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Fifty-seven patients with hypopharyngeal cancer treated by irradiation at Kyushu University Hospital between 1985 and 1992 were analyzed retrospectively. They included 53 men and 4 women, and their ages ranged from 39 to 83 years (mean, 63 years). Two patients had stage I, 7 had stage II, 13 had stage III, and 35 had stage IV disease according to the UICC (1997) classification. Initially, they were irradiated in the conventional way with a dose of 30 Gy, and 17 patients with good response were irradiated to curative dose (more than 60 Gy), and 32 patients with poor response were operated immediately. Medically inoperable or unresectable patients were treated in a semiradical way (n = 8). The 5-year overall and cause-specific survival rates were 46% and 51%, respectively. Five-year cause-specific survival rates were 88% for stages I and II (n = 9), 67% for stage III(n = 13), and 35% for stage IV (n = 35). Five-year cause-specific survival according to treatment method was 58% for surgery and 51% for curative radiotherapy. There was no statistically significant difference between the two rates. These results suggest that initial radiation response is an important factor in deciding on the following treatment method. Curative radiotherapy for hypopharyngeal cancer according to initial radiation response is a desirable treatment strategy.

The results of 54 cases of maxillary sinus squamous cell carcinoma treated between 1980 and 2002 were analyzed retrospectively. The T classification according to the 1997 UICC was as follows: 2 with stage T1, 29 with T3, and 23 with T4. Ten patients(18.5%) had lymph node metastases at diagnosis. All patients underwent combined therapy including radiotherapy, surgery, and regional or systemic chemotherapy. Fifteen patients received hyperfractionated twice-daily radiotherapy (1.2 Gy or 1.5 Gy/fraction), and the remaining 39 patients received a conventional once-daily regimen(1.5-2 Gy/fraction). The 5-year overall survival and 5-year disease-free survival for all patients were 56.0% and 46.7%, respectively. The N classification was the only significant prognostic factor for 5-year disease-free survival by univariate analysis (favoring N = 0, p = 0.04). There were no significant differences in other prognostic factors including gender, T classification (T1-3 vs. T4), hyperfractionated radiotherapy (yes vs. no), total dose (BED: < 69 Gy10 vs. > or = 69 Gy10), and intra-arterial chemotherapy(yes vs. no). Although radiation-induced cataract was observed in 9 patients, no other severe late complications developed.

The purpose of this study was to assess the efficacy of reirradiation with brachytherapy in the treatment of patients with tongue cancer that had recurred after initial brachytherapy. A retrospective analysis was performed in 12 patients with tongue cancer treated by reirradiation with brachytherapy using rigid linear sources such as the 226Ra-needle or 192Ir-hairpin at Kyushu University Hospital from 1978 to 1998. The patients included 8 men and 4 women, who ranged in age from 30 to 69 years (mean, 52 years). At the time of reirradiation, 7 patients had stage I cancer, and 5 had stage II cancer, according to the UICC (1997) classification. The median follow-up time of the surviving patients was 92 months. The 5-year relapse-free and cause-specific survival rates were 31% and 64%, respectively. The 5-year cause-specific survival rate varied according to the interval between the first and second course of brachytherapy and was 25% for intervals of less than 12 months and 83% for intervals of more than 12 months. Only 4 patients with local recurrence were recognized after their second course of brachytherapy. Among the 6 patients who survived more than 2 years after reirradiation without local recurrence, symptomatic complications such as soft tissue necrosis and minimal bone necrosis were found in 3 patients, but these side effects were not serious enough to require surgery. Reirradiation with a second course of brachytherapy may be useful in the treatment of patients with tongue cancer that recurs more than 12 months after initial brachytherapy.

One hundred fifty-four patients with esophageal carcinoma were treated with either irradiation alone or irradiation combined with surgery at the University of Occupational and Environmental Health Hospital between January 1980 and February 1992. The number of patients 75 years old and older was 25. In patients 74 years old and younger, the overall five-year survival rate by Kaplan-Meier method was 24.5%. The survival rate was best in the patients who were treated by a combination of irradiation and surgery. In patients 75 years old and older, the one-year survival rate was 59%, and the three-year rate was 20%. Aged patients had a tendency to be worse in performance status, and there was no correlation between treatment modality and survival time. We conclude that radiotherapy is useful for treating esophageal cancer in aged patients particularly when maintenance of the quality of life is considered.

Thirteen patients with Pancoast tumor were treated with combined radiotherapy and hyperthermia from April 1987 to December 1992. Radiotherapy was performed using 10 MV X-rays, and all patients received a total dosage of 40-118 Gy with conventional fractionation. Hyperthermia was performed once or twice a week within 30 minutes after each irradiation, using 8 MHz RF capacitive heating equipment (Thermotron RF-8). Partial response, defined as 50% or more regression of the tumor, was observed in 7/13 (54%) patients, and the median survival time was 25.2 months. Results of 14 patients treated with irradiation alone from July 1980 to December 1992 were also evaluated, and were used as a historical control. The partial response was 4/14 (29%) and the median survival time was 7.3 months. Radiotherapy combined with hyperthermia is an effective modality for treating Pancoast tumors.

CT findings and the results of radiotherapy were retrospectively evaluated on 11 patients with primary malignant lymphoma of the brain treated at UOEH Hospital from November, 1979 to March, 1989. CT mostly showed an isodensity or slightly high-density round masses with marked contrast enhancement and was useful both for an initial diagnosis and an evaluation of the response following treatment. Radiation therapy was given to the whole brain in 9 patients. Two patients were irradiated only locally to the tumor bearing area, but no long-term effect was observed. The total dosage ranged from 30 to 51.2 Gy. The 8 patients who received 50 Gy or more to the tumors had higher survival and local control rates than the other 3 who received less than 40 Gy. We conclude that whole brain irradiation with at least a total dose of 50 Gy to the tumor area is necessary to control malignant lymphoma of the brain.