Re-irradiation of head and neck cancer-impact of total dose on outcome.

AIM: To evaluate the outcome of re-irradiation and to define favourable pre-treatment characteristics. PATIENTS AND METHODS: seventy-five patients with locally recurrent head and neck cancer were treated with re-irradiation, either postoperatively or as definitive treatment, with and without chemotherapy. Mean time period between first and second series of irradiation was 19 months. Mean overall dose of re-irradiation was 46 Gy. Median follow-up was 8.7 months. RESULTS: Overall survival, loco-regional disease-free survival and metastasis-free survival after two years were 23%, 24% and 77%, respectively. Higher overall doses of re-irradiation gave a statistically significant better outcome with regard to overall survival (p=0.018). CONCLUSION: For patients with locally recurrent head and neck cancer, re-irradiation is a feasible therapeutic option. The total dose at re-irradiation improves overall survival. Therefore, re-irradiation with curative intent should only be applied if a sufficient total dose of ≥46 Gy can be given.

Radiation treatment related factors influencing outcome in vulvar cancer patients.

The objective of this research is to identify the impact of radiation treatment factors on survival in vulvar cancer patients. We performed a follow-up study on 60 women with squamous cell carcinoma of the vulva treated at the Department of Radiotherapy of the University of Ulm from 1980 to 1997. The follow-up time ranged from 0.5 to 17 years (mean 6.5 years). The irradiated volume included vulva and regional lymph nodes. The influence of treatment factors (tumor resection versus no tumor resection, treatment time, dose) on overall and disease-free survival was examined. In addition, applied doses were corrected for treatment time using the extended alpha/beta-model for calculating the biologically effective doses. The applied dose was 48.1 +/- 13.2 Gy (median: 50 Gy). Treatment time was 40.4 +/- 19.4 days (median: 38 days). 34/60 patients underwent surgery with complete resection of macroscopic tumor. 26 of 60 patients were resected incompletely or only a biopsy was taken. In univariate analysis prognostic factors influencing overall and disease-free survival were, along with T- and N-stage, treatment time, and biologically effective dose. In multivariate analysis, biologically effective dose was the only significant factor. We conclude that biologically effective dose and treatment time are important treatment factors influencing overall and disease-free survival vulvar cancer patients.

[Effect of therapy on survival of patients with pancreatic carcinoma]. / Der Einfluss der Therapie auf das Uberleben von Patienten mit Pankreaskarzinom. Eine Analyse von Einzelfaktoren.

PURPOSE: To identify the impact of treatment factors on overall survival in patients with pancreatic carcinoma. PATIENTS AND METHODS: We performed a follow-up study on 38 patients with adenocarcinoma of the pancreas treated from 1984 to 1998. 18/38 patients were resected. Irradiated volume included the primary tumor (or tumor bed) and regional lymph nodes. Thirty-seven patients received in addition chemotherapy consisting of mitoxantrone, 5-fluorouracil and cis-platin, either i.v. (14/38) or i.a. (23/38). The influence of treatment related factors on the overall survival was tested. Biologically effective dose was calculated by the linear-quadratic model (alpha/beta = 25 Gy) and by losing 0.85 Gy per day starting accelerated repopulation at day 28. RESULTS: Treatment factors influencing overall survival were resection (p = 0.02), overall treatment time (p = 0.03) and biologically effective dose (p < 0.002). Total dose and kind of chemotherapy had no significant influence. Treatment volume had a negative correlation (r = -0.5, p = 0.06) with overall survival, without any correlation between tumor size, tumor stage, and treatment volume. In multivariate analysis only biologically effective dose remained significant (p = 0.02). CONCLUSIONS: Among with surgery, biologically effective dose strongly influences overall survival in patients treated for pancreatic carcinoma. Treatment volume should be kept as small as possible and all efforts should be made to avoid treatment splits in radiation therapy.

20 MHz ultrasonic imaging for quantitative assessment and documentation of early and late postradiation skin reactions in breast cancer patients.

BACKGROUND AND PURPOSE: In dermatology high resolution ultrasonic systems proved to be valuable in following up genuine and experimental inflammatory dermatoses. The opportunities of 20 MHz ultrasonic imaging for quantitative assessment of early and late postradiation skin reactions are investigated. MATERIAL AND METHODS: Between April and November 1996, 96 high resolution ultrasound examinations of the skin in 29 patients treated for breast cancer at the University of Ulm were analyzed. Total doses between 46 and 60 Gy were applied. The time interval between the completion of radiotherapy and ultrasonic examination was < or =3 months in 18 patients and 6-135 months in 11 patients. For examinations we used a digital high resolution ultrasonic system with a ceramic 20 MHz transducer. Irradiated and non-irradiated skin were compared. RESULTS: A change of thickness and texture of the dermis depending on the time interval between the completion of radiotherapy and ultrasonic examination and on the administered radiation dose was found. There were significant differences between irradiated and non-irradiated skin regarding the dermal thickness in early (P < 0.001) as well as in late (P = 0.0018) reactions. Echogenicity of the upper and lower corium of irradiated skin decreased in early and late reaction. In upper corium the greatest reduction of signal intensity occurred in early reactions (P = 0.0001). Early reactions of the lower corium differed significantly from late changes (P = 0.001). Discrepancies between visible skin reactions described by examining physicians and ultrasonically proven changes were obvious mainly in late reactions. CONCLUSIONS: There are specific textures of early and late postradiation skin reactions in comparison to non-irradiated skin. High resolution digital 20 MHz ultrasound is non-invasive and quantitative, and in contrast to physical examination, an easy reproducible method for assessing and documenting early and late skin reaction during and after radiation therapy treatment.