Akihiko Hoshi

Squamous Cell Carcinoma of the Maxillary Sinus and the Oral Part of the Upper Jaw: Comparison of treatment results

The treatment results were compared in 77 patients with maxillary sinus squamous cell carcinoma (MC) and 53 patients with squamous cell carcinoma arising from the oral part of the upper jaw (OC). Both sets of patients received radiotherapy alone, or radiotherapy combined with surgery and/or chemotherapy. Computerized tomography was useful for the definition of the treatment volume. Intraarterial chemotherapy was given in 89 of 130 patients and in these patients the total radiation dose was reduced by about 10 Gy. No difference was found in the 5-year survival rate between the MC (65%) and the OC (66%) groups. The cumulative incidence of local failure was higher in MC (36%) than in OC (26%), whereas the ultimate incidence of neck node metastasis was higher in OC (43%) than in MC patients (18%). Half of the inoperable patients (9/18) were older than 80 years and had contraindications to anaesthesia and major surgery. The local recurrence rate was high in the inoperable MC patients (6/8). Contralateral sinus cancers occurred in 4 patients in the MC group.

PROGNOSTIC FACTORS IN RADIATION-TREATED ESOPHAGEAL CARCINOMA

Prognostic factors in esophageal carcinoma treated with irradiation were examined. The prognosis of 111 patients without metastasis who had received more than 60 Gy was analyzed. Significant associations were found between survival rates and tumor length, stage, radioresponse of the primary tumor and the s.c. X-P classification based on barium contrast radiography; superficial type (tumor limited to the surface of the esophageal wall), tumorous type (solid mass without ulceration), Ul-A type (tumor with shallow ulceration with regular margin), Ul-B type (tumor with deep ulceration or irregular ulcer margin), and funneled type (tumor invading the esophageal wall in a scirrhous pattern). In multiple regression analysis, the X-P classification had the strongest correlation with survival and the survival rates of patients with the superficial type, the tumorous type and the s.c. Ul-A type were significantly higher than those of patients with the other tumor types (p < 0.001).

Postoperative Irradiation for Esophageal Carcinoma

Postoperative irradiation for curative resection of esophageal carcinoma has been used in order to eradicate micro-dissemination and micro-metastases. Generally, a long T-shaped field is employed for postoperative irradiation, and the risk of radiation myelopathy increases even at low doses when the irradiated volume of the spinal cord enlarges. Some questions arise about the postoperative irradiation: First, whether its effectiveness outweighs the risk; second, for which patients it is indispensable; third, what is the optimal dose of irradiation; fourth, whether combined chemotherapy improves the prognosis; and fifth, what the actual incidence of radiation myelopathy is. We analyzed data compiled over the last decade.

Low-dose rate telecobalt-therapy as a boost against brain-tumors.

We applied low-dose rate telecobalt therapy (LDRT) as a boost for 26 brain tumors (17 malignant gliomas, 4 pontine gliomas and 5 others). Eleven of those cases were recurrent. The LDRT; 1 Gy per hour, 7 Gy per day, a total dose of 14 Gy in two successive days, was boosted after a conventional irradiation. In malignant glioma, the local control rate and the survival rate were not improved, compared with those of the control group. The treatment results of other brain tumors were also unsatisfactory. The incidence of brain necrosis was higher in the LDRT group. The benefits of the LDRT as a boost for radioresistant brain tumors seem to be small.