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Background: Radiotherapy is an important treatment modality for brain tumors and is the standard radical treatment for nasopharyngeal carcinoma (NPC). However, the treatment is not free of side effects, and one possible neurologic sequela is the occurrence of temporal lobe radionecrosis (TLN) associated with cognitive dysfunction. Currently, there is no effective intervention to improve patients' cognitive performance., Methods: Twenty-nine patients with TLN after radiotherapy for NPC were recruited on a voluntary basis. Among them, 19 patients (15 males and 4 females) received a megadose of alpha-tocopherol (vitamin E) (2000 international units per day) for 1 year, whereas the other 10 (5 males and 5 females) served as control patients. Their cognitive function (i.e., global cognitive ability, attention, memory, language, and executive function) was evaluated by a battery of neuropsychological tests before and after treatment., Results: Significant improvement in global cognitive ability (P = 0.035) and memory (verbal: P = 0.036; visual: P = 0.007) occurred among patients in the treatment group after a 1-year medication period. In addition, the executive function of the treatment group improved significantly (P = 0.04). No difference was found between the two groups with respect to attention or language., Conclusions: The current investigation was a preliminary study on the effect of alpha-tocopherol on the cognitive function of patients with TLN after radiotherapy for NPC. In view of the absence of effective treatment for patients with cerebral radionecrosis, alpha-tocopherol has the potential to be a complementary intervention for patients with cognitive dysfunction due to TLN., (Copyright 2003 American Cancer Society.)

Background: It is known that patients with papillary microcarcinoma (PMC) of the thyroid gland have a very favorable prognosis. The rising incidence of PMC among papillary thyroid carcinoma (PTC) necessitates the identification of prognostic factors and the formulation of treatment protocols., Methods: The authors conducted a retrospective analysis of 203 patients with PMC who were diagnosed on or before 1999 and were treated at the Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong., Results: The cause specific survival, locoregional (LR) failure free survival, and distant metastases failure free survival rates at 10 years were 100%, 92.1%, and 97.1%, respectively. Five patients had lung metastases; 2 patients died of their metastases 12.9 years and 14.8 years after diagnosis, and 3 patients achieved clinical remission after radioiodine (RAI) treatment. Twelve patients had LR recurrences. Patients with LR recurrence were highly salvageable with a combination of surgery, RAI treatment, and external radiotherapy; all but one (who refused treatment) were alive without disease at last follow-up. Multivariate analyses did not reveal any independent prognostic factor for survival. The risk of cervical lymph node (LN) recurrence increased 6.2-fold (P = 0.01) and 5.6-fold (P = 0.02) when LN metastases and multifocal disease were present at diagnosis. RAI ablation reduced the LN recurrence rate to 0.27 (P = 0.04). The presence of LN metastasis increased the rate of distant metastasis 11.2-fold (P = 0.03). Age was not a significant factor in predicting disease recurrence or survival. Subdivision by tumor sizes 5 mm did not affect the outcome, but no patient with tumors

Background: Cognitive dysfunction is common in patients who develop radionecrosis after receiving radiotherapy for nasopharyngeal carcinoma (NPC). However, the impact of the location and volume of radionecrosis on cognitive dysfunction remains unclear. The authors found a significant association between the severity of cognitive impairment and the volume of radionecrosis; in turn, the volume of radionecrosis was affected by patient age at time radiotherapy was completed., Methods: Fifty patients with NPC who received radiotherapy were evaluated by a battery of neuropsychologic tests of cognitive function. The brain lesion volume was quantified, and the lesion locations were identified by standardized brain templates. The results of the neuropsychologic tests were correlated with lesion volume. Gender, education, age at the completion of radiotherapy, brain volume, total dose, and fractional dose were evaluated as risk factors for lesion volume., Results: Lesion volume was correlated significantly with the severity of cognitive deficits. Larger left-hemisphere lesions were correlated with lower verbal memory (from P < 0.001 to P = 0.008) and language abilities (from P = 0.001 to P = 0.018), whereas larger right-hemisphere lesions were associated with worse visual memory (from P = 0.009 to P = 0.039). Finally, patients who received radiotherapy at a younger age had smaller lesion volumes (P < 0.001)., Conclusions: The volume and location of radionecrosis had an influential impact on the pattern of cognitive impairment found in patients with NPC, and patient age at the time radiotherapy was completed appeared to affect the volume of radionecrosis found after radiotherapy., (Copyright 2003 American Cancer Society.)

Background: The objective of this study was to investigate the patterns of recurrence, various prognostic factors, and the role of radioiodine in the treatment of patients with follicular thyroid carcinoma (FTC)., Methods: The clinical outcomes of 215 patients with FTC who were treated at a single institution were analyzed retrospectively. The mean follow-up was 10.8 years., Results: The actuarial rates of cause specific survival (CSS), locoregional (LR) control, and freedom from distant metastasis (DM) at 10 years were 81%, 83%, and 72.3%, respectively. The independent prognostic factors for survival were metastasis at presentation (relative risk [RR], 47.7), radioiodine (RAI) treatment (RR, 0.25), extrathyroidal extension (RR, 3.8), and the postoperative absence of macroscopic disease in the neck region (RR, 0.06). In patients who were treated with RAI, both the LR failure rate (RR, 0.24) and the mortality rate (RR, 0.25) were reduced to about 25%. Subgroup analysis revealed that RAI improved the survival of patients with DM at presentation (RR, 0.17) and improved the LR control rate in patients who had no DM at presentation (RR, 0.13). For patients who underwent total thyroidectomy with negative resection margins, RAI significantly reduced the rate of LR recurrence (RR, 0.05). Patients with the minimally invasive type of FTC had a good prognosis. The 10-year rates for CSS, LR control, and freedom from DM were 97.6%, 100%, and 90.6%, respectively. The prognosis of patients with frankly invasive FTC was much poorer. The 10-year rates for CSS, LR control, and freedom from DM were 66.7%, 100%, and 45%, respectively., Conclusions: RAI is an effective treatment for patients with FTC. It was associated with improved survival rates and fewer recurrences., (Copyright 2002 American Cancer Society.)