International journal of radiation oncology, biology, physics
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Int. J. Radiat. Oncol. Biol. Phys. · Oct 1990
Regional nodal irradiation in the conservative treatment of breast cancer.
At this institution conservative treatment of breast cancer was begun in the 1960's. The following analysis represents our experience through 1984 with specific reference to the management of the regional lymph nodes. A total of 432 patients with clinical stage I and II breast cancer were treated between 1962 and 1984 with lumpectomy and radiation therapy. ⋯ The actuarial 5-year regional nodal control rate was the same for both the group of patients receiving regional RT alone without axillary dissection and the group of patients receiving axillary dissection and supraclavicular/internal mammary radiation. There has been minimal morbidity associated with this treatment policy. We conclude that regional nodal irradiation as described above, with or without axillary dissection, results in a high rate of regional nodal control and minimal treatment morbidity in patients undergoing conservative treatment of early stage breast cancer.
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Int. J. Radiat. Oncol. Biol. Phys. · Oct 1990
Breast recurrence following conservative surgery and radiation: patterns of failure, prognosis, and pathologic findings from mastectomy specimens with implications for treatment.
Between 1978 and 1986, 1030 women with clinical Stage I or II breast cancer underwent excisional biopsy, axillary dissection (948 patients), and definitive irradiation. Sixty-five patients developed a recurrence in the treated breast, 9 of which were associated with simultaneous (8) or antecedent (1) distant metastases. Detection was by mammography alone in 29%, physical exam alone in 50%, and both in 21%. ⋯ The only significant prognostic factor for survival was the initial clinical tumor size, which was related to the extent of the recurrence. Based on the inability to identify factors which would predict for a localized recurrence pathologically, we recommend mastectomy as the preferred surgical treatment for an isolated breast recurrence. Adjuvant chemotherapy may be beneficial in patients with an unfavorable prognosis.
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Int. J. Radiat. Oncol. Biol. Phys. · Oct 1990
Definitive irradiation for intraductal carcinoma of the breast.
During the period from 1978 to 1985, 51 women with intraductal carcinoma of the breast were treated with definitive irradiation following breast-conserving surgery. Surgical treatment of the primary tumor in all patients consisted of excisional biopsy or wide resection. In general, definitive irradiation consisted of conventional breast tangents to 4500-5000 cGy followed by a breast boost to a total dose of 6000-6600 cGy (median = 6000 cGy; range = 4200-6600 cGy). ⋯ All five of the patients with breast failures are alive and NED (no evidence of disease), although with limited follow-up (median = 12 months; range = 6-68 months). These results suggest that definitive irradiation is an acceptable alternative to conventional mastectomy for appropriately selected and staged patients with intraductal carcinoma of the breast. In view of the long natural history of this disease, prolonged and careful follow-up of these patients is required.
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Int. J. Radiat. Oncol. Biol. Phys. · Oct 1990
Isolated local-regional recurrence of breast cancer following mastectomy: radiotherapeutic management.
Two hundred twenty-four patients with their first, isolated local-regional recurrence of breast cancer were irradiated with curative intent. Patients who had previous chest wall or regional lymphatic irradiation were not included in the study. With a median follow-up of 46 months (range 24 to 241 months), the 5- and 10-year survival for the entire group were 43% and 26%, respectively. ⋯ Axillary and internal mammary failures were infrequent, regardless of prophylactic treatment. Although the majority of patients with local and/or regional recurrence of breast cancer will eventually develop distant metastases and succumb to their disease, a significant percentage will live 5 years. Therefore, aggressive radiotherapy should be used to provide optimal local-regional control.(ABSTRACT TRUNCATED AT 400 WORDS)
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Int. J. Radiat. Oncol. Biol. Phys. · Aug 1990
Clinical Trial"Instant-mix" whole brain photon with neutron boost radiotherapy for malignant gliomas.
From July 1985 through March 1987, 44 consecutive patients with supratentorial, nonmetastatic anaplastic astrocytoma (AA) and glioblastoma multiforme (GBM) were treated with whole brain photon irradiation with concomitant neutron boost at the University of Chicago. All patients had biopsy proven disease and surgery ranged from biopsy to total gross excision. Whole brain photon radiation was given at 1.5 Gy per fraction, 5 days weekly for a total dose of 45 Gy in 6 weeks. ⋯ GBM), age (less than or equal to 39 years vs. older), and extent of surgery (total gross or partial excision vs. biopsy) whereas tumor size and Karnofsky performance status did not have a significant influence. The median survival of the anaplastic astrocytoma group was better than expected compared to the RTOG 80-07 study (a dose-finding study of similar design to this study) and historical data. Reasons for this are discussed.