Benefit Of Postoperative Radiotherapy Research Articles

Post-Operative Radiation Therapy (PORT) in Completely Resected Non-Small-Cell Lung Cancer

High-level evidence to guide the optimal postoperative management of patients with completely resected non-small-cell lung cancer (NSCLC) is lacking. Large randomized controlled trials have established postoperative chemotherapy as the standard of care for patients with pathologically involved lymph nodes. Recent retrospective and non-randomized studies provide evidence of the benefit of post-operative radiation therapy (PORT) in patients with mediastinal nodal involvement (N2 stage). A large multi-institutional randomized trial of PORT in this patient population is now underway. Based on currently available data, PORT may be considered for fit patients with completely resected NSCLC with N2 nodal involvement, preferably after completion of adjuvant chemotherapy. At this point, PORT is not recommended for patients with less than N2 nodal stage. Ideally, modern three-dimensional conformal radiation technique should be used, with attention to normal organ sparing, particularly lung and heart. Appropriate image guidance tools are encouraged to individualize treatment margins, account for breathing-induced motion, and minimize irradiation of normal tissues. The target volume should include at a minimum the bronchial stump, ipsilateral hilum, and involved nodal stations, and covering adjacent mediastinal nodal stations is recommended. A total dose of 50-54 Gy in 1.8-2 Gy fractions is appropriate.

A Nomogram for Predicting the Survival Benefit of Post-operative Radiotherapy for Patients with Non-small Cell Lung Cancer

A Nomogram for Predicting the Survival Benefit of Post-operative Radiotherapy for Patients with Non-small Cell Lung Cancer

Stage-Specific Survival Benefit of Postoperative Radiation Therapy for Cancers of the Rectosigmoid Junction

The rectosigmoid junction is anatomically located between the sigmoid colon, for which adjuvant radiation therapy (RT) is rarely used, and the rectum, for which adjuvant RT is commonly indicated. In many analyses, rectosigmoid cancers are lumped together with rectal cancers, rather than sigmoid or colon cancers. However, when considered separately, rectosigmoid junction adenocarcinomas presented with obstruction more often than rectal cancers. Furthermore, they were resectable less often than sigmoid cancers.

Lack of survival benefit of post-operative radiation therapy in prostate cancer patients with positive lymph nodes

Randomized data from SWOG 8794 and EORTC 22911 confirm the benefit of post-operative radiation therapy (RT) for selected patients with pT3 prostate cancer (CaP) after radical prostatectomy (RP). However, data regarding the potential benefit of RT for patients post-RP with positive lymph node (+LN) involvement are limited. We analyzed the Surveillance Epidemiology End Results (SEER) registry for population-based data on efficacy of post-operative RT for +LN patients after RP. As LN data have only been captured by SEER since 1988, we analyzed data for 1988-1992, with specific attention to 10-year relative survival (defined as observed survival divided by the survival of a gender-, age- and race-matched population cohort without disease). Specifically analyzed were data for 1921 patients with nonmetastatic prostate cancer who underwent surgery alone, or surgery followed by RT, and who had +LNs documented. SEER does not code the interval between surgery and RT, so the ratio of patients receiving salvage versus adjuvant therapy is unknown. Using follow-up data through 2002, post-diagnosis survival was examined by number of +LNs. There was no significant relative survival benefit for +LN patients receiving post-operative RT (chi(2)P=0.270). These data do not support routine use of post-operative RT for patients with +LNs in the surgical specimen.

Postoperative radiotherapy of NSCLC--outcome after 3-D treatment planning.

To evaluate the benefit of postoperative radiotherapy depending on lymph node involvement in non-small-cell lung cancer (NSCLC). Retrospective analysis of patients with NSCLC, who have been treated at the University of Giessen between 1986 and 1996 by surgery (n = 437) or surgery and 3-D planned postoperative radiotherapy with 50-60 Gy (n = 115). Evaluation of survival rates and risk of death depending on postoperative radiotherapy taking into account N-category, tumor stage, completeness of resection and performance status. With individually 3-D planned postoperative radiotherapy there was a lower risk of death in all stages with lymph node metastases. The relative risks of death and the 95% CI were in pN1 0.64 (0.39-1.03), in pN2 0.31 (0.18-0.56) and in pN3 0.25 (0.10-0.64). Our results suggest that the risk of death in NSCLC with lymph node involvement can be reduced by individually 3-D planned postoperative radiotherapy.

The Rationale for Early Diagnosis of Cancer: The Example of Breast Cancer

The main advantage of early diagnosis of cancer is the reduction of tumor size at initial treatment and thereby an increase in the proportion of patients without distant dissemination. This benefit is illustrated by the example of breast cancer. A model of its natural history was built using data extracted from the files of over 4000 patients followed in the same institution for 20 to 35 years. The model was used to quantify the impact of tumor size, histologic grade, and lymph node involvement on the probability of distant spread. The relationships were found to be highly significant. The model also and unexpectedly revealed that the tumors progress while they grow; avoiding histologic progression is therefore another advantage of early diagnosis. The model showed that residual tumor can be a nidus for distant dissemination, and that consistency between the prediction of the model and the results of post-operative radiotherapy is satisfactory. Conversely to what is often stated, the benefits of post-operative radiotherapy appear to be greater for small tumors, even in the absence of lymph node involvement, than for large ones. The model could be used to help improve screening strategies, but more data are required, in particular for the young age range.

A randomized prospective trial of the benefit of postoperative radiotherapy in the treatment of single metastases to the brain

A randomized prospective trial of the benefit of postoperative radiotherapy in the treatment of single metastases to the brain

Benefit of postoperative radiotherapy with surgery for read and neck cancer for patients with low risk pathological findings

Benefit of postoperative radiotherapy with surgery for read and neck cancer for patients with low risk pathological findings

Postoperative radiation therapy for rectal cancer. An interim analysis of a prospective, randomized multicenter trial in the Netherlands

The authors assessed the potential benefit of postoperative radiation therapy for rectal cancer in a two-arm, prospective multicenter trial. One hundred seventy-two patients who had undergone surgical resection for rectal adenocarcinoma were randomly assigned to either treatment consisting of external irradiation to a dose of 5000 cGy in 5 weeks or a control group (no adjuvant therapy). It was assumed that the number of cells remaining after radical surgery would be low and that the dose of 5000 cGy would be adequate in eradicating the majority of those cells. The number of local recurrences was lower in the treated group of patients, but the difference was not statistically significant. It was assumed that if a significant reduction in the number of local recurrences could be obtained, improved (disease-free) survival would result. No influence on disease-free or overall survival could be detected. These results were in agreement with those reported in Europe and the US, and it was concluded that postoperative radiation therapy alone cannot be justified as a routine procedure in the primary management of resectable rectal cancer.

Postoperative Radiotherapy of the Prostate for Patients Undergoing Radical Prostatectomy With Positive Margins, Seminal Vesicle Involvement and/or Penetration through the Capsule

A group of 159 patients previously reported as having margins positive for disease after radical prostatectomy with or without adjunctive postoperative radiation was reanalyzed to determine whether the reported benefit did indeed exist. Upon re-examination of the 159 patients 15 were identified who did not receive radical prostatectomy but who were analyzed as if they had received this therapy. An updated review of the total pool of 159 patients with analysis as to failure, death of any cause or death of prostatic cancer demonstrated no benefit of postoperative radiation therapy for margin positive disease. Exclusion of patients who did not receive radical prostatectomy and analysis as described also failed to identify any benefit of postoperative adjunctive radiation therapy.

Craniopharyngiomas in children and adults.

✓ The records of 51 patients with craniopharyngiomas were reviewed to compare the clinical features of the tumor in children and adults, to weigh the results of radical removal of the neoplasm, and to evaluate the benefit of postoperative radiation therapy. Signs and symptoms in the two age groups differed modestly. Endocrine abnormalities and visual field deficits were recognized more often in adults, whereas skull films were more likely to be abnormal in children. Six patients underwent radical removal of tumor. All have returned to normal life and remain free of recurrence. When tumor removal was incomplete, recurrence was common, appearing earlier in the younger patients. The administration of postoperative radiotherapy following partial removal of tumor appeared to delay recurrence in both age groups.