5-year Local Recurrence-free Survival Rates Research Articles

Packing with alpha-tricalcium phosphate followed by curettage and phenol-ethanol ablation for appendicular giant cell tumor of bone

Giant cell tumor of bone (GCTB) is an intermediate and locally aggressive bone tumor. Alpha-tricalcium phosphate (alpha-TCP) is an adjustable bone substitute used to fill various sizes of bone cavities after curettage for GCTB. This study aimed to evaluate the surgical outcome of packing with alpha-TCP followed by curettage and phenol-ethanol ablation. We retrospectively reviewed data of 16 patients with GCTB who underwent primary surgery in our institute between January 2009 and April 2021. Data of Campanacci grading system; number of local recurrences and distant metastases; local recurrence-free survival rate using the Kaplan-Meier method; oncological outcomes; and complications after surgery (secondary osteoarthritis and postoperative fracture) were evaluated in this study. Regarding the Campanacci grading system, 2 patients were classified as grade I, 14 as grade II, and none as grade III. The 5-year local recurrence-free survival rate was 77.8% in all cases. Lung metastasis was not detected in this study. Oncological outcomes were: continuous disease free, 13 patients; alive with disease, 3 patients; and no evidence of disease or death of disease, none of the patients. Secondary osteoarthritis after surgery was not detected in the present study. Packing with alpha-TCP followed by curettage and phenol-ethanol ablation for appendicular GCTB may be safe and effective in suppressing the risk of secondary osteoarthritis.

Feasibility of low-dose radiotherapy for patients with stage I/II extranodal NK-/T-cell lymphoma, nasal type achieving complete response after l-asparaginase-containing chemotherapy

PurposeTo assess treatment outcomes in patients with stage I/II extranodal NK-/T-cell lymphoma, nasal type (ENKTCL-NT) and the feasibility of low-dose radiotherapy (RT) for achieving complete response (CR, defined as showing no residual hypermetabolic uptake on positron emission tomography [PET] or no residual lesions on computed tomography [CT]) after l-asparaginase-containing chemotherapy (l-ASP). Materials and methodsBetween 1992 and 2018, 76 patients with early-stage ENKTCL-NT who achieved CR or partial response (PR) after induction chemotherapy received adjuvant RT. RT doses (using biologically equivalent doses in 2 Gy fractions [EQD2]) and rates of local recurrence-free survival (LRFS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and cancer-specific survival (CSS) were determined. ResultsMedian follow-up was 5.1 years (range, 0.5–20.8). The median RT dose was 45 Gy (range, 20–54). The 5-year LRFS, LRRFS, DMFS, PFS, and CSS rates were 82.7 %, 78.2 %, 81.1 %, 68.7 %, and 84.4 %, respectively. CR after induction chemotherapy was notably linked to better survival outcomes across each endpoint. Survival outcomes were not affected either by the administration of l-ASP or EQD2 < 40 Gy in patients displaying CR after l-ASP. Adverse events (AEs) ≥ Grade 2 were significantly reduced with EQD2 < 40 Gy, compared with EQD2 ≥ 40 Gy. ConclusionAchieving CR after chemotherapy was the most predictive factor of survival outcomes in early-stage ENKTCL-NT. Decreasing RT doses in patients with CR after l-ASP appeared to minimize the occurrence of AE without compromising LRR risk; however, longer follow-ups and cautious application are warranted.

Neoadjuvant Chemo-Radiation Using IGRT in Patients with Locally Advanced Gastric Cancer.

The goal of this study was to see how effective and safe neoadjuvant chemoradiation with image-guided IMRT was in patients with locally advanced resectable gastric cancer. Between January 2013 and June 2019, patients with locally advanced (cT3/cT4 or N+) gastric cancer treated with neoadjuvant chemoradiotherapy at PUMCH (Peking Union Medical College Hospital) were retrospectively studied. Using concurrent chemotherapy (Capecitabine alone or XELOX*2 cycles), radiotherapy (IMRT (intensity-modulated radiation therapy) 45 Gy, 25#, 5 weeks) was delivered with IGRT (image-guided radiotherapy) before the start of each weeks therapy to ensure accuracy and repeatability. A total of 95 patients were enrolled in the study, 93 (97.9%) stage cT3/T4 and 85 (89.5%) stage N+. Of these, 85 patients (89.5%) had a tumor located in the upper 1/3 of the stomach, and 93/95 patients (97.9%) completed neoadjuvant chemoradiation, with 80 patients (84.2%) undergoing stomach resection (58 D2 and 22 D1 gastrostomies). Pathology downstaging was found in 68 patients (85.0%), with 66 patients (82.5%) receiving T downstaging and 56 patients (70.0%) receiving N downstaging. There were 11 individuals (13.8%) who had a pathological complete response (PCR). The average period of follow-up was 44.7 months (19–96 months). The 5-year OS (overall survival), LRFS (local recurrence-free survival), and DMFS (distant metastasis free survival) rates of patients were 47.0% (95% CI: 38.6–55.4), 86.55% (95% CI: 79.1–93.99) and 60.71% (95% CI: 51.49–69.93%), respectively. Thirteen (13.7%) patients had grade 3–4 leukopenia, anemia, and thrombocytopenia, while 9 (9.5%) patients had grade 3–4 anemia, and 5 (5.3%) patients had grade 3–4 thrombocytopenia. PCR was found to be a significant predictive factor for OS in multivariate analysis (HR = 11.211, 95% CI: 1.500–83.813, p = 0.024). The method of using IGRT image-guided IMRT (45 Gy, 25 fractions, 5 weeks) combined with concurrent chemotherapy in patients with locally advanced resectable gastric cancer was equally effective when compared to the clinical efficacy of neoadjuvant chemoradiotherapy, with clinical outcomes achieving equal efficacy, with similar PCR rates and high rates of OS, LRFS, and DMFS, as well as good tolerances of concurrent chemoradiotherapy with acceptable side effects.

Selecting lymph node-positive patients for adjuvant therapy after radical prostatectomy and extended pelvic lymphadenectomy: An outcome analysis of 100 node-positive patients managed without adjuvant therapy.

The aim of the study is to evaluate the effect of deferred androgen deprivation therapy on biochemical recurrence (BCR) and other survival parameters in node-positive prostate cancer patients after robot-assisted radical prostatectomy with bilateral extended pelvic lymph node dissection (RARP + EPLND). Of the 453 consecutive RARP procedures performed from 2011 to 2018, 100 patients with no prior use of androgen deprivation therapy were found to be lymph node (LN) positive and were observed, with initiation of salvage treatment at the time of BCR only. Patients were divided into 1 or 2 LNs (67)-and more than 2 LNs (33)-positive groups to assess survival outcomes. At a median follow-up of 21 months (1-70 months), the LN group (p < 0.000), preoperative prostate-specific antigen (PSA, p = 0.013), tumor volume (TV, p = 0.031), and LND (p = 0.004) were significantly associated with BCR. In multivariate analysis, only the LN group (p = 0.035) and PSA level (p = 0.026) were statistically significant. The estimated BCR-free survival rates in the 1/2 LN group were 37.6% (27%-52.2%), 26.5% (16.8%-41.7%), and 19.9% (9.6%-41.0%) at 1, 3, and 5 years, respectively, with a hazard of developing BCR of 0.462 (0.225-0.948) compared with the more than 2 LN-positive group. Estimated 5-year overall survival, cancer-specific, metastasis-free, and local recurrence-free survival rates were 88.4% (73.1%-100%), 89.5% (74%-100%), 65.1% (46.0%-92.1%), and 94.8% (87.2%-100.0%), respectively, for which none of the factors were significant. Based on cutoff values for PSA, TV, and LND of 30 ng/mL, 30%, and 10%, respectively, the 1/2 LN group was substratified, wherein the median BCR-free survival for the low- and intermediate-risk groups was 40 and 12 months, respectively. Nearly one fourth and one fifth of 1/2 node-positive patients were BCR-free at 3 and 5 years after RARP + EPLND. Further substratification using PSA, TV, and LN density may help in providing individualized care regarding the initiation of adjuvant therapy.

Predictors of local recurrence of renal cell cancer. Our experience

Risk factors for renal cell cancer (RCC) recurrence, including its local form, include stage and high Fuhrman grading system score, regional lymph node involvement, microvascular invasion, tumor necrosis, positive surgical margin, and sarcomatoid or rhabdoid tumor differentiation. Objective. The study analyzes data from Moscow Research Oncological Institute named by PA Herzen to determine the predictors of local recurrence of kidney cancer based on the data from surgically treated patients with local recurrent RCC. Material and methods. We analyzed retrospectively data from 87 patients who were divided into 2 groups: 1-st, patients with detected local recurrence of kidney cancer (n=43), and 2-nd, control group (n=44). The following predictors were evaluated: tumor size, tumor histotype, tumor stage, Fuhrman grading system, surgical margin status, tumor necrosis, sarcomatoid and rhabdoid changes, microvascular invasion, hemorrhage and invasion of collecting system components (CSS), renal capsule, and perirenal cellular tissue and primary treatment. Results. The risk of local recurrence was higher in the primary tumor, over 40 mm in diameter (OR=5.8, p&lt;0.001), as well as microvascular invasion and focal hemorrhage (OR=15.1, p=0.001 and OR=3.3, p=0.008, respectively). Both univariate and multivariate analyses showed a negative effect on the risk of local RCC recurrence only for tumor necrosis (OR=15.4, p&lt;0.001 and OR=53.6, p=0.002, respectively) and high Fuhrman grade (OR=10.9, p=0.042 and OR=5.7, p=0.032, respectively). The most significant predictors of local renal cancer recurrence are tumor necrosis (p&lt;0.001), microvascular invasion (p=0.019), positive surgical margin (p=0.009), and high Fuhrman grade (p=0.04). High Fuhrman grade (3–4) of malignancy (HR=1.9, p=0.042), tumor diameter (HR=1.0, p=0.054), positive surgical margin (HR=3.5, p=0.001), and tumor necrosis (HR=2.3, p=0.029) were found to be the most significant factors influencing 5-year local recurrence-free survival rate. Conclusion. The course of renal cell cancer is determined by multiple interrelated and independent prognostic factors.

Overview of adjuvant radiotherapy on survival, failure pattern and toxicity in stage I to II endometrial carcinoma: a long-term multi-institutional analysis in China

BackgroundThis research aimed to provide an overview of the impact of adjuvant vaginal brachytherapy (VBT) and external beam pelvic radiotherapy (EBRT) with or without VBT on survival in stage I to II EC patients in China from a long-term multi-institutional analysis.MethodsWe retrospectively analyzed stage I to II EC patients from 13 institutions treated between 2003 and 2015. All patients underwent surgical staging and received adjuvant RT. Patients were divided into groups of low-risk (LR), intermediate-risk (IR), high-intermediate-risk (HIR) and high-risk (HR). Survival statistics, failure pattern, and toxicity of different radiation modalities in different risk groups were analyzed.ResultsA total of 1048 patients were included. HR disease represented 27.6%, HIR 17.7%, IR 27.7% and LR 27.1%, respectively. Endometrioid adenocarcinoma (EAC) and non-endometrioid carcinoma (NEC) accounted for 92.8 and 7.2%. A total of 474 patients received VBT alone and 574 patients received EBRT with or without VBT.As for EAC patients, the 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rate was: 94.6, 90.4, 93.0 and 91.6%, respectively. For LR patients, EBRT (with or without VBT) seemed to be a risk factor. With the higher risk category, the survival benefit of EBRT gradually became remarkable. EBRT (with or without VBT) significantly increased DFS, LRFS and DMFS compared to VBT alone in the HR group (p < 0.05). Distant metastasis was the main failure pattern for all risk groups. As for NEC patients, the 5-year OS, DFS, LRFS and DMFS rate was: 93.4, 87.2, 91.7 and 89.3%, respectively. As for toxicity, EBRT (with or without VBT) significantly increased the incidence of grade 1–2 gastrointestinal, urinary, and hematological toxicity.ConclusionsFor stage I to II EC patients, EAC accounted for the majority and had better prognosis than NEC. For EAC patients, VBT alone resulted in comparable survival to EBRT in the LR, IR and HIR groups, while EBRT significantly increased survival in the HR group. EBRT had higher rate of toxicity than VBT.

Endoscopic resection as an independent predictive factor of local control in patients with T1bN0M0 esophageal squamous cell carcinoma treated with chemoradiotherapy: a retrospective study

BackgroundAlthough chemoradiotherapy (CRT) is one of the curative treatments for thoracic esophageal squamous cell carcinoma (ESCC) with submucosal invasion, the risk of local recurrence after CRT remains a clinical problem. This retrospective study aimed to analyze the predictive factors for local recurrence after CRT.MethodsNinety-one patients with clinical or pathological (c/p) T1bN0M0 thoracic ESCC who underwent CRT from 2004 to 2017 in our institution were analyzed retrospectively. Sixty-three patients were diagnosed with pathological T1b after undergoing initial endoscopic resection (ER) and treated with additional CRT; meanwhile, 28 patients were clinically diagnosed with T1b and underwent definitive CRT. We investigated the predictors of disease–specific survival (DSS) and local recurrence–free survival (LRFS) by performing univariate and multivariate analyses.ResultsThe median observation period was 59.8 months. The 5-year DSS and LRFS rates were 84.3% (95% confidence interval [CI]: 76.1–92.5) and 87.1% (95% CI: 79.1–95.1), respectively. The multivariate analysis revealed no significant predictors associated with DSS. On the contrary, ER (hazard ratio [HR]: 0.11, 95% CI: 0.02–0.48, p = 0.003) and tumor length (HR: 6.78, 95% CI: 1.28–36.05, p = 0.025) were recognized as independent predictive factors for LRFS. During follow-up, recurrence was observed in 18 patients (19.8%). With regard to the patterns of relapse, local recurrence was the most common in 11 patients, and salvage ER was performed in 9 of 11 patients.ConclusionsER and tumor length were independent predictive factors for LRFS. Our study suggested that performance of ER prior to CRT improved the local control in patients with c/p T1bN0M0 ESCC. In addition, most of the patients who experienced local recurrence were treated with salvage ER, which contributed to preserving the organs.

Clinical Significance and Risk Factors of Local Recurrence in Synovial Sarcoma: A Retrospective Analysis of 171 Cases.

Objective: To investigate risk factors of local recurrence of synovial sarcoma and the impact of local recurrence on survival.Methods: We retrospectively reviewed clinical data of patients with II to IIIB (AJCC8) synovial sarcoma who underwent surgery at our center between March 2005 and December 2016. Data relating clinicopathological factors, treatment and prognosis were collected. The impact of local recurrence on overall survival (OS), local recurrence-free survival (LRFS), and distant relapse-free survival (DRFS) were analyzed. The prognostic factors associated with local recurrence were also analyzed using Kaplan-Meier Curves and Cox regression analysis.Results: A total of 171 patients were included in this analysis. After a median follow-up of 48 months, 66 patients (38.6%) experienced local recurrence. The 5-year OS, LRFS, and DRFS rates of patients with local recurrence were 37.6, 6.1, and 24.1%, respectively. Multivariate analysis showed that larger initial tumors, multiple recurrences, positive resection margins, marginal resection, and lack of adjuvant therapy were associated with higher local recurrence.Conclusion: Local recurrence of synovial sarcoma is associated with distant metastasis and poor survival. Chemoradiation improves the prognosis of patients with local recurrence, in particular those for which recurrence occurs shortly after initial treatment.

Treatments and Outcomes of Paget’s Sarcoma: Literature Review and Cohort Study

Background Sarcomatous transformation of Paget's disease of bone is a very rare, highly fatal complication. Isolated cohort studies have characterized these findings many times. Still, little has been established concerning the effects of patient and tumor characteristics and treatment type on the oncologic prognosis when defined as local recurrence-free, metastatic disease-free, disease-specific, and overall survival. Questions/Purposes (1) What are the oncologic and clinical characteristics of patients who develop and are diagnosed with Paget’s sarcoma? (2) What are the outcomes when examining variables such as sarcoma type, presentation at diagnosis and treatment in Paget’s sarcoma patients? (3) How have treatment and oncologic prognosis changed in recent decades? Methods A literature review of (n=1,001) Paget’s sarcoma cases, retrieved from previous studies and public databases, and a retrospective analysis on a cohort of all adult patients with Paget’s disease of bone (n=1,872) admitted to two large academic centers between 1979 and 2019 was performed. Medical records and the Social Security Index assessed patient survival. Surgical reports were reviewed to determine margin characteristics and intervention type. Incidences of metastasis and recurrence were based on patient notes and biopsy report review. This two-part study describes the effects of patient and tumor characteristics and treatment type on oncologic prognosis. Results Pooled data from our literature review demonstrated a 5-year overall survival rate of 7.9%, in which patient age was significantly associated with worse survival prognosis (p=0.026). Treatment with surgery and adjuvant therapy was significantly associated with improved overall survival (p=0.006) compared to surgery alone or non-surgical treatment. Examining overall trends historically, neither presenting age nor survival appear to have a significant association with the year of diagnosis, demonstrating an R2 of 0.003 (p=0.48) for age at diagnosis and 0.023 (p=0.39) for survival from 1960 and 2016. From our retrospective cohort study, 32 out of 1,872 Paget’s patients were determined to have Paget’s sarcoma, indicating a prevalence of 1.7% for our database. The 5-year local recurrence-free, metastatic disease-free, disease-specific, and overall survival rates were 12.5%, 15.6%, 12.5%, and 18.8%, respectively. Patient age was significantly associated with worse survival outcomes (p=0.005) in our institutions’ patient registry. Conclusion Including over 1,000 Paget's sarcoma patients in our study greatly strengthens the associations between treatment type and survival. While patients undergoing multimodal therapy reported the greatest longevity, concerns remain for mobility and quality of life. Our cohort study indicates that few factors can effectively predict oncologic outcomes for Paget's sarcoma patients. Age is the strongest underlying factor for poor prognosis. Patient outcomes have not changed significantly in the last 80 years; our literature and cohort study highlights the need for increased clinician awareness and improved treatment modalities for Paget's sarcoma. Level of Evidence Level III, retrospective comparative study and review of other level III studies.

Outcomes in Exceptionally Poor-Responders to Neoadjuvant Chemotherapy

<h3>Purpose/Objective(s)</h3> The use of neoadjuvant chemotherapy (NAC) in patients with operable breast cancer allows for assessment of treatment response, and subsequent tailoring of adjuvant therapy. While there is robust evidence demonstrating worse prognosis with residual disease versus path CR after NAC, there is little data regarding outcomes among patients with a heavy residual tumor burden after NAC. We report outcomes in patients who have exceptionally poor responses to NAC—those with > 9 nodes after NAC or with 5 cm or more of residual disease in the breast. <h3>Materials/Methods</h3> Between 06/2014 and 04/2020, 1511 patients received NAC followed by surgery at our institution. Poor responders, defined as those with positive nodes or residual tumor in the breast, were identified for analysis. Those with 1-3 positive nodes after NAC were used as a comparison cohort. Recurrence and survival outcomes were compared based on residual disease burden after NAC. Clinicopathologic parameters were summarized with descriptive statistics. Overall survival and recurrence-free survival estimates were calculated using Kaplan Meier methodology. <h3>Results</h3> Among 517 poor-responders, 315 patients had 1-3 positive nodes (N1a), 108 had 4-9 positive nodes (N2a), and 62 had > 9 positive nodes (high-volume residual, HVR); 32 patients with > 5cm of residual tumor in the breast were categorized as HVR. With a median follow-up of 39 months (IQR 27-50), the 5-year overall survival rate was 90% among N1a, 72% among N2a, and 78% among HVR patients (<i>P</i> = 0.003). The 5-year distant recurrence-free survival and local recurrence-free survival rates were 87%/87% among N1a vs. 59%/71% among N2a vs. 68%/75% among HVR (<i>P</i> < 0.001 and <i>P</i> = 0.009), respectively. 5-year local-regional and distant recurrence cumulative incidence rates, stratified by residual disease burden and by breast cancer subtype, are shown in Table 1. <h3>Conclusion</h3> Our work confirms that patients with high-volume residual are at high risk for LR and distant recurrence as well as death, despite best available standard-of-care treatment. ypN2a patients appear to perform as bad as HVR patients in terms of DM and death, but better in terms of local-regional recurrence. Triple-negative patients with residual disease had high rates of recurrence and death compared to other subtypes. Treatment intensification efforts are urgently needed.

The Role of Endoscopic Resection in Long-Term Results of Chemoradiotherapy for T1bN0M0 Thoracic Esophageal Squamous Cell Carcinoma

<h3>Purpose/Objective(s)</h3> An analysis of long-term treatment results of chemoradiotherapy (CRT) for T1bN0M0 thoracic esophageal squamous cell carcinoma (TESCC) at our institution suggested that the appropriate combination of endoscopic resection (ER) with CRT may lead to improved local control and organ-conserving survival (OCS). Here, we investigated the role of ER in the long-term outcomes of CRT for T1bN0M0 TESCC. <h3>Materials/Methods</h3> We retrospectively analyzed the cases of 91 patients with T1bN0M0 (UICC, 7th) TESCC treated with CRT from 2004 to 2017 at a single facility. There were 63 patients who were pathologically diagnosed with T1b based on ER results and then treated with additional CRT (ER+CRT group) and 28 patients who were diagnosed clinically as having T1b without ER and underwent definitive CRT (dCRT group). We determined the OCS and adverse events and compared the rates of local recurrence-free survival (LRFS) and overall survival (OS) between the two groups. <h3>Results</h3> The median observation period was 61 months. The 5-year OS rate of the ER+CRT group was 78.0% (95% CI: 67.4–88.6) and that of the dCRT group was significantly lower at 63.5% (95% CI: 43.9–83.1) (<i>P</i> = 0.312). However, the 5-year LRFS rate of the ER+CRT group at 93.2% (95% CI: 85.6–100) was significantly higher than that of the dCRT group at 74.9% (95% CI: 56.9–92.9) (<i>P</i> < 0.001). Regarding the relapse pattern, intra-esophageal recurrence was the most common, observed in 11 patients (ER+CRT: 3, dCRT: 8), and salvage ER was performed in nine of the 11 patients. The 5-year OCS rate of all patients including who underwent salvage treatment was 72.0% (95% CI: 62.0–82.0). The most notable late adverse event (Grade 3 or higher) was pneumonitis in three patients. <h3>Conclusion</h3> The organ-conserving treatment for TESCC with submucosal invasion has been mainly CRT, but the problem of local recurrence after CRT (compared to esophagectomy) remains. Our long-term results suggest that ER improved the local control and enabled salvage treatment with a minimally invasive procedure. The combination of ER with CRT provides long-term survival that is comparable to that of esophagectomy, in addition to a high organ conservation rate.

Long-Term Follow-Up of Patients Receiving Neoadjuvant Treatment Modalties for Soft Tissue Sarcomas of the Extremities.

Simple SummaryNeoadjuvant radiotherapy has gained popularity as a treatment strategy for locally advanced soft tissue sarcoma of the extremities. However, little is yet known about the benefits and risks of adding preoperative chemotherapy. High-risk patients with soft tissue sarcomas of the extremities are treated with a combined preoperative radiochemotherapy at our institution. This study reports an analysis of patients treated either with primary surgery or with preoperative radiochemotherapy, followed by surgery. This kind of multimodal therapy leads to excellent oncological outcomes and is associated with low rates of severe postoperative complications in highly specialized centers.Background: Neoadjuvant treatment modalities in soft tissue sarcoma (STS) of the extremities have become more popular in recent years, but because of the rarity and heterogeneity of STS, there are yet few studies on the long-term impact of neoadjuvant treatment modalities, especially in terms of neoadjuvant radiochemotherapy. Methods: The study enrolled 136 patients with primary STS of the extremities who underwent surgery with curative intent or neoadjuvant therapy, followed by surgery in a 15-year period. Neoadjuvant treatment consisted of radiotherapy (RT) with 60 Gy and in most cases simultaneous chemotherapy (CTx) with ifosfamide (1.5 g/m2/d, d1–5, q28) and doxorubicine (50 mg/m2/d, d3, q28). We investigated the clinical, (post)-operative and histopathological data and the oncological follow-up as well. The median follow-up period was 82 months (range 6–202). Results: A total of 136 patients (M:F = 73:63) with a mean age of 62 years (range; 21–93) was observed. Seventy-four patients (54.4%) received neoadjuvant therapy (NT), 62 patients (45.6%) received primary surgery (PS). When receiving NT, patients with high-risk STS had a lower risk to develop distant metastasis (p = 0.025). Age, histological type, tumor size and surgical margins (R0 vs. R1) had no influence on any survival rates. There was an association between NT and the occurrence of postoperative complications (p = 0.001). The 5-year local recurrence free survival (LRFS), metastasis free survival (MFS), disease free survival (DFS) and overall survival (OS) rate of the whole cohort was 89.9%, 77.0%, 70.6% and 72.6%; whereas the 5-year LRFS, MFS, DFS and OS rate was 90.5%, 67.2%, 64.1% and 62.8% for the NT group and 89.5%, 88.3%. 78.4% and 83.8% for the PS group. Conclusions: Multimodal treatment strategies in patients with STS of extremities lead to excellent oncological outcomes. Patients with high-risk STS had a significantly better MFS when receiving NT than patients with low-risk STS. NT was associated with a higher probability of postoperative but well-manageable complications.

Dysfunction of apoptosis and autophagy correlates with local recurrence in esophageal squamous cell carcinoma after definitive chemoradiation

ObjectiveDefinitive chemoradiotherapy (dCRT) is one of the standard treatments for esophageal squamous cell carcinoma (ESCC), but local recurrence is the main cause of treatment failure. The changes in apoptosis and autophagy in recurrent tumors of patients with ESCC following dCRT have been poorly estimated. Thus, this study aimed to investigate the expressions of key regulators of apoptosis and autophagy in matched paired samples of primary and recurrent ESCC.MethodsThe medical records of patients with locally advanced ESCC who developed local recurrence after dCRT were reviewed, and the expression profiling of apoptosis-related genes, cell apoptosis, autophagy and autophagy-related proteins were detected in normal esophageal squamous epithelium and paired samples of primary and recurrent ESCC.ResultsA total of 126 patients were enrolled, and 52.4% of them had stage III disease. The 1-, 3- and 5-year local recurrence-free survival (LRFS) rates were 54.8, 19.8 and 14.3%, respectively, with a median LRFS of 13.0 months. Patients with T2 tumor or stage II disease showed a significantly prolonged LRFS compared with that of patients with T3-4 tumor or stage III disease. The Apoptotic Machinery key genes expression profiling identified 5 upregulated and 7 downregulated apoptosis-related genes in recurrent tumors compared with their expression levels in the matched primary ESCC tumors. High expression of CD40, TRAF4 and BCL2A1, and low expression of CARD6 and TNFRSF21 were associated with increased risk of early local recurrence after dCRT. No differences in apoptotic index between primary and recurrent samples were detected. However, typical morphological features of autophagosomes and elevated LC3-II protein expression were detected in recurrent tumor samples, and positive LC3-II expression was correlated with increased risk of early local recurrence.ConclusionOur findings indicated that apoptosis and autophagy dysfunction correlated with early local recurrence in patients with locally advanced ESCC receiving dCRT. Further studies are necessary to understand the biology of tumor recurrence in esophageal cancer.

Loosening Neuro-Optic Structures Dosimetric Constraints Provides High 5-Year LocalRecurrence-FreeSurvival With Acceptable Toxicity in T4 Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy.

ObjectiveWhether the original dosimetric constraints of neuro-optic structures (NOS) are appropriate for patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiotherapy (IMRT) remains controversial. The present study compared the survival rates and radiation-induced optic neuropathy (RION) occurrence between T4 NPC patients whose NOS were irradiated with a near maximum dose received by 2% of the volume (D2%) >55 Gy and ≤55 Gy. Moreover, the NOS dosimetric parameters and their correlation with RION occurrence were also evaluated.MethodsIn this retrospective study, 256 T4 NPC patients treated with IMRT between May 2009 and December 2013 were included. Patient characteristics, survival rates, dosimetric parameters, and RION incidence were compared between the D2% ≤55 Gy and D2% >55 Gy groups.ResultsThe median follow-up durations were 87 and 83 months for patients in the D2% >55 Gy and D2% ≤55 Gy groups, respectively. The 5-year local recurrence-free survival rates were 92.0 and 84.0% in the D2% >55 Gy and D2% ≤55 Gy groups (P = 0.043), respectively. There was no significant difference in the 5-year overall survival (OS) between both groups (D2% >55 Gy, 81.6%; D2% ≤55 Gy, 79.4%; P = 0.586). No patients developed severe RION (Grades 3–5), and there was no significant difference (P = 0.958) in the incidence of RION between the two groups. The maximum dose of NOS significantly affected the RION incidence, with a cutoff point of 70.77 Gy.ConclusionAppropriately loosening NOS dosimetric constraints in order to ensure a more sufficient dose to the target volume can provide a better 5-year local recurrence-free survival and acceptable neuro-optic toxicity in T4 NPC patients undergoing IMRT.

Computed tomography-guided cryoablation for adrenal metastases secondary to lung cancer

The objective of the study was to assess the clinical efficacy of computed tomography (CT)-guided cryoablation as a means to treat adrenal metastasis (AM) secondary to lung cancer. This study was a single-center retrospective study that analyzed 39 consecutive patients with AM secondary to lung cancer who underwent CT-guided cryoablation in our center. The rates of complete ablation, local recurrence, local recurrence-free survival (RFS), and overall survival (OS) were analyzed. The rates of primary and secondary complete ablation were 94.9% and 100%, respectively, and none of the patients suffered from a hypertensive crisis associated with the treatment. Over the follow-up period, 20.5% of the patients experienced local recurrence, and the median RFS duration was 26 months. The cumulative 1-, 3-, and 5-year local RFS rates in this study were 84.6%, 51.3%, and 5.9%, respectively. Extra-adrenal gland metastases were detected in five patients. Over the course of follow-up, 26 patients died. The mean OS duration was 34 months with cumulative 1-, 3-, and 5-year OS rates of 89.7%, 53.4%, and 8.3%, respectively. Advanced age (P = 0.001), primary adenocarcinoma (P = 0.006), other primary lung cancers (P = 0.038), and primary Stage III lung cancers (P = 0.007) were all found to be independent predictive factors of poor OS in these patients. CT-guided cryoablation can be safely and effectively used to control AM secondary to lung cancer, and patients with AM secondary to lung squamous cell carcinoma may be best suited for this form of treatment.

Operabilni invazivni karcinom dojke u eri konzervativne kirurgije; retrospektivna analiza 5-godišnjeg preživljenja i kontrole bolesti

Background: Following breast cancer treatment recommendations, the conservative approach is accepted and highly respected in the Clinical Hospital Center (CHC) Rijeka. However, we have found that institutional follow-up data are lacking. This retrospective analysis aims to update institutional data on survival and disease control rates. Methods: From 2011 till 2014, 915 breast cancer patients underwent surgery at CHC Rijeka, and 615 were included in this analysis. The Institutional Ethics Committee approved the analysis. Results: All patients were female, and the average age was 59 years. In the 5-year postoperative period, local, regional, and distant recurrence-free survival rates and overall survival and disease-free survival were calculated. All rates negatively correlate with a higher T and N status and a higher stage of the disease. The analysis has also demonstrated that in the pT1-3 pN0-1 subgroup, sentinel lymph node biopsy (SLNB) was not inferior to axillary lymph node dissection (ALND) in terms of locoregional control of disease and overall survival. Conclusion: Besides updating institutional data, the analysis confirmed that overall survival and locoregional control of the disease in the upfront-surgery patients are similar between pN0 and pN1 subpopulations and between pN2 and pN3, but statistically significantly different between pN0-1 and pN2-3. Currently ongoing, prospective observational multicenter clinical trial aims to translate the significance of these results into the neoadjuvant era.

Reconstruction after periacetabular tumor resection with Lumic® endoprosthesis: What are the midterm results?

This study aimed to analyze the midterm outcomes of LUMiC® endoprosthetic reconstruction following periacetabular resection of primary bone sarcomas and carcinoma metastases. We retrospectively reviewed the charts of 21 patients (11 male [52.3%], 10 female [47.6%]; mean age 47 ± 16 years) for whom a LUMiC® endoprosthesis (Implantcast) was used to reconstruct a periacetabular defect after internal hemipelvectomy. The tumor was pathologically diagnosed as Ewing's sarcoma in six (28.5%), chondrosarcoma in 10 (47.6%), and bone metastasis from carcinoma in five (23.8%) patients. The median follow-up of patients was 57.8 months (95% confidence interval: 51.9-63.7). The implant survival rate at 1, 2, and 5 years were 95.2%, 85.7%, and 80.9%, respectively. The overall complication rate was 33.3% (n = 7). Four (19%) complications resulted in reconstruction failure. Total reoperation rate was 28.5% (n = 6). The complications were soft tissue failure/dislocation in two patients, aseptic loosening in one, infection in two, and local recurrence in two. At the time of study, seven patients were alive with no evidence of disease, seven were alive with disease, and seven died of disease. The 5-year overall survival rate and local recurrence-free survival rates were 67% and 76%, respectively. The median Musculoskeletal Tumor Society score at final follow-up was 70% (range: 50%-86.6%). We conclude that LUMiC® endoprosthesis provides good functional outcomes and a durable reconstruct. Even though this reconstruction method presents some complications, it provides a stable pelvis in the management of periacetabular malignant tumors.

Clinical Outcome of Type C Thymic Epithelial Tumor: The Results of Multimodality Treatments Combined with Radiotherapy

Thymic epithelial tumor (TET) is a rare intrathoracic malignancy that usually follows an aggressive clinical course. Owing to the paucity of clinical data, treatment strategy varies among institutions and the role of radiotherapy (RT) in the treatment of type C TET is not yet definitely determined. In addition, no previous studies have addressed the clinical benefit of intensity-modulated radiotherapy (IMRT) compared to three-dimensional conformal radiotherapy (3D-CRT) in the treatment of type C TET. The aim of this study was to report the clinical outcomes of multimodality treatment of type C TET. The treatment outcomes of IMRT compared to 3D-CRT was also analyzed. Ninety-two patients diagnosed with type C TET who were treated between November 2006 and December 2018 were included for analysis. Among these patients, patients who were not treated with RT or who received RT to lesions other than thymus were excluded (n = 20). Thus, a total of seventy-two patients with stage I to IV type C TET treated with RT combined with surgery and/or chemotherapy were analyzed. Regional nodal areas were electively covered only when involved at initial diagnosis. 3D-CRT and IMRT were used in 41 (41.7%) and 30 (56.9%) patients, respectively. With a median follow-up period of 25.9 months (3.7-137.3 months), the 5-year rates of overall survival, progression-free survival, local recurrence-free survival rates were 73.3%, 52.9%, 94.9%, respectively, which were better than those of historical reports. During the follow-up period, 15 deaths and 25 recurrences were observed. Regarding RT field, no isolated infield or marginal failure were observed. Outfield failure was the most common pattern of failure (n = 20, 80%). No failure at the primary tumor site was observed. The failure patterns were also analyzed according to International Thymic Malignancy Interest Group (ITMIG) guidelines. Distant failure was most common (n = 16, 64%), followed by regional failure (n = 6, 24%). As for the seven patients who were irradiated including the involved supraclavicular area, no failure within the supraclavicular area occurred. In terms of toxicity, patients treated with IMRT developed less overall toxicity compared to patients treated with 3D-CRT (31.7% vs. 76.7%, p = .001). In addition, there was a tendency towards lower mean lung dose in patients treated with IMRT compared to 3D-CRT (12.1 Gy vs. 14.5 Gy, p = .072). The 5-year overall survival and progression-free survival rates in our study was favorable compared to previous studies. In addition, an excellent 5-year local recurrence-free survival rate was achieved by RT. Our experience suggests that RT should be incorporated into the multidisciplinary management of type C TET to enhance oncologic outcomes, even in stage IVB patients with regional node metastases. In addition, RT with advanced precision technique such as SIB-IMRT reduced treatment related toxicity while maintaining good local control.

Is There A Role of Post-Mastectomy Radiotherapy for T1-2 Breast Cancer Patients with Node-Positive Pathology who Develop Pathologic Negative Lymph Nodes after Neoadjuvant Chemotherapy and Mastectomy?

To assess the benefit of post-mastectomy radiotherapy (PMRT) in breast cancer (BC) patients with T1-2N1M0 who developed pathologic negative lymph nodes (pN0) after underwent neoadjuvant chemotherapy (NAC) and mastectomy. Patients with T1-2 tumors and positive lymph node(s) who became pN0 after NAC and mastectomy were screened from our prospectively maintained database. The primary endpoint was recurrence-free survival (RFS), and the secondary endpoints included local recurrence-free survival (LRFS) and overall survival (OS). Propensity-score matching (PSM) was conducted for the comparison between PMRT and non-PMRT groups. Of the 142 eligible patients, 110 (77.5%) received PMRT and 32 (22.5%) did not. A median follow-up time was 72 months. Univariate analyses showed that 5-year RFS, LRFS, and OS rates were 88.7%, 94.5%, and 96.1% with PMRT and 72.4%, 90.1%, and 95.0% without PMRT, respectively, (P = 0.028; P = 0.151; P = 0.971). Multivariate analyses established PMRT as a significant prognostic factor for RFS rate (HR, 0.411; 95%CI, 0.175-0.968; P = 0.042). After a PSM analysis of 96 patients (64 in the PMRT group vs. 32 in the non-PMRT group), PMRT remained significant with improved RFS in univariate and multivariate analyses (with 5-year RFS rates of 90.1% vs. 72.7%, P = 0.016; HR, 0.321, 95%CI, 0.114-0.904, P = 0.031). In the subgroup of 48 (33.8%) patients with pathologic complete response (pCR) after NAC, PMRT did not affect RFS (HR, 0.226; 95%CI, 0.034-1.500; P = 0.123). PMRT may be beneficial for the pT1-2N1M0 patients with pN0 after NAC. Patients with pCR status might consider omitting the PMRT. Prospective studies are needed to further assess the effect of PMRT in this specific patient population.

A novel nomogram for predicting local recurrence-free survival after surgical resection for retroperitoneal liposarcoma from a Chinese tertiary cancer center.

Local recurrence is the most difficult postoperative challenge and the leading cause of death in patients with retroperitoneal liposarcoma (RLPS). We aimed to establish a postoperative nomogram exclusively focused on RLPS for predicting local recurrence-free survival (LRFS). A cohort of 124 patients after surgical resection with curative intent in the Peking University Cancer Hospital Sarcoma Center were included in the study. Demographic, clinicopathologic, and treatment variables were analyzed using the Cox regression model. Significant clinically relevant variables in multivariable analysis were incorporated into the RLPS-specific nomogram. The discriminative ability and predictive accuracy of the nomogram were assessed by calculating the concordance index and drawing a calibration plot. At a median follow-up of 26.5 (interquartile range 10.9-39.4) months, 71 patients had recurrent disease. The 3-year and 5-year LRFS rates were 35.6% (95% confidence interval, 27.0-46.9%) and 28.2% (95% CI 15.8-38.6%), respectively. Multivariate analysis identified the French Federation of Cancer Centers Sarcoma Group (FNCLCC) grade and completeness of resection as independent predictors of LRFS. Variables included in our nomogram were: presentation status, multifocality, completeness of resection, histologic subtypes, and FNCLCC grade. The concordance index of our nomogram was 0.732 (95% CI 0.667-0.797) and the calibration plot was excellent. Our novel nomogram for patients with resected RLPS could improve recurrence risk stratification to explore molecular analysis associated with recurrence.