scholarly journals Locoregional disease control after external beam radiotherapy in 91 patients with differentiated thyroid carcinoma and pT4 tumor stage - a single institution experience

2018 ◽  
Vol 52 (4) ◽  
pp. 453-460 ◽  
Author(s):  
Nikola Besic ◽  
Marta Dremelj ◽  
Gasper Pilko
Keyword(s):  
Thyroid Carcinoma ◽  
Multimodal Treatment ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Differentiated Thyroid Carcinoma ◽  
Locoregional Control ◽  
External Beam ◽  
Regional Metastases ◽  
Disease Free

Abstract Background Locoregional recurrence is common in patients with locally advanced differentiated thyroid carcinoma (DTC). Our aim was to find out the rate of locoregional control of the disease after external beam radiotherapy (EBRT) of the neck and mediastinum in patients with DTC and pT4 tumor. Patients and methods Altogether 91 patients (47 males, 44 females, median age 61 years) with DTC had EBRT of the neck and mediastinum as part of the multimodal treatment of pT4 tumor (63 cases pT4a, 28 cases pT4b) from the year 1973 to 2015. Data on clinical factors, histopathology and recurrence were collected. Disease-free, disease-specific and overall survival was calculated. Results Median tumor size was 5 cm (range 1–30 cm). Out of 91 patients, 23 had distant and 38 regional metastases. A total or near-total thyroidectomy, lobectomy, subtotal thyroidectomy and lymph node dissection was performed in 70%, 14%, 2% and 30% of cases, respectively. Thirteen percent of patients were not treated with surgery. All patients had EBRT and 39 had chemotherapy. Radioiodine (RAI) ablation of thyroid remnant and RAI therapy was applied in 90% and 40% of cases, respectively. Recurrence was diagnosed in 29/64 patients without a persistent disease: locoregional and distant in 16 and 13 cases, respectively. Five-year and ten-year disease-free survival rate was 64% and 48%, respectively. Conclusions The majority of patients with DTC and pT4 tumors who were treated with EBRT of the neck and mediastinum region as part of multimodal treatment have long-lasting locoregional control of the disease.

scholarly journals EP-1167: Indications for external beam radiotherapy in differentiated thyroid carcinoma: an expert consensus

2018 ◽  
Vol 127 ◽  
pp. S653-S654
Author(s):  
E. Blais ◽  
P. Lagarde ◽  
B. Henriques de Figueiredo ◽  
B. Nicolescu-Catargi ◽  
O. Schneegans ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
External Beam Radiotherapy ◽  
Differentiated Thyroid Carcinoma ◽  
Expert Consensus ◽  
External Beam

Multicenter Study Differentiated Thyroid Carcinoma (MSDS)

2003 ◽  
Vol 42 (06) ◽  
pp. 244-250 ◽  
Author(s):  
M. K. Pixberg ◽  
A. Schuck ◽  
A. Heinecke ◽  
W. Köpcke ◽  
K. W. Schmid ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Randomized Trial ◽  
Multicenter Study ◽  
External Beam Radiotherapy ◽  
Differentiated Thyroid Carcinoma ◽  
Steering Committee ◽  
Clinical Event ◽  
External Beam ◽  
Thyroxine Therapy ◽  
Number Of Patients

Summary Aim: The Multicenter Study Differentiated Thyroid Carcinoma (MSDS) is an ongoing study in Germany, Austria, and Switzerland on the clinical benefit of adjuvant external beam radiotherapy (RTx) for locally invasive differentiated thyroid carcinoma (DTC) in TNM stages pT4 pN0/1/x M0/x (5th ed. 1997). Methods: MSDS was designed as a prospective randomized trial. Patients receive thyroidectomy, radioiodine therapy (RIT) to ablate the thyroid remnant, and TSH-suppressive L-thyroxine therapy with or without RTx after documented elimination of cervical iodine-131 uptake (http://msdsstudie.uni-muenster.de). Results: 311 patients were enrolled between January 2000 and March 2003. 279 patients met the trial’s inclusion criteria. 45 consented to randomization, of whom 17 were randomized into treatment arm A (RTx) and 18 into arm B (no RTx).Advised by the trial’s independent Data Monitoring and Safety Committee, the MSDS steering committee decided to terminate randomization in April 2003 and continue MSDS as a prospective cohort study. 23 of the 234 patients in the observation arm of the trial were prescribed RTx by their physicians. Thus, 14% of the trial cohort were randomized or assigned to receive RTx (intention-to-treat analysis). In contrast, at least 44% of all patients with pT4 papillary DTC in Germany in the nationwide PCES study underwent RTx in 1996 (p <0.001, χ2-test). Conclusions: Acceptance of external beam RTx as a treatment modality for DTC has receded to a degree that accrual of a sufficient number of patients for a randomized trial has been impossible. Observation of the trial cohort is continued in order to assess clinical event rates with and without RTx and chronic RTx toxicity.

Stereotactic Body Radiation Therapy Boost in Patients With Cervical Cancer Ineligible for Brachytherapy

2021 ◽  
Vol 1 (2) ◽  
pp. 53-60
Author(s):  
GIUSEPPE FACONDO ◽  
GIANLUCA VULLO ◽  
VITALIANA DE SANCTIS ◽  
MAURIZIO VALERIANI ◽  
ANNA MARIA ASCOLESE ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Cervical Canal ◽  
Free Survival ◽  
Stereotactic Body Radiation ◽  
Disease Free

Background: Standard treatment for locally advanced cervical cancer is external beam radiotherapy followed by brachytherapy (BT). Stereotactic body radiation therapy (SBRT) is a possible option for treating patients ineligible for BT. Patients and Methods: From October 2012 to July 2020, nine women with cervical cancer received SBRT to high-risk volumes. The Kaplan–Meier method was used to estimate the rates of overall and disease-free survival. Results: The median age was 52 years; 88% of patients had squamous carcinoma. Reasons for forgoing BT were cervical canal stenosis, treatment refusal and hematological disease. The median boost dose was 18 Gy and the median dose per fraction was 6 Gy. Median follow-up was 16 months. The median survival was 24 months, the actuarial 2-year OS rate was 70%, and median disease-free survival was 11 months. One grade 3 late vaginal toxicity was reported. No acute nor late grade 4 toxicities were observed. Conclusion: SBRT boost in patients with cervical cancer ineligible for BT led to acceptable survival outcomes and a safe toxicity profile.

scholarly journals External beam radiotherapy in differentiated thyroid carcinoma: A systematic review

Head & Neck ◽  
2015 ◽  
Vol 38 (S1) ◽  
pp. E2297-E2305 ◽  
Author(s):  
Jonathan M. Fussey ◽  
Rosa Crunkhorn ◽  
Miroslav Tedla ◽  
Martin O. Weickert ◽  
Hisham Mehanna
Keyword(s):  
Systematic Review ◽  
Thyroid Carcinoma ◽  
External Beam Radiotherapy ◽  
Differentiated Thyroid Carcinoma ◽  
External Beam

scholarly journals 220: Patterns of Recurrence After External Beam Radiotherapy for Anaplastic And Differentiated Thyroid Carcinoma

2016 ◽  
Vol 120 ◽  
pp. S80 ◽  
Author(s):  
Horia Vulpe ◽  
Jennifer Kwan ◽  
Andrea McNiven ◽  
James Brierley ◽  
Richard Tsang ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
External Beam Radiotherapy ◽  
Differentiated Thyroid Carcinoma ◽  
External Beam ◽  
Patterns Of Recurrence

Magnetic resonance imaging after external beam radiotherapy and concurrent chemotherapy for locally advanced cervical cancer helps to identify patients at risk of recurrence

2019 ◽  
Vol 29 (3) ◽  
pp. 480-486 ◽  
Author(s):  
Martina Aida Angeles ◽  
Pauline Baissas ◽  
Eric Leblanc ◽  
Amélie Lusque ◽  
Gwénaël Ferron ◽  
...  
Keyword(s):  
Tumor Size ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
Reduction Rate ◽  
Disease Free Survival ◽  
Concurrent Chemotherapy ◽  
Size Reduction ◽  
External Beam ◽  
Free Survival

ObjectiveTumor volume and regression after external beam radiotherapy have been shown to be accurate parameters to assess treatment response via magnetic resonance imaging (MRI). The aim of the study was to evaluate the prognostic value of tumor size reduction rate after external beam radiotherapy and chemotherapy prior to brachytherapy.MethodsPatients with locally advanced cervical cancer treated at two French comprehensive cancer centers between 1998 and 2010 were included. Treatment was pelvic external beam radiotherapy with platinum based chemotherapy followed by brachytherapy. Records were reviewed for demographic, clinical, imaging, treatment, and follow-up data. Anonymized linked data were used to ascertain the association between pre-external and post-external beam radiotherapy MRI results, and survival data.Results185 patients were included in the study. Median age at diagnosis was 45 years (range 26–72). 77 patients (41.6%) were International Federation of Gynecology and Obstetrics stage IB2-IIA disease and 108 patients (58.4%) were stage IIB-IVA. Median tumor size after external beam radiotherapy and chemotherapy was 2.0 cm (range 0.0–8.0) and median tumor size reduction rate was 62.4% (range 0.0–100.0%). Tumor size and tumor reduction rate at 45 Gy external beam radiotherapy MRI were significantly associated with local recurrence free survival (P<0.001), disease free survival, and overall survival (P<0.05). Tumor reduction rate ≥60% was significantly associated with a decreased risk of relapse and death (HR (95% CI) 0.21 (0.09 to 0.50), P=0.001 for local recurrence free survival; 0.48 (0.30 to 0.77) P=0.002 for disease free survival; and 0.51 (0.29 to 0.88), P=0.014 for overall survival).ConclusionsTumor size reduction rate >60% between pre-therapeutic and post-therapeutic 45 Gy external beam radiotherapy with concurrent chemotherapy was associated with improved survival. Future studies may help to identify patients who may ultimately benefit from completion surgery, adjuvant chemotherapy, and closer follow-up.

Role of adjuvant therapy in stage IIIC2 endometrial cancer

2020 ◽  
Vol 30 (8) ◽  
pp. 1169-1176
Author(s):  
Giorgio Bogani ◽  
Serena Cappuccio ◽  
Jvan Casarin ◽  
Deepa Maheswari M Narasimhulu ◽  
William A Cilby ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Adjuvant Therapy ◽  
External Beam Radiotherapy ◽  
Disease Free Survival ◽  
External Beam ◽  
Free Survival ◽  
Radiotherapy Alone ◽  
Node Metastases ◽  
Disease Free

ObjectiveThe role of the different types of adjuvant treatments in endometrial cancer with para-aortic node metastases is unclear. The aim of this study was to report oncologic outcomes after adjuvant therapy in patients with stage IIIC2 endometrial cancer.MethodsThis retrospective single-institution study assessed patients with stage IIIC2 endometrial cancer who underwent primary surgery from January 1984 to December 2014. All patients had hysterectomy (±salpingo-oophorectomy) plus lymphadenectomy (para-aortic nodes, ±pelvic nodes). We included all patients with stage III endometrial cancer and documented para-aortic lymph node metastases (International Federation of Obstetrics and Gynecologists stage IIIC2). We excluded patients who did not provide consent, who had synchronous cancer, or who underwent neoadjuvant chemotherapy. Follow-up was restricted to the first 5 years post-operatively. Cox proportional hazards models, with age as the time scale, was used to evaluate associations of risk factors with disease-free survival and overall survival.ResultsAmong 105 patients with documented adjuvant therapy, external beam radiotherapy was administered to 25 patients (24%), chemotherapy to 24 (23%), and a combination (chemotherapy and external beam radiotherapy) to 56 (53%) patients. Most patients receiving chemotherapy and external beam radiotherapy (80%) had chemotherapy first. The majority of relapses had a distant component (31/46, 67%) and only one patient had an isolated para-aortic recurrence. Non-endometrioid subtypes had poorer disease-free survival (HR 2.57; 95% CI 1.38 to 4.78) and poorer overall survival (HR 2.00; 95% CI 1.09 to 3.65) compared with endometrioid. Among patients with endometrioid histology (n=60), chemotherapy and external beam radiotherapy improved disease-free survival (HR 0.22; 95% CI 0.07 to 0.71) and overall survival (HR 0.28; 95% CI 0.09 to 0.89) compared with chemotherapy or external beam radiotherapy alone. Combination therapy did not improve prognosis for patients with non-endometrioid histology (n=45).ConclusionsIn our cohort of patients with stage IIIC2 endometrioid endometrial cancer, those receiving chemotherapy and external beam radiotherapy had improved survival compared with patients receiving chemotherapy or external beam radiotherapy alone. However, the prognosis of patients with non-endometrioid endometrial cancer remained poor, regardless of the adjuvant therapy administered. Distant recurrences were the most common sites of failure.

scholarly journals The surgical management of locally advanced well-differentiated thyroid carcinoma: changes over the years according to the AJCC 8th edition Cancer Staging Manual

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Alessio Metere ◽  
Valerio Aceti ◽  
Laura Giacomelli
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Carcinoma ◽  
Surgical Management ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Cancer Staging ◽  
Differentiated Thyroid Carcinoma ◽  
Main Body ◽  
Well Differentiated ◽  
8Th Edition

Abstract Background Well-differentiated thyroid carcinoma is defined as locally advanced in the presence of an extra thyroid extension, e.g., when the surrounding structures such as the trachea, larynx, esophagus and main blood vessels are invaded by cancer. The 8th edition AJCC Cancer Staging Manual states that this is the main characteristic to evaluate for the staging and consequently for the prognosis in patients over 55 years old. Main body Distinguishing different forms of locally advanced thyroid cancer is essential, and the various anatomical structures and the clinical and therapeutic consequences must be taken into account. An accurate diagnosis of the organs invaded by thyroid cancer is necessary for the planning of surgical treatment, and both aspects are crucial to improving the patients’ survival. Patients affected by thyroid cancer with extra thyroid extension have a poor prognosis and the removal of the entire neoplasm represents a key factor for better disease-free survival. Conclusions We discuss the changes introduced by the 8th edition AJCC Cancer Staging Manual, in terms of the diagnostic and surgical management of extra thyroid extension, in patients affected by papillary and follicular thyroid cancer.

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