No abstract

This study was undertaken to determine the disease outcomes in patients treated with surgery alone or surgery and adjuvant radiotherapy (RT) for myxopapillary ependymoma (MPE) of the spine. The medical records of 35 patients with MPE treated at The University of Texas M.D. Anderson Cancer Center between December 1968 and July 2002 were reviewed. The endpoints analyzed were progression-free survival (PFS), overall survival, and local control. The median age of patients was 35 years (range, 14-63 years), and the male to female ratio was 2.5:1. In total, 21 (60%) patients underwent a gross total resection, 13 (37%) a subtotal resection, and 1 (3%) a biopsy only; 22 of them (63%) also received adjuvant RT. The median follow-up was 10.7 years. The 10-year overall survival, PFS, and local control rates for the entire group were 97%, 62%, and 72%, respectively. Of 11 patients 5 (45%) who had undergone gross total resection alone had recurrence. A total of 12 (34%) patients had disease recurrence, all in the neural axis; 8 of them had treatment failure at the primary site only, 3 in the distant neural axis only, and 1 at the primary site and in the distant neural axis. Patient age (> 35 years; P = 0.002) and adjuvant RT (P = 0.04) significantly affected PFS. The long-term patient survival duration for MPE managed with surgery and adjuvant RT is favorable. Regardless of the extent of resection, adjuvant RT appears to significantly reduce the rate of tumor progression. Failures occurred exclusively in the neural axis, mainly at the primary site.

SRS can be used as primary treatment of brain metastases or salvage of recurrences after whole-brain radiation therapy to achieve good local control on the order of close to 80% at 1 year. The median survival of brain metastasis patients with breast cancer of 19 months appears favorable compared with the general brain metastasis population.

Radiation induced thyroid dysfunction is usually underestimated in patients with breast cancer who had supraclavicular irradiation (RT). In the present study, a total of 28 patients with breast cancer received supraclavicular RT were evaluated focusing on radiation dose-volume factors in relation to thyroid function. Thyroid function tests, including serum thyroid stimulating hormone, free thyroxine, free triiodothyronine, were analyzed prior to RT and 3,6,9,12,18 and 24 months after RT. Based on each patient's dose volume histogram (DVH), total volume of the thyroid, mean radiation dose the thyroid and percentages of thyroid volume which received radiation doses 10-50 Gy (V10-V50) were considered for statistical analysis. The median follow-up time was 25 months (range, 12.3-36 months). Of 28 patients 6 (21%) were diagnosed with hypothyroidism (HT). The median time to the development of HT was 9 months (range: 3-18 months). Mean thyroid dose was 31 Gy (19-48 Gy) and mean thyroid volume was 32 cc (12-64 cc). We found that V20 (OR= 10, 95% CI= 1.15-86.88, p= 0.05), V30 (OR= 10, 95% CI= 1.15-86.88, p= 0.05) and V40 (OR= 21, 95% CI= 1.61-273.34, p= 0.02) and mean thyroid dose ≥36 Gy (OR= 10, 95% CI= 1.15-86.88) (p= 0.05), had a significant impact on development of HT. Moreover, significant elevation was observed in mean TSH level between baseline (1.85±1.47 mIU/L) and at 6 months (3.80±7.42 mIU/L), (p= 0.003). Supraclavicular RT in patients with breast cancer appear to amplify the risk of HT. We believe further investigations in larger cohort are required to confirm our results. Keywords: Thyroid dysfunction, Breast Cancer, Radiotherapy ÖZET Meme Kanserinde Supraklavikuler Işınlama Sonrası Tiroid Fonksiyon BozukluğuSupraklavikuler radyoterapi (RT) alan meme kanserli hastalarada tiroid fonksiyon bozuklukları genellikle göz ardı edilir. Bu çalışmada supraklavikuler RT alan 28 meme kanserli hasta, radyasyon doz-volüm faktörleri ve tiroid fonksiyon testlerine fokuslanarak değerlendirildi. Tiroid stümülan hormon, serbest triiyodotironin, serbest tiroksin, RT'den önce ve 3, 6, 9,12,18 ve 24 sonra analiz edildi. Tüm hastaların doz-volüm histogramlarına (DVH) dayanarak total tiroid volümü, mean tiroid dozu ve 10-50 Gy radyasyon alan tiroid volüm yüzdesi (V10-50) istatiksel analiz için elde edildi. Ortalama takip süresi 25 aydı (12.3-36 ay). Yirmisekiz hastanın 6 (%21)'sında hipotiroidizm (HT) saptandı. Median HT gelişme zamanı 9 (3-18 ay) aydı. Mean tiroid dozu 31 Gy (19-48 Gy) ve mean tiroid volümü 32 cc (12-64 cc) idi. V20 (OR= 10, 95% CI= 1.15-86.88, p= 0.05), V30 (OR= 10, 95% CI= 1.15-86.88, p= 0.05) ve V40 (OR= 21, 95% CI= 1.61-273.34, p= 0.02) ile mean tiroid dozunun ≥36 Gy (OR= 10, 95% CI= 1.15-86.88) (p= 0.05) olması HT gelişiminde anlamlı bulundu. Ek olarak, bazal mean TSH (1.85±1.47 mIU/L) düzeyi ile karşılaştırıldığında 6. ayda (3.80±7.42 mIU/L), (p= 0.003) anlamlı fark gözlendi. Meme kanserli hastalarda supraklaviküler RT, HT riskini artırıyor görünmektedir. Sonuçlarımızın daha fazla hasta sayılı çalışma...