Primary radiotherapy with or without chemotherapy in non-metastatic esophageal squamous cell carcinoma: a retrospective study

The purpose of this study was to report the outcome of radio(chemo)therapy in the curative management of esophageal squamous cell carcinoma (ESCC). We retrospectively analyzed 163 patients with T1-T4, N0-1, M0 ESCC who were treated between January 1988 and December 2006 at the Technische Universität München. One hundred sixty patients were inoperable due to a poor performance status, comorbidities or locally advanced unresectable disease. External beam radiation therapy (EBRT) was performed with (n= 146) or without (n= 17) systemic chemotherapy. Fifty-four patients received an additional boost with intraluminal brachytherapy (IBT). Surviving patients were followed for a median of 72 months (range 10-173 months). The estimated overall survival (OS) at 2 and 5 years was 27 ± 4% and 11 ± 3%, respectively. Loco-regional recurrence at the primary site was observed in 29% of patients (n= 47). The recurrence-free survival (RFS) at 2 and 5 years was 24 ± 3% and 9 ± 2%, respectively. In multivariate analyses, the ECOG performance status (P= 0.004), 3D conformal (vs conventional) radiotherapy (P= 0.031) and continuous standard fractionation (vs split-course radiotherapy, P= 0.048) were associated with a better OS. Simultaneous chemotherapy (P= 0.49) or IBT (P= 0.31) had no significant impact on survival. Outcome for patients with ESCC is poor. Despite the very unfavorable patient selection (poor performance status, high rate of comorbidities, and advanced disease), long-term survival with radio(chemo)therapy was achieved in about 10% of patients. The introduction of modern treatment techniques/modalities (3D conformal planning/ continuous standard fractionation) might be associated with better outcomes.

Palliative radiotherapy of malignant melanoma with reactor fission neutron therapy (RENT): a prospective study

To study the efficacy and safety of relatively low-dosed reactor fission neutron therapy (RENT) at the research reactor of the Technical University Munich, we treated 33 superficial lesions of 20 patients with advanced malignant melanoma by neutron beam alone (n = 22), mixed neutron/electron beam (n = 5), or by neutron beam after incomplete surgery (n = 6). Median tumor volume was 17.0 cm3. Median dose for neutron beam alone was 8.0 Gy and for mixed beam 3.0 Gy n + 45.3 Gy e-. Local tumor response, local control time, survival and treatment related toxicity were followed prospectively over a time period of 52 months. Overall response rate (CR;PR) after neutron beam alone and mixed beam therapy was 64% (CR: 36%) and 100% (CR: 60%), respectively. Observed differences between complete (CR) and incomplete (PR, NC) responding lesions were as follows: median tumor volume: 2.0 vs. 51.5 cm3, local control time: 13.3 vs. 3.7 months, median survival: 19.8 vs. 9.0 months. No severe acute or late sequelae could be observed. In conclusion, low-dosed RENT is an effective and well tolerated palliative treatment of superficial malignant melanoma utilizing the biologic advantage of diminished cellular repair capacity. Because melanoma lesions of small size (< or = 6 cm3) tend to respond completely, neutron beam should be performed at an early stage.

The role of fast neutrons in the treatment of squamous cell carcinomas of the head and neck: The European experience

After the first European stet on neutron therapy of head and neck cancer, published by Catterall and Bewley, revealed significant advantages of neutrons over photons in 134 randomized patients, the subsequent phase II and phase III studies led to controversial results. Figures for local tumor control varied from 26-76% after 2 years to 19% after 10 years and for survival from 16-46% after 2 years to 14% after 10 years. Results of all studies were consistent with showing an increased incidence of severe late effects. Eligibility criteria with regard to the tumor stage, history, and previous therapies of relapses varied from study to study. Also, physical treatment parameters, such as neutron energy, LET and OER, neutron and photon doses for one fraction and for the total radiotherapy were rather different. The benefit of neutron therapy in comparison with photons was low or non-existent when smaller tumor stages, such as primaries T2 or lymph nodes N1 were included into the trial. It increased when only T4 tumors, recurrences or tumors persisting after conventional radiotherapy were treated and when the percentage of fixed lymph nodes increased. There was only one European study in which patients suffering form lymph node metastases of the neck had, in contrast to American data (Griffin et al. 1978), a worse prognosis after neutrons than after photon therapy (Duncan et al. 1987b). In our own phase II study on reactor neutron therapy of 100 patients suffering from relapses and persistent tumors, not yet published, 3-year survival of 21% and 3-year local control of 32% were obtained. Although this was not a randomized study, during this period all patients with equivalent tumors treated by photon therapy alone died within 2 years. In conclusion there is no general indication for neutron therapy in squamous cell carcinoma of the head and neck, but there is a benefit of neutrons in palliative treatment of recurrences, necrotic and hypoxic primaries and lymph nodes.

A comparison of bone imaging with Tc-99m DPD and Tc-99m MDP: concise communication

Bone to soft tissue (ST) ratios for both high-uptake bone (sacrum) and low-uptake bone (femoral diaphysis) were obtained with a derivative of phosphonic acid, TC-99m 2,3-dicarboxypropane-1, 1-diphosphonate (DPD), in 26 normal subjects and 177 patients with malignant disease but without metastases. Tests were run 2 hr after tracer injection. Similar ratios were obtained with Tc-99m methylene diphosphonate (MDP) in 220 normal subjects and 451 patients. With MDP, the influence of incubation time (5-10 min in 416 cases, 45 min in 185 cases) on these ratios was determined. DPD was superior to MDP for both ratios. With MDP, prolonged incubation time yielded significantly enhanced ratios; however, the ratios for the DPD were still higher. With either agent and preparation, sacrum-to-ST ratios decreased with increasing subject age, and in patients with malignant disease the ratios tended to be higher than those obtained from normals.