Implications For Adjuvant Radiotherapy Research Articles

Locoregional recurrence after cystectomy in muscle invasive bladder cancer: Implications for adjuvant radiotherapy

PurposeWe report the patterns of locoregional recurrence (LRR) in muscle invasive bladder cancer (MIBC), and propose a risk stratification to predict LRR for optimizing the indication for adjuvant radiotherapy. Materials and MethodsThe study included patients of urothelial MIBC who underwent radical cystectomy with standard perioperative chemotherapy between 2013 and 2019. Recurrences were classified into local and/or cystectomy bed, regional, systemic, or mixed. For risk stratification modelling, T stage (T2, T3, T4), N stage (N0, N1/2, N3) and lymphovascular invasion (LVI positive or negative) were given differential weightage for each patient. The cohort was divided into low risk (LR), intermediate risk (IR) and high risk (HR) groups based on the cumulative score. ResultsOf the 317 patients screened, 188 were eligible for the study. Seventy patients (37.2%) received neoadjuvant chemotherapy (NACT) while 128 patients (68.1%) had T3/4 disease and 66 patients (35.1%) had N+ disease. Of the 55 patients (29%) who had a recurrence, 31 (16%) patients had a component of LRR (4% cystectomy bed, 11.5% regional 0.5% locoregional). The median time to LRR was 8.2 (IQR 3.3–18.8) months. The LR, IR and HR groups for LRR based on T, N and LVI had a cumulative incidence of 7.1%, 21.6%, and 35% LRR, respectively. The HR group was defined as T3, N3, LVI positive; T4 N1/2, LVI positive; and T4, N3, any LVI. The odds ratio for LRR was 3.37 (95% CI 1.16–9.73, P = 0.02) and 5.27 (95% CI 1.87–14.84, P = 0.002) for IR and HR respectively, with LR as reference. ConclusionLRR is a significant problem post radical cystectomy with a cumulative incidence of 35% in the HR group. The proposed risk stratification model in our study can guide in tailoring adjuvant radiotherapy in MIBC.

Predictors of Locoregional Recurrence in Patients Treated with Nephroureterectomy for Upper Tract Urothelial Carcinoma and Implications for Adjuvant Radiation Therapy

Predictors of Locoregional Recurrence in Patients Treated with Nephroureterectomy for Upper Tract Urothelial Carcinoma and Implications for Adjuvant Radiation Therapy

Growth of Pituitary Macroadenomas Postpartial Resection: Implications for Adjuvant Radiotherapy.

Objective To determine the volumetric growth in macroadenomas (MAs) patients with residual postoperative disease and to identify subpopulations with rapid postoperative growth rate that may benefit from early salvage radiotherapy (RT). Methods Patients who had undergone a partial resection for MAs and did not receive immediate postoperative RT were eligible. Residual tissue was contoured on serial magnetic resonance imaging and planimetric and volumetric changes in size were measured. Growth rates were established by a single observer using serial volumetric measurements. Data were analyzed to find a relationship among growth rate, adjuvant treatment, and patient and tumor characteristics. Results Thirty-one patients met the eligibility criteria. Nine patients (29%) required adjuvant treatment because of tumor growth. Volumetric growth was identified 95% of the time compared with 64% planimetrically. Planimetric growth could not be established in 10% of patients showing volumetric changes. Median growth rate was 0.4464 mL/y. Growth rate positively correlated with size of residual postoperative volume ( p < 0.001). Receiving salvage treatment positively correlated with growth rate ( p = 0.001), particularly at a rate above 2.19 mL/y ( p = 0.0064). Five patients (16%) had a growth rate above this level, all of which required salvage treatment. Patients with postoperative residual volume > 3.95 mL were most likely to experience rapid growth rate and require salvage treatment ( p = 0.007). Conclusion Volumetric measurement was found to be superior to planimetric measurement in detecting changes in patients with residual tumors. Patients with postoperative residual volume > 3.95 mL should be considered for early treatment with RT.

The impact of race on adverse pathologic features at the time of radical prostatectomy in men with prostate cancer and implications for adjuvant radiotherapy.

75 Background: Patients with adverse pathologic features (≥pT3 disease or positive margins) at the time of radical prostatectomy (RP) have higher biochemical recurrence (BR). Adjuvant radiotherapy (ART) reduces BR, but has potential toxicities. Also, studies suggest Black men are more likely to have aggressive prostate cancer. Our objective was to identify whether black men undergoing RP are more likely to have adverse pathologic features (APF) that lead to an indication for ART. Methods: We conducted a retrospective cohort study of men with cT1-4 Nx/0 Mx/0 prostate adenocarcinoma in the National Cancer Database who underwent RP. Race was divided into 3 groups (Caucasian, Black, Other). Chi-square tests and analysis of variance (ANOVA) tests were used to compare clinical and socioeconomic covariates between race groups. Univariate (UVA) and multivariable analysis (MVA) were performed using logistic regression (LR) to identify covariates predicting for APF. LR was performed to identify the impact of race on pT3 disease and positive margins. Results: A total of 313,013 patients diagnosed between 2004-2014 and undergoing RP were included. 256,315 (85%) were Caucasian, 33,725 (11%) were Black, and 12,973 (4%) were Other race. Fewer Black men had Gleason group 1 (33% vs. 41%) but more had Gleason group 2 disease (46% vs. 38%, p &lt; 0.001). Black men more frequently had PSA ≥10 ng/ml (18% vs. 16%, p &lt; 0.001) and ≥cT2b disease (18% vs. 14%, p &lt; 0.001). On UVA, Black men were more likely to have APF (Odds Ratio [OR] 1.18; 95% Confidence Interval [CI] 1.15-1.21; [p &lt; 0.001]). On MVA, black race was independently associated with having APF (OR 1.21; 95% CI 1.18-1.24; p &lt; 0.001). Black men were more likely to have positive margins (OR 1.26; 95% CI 1.22-1.29; p &lt; 0.001) but less likely to have ≥pT3 disease (OR 0.77; 95% CI 0.74-0.79; p &lt; 0.001). Conclusions: Independent of socioeconomic and clinical factors, Black men undergoing RP are more likely to have APF, increasing the risk of BR in this group, and more frequently creating an indication for ART. This appears to be more due to positive margins than locally advanced tumor. The underlying cause of this disparity warrants further exploration.

Patterns of initial failure after resection for gallbladder cancer: implications for adjuvant radiotherapy.

PurposeThis study sought to identify potential candidates for adjuvant radiotherapy and patterns of regional failure in patients who underwent curative-intent surgery for gallbladder cancer.Materials and MethodsRecords for 70 patients with gallbladder cancer who underwent curative resection at a single institution between 2000 and 2016 were analysed retrospectively. No patients received adjuvant radiotherapy. Initial patterns of failure were evaluated. Regional recurrence was categorized according to the definitions of lymph node stations suggested by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.ResultsMedian follow-up was 23 months. Locoregional recurrence as any component of first failure occurred in 29 patients (41.4%), with isolated locoregional recurrence in 13 (18.6%). Regional recurrence occurred in 23 patients, and 77 regional recurrences were identified. Commonly involved regional stations were #13, #12a2, #12p2, #12b2, #16a2, #16b1, #9, and #8. Independent prognostic factors for locoregional recurrence were ≥pT2 disease (hazard ratio [HR], 5.510; 95% confidence interval [CI], 1.260–24.094; p = 0.023) and R1 resection (HR, 6.981; 95% CI, 2.378–20.491; p < 0.001).ConclusionPatients with pT2 disease or R1 resection after curative surgery for gallbladder cancer may benefit from adjuvant radiotherapy. Our findings on regional recurrence may help physicians construct a target volume for adjuvant radiotherapy.

Margin Distance in Resected Pancreatic Cancer Independently Predicts Survival: Implications for Adjuvant Radiation Therapy

Margin Distance in Resected Pancreatic Cancer Independently Predicts Survival: Implications for Adjuvant Radiation Therapy

Impact of Tumor Location on Local Recurrence After Nephroureterectomy for Upper Tract Urothelial Carcinoma: Implications for Adjuvant Radiotherapy

PurposeTo evaluate the impact of tumor location on local recurrence in upper tract urothelial carcinoma (UTUC). Patients and MethodsAmong UTUC patients who underwent radical nephroureterectomy, 192 with renal pelvic tumors and 161 with ureteral tumors were included. Local recurrence was divided into regional lymph node recurrence (rLNR) and surgical bed recurrence (SBR). ResultsDuring a mean follow-up of 73 months, local recurrence occurred in 33 patients (9.3%). The postoperative 5-year local recurrence-free survival (80.5% vs. 94.2%; P = .002), rLNR-free survival (89.8% vs. 96.5%; P = .046), and SBR-free survival (88.3% vs. 97.6%; P = .005) were poorer in ureteral tumor than renal pelvic tumor. Ureteral tumor (hazard ratio [HR], 2.552; P = .017), high-grade tumor (HR, 3.064; P = .016), and advanced tumor stage (T3 or greater) (HR, 3.236; P = .002) were associated with local recurrence. Ureteral tumor (HR, 3.516; P = .033) and advanced tumor stage (HR, 2.907; P = .039) were risk factors for SBR. Although tumor location was not associated with rLNR, lymphovascular invasion (HR, 5.451; P < .001) and high-grade tumor (HR, 4.191; P = .012) were related to rLNR. ConclusionUreteral tumors are associated with local recurrence in the form of SBR. Adjuvant radiotherapy or surgical techniques aimed at reducing the risk of SBR should be considered in patients with ureteral tumors.

Patterns of failure after radical cystectomy for pT3-4 bladder cancer: Implications for adjuvant radiation therapy.

370 Background: In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Methods: Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariable analysis for association with LF and overall survival. Results: 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 and median follow up was 11 months. On univariate analysis, margin status, pT stage, pN stage, and gender were all associated with LF (p &lt; 0.05), however, on multivariable analysis, only pT and pN stage were significantly associated with LF (p &lt; 0.01). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external/internal iliac LNs and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Conclusions: Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.

Impact of tumor location on local recurrence after nephroureterectomy for upper tract urothelial carcinoma: Implications for adjuvant radiotherapy.

390 Background: To date, risk factors for local recurrence after complete removal of upper tract urothelial carcinoma (UTUC) have not been clearly identified. We evaluated the impact of tumor location on local recurrence in UTUC patients underwent radical nephroureterectomy. Methods: Among UTUC patients who underwent radical nephroureterectomy between 1998 and 2012, 192 (54.4%) patients with renal pelvic tumor and 161 (45.6%) patients with ureter tumor were included. Local recurrence was divided into regional lymph node recurrence (LNR) and surgical bed recurrence (SBR). The significance of tumor location and other variables on local recurrence were evaluated. Results: Lymphovascular invasion (p = 0.003), carcinoma in situ (p = 0.006) and high grade tumor (p &lt; 0.001) were more common in ureter tumor. During median follow-up period of 73 months, local recurrence was occurred in 33 (9.3%) patients. Among subtype of local recurrence, SBR (8.1 vs. 2.1%, p = 0.011) were more common in patients with ureter tumor compared to renal pelvic tumor although the probability of regional LNR was not significantly different according to tumor location (7.5% vs. 3.1%, p = 0.088). 5-year local recurrence-free survival (80.5% vs. 94.2%, p = 0.002), LNR-free survival (89.8 vs. 96.5%, p = 0.046) and SBR-free survival (88.3% vs. 97.6%, p = 0.005) were inferior in ureter tumor compared to renal pelvic tumor. Ureter tumor (HR; 2.552, p = 0.017), high grade tumor (HR; 3.064, p = 0.016) and advanced tumor stage (≥T3) (HR; 3.236, p = 0.002) were associated with local recurrence. Ureter tumor (HR; 4.704, p = 0.002) and advanced tumor stage (HR; 4.840, p = 0.006) were risk factors for SBR. However, tumor location was not associated with LNR although lymphovascular invasion (HR; 5.451, p &lt; 0.001) and high grade tumor (HR; 4.191, p = 0.012) were related with LNR. Conclusions: Ureter located tumor was associated with local recurrence which comes from the SBR. Adjuvant radiotherapy or surgical technique for reducing the risk of SBR should be considered in patients with ureter tumor.

Patterns of Failure After Radical Cystectomy for pT3-4 Bladder Cancer: Implications for Adjuvant Radiation Therapy

In patients with muscle-invasive bladder cancer, local-regional failure (LF) has been reported to occur in up to 20% of patients following radical cystectomy. The goals of this study were to describe patterns of LF, as well as assess factors associated with LF in a cohort of patients with pT3-4 bladder cancer. This information may have implications towards the use of adjuvant radiation therapy. Patients with pathologic T3-4 N0-1 bladder cancer were examined from an institutional radical cystectomy database. Preoperative demographics and pathologic characteristics were examined. Outcomes included overall survival and LF. Local-regional failures were defined using follow-up imaging reports and scans, and the locations of LF were characterized. Variables were tested by univariate and multivariate analysis for association with LF and overall survival. A total of 334 patients had pT3-4 and N0-1 disease after radical cystectomy and bilateral pelvic lymph node dissection. Of these, 46% received perioperative chemotherapy. The median age was 71 years old, and median follow-up was 11 months. On univariate analysis, margin status, pT stage, and pN stage, were all associated with LF (P<.05), however, on multivariate analysis, only pT and pN stages were significantly associated with LF (P<.05). Three strata of risk were defined, including low-risk patients with pT3N0 disease, intermediate-risk patients with pT3N1 or pT4N0 disease, and high-risk patients with pT4N1 disease, who had a 2-year incidence of LF of 12%, 33%, and 72%, respectively. The most common sites of pelvic relapse included the external and internal iliac lymph nodes (LNs) and obturator LN regions. Notably, 34% of patients with LF had local-regional only disease at the time of recurrence. Patients with pT4 or N1 disease have a 2-year risk of LF that exceeds 30%. These patients may be the most likely to benefit from local adjuvant therapies.

Impact of margin status and lymphadenectomy on clinical outcomes in resected pancreatic adenocarcinoma: implications for adjuvant radiotherapy.

Adjuvant chemoradiotherapy (CRT) in the treatment of pancreatic ductal adenocarcinoma (PDA) is controversial. Minimal data exists regarding the clinical significance of margin clearance distance and lymph node (LN) parameters, such as extent of dissection and LN ratio. We assessed the impact of these variables on clinical outcomes to more clearly define the subset of patients who may benefit from adjuvant radiotherapy (RT). We identified 106 patients with resected stage 1-3 PDA from 2007-2013. Resection margins were categorized as positive (tumor at ink), ≤1, or >1 mm. LN evaluation included total number examined (NE), number of positive nodes (NP), ratio of NP to NE (NR), extent of dissection, and positive periportal LNs. The impact of these variables was assessed on disease-free survival (DFS) and overall survival (OS) using multivariate cox proportional hazards modeling. In patients receiving adjuvant chemotherapy (CT) alone, greater margin clearance led to improved DFS (P=0.0412, HR =0.51). Range of NE was 4-37, with a mean of 19. NE was not associated with DFS or OS, yet absolute NP of 5 or more was associated with a significantly worse DFS (P=0.005). Whereas periportal lymphadenectomy did not result in improved DFS or OS, patients with positive periportal LN had worse clinical outcomes (DFS, P=0.0052; OS, P=0.023). The use of adjuvant CRT was associated with improved OS (P=0.049; HR=0.29). In patients receiving adjuvant CT alone, there was a clinically significant benefit to clearing the surgical margin beyond tumor at ink. Having ≥5 NP and positive periportal LN led to significantly worse clinical outcomes. The addition of adjuvant RT to CT in resected PDA improved OS. A comprehensive evaluation of resection margin distance and LN parameters may identify more patients at risk for locoregional failure who may benefit from adjuvant CRT.

Margin Clearance and Lymphadenectomy in Pancreatic Adenocarcinoma: Clinical Outcomes and Implications for Adjuvant Radiation Therapy

Margin Clearance and Lymphadenectomy in Pancreatic Adenocarcinoma: Clinical Outcomes and Implications for Adjuvant Radiation Therapy

Locoregional recurrence after curative intent resection for intrahepatic cholangiocarcinoma: implications for adjuvant radiotherapy.

As for intrahepatic cholangiocarcinoma, the most frequent site of failure after curative intent resection is the liver. We identified the risk factors for locoregional recurrence after curative intent resection for intrahepatic cholangiocarcinoma. Medical records of 115 patients treated with surgical resection alone for intrahepatic cholangiocarcinoma from November 2000 to December 2010 were retrospectively reviewed. Locoregional failure was defined as recurrence within 20 mm from resection margin or regional lymph node. Overall survival and locoregional recurrence rates were analyzed using Kaplan-Meier methods, and the prognostic factors were analyzed using Cox proportional hazards model. Median follow-up duration of surviving patients was 61 months (range 8-139). Sixty-six patients had recurrence, and 45 of 66 patients (68 %) had locoregional recurrence. The 5-year overall survival and locoregional control rates were 49.1 and 51.6 %, respectively. ≥ T2b disease and R1 resection were associated with locoregional recurrence in multivariate analysis. Patients were divided into two groups whether these risk factors exist or not. The 5-year locoregional control rates of low (no risk factor n = 64) and high (1 or 2 risk factors n = 51) risk groups were 62.5 and 34.7 %, respectively (P = 0.001). After curative intent resection, locoregional control and survival of patients with intrahepatic cholangiocarcinoma were far from satisfactory. Further studies are needed to evaluate the potential benefit of adjuvant locoregional treatment such as radiotherapy for patients with high-risk factors (≥ T2b disease or R1 resection).

Impact of margin status and lymphadenectomy on clinical outcomes in resected pancreatic cancer: Implications for adjuvant radiotherapy.

429 Background: Adjuvant chemoradiotherapy (CRT) in the treatment of pancreatic ductal adenocarcinoma (PDA) is controversial. Minimal data exists regarding the clinical significance of margin clearance distance and lymph node (LN) parameters, such as extent of dissection and LN ratio. We assess the impact of these variables on clinical outcomes to identify the subset of patients who may benefit from adjuvant CRT. Methods: We identified 106 patients with resected stage 1-3 PDA from 2007-13. Resection margins were categorized as positive (tumor at ink), ≤ 1 mm, or &gt; 1 mm. LN evaluation included total number examined (NE), number of positive nodes (NP), ratio of NP to NE (NR), and presence of periportal adenopathy. The impact of these variables was assessed on disease-free survival (DFS) and overall survival (OS) using multivariate cox proportional hazards modeling. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Results: Margin status was highly correlated with NP (p=0.012). Margin status adjusted for NP was a significant predictor of DFS in patients receiving adjuvant chemotherapy (CT) alone with greater margin clearance leading to improved DFS for all 3 groups (p=0.0412, HR = 0.51). Range of NE was 4-37, with a mean of 19. NE was not associated with DFS or OS, yet absolute NP of 5 or more was associated with a significantly worse DFS (p=0.005). A median NR of 0.11 was associated with inferior DFS (p=0.0043; HR=4.04), but was not associated with OS. Whereas periportal lymphadenectomy did not result in improved DFS or OS, patients with positive periportal LN had worse clinical outcomes (DFS, p=0.0052; OS, p=0.023). The use of adjuvant CRT was associated with improved OS (p=0.049; HR=0.29). Conclusions: In patients receiving adjuvant CT alone, there was a clinically significant benefit in clearing the surgical margin beyond tumor at ink. Higher NR, having 5 or more NP and presence of periportal adenopathy clearly led to worse clinical outcomes. A more comprehensive evaluation of margins and LN parameters may identify an increasing number of patients at risk for locoregional failure who may benefit from adjuvant CRT.

Risk factors for locoregional recurrence in patients with resected N1 non-small cell lung cancer: a retrospective study to identify patterns of failure and implications for adjuvant radiotherapy

BackgroundMeta-analysis of randomized trials has shown that postoperative radiotherapy (PORT) had a detrimental effect on overall survival (OS) in patients with resected N1 non–small cell lung cancer (NSCLC). Conversely, the locoregional recurrence (LR) rate is reported to be high without adjuvant PORT in these patients. We have evaluated the pattern of failure, actuarial risk and risk factors for LR in order to identify the subset of N1 NSCLC patients with the highest risk of LR. These patients could potentially benefit from PORT.MethodsWe conducted a retrospective study on 199 patients with pathologically confirmed T1–3N1M0 NSCLC who underwent surgery. None of the patients had positive surgical margins or received preoperative therapy or PORT. The median follow-up was 53.8 months. Complete mediastinal lymph node (MLN) dissection and examination was defined as ≥3 dissected and examined MLN stations; incomplete MLN dissection or examination (IMD) was defined as <3 dissected or examined MLN stations. The primary end point of this study was freedom from LR (FFLR). Differences between patient groups were compared and risk factors for LR were identified by univariate and multivariate analyses.ResultsLR was identified in 41 (20.6%) patients, distant metastasis (DM) was identified in 79 (39.7%) patients and concurrent LR and DM was identified in 25 (12.6%) patients. The 3- and 5-year OS rates in patients with resected N1 NSCLC were 78.4% and 65.6%, respectively. The corresponding FFLR rates were 80.8% and 77.3%, respectively. Univariate analyses identified that nonsmokers, ≤23 dissected lymph nodes, visceral pleural invasion and lymph node ratio >10% were significantly associated with lower FFLR rates (P < 0.05). Multivariate analyses further confirmed positive lymph nodes at station 10 and IMD as risk factors for LR (P < 0.05). The 5-year LR rate was highest in patients with both these risk factors (48%).ConclusionsThe incidence of LR in patients with surgically resected T1–3N1M0 NSCLC is high. Patients with IMD and positive lymph nodes at station 10 have the highest risk of LR, and may therefore benefit from adjuvant PORT. Further investigations of PORT in this subset of patients are warranted.

The Incidence and Patterns of Failure in Patients With Stage I/II Squamous Cell Carcinoma of the Oral Cavity (SCC-OC) Treated With Surgery Alone: Implications for Adjuvant Radiation Therapy

Materials/Methods: From August 2001 through May 2012, 183 patients with cancer of the oral cavity were identified. Following exclusion of patients with prior head and neck cancer, non-squamous histology, no surgery, N2c or greater or M1 staging, or PORT plans unavailable or bilateral necks treated, 57 patients remained for analysis. Patient demographics, tumor, treatment, and outcome information were abstracted from the charts. Regional recurrence was estimated via Kaplan-Meier method and groups were compared via log-rank test. Results: Median follow-up from diagnosis was 21 months range. Primary sites included alveolar ridge (17.5%), buccal (8.8%), floor of mouth (21.1%), hard palate (5.3%), retromolar trigone (5.3%), and oral tongue (42.1%). Primary site was staged T1-2 in 59.6% and T3-4 in 40.4%. Of the cohort, 12% did not undergo neck dissection, while 18% underwent bilateral and 70% ipsilateral neck dissection. Concurrent chemotherapy was used in 26.3% of patients. Of the cohort, 34 (59.6%) patients were found to be clinically or pathologically node negative, out of which 22 (38.5%) were treated with PORT only to the primary site and 12 (21.1%) had primary site and ipsilateral neck PORT; actuarial regional control (RC) at 2 years was 78.6% and 80%, respectively. Of the 4 total regional failures in the PORT-primary only group, 1 patient had a regional only relapse, the remainder failed both locally and regionally. Of the 2 total regional failures in the PORT-primary/ipsilateral neck, both were in the treated neck, and one was both local and regional. Of the node positive patients, all 23 were treated with primary and ipsilateral PORT with 2 year RC rate of 94.7%. The one patient with regional failure relapsed in the treated neck. Conclusions: In selected patients with lateralized oral cavity squamous cell carcinoma it may be reasonable to exclude the N0 bilateral neck, or in ipsilateral node positive neck the contralateral neck, from the post-operative radiation therapy volumes. Author Disclosure: J.A. Contreras: None. N.G. Rao: None. A.M. Trotti: None. J.J. Caudell: None.

Presentation, Treatment, and Outcomes for Bladder Cancer Patients With Nonurothelial Histologies Treated by Radical Cystectomy: Implications for Adjuvant Radiation Therapy

Presentation, Treatment, and Outcomes for Bladder Cancer Patients With Nonurothelial Histologies Treated by Radical Cystectomy: Implications for Adjuvant Radiation Therapy

Risk Factors for Locoregional Recurrence in Patients With Completely Resected N1 Non-Small Cell Lung Cancer and Implications for Adjuvant Radiation Therapy

Risk Factors for Locoregional Recurrence in Patients With Completely Resected N1 Non-Small Cell Lung Cancer and Implications for Adjuvant Radiation Therapy

Risk stratification of abdominopelvic failure for FIGO stage III epithelial ovarian cancer patients: implications for adjuvant radiotherapy

ObjectiveTo analyze patterns of abdominopelvic failures and to define subgroups for the use of adjuvant radiotherapy in the International Federation of Gynecology and Obstetrics (FIGO) stage III epithelial ovarian cancer (EOC).MethodsWe reviewed 149 patients treated with debulking surgery followed by intravenous taxane and platinum chemotherapy between 1999 and 2008. Patient characteristics, patterns of failure, abdominopelvic failure APF-free survival (APFFS) and overall survival (OS) were analyzed.ResultsThe median age of the patients was 51 years. Thirty-two patients (21.5%) were found to have residuum >2 cm after surgery. The median pretreatment CA-125 was 604 and 54.4% of patients had a decline in CA-125 ≥90% between pretreatment and at postoperative 1 month. With a median follow-up of 50 months, 79 patients (53.0%) experienced abdominopelvic failure (APF). The 5-year APF-free survival rate was 41.1%. Lymph node metastasis, size of residual disease, and decline in CA-125 were found to be significant prognostic factors for APF upon multivariate analysis. The group of patients in whom abdominopelvic irradiation was indicated as definitive postoperative treatment comprised 55% of the overall patient population and their 5-year survival rate was 68%.ConclusionThe stratification was suggested to predict APF based on lymph node metastasis, size of residual tumor, and decline in CA-125. Adjuvant radiotherapy covering the whole abdominopelvis using the intensity modulation technique may be considered to reduce APF in FIGO stage III EOC patients with intermediate risk.

Patterns of Failure and Prognostic Factors for Locoregional Recurrence after Radical Surgery in Upper Urinary Tract Transitional Cell Carcinoma: Implications for Adjuvant Radiotherapy

Aims: We investigated the patterns of failure and prognostic factors for locoregional control (LRC) in patients with upper urinary tract (UUT) transitional cell carcinoma (TCC) treated with radical surgery to evaluate the role of adjuvant radiotherapy. Materials and Methods: We retrospectively reviewed the medical records of 76 patients with TCC of the renal pelvis and ureter without distant metastasis who underwent curative-intent surgery. No locoregional or distant failure occurred in 19 patients with pTa-1 tumor, and we evaluated patterns of failure and prognostic factors in 57 patients with pT2 or more tumors. Adjuvant chemotherapy was applied in 25 patients. Results: Recurrences occurred in a total of 23 patients, and 20 of these experienced some kind of locoregional failure during follow-up. The overall crude and initial isolated locoregional recurrence rates were 35 and 28%, respectively. In pT2 patients, all 4 recurrences were isolated locoregional recurrences, and 3 of them were successfully salvaged with chemoradiotherapy. Patients with pT3-4 or who were positive for nodal disease (N+) had a lower rate of LRC and worse prognosis after recurrences. On multivariate analysis, incomplete surgery, venous invasion and squamous metaplasia were identified as independent prognostic factors for LRC. Conclusions: Initial loco-regional recurrence was commonly detected by routine computed tomography in locally advanced UUT-TCC. Incomplete surgery, venous invasion and squamous meta-plasia were independently associated with poor LRC. Active postoperative adjuvant treatment such as concurrent chemoradiotherapy could be considered in pT3-4 or N+ patients with adverse risk factors.