- Email: [email protected]
IR 192 brachytherapy in the management of 147 T2NO oral tongue carcinoma treated with irradiation alone
139
Proceedings of the 32nd Annual ASTRO Meeting
Mice were divided into 4 groups: Growth delay assay in mammary carcinoma was performed. Group 2 received IL-l injection (subcutaneously 150 Group 1 received no treatment; ug/kg) started at day 1 and repeated at an interval of 3 days; Group 3 received a single irradiation of 20 Gy at day 1; and Group 4 received both the injection of IL-l and the doubling time of each group (mean days +SD) was irradiation of 20Gy. The volume We observed significant respectively. 13.83+1.65, 16.09+3.07, 4.03+1.08, 7.00~2.60, differences between Groups l-and 2 (p=O.O?), and Groups 3 and 4 (p=O.O47), respectively. in the center area Our findings suggest that IL-l may cause vascular damage, especially of the tumor, and it may be one of the causes of antitumor effect on these tumors.
31 DOES LOCAL-REGIONAL CONTROL AFFECT DISTANT METASTATIC SPREAD IN SQUAMOUS THE HEAD AND NECK? RESULTS OF AN RTOG ANALYSIS. Steven A. Leibel, M.D.1, Charles B. Scott, B.S2, Mohammed Mohiuddin, Lawrence R. Coia, M.D.5, Lawrence W. Davis, M.D.6, Zvi Fuks, M.D.1
CELL CARCINOMA
OF
M.D.3, Victor A. Martial, M.D.4,
IMemorial Sloan-Kettering Cancer Center, 2RTQG Statistical Center, 3Thomas Jefferson University Hospital, 4University of Puerto Rico Cancer Center, 5Fox Chase Cancer Center/University of Penn, 6Montefiore Medical Center The specific aim of this analysis was to examine whether local-regional control affects the frequency of distant metastatic dissemination in squamous cell carcinoma of the head and neck. There is concern that efforts to improve local tumor control may be abrogated by the subsequent appearance of metastatic disease. However, there is also evidence in some tumor sites that failure to initially control the primary tumor may lead to the later development of metastases and that an increase in the rate of local control may translate into an improvement in survival. To examine this issue 2860 cases from the RTQG head and neck database were analyzed. Two endpoints including actuarial survival and the frequency of distant metastases were examined. The patients were divided into two sub-groups: those who achieved local-regional control by six months after treatment (NED) (1968 pts.) and patients who did not achieve local-regional control by six months (no NED) (892 pts.). Patients were evaluated by AJCCS T and N stage and by site [oral cavity (571), nasopharynx (201), oropharynx (951), hypopharynx (265), supraglottic larynx (284) and glottis (454)]. The 5-year survival rate for patients who were NED was 47% compared to 16% for patients who were no NED (p
32 IR 192 BRACHYTHERAPY IRRADIATION
IN THE MANAGEMENT
OF 147 T2NO ORAL
TONGUE
CARCINOMA
TREATED
WITH
ALONE
M. PERNOT, L. MALISSARD,
P. ALE-ITI, S. HOFFSTETTER,
J. J. FORCARD,
P. BEY
Department of Radiation Oncology Centre Alexis Vautrin 54500 NANCY-VANDOEWRE
- FRANCE
Our purpose is to analyse local control, complications, and the proportion of total dose delivered by external beam irradiation versus interstitial implant in 147 patients with previously untreated T2NO squamous cell carcinoma of the oral tongue, and managed between 1973 and 1986 (UICC staging system). These T2NO patients are part of a group of 430 patients with oral tongue carcinoma (Tl, T2, T3) treated with irradiation alone. Of these 147 T2NO patients, 70 were treated with interstitial implant alone and 77 with both external beam radiation therapy and implant. In the group treated with interstitial implant alone, five-year local control reached 89.8% against 50.6% in the group treated with external beam radiotherapy and interstitial implant (log Rank test p = 0.00002), (61.6% versus 46.5% for locoregional control p = 0.029 and 62.2% versus 34.74 0 f or specific survival (p = 0.0015).
140
Radiation Oncology, Biology, Physics
October 1990, Volume 19, Supplement
1
Since 1980, all the patients undergoing Iridium implantation have been provided with a leaded spacing device between the tongue and the mandible. Soft tissue necrosis and bone exposure following treatment were scored according to the following criteria : minor, moderate or severe. Seven moderate and 1 severe complications were recorded on the brachytherapy group. None of the patients required surgery. In the combined treatment group 6 moderate and 2 severe complications were observed. The patients treated with interstitial implant alone, and showing moderate or severe complications had received an average brachytherapy dose of 7 600 cGy. In the same group the patients without complications had received an average dose of 6 800 cGy. In the combined treatment group, the average external radiation dose and the average brachytherapy dose were not significantly different wether or not the patients had complications, but we noted an improvment in local control when the major part of the dose was delivered by interstitial implant. Under those conditions, we currently recommend brachytherapy alone for the initial treatment of Tl T2 NO cancers of the oral tongue, but a functional neck dissection seems essential for T2 patients to avoid neck node metastases. In the total group of 430 patients (Tl T2 T3 - NO Nl N2 N3) treated in the same p&iod for oral tongue carcinoma with interstitial implant alone (177 patients) or with external beam radiotherapy plus implant (253 patients) we observed the following results : Tl 94 %, ‘l-2 65 % , l-3 51% localcontrol : ” 86%, ” 55 %, ” 37 % locoregional ” I3 40 % , 1v 25 % global survival’: ‘I 69 %, *( 47 % , VI 25 % and specific survival : ” 81 %,
33 CONTROL
OF CERVICAL
LYMPHADENOPATHY
L.J. Korb,
C.A. Spaulding,
University
of Virginia
W.C.
Health
IN CANCERS
Constable,
Sciences
OF THE ORAL TONGUE
P.A. Levine,
R.W. Cantrell
Center
Between 1968 and 1985, 114 patients with cancer of the oral tongue were evaluated in Radiation Oncology; Forty-eight percent (41 patients) presented with of these, 86 received treatment with curative intent. The institutional protocol for clinically palpable adenopathy in the cervical or supraclavicular areas. Patients with a positive necks was pre-operative radiotherapy followed by modified radical neck dissection. clinically negative neck were treated with radiotherapy to the neck only if, in the judgement of the treating This policy physician, the primary lesion had a reasonable probability of sub-clinical microscopic disease. resulted in 16 N-O patients (8 T-l, 7 T-2, and 1 T-3) who were treated with limited field (less than 75 sq cm) external beam radiotherapy or brachytherapy alone. The three-year adjusted recurrence rate in the neck in the 16 N-O patients who did not receive total neck irradiation was strikingly high at 71%, particularly in contrast to the 3% neck recurrence rate in the 29 N-O patients who received radiotherapy to the entire neck. The three-year adjusted recurrence rate for patients in the N-l group treated with combined modality was 21%. Due to the poor surgical salvage in the neck failure group, the three year adjusted survival for the N-l group was better than that for the N-O group, 74% versus 62% respectively. Despite combined modality therapy, the three-year adjusted survival rates for the N-2 and N-3 necks reflecting a high incidence of distant metastases and second malignancies. were 27% and 0% respectively, For N-2 disease, 4/19 patients failed in the neck; only 4 patients in this group were alive at 3 years, All (4/4) patients with N-3 disease failed in the neck and compromising assessment of regional control. none were successfully salvaged. The results of this study demonstrate: 1) the necessity for external beam treatment to the N-O neck for all lesions of the oral tongue; 2) the effectiveness of pre-operative radiotherapy followed by neck dissection for N-l disease, and 3) the improved survival of patients with N-O/N-l disease as compared with N-2/N-3 disease.
34 PROSPECTIVE RANDOMIZED TRIAL COMPARING HYPERFRACTIONATED CONVENTIONAL RADIOTHERAPY IN STAGES III AND IV OROPHARYNX Luiz
H.J.
Department
Pinto,
Paulo
of Radiation
C.V.
Canary,
Oncology,
Carlos Instituto
M.M.
Araujo,
National
Silvia de
C. Bacelar,
Cancer,
Rio
Luis
VERSUS CARCINOMA.
Souhami
de Janeiro,
Brazil.
From April 1986 to May 1989, 112 patients seen at a single institution with previously untreated squamous oropharynx carcinoma, stage III and IV, were randomly assigned, after stratification by site (base of tongue vs others), T stage (Tl, T2, vs T3, T4), N stage (NO, Nl vs N2, N3) and lymph node size (~6 cm vs > 6 cm), to cell
66 Gy in 33 fractions of 2 Gy each with a minima1 interfraction interval l/2 weeks.
(conventional of 6 hours
RT) versus 70.4 (hyperfractionated
Gy in 64 fractions of 1.1 Gy RT). The overall time for
given both
twice arms
a day was 6
As of January 1990, an analysis was performed in 98 patients (8 patients in the conventional arm and 6 in the hyperfractionation not included). The groups were balanced by age, performance status, stage and site of primary disease. The median follow-up time is 25 months. The probability of complete loco-regional response was 62% in the hyperfractionation arm and 52% for the conventional fractionation (p = 0.28). There was no
Proceedings of the 32nd Annual ASTRO Meeting
Mice were divided into 4 groups: Growth delay assay in mammary carcinoma was performed. Group 2 received IL-l injection (subcutaneously 150 Group 1 received no treatment; ug/kg) started at day 1 and repeated at an interval of 3 days; Group 3 received a single irradiation of 20 Gy at day 1; and Group 4 received both the injection of IL-l and the doubling time of each group (mean days +SD) was irradiation of 20Gy. The volume We observed significant respectively. 13.83+1.65, 16.09+3.07, 4.03+1.08, 7.00~2.60, differences between Groups l-and 2 (p=O.O?), and Groups 3 and 4 (p=O.O47), respectively. in the center area Our findings suggest that IL-l may cause vascular damage, especially of the tumor, and it may be one of the causes of antitumor effect on these tumors.
31 DOES LOCAL-REGIONAL CONTROL AFFECT DISTANT METASTATIC SPREAD IN SQUAMOUS THE HEAD AND NECK? RESULTS OF AN RTOG ANALYSIS. Steven A. Leibel, M.D.1, Charles B. Scott, B.S2, Mohammed Mohiuddin, Lawrence R. Coia, M.D.5, Lawrence W. Davis, M.D.6, Zvi Fuks, M.D.1
CELL CARCINOMA
OF
M.D.3, Victor A. Martial, M.D.4,
IMemorial Sloan-Kettering Cancer Center, 2RTQG Statistical Center, 3Thomas Jefferson University Hospital, 4University of Puerto Rico Cancer Center, 5Fox Chase Cancer Center/University of Penn, 6Montefiore Medical Center The specific aim of this analysis was to examine whether local-regional control affects the frequency of distant metastatic dissemination in squamous cell carcinoma of the head and neck. There is concern that efforts to improve local tumor control may be abrogated by the subsequent appearance of metastatic disease. However, there is also evidence in some tumor sites that failure to initially control the primary tumor may lead to the later development of metastases and that an increase in the rate of local control may translate into an improvement in survival. To examine this issue 2860 cases from the RTQG head and neck database were analyzed. Two endpoints including actuarial survival and the frequency of distant metastases were examined. The patients were divided into two sub-groups: those who achieved local-regional control by six months after treatment (NED) (1968 pts.) and patients who did not achieve local-regional control by six months (no NED) (892 pts.). Patients were evaluated by AJCCS T and N stage and by site [oral cavity (571), nasopharynx (201), oropharynx (951), hypopharynx (265), supraglottic larynx (284) and glottis (454)]. The 5-year survival rate for patients who were NED was 47% compared to 16% for patients who were no NED (p
32 IR 192 BRACHYTHERAPY IRRADIATION
IN THE MANAGEMENT
OF 147 T2NO ORAL
TONGUE
CARCINOMA
TREATED
WITH
ALONE
M. PERNOT, L. MALISSARD,
P. ALE-ITI, S. HOFFSTETTER,
J. J. FORCARD,
P. BEY
Department of Radiation Oncology Centre Alexis Vautrin 54500 NANCY-VANDOEWRE
- FRANCE
Our purpose is to analyse local control, complications, and the proportion of total dose delivered by external beam irradiation versus interstitial implant in 147 patients with previously untreated T2NO squamous cell carcinoma of the oral tongue, and managed between 1973 and 1986 (UICC staging system). These T2NO patients are part of a group of 430 patients with oral tongue carcinoma (Tl, T2, T3) treated with irradiation alone. Of these 147 T2NO patients, 70 were treated with interstitial implant alone and 77 with both external beam radiation therapy and implant. In the group treated with interstitial implant alone, five-year local control reached 89.8% against 50.6% in the group treated with external beam radiotherapy and interstitial implant (log Rank test p = 0.00002), (61.6% versus 46.5% for locoregional control p = 0.029 and 62.2% versus 34.74 0 f or specific survival (p = 0.0015).
140
Radiation Oncology, Biology, Physics
October 1990, Volume 19, Supplement
1
Since 1980, all the patients undergoing Iridium implantation have been provided with a leaded spacing device between the tongue and the mandible. Soft tissue necrosis and bone exposure following treatment were scored according to the following criteria : minor, moderate or severe. Seven moderate and 1 severe complications were recorded on the brachytherapy group. None of the patients required surgery. In the combined treatment group 6 moderate and 2 severe complications were observed. The patients treated with interstitial implant alone, and showing moderate or severe complications had received an average brachytherapy dose of 7 600 cGy. In the same group the patients without complications had received an average dose of 6 800 cGy. In the combined treatment group, the average external radiation dose and the average brachytherapy dose were not significantly different wether or not the patients had complications, but we noted an improvment in local control when the major part of the dose was delivered by interstitial implant. Under those conditions, we currently recommend brachytherapy alone for the initial treatment of Tl T2 NO cancers of the oral tongue, but a functional neck dissection seems essential for T2 patients to avoid neck node metastases. In the total group of 430 patients (Tl T2 T3 - NO Nl N2 N3) treated in the same p&iod for oral tongue carcinoma with interstitial implant alone (177 patients) or with external beam radiotherapy plus implant (253 patients) we observed the following results : Tl 94 %, ‘l-2 65 % , l-3 51% localcontrol : ” 86%, ” 55 %, ” 37 % locoregional ” I3 40 % , 1v 25 % global survival’: ‘I 69 %, *( 47 % , VI 25 % and specific survival : ” 81 %,
33 CONTROL
OF CERVICAL
LYMPHADENOPATHY
L.J. Korb,
C.A. Spaulding,
University
of Virginia
W.C.
Health
IN CANCERS
Constable,
Sciences
OF THE ORAL TONGUE
P.A. Levine,
R.W. Cantrell
Center
Between 1968 and 1985, 114 patients with cancer of the oral tongue were evaluated in Radiation Oncology; Forty-eight percent (41 patients) presented with of these, 86 received treatment with curative intent. The institutional protocol for clinically palpable adenopathy in the cervical or supraclavicular areas. Patients with a positive necks was pre-operative radiotherapy followed by modified radical neck dissection. clinically negative neck were treated with radiotherapy to the neck only if, in the judgement of the treating This policy physician, the primary lesion had a reasonable probability of sub-clinical microscopic disease. resulted in 16 N-O patients (8 T-l, 7 T-2, and 1 T-3) who were treated with limited field (less than 75 sq cm) external beam radiotherapy or brachytherapy alone. The three-year adjusted recurrence rate in the neck in the 16 N-O patients who did not receive total neck irradiation was strikingly high at 71%, particularly in contrast to the 3% neck recurrence rate in the 29 N-O patients who received radiotherapy to the entire neck. The three-year adjusted recurrence rate for patients in the N-l group treated with combined modality was 21%. Due to the poor surgical salvage in the neck failure group, the three year adjusted survival for the N-l group was better than that for the N-O group, 74% versus 62% respectively. Despite combined modality therapy, the three-year adjusted survival rates for the N-2 and N-3 necks reflecting a high incidence of distant metastases and second malignancies. were 27% and 0% respectively, For N-2 disease, 4/19 patients failed in the neck; only 4 patients in this group were alive at 3 years, All (4/4) patients with N-3 disease failed in the neck and compromising assessment of regional control. none were successfully salvaged. The results of this study demonstrate: 1) the necessity for external beam treatment to the N-O neck for all lesions of the oral tongue; 2) the effectiveness of pre-operative radiotherapy followed by neck dissection for N-l disease, and 3) the improved survival of patients with N-O/N-l disease as compared with N-2/N-3 disease.
34 PROSPECTIVE RANDOMIZED TRIAL COMPARING HYPERFRACTIONATED CONVENTIONAL RADIOTHERAPY IN STAGES III AND IV OROPHARYNX Luiz
H.J.
Department
Pinto,
Paulo
of Radiation
C.V.
Canary,
Oncology,
Carlos Instituto
M.M.
Araujo,
National
Silvia de
C. Bacelar,
Cancer,
Rio
Luis
VERSUS CARCINOMA.
Souhami
de Janeiro,
Brazil.
From April 1986 to May 1989, 112 patients seen at a single institution with previously untreated squamous oropharynx carcinoma, stage III and IV, were randomly assigned, after stratification by site (base of tongue vs others), T stage (Tl, T2, vs T3, T4), N stage (NO, Nl vs N2, N3) and lymph node size (~6 cm vs > 6 cm), to cell
66 Gy in 33 fractions of 2 Gy each with a minima1 interfraction interval l/2 weeks.
(conventional of 6 hours
RT) versus 70.4 (hyperfractionated
Gy in 64 fractions of 1.1 Gy RT). The overall time for
given both
twice arms
a day was 6
As of January 1990, an analysis was performed in 98 patients (8 patients in the conventional arm and 6 in the hyperfractionation not included). The groups were balanced by age, performance status, stage and site of primary disease. The median follow-up time is 25 months. The probability of complete loco-regional response was 62% in the hyperfractionation arm and 52% for the conventional fractionation (p = 0.28). There was no