Impact Of Postoperative Radiation Therapy Research Articles

Prognosis stratification and postoperative radiation therapy utilization in adenoid cystic carcinoma of the breast

PurposeAdenoid cystic carcinoma of the breast (ACCB) is a rare malignancy with a favorable prognosis. Little information exists regarding the impact of postoperative radiation therapy (RT) on survival outcome in patients with ACCB. This study aimed to evaluate the clinical significance of postoperative RT in ACCB. MethodsData of patients with ACCB were extracted from the Surveillance, Epidemiology, and End Results database (2000–2019). Univariate and multivariable Cox regression analyses were performed to identify prognostic factors. In addition, a nomogram model was constructed and internally validated for discrimination and calibration. The value of postoperative RT was respectively accessed in each risk subgroup according to nomogram-deduced individualized score. ResultsA total of 689 eligible patients were included in the analysis. Partial mastectomy was associated with an increased risk of death compared with partial mastectomy plus postoperative RT (P = 0.020), but total mastectomy with or without postoperative RT was comparable (P = 0.624). Then, in-depth analysis was performed for patients receiving breast-conserving therapy (n = 485, the training set vs. the testing set = 340 vs. 145). Age at diagnosis, histological grade, and T stage were identified as prognostic factors for overall survival (OS) (All P < 0.05). A nomogram was constructed to provide predictive accuracy toward individual OS rates of ACCB and to divide patients into different risk subgroups. Notably, compared with non-RT, postoperative RT significantly improved OS in the high-risk subgroup (P = 0.006 for the training set, and P = 0.013 for the overall population) but not in the low-risk subgroup (P = 0.807 for the training set, and P = 0.293 for the overall population), suggesting that these patients may be able to exempt from postoperative RT. ConclusionA robust and effective nomogram was developed to predict prognosis and assist in treatment decisions in patients with ACCB undergoing partial mastectomy.

A Risk Score Model for Locoregional Recurrence Following Upfront Surgery for Pancreatic Adenocarcinoma: Implications for Adjuvant Therapy

AimsThe aims of the study were to identify predictors of locoregional failure (LRF) following surgery for pancreatic adenocarcinoma, develop a prediction risk score model of LRF and evaluate the impact of postoperative radiation therapy (PORT) on LRF. Materials and methodsA retrospective review was conducted on patients with stages I–III pancreatic adenocarcinoma who underwent surgery at our institution (2005–2016). Univariable and then multivariable analyses were used to evaluate clinicopathological factors associated with LRF for patients who did not receive PORT. The risk score of LRF was calculated based on the sum of coefficients of the predictors of LRF. The model was applied to the entire cohort to evaluate the impact of PORT on the high- and low-risk groups for LRF. ResultsIn total, 467 patients were identified (median follow-up 22 months). Among patients who did not receive PORT (n = 440), predictors of LRF were pN+, involved or close ≤1 mm margin(s), moderately and poorly differentiated tumour grade and lymphovascular invasion. After adding patients who received PORT, the 2-year LRF in the high-risk group was 57% for patients who did not receive PORT (n = 242) and 32% among patients who received PORT (n = 22), with an absolute benefit to LRF of 25% (95% confidence interval 5–52%, P = 0.07). The 2-year overall survival for the high-versus the low-risk group was 36% versus 67% (P < 0.001). ConclusionThis risk group classification could be used to identify pancreatic adenocarcinoma patients with higher risk of LRF who may benefit from PORT. However, validation and prospective evaluation are warranted.

P26.03 The Impact of Postoperative Radiation Therapy on the Overall Survival of Resected Stage II Thymoma: An Up-to-date Meta-Analysis

P26.03 The Impact of Postoperative Radiation Therapy on the Overall Survival of Resected Stage II Thymoma: An Up-to-date Meta-Analysis

The Impact of Postoperative Radiation Therapy (PORT) on Clinical Outcomes of Resected Atypical Meningioma: A Meta-Analysis

The Impact of Postoperative Radiation Therapy (PORT) on Clinical Outcomes of Resected Atypical Meningioma: A Meta-Analysis

The Impact of Postoperative Radiation Therapy (PORT) on the Overall Survival (OS) of Completely Resected Masaoka/Masaoka-Koga Stage II Thymoma: An Updated Meta-Analysis

The benefit of PORT in patients with completely resected stage II Thymoma has been controversial. Two separate meta-analyses were conducted in 2015 and 2016 to address this uncertainty. The former revealed no survival benefit to PORT in stage II. However, the latter, which was methodologically flawed, revealed an increased survival in a combined cohort of stage II & III. The purpose of this meta-analysis is to evaluate the impact of PORT on OS in patients with completely resected Masaoka or Masaoka-Koga strictly stage II Thymoma incorporating more recent studies. A review of the medical literature was conducted using online databases. Inclusion criteria consisted of (i) resected Masaoka stage II Thymoma (ii) English language (iii) studies reporting OS with hazard ratios (HR) or Kaplan-Meier curves, and (iv) OS data on patients that underwent PORT versus those that did not. Studies that combined stage II with other stages and those that combined Thymoma with Thymic carcinoma were excluded. A meta-analysis was conducted using an inverse variance method with random-effects model. Seven retrospective series with a total of 2828 patients were included and analyzed. Three of these studies analyzed their data using stage IIB as a separate category while the remaining 4 analyzed stage II as whole. PORT was found to be significantly associated with OS benefit in patients with completely resected stage II Thymoma (HR 0.77, 95%CI 0.71-0.84; I2 = 0%). This is the first meta-analysis to show that PORT is associated with survival benefit in patients with completely resected Masaoka/Masaoka-Koga stage II/IIB Thymoma using studies that reported OS data distinctly for stage II. In the absence of randomized clinical trials, it represents the most compelling data supporting the use of PORT in this patient population.

Practice patterns and impact of post-operative radiation therapy on overall survival after neoadjuvant chemotherapy for cN2 non-small cell lung cancer

Practice patterns and impact of post-operative radiation therapy on overall survival after neoadjuvant chemotherapy for cN2 non-small cell lung cancer

Impact of postoperative radiation therapy for deeply invasive oral cavity cancer upstaged to stage III.

This article is about the eighth edition staging guidelines for upstaged patients with oral cavity squamous cell carcinoma (OCSCC) with >10 mm depth to pT3. This upstages some patients from stage I-II to stage III, a point at which patients are traditionally considered for postoperative radiation therapy (PORT). The role of PORT in patients upstaged for >10 mm depth is unknown. We identified patients with surgically resected stage I-II OCSCC with >10 mm depth who were upstaged to stage III. We used Cox proportional hazard modeling to compare patients who received PORT to those who did not (median follow-up 38.6 months). We observed that 3.6% of patients with OCSCC were upstaged to stage III for depth >10 mm including 823 eligible patients. On adjusted analyses, PORT was associated with improved overall survival in patients upstaged to stage III (adjusted hazard ratio [aHR] 0.47, 95% confidence interval [CI] 0.30-0.73). PORT is associated with improved survival for patients with OCSCC upstaged to stage III for >10 mm depth.

P17.07 The impact of postoperative radiation therapy on patterns of failure and survival improvement in patients with intracranial hemangiopericytoma

P17.07 The impact of postoperative radiation therapy on patterns of failure and survival improvement in patients with intracranial hemangiopericytoma

The Differential Impact of Postoperative Radiation Therapy for Completely Resected Stage IIIA (N2) Non-Small Cell Lung Cancer: Based on the Risk Prediction Model for Locoregional Recurrence

The Differential Impact of Postoperative Radiation Therapy for Completely Resected Stage IIIA (N2) Non-Small Cell Lung Cancer: Based on the Risk Prediction Model for Locoregional Recurrence

Survival Impact of Adjuvant Radiation Therapy in Masaoka Stage II to IV Thymomas: A Systematic Review and Meta-analysis

To evaluate the survival impact of postoperative radiation therapy (PORT) in stage II to IV thymomas, using systematic review and meta-analysis. A database search was conducted with EMBASE, PubMed, Web of Science, Cochrane Library, and Ovid from inception to August 2015. Thymic carcinomas were excluded, and studies comparing overall survival (OS) with and without PORT in thymomas were included. The hazard ratios (HRs) of OS were extracted, and a random-effects model was used in the pooled analysis. Seven retrospective series with a total of 1724 patients were included and analyzed. Almost all of the patients underwent macroscopically complete resection, and thymoma histology was confirmed by the World Health Organization criteria. In the overall analysis of stage II to IV thymomas, OS was not altered with the receipt of PORT (HR 0.79, 95% confidence interval [CI] 0.58-1.08). Although PORT was not associated with survival difference in Masaoka stage II disease (HR 1.45, 95% CI 0.83-2.55), improved OS was observed with the addition of PORT in the discrete pooled analysis of stage III to IV (HR 0.63, 95% CI 0.40-0.99). Significant heterogeneity and publication bias were not found in the analyses. From the present meta-analysis of sole primary thymomas, we suggest the potential OS benefit of PORT in locally advanced tumors with macroscopically complete resection, but not in stage II disease. Further investigations with sufficient survival data are needed to establish detailed treatment indications.

The impact of postoperative radiation therapy on patterns of failure and survival improvement in patients with intracranial hemangiopericytoma.

Because of the rarity of intracranial hemangiopericytomas (HPCs), the role of postoperative radiation therapy (PORT) in the management of HPC remains unclear. This study therefore analyzed the effects of PORT on patterns of failure and survival improvement in patients with HPC. Fifty-two patients surgically treated for intracranial HPC at our institution between 1992 and 2013 were retrospectively analyzed. Patterns of failure were subdivided into local recurrence, regional metastasis, and distant metastasis. Multivariate Cox proportional hazards models were used to assess factors prognostic of treatment failure and survival, and a time-dependent Cox proportional hazards models were used to investigate the correlations between patterns of failure and death. Of the 52 patients, 45 (87%) underwent gross total resection, and 39 (75%) received PORT. PORT significantly lengthened local control (LC) and overall survival (OS), by 14 and 13months, respectively, independent of the extent of resection. Patients who did and did not receive PORT had 5year LC rates of 97 and 44%, respectively (HR .05, P=.002); and 10year OS rates of 83 and 25%, respectively (hazard ratio (HR) .20, P=.008). PORT, however, did not show preventive effects on regional and distant metastases. The main patterns of failure were local recurrence in patients who did not receive PORT and distant metastasis in those who received PORT. Regional metastasis was a main immediate cause of death (P<.001), and tended to occur more frequently and earlier in patients not receiving PORT.

Assessing the Impact of Postoperative Radiation Therapy for Completely Resected Limited-Stage Small Cell Lung Cancer Using the National Cancer Database

IntroductionSurgical resection is being increasingly used for early-stage small cell lung cancer (SCLC). However, there are sparse data regarding the role of adjuvant therapies, particularly postoperative radiation therapy (PORT). We investigated the impact of PORT on survival after complete surgical resection for SCLC using the National Cancer Database. MethodsThere were 3017 patients diagnosed with nonmetastatic SCLC between 1998 and 2011 who underwent R0 sublobar resection, lobectomy, or pneumonectomy. Patients were stratified by the use of PORT, and only those who received a minimum dose of 45 Gy were included. The overall survival (OS) of patients based on PORT use were analyzed by Kaplan–Meier analysis and compared using the log-rank test. Multivariate Cox regression analysis was used to identify factors associated with survival. ResultsFor the entire study population, the 5-year OS was significantly poorer with the addition of PORT (33.9% versus 40.6%; p = 0.005). When analyzed by subgroup, patients with pN0 stage had significantly decreased OS with PORT (39.3% versus 46.3%; p = 0.07) and patients with pN2 stage had significantly improved OS with PORT (29.0% versus 18.6%; p < 0.001). No differences in OS were observed in patients with pN1 stage. On multivariate analysis, the hazard ratio for PORT in pN0 disease was 1.36 (95% confidence interval, 1.09–1.70; p < 0.001) and the hazard ratio for PORT in pN2 disease was 0.60 (95% confidence interval, 0.45–0.80; p < 0.001). ConclusionThe use of PORT was associated with a deleterious effect on OS in patients with pN0 disease but significantly improved OS in patients with pN2 disease.

Ruolo Della Radioterapia Nei Tumori Urologici Localmente Avanzati e/o Recidivati

Radiation therapy (RT) plays a fundamental role in the treatment of locally advanced and/or relapsed urological tumors, as well as in palliation, or as definitive treatment, and even where integrated into a multi-modal approach. In operated renal tumors, positive margins or extracapsular extension show a positive impact of postoperative RT, with a reduction of relapses between 100% and 30%, while, in the case of palliation, treatments with RT at high doses are preferred. In advanced cancers of the upper urinary tract, RT plays a limited role, even if it seems to increase the level of disease control locally and, with the combination of cisplatin, survival rates too. An important reduction in the recurrence is also observed in locally advanced tumors of the urethra, with a recurrence of 60% after surgery, 36% after RT and 25% after pairing of the two. In locally advanced tumors of the penis, RT shows poorer results than surgery, and the addition of postoperative RT does not seem to add any further outcome, except where, in the presence of a positive inguinal dissection, the postoperative RT reduces lymph node recurrences by 60%-11%. Interesting data for the preservation of the organ are reported with reference to the combination with chemotherapy. In the tumors of the testis, it is still disputable whether the treatment of residual masses after chemotherapy may be appropriate, with a view to a possible salvage radiotherapy. In the treatment of the prostate, the role of RT is consolidated and evolving with the progress of dose escalation, the association with hormonal therapy, new technologies, new possibilities of IMRT and proton therapy and various studies on multi-modal approaches (hormone therapy, surgery, radiotherapy, chemotherapy). Cystectomy is the gold standard for the treatment of locally advanced bladder cancer, even though there is a revived interest in multimodal treatments (transurethral resection, chemotherapy, RT) that may allow the organ preservation. Postoperative radiotherapy, which can reduce by 50% to 20%-5% local recurrences that are highly correlated with distance failure and with survival, should be revised in the light of modern RT techniques that can further increase local control levels and reduce the toxicity significantly.

Prognostic impact of postoperative radiation in patients undergoing radical esophagectomy for pathologic lymph node positive esophageal cancer

PurposeThough postoperative radiation for esophageal squamous cell carcinoma is offered in selected cases, there is conflicting evidence as to whether it improves overall survival (OS). A retrospective investigation was performed to analyze the prognostic impact of postoperative radiation therapy (PORT) in a large cohort of patients.MethodsFrom 2001 to 2009, 725 patients underwent radical esophagectomy (R0) with or without PORT were eligible for retrospective analysis. Patients were grouped into surgery alone (n = 467) and surgery plus PORT (n = 258). Median irradiation doses were 50 Gy (range: 40-56 Gy). Radiation fields encompassed the bilateral supraclavicular fossa, mediastinum, subcarinal area, and the tumor bed for the upper/middle-third disease; the bilateral supraclavicular fossa, mediastinum, the tumor bed, subcarinal area, and lower thoracic paraesophageal area for the lower-third disease. Kaplan-Meier and Cox regression analysis were used to compare OS.ResultsAfter median follow-up of 53 months, the median OS was 29 months in the PORT group and 23 months in the surgery alone group. The addition of PORT improved OS at 3 years from 36.6 to 43.6% compared with surgery alone. The use of PORT was associated with significantly improved OS (p = 0.018). For American Joint Committee on Cancer (AJCC) stage III esophageal cancer (T1-2N2M0, T3N1-2M0, T4N1-3M0), there was significant improvement in OS (p = 0.002) in the PORT group, not only for lymph-node metastatic ratio (LNMR) ≥0.25 (p = 0.001), but also for LNMR <0.25 (p = 0.043). However, for stage IIB disease (T1-2N1M0) there was no significant differences. The addition of POCT didn’t prolong the OS significantly (Surgery alone group, p = 0.079; PORT group, p = 0.111).ConclusionsThis large retrospective analysis supports the use of PORT for pathologic lymph node positive stage III esophageal squamous cell carcinoma. Given the retrospective nature of this study, the results should be confirmed by appropriately powered randomized trials. Further development of adjuvant therapy in EC is warranted.

The Role of Adjuvant Radiation Therapy for Resected Stage III Thymoma: A Population-Based Study

Because of the rarity of the disease and long survival of most patients, the role of adjuvant radiation therapy in patients with surgically resected stage III thymoma is unclear, and few prospective studies are available. The objective was to evaluate the impact of postoperative radiation therapy after resection of stage III thymoma. The Surveillance, Epidemiology, and End Results (SEER) database was queried for all patients with stage III thymoma who underwent surgical therapy and survived more than 30 days after diagnosis. Survival was estimated with the Kaplan-Meier method. The hazard ratio for death was determined using a Cox proportional hazard model. There were 476 patients with stage III thymoma identified who underwent surgical therapy, did not receive preoperative radiotherapy, and had complete SEER records with regard to radiation treatment. Postoperative radiation therapy was given to 322 patients (67.6%). Patients who received postoperative radiation therapy were younger and had a higher rate of debulking surgery than patients who did not. Patients receiving postoperative radiation had a median overall survival of 127 months (95% confidence interval, 100.9 to 153.1) compared with 105 months (95% confidence interval, 76.9 to 133.1) in patients treated with surgery alone (p=0.038). However, in multivariate analysis, postoperative radiation was not a significant factor affecting overall survival. Disease-specific survival was significantly improved in the adjuvant radiation group, and in multivariate analysis, improved outcomes were associated with postoperative radiation (p=0.049). In this large population-based study, most patients with stage III thymoma were treated with adjuvant radiation. Postoperative radiation was associated with improved disease-specific survival, but not improved overall survival.

The Impact of Adjuvant Radiotherapy on Survival in T1-2N1 Squamous Cell Carcinoma of the Oral Cavity

To evaluate the survival impact of postoperative radiation therapy (RT) in patients with early T stage (T1-2) oral cavity squamous cell carcinoma (OCSCC) and a single positive lymph node. Between 1983 and 2004, a total of 1539 patients were treated with surgery for T1-2N1 OCSCC. The Surveillance, Epidemiology, and End Results database was used to determine whether postoperative RT improves survival in patients with T1-2N1 OCSCC. Postoperative RT improved the 5-year overall survival rate (41.4% for surgery alone vs 54.2% for surgery plus RT [P < .001]). Improvement in overall survival in patients with T1N1 disease did not achieve statistical significance with the addition of RT in contradistinction to that in patients with T2N1 disease. Adjuvant RT improved survival in patients with T2 tongue and floor of mouth disease (52.3% vs 37.9% [P = .002] and 39.9% vs 17.7% [P = .003], respectively). In cases involving T1-2N1 OCSCC in the Surveillance, Epidemiology, and End Results database, the use of RT is associated with statistically significant improved overall survival and cause-specific survival in patients with T2 disease, most strongly in the oral tongue and the floor of the mouth.

Invited Commentary

Invited Commentary

Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non–small-cell lung cancer treated with adjuvant chemotherapy: the adjuvant Navelbine International Trialist Association (ANITA) Randomized Trial

Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non–small-cell lung cancer treated with adjuvant chemotherapy: the adjuvant Navelbine International Trialist Association (ANITA) Randomized Trial

Impact of Postoperative Radiation Therapy on Survival in Patients With Complete Resection and Stage I, II, or IIIA Non–Small-Cell Lung Cancer Treated With Adjuvant Chemotherapy: The Adjuvant Navelbine International Trialist Association (ANITA) Randomized Trial

To study the impact of postoperative radiation therapy (PORT) on survival in the Adjuvant Navelbine International Trialist Association (ANITA) randomized study of adjuvant chemotherapy. ANITA is a randomized trial of adjuvant cisplatin and vinorelbine chemotherapy vs. observation in completely resected non-small-cell lung carcinoma (NSCLC) Stages IB to IIIA. Use of PORT was recommended for pN+ disease but was not randomized or mandatory. Each center decided whether to use PORT before initiation of the study. We describe here the survival of patients with and without PORT within each treatment group of ANITA. No statistical comparison of survival was performed because this was an unplanned subgroup analysis. Overall, 232 of 840 patients received PORT (33.3% in the observation arm and 21.6% in the chemotherapy arm). In univariate analysis, PORT had a deleterious effect on the overall population survival. Patients with pN1 disease had an improved survival from PORT in the observation arm (median survival [MS] 25.9 vs. 50.2 months), whereas PORT had a detrimental effect in the chemotherapy group (MS 93.6 months and 46.6 months). In contrast, survival was improved in patients with pN2 disease who received PORT, both in the chemotherapy (MS 23.8 vs. 47.4 months) and observation arm (median 12.7 vs. 22.7 months). This retrospective evaluation suggests a positive effect of PORT in pN2 disease and a negative effect on pN1 disease when patients received adjuvant chemotherapy. The results support further evaluation of PORT in prospectively randomized studies in completely resected pN2 NSCLC.

Impact of Postoperative Radiation Therapy on Postmastectomy Breast Reconstruction

Impact of Postoperative Radiation Therapy on Postmastectomy Breast Reconstruction