Postoperative irradiation in patients with pT3-4N0 laryngeal cancer: results and prognostic factors.

Approximately 60 % of patients with locally advanced laryngeal cancer (LALC) treated primarily with surgery require adjuvant radiotherapy. In the available literature predominate series of patients were with pathologically confirmed node-positive status. Subgroups of pN0 patients with LALC are scarce. The aim of the study is to evaluate the efficacy of postoperative radiotherapy in patients with pathological stage T3-4N0M0 and identification of prognostic factors in this group. Between 1975 and 2005, 138 patients with squamous pT3-4N0 laryngeal cancer were irradiated postoperatively. Primary surgical treatment consisted of total laryngectomy and cervical lymphadenectomy. The median time between surgery and the implementation of radiotherapy was 56 days. The median total dose was 60 Gy (range 40-70 Gy). Five-year disease-free survival (DFS5) was achieved in 76 % of patients. Cancer recurrence was observed in 34 patients. In 28 (82 %) cases it was locoregional failure. DFS5 rates for pT3 and pT4 were 92 and 69 %, for margin status R0, R1 and R2 were 82, 72 and 67 %, respectively. The pharyngeal invasion was related to a decrease in DFS5 from 80 to 59 %. Postoperative irradiation in patients with pT3-4N0 LALC is an effective treatment method. The main reason of the failure is local recurrence. The following independent prognostic factors were identified in this group of patients: pT stage, surgical margin status and pharyngeal invasion.

[Predictive and prognostic value of p53, Ki-67 and EGFR in patients with advanced oral cavity and oropharyngeal cancer treated with induction chemotherapy]. / Ocena wartosci predykcyjnej i prognostycznej p53, Ki-67 i EGFR u chorych na zaawansowanego raka jamy ustnej i ustnej czesci gardla leczonych z zastosowaniem indukcyjnej chemioterapii.

BACKGROUND: To determine predictive and prognostic value of p53, Ki-67 and EGFR in patients with advanced oral cavity and oropharyngeal cancer treated with induction chemotherapy. MATERIALS AND METHODS: The data form 40 patients with advanced oral cavity and oropharyngeal cancer treated between January 1988 and December 1997 were analyzed retrospectively. All patients received 1 to 3 cycles of induction chemotherapy (ICHT) consisting of cisplatin and fluoruracil. Twenty two patiemts (68%) underwent subsequent radical radiotherapy. Histologic and immunohistochemical analyzes of p53, Ki-67 and EGFR were performed in all patients. RESULTS: Response to induction chemotherapy was obtained in 18 patients (45%). None of the analyzed factors significantly influenced the chance to obtain the response to chemotherapy. The 3-year loco-regional control and overall survival rates in the group of 22 patients treated radically were 20% and 23%, respectively. CONCLUSIONS: Lack of EGFR expression is favorable prognostic factor for overall survival in patients with advanced oral cavity and oropharyngeal cancer treated with induction chemotherapy.

Long-term follow-up in adult patients with low-grade glioma (WHO II) postoperatively irradiated. Analysis of prognostic factors.

AIM: To report the long-term follow-up of a cohort of adult patients with LGG post-operatively irradiated in one institution, and to identify prognostic factors for progression free survival. BACKGROUND: There is little consensus about the optimal treatment for low-grade glioma (LGG), and the clinical management of LGG is one of the most controversial areas in neurooncology. Radiation therapy is one option for treatment of patients with LGG, whereas other options include postoperative observation. MATERIALS AND METHODS: Between 1975 and 2005, 180 patients with LGG (WHO II) received postoperative irradiation after non radical (subtotal or partial) excision. Patients had to be 18 years of age or older, and have histologic proof of supratentorial fibrillary (FA), protoplasmic (PA) or gemistocytic astrocytoma (GA). Radiotherapy was given within 3-10 weeks after surgery. Treatment fields were localized and included the preoperative tumor volume, with a 1-2 cm margin, treated to a total dose of 50-60 Gy in 25-30 fractions over 5-6 weeks. RESULTS: Actuarial ten-year progression free survival (APFS) in the whole group was 19%. The worse prognosis was observed in patients with GA. Ten-year APFS rates for GA, PA and FA were 10%, 18% and 22%, respectively. CONCLUSION: The findings from our long-term cohort of 180 patients with LGG confirmed by uni- and multivariate analysis demonstrated that only astrocytoma histology significantly determined the prognosis. The best survival was observed in patients with the fibrillary variant, and the worst for the gemistocytic one.

Prognostic value of the interval from surgery to initiation of radiation therapy in correlation with some histo-clinical parameters in patients with malignant supratentorial gliomas.

AIM OF THE STUDY: To determine the relationship between the interval from surgery to initiation of radiation therapy (ISRT) and prognostic factors, such as age, performance status, tumour location, extent of surgical resection and tumour histology in patients with malignant gliomas. MATERIALS AND METHODS: From 1995 to 2005, 308 adults patients with supratentorial malignant gliomas (198 glioblastomas, and 110 anaplastic astrocytomas) received postoperative radiotherapy with radical intent. A total tumour dose of 60 Gy in 30 fractions in 6 weeks was delivered. ISRT varied from 15 to 124 days, with median time of 37 days, and it was a cut-off value to assess the results. The end point in our study was two-year overall survival. RESULTS: The two-year overall survival rate in the whole group was 17%, with 24% for patients with ISRT value ≤ 37 days, and 14% for patients with an interval longer than 37 days (p = 0.042). Univariate analysis showed that delayed initiation of radiotherapy influenced the outcome of patients with glioblastoma older than 40 years, and with other than frontal location of tumour. Two-year overall survival rates for ISRT ≤ 37 days were 15%, 18% and 22% respectively, compared to 8%, 4% and 11% for ISRT > 37 days. In a multivariate analysis (Cox's model) the only variables that were significantly associated with worse survival were older age and ISRT prolonged for more than 37 days. CONCLUSION: The study showed longer than 37 days waiting time from surgery to initiation of radiotherapy to be a significant predictor of overall survival for adult patients with malignant supratentorial gliomas.

Prognostic and predictive significance of p53, EGFr, Ki-67 in larynx preservation treatment.

BACKGROUND: The optimal management of advanced laryngeal and hypopharyngeal cancers (L&HC) must involve consideration of both survival and functional effect of the given treatment approach. Despite over two decades of investigations of several treatment options, including surgery, radiotherapy, chemotherapy or some combinations thereof, little consensus exists as to which treatment offers the best survival, together with functional speech and swallowing. AIM: To determine predictive and prognostic value of p53, EGFr, Ki-67 in patients with advanced laryngeal and hypopharyngeal cancer, treated with larynx preservation intent. MATERIALS AND METHODS: Thirty-three patients received 2-3 cycles of induction chemotherapy (ICHT) consisting of cisplatin and fluoruracil and underwent subsequent radical radiotherapy. Immunohistochemical analyzes of p53, EGFr and Ki-67 were performed. RESULTS: Response to ICHT was obtained in 24 patients (75%). Better response to ICHT was correlated only with EGFr expression (p = 0.04, RR = 1.91). The 5-year loco-regional control (LRC) and disease-specific survival (DSS) rates were 48% and 57%, respectively. The 5-year larynx preservation rate was 68% in responders to ICHT compared to 21% in non-responders (p = 0.02). It was also higher in patients without EGFr expression (but not significantly, p = 0.43). CONCLUSION: Lack of EGFr expression is a favorable predictive factor for response to ICHT. Neither p53 nor Ki-67 have predictive and prognostic value in larynx preservation treatment.

[Cerebellar metastasis from ovarian carcinoma. A case report]. / Przerzut do mózdzku w przebiegu raka jajnika.

This report presents an unusual case of 40-year-old woman with complete locoregional remission of ovarian carcinoma, presented with a single cerebellar metastasis. Surgical excision of the cerebellar lesion, followed by brain irradiation, resulted in complete resolution of her symptoms.

Postoperative irradiation of incompletely excised gemistocytic astrocytomas. Clinical outcome and prognostic factors.

BACKGROUND AND PURPOSE: Although gemistocytic astrocytomas are considered slow-growing tumors, they often behave aggressively and carry the least favorable prognosis among low-grade astrocytomas. The aim of this study is to evaluate the outcomes and prognostic factors of patients with incompletely excised gemistocytic astrocytomas irradiated postoperatively. PATIENTS AND METHODS: Records of 48 patients with incompletely excised gemistocytic astrocytoma, irradiated between 1976 and 1998 at the Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Cracow, Poland, were reviewed. The total dose ranged from 50 to 60 Gy (mean: 59.35, median: 60 Gy) delivered in daily fractions of 2 Gy, 5 days a week. The treatment volume covered the residual tumor with a margin of 1-2 cm. RESULTS: Toxicity was acceptable. The overall actuarial survival rates at 5 and 10 years were 30% and 17%, respectively. Age and gender had an influence on overall survival by univariate and multivariate analysis (p < 0.05). Patients < or = 35 years of age and female patients carried the best prognosis. CONCLUSION: In most patients with gemistocytic astrocytoma, combined surgery and postoperative radiotherapy result in only short-term survival. Older age is the most important unfavorable prognostic factor in patients with gemistocytic astrocytoma.