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Local control of metastatic neck nodes is important for treatment in patients with locally advanced head and neck cancer. However, managing inoperable bulky metastatic nodes with necrotic tissue is difficult using ordinary chemoradiotherapy (CRT). Since, hyperthermia (HT) offers complementary and synergistic effects with irradiation and anti-cancer agents, HT combined with CRT was used for treatment in 11 patients with locally advanced head and neck cancer displaying bulky metastatic neck nodes.The 11 cases included 8 cases with pathological Complete Response (CR), 2 with Partial Response (PR) and 1 with No Change (NC). The response rate was 90.9%. Overall survival rate (OS) at 1 and 2 years was 90.9% and 42.4%, respectively, and median survival time was 22.0 months. Local control rate (LCR) was 61.4% at both 1 and 2 years.These clinical results indicate the effectiveness of thermochemoradiotherapy in patients with head and neck cancer displaying bulky lymph node metastasis.

The patient was a 74-year-old man who suffered from epigastric abdominal pain. He visited our hospital in April 2008. An esophageal endocrine cell carcinoma was pointed out by gastrointestinal endoscopy, and he was diagnosed as esophageal endoscopic cell carcinoma with mediastinum lymph node by CT scan(Stage IVa: cT3N4M0). Concurrent chemoradiotherapy using CDDP+EP was started. After two courses, the primary tumor was markedly reduced, and endoscopy showed only a scar. We diagnosed the patient as being in complete remission. However, CT showed a liver metastasis relapse in June 2009, and we started AMR as second-line chemotherapy. His general condition went into a decline, however, He died on October 2, 2009.

It is important to clarify the predictive and prognostic factors for chemoradiotherapy (CRT) in patients with inoperable esophageal cancer.Forty-one patients with inoperable advanced esophageal cancer were evaluated. The predictive factors for the response to CRT (low-dose 5-FU and Cisplatin (FP) therapy plus 60 Gy of radiation) and the prognostic factors after CRT were analyzed.Of the 41 patients, seven achieved complete remission, 21 achieved partial remission, nine showed no change and four showed progressive disease. The median survival time was 19 months in patients with a tumor response, compared to 7 months in patients with non-responsive tumors. Only the serum cytokeratin (CYFRA) level independently predicted the responsiveness to treatment. In the multivariate analysis, the serum CYFRA level and the p53 gene mutation independently influenced prognosis.The presence of a p53 mutation in the biopsy specimen or a high serum CYFRA level may be predictive of an adverse therapeutic outcome.

Radiotherapy (RTx) has been considered as the treatment for locally advanced squamous cell carcinoma of the head and neck (SCCHN). However, with only conventional fractionation (Cfx), response rates are relatively low. In this study, we report the results of hyperfractionation (Hfx) RTx with concurrent docetaxel, cisplatin and 5-fluorouracil (TPF) chemotherapy (CTx) in patients with locally advanced SCCHN and compare Hfx and Cfx RTx with concurrent TPF CTx. Fifty patients with previously untreated stage III–IV SCCHN were entered into this study. Eligible patients received RTx delivered using arm 1: Hfx at 1.2 Gy/fraction, twice daily, 5 days/week to 76.8 Gy/64 fractions, and arm 2: Cfx at 2 Gy/fraction/day, 5 days/week to 70 Gy/35 fractions. Patients received 2 cycles CTx every 4 weeks. The doses were docetaxel 50 mg/m2 (day 1), cisplatin 60 mg/m2 (day 4), and 5-FU 600 mg/m2/day (days 1–5). The overall clinical response rate and the pathological CR were 100% (25/25) and 84% (21/25) in arm 1, and 100% (25/25) and 80% (20/25) in arm 2. Local–regional control was better significant in arm 1 than arm 2 (P = 0.048). There were also trend toward improved disease-free survival (P = 0.059) and overall survival (P = 0.078) in arm 1. Mucositis was significantly more frequent in arm 1 (P = 0.048). There were trend toward improved local–regional control, disease-free survival and overall survival in Hfx RTx with concurrent TPF CTx, compared to Cfx RTx with concurrent TPF CTx.

Positron emission tomography (PET) with 2-[(18)F]fluoro-2-deoxy-D-glucose (FDG) is well known for providing excellent clinical information regarding malignant tumors. We investigated whether dual-time FDG-PET performed immediately post radiation could predict early regrowth of malignant tumors.Twenty patients with malignant tumors were included in this study. All patients received radiation, and each underwent FDG-PET before the initiation of therapy and within 10 days of completing their course of irradiation. PET images after irradiation were obtained at 60 min and 180 min post FDG injection. For 26 lesions in 20 patients, standardized uptake value (SUV) before and after treatment was calculated and then correlated with postradiation tumor response and outcome at 3 months status post irradiation.Retention index [RI = (SUV on delayed image - SUV on early image)/SUV on early image] after irradiation showed a significant difference between patients with residual tumor and those without residual tumor at 3 months status post irradiation (p0.0025). All 9 lesions in 6 patients with residual tumors showed more than 0.1 of RI, whereas none of the lesions with less than 0.1 of RI revealed residual tumors.Dual-time FDG-PET imaging just after irradiation is potentially useful for predicting early regrowth of malignant tumors.

A case report on a long-term surviving patient with advanced gastric cancer with supraclavicular lymph node metastasis treated by radiation and chemotherapy is presented. The Borrman type 2 of advanced gastric cancer was found on the greater curvature of the antrum at the first radiological examination. Radiation was administered to the supraclavicular lymph node at 60 Gy and to the stomach at 64 Gy. The patient received mitomycin C (24 mg) and Tegafur (230 g). After completion of the combined therapy the endoscopy revealed an irregular mucosal change with erosion and hemorrhage. Radiological examination revealed atrophic and hyperplastic areas throughout the stomach. These findings lasted more than six years. The patient died of unknown cause in February 1983. She had survived nine years and seven months after her initial diagnosis. Radiotherapy may play a role as a means of radical treatment in certain cases of advanced gastric cancer.