Mehmet Şen

Prognostic factors in lung cancer with brain metastasis

Abstract Background and purpose : Metastasis to the brain develops in 25% of all patients with lung cancer. Although the outcome is usually poor, there seems to be a subset of patients with favorable prognostic factors who may live longer. Prognostic factors were analyzed retrospectively in 103 patients with brain metastases from lung carcinoma to identify patients who would benefit from more intensive treatment strategies. Materials and methods : Between October 1991 and December 1994, 103 patients with brain metastasis from lung cancer were irradiated with palliative intent. Palliation was defined as 50% or more regression of neurological signs and symptoms 2 weeks after the completion of cranial radiotherapy. Local (related to the lung tumor) symptom status at the time of brain metastasis, the presence of metastases other than brain, multiplicity of brain metastases on CT scan and time of occurrence of brain metastasis were the factors which were evaluated with multivariate analysis. Results : Palliation was accomplished in 85% of cases. Palliation duration ranged from 0.5 to 54 months (median 3 months). The overall median survival was 5 months. Only one patient is under follow-up without any symptoms related to the brain metastasis. According to the multivariate analysis survival was significantly decreased in the presence of symptoms related to the primary tumor ( P =0.001). Conclusion : The presence of symptoms related to the primary tumor at the time of brain metastasis is one of the factors that can be used to distinguish patients with a favorable outcome. In patients with favorable prognostic factors and thus longer survival probability, the role of boost dose after whole brain radiotherapy or surgical resection in suitable cases needs to be investigated.

The Impact of 18F-FDG PET CT Prior to Chemoradiotherapy for Stage III/IV Head and Neck Squamous Cell Carcinoma

Introduction. To determine the value of a FDG-PET-CT scan in patients with locally advanced head and neck squamous cell carcinoma (HNSCC) prior to chemoradiotherapy. Materials and Methods. Consecutive patients with stage III or IV HNSCC who had undergone a staging FDG-PET-CT scan prior to chemoradiotherapy between August 2008 and April 2011 were included. Clinical details and conventional imaging (CT and/or MRI) were, retrospectively, reviewed, a TNM stage was assigned, and levels of cervical lymph node involvement were documented. This process was repeated with the addition of FDG-PET-CT. Radiotherapy plans were reviewed for patients with an alteration identified on TNM staging and/or nodal level identification with FDG-PET-CT and potential alterations in radiotherapy planning were documented. Results. 55 patients were included in the analysis. FDG-PET-CT altered the TNM stage in 17/55 (31%) of patients, upstaging disease in 11 (20%) and downstaging in 6 (11%); distant metastases were identified by FDG-PET-CT in 1 (2%) patient. FDG-PET-CT altered the lymph node levels identified in 22 patients (40%), upclassifying disease in 16 (29%) and downclassifying in 6 (11%). Radiotherapy plans were judged retrospectively to have been altered by FDG-PET-CT in 10 patients (18%). Conclusions. The use of FDG-PET-CT potentially impacts upon both treatment decisions and radiotherapy planning.

185 Our treatment protocol in nasopharyngeal carcinoma

Nasopharynx cancers are classified differently from other types of head and neck cancers by their extensive lymphatic spread and frequent distant metastasis. In most cases RT is the only treatment modality because of the localization. Neoadjuvant chemotherapy studies are held to have better results in the local-regional advanced disease. 39 was treated in our clinic between August 91–June 94. Thirty of the 39 cases were treated according to the NF cancer treatment protocol of Dokuz Eylul University Head and Neck Cancer Group. Our treatment protocol for Stage I–III disease is curative RT and for Stage IV disease both neoadjuvant CT (CDDP + Bleomycin + Methotrexate) and RT. This protocol is activated in October 1992. Twenty-six cases were Stage IV, 3 cases Stage III, 1 case Stage II. Fifteen cases were treated by RT and CT and 15 cases were treated with RT alone. The applied RT technique and total doses are standard in all cases. Each case is irradiated with 50 Gy to the supraclavicular and cervical areas without lymphatic involvement and with 70 Gy irradiation to the primary tumor and to involved cervical lymph node areas. Neoadjuvant CT is applied two courses every 21 days and after and after subsequent tumor response evaluation, RT was started. Median follow-up period is 22 month (3–40 months). Three cases with distant metastases died. Local recurrence is detected in two cases and second series of RT was applied. A case with regional recurrence was treated with CT alone. Two cases were lost in follow up (one having a pulmonary metastasis). The rest of the patients are disease free.

184 Radiotherapy results in early stage (T1-T2) vocal cord carcinoma

In early stage larynx carcinoma, the function preserving treatment can be performed only if patients are evaluated properly. In this study we present the preliminary results of 44 patients of early stage larynx carcinoma which are treated according to the prospective larynx carcinoma protocol of Dokuz Eylul Head And Neck Cancer Group. Forty-three patients were male and 1 patient was female. The average age is 61 (27–87). Thirty-seven patients were staged as TIN0 and 7 patients as T2N0. In 40 cases, the tumor localization was in the glottic and in 4 cases in the supraglottic area. The tumor histology was squamous cell carcinoma in 36 patients, in-situ carcinoma 7 and small cell carcinoma in 1 patient. Lung cancer was detected as a second primary in 1 patient. Diagnosis was made by biopsy in 28 cases, by stripping in 12 cases, by cordectomy in 1 case, by polypectomy in 1 case, and by mass excision in 2 cases. All cases were treated by radiotherapy alone. Treatments were completed in all cases. The delivered total dose is 66–70 Gy in 33–35 fractions (in 200 cGy fractions). There was total tumor regression in all cases, 2 months after radiotherapy. No serious side effects were observed. The self evaluation of voice quality was revealed as very satisfactory in 43 patients. Only in the cordectomy case the voice quality was unsatisfactory. The case with lung cancer is lost to follow up. Two cases died because of other reasons and the rest are disease free.

149 Prognostic factors in lung cancer with brain metastasis

BACKGROUND AND PURPOSE Metastasis to the brain develops in 25% of all patients with lung cancer. Although the outcome is usually poor, there seems to be a subset of patients with favorable prognostic factors who may live longer. Prognostic factors were analyzed retrospectively in 103 patients with brain metastases from lung carcinoma to identify patients who would benefit from more intensive treatment strategies. MATERIALS AND METHODS Between October 1991 and December 1994, 103 patients with brain metastasis from lung cancer were irradiated with palliative intent. Palliation was defined as 50% or more regression of neurological signs and symptoms 2 weeks after the completion of cranial radiotherapy. Local (related to the lung tumor) symptom status at the time of brain metastasis, the presence of metastases other than brain, multiplicity of brain metastases on CT scan and time of occurrence of brain metastasis were the factors which were evaluated with multivariate analysis. RESULTS Palliation was accomplished in 85% of cases. Palliation duration ranged from 0.5 to 54 months (median 3 months). The overall median survival was 5 months. Only one patient is under follow-up without any symptoms related to the brain metastasis. According to the multivariate analysis survival was significantly decreased in the presence of symptoms related to the primary tumor (P = 0.001). CONCLUSION The presence of symptoms related to the primary tumor at the time of brain metastasis is one of the factors that can be used to distinguish patients with a favorable outcome. In patients with favorable prognostic factors and thus longer survival probability, the role of boost dose after whole brain radiotherapy or surgical resection in suitable cases needs to be investigated.