[show abstract][hide abstract] ABSTRACT: Abstract Background. To investigate post-treatment changes in serum testosterone in low- and intermediate-risk prostate cancer patients treated with hypofractionated passively scattered proton radiotherapy. Material and methods. Between April 2008 and October 2011, 228 patients with low- and intermediate-risk prostate cancer were enrolled into an institutional review board-approved prospective protocol. Patients received doses ranging from 70 Cobalt Gray Equivalent (CGE) to 72.5 CGE at 2.5 CGE per fraction using passively scattered protons. Three patients were excluded for receiving androgen deprivation therapy (n = 2) or testosterone supplementation (n = 1) before radiation. Of the remaining 226 patients, pretreatment serum testosterone levels were available for 217. Of these patients, post-treatment serum testosterone levels were available for 207 in the final week of treatment, 165 at the six-month follow-up, and 116 at the 12-month follow-up. The post-treatment testosterone levels were compared with the pretreatment levels using Wilcoxon's signed-rank test for matched pairs. Results. The median pretreatment serum testosterone level was 367.7 ng/dl (12.8 nmol/l). The median changes in post-treatment testosterone value were as follows: +3.0 ng/dl (+0.1 nmol/l) at treatment completion; +6.0 ng/dl (+0.2 nmol/l) at six months after treatment; and +5.0 ng/dl (0.2 nmol/l) at 12 months after treatment. None of these changes were statistically significant. Conclusion. Patients with low- and intermediate-risk prostate cancer treated with hypofractionated passively scattered proton radiotherapy do not experience testosterone suppression. Our findings are consistent with physical measurements demonstrating that proton radiotherapy is associated with less scatter radiation exposure to tissues beyond the beam paths compared with intensity-modulated photon radiotherapy.
[show abstract][hide abstract] ABSTRACT: Purpose: To analyze prostate intrafraction motion using both non-gas-release (NGR) and gas-release (GR) rectal balloons and to evaluate the ability of GR rectal balloons to reduce prostate intrafraction motion.Methods: Twenty-nine patients with NGR rectal balloons and 29 patients with GR balloons were randomly selected from prostate patients treated with proton therapy at the University of Florida Proton Therapy Institute (Jacksonville, FL). Their pretreatment and post-treatment orthogonal radiographs were analyzed, and both pretreatment setup residual error and intrafraction-motion data were obtained. Population histograms of intrafraction motion were plotted for both types of balloons. Population planning target-volume (PTV) margins were calculated with the van Herk formula of 2.5Σ + 0.7σ to account for setup residual errors and intrafraction motion errors.Results: Pretreatment and post-treatment radiographs indicated that the use of gas-release rectal balloons reduced prostate intrafraction motion along superior-inferior (SI) and anterior-posterior (AP) directions. Similar patient setup residual errors were exhibited for both types of balloons. Gas-release rectal balloons resulted in PTV margin reductions from 3.9 to 2.8 mm in the SI direction, 3.1 to 1.8 mm in the AP direction, and an increase from 1.9 to 2.1 mm in the left-right direction.Conclusions: Prostate intrafraction motion is an important uncertainty source in radiotherapy after image-guided patient setup with online corrections. Compared to non-gas-release rectal balloons, gas-release balloons can reduce prostate intrafraction motion in the SI and AP directions caused by gas buildup.
Medical Physics 10/2012; 39(10):5869-73. · 2.91 Impact Factor
[show abstract][hide abstract] ABSTRACT: Preoperative treatment of rectal cancer with combined chemotherapy and radiation therapy has become a widely accepted strategy. The current challenge is to improve outcomes whereas minimizing morbidity and maximizing the potential for a sphincter sparing procedure. This study sought to evaluate the safety and efficacy of a combination of 2 novel approaches-accelerated, hyperfractionated radiation therapy and twice daily oral capecitabine.
Consenting patients with locally advanced T3-T4, N0-1, M0 rectal adenocarcinoma, located no further than 15 cm from the anal verge, were treated with twice daily fractions of 1.2 Gy M-F to a total of 50.4 Gy for T3 lesions and 55.2 Gy for T4 lesions. Concomitantly, the patients received capecitabine 825 mg/m twice per day 7 days per week. Patients were operated on 4 to 6 weeks after completion of therapy.
Sixteen of 17 enrolled patients were eligible and all 16 completed the full course of treatment including definitive surgery. Eleven patients had a sphincter sparing procedure and 5 had an abdominoperineal resection. Tumor and/or nodal downstaging occurred in 81% of patients, 100% of resections were R0, and the sphincter preservation rate was 68%. There were 18% pathologic complete remissions and 68% of specimens were node negative with an additional 12% Nx owing to transanal excision. The therapy was well tolerated and there were no unexpected toxicities with only diarrhea reaching grade 3 in 4 patients.
This novel approach to preoperative treatment of rectal adenocarcinoma was well tolerated and effective. Comparison with more established approaches appears justified.
American journal of clinical oncology 10/2009; 33(3):251-6. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: Orbital pseudotumor is a benign condition that accounts for approximately 10% of all orbital mass lesions. Any part of the orbit may be involved. The etiology is unknown. The presentation may be either acute or subacute. Patients may present with a palpable mass, a swollen eyelid, congestion, pain, diminished ocular motility, and/or decreased visual acuity. Approximately, 25% of patients present with bilateral disease. A modest proportion of patients experience resolution of their symptoms without treatment. Biopsy is indicated for those who do not respond to, or relapse after, first-line therapy. Oral corticosteroids are the initial treatment and approximately 80% of patients respond. Roughly half of those who respond to corticosteroids relapse. Second-line therapy consists of either low-dose radiotherapy (20-30 Gy at 2 Gy per fraction), cytotoxic chemotherapy, or immunosuppressive agents. Radiotherapy results in long-term local control rates of 50% or higher. Limited lesions may be successfully resected. A small subset of patients may experience inexorable progression to a fixed, painful, sightless eye and require orbital exenteration.
American journal of clinical oncology 10/2009; 33(3):304-6. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: To report long-term rates of tumor control after radiotherapy (RT) for carcinoma in situ (CIS) of the true vocal cords (TVC).
Thirty-seven patients with CIS of the TVC were treated curatively with megavoltage RT between July 1967 and December 2005. Most patients (28/37) were treated with cobalt-60; the remainder were treated with 2- to 6-MV photons. Small (usually 5 x 5) fields were used. Median RT dose was 60.0 Gy (range, 56.25-66.50 Gy; mean dose, 59.55 Gy) at 2.25 Gy per fraction. Approximately two-thirds of the patients (23/37) were referred for RT because of a recurrence after at least 1 stripping procedure.
With a mean follow-up of 9.5 years (range, 2-25 years), the 5-year rates of local control, local control with larynx preservation, and ultimate local control (including salvage surgery) were 91%, 91%, and 91%, respectively. Invasive squamous cell carcinoma developed in 4 patients (11%). Time to failure was 6 months, 12 months, 48 months, and 13 years. Two patients were surgically salvaged with a total laryngectomy, 1 with transoral laser excision, and 1 patient declined further treatment. Cause-specific survival at 5 years was 100%. No late complications were noted.
RT to approximately 63 Gy at 2.25 Gy per fraction, using small (5 x 5 cm) fields produces excellent results in patients with CIS of the TVC.
American journal of clinical oncology 10/2009; 33(1):94-5. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: Soft tissue sarcomas are a relatively rare, heterogeneous group of tumors arising from mesenchymal tissues and occurring almost anywhere in the body. The rate of progression and likelihood of hematogenous dissemination, usually to the lung, is determined primarily by tumor grade. The likelihood of regional spread is low. Pretreatment evaluation includes computed tomography of the primary site and chest and magnetic resonance imaging of the primary tumor. The mainstay of treatment is surgery; wide excision for low-grade lesions and wide or radical (compartmental) resection for high-grade tumors. Often, these procedures cannot be achieved either because of the location and extent of the sarcoma or anticipated functional deficit. Adjuvant preoperative and/or postoperative radiotherapy improves the likelihood of local control and preserves function when adequate margins cannot be achieved with surgery alone. The role of adjuvant chemotherapy is unclear; however, some data suggest the doxorubicin containing regimens may improve the likelihood of cure for high-grade lesions, particularly large tumors arising in the extremities. Prognosis is influenced by a variety of factors, including age, tumor size, histologic grade, depth (superficial or deep), histologic subtype, and site. Approximately 90% and 98% of recurrences are observed within 5 years and 10 years, respectively. Five-year overall survival rates range from approximately 60% to 80%.
American journal of clinical oncology 09/2009; 32(4):436-42. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: To review the outcomes of definitive radiotherapy (RT) alone or combined with chemotherapy (CT) in the treatment of squamous cell carcinoma of the anal canal.
Between November 1968 and June 2005, 69 patients were treated with curative intent at the University of Florida. Distribution according to T stage was: T1, 11 (16%); T2, 29 (42%); T3, 21 (30%); and T4, 8 (12%). Distribution according to N stage was: N0, 53 (77%); N1, 3 (4%); N2, 7 (10%); and N3, 6 (9%). RT consisted of external beam RT (EBRT) in 30 patients (43%) and EBRT plus brachytherapy in 39 patients (57%). Thirty-eight patients (55%) received adjuvant CT: mitomycin C and fluorouracil, 21 patients (30%); cisplatin plus fluorouracil, 16 patients (23%); and other, 1 patient (1%). Median follow-up for all patients was 7.9 years (range: 0.1-17.3 years). One patient who was disease-free was lost to follow-up at 129 months.
The 5-year local control rates were: T1, 100%; T2, 93%; T3, 70%; T4, 88%; and overall, 86%. The 5-year regional control rates were: N0, 96%; N1 and N2, 89%; N3, 100%; and overall, 96%. The 5-year colostomy-free survival rates were: T1, 82%; T2, 89%; T3, 65%; T4, 38%; and overall, 74%. The 5-year cause-specific and overall survival rates were: stage I, 100% and 64%; stage II, 86% and 70%; stage III, 80% and 76%; and overall, 87% and 71%, respectively. Seven patients (10%) developed Radiation Therapy Oncology Group grade 3 late complications and 4 additional patients (6%) experienced grade 4 late complications. A fatal acute complication occurred in 1 patient (1%).
The likelihood of cure and colostomy-free survival after EBRT alone or combined with brachytherapy is relatively high and likely improved by adjuvant CT. The acute toxicity of treatment is significant; the major risk is neutropenia and sepsis. Patients with advanced T4 cancers that result in sphincter dysfunction requiring a pretreatment colostomy will usually have a permanent colostomy.
American journal of clinical oncology 09/2009; 33(1):47-51. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: An increasing subset of patients with head and neck squamous cell carcinoma (HNSCCA) is positive for high-risk human papillomavirus (HR-HPV). Patients tend to be younger, have a minimal or absent tobacco and ethanol abuse history, increased number of lifetime sexual partners (particularly oral-genital sex), and squamous cell carcinomas (SCCAs) arising in the oropharynx. The most common HR-HPV associated with HNSCCA is HPV-16. HR-HPV positivity is associated with decreased expression of the p53 and Rb genes, overexpression of p16, decreased expression of EGFR, and a different genetic expression pattern compared with patients with HR-HPV-negative SCCAs, leading to the conclusion that this is a distinct clinical entity. Patients who have HR-HPV-positive HNSCCAs have an improved prognosis, particularly those with oropharyngeal SCCAs, leading some to speculate that the intensity of treatment might be decreased. At present, whether this can be done safely remains unclear.
American journal of clinical oncology 08/2009; 32(5):535-9. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate toxicity, efficacy, feasibility, and target volume dosimetry of single-fraction stereotactic body radiotherapy or radiosurgery for spine tumors.
Twenty-five patients were treated on a prospective phase II protocol of single-fraction stereotactic body radiotherapy or radiosurgery for tumors near the spinal cord (N = 21). Patients received 15 Gy, given a spinal cord limit of 12 Gy to 0.1 mL for patients with no prior spine radiotherapy (N = 9), and 5 Gy to 0.5 mL for patients with prior spine radiotherapy (N = 12). The primary endpoint was toxicity. The secondary endpoint was efficacy measured with a pain scale, 2 neurologic function scales, and magnetic resonance scans. Minor endpoints were feasibility and dose coverage.
Acute toxicity was grade 1 to 2 dysphagia or nausea. There were no late toxicities. Three patients experienced radiographic evidence of vertebral body compression in field; 2 were asymptomatic and 1 was managed with vertebroplasty. One patient progressed at the radiosurgery site (local control, 95%); 43% experienced pain relief. Most patients died or developed progressive systemic disease soon after radiosurgery. One-year progression-free survival was 5% with 60% of patients dead by 1 year. Patients with the site of radiosurgery as their only site of disease also did poorly: 2-year progression-free survival ≈ 10% with half dead of cancer within 2 years. There were no problems planning and delivering spine radiosurgery with a 60-minute treatment slot. In patients with and without prior radiotherapy, we achieved our target-coverage goal in 91% and 95%, respectively.
Radiosurgery is an excellent option for patients with symptomatic spine metastases in previously irradiated areas. In patients without previous irradiation, the biology of metastatic cancer limits spine radiosurgery's ability to improve outcome.
American journal of clinical oncology 07/2009; 32(5):515-20. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: The goal of treatment is to cure whereas maintaining sphincter function and minimizing toxicity. Although the mainstay of the treatment is surgery, radiotherapy (RT) is used in a substantial proportion of patients depending on the location and extent of the tumor. The aim of this article is to discuss the role of RT in patients with resectable rectal adenocarcinoma. This article is a review of the pertinent literature. Results show that patients with T1N0 exophytic, well to moderately differentiated, mobile tumors < or = 3 cm in diameter may be treated with either transanal excision or endocavitary RT. The probability of cure with either approach is approximately 80% to 90% and depends on selection criteria. The advantages of endocavitary RT are that it is an outpatient procedure requiring, at most, local anesthesia and is suitable for elderly, infirm patients. The disadvantage is that few of these treatment units are available. Patients who experience a local-regional recurrence may be surgically salvaged. Patients who undergo transanal excision and have unfavorable pathologic findings including equivocal or close margins, poor differentiation, invasion of the muscularis propria, and/or endothelial-lined space invasion have a high risk of local-regional recurrence after surgery alone. The addition of postoperative RT improves the likelihood of cure from 85% to 90%. Patients presenting with unfavorable tumors that are borderline resectable with a transanal excision may be downstaged with preoperative RT and rendered suitable for a wide local excision. The addition of concomitant chemotherapy probably enhances downstaging and may improve the likelihood of sphincter preservation. Patients with T3 and/or N1 rectal cancers have a relatively high probability of local-regional recurrence after surgery alone. Preoperative RT and postoperative RT combined with adjuvant chemotherapy have been shown to significantly reduce the risk of local-regional recurrence and improve survival. Whether preoperative RT alone or combined with chemotherapy is more efficacious than postoperative chemoradiation remains unclear. Endocavitary RT or transanal excision is suitable for patients with T1N0 cancers. Depending on tumor location and extent, adjuvant RT may improve the probability of local-regional control and survival for patients with locally advanced rectal adenocarcinomas.
American journal of clinical oncology 07/2009; 32(6):629-38. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to determine the efficacy and toxicities of single-agent weekly cisplatin for patients with squamous cell carcinoma of the head and neck treated definitively with radiation therapy (RT).
Thirty-five patients with American Joint Committee of Cancer stage II (3%), stage III (14%), or stage IV (83%) squamous cell carcinoma of the oropharynx, larynx, or hypopharynx treated from June 2000 to November 2003 at the University of Florida were retrospectively reviewed. Subjects received radiation therapy (RT; median, 74.4 Gy) and cisplatin, 30 mg/m2/wk. Altered fractionation was used in 34 of 35 (97%) patients. The endpoints were best response, percentage of grade III or IV toxicities, local-regional control, disease-free survival, cause-specific survival, and overall survival.
The median number of cycles of cisplatin administered was 6. Grade III or IV toxicities were: anemia, 11%; thrombocytopenia, 6%; leukopenia, 26%; and mucositis, 23%. No patients had renal failure and 1 patient (3%) died because of therapy-related complications. Responses to therapy included 71% complete response, 17% partial response, and 6% stable disease. Median follow-up for all patients was 1.8 years (range, 0.1-7.8 years); median follow-up for living patients was 4.4 years (range, 2.6-7.8 years). The 3-year outcomes were: local-regional control, 85%; disease-free survival, 56%; cause-specific survival, 59%; and overall survival, 40%.
Concomitant weekly CDDP with definitive RT is feasible, tolerable, highly active, and comparable with more complex, costly, and toxic regimens. Intercurrent disease was a significant contributor to mortality in our population. Our regimen is an attractive alternative to sequential chemoradiotherapy programs.
American journal of clinical oncology 07/2009; 32(5):488-91. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: To analyze the outcomes of patients treated for solitary plasmacytoma with definitive radiotherapy (RT).
Thirty-two patients with solitary plasmacytoma of bone (SPB; 22 patients) and extramedullary plasmacytoma (EMP; 10 patients) were treated between 1963 and 2006. The median RT dose was around 42.7 Gy (range, 15-54 Gy) over a median of 25 fractions (range, 1-32 fractions). No patient received adjuvant chemotherapy. Median follow-up was 10.1 years (range, 1-33 years). Median follow-up on living patients was 7.3 years (range, 2.1-33 years).
The 10-year local-control rate after RT was 87%. All 4 patients who developed a local recurrence had SPBs > or = 5 cm. The 10-year multiple myeloma-free survival rates were: SPB, 30%; EMP, 90%; and overall, 50%. Progression to multiple myeloma occurred at a median of 25.1 months after RT. The 10-year overall and cause-specific survival rates were 65% and 77%, respectively. The 10-year cause-specific survival rate was 65% for patients with SPB versus 100% for those with EMP (P = 0.006).
Moderate dose RT results in a high rate of local control. Patients with SPB are more likely to progress to multiple myeloma, which adversely affects their survival compared with those with EMP.
American journal of clinical oncology 07/2009; 32(6):612-7. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: The roles of adjuvant postoperative radiotherapy (RT) after radical prostatectomy, and salvage RT for apparent local-regional recurrence, are reviewed. Postprostatectomy patients with pT3N0 disease have improved biochemical progression-free survival, clinical progression-free survival, and local-regional control after postoperative RT. Although a benefit in overall survival has not been demonstrated, patients who have a life expectancy of ≥ 10 years likely will have improved long-term cause-specific survival if postoperative RT is administered. The optimal postoperative RT dose is probably about 70 Gy at 2 Gy per once-daily fraction. Salvage RT should be considered for patients with local regionally recurrent cancer without distant metastasis and those with a biochemical relapse. The optimal dose probably exceeds 70 Gy, but is likely not feasible because of the risk of late toxicity. Thus, the preferred dose-fractionation schedule is approximately 70 Gy in 35 once-daily fractions. The role of androgen deprivation therapy in combination with RT is ill defined, but it should be considered for high-risk patients. Similarly, the role for whole-pelvis RT is unclear, but it may be considered for those with a ≥ 20% risk of positive pelvic nodes.
American journal of clinical oncology 07/2009; 32(5):529-34. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: To compare the dose-volume data of three-dimensional conformal proton therapy (3DCPT) versus intensity-modulated radiotherapy (IMRT) for a paranasal sinus malignancy.
3DCPT and IMRT plans were created for a T4N0 maxillary sinus carcinoma.
The target volume dose distributions were comparable for 3DCPT and IMRT. The mean and integral doses for all normal tissues were lower for 3DCPT. The maximum doses for both plans to the ipsilateral optic nerve/retina/lens, temporal lobe, pituitary, and brain exceeded tolerance doses. The contralateral parotid, lacrimal gland, and lens were avoided with 3DCPT. Neither 3DCPT nor IMRT exceeded the maximal tolerated dose for the brainstem, optic chiasm, contralateral temporal lobe, parotid, or lacrimal gland.
Both 3DCPT and IMRT sufficiently covered the target volume(s). Although 3DCPT reduced the mean and integral dose to all of the normal tissues, both 3DCPT and IMRT irradiated the ipsilateral optic structures beyond acceptable tolerance doses.
American journal of clinical oncology 06/2009; 32(3):296-303. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: Squamous cell carcinoma (SCCA) of the external auditory canal (EAC) is often treated with a combination of surgery and radiotherapy (RT) to optimize the chance of achieving locoregional control. This retrospective review describes a 27-year experience of treating these tumors at the University of Florida.
Thirty patients with histologically confirmed SCCA of the EAC received external-beam radiation (RT) alone or combined with surgical resection between 1976 and 2003. Seven patients were treated with RT alone, 22 with postoperative RT, and 1with preoperative RT. Patients were grouped according to nodal status (N0/N1) and the Stell staging system for tumors of the EAC and middle ear. Early stage was defined as T1/T2 (n = 12) and advanced stage as T3 (n = 18). Median follow-up was 2 years (range, 0.1-19.4 years) with no patients lost to follow-up.
The 5-year actuarial probabilities for local control, locoregional control, and cause-specific survival for patients with early stage (T1/T2) versus advanced-stage (T3) tumors were 74% and 55% (P = 0.27), 63% and 38% (P = 0.16), and 70% and 41% (P = 0.04), respectively. The regional control rate was 83% (P = 0.6). There were 12 local recurrences and 4 neck recurrences as the first site of failure. One failure was successfully salvaged with surgery. Five of 23 (21%) patients undergoing surgery had significant complications (grade 3 or 4), whereas 2 of 30 (7%) patients receiving RT experienced grade 3 complications.
Patients with early stage disease achieved better local control, locoregional control, and cause-specific survival than those with advanced tumors. Less than half of the patients (13 of 30; 43%) were cured without significant complications, suggesting a suboptimal therapeutic ratio, using current treatment methods.
American journal of clinical oncology 05/2009; 32(4):401-4. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this experimental study with rabbits, the influence of intraarterial high-dose cisplatin with concomitant irradiation on arterial microanastomoses was evaluated to determine their impact on free-tissue transfers.
The right and left iliac arteries of 10 rabbits were injected with 150 mg/m of cisplatin (group 1). To serve as physiological controls, the iliac arteries of 10 other rabbits were injected with the same volume of saline (group 2). Hypofractionated radiotherapy was given to the right inguinal area of all rabbits using a Co unit, 1.25 MeV, and an SSD of 80 cm for 25 Gy at 5 fractions a day for 5 days (groups 1A and 2A) and the left inguinal areas remained unirradiated (groups 1B and 2B). Both femoral arteries of all 20 rabbits were transected and anastomosed using microsurgical techniques on day 7 after the treatment. All femoral artery anastomoses were examined under anesthesia for pulsatile blood flow 14 days after the surgery. Arteries, including the anastomotic site, were harvested and fixed for histologic evaluation by light microscopy and transmission electron microscopy.
Microscopic evaluation showed that all femoral artery anastomoses had good, pulsatile blood flow. Histologic examination of the femoral artery anastomotic site revealed changes of the arterial walls that varied between the groups. Evidence of intimal changes included detachment of endothelial cells in the intimal layer, edema of the endothelial cells in the intima, intimal thickening, separation of the intima from the tunica media, and collagen deposition. Evidence of damage to the tunica media included vacuolation and disarray of the smooth muscle cells, fibrinoid necrosis, and hemorrhage. The damage was most pronounced in the arteries that received both intraarterial cisplatin and radiotherapy (group 1A). The degree of damage diminished in the arteries of the radiotherapy-alone group (group 2A) and the intraarterial cisplatin-alone arteries (group 1B) compared with the control arteries (group 2B). Despite the arterial damage after irradiation and/or cisplatin, the patency rates after vascular anastomosis were 100% for every group.
Although damage to the arterial walls in the group that received intraarterial high-dose cisplatin with concomitant irradiation was most obvious, there were no differences in the patency rates after vascular anastomosis between any of the groups. Thus, after intraarterial high-dose cisplatin with concomitant irradiation, the femoral arteries can be used with caution as recipient vessels for free-tissue transfer.
American journal of clinical oncology 04/2009; 32(2):158-62. · 2.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: Metastatic spread to parotid-area lymph nodes (PALN) occurs in 1% to 3% of patients with cutaneous squamous cell carcinoma of the head and neck. Presented herein is the University of Florida experience using radiation therapy (RT) to treat patients with PALN metastases from a skin primary.
From November 1969 to February 2005, 121 parotids in 117 patients received irradiation for nonmelanotic skin carcinoma metastatic to PALN. Patients were staged by the O'Brien staging system. Of the 121 parotids receiving RT, 17 (14%) were treated preoperatively, 87 (72%) postoperatively, and 17 with RT alone.
Five-year actuarial probabilities of local (parotid) control, local-regional control, disease-free survival and overall survival were 78%, 74%, 70%, and 54%, respectively. When patients were separated by O'Brien P-stage, statistically significant differences were seen among the groups for local (parotid) control, local-regional control, and disease-free survival. A statistically significant decrease in local control was seen in patients treated with positive surgical margins (92% vs. 76%) and in local-regional control for patients treated with preoperative RT or RT alone when compared with postoperative RT (59% and 47% vs. 83%, respectively). The 5-year actuarial probability of freedom from distant metastases was 92%. Three (2.6%) patients suffered severe complications.
PALN metastases from a cutaneous head and neck primary site are best treated with surgery and postoperative RT. Our data support the hypothesis that the O'Brien staging system is superior to the American Joint Committee on Cancer system for the staging of cutaneous metastases to PALN. Positive surgical margins confer a worse prognosis in terms of local-regional control and disease-free survival. Patients treated with preoperative RT seem to have a worse prognosis than those treated postoperatively, likely a result of patient selection and the surgeon's inability to accurately assess viable tumor extent after preoperative RT. Severe complications are uncommon after surgery and RT for PALN metastases.
The Laryngoscope 11/2008; 118(11):1989-96. · 1.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: This article presents a case of a patient with follicular dendritic cell sarcoma (FDS), a rare neoplasm usually of the head and neck, and reviews the literature.
A MEDLINE literature search was performed and the literature was reviewed.
Our patient presented with an FDS that had been excised from the upper neck and recurred in a level V node. He was treated with neck dissection and postoperative irradiation and remains disease free 5.25 years after salvage treatment. The literature search yielded 67 case reports on FDS of the head and/or neck. Most patients were treated with surgery (94%). Twenty-eight percent of patients received adjuvant radiotherapy; 18% received adjuvant chemotherapy. Fifty percent of patients were alive with no evidence of disease at last follow-up; 9% died from disease.
We currently treat head and neck FDS with wide resection and postoperative radiotherapy.
The Laryngoscope 07/2008; 118(9):1607-12. · 1.98 Impact Factor