Treatment outcomes and prognostic factors of patients with supratentorial low-grade oligodendroglioma

: Oligodendroglioma is a relatively rare central nervous system tumor. Currently, surgical intervention is the mainstay of treatment, and the role of postoperative radiotherapy (RT) remains a subject of controversy. The objective of this study was to investigate the prognostic factors, evaluate the treatment outcomes, and assess whether postoperative RT has a benefit on local control and overall survival rates.

: This was a retrospective review of 52 consecutive adult patients with supratentorial low-grade oligodendrogliomas diagnosed at our institution between September 1980 and September 1998. Thirty-two received postoperative RT. Data were analyzed retrospectively to survey the significant prognostic factors for local control and overall survival.

: The 5-year overall and progression-free survival rate was 80% and 67%, respectively. Twenty-five patients experienced local disease progression during the follow-up period. In multivariate analysis, postoperative RT and age at diagnosis showed independent prognostic significance for overall survival. For progression-free survival, postoperative RT was the only independent prognostic factor.

: On the basis of the results of this study, we recommend considering postoperative RT as one of the standard adjuvant treatment modalities for patients with supratentorial low-grade oligodendroglioma, regardless of the extent of surgical resection. The optimal treatment strategy to maximize the treatment outcome should still be explored.     

Incidence of needle tract seeding and responses of soft tissue metastasis by hepatocellular carcinoma postradiotherapy.

AIM: To determine the incidence of needle tract seeding after fine needle aspiration (FNA) or percutaneous ethanol injection (PEI) and compare iatrogenic or spontaneous soft tissue metastasis (STM) by hepatocellular carcinoma (HCC) postradiotherapy (RT) in responses. METHODS: From November 1997 to January 2006, those who presented with STM by HCC after our invasive procedures or developed spontaneously were enrolled into this retrospective study. Metastatic lesions could be divided into procedure related (PR), which were located at the liver span and were related to invasive procedures, and non-procedure related (NPR), which were in extrahepatic areas. STM was treated with an electron or photon beam. RESULTS: A total of 39 HCC cases with developed STM were referred for RT, including 17 in the PR group and 22 in the NPR group. During the same period, a total of 18,227 person-times of FNA or PEI were performed on these HCC patients. The overall incidence of HCC with STM that was caused by invasive procedures was estimated at 0.13%. According to the Cox' regression model, the initial treatment modality influences the time duration after the initial diagnosis of HCC when STM has not occurred. None of these patients' soft tissue tumor increased in size during RT. The PR group had lower rates of bone metastasis (P=0.003) and coexisting extrahepatic metastasis (P=0.011) and a longer survival rate (P=0.003) than the NPR group. The estimated rates of 18-gauge and 22-gauge needle-induced HCC-related STM were 0.60% and 0.11%, respectively (P=0.064). CONCLUSION: The PR group bears a better prognosis than the NPR group post-RT.     

The different volume effects of small-bowel toxicity during pelvic irradiation between gynecologic patients with and without abdominal surgery: a prospective study with computed tomography-based dosimetry

PURPOSE: To evaluate the effect of abdominal surgery on the volume effects of small-bowel toxicity during whole-pelvic irradiation in patients with gynecologic malignancies. METHODS AND MATERIALS: From May 2003 through November 2006, 80 gynecologic patients without (Group I) or with (Group II) prior abdominal surgery were analyzed. We used a computed tomography (CT) planning system to measure the small-bowel volume and dosimetry. We acquired the range of small-bowel volume in 10% (V10) to 100% (V100) of dose, at 10% intervals. The onset and grade of diarrhea during whole-pelvic irradiation were recorded as small-bowel toxicity up to 39.6 Gy in 22 fractions. RESULTS: The volume effect of Grade 2-3 diarrhea existed from V10 to V100 in Group I patients and from V60 to V100 in Group II patients on univariate analyses. The V40 of Group I and the V100 of Group II achieved most statistical significance. The mean V40 was 281 +/- 27 cm(3) and 489 +/- 34 cm(3) (p < 0.001) in Group I patients with Grade 0-1 and Grade 2-3 diarrhea, respectively. The corresponding mean V100 of Group II patients was 56 +/- 14 cm(3) and 132 +/- 19 cm(3) (p = 0.003). Multivariate analyses revealed that V40 (p = 0.001) and V100 (p = 0.027) were independent factors for the development of Grade 2-3 diarrhea in Groups I and II, respectively. CONCLUSIONS: Gynecologic patients without and with abdominal surgery have different volume effects on small-bowel toxicity during whole-pelvic irradiation. Low-dose volume can be used as a predictive index of Grade 2 or greater diarrhea in patients without abdominal surgery. Full-dose volume is more important than low-dose volume for Grade 2 or greater diarrhea in patients with abdominal surgery.     

Health-related quality of life for nasopharyngeal carcinoma patients with cancer-free survival after treatment

PURPOSE: To evaluate the health-related quality of life (HR-QOL) of nasopharyngeal cancer (NPC) patients with cancer-free survival after treatment and to investigate the factors correlated with their HR-QOL. METHODS AND MATERIALS: One hundred eighty-two NPC patients with cancer-free survival of more than 2 years after treatment were enrolled in the study. Data from the same number of people without a history of cancer, who had come to the hospital for health checkups, were also collected for comparison. The Chinese SF-36 questionnaire and nine items about head-and-neck functional impairments (HNFI) were self-reported by all participants at the clinics. Data relating to sociodemographic factors, cancer stage, and treatment of NPC survivors were analyzed. RESULTS: Psychometric tests revealed the excellent internal reliability (Cronbach's alpha: 0.87-0.96) and discriminative validity of the Chinese SF-36 used in Taiwan. Most functional domains of the Chinese SF-36 and all nine HNFI items were significantly worse in NPC survivors than in control subjects. No cancer or treatment-related variables significantly correlated with any functional domains of SF-36 or any items of HNFI for NPC survivors. Economic status, educational level, occupational status, and the number of comorbidities were the variables that significantly correlated with most functional domains of SF-36 for NPC survivors. Patients with more sufficient economic status, higher educational levels, with employment, or without comorbidity tended to enjoy better HR-QOL as detected by the SF-36. Salivation, hearing, and swallowing dysfunctions were the top three HNFI that disturbed NPC survivors. Economic status remained the most significant variable correlated with HNFI, including salivation, swallowing, neck stiffness, taste, and phonation. Survivors with better economic status reported less severe HNFI. CONCLUSIONS: NPC survivors had worse HR-QOL than healthy control subjects in the study. Socioeconomic status was the most significant variable that correlated with the HR-QOL of NPC survivors. This result might indicate that patients' superior individual characteristics and financial resources are important variables determining their ability to cope with cancer and treatment complications affecting their HR-QOL.     

Exacerbated radiodermatitis and bilateral subdural hemorrhage after whole brain irradiation combined with epidermal growth factor receptor tyrosine kinase inhibitors for brain metastases in lung cancer

A 57-year-old male developed an adenocarcinoma lung cancer in November 2003. He received the full course chemotherapy but without a significant regression. The targeted therapy gefitinib was prescribed 2 years after diagnosis, producing a very good partial response. However, brain metastasis was diagnosed. A whole brain irradiation was performed for 37.5Gy with a fraction size of 2.5Gy and gefitinib was replaced with erlotinib on the 5th day after radiation therapy commenced for disease progressing. Unexpectedly, the patient developed a severe skin reaction in the region exposed to the radiation field, and a bilateral subdural hemorrhage, following radiation therapy. The reaction was thought to be triggered by the combination of radiation and epidermal growth factor receptor tyrosine kinase inhibitors, which may be responsible for hypersensitizing the radiation response in normal tissue in the unique individual.     

Postoperative Radiotherapy for Supratentorial Malignant Gliomas

From January 1988 to December 1996, sixty-five patients with histologically confirmed supratentorial malignant gliomas were treated with postoperative radiation therapy in our department. They were subjected to this analysis according to different clinical and pathologic parameters. The overall 1-year, 2-year survival rate was 57% and 23%, respectively. With univariate analysis, age, postoperative Karnofsky performance status, duration of symptoms, multiplicity of lesions and the extent of surgery were identified as significant prognostic factors. With multivariate analysis, postoperative Karnofsky performance status and the extent of surgery continued to show independent prognostic significance on overall survival.