 8 with loco-regional failure and 9 with distant metastases). Distant metastases were related to the RT dose (<70 Gy, P = 0.031). The 2-year loco-regional control (LRC), PFS, and overall survival (OS) rates were 74.6%, 45.1%, and 82.0%, respectively. The LRC rate was not different between the patients treated with RT for the first time and those treated with reirradiation (P = 0.101, 2-year LRC 79.5% vs. 41.7%). However, reirradiation was related to poor PFS (P = 0.022) and OS (P = 0.002). An escalated RT dose (≥70 Gy) was associated with a higher PFS (P = 0.014, 2-year PFS 63.5% vs. 20.8%). CONCLUSION: Salvage RT for locally recurrent colorectal cancer can be offered when surgery is impossible. Dose-escalated RT shows a possible benefit in reducing the risk of progression.

Postoperative Radiotherapy in the Rectal Cancers Patterns of Care Study for the Years of 1998~1999 / 대한방사선종양학회지

PURPOSE: To conduct a nationwide survey on the principles in radiotherapy for rectal cancer, and produce a database of Korean Patterns of Care Study. MATERIASL AND METHODS: We developed web-based Patterns of Care Study system and a national survey was conducted using random sampling based on power allocation methods. Eligible patients were who had postoperative radiotherapy for rectal cancer without gross residual tumor after surgical resection and without previous history of other cancer and radiotherapy to pelvis. Data of patients were inputted to the web based PCS system by each investigators in 19 institutions. RESULTS: Informations on 309 patients with rectal cancer who received radiotherapy between 1998 and 1999 were collected. Male to female ratio was 59 : 41, and the most common location of tumor was lower rectum (46%). Preoperative CEA was checked in 79% of cases and its value was higher than 6 ng/ml in 32%. Pathologic stage were I in 1.6%, II in 32%, III in 63%, and IV in 1.6%. Low anterior resection was the most common type of surgery and complete resection was performed in 95% of cases. Distal resection margin was less than 2 cm in 30%, and number of lymph node dissected was less than 12 in 31%. Chemotherapy was performed in 91% and most common regimen was 5-FU and leucovorine (69%). The most common type of field arrangement used for the initial pelvic field was the four field box (Posterior-Right-Left) technique (65.0%), and there was no AP-PA parallel opposing field used. Patient position was prone in 81.2%, and the boost field was used in 61.8%. To displace bowel outward, pressure modulating devices or bladder filling was used in 40.1%. Radiation dose was prescribed to isocenter in 45.3% and to isodose line in 123 cases (39.8%). Percent delivered dose over 90% was achieved in 92.9%. CONCLUSION: We could find the Patterns of Care for the radiotherapy in Korean rectal cancer patients was similar to that of US national survey. The type of surgery and the regimen of chemotherapy were variable according to institutions and the variations of radiation dose and field arrangement were within acceptable range.

Regulation of Apoptosis and Cell Cycle in Irradiated Mouse Brain / 대한방사선종양학회지

PURPOSE: To investigate the regulation of apoptosis and cell cycle in mouse brain irradiation. MATERIALS AND METHODS: 8-week old male mice, C57B1/6J were given whole body gamma-radiation with a single dose of 25 Gy using Cobalt 60 irradiator. At different times 1, 2, 4, 8 and 24hr after irradiation, mice were killed and brain tissues were collected. Apoptotic cells were scored by TUNEL assay. Expression of p53, Bcl-2, and Bax and cell cycle regulating molecules; cyclins B1, D1, E and cdk2, cdk4, p34cdc2 were analysed by Western blotting. Cell cycle was analysed by Flow cytometry. RESULTS: The peak of radiation induced apoptosis is shown at 8 hour after radiation. With a single 25 Gy irradiation, the peak of apoptotic index in C57B1/6J is 24.0+/-0.25 (p<0.05) at 8 hour after radiation. Radiation upregulated the expression of p53/tubulin, Bax/tubulin, and Bcl-2/tubulin with 1.3, 1.1 and 1.45 fold increase, respectively were shown at the peak level at 8 hour after radiation. The levels of cell cycle regulating molecules after radiation are not changed significantly except cyclin D1 with 1.3 fold increase. Fractions of Go-G1, G2-M and S phase in the cell cycle does not specific changes by time. CONCLUSIONS: In mouse brain tissue, radiation induced apoptosis is particularly shown in a specific area, subependyma. These results and lack of radiation induced changes in cell cycle offer better understanding of radiation response of normal brain tissue.

Radiation Results and Survival Rate of Small Cell Lung Cancer / 대한치료방사선과학회지

PURPOSE: To improve treatment modality and results by analysis of clinical characteristics. local control, survival and resurrence rate in limited stage small cell lung cancer. METHODS AND MATERIALS : 26 patients with limited stage small cell lung cancer were treated with combined radiation and chemotherapy from Feb. 1986 to Dec. 1992 at the National Medical Center. We followed up on 21 patients (81%) , who were mostly irradiated with 4,000-5,000cGy (75% of all patients) in the results by the analysis retrospectively. Survival rate was evaluated by the Kaplan-Meier method. RESULTS: Mean survival of irradiated patients with limited small cell lung cancer was 12 months. 1-year and 2-year survival rate were 65.3% and 15.4%. Tumor response rate and median survival after combined chemotherapy and irradiation were the following ; 50% and 15 months of complete response, and 23% and 11 months of partial response respectively. Response rates by radiation dose were 66% for below 4,000cGy. 69% for between 4,000-5,000cGy and 86% for above 5,000cGy. 21 of all patients showed treatment failure(81%), which as appeared 9 of local failure.9 of distant failure and 3 of local and distant failure. CONCLUSION: Local response rate after induction chemotherapy alone in limited stage of small cell lung cancer was 54%. Furthermore it was increased to 73% after adding of radiation. We have to increase radiation dose above 5,000cGy and need to try new effective chemotherapy agents for the improvement of local control and survival rate and also will try concurrent chemoradiotherapy in near time.

Role of Radiotherapy in Unresectable Pancreatic Carcinoma / 대한치료방사선과학회지

From 1988 to 1991, nineteen patients with unresectable localized pancreatic carcinoma were treated with radiotherapy and/or hyperthermia or in combination with chemotherapy. Radiation dose of 4500-5000 cGy with or without additional 500-1000 cGy was administered over 5 to 6 weeks to the pancreatic tumor area using 10 MV linear accelerator. Five of 19 patients were given chemotherapy, either neoadjuvant or maintenance setting with FAM regimen (5-FU, adriamycin and mitomycin C), which was repeated every 4 weeks for one year or until progression. Symptomatic palliation was achieved in 17 among 19 patients (89%) and objective response(complete or partial response in CT finding) was achieved in 5 among 11 patients (45%). The median survival time was 9 months and one-year survival rate, 32%. Local-regional failure was documented in 10 among 13 patients(77%) and distant failures were found in the liver (3 patients) and carcinomatosis (2 patients). Prognostic significance of various factors such as age, sex, performance status, tumor location, stage, etc. were assessed. Any factors did net have the prognostic significance in univariate analysis. Treatment was well tolerated in most of the patients with only wild to moderate toxicity.

Management of rocoregional recurrent breast cancer / 대한암학회지

No abstract available.

Large Cell Carcinoma of the Lung: An analysis of clinical features and survival / 대한치료방사선과학회지

This is a retrospective review of 33 patients with large cell lung carcinoma treated at Yonsei University Cancer Center between Jan. 1985 and Dec. 1989. Of the thirty-three patients, twenty eight were men and five women. Median age was 59 years. Large cell undifferentiated carcinoma was the most common pathologic type, 78.8%. Twenty one of thirty three patients had far advanced diseases, stage IIIB-IV at the time of initial diagnosis. Pleural effusion was initially presented in 12 patients, and SVC syndrome appeared in 5 patients. As to location of the primary tumor, 19(57.6%) appeared in the right lung and 14 (42.4%) in the left. Patients with a centrally located primary tumor mass were nearly the same as those peripherally located (17 vs. 16). Fifteen of thirty three patients developed metastasis involving not only bone, brain, the opposite lung, adrenal gland but also soft tissue, skin, pancreas and appendix. Treatment was individualized with 19 treated radically and 14 palliatively. After treatment, only two patients showed a complete response. Long term survival was observed in 4 patients: 1 (24 mo.), 2 (41 mo.) and 1 (54 mo.). The overall 2 year survival rate was 14.3% while the median survival time was 6.0 months. Through the analysis of the various factors affecting survival, we observed that pleural effusion-absent group and complete response group had a statistical significant better survival rate (p<0.01).

Radiation Treatment for Primary Adenocarcinoma of Bartholin's Gland: A Case Report and Review of Literature / 대한치료방사선과학회지

A patient with primary adenocarcinoma of Bartholin's gland is reported and the literatures relevant to this disease reviewed. Not only this disease is very rare but also primary carcinomas of Bartholin's gland are misdiagnosed as cysts or abscesses in half of the cases, leading to considerable delay in diagnosis. And so, It was wasted long time before definitive therapy. However, because of a different clinical behavior, cancer of the Bartholin's gland should be distinguished from other vulvar carcinomas. Histologically, squamous cell carcinoma and adenocarcinoma are the most common. Virtually all histologic types of Bartholin's gland carcinoma metastasize to lymph node, bone, lung and liver in distant sites. The authors data and a review of the literature support the concept that radical vulvectomy with or without bilateral inguina1-femoral lymphadenectomy is required. On the other hand, except primary radiation treatment for small or medium sized cancers, the results obtained by radiation therapy in carcinoma of the vulva including Bartholin's gland are generally discouraging. A role for postoperative adjuvant radiation therapy suggests because of high incidence of positive inguinal-femoral lymph nodes. In the near time, natural history and biological behavior of Bartholin's gland cancer must be disclosed in detail. And also optimal treatment modality and prognostic factors shall be determine.

A Study of Relationship Between PPC(Probability of Primary Clearance: a multivariate modeling system predicting tumor clearance proposed by RTOG) and Survival in the Patients with Carcinoma of the Nasopharynx Following Radiation Therapy / 대한치료방사선과학회지

RTOG proposed a multivariate modeling system predicting the response of head and neck cancers to radiation therapy in 1984. The aim of this study was to verify whether PPC (Probability of primary clearance calculated by a multivariate modeling system) had any correlation with the survival in the patients with carcinoma of the nasopharynx following radiation therapy. Analysing 81 patients with carcinoma of the nasopharynx treated with radiotherapy between January 1, 1971 and December 31, 1983 at Yonsei University College of Medicine, Yonsei Cancer Center, the actuarial 5 year survival rate was 36% and median survival was 39 months. The survivals for Group 1 (27 who had more than 80% of PPC), Group 2 (20 who had between 71 and 80% of PPC), and Group 3 (29 who had less than 71% of PPC) were 66% (median survival months: more than 72), 27% (31), and 4% (12) respectively. There was a definite correlation between PPC and survival among the three groups.