Benefit Of Radiotherapy In Patients Research Articles

Radiotherapy to reinvigorate immunotherapy activity after acquired resistance in metastatic non-small-cell lung cancer: A pooled analysis of two institutions prospective phase II single arm trials

AimThe current work aimed to investigate the clinical benefit of radiotherapy in patients with metastatic non-small cell lung cancer (NSCLC) developing acquired resistance to immune checkpoint inhibitors. MethodWe report on a pooled, two-institution, phase II single-arm prospective cohort study. The study included patients with stage IV NSCLC who showed progression of one or more measurable lesions under anti-PD-(L)1 inhibition alone, after initially having achieved at least stable disease. Hypofractionated radiotherapy (hRT) of one to four metastases was performed, while one or more lesions were kept untreated. Following hRT, treatment with immune checkpoint inhibitors was continued unchanged until further evidence of tumor progression or unacceptable toxicity. Primary endpoint of the pooled analysis was progression-free survival (PFS), secondary endpoints included overall survival (OS) and toxicity. ResultsA total of 48 patients were enrolled: mean age was 67.1 ± 9.3 years, 50 % were male and 72.9 % were PD-L1 positive. Immunotherapy was in 95.8 % of patients the first or second line therapy at time of enrollment. hRT was performed to one (93.8 % of cases) or more lesions (median total dose: 27.5 Gy, median 6.5 Gy/fraction). Forty-five patients (93.8 %) were able to continue immunotherapy for a median of 6.2 months following hRT. Median PFS was 4.4 months, with 62.5 % disease control at three months and 37.5 % at six months. Median OS was 14.9 months. Severe adverse events (grade ≥ 2) were reported in 12 cases (25 %), of which none were radiotherapy-related and four were immunotherapy-related. Salvage therapy consisted of chemotherapy (48.8 %) or repeated irradiation (21.9 %). No further tumor treatment was performed in 29.3 % of patients. ConclusionsThe current pooled analysis is a prospective evaluation of the role of radiation therapy for metastatic NSCLC in the setting of newly acquired immunotherapy resistance. Hypofractionated radiotherapy can support the outcome of immune checkpoint inhibitors and thus allow continuation of treatment for a relevant amount of time despite initial tumor progression.

A propensity score matching study on survival benefits of radiotherapy in patients with inoperable hepatocellular carcinoma

With the advancements in radiotherapy (RT) in recent years, several studies have shown that RT can significantly prolong the survival of patients with hepatocellular carcinoma (HCC). As a noninvasive treatment option, the application of RT for the treatment of HCC is garnering increasing attention. In this retrospective study, we included data from 13,878 patients with HCC from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019 and 325 patients with HCC treated in three tertiary hospitals in China between 2015 and 2021. Patient data were divided into RT and non-RT groups based on whether the patients underwent RT. Propensity score matching analysis was performed to minimize the deviation between the RT and non-RT groups, and the Kaplan–Meier method, Cox proportional hazard model, and nomogram were used to assess the efficacy of undergoing RT. The median overall survival (mOS) of the RT group was significantly longer compared with that of the non-RT group for the SEER data (16 months versus 9 months, p < 0.01). Similarly, the survival benefit was more significant in the RT group than in the non-RT group at our hospitals (34.1 months versus 15.4 months, p < 0.01). Furthermore, multivariate Cox analysis revealed that factors, including tumor (T) stage, patient age, tumor grade, serum AFP level, and chemotherapy, also affected patient survival. Moreover, these factors were also used to construct a nomogram. Subgroup analysis of these factors showed that RT was effective in prolonging patient survival in different populations. RT significantly improves the survival time of patients with inoperable HCC, thereby providing a basis for selecting HCC patients who can benefit from RT.

Benefits of radiotherapy for patients with solitary plasmacytoma or multiple myeloma

Treatment options for patients with solitary plasmacytoma (SP) or multiple myeloma (MM) should be discussed in an interdisciplinary context. This systematic review focuses on the importance of radiotherapy in MM and SP. Summary of local radio-oncological treatment options for patients with SP and MM. Based on asystematic literature search, the current evidence on the topic was analyzed and summarized. Patients with SP should be primarily treated with radiotherapy with or without surgery. Irradiation concepts may vary depending on risk factors and manifestation (solitary bone plasmacytoma vs. solitary extramedullary plasmacytoma). Although local control rates are high after radiotherapy, progression to multiple myeloma frequently occurs. In patients with MM, radiation is mainly used in palliative settings for pain relief, prevention of fractures or in patients who suffer from neurological symptoms due to spinal cord compression. Irradiation dose and fractionation should be selected based on treatment indication and general condition of the patient. Although most patients receive systemic treatment at initial diagnosis, approximately 40% of patients with MM will require radiation during the course of their disease. While radiation is mainly used for palliation in patients with MM, it represents the primary and curative treatment option in patients with SP.

Analysis of patterns of care and benefit of thoracic radiotherapy for patients with stage IV NSCLC in the immunotherapy-era from a national hospital-based registry.

9123 Background: Metastatic non-small cell lung cancer (mNSCLC) has classically been treated with platinum-doublet chemotherapy. Recent studies have established immunotherapy as an integral part of therapy for mNSCLC without targetable mutations. There are limited data on the role of consolidative thoracic radiotherapy (TRT) for patients with mNSCLC in the immunotherapy-era. A secondary analysis of KEYNOTE-001 showed significant improvement in overall survival in patients who received radiotherapy with pembrolizumab compared to patients not previously receiving radiotherapy. Methods: We queried the National Cancer Database (NCDB) for patients with metastatic presentation, stage IVA/IVB non-small cell lung cancer between the ages of 18-90 years treated between 2012-2017 with a combination of chemotherapy, immunotherapy, and thoracic radiotherapy. Patients with unknown treatment status, follow up time, or vital status were excluded. Overall survival (OS) was estimated using the Kaplan-Meier method and compared between treatment groups utilizing log-rank testing. A 3:1 nearest-neighbor propensity-score matching was performed utilizing clinical and demographic covariates to reduce the impact of potential confounders of overall survival on the probability of receipt of TRT. Cox proportional hazards regression was used to identify predictors of overall survival. Results: A total of 81,382 patients were identified that met inclusion criteria. The median age was 68 (18-90) years. The majority of patients (n = 51,681, 64%) had chemotherapy, while 7,929 (10%) patients received immunotherapy, and 15,984 (20%) received TRT. The median follow-up was 6.18 (range 0-76.9) months. For the entire cohort of patients receiving immunotherapy, 2 year OS was 29.4% with TRT compared to 32.7% without. Following propensity matching by age, sex, race, and comorbidity score, a total number of 4,264 patients receiving immunotherapy were matched. The 2 year OS was 27.7% in patients receiving TRT and immunotherapy vs. 22.2% in patients with immunotherapy alone (p = 0.004). On multivariable analysis receipt of TRT was a significant predictor of OS after adjustment for age, race, comorbidity score, sex, and median income (p = 0.0003, HR 0.87, 95% CI 0.80 - 0.94). For patients receiving BED10 &gt; 39 Gy (equivalent to 30 Gy in 10 fractions), 2 year OS was significantly improved at 37.0% vs 18.1% (p &lt; 0.0001). Conclusions: In patients with mNSCLC, the addition of TRT to immunotherapy is associated with improved overall survival at 2 years. Receipt of a higher BED10 is associated with further improved survival. Selection of mNSCLC patients receiving immunotherapy for TRT approaching definitive doses warrants further investigation. Data from prospective, randomized trials may better elucidate this benefit and identify a potential mechanism.

Postoperative radiotherapy is associated with improved survival in pT1-2N1 oral and oropharyngeal cancer\xa0without adequate neck dissection

BackgroundTo assess the benefit of postoperative radiotherapy in patients with pT1-2N1M0 oral and oropharyngeal cancer by the quality of neck dissection.MethodsIn the Surveillance, Epidemiology, and End Results database, pT1-2N1M0 oral and oropharyngeal cancer patients treated by primary tumor resection and neck dissection with or without radiotherapy were included between 2004 and 2015. Univariate and multivariate analysis were used to explore the effect of adjuvant radiotherapy on 5-year overall survival (OS) and disease-specific survival (DSS) among different quality of neck dissection.ResultsOf the 1765 patients identified, 1108 (62.8%) had oral cancer, 1141 (64.6%) were men, and 1067 (60.5%) underwent adjuvant radiotherapy. After adjusting for confounding factors, postoperative radiotherapy reduced the adjusted hazard ratio (aHR) of 5-year OS to 0.64 (95% confidence interval [CI] 0.49–0.84) in those with < 18 lymph nodes (LNs) removed, but not in those with 19–24 LNs removed (aHR 0.78; 95% CI 0.73–1.13), and in those with ≥ 25 LNs removed (aHR 0.96; 95% CI 0.75–1.24). For 5-year DSS, similar effect was observed. The adjusted hazard ratio was 0.66 (95% confidence interval, 0.45–0.97) in those with < 18 LNs. The protective effect was not seen in those with 18–24 LNs (aHR 1.07; 95% CI 0.59–1.96), and in those with ≥ 25 LNs (aHR 1.12; 95% CI 0.81–1.56). Sensitivity testing also showed a robust protective effect of postoperative radiotherapy in patients with < 18 LNs removed.ConclusionRadiotherapy was associated with improved survival in pT1-2N1M0 oral and oropharyngeal cancer patients without adequate neck dissection.

Survival benefit of radiotherapy in metastatic esophageal cancer: a population-based study.

BackgroundPopulation-based estimates of survival benefits of radiotherapy on metastatic esophageal cancer (EC) are lacking. The aim of this study was to analyze survival benefits of radiotherapy in patients with metastatic EC at the time of cancer diagnosis.MethodsPatients with metastatic EC were selected from Surveillance, Epidemiology, and End Results databases. The covariates included radiotherapy status, age, sex, insurance, histological type, differentiation, metastatic sites (bone, brain, liver, lung), and chemotherapy. Propensity score matching model was used to reduce bias of patients’ selection. Median overall survival (OS) and cancer-specific survival (CSS) were compared and Cox regression analysis was performed.ResultsA total of 4,761 patients with metastatic EC met the selection criteria. It was found that radiotherapy significantly improved 2-year OS (P=0.020) and 2-year CSS (P=0.009) in matched patients. In the propensity score model (N=3,672), Cox regression analysis demonstrated that radiotherapy was an independent prognostic factor which associated with a longer OS (P<0.001) and esophageal cause-specific survival in matched patients (P<0.001). Additionally, age, sex, insurance status, differentiation, number of metastatic sites and chemotherapy were also found to be significantly associated with OS and CSS in matched patients.ConclusionsThe population-based study demonstrated that patients with metastatic EC might benefit from radiotherapy. This data supports the proposal to change the current management for patients with metastatic EC.

Effective Adaptive Radiotherapy for Locally Advanced Lung Cancer Treated with 3D Conformal Technique

Background: The reduction in tumor volume during the treatment of locally advanced non-small cell lung cancer (NSCLC)with chemoradiotherapy allows the application of adaptive radiotherapy strategy. Adaptive planning has the potential forimproving radiotherapy planning indices and dose escalation while respecting the dose to the organs at risk (OARs).Aim: To evaluate the benefit of adaptive radiotherapy in patients with advanced NSCLC treated with conformal technique.Methods: In this dosimetric planning study, we included computerized tomography data-sets from 10 patients with locallyadvanced NSCLC who responded to the first 22 fractions (44 Gy) and achieved ˃ 20% regression in gross tumor volume. We designed for each patient two plans. Plan 1 (conventional planning) in which the whole prescribed dose (64 Gy) was delivered to the planning target volume 1 (PTV1). Plan 2 (adaptive planning) was divided into plan 2A delivering 44 Gy to PTV1 and plan 2B delivering 20 Gy to PTV2. In plan 2B we re-delineated the PTV and all the target volumes on the repeated CT images to deliver the rest of the prescribed dose (20 Gy). Plan 2A and Plan 2B were summed to measure the accumulated dose delivered to OARs.Results: The mean PTV2 was significantly smaller than the mean PTV1 (p < 0.001) with 53% reduction. Adaptive planningresulted in 13.2% mean reduction in the maximum dose to the spinal cord (p < 0.001), 10.4% in esophagus V35 (p < 0.001), 11.4% in esophagus V50 (p < 0.001), 24.3% in mean lung dose (p=0.001) and 19.7% in lung V20 (p < 0.001). The reduction in heart d-max and heart mean dose was not significant.Conclusion: The adaptive radiotherapy technique used in our study can reduce the irradiated volume and minimize the dose delivered to OARs. This simple applicable technique can be easily implemented in limited resources centers.

The Role of Radiation Therapy in Patients with Stage III Classical Hodgkin Lymphoma: A Propensity Score Matched Analysis of the Surveillance, Epidemiology, and End Results Database

The role of radiotherapy (RT) in the management of patients with stage III Hodgkin lymphoma (HL) is controversial. Prospective, randomized evidence and retrospective studies fail to clearly define efficacy/morbidity for this group since they include a heterogeneous population of “advanced stage” patients, with both stage III and stage IV disease. We theorize that differences in disease distribution and burden, as well as overall survival (OS), between these two stages may obfuscate the benefit of RT in patients with stage III disease. We aimed to investigate our theory in a population-based cohort from a very contemporary time period to minimize the effect of changing patterns of chemotherapy. We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients with stage III HL diagnosed between 2004 and 2012 and at least 20 years of age. In addition to standard Kaplan-Meier and Cox proportional hazards analyses for several variables, we performed a propensity score matched analysis (PSMA) for the effect of RT on both OS and cause-specific survival (CSS). Propensity scores were calculated based on race, gender, age, histologic subtype, presence of B symptoms, and presence of extranodal disease. A total of 3,600 patients were identified; 1,224 were included in the PSMA. The median follow-up was 34 months. In the unmatched analysis, age greater than 65 years was associated with worse OS (hazard ratio (HR), 5.31; 95% confidence interval (CI), 4.61 – 6.11; P < 0.001). The presence of B symptoms (data available in 3,185 patients) was associated with diminished OS (HR, 1.33; 95% CI, 1.14 – 1.56; P < 0.001). The receipt of RT was associated with improved OS (HR, 0.45; 95% CI, 0.35 – 0.59; P < 0.001; 5-year OS, 87.5% vs 69.6%). The statistical significance of these associations was identical on analysis for CSS. The association between RT and improved OS held on PSMA (HR, 0.70; 95% CI, 0.51 – 0.95; P = 0.02). This association was not statistically significant in analysis for CSS on PSMA (HR, 0.66; 95% CI, 0.42 – 1.02; P = 0.06). In this large population-based hypothesis-generating analysis, we show that the receipt of RT is associated with improved OS in patients with stage III HL on both unmatched analysis and PSMA. We additionally show an association between RT and improved CSS on unmatched analysis, but not PSMA. These conclusions are limited by those limitations inherent in the SEER database, including lack of information on RT dose, treatment volume, and administered chemotherapy regimens. We attempted to minimize the effect of these limitations by choosing a contemporary cohort of patients. These results support a cautionary approach towards the omission of RT in stage III HL patients. Further prospective evaluation of the role of RT in stage III HL patients is warranted.

Evaluation of the Benefit of Radiotherapy in Patients with Occult Breast Cancer: A Population-Based Analysis of the SEER Database.

PurposeFew studies for occult breast cancer (OBC) have evaluated the effect of radiotherapy (RT) after mastectomy or axillary lymph node dissection (ALND) with/without breast surgery. Therefore, we investigated clinicopathologic factors of OBC with the impact of postoperative RT to determine its prognostic significance using large population-based data.Materials and MethodsWe performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database from 1983 to 2013. A total of 1,045 eligible patients with OBC were identified. We compared overall survival (OS) using Cox proportional hazards regression with propensity score matching after verifying an imbalance of prognosticators between RT group (n=518) and non-RT group (n=479).ResultsPatients with age < 70 (p=0.033), married marital status (p < 0.001), undergoing ALND (p < 0.001), more examined lymph nodes (LNs) (p < 0.001), and more metastatic LNs (p < 0.001) were more likely to receive RT. Multivariate analysis after propensity score matching (n=798) showed that patients treated with RT survived significantly longer than those without RT (5-year OS, 81.5% vs. 78.3%; p=0.014). A significantly prolonged OS was observed when RT was given to patients treated with mastectomy (p=0.033), those treated with ALND (p=0.036), or those with more than seven metastatic LNs (p=0.016).ConclusionRT may offer survival benefit in OBC even after mastectomy or ALND, especially in patients with more than seven metastatic LNs. Further prospective studies are needed to validate these findings.

Role of radiotherapy to primary/metastatic sites in pediatric patients with metastatic rhabdomyosarcoma in the BERNIE study.

10541 Background: Local control is a key part of treatment of local/locoregional rhabdomyosarcoma (RMS) and often involves radiotherapy (RT) with/without surgery. The role of RT in metastatic RMS is uncertain, with little published evidence to guide clinicians. We analyzed data from the BERNIE trial to assess the benefit of RT for patients (pts) with metastatic RMS. Methods: In the BERNIE study (NCT00643565) pts aged ≥6 months to &lt;18yrs with metastatic RMS and non-RMS soft tissue sarcoma were randomized to receive chemotherapy (CT) with/without bevacizumab (BEV), surgery, and/or RT (at cycle 6–9) then maintenance CT. RT was recommended for all sites of metastases if feasible (investigator discretion allowed, resulting in variability in actual RT given). Pts were categorized into those receiving: RT all sites, partial RT, no RT. Event-free survival (EFS) and overall survival (OS) were calculated using Cox proportional hazards models and a landmark approach: only pts who were event free at day 221 (i.e. end of cycle 9 + 1 month) were included (EFS, n=85; OS, n=97). Variables adjusted were: treatment (as randomized), disease type (alveolar/embryonal/other), risk group, age &gt;10yrs, metastatic lesion count (1, 2–3, 4+). The analysis was non-randomized, exploratory and post hoc. Results: Of 102 pts with RMS, 22 received no RT, 49 partial RT, and 31 RT to all sites. Baseline characteristics were mostly balanced, and comparable proportions of pts received BEV. Better OS was observed in the RT group (Table) (comparable with unadjusted results). A non-significant EFS improvement was observed for the RT groups. Conclusions: Partial RT and RT to all sites of disease in metastatic RMS was associated with significant OS benefits, albeit in small pt numbers. This should be confirmed in a prospective randomized trial. Clinical trial information: NCT00643565. [Table: see text]

PO-0712: Benefit of semi-extended field radiotherapy in patients with locally advanced cervical cancer

PO-0712: Benefit of semi-extended field radiotherapy in patients with locally advanced cervical cancer

Therapeutic Potential of Umbilical Cord Mesenchymal Stem Cells for Inhibiting Myofibroblastic Differentiation of Irradiated Human Lung Fibroblasts.

Radiation-induced lung injury (RILI) limits the benefits of radiotherapy in patients with lung cancer. Radiation-induced differentiation of lung fibroblasts to myofibroblasts plays a key role in RILI. Recent studies have shown that mesenchymal stem cells (MSCs) can protect against lung fibrosis and that Wnt/β-catenin signaling is involved in fibrotic processes. In the present study, we explored the therapeutic potential of human umbilical cord MSCs (HUMSCs) for preventing radiation-induced differentiation of human lung fibroblasts (HLFs) to myofibroblasts. There are two advantages in the use of HUMSCs; namely, they are easily obtained and have low immunogenicity. Irradiated HLFs were co-cultured with HUMSCs. Expression of α-smooth muscle actin (α-SMA), a myofibroblast marker, was measured by Western blot analysis and immunohistochemistry. Irradiation (X-rays, 5 Gy) induced the differentiation of HLFs into myofibroblasts, which was inhibited by co-culture with HUMSCs. Irradiation also caused activation of the canonical Wnt/β-catenin signaling in HLFs, as judged by increased phosphorylation of glycogen synthase kinase 3β, nuclear accumulation of β-catenin, and elevated levels of Wnt-inducible signaling protein-1 (WISP-1) in the conditioned medium. However, co-culture with HUMSCs attenuated the radiation-induced activation of the Wnt/β-catenin signaling. We also measured the expression of FRAT1 that can enhance the Wnt/β-catenin signaling by stabilizing β-catenin. Co-culture with HUMSCs decreased FRAT1 protein levels in irradiated nHLFs. Thus, co-culture with HUMSCs attenuated the radiation-induced activation of Wnt/β-catenin signaling in HLFs, thereby inhibiting myofibroblastic differentiation of HLFs. Wnt/β-catenin signaling is a potential therapeutic target for limiting RILI in patients receiving radiotherapy for lung cancer.

Development and validation of a gene profile predicting benefit of postmastectomy radiotherapy in patients with high-risk breast cancer: a study of gene expression in the DBCG82bc cohort.

To identify genes predicting benefit of radiotherapy in patients with high-risk breast cancer treated with systemic therapy and randomized to receive or not receive postmastectomy radiotherapy (PMRT). The study was based on the Danish Breast Cancer Cooperative Group (DBCG82bc) cohort. Gene-expression analysis was performed in a training set of frozen tumor tissue from 191 patients. Genes were identified through the Lasso method with the endpoint being locoregional recurrence (LRR). A weighted gene-expression index (DBCG-RT profile) was calculated and transferred to quantitative real-time PCR (qRT-PCR) in corresponding formalin-fixed, paraffin-embedded (FFPE) samples, before validation in FFPE from 112 additional patients. Seven genes were identified, and the derived DBCG-RT profile divided the 191 patients into "high LRR risk" and "low LRR risk" groups. PMRT significantly reduced risk of LRR in "high LRR risk" patients, whereas "low LRR risk" patients showed no additional reduction in LRR rate. Technical transfer of the DBCG-RT profile to FFPE/qRT-PCR was successful, and the predictive impact was successfully validated in another 112 patients. A DBCG-RT gene profile was identified and validated, identifying patients with very low risk of LRR and no benefit from PMRT. The profile may provide a method to individualize treatment with PMRT.

Adjuvant radiotherapy following total mesorectal excision for stage IIA rectal cancer: is it beneficial?

The benefit of adjuvant radiotherapy in patients with stage IIA (T3N0) rectal cancer following total mesorectal excision (TME) is controversial. We evaluated the effect of adjuvant chemoradiotherapy (CRT) versus chemotherapy (CT) alone on the local recurrence and survival of patients with stage IIA rectal cancer after TME. Between 1996 and 2004, patients with stage IIA rectal cancer who received adjuvant CT (n = 29) or CRT (n = 122) following TME were enrolled. Oncologic outcomes were compared between groups, and risk factors for local recurrence and overall survival rates were analyzed. The median follow-up period was 78 months. No significant differences were observed in the 5-year local recurrence (3.4% versus 9.0%; P = 0.348) or 5-year overall survival rates (86.2% versus 80.3%; P = 0.924) between CT and CRT. However, involvement of the circumferential resection margin and age >60 years were associated with adverse oncologic outcomes. Additional postoperative radiotherapy did not alter local recurrence or survival after TME in patients with stage IIA rectal cancer. Postoperative radiation may be an overtreatment as an adjuvant therapy in patients with stage IIA rectal cancer if they had no other risk factors. However, randomized controlled trials are warranted to confirm this suggestion.

8727 Outcome after high-dose methotrexate and radiotherapy for primary central nervous system lymphoma

Current treatment for primary central nervous system lymphoma (PCNSL) involves high-dose methotrexate (HDMTX) with or without radiotherapy. Many published studies describing this approach include a highly selected group of patients. We report a single-centre experience of unselected cases of PCNSL.We retrospectively reviewed the case notes of 55 consecutive patients diagnosed with biopsy-proven PCNSL between 1995 and 2003 at Addenbrooke's Hospital Cambridge, UK. We describe the treatment and outcome, including survival, treatment-related toxicity and long-term functional disability.At diagnosis, 45% of patients were considered unfit to receive treatment with HDMTX, owing to poor performance status or comorbidity. These patients had a median survival of 46 days and may not have been included in other published studies. The remaining patients were treated with a chemotherapy regimen, which included HDMTX. Patients who received at least one cycle of a chemotherapy containing HDMTX had a median survival of 31 months. Forty per cent did not complete planned chemotherapy owing to toxicity, disease progression or death. The median survival of patients treated with HDMTX aged 60 years compared with patients aged under 60 years was 26 months vs 41 months (P = 0.07), respectively. Younger patients treated with HDMTX, who achieved complete remission with chemotherapy, had a median survival of 56 months. We identified a high incidence of functional disability among survivors, resulting from a combination of the tumour itself, the neurosurgical procedure required for diagnosis and the late neurotoxicity of combined chemoradiotherapy.The treatment of PCNSL is associated with significant early and late toxicity. Further attempts to improve treatment should address mechanisms to reduce this toxicity. In particular, the benefit of radiotherapy in patients who achieve complete remission with HDMTX will remain uncertain until it is addressed in a multicentre, randomised trial.

Determining the survival benefit of adjuvant radiotherapy in patients with node-positive head and neck cancer

Whether postoperative radiotherapy improves survival compared with surgery alone in patients with head and neck cancer remains unclear. This Practice Point commentary discusses the findings of a study by Kao et al. who used the Surveillance, Epidemiology, and End Results database to look for evidence of improved overall survival in patients with node-positive head and neck cancer. The analysis included 5,297 eligible patients who were treated with first-line surgery, of whom 4,307 (81%) received adjuvant radiotherapy. On multivariate analysis, adjuvant radiotherapy, age, primary tumor site, tumor and nodal stage were significant predictors of overall survival. While these results show an association between the use of adjuvant radiotherapy and improved overall survival in a selected group of patients, several aspects of the study limit its interpretation. Whether there is a causal relationship between postoperative radiotherapy and the observed overall survival benefit remains undetermined.

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

Primary central nervous system lymphoma: a single-centre experience of 55 unselected cases

Current treatment for primary central nervous system lymphoma (PCNSL) involves high-dose methotrexate (HDMTX) with or without radiotherapy. Many published studies describing this approach include a highly selected group of patients. We report a single-centre experience of unselected cases of PCNSL. We retrospectively reviewed the case notes of 55 consecutive patients diagnosed with biopsy-proven PCNSL between 1995 and 2003 at Addenbrooke's Hospital Cambridge, UK. We describe the treatment and outcome, including survival, treatment-related toxicity and long-term functional disability. At diagnosis, 45% of patients were considered unfit to receive treatment with HDMTX, owing to poor performance status or comorbidity. These patients had a median survival of 46 days and may not have been included in other published studies. The remaining patients were treated with a chemotherapy regimen, which included HDMTX. Patients who received at least one cycle of a chemotherapy containing HDMTX had a median survival of 31 months. Forty per cent did not complete planned chemotherapy owing to toxicity, disease progression or death. The median survival of patients treated with HDMTX aged 60 years compared with patients aged under 60 years was 26 months vs 41 months (P = 0.07), respectively. Younger patients treated with HDMTX, who achieved complete remission with chemotherapy, had a median survival of 56 months. We identified a high incidence of functional disability among survivors, resulting from a combination of the tumour itself, the neurosurgical procedure required for diagnosis and the late neurotoxicity of combined chemoradiotherapy. The treatment of PCNSL is associated with significant early and late toxicity. Further attempts to improve treatment should address mechanisms to reduce this toxicity. In particular, the benefit of radiotherapy in patients who achieve complete remission with HDMTX will remain uncertain until it is addressed in a multicentre, randomised trial.

Is Adjuvant Radiotherapy Effective in Intermediate-risk Surgical Stage I Endometrial Cancer?

Summary Objective To better understand the potential risks and benefits of adjuvant radiotherapy in patients with intermediate-risk surgical stage I endometrial cancer. Materials and Methods A retrospective chart review identified 55 patients with endometrial carcinoma stage IA grade 3, stage IB grade 2, and stage IC grade 1, treated at Taipei Veterans General Hospital, Taipei, Taiwan, between 1980 and 2001. The median duration of follow-up was 47 months, and patient age ranged from 34 to 82 years. One patient had stage IA grade 3 cancer, 52 had stage IB grade 2, and two had stage IC grade 1. Thirty-four patients underwent surgery alone and 21 underwent surgery plus radiotherapy. We determined the outcome of adjuvant treatment with postoperative pelvic radiotherapy or surgery alone, comparing locoregional control, overall survival, and treatment-related morbidity. Results There was no statistically significant survival difference between the surgery-only and surgery-plus- radiation groups ( p = 0.5927). The 5-year overall survival rates were 97% and 95%, respectively. Univariate analysis of prognostic factors showed that only hypertension influenced survival rate ( p Conclusion The survival rate was high and the relapse rate was low in intermediate-risk surgical stage I endometrial cancer patients. Radiotherapy may be reserved for recurrence.

Radiation treatment in patients with recurrent Kimura's disease

To assess the benefits of radiotherapy for patients with recurrent Kimura's disease and to document the role of radiation treatment as a successful mode of therapy. From 1985 to 1991, a total of 26 patients with Kimura's disease were treated by local excision and/or systemic steroids at Yonsei University, Yonsei Cancer Center Hospital. Seventeen patients among them eventually had local recurrence after surgical excision. The 17 patients with recurrent Kimura's disease were divided into two groups on the basis of those who received radiation treatment and those who did not. Eight patients in the nonradiation group were treated by systemic steroids alone with individualized doses and schedules. The remaining nine patients in the radiation group were treated by external beam irradiation. The prescribed radiation doses varied from 21.6 to 45 Gy. A comparative analysis on treatment results between both groups was undertaken retrospectively. The majority of the recurrent cases in the nonradiation group treated by steroids alone experienced rapid rerecurrence of the disease. In contrast, all of the patients except one case in the radiation group achieved excellent local control with moderate doses of radiation. There was a significant difference in the rerecurrence rate between the patients of the radiation group (11%) and the nonradiation group (75%). No clear dose-response relationship could be derived from the patients of the radiation group. No secondary malignancies in the irradiated areas have been observed. Our results suggest that radiation treatment is preferable as an alternative option for patients with recurrent Kimura's disease who have failed to achieve local control by other modalities.