Neoadjuvant radiochemotherapy in patients with advanced adenocarcinoma of the esophagogastric junction followed by thoracoabdominal surgery is a feasible concept. Significant tumor regression in 44% of the patients and an ypN0 rate in 67% of the patients may favor this approach due to its high efficacy. However, to avoid toxic pulmonary effects constraints for low-dose radiation volume parameters need specific attention.
Background: With increasing numbers of patients subjected to total body irradiation and bone marrow transplantation for treatment of several systemic malignancies more and more patients with second malignancies were observed. Case Report: We report the case of a 29- year-old man who developed breast cancer 13 years after treatment for acute lymphoblastic leukemia. Therapy for leukemia included total body irradiation (TBI) and bone marrow transplantation (BMT). Breast cancer was treated with mastectomy and irradiation of the left chest wall. 17 months later the patient developed malignant pleural effusion and died despite chemotherapy and hormonal therapy due to further tumor progression. Conclusion: The increased risk for secondary solid cancers after TBI and BMT and the greater risk among younger patients indicate the need for lifelong careful follow up.
We evaluated the files of 80 women who were treated for vulvar carcinoma. In 13 women radiotherapy was used as primary treatment, in 45 cases postoperatively and in 22 women because of local recurrence. Patients older than 60 years had a significantly worse 5-year survival rate (39%) than younger women (57%) (p = 0.02). The 5-year survival rate for patients with negative nodes was 72% versus 46% for the N1- and 47% for the N2-status, respectively (p = 0.027). The 5-year actuarial survival rate for patients with tumor manifestation in the clitoris was 77.9% versus 26.1% for patients with tumors in the labia majora (p = 0.0044). There was no difference in survival in patients who had been treated with radical vulvectomy and bilateral groin dissection plus local radiotherapy when compared with patients who had been irradiated (whole pelvis) after tumor resection alone. The 5-year survival rates and the median survival time were identical in both groups (61%/62 months).
Purpose: Feasibility and morbidity of intraoperative radiotherapy (IORT) for malignant brain tumors as well as value of innovative imaging for diagnosis of rest tumors and recurrences were examined. Patients and Methods: Between May 1992 and October 1995 40 patients suffering from malignant brain tumors were treated with IORT at the University of Münster. The patient group was heterogenous, negative selection had been applied, which – besides patients receiving primary treatment – included patients with relapses and metastases with whom all treatment efforts had been exhausted. Therapy consisted of radical surgical resection and intraoperative electron beam therapy using total doses of 15-25 Gy, normalized to the 90% isodose. Thereafter, patients without prior treatment underwent percutaneous irradiation to a dose of 60 Gy of the residual tumor tissue or the area supporting the tumor, including a safety margin of 2 cm. Results: No increase of perioperative morbidity and of late sequelae was observed; however, the follow-up period was short. The 1-year survival rate was 42.9% for patients with grade III gliomas (WHO), and 51.5% for patients with glioblastomas. Considering the selection criteria according to Matsutani (initial therapy of supratentorial, peripherally located astrocytoma grade III or glioblastoma with less than 5 cm in diameter and a Karnofsky index of > 60% possibility of wide resection), the 1-year survival rate amounted to 71.4%. Imaging with 123I-α-methyltyrosine SPECT proved to be a valuable method for diagnosing not resected tumor tissue as well as relapse. Conclusions: The practicability of IORT for malignant brain tumors is shown in this study. Neither perioperative morbidity nor subacute sequelae were increased.
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