Esophageal sarcomas.

The clinical and pathologic characteristics of five patients with esophageal sarcomas are presented, including the only recorded esophageal Triton tumor (malignant schwannoma), the third recorded synovial sarcoma, two patients with carcinosarcoma, and one with leiomyosarcoma. All five patients were males who presented with dysphagia. Three tumors were in the cervical esophagus, and the remaining two were in the distal esophagus. On endoscopic examination, three of the tumors were noted to be polypoid, while the other two were sessile. Two patients presented with disseminated disease, and a third was locally unresectable. These three patients were treated with palliative intent. The remaining two patients underwent surgical excision and postoperative radiation therapy, and are alive and well 6 and 7 years following treatment. This experience suggests that combined modality therapy employing postoperative radiation may be effective in managing these rare lesions

Radiotherapy Doses of 80 Gy and Higher Are Associated With Lower Mortality in Men With Gleason Score 8 to 10 Prostate Cancer

PURPOSE: Men with Gleason score (GS) 8-10 prostate cancer (PCa) are assumed to have a very high risk of micrometastatic disease at presentation. However, local failure is also a major problem. We sought to establish the importance of more aggressive local radiotherapy to ≥80 Gy. METHODS: There were 226 men treated consecutively with RT ± ADT from 1988 to 2002 for GS 8-10 PCa. Conventional, 3D conformal, or intensity-modulated (IM) RT was used. Radiation dose was divided into three groups: 1: <75 Gy (n=50); 2: 75-79.9 Gy (n=60); or 3: ≥80 Gy (n=116). The endpoints examined included biochemical failure (BF; nadir+2 definition), distant metastasis (DM), cause specific mortality (CSM) and overall mortality (OM). RESULTS: Median follow-up was 66, 71, and 58 months for groups 1, 2 and 3. On Fine and Gray’s competing risk regression analysis, significant predictors of reduced BF were RT dose ≥80 Gy (p=0.011) and ADT duration ≥24 months (p=0.033). In a similar model of DM, only RT dose ≥ 80 Gy was significant (p=0.007). On Cox regression analysis, significant predictors of reduced OM were RT dose ≥ 80 Gy (p=0.035) and T-category (T3/4 vs. T1, p=0.041). Dose was not a significant determinant of CSM. Results for RT dose were similar in a model with RT dose and ADT duration as continuous variables. CONCLUSION: The results indicate that RT dose escalation to ≥80 Gy is associated with lower risks of BF, DM, and OM in men with GS 8-10 PCa, independently of ADT