Fadime Akman

Backround: The purpose of this study was to evaluate the outcomes of different radiotherapy techniques used in routine clinical practice for the radical treatment of hypopharyngeal cancer and to assess improvements over the last few decades. Methods: We compared the outcomes of patients with hypopharyngeal squamous cell carcinoma treated with curative radiotherapy (RT) or chemoradiotherapy between January 1992 and December 2020, using 2D-RT, 3D-CRT/IMRT, and VMAT techniques. A retrospective analysis was conducted on eighty-one patients with hypopharyngeal cancer. Results: The median follow-up time was 26 months (range: 6-290). In multivariate analysis, radiotherapy technique, Karnofsky Performance Status (KPS), nodal stage, and clinical stage were identified as statistically significant factors affecting overall survival and local-regional relapse-free survival. Grade 2-4 early and late side effects were significantly more frequent in Group I patients (treated with 2D Conventional Radiotherapy) (20.3%) compared to Group II patients (treated with 3DCRT/IMRT and VMAT techniques) (3.1%) Conclusion: KPS, stage, and advanced RT techniques independently significantly affected outcomes. Moreover, advanced RT techniques were associated with a significant reduction in side effects.

For laryngeal cancer, surgical excision of the primary tumor should be undertaken with the aim of achieving tumor-free margins. Adequate pathological assessment of the specimen and the competency of the treatment center play a crucial role in achieving cure. The present study aimed to analyze the significance of place of surgery on the outcome of patients with laryngeal cancer who underwent surgical operation in other centers and were subsequently referred to Doküz Eylul University Head and Neck Tumour Group (DEHNTG) for postoperative irradiation. Patients were divided into three groups according to their place of surgery. The first group (Group I) consisted of patients who had their surgical operation at DEUH. Patients in the second group (Group II) were referred from centers with oncological surgical experience. The third group (Group III) consisted of patients referred from hospitals with no surgical teams experienced in head and neck cancer treatment. The clinical and pathological features of patients in these three groups were analyzed to assess the impact of place of surgery on clinical outcome as well as the prognostic factors for survival. The study population consisted of 253 patients who were treated between 1991 and 2006 with locally advanced laryngeal cancer according to the protocol of DEHNTG. The median follow-up was 48 (3–181) months. The 5 years overall, loco-regional disease-free and distant disease-free survivals were 66, 88 and 91%, respectively. When patients’ clinical and histopathological features were analyzed for the impact of place of surgery, surgical margin positivity rates were found to be higher in Group III (P = 0.032), although the other two groups had more advanced clinical and pathological N stage disease (P = 0.012, P = 0.001). In multivariate analysis, older age (P < 0.0001), presence of perinodal invasion (P = 0.012), time interval between surgery and radiotherapy longer than 6 weeks (P = 0.003) and tumor grade (P = 0.049) were the most significant factors. For loco-regional failure-free survival, advanced clinical stage (P = 0.002), place of surgery (P = 0.031) and presence of clinical subglottic invasion (P = 0.029) were shown to be important prognostic factors. For distant metastasis-free survival, only pathological (+) lymph node status (P = 0.046) was a significant factor in multivariate analysis. The significance of place of surgery as well as other well-known prognostic factors underlines the importance of an experienced multidisciplinary treatment team if best results are to be obtained for the patient.

Accelerated radiotherapy and concurrent chemoradiotherapy is an effective treatment modality in locally advanced head and neck carcinomas. In this study, we examined the efficacy and feasibility of concomitant boost radiotherapy and chemotherapy in the routine outpatient- based radiotherapy clinic. Between January 1993 and December 2000, only 51 out of 127 eligible patients were deemed suitable to receive concomitant boost radiotherapy and/or chemotherapy. Their median age was 60 years (range 17-83 years). The histological diagnosis was squamous-cell carcinoma in 38 (75%) patients, undifferentiated nasopharyngeal carcinomas (WHO type III) in 10 (20%) patients and other histology in 3 (5%) patients. The concomitant boost regimen consisted of 70 Gy in 6 weeks (1.8 Gy/fraction/day, 5 days/week, to the clinical target volume (CTV), and 1.6 Gy/fraction/day to the gross tumor volume (GTV) as a second-daily treatment for the last 2 weeks). The concomitant chemotherapy regimen consisted of cisplatin 100 mg/m(2) given every 3 weeks for 3 courses, and the neoadjuvant regimen of cisplatin 100 mg/m(2) plus epirubicin 100mg/m(2), every 3 weeks for 3 courses. Only 55% of patients completed the treatment exactly as planned, with 82% completing treatment within acceptable limits. The median radiotherapy duration was 45 days (40-95 days). In univariate analysis, patients with better performance status (p=0.002) or nasopharyngeal carcinomas (p=0.043) had a significantly better compliance to treatment. In multivariate analysis only nasopharyngeal site was a significant predictor of compliance (p=0.019). The maximum acute reaction was grade 3 mucositis in 24 (49%) patients. No grade 4 acute or late reactions were seen. Complete and overall response rates were 51% and 75.5%, respectively. Patients with nasopharyngeal cancer and good treatment compliance had a better response rate (p=0.009 and 0.01, respectively). The median follow-up period of surviving patients was 28 months (range 6-58 months). The 3-year progression-free survival rate was 39%. In the routine outpatient-based setting we found that this intensive treatment schedule can only be given to a limited and highly selected group of patients.

Although different prognostic indices for malignant gliomas have been developed, their validity outside of clinical trials has not been widely tested. The aim of this study was to determine whether...