Meningeal Solitary Fibrous Tumor: A Single-Center Retrospective Cohort Study

Introduction A meningeal solitary fibrous tumor (SFT), also called hemangiopericytoma, is a rare mesenchymal malignancy. Due to anatomic constrains, even after macroscopic complete surgery with curative intent, the local relapse risk is still relatively high, thus increasing the risk of dedifferentiation and metastatic spread. This study aims to better define the role of postoperative radiotherapy (RT) in meningeal SFTs. Patients and methods A retrospective study was performed across seven sarcoma centers. Clinical information was retrieved from all adult patients with meningeal primary localized SFT treated between 1990 and 2018 with surgery alone (S) compared to those that also received postoperative RT (S + RT). Differences in treatment characteristics between subgroups were tested using independent samples t-test for continuous variables and chi-square tests for proportions. Local control (LC) and overall survival (OS) rates were calculated as time from start of treatment until progression or death from any cause. LC and OS in groups receiving S or S + RT were compared using Kaplan–Meier survival curves. Results Among a total of 48 patients, 7 (15%) underwent S and 41 (85%) underwent S + RT. Median FU was 65 months. LC was significantly associated with treatment. LC after S at 60 months was 60% versus 90% after S + RT (p = 0.052). Furthermore, R1 resection status was significantly associated with worse LC (HR 4.08, p = 0.038). OS was predominantly associated with the mitotic count (HR 3.10, p = 0.011). Conclusion This retrospective study, investigating postoperative RT in primary localized meningeal SFT patients, suggests that combining RT to surgery in the management of this patient population may reduce the risk for local failures.

Radiation therapy for pituitary adenoma: Treatment outcome and prognostic factors

Recurrent pleomorphic adenoma of the parotid gland: Long-term outcome of patients treated with radiation therapy

Objective Pathological Ⅲ A-N2 non-small-cell lung cancer (p Ⅲ A-N2 NSCLC) is a heterogeneous population, and the role of postoperative radiotherapy(PORT) after the adjuvant chemotherapy (ACT) in pⅢA-N2 NSCLC remains ambiguous. Not all pⅢA-N2 patients can benefit from PORT. This study was performed to identify the subgroup that can benefit from PORT after ACT. Methods This study included 804 pⅢ A-N2 NSCLC patients completing radical resection and ACT from January 2006 to December 2015. The patients were divided into two groups: PORT group, patients who underwent PORT after radical resection and ACT; and NON-PORT group, control group of patients who only underwent radical resection and ACT. The PORT and NON-PORT groups consisted of 276 and 528 patients, respectively. Accurate clinical lymph node staging was obtained through contrast-enhanced CT and/or PET/CT. Lymph nodes measured in the short axis≥10 mm on CT or SUV>2.5 on PET/CT were considered as metastases. Using 3-dimensional conformal radiation therapy or intensity modulated radiation therapy techniques, PORT was administered at 1.8-2.2 Gy per fraction to a prescription dose to the planning target volume of 50-60 Gy. Outcome measures included overall survival(OS), disease-free survival (DFS), locoregional recurrence-free survival(LRFS), and distant metastasis-free survival(DMFS). Kaplan-Meier, Log Rank test, and Cox regression were used to analyze survival data and identify prognostic factors. Statistically significant difference was set to P<0.05. Results Median follow-up time was 32.07 months. The 2-year and 5-year OS of the patients in the entire cohort were 82.1% and 54.5%, respectively. The median values of the DFS, LRFS, and DMFS were 19.84, 120.31, and 30.52 months, respectively. In the overall study cohort, the median values of the OS(97.31 months vs. 64.10 months, χ2=5.253, P=0.022), DFS (25.76 months vs. 17.97 months, χ2=18.397, P<0.001), LRFS(120.31 months vs. 101.03 months, χ2=15.358, P<0.001) and DMFS(36.83 months vs. 28.49 months, χ2=6.434, P=0.011) were significantly higher in the PORT group than in the NON-PORT group. Univariate analysis showed that the adverse prognostic factors which significantly affected OS were: male, age≥60 years, advanced preoperative T staging, preoperative N1-N2, non-squamous carcinoma and non-adenocarcinoma, 1-2 chemotherapy cycles and NON-PORT. Multivariate Cox analyses revealed that factors independently associated with longer OS were PORT(HR=0.754, 95%CI=0.584-0.973, P=0.03), female, age <60 years, preoperative clinical N0, clinic stage Ⅰ-Ⅱ, adenocarcinoma, or squamous carcinoma. Subgroup analysis indicated that several preoperative clinical factors could predict the population that would benefit from PORT after ACT. These factors included male(HR=0.697, 95%CI= 0.513-0.947, P=0.021), smoking patient (HR=0.648, 95%CI=0.464-0.905, P=0.011), preoperative clinical N1-N2(HR=0.640, 95%CI=0.465-0.881, P=0.006), clinic stage Ⅲ(HR=0.688, 95%CI= 0.484-0.980, P=0.038), and adenocarcinoma(HR=0.726, 95%CI=0.527-0.999, P=0.049). Conclusions PORT after ACT could significantly improve the 5-year OS, DFS, LRFS, and DMFS in pⅢA-N2 NSCLC patients. Moreover, PORT could improve the 5-year OS of the subgroups with the following characteristics: male, smoking patient, preoperative clinical N1-N2, clinic stage Ⅲ, and adenocarcinoma. Key words: Carcinoma, non-small-cell lung; Radiotherapy; Chemotherapy; Therapeutic evaluation

Surgery Followed by Postoperative Radiation Therapy for Minor Salivary Gland Tumors

To analyze patterns of failure according to treatment modalities and evaluate the adequacy of an institution's current volume of postoperative radiotherapy (PORT) for World Health Organization (WHO) grade II or III meningiomas. Data of 98 patients treated by either surgery and PORT (PORT group, n = 53) or surgery alone (surgery group, n = 45) between March 2000 and December 2013 were reviewed. Clinical target volume of PORT was delineated as a 1.5-2-cm expansion from the tumor bed. Local failure (LF) was defined as recurrence within a 2-cm margin from the tumor bed. Failures other than LF were defined as out-field failure (OFF). Median total dose of PORT was 59.4 (range 45.0-69.0) Gy. The PORT group had larger proportions of grade III meningiomas (18/53, 34.0%) than the surgery group (8/46, 15.6%) (p = 0.037). After a median 73.4-month follow-up, 29 patients experienced LF and 5 developed OFF. The actuarial 5-year local control (LC) rates were 86.7% and 59.3% in the PORT and surgery groups, respectively (p = 0.002). PORT was a significant factor of LC in the univariate (p = 0.003, hazard ratio [HR] 3.449, 95% confidence interval [CI] 1.516-7.846) and multivariate analyses (p < 0.001, HR 5.486, 95% CI 2.178-13.820). Despite the larger proportion of grade III meningiomas in the PORT group, PORT reduced LF in patients with WHO grade II or III meningiomas compared with the surgery group. The current PORT field seems reasonable because LF was the dominant pattern of failure in patients treated by surgery alone.

Postoperative Radiotherapy (PORT) Improves Survivals of Resected pN2 Non-Small Cell Lung Cancer (NSCLC): A Propensity Score-Matched (PSM) Analysis

Postoperative Radiotherapy (PORT) Improves the Survival of Patients With N2 Non-Small Cell Lung Cancer (NSCLC) with Regional Nodes Examined (RNE) ≤16 - A Real World Study Using Surveillance, Epidemiology, and End Results (SEER) Database

Objective To observe the efficacy and adverse reactions of intensity-modulated radiotherapy (IMRT) with or without chemotherapy in the treatment of esophageal carcinoma, and to explore the influencing factors for prognosis. Methods The short-term outcomes and acute adverse reactions in 349 patients with esophageal carcinoma who received IMRT with or without chemotherapy from 2006 to 2012 were retrospectively analyzed. The 1-, 3-, and 5-year local control (LC) rates and overall survival (OS) rates were calculated with the Kaplan-Meier method. The influencing factors for survival were analyzed using the Cox regression model. Results The sample sizes at 3 and 5 years were 174 and 63, respectively. For all patients, the 1-, 3-, and 5-year LC rates were 72. 9%, 61. 2%, and 58. 4%, respectively, and the 1-, 3-, and 5-year OS rates were 66. 5%, 39.1%, and 24%, respectively. According to the results of subgroup analysis, the 1-, 3-, and 5-year LC and OS rates in patients with a tumor volume of < 54. 73 cm3 were significantly higher than those in patients with a tumor size of ≥54. 73 cm3 ( P=0. 001 and 0. 000). There were no significant differences in 1-, 3-, and 5-year LC rates between patients with and without lymph node metastasis (P= ?). However, the 1-, 3-, and 5-year OS rates were significantly lower in patients with lymph node metastasis than in patients without lymph node metastasis (62. 7% vs. 83.1%; 35. 9% vs. 53. 3%; 20. 4% vs. 38. 3%; P= 0.003). There were significant differences in the 1-, 3-, and 5-year LC and OS rates between patients with complete response, partial response, and no response (P= 0. 000 and 0. 000). The incidence rates of grade ≥ 2 acute radiation pneumonitis and grade ≥ 3 acute radiation esophagitis were 11. 3% and 9.0%, respectively. The tumor volume, short-term outcome, and lymph node metastasis were the influencing factors for OS (P= 0. 038, 0. 000, and 0. 008). Conclusions IMRT with or without chemotherapy is effective and safe in the treatment of esophageal carcinoma. The prognosis becomes poor along with increased tumor volume and regional lymph node metastasis. The evaluation of short-term outcomes is closely correlated with LC and OS. Key words: Esophageal neoplasms/radiotherapy; Radiotherapy, intensity-modulated; Prognosis

The value of postoperative radiotherapy in thymoma patients with myasthenia gravis

The objective of the present study was to investigate the role of postoperative radiotherapy (PORT) after radical resection of stage IIIA-N2 non-small cell lung cancer (NSCLC). Subgroups of patients who benefited from PORT were evaluated. A retrospective review of 288 consecutive patients with resected pIIIA-N2 NSCLC at Beijing Chest Hospital (Beijing, China) was performed. Of these patients, 61 received PORT. The 288 patients were divided into PORT and non-PORT groups according to the treatment received. The baseline characteristics of the two patient groups were balanced using propensity score-matching (PSM; 1:1 matching). In total, 60 patients in the PORT group and 60 patients in the non-PORT group were matched. After PSM, the median survival time of the matched patients was 53 months. The 1-, 3- and 5-year overall survival (OS) rates of the PORT patient group were 95.0, 63.2 and 48.2%, respectively, while those of the non-PORT group were 86.7, 58.3 and 34.5%, respectively, and there was no significant difference between the two groups (P=0.056). The 5-year local recurrence-free survival (LRFS) rate in the PORT group was significantly improved (P=0.001). The effects of PORT on OS and LRFS rates were analysed in patients with different clinicopathological features. For subgroups with multiple N2 stations, N2 positive lymph nodes ≥4 and squamous cell carcinoma, PORT significantly increased the OS and LRFS rates (P<0.05). In conclusion, there was no statistically significant improvement in the 5-year OS rate with PORT overall, but there may be subgroups, such as patients with multiple N2 stations, N2 positive nodes ≥4 and squamous cell carcinoma histology, that could be explored as potentially benefitting from improved 5-year OS and LRFS rates with PORT.

Tumor Volume Is an Independent Prognostic Factor for Local Control of Nasopharyngeal Carcinoma Patients Treated With Intensity Modulated Radiation Therapy

Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART): an open-label, randomised, phase 3 trial.

The Value of Preoperative Radiotherapy in the Treatment of Locally Advanced Nasal Cavity and Paranasal Sinus Squamous Cell Carcinoma: A Single Institutional Experience

BackgroundFor patients with ypN2 non‐small cell lung cancer (NSCLC) after neoadjuvant chemotherapy followed by surgery (NCS), the role of postoperative radiotherapy (PORT) is unclear. The aim of our study was to evaluate the effect of PORT on survival of ypN2 NSCLC patients after NCS.MethodsBetween 2004 and 2015, patients with ypN2 NSCLC after NCS were filtrated from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance the baseline characteristics of the PORT and non‐PORT groups. Kaplan–Meier method and Cox proportional hazards models were adopted to estimate overall survival (OS) and cancer‐specific survival (CSS).ResultsA total of 257 patients who met the criteria were included in the study. After PSM, 115 patients remained in each group. The survival of patients in the PORT group was significantly better than those in the non‐PORT group. Median OS was 36 months vs. 26 months, and 5‐year OS rate was 40.5% vs. 21.0% (p = 0.002). The median CSS was 38 months vs. 27 months, and the 5‐year CSS rate was 43.7% vs. 22.1% (p < 0.001). Multivariable analysis showed that PORT was an independent prognostic factor for OS (HR = 0.59, 95% CI: 0.43–0.82, p = 0.001) and CSS (HR = 0.56, 95% CI: 0.41–0.78, p = 0.001). Subgroup analysis showed that patients in the following subgroups could benefit from PORT: age ≤ 70, diagnosed in the later period (2010–2015), white race, squamous cell carcinoma, grade III–IV, lobectomy, stage T3‐4, or with positive regional nodes ≤3 or > 3.ConclusionsFor patients with ypN2 NSCLC after NCS, PORT significantly improves OS and CSS. These results need to be confirmed by further randomized studies.