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PubMed1992

Controlled localized heat therapy in cutaneous warts.

BACKGROUND: Controlled localized heating as a method of superficial tissue destruction has been used in veterinary medicine for the treatment of benign and malignant tumors. The rationale for its use is that the diseased tissue being treated is more sensitive to the effects of heating than is normal tissue. This technology was applied to the treatment of common hand warts in a placebo-controlled study. OBSERVATIONS: Twenty-nine warts were treated one to four times (median, two times) at 50 degrees C for 30 to 60 seconds. Twenty-five (86%) of 29 treated verrucae regressed completely while seven (41%) of 17 control warts resolved during the course of the study. No wart that regressed regrew during the follow-up period (mean, 15.6 weeks). CONCLUSIONS: Controlled localized heating can cause the regression of hand warts. The 86% regression rate compares favorably with other wart treatment modalities. The mechanism of action and the effect of heat on these virally induced tumors is not known but may involve direct antiviral effects, physical destruction of the tumor, or the promotion of an inflammatory response that ultimately eradicates the lesion.

Adult↗
PubMed1994

Does prolonged treatment course adversely affect local control of carcinoma of the larynx?

PURPOSE: The purpose of this paper is to present local control rates of carcinoma of the larynx in relation to the total treatment course after radical radiation therapy. METHODS AND MATERIALS: A total of 1350 patients with laryngeal carcinoma treated at the Massachusetts General Hospital for the past three decades were available for analysis. Treatment courses were divided into two groups: 45 days and > 45 days. The local control rates were compared and evaluated for statistical differences. RESULTS: The data indicated that prolonged treatment course adversely affects local tumor control of both advanced glottic and supraglottic lesions, but to a lesser degree for the early tumors. CONCLUSION: The study indicated that for optimal local control, radiation treatment should be completed as soon as possible, preferably within 6.5 weeks, either by once- or twice-daily accelerated programs. The local control of early T1 glottic cancer has been exceedingly satisfactory by conventional once-daily radiation therapy. Further improvement by shortening of treatment time for such early lesions will be difficult to assess without a prospective randomized trial.

Adult↗
PubMed1996

[The effect of local control on overall survival after the breast-conserving therapy of breast carcinoma].

BACKGROUND: The impact of local control on survival in breast carcinoma has been controversially discussed depending upon the specific view of disease as being systemic from the initial onset or locally confined with spread sequentially from the primary tumor to the regional lymph nodes and then to distant sites. Results of recent studies provide a good example of why controversy persists over the benefit of local control on survival. PATIENTS AND METHODS. There are 4 recently updated randomised trials that compare conservation surgery alone or with radiation: Milan III (follow-up 3.5 years), Canada (follow-up 5 years), Uppsala/Orebro (follow-up 5 years), and NSABP-B06 (follow-up 10 to 12 years). In addition, the reanalysis of NSABP-B06-protocol reported by the EMMES Corporation has become available. Of further importance is the meta-analysis of Levitt et al. [7], which has used special statistical tools, the BAYESIAN-technique. RESULTS: All 4 trials report statistically significant increased local control and improved survival for the irradiated patients. Based on p-values and confidence intervals, survival was statistically improved in long-term follow-up of the NSABP-B06 trial, but not in the other trials, probably because of small sample sizes and short follow-up. At 10 years, the overall survival rates for the NSABP-B06 were 65 +/- 2.1% and 71 +/- 2.0% for lumpectomy alone or with radiation respectively (p = 0.04), the distant-disease-free survival 55 +/- 2.3% vs. 62 +/- 2.2% (p = 0.03), and the disease-free survival 48 +/- 2.2% vs. 56 +/- 2.2% (p < 0.01). Within the Bayesian framework, the expected advantage in 10 year survival was 6% (the mean of NSABP-B06 10 year survival) with an 83% probability that the 10-year-survival difference ranges between 2% and 10%. CONCLUSIONS: The careful analysis of these randomized trials comparing lumpectomy with or without radiation clearly indicate an improvement in overall survival for the irradiated patients which is associated with increased local control. Combination of this survival trend with the reduced psychological and economic costs associated with local recurrence provides excellent arguments for radiation therapy as the standard treatment concept in breast conservation therapy.

Bayes Theorem↗
PubMed2004

A simplified local control model of calcium-induced calcium release in cardiac ventricular myocytes.

Calcium (Ca2+)-induced Ca2+ release (CICR) in cardiac myocytes exhibits high gain and is graded. These properties result from local control of Ca2+ release. Existing local control models of Ca2+ release in which interactions between L-Type Ca2+ channels (LCCs) and ryanodine-sensitive Ca2+ release channels (RyRs) are simulated stochastically are able to reconstruct these properties, but only at high computational cost. Here we present a general analytical approach for deriving simplified models of local control of CICR, consisting of low-dimensional systems of coupled ordinary differential equations, from these more complex local control models in which LCC-RyR interactions are simulated stochastically. The resulting model, referred to as the coupled LCC-RyR gating model, successfully reproduces a range of experimental data, including L-Type Ca2+ current in response to voltage-clamp stimuli, inactivation of LCC current with and without Ca2+ release from the sarcoplasmic reticulum, voltage-dependence of excitation-contraction coupling gain, graded release, and the force-frequency relationship. The model does so with low computational cost.

Animals↗
PubMed1993

Can pretreatment computed tomography findings predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone?

PURPOSE: To determine if pretreatment computed tomography findings can predict local control in T3 squamous cell carcinoma of the glottic larynx treated with radiotherapy alone. METHODS AND MATERIALS: Twenty-nine patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with radiotherapy alone; all had a minimum 2-year follow-up. High-quality pretreatment computed tomography scans were retrospectively reviewed by a single head and neck radiologist for tumor involvement of various anatomic subsites within the larynx, and total tumor volumes were calculated for 18 of the most recent patients using a computer digitizer. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread. RESULTS: A significant decrease in the local control rate was observed for cancers involving the face of the arytenoid (11 of 20 [55%] vs. 9 of 9 [100%]; p = .02), or the paraglottic space at the false vocal cord level (7 of 16 [44%] vs. 13 of 13 [100%]; p not equal to < .01). Tumors assigned a high tumor score (6, 7, or 8) had a significantly decreased rate of local control with radiation therapy when compared with tumors assigned a low tumor score (< or = 5): 1 of 7 (14%) vs. 19 of 22 (86%) (p = .01). Total tumor volume also significantly correlated with the rate of tumor control. For tumors measuring 3.5 cm3 or less, local control was achieved in 11 of 12 patients (92%), whereas for tumors greater than 3.5 cm3, local control was achieved in 2 of 6 patients (33%) (p = .02). CONCLUSION: Pretreatment computed tomography scans can contribute significantly to the treatment decision for patients with T3 glottic carcinoma and can define a subset of patients with an excellent chance of being cured with preservation of a functional larynx after treatment with radiotherapy alone.

Adult↗
PubMed1992

Local control and patient survival.

Consideration is given to the concern that future improvements in radiation therapy which achieve increases of local control probabilities will fail to yield gains in survival, in that the new local control patients will ultimately fail because of the development of distant metastasis. The concept is that the local failure merely represents a marker of the exceptionally malignant nature of the tumor; hence, elimination of the local tumor will not affect the ultimate outcome, viz distant failure. This would mean that all tumors which fail locally after the current best radiation therapy will have established distant metastasis (subclinical) at the time of treatment of the primary tumor in stage M0 patients. Thus, a more effective local treatment would not impact on the ultimate fate of the patient. Several lines of evidence are discussed which document that tumor free survival is greater after treatment which yields higher local control probabilities than those achieved by conventional external beam radiation therapy. That is, not all of the new local control patients develop distant metastasis.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1998

The role of Ki67 proliferation assessment in predicting local control in bladder cancer patients treated by radical radiation therapy.

PURPOSE: To assess whether tumour proliferation as measured by Ki67 immunostaining has any predictive value for local control in bladder cancer patients treated by radiotherapy. PATIENTS AND METHODS: Fifty-five patients suffering from infiltrating bladder carcinoma recommended for radical radiotherapy (66 Gy/6-7 weeks) were included in this study. Paraffin-embedded pre-treatment tumour sections were stained with the Ki67 antibody. The percentage of Ki67-positive nuclei was correlated with established prognostic factors, local control and survival. RESULTS: The Ki67 index was not related to local control in our patients when the median was selected as the cut-off value. Patients with tumours with a very low (<27%) Ki67 index had better local control at 5 years (69%) than patients with tumours with greater (>27%) Ki67 expression indices (31.5%) (P<0.05; log-rank test). CONCLUSIONS: Ki67 immunostaining was a feasible method to estimate tumour proliferation. Patients with very low proliferating tumours seemed to achieve better local control after fractionated radiotherapy compared to other patients. Further studies are needed with a greater number of patients to accurately define the role of Ki67 expression in predicting tumour repopulation during fractionated radiotherapy.

Biomarkers, Tumor↗
PubMed1993

[Influence of the overall time of radiotherapy on local control for T2 cancer of the tongue].

Forty patients with T2 cancer of the tongue treated with external irradiation plus radium implants at Aichi Cancer Center were reviewed retrospectively to analyze the influence of overall treatment time on local control. One hundred percent (11/11) local control was achieved in patients irradiated within 35 days, in contrast to only 52% (13/25) local control in those irradiated over 35 days. This result indicates that prolonged overall time is associated with loss of local control. This prolongation is mainly due to the prolonged interval between external and interstitial irradiation. The interval was likely to be longer because of enhanced acute radiation mucositis, especially in patients administrated bleomycin during external irradiation. External irradiation should be followed by interstitial irradiation as soon as possible to keep overall time shorter.

Bleomycin↗
PubMed2005

The time frame of Epstein-Barr virus latent membrane protein-1 gene to disappear in nasopharyngeal swabs after initiation of primary radiotherapy is an independently significant prognostic factor predicting local control for patients with nasopharyngeal carcinoma.

PURPOSE: The presence of Epstein-Barr virus latent membrane protein-1 (LMP-1) gene in nasopharyngeal swabs indicates the presence of nasopharyngeal carcinoma (NPC) mucosal tumor cells. This study was undertaken to investigate whether the time taken for LMP-1 to disappear after initiation of primary radiotherapy (RT) was inversely associated with NPC local control. METHODS AND MATERIALS: During July 1999 and October 2002, there were 127 nondisseminated NPC patients receiving serial examinations of nasopharyngeal swabbing with detection of LMP-1 during the RT course. The time for LMP-1 regression was defined as the number of days after initiation of RT for LMP-1 results to turn negative. The primary outcome was local control, which was represented by freedom from local recurrence. RESULTS: The time for LMP-1 regression showed a statistically significant influence on NPC local control both univariately (p < 0.0001) and multivariately (p = 0.004). In multivariate analysis, the administration of chemotherapy conferred a significantly more favorable local control (p = 0.03). Advanced T status (> or = T2b), overall treatment time of external photon radiotherapy longer than 55 days, and older age showed trends toward being poor prognosticators. The time for LMP-1 regression was very heterogeneous. According to the quartiles of the time for LMP-1 regression, we defined the pattern of LMP-1 regression as late regression if it required 40 days or more. Kaplan-Meier plots indicated that the patients with late regression had a significantly worse local control than those with intermediate or early regression (p = 0.0129). CONCLUSION: Among the potential prognostic factors examined in this study, the time for LMP-1 regression was the most independently significant factor that was inversely associated with NPC local control.

Adult↗
PubMed1999

Computed tomography findings of bony regeneration after radiotherapy for nasopharyngeal carcinoma with skull base destruction: implications for local control.

PURPOSE: To evaluate the response of bony destruction (BD) of the skull base following radiotherapy in nasopharyngeal carcinoma (NPC) and investigate the implications of bony regeneration (BR) on local control and its related factors. METHODS AND MATERIALS: Ninety patients with NPC with skull base destruction clearly demonstrated on computed tomography (CT) were reviewed. These patients have completed the prescribed treatment and received regular CT follow-up. A total of 338 sets of CT images of the head and neck were reviewed. The tumor response and the appearance of BR in the previous destructive part of the skull base were recorded and analyzed. The tumor response was divided into complete, partial, or no response. BR was defined as recalcification or sclerotic change with partial or complete healing in the previous osteolytic bony defect. Local failure was confirmed either by pathological or merely by imaging studies showing progression of tumor in consecutive radiological pictures. RESULTS: The distribution of specific sites of bony destruction (BD) in these patients included the sphenoid bone (68%), paracavernous sinus area (48%), petrous apex (47%), clivus (44%), pterygoid plates (20%), and others (7%). The CT showed 57 patients (63%) had BR. All were observed within 1 year after treatment. Sixty-two patients (69%) had complete tumor response after treatment. Analyzed by logistic regression method, tumor response after treatment was found to have a statistically significant correlation with BR (p = 0.0004). Most BR (55/57) was demonstrated in patients with complete tumor response. The 3-year actuarial local control rate was 54 % in these patients. The local control was quite different in the comparison of patients with BR versus those with persistent BD (77% vs. 21%, p < 0.0001). Multivariate analysis showed that patients with complete tumor response or with BR on imaging had statistically better local control than those without either of the two findings (p < 0.05). CONCLUSION: Appearance of BR at previous destructive skull base following radiotherapy for NPC patients could be clearly demonstrated on CT. Bony regeneration significantly correlated with treatment response and local control. Although the underlying significance of BR was unknown, to predict the outcome after treatment, the appearance of BR shown on CT may imply the complete eradication of tumor in this area.

Adolescent↗
PubMed1987

Local control with pre-operative radiotherapy alone versus "sandwich" radiotherapy for rectal carcinoma.

Forty-nine patients with primary adenocarcinoma of the rectum, clinically localized to the pelvis were treated with pre-op radiotherapy (RT) 1500 cGy/5 fx with AP/PA fields, followed by immediate curative resection. Patients staged as Astler-Coller B2, C1, or C2 were considered for post-op RT, 4140 cGy/23 fxs with a 4-field technique. There were 47 evaluable patients in this non-randomized study. Two groups of patients were analyzed, namely pre-op RT only (24 patients) and combined pre- and post-op ("sandwich") RT (23 patients). Two patients with pre-op RT only were considered inevaluable for recurrence because they died NED at 1 and 7 mo. All patients have been followed for greater than 1 year; 77% have been followed for greater than 2 yr. There has been only one local recurrence (LR), surprisingly in a Stage A pre-op RT patient who had no residual tumor in the final operative specimen. In the pre-op group which included 10 B2s, and 1 C2, 1500 cGy in 5 days (equivalent to 1940 cGy by the NSD formulation) was associated with no local recurrence. No distant metastases (DM) have developed in this group. In the "sandwich" RT group, which included 3 B2s, 1 C1, 17 C2s, and 1 D (localized to the pelvis, i.e. ovary), there were no LRs and 7 DMs (1 B2 and 6 C2s). Actuarial survival is 92% in the pre-op RT group at 2 and 3 yr, and 82% in the "sandwich" group at 2 and 3 yr. There have been no serious early or late complications related to RT in our pre-op group. The use of 1500 cGy in 5 days as pre-op RT with immediate surgery may prove, upon longer follow-up, to be sufficient for increasing local control, with minimum morbidity, in patients with B2 disease. Patients with C2 disease are being controlled locally with the "sandwich" regimen, but it is not clear whether pre-op RT alone may be adequate in this group as well. We are now addressing this question in a randomized study.

Adenocarcinoma↗
PubMed1980

Intergroup Ewing's Sarcoma Study: local control related to radiation dose, volume, and site of primary lesion in Ewing's sarcoma.

One hundred ninety-three patients with localized Ewing's sarcoma treated at participating instutitions of the Intergroup Ewing's Sarcoma Study form the basis for this report. All patients received radiation therapy to the primary lesion and were randomized to receive vincristine, actinomycin-D, and cyclophosphamide (VAC) plus adriamycin (Regimen I); VAC alone (Regimen II); or VAC and bilateral pulmonary irradiation (Regimen III). Local control was achieved in 96% of the patients in Regimen I, and 86% of the patients in both Regimens II and III. The median duration of follow up was 83 weeks and median survival time was 172 weeks. Incremental doses of irradiation did not result in significant changes in the rate of local control of primary lesions. The local control rate was the same (92%) for tumors treated by means of whole-bone irradiation or with at least 5 cm of free margin around the lesion. The local control rate decreased to 79% for lesions treated with less than 5-cm margin. Excellent control was obtained for lesions involving the skull or spine (100%), and distal bones (fibula, 96% and tibia, 91%). Less favorable control rates were noted for pelvic and humeral lesions (84% and 79%, respectively). Bilateral pulmonary irradiation for subclinical disease played a role in lowering the incidence of lung metastases from 38% to 20% for patients treated with VAC. Lung metastases were similarly decreased (10%) when adriamycin was added to VAC chemotherapy.

Bone Neoplasms↗
PubMed1985

Carcinoma of the tonsil: the effect of dose-time-volume factors on local control.

Between 1970 and 1979, 372 patients with squamous cell carcinoma of the tonsil were treated with primary irradiation therapy, with salvage surgery for failures. The median age was 60 years and the male to female ratio was 2:1. The staging system used was the 1974 UICC TNM system. There were 47 T1 lesions (13%), 161 T2 lesions (43%), and 164 T3 lesions (44%). Regional nodes were not palpable in 173 (46%); 122 had N1 nodes (33%), 6 had N2 nodes (2%) and 71 had N3 nodes (19%). All patients received external beam radiation which was supplemented in 68 patients with a radioactive implant for disease into adjacent tongue. The overall survival for all patients was 38% at 5 years and 54% when corrected for intercurrent disease. Local control was 87% for T1 lesions, 68% for T2 lesions and 50% for T3 lesions. Regional control was 96% for N0, 67% for N1 and 37% for N2-3. A detailed dose-time-volume analysis revealed that increasing volume improved local control in T1 and T2 lesions (77% had local control if the volume was greater than 80 cm2 versus 53% if the volume was less than 80 cm2, p = 0.014), except for T3 lesions. Increasing the dose in the range of 5000 to 6500 rad had no significant effect on primary control in any stage of disease. The addition of a radioactive implant did not increase local control if disease extended into the tongue (57% local control if implant, 52% if no implant). This study demonstrates the significance of adequate treatment volume in local control for carcinoma of the tonsil. No significant dose response was found and subsequent surgery was not compromised when a moderate dose of radiation was used.

Adult↗
PubMed1983

Phase I pilot study on fast neutron teletherapy for advanced carcinomas of the head and neck region. Final report on local control rate and survival.

A final report is presented on the local control rate and length of survival for 100 patients with advanced squamous cell carcinomas of the head and neck region who received fast neutron teletherapy at the University of Washington during the period 1973 through 1977. Sixty-two patients were treated with neutrons alone and 38 were treated with a combination of neutrons and photons as part of a mixed beam fractionation scheme. The overall initial complete remission rate was 68% for the mixed beam group and 44% for the group treated with neutrons alone. Initial complete remission rates for the two groups of patients are given as a function of T-stage and N-stage and acturarial curves are presented which show the time course of local control and survival for the two treatment groups. For T3 and T4 lesions the initial complete remission rate appears to be greater using the mixed beam form of treatment than using neutrons alone. Treatment to high-dose levels using neutrons alone gave rise to significantly greater morbidity--both acute and late effects--than resulted from the mixed beam form of treatment. Local control rates and survival rates are compared with similar groups of patients treated with neutrons at other institutions.

Adult↗
PubMed1996

Local control of T3 carcinomas after accelerated fractionation: a look at the "gap".

PURPOSE: To study the effects of midcourse treatment break or gaps related to the local control of T3 carcinoma of the oropharynx and larynx following accelerated hyperfractionated radiation therapy. METHODS AND MATERIALS: All patients were treated at the Massachusetts General Hospital from 1979 through 1994 with treatment consisting of 1.6 Gy per traction, two fractions a day for the treatment of T3 carcinoma of the oropharynx and larynx. They were entered in the head and neck data base. Their treatment dates, treatment breaks, and doses vs. local control were analyzed and compared. A p-value of 0.05 was considered statistically significant. RESULTS: A total of 162 patients were available for review. Due to the acute severe mucosal effects, most of the patients required a midcourse pause or "break" after a dose of 38.4-48 Gy before treatment could be resumed and completed. The data indicate that (a) prolongation of the treatment gap for more than 14 days, (b) total treatment course longer than 45 days, (c) total dose less than 67 Gy, and (d) male gender adversely affected local control. In spite of the gaps, the female patients with advanced carcinomas enjoyed the benefits of improved local control after the accelerated hyperfractionated radiation therapy. CONCLUSIONS: Accelerated hyperfractionation radiation therapy using 1.6 Gy per fraction/twice-a-day (b.i.d.) for a total dose of 70.4 Gy in 6 weeks is effective in achieving high local control of T3 squamous cell carcinoma of the oropharynx and larynx. The midcourse treatment gap should be as short as possible with the projected total dose and time. Should the gaps be unduly prolonged due to various circumstances, further increase in the total dose, for example, 72-75 Gy, and/or increase of the fraction sizes, for example, 1.8-2.0 Gy/f b.i.d. after the gap may be necessary to compensate for the adverse effects of the tumor regeneration from the prolonged gap.

Adolescent↗
PubMed1995

Local control of muscle-invasive bladder cancer: preoperative radiotherapy and cystectomy versus cystectomy alone.

PURPOSE: The role of preoperative radiotherapy for patients with muscle-invasive bladder cancer remains controversial. Since 1985, the primary modality for treatment of these patients at our institution has been radical cystectomy alone. Prior to that time, the use of preoperative and cystectomy had been the mainstay of treatment. In this retrospective review we compare the results of these treatments, focusing on local control. METHODS AND MATERIALS: The preoperative radiotherapy and radical cystectomy (PREOP) group was comprised of 338 patients with muscle-invasive (Stages T2-T4) transitional cell carcinoma of the bladder treated between 1960 and 1983. A mean total dose of 49.3 +/- 0.2 Gy (+/- SE) was administered at 2 Gy per fraction 4-6 weeks prior to cystectomy. The radical cystectomy alone (CYST) group was comprised of 232 patients treated between 1985 and 1990. The median follow-up for the PREOP group was 91 months and for the CYST group was 54 months. Only those patients who completed planned PREOP (n = 301) and CYST (n = 220) treatments were included in the analyses described below. RESULTS: The treatment groups were stratified by clinical stage and compared in terms of actuarial local control. There were no differences between the groups for Stage T2 or T3a patients, and there were not enough Stage T4 patients in the PREOP group with which to make a meaningful comparison. However, for those with T3b disease, actuarial 5 year local control for the PREOP group (n = 92) was 91%, compared to 72% for the CYST group (n = 43). This difference was significant at p = 0.003 (log rank). Patients with T3b disease who received PREOP also fared slightly better at 5 years in terms of freedom from distant metastasis (67% vs. 54%), disease freedom (59% vs. 47%), and overall survival (52% vs. 40%); although, these differences did not reach statistical significance. The distribution of prognostic factors in the groups was analyzed to determine if this could account for the differences in local control in Stage T3b patients. For patients with Stage T3b disease, the only significant difference was by grouped age (p < 0.05, chi-square), which was not a significant factor in the univariate analyses of local control. A multivariate analysis using Cox proportional hazards models revealed pretreatment hemoglobin, blood urea nitrogen (BUN) concentration, and treatment type (PREOP vs. CYST) to be independently predictive of local control. CONCLUSION: We document here in a large number of patients treated at a single institution that preoperative radiotherapy had a significant impact on local control for patients with clinical Stage T3b disease. Because the CYST patients were treated using modern-day surgical techniques and 80% of those with Stage T3b disease received multiagent chemotherapy, it is probable that any biases, if present, would favor the CYST group. Thus, the differences between PREOP and CYST described may be underestimated. Preoperative radiotherapy should be considered as an adjunct to chemotherapy and surgery for clinical Stage T3b patients.

Actuarial Analysis↗
PubMed1996

The effect of combined external beam radiotherapy and brachytherapy on local control and wound complications in patients with high-grade soft tissue sarcomas of the extremity with positive microscopic margin.

PURPOSE: A previously reported randomized trial from out institution demonstrated a local control advantage to adjuvant brachytherapy (BRT) for completely resected high grade soft tissue sarcoma (STS). In recent years, BRT boost has been combined with wide field external beam radiotherapy (EBRT) for selected patients in whom the margin(s) of resection was positive. This study evaluates the impact of BRT boost plus EBRT on local control in this subset of patients and on wound complication rates. METHODS AND MATERIALS: Between January, 1987 and December, 1992, 105 adult patients with primary or locally recurrent high grade STS of the extremity were treated with wide local excision and BRT alone (87 patients; dose: 45 Gy) or BRT plus EBRT (18 patients; dose: 15-20 Gy BRT + 45-50 Gy EBRT). The margin(s) of resection was positive in 10 out of 18 patients in the BRT + EBRT group vs. 17 out of 87 patients in the BRT alone group. Wound complications were classified as major if they required further operative intervention; moderate if there was purulent discharge, hematoma > 25 ml, wound separation > 2 cm, and persistent seroma requiring drainage; or minor if less than moderate. Median follow-up was 22 months. RESULTS: The overall 2-year actuarial local control rate was 86%. There was no difference in the 2-year actuarial local control rate between the BRT + EBRT group (90%) and the BRT alone group (82%) (9 = 0.32). However, for patients with positive resection margins the use of BRT + EBRT produced better local control than BRT alone [9 out of 10 (90%) vs. 10 out of 17 (59%)]. This difference approached but did not reach statistical significance (p = 0.08). No difference was seen in patients with negative margins. There was no significant difference in the overall wound complication rate (26% BRT vs. 38% BRT + EBRT, p = 0.31) nor in the combined major and moderate wound complication rate (16% BRT vs. 27% BRT + EBRT, p = 0.39). CONCLUSION: Our preliminary data suggest a trend in favor of BRT boost + EBRT as the optimal adjuvant local strategy for STS with positive resection margins. There is no significant difference in the wound complication rate with either technique.

Adolescent↗
PubMed2000

The impact of primary tumor volume on local control for oropharyngeal squamous cell carcinoma treated with radiotherapy.

BACKGROUND: A study was needed to determine the effect of primary tumor volume on local control of oropharyngeal carcinoma treated with radiation therapy, with or without induction chemotherapy. METHODS: Between July 1983 and April 1995, 114 patients with T2-T4 squamous cell carcinoma of the oropharynx were treated for cure with radiation therapy, with or without induction chemotherapy, and had a pretreatment CT scan available for retrospective review. All scans were reviewed by a single radiologist (A. A. M.) to determine the tumor volume of the primary lesion. Volume was measured with a computer digitizer for each CT slice showing the primary lesion. RESULTS: A large variation in tumor volume within a given T stage was found. Multivariate analysis demonstrated T stage to be the most significant factor affecting local control. Tumor volume marginally influenced local control (p =.10). CONCLUSIONS: Primary tumor volume varies significantly within a given T stage and has a marginal impact on the likelihood of local control after radiotherapy.

Adult↗