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391Extramedullary plasmacytomas of the upper respiratory tract
SIO1 390
391
COMBINED E X T E R N A L BEAM RADIOTHERAPY AND HDR BRACHYTHERAPY B O O S T IN NASOPHARYNGEAL CANCER
E X T R A M E D U L L A R Y PLASMACYTOMAS O F THE UPPER R E S P I R A T O R Y TRACT
Enis Ozyar, Dilek UzaI,Salih GLIrdalh,Fadfl Akyol, I.Lale Atahan Department o f Radiation Oncology, Faculty o f Medicine, Hacettepe University, Ankara, 06100, Turkey
M. Serin (I), H.S. Erkal (1), S.D. Sak (2), I. Ko~:ak (3), A. Cakmak ( I ),
Between September 1994 and December 1995, 28 patients (22 male,8 female) with the diagnosis of non-metastatic nasopharyngeal carcinoma were treated with external beam radiotherapy (EBRT) and High Dose Rate brachytherapy boost (HDRB). The mean age was 46.9 (Range:20-82). According to AJC staging system there was one patient in Stage I, one in Stage II, 6 in Stage III and 20 in Stage IV. There was 5 patients with T1, 6 with T2, 11 with T3 and 6 with T4 tumor. Histopathological diagnosis was undifferantiated carcinoma in 23 patients (% 82). Patients were treated with 6 MV linear accelerator or a cobalt unit. Total nasopharynx EBRT doses ranged between 5900-7070 cGy (Mean:6577 cGy, median:6920 cGy). At the end of EBRT all patients were treated with HDRB using a nasal applicator with a HDR iridium-192 microSelectron Afterloading Unit.. Dose was prescribed at 1 cm from the source and all patient were treated with total dose of 12 Gy in 3 fractions in 3 consecutive days. Length of the source ranged between 2 - 5.75 cm (Mean:3.2 cm, median:3 cm). Reference dose rate was varied between 50.1-246.9 Gy/hour. (Mean:112.74 Gy/hr) Dimensions of the specified dose volume ranged between 11.3 - 23 cm a. Beside radiotherapy, 17 patients were treated with cisplatin based chemotherapy. Follow-up time is between 1-21 months. (Median:13 months) All patients are locally controlled. Five patients developed distant metastasis (one with regional metastasis) and one developed regional metastasis only. No acute complications due to the HDRB was observed.
392 CYFRA 21-1 SERUMLEVEL CHANGES FOLLOWING RADIOTHERAPY IN 45 PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE HEADAND NECK.
Ankara University Faculty of Medicine Dpts of Radiation Oncology ( 1), Pathology (2), Otorhino]aryngology (3), Ankara, Turkey. B a c k g r o u n d : extramedullary plasmacytomas are uncommon plasma cell tumors localized to submucosal areas, with 80% occurring in the head and neck. Unlike medullary plasmacytomas, they remain well localized and have a more favorable prognosis. M a t e r i a l and methods : medical reports o f six patients with extramedullary plasmacytomas of the upper respiratory tract, treated between 1982 and 1992, were retrospectively evaluated. These included four men and two women, their ages ranging from 18 to 65 years (mean, 47 years). Primary tumor site was the nasal cavity in four patients and nasopharynx in two. One patient had cervical lymph node in involvement. Diagnosis o f multiple myeloma was ruled out in all patients. They were treated with radiation therapy, with doses ranging from 40 to 50 Oy (mean, 43 Gy). One patient received adjuvant chemotherapy consisting o f melphalan and prednisolone. Results : follow-up ranged from 1.1 to 13.3 years (mean, 7.6 years). Locoregiona] tumor control was achieved in all patients. T w o patients died of intercurrent diseases at l.I and 2.3 years, respectively.
All patients remained disease-free as to the date of their last followup. Conclusion: although plasma cell tumors represent a spectrum of disease, differentiation between them is essential for prediction of prognosis. Extramedullary plasmacytomas may be locally aggressive but progression to multiple myeloma is uncommon; therefore treatment should focus on local as well as regional tumor control. This can be managed with radiation therapy, achieving as much organ-sparing as possible.
393 A%t! "='~IP;OF"|)1R PV]'IE%T~,~AITn %AM)PIIAR~%(;EAI. ('~,Rf'I~,OM
M.AKMANSU'. S.YOCEL', M.SERiN'. A.(~AKMAK" "GazJUnwersdyMedccalSchoolRadiationOncok>gyDepartment.AnkaraTURKEY "'AnkaraUnwersdyMedicalSchoo~RadmtmnOncologyDepartment.Ankara.TURKEY
A. M. Niemann, B. M. Lippert, G. Kovfics, B. J. Folz, J. A. Werner
CYFRA 21-1 was found to be a sensitive and specific tumor marker especiaiIy for squamous ceii carcinoma of the lung. There is no reiiabie tumor marker avaiIabie for squamous cell carcinoma of the head and neck (HNSCC). CYFRA 21-1 serum ieveis were determined prior to therapy and 9 months after compIeted radiotherapy. The cut-off vaiue for CYFRA 21-1 determined at a 95%-specificity of the reference group was found to be 2.2 ng/mi [Niemann et ai.: J. Tumor Marker Oncoi. 1 0 : 7 0 (1995)). Appiying this cut-off vaiue on 45 HNSCC patients 32 of them showed initiaiiy increased CYFRA 21-i serum ieveis at time of diagnosis. Twenty-nine out of 45 patients had a decrease (changes > 0.5 ng/mi), 9 patients had an increase and 7 patients showed no changes of serum ieveis at controis 12 months after initiai diagnosis. Twenty-four of 29 patients with a decrease in the CYFRA serum ievei had no tumor recurrence. In patients with an increase oniy 2 out of 9 had no recurrent tumor whereas 4 had iocoregionai recurrence, 3 patients suffered from distant metastasis and 2 patients deveioped iocai and distant metastatic disease. Considering these resuits CYFRA 21-1 showed an improved vaiue compared to other tumor markers and seems to be a sensitive marker for HNSCC.
Thin study encompasses 362 pabents who came to Ankara Umvers=ty.Radiation Onealogy Department between April 1978 and April 1994 with nesopharyngeal carcinoma without dlSt,ant metastases Apprommataly 900 new cases are treated annually in our department and nasopharyngeal cancer pabents hawng no distant metastasis consbtute approximately 3% of these pahents The patients were classified according to their initial examination, sex. a g e . hlstopathologlcal diagnosis, stage.and the c~ty which they were hying [n for the last ten years T~N~=M0 pabents were also grouped according to site of the tumor at presenlation Male to female raho was found to be (271191)297 Average age of these patients was 46 5.ranging between 5 and 79 years There was a bimodal distribution among the pahents making peaks m the 10-19 (11%) and 40-59 (50.1%) age groups Most frequently seen h=stopathoiog~cal diagnoses were Ind=fferent=ated carcinoma (48.2%). poorly differentiated carcinoma (24.6%) and lymphoepRhehoma-lymphoma (14.0%) respectively Stage-I patients were 4.7%. StageII patients were 4%. Stage-Ill patients were 29.4% and Stage-IV patients were 63.6% Upon the analysis of 85 T,N~ 4M0cases the most common site of presentation of the primary tumor m the nasopharynxwas found to be m the nasopharyngeal roof (30.5%) and the left wall of the nasopharynx (28.2%)Patients were also evaluated according to the cities they hved m for the last ten years and their dmtance from our hospital Most of the pabents had come from inner Anatoha (55.5%) and the Mediterranean (12.6%) regionsOur results were compared to the cancer stabsbcs of the Repubhc of Turkey and to the literature
391
COMBINED E X T E R N A L BEAM RADIOTHERAPY AND HDR BRACHYTHERAPY B O O S T IN NASOPHARYNGEAL CANCER
E X T R A M E D U L L A R Y PLASMACYTOMAS O F THE UPPER R E S P I R A T O R Y TRACT
Enis Ozyar, Dilek UzaI,Salih GLIrdalh,Fadfl Akyol, I.Lale Atahan Department o f Radiation Oncology, Faculty o f Medicine, Hacettepe University, Ankara, 06100, Turkey
M. Serin (I), H.S. Erkal (1), S.D. Sak (2), I. Ko~:ak (3), A. Cakmak ( I ),
Between September 1994 and December 1995, 28 patients (22 male,8 female) with the diagnosis of non-metastatic nasopharyngeal carcinoma were treated with external beam radiotherapy (EBRT) and High Dose Rate brachytherapy boost (HDRB). The mean age was 46.9 (Range:20-82). According to AJC staging system there was one patient in Stage I, one in Stage II, 6 in Stage III and 20 in Stage IV. There was 5 patients with T1, 6 with T2, 11 with T3 and 6 with T4 tumor. Histopathological diagnosis was undifferantiated carcinoma in 23 patients (% 82). Patients were treated with 6 MV linear accelerator or a cobalt unit. Total nasopharynx EBRT doses ranged between 5900-7070 cGy (Mean:6577 cGy, median:6920 cGy). At the end of EBRT all patients were treated with HDRB using a nasal applicator with a HDR iridium-192 microSelectron Afterloading Unit.. Dose was prescribed at 1 cm from the source and all patient were treated with total dose of 12 Gy in 3 fractions in 3 consecutive days. Length of the source ranged between 2 - 5.75 cm (Mean:3.2 cm, median:3 cm). Reference dose rate was varied between 50.1-246.9 Gy/hour. (Mean:112.74 Gy/hr) Dimensions of the specified dose volume ranged between 11.3 - 23 cm a. Beside radiotherapy, 17 patients were treated with cisplatin based chemotherapy. Follow-up time is between 1-21 months. (Median:13 months) All patients are locally controlled. Five patients developed distant metastasis (one with regional metastasis) and one developed regional metastasis only. No acute complications due to the HDRB was observed.
392 CYFRA 21-1 SERUMLEVEL CHANGES FOLLOWING RADIOTHERAPY IN 45 PATIENTS WITH SQUAMOUS CELL CARCINOMA OF THE HEADAND NECK.
Ankara University Faculty of Medicine Dpts of Radiation Oncology ( 1), Pathology (2), Otorhino]aryngology (3), Ankara, Turkey. B a c k g r o u n d : extramedullary plasmacytomas are uncommon plasma cell tumors localized to submucosal areas, with 80% occurring in the head and neck. Unlike medullary plasmacytomas, they remain well localized and have a more favorable prognosis. M a t e r i a l and methods : medical reports o f six patients with extramedullary plasmacytomas of the upper respiratory tract, treated between 1982 and 1992, were retrospectively evaluated. These included four men and two women, their ages ranging from 18 to 65 years (mean, 47 years). Primary tumor site was the nasal cavity in four patients and nasopharynx in two. One patient had cervical lymph node in involvement. Diagnosis o f multiple myeloma was ruled out in all patients. They were treated with radiation therapy, with doses ranging from 40 to 50 Oy (mean, 43 Gy). One patient received adjuvant chemotherapy consisting o f melphalan and prednisolone. Results : follow-up ranged from 1.1 to 13.3 years (mean, 7.6 years). Locoregiona] tumor control was achieved in all patients. T w o patients died of intercurrent diseases at l.I and 2.3 years, respectively.
All patients remained disease-free as to the date of their last followup. Conclusion: although plasma cell tumors represent a spectrum of disease, differentiation between them is essential for prediction of prognosis. Extramedullary plasmacytomas may be locally aggressive but progression to multiple myeloma is uncommon; therefore treatment should focus on local as well as regional tumor control. This can be managed with radiation therapy, achieving as much organ-sparing as possible.
393 A%t! "='~IP;OF"|)1R PV]'IE%T~,~AITn %AM)PIIAR~%(;EAI. ('~,Rf'I~,OM
M.AKMANSU'. S.YOCEL', M.SERiN'. A.(~AKMAK" "GazJUnwersdyMedccalSchoolRadiationOncok>gyDepartment.AnkaraTURKEY "'AnkaraUnwersdyMedicalSchoo~RadmtmnOncologyDepartment.Ankara.TURKEY
A. M. Niemann, B. M. Lippert, G. Kovfics, B. J. Folz, J. A. Werner
CYFRA 21-1 was found to be a sensitive and specific tumor marker especiaiIy for squamous ceii carcinoma of the lung. There is no reiiabie tumor marker avaiIabie for squamous cell carcinoma of the head and neck (HNSCC). CYFRA 21-1 serum ieveis were determined prior to therapy and 9 months after compIeted radiotherapy. The cut-off vaiue for CYFRA 21-1 determined at a 95%-specificity of the reference group was found to be 2.2 ng/mi [Niemann et ai.: J. Tumor Marker Oncoi. 1 0 : 7 0 (1995)). Appiying this cut-off vaiue on 45 HNSCC patients 32 of them showed initiaiiy increased CYFRA 21-i serum ieveis at time of diagnosis. Twenty-nine out of 45 patients had a decrease (changes > 0.5 ng/mi), 9 patients had an increase and 7 patients showed no changes of serum ieveis at controis 12 months after initiai diagnosis. Twenty-four of 29 patients with a decrease in the CYFRA serum ievei had no tumor recurrence. In patients with an increase oniy 2 out of 9 had no recurrent tumor whereas 4 had iocoregionai recurrence, 3 patients suffered from distant metastasis and 2 patients deveioped iocai and distant metastatic disease. Considering these resuits CYFRA 21-1 showed an improved vaiue compared to other tumor markers and seems to be a sensitive marker for HNSCC.
Thin study encompasses 362 pabents who came to Ankara Umvers=ty.Radiation Onealogy Department between April 1978 and April 1994 with nesopharyngeal carcinoma without dlSt,ant metastases Apprommataly 900 new cases are treated annually in our department and nasopharyngeal cancer pabents hawng no distant metastasis consbtute approximately 3% of these pahents The patients were classified according to their initial examination, sex. a g e . hlstopathologlcal diagnosis, stage.and the c~ty which they were hying [n for the last ten years T~N~=M0 pabents were also grouped according to site of the tumor at presenlation Male to female raho was found to be (271191)297 Average age of these patients was 46 5.ranging between 5 and 79 years There was a bimodal distribution among the pahents making peaks m the 10-19 (11%) and 40-59 (50.1%) age groups Most frequently seen h=stopathoiog~cal diagnoses were Ind=fferent=ated carcinoma (48.2%). poorly differentiated carcinoma (24.6%) and lymphoepRhehoma-lymphoma (14.0%) respectively Stage-I patients were 4.7%. StageII patients were 4%. Stage-Ill patients were 29.4% and Stage-IV patients were 63.6% Upon the analysis of 85 T,N~ 4M0cases the most common site of presentation of the primary tumor m the nasopharynxwas found to be m the nasopharyngeal roof (30.5%) and the left wall of the nasopharynx (28.2%)Patients were also evaluated according to the cities they hved m for the last ten years and their dmtance from our hospital Most of the pabents had come from inner Anatoha (55.5%) and the Mediterranean (12.6%) regionsOur results were compared to the cancer stabsbcs of the Repubhc of Turkey and to the literature