Addition Of Postoperative Radiotherapy Research Articles

Clinical impact of postoperative radiotherapy in pIII-N2 non-small cell lung cancer after complete resection followed by adjuvant chemotherapy: a systematic review and meta-analysis.

Theoretically, postoperative radiotherapy (PORT) could reduce the risk of local recurrence and further improve survival outcomes. This study aimed to evaluate the clinical impact of PORT on patients with pIII-N2 non-small cell lung cancer (NSCLC) after complete resection followed by adjuvant chemotherapy. A systematic literature search was performed in November 2022 to identify randomized controlled trials (RCTs) that compare PORT with observation in patients with pIII-N2 NSCLC using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. This meta-analysis is in accordance with the recommendations of the PRISMA statement. The main outcomes were overall survival (OS), disease-free survival (DFS), and local recurrence rates, which were compared using hazard ratios (HRs). Five RCTs involving 1,138 patients were included: 572 patients in the PORT group and 566 patients in the observation group. The methodological quality of the five RCTs was high. Pooled analysis revealed that PORT decreased local recurrence rate [odds ratio =0.53, 95% confidence interval (CI): 0.40-0.70]. However, PORT did not improve median DFS (HR =0.93, 95% CI: 0.80-1.08) and OS (HR =0.94, 95% CI: 0.78-1.14). Compared to adjuvant chemotherapy alone, additional PORT was significantly associated with a reduced local recurrence rate. However, neither DFS nor OS benefited from PORT in patients with pIII-N2 NSCLC who had undergone complete resection.

Addition of Postoperative Radiation Therapy After Preoperative Chemotherapy and Surgery in Patients With Locally Advanced Endometrial Cancer Is Associated With Improved Outcomes

PurposeOur purpose was to examine outcomes of patients with locally advanced endometrial cancer who undergo neoadjuvant chemotherapy followed by surgery (PreCT) with/without postoperative adjuvant radiation therapy. A secondary analysis of down staging and margin clearance was made with reference to those receiving upfront surgery and then adjuvant chemotherapy (PostCT). Methods and MaterialsThe National Cancer Database was queried for FIGO (The International Federation of Gynecology and Obstetrics) stage III/IV locally advanced endometrial cancer cases who underwent definitive surgery from 2010 to 2016 and received chemotherapy as part of their treatment. Cases were classified into 2 cohorts: preoperative chemotherapy +/- postoperative chemotherapy cohort (PreCT) and postoperative chemotherapy cohort (PostCT) for reference for margin assessment. Cases who received preoperative radiation therapy were excluded while those who received postoperative radiation were included in the analysis. Primary endpoints were overall survival (OS), surgical margin status, rate of downstaging, and effect of adjuvant radiation therapy on OS among the PreCT cohort. Univariable (UVA) and multivariable (MVA) Cox regression analyses were performed. ResultsA total of 13,369 cases were identified with 1059 in PreCT and 12,310 in PostCT cohorts. PreCT had lower OS than PostCT (UVA: hazard ratio [HR], 2.18; P < .001; MVA: HR, 1.873; P < .001). PreCT cases with negative margins, who presumably had unresectable tumors initially, also had worse OS compared with PostCT with negative margins (UVA: HR, 2.20; P < .001; MVA: HR, 1.84; P < .001); however, PreCT with negative margins had similar survival to PostCT with positive margins (UVA: HR, 0.825; P < .001; MVA: P = .885). The addition of radiation after surgery in the PreCT cohort was associated with improved survival (5-year OS 20.5% compared with 50%, respectively; UVA: HR, 0.450; P < .001; MVA: HR, 0.337; P < .001). Although fewer cases in PreCT had negative margins compared with PostCT (72% compared with 84%, P < .001), approximately 19% of cases in PreCT had lower pathologic T-stage compared with clinical T-stage and 11% had lower N-stage. ConclusionsNeoadjuvant chemotherapy was given in cases with worse oncologic prognostic factors, many of whom were likely unresectable at outset, compared with those who received postoperative chemotherapy. Although neoadjuvant chemotherapy is associated with tumor downstaging, survival is lower than with primary surgery probably because of these baseline differences. The addition of adjuvant radiation after surgery in cases who received preoperative chemotherapy is associated with improved survival.

Postoperative radiation therapy improves prognoses in extramammary Paget's disease presenting with multiple lymph node metastases.

Invasive extramammary Paget's disease may cause lymph node and distant metastases. Complete lymph node dissection is generally performed for extramammary Paget's disease presenting with lymph node metastases. Patients with extramammary Paget's disease and multiple lymph node metastases typically have poor prognoses, and there is no effective postoperative treatment to prevent recurrence or further metastases in such patients to date. This study aimed to evaluate the efficacy of postoperative radiotherapy in patients with extramammary Paget's disease and multiple lymph node metastases. We enrolled 26 patients with extramammary Paget's disease with ≥3 lymph node metastases who were treated at the National Cancer Center Hospital in Japan between January 2000 and June 2021. The patients were divided into those who underwent complete lymph node dissection only or with postoperative radiotherapy. We evaluated recurrence-free survival, distant metastasis-free survival, and overall survival outcomes with Kaplan-Meier curves. Among the 26 enrolled patients, 16 underwent complete lymph node dissection only and 10 underwent complete lymph node dissection with postoperative radiotherapy. The median follow-up period was 16 months. The 5-year recurrence-free, distant metastasis-free, and overall survival values were 47.3%, 63.0%, and 90% in those with complete lymph node dissection and postoperative radiotherapy, while these outcomes were all 0% (p=0.001, 0.004, and 0.009, respectively) in those with only complete lymph node dissection. Thus, survival was significantly prolonged with postoperative radiotherapy. Additional postoperative radiotherapy may substantially improve the prognoses of patients with extramammary Paget's disease and ≥3 lymph node metastases, and undergoing curative surgery.

Additional Postoperative Radiotherapy Prolonged the Survival of Patients with I-IIA Small Cell Lung Cancer: Analysis of the SEER Database.

Purpose Complete resection and adjuvant chemotherapy are recommended as the standard strategy for patients with stage I-IIA small cell lung cancer (SCLC). However, the role of additional postoperative radiotherapy (PORT) in treatment remains controversial. Methods Patients with stage I-IIA SCLC undergoing surgery and adjuvant chemotherapy were extracted from the Surveillance, Epidemiology, and End Results database. Stage I-IIA, defined as T1-2N0M0, was recalculated according to the 8th AJCC TNM staging system. Propensity score matching (PSM) was conducted to identify the therapeutic impact of PORT. Univariate Cox hazards regression and least absolute shrinkage and selection operator regression were utilized for primary screening of prognostic variables for I-IIA SCLC disease. A nomogram to predict overall survival (OS) was constructed based on the multivariate Cox proportional hazards model, evaluated with area under the curve, calibration curve, and decision curve analysis, and validated with bootstrap resampling. Results Our results demonstrated that compared with no PORT, PORT significantly prolonged the median OS (8.58 vs. 5.17 years, HR = 0.61 [0.39–0.96], P = 0.032) and median cancer-specific survival (11.33 vs. 8.08, HR = 0.47 [0.27–0.82], P = 0.0086) after PSM. The 5-year OS rate was 61.56% vs. 46.60%. Five variables including age at diagnosis, gender, T stage, surgical type, and PORT were elucidated to impact on prognosis and included in a nomogram to predict 3-/5-/10-year OS probability. The area under the curve values were 0.72, 0.71, and 0.81, respectively. The nomogram also exhibited satisfactory accuracy and clinical usefulness. Conclusion PORT was verified to improve the OS of patients with T1-2N0M0 SCLC after surgery and chemotherapy. A prognostic nomogram was developed and validated for OS prediction for these patients.

PD26-06 ADJUVANT CHEMOTHERAPY PLUS RADIOTHERAPY VERSUS CHEMOTHERAPY ALONE FOR LOCALLY ADVANCED BLADDER CANCER AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyCME1 May 2022PD26-06 ADJUVANT CHEMOTHERAPY PLUS RADIOTHERAPY VERSUS CHEMOTHERAPY ALONE FOR LOCALLY ADVANCED BLADDER CANCER AFTER RADICAL CYSTECTOMY John Ernandez, Sumedh Kaul, Aaron Fleishman, Ruslan Korets, Peter Chang, Andrew Wagner, Simon Kim, Joaquim Bellmunt, Irving Kaplan, Aria Olumi, and Boris Gershman John ErnandezJohn Ernandez More articles by this author , Sumedh KaulSumedh Kaul More articles by this author , Aaron FleishmanAaron Fleishman More articles by this author , Ruslan KoretsRuslan Korets More articles by this author , Peter ChangPeter Chang More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , Simon KimSimon Kim More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Irving KaplanIrving Kaplan More articles by this author , Aria OlumiAria Olumi More articles by this author , and Boris GershmanBoris Gershman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002574.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Survival for patients with locally advanced bladder cancer following radical cystectomy (RC) remains poor. Although adjuvant chemotherapy (AC) is standard of care, one small randomized trial has suggested a potential disease-free survival benefit with the addition of post-operative radiotherapy (PORT). We therefore examined the association of PORT with overall survival (OS) in patients with locally advanced bladder cancer after RC. METHODS: Using a completed phase 2 trial to inform the design of the present study, we conducted observational analyses to emulate a hypothetical target trial of patients aged 18-79 years with pT3-4 Nany M0 or pTany N1-3 M0 urothelial carcinoma of the bladder following RC who were treated with AC (multiagent chemotherapy within 3 months of RC) with or without PORT (≥45 Gy to the pelvis) from 2006-2015 in the National Cancer Database. Patients who received preoperative chemotherapy or radiotherapy were excluded. The associations of treatment arm with OS were evaluated using multivariable Cox regression. RESULTS: A total of 1,684 patients were included, of whom 66 underwent PORT+AC and 1,618 AC alone. Compared to patients treated with AC alone, those treated with PORT+AC were more likely to have pT4 disease (52% vs 26%; p<0.01), have positive surgical margins (44% vs 17%; p<0.01), and be treated at a non-academic facility (75% vs 53%; p<0.01). Crude 3- and 5-year OS were 31% and 19% for PORT+AC versus 48% and 36% for AC alone (p=0.01). Adjusted 3- and 5-year OS were 44% and 33% for PORT+AC versus 48% and 36% for AC alone (p=0.49). After adjusting for baseline characteristics including pathologic features, PORT+AC was not associated with improved OS compared to AC alone (HR 1.11; 95% CI 0.82-1.51; Figure 1). CONCLUSIONS: Although infrequently utilized, the present analyses suggest that the addition of radiotherapy to AC is not associated with improved OS in locally advanced bladder cancer. These results highlight the need for prospective trials to better define the potential benefits from PORT with regard to symptomatic progression and oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e489 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Ernandez More articles by this author Sumedh Kaul More articles by this author Aaron Fleishman More articles by this author Ruslan Korets More articles by this author Peter Chang More articles by this author Andrew Wagner More articles by this author Simon Kim More articles by this author Joaquim Bellmunt More articles by this author Irving Kaplan More articles by this author Aria Olumi More articles by this author Boris Gershman More articles by this author Expand All Advertisement PDF DownloadLoading ...

A retrospective review of phyllodes tumor of breast treated with multimodality approach: Experience of a tertiary care institution in Eastern India

Background: The cornerstone of management of phyllodes tumor is surgery. No standard of care exists regarding adjuvant therapy; however, local recurrence is a predominant pattern of failure. The aims of this study were to evaluate the clinical characteristics and treatment patterns of phyllodes tumor and to compare local recurrence and disease-free survival rates of patients with borderline and malignant phyllodes tumor treated with or without adjuvant radiotherapy. Materials and Methods: We analyzed the demographic data, treatment details, and recurrence patterns of all patients with nonmetastatic phyllodes tumors of the breast (n = 34) treated with a multimodality approach who presented to our institute from January 2015 to December 2020. Results: The median age at presentation was 41.2 years, and the median tumor size was 12.5 cm. All patients underwent definitive surgical procedures in the form of wide local excision or mastectomy. No recurrence was noted in the patients with a benign histology. After a median follow-up period of 38 months, the local recurrence rate was 27% for the patients with borderline and malignant histology treated with adjuvant radiotherapy (n = 11) versus 47% for those (n = 17) who did not receive adjuvant radiotherapy. The 3-year local recurrence-free survival rate was 72% in the adjuvant radiotherapy group, versus 51% in the surgery only group. Conclusion: The results of the current study confirm the excellent prognosis of patients with benign phyllodes tumor undergoing surgery alone. Local recurrence was the predominant mode of failure in the patients with borderline and malignant histology. Locoregional control was improved with the addition of postoperative radiotherapy in the patients with borderline and malignant histology irrespective of margin status.

Role of Adjuvant Radiotherapy in Early Stage Tongue Cancer: Need for Establishing Stringent Guidelines.

The primary objective of this study was to determine, using population-based data, whether the addition of postoperative radiotherapy (RT) provides an overall survival benefit in patients with early primary squamous cell carcinoma (SCC) of tongue. The study included the data of tongue cancer patients treated between January 2016 and July 2019 retrieved from our hospital database. Tumours limited to pathologic T1 and T2 category managed with primary surgery with or without postoperative external beam RT were included. Overall survival (OS) and disease-free survival (DFS) were the main outcomes of interest. A total of 211 cases of oral cancer were evaluated and all the patients had clear surgical and pathological margins. Postoperative adjuvant therapy (PORT) was received by 16 patients. Comparison of DFS and OS at 2-year follow-up depicted a similar outcome (p = 0.582 and p = 0.312 respectively). Findings from our study suggest that in the absence of any absolute advantage on quantifiable survival and disease control, it is necessary to define stringent criteria when advocating PORT in early tongue cancer.

Invasive thymoma - Which patients benefit from post-operative radiotherapy?

The aim of this study is to identify patients with thymoma who should receive post-operative radiotherapy. The Surveillance, Epidemiology, and End Results database was queried for stage IIB-IV thymoma patients diagnosed during 1988-2015. We analyzed the prognostic implications of various clinical-pathological factors by comparing the outcomes of those who received surgery with and without post-operative radiotherapy. A total of 1120 patients were identified; 62% received post-operative radiotherapy and 38% underwent surgery alone. In a propensity-matched cohort of 812 patients, no survival difference was seen in World Health Organization A, AB, B1, B2, or B3 tumors with the addition of post-operative radiotherapy to surgery (p>0.05). Post-operative radiotherapy also did not improve survival over surgery alone for tumors ≥ or < less than the 4 cm, 7 cm, 10 cm, and 13 cm cutoffs, all p>0.05. Post-operative radiotherapy was an independent, positive prognostic indicator only in the subgroup with stage III disease and in those receiving chemotherapy in addition to post-operative radiotherapy, both p<0.05. Patients with stage III thymoma are most likely to benefit from the addition of post-operative radiotherapy to surgical treatments. Tumor size or World Health Organization histology alone should not be criteria for determining the need for post-operative radiotherapy in locally advanced thymoma. Masaoka-Koga stage, which has traditionally been used to help make such decisions, appears to be the most reliable determinant of the use of post-operative radiotherapy.

Aggressive Local Treatment Improves Survival in Stage IV Breast Cancer With Synchronous Metastasis.

IntroductionTo investigate the effect of local treatment strategy on survival outcome in de novo stage IV breast cancer patients who received chemotherapy.MethodsWe identified stage IV breast cancers that presented with synchronous metastasis from the Surveillance, Epidemiology, and End Results database. Binomial logistic regression, Kaplan–Meier survival curves, propensity score matching (PSM), and multivariate Cox regression model were used for statistical analyses.ResultsWe identified 5,374 patients in total, including 2,319 (43.2%), 2,137 (39.8%), and 918 (17.1%) patients who received surgery alone, surgery+radiotherapy, and radiotherapy alone, respectively. The probability of patients receiving surgery alone decreased over time, and the probability of patients receiving radiotherapy alone increased over time. However, no significant difference was observed in the probability of patients receiving postoperative radiotherapy (P = 0.291). The 3-year breast cancer-specific survival (BCSS) in patients treated with surgery alone, radiotherapy alone, and surgery+radiotherapy was 57.1, 35.9, and 63.9%, respectively (P < 0.001). The local treatment strategy was the independent prognostic factor related to BCSS. Using surgery alone as the reference, radiotherapy alone was related to lower BCSS (P < 0.001), while additional radiotherapy after surgery improved BCSS (P < 0.001). Similar results were observed using PSM.ConclusionsCompared to radiotherapy alone, surgery to the primary site may confer a survival benefit in stage IV breast cancer with synchronous metastasis, and additional postoperative radiotherapy further improves outcome after primary tumor removal. Local treatment can only be an option in highly selected patients with de novo stage IV disease in the treatment guidelines. More prospective studies are needed to investigate the role of local management for this patient subset.

Advances in the treatment of gastric cancer: 2019.

The aim of this study was to review studies published within the past year regarding management of gastric cancer. Laparoscopic gastrectomy achieves equivalent survival compared with open gastrectomy in early stage and locally advanced gastric cancer. Adjuvant chemotherapy with 6 months of S-1 and oxaliplatin was superior to 12 months of S-1, and the addition of postoperative radiation therapy did not improve survival. The FLOT regimen is the new standard for preoperative chemotherapy. In metastatic gastric cancer, the addition of docetaxel to S-1 and cisplatin failed to improve overall survival over two-drug chemotherapy. The addition of the immune checkpoint inhibitor pembrolizumab to chemotherapy failed to improve overall survival compared with chemotherapy alone. Laparoscopic gastrectomy is acceptable in early and locally advanced gastric cancer. Combination adjuvant chemotherapy is superior to S-1 monotherapy. Adjuvant radiation therapy after D2 gastrectomy for node-positive gastric cancer does not improve survival. Preoperative chemotherapy with FLOT (5-FU, leucovorin, oxaliplatin and docetaxel) without radiation therapy is the standard treatment in the West. Two-drug chemotherapy is the optimal initial treatment in metastatic disease. Adding pembrolizumab to front-line chemotherapy did not improve survival, with use of immune checkpoint inhibitors reserved to treat chemotherapy refractory metastatic disease.

Two steps forward and one step back.

Perioperative chemotherapy is the standard of care for localized gastric cancer (GC). In 2018, additional postoperative radiotherapy was found to be ineffective; although, docetaxel was found to be superior to epirubicin in perioperative three-drug chemotherapy regimens. Validated biomarkers are needed for benefit from immunotherapy in advanced-stage GC. Metachronous GC can be prevented by Helicobacter pylori eradication.

Neoadjuvant and adjuvant therapy for Stage III non-small cell lung cancer.

The treatments for advanced non-small cell lung cancer (NSCLC) should control both local and microscopic systemic disease, because the 5-year survival of patients with Stage III NSCLC who underwent surgical resection alone has been dismal. One way to improve surgical outcome is the administration of chemotherapy before or after the surgical procedure. During the last two decades, many clinical studies have focused on developing optimal adjuvant or neoadjuvant chemotherapy regimens that can be combined with surgical treatment and/or radiotherapy. Based on the results of those clinical studies, multimodality therapy is considered to be an appropriate treatment approach for Stage IIIA NSCLC patients; although, optimal treatment strategies are still evolving. When N2 nodal involvement is discovered postoperatively, adjuvant cisplatin-based chemotherapy confers an overall survival benefit. The addition of postoperative radiotherapy might be considered for patients with nodal metastases. Although definitive chemoradiation remains a standard of care for cN2 NSCLC, alternative approaches such as induction chemotherapy or chemoradiotherapy and surgery can be considered for a selective group of patients. When surgical resection can be performed after induction therapy with low risk and a good chance of complete resection, the outcome may be optimal. The decision to proceed with resection after induction therapy must include a detailed preoperative pulmonary function evaluation as well as a critical intraoperative assessment of the feasibility of complete resection.

Management of eosinophilic granuloma in pediatric patients: surgical intervention and surgery combined with postoperative radiotherapy and/or chemotherapy.

Eosinophilic granuloma (EG) of spine in pediatric patients presents kinds of clinical manifestation and a difficult management scenario. The choice of treatment, issues of surgical intervention versus conservative treatment, combination therapy or single treatment, all these factors, including neurological deficits, spinal stability, long-term complications, and continued skeletal growth, must be considered. From 2008 to the 2015, 31 pediatric patients of spinal EG were retrospectively reviewed. They were 17 males and 14 females, with a mean age 8.89±2.84years old (range, 3.5-14years old). All the cases were divided into two groups. Twenty-three cases (Group S) accepted surgical interventions and surgery combined with local low-dose radiotherapy and/or chemotherapy. Eight patients (Group C) accepted radiotherapy and/or chemotherapy. All the patients had imaging studies of the lesion including standard radiography, three-dimensional computed tomography (CT) scan, and magnetic resonance imaging (MRI) prior to and after treatment. Cases in group S underwent surgery-related treatment, which include six patients accepted surgery only, nine patients accepted postoperative low-dose radiotherapy, four patients accepted additional chemotherapy, and four patients accepted both. Cases in group C accepted radiotherapy and/or chemotherapy, which include five patients accepted radiotherapy, one patient accepted chemotherapy, and two patients accepted both radiotherapy and chemotherapy. Clinical symptoms, neurologic status, radiologic manifestations, treatment, outcome, and/or complications were recorded and analyzed. All the 31 patients had pain relief (both in group S and group C) but the patients in group S obtained more prompt pain relief. All the patients in group S obtained local kyphosis correction, reconstruction of stability of spine, and recovery of neurological deficit after treatment. They have no surgery-related complications after treatment and in follow-up. Seventeen patients who received additional postoperative radiotherapy and/or chemotherapy also had good outcomes. There were no severe radiation and chemotherapy complications in procedure. The patients (group C) who accepted non-surgical treatment also have no severe complications, and a new femur lesion was found in one patient in follow-up. Surgical intervention, including anterior and/or posterior approach with bone graft or surgery combined with postoperative low-dose radiotherapy and/or chemotherapy is a safe and effective way for treatment of the spinal EG. Compared with radiotherapy and/or chemotherapy, more prompt pain relief can be achieved via surgical intervention or surgery combined radiotherapy and/or chemotherapy.

An update in the nonendoscopic treatment of gastric cancer.

This article reviews the recent seminal studies in esophagogastric cancer. Regular low aspirin use may reduce the risk of esophagogastric cancer. Laparoscopic resection of locally advanced gastric cancer appears equivalent to open resection. There is no survival benefit for the addition of postoperative radiation therapy to adjuvant chemotherapy after primary gastric cancer resection. For tumors of the esophagus and gastroesophageal junction, the combination of preoperative radiation therapy with concurrent chemotherapy may be required to ensure achievement of a negative surgical margin and to reduce local tumor recurrence. Epirubicin may not add benefit to fluorinated pyrimidine and platinum-based chemotherapy, either in the preoperative setting or in the treatment of metastatic disease. The Her2-targeted agents lapatinib and trastuzumab emtansine failed to improve outcome when either added to or compared with chemotherapy. Immune checkpoint inhibition appears to be active in metastatic gastric cancer. Recent studies in esophagogastric cancer help clarify the role of radiation therapy in surgical management, as well as the role of chemotherapeutic and targeted agents.

Outcome after PORT in ypN2 or R1/R2 versus no PORT in ypN0 Stage III-N2 NSCLC after Induction Chemotherapy and Resection

IntroductionWe investigated patients with contemporarily staged and treated stage III-N2 NSCLC treated with induction chemotherapy and surgery with or without postoperative radiotherapy (PORT). We focused on survival and toxicity and investigated what additional PORT may offer in patients with ypN2 status or incomplete resection. MethodsWe identified 161 patients with pathologically proven, resectable stage III-N2 NSCLC from our prospective database who were treated between 1998 and 2012. Of these patients, 150 without progressive disease after chemotherapy underwent resection. Patients with ypN2 status or R1/2 resection received three-dimensional PORT (n = 70) to a dose of 50 to 66 Gy in 2-Gy fractions. ResultsThe mean follow-up time was 49 months. The 5-year overall survival (OS) rate was 35.1% in intention-to-treat analysis; relapse-free survival was 31.8%, the cumulative local recurrence (LR) rate was 50.9%, and the distant metastasis rate was 63.4%. The 5-year OS, relapse-free survival, and cumulative LR and distant metastasis rates were 32.0%, 32.9%, 47.0%, and 63.9% in the PORT group versus 38.1%, 30.7%, 54.1%, and 63.2% in the non-PORT group. These results were not significantly different, even though patients in the PORT group had worse prognostic features. Cardiac toxicity was higher in the non-PORT group (p = 0.02), but pulmonary toxicity was similar (p = 0.15). There was no difference between the two groups regarding dyspnea (p = 0.32), cough (p = 0.37), forced expiratory volume in 1 second (p = 0.30), and diffusing capacity of the lung for carbon monoxide (p = 0.61). ConclusionsA similar outcome (OS, LR, and toxicity) was seen in both patient groups (PORT versus non-PORT group). Despite the limitations of this retrospective study, PORT can be both effective and safe for patients with stage III-N2 NSCLC with an R1/R2 resection or yN2 after induction chemotherapy and surgery.

Survival benefit of adjuvant radiotherapy in stage III and IV bladder cancer: results of 170 patients.

Background:Radical cystectomy (RC) with or without neoadjuvant chemotherapy is the standard treatment for muscle-invasive bladder cancers. However, the locoregional recurrence rate is still significantly higher for locally advanced cases post-RC. The underuse of postoperative radiotherapy (PORT) in such cases after RC is related mainly to a lack of proven survival benefit. Here we are reporting our long-term Egyptian experience with bladder cancer patients treated with up-front RC with or without conformal PORT.Patients and methods:This retrospective study included 170 locally advanced bladder cancer (T3–T4, N0/N1, M0) patients who had RC performed with or without PORT at Damietta Cancer Institute during the period of 1998–2006. The treatment outcomes and toxicity profile of PORT were evaluated and compared with those of a non-PORT group of patients.Results:Ninety-two patients received PORT; 78 did not. At median follow-up of 47 months (range, 17–77 months), 33% locoregional recurrences were seen in the PORT group versus 55% in the non-PORT group (P<0.001). The overall distant metastasis rate in the whole group was 39%, with no difference between the two groups. The 5-year disease-free survival for the whole group of patients was 53%±11%, which was significantly affected by additional PORT, and 65%±13% compared with 40%±9% for the non-PORT group (P=0.04). The pathological subtypes did not affect 5-year disease-free survival significantly (P=0.9). The 5-year overall survival was 44%±10%. Using multivariate analysis, PORT, stage, and extravesical extension (positive surgical margins) were found to be important prognostic factors for locoregional control. Stage and lymph node status were important prognosticators for distant metastasis control.Conclusion:PORT was found to be a safe and effective tool in decreasing local recurrence rates and improving disease-free survival.

Anaplastic Thyroid Carcinomas Incidentally Found on Postoperative Pathological Examination

Anaplastic thyroid carcinoma (ATC) is occasionally found on postoperative pathological examination of patients with differentiated thyroid carcinoma (DTC). There is no general consensus on how we should treat these incidentally diagnosed ATC (incidental ATC). A total of 675 patients with ATC were registered with the ATC Research Consortium of Japan. These patients were treated between 1995 and 2008 in 38 registered institutions. About 81 % of the ATC patients had common-type ATC and about 14 % had ATC co-existing with a metastatic DTC lesion. The remaining 5 % had incidental ATC. Among the patients with incidental ATC, we investigated 25 patients whose clinical data were fully available. We examined the clinical profile of incidental ATC, and the relationships between treatment and outcome in patients with incidental ATC. The tumor size was clearly smaller, and patients with extrathyroid invasion or distant metastasis were significantly fewer in incidental ATC than in common-type ATC. Most incidental ATC coexisted with papillary carcinoma. While the clinical course of incidental ATC was favorable compared with common-type ATC, half of the patients had disease-related deaths. The prognostic factors of incidental ATC were nearly the same as those of common-type ATC, but the tumor size alone was an independent factor on multivariate analysis. Regarding treatments, the outcome was more favorable in those who underwent curative resection, and the clinical course showed a slight improvement by the addition of external beam radiotherapy and/or chemotherapy after curative resection, but it did not reach statistical significance. Incidental ATC is the only curable type of ATC, and further studies are needed to establish the effectiveness of additional postoperative radiotherapy and/or chemotherapy in incidental ATC.

Myoepithelial carcinoma of the head and neck: A report of 23 cases and literature review

Abstract Objective Myoepithelial carcinoma (MC) of head and neck is extremely rare. The relevant literature consists only of case reports, and consequently many of its clinical characteristics and optimal treatment strategies remain unknown. Methods We retrospectively analyzed 23 patients diagnosed with MC of the head and neck between 1991 and 2005. Most patients were treated with surgery and postoperative radiotherapy or adjuvant chemotherapy. The recurrence, survival and local control rates were evaluated. Results Thirteen (56.5%) patients were male and 10 were female with a median age of 52 years (range: 15–77 years). The parotid was the most frequently involved site (39.1%). Eighteen patients underwent surgery as their initial treatment and nine of these received postoperative radiotherapy. The 3-year and 5-year overall survival rates were 59% and 31.8%, respectively. The local relapse rate was 30.4% (6/23); eight patients had a distal metastasis, and the lung was the most common site. There was no difference in the local control and survival rates between patients who received surgery alone and those with additional postoperative radiotherapy ( p =0.059). Two patients had partial response after chemotherapy with dacarbazine. Conclusions The detailed clinical data presented here reveal several new characteristics of MC of the head and neck. Postoperative radiotherapy did not improve the prognosis. Chemotherapeutic regimens that include dacarbazine might be useful.

Role of Postoperative Radiotherapy for Microscopic Margin Involvement in the Squamous Cell Carcinoma of Esophagus

PurposeThe objective of this study was to assess the effect of postoperative radiotherapy on the outcome of esophageal cancer with microscopically positive resection margin by comparing the results with those of patients with negative resection margin.Materials and MethodsMedical records of 88 patients treated with macroscopic resection followed by postoperative radiotherapy for stage II or III squamous cell carcinoma of the esophagus from June 1984 to March 2008 were reviewed. Twelve patients had received chemotherapy. Patients were classified into two groups based on resection margin status: negative resection margin (group A, n=66) and microscopically positive resection margin (group B, n=22). Median follow-up duration of living patients was 68 months (range, 18 to 115 months). Median total radiation dose of group A and group B was 51.5 Gy (range, 45 to 69 Gy) and 52.1 Gy (range, 45 to 64 Gy), respectively.ResultsMedian overall survival and disease-free survival were 15 and 10 months, respectively. The five-year overall survival, disease-free survival, and local control rates for group A and group B were 15.9% and 16.4%, 13.5% and 9.1%, and 76.3% and 69.6%, respectively. No statistically significant difference in terms of overall survival, disease-free survival, and local control (p=0.295, p=0.209, and p=0.731, respectively) was observed between group A and group B. Seven patients experienced toxicity of grade 3 or higher.ConclusionA significant portion of patients with margin involvement reached long term survival after addition of postoperative radiotherapy. These results suggest a potential role of postoperative radiotherapy, especially for patients with margin involvement.

Ruolo Della Radioterapia Nei Tumori Urologici Localmente Avanzati e/o Recidivati

Radiation therapy (RT) plays a fundamental role in the treatment of locally advanced and/or relapsed urological tumors, as well as in palliation, or as definitive treatment, and even where integrated into a multi-modal approach. In operated renal tumors, positive margins or extracapsular extension show a positive impact of postoperative RT, with a reduction of relapses between 100% and 30%, while, in the case of palliation, treatments with RT at high doses are preferred. In advanced cancers of the upper urinary tract, RT plays a limited role, even if it seems to increase the level of disease control locally and, with the combination of cisplatin, survival rates too. An important reduction in the recurrence is also observed in locally advanced tumors of the urethra, with a recurrence of 60% after surgery, 36% after RT and 25% after pairing of the two. In locally advanced tumors of the penis, RT shows poorer results than surgery, and the addition of postoperative RT does not seem to add any further outcome, except where, in the presence of a positive inguinal dissection, the postoperative RT reduces lymph node recurrences by 60%-11%. Interesting data for the preservation of the organ are reported with reference to the combination with chemotherapy. In the tumors of the testis, it is still disputable whether the treatment of residual masses after chemotherapy may be appropriate, with a view to a possible salvage radiotherapy. In the treatment of the prostate, the role of RT is consolidated and evolving with the progress of dose escalation, the association with hormonal therapy, new technologies, new possibilities of IMRT and proton therapy and various studies on multi-modal approaches (hormone therapy, surgery, radiotherapy, chemotherapy). Cystectomy is the gold standard for the treatment of locally advanced bladder cancer, even though there is a revived interest in multimodal treatments (transurethral resection, chemotherapy, RT) that may allow the organ preservation. Postoperative radiotherapy, which can reduce by 50% to 20%-5% local recurrences that are highly correlated with distance failure and with survival, should be revised in the light of modern RT techniques that can further increase local control levels and reduce the toxicity significantly.