No abstract

This study showed that, in extensively pre-treated patients with locally recurrent breast cancer, local tumour control after thermoradiotherapy depended on tumour resectability, response of macroscopic tumour to thermoradiotherapy, and total irradiation dose.

Background: The RTOG 94-13 trial has provided evidence that patients with high risk prostate cancer benefit from an additional radiotherapy to the pelvic nodes combined with concomitant hormonal ablation. Since lymphatic drainage of the prostate is highly variable, the optimal target volume definition for the pelvic lymph nodes is problematic. To overcome this limitation, we tested the feasibility of an intensity modulated radiation therapy (IMRT) protocol, taking under consideration the individual pelvic sentinel node drainage pattern by SPECT functional imaging.

Background: 2-year results of a German multicenter randomized trial showed that accelerated chemoradiation with MMC/5-FU to 70.6 Gy is more effective than accelerated radiation to 77.6 Gy alone at equivalent levels of acute and late radiation morbidity. Frequency, histopathology and impact on local tumor control of selective lymph node dissection were analyzed. Patients and Methods: Between February 1996 and October 2000 at Tübingen University 42 randomized patients plus 45 nonrandomized patients with stage III/IV MO head and neck cancer were treated according to this protocol. After completion of hyperfractionated accelerated (chemo-)radiation a selective lymph node dissection was performed, if the primary tumor was in complete remission and clinical plus computed tomography proved residual lymph node disease. 17 of 38 patients with residual node metastasis underwent uni-or bilateral selective node dissection, the remaining patients had residual primary tumors, clinical deterioration or refused neck dissection. Results: After a median follow-up of 26 months, the Kaplan-Meier analysis showed a 2-year overall survival of 49%, disease-specific survival of 64% and loco-regional tumor control of 60%, respectively. 3-year loco-regional tumor control in randomized patients was 52% compared to 58% in non-randomized patients (log rank p = 0.23). 2-year loco-regional tumor control in stage cT4cN0 was 76% compared to 57% in cT2-4 cN1-3 tumors. Subgroup analysis of patients with involved nodes revealed a 2-year loco-regional tumor control of 74% after complete remission of primary tumor and neck disease, 53% after complete remission of primary tumor and partial remission of neck disease. In patients with selective lymph node dissection loco-regional tumor control was 62%. Histopathological examination showed viable tumor in eight of 17 patients. Conclusions: Selective lymph node dissection of residual neck masses after completion of hyperfractionated accelerated radio-(chemo-)therapy is likely to contribute to loco-regional tumor control in advanced head and neck cancer. Selektive Neck-Dissection nach hyperfraktionierter akzelerierter Radio-(Chemo-)Therapie bei lokal fortgeschrittenen Kopf-Hals-TumorenHintergrund: Die multizentrische Phase-III-Studie (ARO 95-6) zur akzelerierten hyperfraktionierten Strahlentherapie ± 5-Fluorouracil/Mitomycin C bei lokal fortgeschrittenen Kopf-Hals-Tumoren konnte nachweisen, dass die kombinierte Radiochemotherapie bezüglich lokaler Tumorkontrolle und Gesamtüberleben wirksamer ist als die alleinige Strahlentherapie. Wir untersuchten Häu-figkeit, histopathologisches Ergebnis und den Einfluss der selektiven Neck-Dissection auf die lokale Tumorkontrolle. Patienten und Methoden: Zwischen Februar 1996 und Oktober 2000 wurden in Tübingen insgesamt 42 randomisierte und 45 nicht randomisierte Patienten mit fortgeschrittenen Kopf-Hals-Tumoren im Stadium III/IV MO nach diesem Protokoll behandelt. Nach Abschluss der akzelerierten hyperfraktionierten Strahlentherapie ± 5-Fluorouracil/Mitomycin C wurde ei...

In high-risk breast cancer patients postmastectomy irradiation with the electron-beam-rotation technique is an effective therapy, resulting in a 5-year local failure rate of 8%. Intensified local therapy needs further investigation in subgroups of patients with additional risk factors.