Lyubov Girshovich

Intraluminal low-dose rate brachytherapy for malignant endobronchial obstruction☆

From October 1985 through October 1989, 87 patients underwent 105 intraluminal brachytherapy treatments for endobronchial or endotracheal malignant tumors. Low-dose rate iridium-192 seeds were used. Of the 60 patients treated for primary lung carcinoma, 52 patients (87%) had previously received full-course external beam radiotherapy to the tumor sites. Ten patients were treated for symptomatic metastatic disease, and one patient had extension of tumor into the trachea from carcinoma of the cervical esophagus. Clinical or bronchoscopic improvement was noted in 42 patients (59%). No significant difference in the response rate was observed between various types of tumor. Patients who were treated with a radiation dose larger than 2500 cGy at a 2 cm radius had a significantly greater response rate (77%) than patients treated with a dose less than 2500 cGy (38%) (p = 0.001). A trend toward better results was apparent in patients who had undergone Nd:YAG laser bronchoscopy in the 2 weeks before brachytherapy. The treatments were well tolerated, and the incidence of serious complications was low and acceptable.

MULTIDISCIPLINARY CARE FOR PATIENTS WITH BREAST CANCER

Breast cancer management requires a multidisciplinary approach that is tailored to the patients stage at presentation, desire for breast conservation or reconstruction, estimation of risk of recurrence, and assessment of the benefits and toxicities of potential adjuvant therapies. At the Lahey Clinic Medical Center, breast surgeons, plastic surgeons, radiation oncologists, and medical oncologists staff the Breast Cancer Treatment Clinic, and work closely together to formulate treatment plans that will optimize the likelihood for cure with an acceptable cosmetic result. This involves careful preoperative work-up, surgical axillary staging, breast irradiation in the setting of breast conservation, and selection of chemotherapy or hormonal therapy if appropriate. Newer aspects of breast cancer care, including sentinal lymph node biopsy, postmastectomy radiation therapy, expanded use of hormonal therapy in younger women, new agents and chemotherapy combinations, and autogenous reconstruction techniques, have become an essential part of the multidisciplinary clinic approach.

Combined Chemoradiation as Primary Treatment for Invasive Male Urethral Cancer

PURPOSE We evaluated the efficacy and intermediate term outcomes of a combined chemoradiation protocol for the treatment of primary invasive carcinoma of the male urethra. MATERIALS AND METHODS We retrospectively reviewed the medical records of 29 male patients diagnosed with carcinoma of the urethra between 1991 and 2014. All patients were treated at the same tertiary care referral center, and received a combination chemoradiation protocol consisting of 2 cycles of 5-fluorouracil and mitomycin-C with concurrent external beam radiation therapy to the genitalia, perineum, and inguinal and external iliac lymph nodes. Kaplan-Meier curves were constructed to assess overall, disease specific and disease-free survival. RESULTS A total of 26 patients met inclusion criteria for the study. Median followup was 35.5 months. The histology was squamous cell carcinoma in all but 1 patient with adenocarcinoma. Overall 88% of patients presented with at least T3 disease or metastatic to the lymph nodes and only 10% presented with a well differentiated tumor. Nineteen (79%) patients showed complete response to treatment. Five patients (21%) had no response to treatment and ultimately died of their disease, regardless of salvage therapy. Of the 19 complete responders 8 (42%) had disease recurrence at a median of 12.5 months. The 5-year overall, disease specific and disease-free survival rates were 52% (SE 10.6%), 68.4% (SE 10%) and 43.2% (SE 10.2%), respectively. CONCLUSIONS Male squamous cell carcinoma treated with combination chemoradiation offers the potential for genital preservation and is an alternative therapeutic choice in patients not seeking surgery or considered surgical candidates.