Long-term risk of sarcoma following radiation treatment for breast cancer

At the hospital de la Santa Creu i Sant Pau, Barcelona, Spain, 3,120 patients with breast carcinoma were submitted to radiation between 1976 and 1994. Among them there were three patients (0.06%) in whom malignant neoplasm developed in areas of prior irradiation. Histologically, the three tumors were postirradiation sarcomas (PIS): 2 osteogenic sarcomas and one angiosarcoma. The radiation doses varied between 46 and 50 Gy. One patient additionally received chemotherapy. The median interval that transcurred between the start of radiation therapy and the detection of the new growth was 14.3 years. One patient is still alive and in treatment. The other two patients died of sarcoma, 1 and 12 months after the diagnosis of PIS. Taking into account the unfavourable outcome of these three cases, we want to emphasize that the benefit of postsurgical radiation therapy in breast cancer patients by far exceeds its risk of causing a second malignant growth.

Function preservation in stage III squamous laryngeal carcinoma: results with an induction chemotherapy protocol

Until recently, standard treatment for stage III laryngeal carcinoma (LC) was total laryngectomy and radiotherapy. Recent data suggest that induction chemotherapy (ICH) plays a role in preserving function in advanced head and neck cancer. No reports to date prospectively evaluate ICH exclusively in stage III LC. The authors designed a sequential phase II trial to assess if ICH allowed a conservative treatment in this disease. The objective of the first part of the study was to rule out a complete response rate with ICH below 30% with P < .05. ICH protocol consisted of three courses of cisplatin 100 mg/M2 on day 1 and 5-fluorouracil 5000 mg/M2 continuous infusion over 120 hours. Radiotherapy was administered to patients who attained a complete response (CR). Functional surgery (FS) was planned for patients with partial response. A total laryngectomy followed by radiotherapy was performed when FS was not feasible. Fifty-two previously untreated patients (all males) with squamous stage III LC were diagnosed in our institution, and 46 were entered in the ICH trial. After 9 patients were included, data showed 7 (78%) CR, ruling out a CR rate of less than 30%. After ICH, a CR was achieved in 29 (63%) of 46 patients. At the end of treatment, 35 patients (76%) had a functioning larynx. With a median follow-up of 3 years, larynx function was preserved in 26 (57%) of 46 patients and in 64% of survivors. Four-year actuarial larynx function preservation, overall survival, and disease-free survival were 55%, 77%, and 67%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of radiation therapy in vertebral hemangiomas without neurological signs

We describe 5 patients with vertebral haemangiomas treated by radiotherapy of 30-40 Gy, 2-3 Gy/day. The management of vertebral haemangiomas is discussed.

High dose level radiation therapy for local tumour control in esthesioneuroblastoma

Esthesioneuroblastoma is an uncommon tumour of neural crest origin arising in the nasal cavity. This paper is a retrospective review of 7 patients with esthesioneuroblastoma treated at a single institution from May 1974 to July 1990. 5 patients were treated with radiation therapy alone and 2 patients were irradiated after surgical resection. No local or regional occurrence was observed in any patient at 6 months, or at 1, 3, 6, 11.5 and 12 years following treatment. One patient died of intercurrent disease 6 years after radiation therapy. 2 patients died of disease, 1 of distant metastasis at 6 months and the other patient of meningeal carcinomatosis and distant metastases 1 year after treatment. One patient is alive with distant metastases 1 year after treatment. None of the patients experienced significant complications of irradiation. High-dose irradiation (60 Gy or more) alone or in combination with resection is an effective local treatment modality for esthesioneuroblastoma.

Salvage irradiation of oral and oropharyngeal cancers using interstitial radiotherapy with au-198 grains

Fourteen patients with recurrent or persistent carcinoma of the oral cavity or oropharynx were treated with Au-198 grain implants at the Santa Creu i Sant Pau Hospital from June 1987 through April 1991. Five patients presented recurrent carcinoma, four patients persistent carcinoma, and five patients a second primary. Local control was achieved with Au-198 implants in six patients (42.8%) at 8, 16, 23, 29, 39 and 53 months following treatment. Seven patients died of local recurrence or persistent disease at 5, 7, 7, 10, 10, 12 and 15 months after interstitial implant. Three patients (21.4%) died of significant complications of salvage irradiation (Hemorrhage in two patients and edema in one patient) at 0.5, 8 and 16 months following treatment. Three patients of fourteen (21.4%) are alive and well at 53, 39 and 23 months after salvage Au-198 grain implant. Considerations regarding the usefulness of Au-198 grain implants in the treatment of recurrent or persistent oral and oropharyngeal cancer are discussed.

External and interstitial radiation therapy of locally advanced carcinoma of the breast

The present report concerns 164 cases of locally advanced breast cancer (stage III), treated between December 1977 and January 1987. The local therapy consisted exclusively of radiation therapy including external beam irradiation (60Co) up to 45-50 Gy supplemented with a boost, delivered either by interstitial 192Ir (30-40 Gy) or by external irradiation from limited fields (15-22 Gy). Eighty-one patients also received adjuvant systemic chemotherapy. A total of 51 local failures (31%) occurred. The actuarial rate of survival with local tumor control was 53% at 5 years and 49% at 6.5 years. A total of 69 patients developed distant metastases (42%). The actuarial survival without distant failure was 43% at 5 years and 37% at 6 years. The actuarial survival rate at 5 years was 53% and 38% at 7 years. The cosmetic results were excellent in 58 patients and poor in 13 patients (9.7%). The result suggests that stage III breast cancer can be satisfactorily treated with radiation therapy alone as local treatment.

Radiotherapy for chemodectoma of the carotid body and ganglion nodosum

Chemodectomas of the carotid body and of the glomus vagale are uncommon tumors of the head and neck. Between 1981 and 1986, 6 patients with advanced chemodectomas of either the carotid body (5 patients) or the glomus vagale (1 patient) were treated with radiotherapy at the University of Florida. Tumors were bilateral in 2 patients. Five patients have had no evidence of disease progression for 5, 5.5, 7, 7, and 8.5 years following irradiation. One of the 5 patients experienced complete regression, 2 noted partial regression, and 2 remained stable (without progression). One patient, who had received 2 prior operations and a course of irradiation at another institution, died of locally recurrent disease 5 years after re-irradiation at the University of Florida. No patient experienced a significant complication secondary to irradiation.

Primary subglottic cancer: results of radical radiation therapy

Between October 1964 and December 1985, six patients with primary squamous cell carcinoma of the subglottis were treated with radical radiation therapy at the University of Florida. The disease was staged as Tis (one patient), T2N0 (two patients), and T4N0 (three patients). Local control was achieved with irradiation in four patients (66%) who were observed for 3.5, 4, 4, and 5 years after radiation therapy. Two patients whose tumors recurred at the primary site underwent salvage laryngectomy, which was successful in one patient.

Chromosomal instability in breast cancer patients

We have carried out cytogenetic studies, using the G-banding technique, in peripheral blood lymphocytes of 10 patients affected by breast carcinoma. The frequency of aberrant metaphases (7.36%) is significantly different from that of our laboratory controls (3.76% of aberrant metaphases) but not from that detected in patients suffering from bladder cancer (10.64%) and Hodgkin's disease (11.03%), two conditions that have previously been described as chromosomally unstable. Our results suggest that breast carcinoma patients show a degree of chromosomal instability that could be related to a predisposition to neoplastic disease.

Inflammatory component: a worsening factor in locally advanced breast cancer treated by radiotherapy and systemic therapy

Locally advanced and inflammatory carcinomas of the breast are two distinct entities with clear differential clinical criteria. We described a particular type of locally advanced breast cancer which, during its evolution, developed inflammatory characteristics limited to a small area of the skin. It, therefore, did not meet the common diagnostic criteria of inflammatory carcinoma. In our series, studied from December 1977 to January 1987, we treated 59 cases of locally advanced breast cancer and 105 cases of locally advanced breast cancer with an inflammatory component. The actuarial overall survival was 53.3% at 5 years and 38.4% at 7 years. Differences were observed when the two tumor types were compared. Specifically, locally advanced breast cancer with an inflammatory component had a worse prognosis, poorer survival and poorer disease-free rates than locally advanced breast cancer.

The role of radiation therapy in inverted papilloma of the nasal cavity and paranasal sinuses

Between December 1969 and March 1985, seven patients with advanced biologically aggressive inverted or cylindrical cell papillomas were treated with irradiation at the University of Florida. Three patients were treated with radiation therapy alone, and four patients were irradiated either before (one patient) or after (three patients) resection. No recurrences were observed in six patients at 4.5, 7, 8, 8, 9, and 20 years following treatment (including two who died of intercurrent disease at 7 and 9 years after radiation therapy without evidence of recurrent tumor). One patient treated with irradiation alone for an advanced recurrent papilloma developed a local recurrence extending into the frontal lobe of the brain and died 17 months after radiation therapy. None of the patients experienced a significant complication of irradiation. Although surgery is generally the primary treatment modality for this disease, radiation therapy should be considered for patients with advanced, incompletely resected, or unresectable lesions.

Cytogenetic effects of radiotherapy: frequency and types of chromosome aberrations

The frequency and types of chromosome aberrations induced by ionizing radiation in cancer patients were evaluated in 24 cases studied just before and immediately after radiotherapy. The incidence of aberrant metaphases prior to treatment was 9.98% and increased significantly after treatment to 32.8%. The frequency of chromosome aberrations before radiotherapy was, with the exception of the cases of breast cancer and seminoma, significantly higher than that in our laboratory controls. A comparison of chromosome abnormalities observed before and after treatment indicated that dicentric translocations, rings, and reciprocal translocations increased by a factor of 23, 13, and 11, respectively, after radiotherapy. Ionizing radiation produces more asymmetrical than symmetrical chromosome aberrations and more two-break than one-break anomalies.

Cytogenetic effects of radiotherapy. Breakpoint distribution in induced chromosome aberrations

A total of 660 breakpoints were identified in the chromosome aberrations detected in lymphocytes from cancer patients after radiotherapy. The results show that chromosomes 1, 3, and 7 were significantly more affected than other chromosomes by ionizing radiation in vivo. Chromosome arms 1p, 1q, 7q, and 11p were also significantly more affected. Some bands also showed a special sensitivity to radiation, and band 1q32 was the most affected. This band is proposed as a "hot point" for the clastogenic effect of ionizing radiation. A significant clustering of breakpoints in G bands was also found, especially at the telomeres, as previously described by other authors. Clustering of breakpoints was also observed in bands where fragile sites, protooncogenes, breakpoints involved in chromosomal cancer rearrangements, and breakpoints involved in chromosomal evolution of the Hominoidea are located.