Biomedical subjects

George E Laramore

Publications and source records attributed to George E Laramore.

9 recordsLinked to original sources

PubMed2005

FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma.

PURPOSE: Image localization of head-and-neck squamous cell carcinoma lags behind current techniques to deliver a precise radiation dose with intensity-modulated radiotherapy. This pilot study prospectively examined the use of registered 18-F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT for preradiotherapy staging of the neck. METHODS AND MATERIALS: Sixty-three patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were enrolled into an institutional FDG-PET imaging protocol between September 2000 and June 2003. Of these patients, 20 went on to immediate neck dissection surgery and were studied further. Of these 20, 17 (85%) had American Joint Committee on Cancer Stage III or IV disease. All patients underwent preoperative FDG-PET and contrast-enhanced CT of the head and neck. FDG-PET/CT images were created using a nonrigid image registration algorithm developed at the University of Washington. Alternate primary and nodal gross tumor volumes were contoured with radiotherapy treatment planning software, blinded to each other and to the pathology results. One set of volumes was designed with CT guidance alone and the other with the corresponding FDG-PET/CT images. Neck dissection specimens were subdivided into surgical nodal levels intraoperatively, and the histopathologic findings were correlated with the CT and FDG-PET/CT nodal level findings. RESULTS: FDG-PET/CT detected 17 of 17 heminecks and 26 of 27 nodal zones histologically positive by dissection (100% and 96% sensitivity, respectively). The nodal level staging sensitivity and specificity for FDG-PET/CT was 96% (26 of 27) and 98.5% (68 of 69), respectively. FDG-PET/CT correctly detected nodal disease in 2 patients considered to have node-negative disease by CT alone. Agreement between the imaging results and pathology findings was stronger for FDG-PET/CT (kappa 0.95, 95% confidence interval 0.82-0.99) than for CT alone (kappa 0.81, 95% confidence interval 0.63-0.91; p = 0.06 by two-sided McNemar's testing). CONCLUSION: These early findings suggest that FDG-PET/CT is superior to CT alone for geographic localization of diseased neck node levels. Confirmatory trials to substantiate the accuracy of FDG-PET/CT neck staging should be prioritized.

Adult↗

PubMed2005

FDG-PET/CT-guided intensity modulated head and neck radiotherapy: a pilot investigation.

BACKGROUND: 2-deoxy-2[(18)F]fluoro-D-glucose-positron emission tomography (FDG-PET) imaging can be registered with CT images and can potentially improve neck staging sensitivity and specificity in patients with head and neck squamous cell cancer. The intent of this study was to examine the use of registered FDG-PET/CT imaging to guide head and neck intensity modulated radiotherapy (IMRT) planning. METHODS: Twenty patients with squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx underwent FDG-PET and contrast-enhanced CT imaging of the head and neck before neck dissection surgery. Combined FDG-PET/CT images were created by use of a nonrigid image registration algorithm. All IMRT plans were theoretical and were not used for treatment. We prescribed 66 Gy in 30 fractions to FDG-avid CT abnormalities and nodal zones directly involved with disease, without prophylactic coverage of uninvolved neck levels. Matched CT-guided IMRT plans designed according to the specifications of Radiation Therapy Oncology Group (RTOG) H-0022 were available for comparison. We investigated the feasibility of FDG-PET/CT-directed IMRT dose escalation in five patients with FDG-avid disease located away from critical normal structures. After 66 Gy, FDG-avid disease with 0.5-cm margins was boosted in 220 cGy increments until dose-limiting criteria were reached. RESULTS: Elimination of prophylactic coverage to FDG-PET/CT-negative neck levels markedly reduced mean dose (Dmean) to the contralateral parotid gland (p < .001) and Dmean to the laryngeal cartilage (p = .001). No FDG-PET/CT-directed plan missed pathologically verified nodal disease. During the dose escalation exercise, we successfully increased the dose to 95% of the planning target volume (PTV95%) to a mean of 7490 cGy (range, 7153-8098 cGy). CONCLUSIONS: We demonstrate early proof of the principle that FDG-PET/CT-guided IMRT planning can selectively target and intensify treatment of head and neck disease while reducing critical normal tissue doses. Routine clinical use of such planning should not be engaged until the accuracy of FDG-PET/CT is fully validated. Future directions, including refinement of treatment to gross disease and radiologically uninvolved neck nodal levels, are discussed.

Adult↗

PubMed2004

Gamma knife stereotactic radiosurgical boost for patients treated primarily with neutron radiotherapy for salivary gland neoplasms.

OBJECT: To determine the feasibility of utilizing a Gamma Knife stereotactic boost for patients at high risk of local recurrence from minor salivary gland tumors invading the base of skull. METHODS: Eight patients with minor salivary gland tumors invading the base of skull were treated with primary neutron radiotherapy followed by a Gamma Knife radiosurgical boost to the base of skull. Patients had the following characteristics: (1) primary site of disease: paranasal sinuses (n = 3), nasopharynx (n = 3), hard palate (n = 1), pterygopalatine fossa (n = 1); (2) median age 59 years (range 37-80); (3) interval from completion of neutron radiotherapy to Gamma Knife boost 4 weeks (range 2-8 weeks); (4) median stereotactic dose delivered 10 Gy (prescribed to 50% isodose line, range 8-12 Gy), and (5) median number of isocenters treated 16 (range 14-21). Dosimetry from the neutron radiotherapy was used to determine both the volume boosted and the dose utilized. The median follow-up interval from the time of Gamma Knife treatment was 21.5 months (range 16-23 months). RESULTS: All patients tolerated the procedure well. Acute side effects were minimal and included 1 patient with a delayed fatigue reaction at 2 months, 1 patient with vertigo of limited duration, and a third patient with prolonged nausea requiring steroid use. All patients were placed on a tapering dose of steroids after the procedure. One patient suffered a local relapse, with a 2-year actuarial disease-free survival rate of 80%. CONCLUSIONS: Gamma Knife radiosurgical boost following primary neutron radiotherapy for patients with a high risk of local failure is feasible and well tolerated acutely. Careful attention must be given to the previously treated regions in regard to volume treated and dose delivered. Further follow-up will be necessary to determine the long-term effectiveness and complications of such a boost in these high-risk patients.

Adult↗

PubMed2004

3D naming system.

Technology now allows vast amounts of information to be shared among individuals and applications with great speed. The need for nomenclature that is conducive for clear and accurate communication is critical. This is especially true in medicine, and radiation oncology in particular, where miscommunication can cause significant harm to patients. Frequent sharing of radiation treatment information occurs not only between members within a department, but also between different treatment centers. Physicians share techniques with each other at conferences, in publications, and over the phone. Retrospective investigation may be done evaluating various treatment courses. Descriptions of treatment beams are perhaps the most commonly shared information about a patient's course of treatment in radiation oncology. This paper highlights the advantages of using a 3D naming system to identify treatment beams with unique names.

Humans↗

PubMed2003

Treatment of salivary gland neoplasms with fast neutron radiotherapy.

OBJECTIVE: To evaluate the efficacy of fast neutron radiotherapy for the treatment of salivary gland neoplasms. DESIGN: Retrospective analysis. SETTING: University of Washington Cancer Center, Neutron Facility, Seattle. PATIENTS: The medical records of 279 patients treated with curative intent using fast neutron radiotherapy at the University of Washington Cancer Center were reviewed. Of the 279 patients, 263 had evidence of gross residual disease at the time of treatment (16 had no evidence of gross residual disease), 141 had tumors of a major salivary gland, and 138 had tumors of minor salivary glands. The median follow-up period was 36 months (range, 1-142 months). MAIN OUTCOME MEASURES: Local-regional control, cause-specific survival, and freedom from metastasis. RESULTS: The 6-year actuarial cause-specific survival rate was 67%. Multivariate analysis revealed that low group stage (I-II) disease, minor salivary sites, lack of skull base invasion, and primary disease were associated with a statistically significant improvement in cause-specific survival. The 6-year actuarial local-regional control rate was 59%. Multivariate analysis revealed size 4 cm or smaller, lack of base of skull invasion, prior surgical resection, and no previous radiotherapy to have a statistically significant improved local-regional control. Sixteen patients without evidence of gross residual disease had a 100% 6-year actuarial local-regional control. The 6-year actuarial freedom from metastasis rate was 64%. Factors associated with decreased development of systemic metastases included negative lymph nodes at the time of treatment and lack of base of skull involvement. The 6-year actuarial rate of development of grade 3 or 4 long-term toxicity (using the Radiation Therapy Oncology Group and European Organization for Research on the Treatment of Cancer criteria) was 10%. No patient experienced grade 5 toxic effects. CONCLUSIONS: Neuron radiotherapy is an effective treatment for patients with salivary gland neoplasms who have gross residual disease and achieves excellent local-regional control in patients without evidence of gross disease.

Carcinoma, Squamous Cell↗

PubMed2003

Postradiotherapy surveillance practice for head and neck squamous cell carcinoma--too much for too little?

INTRODUCTION: Limited information is available regarding surveillance patterns after head and neck cancer radiotherapy. We cataloged follow-up for a specified patient cohort treated at three neighboring university, community, and Veterans Administration institutions. METHODS: One hundred fifteen patients were treated with curative intent between 1994-1998 with definitive or postoperative radiotherapy for newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx. One hundred patients had continuous follow-up at their treating institution and were included for analysis. Median follow-up until disease recurrence or censorship was 28.5 months. RESULTS: Median follow-up frequency was 5.7 visits/year and was highly variable. Although visit frequency correlated with disease stage and the presence of high-risk disease features, this association was lost when patients with early recurrences were removed from analysis. Procedure and test utilization closely mirrored visit frequency, resulting in a wide range of estimated yearly charges (0-15,668 dollars/year; median, 1,772 dollars/year). Actuarial 3-year overall survival for the study group was 71%. Eighty-six percent (19 of 22) of potentially salvageable locoregional failures were discovered secondary to symptomatic complaint rather than by test results. Disease failure, whether detected by symptom or testing, predicted for poor survival (22% at 24 months after recurrence). CONCLUSIONS: Postradiotherapy surveillance for head and neck cancer is inconsistently pursued. A proven correlation between intensive follow-up and improved patient survival is lacking. Surveillance directed by patient symptoms should be investigated as an alternative approach.

Adult↗

PubMed2003

Organ preservation strategies in the treatment of laryngeal cancer.

For most patients, a total laryngectomy should not be used as the initial treatment for any stage laryngeal tumor. The goal in treating a patient with laryngeal cancer must be not only to cure but also to provide the best functional outcome for the patient. In the United States, the treatment of laryngeal cancer has moved from radical surgery toward a more conservative approach involving definitive radiotherapy and chemotherapy, with extirpative surgery held in reserve for salvage. In Europe, there has been increasing reliance on limited endoscopic cordectomy procedures for early tumors and the use of function-preserving surgical approaches for more advanced lesions. Careful monitoring of the conservatively treated patient is mandatory to allow for early salvage of failures to the original therapy. Because of the high costs of hospitalization, the direct medical costs attributable to conservative approaches are equal to or less than the costs for more radical surgical resections. Even if survivals are only equivalent, organ preservation approaches should be the treatment of choice for most patients.

Combined Modality Therapy↗

PubMed2002

The effect of delayed postoperative irradiation on local control of soft tissue sarcomas of the extremity and torso.

PURPOSE: The impact of delayed adjuvant radiotherapy in patients treated by surgical resection for peripheral or torso soft tissue sarcoma has not been well characterized. We retrospectively examined this issue in an institutional patient cohort. METHODS AND MATERIALS: One hundred two adult patients were treated at the University of Washington Medical Center between 1981 and 1998 with postoperative radiotherapy for cure of a newly diagnosed soft tissue sarcoma. Of this group, 58 patients had primary intermediate- or high-grade disease of the extremity or torso (50 extremity/8 torso). Tumor histology was predominantly malignant fibrohistiocytoma, synovial cell sarcoma, and leiomyosarcoma. The group was dichotomized according to time interval from definitive resection to the start of adjuvant radiation. Twenty-six patients had a short delay, defined as <4 months, and 32 patients had a long delay of >or=4 months. Both groups were balanced with regard to site, size, margin status, and tumor depth; however, the long-delay group had a larger proportion of high histologic grade lesions and was treated more frequently with chemotherapy (31/32 [97%] for long-delay patients vs. 14/26 [54%] for short-delay patients). Median follow-up was 49.5 months (range: 7-113 months). Median follow-up for patients still alive was 54 months (range: 9-113 months). Survival outcomes were estimated by the Kaplan-Meier method. RESULTS: Overall local relapse-free survival at 5 years from the time of definitive resection was 74%. On univariate analysis, estimated 5-year local relapse-free survival was significantly improved in the short-delay group (88% vs. 62% for the long-delay group, p = 0.048 by log rank). Overall distant relapse-free survival, disease-free survival, and overall survival at 5 years were 77%, 68%, and 86%, respectively. These survival outcomes were statistically equivalent in both radiation delay groups. There was no evidence to suggest that delaying adjuvant systemic therapy for postoperative radiation negatively impacted distant relapse-free survival, disease-free survival, or overall survival. Patterns of failure analysis revealed that 11/12 disease failures in the long-delay group had a local component, with five patients presenting with solitary local recurrences. Severe chronic radiation-related soft tissue or peripheral nerve morbidity was infrequent (5/58 or 8.6%) and similar in both groups. CONCLUSIONS: Postoperative radiation delays of 4 months or greater were associated with inferior local disease control for intermediate- and high-grade soft tissue sarcomas of the extremity and torso. Our results suggest that timing postoperative radiation before postoperative chemotherapy may optimize local therapy for such patients without adversely affecting distant disease control, long-term morbidity, or overall survival. Prospective testing of this hypothesis is warranted.

Adolescent↗

PubMed1991

Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer.

BACKGROUND: We performed a prospective, randomized study in patients with previously untreated advanced (Stage III or IV) laryngeal squamous carcinoma to compare the results of induction chemotherapy followed by definitive radiation therapy with those of conventional laryngectomy and postoperative radiation. METHODS: Three hundred thirty-two patients were randomly assigned to receive either three cycles of chemotherapy (cisplatin and fluorouracil) and radiation therapy or surgery and radiation therapy. The clinical tumor response was assessed after two cycles of chemotherapy, and patients with a response received a third cycle followed by definitive radiation therapy (6600 to 7600 cGy). Patients in whom ther was no tumor response or who had locally recurrent cancers after chemotherapy and radiation therapy underwent salvage laryngectomy. RESULTS: After two cycles of chemotherapy, the clinical tumor response was complete in 31 percent of the patients and partial in 54 percent. After a median follow-up of 33 months, the estimated 2-year survival was 68 percent (95 percent confidence interval, 60 to 76 percent) for both treatment groups (P = 0.9846). Patterns of recurrence differed significantly between the two groups, with more local recurrences (P = 0.0005) and fewer distant metastases (P = 0.016) in the chemotherapy group than in the surgery group. A total of 59 patients in the chemotherapy group (36 percent) required total laryngectomy. The larynx was preserved in 64 percent of the patients overall and 64 percent of the patients who were alive and free of disease. CONCLUSIONS: These preliminary results suggest a new role for chemotherapy in patients with advanced laryngeal cancer and indicate that a treatment strategy involving induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients, without compromising overall survival.

Adult↗