The International Lymphoma Radiation Oncology Group presents a standardized approach to the use and implementation of definitive RT in solitary plasmacytomas. The modern principles outlining the supportive role of palliative RT in multiple myeloma in an era of novel systemic therapies are also discussed.

Treatment with radiation alone had suboptimal results, partly because of the occurrence of a variety of systemic failure with diverse clinicopathologic features. Given the frequent occurrence of systemic failure after radiation treatment, we believe that the multimodality treatment approach containing more effective chemotherapeutic agents should be incorporated in the treatment of angiocentric lymphoma confined to the head and neck.

To characterize the radiation-enhancing effects on human cancer cells and underlying mechanisms of celecoxib, a cyclooxygenase (COX)-2 selective inhibitor, and to ascertain whether its effects are COX-2 dependent. Clonogenic cytotoxicity assays and radiation survival assays after treatment with celecoxib F radiation were done on four human cancer cell lines that expressed differential COX-2 levels. Stably COX-2 knocked down or overexpressed cell lines were developed, and clonogenic assays, apoptosis assays, or cell cycle change measurements were conducted after treatment with celecoxib F radiation. Prostaglandin E 2 (PGE 2 ) was applied to medium after treatment with celecoxib F radiation to determine whether the radiation-enhancing effect associated with celecoxib results from reduced generation of prostaglandin. Celecoxib's radiation-enhancing effect was observed in COX-2-expressing A549 and NCI-H460 cells but was not observed in the COX-2 nonexpressing MCF-7 and HCT-116 cells. Celecoxib's radiation-enhancing effects in A549 cells were shown to disappear after the administration of COX-2 knocked down. In contrast, the HCT-116 cells were radiosensitized by celecoxib after being transfected with COX-2 expression vector. The addition of PGE 2 after treatment with celecoxib F radiation had no significant effects on celecoxib's radiation-enhancing effects in A549 and COX-2 transfected HCT-116 cells. Radiation-induced G 2 -M arrest was enhanced and sustained in the COX-2-overexpressing cells compared with that seen in COX-2 low-expressing cells. Celecoxib or NS-398 effected no changes or attenuated radiation-induced G 2 -M arrest in the COX-2-overexpressing cells but further enhanced the radiation-induced G 2 -M arrest in the COX-2 low-expressing cells. Celecoxib's radiation-enhancing effects seem to occur in a COX-2 expression-dependent manner in the cancer cells. This effect does not seem to be the result of reduced PGE 2 generation. Celecoxib may exert an inhibitory effect on enhanced radiation-induced G 2 -M arrest in the COX-2-overexpressing cells, which may allow the arrested cells to enter mitosis and die after radiation, but may also further enhance radiation-induced G 2 -M arrest in the COX-2 low-expressing cells, by virtue of another mechanism. (Cancer Res 2005; 65(20): 9501-9)

Results: Positive immunoreactivity for EGFR and COX-2 was observed in 49 of 68 (72%) and 19 of 68 (28%), respectively. However, no strong correlation was found between the levels of EGFR and COX-2 immunopositivity (R 2 ‫؍‬ 0.05, P ‫؍‬ 0.07). Patients in the EGFR-positive/COX-2-positive group had a higher likelihood of locoregional recurrence than those in the other three groups (P ‫؍‬ 0.02). Of the patients in the four groups, patients positive for both oncoproteins were found to have the worst prognosis with an overall 5-year disease-free survival rate of 55% compared with 91% for the EGFR-negative/COX-2-negative patients, 88% for the EGFR-negative/COX-2-positive patients, and 69% for the EGFR-positive/COX-2-negative patients (P ‫؍‬ 0.05, log-rank test). In addition, the synchronous coexpression of the EGFR and COX-2 oncoproteins was found to be an independent prognostic factor by univariate and multivariate analyses (relative risk ‫؍‬ 4.0, P ‫؍‬ 0.03).Conclusions: Given these observations, we conclude that the coexpression of EGFR and COX-2 immunoreactivity may be used as a potent molecular risk factor for predicting the poor survival of patients with the International Federation of Gynecology and Obstetrics stage IIB squamous cell carcinoma of the uterine cervix.

BACKGROUND The objective of this study was to determine whether cyclooxygenase‐2 (COX‐2) overexpression was an indicator of prognosis in patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IIB uterine cervical carcinoma who underwent radiation and concurrent chemotherapy. METHODS Seventy‐five patients with FIGO Stage IIB squamous cell carcinoma (SCC) of the uterine cervix who were treated with radiotherapy and concurrent chemotherapy between 1991 and 1996 were divided into two groups according to their COX‐2 level in an immunohistochemical study: the COX‐2 negative group (n = 54 patients) and the COX‐2 positive group (n = 21 patients). The clinicopathologic features, patterns of treatment failure, and survival data for patients in the COX‐2 positive group were compared with data from the patients in the COX‐2 negative group. Univariate and multivariate analyses were performed to determine the prognostic factors that influenced patient survival. RESULTS In the immunohistochemical study, COX‐2 overexpression was observed in approximately 30% of patients with FIGO Stage IIB SCC of the uterine cervix. With delayed regression to the initial treatment, the treatment failure rate of patients in the COX‐2 positive group was much higher compared with the treatment failure rate of patients in the COX‐2 negative group. The higher incidence of central failure and lymph node failure for patients in the COX‐2 positive group was statistically significant (48% for the COX‐2 positive group vs. 13% for the COX‐2 negative group). However, there was no difference in the incidence of hematogenous metastases between the two groups (5% for the COX‐2 positive group vs. 7% for the COX‐2 negative group). In addition, increased COX‐2 expression in tumor cells also was correlated with a shorter interval to tumor recurrence (median interval to recurrence, 9 months in the COX‐2 positive group vs. 26 months in the COX‐2 negative group). Compared with patients in the COX‐2 negative group, patients in the COX‐2 positive group had lower overall actuarial and disease free survival rates (overall 5‐year actuarial survival rates: 56% for the COX‐2 positive group vs. 94% for the COX‐2 negative group; P = 0.003). Univariate and multivariate analyses showed that COX‐2 overexpression was an independent prognostic factor that surpassed other well‐known clinicopathologic parameters. CONCLUSIONS COX‐2 overexpression can be used as a potent molecular risk factor in patients with FIGO Stage IIB SCC of the uterine cervix who are treated with radiotherapy and concurrent chemotherapy. Cancer 2002;95:531–9. © 2002 American Cancer Society. DOI 10.1002/cncr.10684