E. Cellai

Accelerated fractionation in advanced head and neck cancer: results and analysis of late sequelae

From 1975 to 1985, 161 patients affected by head and neck cancer (58 oropharynx, 67 oral cavity, 36 paranasal sinuses) were treated with radiotherapy using an accelerated fractionation (AF) schedule at the University and Hospital Radiotherapy Departments of Florence. Most cases, classified with U.I.C.C. and A.J.C. TNM (1978) were advanced (137/161 = 85%). Five-year actuarial local control and survival was 38% for the oropharynx, 18% and 20% for the oral cavity, and 38% and 31% for the paranasal sinuses. Results were analysed according to T and N stage as well. Severe late sequelae were evaluated in 53 patients without local disease and with a minimum follow-up of one year: 8 patients developed osteonecrosis; there were 3 cases of trismus, 2 cases of laryngeal oedema, one case of blindness and one case of ophthalmitis.

Real-Time Quantitative Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) for the Measurement of Prostate-Specific Antigen mRNA in the Peripheral Blood of Patients with Prostate Carcinoma Using the TaqManTM Detection System

Abstract Circulating prostate cells can be detected in peripheral blood of patients with clinically localized or advanced prostate carcinoma. Traditionally, nested reverse transcriptase-polymerase chain reaction (RT-PCR) is used for this as a sensitive, but qualitative only, detection system. We developed a quantitative real-time RT-PCR method for measuring prostate-specific antigen (PSA) mRNA in peripheral blood of prostate cancer patients. A quantitative assay was developed using an external standard reference curve generated with RNA from the human prostate cell line LNCaP. Basal blood samples were collected from 44 patients without evidence of distant metastases and from 30 healthy controls. In 29 patients surgically treated with radical prostatectomy, the measurement of PSA mRNA was performed in blood samples collected before, at the end and 6 days after surgery. In 14 patients treated with radiotherapy, the measurements were repeated at 3-month intervals to evaluate time-related changes during therapy. The measurements were also performed for one year at 3-month intervals in one patient treated with anti-androgen therapy. We found detectable PSA mRNA in 14/44 (32%) basal blood samples. A wide range of values were observed in these patients, ranging from 0.5 to 1724 pg of total LNCaP RNA/ml blood. In patients undergoing radical prostatectomy, circulating PSA mRNA was detectable in eight patients in basal samples, and in seven of them also in blood specimens collected at the end of surgery, showing an increase in only two patients. In blood samples collected 6 days later, PSA mRNA was dramatically reduced in all patients, but still present in seven of them. In four patients, whose basal samples were negative, PSA mRNA was detectable in samples collected at the end of surgery and three of them were negative after 6 days. In patients who did not receive surgical treatment, a rapid decrease in PSA mRNA was demonstrated in five patients treated with radiotherapy and in one patient undergoing androgen deprivation. No detectable PSA mRNA was found in healthy controls. The levels of PSA mRNA in peripheral blood from patients with prostate carcinoma can be easily measured by this sensitive, quantitative and reliable procedure. This assay is a promising tool for the detection and follow-up of these patients.

Causes of failure of curative radiation therapy in 205 early glottic cancers

A retrospective analysis of the results obtained with curative radiation therapy in a series of 205 patients affected by early glottic cancer treated from 1970 to 1985 at the Florence University and Hospital Departments of Radiotherapy is presented. All patients were staged according to TNM System (UICC 1978) as T1-T2 NO. The overall 5-year local control rates were 88% for T1a, 75% for T1b, and 64 for T2. The main cause of failure was progression or recurrence in T (41/48); five failures were observed in T and N at the same time and two in N. Of these 48 patients, 21 (44%) were salvaged with surgery. After surgical salvage of radiation failures, the 5-year survival rates were 95%, 91%, and 73%, respectively, for T1a, T1b, and T2. The extent of T and the number of subsites involved significantly affected local control. Vocal cord mobility was less important. The incidence of failures and damages was analyzed according to the radiation beam, the size of the irradiated volume, fractionation, and total tumor dose.

Computed tomography in nasopharyngeal carcinoma: Part II: Impact on survival

Two hundred and seventeen consecutive patients affected by nasopharyngeal carcinoma (NPC) were treated with radiotherapy alone, with curative intent, from 1970 to 1985 at the Radiotherapy Unit of the University and Hospital of Florence. A group (A) of 111 patients staged with conventional clinical and radiological method was compared to a second group (B) of 106 patients who underwent CT staging before treatment. Group B showed better 5-year NED survival and local control; only the differences in local control were significant (p less than 0.01). As to primary control statistically significant differences were observed in T2 and T4 cases. We feel that CT could have contributed to the improvement, probably through a more reliable display of the primary extent and a more adequately planned radiotherapeutic treatment. With CT staging we could not increase our skills in prognostically separating stages according to UICC criteria (1978); in Group B only T2 patients presented significant differences in primary control when compared to T3 and T4 patients. However, a multivariate analysis of prognostic factors showed that nodal involvement, primarily, and histology, secondarily, were the most important factors; T stage showed a minor influence on prognosis.

Carcinoma of the Nasopharynx Results of Radiation Therapy

Of a series of 186 patients with nasopharyngeal neoplasm 138 cases were treated with curative irradiation between 1959 and 1978. All cases were reviewed and retrospectively classified according to the TNM system. The 5-year crude survival rate was 39.5 per cent. A better prognosis was found for women and for younger age groups. The degree of neck node involvement had more prognostic value than the extent of the primary tumor. The causes of failure were analyzed. In 35 cases distant metastases were observed.

Computed tomography in nasopharyngeal carcinoma: Part I: T-stage conversion with CT-staging

Two hundred seventeen consecutive patients were treated with radiotherapy alone, with curative intent, from 1970 to 1985 at the Radiotherapy Unit of the University and Hospital of Florence. The distribution according to T and N staging with polytomography was compared to patients (106 out of 217) who had CT scans done at presentation. T1 cases were less frequent (6.6% vs 27%) in the CT-staged series, whereas T3 showed a higher incidence (30.2% vs 12.6%). The advantages of CT over conventional tomography were quantitated in a subset of 97 patients who underwent both staging procedures. Site-by-site, CT displayed a higher percentage of involvement than polytomography: parapharyngeal spread 18% vs 2%, oropharynx 16% vs 8%, choanae and nasal cavities 28% vs 13%, ethmoid and maxillary sinus 29% vs 13%. Information provided by CT caused a T-stage conversion in 23 out of 97 cases (23%): 4 out of 11 T1, 16 out of 44 T2, 3 out of 16 T3.

Paranasal sinuses and nasal cavity cancer: Different radiotherapeutic options, results and late damages

From 1970 to 1983, 69 patients, affected by malignant epithelial tumors of paranasal cavities and nasal fossae, were treated with radiotherapy at the Radiology Institute of the University and Radiotherapy Hospital Department of Florence. Primary carcinoma of the maxillary sinus occurred in 44 patients, of the nasal cavity in 20, and of the other sinuses in 5. Most of the patients had locally advanced lesions (63 T3-4: 91.5%) according to the adopted TNM system (Lederman-Gadeberg, Sisson-Jesse). Crude survival data showed 35% and 13% of NED patients at 2 and 5 years, respectively. Local progression was the most important cause of death; patients relapsed within 2 years. The actuarial 5-year survival, corrected for causes of death other than disease, was 32% for the overall series, 32% for maxillary sinus, and 41% for the nasal cavity. There was no difference in survival in patients treated with conventional fractionation (CF) vs. multiple daily fractionation (MDF) –30% vs. 33% at 5 years. The late damages of the radiation therapy in 22 patients without local disease, with a minimum follow-up of 2 years, is also analyzed.

Advanced carcinomas of the oropharynx treated with radiotherapy—A comparison of three different fractionation schemes

INTRODUCTION This report reflects a retrospective comparison among historical series of patients with similar site and stage of disease treated by three fractionation schemes. MATERIALS AND METHODS A hyperfractionation (HF) scheme delivered 1 Gy three times a day, 5 days a week, to a total dose of 60 to 63 Gy over 26 to 29 days. A group of 48 patients received HF. Accelerated fractionation (AF) consists of 2 Gy three times a day, 5 days a week, to a total of 48 to 52 Gy delivered over 11 to 12 days. A group of 46 patients underwent this therapy. A third group of 48 patients were treated with conventional fractionation (CF). These patients received 2 Gy each day, 5 days a week, to a total dose of 60 to 66 Gy. RESULTS Ned survival at 5 years was 23.8%, 32.8%, and 29.3% for CF, AF, and HF, respectively. The most important cause of failure was inability to control disease at the primary site; however, isolated distant metastasis were observed in 15.4% of all failures. Treatment delays were more common in the HF and CF groups. The highest incidence of late complications occurred in the AF group. CONCLUSIONS Advanced lesions of the oropharynx have an ominous prognosis. New fractionation regiments represent a warranted approach as an alternative to or an integration into combined chemotherapy and radiotherapy.

Early Glottic Cancer: Surgery or Radiation Therapy?

From 1970 to 1979 at the University Otorhinolaryngological Clinic, at the Radiology Institute of the University and at the Radiation Therapy Department of the Hospital of Florence, 385 early glottic cancers were treated: 300 by surgery and 85 with radiation therapy as the primary therapy. The policy of treatment in this period was in most cases surgery; those patients who could not be operated were treated with radiation therapy. The local control actuarial rates at 5 years were 85 %, 70 % and 65 % for the T1a, T1b and T2 patients treated by surgery, and 86 %, 83 % and 57 % for those treated with radiation therapy. Considering the surgical salvage, the actuarial results at 5 years were 95 %, 86 % and 71 % for the group treated by surgery, and 86 %, 90 % and 69 % for the one treated with radiotherapy. The crude results at 3 and 5 years with an analysis of failures according to treatment modalities are also reported. In our experience, cordectomy can be the treatment of choice in T1a glottic cancer, whereas radiation therapy offers better results in the T1b forms. Tratment policy is more questionable in the T2 cases.

Endocrine status in 29 patients treated by curative radiation therapy for nasopharyngeal carcinoma.

The basal endocrine status of 29 patients treated with curative radiation therapy for nasopharyngeal carcinoma was assessed; they were disease-free for a minimum of 4 years from the end of treatment. None showed clinical evidence of endocrine disease, and most of them had a substantially normal hormonal blood pattern. A slightly elevated TSH value, suggesting subclinical primary hypothyroidism, was found only in two male patients, which could be ascribed to the radiotherapeutic treatment of the neck. Although we cannot exclude more subtle alterations of hypothalamic-pituitary function, the percentage incidence of endocrine impairment in our patients seems lower than previously reported by other authors.