Prostate-specific antigen as a pretherapy prognostic factor in patients treated with radiation therapy for clinically localized prostate cancer.

PURPOSE: This study was conducted to determine the value of prostate-specific antigen (PSA) as a pretherapy prognostic factor for localized prostate cancer treated with primary irradiation (RT). PATIENTS AND METHODS: Between March 1987 and December 1990, 254 patients with pretherapy PSA determinations were treated for clinical stage A2 to C prostate adenocarcinoma. In conjunction with other prognostic factors, pretherapy PSA was evaluated to determine whether it had independent predictive value for disease outcome. RESULTS: Pretherapy PSA was highly and directly correlated with clinical stage, tumor grade, and acid phosphatase level. With a median follow-up duration of 24 months, 241 patients (95%) were fully assessable for disease outcome. In these patients, PSA and tumor grade were the sole independent predictive factors for tumor relapse (ie, clinically determined and/or increasing PSA level). The combination of pretherapy PSA and tumor grade information defined groups of patients with distinctly different outcome. For patients in low- (favorable PSA and tumor grade), intermediate- (favorable PSA or tumor grade), and high- (adverse PSA and tumor grade) risk categories, the actuarial rates of survival free of tumor relapse or increasing PSA level were 94%, 77%, and 42% at 3 years, respectively (P < .0001). CONCLUSION: Pretherapy PSA is a strongly independent prognostic factor for disease outcome following primary RT. The combination of adverse pretherapy PSA and unfavorable tumor grade identified a cohort of patients with a high risk of early treatment failure in whom combined modality therapy may be appropriately investigated.

Radiation treatment of heterotopic bone formation in the temporomandibular joint articulation.

PURPOSE: The efficacy and toxicity of radiation therapy used for preventing re-formation of heterotopic bone involving the temporomandibular joint are assessed. METHODS AND MATERIALS: Ten patients (15 TMJs) with bony ankylosis of the TMJ were referred after reconstruction with costochondral graft, gap arthroplasty, or debridement of heterotopic bone. Treatment consisting of 10 Gy was delivered early postoperatively to a field encompassing the TMJ with adequate margin. Response to therapy was assessed by comparison of routine roentgenograms obtained preoperatively, immediately postoperatively, and at last follow-up; the Turlington-Durr grading system was used. Median duration of postoperative follow-up was 19 months. RESULTS: Radiation therapy prevented ectopic bone re-formation in 10 (69%) of 15 TMJs with prior bony ankylosis. Of the 15 TMJs, 13 (87%) had improvement in their Turlington-Durr scores compared with the preoperative scores. Development of ectopic bone formation was prevented in 9 (90%) of 10 TMJs rendered Turlington-Durr grade 0 postoperatively. Eight of the 10 patients have remained asymptomatic. Treatment was well tolerated. The only complication experienced was parotitis in three patients. CONCLUSION: Radiation therapy is useful for prevention of heterotopic bone redevelopment after TMJ operation. We recommend 10 Gy in 5 fractions beginning early postoperatively for high-risk patients. This strategy appears beneficial in this young patient population, who suffer significant pain and functional impairment in the TMJ articulation.

Evaluation of serum prostate-specific antigen levels after postoperative radiation therapy for pathologic stage T3, N0 prostate cancer.

OBJECTIVE: To analyze freedom from progression of serum prostate-specific antigen (PSA) levels in patients who have received radiation therapy after radical prostatectomy for pathologic stage T3, N0 prostate cancer. DESIGN: We assessed the freedom from PSA progression after postoperative radiation therapy and its relationship to several potential prognostic factors during a median follow- up of 43 months. MATERIAL AND METHODS: Thirty Mayo patients received postoperative radiation therapy for pathologic stage T3, N0 prostate cancer between January 1988 and April 1993. Radiation therapy was initiated within 6 months after prostatectomy. Radiation doses ranged from 60 to 67 Gy. RESULTS: "Freedom from PSA failure" was defined as the actuarial risk of maintaining a serum PSA level at 0.3 ng/mL or less. The freedom from failure rate was 66% at 3 and 4 years. Prognostic factors significantly associated with an improved freedom from failure were a pre-radiation PSA level of 1.0 ng/mL or less and no seminal vesicle involvement. A trend toward an improved freedom from failure was noted in patients with low-grade (1 and 2) tumors in comparison with high-grade (3 and 4) tumors. Treatment-related morbidity was minimal. CONCLUSION: Radiation therapy after radical prostatectomy for pathologic stage T3, N0 prostate cancer seems to provide an improved freedom from PSA failure in comparison with that noted in other series of similar patients treated with radical prostatectomy only.

Management of stage IE primary gastric lymphoma.

From 1975 to 1991, stage IE gastric lymphoma was diagnosed or treated in 40 patients at our institution. Thirty-five evaluable patients were the subject of this analysis (median age, 63 years). All histologic specimens were reviewed and classified according to the working formulation. Immunohistochemical stains were performed in 33 of 35 cases. The following histologic subtypes were identified: 26 patients had diffuse large cell, 2 had diffuse mixed cell, and 7 had mucosa-associated lymphocytic lymphoma (small lymphocytic lymphoma with features of MALT lymphoma). Of the 35 patients, 30 (86%) underwent laparotomy, with subtotal or total gastrectomy performed in 29. After gastrectomy, 17 patients had radiation therapy, 3 had chemotherapy, 2 had radiation plus chemotherapy, and 7 had no further treatment. Five patients were diagnosed with endoscopic biopsy and had radiation therapy, chemotherapy, or both without further surgical treatment. The median follow-up period was 69.2 months. The commonest presenting symptom was pain. The 5-year disease-free survival was 90% for the entire group and 88% for the 28 patients with working formulation intermediate histology. For patients with MALT lymphoma, the 5-year disease-free survival was 100%. The prognosis for patients with stage IE working formulation intermediate-histology gastric lymphoma is good and for those with stage IE MALT lymphoma, excellent.