Factors For Local Control Research Articles

Patterns of failure in nasopharyngeal cancer patients of northeastern region of India.

94 Background: We aimed to analyze patterns of failure and relationship between disease volume and treatment outcomes in patients of Nasopharyngeal cancer receiving chemoradiation at tertiary cancer centre in northeast region of India. Methods: From February 2018 to February 2022, 99 histopathologically proven non metastatic NPC patients treated with IMRT and chemotherapy were analysed retrospectively. Locally advanced patients received neoadjuvant or adjuvant chemotherapy. Locoregional failures were classified as in-field or out-of-field in relation to the CT data sets used for pretreatment planning. The Cox proportional hazards model was used to investigate the impact of various prognostic factors on locoregional free survival (LRFS), distant metastasis free survival (DMFS), progression free survival (PFS) and overall survival (OS). The log-rank test and Kaplan-Meir curves were used to compare outcome variables based on classified tumour volume as determined by ROC analysis. Results: During a median follow up of 25.4 months (17.3-39.2), 35 (35.4%) patients developed recurrence. Twenty-nine patients developed locoregional failures, of which 11 were in-field; 12 patient showed an out-field failure. The 3-year LRFS, DMFS, PFS and OS was 71.10%, 70.90%, 64.10 and 74.10 % respectively. There was statistically significant difference in locoregional failure-free survival according to T staging (p<0.0001). Cox regression analysis revealed that gross tumor volume(GTVp) and gross nodal volume(GTVn) were an independent prognostic factor for OS, PFS, LRFS and DMFS. The cut-off volumes for GTVp and GTVn for distant metastases and locoregional failure, respectively, were found to be 13 and 22.7 mL and 3.7 and 39.2 mL, respectively, by ROC curve analysis. Based on this, 99 patients were divided into three subgroups. OS demonstrated significant differences among patients in different volume subgroups for GTVp (p=0.03) and GTVn (p=0.00024) and were superior to T classification for predicting prognosis of NPC patients. Conclusions: Distant failure is most common pattern of failure. With advanced T-stage NPC, locoregional failure is more common. GTVp and GTVn are an independent prognostic factor in local control, distant metastasis, disease-free survival, and overall survival in NPC. This justifies their use as quantitative prognostic indicator for NPC.

Retrospective analysis of local recurrence pattern by computed tomography image-guided intracavitary and interstitial brachytherapy for locally advanced cervical cancer in a single Japanese institution

PURPOSEThe purpose of this study was to investigate the treatment results with focus on local control (LC) by computed tomography (CT)-guided intracavity brachytherapy and interstitial brachytherapy (ICBT/ISBT) for locally advanced cervical cancer (LACC). METHODS AND MATERIALSPatients with LACC undergoing ICBT/ISBT at least once in our institution between January 2017 and June 2019 were analyzed retrospectively. The primary endpoint was local control (LC), and the secondary endpoints were progression-free survival (PFS), overall survival (OS), and late toxicities. Differences between patient subgroups for prognostic factors in LC, PFS, and OS were analyzed using the log-rank test. The recurrence patterns of LC were also investigated. RESULTSForty-four patients were included in the present study. The median high-risk clinical target volume (HR-CTV) at the initial brachytherapy was 48.2 cc. The median total dose of HR-CTV D90 (EQD2) was 70.7 Gy. The median followup period was 39.4 months. The 3-year LC, PFS and OS rates in all patients were 88.2%, 56.6%, and 65.4% (95% CI 50.3–78.0%), respectively. Corpus invasion and large HR-CTV (70 cc or more) were significant prognostic factors in LC, PFS, and OS. Marginal recurrences at the fundus of the uterus were detected in 3 of 5 patients in whom local recurrence was observed. Late toxicities of Grade 3 or higher were detected in 3 patients (6.8%). CONCLUSIONSFavorable LC was achieved by performing CT-guided ICBT/ISBT for LACC. The brachytherapy strategy for patients with corpus invasion or large HR-CTV may need to be reconsidered.

Local control results in extremity soft tissue sarcomas

Aim: The aim of this study is to investigate local control results and effective predictive factors in local control of extremity soft tissue sarcomas, retrospectively. Material and Method: 51 patients underwent postoperative adjuvant radiotherapy (RT) in Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital between October 2008-January 2022. Patients who underwent post-operative adjuvant RT were treated with 60-68 Gy in 2 phases from 2 Gy /day using conformal radiotherapy technique. IMA chemotherapy protocol was applied to 31.4% of the patients after radiotherapy. Results: The median follow up time was 46 months range (1-135). Recurrence was detected in 5 of the patients and the mean time of recurrence was 11.6 months (min: 3-max: 27). 10 patients developed metastasis at follow-up, the mean time until metastasis was 27 months (min: 18- max: 46). The mean overall survival (OS) was 103 (min:4-max:139) months and the OS of 2, 5 and 10 years were 93%, 65% and 60%, respectively. Disease-free survival (DFS) was 97 (min:4-max:139) months; 2, 5 and 10 years of DFS were 77%, 65% and 60%, respectively. The OS in patients aged ≥65 years old was significantly lower than in patients <65 years old (p=0.02). Overall and disease-free survival was significantly lower in patients undergoing chemotherapy (p=0.037 for overall survival, p=0.013 for disease-free survival). The occurrence of recurrence, metastasis or death within 3 years after the operation was significantly higher than after 3 years (p<0.001). Local failure was significantly higher in grade 3 tumors (p=0.05). All patients who recurred had grade 3 tumors. Metastasis and excitus were significantly higher in the follow-up of patients who underwent chemotherapy at one point during their treatment (p=0.027 for metastasis, p=0.042). Conclusion: While favorable local control results are obtained with adjuvant high dose-conformal radiotherapy in extremity sarcomas, close follow up is important for distant metastasis and local recurrence, especially in the first 3 years.

Experience with stereotactic r adiation therapy for liver oligometastases of colorectal cancer

Introduction: The problem of treating patients with unresectable liver metastases of colon cancer is currently far f rom being solved. One possible approach is the use of stereotactic body radiotherapy.The purpose of this study was to evaluate the immediate and long-term results of stereotactic radiotherapy in patients with colorectal cancer and oligometastatic liver metastases.Methods: This study was designed as a retro-prospective, open-label, controlled, non-randomized clinical trial. We assessed one-year local control, one-year overall survival, progression-free survival, and toxicity in 60 patients with oligometastatic liver disease from colorectal cancer who underwent stereotactic body radiotherapy, with median dose of 54 Gy.Results: The median follow-up was 20,1 months. One-year local control (LC) was 73,7 % (95 % CI = 62,7–86,6 %). Oneyear overall survival (OS) was 92,8 % (95 % CI = 86,3–99,9 %), one-year progression-free survival (PFS) was 31,3 % (95 % CI = 21,1–46,4 %) with a median of 8,1 months. Grade ≥ 3 toxicity was not noted. No cases of radiation-induced liver failure were observed. Radiation dose (HR = 0.88, 95 % CI = 0.81–0.95, p = 0.00087), metastasis size (HR = 1.51, 95 % CI = 1.07–2.12, p = 0.01858) and their number (HR = 1.8, 95 % CI = 1.01–3.22, p = 0.04669) are significant risk factors for LC. Metastasis size > 3 cm is a significant risk factor for LC (HR = 5.5, 95 % CI = 1.7–17.9, p = 0.005) and OS (HR = 3.8, 95 % CI = 1.3–11.7, p = 0.02).Conclusion: Stereotactic body radiotherapy is an effective and safe method of providing local control of oligometastatic liver metastases in colorectal cancer as part of a combined treatment approach. Further studies are required to individualize the indications for this treatment method.

Tumor size before image-guided brachytherapy is an important factor of local control after radiotherapy for cervical squamous cell carcinoma: analysis in cases using central shielding.

We analyzed the local control (LC) of cervical squamous cell carcinoma treated by computed tomography (CT)-based image-guided brachytherapy (IGBT) using central shielding (CS). We also examined the value of tumor diameter before brachytherapy (BT) as a factor of LC. In total, 97 patients were analyzed between April 2016 and March 2020. Whole-pelvic (WP) radiotherapy (RT) with CS was performed, and the total pelvic sidewall dose was 50 or 50.4 Gy; IGBT was delivered in 3–4 fractions. The total dose was calculated as the biologically equivalent dose in 2 Gy fractions, and distribution was modified manually by graphical optimization. The median follow-up period was 31.8 months (6.3–63.2 months). The 1- and 2-year LC rates were 89% and 87%, respectively. The hazard ratio was 10.11 (95% confidence interval: 1.48–68.99) for local recurrence in those with a horizontal tumor diameter ≥ 4 cm compared to those with < 4 cm before BT. In CT-based IGBT for squamous cell carcinoma, favorable LC can be obtained in patients with a tumor diameter < 4 cm before BT. However, if the tumor diameter is ≥ 4 cm, different treatment strategies such as employing interstitial-BT for dose escalation may be necessary.

Clinical Outcomes of MRI-Guided Adaptive Brachytherapy for Each Fraction in Locally Advanced Cervical Cancer: A Single Institution Experience

PurposeThis study aims to evaluate clinical outcomes of MRI-guided adaptive brachytherapy (MR-IGABT) for each brachytherapy fraction in patients with locally advanced cervical cancer (LACC).Methods and MaterialsA retrospective analysis was performed on 97 consecutive patients with LACC treated with 44.0–50.4 Gy external beam radiotherapy (EBRT) ± concurrent platinum-containing chemotherapy followed by 4 × 7 Gy MR-IGABT between September 2014 and April 2019. Intracavitary (IC)/interstitial (IS)/hybrid intracavitary and interstitial (IC/IS) brachytherapy was used in MR-IGABT. Brachytherapy planning and dose reporting followed the GEC-ESTRO recommendations. Clinical outcomes including overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), local control (LC), and treatment-related toxicity evaluated by the RTOG criteria were analyzed. Kaplan–Meier and univariable and multivariable Cox regression analyses were used to analyze the prognostic factor.ResultsMedian follow-up was 21.1 months. Median dose to 90% (D90) of the high-risk clinical target volume (HR-CTV) was 91.7 Gy (range 76.7~107.2 Gy). Two-year OS, CSS, PFS, and LC were 83.5%, 84.1%, 71.1%, and 94.8%, respectively. Four patients (4.1%) suffered from grade 3 late gastrointestinal radiation toxicity, and no other grade 3 or greater radiation toxicity occurred. Initial HR-CTV was an independent factor of OS (p = 0.001, HR = 1.018/cm3), PFS (p = 0.012, HR = 1.012/cm3), and LC (p = 0.011, HR = 1.028/cm3). The HR-CTV D90 (p = 0.044, HR = 0.923/Gy) was an independent factor of PFS. Age was an independent factor of LC (p = 0.010, HR = 1.111/year).ConclusionFor patients with LACC, MR-IGABT was effective and safe. It showed favorable LC, OS, and minimal toxicity. Moreover, initial HR-CTV, HR-CTV D90, and age were significant prognostic factors.

The Important Factor in Local Control of Bone Metastatic Lesions in Radiotherapy

With the advance of systemic therapy, long-term survivors have increased and long-term local control of bone metastases are required for some of patients. The purpose of this study was to search for factors affecting local control of bone metastatic lesions in external-beam radiotherapy (EBRT). Between January 2010 and December 2019, 361 osteolytic bone metastases (spinal column, 192; pelvis, 87; rib/sternum, 35; extremity, 41; facial, 6) in 257 patients received EBRT. Local control was evaluated by follow-up CT. Doses of EBRT were 8-50 Gy (median 30 Gy). One and three-year overall survival rates were 59% and 33%, respectively. One and three-year control rates at EBRT sites were 78% and 67%, respectively. Local recurrence was observed in 18% (64 lesions) and the time of recurrence were 0.5-105 months (median 3 months). Male, age of > 70, rib/sternum and facial bone metastases, bone metastases from hepatobiliary/pancreatic/colorectal carcinoma, extraosseous invasion, EBRT ≤ 20 Gy, no use of bisphosphonates/receptor activator of NF-κB ligand (RANKL) formulation, and no use of systemic therapy after EBRT were statically significant unfavorable factors for local control (p = 0.0155,0.0005, <0.0001, <0.0001, 0.0361, 0.0010, <0.0001, and 0.0008, respectively). In multivariate analysis, age of > 70, rib/sternum/facial bone metastases, bone metastases from hepatobiliary/pancreatic/colorectal carcinoma, EBRT ≤ 20 Gy, and no use of bisphosphonates/RANKL formulation were significant unfavorable factor for local control (p = 0.0001, <0.0001, 0.0006, 0.0010, and 0.0349, respectively). For patients who can expect long-term survival, the use of bisphosphonates/RANKL formulation and higher dose EBRT seemed to be useful. Although further studies are needed, it seemed to be comparatively difficult to control bone metastases of elderly patients, rib/sternal/facial bone, hepatobiliary/pancreatic/colorectal carcinoma.

Prognostic factors of local control and disease free survival in centrally located non-small cell lung cancer treated with stereotactic body radiation therapy

Background: Stereotactic body radiation therapy (SBRT) results in high local control (LC) rates in patients with non-small cell lung cancer (NSCLC). For central lung tumors, risk-adapted fractionation schedules are used and underdosage to the Planned Target Volume (PTV) is often accepted to respect the dose constraints of the organs at risk in order to avoid high rates of toxicity. The purpose of this study was to analyze the effect of PTV underdosage and other possible prognostic factors on local- and disease control after SBRT in patients with central lung tumors.Material and Methods: Patients with centrally located NSCLC treated with SBRT were included. The doses were converted into biologically equivalent dose using α/β-value of 10 Gy (BED10). Underdosage to the PTV was defined as the (percentage of) PTV receiving less than 100 Gy BED10; (%)PTV < 100 BED10. Potential prognostic factors for LC and Disease Free Survival (DFS) were evaluated using Cox regression analysis.Results: Two hundred and twenty patients received ≤12 fractions of SBRT. LC-rates were 88% at 2 years and 81% at 3 years. Twenty-seven patients developed a local recurrence. Both the PTV < 100 BED10 and %PTV < 100 BED10 were not prognostic for LC. Tumor size and forced expiratory volume in 1 second (FEV1) were independently prognostic for LC. Disease progression was reported in 75 patients with DFS-rates of 66% at 2 years and 56% at 3 years. Disease recurrence was independent significantly associated with larger tumor diameter, lower lobe tumor location and decreased FEV1. Grade 4–5 toxicity was reported in 10 patients (8 with ultra-central tumors) and was fatal in at least 3 patients.Conclusion: Decrease in tumor coverage was not correlated with the local recurrence probability. The LC and DFS were promising after SBRT of centrally located NSCLC with tumor size, FEV1 and tumor location (for DFS only) as prognostic factors.

Tumor volume and sphericity as predictors of local control after stereotactic radiosurgery for limited number (1-4) brain metastases from nonsmall cell lung cancer.

This study aims to evaluate the usage of brain metastases (BM) tumor volume and sphericity as prognostic factors in local control (LC) after stereotactic radiosurgery (SRS) for limited number (1-4) BM from nonsmall cell lung cancer (NSCLC). We retrospectively reviewed 80 patients, with 141BM, who were treated with SRS from 2012 to 2017. Local failure was defined as an increase in lesion size after SRS. LC and overall survival (OS) were estimated using Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. The median clinical and radiographic follow-up was 11.2 and 9.0 months, respectively. The median BM tumor volume was 0.31 cm3 (0.01-21.64 cm3 ) and the median tumor sphericity was 0.76 (0.39-0.95). The median LC of the entire cohort was 28.8 months. LC rate at last follow-up was achieved in 84.4% of patients (35.5% CR, 35.5% PR, and 13.5% SD). LC was 83.8% at 1 year and 56.3% at 2 years. On multivariate analysis, only sphericity (P<.001) and volume (P=.004) were found to be a strong predictor for LC. The median OS of the entire cohort was 24.1 months. On multivariate analysis, only GPA score was found to be a predictor for OS. BM tumor sphericity and volume were found to be strong predictors for LC. Tumor sphericity and volume should be taken into consideration when treating patients with BM and when designing future prospective studies and developing prognostic indices.

Integrative assessment of brain and bone invasion in meningioma patients

BackgroundVarious prognostic factors have been suggested in meningioma patients including WHO grading, brain invasion and bone involvement, for instance. Brain invasion was included as an independent criterion in the recent WHO classification. However, assessability of brain or bone involvement is often limited or varies between histopathologic, operative and imaging reports. Objective of our study was to investigate prognostic values including brain and bone involvement according to different clinical approaches.MethodsA cohort of 111 patients was treated with primary, adjuvant or salvage irradiation between 2008 and 2017 using intensity-modulated radiotherapy. Positron-emission tomography (PET) was available for treatment planning in 81% of patients. Clinical data were extracted from the medical reports. Brain and bone involvement were stratified separately according to histopathologic, operative and imaging reports as well as judged in synopsis.ResultsWHO grade I tumours, lower estimated proliferation index, primary versus recurrence treatment and localization (i.e. skull base, optic nerve sheath) were beneficial prognostic factors for local control. Judgement of brain and bone invasion partly differed between diagnostic modalities. In synopsis, brain or bone invasion did not show a significant influence on local control rates.ConclusionsSeveral previously described prognostic factors could be reproduced. However, partly divergent histopathological, surgical and image-based judgements could be found in regard to brain and bone invasion and all methods imply limitations. Therefore, we suggest a particular, complemental synopsis judgement. In synopsis, brain or bone involvement did not coherently impair local control in our irradiated patients. This might be explained by elaborate radiation techniques and PET-based treatment planning.

Treatment outcomes according to the macroscopic tumor type in locally advanced esophageal squamous cell carcinoma treated by chemoradiotherapy.

To identify predictive factors for local control of locally advanced esophageal cancer by chemoradiotherapy, the relationship between clinical features, including macroscopic tumor type, and treatment outcome was analyzed in 83 patients. Macroscopic tumor type was defined by endoscopy as follows: type 1: protruding type; type 2: ulcerative and localized type; type 3: ulcerative and infiltrative type; type 4: diffusely infiltrative type; and type 5: unclassifiable type. We analyzed the overall survival, cause-specific survival, local progression-free rate, and predictive factors for locally advanced esophageal cancer after chemoradiotherapy. The median follow-up period at the time of evaluation was 59months among survivors. The 5-year overall survival, cause-specific survival, and local progression-free rates for type 1 and other types were 37.0% and 23.3% (P = 0.4255), 71.8% and 30.3% (P = 0.0325), and 100% and 63.3% (P = 0.0246), respectively. Macroscopic tumor type (type 1) was the most significant predictive factor of cause-specific survival and local progression-free rates. Macroscopic tumor type 1 was the significant favorable predictive factor for local control. The study results suggested that the macroscopic tumor type was useful in predicting tumor responses.

Margens cirúrgicas no dermatofibrossarcoma protuberans: relato de caso e revisão da literatura

Introdução: O dermatofibrossarcoma protuberante (DFSP) é um tumor fibrohistiocítico de origem dérmica raro, que acomete a pele, representando 1% dos sarcomas de partes moles e menos de 0,1% de todas malignidades. A principal característica deste tipo de tumor é a sua elevada taxa de recidiva local após excisão cirúrgica. Decidir a margem cirúrgica adequada para a ressecção completa é um desafio. Relato de caso: 24 anos, apresenta lesão tumoral vegetante avermelhada no ombro esquerdo, assintomática. Possui história familiar positiva de DFSP em membro inferior. O laudo histopatológico definitivo confirmou Dermatofibrossarcoma protuberans. Discussão: A característica histológica do tumor é a presença de projeções tipo tentáculos de células neoplásicas na periferia que se estendem através do tecido subcutâneo até a fáscia muscular. Certamente, o fator de maior importância para o controle local é a obtenção de margens cirúrgicas livres. A excisão através da cirurgia micrográfica de Mohs é uma ótima opção em regiões onde a excisão ampla não é desejável, como na face. A margem padrão estabelicida em grande parte da literatura é de 3 cm com ressecção até a fáscia muscular, podendo ser diminuida para 2 cm em locais em que a excisão ampla prejudique a conformação do local, como na face

Clinical Outcome of Definitive Radiotherapy and/or Surgery in T1-2N0M0 Glottic Squamous Cell Carcinoma: A Single Institution Retrospective Report

Background: The current treatment options of early glottic carcinoma are radiotherapy; trans laser microsurgery, and open surgery. However, the best treatment is still controversial due to lack of randomized controlled trials. We aimed to evaluate the treatment results and the prognostic factors of local control of early glottic squamous cell carcinoma patients (GSCC) T1-2N0M0 treated at our institution. Material and Methods: We retrospectively studied the charts of 52 patients with early GSCC T1-T2N0M0 from 2010-2015 at the Clinical Oncology Department, Ain-Shams University. 24 patients had T1 and 28 had T2 early glottic carcinoma. The overall survival OS, local control rate, and laryngeal preservation rate were evaluated. Kaplan-Meier method, Cox proportional hazards model were used to analyze the data. Results: Median duration of follow-up was 13 months. Thirty-eight patients received radiation treatment alone (73.1%), 7.7% of the patients underwent surgery alone, and 19.2% of the patients had surgery combined with radiotherapy. Local recurrence after radiation failure developed in 6/52 patients, all had T2 disease and were salvaged by total laryngectomy. The ultimate local control rate was 88.5%, and the ultimate laryngeal preservation rate was 77.2% (40/52 patients). The median OS of the 52 patients was 13 months (range 2 - 46 months). Univariate analysis of factors associated with poor local control showed that age > 60 years was the only significant factor (P = 0.048). Conclusion: Radiotherapy achieves high local control and laryngeal preservation rates for patients with early glottic carcinoma, and is associated with a low rate of severe complications compared to surgery. Salvage surgery is feasible after radiotherapy failure.

A comparative study of different irradiation ranges in radical radiotherapy for early-stage esophageal cancer

Objective To compare the efficacy of elective nodal prophylactic irradiation (ENI) and involved-field irradiation (IFI) in radical radiotherapy for early-stage esophageal cancer and to determine the appropriate irradiation range for early-stage esophageal cancer. Methods The clinical data of 121 patients with early-stage esophageal cancer receiving radical radiotherapy in our hospital from January 2006 to December 2011 were collected and respectively analyzed. Sixty-one patients received ENI, and the other 60 patients received IFI. The Kaplan-Meier method was used to calculate local control (LC) and overall survival (OS) rates; the log-rank test was used for survival difference analysis and univariate prognostic analysis; the Cox regression model was used for multivariate prognostic analysis. Results The 1-, 3-, and 5-year LC rates in ENI group and IFI group were 81.1%, 60.1%, and 57.5% vs. 64.5%, 43.9%, and 27.2%, respectively (P=0.003). The 1-, 3-, and 5-year OS rates in ENI group and IFI group were 86.9%, 56.8%, and 34.8% vs. 86.7%, 34.3%, and 19.1%, respectively (P=0.019). The 1-, 3-, and 5-year overall failure rates in ENI group and IFI group were 22.3%, 53.8%, and 63.2% vs. 43.3%, 65.8%, and 78.8%, respectively (P=0.023). Multivariate analysis showed that irradiation range was the influencing factor for LC and OS. Conclusions As for the radical radiotherapy for early-stage esophageal cancer, ENI can significantly increase LC and reduce locoregional failure, and therefore improve long-term OS. Key words: Esophageal neoplasms/radiotherapy; Elective nodal prophylactic irradiation; Involved-field irradiation; Prognosis

A Retrospective Study of Clinicoepidemiological Aspects of Nasopharyngeal Cancer at NCI-Cairo (2000-2010)

Aim of Work: The aim of this work was to study the clinico-epidemiological characteristics of the patients with nasopharyngeal carcinoma (NPC), analyse the prognostic factors of the disease and to analyse the results of different treatment modalities and their effect on loco-regional, distal metastatic disease control and both overall survival (OS) and disease free survival (DFS) rates. Patients and Methods: This is a retrospective study reviewing all adult nasopharyngeal carcinoma (NPC) patients who presented to the radiotherapy department—National Cancer Institute Cairo University in the period from (2000-2010). Results: In this study, it was found that the mean age was 45 years; most of the patients were of locally advanced stages. Multivariate cox proportional hazards regression identified T-stage, radiotherapy course completion & addition of chemotherapy as independent prognostic factors for local control (LC), DFS, & OS. The 5-year LC, DFS and OS rates for all studied patients were 38.2%, 33.5% & 37.2% respectively. The median DFS was 26 months and median OS was 36.5 months. Conclusion: This study matches the published data that support that radical concurrent chemoradiation is the mainstay of treatment of locally advanced NPC, & that T-stage, M-stage, prescribed dose completion, response to initial treatment are independent prognostic factors for survival. All measures should be taken to improve the local response during primary treatment as this will improve survival rates of patients with NPC.

Adjuvant chemoradiotherapy in gastric cancer: a pooled analysis of the AIRO gastrointestinal group experience.

Given the poor compliance with adjuvant chemoradiotherapy (CRT) in gastric cancer reported in previous studies, a survey was conducted among 18 Italian institutions within the AIRO Gastrointestinal Group to investigate current treatment modalities, toxicities, and compliance with adjuvant CRT. Data from 348 patients operated on for gastric cancer were collected retrospectively from September 2000 to June 2008 and analyzed. The adjuvant treatments included CRT according to center guidelines. In multivariate analysis, acute hematological, gastrointestinal, and renal toxicity (according to the RTOG Acute Radiation Morbidity Scoring Criteria) and compliance with treatment were studied, as well as risk factors for local control, metastasis-free survival, disease-free survival, and overall survival. Compliance with treatment was excellent: 95.7% of patients completed CRT. During CRT, acute G3-G4 ­hematological toxicity was 3.7% and acute G3-G4 gastrointestinal toxicity 4%. 78.4% of patients completed chemotherapy (CT), either before or after CRT. During CT acute G3-G4 hematological toxicity was 5.4% and acute G3-G4 gastrointestinal toxicity 6%. Overall, 74.1% of patients completed the prescribed treatment (CRT and CT). Doses greater than 4500 cGy did not compensate for more aggressive disease. The 5-year overall survival was 51%. The adjuvant treatment of gastric cancer within the AIRO group was diverse, but radiotherapy treatment was homogeneous (in terms of technique) and well tolerated. Toxicity was low and compliance with treatment was good during CRT; these results may be due to the radiotherapy technique applied. This survey could be used as a benchmark for further studies.

Prognostic Factors of Local Control After Re-irradiation With Intensity Modulated Radiation Therapy of Locally Recurred Nasopharyngeal Carcinoma

Prognostic Factors of Local Control After Re-irradiation With Intensity Modulated Radiation Therapy of Locally Recurred Nasopharyngeal Carcinoma

The desmoid tumour: Local control after surgical treatment

Desmoid tumours are uncommon non-malignant tumours that show a locally aggressive growth pattern and a high local recurrence rate after surgery. Approximately 10% of the desmoid tumours are associated with familial adenomatous polyposis (FAP). Variable natural history of the disease challenges treatment decision-making in the absence of prospective, randomised data. Association of this rare tumour to GIST is speculated and the tumorigenesis may share common steps. This study reviews given treatment and reports prognostic factors for local control and concurrent neoplasms in patients evaluated by a single soft tissue tumour group. Patients referred to the soft tissue tumour group at Helsinki University Central Hospital (HUCH) for a desmoid tumour (primary or recurred) during 1987–2007 and receiving surgical treatment with or without adjuvant treatment were included in this retrospective review. All locations and also patients with a FAP-associated tumour were included. Extra-abdominal location showed lower local control despite the fact that 27% of patients also received radiation therapy. One amputation was performed. Female sex and location in the rectus abdominis muscle predicted improved local control in multivariate analysis. In this review, the occurrence (14%) of concurrent neoplasms was higher than expected with unusual tumour types noted including two GISTs. In those patients in whom surgical treatment is chosen, adjuvant radiation therapy should also be considered in order to decrease morbidity from aggressive surgery aiming at R0 resection. Further studies are suggested to illuminate the biological association between the desmoid tumour and other neoplasms.

Local control in non-metastatic medulloblastoma

Background. A single-institution review of long-term outcomes and factors affecting local control (LC) following radiotherapy for non-metastatic medulloblastoma.Material and methods. From 1963 to 2008, 50 children (median age, 7.3 years; range 1.2–18.5) with stage M0 medulloblastoma were treated with radiotherapy; half underwent a gross total resection (no visible residual tumor) or near-total resection (< 1.5 cm3 of gross disease remaining after resection). Median craniospinal dose was 28.8 Gy (range 21.8–38.4 Gy). Median total dose to the posterior fossa was 54.3 Gy (range 42.4–64.8 Gy). Eighteen patients (36%) received chemotherapy as part of multimodality management, including 11 who received concurrent chemotherapy.Results. Median follow-up was 15.7 years (range 0.3–44.4 years) for all patients and 26.6 years (range 7.3–44.4 years) for living patients. The 10-year overall survival, cancer-specific survival, and progression-free survival rates were 65%, 65%, and 69%. The 10-year LC rate was 84% and did not significantly change across eras. Four percent of patients experienced local progression five years after treatment. On univariate analysis, chemotherapy and overall duration of radiotherapy ≤ 45 days were associated with improved LC. Patients receiving chemotherapy had a 10-year 100% LC rate versus 76% in patients not receiving chemotherapy (p = 0.0454). When overall radiotherapy treatment lasted ≤ 45 days, patients experienced a superior 95% 10-year LC rate (vs. 73% in patients treated > 45 days; p = 0.0419). Three patients (6%) died from treatment complications, including radionecrosis/cerebellar degeneration, severe cerebral edema leading to herniation, and secondary malignancy.Conclusions. While we cannot draw definitive conclusions given the retrospective nature of our study, our long-term data suggest that reductions in craniospinal dose and boost target volume to reduce toxicity have not compromised disease control in the modern era. Our data also support analyses that implicate duration of radiotherapy, rather than interval between surgery and radiotherapy, as a factor in LC. Chemotherapy in multimodality management of medulloblastoma may have an underappreciated role in improving LC rates.

Stereotactic Body Radiotherapy (SBRT) for Primary Non-Small Cell Lung Cancer (NSCLC) and Pulmonary Metastases: Analysis of Outcomes and Predictive Factors for Local Control

the oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx, often managed with a combination of surgery, chemotherapy, and radiation therapy. Prognostic factors affecting treatment outcomes in the elderly have not been clearly defined in the literature. Patient-specific factors may be important when considering treatment options for this population in order to maximize patient survival and post-treatment quality of life (QOL). This study aims to explore and clarify the role of key prognostic factors on outcomes in HNC patients over the age of 80 years treated with radiation therapy at the Odette Cancer Centre (OCC). Methods and Materials: From a database of 933 HNC patients treated at OCC between Jan 2007 and December 2012, a sample of 40 eligible patients will be randomly selected. Prognostic factors identified from the literature will be extracted from relevant patient records and recorded in a database in three key categories: disease-related, treatment-related and patient-specific. Patient outcome datadoverall survival and rates of recurrence, treatment completion, and radiation toxicitydwill also be retrieved and recorded. Univariate analysis will be employed to determine which of the patient, disease, and treatment factors significantly predict for outcomes in this population. Results: 92.5% of patients successfully completed their treatment as prescribed. Though palliative patients (mean age 89, median 91) were likely to be older than radical patients (mean age 84.7, median 84), no connection was found between age and outcome measures. Dose, fractionation, and stage were not found to significantly impact outcomes in this sample. Mortality status was unavailable for 25% of patients. Further data collection is ongoing to confirm these and other findings. Conclusions: Preliminary results suggest that choice of treatment regime may be tailored to patient convenience without compromising outcome, and that many older patients are able to successfully complete even aggressive radical therapy. The results of this study and the database from which the sample was drawn may be useful in further studies to inform practices in the HN site group at OCC. Prognostic data may also be utilized to create a medical nomogram, in the form of a visual tool useful in facilitating patient-specific education during the informed consent procedure.