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At least 253 records · Page 14Linked to original sources
PubMed1994

In vitro parameters and treatment outcome in head and neck cancers treated with surgery and/or radiation: cell characterization and correlations with local control and overall survival.

PURPOSE: To determine whether in vivo parameters (surviving fraction at 2 Gy, alpha values, and calculated cell growth fraction) were predictive of the treatment outcome. METHODS AND MATERIALS: Biopsies were obtained from patients with a head and neck tumor. In vitro parameters were determined using the CAM plate assay. Cell characterization by cytogenetic analysis was performed on 19 different cell cultures. In 25 additional cell cultures, cell clonogenicity was tested using the Courtenay Mills assay. RESULTS: Biopsies were obtained from 156 patients with a head and neck tumor and the oropharynx was the predominant primary site. In vitro parameters were obtained in 113 cases (72%) (SF2 in 93 cases and calculated cell growth fraction in 103 cases). Cell characterization showed that cells in CAM plates were diploid with no clonal chromosome abnormalities and gave colonies in soft agar with a mean cloning efficiency of 1.610(-3). Only patients treated with surgery and/or radiation (76), were considered eligible for in vitro parameters and treatment outcome correlation studies. The mean follow-up is over 2 years (range 9-47 months). The local control rate was significantly higher (p = 0.04) for patients with alpha values above the cut-off point of 0.07 Gy-1 (69% vs. 38% at 2 years). The local control rate was also significantly higher (p = 0.04) for patients with calculated cell growth fraction values about the cut-off point of 0.06% (70% vs. 48% at 2 years). Moreover for these latter patients the overall survival rate was also significantly higher (p = 0.004) (54% vs. 26% at 2 years). It is worth noting that alpha and calculated cell growth fraction values below the cut-off points identified a small group of patients (about 20%) who were at a significantly high risk of local failure. From a pragmatic point of view, as only radiosensitivity or calculated cell growth fraction values could be obtained in a certain number of experiments due to technical reasons, the treatment outcome of patients who had either alpha and/or calculated cell growth fraction values below the cut-off levels (about 30% of all patients) was analyzed. This group of patients fared significantly worse (p = 0.02) in terms of local control (50% vs. 68% at 2 years) and (p = 0.04) overall survival (36% vs. 50% at 2 years). CONCLUSION: These results suggest that in vitro parameters using the CAM plate assay, might be useful in predicting the treatment outcome of patients with a head and neck tumor treated with surgery and postoperative radiation, or radiation alone. However, they must be considered as preliminary because the cut offs used in the study were chosen for exploratory purposes. Only a multivariate analysis including all clinical and biologic factors will allow us to draw any firm conclusions.

Carcinoma, Squamous Cell↗
PubMed1992

Postoperative radiotherapy of carcinoma in bilharzial bladder: improved disease free survival through improving local control.

Two hundred thirty-six patients with T3 bladder cancer who survived radical surgery and proved to have P3a, P3b, or P4a tumors were randomized in two phases into three groups: (a) no further treatment (83 patients); (b) postoperative radiotherapy multiple daily fractionation (MDF), using 3 daily fractions of 1.25 Gy each, with 3 hr between fractions, up to a total dose of 37.5 Gy in 12 days (75 patients); and (c) postoperative radiotherapy conventional fractionation (CF), for a total dose of 50 Gy/5 weeks (78 patients). The tolerance of the patients to postoperative radiotherapy was quite acceptable, with equal acute reactions in MDF and CF groups. The 5-year disease-free survival (DFS) rates amounted to 49 and 44% in MDF and CF postoperative radiotherapy groups, respectively, compared to 25% in the cystectomy-alone group. The 5-year local control rates were 87% and 93% for those treated with multiple daily fractionation and conventional fractionation while it was 50% in the surgery-alone group. The therapeutic benefit of postoperative irradiation was consistent for all tumor types, histological grades, and pathological stages for both the disease-free survival and local control. Patients with nodal metastases demonstrated lower recurrence rates in the postoperative radiotherapy groups, but this was not associated with improved disease-free survival. Multivariate analysis using the Cox Model confirmed these results. The independent prognostic factors affecting both disease-free survival and local control were the addition of postoperative radiotherapy, the nodal status, the pathological stage, and the tumor grade. Late complications of radiotherapy in the skin, small intestine, rectum, and the anastomotic site of the urinary division were lower with MDF than with conventional fractionation.

Adult↗
PubMed1991

Re-analysis of the time factor in local control by radiotherapy of T3T4 squamous cell carcinoma of the larynx.

The use of logistic regression for the analysis of local control data is illustrated via a re-analysis of previously published data. A larger effect of overall time is found than in the original publication. In addition, the original analysis of 50 percent effective dose (ED50) is found to have obscured the relationship between local control and overall time for some doses.

Carcinoma, Squamous Cell↗
PubMed1989

[Local control after radiation therapy for T1N0M0 glottic carcinoma].

From 1978 through 1984, we had 151 patients with T1N0M0 glottic carcinoma. They were treated by radiotherapy with 4MV x-ray in parallel opposing field of 5 X 5 cm2 or 6 X 6 cm2. The total dose was 60 Gy/30 fractions/6 weeks. The local control rate was 88.1%, the local recurrence being noted in 18 cases (11.9%). Of these 18 cases, 6 underwent partial laryngectomy, and 10 total laryngectomy. The remaining two cases died: one refused further treatment for recurrence and the other died in spite of total laryngectomy due to recurrence after partial laryngectomy. The salvage rate was 94.1%. The cumulative survival rate was 82.6% in Tla, 71.5% in Tlb and 81.1% in 151 T1N0. The tumor response was poor in the presence of lesion occupying the whole length of the vocal cord. Also, in the cases with ulcer formation or thickened vocal cord as seen on laryngogram, local control rate was not good. Better results will be achieved by improving treatment techniques, specially by improving dose-distribution by wedge-filtered technique and method for immobilization in plastic shell during radio-therapy.

Adult↗
PubMedDate not supplied

Promising early local control of malignant pleural mesothelioma following postoperative intensity modulated radiotherapy (IMRT) to the chest.

PURPOSE: Malignant pleural mesothelioma often recurs locally in spite of aggressive resection by extrapleural pneumonectomy and conventional radiotherapy. This may be due to failure to recognize the extent of clinical target volume (CTV) or suboptimal dose delivery to a target that abuts the heart, esophagus, liver, lung, kidney, and spinal cord. We report how these geometric/dosimetric constraints were overcome by exploiting intensity-modulated radiotherapy in the first cohort patient. MATERIALS AND METHODS: Twenty-eight patients who had undergone extrapleural pneumonectomy were treated with intensity-modulated radiotherapy. The CTV included the surgically violated inner chest wall, insertion of diaphragm, pleural reflections, and deep margin of the incision. CTV delineation was facilitated by intraoperative radio-opaque marking. Motion was assessed. CTV doses were 45-50 Gy with boosts taken to 60 Gy. RESULTS: Despite the large, irregular CTV (median, 4151 cc; range, 2667-7286 cc), an average of 97% of the CTV was covered to the target dose (range, 92%-100%). Respiratory motion was minimal because of immobility of the prosthetic diaphragm. Normal tissue dose constraints were met. The commonest effects were nausea/vomiting (89%) and dyspnea (80%). Esophagitis was absent (59% of patients) or mild (34% grade 1/2). At median follow-up of 9 months (range, 5-27 months), local control within the contoured target was 100%. One-year survival, disease-specific survival, and disease-free survival are 65%, 91%, and 88%, respectively. CONCLUSIONS: Intensity-modulated radiotherapy after extrapleural pneumonectomy is tolerable and seems effective, at least at this early point. As local control improves, systemic metastases become more common, and it may be appropriate to add novel agents to further improve the therapeutic ratio.

Adult↗
PubMed2001

[Local control in the management of cancer: a few thoughts].

Cancer is still considered from a physiopathological point of view as a disease of the cell. This concept is underlying the idea of cure. Treatment with curative intent should aim at eradicating all the tumoral cells. Local control is mandatory and essential in cancers localized in organ with vital function. In breast cancer a complex and controversial relationship exists between local relapse and increased risk of fatal distant metastasis. In case of organ preserving treatment, a complete local control is necessary from the start. If a too high risk of local relapse is foreseable, conservative treatment should not be recommended.

Breast Neoplasms↗
PubMed1993

Radiotherapy of tonsillar and base of the tongue carcinoma. Prediction of local control.

119 patients with squamous cell carcinoma of the tonsillar region (68) and the base of the tongue (51), who received external radiotherapy with curative intent between 1966 and 1984, are analysed with respect to overall treatment results, local tumour control and prognostic factors. Radiation doses were equivalent to 60-70 Gy in 6-7 weeks, with a mean fraction dose of 2.4 Gy on the cobalt 60 equipment and 2 Gy on the linear accelerator. Significant differences were found between both oropharyngeal subsites. Three-year overall survival was 57% in tonsillar carcinoma and 38% in base of the tongue (P = 0.006); disease-specific survival was 70% and 47%, respectively (P = 0.005); and local control rates were 82% and 61% (P = 0.02). Late damage to normal tissues, like persistent dysphagia and osteomyelitis, were seen in 11% of patients. Patients with large tumours in the tongue based developed significantly more complications (P = 0.04). T-stage and tumour subsite predicted local control independently before start of the treatment (P = 0.02 in both cases). A significant nonlinear correlation between Normalised Total Dose (using an alpha/beta ratio of 15 Gy) and local control rate was found (P = 0.006), the middle range having the worst prognosis. The size of radiation field and overall treatment time did not correlate with local control in either site. Response at the end of radiotherapy and 6 weeks later have additional prognostic value for local control, irrespective of the initial stage or subsite (P = 0.004 and < 0.001, respectively).

Adult↗
PubMed1986

Adjuvant irradiation of gastrointestinal malignancies: impact on local control and tumor cure.

Radiation therapy has recently been used more frequently in the adjuvant treatment of gastrointestinal malignancies. A number of studies have shown a high local failure in patients with Stages B2 and C rectal carcinomas and in Stages B3, C2 and C3 colon carcinomas. In rectal cancer, both randomized and non-randomized studies have demonstrated improved local control and survival with the use of adjuvant radiation. Randomized studies have not been performed in colon cancer, but preliminary data from MGH indicate improved local control and survival in some patient subsets with the use of local irradiation after resection. Both gastric and pancreatic cancer have a greater propensity to distant metastases. A review of failure patterns after resection has, nonetheless, shown a high incidence of local recurrence and small prospective randomized studies have recently demonstrated a survival advantage with the use of adjuvant irradiation.

Clinical Trials as Topic↗
PubMed1983

The influence of the number of fractions and of overall treatment time on local control and late complication rate in squamous cell carcinoma of the larynx.

Three hundred and ten patients with T3/T4, N0, M0 squamous cell carcinoma were irradiated with 200 kV X rays with total doses ranging from 4,900 to 6,200 rad, given in 21 to 35 fractions in 32-63 days. After a minimum follow-up period of 3 years, the local control rate was 50%; 21 severe late complications were observed among the patients. The dependence of local control rate and of late complication rate on the dose per fraction and on overall treatment time was analyzed by various statistical methods. Whereas the late complication rate depended significantly on dose per fraction, local tumor control depended strongly on overall treatment time.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Early breast cancer: significance and effectiveness of local control by conservative surgery and primary radiation therapy.

The significance of local-regional control in patients with early breast cancer is examined in the light of data from recent studies. Information from prospectively randomized studies assessing early detection, surgical and radiation therapy procedures, and adjuvant systemic therapies, supports the importance of achieving optimal local-regional control. In most patients effective local control can be achieved without removal of the breast. Wide excision of the primary tumor, axillary dissection and radiation therapy, result in good local control and survival rates that are equal to those achieved with radical mastectomy. The historical development of alternatives to mastectomy is described. Recent data from retrospective and prospective randomized studies evaluating the effectiveness of limited surgery and primary radiotherapy are reviewed and analyzed.

Breast Neoplasms↗
PubMed1998

Local control of mammary development and function.

For the mother, lactation represents the final stage of an investment in her genetic material. Like any investment it is costly and, hence, it needs to be carefully controlled. To her offspring, lactation means survival, so it must happen at any cost. This apparent conflict is rationalized by the mother devolving some control to the offspring while retaining ultimate sanction herself. Part of this results from overt and more subtle influences of the presence of young on the mother's endocrine system, but an equally important part operates at each mammary gland to ensure that output is appropriate to the needs of the young, and no more. The young exert influence by removing milk, while the mother retains control by responding on an hour to hour basis to the presence of milk in the gland. Local control is inevitably most evident where secretion itself is concerned, but also operates to influence lactogenesis, gland development and, eventually, gland involution. This paper will review local control of mammary function, emphasising the important role played by an autocrine inhibitory protein, the feedback inhibitor of lactation.

Animals↗
PubMed2004

Clinical response to induction chemotherapy predicts local control and long-term survival in multimodal treatment of patients with locally advanced esophageal cancer.

PURPOSE: From 1991 to 1994 we performed a phase II study with intensive preoperative chemoradiation in locally advanced squamous cell carcinoma and adenocarcinoma of the esophagus. We now report on a multivariate analysis of prognostic factors based on the long-term results at a median follow-up of 6.5 years. PATIENTS AND METHODS: Eighty-eight patients were treated. Prognostic factors for overall survival and local tumor control were identified by univariate and multivariate analysis. RESULTS: Median overall survival reached 17 months, and the survival rate at 5 years was 22% (95%-confidence interval: 18-26%). Response to induction chemotherapy was the only independent factor predicting local tumor control and--beside weight loss prior to treatment--it also proved to be an independent prognostic factor for long-term survival. CONCLUSIONS: Intensive chemoradiation followed by surgery seems to be appropriate to improve long-term survival of high-risk patients with locally advanced esophageal cancer. In our trial, local tumor control and prognosis were best correlated with response to induction chemotherapy. These results may help to guide decisions regarding surgery in multimodal treatment of EC. Further efforts are needed to increase the number of treatment responders and to predict tumors not responding to chemo(radio)therapy earlier.

Adenocarcinoma↗
PubMed1987

Regression rate of metastatic neck lymph nodes after radiation treatment as a prognostic factor for local control.

This study was carried out to assess whether the regression rate of neck node metastases after radiotherapy could be a prognostic factor for local control. Measurements of 283 neck nodes were made before and at completion of treatment and at intervals during 3 years follow-up. The results indicate that complete regression at the end of treatment correlates strongly with local control. A false negative rate of 0.1 was calculated. Partial regression seems to be a prognostic factor for failure in lymph nodes because of a true positive rate of 0.8. The results suggest that accurate measurements of the response of neck lymph nodes could give early prognostic information, useful for the choice of optimal treatment.

Carcinoma, Squamous Cell↗
PubMed1994

Local recurrence after complete resection for non-small-cell carcinoma of the lung. Significance of local control by radiation treatment.

Of 471 patients undergoing a complete resection for non-small-cell carcinoma of the lung between 1972 and 1989, 40 patients (8.5%) had local recurrences without extrathoracic distant metastasis. Excluding 8 patients who had malignant pleural effusion, we selected 32 patients (24 with hilar-mediastinal lymph node, 6 with bronchial stump, and 2 with chest wall recurrence) from the 40 patients and assessed the significance of local control by radiotherapy. The median length of survival after disease recurrence for these 32 patients was 19 months. Of 29 patients given radiation treatment, 16 who responded to the treatment survived significantly longer than nonresponders (median survival time 27 months versus 6 months, p < 0.01). Univariate analyses of survival after recurrences in relation to various factors revealed that sex and disease-free intervals were significant prognostic factors (p < 0.05) other than the effect of radiotherapy. A multivariate analysis showed that the effect of radiotherapy was the predominant prognostic factor. From these results, we conclude that local control with radiation is beneficial in patients with solely locally recurrent tumors in terms of improved survival.

Adult↗
PubMed1999

Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients.

AIMS: Improved local control and survival in the treatment of rectal cancer have been reported after total mesorectal excision and after extended lymphadenectomy. Comparison of published results is difficult because of differences in patient populations and definitions. We compared three series of patients who underwent standardized surgery [i.e. total mesorectal excision (TME) or D3 lymphadenectomy] with patients who underwent conventional surgery, using actual patient data and uniform definitions. METHODS: TME was performed at Memorial Sloan-Kettering Cancer Center, New York, USA (n=254) and the North Hampshire Hospital, Basingstoke, UK (n=204). D3 lymphadenectomy was performed at the National Cancer Center, Tokyo (n=233). Conventional surgery was used in hospitals in Norway (n=366) and in hospitals of the Comprehensive Cancer Center West, The Netherlands (n=354). Only patients with a curatively resected primary TNM Stage II or Stage III rectal cancer within 12 cm from the anal verge were included. RESULTS: Five-year overall survival and cancer-specific survival were 62-75% and 75-80%, respectively, in the standardized surgery groups and 42-44% and 52%, respectively, in the conventional surgery groups. Local recurrence rates ranged from 4 to 9% in the standardized surgery groups and 32-35% in the conventional surgery groups. CONCLUSIONS: A 30% survival difference and 25% local recurrence difference is not likely to be caused by the shortcomings which are inherent in a non-randomized study: selection bias, assessment variability or stage migration. This study suggests that standardized surgery gives superior survival and local control when compared to conventional surgery.

Aged↗
PubMed2006

Local control of the quantum dynamics in multiple potential wells.

The driven wave-packet dynamics in potentials exhibiting several potential wells is investigated. Therefore, local-control strategies are employed where the control field is constructed from the system's dynamics at any instant of time. It is shown that particles can be moved successively between various potential minima. Furthermore, results presented indicate that the intuitive local-control scheme allows for the initiation of a clockwise or counterclockwise rotational motion of a model molecular motor.

Journal Article↗
PubMed2004

Prognostic significance of pretreatment hemoglobin for local control and overall survival in T1-T2N0 larynx cancer treated with external beam radiotherapy.

PURPOSE: To elucidate a relationship between pretreatment hemoglobin and local control in patients with T1-T2N0 larynx cancer treated with radiotherapy. METHODS AND MATERIALS: A total of 246 patients with T1-T2N0 cancer of the larynx were included in this analysis. Patients were treated using a median daily fraction of 200 cGy to a total median dose of 66 Gy within 47 days. Prognostic factors included pretreatment hemoglobin, age, gender, race, T stage, tumor subsite, beam energy, biologically equivalent dose, and therapy duration. RESULTS: Fifty patients developed local relapse, for an actuarial 5-year relapse-free rate of 77.3%. The actuarial 5-year survival rate was 69.8%. The pretreatment hemoglobin levels were assessed using the following hemoglobin quartiles: 10.1-13.3, 13.4-14.1, 14.2-14.9, and 15.0-18.3 g/dL. On Cox multivariate analysis, the pretreatment hemoglobin level predicted for local failure and poorer overall survival. The relative risk for 5-year local relapse by hemoglobin quartile was 2.70, 2.33, 1.91, and 1.00 (p = 0.034). The relative risk for poorer 5-year overall survival by hemoglobin quartile was 2.23 1.30, 0.80, and 1.00 (p <0.001). CONCLUSION: Pretreatment hemoglobin levels predicted for local control and overall survival for larynx cancer in a multivariate model. This relationship has potential therapeutic implications regarding correcting anemia before the initiation of radiotherapy for optimal outcome.

Adult↗
PubMed2001

From translational research to improved local control and survival: the Gilbert Fletcher Award Lecture, Lugano, March 2000.

Recent clinical trials have shown us that it is possible to improve local control and survival by the concomitant use of radiotherapy and chemotherapy in a large variety of solid tumors, such as head and neck, lung, cervical, and anal cancer. The selection of drugs for this combined treatment, however, has been based on a rather empiric approach. Further research combining the clinical and laboratory expertise now offers the possibility of predicting and improving treatment efficacy for radiotherapy and systemic treatment, given alone or in combination. New methods, such as chromosome and gene expression profiling of individual tumors, are now becoming available with the comparative genomic hybridization assay and microchip DNA arrays. These assays will hopefully be of help in selecting patients for their optimal treatment regimen in the near future. Detailed knowledge of the mechanisms of action of these two treatment modalities will also lead to the development of new and more effective drugs, to be used concomitantly. It is the challenge of translational research to implement its opportunities into daily clinical practice. In analogy to the results obtained with concomitant radiotherapy and chemotherapy, this will lead to improved local control and survival rates in cancer patients.

Antineoplastic Agents, Hormonal↗