Efficacy Of Postoperative Radiation Therapy Research Articles

Higher Lung and Heart Doses Decrease Early and Long-Term Survival, Respectively, in Patients With Non-Small Cell Lung Cancer Undergoing Postoperative Radiation

Cardiopulmonary toxic effects may reduce the efficacy of postoperative radiation therapy (PORT) in patients with non-small cell lung cancer (NSCLC). However, few studies have examined whether the heart and lung doses affect overall survival (OS). We investigated the correlation of heart and lung doses with OS in patients with NSCLC undergoing PORT. This retrospective analysis included 307 patients with NSCLC undergoing PORT. The total dose was 50 Gy. Landmark analyses were performed at 36 months, with hazard ratios (HRs) calculated separately for events occurring up to 36 months (early survival) and after 36 months (long-term survival). Stabilized inverse probability of treatment weighting (sIPTW) was performed to balance the characteristics of the high- and low-dose groups. We performed sensitivity analyses at 24 and 48 months. The median follow-up period was 67.42 months. Heart doses were significantly correlated with long-term survival (HR, 1.14; P=.015) but not with early survival (HR, 0.97; P=.41) or whole survival (HR, 1.02; P=.58). Lung doses were marginally significantly correlated with early survival (HR, 1.03; P=.07) but not with long-term survival (HR, 1.00; P=.85) or whole survival (HR, 1.02; P=.12). Higher heart and lung doses were associated with decreased long-term and early survival, respectively, before and after sIPTW. Landmark analyses at 24 and 48 months showed consistent results. For patients with NSCLC undergoing PORT, a higher heart dose was associated with decreased long-term survival, whereas a higher lung dose was associated with decreased early survival.

Lymph node ratio predicts efficacy of postoperative radiation therapy in nonmetastatic Merkel cell carcinoma: A population-based analysis.

After radical resection of a nonmetastatic Merkel cell carcinoma (M0 MCC), postoperative radiation therapy (RT) is recommended as it improves survival. However, the role of RT in specific subgroups of M0 MCC is unclear. We sought to identify whether there is a differential survival benefit from RT in specific M0 MCC patient subgroups. M0 MCC patients from the Surveillance, Epidemiology, and End Results (SEER) database registry were collected. The best prognostic age, tumor size, and lymph node ratio (LNR, ratio between positive lymph nodes and resected lymph nodes) cutoffs were calculated. The primary endpoint was overall survival (OS). A total of 5644 M0 MCC patients (median age 77 years, 62% male) were included: 4022 (71%) node-negative (N0) and 1551 (28%) node-positive (N+). Overall,2682 patients (48%) received RT. Age > 76.5 years, tumor size >13.5 mm, and LNR >0.215 were associated with worse OS. RT was associated with longer OS in the M0 MCC, N0, and N+ group and independently associated with a 25%, 27%, and 26% reduction in the risk for death, respectively. RT benefit on survival was increased in tumor size >13.5 mm in the N0 group and LNR >0.215 in the N+ group. No OS benefit from RT was observed in T4 tumors (N0 and N+ groups). RT was associated with improved survival in M0 MCC, irrespective of the nodal status. LNR >0.215 is a useful prognostic factor for clinical decision-making and for stratification and interpretation of clinical trials.

Brainstem intraparenchymal schwannoma with genetic analysis: a case report and literature review

BackgroundSchwannomas are neoplasms that typically arise from the myelin sheath of peripheral nerves and rarely originate within the brain parenchyma. Some case reports present schwannomas arising from the brainstem, but regrowth of the tumor and the efficacy of postoperative irradiation have not been examined. In addition, the genetic background of schwannomas arising from the brainstem has not been investigated.Case presentationA 21-year-old male presented with diplopia, dysphagia, and left-sided hemiparesis, dysesthesia, and ataxia. Intracranial imaging showed a heterogeneous mass with a cystic lesion in the pontomedullary junction. Since the tumor caused obstructive hydrocephalus, the patient underwent subtotal tumor resection. A histopathologic evaluation aided a diagnosis of brainstem intraparenchymal schwannoma. Gradual postoperative mass regrowth was recognized. Three-dimensional conformal radiotherapy was performed on the residual mass and surgical cavity. No tumor regrowth was observed 4 years after surgery. To investigate the genetic background of the tumor, target sequences for 36 genes, including NF2, SMARCB1, and LZTR1, and microsatellite analysis for loss of 22q did not show any somatic variants or 22q loss.ConclusionsWe suggest that brainstem schwannomas might differ from conventional schwannomas in their genetic background.

1088P Efficacy of post-operative radiation therapy in non-metastatic Merkel cell carcinoma: A registry-based analysis

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine tumor of the skin. The optimal management of non-metastatic MCC is still unclear but it is crucial to decrease relapse risk and improve survival. We sought to assess the efficacy of radiation therapy (RT) of MCC without distant metastases (M0 MCC) by analyzing data from the Surveillance, Epidemiology, and End Results (SEER) registry. We extracted from the SEER Registry data about M0 MCC patients, identified by the 8247 ICD-03 code, irrespective of the site of origin. We collected data about stage at diagnosis, site and size of primary, extent of surgery, lymph node directed surgery, number of involved lymph nodes, RT, and survival outcome. Primary endpoint was overall survival (OS). Of 9773 MCC patients in the SEER registry, 2335 were M0 MCC (63% male, median age 77 years). MCC originated from skin of the limbs in 994 (61.6%), head and neck district in 386 (23.9%), and trunk in 234 (14.5%). Lymph nodes were negative in 1577 patients (67.5%), while among the 687 (32.5%) MCC with nodal involvement this was microscopic in 214, macroscopic in 233, not otherwise specified (NOS) in 240; 71 had in-transit metastases. Post-operative RT was performed in 1212 (51.9%) patients. Overall, median OS of M0 MCC patients was 56 months (95%CI: 50.7-61.3) and was affected by age, site, tumor size, nodal involvement, type of surgery of primary and RT (HR for RT: 0.65 [95%: 0.53-0.79]; p<0.001) at multivariate analysis. In the 1577 with negative lymph nodes, after correcting for confounding factors, OS was affected by age, sex, site, size of primary, extent of surgery and RT (HR for RT: 0.63 [95%: 0.47-0.82]; p<0.001). Among 687 patients with positive lymph nodes (67% male, median age 74), at multivariate analysis OS was affected by age, nodal involvement, number of positive lymph nodes and RT (HR for RT: 0.67 [95%CI: 0.49-0.92]; p=0.012). RT was associated with a decreased risk for death in M0 MCC, irrespective of nodal status.

Outcome of Postoperative Radiation Therapy for Cholangiocarcinoma and Analysis of Dose-Volume Histogram of Remnant Liver

There are few reports about tolerance dose of postoperative remnant liver. The aim of this study was to analysis dose-volume histogram (DVH) of the remnant liver for postoperative Cholangiocarcinoma (CCA) patients, to find toxicity rates, and to confirm the safety and efficacy of postoperative radiation therapy (RT). ALL thirty-two postoperative CCA patients received partial liver resection and postoperative RT with curative intent. The “liver reduction rate” was calculated by contouring liver volume at CT just before the surgery and at CT for planning the RT. To evaluate late toxicity, the radiation-induced hepatic toxicity (RIHT) was determined by CTCAE toxicity grade of bilirubin, AST, ALT, ALP, and albumin, and was defined from 3 months after RT until liver metastasis was revealed. The radiation-induced liver disease (RILD) was also evaluated. Tumor stages were distributed as follows: I: 1, II: 8, IIIA: 1, IIIB: 6, IIIC: 14, IVA: 2. Median prescribed total dose was 50 Gy. Median follow-up time was 27 months. Two-year overall survival (OS): 72.4%, disease-free survival: 47.7%, local control (LC): 65.3%, and the Median survival time was 40 months. The median “liver reduction rate” was 21%. The OS had statistically significant difference in nodal status (P=0.032) and “liver reduction rate” >30% (P=0.016). In the association between the ≥grade 2 RIHT and DVH, there were significantly differences in V30 and V40 (P=0.0041, P=0.0034), respectively. The grade ≥2 RIHT rates differ also significantly by sex (P=0.0084). Two patients (6.2%) were suspected RILD. This is the first report to analyze the tolerance dose or to report RILD and RIHT rates in the remnant liver after surgery for CCA. The postoperative RT showed good LC and acceptable intermediate-term tolerance. We suggest that RT for remnant liver should be considered the liver V30, V40 to prevent radiation-induced liver dysfunction.

Outcome of postoperative radiation therapy for cholangiocarcinoma and analysis of dose-volume histogram of remnant liver.

The aim of this study was to analyze dose-volume histogram (DVH) of the remnant liver for postoperative cholangiocarcinoma (CCA) patients, to find toxicity rates, and to confirm efficacy of postoperative radiation therapy (RT).Thirty-two postoperative CCA patients received partial liver resection and postoperative RT with curative intent. The "liver reduction rate" was calculated by contouring liver volume at computed tomography (CT) just before the surgery and at CT for planning the RT. To evaluate late toxicity, the radiation-induced hepatic toxicity (RIHT) was determined by the common terminology criteria for adverse events toxicity grade of bilirubin, aspartate transaminase, alanine transaminase, alkaline phosphatase, and albumin, and was defined from 3 months after RT until liver metastasis was revealed. The radiation-induced liver disease (RILD) was also evaluated.Tumor stages were distributed as follows: I: 1, II: 8, IIIA: 1, IIIB: 6, IIIC: 14, IVA: 2. Median prescribed total dose was 50 Gy. Median follow-up time was 27 months. Two-year overall survival (OS): 72.4%, disease-free survival: 47.7%, local control: 65.3%, and the median survival time was 40 months. The median "liver reduction rate" was 21%. The OS had statistically significant difference in nodal status (P = .032) and "liver reduction rate" >30% (P = .016). In the association between the ≥grade 2 RIHT and DVH, there were significantly differences in V30 and V40 (P = .041, P = .034), respectively. The grade ≥2 RIHT rates differ also significantly by sex (P = .008). Two patients (6.2%) were suspected of RILD.We suggest that RT for remnant liver should be considered the liver V30, V40 to prevent radiation-induced liver dysfunction.

Malignant Melanoma: Beyond the Basics.

After reading this article, the participant should be able to: 1. Discuss the initial management of cutaneous malignant melanoma with regard to diagnostic biopsy and currently accepted resection margins. 2. Be familiar with the management options for melanoma in specific situations such as subungual melanoma, auricular melanoma, and melanoma in the pregnant patient. 3. Discuss the differentiating characteristics of desmoplastic melanoma and its treatment options. 4. List the indications for sentinel lymph node biopsy and be aware of the ongoing trials and current literature. 5. Discuss the medical therapies available to patients with metastatic melanoma. Management of the melanoma patient is a complex and evolving subject. Plastic surgeons should be aware of the recent changes in the field. Excisional biopsy remains the gold standard for diagnosis, although there is no evidence that use of other biopsy types alters survival or recurrence. Wide local excisions should be carried out with margins as recommended by National Comprehensive Cancer Network guidelines according to lesion Breslow depth, with sentinel lymph node biopsy being offered to all medically suitable candidates with intermediate thickness melanomas (1.0 to 4.0 mm), and with sentinel lymph node biopsy being considered for high-risk lesions (ulceration and/or high mitotic figures) with melanomas of 0.75 to 1.0 mm. Melanomas diagnosed during pregnancy can be treated with preoperative lymphoscintigraphy and wide local excision under local anesthesia, with sentinel lymph node biopsy under general anesthesia delayed until after delivery. Management of desmoplastic melanoma is currently controversial with regard to the indications for sentinel lymph node biopsy and the efficacy of postoperative radiation therapy. Subungual and auricular melanoma have evolved from being treated by amputation of the involved appendage to less radical procedures-ear reconstruction is now attempted in the absence of gross invasion into the perichondrium, and subungual melanomas may be treated with wide local excision down to and including the periosteum, with immediate full-thickness skin grafting over bone. Although surgical treatment remains the current gold standard, recent advances in immunotherapy and targeted molecular therapy for metastatic melanoma show great promise for the development of medical therapies for melanoma.

Is Post Operative Radiotherapy Justified for Completely Resected Locally Advanced Renal Cell Cancers?

Background: There is an underutilization of postoperative radiation therapy (PORT) in renal cell carcinoma (RCC) following radical nephrectomy (RN). The main reason for that is the lack of strong evidence and the contradictory data in the literature regarding its benefit. We aimed to evaluate the efficacy of PORT in locally advanced patients with RCC following complete resection. Materials and Methods: The patients had RN and at least two of the poor prognostic factors like lymph nodes involvement (LN+), renal vein invasion (RVI), inferior vena cava invasion (IVCI) and renal capsule infiltration (RCI) were included in the study. Ninety-four patients were retrospectively evaluated; 56 patient received PORT 50Gy/25 fractions/5 weeks and 38 patients who did not receive PORT were compared. The LN+, RVI, IVCI and RCI were documented in 63 (67%), 46 (49%), 30 (32%) and 71 (76%) patients respectively. Results: Eight patients (14%) in PORT arm developed local recurrence (LR) are compared with 10 patients (26%) for non-PORT arm. Five-year overall survival (OS) rates were 78% and 70% for PORT and non-PORT arms respectively (p = 0.3), while 5-year locoregional control (LRC) rates were 88% for PORT arm and 70% for the non-PORT arm (p = 0.05). The IVCI and LN+ affected OS significantly (p values 0.007 and 0.009) respectively. The RCI and LN+ only affected the LRC with p values 0.03, 0.04 respectively. Two out of 56 patients (3.5%) received PORT developed intestinal obstruction which was treated surgically. Conclusion: The PORT decreased the LR rate in high risk locally advanced RCC patients significantly. The high incidence of distant metastasis offsets this improvement at the level of overall survival.

E1. What the past is telling us about the future

Having had the honour and the pleasure of working with Emmanuel van der Schueren and of assisting him as his secretary general when he was president of European Organisation for Research and Treatment of Cancer (EORTC) and president of the European Society of Mastology (EUSOMA), it gives me even more pleasure to be here today and to share with you what I believe I have learnt in more than 30 years of research and clinical practice in the field of breast cancer. Being a surgeon, I probably feel more comfortable than any other colleague in this room in saying that the first message which comes from the past and tells us something important about the future is that breast-cancer management is not (only) breast-cancer surgery. Women who are still treated in centres where doctors believe that the cure for breast cancer is mastectomy are really unlucky, not only because they miss the opportunity to preserve a comfortable body image, but mostly because they miss the benefit of the multidisciplinary treatment of their disease. In the past we thought of cancer as an external entity coming to invade our bodies, and medicine’s answer was to ‘destroy’. To destroy with surgery, with radiotherapy and with chemotherapy. To destroy the tumour, mostly, nearly ignoring the rest of the patient’s body and mind. Now we have learnt that what we have to do is gently to reduce the tumour presence, to oppose its growth, antagonise its proliferation, and induce the apoptosis of its cells, from the maximum tolerated action to the minimum effective one. I believe that surgeons have played an important role in this cultural revolution [1]. In the past we were also absolutely convinced that the maxim ‘the earlier the better’ was undeniable, and we have sometimes promoted breast-cancer screening like a religion (despite the fact that most of us are definitively non-religion-oriented). Anti-screening scientists and researchers have also reacted against this approach, sometimes with excessive furore, generating unnecessary antibodies and preventing an objective analysis of the facts and figures. I believe we should in the future continue to seek for an early detection of breast cancer, but we cannot ignore the fact that screening might not actually reduce mortality in certain conditions, as for example in the incidence of advanced breast cancers [2]. How about technology? Is technology always good by definition, as we tended to believe in the past? Probably not. Those who belong to my generation may remember the disappointment at the failure of thermography as a safe, non-x-ray method for diagnosing breast cancer. And those belonging to the current generation are witnessing the downsides of indiscriminate use of MRI: since only 25% of positive findings by magnetic resonance imaging (MRI) represent malignancy, surgical planning should not be routinely based on this exam [3] if we do not wish to go back to the past and to justify ‘the current resurgence in mastectomy’ [4]. How about biology? Is it still relevant to debate whether breast cancer is a local or a systemic disease? Since scientific evidence has proved the efficacy of postoperative radiation therapy after breast-conserving surgery and of adjuvant medical treatment, ‘the era in which surgery was the sole treatment for primary breast cancer [has] come to an end’ [4]. Pathology reports were once a few lines long, now they often need more than a page. The possible combinations of the various parameters (grading, lymph-node status, hormonal receptors, vascular invasion, size, Her2 test, etc) are so many that no patient actually has the same disease as her roommate, and doctors and nurses have to make constant efforts to personalise their communication and treatment plans. Classifications which have been important in the past, such as the tumour-node-metastasis (TNM) system, are becoming less and less meaningful because they are too rigid, and we have learnt that rigidity does not pay. Who would still decide the surgical operation on the basis of the T without also taking into consideration the size of the breast? The old dogma was always mastectomy for any tumour larger than 2.5 cm. Now we have finally become capable of evaluating the tumour/breast size ratio and performing conservative surgery even for a 3-cm tumour if the breast size of the patient allows it, while we find it more appropriate to perform a nipple-sparing subcutaneous mastectomy for a 1.5 cm tumour in a small breast. Still, what is probably most important in what the past is telling us about the future is that breast-cancer management must involve teamwork. The omniscient and

口腔扁平上皮癌の頸部リンパ節転移症例に対する術後放射線照射の有用性に関する検討

The purpose of this study was to evaluate the efficacy of postoperative radiation therapy of the neck in patients with oral squamous cell carcinoma who had lymph node metastasis on pathological examination. The following results were obtained.1 )Eighteen patients received postoperative radiation therapy(RT + group), and 42 patients did not receive postoperative radiation therapy(RT － group). The recurrent rate in the neck was 11.1 % in the RT + group and25.6 % in the RT － group.2 )The overall survival rate was 76.9% in the RT + group and 60.6 % in the RT － group. This difference was not significant.3 )There were significant differences in the overall survival rate between the RT + group and RT － group when nodal metastases were found at multiple levels or when nodal metastases were associated with extracapsular spread. The overall survival rate did not differ significantly between the RT + group and RT － group when the number of nodal metastases was three or more or when the farthest metastatic nodes were found at levels III, IV,or V.

The treatment outcome of patients undergoing breast-conserving therapy: the clinical role of postoperative radiotherapy

Treatment outcome was evaluated in patients who underwent breast-conserving therapy and tangential irradiation. After verifying background factors including systemic therapy, the clinical efficacy of postoperative irradiation was investigated. There were 708 study subjects, all of whom had early breast cancer treated between 1992 and 2002. The median follow-up period was 83 months. After breast-conserving surgery, in patients with negative surgical margins, only tangential irradiation at 48 Gy/24 fr was performed. In contrast, in those with positive surgical margins, 10 Gy of radiation boost to the tumor bed with electrons was administered after tangential irradiation with 50 Gy/25 fr. Treatment outcome was analyzed using the Kaplan-Meier method and Cox's proportional hazards regression model. The disease-free survival and no-recurrence rates within the ipsilateral breast after 5 years were 93.4 and 97.2%, respectively. Risk factors for recurrence within the ipsilateral breast included younger age of patient, the number of positive lymph nodes, and no endocrine therapy. However, the surgical margin was not a risk factor. Risk factors for relapse outwith the ipsilateral breast included younger age, the number of positive lymph nodes, and recurrence within the ipsilateral breast. From our analysis of 708 Japanese women who received breast-conserving therapy, which can be regarded as a standard method in Japan, the treatment outcome was compatible with previous reports from other countries.

Radiation Therapy in Stage II and III Rectal Cancer

Over the past 25 years, significant advances have been made in the management of patients with rectal cancer. Phase III studies have shown the efficacy of postoperative radiation therapy and chemotherapy in improving local control and survival of patients with resected stage II and III disease. Data from the randomized German CAO/ARO/AIO-94 trial of preoperative versus postoperative chemoradiation have provided a strong rationale and support for the use of preoperative chemoradiation in the treatment of patients with clinical stage II and III rectal cancer. Current phase III studies are evaluating novel combinations of chemotherapy and targeted agents with radiation therapy.

Postoperative radiation therapy for carcinoma of the uterine cervix

Postoperative radiation therapy (PORT) for cervical cancer has been empirically performed for patients with pathologic risk factors for recurrence after surgery. The efficacy of PORT is mainly supported by retrospective studies. Despite convincing evidence demonstrating a reduction in pelvic recurrence rates when PORT is employed, there is no evidence that it eventually improves patient survival. Local recurrence, such as vaginal stump recurrence, is not always fatal if diagnosed earlier. Some patients, unfortunately, may develop distant metastases even after PORT. The positive effects of PORT also may be counterbalanced by increased toxicities that result from combining local therapies. These factors obscure the efficacy of PORT for cervical cancer patients. There has been no consensus on the predictive value of risk factors for recurrence, which renders indication of PORT for early-stage cervical cancer quite variable among institutions. Today, efforts have been made to divide patients into three risk groups based on the combination of risk factors present after radical hysterectomy. In Europe/USA and Japan, however, a fundamental difference exists in the indications for radical surgery, highlighting differences in the concept of PORT; "adjuvant pelvic irradiation for stage IB-IIA patients after complete resection" in Europe/USA and "pelvic irradiation after surgery irrespective of initial clinical stage and surgical margin status" in Japan. Thus, it is questionable whether scientific evidence established in Europe/USA is applicable to Japanese clinical practice. The purpose of this article is to review the role of PORT by interpreting the results of clinical studies.

Radiation Treatment for Medulloblastoma: a Review of 64 Cases at a Single Institute

Although the optimal treatment mode for medulloblastoma is frequently discussed, results based on large series of cases, especially those treated in Asia, have rarely been reported. Our purpose was to evaluate the efficacy of postoperative radiation therapy, and to identify prognostic factors, in a relatively large cohort of patients with limited-stage medulloblastoma treated at a single institute in China. Between January 1996 and April 2001, 69 patients with Chang stage M0/M1 medulloblastoma were referred to our hospital for radiation therapy after total or subtotal resection of the primary tumor. All patients received 30 Gy to the craniospinal axis followed by a 20-25 Gy boost to the posterior fossa (median fraction, 1.8 Gy). Sixty-four patients were followed for a median period of 38.5 months. The rates of 3-year and 5-year overall survival were 68.8% and 55.7%, respectively; corresponding disease-free survival were 57.8% and 51.4%, respectively. Patients who had received radiation treatment within 25 days after resection had a greater probability of 3-year survival (81.5% versus 59.5%; P = 0.11) and 3-year disease-free survival (74.1% versus 46.0%; P = 0.03) than patients who began radiation treatment later. No relationship was found between survival and age, sex or tumor size. This regimen was comparatively ineffective in preventing recurrence of postoperative medulloblastoma; however, we found that the interval between surgery and radiation is a significant prognostic factor for disease-free survival.

The efficacy of postoperative radiation therapy in patients with carcinoma of the buccal mucosa and lower alveolus with positive surgical margins

A retrospective analysis to determine the efficacy of postoperative radiation therapy, in patients of carcinoma of the buccal mucosa and lower alveolus with pathologically verified positive surgical margins (PSM). Ninety-four patients were analysed, who underwent surgery plus postoperative radiation therapy. Twenty-nine patients (31%) had PSM. Other pathological factors like nodal stage, number of nodes, bone involvement etc. were also analysed. Disease free survival (DFS) of patients with a PSM was significantly worse when compared with those with negative surgical margins (NSM). Poor DFS was also observed for variables like nodal stage, number of nodes and extranodal extension and radiation dose. In multivariate analysis only two variables showed significant impact on DFS, those were surgical margins and number of nodes. To conclude in our study median dose of 60 Gy in PSM patients was not able to improve DFS and showed poor results as compared with NSM patients. There is also evidence from other studies, to suggest that post-operative radiation doses upto 60 Gy may not be sufficient to overcome this poor prognostic factor. To overcome this poor prognostic group patients, we in our institution are now employing radiation dose intensification and altered fractionation in an effort to improve our results. In physically fit patients we are trying to administer concomitant chemotherapy along with radiation treatment.

Localization of internal mammary lymph nodes by CT simulation: implications for breast radiation therapy planning

The efficacy of post-operative radiation therapy in breast cancer management has been evident for several decades. In recent years there has been increasing interest in treating the internal mammary lymph nodes. In an attempt to simplify their localization for treatment planning purposes, the position of the internal mammary lymph nodes was systematically studied in 65 breast cancer patients undergoing CT simulation.

PSA based review of adjuvant and salvage radiation therapy vs. observation in postoperative prostate cancer patients

Because of the uncertainties regarding the efficacy of postoperative radiation therapy for early prostate cancer, treatment strategies following radical prostatectomy include: (1) observation alone in high-risk patients, (2) adjuvant radiation therapy (PSA undetectable) in high-risk patients, or (3) salvage radiation therapy for biochemical and clinical recurrence. Fifty-two patients treated with postoperative radiation therapy in either an adjuvant setting (13) or for salvage (39) were retrospectively reviewed. The actuarial biochemical disease-free survival (bNED) rates following radiation therapy were calculated using the life-table method. Univariate and multi variate analyses were used to define the clinical factors that predict biochemical failure following postoperative radiation therapy. In addition, the bNED survival rate for 36 high-risk surgery patients who were simply observed following prostatectomy was determined. The 3-year bNED survival rate for the adjuvant radiation group was 85% compared with 27% for salvage radiation and 43% for the observation group. These results are statistically significant. Factors that predict biochemical failure following postoperative radiation therapy include preoperative PSA level, pre-radiation therapy PSA level, and seminal vesicle involvement. At our institutions, adjuvant radiation therapy was a superior strategy compared with either observation alone or salvage radiation therapy for high-risk postoperative prostate cancer patients. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 29–36 (2000). © 2000 Wiley-Liss, Inc.

PSA based review of adjuvant and salvage radiation therapy vs. observation in postoperative prostate cancer patients

Because of the uncertainties regarding the efficacy of postoperative radiation therapy for early prostate cancer, treatment strategies following radical prostatectomy include: (1) observation alone in high-risk patients, (2) adjuvant radiation therapy (PSA undetectable) in high-risk patients, or (3) salvage radiation therapy for biochemical and clinical recurrence. Fifty-two patients treated with postoperative radiation therapy in either an adjuvant setting (13) or for salvage (39) were retrospectively reviewed. The actuarial biochemical disease-free survival (bNED) rates following radiation therapy were calculated using the life-table method. Univariate and multi variate analyses were used to define the clinical factors that predict biochemical failure following postoperative radiation therapy. In addition, the bNED survival rate for 36 high-risk surgery patients who were simply observed following prostatectomy was determined. The 3-year bNED survival rate for the adjuvant radiation group was 85% compared with 27% for salvage radiation and 43% for the observation group. These results are statistically significant. Factors that predict biochemical failure following postoperative radiation therapy include preoperative PSA level, pre-radiation therapy PSA level, and seminal vesicle involvement. At our institutions, adjuvant radiation therapy was a superior strategy compared with either observation alone or salvage radiation therapy for high-risk postoperative prostate cancer patients. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 29-36 (2000).

Efficacy of postoperative radiation therapy for recurrent squamous cell carcinoma of the head and neck

Postoperative radiation therapy (RT) following surgical resection is often the recommended treatment for recurrent squamous cell carcinoma (SCC) of the head and neck. Despite common use, there are few published series evaluating such a management approach. We evaluated the efficacy of postoperative RT in 31 patients with recurrent SCC of the head and neck treated between 1981 and 1993. None of the patients had prior RT. All had complete resection of recurrent gross disease and no distant metastases. Maximum postoperative RT doses ranged from 59.4-70 Gy (median = 66 Gy). The 5-year disease-specific survival (DSS) and local control (LC) rate for all patients were 32 and 46%, respectively. Several prognostic factors were analyzed including site and stage of original primary tumor, disease-free interval, site of recurrence, status of surgical margins, and dose. Only site of recurrence significantly influenced both DSS and LC. Patients whose recurrence was limited to previously undissected tissue had 5-year DSS and local control rates of 60 and 74%, respectively, as compared to 19 and 29%, respectively, for patients whose recurrence was within previously dissected tissue (p = 0.05). Patients with recurrent SCC of the head and neck treated with standard postoperative RT following surgical resection do relatively well if the recurrence is within previously undissected tissue (i.e., nodal only); however, patients whose recurrence is within previously dissected tissue do poorly. Every effort to prevent locoregional disease recurrence at the time of primary therapy should be emphasized.

Postoperative radiation for cervical cancer with pathologic risk factors

To examine the efficacy of postoperative radiation therapy for early-stage cervical cancer with pathologic risk factors. We reviewed the charts of 83 patients who received postoperative radiation therapy at our facility from March 1980 to November 1993 for early stage cervix cancer with positive surgical margins, positive pelvic or periaortic lymph nodes, lymphovascular space invasion, deep invasion, or for disease discovered incidently at simple hysterectomy. Twenty-eight patients received low dose rate (LDR) intracavitary radiation with or without external beam pelvic irradiation and 55 patients received external beam pelvic irradiation with high dose rate (HDR) intracavitary implants. Of these 83 patients, 66 were evaluable--20 LDR and 46 HDR patients. All patients received 45-50 Gy external beam irradiation and 20 Gy LDR equivalent intracavitary irradiation prescribed to 0.5 cm below the mucosa. Ninety percent of the LDR group and 92% of the HDR group completed treatment within < 56 days. Treatment-related toxicities were scored according to the GOG toxicity scale. Mean and median follow-up times were 101 months and 111 months (3-172 months) for the LDR group and 42 and 40 months (3-98 months) for the HDR group. The 5-year disease-free survival was 89% for the LDR group and 72% for the HDR group. Local control was observed in 90% (18 out of 20) of the LDR patients and 89% (41 out of 46) of the HDR patients for an overall local control rate of 89.5%. Two of 20 LDR patients (10%) experienced recurrence (two pelvic with distant metastasis). Nine of 46 HDR patients (22%) had recurrence of disease (three pelvic, four distant metastasis, and two pelvic with distant metastasis). In the HDR group, 6 out of 16 (38%) with positive lymph nodes died of disease whereas, 27 out of 30 (90%) of the patients with negative lymph nodes remain free of disease. Three of 20 (15%) LDR patients and 4 out of 46 (9%) HDR patients experienced Grade 2 or 3 late treatment- related complications. No patient in either group had Grade 4 or 5 complications. Pathologic risk factors were analyzed. Lymph node positivity and lymphovascular space invasion were found to be significant (p = 0.01 and p = 0.02). Positive margins, deep invasion, and age were not significant. Our results demonstrate the efficacy of postoperative irradiation for cervical cancer with pathologic risk factors. Overall, the local control rate was 89.5% The HDR results demonstrate that this method can be delivered safely and effectively.