Thoracic metastases from breast cancer: a single-institution's experience.

OBJECTIVE: Thoracic metastasis from breast cancer (TMBC) is a relatively uncommon condition, and few reports of its therapeutic palliation and patient outcomes exist. We therefore reviewed retrospectively our radiotherapeutic experience of TMBC. METHODS: Between 1981 and 2003, 19 patients were treated with radiation (with doses raging from 10 Gy to 50 Gy) for palliation of TMBC. RESULTS: The mean age was 55.4 years. Mediastinal lymph node disease was the most common form of TMBC. TMBC developed within five years of breast cancer diagnoses in 11 patients (58%). Among the evaluable symptomatic individuals, subjective palliation was complete in 78% of the cases. The complete objective response (e.g., complete resolution of clinically manifested superior vena caval obstruction or imaging-demonstrated atelectasis) rate was 50%. There was no significant difference in survival between patients presenting with airway obstruction and women who were not in respiratory distress, asymptomatic and symptomatic patients, and women with and without concurrent extrathoracic metastases. CONCLUSION: Although the prognosis of women with TMBC was quite ominous, radiotherapy should be considered in very symptomatic patients because justifiable palliation can be effected in some individuals.

Breast cancer metastasis to the medulla oblongata: a case report.

Breast cancer metastasis to the brain stem is uncommon. Because of the rarity of the condition, the clinical course of such patients is not known. The case of a 41-year-old woman with advanced-stage carcinoma of the breast involving the medulla oblongata is presented and the literature concerning management, including patient outcome, is reviewed.

Wide-field radiation therapy plus simultaneous chemotherapy for refractory Hodgkin's disease.

Nine male patients with disseminated Hodgkin's disease who had relapsed and/or were refractory to two or more non-"cross-resistant" programs of combination chemotherapy (range, two to five previous programs; median, three) were admitted into a study of treatment with wide-field low-dose radiation therapy (2,000 cGy), to all lymph node bearing areas, the liver, the spleen, and in selected cases the lungs (1,000 cGy). Simultaneous with each course of radiation therapy, chemotherapy with BCNU and procarbazine given at 50% doses of a known program of chemotherapy (BOPP) with vincristine and prednisone was given. Treatment was completed in five patients. Three of these achieved a complete remission; the other two had a partial response. Of the other four, two died during treatment with interstitial pneumonitis (probably radiation induced), and two failed to respond. Remission durations were 18+, 38, and 44+ months. Pulmonary toxicity was severe; however, hematologic and other toxicities were acceptable. The incorporation of wide-field low-dose radiation should be considered in programs of rescue for patients with Hodgkin's disease who relapse or are refractory to standard combination chemotherapy.

Primary chemotherapy for localized non-Hodgkin's lymphomas with diffuse histologic characteristics. Preliminary report of a prospective study.

Thirty-three patients with diffuse non-Hodgkin's lymphoma (stages I and II) received intermediate doses of oral methotrexate followed by leucovorin calcium every four weeks, on days 1 and 8, followed on day 15 by intravenous cyclophosphamide and vincristine sulfate. Prednisone was given for four weeks on alternate courses of treatment. A total of six such four-week courses was planned. Involved-field radiation (3000 or 3600 rad [30 or 36 Gy]) was given between three courses of chemotherapy to 18 patients who presented with tumors exceeding 7 cm in greatest diameter and who had responded to the initial chemotherapy. On completion of treatment, 27 patients (82%) were in complete remission; all the failures were in patients with large intra-abdominal masses. The presence of high lactate dehydrogenase levels, large tumor size, and age over 60 years had a suggestive negative correlation with the achievement of complete remission. The median follow-up was 26 months (range, ten to 59 months). At 48 months, the actuarial disease-free survival, remission duration, and overall survival were 53%, 72%, and 68% respectively. No deaths from toxic effects and no septic episodes were observed during treatment. The complete remission rate achieved with this program is comparable with those of other intensive programs of treatment reported previously.

Treatment of early--stages I and II--nodular, poorly differentiated lymphocytic lymphoma.

Twenty-nine patients with Stages I and II nodular, poorly differentiated lymphocytic lymphoma were treated with radiation therapy or radiation therapy plus chemotherapy. Twenty-two patients with Stage I received radiation to the involved field, the other seven with Stage II received total lymphoid radiation. Complete remission was achieved in all 29. There were no differences in remission duration or survival according to treatment modality. Five of 29 (17%) patients relapsed. No relapses were observed after 5 years. Ten patients died; one patient died of lymphoma, and nine others died in continuous complete remission of various other causes. Sixty-six percent of the patients were alive at 74-160 months (median 118 months). Involved field radiation with or without chemotherapy was well tolerated, producing acceptable toxicity. Substantially more toxicity was observed after total lymphoid irradiation and although cures were also achieved, less toxic treatment programs should be investigated. The low rate of relapse observed in early stages of this lymphoma in this and in other studies is suggestive that cures might be achieved in nearly one-half of the patients presenting in early stage.

Feasibility of limb salvage and survival in soft tissue sarcomas.

One hundred nine consecutive patients with soft tissue sarcomas were treated in the period 1977 through 1983. Of 85 patients with extremity sarcomas, only 3 patients (4%) were managed with amputation, whereas in the previous decade, 40% of such patients were treated with amputation in our institute. The current 5-year survival rate is 63%; in the previous decade it was 45%. In the current series, for extremity locations, patients with minimum surgical margins of 2 cm or greater and no further local therapy had a 5-year local recurrence rate of 17%, whereas those with minimum surgical margins of less than 2 cm and who were treated with adjuvant postoperative radiation had a local recurrence rate of 7%. In the previous period, the local recurrence rate was 30% after wide resection and 66.6% after local excision. With a combination of modalities, limb salvage can be practiced currently in the majority of patients with extremity soft tissue sarcomas without any adverse effect on recurrence rates and survival.

Successful treatment of meningeal myeloma with combination of radiation therapy, chemotherapy, and intrathecal therapy.

Meningeal involvement is a rare complication of multiple myeloma. None of the previously described patients presenting this syndrome had responded to treatment. We describe a 64-year-old man with meningeal myelomatosis. A favorable response to treatment was produced by radiation therapy administered to the head and by intrathecal and systemic chemotherapy including high-dose corticosteroids.

Survival of nonsurgically staged patients with negative lymphangiograms who had Stage IIB carcinoma of the cervix treated by pelvic radiation plus hydroxyurea.

Twenty patients with Stage IIB carcinoma of the cervix who did not undergo pretherapy para-aortic lymphadenectomy, but who had negative preradiation therapy lymphangiograms, were treated with pelvic radiation plus hydroxyurea. Patients received a median of 5020 rads of pelvic radiation plus 4000 rads of radium to point A. During radiation therapy and for a total of 12 weeks, patients received hydroxyurea administered at a dose of 80 mg/kg of body weight every 3 days if the white blood cell count was greater than or equal to 2,500/mm3 and platelets were greater than or equal to 75,000/mm3. The median follow-up time was 28 months (6 to 83 months). The estimated 5-year survival rate was 92%. Seventeen patients are alive with no evidence of disease (median, 28 months); one died of intercurrent disease with no evidence of disease (17 months); one is alive with no evidence of disease after recurrence (18 months); and one died of cervical cancer (22 months). The survival rate of patients with nonsurgically staged negative pretherapy lymphangiograms who had Stage IIB cervical cancer treated by pelvic radiation therapy plus hydroxyurea approximated the improved survival rate reported for patients with negative pretherapy para-aortic lymphadenectomy who were treated with pelvic radiation therapy plus hydroxyurea. Both studies would suggest that pelvic radiation plus hydroxyurea improves the rate of survival in patients with Stage IIB cervical cancer.

Hyperthermia in combination with radiotherapy: a review of five years experience in the treatment of superficial tumors.

Facilities for regional tumor hyperthermia has been in use at RPMI since 1976, and have been routinely used to treat patients according to protocol since 1977. Hyperthermia delivery has been exclusively by microwave using 434 MHz, 915 MHz and 2450 MHz. Greatest success at reaching tumor temperatures of 43-44 degrees C with minimal skin heating was obtained using 915 MHz. The majority of the patients were treated with this frequency. Approximately 125 patients have been treated and 70 have achieved completion of therapy and follow-up. Follow-up has been at least one month and several patients have been followed for one to two years. Initially, for entry into the hyperthermia protocol, patients were required to have three or more lesions. One lesion on each patient was treated with 800 rad fractions repeated three times on a 72 hour schedule. The second lesion was treated with 700 rad fractions and the third with 500 rad plus hyperthermia on the same schedule. Twelve patients with multiple melanoma lesions completed this study. One of 12 patients showed no response to the combination of hyperthermia plus radiotherapy, while four showed no response to radiotherapy alone. Of eight patients who survived three months, all lesions treated by hyperthermia plus radiotherapy responded completely, while only five lesions treated by radiotherapy alone so responded. In a second study, 58 patients with superficial tumors were treated by a protocol where hyperthermia was added to optimal conventional radiotherapy. Of the total, 43 patients had complete tumor response at follow-up varying from one month to 18 months. A subgroup of 24 of these patients had two lesions, one of which was treated with hyperthermia in addition to radiotherapy while the other served as control, receiving radiotherapy only. Nineteen lesions demonstrated complete response to hyperthermia plus radiotherapy, while only 14 of the controls had complete response. None of the lesions treated with hyperthermia responded less well than those treated by radiotherapy alone. Morbidity, as measured by skin reaction, was rarely increased in the heated field.