Addition Of Adjuvant Radiotherapy Research Articles

A reformed surgical treatment modality for children with giant cystic craniopharyngioma.

Surgical removal plays an important role in treating children's craniopharyngioma. For a safe and minimally invasive craniotomy, a reformed surgical modality was proposed in this paper by combining the insertion of an Ommaya reservoir system (ORS) by stereotactic puncture, aspiration of cystic fluid in 2-day interval for consecutive 7-10days, and the delayed tumor resection. Eleven patients (aged from 5 to 9years old) with giant cystic craniopharyngiomas who had undergone the reformed surgical modality during November 2014 and December 2015 were collected as group A. In contrast, seven patients (aged from 5 to 11years old) who had undergone the traditional directed operation without any prior management from January 2014 to October 2014 were collected into group B. A retrospective analysis was performed for both groups at one institution. The preoperative and postoperative clinical presentations, neuroimaging, early postoperative outcome, and the surgery-related complications of both groups were reviewed. For group A, the mean value of the maximum tumor diameters shank from 52.36 to 23.82mm after implementing aspiration of the cystic fluid in 1-day interval for consecutive 8.23days. Eight patients (72.73%) in group A underwent a gross total resection (GTR), while two (28.57%) patients underwent GTR in group B. The postoperative electrolyte disturbance rate and endocrine disorder rate of group B were significantly higher than those of group A (42.86 vs 36.36%; 71.43 vs 45.45%). Postoperative long-term diabetes insipidus only occurred in one patient of group B, and postoperative visual deterioration occurred in two patients of group B. Besides, one patient of group B died of severe postoperative hypothalamus dysfunction. Patients with residual tumors were applied with additional adjuvant radiotherapy, and no recurrence was observed in follow-up examinations. A favorable outcome can be achieved by combining the insertion of an ORS by stereotactic puncture, aspiration of cystic fluid in 2-day interval for continuously 7-10days, and the delayed tumor resection. This combined treatment modality maybe an effective method to treat children with giant cystic craniopharyngiomas.

Audit of local practice regarding interval between surgery and adjuvant radiotherapy in patients with early breast cancer

Background to the audit: Level 1 evidence demonstrating that the addition of adjuvant radiotherapy (RT) to breast conservation surgery improves local control and survival, suggests that RT is most effective when patients receive RT within eight weeks of surgery.[1] In 2007 the Cancer Reform Strategy stated that patients should start RT within 31 days of being ‘deemed fit for treatment’.[2] This is set as the date of the first outpatient RT consultation, and therefore does not account for a possible delay from surgery to seeing the oncologist.

P17.08 Does adjuvant radiotherapy improve local control rate in intracranial hemangiopericytoma?

Abstract This is a single-institution retrospective cohort study designed to investigate the role of adjuvant radiotherapy in intracranial hemangiopericytoma.. Between 1995 and 2016, 53 patients received definitive surgery and diagnosed as intracranial hemangiopericytoma at the Seoul National University Hospital. There were 24 males and 29 females and median age of all the patients was 44 years. Of gross total resection (N=30), 14 received adjuvant radiotherapy. Among subtotal resection (N=23), 13 received adjuvant radiotherapy, 6 received stereotactic radiosurgery. Adjuvant chemotherapy was administered in 5 patients. With the median follow-up period of 44 months (range, 3-307 months), 19 patients (36%) had disease relapse (intracranial; 17, extracranial; 7). The 10-year Intracranial and extracranial failure free rate were 44.0% and 62.2%, respectively. In 17 patients with intracranial failure, total of 31 relapsed lesions were observed, 20 of which were at the surgical bed. The other 11 lesions were more than 1.5cm away from the surgical bed. Addition of adjuvant radiotherapy significantly lowered the surgical bed failure rate (p=0.025, 10-year surgical bed control: 58.2% vs. 37.8%). Both non-surgical bed failure and extracranial failure were not associated with adjuvant radiotherapy. The sites of extracranial metastases were bone(4), lung(3), liver(3), inguinal lymph node(1), and Kidney(1). Adjuvant radiotherapy to the surgical bed, obviously with residual tumor if confirmed, seemed to improve local control rate in intracranial hemangiopericytoma.

Postoperative radiation therapy of pT2-3N0M0 esophageal carcinoma-a review.

Esophageal cancer is one of the most malignant gastrointestinal cancers worldwide. Despite advances in surgical technique, 5-year survival in pathologic stage T2-3N0M0 esophageal squamous cell carcinoma patients who are treated with surgery alone is still poor. The addition of adjuvant radiotherapy may confer a benefit for these patients. However, not all patients could get a benefit from radiotherapy and patients with esophageal squamous cell carcinoma receiving radiotherapy seem to have a disparity in treatment response. Thus, identifying effective prognostic indicator to complement current clinical staging approaches is extremely important. Those prognostic factors could give rise to a novel prognostic stratification system, which serve as criteria for selecting patients for adjuvant therapy. Consequently, it may help to define the subgroups who are more likely to benefit from postoperative radiation therapy.

Adjuvant radiotherapy for atypical meningiomas.

OBJECTIVE The aim of this paper was to evaluate outcomes in patients with atypical meningiomas (AMs) treated with surgery alone compared with surgery and radiotherapy at initial diagnosis, or at the time of first recurrence. METHODS Patients with pathologically confirmed AMs treated at the University of Utah from 1991 to 2014 were retrospectively reviewed. Local control (LC), overall survival (OS), Karnofsky Performance Status (KPS), and toxicity were assessed. Outcomes for patients receiving adjuvant radiotherapy were compared with those for patients treated with surgery alone. Kaplan-Meier and the log-rank test for significance were used for LC and OS analyses. RESULTS Fifty-nine patients with 63 tumors were reviewed. Fifty-two patients were alive at the time of analysis with a median follow-up of 42 months. LC for all tumors was 57% with a median time to local failure (TTLF) of 48 months. The median TTLF following surgery and radiotherapy was 180 months, compared with 46 months following surgery alone (p = 0.02). Excluding Simpson Grade IV (subtotal) resections, there remained an LC benefit with the addition of radiotherapy for Simpson Grade I, II, and III resected tumors (median TTLF 180 months after surgery and radiotherapy compared with 46 months with surgery alone [p = 0.002]). Patients treated at first recurrence following any initial therapy (either surgery alone or surgery and adjuvant radiotherapy) had a median TTLF of 26 months compared with 48 months for tumors treated at first diagnosis (p = 0.007). There were 2 Grade 3 toxicities and 1 Grade 4 toxicity associated with radiotherapy. CONCLUSIONS Adjuvant radiotherapy improves LC for AMs. The addition of adjuvant radiotherapy following even a Simpson Grade I, II, or III resection was found to confer an LC benefit. Recurrent disease is difficult to control, underscoring the importance of aggressive initial treatment.

Abstract P3-12-10: Overall survival in triple-negative breast cancers - Prognostic influence of type of surgery and adjuvant radiotherapy: A systematic review and meta-analysis

Abstract BACKGROUND: Triple negative breast cancers (TNBC) are an aggressive, poorer prognostic tumour subtype which are negative for oestrogen, progesterone and human epidermal growth factor receptor 2 (HER-2) expression. Whilst the role of radiotherapy (RT) following breast conserving therapy (BCT) is widely accepted, there is no agreed consensus on the use of post-mastectomy RT, particularly in early-stage TNBC patients. METHODS: Four electronic databases were searched from their inception to April 2015 including PubMed, MEDLINE, EMBASE and web of science. Observational studies investigating overall survival and locoregional/distant recurrence outcomes in women with TNBC according to type of surgery and radiotherapy receipt were included. Authors were contacted directly for further data. A random effects model was used to pool study effect estimates using mastectomy (MT) only patients as the reference group. RESULTS: 8 studies including data from 3,456 patients were included. The median age and duration of follow-up was 54 years and 3.6 years respectively. The adjusted pooled hazard ratio (HR) and 95% confidence interval (CI) for overall survival comparing BCT and MT+RT to MT only was 0.52 (95% CI 0.31, 0.87; I2= 70.9%) and HR 0.60 (95% CI 0.38, 0.96; I2=41.5%) respectively. In subgroup analysis of MT+RT vs. MT alone, there was no significant interaction with early (T1-2, N0-1) vs. late stage (T3-4, N2-3) disease p=0.773 or age at diagnosis (<40, 40-64, ≥65 years) p=0.320. 5 studies evaluated local regional recurrence. Comparing BCT and MT+RT to MT only, the pooled HR was 0.61 (95% CI 0.41, 0.92) and HR 0.83 (95% CI 0.55, 1.26) respectively, with low heterogeneity detected (I2 0.0%). 4 studies assessed distant metastases. The pooled HR comparing BCT and MT+RT to MT only was 0.88 (95% CI 0.62, 1.23; I2= 0.0%) and HR 1.95 (95% CI 0.85, 4.49; I2= 75.1%) respectively. CONCLUSIONS: The addition of adjuvant radiotherapy appears to favourably impact overall survival, irrespective of the type of surgery received. BCT may reduce the risk of locoregional recurrence in comparison to MT only. The small number of contributing studies and often high study heterogeneity suggest cautious interpretation of the findings. Further epidemiological studies or pooled analyses of individual patient data are warranted. Citation Format: O'Rorke MA, Murray LJ, Bhoo Pathy N. Overall survival in triple-negative breast cancers - Prognostic influence of type of surgery and adjuvant radiotherapy: A systematic review and meta-analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-10.

“Comments on - Recurrence of Primary Synovial Sarcoma of the Lacrimal Gland”

Madam I read with great interest the article by Yadav et al regarding “Recurrence of primary synovial sarcoma of the Lacrimal Gland.1 I applaud the effort made in describing the rare case, its management and review of literature. However certain aspect merit discussion and I would like to express my comments. Though the article describes the clinical presentation and management of this rare entity the authors have not mentioned about the role of adjuvant radiotherapy. Lacrimal gland tumours is a therapeutic challenge due to their complex orbital anatomy limiting complete surgical resection, more so when the case is advanced and is planned for neoadjuvant chemotherapy to down stage the tumour as in the case reported. As already reported by the authors the case is a recurrent tumour and the likelihood of survival and recurrence free rate will be superior with the addition of adjuvant radiotherapy after surgical excision.2 Skinner et al have emphasized the role of adjuvant radiation therapy to improve local control in malignant epithelial neoplasms of lacrimal gland.3 It was observed that patients who did not receive adjuvant radiation therapy developed local recurrence earlier as compared to the group who received radiation. It is also noteworthy to mention that in the present day practice of enhanced functional and cosmetic outcome, for appropriately selected patients, eye sparing surgery with adjuvant radiotherapy can achieve similar survival outcome to those treated with orbital exenteration. It may therefore be worthwhile to consider adjuvant radiotherapy after en bloc excision thus avoiding exenteration. References

Effects of adjuvant radiotherapy on borderline and malignant phyllodes tumors: A systematic review and meta-analysis

The standard treatment for borderline and malignant phyllodes tumors is wide local excision (margins ≥1 cm), in the context of either breast-conserving surgery (BCS) or total mastectomy (TM). Due to the high risk of local recurrence (LR) following surgical intervention alone, the addition of adjuvant radiotherapy (RT) has been previously investigated; however, the conclusions have been inconsistent. This systematic review and meta-analysis was designed to assess the efficacy of adjuvant RT for borderline and malignant phyllodes tumors. Pubmed and Web of Science were systematically searched to identify relevant studies assessing the effect of adjuvant RT on borderline and malignant phyllodes tumors from the inception of this technique through May, 2014. A total of 8 studies were identified among 332 citations. In this meta-analysis, patients who received adjuvant RT had a lower relative risk of LR [hazard ratio (HR) = 0.43, 95% confidence interval (CI): 0.23-0.64]. The absolute risk difference was 10.1% (95% CI: 4.9-17.6), corresponding to a number needed to treat of 10. Our pooled meta-analysis clearly demonstrated a decreased risk of LR in patients with borderline and malignant phyllodes tumors who received RT following BCS (HR=0.31, 95% CI: -0.10-0.72). However, the combined HR for LR in the TM group did not demonstrate that adjuvant RT was superior to no RT (HR=0.68, 95% CI: -0.28-1.64). No significant differences were observed in overall survival (OS) or disease-free survival (DFS) between the two groups. Our analysis suggested that adjuvant RT for borderline and malignant phyllodes tumors decreased the LR rate in patients undergoing BCS. However, adjuvant RT was not found to exert an effect on OS or DFS.

New trends in rectal cancer treatment

SUMMARY The treatment philosophy for rectal cancer has changed a lot during the last three decades. In the 1970s it was more or less a pure surgical business and rectal cancer was considered radiation resistant. Owing to the unacceptable high local recurrence rates, surgery was changed (the total mesorectal excision technique) during the 1980s and treatment was, in many countries, concentrated to lager units. Moreover, the addition of adjuvant radiotherapy was tested during the same period in several randomized trials and demonstrated that the local recurrence rate could be reduced by 50%, provided the radiation dose was high enough. Since then, treatment has changed very rapidly with several interesting approaches, such as timing and type of radiotherapy, the place of chemotherapy, surgery with modern technique including laparoscopy; natural orifice transendoscopic surgery or robotics; and the whole idea of ‘wait-and-watch’ program. All of these new aspects are covered and discussed in the view of the standard-of-care in 2014.

Increased CD44s and decreased CD44v6 RNA expression are associated with better survival in myxofibrosarcoma patients: a pilot study

BackgroundNew prognostic markers may be of value in determining survival and informing decisions of adjuvant treatment in the heterogeneous group of soft tissue sarcomas known as malignant fibrous sarcomas (MFS). Increased CD44 expression has been associated with a better outcome in cancers such as bladder tumors and could potentially relate to cell-cell interaction as a marker for potential invasion/metastasis. The aim of this pilot study was to determine if there is a correlation between the expression rate of CD44 in adult patients with MFS and clinical outcomes.MethodsThe clinical outcome of 34 adult MFS patients (19 males and 15 females, average age 62 years, median 63 years, range: 38–88 years) who underwent surgical treatment were evaluated. Twenty-five of these patients had additional adjuvant radiotherapy. Extracted RNA from sarcoma tissues was used to measure the transcripts of CD44s (standard form) and isoform expression.The pooled data for each variant of CD44 was divided in half at the median expression value into two equally sized groups (low and high). Survival modeling and multivariate analysis were used with these two groups to determine if there were differences in survival times and whether this was independent of known factors such as tumor stage/grade, patient age and resection margin status.ResultsHigh CD44s and low of CD44v6 expression significantly correlated with an improved outcome (P <0.05 and P <0.02, respectively) whereas CD44v8 and hCD44 (isoforms) did not. Differences in survival were apparent within 6–12 months of operation with >30% difference in survival between low/high expressions at 5 years. These finding were independent of the other measured MFS survival predictors, though the group was homogenous.ConclusionsHigh CD44s and low CD44v6 expression may be an independent predictor of improved survival in MFS patients in this pilot data. This is contrary to other MFS data, which did not account for the CD44 isoforms but is confirmed by data from other cancer types. Further investigation is needed to confirm CD44 isoform expression data as a relevant survival biomarker and whether it could be used to inform clinical decisions such as adjuvant therapy.

The role of adjuvant radiotherapy in atypical meningioma

The object of this study was to analyze treatment outcomes and to identify the prognostic factors, with a focus on the role of adjuvant radiotherapy (ART), predicting disease progression in atypical meningiomas. From 1997 to 2011, 83 patients with meningioma were included in this study. All patients were histologically confirmed as atypical meningioma and were treated with surgical resection with or without ART. As primary therapy, 27 patients received surgical resection followed by ART, and 56 received no adjuvant therapy. Of 83 evaluable patients, 55 (66.3 %) patients underwent complete resection. The median ART dose was 61.2 Gy and their median age was 52 years. The 5- and 10-year actuarial overall survival rates were 90.2 and 62.0 %, and the 5- and 10-year progression-free survival (PFS) rates were both 48.0 %, with a median follow-up of 43.0 months. Addition of ART (p = 0.016) and complete tumor resection (p = 0.002) were associated with superior PFS. When stratified to four groups according to resection status and ART, the groups of patient with incomplete resection without ART showed significantly worse PFS compared to other three groups (p < 0.001). In conclusion, surgical resection followed by ART led to lower local tumor progression in patients with atypical meningioma defined by the updated 2000/2007 WHO classification. Our results may contribute to the routine use of ART, especially after incomplete resection, until the outcomes of ongoing prospective trials are available.

Multimodal therapy in patients with node-positive (stage IIIC) uterine papillary serous carcinoma: A National Cancer Database study.

5585 Background: Uterine papillary serous carcinoma (UPSC) is an aggressive endometrial cancer that carries a 30-40% risk of nodal metastasis. Adjuvant systemic chemotherapy has become standard of care in advanced UPSC, but the role of additional adjuvant radiotherapy is unclear. This study aims to evaluate survival outcomes of multimodal therapy through the use of the National Cancer Data Base (NCDB). Methods: All patients diagnosed with surgically-staged FIGO stage IIIC uterine papillary serous carcinoma were identified in the NCDB from 1/1998 through 12/2010. Patients were divided into those who received chemotherapy only (CT) and both chemotherapy and radiation therapy (CT+RT). Overall survival was estimated using the Kaplan-Meier method. Univariate comparison by log rank test and multivariable analysis by Cox regression modeling were performed to identify and control for prognostic factors. Results: A total of 13,356 cases of uterine cancer were identified, of which 794 were UPSC. Of these patients, 387 underwent lymphadenectomy (median 14 nodes removed) with 75 patients (median age 65) found to have stage IIIC disease. Median follow up is 20.4 (range: 0-114) months. There were no significant differences were found between the RT and CT+RT group with regards to patient demographic, medical comorbidity, treatment facility or disease characteristics. The median overall survival was 23.2 (95% CI 14.5-31.9) and 40.3 (95% CI 31.5-49.1) months, (p&lt;0.05) for the CT and CT+RT groups, respectively. Multivariate analysis controlling for age, race, income, Charlson-Deyo comorbidity index, treatment facility type, year of diagnosis, number of lymph nodes removed, number of positive lymph nodes and tumor size found radiotherapy independently predicted improved survival [HRdeath0.024 (95% CI 0.001-0.668)]. Conclusions: Patients with stage IIIC UPSC benefit from adjuvant radiotherapy in addition to adjuvant chemotherapy.

Abstract P4-16-12: Outcomes of low- risk Ductal Carcinoma in situ in South East Asian women treated with breast conservation surgery.

Abstract Background: Singapore is the first South East Asian country to establish a nationwide breast cancer screening programme in 2002. Since then, the incidence of breast cancer and pre-invasive disease, in particular, has increased tremendously. Ductal carcinoma in situ (DCIS) constitutes over a quarter of all screen-detected cancers. In Singapore, most patients with DCIS are managed with breast conserving surgery (BCS). In almost all cases, this is followed by adjuvant radiotherapy (RT) to the whole breast. However, the optimum management of low-risk DCIS remains contentious. Non-randomized data in Caucasian women suggests benefits in the reduction of local recurrence despite already low recurrence rates. Similar information in Asian women is lacking. We examined the outcomes of South East Asian women with low-risk DCIS treated with BCS. Methods: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 was performed. Patients meeting the pathological criteria from ECOG 5194 were included: Low-Intermediate grade (LG) DCIS ≥0.3cm but ≤2.5cm excised with final margins ≥3mm and High grade (HG) DCIS ≥3mm but ≤1.0cm. Most patients received adjuvant RT consisting of whole breast RT to 50Gy followed by a 10Gy boost to the tumour bed. Patients deemed to have especially low recurrence risks did not receive RT and some patient declined adjuvant RT. Patients who are oestrogen receptor positive were offered 5 years of tamoxifen. Results: A total of 744 patients with pathological diagnosis of pure DCIS were identified, of which 273 meets the selection criteria: LG (N = 219); HG (N = 54). Median follow-up for these patients is 60 months. Median age at diagnosis is 50 years old. About 70% of patients were screen detected; only 21 of which (7.7%) were diagnosed before the introduction of breast screening. There were 8 ipsilateral breast tumour recurrences (IBTR) in total; 7 of which were DCIS. The estimated actuarial IBTR rates at 5- and 10-year for the entire cohort are 1.8% and 4.3% respectively. In comparison, 10 contralateral new breast primaries were diagnosed in this cohort, giving 5- and 10-year contralateral relapse rates of 1.9% and 7.2% respectively. All patients with LG DCIS received RT except for 9. There were 7 recurrences in this group, two among the 9 patients who did not receive RT. The estimated IBTR rates at 5- and 10-year are 2.3% and 4.2% respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years giving an estimated IBTR rate of 4.5% at 10-year. These results compare favourably with the 5-year IBTR rates of 6.1% and 15.3% in the LG and HG patients respectively in the ECOG 5194 study where patients were managed with BCS alone. One patient died of metastatic breast cancer from the contralateral breast giving a 10-year overall survival of 98.5%. Conclusions: South East Asian women with screen detected DCIS have exceedingly low rates of IBTR after breast conservation therapy. The addition of adjuvant RT approximately halved the IBTR rates in our study patients. The high proportion of recurrence in the small group of patients who did not receive RT warns of the potential hazards of managing even these low-risk patients without radiation. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-16-12.

Early‐stage squamous cell carcinoma of the lip: The Australian experience and the benefits of radiotherapy in improving outcome in high‐risk patients after resection

The purpose of this study was to analyze the outcome of Australian patients treated for early lip cancer. Data on 217 patients with T1 to T2 squamous cell carcinoma (SCC) of the lip and treated with radical intent were analyzed. The addition of local adjuvant radiotherapy in patients with a close/positive margin was associated with a significant improvement in relapse-free survival (RFS; p = .008). Tumor thickness (≤4 mm vs >4 mm) was also significantly associated with RFS (p = .01). The 5-year RFS was 51% after surgery, 87% after radiotherapy, and 92% after adjuvant radiotherapy. Patients with a tumor thickness >4 mm experienced an increased risk of recurrence, especially nodal. Compared with patients having any radiotherapy, those undergoing surgery experienced a higher rate of locoregional recurrence. The addition of adjuvant radiotherapy in patients with inadequate excision significantly decreased the risk of recurrence.

EP-1087 RESULTS FROM A PHASE II NON RANDOMIZED TRIAL ON 145 PATIENTS WITH HEPATO-CELLULAR CARCINOMA WITH VMAT

Materials and Methods: This is a retrospective study of 106 patients with EBDC who received curative intent surgery. The definitions of tumor location were as follows: proximal EBDC from the confluent portion of the bilateral bile ducts to the junction of cystic duct, and distal EBDC between the junction of cystic duct and intrapancreatic portion. Twenty nine patients had proximal EBDC and 77 patients had distal EBDC. A total of 9 patients underwent postoperative adjuvant therapy; chemoradiotherapy for 7 patients and chemotherapy for 2 patients. Complications were graded by the Common Terminology Criteria for Adverse Events v4.0. Results: The median follow-up was 24 months for the surviving patients. The median overall survival (OS) and locoregional progression-free survival (LRPFS) were 46 months and 30 months in all patients, respectively. The 3-year OS and LRPFS rates were 54% and 49% for all locations, 43% and 39% for proximal EBDC, and 57% and 55% for distal EBDC, respectively. A total of 40 patients experienced locoregional recurrence (LRR) initially; 13 (45%) patients with proximal EBDC and 27 (35%) patients with distal EBDC. The area around hepatoduodenal ligament and adjacent tumor bed was the most commonly involved sites. Distant metastases were noted in 10 patients (34%) with proximal EBDC and 15 patients (19%) with distal EBDC. The liver was the most common organ of distant metastasis. In the multivariate analysis, perineural invasion and high level of postoperative CA 19-9 (> 37 U/ml) were associated with poor LRPFS, distant metastasis-free survival, and progression-free survival, while OS had association with angiolymphatic invasion, venous invasion, and CA 19-9. Grade 3 or more acute complications were occurred in 30 patients, and 1 patient died of complicated fluid collection followed by septic shock. Seventeen patients experienced Grade 3 or more chronic complication. Conclusions: Both proximal and distal EBDC showed considerable LRR probabilities without significant difference by tumor locations. The area around hepatoduodenal ligament and adjacent tumor bed, the risky site of LRR, could be routinely encompassed by adjuvant radiotherapy. We can speculate the addition of adjuvant radiotherapy can improve LRPFS in these patients. Especially adjuvant radiotherapy needs to be considered in the patients with perineural invasion and high postoperative CA 19-9 for better LRPFS.

Predictors of outcome in patients with metastatic cutaneous head and neck squamous cell carcinoma involving cervical lymph nodes: Improved survival with the addition of adjuvant radiotherapy

The purpose of this study was to compare the outcome of surgery against surgery plus radiotherapy in patients with metastatic cutaneous head and neck squamous cell carcinoma (HNSCC) to cervical nodes. We conducted a 28-year retrospective analysis of 122 patients whom were treated for metastatic cutaneous HNSCC involving the cervical nodes (levels I-V). After surgery alone, 11 patients (55%) developed recurrence compared with 23 patients (23%) after surgery plus radiotherapy. On multivariate analysis, the following variables were significantly associated with disease-free survival (DFS): immunosuppression (p = .002), treatment modality (p < .001), extracapsular spread (p = .009), and pathological nodal stage (p = .04). Patients undergoing surgery plus radiotherapy had a significantly better 5-year DFS (74% vs 34%; p = .001) and 5-year overall survival (OS; 66% vs 27%; p = .003) compared with surgery alone. In patients with metastatic cutaneous HNSCC involving cervical nodes, survival was significantly improved with the addition of radiotherapy.

Editorial Comment

The authors should be commended for studying the difficult population of men with stress incontinence after radical prostatectomy and radiotherapy. The authors report the outcomes for the AdVance sling and conclude that, in select patients, the procedure achieves a success rate of 50%, with results stable for a median follow-up of 18 months. They also state that treatment success is reduced compared with the reported success rates in patients who have not undergone radiotherapy. Some of the criticisms of this study are common to many reports on the outcomes after treatment of male stress incontinence. A careful reading of this report (and many others on the same topic) raises 2 important questions. First, whether the “success” rate is really 50%; and second, whether the outcomes are really worse in patients who have undergone adjuvant radiotherapy. Results of the AdVance Transobturator Male Sling After Radical Prostatectomy and Adjuvant RadiotherapyUrologyVol. 77Issue 2PreviewTo prospectively evaluate the efficacy of the functional AdVance transobturator sling for the treatment of male stress urinary incontinence (SUI) in patients after radical prostatectomy and additional adjuvant radiotherapy. Full-Text PDF ReplyUrologyVol. 77Issue 2PreviewWe agree with the authors of the editorial comment concerning their first question that “surgical cure” is not a sufficient measure to assess the success of stress urinary incontinence (SUI) treatment. However, measurement of the outcomes of SUI treatment is still challenging. The outcome measures used to evaluate therapy success lack consensus and comparability.1 As the authors state, patients' subjective satisfaction rates have often been greater than the pad-free or cure rates. Despite that, some patients might not be satisfied with the surgical outcome despite postoperative continence. Full-Text PDF

Results of the AdVance Transobturator Male Sling After Radical Prostatectomy and Adjuvant Radiotherapy

To prospectively evaluate the efficacy of the functional AdVance transobturator sling for the treatment of male stress urinary incontinence (SUI) in patients after radical prostatectomy and additional adjuvant radiotherapy. Between February 2007 and November 2008, 24 patients with postprostatectomy SUI (ICS grade 2-4) and additional adjuvant radiotherapy were treated consecutively with the AdVance sling. Preoperatively, intensive workup, including urodynamic assessment and flexible urethroscopy, was performed. Physical examinations (pad test, uroflowmetry, ultrasound) and questionnaires (I-QOL score, ICIQ-UI-SF score) were performed during baseline and during follow-up. Cure rate was defined as no pad use or one dry pad, and improved rate as 1-2 pads or reduction of pads by ≥50%. After a median follow-up of 18.0 months (range 12-33 months, mean 18.8 months), the success rate was 50%. Daily pad use and pad weight in the 1-hour pad test decreased significantly. Patients with ICS grade 2 SUI exhibited a trend for a better success rate in comparison with patients with grade 3 and 4 SUI. Results were durable over time. Postoperatively, 16.7% of the patients exhibited transient acute urinary retention which resolved without further treatment after a maximum of 6 weeks. 1 sling had to be removed because of initial misplacement. In selected patients after adjuvant radiotherapy, the AdVance sling achieved a success rate of 50% and results were stable in a median follow-up of 18 months. Complication rates were low and comparable to complication rates for patients without additional radiotherapy.

Survival Outcomes in Resected Extrahepatic Cholangiocarcinoma: Effect of Adjuvant Radiotherapy in a Surveillance, Epidemiology, and End Results Analysis

The benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic cholangiocarcinoma has not been clearly established. We analyzed survival outcomes of patients with resected extrahepatic cholangiocarcinoma and examined the effect of adjuvant RT. Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2003. The primary endpoint was the overall survival time. Cox regression analysis was used to perform univariate and multivariate analyses of the following clinical variables: age, year of diagnosis, histologic grade, localized (Stage T1-T2) vs. regional (Stage T3 or greater and/or node positive) stage, gender, race, and the use of adjuvant RT after surgical resection. The records for 2,332 patients were obtained. Patients with previous malignancy, distant disease, incomplete or conflicting records, atypical histologic features, and those treated with preoperative/intraoperative RT were excluded. Of the remaining 1,491 patients eligible for analysis, 473 (32%) had undergone adjuvant RT. After a median follow-up of 27 months (among surviving patients), the median overall survival time for the entire cohort was 20 months. Patients with localized and regional disease had a median survival time of 33 and 18 months, respectively (p<.001). The addition of adjuvant RT was not associated with an improvement in overall or cause-specific survival for patients with local or regional disease. Patients with localized disease had significantly better overall survival than those with regional disease. Adjuvant RT was not associated with an improvement in long-term overall survival in patients with resected extrahepatic bile duct cancer. Key data, including margin status and the use of combined chemotherapy, was not available through the SEER database.

Mid‐term results for the retroluminar transobturator sling suspension for stress urinary incontinence after prostatectomy

• To evaluate prospectively the efficacy of the retroluminar transobturator male sling (AdVance® sling) for the functional treatment of stress urinary incontinence (SUI) after prostatectomy. • A total of 137 patients with grade II-IV SUI, resulting from radical prostatectomy, were treated with the AdVance® sling in a prospective clinical study. In all, 11 patients were lost to follow-up. A total of 17 patients (13.5%) had additional adjuvant radiotherapy before sling implantation. • Before and after sling implantation, a standardized 1-h pad test was performed and post-void residual urine, uroflowmetry, quality-of-life scores and the International Index of Erectile Function (IIEF-5) were assessed. • When calculating the cure and improvement rates, 'cure' was defined as no pad use or one dry prophylactic pad; and 'improved' was defined as 1-2 pads or reduction of pads ≥ 50%. • After a median (range) follow-up of 27 (20-37) months, and a mean follow-up of 27.2 months, the success rate was 75.4% with 51.6%'cured' and 23.8%'improved'. • Overall daily pad use, urine loss in the 1-h pad test and quality-of-life scores improved significantly after sling implantation. • Compared with 1-year follow-up data, no worsening over time was noticed and no additional complications were seen. • With a mid-term follow-up, the retroluminar transobturator male sling is an effective, safe and attractive treatment option for SUI after radical prostatectomy. Results are stable over time.