Adjuvant Radiotherapy In Patients Research Articles

Use of Geriatric Assessment Tools in Selecting Therapies in Women Aged ≥70 Years With Hormone Receptor–Positive Early-Stage Breast Cancer: Preliminary Experience With a Quality Improvement Initiative

Todevelop a multidisciplinary algorithmic approach to management of women aged ≥70years with clinically staged T1N0 hormone receptor-positive breast cancer, including geriatric assessments predicting life expectancy and the likelihood of functional decline in the near future, in the context of a program-wide quality improvement initiative, to better select patients for therapeutic interventions. Two geriatric assessment tools, the Combined Lee-Schonberg Index and the Vulnerable Elderly Scale, were introduced into our clinical workflow to predict long-term mortality and likelihood of functional decline. Scores from these tools, along with patient preferences and clinical features, were incorporated into a preoperative algorithm addressing the use of sentinel lymph node biopsy (SLNB), and a postoperative algorithm addressing the use of adjuvant radiation therapy (RT). The algorithms were approved for use in August 2015. Twenty-four patients were identified by in-clinic screening and have been managed using the algorithms as a guide. Mean patient age was 80years (range, 71-89years). Per the preoperative algorithm, consideration of omission of SLNB was an option in 11 of 24 patients (46%), and in total 18 of 24 (75%) opted against SLNB. Per the postsurgical algorithm, consideration of omission of adjuvant RT was an option for 19 of 24 patients (79%), and in total 17 of 24 (71%) opted to forego RT. Incorporation of simple geriatric assessments seems to have had a marked impact on decision making regarding both surgical and adjuvant therapies for women aged ≥70years with early-stage hormone-positive breast cancer compared with historical patterns, with ≥71% omission of both SLNB and adjuvant RT in patients managed according to an institutional quality improvement initiative.

Association of Lymphovascular Space Invasion With Locoregional Failure and Survival in Patients With Node-Negative Oral Tongue Cancers

The indications for adjuvant therapy in resected oral tongue cancers are based on both clinical and pathological factors, with clear evidence for adjuvant radiation in patients with pathologically positive neck lymph nodes, positive margins, and extracapsular extension, but the data for patients with no nodal disease are sparse. To investigate determinants of failure and survival in patients with node-negative oral tongue cancer. Medical records for patients with oral tongue cancer treated with definitive surgery from 2003 to 2013 were reviewed. All patients were cN0 negative and classified as pathologically node-negative (pN0) if a neck dissection was performed. Patients received adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) based on standard clinical and pathological determinants. Kaplan-Meier and multivariable (MVA) logistic regression and Cox proportional hazard regression analyses were performed to identify patient, tumor, and treatment characteristics predictive of locoregional control (LRC) and overall survival (OS). A total of 180 patients met entry criteria, with a median follow-up time of 4.9 years (range, 0.9-12.5 years); 102 patients (56.7%) were female and 42 patients (23.3%) were younger than 45 years at diagnosis. One hundred fifty-three patients (85%) had T1/T2 tumors, and 112 patients (62%) had elective neck dissections with confirmed pN0. Lymphovascular space invasion (LVSI) was present in 36 patients (20%). On MVA, LVSI (OR, 0.06; 95% CI, 0.02-0.19; P < .01) was associated with worse LRC. Elective neck dissection (odds ratio [OR], 2.99; 95% CI, 1.16-7.73; P = .02) and receipt of RT (OR, 7.74; 95% CI, 2.27-26.42; P < .01) were associated with improved LRC. Three-year LRC rates were significantly lower for patients with LVSI (38.8%; 95% CI, 22.8%, 54.6%) than those without LVSI (81.9%; 95% CI, 74.4%, 87.4%). On MVA, only LVSI (hazard ratio, 2.20; 95% CI, 1.19-4.06; P = .01) and age greater than 44 years (hazard ratio, 4.38; 95% CI, 1.34-14.27; P = .01) were associated with worse OS. Three-year OS rates were significantly lower in patients with LVSI (71.3%; 95% CI, 53.2%-83.4%) than those without LVSI (90.3%; 95% CI, 83.8%-94.3%). Lymphovascular space invasion in patients with node-negative oral tongue cancer treated with upfront definitive surgery is associated with worse LRC and OS. Node-negative oral cavity cancers with LVSI warrant consideration of further adjuvant therapy, which should be further evaluated in a prospective setting.

P2.04-010 Survival after Surgery and Radiotherapy for Thymic Epithelial Tumors: A Single-Centre Experience from the United Kingdom: Topic: Thymic Malignancies Clinical and Translational

Thymic epithelial tumors are rare thoracic tumors primarily treated with surgical excision. Adjuvant radiotherapy has been shown to be beneficial in locally advanced disease. There is limited published data on thymoma outcomes in the United Kingdom. We retrospectively reviewed records of patients who underwent thoracic surgery for thymic tumors between July 2005 and December 2015. Imaging, pathology reports and follow-up clinic records were evaluated. Kaplan-Meier curves were generated for overall survival, and the log-rank test was used for univariate survival analysis. 79 patients were identified. The median age was 58 years (range 16 - 83 years). 58% were female. 24% of patients had associated myasthenia gravis. Masaoka Stage 1 disease was most common (48%), with Stage 2a disease (27%) next in frequency. The most common histological grading was WHO B3 (33%) followed by AB (25%). 58% had surgical margins < 1 mm, with tumor at margin in 24%. 39 patients (51%) had adjuvant radiotherapy, with median follow-up of 5.1 years for these patients. A radiotherapy dose of 45 – 50.4 Gy in 1.8 Gy fractions was used. 5-year survival for the whole cohort was 68% after surgery alone, and 86% with adjuvant radiotherapy, but the difference was not statistically significant. There were no deaths during follow-up in patients who had clear surgical margins, with or without radiotherapy. If surgical margins < 1 mm, there was a trend towards improved overall survival with adjuvant radiotherapy (5-year survival 88%), compared to surgery alone (5-year survival 50%) (log-rank test chi-square 3.7, p = 0.056) (Fig. 1). The long-term outcomes of thymic epithelial tumors are excellent after complete surgical excision. There is a trend towards improved overall survival with adjuvant radiotherapy in patients with surgical margins less than 1 mm. Routine referral of patients with close surgical margins for consideration of radiotherapy is recommended.

Breast-Conserving Surgery Alone for Ductal Carcinoma In Situ: Factors Associated with Increased Risk of Local Recurrence.

This retrospective study was aimed at identifying clinicopathologic characteristics associated with an increased risk for ipsilateral local recurrence (LR) in patients with ductal carcinoma in situ (DCIS) treated with wide local excision (WLE) alone without radiotherapy (RT). All patients with DCIS treated with WLE alone at the Beth Israel Deaconess Medical Center, Boston, MA, USA, between the years 2000 and 2010 were identified. We collected data on demographics, parity, personal or family history of breast cancer, exogenous hormone use, tobacco use, comorbidities, genetic mutation carrier status, imaging interval, and tumor-specific characteristics. Overall, 222 patients were included in the study. Median follow-up time was 8years. LR occurred in 9% of patients, with a recurrence rate of 11.3 per 1000 person-years. The risk of recurrence was lower for patients with nuclear grade (NG)I tumors than for patients with NGII or NGIII tumors (3, 8.5, and 19%, respectively; p=0.01). The median margin width was 1mm in patients experiencing LR versus 1.8mm in patients without LR (p=0.3). Patients who had used exogenous hormones, or patients with a history of tobacco use, had higher rates of LR than those who did not, although the difference did not reach statistical significance. Our data indicate that higher NG, narrower margin width, use of exogenous hormones, and smoking history may be associated with an increased risk of LR. The evaluation of these factors may be helpful when considering whether or not to use adjuvant RT for patients with DCIS.

Predicting Radiotherapy Necessity in Tongue Cancer Using Lymph Node Yield

In patients with head and neck cancer and a single metastatic lymph node (pN1), the value of lymph node yield (LNY) remains controversial in determining the prognosis and identifying patients who require radiotherapy. This study evaluated the role of LNY in predicting the adequacy of neck dissection, need for adjuvant radiotherapy, and survival in patients with pN1 oral tongue squamous cell carcinoma. The authors implemented a retrospective cohort study. The predictor variable was LNY. The outcome variables were 5-year disease-specific survival and the need for adjuvant radiotherapy. Other study variables were age, gender, tumor stage, pathologic grade, growth pattern, tobacco and alcohol habits, and time frame. Descriptive and bivariate statistics were computed, and a P value less than .05 was considered statistically significant. The sample was chosen from among 2,792 patients who were histopathologically diagnosed as having oral squamous cell carcinoma and underwent surgical treatment from June 1996 through December 2012. One hundred forty-one patients treated at the Department of Oral and Maxillofacial-Head and Neck Oncology of the Beijing Stomatological Hospital (Beijing, China) were screened for the study. Receiver operating characteristics curve analysis identified that a cutoff (LNY, 20; area under the curve, 0.708; 95% confidence interval, 0.625-0.781; sensitivity and specificity, 64.94 and 70.31%, respectively; P= .0001) could best discriminate patients into 2 groups according to need for adjuvant radiotherapy. Interestingly, subgroup analyses showed that patients who underwent adjuvant radiotherapy had notably better 5-year disease-specific survival than those who did not undergo radiotherapy if the LNY was smaller than 20 (58.0 vs 21.0%; P= .021). However, there was no significant association for 5-year disease-specific survival between the low and high LNY groups (49.2 vs 58.7%; P= .363). An LNY smaller than 20 at levels I to III predicted a benefit from adjuvant radiotherapy in patients with tongue cancer who had pN1 neck status without other adverse histopathologic features.

Long-Term Outcomes of Atypical Meningioma After Gross Total Resection (GTR) or Subtotal Resection (STR) With or Without Postoperative Radiation Therapy (PORT)

The role of adjuvant radiation in patients after surgical resection for WHO Grade II atypical meningioma remains controversial. We sought to characterize the long-term outcomes of this population and to define any factors predictive of worse outcomes. We retrospectively analyzed 151 patients who underwent initial resection for WHO Grade II atypical meningioma at our institution from 2000-2012. GTR was defined as Simpson Grade I-III and STR as Simpson Grade IV-V. Risk factors for progression and death were analyzed with multivariate Cox regression. Kaplan-Meier survival curves were compared with the log-rank test. Median follow-up was 71.5 months. GTR was achieved in 101 patients. PORT was delivered to 34% of the entire cohort. Median age was 62 years. Treatment after 2008, smaller tumors, and STR predicted for PORT delivery. Overall, PORT was associated with improved progression free survival (PFS: HR = 0.47; 95% CI = 0.20-0.74, P = 0.010) after adjustment for confounding variables (size, age) in multivariate analysis. The 5-year/10-year PFS rates were 74%/59% in the PORT arm and 51%/41% in the non-PORT arm, respectively. Improvement in local control (LC: HR = 0.56, 95% CI = 0.32-1.06, P = 0.077) with the addition of PORT neared statistical significance but not for overall survival (OS: HR = 0.84, 95% CI = 0.44-1.61, P = 0.60). The 5-year/10-year LC rates were 83%/66% in the PORT arm and 65%/54% in the non-PORT arm, while the 5-year/10-year OS rates were 85%/53% in the PORT arm and 77%/66% in the non-PORT arm, respectively. PORT was also associated with better PFS in the GTR subgroup (HR = 0.35, 95% CI = 0.02-0.67, P = 0.028) and STR subgroup (HR = 0.41, 95% CI = 0.08-0.74, P = 0.028) multivariate analyses. No differences were seen in OS for either subgroup or LC for the GTR subgroup with the addition of PORT. However, improvement in LC for the STR subgroup neared statistical significance (HR = 0.39, 95% CI = 0.13-1.03, P = 0.059). Of the 45 patients that developed progression, 38 underwent salvage therapy (5 with surgery alone, 21 with radiation alone, 11 with surgery and PORT, one with chemotherapy alone). Almost 50% (17/38 patients) of salvaged patients received at least one more series of salvage therapy for re-progression. Five patients experienced transformation to WHO Grade III malignant meningioma. All had undergone initial GTR, developed recurrence, and received subsequent salvage radiation. Only one patient had undergone PORT as part of initial treatment. To our knowledge, we performed the largest review of patients in the literature with WHO Grade II atypical meningioma managed with initial surgery. Our data suggest that it is reasonable to consider PORT regardless of resection status based on the improvement in PFS. Randomized, prospective trials are ongoing to further assess and confirm the impact of PORT.

Adjuvant radiotherapy in management of trichilemmal carcinoma of left nasal alae with positive surgical margins: A case report

Background: Trichilemmal carcinoma (TLC) is a rare adnexal malignant tumor developing from the outer root sheath of hair follicles with no distinct clinical features which might clinically be misdiagnosed as actinic keratosis, nodular melanoma, basal or squamous cell carcinoma. Albeit no consensus exists on standard treatment of TLC, tumor excision with adequate clear margins is the current widely accepted treatment consideration with no previous literature on use of radiotherapy (RT) in definitive or postoperative settings. Case presentation: A 60-year-old woman who was repeatedly treated with cryotherapy located on her left nasal alae for an initial diagnosis of actinic keratosis and diagnosed as TLC at last surgery was referred for RT of microscopic surgical margins. The patient was treated with 6 MeV electron beam RT prescribed to surgical bed plus 1-cm margins at all directions, namely the planning target volume. The total and per fraction doses were 60 and 2 Gy, respectively, which is commonly practiced for any skin tumor with positive margins. The treatment was well tolerated with no acute or chronic complications. The patient was alive with no local, regional, or distant recurrences at the 49 months of her follow-up. Conclusions: Although the follow-up period is relatively short and further evidence is needed to confirm the exact role of RT in adjuvant treatment of TLC, the outcomes of present rare case of a nasal TLC suggests that adjuvant RT in patients with positive surgical margins may provide satisfactory local tumor control.

P-093 Is there a role of adjuvant radiotherapy in patients with primary resectable gastric cancer?

P-093 Is there a role of adjuvant radiotherapy in patients with primary resectable gastric cancer?

Time interval between surgery and start of adjuvant radiotherapy in patients with soft tissue sarcoma: A retrospective analysis of 1131 cases from the French Sarcoma Group

The aim of this study was to evaluate the impact of the time interval (TI) between surgery and adjuvant radiotherapy (RT) in soft tissue sarcoma (STS). Data from 1131 patients treated between 1990 and 2014 were retrospectively reviewed. Inclusion criteria were: limb or superficial trunk wall STS (R0 or R1 resection) and adjuvant RT. The impact of TI on 10-year local relapse-free survival (LRFS) and 10-year overall survival (OS) was analyzed using a Log-rank test and then Cox Model. The median TI was 82days (range, 18-346). With a median follow-up of 235months (range, 2-296months), the 10-year LRFS was 57.5% (±2%) and the 10-year OS was 64.2% (±2%). With a TI of 19-39days, 40-79days, 80-119days, and ⩾120days, 10-year LRFSs were 65.3%, 55.5%, 56.9% and 61.2% (p=0.465), and 10-year OSs were 72.8%, 60.7%, 66.4% and 62.1% (p=0.347), respectively. After adjustment for the factors significantly (p⩽0.05) associated with LRFS and OS, TI did not alter LRFS (p=0.182) either OS (p=0.335). In this retrospective STS database study, the TI between surgery and start of adjuvant RT did not seem to affect outcomes.

Myoepithelial Carcinoma: The Role of Radiation Therapy. A Case Report and Analysis of Data From the Surveillance, Epidemiology, and End Results (SEER) Registry

The role of radiation therapy in the treatment of myoepithelial carcinoma (MC) is unknown. We present a case of a high-grade soft-tissue MC in a pediatric patient and retrospectively examine the effect of postoperative radiation on survival in patients with MC. Our patient was treated with 4 cycles of ifosfamide, cisplatin, and etoposide followed by 3 cycles of ifosfamide vincristine and etoposide. Radiation was delivered to a total dose of 5580 cGy in 180 cGy/fraction to the surgical bed with a 2 cm margin starting after the third cycle of chemotherapy. The Surveillance, Epidemiology, and End Results (SEER) registry database was queried for cases of surgically resected MC. Retrospective analysis was performed with the endpoint of overall survival (OS). Two hundred thirty-four cases of MC were identified; for 62 of these cases, the grade of the tumor wasidentified. Of these 62 patients, 27 received postoperative radiation. OS was improved with adjuvant radiation therapy in patients with grade III or IV MC (P<0.01) as determined by the log-rank test. This analysis of SEER data showed an OS benefit with adjuvant radiation therapy in the treatment of high-grade MC. Physicians should report all cases of MC to improve clinical decision making in the treatment of this rare disease.

Characteristics and prognosis of patients with early-stage endometrial cancer who refuse adjuvant radiotherapy

To investigate the risk factors for refusing adjuvant radiotherapy in patients who have undergone surgery for early-stage endometrial cancer, and to compare their survival rates with patients who have undergone adjuvant radiotherapy. Data from the Surveillance, Epidemiology, and End Results database for patients operated on for histologically-proven early-stage endometrioid endometrial cancer, between 1988 and 2012, were screened. Univariate and multivariate logistic regression analyses tested the associations between refusal of adjuvant radiotherapy and demographic, tumoral, and management characteristics. Overall and cancer-related survival rates were compared between 376 patients who refused adjuvant radiotherapy and 752 patients who received adjuvant radiotherapy, matched for demographics (age, race, year of diagnosis, marital status, region), tumoral (grade, FIGO stage, size), and management (lymphadenectomy performed) criteria. 434 of the 16,014 patients (2.7%) who were proposed adjuvant radiotherapy refused this treatment. Older, widowed, divorced, or separated patients, who were recently diagnosed and managed in the Northern plains or Pacific coast (USA), with limited tumoral extension, were more likely to refuse adjuvant radiotherapy. Five-year cancer-related survival was significantly lower in patients who refused adjuvant radiotherapy (88.9% vs. 95.7%, p<0.001) whereas overall survival did not significantly differ between the two groups (76.4% vs. 83.7%, p=0.23). We have identified the patients' characteristics related to refusal of adjuvant radiotherapy. Refusing adjuvant radiotherapy increased cancer-related death but probably does not reduce overall survival.

The Role of Adjuvant Radiation Therapy for Locoregionally Advanced Papillary Thyroid Carcinoma

Objectives: To investigate the role of adjuvant radiation therapy in locoregional control in patients with locoregionally advanced papillary thyroid carcinoma (pT4 or pN1b) based on a comparison of a group that received radiation therapy and a group that did not receive radiation therapy. Methods: A retrospective analysis was performed on 165 patients with locoregionally advanced papillary thyroid carcinoma who underwent treatment between 2002 and 2011. Of these, 32 patients received adjuvant radiation therapy, and 133 patients did not receive radiation therapy. Results: The median follow-up period was 7.2 years (range, 3.4-13.6) for the overall study population. The 10-year locoregional recurrence-free survival rates for patients in the radiation therapy and no radiation therapy groups were 83.9 and 60.8%, respectively (p = 0.037). The overall survival rate and distant recurrence-free survival rate were not different between the two groups (p = 0.076 and p = 0.813, respectively). Multivariate analysis showed that adjuvant radiation therapy was an independent prognostic factor for locoregional recurrence-free survival (p = 0.040). Conclusions: Adjuvant radiation therapy for patients with either pT4 or pN1b disease improved locoregional recurrence-free survival and might be of benefit for patients with these high-risk features by reducing the need for additional salvage treatment after locoregional recurrence.

Transanal Local Excision for Patients With Rectal Cancer: Can Radiation Compensate for What Is Perceived as a Nondefinitive Surgical Approach?

Total mesorectal excision has long been the standard of care for patients with rectal cancer. However, in select patients, local excision is an appropriate alternative option. The role of adjuvant radiation therapy in patients treated with local excision is controversial and evidence is lacking. The purpose of this study was to report oncological outcomes of patients with rectal cancer treated with local excision and adjuvant radiation. This study was a retrospective chart review. The study was conducted at the BC Cancer Agency, a tertiary referral hospital. A total of 93 patients with node-negative rectal cancer treated with local excision and adjuvant radiotherapy between 2001 and 2010 were included in the study. Patient and tumor characteristics are reported. Five-year local control, progression-free survival, and overall survival were analyzed using Kaplan-Meier methods. Five-year overall survival, local control, and progression-free survival for patients treated with local excision and adjuvant radiotherapy were 78.5%, 86.1%, and 83.8%. In T1 disease, local control was 92.5%. Referral bias, selection bias, lack of uniform surveillance, and retrospective analysis are the study limitations. Local excision with adjuvant radiotherapy provides a good level of local control in T1 disease and remains a good treatment option for patients who are either medically not suitable for a more radical surgical approach or who refuse this procedure. Local excision and radiotherapy should not be advocated in T2/T3 disease; however, it can provide a good alternative in those patients who are not fit enough for a more radical operation.

Treatment Outcome of Adjuvant Radiation Therapy for Patients With Oral Cavity Cancer

Treatment Outcome of Adjuvant Radiation Therapy for Patients With Oral Cavity Cancer

A Population-Based Comparative Outcome of Adjuvant Radiation Therapy in Patients With Soft Tissue Sarcoma of the Head and Neck

A Population-Based Comparative Outcome of Adjuvant Radiation Therapy in Patients With Soft Tissue Sarcoma of the Head and Neck

Postoperative PET/CT and target delineation before adjuvant radiotherapy in patients with oral cavity squamous cell carcinoma.

The purpose of this study was for us to present our evaluation of the effectiveness of positron emission tomography (PET)/CT imaging in postoperative patients with oral cavity squamous cell carcinoma (SCC) before initiating adjuvant radiation therapy. Treatment planning PET/CT scans were obtained in 44 patients with oral cavity SCC receiving adjuvant radiation. We identified target areas harboring macroscopic disease requiring higher radiation doses or additional surgery. Fourteen PET/CT scans were abnormal. Thirteen patients underwent surgery and/or biopsy, increased radiation dose, and/or addition of chemotherapy. Eleven patients received higher radiation doses. Patients undergoing imaging >8 weeks were more likely to have abnormal results (p = .01). One-year distant metastases-free survival was significantly worse in patients with positive PET/CT scans (61.5% vs 92.7%; p = .01). The estimated positive predictive value (PPV) was 38% for postoperative PET/CT scanning. We demonstrated that 32% of patients have abnormal PET/CT scans resulting in management changes. Patients may benefit from postoperative PET/CT imaging to optimize adjuvant radiation treatment planning. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1285-E1293, 2016.

Adjuvant radiation for patients with melanoma

Adjuvant radiation for patients with melanoma

Prognostic Factors and Patterns of Relapse in Ewing Sarcoma Patients Treated With Chemotherapy and R0 Resection

To identify prognostic factors and patterns of relapse for patients with Ewing sarcoma who underwent chemotherapy and R0 resection without radiation therapy (RT). We reviewed the medical records of patients who underwent surgical resection at our institution between 2000 and 2013 for an initial diagnosis of Ewing sarcoma. The associations of demographic and clinical factors with local control (LC) and patient outcome were determined by Cox regression. Time to events was measured from the time of surgery. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. A total of 66 patients (median age 19 years, range 4-55 years) met the study criteria. The median follow-up was 5.6 years for living patients. In 43 patients (65%) for whom imaging studies were available, the median tumor volume reduction was 73%, and at least partial response by Response Evaluation Criteria in Solid Tumors was achieved in 17 patients (40%). At 5 years, LC was 78%, progression-free survival (PFS) was 59%, and overall survival (OS) was 65%. Poor histologic response (necrosis ≤95%) was an independent predictor of LC (hazard ratio [HR] 6.8, P=.004), PFS (HR 5.2, P=.008), and OS (HR 5.0, P=.008). Metastasis on presentation was also an independent predictor of LC (HR 6.3, P=.011), PFS (HR 6.8, P=.002), and OS (HR 6.7, P=.002). Radiologic partial response was a predictor of PFS (HR 0.26, P=.012), and postchemotherapy tumor volume was associated with OS (HR 1.06, P=.015). All deaths were preceded by distant relapse. Of the 8 initial local-only relapses, 5 (63%) were soon followed by distant relapse. Predictors of poor postrecurrence survival were time to recurrence <1 year (HR 11.5, P=.002) and simultaneous local and distant relapse (HR 16.8, P=.001). Histologic and radiologic response to chemotherapy were independent predictors of outcome. Additional study is needed to determine the role of adjuvant radiation therapy for patients who have poor histologic response after R0 resection.

The Role of Adjuvant Therapy in the Management of Head and Neck Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare neuroendocrine malignant neoplasm that most commonly occurs in the head and neck and is rapidly increasing in incidence. The role of adjuvant chemoradiotherapy (CRT) in the management of head and neck MCC remains controversial. To evaluate the association between different adjuvant therapies and survival in head and neck MCC. Retrospective review of adult patients with head and neck MCC who had surgery recorded in the National Cancer Data Base from 1998 to 2011. Surgical excision, adjuvant radiation therapy (RT), or adjuvant CRT. Our main outcome was overall survival (OS). Statistical analysis included χ2, t tests, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis. We identified 4815 patients; 92.0% underwent standard surgical excision, and 8.0% underwent Mohs surgery. On multivariate analysis, age at least 75 years (hazard ratio [HR], 2.83 [95% CI, 1.82-4.41]), larger tumor size, positive margins (HR, 1.52 [95% CI, 1.25-1.85]), and metastatic lymph nodes (HR, 2.29 [95% CI, 1.84-2.85]) were independently associated with decreased OS. Postoperative CRT (HR, 0.62 [95% CI, 0.47-0.81]) and RT (HR, 0.80 [95% CI, 0.70-0.92]) provided a survival benefit over surgery alone. Adjuvant CRT was associated with improved OS over adjuvant RT in patients with positive margins (HR, 0.48 [95% CI, 0.25-0.93]), tumor size at least 3 cm (HR, 0.52 [95% CI, 0.30-0.90]), and male sex (HR, 0.69 [95% CI, 0.50-0.94]). To our knowledge, this the first study examining the role of adjuvant CRT in head and neck MCC. Results suggest that adjuvant CRT may help improve survival in high-risk patients, such as males and those with positive margins and larger tumors.

Nomograms for Prediction of Outcome With or Without Adjuvant Radiation Therapy for Patients With Endometrial Cancer: A Pooled Analysis of PORTEC-1 and PORTEC-2 Trials

Postoperative radiation therapy for stage I endometrial cancer improves locoregional control but is without survival benefit. To facilitate treatment decision support for individual patients, accurate statistical models to predict locoregional relapse (LRR), distant relapse (DR), overall survival (OS), and disease-free survival (DFS) are required. Clinical trial data from the randomized Post Operative Radiation Therapy for Endometrial Cancer (PORTEC-1; N=714 patients) and PORTEC-2 (N=427 patients) trials and registered group (grade 3 and deep invasion, n=99) were pooled for analysis (N=1240). For most patients (86%) pathology review data were available; otherwise original pathology data were used. Trial variables which were clinically relevant and eligible according to data constraints were age, stage, given treatment (pelvic external beam radiation therapy (EBRT), vaginal brachytherapy (VBT), or no adjuvant treatment, FIGO histological grade, depth of invasion, and lymph-vascular invasion (LVSI). Multivariate analyses were based on Cox proportional hazards regression model. Predictors were selected based on a backward elimination scheme. Model results were expressed by the c-index (0.5-1.0; random to perfect prediction). Two validation sets (n=244 and 291 patients) were used. Accuracy of the developed models was good, with training accuracies between 0.71 and 0.78. The nomograms validated well for DR (0.73), DFS (0.69), and OS (0.70), but validation was only fair for LRR (0.59). Ranking of variables as to their predictive power showed that age, tumor grade, and LVSI were highly predictive for all outcomes, and given treatment for LRR and DFS. The nomograms were able to significantly distinguish low- from high-probability patients for these outcomes. The nomograms are internally validated and able to accurately predict long-term outcome for endometrial cancer patients with observation, pelvic EBRT, or VBT after surgery. These models facilitate decision support in daily clinical practice and can be used for patient counseling and shared decision making, selecting patients who benefit most from adjuvant treatment, and generating new hypotheses.