Chemoradiotherapy Group Research Articles

A comparative analysis of radical cystectomy with perioperative chemotherapy, chemoradiation therapy, or systemic therapy in patients with clinically advanced node-positive bladder cancer (cN2/N3).

The management of non-metastatic clinically advanced lymph nodal (cN2/N3) bladder cancer (Stage IIIB) could involve radical cystectomy, chemoradiation, or systemic therapy alone. However, a definitive comparison between these approaches is lacking. This study aims to compare the outcomes of patients undergoing radical cystectomy with pelvic lymph node dissection (RC-PLND), chemoradiation therapy (CRT) or systemic therapy (including immunotherapy) (ST) only in patients with stage IIIB bladder cancer. A retrospective analysis of the National Cancer Database for patients with stage IIIB urothelial bladder cancer was done from 2004-2019. Patients were classified as Group A: Those who received RC-PLND with perioperative chemotherapy, Group B: Those who received CRT, and Group C: Those who received only ST alone. The primary outcome was overall survival (OS). Inverse probability weighting (IPW)-adjusted Kaplan Meier curves were utilized to compare overall survival (OS) and cox multivariate regression analysis was used to identify predictors for OS. Overall, 2,575 patients were identified. They were classified into Group A (n=1,278), Group B (n=317) and Group C (n=980). Compared to Group B, patients in Group A were younger (SMD=19.6%), had lower comorbidities (SMD=18.2%), had higher income (SMD=31.5%), had private insurance (SMD= 26.7%), were treated at academic centres (SMD=29.3%) and had higher percentage of N2 disease (SMD=31.1%). Using IPW-adjusted survival analysis, compared to Group C, the median OS was significantly higher in Group A (20.7 vs 14.2 months, p<0.001) and Group B (19.7 vs 14.2 months, p<0.001) but similar between Group A and Group B (20.9 vs 19.7 months, p=0.74). Both surgery (HR=0.72 (0.65-0.80), p<0.001) and CRT (0.70 (0.59-0.82), p<0.001) appeared to be independent predictors for OS on cox-regression analysis. The major limitations include bias due to retrospective analysis and non-assessment of cancer-specific survival. In stage IIIB bladder cancer with advanced lymph nodal disease, both RC and CRT offer equivalent survival benefits and are superior to systemic therapy alone.

Safety and efficacy of radiotherapy combined with chemotherapy for recurrent metastatic renal pelvic and ureteral carcinoma.

To retrospectively investigate the safety and efficacy of radiotherapy combined with chemotherapy for recurrent metastatic renal pelvic and ureteral carcinoma. 109 patients were enrolled in this study, including 44 patients in the radiochemotherapy group and 65 patients in the chemotherapy group. Propensity score matching (PSM) was used to balance the baseline characteristics of the two groups by 1:1 matching. Kaplan-Meier method was used to calculate PFS and OS. Cox regression model was used for multivariate analysis. The side effects were evaluated by CTCAE v5.0 RESULTS: The median follow-up time was 14.5months. Multivariate analysis showed that radiotherapy was a good independent prognostic factor for OS (HR: 0.327, 95% CI 0.157-0.680, P = 0.003). After matching, there were 40 patients in both groups, and the median PFS and OS in the radiochemotherapy group were longer than those in the chemotherapy group (PFS: 10.4 vs. 6.7months, P = 0.035; OS: 43.5 vs. 18.8months, P < 0.001). In addition, in the radiochemotherapy group, patients treated with radiotherapy before first-line chemotherapy failure had a longer PFS than those treated with radiotherapy after chemotherapy failure (median PFS: 15.7 vs. 6months, P = 0.003). There was no significant difference in the incidence of grade 3-4 toxicities between the two groups (52.3% vs. 50.8%, P = 0.878). For patients with recurrent metastatic renal pelvic and ureteral carcinoma, radiotherapy combined with chemotherapy is well tolerable and expected to bring long-term survival benefits, and the benefits of early interventional radiotherapy may be more obvious.

Concurrent Olaparib and Radiation Therapy in Older Patients With Newly Diagnosed Glioblastoma: The Phase 1 Dose-Escalation PARADIGM Trial

Background: Patients with glioblastoma who are elderly or have poor performance status (PS) experience particularly poor clinical outcomes. At the time of study initiation, these patients were treated with short-course radiotherapy (40 Gy in 15 fractions). Olaparib is an oral inhibitor of the DNA repair enzyme poly(ADP-ribose) polymerase (PARP) that is well tolerated as a single agent but exacerbates acute radiation toxicity in extracranial sites. Preclinical data predicted that PARP inhibitors would enhance radiosensitivity in glioblastoma without exacerbating adverse effects on the normal brain. Methods: Phase I of the PARADIGM trial was a 3+3 dose escalation study testing olaparib in combination with radiotherapy (40 Gy 15 fractions) in patients with newly diagnosed glioblastoma who were unsuitable for radical treatment either because they were aged 70 or over (WHO PS 0-1) or aged 18-69 with PS 2. The primary outcome was the recommended phase 2 dose (RP2D) of olaparib. Secondary endpoints included safety and tolerability, overall survival (OS) and progression free survival (PFS). Effects on cognitive function were assessed by mini-mental state examination (MMSE). Results: Of 16 eligible patients (56.25% male, median age 71.5 [range 44-78 years], 75% PS 0-1), one dose-limiting toxicity was reported (grade 3 agitation). Maximum tolerated dose was not reached and the RP2D was determined as 200 mg twice daily. Median OS and PFS were 10.8 months (80% CI: 7.3-11.4) and 5.5 months (80% CI: 3.9-5.9) respectively. MMSE plots indicated that cognitive function was not adversely affected by the olaparib-radiotherapy combination. Conclusions: Olaparib can be safely combined with hypofractionated brain radiotherapy and is well tolerated in patients unsuitable for radical chemoradiation. These results enabled initiation of a randomised phase II study and support future trials of PARP inhibitors in combination with radiotherapy for patients with brain tumors.

Coexistence of Left Atrial Tumor and Lung Cancer-The Key Role of an Individualized Approach.

During the diagnostic work-up in oncology, it is exceedingly rare to assume a concomitant presence of two cancers, a benign one and a malignant one, in a single patient. A 61-year-old man was admitted to the cardiology department for cardiac evaluation prior to planned radical treatment of non-small cell (NSCLC) left lung cancer (cT3N1M0). Echocardiography revealed a prominent, unpedunculated structure, measuring 17 × 14 mm, located in the left atrium (LA) near the fossa ovalis. The tumor was confirmed via cardiac magnetic resonance (CMR) imaging, which showed the radiological features of an atrial myxoma. The patient consulted with the Cardiac Surgery Department and was deemed ineligible for surgical treatment of a lesion with mucinous features; thus, no definitive histopathologic confirmation of the tumor present was possible. He was then successfully treated with radical radiochemotherapy and immunotherapy. During the 2-year follow-up, regular echocardiography and CMR were performed, which documented a stable LA tumor size.

Radical chemoradiotherapy for superficial esophageal cancer complicated with liver cirrhosis.

Although chemoradiotherapy is an effective treatment for esophageal cancer, its feasibility in esophageal cancer with cirrhosis remains largely unclear. We retrospectively studied 11 patients with superficial esophageal cancer with liver cirrhosis (Child-Pugh score ≤8) who underwent radical chemoradiotherapy from four centers, and the overall survival rate, local control rate and adverse events at 1 and 3 years were explored. The median age of the included patients was 67 years (Inter-Quartile Range 60-75 years). Complete response was observed in most patients (n = 10, 90.9%), and the remaining patient was unevaluable. The 1- and 3-year overall survival and local control rates were 90.9% and 90.9%, and 72.7% and 63.6%, respectively. Hematotoxicity was a common adverse reaction, and seven patients developed radiation esophagitis, with grade 3-4 observed in two cases. All cases of radiation dermatitis (n = 4) and radiation pneumonia (n = 2) were grade 1-2. Gastrointestinal bleeding occurred in two patients, including one with grade 1-2 bleeding, and one died. Radical chemoradiotherapy is a potential treatment option for patients with superficial esophageal cancer complicated with cirrhosis. However, it can increase the risk of bleeding, which warrants prompt recognition and intervention.

Circulating tumor cells in patients with cervical cancer undergoing chemoradiotherapy combined with brachytherapy.

Circulating tumor cells (CTCs) have significant potential to become an important tool for monitoring the effects of treatment in solid tumors. The present study reports the occurance of CTCs in cervical cancer (CC) patients during radical chemoradiotherapy (CRT), including brachytherapy (BRT), and during the follow-up period. Patients diagnosed with CC treated with radical CRT were included in the study (n=30). A total of 167 CTC-tests (MetaCell®) were provided at predefined testing time points during the study follow-up (e.g., before CRT, after CRT, every three months of follow-up). In parallel with CTC-testing, SCC-Ag were measured to compare their predictive values during treatment. CTCs were present in 96% (25/26) of patients at the time of diagnosis and in 61% (14/23) after treatment. Patients who relapsed during the 36-month follow-up (n=10) showed an elevation in pre-treatment CTC- numbers, similarly there was a significant increase in pre-treatment SCC-Ag. As next, an increased number of CTCs was observed approximately 12 weeks before relapse was diagnosed by standard imaging modalities (MRI, US, PET-CT) in 3 of 4 patients. In addition to standardized vital cytomorphology of enriched CTCs, quantitative PCR (qPCR) was used to inform the nature of CTCs before treatment. Analysis revealed increased SOX2 and POUSF expression in CTCs in the group of patients with recurrence (P < 0.02). Disease aggressiveness may be related to increased expression of stem cell markers, as found in samples from relapsed patients. CTCs may be an aid to assess tumor burden and disease aggressiveness. An increase in CTCs precedes an increase in SCC-Ag and confirmation of relapse by imaging, as shown in our study.

Heterogeneity in peripheral blood immune lymphocyte subsets predicts the response of immunotherapy or chemoradiotherapy in advanced lung cancer: an analysis across different pathological types, treatment modalities and age.

The shaping of the tumor immune microenvironment does not only rely on tumor-infiltrating lymphocytes but on the recruitment of lymphocytes in peripheral blood. Monitoring peripheral blood lymphocyte subsets level (PBLSL) can predict treatment response and prognosis with immune checkpoint inhibitors. This study investigated the heterogeneity of PBLSL in response to chemoradiotherapy (CRT) or combined with immunotherapy (CRIT) in advanced lung cancer patients. 77 patients with advanced lung cancer receiving CRT or CRIT were divided into treatment-responsive and non-responsive groups based on efficacy. The study analyzed short-term efficacy and progression-free survival (PFS) according to baseline PBLSL and explored the impact under different stratifications, including treatment modality, pathology type, and age. In all patients, higher levels of B cells, higher CD4+/CD8+ T cell ratios, and lower CD8+ T cell levels were associated with better short-term outcomes (P = 0.0035, P = 0.044, P = 0.022). Subgroup analysis revealed that in the CRT group, higher B cell levels correlated with improved efficacy (P = 0.011) and superior PFS (P = 0.048, HR = 0.3886, 95% CI = 0.1696 to 0.8902). In the CRIT group, higher CD4+ T cell levels, lower CD8+ T cell levels, and higher CD4+/CD8+ T cell ratios were linked to better efficacy (P = 0.038, P = 0.047, P = 0.017). For adenocarcinoma patients, higher CD4+/CD8+ T cell ratios and lower CD8+ T cell levels predicted better efficacy (P = 0.0155, P = 0.0119). B cell levels were significant in squamous cell carcinoma (P = 0.0291), while no PBLSL was predictive for small cell lung cancer. Among patients under 65, higher B cell levels were linked to improved efficacy and prolonged PFS (P = 0.0036, P = 0.0332, HR = 0.4111, 95% CI = 0.1973 to 0.8563). For patients over 65, differences in CD4+ T cell levels and CD4+/CD8+ T cell ratios were significant (P = 0.0433, P = 0.0338). PBLSL predicted efficacy and prognosis in various patient stratifications, suggesting PBLSL is a reliable predictor for CRT and CRIT in advanced lung cancer. Detecting different cellular subpopulations helps identify patients with significant treatment responses across different stratifications.

Role of Radical Surgery Following Preoperative Chemoradiotherapy in Octogenarians With Rectal Cancer: A SEER Analysis.

There has been a growing trend toward a watch-and-wait strategy to avoid surgery. This study evaluated the prognostic outcomes of nonoperative management following chemoradiotherapy (CRT) in the very old patients with rectal cancer. Using the Surveillance, Epidemiology, and End Results database, we conducted a retrospective analysis of octogenarians (age ≥80 years) with stage II-III rectal cancer who received neoadjuvant CRT with or without radical surgery between 2005 and 2016. Long-term survival outcomes of the two treatment strategies were compared. Propensity-matched cohorts were identified and analyzed for CRT followed by radical surgery vs. CRT alone (n=782). The 7-year rates of overall survival (OS) and disease-specific survival (DSS) of the two groups were 43% vs. 11% and 57% vs. 26%, respectively (p<0.001 for both comparisons). Radical surgery after CRT was the strongest prognostic factor associated with improved OS and DSS [hazard ratio (HR)=2.66 and 95% confidence interval (CI)=2.15-3.28 for OS; HR=2.50 and 95%CI=1.94-3.24 for DSS]. Based on the time-course hazard rate function plots of disease-specific mortality, short-term and late risk increments were observed in patients who underwent nonoperative management. This study highlights the importance of an active treatment strategy with radical surgery even in the highest age population with rectal cancer. Omitting surgery may not generally be considered safe when it is considered solely on chronological age. Further research is needed to identify the appropriate indications for nonoperative management.

The Role of c-MET as a Biomarker in Patients with Bladder Cancer Treated with Radical Chemo-Radiotherapy.

Bladder cancer is a highly aggressive cancer, and muscle invasive urothelial carcinoma (MIUC) requires aggressive strategy. Concomitant chemo-radiotherapy (CRT) appears as a therapeutic option that allows bladder sparing. No biomarker is currently available to optimally select patients for CRT. We retrospectively enrolled patients with MIUC who were treated in a curative setting with CRT. Based on c-MET expression in pre-treatment tumor tissue, patients were stratified into two groups: no expression of c-MET (group A) and expression of c-MET (group B). We evaluated the outcome of these patients based on c-MET expression. After a median follow-up of 40 months, 13 patients were enrolled in this analysis, 8 in group A and 5 in group B. The disease recurrence was 25% in group A and 100% in group B. Compared to group A, patients from group B experienced more frequent and more rapid recurrence in terms of metastases; the 3-year metastatic recurrence rate was 13% and 100%, respectively. The c-MET expression was also associated with a higher rate of cancer-related deaths. In this retrospective analysis, c-MET expression was associated with worse disease-free survival and survival in patients treated radically with CRT.

Prognostic Value of Tumor Volume, Tumor Volume Reduction Rate and Magnetic Resonance Tumor Regression Grade in Rectal Cancer.

Background and Objectives: Rectal cancer poses significant treatment challenges, especially in advanced stages. Radiologic assessment, particularly with MRI, is critical for surgeons and oncologists to understand tumor dynamics and tailor treatment strategies to improve patient outcomes. The purpose of this study was to correlate MRI-based tumor volumetric and tumor regression grade analysis in patients with advanced rectal cancer, assessing the impact of preoperative chemotherapy (CT) alone or chemoradiotherapy (CRT) on surgical technique choices. Materials and Methods: Between 2015 and 2022, a prospective study was enrolled, including a cohort of 89 patients diagnosed with rectal cancer at stage II or III. The participants were divided into two distinct therapy groups, ensuring an equal distribution with a ratio of 1:1. The initial group was treated with the contemporary preoperative chemotherapy protocol FOLFOX4. In contrast, the alternative group received conventional preoperative chemoradiotherapy. Before surgery, each patient underwent a rectal MRI scan at 1.5 T, including T2-weighted and diffusion-weighted imaging (DWI) sequences. Results: The CT group showed a 36.52% tumor volume reduction rate (TVRR), and the CRT group showed 54.87%, with varying magnetic resonance and pathological tumor regression grades (mrTRG and pTRG). Analysis revealed a significant interaction between mrTRG and tumor volumetrics (volume and VRR) in both groups, especially CRT, underscoring the complexity of tumor response. Both treatment groups had similar initial tumor volumes, with CRT displaying a higher TVRR, particularly in higher pathological TRG (3/4) cases. This interaction and the strong correlation between mrTRG and pTRG suggest mrTRG's role as a non-invasive predictor for treatment response, highlighting the need for personalized treatment plans. Conclusions: Rectal tumor volume, volume reduction rate, and mrTRG are not just abstract measures; they are concrete indicators that have a direct and practical impact on surgical decision-making, planning, and prognosis, ultimately influencing the quality of care and life expectancy of patients with rectal cancer.

Predicting anal cancer recurrence after radical chemoradiotherapy: a ten-year study based on tumour growth kinetics

Predicting anal cancer recurrence after radical chemoradiotherapy: a ten-year study based on tumour growth kinetics

Prospective Study to Compare Efficacy of Conventional Chemoradiotherapy with Hypofractionated Chemoradiotherapy in Locally Advanced Carcinoma of Oropharynx.

Chemoradiotherapy is the standard treatment for advanced Oropharyngeal squamous cell carcinoma (OPSCC). Upcoming hypofractionation has led to better compliance and non-inferior results in various sites such as breast and prostate cancer etc. This study prospectively compared a dose-intensified schedule in advanced OPSCC with standard hypofractionation. Patients with advanced stage III and IV OPSCC suitable for radical chemoradiotherapy were eligible. Patients were alternatively allocated to both the treatment arms. Arm A planned to receive 64 Gy in 25 fractions (#) with concurrent cisplatin and Arm B received standard fractionation 70 Gy in 35 # with concurrent cisplatin. All patients completed a median follow up of 6 to 18 months. The primary end point was acute toxicity (less than 3 months) and late toxicity at 1 year. Secondary end point was disease free survival and overall survival at 1 year. 44 patients in arm A and 49 patients in arm B were recruited over 18 months. 34 patients completed full-dose radiotherapy in both arms. Maximum acute toxicity in arm A in terms of skin reaction was Grade II in 47.05% cases and mucositis grade II in 67.6% cases. In arm B grade II skin toxicity was seen in 47.1% and mucositis grade II was seen in 79.4 % cases. Ryle's tube dependency was seen in 38.2 % cases in arm A and 50% in arm B. Complete response rate at 3 months was equivalent in both arms in Arm A (100%), and in Arm B (96.7%). Disease free survival (DFS), Overall survival (OS) at 3 month, 6 months, and 12 months was comparable. 64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with equivalent results and better compliance. Shorter fractionation schedule is more acceptable and we look forward for more randomized control trials.

Radical chemoradiotherapy to the bladder: a UK single-centre review of practice

Radical chemoradiotherapy to the bladder: a UK single-centre review of practice

The rocky road to recovery – Auditing weight changes and nutritional impact symptoms in HPV+ oropharyngeal (OPX) patients who have completed radical chemoradiation (CRT)

The rocky road to recovery – Auditing weight changes and nutritional impact symptoms in HPV+ oropharyngeal (OPX) patients who have completed radical chemoradiation (CRT)

Appropriate timing to perform an interim 18F-FDG PET/CT in patients with nasal-type extranodal natural killer/T cell lymphoma.

Interim 18F-FDG PET/CT (I-PET) has a role in response evaluation and treatment guidance in patients with nasal-type extranodal natural killer/T cell lymphoma (ENKTL). However, there was no agreement on the timing of I-PET performed, after chemotherapy or after chemoradiotherapy. We aimed to find the appropriate timing for I-PET by assessing the prognostic value of I-PET in response evaluation in ENKTL patients. Two hundred and twenty-seven ENKTL patients who had undergone I-PET were retrospectively included. All patients were grouped based on their therapeutic strategy received, chemotherapy or chemoradiotherapy. The Deauville 5-point score (DS) was used to interpret the I-PET images. The hazard ratio (HR) and C-index were used to measure the discriminatory and prognostic capacities of I-PET performed at different times. One hundred and six patients underwent the I-PET after chemotherapy (chemotherapy group), while I-PET was performed after chemoradiotherapy in 121 patients (chemoradiotherapy group). Eighty-seven patients were classified as metabolic remission (DS score of 1-3), while the other 140 were classified as non-metabolic remission (DS score of 4-5) according to the Deauville criteria. There were no significant survival differences between patients in metabolic remission and in non-metabolic remission in either progression-free survival (PFS, p = 0.406) or overall survival (OS, p = 0.350). In the chemotherapy group, patients in metabolic remission had significantly superior PFS than patients in non-metabolic remission (p = 0.012). For OS, a discriminative trend was also found on the survival curve between patients in metabolic remission and in non-metabolic remission (p = 0.082). In the chemoradiotherapy group, there was no significant difference in PFS (P = 0.185) or OS (P = 0.627) between patients in metabolic remission and in non-metabolic remission. I-PET after chemotherapy yields higher discriminative power and has the ability for prognostic prediction in nasal-type ENKTL patients. I-PET after radiochemotherapy has no prognostic value. Thus, the appropriate timing for I-PET is after chemotherapy but before radiotherapy for response evaluation in nasal-type ENKTL patients.

Neoadjuvant Chemotherapy With/Without Radiotherapy for Locally Advanced Rectal Cancer: A Nationwide Retrospective Cohort Study.

The role of neoadjuvant radiotherapy in the management of patients with locally advanced rectal cancer (LARC) who have undergone neoadjuvant systemic therapy has been the subject of recent debate. We identified eligible rectal cancer patients diagnosed between 2011 and 2020 using data from the Taiwan Cancer Registry. In our primary analysis, we applied propensity score weighting (PSW) to balance observable potential confounders. We then compared the hazard ratio (HR) of death the neoadjuvant concurrent chemoradiotherapy (nCCRT) group and the neoadjuvant chemotherapy without radiotherapy (nCT) group. Additionally, we conducted a comprehensive assessment of other outcomes and performed various supplementary analyses. The primary analysis included 2,298 patients. The overall survival did not exhibit statistically significant differences, with a PSW-adjusted HR of 0.72 (95% confidence interval=0.33-1.56, p=0.40) when comparing the nCCRT group to the nCT group. These findings were consistent with those of other long-term outcomes and supplementary analyses. In patients with LARC who have undergone neoadjuvant systemic therapy, the addition of radiotherapy did not yield statistically significant differences in long-term clinical outcomes.

Analysis of Efficacy and Prognosis of Extranodal Natural Killer/T Cell Lymphoma

Objective: Extranodal natural killer/T cell lymphoma (ENKTCL) is one type of non-Hodgkin's lymphomas. It's highly malignant and aggressive. The survival rate of patients with ENKTCL is low and the prognosis is extremely pessimistic. With regard to the common therapeutic regimen, there is no absolute answer. Thus, this research aims to retrospectively analyze clinical features, efficacy and prognosis based on the data of ENKTCL patients from two different clinical centers, so as to provide real-world evidence for the clinical treatment of the disease. Methods : Clinical data of 18 ENKTCL patients treated in Hematological Department of Zhongda hospital Southeast University from January 2013 to December 2022 and 104 ENKTCL patients from Jiangsu Cancer Hospital from January 2017 to December 2022 were retrospectively collected. Clinical data included age at initial diagnosis, gender, stage, clinical classification, B symptom, number of extranodal involvement sites, the situation of regional lymph nodes involvement, the situation of bone marrow involvement, KPS, ECOG, PINK, NRI, immunohistochemistry, the clinical symptom, therapy regimen, laboratory and imaging test. Then analysis of efficacy and prognosis was done. Follow-up was conducted by telephone contact with the patient and/or family until April 2023. Results: 1. Among the different treatment options, the efficacy of a combination of chemotherapy with radiotherapy group was statistically significant compared with either single chemotherapy group (P=0.000) or single radiotherapy group (P= 0.009) for patients with limited-stage disease (stage I/II), but there was no significant difference in the efficacy between chemotherapy group and radiotherapy group (P&amp;gt;0.05).Similarly, the efficacy of chemotherapy with radiotherapy group was statistically higher than that of single chemotherapy group (P=0.012), and that of a combination of chemotherapy with targeted therapy group was statistically higher compared with single chemotherapy group (P= 0.041) for patients with advanced-stage disease (stage III/IV), but there was no statistical difference between the single chemotherapy group and its combination with radiotherapy and targeted therapy group, the combination of chemotherapy with radiotherapy group and their combinations with targeted therapy group, the combination of chemotherapy with targeted therapy group and their combinations with radiotherapy group (All P &amp;gt;0.05). For all patients receiving chemoradiotherapy, there was no statistical significance in the efficacy of the sequential chemoradiotherapy group compared with the sandwich chemoradiotherapy group (P=0.547). 2. Univariate analysis showed that age at initial diagnosis, stage, presence of B symptoms, lactate dehydrogenase (LDH), ECOG score, extranodal involved site and number, and therapy regimen were factors related to the prognosis of patients (All P&amp;lt;0.05). Multivariate analysis further showed that patients' age at initial diagnosis, LDH, ECOG score and therapy regimen were the main factors affecting the prognosis of ENKTCL patients (P&amp;lt;0.05). Conclusion: 1. In the treatment scheme of ENKTCL, the combination of radiotherapy and chemotherapy has a better effect for patients at stage I and II, whereas chemotherapy should be combined with radiotherapy or targeted therapy to improve the efficacy of patients at advanced stage III and IV. For all patients with chemoradiotherapy, the efficacy of sequential chemoradiotherapy is similar to sandwich chemoradiotherapy. 2. The age at initial diagnosis, LDH, ECOG score and therapy regimen are the main factors affecting the prognosis of ENKTCL patients.

Induction chemoimmunotherapy may improve outcomes of chemoradiotherapy in patients with unresectable stage III NSCLC.

Currently, the value of induction chemoimmunotherapy before chemoradiotherapy (CRT) in unresectable stage III non-small cell lung cancer (NSCLC) has not been explored. This study was designed to explore the efficacy and safety of induction chemoimmunotherapy in patients with unresectable stage III NSCLC. Unresectable stage III NSCLC patients who received CRT with or without induction chemoimmunotherapy between August 2014 and December 2021 were retrospectively enrolled. Progression-free survival (PFS) and overall survival (OS) were assessed from the initiation of treatment and estimated by the Kaplan-Meier method. The potential factors affecting PFS and OS were analyzed by univariate and multivariate Cox regression models. One-to-one propensity score matching (PSM) was used to further minimize confounding. A total of 279 consecutive patients were enrolled, with 53 (19.0%) receiving induction chemoimmunotherapy followed by CRT (I-CRT group), and the remaining 226 (81.0%) receiving CRT alone (CRT group). After PSM, the median PFS was 24.8 months in the I-CRT group vs. 13.3 months in the CRT group (P=0.035). The median OS was not reached (NR) vs. 36.6 months ((P=0.142). The incidence of treatment-related adverse events (TRAEs) was similar in both groups, except that the incidence of hematological toxicity was higher in the I-CRT group (77.1% vs. 58.3%, P=0.049). Compared to induction chemotherapy, induction chemoimmunotherapy demonstrated a superior objective response rate (60.4% vs. 22.2%, P<0.001) and further prolonged PFS (median NR vs. 13.2 months, P=0.009) and OS (median NR vs. 25.9 months, P=0.106) without increasing the incidence of TRAEs in patients receiving concurrent chemoradiotherapy. Induction chemoimmunotherapy is safe and may improve outcomes of CRT in patients with unresectable stage III NSCLC. Moreover, induction chemoimmunotherapy may further improve treatment response and survival outcomes compared to induction chemotherapy before cCRT.

OGC P53 Recurrent oesophageal cancer involving complex gastro-pleural fistula: a rare case report on the role of palliative endoscopic stenting

Abstract Background Oesophageal cancer ranks as the 14th most common cancer in the United Kingdom and has witnessed improved survival rates due to advancements in treatment. However, despite initial treatment with curative intent, there is a risk of recurrence associated with poor prognosis. Recurrent oesophageal cancer is typically detected at an advanced stage with predominantly palliative treatment options. In rare cases, a cancer-related fistula can develop between the respiratory system and the oesophagus. This complication poses a risk of sepsis with diminished quality of life; therefore, prompt management of such fistulas with consideration of palliative endoscopic stenting is essential. Methods We present a case of a patient with a gastro-pleural fistula due to recurrent oesophageal cancer following initial treatment in 2016. She received neoadjuvant chemoradiotherapy which down-staged the tumour from pT3 to ypT2, followed by Ivor-Lewis oesophagectomy for a mid-oesophageal squamous cell carcinoma with complete resection margin. Metastatic disease was detected in the right superior mediastinal node in 2018, which was treated by radical chemoradiotherapy. In 2022, further recurrence was detected in a fistulating mass involving the gastric conduit, right posterior chest, pleura and overlying soft tissue. The multidisciplinary team recommended palliative chemotherapy and endoscopic stenting of the fistula. Results Endoscopic stenting is a palliative adjunct in advanced oesophageal cancer to alleviate dysphagia and allow oral nutrition. In this patient, we describe a novel approach of double stenting using the Ovesco Stenfix system, performed by an oesophago-gastric surgeon. Two stents were deployed in a ‘piggyback’ technique to completely occlude the fistula site and secured using Ovesco clips, hence maintaining a single conduit to pass food and fluid through the gastrointestinal tract. Stent placement was confirmed to be satisfactory with fluoroscopy. The patient was admitted 48 hours post-procedure and discharged without intra-procedural complications once oral intake was resumed. Conclusions Despite advances in the treatment of potentially curable oesophageal cancer, recurrence of the disease still occurs with devastating sequelae. As observed in our patient, recurrence in the form of complex fistulating mass is infrequent and associated with significant morbidity. Endoscopic palliative stenting was a safe option with good technical success.

OGC P21 Discrepancy between the clinical and final histopathological staging of locally advanced oesophageal adenocarcinoma

Abstract Background Accurate staging of locally advanced oesophageal cancer plays a pivotal role in treatment planning and prognostic counselling for the patients. Clinical staging employs various imaging modalities to guide treatment decisions and predict outcomes. This study aimed to compare clinical staging (post neoadjuvant chemotherapy) with the final histopathological staging in patients with locally advanced oesophageal adenocarcinoma undergoing oesophagectomy at Belfast Health and Social Care Trust. Methods A retrospective analysis was conducted on a cohort of 81 patients diagnosed with locally advanced oesophageal adenocarcinoma who underwent neo-adjuvant chemotherapy followed by oesophagectomy at Belfast Trust between March 2020 and March 2022. Patients with squamous cell carcinoma, those who proceeded directly to surgery and those treated with salvage oesophagectomy following previous radical chemo-radiotherapy were excluded from the study to minimise heterogeneity. Two independent radiologists reviewed the restaging PETCT scans and validated the clinical staging. The post neoadjuvant clinical staging was subsequently compared to the final histopathological staging obtained from surgical resection specimens. Results Among the 81 patients included in this study, a significant proportion of patients were upstaged (53%) or downstaged (31%). The combined T&amp;N staging accuracy was observed in only 13 patients (16%). 21 patients (26.3%) had their T staging downstaged on final assessments. Nodal staging discrepancies were observed in 35 cases (43.2%) upon final histopathological assessment. These isolated nodal discrepancies primarily involved nodal upstaging, with 14 patients upstaged from N0 to N1 and 13 patients upstaged from N0 to N2. Conclusions The accuracy of clinical staging for oesophageal adenocarcinoma remains poor. Our study revealed notable discrepancies in nodal staging between clinical and final histopathological staging. Approximately 43.2% of patients had isolated nodal discrepancies, primarily involving nodal upstaging. These findings emphasize the challenges in accurately assessing nodal involvement and highlight the need for improved staging methods to guide optimal treatment for locally advanced oesophageal adenocarcinoma. The topic of whether the routine use of EUS is justified for evaluating regional lymphnodes and enhancing staging remains a subject of debate, notwithstanding the limitations and challenges inherent to EUS.