5-year Local Recurrence-free Survival Rates Research Articles

800 Oncological outcomes of radical nephroureterectomy versus kidney-sparing surgery for elective treatment of clinically organ-confined upper tract urothelial carcinoma of the distal ureter

Abstract To compare the oncological outcomes of radical nephroureterectomy (RNU), distal ureterectomy (DU), and endoscopic surgery (ENDO) for elective treatment of clinically organ-confined upper tract urothelial carcinoma (UTUC) of the distal ureter. From a multi-institutional collaborative database, we identified 304 patients with unifocal clinically organ-confined UTUC of the distal ureter and bilateral functional kidneys. Overall survival (OS), cancer-specific survival (CSS), local recurrence-free survival (LRFS), and intravesical recurrence-free survival (IVRFS), according to the surgery type, were compared using Kaplan-Meier statistics. Univariable and multivariable Cox regression analyses were performed to assess the adjusted outcomes of RNU, DU, and ENDO. Overall, 128 (42.1%), 134 (44.1%), and 42 (13.8%) patients were treated with RNU, DU, and ENDO, respectively. Although OS, CSS, and IVRFS were equivalent between the three surgical procedures, the 5-year LRFS rate was lower in the ENDO group (35.7%) when compared to RNU (95.0%; p

Local efficacy and survival outcome of salvage endoscopic therapy for local recurrent lesions after definitive chemoradiotherapy for esophageal cancer.

BackgroundSalvage endoscopic therapy (SET), such as endoscopic mucosal resection (EMR) and photodynamic therapy (PDT), is a less-invasive treatment for local failure at the primary site after chemoradiotherapy (CRT) for esophageal squamous cell carcinoma (ESCC). We conducted this retrospective study to clarify the risk factors for local recurrence along with the long term results after SET for recurrent lesions after definitive CRT for ESCC.MethodsWe enrolled 77 consecutive patients who underwent EMR or PDT for local recurrence without any metastasis after definitive CRT at our institution. We evaluated the local efficacy, local recurrence-free survival (LRFS), and overall survival (OS), and investigated the risk factors associated with survival outcome using a multivariate analysis.ResultsThe complete resection rate of EMR was 84.6 % (33/39), and the complete response rate for PDT was 65.8 % (25/38). Twenty-two patients (28.6 %) exhibited local recurrence without metastasis. Thirty-four patients (44.2 %) were alive at 5 years after undergoing only initial SET or with repeated SET. The 5-year LRFS rate was 59.6 %, and the presence of lesions occupying an esophageal circumference of 1/4 or larger was the only significant risk factor (HR: 3.10, 95 % CI: 1.35–7.15, P = 0.008). The 5-year OS rate was 48.4 %, and an advanced T factor before CRT was marginally associated with a poor OS (HR: 1.96, 95 % CI: 0.98–3.92, P = 0.055).ConclusionsSET enabled a preferable local control and survival outcome for patients with local recurrence after definitive CRT for ESCC. Careful endoscopic follow-up is needed for patients with a large lesion before SET and those with an advanced T factor before CRT.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-016-0604-z) contains supplementary material, which is available to authorized users.

Clinical Outcome and Prognostic Factors of Intensity-Modulated Radiotherapy for T4 Stage Nasopharyngeal Carcinoma.

Objective. To analyze the clinical outcomes and prognostic factors of intensity-modulated radiotherapy (IMRT) for T4 stage nasopharyngeal carcinoma (NPC). Methods. Between March 2005 and March 2010, 110 patients with T4 stage NPC without distant metastases were treated. All patients received IMRT. Induction and/or concurrent chemotherapy were given. 47 (42.7%) patients received IMRT replanning. Results. The 5-year local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) rates were 90.1%, 97.0%, 67.5%, 63.9%, and 64.5%, respectively. Eleven patients experienced local-regional failure and total distant metastasis occurred in 34 patients. 45 patients died and 26 patients died of distant metastasis alone. The 5-year LRFS rates were 97.7% and 83.8% for the patients that received and did not receive IMRT replanning, respectively (P = 0.023). Metastasis to the retropharyngeal lymph nodes (RLN) was associated with inferior 5-year OS rate (61.0% versus 91.7%, P = 0.034). The gross tumor volume of the right/left lymph nodes (GTVln) was an independent prognostic factor for DMFS (P = 0.006) and PFS (P = 0.018). GTVln was with marginal significance as the prognostic factor for OS (P = 0.050). Conclusion. IMRT provides excellent local-regional control for T4 stage NPC. Benefit of IMRT replanning may be associated with improvement in local control. Incorporating GTVln into the N staging system may provide better prognostic information.

Comparison of three different concurrent chemoradiation regimens for treatment of laryngeal cancer.

During last decades, laryngeal organ preservation strategies have emerged. The data about the oncological outcomes mainly come from multi-institutional prospective studies. In this study, we aimed to determine the oncological outcomes of different organ preservation regimens applied in routine practice. Patients who had definitive concurrent chemoradiation (CRT) for treatment of laryngeal cancer between January 2001 and June 2013 were retrospectively reviewed. There were 139 subjects who met the inclusion criteria. Three groups were defined: group A (n=59) consisted of subjects who had concurrent cisplatin and radiotherapy (RT), group B (n=47) consisted of subjects who had cisplatin/docetaxel-based concurrent CRT, and group C (n=33) had induction chemotherapy before concurrent cisplatin and RT. The Kaplan-Meier estimated 5-year overall survival, disease-specific survival, disease-free survival, and local recurrence-free survival (LRFS) rates for the whole study group were 66.5, 69.2, 69.6, and 88.9%, respectively. None of these survival rates were statistically different when the treatment arms were compared. The 3- and 5-year LRFS rates were significantly lower in subjects with a T4a tumor (p=0.030). According to our results, the oncological outcomes of three different platinum-based concurrent chemotherapy schemes were similar and high local control rates could be achieved with the use of these protocols. Neoadjuvant chemotherapy before concurrent CRT was not superior to conventional concurrent treatment.

Clinical role of 18F-FDG PET/CT-based simultaneous modulated accelerated radiotherapy treatment planning for locally advanced nasopharyngeal carcinoma ⁎

Abstract Objective The aim of this study was to compare the long-term local control, overall survival, and late toxicities of positron emission tomography/computed tomography (PET/CT)-guided dose escalation radiotherapy versus conventional radiotherapy in the concurrent chemoradiotherapy treatment of locally advanced nasopharyngeal carcinoma (NPC). Methods A total of 48 patients with stage III-IVa NPC were recruited and randomly administered PET/CTguided dose escalation chemoradiotherapy (group A) or conventional chemoradiotherapy (group B). The dose-escalation radiotherapy was performed using the simultaneous modulated accelerated radiotherapy technique at prescribed doses of 77 gray (Gy) in 32 fractions (f) to the gross target volume (GTV): planning target volume (PTV) 1 received 64 Gy/32 f, while PTV2 received 54.4 Gy/32 f. Patients in group B received uniform-dose intensity-modulated radiotherapy, PTV1 received 70 Gy/35 f and PTV2 received 58 Gy/29 f. Concurrent chemotherapy consisted of cisplatin [20 mg/m2 intravenous (IV) on days 1-4] and docetaxel (75 mg/m2 IV on days 1 and 8) administered during treatment weeks 1 and 4. All patients received 2-4 cycles of adjuvant chemotherapy of the same dose and drug regimen. Results The use of fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT significantly reduced the treatment volume delineation of the GTV in 83.3% (20/24) of patients. The 5-year local recurrence-free survival rates of the two groups were 100% and 79.2%, respectively (P = 0.019). The 5-year disease free survival (DFS) rates were 95.8% and 75.0%, respectively (P = 0.018). The 5-year local progression-free survival and DFS rates were significantly different. The 5-year overall survival (OS) rates were 95.8% and 79.2%, respectively. Differences in OS improvement were insignificant (P = 0.079). Late toxicities were similar in the two groups. The most common late toxicities of the two arms were grade 1-2 skin dystrophy, xerostomia, subcutaneous fibrosis, and hearing loss. There were no cases of grade 4 late toxicity. Conclusion The use of 18F-FDG PET/CT-guided dose escalation radiotherapy is well tolerated and can reduce local recurrence rates for patients with locally advanced NPC compared to conventional chemoradiotherapy.

Management of the Primary Intraosseous Synovial Sarcoma of the Jaws: Be Careful of the Surgical Margin

Synovial sarcoma (SS) is extremely rare in the jaws, and only 8 cases have been reported worldwide. The specific aims of this study were to report 15 cases of primary intraosseous SS (PISS) and analyze the histologic features and outcome-related prognostic factors. Data from patients diagnosed with PISS from 2004 to 2013 were collected in this retrospective study. Patient characteristics (primary location, histologic subtype, tumor size, and surgical margin) were defined as predictor variables. Local recurrence and tumor-related death were outcome variables. The association of tumor-related outcomes with patient characteristics was analyzed using Kaplan-Meier and Cox regression statistics. Other clinical and pathologic characteristics were summarized as a third category of variables for further analysis. This study examined 15 cases (women, n = 10; men, n = 5) with a mean age at diagnosis of 35 years. There was no imbalance in the distribution of primary SS locations (maxilla, n = 7; mandible, n = 8). Six patients (40%) developed local recurrence and 4 patients (26.7%) had a tumor-related death. The 5-year local recurrence-free survival (LRFS) and overall survival rates were 57% and 69.1%, respectively. The strong statistical association of surgical margin with 5-year LRFS rate was shown by univariate (P = .01) and multivariate (hazard ratio = 7.598; P = .028) analyses. PISS is extremely rare in the jaw. Immunohistochemical analysis played an important role in the diagnosis of PISS. The surgical margin showed a strong association with local recurrence. Thus, ideal surgical margins should be achieved during surgery to obtain better local control.

Adult sinonasal soft tissue sarcoma: analysis of 48 cases from the French Sarcoma Group database.

The aim of this study was to determine the frequency of primary sinonasal adult sarcoma, identify histological subtypes, and analyze prognostic factors. Retrospective review. Forty-eight adult sinonasal sarcomas included in the French Sarcoma Group database (Conticabase) were reviewed. The most frequent tumor types were alveolar rhabdomyosarcoma (33.3%), embryonal rhabdomyosarcoma (14,6%), unclassified sarcoma (14.6%), and leiomyosarcoma (12.5%). All round cell tumors were rhabdomyosarcomas. The 5-year overall survival (OS), metastasis-free survival (MFS), and local recurrence-free survival (LRFS) rates were 62.3%, 73%, and 88.8%, respectively. Histotype was a prognostic factor for OS, MFS, and LRFS, with the worst prognosis associated with rhabdomyosarcomas, regardless of the subtype. The tumor grade influenced the OS and MFS. Surgery was a predictive factor for a complete response. These results suggest that sinonasal tract should be considered as an unfavorable site for rhabdomyosarcoma. Moreover, surgery should always be considered in treatment.

Efficacy of preoperative concurrent chemoradiotherapy in treatment of locally advanced middle-low rectal cancer

Objective To evaluate the efficacy and tolerance of preoperative concurrent chemoradiotherapy in the treatment of locally advanced middle-low rectal cancer.Methods From June 2007 to June 2013,51 untreated patients with histopathologically proven rectal cancer (T3/T4 or N (+))were included in this study.Three-dimensional radiotherapy was delivered to the whole pelvic cavity at 45.0-50.4 Gy/25-28 fractions.Two cycles of chemotherapy with FOLFOX4 or XELOX were given concurrently at weeks 1 and 4 of radiotherapy.Surgery was performed at 4-8 weeks after chemoradiotherapy.Adjuvant chemotherapy with FOLFOX4 or XELOX was given within one month after surgery.The Kaplan-Meier method was used to calculate survival rates,and the log-rank test was used for univariate analysis;the Cox regression model was used for multivariate prognostic analysis.Results Fortynine patients completed the preoperative chemoradiotherapy and surgery.The median follow-up was 2.9 years.The overall sphincter preservation rate was 65％;the overall downstaging rate was 59％.Ten (20.4％) of all patients achieved a pathologic complete response (pCR).Grade ≥3 toxicities occurred in 25％ of all patients,and the overall postoperative complication rate was 31％.The 3-and 5-year sample sizes were 24,12,respectively.The 3-and 5-year overall survival rates were 81％ and 69％,respectively;the 3-and 5-year disease-free survival (DFS) rates were 76％ and 60％,respectively;the 3-and 5-year local recurrence-free survival (LRFS) rates were 78％ and 70％,respectively;the distant metastasis-free survival rates were 82％ and 74％,respectively.The multivariate analysis showed that tumor downstaging was an independent prognostic factor for 5-year DFS and LRFS.Conclusions For locally advanced middle-low rectal cancer,preoperative radiotherapy with concurrent FOLFOX4/XELOX chemotherapy can increase pathologic downstaging rate,pCR rate,and sphincter preservation rate.Patients with tumor downstaging may have a better survival advantage. Key words: Rectal neoplasms/radiochemotherapy ; Radiochemotherapy, concurrent ; Rectal neoplasms/surgery ; Downstaging; Prognosis

Expression of basic fibroblast growth factor, CD31, and α-smooth muscle actin and esophageal cancer recurrence after definitive chemoradiation.

There is cumulative evidence that stromal reaction in cancer has an important diagnostic and prognostic significance. The aims of this study were to analyze the expression of basic fibroblast growth factor (FGF-2), CD31, and α-smooth muscle actin (SMA) in esophageal cancer patients and to establish their significance as indicators of disease recurrence after definitive chemoradiation (CRT). Protein expressions of FGF-2, CD31, and SMA were evaluated by immunohistochemistry and Western blot analysis in 70 patients, 20 with esophageal squamous cell carcinoma (ESCC) and 50 with locally recurrent ESCC after definitive CRT. Twenty matched normal esophageal squamous epithelium were also studied as controls. Esophageal cancer tissues showed positive expression of FGF-2, CD31, and SMA; in contrast, FGF-2 expression was not detected and only little staining for CD31 and SMA was noted in normal epithelium. Protein levels of FGF-2, CD31, and SMA were significantly elevated in recurrent ESCC. Among the patients with locally recurrent disease, expression of FGF-2 and SMA was notably high in whom the tumor recurred locally within 24 months after definitive CRT. The 2- and 5-year local recurrence-free survival rate was 15.4 % and 0 in patients with high FGF-2 expression, compared with 45.8 and 33.3 % in those who expressed low FGF-2, respectively (P = 0.005). Of patients who expressed high SMA, the 2- and 5-year local recurrence-free survival rate was 21.7 and 8.7 %, respectively, compared to those with low SMA expression which was 37.0 and 22.2 %, respectively (P = 0.016). Overexpression of FGF-2 and SMA is associated with local recurrence and reduced recurrence-free survival after definitive CRT for ESCC. The data also suggest that targeting stromal cells may be an attractive approach for esophageal cancer therapy strategies.

Outcome of patients undergoing salvage surgery for recurrent nasopharyngeal carcinoma: a meta-analysis.

The common treatment of primary patients with nasopharyngeal carcinoma is chemotherapy and radiotherapy. Surgery is reserved as salvage procedure for recurrent or persistent disease. Nevertheless, information on the outcome of these patients and the role of adjuvant reirradiation treatment is scarce. We conducted a meta-analysis to identify prognostic factors associated with outcomes of patients with recurrent nasopharyngeal carcinoma treated by salvage surgery. The study group consisted of 779 patients from 17 published studies who met the inclusion criteria. The primary tumor classification at recurrence was T1-2 in 83 % of patients and T3-4 in 16.6 %. Regional lymph node metastases were present in 88 patients. The 5-year overall survival and local recurrence-free survival rates of the entire cohort were 51.2 and 63.4 %, respectively, with a distant metastases rate of 11.3 %. The 5-year overall survival was 63 % in patients receiving surgery and adjuvant radiotherapy compared to 39 % in patients receiving surgery alone (P = 0.05). Independent predictors of outcome on multivariate analysis were sex, N classification, surgical approach (endoscopic vs. open), adjuvant treatment, and margin status. Both endoscopic surgery and reirradiation were independent predictors of improved survival. More than half of the patients with recurrent disease can be salvaged by surgery. Margins status, and N and T classification are significant predictors of outcome. Multivariate analysis revealed that endoscopic surgery offers better outcome than open surgery for T3/4 disease in selected patients, and adjuvant reirradiation offers an additional survival advantage over surgery alone.

Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: An analysis of survival and treatment toxicities

Background and purposeTo evaluate the long-term survival outcomes and toxicity of NPC patients treated with intensity-modulated radiotherapy (IMRT). Materials and methodsFrom May 2001 to October 2008, 868 non-metastatic NPC patients treated by IMRT were analyzed retrospectively. The Radiation Therapy Oncology Group (RTOG) criteria were used to assess toxicity. ResultsWith a median follow-up of 50months (range, 5–115months), the 5-year estimated disease specific survival (DSS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) were 84.7%, 91.8%, 96.4% and 84.6%, respectively. Of the 868 patients, 186 (21.3%) developed failure after treatment. Distant metastasis was the major failure pattern after treatment. The 5-year OS rate in patients with stage I, II, III, and IVa–b were 100.0%, 94.3%, 83.6%, and 70.5%, respectively. The 5-year LRFS rate in patients with stage T1, T2, T3, and T4 disease were 100.0%, 96.0%, 90.4%, and 83.3%, respectively (χ2=26.32, P<0.001). The 5-year DMFS for N0, N1, N2, and N3 patients were 96.1%, 85.6%, 73.7%, and 62.1%, respectively (χ2=65.54, P<0.001). Concurrent chemotherapy failed to improve survival rates for patients with advanced locoregional disease. The most common acute toxicities were mainly in grade 1 or 2. Compared with IMRT alone, IMRT plus concurrent chemotherapy increased the severity of acute toxicities. The incidence of brain radiation damage was relatively high (5.5%, 48/868 cases), and was not observed in patients with stage T1–2. ConclusionIMRT for NPC yielded excellent survival outcomes, and distant metastasis was the most commonly seen failure pattern after treatment. The role of concurrent chemotherapy for advanced locoregional stage NPC patients needs to be further investigated. Treatment-related toxicities were well tolerable. However, the incidence of brain radiation damage was relatively high, especially for patients with advanced T-stage.

Re-irradiation with interstitial pulsed-dose-rate brachytherapy for unresectable recurrent head and neck carcinoma

To assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy combined with simultaneous chemotherapy in selected patients with recurrent head and neck tumors not amenable to salvage surgery. A total of 51 patients with recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Forty patients (78%) had salvage brachytherapy alone using a median total dose of 60Gy. Salvage brachytherapy in combination with external beam therapy was performed in 11 patients (22%) using a median total dose of DREF=27Gy. Simultaneously with the PDR brachytherapy, a concomitant chemotherapy was administered in 35/51 (69%) of patients. The analysis was performed after a median followup of 58 months. Local control rates calculated according to Kaplan-Meier after 2 and 5 years were 71% and 57%, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 5-year local recurrence-free survival rates were 78.9% vs. 38.5% (p=0.01), respectively. No other patient or treatment-related parameters had a significant influence on treatment results. A total of 9/51 (17.7%) and 6/51 (11.8%) patients developed soft-tissue necrosis or bone necrosis, respectively, but only 2% of patients required surgical treatment. PDR interstitial brachytherapy with pulse doses between 0.4 and 0.7Gy/h/24h with simultaneous chemotherapy is an effective and safe option for curative therapy in selected patients with head and neck cancer in previously irradiated areas, which are not suitable for salvage surgery.

Interstitial pulsed-dose-rate brachytherapy for head and neck cancer—Single-institution long-term results of 385 patients

To assess the long-term results of protocol-based pulsed-dose-rate (PDR) interstitial brachytherapy (iBT) in 385 patients with head and neck cancer who underwent PDR-iBT preferably after minimal, nonmutilating surgery. From 1997 to 2009, a total of 385 patients received protocol-based PDR-iBT for head and neck cancer. Brachytherapy was preceded by surgery in most of our patients (326/385, 84.7%). Altogether, 246 of 385 patients (63.9%) received iBT alone and 135 of 385 patients (36.1%) in combination with external beam radiation therapy. The analysis was done after a median followup of 63 months. The 5-, 10-, and 15-year local relapse-free survival rates according to Kaplan-Meier test for all analyzed patients were 85.8%, 83.1%, and 80.2%, respectively. The 5-, 10-, and 15-year overall survival and disease-free survival rates were 68.9%, 52.2%, and 44.1%, and 81.3%, 79.3%, and 76.3%, respectively. For N0-/N1- vs. N2-patients, we observed significantly different 5-year local recurrence-free survival rates with values of 92.3% and 73.7%, respectively (p=0.007). No other patient or treatment-related parameters had a significant influence on treatment results. Serious late side effects, such as soft tissue or bone necrosis, were observed in 39 of 385 patients (10.2%) and 18 of 385 patients (4.9%), respectively. The PDR-iBT with 0.4-0.7Gy each hour, 24h per day for patients with head and neck cancer is a proven, effective, and safe treatment method with excellent long-term data.

A Prognostic Nomogram for Prediction of Recurrence in Desmoid Fibromatosis

To construct a postoperative nomogram to estimate the risk of local recurrence for patients with desmoid tumors. The standard management of desmoid tumors is resection, but many recur locally. Other options include observation or novel chemotherapeutics, but little guidance exists on selecting treatment. Patients undergoing resection during 1982-2011 for primary or locally recurrent desmoids were identified from a single-institution prospective database. Cox regression analysis was used to assess risk factors and to create a recurrence nomogram, which was validated using an international, multi-institutional data set. Desmoids were treated surgically in 495 patients (median follow-up of 60 months). Of 439 patients undergoing complete gross resection, 100 (23%) had recurrence. Five-year local recurrence-free survival was 69%. Eight patients died of disease, all after R2 resection. Adjuvant radiation was not associated with improved local recurrence-free survival. In multivariate analysis, factors associated with recurrence were extremity location, young age, and large tumor size, but not margin. Abdominal wall tumors had the best outcome (5-year local recurrence-free survival rate of 91%). Age, site, and size were used to construct a nomogram with concordance index of 0.703 in internal validation and 0.659 in external validation. Integration of additional variables (R1 margin, sex, depth, and primary vs recurrent presentation) did not importantly improve concordance (internal concordance index of 0.707). A postoperative nomogram including only size, site, and age predicts local recurrence and can aid in counseling patients. Systemic therapies may be appropriate for young patients with large, extremity desmoids, but surgery alone is curative for most abdominal wall lesions.

Local recurrence after surgery for non–small cell lung cancer: A recursive partitioning analysis of multi-institutional data

To define subgroups at high risk of local recurrence (LR) after surgery for non-small cell lung cancer using a recursive partitioning analysis (RPA). This Institutional Review Board-approved study included patients who underwent upfront surgery for I-IIIA non-small cell lung cancer at Duke Cancer Institute (primary set) or at other participating institutions (validation set). The 2 data sets were analyzed separately and identically. Disease recurrence at the surgical margin, ipsilateral hilum, and/or mediastinum was considered an LR. Recursive partitioning was used to build regression trees for the prediction of local recurrence-free survival (LRFS) from standard clinical and pathological factors. LRFS distributions were estimated with the Kaplan-Meier method. The 1411 patients in the primary set had a 5-year LRFS rate of 77% (95% confidence interval [CI], 0.74-0.81), and the 889 patients in the validation set had a 5-year LRFS rate of 76% (95% CI, 0.72-0.80). The RPA of the primary data set identified 3 terminal nodes based on stage and histology. These nodes and their 5-year LRFS rates were as follows: (1) stage I/adenocarcinoma, 87% (95% CI, 0.83-0.90); (2) stage I/squamous or large cell, 72% (95% CI, 0.65-0.79); and (3) stage II-IIIA, 62% (95% CI, 0.55-0.69). The validation RPA identified 3 terminal nodes based on lymphovascular invasion (LVI) and stage: (1) no LVI/stage IA, 82% (95% CI, 0.76-0.88); (2) no LVI/stage IB-IIIA, 73% (95% CI, 0.69-0.80); and (3) LVI, 58% (95% CI, 0.47-0.69). The risk of LR was similar in the primary and validation patient data sets. There was discordance between the 2 data sets regarding the clinical factors that best segregate patients into risk groups.

Osteosarcoma and Chondrosarcoma of the Shoulder: Site-specific Comparative Analysis

Osteosarcoma and chondrosarcoma compose most of the primary malignancies of the shoulder. The literature lacks site-specific comparative analyses of these 2 major shoulder sarcomas. The purposes of this study were to describe the different characteristics of the 2 major sarcomas near the glenohumeral joint, examine differences in treatment outcomes, and evaluate the functional outcomes of limb salvage surgery. Thirty-two patients with osteosarcoma or chondrosarcoma who underwent a wide resection including the glenohumeral joint were enrolled in this study. The characteristics of tumor development and treatment, oncologic and functional outcomes, and factors affecting outcomes were compared between groups and with the literature. The results showed shoulder osteosarcoma developing similarly to the literature reports, whereas chondrosarcoma tended to be of a high histologic grade. Nonetheless, the osteosarcoma group had a poorer overall 5-year survival rate (53.0%) than the chondrosarcoma group (85.7%) or those in previous reports. The osteosarcoma group had a tendency toward a worse 5-year metastasis-free survival rate than the chondrosarcoma group (35.4% vs 75.0%, respectively), although the 5-year local recurrence-free survival rate was not significantly different between the 2 groups (75.0% vs 87.5%, respectively). Histologic grade, surgical stage, and chemotherapy affected the oncologic outcomes in univariate analysis, although not a single factor was independent in multivariate analysis. The functional outcomes were not significantly affected by clinical characteristics or surgical methods in patients who had undergone a wide resection including the glenohumeral joint.

Meta-analysis of radiotherapy on triple-negative breast cancer after breast conservation surgery

Objective To systematically evaluate the influence of radiotherapy on triple-negative breast cancer (TNBC) patients treated with breast conservation surgery.Methods Electronic databases including PubMed,Ovid,CBM,VIP and CNKI and seven journals in Chinese (including the Chin J Breast Cancer,Chin J Clin Oncol,Chin J Radiat Oncol,Chin J Cancer,Chin J Oncol,J Pract Oncol and Tumor)were searched.Clinical trials comparing survival rates of patients with TNBC and non TNBC treated with breast conservation surgery and radiotherapy were reviewed.The quality assessment and data extraction were performed by two reviewers independently.RevMan5.1 software developed by the Cochrane collaboration was used for Meta-analysis.The 5-year distant metastasis-free survival (DMFS),overall survival (OS) and local recurrence-free survival (LRFS) rates were the primary end points.Results Five trials including 2345 patients with breast cancer were included in this systematic review.417 patients had TNBC and 1928 patients had non TNBC.Meta-analysis showed that the 5-year DMFS and OS rates of patients with TNBC were lower compared with non TNBC (Z =5.29,P =0.000 and Z =3.35,P =0.001).There was no statistical significant difference in 5-year LRFS rate between patients with TNBC and non TNBC (Z =1.35,P =0.180).Conclusion Radiotherapy provides good local control for patients with TNBC after breast conservation surgery. Key words: Breast neoplasms/surgery; Surgery,breast conservation; Breast neoplasms/radiotherapy; Radiotherapy,convention; Triple negative; Meta analysis

Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer

Identify prognostic factors for survival and patterns of treatment failure after definitive radiochemotherapy for esophageal cancer. Between 2003 and 2006, 143 patients with squamous cell carcinoma and adenocarcinoma of the esophagus were retrospectively reviewed. Median age was 65 years (42-81). Median radiation dose was 62.5 Gy (38-72) with 1.8-2 Gy fraction. Median follow-up was 20.8 months (2.8-92.4). Three and 5-year local recurrence-free survival rates were 58.3% and 50.9%. In univariate analysis, traversable esophageal stricture was a prognostic factor. Three, 5-year locoregional recurrence-free survival rates were 42.4% and 34.9%. In multivariate analysis, traversable esophageal stricture and stage < IIB were independent prognostic factors. Three and 5-year disease-free survival rates were 30.5% and 25.9%. In multivariate analysis, Nutritional Risk Index (NRI) ≥ 97.5 and performance status (PS) = 0 were independent prognostic factors. Median, 3, and 5-year overall survival rates were 22.1 months, 34.4%, and 19.8%. In multivariate analysis, independent prognostic factors were NRI ≥ 97.5 and PS = 0. Median survival times for the NRI classes (no denutrition, moderate and severe denutrition) were 29.5, 19.7, and 12 months (P = 0.0004), respectively. A major impact of baseline NRI was found in terms of survival; it should be included in future prospective trials.

Overexpression of the nuclear factor‐kappa B (p65) in association with local failure in patients with head and neck carcinoma undergong radiotherapy or chemoradiotherapy

The aim of this study was to evaluate nuclear factor-kappa B (NF-κB) expression as a biologic marker to predict local control in patients with head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy or chemoradiotherapy. The mRNA expression levels of the NF-κB family genes were determined with real-time-polymerase chain reaction in 77 patients with HNSCC treated with radiotherapy or chemoradiotherapy. The mRNA NF-κB (p65) expression in pretreatment tumors was significantly related to local control (p = .03). The 5-year local recurrence-free survival rate in patients with low-level NF-κB (p65) expression (n = 42) was 79.9%, and in patients with a high level of expression it was 42.1% (p = .001). In a multivariate analysis, the mRNA NF-κB (p65) expression level was the only variable related to local control of the tumor. Expression of the NF-κB (p65) gene may be a radiosensitivity marker for patients with a HNSCC.

Favorable prognosis in patients with T1a/T1bN0 triple‐negative breast cancers treated with multimodality therapy

The authors evaluated the clinical characteristics, natural history, and outcomes of patients who had ≤1 cm, lymph node-negative, triple-negative breast cancer (TNBC). After excluding patients who had received neoadjuvant therapy, 1022 patients with TNBC who underwent definitive breast surgery during 1999 to 2006 were identified from an institutional database. In total, 194 who had lymph node-negative tumors that measured ≤1 cm comprised the study population. Clinical data were abstracted, and survival outcomes were analyzed. The median follow-up was 73 months (range, 5-143 months). The median age at diagnosis was 55.5 years (range, 27-84 years). Tumor (T) classification was microscopic (T1mic) in 16 patients (8.2%), T1a in 49 patients (25.3%), and T1b in 129 patients (66.5%). Most tumors were poorly differentiated (n = 142; 73%), lacked lymphovascular invasion (n = 170; 87.6%), and were detected by screening (n = 134; 69%). In total, 129 patients (66.5%) underwent breast-conserving surgery, and 65 patients (33.5%) underwent mastectomy. One hundred thirteen patients (58%) received adjuvant chemotherapy, and 123 patients (63%) received whole-breast radiation. The patients who received chemotherapy had more adverse clinical and disease features (younger age, T1b tumor, poor tumor grade; all P < .05). Results from testing for the breast cancer (BRCA) susceptibility gene were available for 49 women: 19 women had BRCA1 mutations, 7 women had BRCA2 mutations, and 23 women had no mutations. For the entire group, the 5-year local recurrence-free survival rate was 95%, and the 5-year distant metastasis-free survival rate was 95%. There was no difference between patients with T1mic/T1a tumors and patients with T1b tumors in the distant recurrence rate (94.5% vs 95.5%, respectively; P = .81) or in the receipt of chemotherapy (95.9% vs 94.5%, respectively; P = .63). Excellent 5-year locoregional and distant control rates were achievable in patients with TNBC who had tumors ≤1.0 cm, 58% of whom received chemotherapy. These results identified a group of patients with TNBC who had favorable outcomes after early detection and multimodality treatment.