Nisar Syed

Followup Prostate Biopsy in Patients with Carcinoma of the Prostate Treated By 192Iridium Template Irradiation Plus Supplemental External Beam Radiation

We reviewed our experience with 81 patients who had undergone followup needle biopsies of the prostate between 12 and 27 months after 192iridium template radiotherapy combined with external beam radiation therapy. When broken down by stage 82% of the patients with stage A2, 92% with B1, 95% with B2 and 55% with C disease demonstrated a negative biopsy and adequate local control of the cancer. We believe that in elderly patients, poor risk patients with early stage disease and stage C lesions this low morbidity, low mortality therapy offers a viable option to other modalities of treatment.

Interstitial brachytherapy as boost for locally advanced T4 head and neck cancer

PURPOSE Locally advanced squamous cell cancers of the head and neck (SCCHN) with bone and cartilage invasion (BCI) or those with soft-tissue invasion (STI) have been treated with resection followedup with chemoradiotherapy (CRT) or definitive CRT. However, locoregional recurrence remained a large component of treatment failure. High-dose-rate interstitial brachytherapy (BT) has been used for dose escalation to further prevent local relapse. This is a review of our experience. METHODS AND MATERIALS T4N0-3M0 locally advanced oral cavity and oropharyngeal squamous cell carcinoma (SCCA) patients underwent definitive CRT or radiotherapy (RT) followedup with brachytherapy (BT). RT doses ranged from 45 to 50.4Gy. The patients were reassessed at this dose and if response was inadequate, patients underwent BT. BT doses ranged from 24 to 30Gy at 3-4Gy per fraction BID with 6h in between fractions. Concurrent chemotherapy was platinum based. RESULTS Twenty patients were treated with CRT or RT alone followed by BT. Thirteen patients had STI and 7 had BCI; 14 patients were treated with CRT followed by BT; and 6 patients were treated with RT alone followed by BT. Five-year locoregional control was 61%. Five-year overall survival was 29%. When we excluded the patients treated with RT alone, 5-year overall survival was 36%. Nodal status was the only prognostic factor. CONCLUSIONS This study suggests CRT followedup with BT for patients with T4 locally advanced SCCHN of the oral cavity, and oropharynx is a feasible treatment option. In patients with poor response to CRT, BT may be used for dose escalation to increase locoregional control.

Initial brachytherapy in the breast conservation approach to breast cancer

The outcome of 100 consecutive newly diagnosed breast cancer patients treated between 1975 and 1985 within a protocol of planned segmental mastectomy and radiation therapy that included an initial brachytherapy boost is reported. Margins were not routinely inked in this study and the tumor bed was determined with the operating surgeon at the time of brachytherapy. There were 30 T1 tumors, 61 T2, and 9 T3. Segmental mastectomy was followed 2 weeks later by an interstitial implant with indium-192 sources given as initial boost dose to the tumor bed, at the time of axillary dissection. All patients received at least 20 Gy as boost dose followed by external beam radiation to a total dose of 45–50 Gy to the breast and regional nodes delivered over a period of 4–5 weeks. With a median follow-up of 7 years a total of 3 (3%) breast recurrences were detected (1/30 in Tl tumors, 2/61 in T2 tumors). Only one of the three recurrences was at the initial tumor bed. None of the nine T3 patients included in this series recurred locally. There were 4 severe complications (2 soft tissue necroses and 2 osteonecroses) occurring in 2/30 T1 and in 2/61 T2. Cosmetic results were good to excellent in 77% of the cases and fair to poor in 23%. The actuarial local control and survival probability rate were, respectively, 95% and 85% at 5 years and 93% and 73% at 10 years. Initial brachytherapy boost to a target volume accurately determined with the operating surgeon followed by subsequent external beam radiotherapy achieved excellent local control in the breast even for lesions larger than 2 cm (70% of the reported cases).

Treatment outcomes of T4 locally advanced head and neck cancers with soft tissue invasion or bone and cartilage invasion.

Purpose/Objective(s):T4 locally advanced squamous cell cancers of the head and neck (SCCHN) with bone and cartilage invasion (BCI) traditionally have been treated with resection followed up with chemoradiotherapy (CRT). Because the organ preservation trials, more patients with BCI, as well as those with soft tissue invasion (STI), have been treated with definitive CRT. This is a review of our experience. Materials/Methods:We performed a retrospective review of patients who underwent definitive CRT or radical resection followed up with postoperative CRT for T4N0-3M0 locally advanced SCCHN. We analyzed outcomes based on STI/BCI and types of treatment. Radiotherapy doses ranged from 59.4 to 72 Gy. Concurrent chemotherapy was platinum based in all CRT patients. Results:From 1995 to 2006, 101 patients with locally advanced SCCHN were treated definitively. Of these, 51 had STI and 50 had BCI. Of the 51 patients with STI, 42 were treated with CRT, 5 patients were treated with resection followed by CRT, and 4 patients were treated with radiotherapy alone. Of the 50 patients with BCI, 26 patients were treated with CRT, 20 patients were treated with radical resection followed by radiotherapy or CRT, and 4 patients were treated with radiotherapy alone. Five-year local-regional control was 51% and 43% for STI and BCI patients treated with CRT, respectively, and 44% for BCI treated with radical resection. Five-year overall survival was 23%, 51%, and 28% for STI treated with CRT, BCI treated with CRT, and BCI treated with radical resection. Outcomes were not statistically different between these groups. Conclusions:This study suggests similar outcomes for CRT or resection followed up with chemoradiotherapy for patients with locally advanced SCCHN with BCI. Concurrent CRT may be viable alternative to upfront resection in these patients. Further studies should be performed to validate these provocative findings.

Prognostic significance of bone or cartilage invasion of locally advanced head and neck cancers.

Purpose/Objective(s):Locally advanced squamous cell cancers of the head and neck with bone and cartilage invasion (BCI) traditionally have been treated with resection followed up with radiotherapy or less commonly definitive chemoradiotherapy (CRT). However, it is unclear whether bone or cartilage invasion confers a worse prognosis in comparison with each other. Materials/Methods:T4N0–3M0 squamous cell cancers of the head and neck patients underwent CRT or radical resection followed up with postoperative CRT. Oral cavity, oropharynx, laryngeal and hypopharyngeal squamous cell cancers were included. Radiotherapy ranged from 59.4 to 72 Gy. Concurrent chemotherapy was platinum based. Results:Forty-six patients with BCI were treated. When treated with CRT, 5-year local control was 55% and 43% for BCI, respectively (P = 0.23). Five-year overall survival for these patients was 54% and 29% for BCI, respectively (P = 0.99). When treated with upfront resection, 5-year local control was not significantly different (P = 0.60) nor was 5-year overall survival (P = 0.15). Conclusions:This study suggests similar outcomes between patients with bone or cartilage invasion treated with upfront CRT or resection followed by CRT. Concurrent CRT may be viable alternative to resection in patients with either bone or cartilage invasion.