Results of radiotherapy of esophageal cancer

From 1972 to 1987, sixty-seven patients with esophageal cancer were treated with radiotherapy over 50 Gy. The actuarial survival at 5 years and the median survival in all patients were 5.3% and 7 months, respectively. Survival was analyzed according to the intent of radiotherapy and the tumor response. The 5 year survival and the median survival were 5.6% and 8 months for the group of radiotherapy with curative intent, whereas they were 0% and 7 months for the group of non-curative radiotherapy (p less than 0.02). The median survivals of absolutely curable, relatively curable, relatively non-curable and absolutely non-curable group were 13, 9, 5 and 3 months, respectively. And survivals of the first two groups were significantly longer than those of the last two groups. The survival in patients with distant metastasis was worse than in those who had no distant metastasis (p less than 0.05). In the fifty-five patients with no distant metastasis, the significant prognostic factors were performance status and radiation dose (TDF).     

Radiolesions after radiotherapy of breast cancer]

A study is presented of the late radiolesions which occur after breast cancer irradiation. These lesions are described and the etiological factors are studied, with special emphasis given to the effect of dose and time factors. For the large volume considered in the irradiation of breast cancers, the tolerance dose for normal tissue (skin and connective subcutaneous tissue) can be set at 1,700 rets, that is, 5,600 rads in 28 sessions of 200 rads over a period of 38 days. Technical irradiation problems are given special mention as they can be the cause of dosimetric errors resulting in complications. Dosimetry should be in the whole volume, and not only in a single plane, as is still most often the case.     

Hypofractionated radiotherapy in the treatment of early breast cancer

Radiotherapy (RT) after tumorectomy in early breast cancer patients is an established treatment modality which conventionally takes 6-7 wk to complete. Shorter RT schedules have been tested in large multicentre randomized trials and have shown equivalent results to that of standard RT (50 Gy in 25 fractions) in terms of local tumor control, patient survival and late post-radiation effects. Some of those trials have now completed 10 years of follow-up with encouraging results for treatments of 3-4 wk and a total RT dose to the breast of 40-42.5 Gy with or without boost. A reduction of 50% in treatment time makes those RT schedules attractive for both patients and health care providers and would have a significant impact on daily RT practice around the world, as it would accelerate patient turnover and save health care resources. However, in hypofractionated RT, a higher (than the conventional 1.8-2 Gy) dose per fraction is given and should be managed with caution as it could result in a higher rate of late post-radiation effects in breast, heart, lungs and the brachial plexus. It is therefore advisable that both possible dose inhomogeneity and normal tissue protection should be taken into account and the appropriate technology such as three-dimensional/intensity modulated radiation therapy employed in clinical practice, when hypofractionation is used.     

Plesiobrachytherapy for chest wall recurrences of breast cancer after mastectomy and radiotherapy for breast cancer

PurposeThe purpose of the study was to evaluate the results of high-dose-rate plesiobrachytherapy for local relapse after mastectomy and radiotherapy in terms of both local control and survival.MethodsWe reviewed retrospectively 43 patients who experienced a chest wall relapse of breast cancer after local excision (22 patients) or not (21 patients). Patients were treated with an individually designed mold with four to six fractions of 3–6 Gy high-dose-rate brachytherapy, two fractions per week. Mean total dose was 24 Gy.ResultsAfter surgical resection, the 3- and 5-year local control rates were 80% and 73%, respectively. For nonresectable patients, the overall response rate was 86%, and the 3-year infield local control and chest wall local control were 51% and 26%, respectively. The 5-year survival rate was 50.5% for the whole population, 62% after surgery, and 45.4% for irresectable patients. Acute Grade 2 or 3 toxicity occurred in 43% of the patients, resolving in a few days. Two patients had a local necrosis lasting 3 to 7 months. Late toxicity was observed in 5 patients.ConclusionsHigh-dose-rate plesiobrachytherapy is a simple outpatient technique to treat chest wall local relapse of breast cancer. As a reirradiation technique, its tolerance is acceptable. This technique may obtain long-term local control after incomplete surgery; in case of nonresectable disease, a high response rate was observed, which might improve the quality of life of these patients.