Effect of radiotherapeutic technique on local control in primary vaginal carcinoma

1993 ◽  
Vol 3 (6) ◽  
pp. 399-404 ◽  
Author(s):  
G. L. Eddy ◽  
J. M. Jenrette ◽  
W. T. Creasman
Keyword(s):  
Optimal Control ◽  
Radiation Therapy ◽  
Retrospective Analysis ◽  
Local Control ◽  
Local Control Rate ◽  
External Beam ◽  
Surface Dose ◽  
Vaginal Carcinoma ◽  
Significant Difference

A retrospective analysis of 73 patients treated for primary vaginal carcinoma with radiation therapy was performed to evaluate the effect of radiotherapeutic technique on local control. Local control was achieved in five of 22 patients (23%) treated with pelvic external beam therapy alone, three of four patients (75%) treated with intracavitary cylinder or Bloedorn applicator alone, and 30 of 47 patients (64%) treated with combination of external beam and brachytherapy. Radiation therapy complications requiring hospitalization occurred in six patients (8%). A statistically significant difference in local control was achieved only when patients receiving external beam and brachytherapy were compared with patients receiving external beam therapy alone (P< 0.005). Total mid-tumor dose was defined as the sum of midplane tumor dose from external beam therapy, mid-tumor dose from interstitial radium needles, and the vaginal surface dose from intracavitary radium systems. Total mid-tumor doses ranged from 16 to 121.7 Gy. Only two of 16 patients receiving less than 55 Gy total mid-tumor dose achieved local control. As a result, dividing doses of 45, 55, 65 and 75 Gy produced a statistically significant superior local control rate in the patients receiving the higher dose (P< 0.01). None of the 16 patients receiving less than 55 Gy total mid-tumor dose had received brachytherapy. We conclude that the combination of external beam therapy and brachytherapy is essential to achieve optimal control of primary vaginal carcinoma.

scholarly journals Analysis of Radiation Therapy for the Control of Merkel Cell Carcinoma of the Head and Neck Based on 36 Cases and a Literature Review

2008 ◽  
Vol 87 (11) ◽  
pp. 634-643 ◽  
Author(s):  
Brian D. Lawenda ◽  
Michelle G. Arnold ◽  
Valerie A. Tokarz ◽  
Joshua R. Silverstein ◽  
Paul M. Busse ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Local Control ◽  
Clinical Stage ◽  
Local Control Rate ◽  
Stage I ◽  
Stage Iii ◽  
Regional Control ◽  
Kaplan Meier ◽  
Significant Difference

Merkel cell carcinoma (MCC) is a rare and aggressive epidermal cancer. We conducted a retrospective study and literature review to investigate the impact that radiation therapy has on local, regional, and distant control as part of the oncologic management of MCC of the head and neck and to further elucidate the role of radiation therapy with regard to regional control for the clinically uninvolved neck. We reviewed all registered cases of head and neck MCC that had occurred at four institutions from January 1988 through December 2005. Treatment and outcomes data were collected on patients with American Joint Committee on Cancer stage I, II, and III tumors. Local, regional, and distant control rates were calculated by comparing variables with the Fisher exact test; Kaplan-Meier analysis was used to report actuarial control data. Stage I to III head and neck MCC was identified in 36 patients— 22 men and 14 women, aged 43 to 97 years (mean: 71.6) at diagnosis. Patients with stage I and II tumors were combined into one group, and their data were compared with those of patients with stage III tumors. Twenty-sixpatients(72%) had clinical stage I/II disease and 10 patients (28%) had clinical stage III disease. Median follow-up was 41 months for the stage I/II group and 19 months for the stage III group. Based on examination at final follow-up visits, local recurrence was seen in 7 of the 36 patients (19%), for a local control rate of 81 %. The 2-year actuarial local control rate for all stages of MCC was 83%; by treatment subgroup, the rates were 95% for those who had undergone radiation therapy to the primary site and 69%) for those who had not— a statistically significant difference(p = 0.020). Based on information obtained at final follow-ups, 10 of the 36 patients (28%) experienced a regional recurrence, for a regional control rate of 72%. The 2-year actuarial regional control rate among all patients was 70%; by subgroup, rates were 82%) for patients who had undergone regional node radiation therapy and 60% for those who had not— not a statistically significant difference (p = 0.225). Nine patients (25%) overall developed a distant metastasis, for a distant control rate of 75%. Salvage therapies included chemotherapy and/or radiation therapy to the metastatic site, but neither had any significant effect on survival. Regardless of treatment, the Kaplan-Meier survival curves leveled off at 30 months with 82% survival for the stage I/II group and at 19 months with 60% survival for the stage III group. We conclude that radiation therapy to the primary tumor site (either following resection or definitively) results in a local control rate of more than 90% in patients with head and neck MCC. We also found a trend toward improved regional control of the clinically negative neck with the addition of radiation therapy.

Is gross-total resection sufficient treatment for posterior fossa ependymomas?

2005 ◽  
Vol 102 (4) ◽  
pp. 629-636 ◽  
Author(s):  
Leland Rogers ◽  
Jeanette Pueschel ◽  
Robert Spetzler ◽  
William Shapiro ◽  
Stephen Coons ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Posterior Fossa ◽  
Local Control ◽  
Median Duration ◽  
Local Control Rate ◽  
Gross Total Resection ◽  
Total Resection ◽  
Content Type ◽  
Significant Difference ◽  
Fine Print

Object. The goals of this study were to analyze outcomes in patients with posterior fossa ependymomas, determine whether gross-total resection (GTR) alone is appropriate treatment, and evaluate the role of radiation therapy. Methods. All patients with newly diagnosed intracranial ependymomas treated at Barrow Neurological Institute between 1983 and 2002 were identified. Those with supratentorial primary lesions, subependymomas, or neuraxis dissemination were excluded. Forty-five patients met the criteria for the study. Gross-total resection was accomplished in 32 patients (71%) and subtotal resection (STR) in 13 (29%). Radiation therapy was given to 25 patients: 13 following GTR and 12 after STR. The radiation fields were craniospinal followed by a posterior fossa boost in six patients and posterior fossa or local only in the remaining patients. With a median follow-up period of 66 months, the median duration of local control was 73.5 months with GTR alone, but has not yet been reached for patients with both GTR and radiotherapy (p = 0.020). The median duration of local control following STR and radiotherapy was 79.6 months. The 10-year actuarial local control rate was 100% for patients who underwent GTR and radiotherapy, 50% for those who underwent GTR alone, and 36% for those who underwent both STR and radiotherapy, representing significant differences between the GTR-plus-radiotherapy and GTR-alone cohorts (p = 0.018), and between the GTR-plus-radiotherapy and the STR-plus-radiotherapy group (p = 0.003). There was no significant difference in the 10-year actuarial local control rate between the GTR-alone and STR-plus-radiotherapy cohorts (p = 0.370). The 10-year overall survival was numerically superior in patients who underwent both GTR and radiotherapy: 83% compared with 67% in those who underwent GTR alone and 43% in those who underwent both STR and radiotherapy. These differences did not achieve statistical significance. Univariate analyses revealed that radiotherapy, tumor grade, and extent of resection were significant predictors of local control. Conclusions. Gross-total resection should be the intent of surgery when it can be accomplished with an acceptable degree of morbidity. Even after GTR has been confirmed with postoperative imaging, however, adjuvant radiotherapy significantly improves local control. The authors currently recommend the use of postoperative radiotherapy, regardless of whether the resection is gross total or subtotal.

Radiofrequency Ablation and Radiation Therapy Improve Local Control in Spinal Metastases Compared to Radiofrequency Ablation Alone

2018 ◽  
Vol 36 (5) ◽  
pp. 417-422 ◽  
Author(s):  
Kavitha M. Prezzano ◽  
Dheerendra Prasad ◽  
Gregory M. Hermann ◽  
Ahmed N. Belal ◽  
Ronald A. Alberico
Keyword(s):  
Radiation Therapy ◽  
Radiofrequency Ablation ◽  
Local Control ◽  
Combined Treatment ◽  
Spinal Metastases ◽  
Significant Benefit ◽  
Unequal Distribution ◽  
Common Location ◽  
Significant Difference

Purpose: The spinal column is the most common location for osseous metastases and is associated with pain and decreased quality of life. This study evaluated combined radiofrequency ablation (RFA) with radiation therapy (RT) compared to RFA alone for improving pain and local control. Methods: This was a single-institution retrospective review of patients who underwent RFA of spinal metastases between 2016 and 2017, with or without RT to the same vertebral level. Pain was measured with visual analog scale at initial presentation and at 3 and 12 weeks of follow-up. Local failure (LF), distant failure, and overall survival (OS) were compared and Kaplan-Meier statistics were calculated. Results: Twenty-six patients with 28 spinal metastases were treated with RFA. Ten patients with 11 metastases were treated with RFA + RT. More patients with lung primaries were treated with RFA alone and more patients with breast primaries were treated with combination RFA+RT. There was no significant difference in pain scores between groups ( P = .96). At a median follow-up of 8.2 months, LF was noted in 8 of 17 metastases treated with RFA alone compared to 1 of 11 metastases treated with RFA+RT ( P = .049). There was a significant benefit in time to LF favoring RFA+RT ( P = .02) and a significant benefit in OS ( P = .0045). Conclusion: This study demonstrates a benefit in local control with RFA+RT versus RFA alone. Palliation of pain was effective using both regimens. This study was limited by a nearly unequal distribution of primary tumor histologies between groups. Literature regarding combined treatment of RFA and RT for spinal metastases is scarce and prospective protocols are warranted.

scholarly journals Examining the use of radiation therapy for cholangiocarcinoma: benefits through modern techniques

2020 ◽  
Author(s):  
Felix Gattermann ◽  
Michael Oertel ◽  
Sergiu Scobioala ◽  
Christian Wilms ◽  
Hartmut Schmidt ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Local Control ◽  
Progression Free Survival ◽  
Blood Parameters ◽  
Series Data ◽  
Treatment Situation ◽  
Effective Combination ◽  
Significant Difference ◽  
Definitive Surgery

Abstract BackgroundCholangiocarcinoma (CCA) is a rare malignant tumor of the bile duct epithelium. At first diagnosis, only a minority of patients is eligible for surgery, which is regarded as the only curative treatment. This study examines the role of radiation therapy (RT) and chemoradiotherapy (CRT) in the definitive and adjuvant treatment situation.MethodsThe monocentric retrospective analysis included 39 patients (31 males, 8 females) with CCA undergoing 53 RT series. Data was collected from January 2005 to September 2018. There were 11 cases of CRT, 6 of which were definitive. Surgery was either palliative (n=6) or radical (n=15).ResultsAfter RT, median overall survival (OS) was 10.4 months (mo; 95% confidence interval [CI] 6.6-14.2), median progression-free survival (PFS) was 5.6 mo (95% CI 3-8.2), median duration of local control (DOLC) was 8.9 mo (95% CI 4.7-13.1) and 1-year OS rate was 44.7%. There was a significant difference between patients with and without locoregional lymph node metastasis (OS: 4.3 mo vs. 15.4 mo, p=0.031; PFS: 2.1 mo vs. 11.5 mo, p<0.0005; DOLC: 4.2 mo vs. 12.3 mo, p=0.02). After treatment of a primary tumor, DOLC was about twice as long as in the recurrent situation (10.4 mo vs. 5.4 mo, p=0.032). Conservative therapy significantly elevated the risk of local recurrence compared to radical surgery in univariate (HR 11.04, p=0.004) and multivariate (HR 98.34, p=0.024) analysis. Tomotherapy may be advantageous with respect to local recurrence and survival.Side effects were mostly classified as grade I-II according to CTCAE. There were 10 toxicities of grade III and 4 of grade IV, all affecting blood parameters. Termination of RT and increased glutamic pyruvic transaminase (GPT) were significantly less frequent after stereotactic body radiation therapy and hypofractionation.ConclusionRT can achieve local control in patients with CCA. However, since overall prognosis remains poor, effective combination therapies are needed. Toxicities of RT are manageable but require close clinical and laboratory follow-up.

scholarly journals Risk factors of recurrence after postoperative electron beam radiation therapy for keloid: Comparison of long-term local control rate

2020 ◽  
Vol 25 (4) ◽  
pp. 606-611 ◽  
Author(s):  
Hitoshi Maemoto ◽  
Shiro Iraha ◽  
Ken Arashiro ◽  
Kousei Ishigami ◽  
Fumikiyo Ganaha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radiation Therapy ◽  
Electron Beam ◽  
Local Control ◽  
Local Control Rate ◽  
Beam Radiation ◽  
Electron Beam Radiation

Carcinoma of the ampulla of Vater: Patterns of failure after resection and benefit of adjuvant radiotherapy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 254-254
Author(s):  
M. Palta ◽  
C. G. Willett ◽  
P. Patel ◽  
D. S. Tyler ◽  
H. E. Uronis ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Survival Rates ◽  
Radical Resection ◽  
Ampulla Of Vater ◽  
Ampullary Carcinoma ◽  
Local Failure ◽  
Term Survival ◽  
Free Survival ◽  
Significant Difference

254 Background: Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. To define the role of radiation therapy and chemotherapy with surgery, we performed a single institution analysis of treatment- related outcomes. Methods: A retrospective analysis was performed of all patients undergoing potentially curative therapy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1975 and 2009. Local control (LC), overall survival (OS), disease-free survival (DFS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier Method. Results: One hundred thirty-seven patients with ampullary carcinoma underwent potentially curative pancreaticoduodenectomy. Sixty-one patients undergoing resection received adjuvant (n= 43) or neoadjuvant (n=18) radiation therapy with concurrent chemotherapy (CRT). Patients receiving radiotherapy were more likely to have poorly differentiated tumors. Median radiation dose was 50 Gy. Median follow up was 8.8 years. Of patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response. Three-year local control was significantly improved in patients receiving CRT (88% vs. 55% p= 0.001) with trend toward a 3-year OS benefit in patients receiving CRT (62% vs. 46% p=0.074). Despite this, there was no significant difference in 3-year DFS (66% CRT vs 48% surgery alone p=0.09) or MFS (69% CRT vs 63% surgery alone p=0.337). Conclusions: Long term survival rates are low. Local failure rates are high following radical resection alone and improved with CRT. Despite more adverse pathologic features in patients receiving CRT, survival outcomes were at least equivalent with a trend toward statistical significance. Given the patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered. No significant financial relationships to disclose.

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