Actuarial Disease-free Survival Rates Research Articles

Outcomes of Locally Advanced Rectal Cancer Patients Treated with Total Neoadjuvant Treatment: A Meta-Anaysis of Randomized Controlled Trials

Background & AimsDetermining outcomes using the total neoadjuvant therapy (TNT) in patients with local advanced rectal cancer is important for stratifying patients according to expected outcomes in future studies in the era of treatment combination. The present meta-analysis estimated the pathological complete response, disease-free survival, and overall survival probabilities of rectal cancer patients and identified predictors of outcomes. MethodsStudies reporting pathological complete response rate and time-dependent outcomes (progression or death) after total neoadjuvant treatment of locally advanced rectal cancer (LARC) were identified in MEDLINE through January 2022. Three independent observers extracted data on patient populations and outcomes and combined the data using a distribution-free summary survival curve. The primary outcomes were actuarial probabilities of recurrence and survival. ResultsFourteen RCTs, including 18 TNT arms, met the inclusion criteria. The pooled estimate of pathological complete response (pCR) probability was 23.6%, with moderate heterogeneity between studies. The pooled estimates of actuarial disease-free survival rate were 70.6% at 3 years and 65.4% at 5 years. The pooled estimates of actuarial survival rates were 93% at 3 years and 81.6% at 5 years. In both these outcomes, heterogeneity between studies was highly significant. ConclusionThis meta-analysis showed that Total Neoadjuvant Therapy is an optimal approach for LARC patients. The results provide a useful benchmark for future comparisons of the benefits of combinations of other drug families as target therapies or immunotherapies.

International Intraductal Papillary Mucinous Neoplasms Registry: Long-Term Results Based on the New Guidelines.

The aim of this study was to analyze the outcomes of a long-term intraductal papillary mucinous neoplasm (IPMN) registry and evaluate new guidelines. A prospectively maintained IPMN registry involving 6 centers in Europe and the United States was used to collect the data. Patients with more than 1-year follow-up and no malignancy diagnosed within the first 3 months of surveillance were included. From 1999 to 2014, 620 patients were included. The median follow-up time was 3 years. Thirty-seven (6%) patients developed malignancy with a median time from IPMN diagnosis to malignancy of 10.3 months. The 1-, 5-, and 10-year actuarial rates of disease-free survival were 97%, 93%, and 92% respectively. Four hundred thirty-one patients met criteria for low-risk branch duct IPMN consisting of cyst size less than 3 cm, with no solid component or main duct dilation. Eight malignancies were diagnosed in this subgroup, all of them within the first 5 years. From this subcohort, 112 patients had a follow-up time of more than 5 years, and no malignancy was diagnosed. In IPMN lesions with low-risk features at baseline, the risk of progression to malignancy after the first 5 years of follow-up was minimal. Furthermore, the main cyst characteristics remained unchanged during their surveillance.

Anal cancer FDG-PET standard uptake value: correlation with tumor characteristics, treatment response and survival.

The present work studies the correlation of (18) F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) standardized uptake value (SUV) with tumor characteristics, clinical response and prognosis in a series of anal canal cancer patients treated with chemo-radiotherapy. Fifty-five patients were included in the present analysis. PET maximum SUV (SUVmax) of primary tumor was calculated for each patient. The correlation with clinical parameters, tumor response and survival data were analyzed. SUVmax significantly correlated with T-stage (p = 0.01) and histology (p = 0.03). Median SUVmax was higher for lesions with partial response (PR, 21/55, 38%) than for lesions with complete response (CR, 34/55, 62%) but without statistical significance (p = 0.17). The actuarial disease-free survival (DFS) and overall survival (OS) rates were 53.0 and 77.8% at 2 years and 41.3 and 58.6% at 5 years, respectively. Median SUVmax did not statistically correlate with clinical response or survival. CR and T1-T2 stage were statistically significant prognostic factors for disease-free survival (p < 0.0001 and p = 0.02, respectively) and CR was significant also for overall survival (p < 0.0001). Our data suggest that pre-treatment FDG-PET/CT SUVmax cannot directly predict tumor response and survival, but it is strongly associated with tumor characteristics such as primary tumor stage and histology, being the first one of the most important and validated prognostic factors for anal cancer.

Oncologic Outcomes of Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer: A Single-institution Experience

This study reports the outcomes of patients with locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by surgery in a local population of Singapore. The records of 85 patients who underwent neoadjuvant chemoradiation for locally advanced rectal cancer followed by surgery at the Tan Tock Seng Hospital (TTSH) between November 2002 and January 2012 were reviewed. The treatment protocol comprised radiotherapy to a total dose of 50.4 Gy concurrent with 5-fluorouracil-based chemotherapy. Patients underwent total mesorectal excision surgery following the completion of neoadjuvant chemoradiation. Local control, disease-free survival and overall survival were analysed using Kaplan-Meier methods. Median age of the patients was 61 years. All of them completed radiotherapy. One patient did not complete neoadjuvant chemotherapy. The median time to surgery was 52 days. Fifty-five percent (47 of 85) of patients achieved pathological downstaging and 13% (11 of 85) of patients had a pathologic complete response to preoperative treatment. The neoadjuvant chemoradiation was well tolerated. Four percent of patients had grade 3 diarrhoea and 4% of them had grade 3 dermatitis. There were no grade 4 toxicities. With a median follow-up of 41 months, the 5-year actuarial local recurrence, disease-free survival and overall survival rates were 7%, 71.9%, and 83.2% respectively. Univariate analysis showed that patients with positive surgical margins had significantly worse disease-free survival and overall survival (P=0.012 and P<0.001 respectively) and a trend towards a higher rate of local recurrence (P=0.08). Our study provides evidence that neoadjuvant chemoradiation is an effective treatment for locally advanced rectal cancer. Our outcomes are comparable with internationally published data and demonstrate the reproducibility of the neoadjuvant approach in an Asian population.

Esthesioneuroblastoma in Children and Adolescent

Esthesioneuroblastoma is a rare tumor of the olfactory epithelium. This report analyzed 11 children and adolescents treated in a single institution between 1982 and 2002. For 9 patients, therapy consisted of an initial course of chemotherapy before surgical resection and postoperative radiotherapy, for 1 patient an initial course of chemotherapy before radiotherapy and for another resection before radiotherapy with no chemotherapy. Response to chemotherapy was assessed in 9 patients of whom 6 achieved a complete or a partial remission. Ten patients are long-term survivors. The 5-year actuarial disease-free survival and overall survival rate was 91% (95% confidence interval, 62%-98%). Our study indicates that esthesioneuroblastoma is sensitive to chemotherapy and supports the role of combined modalities including neoadjuvant chemotherapy, surgery, and radiation therapy.

Abstract P5-14-06: Outcomes in 500 patients from a large, retrospective study of APBI with a strut-based breast brachytherapy applicator

Abstract Purpose/Objectives: The SAVI Collaborative Research Group (SCRG) is a coalition of 14 institutions who have retrospectively compiled a large database of APBI patients treated with a strut-based brachytherapy device (SAVI). This report details the findings of statistical correlations between numerous dosimetric variables and cosmetic outcome. Materials/Methods: The SCRG study enrolled 1005 patients. A subset of patients with complete dosimetry and more than 1 year of follow-up by a radiation oncologist were analyzed for toxicity, cosmesis and recurrence/survival. Dosimetric parameters were tabulated for patients, including: V90, V95, V100, V150, V200, skin spacing (skin-bridge), maximum skin dose, tumor size, PTV-Eval volume and applicator size (model). Toxicity (e.g., telangiectasia, fibrosis, fat necrosis, seroma) were graded by physicians for patients with at least 1 year of follow-up (up to 6 years) using the CTCAE v3 Scale and fat necrosis using a simplified CTCAE scale (Grade 1 asymptomatic but seen on imaging, grade 2 symptomatic without intervention, &amp; grade 3 required intervention). Results: Median follow up in this cohort was 29.2 months (range 2.4 to 72.2 months). Follow up was &amp;gt;2 yr and &amp;gt;3 yr for 323 and 191 subjects, respectively. Overall, in 500 subjects the late toxicity (grade ≥2) rates were less than 5% during follow up: telangiectasia 1.0%, fibrosis 4.1%, seroma 2.9% and fat necrosis 0.6%. Cosmesis was reported at various post-APBI follow-up visits following treatment completion (6, 12, 24, 36, 48 &amp; 60+ months). For the 6 and 12 month intervals, 98% (n = 122) and 97% (n = 262) were reported excellent or good (E/G), respectively. At 24, 36, 48 and 60 month intervals, the E/G rates were 93% (n = 184), 90% (n = 98), 100% (n = 41) and 94% (n = 15), respectively. The raw rates of ipsilateral breast tumor recurrence (IBTR) and TR/MM were 1.6% (n = 8) and 1.2% (n = 6), respectively, in 500 patients with &amp;gt;1 year of follow up. The 1- and 2-year actuarial rates of overall survival and disease-free survival were: 1-year, 99.6% &amp; 99.4%, resp. and 2-year, 99.2% &amp; 96.7%. Conclusions: APBI treatment with the strut-based applicators was well-tolerated, demonstrated low toxicity rates, favorable cosmetic outcomes and excellent local control over the follow-up to date. Patients with challenging breast anatomy were successfully treated with strut-based devices. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-14-06.

Locoregional Failure in Early-Stage Breast Cancer Patients Treated With Breast-Conserving Therapy: Which Patients Benefit From Supraclavicular Nodal Irradiation?

To assess the locoregional failure in patients with Stage I-II breast cancer treated with breast conserving surgery followed by adjuvant whole breast radiation therapy (RT), and to evaluate whether potential risk factors might identify patients that are at sufficiently high risk of regional recurrence (RR) to benefit from supraclavicular nodal irradiation. The records of all patients with stage I-II breast cancer treated with breast conserving-surgery and adjuvant whole breast RT were retrospectively reviewed. Loco-regional recurrence (LRR) was defined as clinical or radiographic recurrence in the ipsilateral breast or in the regional lymphatics (axilla, infra/supraclavicular nodes). Kaplan-Meier analysis was used to calculate rates of regional recurrence (RR), LRR, disease-free survival (DFS) and overall survival (OS). Cox proportional hazards methods were used to evaluate potential risk factors. The study was conducted on 492 patients, and the median follow-up was of 95 months (range, 3-309 months). Median patient age was 54 years. One hundred eighty-five (37%) patients were premenopausal; 443 (90%) were affected by invasive ductal carcinoma and 49 (10%) by invasive lobular carcinoma. Four hundred six (83%) women were T1, and 86 (17%) were T2; 324 (66%) were pN0, 47 (10%) pN1a mic, 113 (23%) pN1a, and 8 (2%) were Nx. Two hundred fifteen (44%) tumors were grade 3; 423 (86%) patients were estrogen receptor positive; lymphovascular invasion (LVI) was present in 158 (32%) cases; positive pathologic margin was present in 12 2%) cases. Two hundred twenty-two (45%) patients underwent sentinel node biopsy. One hundred ninety-eight (40%) patients received adjuvant chemotherapy, 246 (50%) received hormonal therapy alone, and 48 (10%) received no adjuvant systemic therapy. The actuarial rates of RR at 5 and 10 years were 2.2% and 3.5%, respectively. The actuarial rates of LRR at 5 and 10 years were 5.5% and 18%, respectively. The actuarial rates of DFS and OS at 10 years were 80.5% and 96.3%, respectively. Statistically significant factors associated with increased risk of RR at the univariate analysis were node positive disease (HR = 3.6, p = 0.003) and the presence of LVI (HR = 3.5, p = 0.03). Patients with Stage I and II breast cancer treated with breast conserving surgery followed by whole breast RT are at a low overall risk of regional and locoregional relapse. However, patients with 1-3 positive lymph nodes and with LVI are higher risk of regional recurrence, and supraclavicular nodal irradiation should be considered.

Radiotherapy for T1‐2N0 glottic cancer: a multivariate analysis of predictive factors for the long‐term outcome in 1050 patients and a prospective assessment of quality of life and voice handicap index in a subset of 233 patients

To evaluate the outcomes of patients with early stage glottic cancer (GC) treated with radiotherapy (RT). The current study report on a retrospective analysis of oncologic outcome of 1050 patients with T1-2N0 glottic cancer treated with radiotherapy. Prospective assessment of quality of life (QoL) and voice handicap index (VHI) was performed in all patients treated from 2006 onwards (n = 233). Local control (LC), regional control (RC), disease-free survival (DFS), overall survival (OS), quality of life and voice handicap index. After a median follow-up of 90 months (range 3-309), the actuarial rates of local control, regional control, disease-free survival and overall survival were 85%, 99%, 84% and 81% at 5 years and 82%, 98%, 80% and 61% at 10 years, respectively. On multivariate analysis, T2 tumours, smoking after radiotherapy and conventional radiation scheme correlated significantly with poor local control. Patients who continued smoking after radiotherapy had also significantly lower overall survival rates (OR 4.3, P < 0.001). Hypothyroidism was reported in 18% of patients. Slight and temporary deterioration of quality of life scores was reported. Patient-reported xerostomia and dysphagia at 48 months were -7.1 and -6.5, compared with baseline, respectively. Voice handicap index improved significantly from 37 at baseline to 18 at 48 months. Patients with T2b and those who continued smoking had significantly worse voice handicap index. In the current study, excellent outcome with good quality of life and voice handicap index scores were reported. T2 tumours, in particular T2b, and continuing smoking after radiotherapy correlated significantly with poor local control and worse voice handicap index.

Survival Benefit of Adding Chemotherapy to Intensity Modulated Radiation in Patients with Locoregionally Advanced Nasopharyngeal Carcinoma

BackgroundTo evaluate the contribution of chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT) and to identify the optimal combination treatment strategy.Patients and MethodsBetween 2006 and 2010, 276 patients with stage II-IVb NPC were treated by IMRT alone or IMRT plus chemotherapy. Cisplatin-based chemotherapy included neoadjuvant or concurrent, or neoadjuvant plus concurrent protocols. The IMRT alone and chemoradiotherapy groups were well-matched for prognostic factors, except N stage, with more advanced NPC in the chemoradiotherapy arm.ResultsWith a mean follow-up of 33.8 months, the 3-year actuarial rates of overall survival (OS), metastasis-free survival (MFS), relapse-free survival (RFS), and disease-free survival (DFS) were 90.3%, 84.2%, 80.3%, and 69.2% for all of the patients, respectively. Compared with the IMRT alone arm, patients treated by concurrent chemoradiotherapy had a significantly better DFS (HR = 2.64; 95% CI, 1.12−6.22; P = 0.03), patients with neoadjuvant-concurrent chemoradiotherapy had a significant improvement in RFS and DFS (HR = 4.03; 95% CI, 1.35−12.05; P = 0.01 and HR = 2.43; 95% CI, 1.09−5.44; P = 0.03), neoadjuvant chemoradiotherapy provided no significant benefit in OS, MFS, RFS, and DFS. Stage group and alcohol consumption were prognostic factors for OS and N stage was a significant predictor for DFS.ConclusionsAddition of concurrent or neoadjuvant-concurrent chemotherapy to IMRT is available to prolong RFS or DFS for locoregionally advanced NPC. Such work could be helpful to guide effective individualized therapy.

Population‐based 10‐year oncologic outcomes after low‐dose‐rate brachytherapy for low‐risk and intermediate‐risk prostate cancer

The objective of this study was to report the rates of disease-free survival (DFS), cause-specific survival (CSS), and overall survival after low-dose-rate (LDR) prostate brachytherapy (PB). Data from 1006 consecutive patients with prostate cancer who received LDR-PB and underwent implantation on or before October 23, 2003 were extracted from a prospective database on November 11, 2011. The selected patients had low-risk (58%) or intermediate-risk (42%) disease according to National Comprehensive Cancer Network criteria. The Phoenix threshold was used to define biochemical relapse. Sixty-five percent of patients received 3 months of neoadjuvant androgen-deprivation therapy (ADT) and 3 months of concomitant ADT. Univariate and multivariate analyses are reported in relation to patient, tumor, and treatment variables. The median follow-up was 7.5 years. By using Fine and Gray competing risks analysis, the 5-year and 10-year actuarial DFS rates were 96.7% (95% confidence interval, 95.2%-97.7%) and 94.1% (95% confidence interval, 92%-95.6%), respectively. When applied to the whole cohort, none of the usual prognostic variables, including dose metrics, were correlated with DFS. However, in both univariate and multivariate models, increasing dose was the only covariate that correlated with improved DFS for the subset of men (N = 348) who did not receive ADT (P = .043). The actuarial 10-year CSS rate was 99.1% (95% confidence interval, 97.3%-99.7%). The overall survival rate was 93.8% at 5 years (95% confidence interval, 92%-95.1%) and 83.5% at 10 years (95% confidence interval, 79.8%-86.6%). Only age at implantation (P = .0001) was correlated with overall survival in multivariate analysis. In a consecutive cohort of 1006 men with National Comprehensive Cancer Network low-risk and intermediate-risk prostate cancer, the actuarial rate of recurrent disease after LDR-PB was approximately 3% at 5 years and 6% at 10 years.

Abstract P4-15-01: Second conservative treatment for ipsilateral breast tumor recurrence: GEC-ESTRO Breast WG study

Abstract For ipsilateral breast cancer tumor (IBTR), radical mastectomy represents the treatment option frequently proposed to the patient. A second conservative treatment (SCT) has been proposed using either lumpectomy alone or associated with a second irradiation of the tumor bed. However, in both clinical situations, the proof level of such therapeutic approaches remains low, based on cased-series or retrospective studies. To analyze the clinical outcome of a SCT using lumpectomy and multicatheter interstitial brachytherapy (MIB) for IBTR, the GEC-ESTRO Breast Working Group retrospectively analyzed the results of 217 patients (pts) with an IBTR treated between 09/00 and 09/10 in 8 European institutions by lumpectomy and MIB (low - LDR, pulse - PDR, or high-dose rate - HDR). Survival rates without 2nd local (2nd LR) and metastatic recurrence, disease free survival (DFS) and specific and overall survivals were analyzed as well as late effects and cosmetic results. Dosimetric data were reported according to the dose rate used. Univariate and multivariate analysis were performed to find local, metastatic and/or DFS progression prognostic factors. With a median follow-up of 14.5 years [3.5–38.2] and 3.9 years [1.1–10.3] from primary tumor and IBTR respectively and a median time interval of 9.4 years [1.1–35.4] between primary and IBTR, 20.7% of the local recurrence were observed at distance from the primary tumor. Median tumor sizes were 15 mm [1–60] and 11 mm [1–40] for the primary and IBTR respectively. Thirty-nine percent of the patient underwent an axillary lymph node dissection at the time of IBTR. Median radiotherapy dose for the primary was 56 Gy [30–69.6]. Positive hormonal receptor status for IBCR was 72.8% while 65% and 19.8% received hormonal and chemotherapy respectively as adjuvant therapy for the IBTR. Five and 10-year actuarial 2nd LR rates were 5.6% [1.5–9.5] and 7.2% [2.1–12.1] respectively. Five and 10-year actuarial metastatic recurrence rates were 9.6% [5.7–15.2] and 19.1% [7.8–28.3] respectively. Five and 10-year actuarial DFS rates were 84.6% [78.9–90.6] and 77.2% [67.5–88.3] respectively. Five and 10-year actuarial overall/specific survival (OS) rates were 88.7% [83.1–94.8] and 76.4% [66.9–87.3] respectively. 141 pts developed 193 complications. Fibrosis was the most frequent complication with 11% of G3-4 complications. Cosmetic result was jugged as excellent/good in 85%. Focusing on multivariate analysis, prognostic factors for 2nd LR, metastatic recurrence and DFS are reported. The results of this study suggest that in case of IBTR, a SCT combining lumpectomy plus MIB is feasible with an overall survival rate at least equivalent to those obtain after salvage mastectomy. The rate of complication remains acceptable with encouraging cosmetic results. The literature analysis suggests that the rate of 2nd LR is 10% [3–32], 25% [7–36] and 10% [2–26], after salvage mastectomy, salvage lumpectomy alone or combined with a second irradiation respectively. However, the 5-y OS rates after salvage mastectomy and SCT seem to be equivalent (75%) mainly influenced by distant metastatic progression. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-15-01.

Complete metabolic response after definitive radiation therapy for cervical cancer: Patterns and factors predicting for recurrence

PurposeThe purpose of this study was to determine the patterns of failure in patients diagnosed with cervical cancer treated with definitive radiotherapy and who subsequently had complete metabolic response (CMR) seen on early post-therapy (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging. Additionally, we sought to determine what factors predict disease recurrence in this patient population. Methods and materialsWe reviewed the records of 155 patients diagnosed with cervical cancer from stages IB1 to IVA who were treated with definitive chemoradiation therapy between 2003 and 2011 and had a FDG-PET at 10–16weeks following completion of therapy. One hundred and twelve (72.0%) had CMR on follow-up FDG-PET and comprised the patients in this study. ResultsThe median age of patients with CMR was 51years and the median tumor size 4.9cm. Median follow up was 15months. Of the 112 patients, 11 (9.8%) had a recurrence and six (5.4%) had isolated local recurrences, and five (4.5%) had distant recurrence. Median time to recurrence was 9months. Three-year actuarial disease-free survival and overall survival rates were 78.9% and 88.0% respectively. On Cox regression multivariate analysis, tumor size was predictive of increased risk of local recurrence in these patients with CMR with p<0.025. Age, stage, histology and nodal positivity were not significant for predicting local, distant or any recurrence. ConclusionPatients treated with concurrent chemoradiation had a CMR which demonstrated good clinical outcomes in terms of local control. There were equal numbers of patients suffering local and distant recurrences. In patients with a CMR, only tumor size was an independent predictor for local recurrence.

Squamous cell carcinoma of buccal mucosa: a 40-year review

PurposeThe aim of this study was to analyze the outcome of surgical therapy for buccal squamous cell carcinoma (SCCA) at a single tertiary care institution during a 40-year period. Materials and methodsA retrospective review was performed by examining the records and pathology of 48 patients with buccal SCCA treated at a single tertiary care institution from 1970 to 2009. ResultsTreatment entailed surgery alone in 18 patients (37.5%) and surgery followed by radiation therapy in 30 patients (62.5%). Composite resection was performed in 17 patients (35.4%), and ipsilateral neck dissections were performed in 37patients (77.1%). One-year observed actuarial disease-free survival rates were 60%, 46%, 0%, and 40% for T1 through T4, respectively. Univariate analysis revealed increased age as a risk factor for disease recurrence (P = .062), with skin taken and neck dissection not achieving significance (P = .24 and .20, respectively). Multivariate analysis demonstrated age as increasing risk and neck dissection as decreasing risk of recurrence (P = .029 and .023, respectively). ConclusionsWe report relatively high disease-free survival rates in patients who underwent aggressive resection and neck dissection. Performance of neck dissection and younger age were associated with a favorable prognosis. Performance of neck dissection may decrease the risk of recurrence in primary SCCA of the buccal mucosa. Although through-and-through resection of skin decreased risk of disease recurrence, this difference is not statistically significant (P = .24).

Postoperative periclavicular radiotherapy in breast cancer patients with 1–3 positive axillary lymph nodes

The goal of this work was to examine the possible influence of periclavicular irradiation on outcome of breast cancer patients with 1-3 positive lymph nodes with special emphasis on late toxicity rates. Between 1997 and 2000, 235breast cancer patients (T1-2, 1-3 involved lymph nodes) were treated at our department following breast conservative surgery: 139patients (59.1%) had one, 62patients (26.4%) two, and 34patients (14.5%) three positive lymph nodes. Extracapsular spread (ECS) was described in 72patients (30.6%). There were 67patients (28.5%) who received additional radiotherapy to the ipsilateral periclavicular lymph nodes (PCLNI), while 168patients did not (noPCLNI). Patients were re-examined or contacted by phone with regard to treatment-related late effects. After a median follow-up of 78months (range 7-107months), 22patients (9.4%) developed local, 9(3.8%) axillary, 4periclavicular (1.7%), and 41distant failure (17.4%). The actuarial 8-year locoregional recurrence-free (LRRFS), disease-free (DFS), and overall survival rates (OS) were 83%, 67%, and 74%, respectively. Survival data for the PCLNI vs. noPCLNI group were 72% vs. 89% (p = 0.3), 56% vs. 73% (p = 0.4), and 86% vs. 70% (p = 0.3), respectively. No higher toxicity rates were reported in the PCLNI group compared to the noPCLNI group. We could not demonstrate any difference in outcome in breast cancer patients with 1-3 positive axillary lymph node metastases with or without periclavicular lymph node irradiation. In addition, patients with PCLNI did not complain about higher rates of late toxicities. However, patients with ECS, which may predict for locoregional failure, may benefit from adjuvant periclavicular irradiation.

Total pelvic exenteration for rectal cancer: outcomes and prognostic factors

To perform complete resection of locally advanced and recurrent rectal carcinoma, total pelvic exenteration (TPE) may be attempted. We identified disease-related outcomes and prognostic factors. We conducted a single-centre review of patients who underwent TPE for rectal carcinoma over a 10-year period. We included 28 patients in our study. After a median follow-up of 35 months, 53.6% of patients were alive with no evidence of disease. The 3-year actuarial disease-free and overall survival rates were 52.2% and 75.1%, respectively. On univariate analysis, recurrent disease, preoperative body mass index greater than 30 and lymphatic invasion were poor prognostic factors for disease-free survival, and only lymphatic invasion predicted overall survival. Additionally, multivariate analysis identified lymphatic invasion as an independent poor prognostic factor for disease-free survival in this patient population with locally advanced and recurrent rectal carcinoma. Despite the significant morbidity, TPE can provide long-term survival in patients with rectal carcinoma. Additionally, lymphatic invasion on final pathology was an independent prognostic factor for disease-free survival.

Squamous Cell Carcinoma of the Buccal Mucosa: A 40‐Year Review

Objective: Evaluate the treatment results of buccal squamous cell carcinoma at a single institution during a 40-year period. Method: A retrospective review was performed by examining the records and reviewing the pathology of 48 patients with buccal squamous cell carcinoma treated at UCLA Medical Center from 1970 to 2009. Forty-eight patients were identified that received first-time surgical therapy for squamous cell carcinoma of the buccal mucosa and had adequate follow-up. Results: Treatment entailed surgery alone in 18 out of 48 patients (37.5%) and surgery followed by radiation therapy in 30 out of 48 patients (62.5%). Composite resection of the tumor was performed in 17 out of 48 patients (35.4%) and ipsilateral neck dissections were performed in 37 out of 48 patients (77.1%). One-year observed actuarial disease-free survival rates were 60%, 46%, 0%, and 40% for T1 through T4, respectively. Univariate analysis revealed increased age as a risk factor ( P = .062), and multivariate analysis demonstrated age as a risk factor and performance of neck dissection having a decreased risk of recurrence ( P = .029 and .023, respectively). Conclusion: We report fairly high disease-free survival rates in this patient population. Performance of neck dissection and younger age were associated with a favorable prognosis. Performance of neck dissection may decrease the risk of recurrences in primary squamous cell carcinoma of the buccal mucosa.

Neoadjuvant chemotherapy and prognostic subgroups defined by survival benefit in patients with locoregionally advanced nasopharyngeal carcinoma.

5536 Background: To evaluate the contribution of neoadjuvant chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) and to identify the prognostic subgroups that could benefit the most from neoadjuvant chemotherapy. Methods: From 2004 through 2009, 164 patients with stage II to IVb NPC were treated by radiotherapy alone (RT; n = 74) or chemoradiotherapy (RT/CT; n = 90). All patients received 68-70 Gy to the nasopharynx. Neoadjuvant chemotherapy consisted of 2-4 cycles of cisplatin and 5-fluorouracil, or cisplatin and docetaxel every 3 weeks. Both groups were well-matched for prognostic factors except cancer stage, with more advanced NPC in RT/CT. Results: With a mean follow-up of 34.5 months, the 3-year actuarial rates of overall survival (OS), disease-free survival (DFS), metastasis-free survival and relapse-free survival for RT/CT and RT alone groups were 84.3% v 78.2% (Log-rank P = 0.132), 81.2% v 58.3% (Log-rank P = 0.024), 86.4% v 71.4% (Log-rank P = 0.029) and 94.8% v 79.8% (Log-rank P = 0.114), respectively. Using the Cox model adjusted for prognostic factors, improvement in OS on RT/CT was significant (P = 0.049). Stratification analysis showed that DFS improvement was pronounced in the following prognostic subgroups: stage IV, T3/T4 stage, N2/N3 stage, non-keratinizing carcinoma, youngers, males, smokers, drinkers and patients without family history of cancer. Conclusions: Neoadjuvant chemotherapy improves OS, DFS and MFS for locoregionally advanced NPC, and DFS improvement was pronounced in some prognostic subgroups. Such work could be helpful to guide effective therapy of individuation.

Outcomes of Patients With Head-and-Neck Cancer of Unknown Primary Origin Treated With Intensity-Modulated Radiotherapy

To analyze survival, failure patterns, and toxicity in patients with head-and-neck carcinoma of unknown primary origin (HNCUP) treated with intensity-modulated radiotherapy (IMRT). Records from 27 patients with HNCUP treated during the period 2002-2008 with IMRT were reviewed retrospectively. Nodal staging ranged from N1 to N3. The mean preoperative dose to gross or suspected disease, Waldeyer's ring, and uninvolved bilateral cervical nodes was 59.4, 53.5, and 51.0 Gy, respectively. Sixteen patients underwent neck dissection after radiation and 4 patients before radiation. Eight patients with advanced nodal disease (N2b-c, N3) or extracapsular extension received chemotherapy. With a median follow-up of 41.9 months (range, 25.3-93.9 months) for non deceased patients, the 5-year actuarial overall survival, disease-free survival, and nodal control rates were 70.9%, 85.2%, and 88.5%, respectively. Actuarial disease-free survival rates for N1, N2, and N3 disease were 100%, 94.1%, and 50.0%, respectively, at 5 years. When stratified by non advanced (N1, N2a nodal disease without extracapsular spread) vs. advanced nodal disease (N2b, N2c, N3), the 5-year actuarial disease-free survival rate for the non advanced nodal disease group was 100%, whereas for the advanced nodal disease group it was significantly lower at 66.7% (p = 0.017). Three nodal recurrences were observed: in 1 patient with bulky N2b disease and 2 in patients with N3 disease. No nodal failures occurred in patients with N1 or N2a disease who received only radiation and surgery. Definitive IMRT to 50-56 Gy followed by neck dissection results in excellent nodal control and overall and disease-free survival, with acceptable toxicity for patients with T0N1 or non bulky T0N2a disease without extracapsular spread. Patients with extracapsular spread, advanced N2 disease, or N3 disease may benefit from concurrent chemotherapy, targeted therapeutic agents, or accelerated radiation regimens in addition to surgery.

Moderate dose escalation with single-fraction high-dose-rate brachytherapy boost for clinically localized intermediate- and high-risk prostate cancer: 5-year outcome of the first 100 consecutively treated patients

Purpose To analyze the clinical outcome and toxicity data of the first 100 consecutive patients treated with a single-fraction high-dose-rate brachytherapy (HDR-BT) and external beam radiotherapy (EBRT). Methods and Materials Two-hundred eighty patients have been treated with HDR-BT boost for localized intermediate- to high-risk prostate cancer. Among these, the outcome and toxicity of the first 100 patients treated with a single HDR-BT fraction were assessed. A median dose of 60 Gy EBRT was given to the prostate and vesicles. Interstitial HDR-BT of 10 Gy was performed during the course of EBRT. Results Median followup time was 61.5 months. The 5-year actuarial rates of overall survival, cause-specific survival, disease-free survival, and biochemical no evidence of disease (bNED) for the entire cohort were 93.3%, 99.0%, 89.3%, and 85.5%, respectively. The 7-year actuarial rate of bNED was 84.2% for the intermediate-risk group and 81.6% for the high-risk group ( p = 0.8464). The 7-year actuarial rates of bNED for Grade 1, 2, and 3 tumors were 97.5%, 80.0%, and 67.1%, respectively. The 5-year probability for developing late Grade 3 gastrointestinal and genitourinary (GU) toxicity was 2.1% and 14.4%, respectively. Grade 3 GU complications occurred significantly more frequently in patients with a history of preirradiation transurethral resection (29.1% vs. 8.8%; p = 0.0047). Conclusions Five-year outcome after 60 Gy EBRT plus a single fraction of 10 Gy HDR-BT boost is encouraging. Preradiation transurethral resection significantly increases the risk of late severe GU complications.

Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.