5-year Local Failure-free Survival Research Articles

Reduced-dose radiotherapy for stage IE gastric mucosa-associated lymphoid tissue lymphoma: a multi-institutional prospective study (KROG 16–18)

PurposeDefinitive radiotherapy (RT) of 30 Gy or higher is commonly recommended to treat Helicobacter pylori-independent gastric mucosa-associated lymphoid tissue (MALT) lymphoma with an excellent disease control rate. However, the efficacy of reduced-dose RT has not yet been evaluated in a prospective cohort study. This multi-institutional study aimed to determine the role of reduced-dose RT in the treatment of stage IE gastric MALT lymphoma. MethodsBetween March 2017 and June 2022, 62 patients with histologically confirmed stage IE gastric MALT lymphoma without evidence of H. pylori infection were enrolled. The patients were treated with reduced-dose RT at a total dose of 24–25.5 Gy to the entire stomach. The response to therapy was evaluated by endoscopy with a biopsy of suspicious lesions if necessary. The primary endpoints were 6-month complete remission (CR) and local failure-free survival (LFFS). ResultsAmong 62 patients, 32 (51.6%) were previously treated for H. pylori eradication. Radiotherapy was delivered using 3D-conformal (n=20, 32.3%) or intensity-modulated radiotherapy (n=42, 67.7%). The median follow-up duration was 34.5 months (range, 9.6–68.8 months). The 6-month CR rate was 96.7%. The 5-year LFFS and progression-free survival rates were 92.0% and 90.4%, respectively. None of the patients experienced grade 3 or worse acute toxicities, and grade 2 acute toxicities were reported in 17 patients (27.4%). ConclusionReduced-dose RT exhibited excellent response rates in stage IE gastric MALT lymphoma, comparable to historical controls of standard dose (≥ 30 Gy) radiotherapy, with a minimal toxicity profile. Current prospective evidence strongly supports the use of definitive radiotherapy (24–25.5 Gy) for the treatment of H. pylori-independent stage IE gastric MALT lymphoma.

Clinical Outcomes in Adenoid Cystic Carcinoma of the Nasal Cavity and Paranasal Sinus: A Comparative Analysis of Treatment Modalities.

This study aimed to present the treatment patterns and outcomes for adenoid cystic carcinoma (ACC) arising in the nasal cavity and paranasal sinus. Sixty-one sinonasal ACC patients were retrospectively reviewed: 31 (50.8%) underwent surgery followed by postoperative radiation therapy (S+PORT), and 30 (49.2%) received definitive radiation therapy (D(C)RT). T4 disease was significantly more frequent in the D(C)RT group (25.8% vs. 80.0%, p < 0.001), where all T4b disease patients underwent D(C)RT. The 5-year local failure-free survival (LFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival were 61.8% versus 37.8% (p = 0.003), 64.8% versus 38.1% (p = 0.036), 52.6% versus 19.3% (p = 0.010), and 93.2% versus 73.4% (p = 0.001) in the S+PORT and D(C)RT groups, respectively. The absolute differences in 5-year rates of LFFS, DMFS, and PFS between the two groups were smaller in the T3-4 subgroup. The univariate analysis showed that T4b disease, neurologic symptoms, longest diameter of tumor, radiological evidence of nerve involvement, and undergoing D(C)RT were associated with worse clinical outcomes, but the significance disappeared in the multivariate analysis, except for in the case of radiological evidence of nerve involvement. In conclusion, most patients with extensive disease underwent upfront D(C)RT and generally exhibited inferior clinical outcomes when compared to those with less extensive disease and who underwent S+PORT.

Prognostic Factors for Survival in Patients With High-grade Chondrosarcoma

Chondrosarcoma (CS) is a rare primary malignant bone tumor, which is the second most common tumor after osteosarcoma. Since chemotherapy and radiotherapy have poor efficacy for CS, amputation or surgical wide resection is the main strategy for localized high-grade CS, making CS therapy difficult. As studies on high-grade CS are limited owing to its rare nature, there are many unknown prognostic factors for survival. This retrospective cohort study included 44 patients with high-grade CS who underwent surgery at a single institution. Overall survival (OS), distant failure-free survival (DFFS), and local failure-free survival (LFFS) were evaluated using the Kaplan-Meier method. Furthermore, we evaluated prognostic factors for survival in patients with high-grade CS using univariate and multivariate analyses. The 5-year OS, LFFS, and DFFS rates of high-grade CS were 75.9%, 90.8%, and 66.5%, respectively. Univariate analysis revealed that tumor size, tumor grade, and surgical margin were significant prognostic factors for OS and DFFS, and distant metastasis was significantly associated with OS. Furthermore, the multivariate analysis indicated that the presence of local recurrence and distant metastasis was significantly associated with OS. Local recurrence and distant metastasis were significant prognostic factors for high-grade CS.

Clinical Outcomes Following Definitive 3D Image-Guided HDR Intracavitary Brachytherapy for Medically Inoperable Endometrial Cancer

<h3>Purpose/Objective(s)</h3> Endometrial cancer (EC) is the most common gynecologic malignancy in the U.S. Brachytherapy alone or in combination with external beam radiation therapy (EBRT) is considered an alternative definitive treatment for women who are not surgical candidates, though limited data exists for outcomes with modern 3D image-guided brachytherapy. As the U.S. population ages and rates of obesity and other comorbidities rise, more women may require definitive radiation therapy. In this study, we report outcomes for a large cohort of patients treated with intrauterine brachytherapy with 3D CT-guided planning. <h3>Materials/Methods</h3> Retrospective review identified 59 women with EC who received high dose rate (HDR) intrauterine brachytherapy with dual or triple tandem applicators with definitive intent, alone or in combination with EBRT, between 2009-2020. All patients underwent endometrial biopsy and 92% had pretreatment diagnostic CT and/or MRI imaging. 3D CT-guided brachytherapy planning was done using planning software. Local failure-free survival (LFFS), disease-free (DFS), and overall survival (OS) estimates were calculated by Kaplan-Meier method. Median follow-up was 44 months (interquartile range [IQR], 17-88). <h3>Results</h3> Median patient age was 68 years (range, 37-87). Patients had atypical complex hyperplasia (15%), or clinical stage I (76%), II (5%), or III (3%) EC. Patients were ineligible for surgery due to medical comorbidities, including obesity (97% of patients), pulmonary disease (36%), cardiovascular disease (41%), renal disease (9%), or complicated prior surgical history (9%). Median BMI was 45.7 kg/m² (range, 17.2-79.7), and 64% of patients met criteria for severe obesity (≥40 kg/m²). Brachytherapy dose delivered ranged from 8.5Gy in 1 fraction to 36.5Gy in 5 fractions. Among patients receiving brachytherapy alone, 83% were treated with 34Gy in 4 fractions. 20% of patients underwent EBRT immediately prior to or following brachytherapy and received lower doses of brachytherapy. Median coverage of the uterus CTV V100 = 92% (range, 65%-99%). 5-year LFFS, DFS, and OS rates were 91%, 82%, and 75%, respectively. Median time to any failure was 15 months (IQR, 10-26). Among 59 patients, 4 failed locally, 3 failed in the peritoneum, and 2 failed both locoregionally and distally. Two of 4 patients who failed locally were successfully salvaged with surgery. Five patients died of EC. Ten patients (17%) had perforation of the uterus with applicator placement. Antibiotics were not given prophylactically and no patients developed bacterial peritonitis or other infectious complication. There was no correlation between perforation of the uterus at the time of brachytherapy and peritoneal spread of EC. <h3>Conclusion</h3> Outcomes following definitive 3D image-guided brachytherapy were excellent, with 5-year LFFS of 91% and 5-year DFS of 82%. Patients rarely died of EC. Our data supports the use of 3D brachytherapy as definitive therapy for patients who are not candidates for surgery.

Treatment of Thymic Oligometastastic or Oligoprogressive Lesions with Hypofractionated Radiation Therapy or Stereotactic Body Radiation Therapy

<h3>Purpose/Objective(s)</h3> Recent large clinical trials have demonstrated an improvement in local failure-free survival (LFFS) and progression free survival (PFS) with hypofractionated radiation therapy (HFRT) and stereotactic body radiation therapy (SBRT) in select patients with oligometastatic (OM) and oligoprogressive (OP) disease. However, little is known about the outcomes of HFRT and SBRT in patients with OM or OP disease from thymic malignancies. Therefore, the purpose of this analysis was to characterize the outcomes of such patients treated at our institution. <h3>Materials/Methods</h3> We retrospectively reviewed patients with OM or OP thymic malignancies treated with HFRT or SBRT between 2009-2021. We defined OM as 5 or fewer sites of metastatic disease at the time of RT and OP as 5 or fewer sites of metastatic disease increasing in radiological size. Patients treated with 20 or fewer fractions of radiation were included. Survival outcomes were defined from the end of RT. Analyses were done using the <i>lifelines</i> module in Python. <h3>Results</h3> We analyzed 48 patients treated to 81 lesions. The median age was 54 years old (range: 24-82 years), 63% were male and 79% were white. Patients had thymoma (54%), thymic carcinoma (38%), or atypical thymic carcinoid (8%). At the time of initial diagnosis, patients were stage I-II (21%), III (12.5%), IVA (23%) or IVB (42%). The majority of patients (65%) received systemic therapy prior to radiation therapy. Of the 81 lesions treated, 67 (83%) were OM lesions and 14 (17%) were polymetastatic, but OP lesions. Treatment sites included bone (37%), pleura (25%), lymph nodes (20%), lung (10%), brain (5%) and other (4%). Most patients were treated in 3 fractions (N=31; 8-10 Gy x 3 fractions), 5 fractions (N=28; 5-7 Gy x 5 fractions (N=20) or 8-10 Gy x 5 fractions (N=8)), or 15 fractions (N=11; 2.5-4 Gy x 15 fractions). The median biological effective dose (BED) was 51.3 Gy. Median follow up was 16 months. The 2-year/5-year rates of LFFS and PFS were 83%/76% and 32%/17%, respectively. The 2-year/5-year/10-year rates of overall survival (OS) were 92%/80%/61%. Patients with thymic carcinoma or atypical carcinoid had similar LFFS vs. those with thymoma (2-year LFFS: 85% vs. 82%, p=0.31), but they had shorter PFS (2-year PFS: 5% vs. 39%, p=0.01), and OS was not significantly different (2-year OS: 86% vs. 96%, p=0.25). Patients (N=14 patients treated to 19 lesions) treated with a BED > 60 Gy did not experience any local failure at 2 years (2-yr LFFS=100%). <h3>Conclusion</h3> Patients with OM or OP thymic malignancies treated with HFRT or SBRT had high rates of LFFS, PFS and OS. Despite having a more aggressive disease, patients with thymic carcinoma still experienced favorable LFFS with HFRT or SBRT. Patients treated with regimens with BED greater than 60 Gy had excellent LFFS. These results suggest that with long OS and PFS times, consideration should be given to SBRT/HFRT regimens to maximize local control in these patients with favorable prognoses.

The Prognostic Value of Gross Tumor Volume in Early-Stage Extranodal NK/T-Cell Lymphoma Treated with Radiotherapy

<h3>Purpose/Objective(s)</h3> Gross tumor volume (GTV) is a biological reflection of tumor burden. We aimed to evaluate the prognostic value of GTV in patients with early-stage extranodal NK/T-cell lymphoma (ENKTCL) treated with radiotherapy. <h3>Materials/Methods</h3> From 2003 to 2019, 326 patients with early-stage ENKTCL underwent intensive-modulated radiotherapy (IMRT) were reviewed retrospectively. GTV was computed using radiation therapy planning system. The association between GTV and death risk was flexibly modeled using smoothed restricted cubic splines. The optimal cutoff point of GTV was determined using receiver operating characteristics (ROC) curve. The overall survival (OS), progression-free survival (PFS), local failure-free survival (LFFS) and distant metastasis-free survival (DMFS) were estimated using Kaplan-Meier method and compared by log-rank test. Cox proportional hazards regression was performed to identify independent risk factors for OS, PFS, LFFS and DMFS. The inverse probability of treatment weighting (IPTW) was conducted to balance patients' characteristics between different subsets. <h3>Results</h3> With median follow-up time of 47.2 months, the 5-year OS, PFS, LFFS and DMFS for entire cohort were 63%, 72%, 92% and 76% respectively. Median GTV was 29.76 ml (ranging from 0.26 to 480.7 ml). GTV linearly correlated with OS. According to ROC curve, 35ml was identified as best cut-off value for OS (AUC = 0.71). Patients in higher GTV group were propensity to be characterized with Ann Arbor stage II, Eastern Cooperative Oncology Group (ECOG) performance score ≥2, B symptom, elevated lactate dehydrogenase and primary tumor invasion (PTI). Higher GTV was an independent risk factor for OS (HR = 2.4, 95%CI, 1.42-4.06, P = 0.001,) PFS (HR = 2.26, 95%CI, 1.44-3.53, P <0.001) and LFFS (P <0.001, HR = 3.79, 95%CI, 1.06-6.5), but not for DMFS (P = 0.1). The difference in OS was not significant (P = 0.084) after adjusting the confounding variables using IPTW. The negative correlation between GTV and LFFS can be attenuated by higher RT dose. <h3>Conclusion</h3> Higher GTV was a risk factor for multiple survival endpoints in early stage ENKTCL treated with radiotherapy. This study can help to provide the rational RT dose selection for different GTV.

Role of salvage radiotherapy for recurrent ovarian cancer

ObjectiveThis study aimed to report clinical outcomes of salvage radiotherapy for recurrent ovarian cancer and identify predictors of clinical outcomes.MethodsWe retrospectively reviewed data of patients who received salvage radiotherapy for...

Multimodality treatment of pediatric Ewing sarcoma: A single-center 10-year analysis of outcomes

BackgroundEwing sarcoma, a malignancy originating from the bone or soft tissues most commonly diagnosed in adolescents, requires multimodality therapy. Although both surgical resection and radiation therapy are effective local control modalities, there are limited data comparing outcomes in patients treated with surgery versus radiation. We sought to determine whether there were differences in 5-year local failure-free survival, event-free survival, and overall survival based on the modality used for local control. MethodsPatients treated for Ewing sarcoma at a single tertiary pediatric hospital between 2010 and 2020 were included for retrospective analysis. Patient and tumor demographics, treatment information, and patient response to therapies were collected from the medical record. Outcome measures were local failure-free survival, event-free survival, and overall survival at 5 years from diagnosis. ResultsSixty-one patients met inclusion criteria. All patients received chemotherapy, and 68.9% of patients presented with localized disease. Of these, 23.8% were treated with radiation alone; the remaining 76.2% underwent resection ± radiation. A total of 52.4% of patients with localized disease achieved R0 resection. Only 3 patients experienced local progression; there was no difference between treatment groups. There was no significant association between local control modality and event-free survival or overall survival in patients with localized disease, regardless of margin status. ConclusionThere was no significant difference in 5-year local failure-free survival, event-free survival, or overall survival in Ewing sarcoma patients treated with radiation versus surgery ± radiation, regardless of whether or not R0 resection was achieved. Future directions include a multi-institutional study to allow for further subgroup analysis and increased sample size.

Stereotactic Body Radiation Therapy for the Treatment of Locally Recurrent and Oligoprogressive Non-Small Cell Lung Cancer: A Single Institution Experience.

ObjectivesTo investigate the efficacy and safety of lung stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC) including oligorecurrent and oligoprogressive disease.MethodsSingle-institution retrospective analysis of 60 NSCLC patients with 62 discrete lesions treated with SBRT between 2008 and 2017. Patients were stratified into three groups, including early stage, locally recurrent, and oligoprogressive disease. Group 1 included early stage local disease with no prior local therapy. Group 2 included locally recurrent disease after local treatment of a primary lesion, and group 3 included regional or well-controlled distant metastatic disease receiving SBRT for a treatment naive lung lesion (oligoprogressive disease). Patient/tumor characteristics and adverse effects were recorded. Local failure free survival (LFFS), progression free survival (PFS), and overall survival (OS) were estimated using the Kaplan Meier method.ResultsAt median follow-up of 34 months, 67% of the study population remained alive. The estimated 3-year LFFS for group 1, group 2, and group 3 patients was 95% (95% CI: 86%-100%), 82%(62% - 100%), and 83% (58-100%), respectively. The estimated 3-year PFS was 59% (42-83%), 40% (21%-78%), and 33% (12%-95%), and the estimated 3-year OS was 58% (41-82%), 60% (37-96%), and 58% (31-100%)), respectively for each group. When adjusted for age and size of lesion, no significant difference in OS, LFFS, and PFS emerged between groups (p > 0.05). No patients experienced grade 3 to 5 toxicity. Eighteen patients (29%) experienced grade 1 to 2 toxicity. The most common toxicities reported were cough and fatigue.ConclusionsOur data demonstrates control rates in group 1 patients comparable to historical controls. Our study also reveals comparable clinical results for SBRT in the treatment of NSCLC by demonstrating similar rates of LFFS and OS in group 2 and group 3 patients with locally recurrent and treatment naïve lung lesion with well-controlled distant metastatic disease.

A Randomized Controlled Trial of Reirradiation Using Diffusion-Weighted MRI Guided Dose-Painting vs. CT-Based Radiotherapy for Locally Recurrent T3 to T4 Nasopharyngeal Carcinoma

We hypothesized that reirradiation using diffusion-weighted MRI (DWI) guided dose-painting radiotherapy was associated with improved tumor control and survival compared with CT-based radiotherapy for locally recurrent nasopharyngeal carcinoma (NPC). The purpose of this randomized study was to compare the efficacy and toxicities of reirradiation using diffusion-weighted MRI guided dose-painting versus CT-based radiotherapy for locally recurrent T3 to T4 nasopharyngeal carcinoma.One hundred and eighty-six patients with locally recurrent T3 to T4 NPC were randomly assigned to receive DWI-guided dose-painting radiotherapy (DP-RT) or CT-based radiotherapy. In DP-RT group (group A, n = 93), subvolume GTVnx-DWI (gross tumor volume of nasopharynx in DWI) was defined as the areas within the GTVnx (gross tumor volume of nasopharynx) with an apparent diffusion coefficient (ADC) below the mean ADC (ADC < mean). The dose to GTVnx-DWI was escalated to DT 65.4 Gy/30 Fx in 2.18 Gy per fraction. In CT-based RT group (group B), PGTVnx was irradiated at DT 60.0 Gy/30 Fx in 2.0 Gy per fraction. Patients in both groups received cisplatin-based induction chemotherapy.Compared with CT-based radiotherapy, DWI-guided DP-RT significantly improved 3-year local failure-free survival (LFFS, 65.6% vs. 51.6%; P = 0.021), progression-free survival (PFS, 48.6% vs. 35.9%; P = 0.032), and had a trend to improve overall survival (OS, 52.8% vs. 43.7%; P = 0.062). No statistically significant differences in acute and late toxic effects (mucosal necrosis, trismus, temporal lobe necrosis, and cranial nerve palsy) were observed between the two groups. Dose painting (DWI-guided DP-RT vs CT-based RT without DP) was a significant independent prognostic factor for LFFS and PFS (P = 0.036 and P = 0.038, respectively).Reirradiation using diffusion-weighted MRI guided dose-painting radiotherapy is associated with a considerable survival benefit, without increasing toxicity, as compared with CT-based RT, among patients with locally recurrent T3 to T4 nasopharyngeal carcinoma. This trial is registered with chictr.org.cn, number ChiCTR1800015779.

Pattern of Failure in Patients with Non-Metastatic Renal Pelvis Transitional Cell Carcinoma: A Single Center Experience in Alexandria, Egypt Shaaban Elassal,Maher Soliman, Naomi Nyambura Clinical Oncology Department,Alexandria University, Egypt.

PURPOSE:Globally, renal pelvis transitional cell carcinoma (RPTCC) is rare. There is a scarcity of information on the pattern of failure from the low and middle-income countries' patients, posing an unmet need. The aim of this study was to identify the patterns of failure and prognostic factors of survival outcomes in non-metastatic RPTCC.PATIENTS AND METHODS:The medical files of all patients with non-metastatic RPTCC who were treated in Alexandria Main University Hospital between January 2007 and December 2017 were reviewed. The clinicopathologic characteristics and treatment outcome data was collected and analyzed using univariate and multivariate analyses. RESULTS:Thirty-six patients were included. The mean age at diagnosis was 60 years (SD ± 9.79). The median tumor size was 7cm (6.0-8.75 cm). High tumor grade and lymphovascular invasion (LVI) were observed in 63.9% and 61.1% of tumors, respectively. About half of patients (47.2%) of the patients developed treatment failures including (13.9%) local recurrence and (33.3%) distant recurrence. Lungs (22.2%) was the most common site of distant failure.The 5-year local failure-free survival (LFFS) was 71%, while the distant failure-free survival (DFFS) was 60.3%. The 5-years overall survival (OS) was 82.5%. In multivariate analysis, the tumor size was an independent predictive factor for LFFS, DFFS and OS. The tumor size (p = 0.03) and LVI (p= 0.01) were significant prognostic factors for DFFS in multivariate analysis. CONCLUSION:RPTCC is very aggressive rare tumor which should be further explored in future research. The tumor size and grade are independent factors for survival outcomes.

Evaluation of Uterine Brachytherapy as Primary Treatment Option for Elderly Patients with Medically Inoperable Endometrial Cancer-A Single-Center Experience and Review of the Literature.

We aimed to gain more evidence regarding the feasibility, toxicity, and oncological outcome of primary brachytherapy in patients with medically inoperable endometrial cancer. Thirteen patients receiving primary brachytherapy ± external beam radiotherapy (EBRT) for endometrial cancer due to medical inoperability were identified. The Kaplan–Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and local failure-free survival (LFFS). Univariate outcome analyses were performed using the log-rank test. Peri-interventional complications, acute and chronic toxicities were evaluated. Additionally, we performed a Pubmed search and review of the literature of the last 10 years. Mean age at time of diagnosis was 73.9 years (60.4–87.1 years). Eleven patients were staged FIGO IA/B and one patient each with FIGO IIIA and IIIC. Kaplan–Meier-estimated 2-/5-year LFFS were 76.2%/56.4%, respectively. High grading correlated with a worse LFFS (p = 0.069). Kaplan–Meier-estimated 2-/5-year PFS were 76.9%/53.8% and 2-/5-year-OS were 76.9%/69.2%, respectively. No acute toxicities > grade II and only two late toxicities grade II/III occurred. We observed three peri-interventional complications. The available evidence suggests high rates of local control after definitive brachytherapy for inoperable endometrial cancer with a favorable toxicity profile. Definitive brachytherapy +/− EBRT should be considered as the preferred approach for this patient group.

The survival benefit of radiotherapy in localized primary adult rhabdomyosarcoma.

To evaluate the role of radiotherapy (RT) in the treatment of localized primary adult rhabdomyosarcoma (RMS). This retrospective study identified 62 consecutive adult patients with localized primary RMS from January 2000 and July 2016. Local failure-free survival (LFFS), distant metastasis-free survival (DMFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. Multivariate Cox proportional hazards regression models were fit to assess the ability of patient characteristics to predict survival. With a median follow-up of 33 months (range, 6-195 months), the 5-year LFFS, DMFS and OS of all patients were 64.0%, 50.0% and 45.0%, respectively. RT was administered to 28 patients (45.2%). Patients who received RT had a higher 5-year LFFS (81.7% vs 47.2%), 5-year DMFS (59.4% vs 43.1%) and 5-year OS (57.1% vs 34.8%) compared with patients who did not received RT. In mulitvariate analysis, RT retained significance as an independent predictor of improved LFFS [hazard ratio (HR)=0.282; 95% confidence interval (CI), 0.095-0.838; P=0.023], DMFS (HR=0.289; 95% CI, 0.125-0.991; P=0.004) and OS (HR=0.334; 95% CI, 0.153-0.727; P=0.006). RT significantly reduced local recurrence, distant metastasis and tumor mortality compared with no radiotherapy for localized primary adult RMS.

Phase II study of induction chemotherapy followed by concurrent chemoradiotherapy with raltitrexed and cisplatin in locally advanced nasopharyngeal carcinoma.

ObjectiveFor locally advanced nasopharyngeal carcinoma (LA-NPC) patients, high incidences of distant metastases and severe treatment related toxicities are the main obstacles needed to be overcome. Raltitrexed, a specific thymidylate synthase inhibitor with a convenient administration schedule, has an acceptable and manageable toxicity, and possesses radio-sensitizing properties. To investigate the efficacy and safety of raltitrexed and cisplatin induction chemotherapy and concurrent chemoradiotherapy (IC+CCRT) in patients with LA-NPC, a phase II clinical study was conducted.MethodsSixty eligible patients with LA-NPC were enrolled into this study. A raltitrexed-cisplatin combination was used as part of an IC+CCRT regimen. Raltitrexed-cisplatin IC was given once every 3 weeks (q3w) for two cycles, followed by raltitrexed-cisplatin based CCRT q3w for two cycles. Intensity-modulated radiotherapy (IMRT) was given for all enrolled patients.ResultsAll patients were included in survival analysis according to the intent-to-treat principle. The objective response rate (ORR) 3 months after treatment was 98%. The 2-year overall survival (OS) rate was 92%. The median relapse-free survival (RFS) time was 30.5 [95% confidence interval (95% CI), 28.4−32.3] months. The 2-year RFS rate was 85%. The 2-year local failure-free survival (LFFS) rate was 97% and the 2-year distant metastasis-free survival (DMFS) rate was 88%. Acute toxicities were mostly grade 2 and 3 reactions in bone marrow suppression, gastrointestinal side effect and oropharyngeal mucositis. Only two patients occurred grade 4 acute toxicities, one was bone marrow suppression and the other was dermatitis radiation.ConclusionsThe combination of raltitrexed and cisplatin has a comparable efficacy to those in standard first-line therapy.

Effectiveness of radiotherapy for head and neck skin cancers: a single-institution study.

PurposeExternal beam radiotherapy (EBRT) is a useful option to treat head and neck skin cancer patients who are not indicated for surgery. In this study, we evaluated the treatment outcomes of EBRT in an Asian population.Materials and MethodsThe records from 19 head and neck skin cancer patients (10 with squamous cell carcinoma and 9 with basal cell carcinoma) who were treated with definitive or adjuvant EBRT from 2009 to 2017 were retrospectively reviewed. The radiotherapy doses administered ranged from 50 to 66 Gy (median, 55 Gy) with 2.0–2.75 Gy per daily fraction (median, 2.5 Gy). The T stage at presentation was as follows: Tis (1 patient), T1 (11 patients), T2 (6 patients), and T3 (1 patient). None had regional lymph node disease or distant metastasis at presentation. The local failure-free survival (LFFS) rates, toxicity, and cosmetic results were analyzed.ResultsThe median age was 75.5 years (range, 52.6 to 92.5 years). The median follow-up duration from the completion of radiotherapy was 44.9 months (range, 5.8 to 82.6 months). One local failure occurred in a patient with a 2.1-cm posterior neck squamous cell carcinoma at 32.5 months after radiotherapy (1/19, 5.3%). The 3-year LFFS rate was 91.7%. No patients died from skin cancer during follow-up, and no grade 3 complications occurred. The cosmetic outcomes were excellent for 16 (84.2%) and good for 3 (15.8%) of the 19 patients.ConclusionEBRT offers good local control and cosmetic outcomes in patients with head and neck skin cancer, with no grade 3 complications.

Grading of MRI\u2013detected skull-base invasion in nasopharyngeal carcinoma with skull-base invasion after intensity-modulated radiotherapy

BackgroundThe aim of this study is to evaluate the prognostic value of grading MRI–detected skull-base invasion in nasopharyngeal carcinoma (NPC) with skull-base invasion after intensity-modulated radiotherapy (IMRT).MethodsThis study is a retrospective chart review of 469 non-metastatic NPC patients with skull-base invasion. Patients were classified as extensive skull-base invasion (ESBI) group and limited skull-base invasion (LSBI) group.ResultsMultivariate analysis showed that the skull-base invasion (LSBI vs. ESBI) was an independent prognostic predictor of progression free survival (PFS). The estimated 5-year local failure free survival (LFFS), distant metastasis free survival (DMFS), PFS, and overall survival (OS) rates for patients in the T3-LSBI and T3-ESBI group were 92.9% versus 93.5, 89.8% versus 86.1, 81.6% versus 76.4, and 93.5% versus 86.3%, respectively (P > 0.05).ConclusionGrading of MRI-detected skull-base invasion is an independent prognostic factor of NPC with skull-base invasion. It is scientific and reasonable for skull-base invasion as a single entity to be classified as T3 classification.

Radiotherapy is a safe and effective salvage treatment for recurrent cervical cancer

ObjectiveThe feasibility of salvage radiotherapy (RT) for patients with recurrent cervical cancer after definitive treatment is contentious. The purpose of this study was to investigate the feasibility and benefit of RT, particularly intensity-modulated RT (IMRT), for salvage treatment in patients with recurrent cervical cancer. MethodsWe retrospectively analyzed 125 patients with recurrent cervical cancer treated with RT at Yonsei Cancer Center between January 2007 and December 2016. All patients received salvage RT for the recurred or metastatic tumor mass. Irradiating dose and volume were determined depending on initial treatment. IMRT was selected in challenging cases, such as re-irradiation or for patients for whom implementing a satisfactory 3-dimensional conformal RT plan was challenging. ResultsThe median follow-up period was 5.5 years (range, 10.8 months to 41 years). The 5-year local failure-free survival (LFFS) and progression-free survival (PFS) rates were 63.9% and 39.6%, respectively. The 5-year overall survival (OS) rate was 66%; 10-year OS reached 51%. The median PFS rates in patients with locoregional failure, distant metastases, or both were 45.4, 29.1, and 14.7 months, respectively (p = 0.005). For the 45 patients that received re-irradiation, 5-year LFFS, PFS, and OS rates were 47.1%, 33.2%, and 66.5%, respectively. Late complications were observed in 12 patients (12/125, 9.6%). ConclusionsOur data suggest that salvage RT is safe and effective against recurrent cervical cancer. IMRT is a safe and effective salvage modality for these patients, including those requiring re-irradiation.

The influence of anatomic location on outcomes in patients with localized primary soft tissue sarcoma.

We hypothesized that survival varied significantly between retroperitoneal soft tissue sarcoma (STS) and extremity/trunk STS. This study explored the reasons for the different outcomes and identified patient characteristics for survival. This retrospective study identified 213 consecutive patients with localized primary STS from January 2002 to July 2013, including 47 retroperitoneal STS (22.1%) and 166 extremity/trunk STS (77.9%). Local failure-free survival (LFFS), distant metastasis-free survival (DMFS) and overall survival (OS) were constructed by the Kaplan-Meier method. Univariate Cox proportional hazards regression models were fit to assess the ability of patient characteristics to predict survival. At presentation, patients with retroperitoneal STS had larger tumor size (median size 18 cm vs. 6 cm; P < 0.001) and positive margin (21.3% vs. 8.4%; P = 0.014), and less often received radiotherapy (2.1% vs. 45.8%; P < 0.001). The median follow-up time for the entire population was 68 months (range, 5-127 months). Local recurrence was more frequent in patients with retroperitoneal STS compared with patients with extremity/trunk STS (53.2% vs. 28.3%; P = 0.001). LFFS and OS were lower in patients with retroperitoneal STS than extremity/trunk STS, with 5-year LFFS (50% vs. 74.3%; P < 0.001) and 5-year OS (65.4% vs. 77.5%; P = 0.017), respectively. Retroperitoneal STS was associated with significantly worse survival compared with extremity/trunk STS. Larger tumor size, more patients with positive margin and fewer patients received radiotherapy in retroperitoneal group may result in worse survival compared with extremity/trunk disease.

Paranasal Sinus Invasion in Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy.

PurposeThe aim of this study is to evaluate the prognostic significance of paranasal sinus invasion for nasopharyngeal carcinoma (NPC) and its suitable position in the T classification.Materials and MethodsThe magnetic resonance imaging (MRI) scans of 695 patients with previously untreated, biopsy-proven, non-metastatic NPC that was treated with intensity-modulated radiotherapy (IMRT) were reviewed retrospectively.ResultsThe incidence of paranasal sinus invasion was 39.4% (274 of 695 patients). Multivariate analysis showed that paranasal sinus invasion was an independent negative prognostic factor for local failure-free survival (LFFS) (p < 0.05). According to the eighth American Joint Committee on Cancer (AJCC) staging system, 275 patients were classified as T3 classification. Of these, 78 patients (28.4%) developed paranasal sinus invasion (T3b) and 197 (71.6%) didn’t (T3a). The estimated 5-year LFFS and overall survival (OS) rates for the patients with T3b and T3a classification were 88.6% versus 95.0% (p=0.047), and 84.5% versus 93.3% (p=0.183), respectively. The estimated 5-year LFFS and OS rates for the patientswith T4 classificationwere 89.5% and 83.2%,whichwere similarwith the outcomes of patients with T3b classification.ConclusionMRI-determined paranasal sinus invasion is an independent prognostic factor of NPC treated by IMRT. Paranasal sinus invasion is recommended to classify as T4 classification in the 8th AJCC staging system for NPC.

Tumor Boost Using External Beam Radiation in Cervical Cancer Patients Unable to Receive Intracavitary Brachytherapy: Outcome From a Multicenter Retrospective Study (Korean Radiation Oncology Group 1419).

We conducted this study to evaluate the outcomes of external-beam radiotherapy tumor boost (EBRT-B) in cervical cancer patients who could not receive intracavitary brachytherapy. A total of 11 hospitals provided the data of patients who received EBRT-B during the period from January 2005 through October 2012. A total of 75 patients were included. The median radiotherapy dose was 46 Gy (range, 40-54 Gy) for whole pelvis and 24 Gy (range, 9-35 Gy) for EBRT-B. Initial tumor responses assessed at 2 to 6 months after radiotherapy were as follows: 46 with complete response, 22 with partial response, 2 with stable disease, and 3 with progressive disease. After a median follow-up time of 33 months, 30 patients (40.0%) showed disease progression including 21 (28.0%) with local progression. The 5-year local failure-free survival rate was 70.0%. Achieving complete response at the first follow-up visit and an overall treatment time of 53 days or less were significantly related to favorable local failure-free survival. The rate of grade 3 or higher toxicity was 2.6%. Approximately 70% of patients had local tumor control after curative radiotherapy using EBRT-B. Early tumor response and overall treatment time of 53 days or less were closely associated with favorable local control.