Jerry L. Barker

Management of inflammatory carcinoma of breast with combined modality approach—an update

Thirty‐two patients with inflammatory breast cancer were treated with a combined modality approach consisting of combination chemotherapy with fluorouracil, doxorubicin hydrochloride, and cyclophosphamide, followed by radiation therapy. The disease‐free interval and survival of this group were compared with 32 patients with inflammatory breast cancer treated with irradiation without systemic therapy at our institution in the past. In the actuarial median follow‐up of 62 months (range: 42+ to 76+ months) of study, 11 patients in combined modality group and three patients in the irradiation group were free of disease. Overall median disease‐free interval was 22.8 months for the combined modality group and nine months for the irradiation group, and survival was 30.1 months and 18 months, respectively. The median disease‐free interval of patients <50 years of age was 19 months for the combined modality group and nine months for the irradiation group; median survival was 24 months for both subgroups. Forty percent of the patients under 50 years of age in the combined modality group and 7% in the irradiation group had recurrence of central nervous system disease. Of the patients ≥50 years of age, the median disease‐free interval was 32.1 months for the combined modality group and nine months for irradiation group; median survival was 42 months and 18 months, respectively. The combined modality approach has resulted in improved disease‐free interval of patients <50 years of age, but survival of this subgroup was not significantly improved possibly because of the high incidence of central nervous system disease recurrence. This treatment was effective in prolonging the disease‐free interval and survival of patients ≥50 years of age, with an estimated 45% of the patients surviving free of disease beyond 42 months.

IMPORTANCE OF PATIENT EXAMINATION TO CLINICAL QUALITY ASSURANCE IN HEAD AND NECK RADIATION ONCOLOGY

When quality assurance programs in clinical radiation oncology focus mainly on the technical aspects of treatment, they tend to underplay questions of therapeutic process and outcome. We determined the value of clinical peer review in radiation therapy for head and neck cancer that involved head and neck examination.

The effect of dental artifacts, contrast media, and experience on interobserver contouring variations in head and neck anatomy

Objectives:To investigate interobserver variability in the delineation of head-and-neck (H&N) anatomic structures on CT images, including the effects of image artifacts and observer experience. Methods:Nine observers (7 radiation oncologists, 1 surgeon, and 1 physician assistant) with varying levels of H&N delineation experience independently contoured H&N gross tumor volumes and critical structures on radiation therapy treatment planning CT images alongside reference diagnostic CT images for 4 patients with oropharynx cancer. Image artifacts from dental fillings partially obstructed 3 images. Differences in the structure volumes, center-of-volume positions, and boundary positions (1 SD) were measured. In-house software created three-dimensional overlap distributions, including all observers. The effects of dental artifacts and observer experience on contouring precision were investigated, and the need for contrast media was assessed. Results:In the absence of artifacts, all 9 participants achieved reasonable precision (1 SD ≤3 mm all boundaries). The structures obscured by dental image artifacts had larger variations when measured by the 3 metrics (1 SD = 8 mm cranial/caudal boundary). Experience improved the interobserver consistency of contouring for structures obscured by artifacts (1 SD = 2 mm cranial/caudal boundary). Conclusions:Interobserver contouring variability for anatomic H&N structures, specifically oropharyngeal gross tumor volumes and parotid glands, was acceptable in the absence of artifacts. Dental artifacts increased the contouring variability, but experienced participants achieved reasonable precision even with artifacts present. With a staging contrast CT image as a reference, delineation on a noncontrast treatment planning CT image can achieve acceptable precision.