The Dutch Co-operative Head and Neck Oncology Group performed a retrospective, nationwide study o... more The Dutch Co-operative Head and Neck Oncology Group performed a retrospective, nationwide study of laryngeal cancer between 1975 and 1984. The results for T3 laryngeal cancer treated with primary laryngectomy (n = 137) with post-operative radiotherapy when indicated or planned combined (pre-operative) radiotherapy with laryngectomy (n = 113) are analysed. The disease-free survival independent prognostic factors were treatment modality (planned combined treatment fared better, P = 0.001), incomplete resection of disease (P = 0.006), positive lymph nodes in the neck dissection specimen (P = 0.03) and poor differentiation (P = 0.04). Local control (95% vs. 85%, P = 0.01) as well as regional control (96% vs. 79%, P = 0.0001) was improved in the combined group compared with the primary laryngectomy group. Regional control was 69% for N0 patients if the neck nodes were not treated electively, compared with 98% for the planned combined treatment group. It is concluded that elective treatment of the neck nodes in T3 laryngeal cancer is mandatory. Radiotherapy is preferred, since as well as regional control, local control will also improve.
This population-based study aimed to analyse variations in surgical treatment and guideline compl... more This population-based study aimed to analyse variations in surgical treatment and guideline compliance with respect to the application of radiotherapy and axillary lymph node dissection (ALND), for early breast cancer, before and after the sentinel node biopsy (SNB) introduction. The study included 13 532 consecutive surgically treated stage I-IIIA breast cancer patients diagnosed in 1989-2002. Hospitals showed large variation in breast-conserving surgery (BCS) rates, ranging between 27 and 72% for T1 and 14 and 42% for T2 tumours. In multivariate analysis marked inter-hospital and time-dependent variation in the BCS rate remained after correction for case-mix. The guideline adherence was markedly lower for elderly patients. In 25.2% of the patients aged > or = 75 years either ALND or radiotherapy were omitted. The proportion of patients with no ALND after an SNB increased from 1.8% in 1999 to 37.8% in 2002. However, in 2002 also 12.2% of the patients with a positive SNB did not ...
Treatment of Hodgkin disease (HD) in ataxia telangiectasia (AT) patients is hampered by hypersens... more Treatment of Hodgkin disease (HD) in ataxia telangiectasia (AT) patients is hampered by hypersensitivity to radiation and chemotherapy. Most patients die, due to toxicity or, rarely, to progressive disease. The authors report on a 9-year-old girl with stage IIA HD and AT She was treated with a tailored combined modality approach. No unacceptable toxicity was found, but the girl died of a relapse outside the irradiation field. In comparison with fibroblasts of non-AT patients, the fibroblasts of the patient were 3 times as sensitive for radiotherapy but just 1.2 times as sensitive for doxorubicin. A good correlation was shown between in vitro radio- and chemosensitivity testing and the observed clinical toxicity. The authors suggest, therefore, treating AT patients as much as possible according to standard protocols by adjusting the radiotherapy delivery and the chemotherapy regimen to individual doses derived from in vitro radio- and chemosensitivity testing.
Background This trial studied the disease-free survival after high-dose chemotherapy in patients ... more Background This trial studied the disease-free survival after high-dose chemotherapy in patients in complete remission of metastatic breast cancer. Patients and methods Thirty women, mean age 42.2 years (range 33–55) with metastatic breast cancer, received high-dose chemotherapy in a phase II study. Patients were eligible if they were ≤ 55 years of age, had achieved complete remission within 6 months of the initiation of chemotherapy, and had a WHO performance scale of 0 or 1. The high-dose regimen consisted of melphalan 180 mg/m2 and mitoxantrone 60 mg/m2 both divided over 3 days. On day 7 bone marrow and/or peripheral stem cells were infused. After bone marrow recovery, external beam radiation was administered to sites of previous metastatic disease in 15 patients. Results Apart from leuko- and thrombocytopenia, mucositis was the major side effect. One patient died during the bone marrow transplant period due to an aspergillus infection. The median follow-up since highdose chemotherapy is 25 months (range 13 to 56 months). The median disease-free survival since high-dose chemotherapy is 27 months and the disease free survival is still 43% with an overall survival of 53% at 3 years. In two patients tumor relapse occurred only in the brain; in one patient the only relapse sign was a meningeal carcinosis. At the moment 17 patients are disease-free (13+–56+) months after high-dose chemotherapy. Conclusion Until now this high-dose regimen in selected patients with complete remission after induction chemotherapy for metastatic breast cancer has a promising disease free survival.
Aggressive fibromatosis is a rare soft tissue tumour with a high tendency to local recurrence, ev... more Aggressive fibromatosis is a rare soft tissue tumour with a high tendency to local recurrence, even after apparently adequate resection. Wide local excision with a margin of at least 3 cm, depending on the anatomical location, should be performed to improve rates of recurrent disease. There is no consensus concerning the role of radiotherapy in the treatment of these lesions. The clinical findings of 39 cases diagnosed between 1972 and 1991 were reviewed retrospectively. Local control was effected in 19 of 32 patients treated with surgery alone after a median (range) follow-up of 72 (18–236) months. There were 40 cases of recurrent fibromatosis in 15 patients. Local control was obtained in 13 of 14 patients who received radiotherapy using a wide-field technique and doses of more than 50 Gy over a period of 5 weeks after marginal or incomplete resection of primary or recurrent lesions (P < 0.001). The results suggest that in a selected group of patients with aggressive fibromatosis radiotherapy may effectively achieve control of residual disease after surgery without marked disfigurement and loss of function.
International Journal of Radiation Oncology Biology Physics, 2005
To compare the Para Mixed technique for irradiation of the internal mammary nodes (IMN) with thre... more To compare the Para Mixed technique for irradiation of the internal mammary nodes (IMN) with three commonly used strategies, by analyzing the dose to the heart and other organs at risk. Four different three-dimensional conformal dose plans were created for 30 breast cancer patients. The IMN were enclosed with the Para Mixed technique by a widened mediolateral tangent photon beam and an anterior electron beam, with the Patched technique by an anterior electron beam, with the Standard technique by an anterior photon and electron beam, and with the PWT technique by partially wide tangents. All techniques were optimized for conformality and produced equally adequate target coverage. Heart dose was lowest with the Para Mixed and Patched technique for all patients and with the PWT technique for right-sided treatment only. Lung dose was highest with the PWT, lowest with the Patched, and intermediate with the Para Mixed and Standard techniques. Skin dose was highest with the Patched, lowest with the PWT, and intermediate with the Para Mixed and the Standard techniques. The Para Mixed technique resulted in a 13-Gy lower dose in an overlap area, and the PWT technique was the only technique that incorporated considerable volumes of the contralateral breast. The Para Mixed technique yielded the overall best results. No other technique resulted in a lower heart dose. Lung and skin were equally spared instead of one of them being compromised, and the contralateral breast was avoided.
The Dutch Co-operative Head and Neck Oncology Group performed a retrospective, nationwide study o... more The Dutch Co-operative Head and Neck Oncology Group performed a retrospective, nationwide study of laryngeal cancer between 1975 and 1984. The results for T3 laryngeal cancer treated with primary laryngectomy (n = 137) with post-operative radiotherapy when indicated or planned combined (pre-operative) radiotherapy with laryngectomy (n = 113) are analysed. The disease-free survival independent prognostic factors were treatment modality (planned combined treatment fared better, P = 0.001), incomplete resection of disease (P = 0.006), positive lymph nodes in the neck dissection specimen (P = 0.03) and poor differentiation (P = 0.04). Local control (95% vs. 85%, P = 0.01) as well as regional control (96% vs. 79%, P = 0.0001) was improved in the combined group compared with the primary laryngectomy group. Regional control was 69% for N0 patients if the neck nodes were not treated electively, compared with 98% for the planned combined treatment group. It is concluded that elective treatment of the neck nodes in T3 laryngeal cancer is mandatory. Radiotherapy is preferred, since as well as regional control, local control will also improve.
This population-based study aimed to analyse variations in surgical treatment and guideline compl... more This population-based study aimed to analyse variations in surgical treatment and guideline compliance with respect to the application of radiotherapy and axillary lymph node dissection (ALND), for early breast cancer, before and after the sentinel node biopsy (SNB) introduction. The study included 13 532 consecutive surgically treated stage I-IIIA breast cancer patients diagnosed in 1989-2002. Hospitals showed large variation in breast-conserving surgery (BCS) rates, ranging between 27 and 72% for T1 and 14 and 42% for T2 tumours. In multivariate analysis marked inter-hospital and time-dependent variation in the BCS rate remained after correction for case-mix. The guideline adherence was markedly lower for elderly patients. In 25.2% of the patients aged > or = 75 years either ALND or radiotherapy were omitted. The proportion of patients with no ALND after an SNB increased from 1.8% in 1999 to 37.8% in 2002. However, in 2002 also 12.2% of the patients with a positive SNB did not ...
Treatment of Hodgkin disease (HD) in ataxia telangiectasia (AT) patients is hampered by hypersens... more Treatment of Hodgkin disease (HD) in ataxia telangiectasia (AT) patients is hampered by hypersensitivity to radiation and chemotherapy. Most patients die, due to toxicity or, rarely, to progressive disease. The authors report on a 9-year-old girl with stage IIA HD and AT She was treated with a tailored combined modality approach. No unacceptable toxicity was found, but the girl died of a relapse outside the irradiation field. In comparison with fibroblasts of non-AT patients, the fibroblasts of the patient were 3 times as sensitive for radiotherapy but just 1.2 times as sensitive for doxorubicin. A good correlation was shown between in vitro radio- and chemosensitivity testing and the observed clinical toxicity. The authors suggest, therefore, treating AT patients as much as possible according to standard protocols by adjusting the radiotherapy delivery and the chemotherapy regimen to individual doses derived from in vitro radio- and chemosensitivity testing.
Background This trial studied the disease-free survival after high-dose chemotherapy in patients ... more Background This trial studied the disease-free survival after high-dose chemotherapy in patients in complete remission of metastatic breast cancer. Patients and methods Thirty women, mean age 42.2 years (range 33–55) with metastatic breast cancer, received high-dose chemotherapy in a phase II study. Patients were eligible if they were ≤ 55 years of age, had achieved complete remission within 6 months of the initiation of chemotherapy, and had a WHO performance scale of 0 or 1. The high-dose regimen consisted of melphalan 180 mg/m2 and mitoxantrone 60 mg/m2 both divided over 3 days. On day 7 bone marrow and/or peripheral stem cells were infused. After bone marrow recovery, external beam radiation was administered to sites of previous metastatic disease in 15 patients. Results Apart from leuko- and thrombocytopenia, mucositis was the major side effect. One patient died during the bone marrow transplant period due to an aspergillus infection. The median follow-up since highdose chemotherapy is 25 months (range 13 to 56 months). The median disease-free survival since high-dose chemotherapy is 27 months and the disease free survival is still 43% with an overall survival of 53% at 3 years. In two patients tumor relapse occurred only in the brain; in one patient the only relapse sign was a meningeal carcinosis. At the moment 17 patients are disease-free (13+–56+) months after high-dose chemotherapy. Conclusion Until now this high-dose regimen in selected patients with complete remission after induction chemotherapy for metastatic breast cancer has a promising disease free survival.
Aggressive fibromatosis is a rare soft tissue tumour with a high tendency to local recurrence, ev... more Aggressive fibromatosis is a rare soft tissue tumour with a high tendency to local recurrence, even after apparently adequate resection. Wide local excision with a margin of at least 3 cm, depending on the anatomical location, should be performed to improve rates of recurrent disease. There is no consensus concerning the role of radiotherapy in the treatment of these lesions. The clinical findings of 39 cases diagnosed between 1972 and 1991 were reviewed retrospectively. Local control was effected in 19 of 32 patients treated with surgery alone after a median (range) follow-up of 72 (18–236) months. There were 40 cases of recurrent fibromatosis in 15 patients. Local control was obtained in 13 of 14 patients who received radiotherapy using a wide-field technique and doses of more than 50 Gy over a period of 5 weeks after marginal or incomplete resection of primary or recurrent lesions (P < 0.001). The results suggest that in a selected group of patients with aggressive fibromatosis radiotherapy may effectively achieve control of residual disease after surgery without marked disfigurement and loss of function.
International Journal of Radiation Oncology Biology Physics, 2005
To compare the Para Mixed technique for irradiation of the internal mammary nodes (IMN) with thre... more To compare the Para Mixed technique for irradiation of the internal mammary nodes (IMN) with three commonly used strategies, by analyzing the dose to the heart and other organs at risk. Four different three-dimensional conformal dose plans were created for 30 breast cancer patients. The IMN were enclosed with the Para Mixed technique by a widened mediolateral tangent photon beam and an anterior electron beam, with the Patched technique by an anterior electron beam, with the Standard technique by an anterior photon and electron beam, and with the PWT technique by partially wide tangents. All techniques were optimized for conformality and produced equally adequate target coverage. Heart dose was lowest with the Para Mixed and Patched technique for all patients and with the PWT technique for right-sided treatment only. Lung dose was highest with the PWT, lowest with the Patched, and intermediate with the Para Mixed and Standard techniques. Skin dose was highest with the Patched, lowest with the PWT, and intermediate with the Para Mixed and the Standard techniques. The Para Mixed technique resulted in a 13-Gy lower dose in an overlap area, and the PWT technique was the only technique that incorporated considerable volumes of the contralateral breast. The Para Mixed technique yielded the overall best results. No other technique resulted in a lower heart dose. Lung and skin were equally spared instead of one of them being compromised, and the contralateral breast was avoided.
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