Naonobu Kunitake

Postoperative radiotherapy in patients with salivary duct carcinoma: clinical outcomes and prognostic factors

This study sought to investigate the clinical outcome and the role of postoperative radiotherapy for patients with salivary duct carcinoma (SDC) who had undergone surgery and postoperative radiotherapy. We performed a retrospective analysis of 25 SDC patients treated between 1998 and 2011 with surgery and postoperative radiotherapy. The median prescribed dose was 60 Gy (range, 49.5–61.4 Gy). The clinical target volume (CTV) was defined as the tumor bed in four patients, the tumor bed and ipsilateral neck in 14 patients, and the tumor bed and bilateral neck in six patients. Local control (LC), disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and prognostic variables were analyzed with the log-rank test. The 5-year LC, DFS and OS were 67%, 45% and 47%, respectively. Disease recurrence was found in 12 patients: seven as local, four as regional and eight as distant failure. Perineural and lymphovascular invasion was a significant prognostic factor for LC (P = 0.03). Local failure was common, and the presence of local recurrence significantly affected the OS (P < 0.05). We conclude that surgery and postoperative radiotherapy is expected to decrease the risk of local failure and contribute to good prognoses for patients with SDC. It might be advisable to have the CTV include the cranial nerves involved and the corresponding parts of the skull base in cases of pathologically positive perineural invasion.

Long-Term Control for a Retroperitoneal Metastasis of Malignant Gastrointestinal Stromal Tumor after Chemoradiotherapy and Immunotherapy

From the Institute of Clinical Medicine, Tsukuba University, Tsukuba, Japan (Y. Shioyama), the Department of Surgery, Kameyama Eikou Hospital, Fukuoka, Japan (Y. Yakeishi), the Department of Anatomic Pathology (T. Watanabe) and Clinical Radiology (K. Nakamura, N. Kunitake, M. Kimura, M. Sasaki, H. Honda, H. Terashima, K. Masuda), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Primary non-Hodgkin's lymphoma of the maxillary sinus.

Primary non-Hodgkins lymphoma of the maxillary sinus is a rare lesion. We studied nine patients with malignant lymphoma involving the maxillary sinus, treated between 1980 and 1994 in the Kyushu University Hospital. All lymphomas had a diffuse pattern; five were the large-cell type, two the mixed type, and one the small lymphatic and small cleaved type. Immunohistologically, all tumors were B-cell type. Using the Ann Arbor staging system, six patients were classified as stage I, two stage II, and one stage IV. Two patients received only radiotherapy because of advanced age; the remaining seven received a combination of radiotherapy and chemotherapy (CHOP or VEPA). The tumor doses ranged from 30 to 51 Gy (mean, 46.7). The mean follow-up was 51 months. Only one patient (stage IV) died of disease, and eight stage I-II patients were rendered disease-free. The 5-year survival rate was 80%, suggesting that primary lymphoma of the maxillary sinus has a relatively good prognosis.

A new, simple method of making a spacer in interstitial brachytherapy for mobile tongue cancer

OBJECTIVES This article demonstrates a new method of making a spacer that increases the distance between the mandible and implanted radioactive sources in interstitial brachytherapy for patients with mobile tongue cancer. STUDY DESIGN Fifty-three patients with mobile tongue cancer underwent interstitial brachytherapy with spacers made by this new technique. RESULTS Our spacer is not difficult to create or to use. The spacer was made from a plastic splint by using thermoforming techniques and quick self-curing resin, which did not need waxing, wiring, or casting. The surface of the spacer, which comes in contact with the tongue, is smooth because it is covered with tissue-conditioning material. There were no complaints of pain from the patients. Osteoradionecrosis of the mandible developed in only 1 (1.9%) of these patients. CONCLUSIONS This spacer is simple to make and prevented osteoradionecrosis.

Change of sonographic findings on cervical lymph nodes before and after preoperative radiotherapy

The aim of this study was to assess the changes in the power Doppler sonographic findings in patients with oral cancer undergoing chemotherapy and radiotherapy. We performed US examinations on 187 cervical lymph nodes (71 metastatic and 116 reactive nodes) excised from 52 patients before and after preoperative therapy. On Power Doppler images, we calculated the vascular index (VI) and evaluated the vascular pattern. We also assessed the diagnostic power using receiver operating characteristic (ROC) curve analysis. Irradiation caused an increase of the VI and better visualization of the vessels within the lymph node in the reactive nodes; however, in the metastatic nodes, the VI was not significantly different between that before and after irradiation. When the reader observed the images before irradiation, the area under an ROC curve (Az values) observed by B-mode sonography were closely similar to those obtained by B-mode plus power Doppler sonography. With both images before and after irradiation, the Az value obtained by B-mode plus power Doppler sonography was higher than that by B-mode sonography alone. After irradiation, the enhanced Doppler signals contributed to a better visualization of the vessels and a better detection of any vascular abnormalities.

Relapse patterns of localized non-Hodgkin's lymphoma of the head and neck after clinical remission: results of a strict follow-up procedure.

AbstractBackground. No effective follow-up strategy for non-Hodgkins lymphoma (NHL) has been identified to date. The aim of this study was to assess the value of a strict follow-up procedure in patients with NHL after they showed clinical remission. Methods. One hundred and twenty-one patients with localized NHL of the head and neck who had achieved clinical remission after radiation therapy and/or chemotherapy were followed with a strict follow-up strategy (consisting of a schedule of frequent office visits, imaging studies, and blood tests, even if the patient was asymptomatic). Results. Thirty-nine patients relapsed after remission. Twenty-two (56.4%) of the relapses were associated with symptoms. In the 17 patients with asymptomatic relapses (43.6%), an abnormal physical examination result initially indicated relapse in 10 patients. The other tests that initially indicated relapse included scheduled computed tomography scans (3 patients), scheduled gallium scans (2 patients), and serum lactate dehydrogenase levels (2 patients). According to the Ann Arbor stage at relapse, 72.7% of the patients with symptomatic relapses were stage III or IV, while 70.6% of the patients with asymptomatic relapses were stage I or II. Conclusions. These results indicate that a strict follow-up procedure is effective in detecting asymptomatic relapses, which generally involve a smaller tumor load than symptomatic relapses.

Utility of algorithm-based chemoradioselection in the treatment for advanced hypopharyngeal carcinoma.

Current organ‐preserving dose‐intensified modalities have apparently reached the limit of human tolerance. To optimize the therapeutic ratio, we evaluated the utility of a chemoradioselection strategy for the treatment of advanced hypopharyngeal carcinoma.

Non-Hodgkin lymphoma and coexisting primary cancers: a retrospective clinical analysis of 10 patients.

The simultaneous occurrence of non-Hodgkin lymphoma (NHL) and primary cancers is rare, and the treatment strategy for both malignancies is unclear. The authors analyzed the clinical records of 10 patients with NHL and coexisting primary cancers. All patients initially had symptoms of NHL, and all carcinomas were found at the initial workup of NHL by chance. The most common primary sites of coexisting cancers were the stomach (six patients) and the colon (two). Histologically, the majority of NHLs were intermediate grade, and all lesions were B-cell type. All primary cancers were adenocarcinoma. Initially, NHL was treated with radiotherapy or chemotherapy. Six primary cancers were resected surgically or endoscopically after the remission of NHL. The remaining four patients received no treatment for primary cancers because of advanced stages or early relapse of NHL. Three patients died of NHL, one died of cancer, and six were still alive, five without evidence of disease and one with disease. The authors conclude that early detection of a coexisting cancer and appropriate treatment after the remission of NHL may increase the possibility of a cure.

Renal function and urological complications after radical hysterectomy with postoperative radiotherapy and platinum-based chemotherapy for cervical cancer

Background We aimed to clarify renal functional changes long term and serious urological complications in women with cervical cancer who undergo radical hysterectomy followed by pelvic radiotherapy and/or platinum-based chemotherapy to treat the initial disease. Methods Data on 380 women who underwent radical hysterectomy at the National Kyushu Cancer Center from January 1997 to December 2013 were reviewed. Main outcome measures were the estimated glomerular filtration rate (eGFR) and monitored abnormal urological findings. Results Postoperative eGFR was significantly lower than preoperative eGFR in 179 women with surgery alone and in 201 women with additional pelvic radiotherapy and/or chemotherapy (both P < 0.01). Two types of univariate analyses for eGFR reduction in women after treatment showed that older age, advanced stage, pelvic radiotherapy, and platinum-based chemotherapy were significant variables on both analyses. Two types of multivariate analyses showed that platinum-based chemotherapy or pelvic radiotherapy were associated with impaired renal function (odds ratio 1.96, 95% confidence interval 1.08-3.54 and odds ratio 2.85, 95% confidence interval 1.12-7.24, for the respective analyses). There was a higher rate of bladder wall thickening in women with pelvic radiotherapy had than those without it (17.4% vs. 2.7%, P < 0.01). One serious urological complication (intraperitoneal rupture of the bladder) occurred among women who underwent pelvic radiotherapy (0.6% vs. 0%). Conclusions Surgeons should be aware that eGFR is reduced after platinum-based chemotherapy and/or postoperative pelvic radiotherapy. Serious and life-threatening urological complications are rare, but surgeons should be aware of the possibility during the long follow-up.

A randomised phase II trial of S-1 plus cisplatin versus vinorelbine plus cisplatin with concurrent thoracic radiotherapy for unresectable, locally advanced non-small cell lung cancer: WJOG5008L

BackgroundCisplatin-based chemoradiotherapy is the standard treatment for unresectable, locally advanced non-small-cell lung cancer (NSCLC). This trial evaluated two experimental regimens that combine chemotherapy with concurrent radiotherapy.MethodsEligible patients with unresectable stage III NSCLC were randomised to either the SP arm (S-1 and cisplatin) or VP arm (vinorelbine and cisplatin), with early concurrent thoracic radiotherapy of 60 Gy, comprising 2 Gy per daily fraction. The primary endpoint was the overall survival rate at 2 years (2-year overall survival (OS)) (Study ID: UMIN000002420).ResultsFrom September 2009 to September 2012, 112 patients were enroled. Of the 108 eligible patients, the 2-year OS was 75.6% (80% confidence interval (CI), 67–82%) in the SP arm and 68.5% (80% CI: 60–76%) in the VP arm. The hazard ratio (HR) for death between the two arms was 0.85 (0.48–1.49). The median progression-free survival was 14.8 months for the SP arm and 12.3 months for the VP arm with an HR of 0.92 (0.58–1.44). There were four treatment-related deaths in the SP arm and five in the VP arm.ConclusionsThe null hypotheses for 2-year OS were rejected in both arms. The West Japan Oncology Group will employ the SP arm as the investigational arm in a future phase III study.