Primary Management of Squamous Cell Carcinoma of the Anal Canal: A 30-year Community Hospital Experience.

We reviewed outcomes of 41 patients treated with curative-intent radiotherapy for anal canal carcinoma at a community hospital between 1985 and 2015. Twenty-six (63%) presented with stage I or II disease while 15 (37%) had stage III. Thirty-seven received definitive chemoradiation and 4 radiotherapy alone. Thirteen (31.7%) received ≤59.4Gy. Thirty-two (78%) were treated with 3-dimensional conformal radiotherapy while 9 (22%) received intensity-modulated radiotherapy. At 5 years, local control, regional control, freedom from distant metastasis, cause-specific survival, and overall survival were 80%, 98%, 88%, 77%, and 51%. Of those who received >59.4Gy, local control and overall survival were not improved.

Radiotherapy Alone or With Chemotherapy in the Management of Carcinoma of the Supraglottic Larynx: A 25-Year Community Hospital Experience.

OBJECTIVES: The purpose of this study was to retrospectively review outcomes for patients treated with definitive radiotherapy for carcinoma of the supraglottic larynx at a community hospital and to compare our results with the literature. MATERIALS AND METHODS: Treatment records of 46 patients with localized carcinoma of the supraglottic larynx treated from January 1987 through January 2012 were reviewed. Overall, 18 (39%) presented with stage I or II disease, whereas 28 (61%) presented with stage III to IV. In total, 30 patients (65%) were treated using hyperfractionation, whereas 16 (35%) received once-daily fractionation. Twelve patients (26%) received concurrent chemotherapy with weekly cisplatin. The Kaplan-Meier method was used to assess outcomes. RESULTS: The median follow-up for the living patients was 6.7 years (range, 1.7 to 23.1 y). At 5 years, the local-regional control (LRC), ultimate LRC, laryngeal preservation, and overall survival (OS) rates were 70%, 82%, 65%, and 53%, respectively. At 5 years, disease-free survival and cause-specific survival rates were 75% and 76%, respectively. The 5-year OS rates by American Joint Committee on Cancer stage were as follows: I to II, 61%; III, 51%; and IV, 44%. For those receiving concurrent chemotherapy, there was no improvement in 5-year LRC (83% vs. 66%; P=0.4081) or OS (55% vs. 50%; P=0.7697). For those receiving hyperfractionation, there was no improvement in 5-year LRC (75% vs. 63%; P=0.3369) or OS (55% vs. 50%; P=0.4161). CONCLUSIONS: Our outcomes are similar to those reported in the literature. Neither hyperfractionation nor chemotherapy appeared to confer a benefit for disease control or OS possibly owing to small sample size and the inherent bias of a retrospective review.

Effect of comorbidity on quality of life and treatment selection in patients with squamous cell carcinoma of the head and neck.

OBJECTIVES: Comorbidity is significantly associated with diminished survival and quality of life (QOL) after treatment of head and neck squamous cell carcinoma (HNSCC). We sought to determine whether comorbidity influenced pretreatment QOL scores and treatment selection in patients with HNSCC. METHODS: The medical records of all patients diagnosed with HNSCC who participated in pretreatment QOL analysis over a 15-month period were retrospectively reviewed. Patients with a history of prior treatment for head and neck cancer, unresectable, or distant metastatic disease were excluded. The University of Washington (UW) QOL questionnaire, Performance Status Scale (PSS), and Karnofsky score were used to measure pretreatment QOL. Comorbidity was graded using the Modified Medical Comorbidity Index. RESULTS: Of 75 patients who met study criteria, 33 underwent primary surgical therapy, and 42 underwent nonoperative (radiation or chemoradiation) therapy. Treatment groups did not differ with respect to patient demographics, UW QOL scores, PSS scores, Karnofsky score, or comorbidity. Treatment groups differed significantly by disease stage and primary site. Patients with advanced stage disease (III/IV) or oropharyngeal primary tumors were more likely to undergo nonoperative treatment, compared with patients with early stage disease (I/II) or oral cavity primary tumors (P < .005). No significant association was found between comorbidity and pretreatment QOL scores. CONCLUSIONS: Comorbidity was not significantly associated with treatment selection or pretreatment QOL scores in patients with HNSCC. Location of the primary tumor and disease stage were significantly associated with treatment selection. Further studies are required to determine the effect of comorbidity on patient and tumor responses to treatment.

Radiotherapy alone or combined with chemotherapy for the treatment of squamous cell carcinoma of the base of the tongue.

OBJECTIVES: To evaluate the efficacy of definitive radiotherapy (RT) for the treatment of base of the tongue cancer in a private practice. METHODS: We retrospectively reviewed the medical records of 48 patients with squamous cell carcinoma of the base of the tongue treated with definitive RT and followed from 0.2 to 15.2 years (median, 2.7 y). Follow-up of living patients ranged from 1.5 to 15.2 years (median, 4.9 y). Two thirds of the patients received twice-daily treatment. The median total dose was 74.4 Gy (range, 65 to 76.8 Gy). The median overall treatment time was 45.5 days (range, 36 to 68 d). There were 3 patients (6%) with clinically positive neck nodes who received a neck dissection. Adjuvant chemotherapy was given to 28 patients (58%) with advanced local-regional disease; 1 patient (4%) received induction chemotherapy and 27 patients (96%) received concomitant chemotherapy. Toxicity was graded according to the Common Terminology Criteria for Adverse Events, v3.0. RESULTS: Local control rates by T stage at 5 years were as follows: T1 to T2, 91%; T3, 83%; and T4, 12%. The 5-year rates of local-regional control were as follows: I to II 80%; III, 89%; IVA, 59%; and IVB, 42%. The rates of overall survival at 5 years were as follows: I to II, 67%; III, 56%; IVA, 45%; and IVB, 33%. The 5-year rates of cause-specific survival were as follows: I to II, 67%; III, 76%; IVA, 50%; and IVB, 60%. Seven patients (15%) experienced severe late complications. CONCLUSIONS: Our data reveal that the local-regional control and overall survival rates after definitive RT were comparable with those in the literature. Twice-daily radiation is well tolerated with moderate-late toxicity, which is consistent with the observations of others.

Definitive radiotherapy for juvenile nasopharyngeal angiofibroma.

OBJECTIVES: To update our experience with definitive radiotherapy (RT) for juvenile nasopharyngeal angiofibroma (JNA). METHODS: Twenty-two patients received definitive RT for advanced JNA between June 1975 and March 2003 and were followed from 2.0 to 30.2 years (median, 12.7 years). Total dose ranged from 30 to 36 Gy. RESULTS: Twenty of 22 patients (91%) remained locally controlled after RT; both patients who developed a local recurrence were salvaged so that the ultimate local control rate was 100%. No patient experienced a severe complication. CONCLUSION: Patients with advanced and/or recurrent JNA thought not to be amenable to complete resection with acceptable morbidity have a high likelihood of cure after RT with a low risk of complications.

Merkel cell carcinoma: treatment and outcomes.

BACKGROUND: The purpose of the current study was to determine the outcomes of patients with previously untreated Merkel cell carcinoma of the skin who were treated with curative intent. METHODS: Between October 1984 and January 2002, 34 patients were treated with radiotherapy alone (2 patients) or combined with surgery (32 patients). Nine patients received adjuvant chemotherapy. Patients had follow-up for a median of 3.0 years (range, 0.3 to 18.5 yrs). Follow-up on living patients ranged from 2.2 to 18.5 years (median, 7.1 yrs). RESULTS: The 5-year outcomes were as follows: local control, 94%, locoregional control, 80%; freedom from distant metastases, 60%; cause-specific survival, 52%; and survival, 37%. No patient experienced a severe complication. CONCLUSIONS: Patients treated aggressively with surgery and locoregional radiotherapy have about a 50% chance of cure. Limited data suggest that definitive radiotherapy alone or after incomplete macroscopic resection may control locoregional disease in a significant subset of patients. The dominant site of failure was distant.