Patterns Of Local Recurrence Research Articles

Patterns of local recurrence after curative resection and reconstruction for oropharyngeal and oral cancers: Implications for postoperative radiotherapy target volumes.

We aimed to determine the patterns of local recurrence after curative resection and reconstruction for oropharyngeal and oral cancers. One hundred-fourteen patients with oropharyngeal and oral cancers underwent resection and reconstruction. The local recurrences were classified as "intra-flap" (the recurrent tumor was located in the flap tissue), "marginal" (≤5 mm from the flap anastomosis), and "outside" (in the original tissue and >5 mm from the anastomosis) recurrences. Twenty-seven patients (23.7%) experienced local recurrence, while 32 (28.1%) experienced regional, and nine (7.9%) recurred distantly. Among those who showed local recurrence, one developed "outside" recurrence and the remaining 26 developed "marginal" recurrences. Age >60 years and lymph node metastasis were associated with poor disease-free survival and overall survival (OS), while the perineural invasion was related to poor locoregional failure-free survival and OS. Most recurrences developed at the anastomosis marginal site, while none developed in the flap tissue.

Histopathologic Patterns of Recurrent Choroidal Melanoma Following I-125 Plaque Brachytherapy

Purpose: Histologic correlation of clinical patterns of recurrent choroidal melanoma following I-125 plaque brachytherapy was performed to identify pathologic mechanisms of recurrence. Methods: We reviewed 7 cases of recurrent choroidal melanoma following I-125 plaque brachytherapy managed with enucleation. Clinical characteristics included tumor dimensions, radiation dose, time to local recurrence, and clinical pattern of recurrence. Histopathology (hematoxylin and eosin and periodic acid – Schiff) and immunohistochemistry (Ki-67, CD-163, HMB45, and SOX10) were performed. Results: Mean follow-up time and time to local recurrence were 42 and 21 months after brachytherapy, respectively. Tumor recurrences were described clinically as marginal in 43%, diffuse in 29%, and extraocular extension (EOE) in 29%. Eighty-six percent were classified as mixed cell type and 14% were epithelioid type. Tumor zonation (histologic demarcation between zones of recurrent and nonrecurrent tumor cells by immunohistochemistry) was present in marginal and EOE cases (n = 6) and absent in the diffuse cases (n = 2). Ki-67 proliferative index was higher in marginal and EOE recurrences, while diffuse cases showed uniform ­Ki-67 staining. CD-163 staining was found to be greater in nonrecurrent tumor. HMB45 correlated with SOX10 with a greater staining in recurrent tumor. Conclusion: Our observations provide a correlation between histopathologic and clinical patterns of local recurrence of choroidal melanoma after brachytherapy.

Is there a role for chemotherapy after local relapse in high-grade osteosarcoma?

High-grade bone osteosarcoma has a high relapse rate. The best treatment of local recurrence (LR) is under discussion. The aim of this study is to analyze LR patterns and factors prognostic for survival. LR diagnostic modality (clinical or imaging), pattern of recurrence, and post-LR survival (PLRS) were assessed. Sixty-two patients were identified, with median age 21 years (range, 9-75 years), including 11 (18%) ≤15 years, 30 (48%) from 16 to 29 years; 21 (34%) were older. Patterns of relapse were LR only 58%, LR + distant metastases (DM) 42%. Seventy-nine percent of patients relapsed within 24 months, and diagnosis was clinical in 88%. LR treatment was surgery 85%, chemotherapy 55%, chemotherapy + surgery 45%. Surgical complete remission after LR (CR2) was achieved in 60% (LR 86%; LR + DM 23%). With a median follow-up of 43 months (range, 5-235 months), the five-year PLRS was 37%, significantly better for patients with longer LR-free interval (LRFI; ≤24 months 31% vs>24 months 61.5%, P=0.03), absence of DM (no DM 56%vs DM 11.5%, P=0.0001), and achievement of CR2 (no CR2 0%vs CR2 58.5%, P=0.0001). No difference was found according to age and chemotherapy (LR only: five-year PLRS: 53% without chemotherapy vs 58% with chemotherapy, P=0.9; LR + DM: five-year PLRS: 25% without chemotherapy vs 9% with chemotherapy, P=0.7). Early relapse is detected by symptoms in 90% of cases and associated with worse outcome. The achievement of CR2, not age, is crucial for survival. For patients with LR only, better survival was demonstrated, as compared with DM, and no improvement with chemotherapy after surgery was found.

Abstract P3-12-09: Dosimetric analysis of the pattern of local recurrence in breast cancer patients undergoing breast reconstruction and post-mastectomy radiotherapy

Abstract Background This study aims to identify spatial and dosimetric patterns of breast cancer relapse in a mono-institutional large series of patients treated with mastectomy and various forms of breast reconstruction. Material and Methods We retrospectively reviewed 196 patients with Stage II-III breast cancer treated with modified radical mastectomy between 1995 and 2016 at the Radiotherapy Department of Careggi Hospital, Florence. All patients performed Skin-sparing mastectomy or nipple-sparing mastectomy with immediate or delayed breast reconstruction and subsequently received post-mastectomy radiotherapy (PMRT). Systemic therapy was prescribed as per local and international guidelines both in neoadjuvant and adjuvant setting. All patients were treated with 3DCRT technique. Diagnostic imaging (e.g. CT, MRI) obtained at recurrence were registered with the original planning computed tomography (pCT) for the dosimetric analysis. Recurrence gross tumor volume (rGTV) were delineated and co-registered with pCT. All rGTV were compared dosimetrically to planned dose and spatially with planning target volumes. Locoregional recurrence (LR) were divided in three categories relative to the high dose region, 95% of prescription dose (D95%). We defined “in field LR” those with more than 90% of their volume within D95% region,“marginal LR” when recurrence volume was between 20 and 90% within D95% and “outfield LR” those with less than 20% of their volume D95%. Results The median age was 49 years (range, 26 - 83 years).163 women (83 %) were classified as stage III; 118 women (60 %) had more than three positive axillary nodes. The majority of lesions were estrogen receptor positive ( 75 %), grade 3 (52%) ,with the presence of LVI (60 %). Adjuvant RT at chest wall were performed in all patients, most of whom underwent a RT of chest wall +infra- supraclavicular nodes (71%).Prescribed RT dose was 50 Gy in 25 fractions. With a median follow-up of 60 months (range, 12-240 months), 22 (11%) patients experienced a locoregional relapse: 10 patients in the chest wall; 7 in ipsilateral axillary region +/- chest wall; 3 in internal mammary nodes -/+ chest wall; one locoregional relapse was observed in the supraclavicular nodes. Most of relapses were G3 (75%) with documented LVI (79%). The topographic analysis of the local failure patterns showed: thirteen (59 %) were “in-field LR”; 9 (41%) were “out-field LR” . For the spatial analysis, all relapses on the chest wall were observed above the breast tissue expander or mammary prosthesis. Free time from recurrence disease was 30 months (range 5-86 months). Conclusion This study suggests that chest wall recurrences are rare after PMRT and are related to biologic aggressiveness of the disease than to inadequate irradiation of target volumes. Prospective studies are warranted to evaluate the relationship between treatment volumes and patterns of recurrences in order to refine new delineation guidelines for women undergoing PMRT and breast reconstruction. Citation Format: Desideri I, Meattini I, Becherini C, Francolini G, Scotti V, Olmetto E, Perna M, Topulli J, Livi L. Dosimetric analysis of the pattern of local recurrence in breast cancer patients undergoing breast reconstruction and post-mastectomy radiotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-12-09.

Patterns of infiltration and local recurrences of various types of cutaneous sarcomas following three-dimensional histology.

Cutaneous sarcomas are rare and characterized by pathogenetic heterogeneity. Knowledge about local infiltration patterns and recurrence rates may be useful in improving patient care and outcomes. The objective of the present study was to compare these two characteristics in sarcomas that had been treated using the identical surgical procedure. Between 2006-2010, 84 patients with various types of sarcoma underwent surgery followed by three-dimensional histology. Tumor entities included dermatofibrosarcoma protuberans (DFSP, 54 patients), leiomyosarcoma (ten patients), rhabdomyosarcoma (one patient), angiosarcoma (seven patients) as well as atypical fibroxanthoma (AFX, three patients) and cutaneous undifferentiated pleomorphic sarcoma (UPS, nine patients). Median follow-up was four years (range: 2-6 years). Local recurrence rates among patients with primary DFSP were 2.2%. All patients undergoing re-excision were subsequently tumor free. Patients with leiomyosarcoma, rhabdomyosarcoma, AFX, and cutaneous UPS experienced no local recurrence; however, one individual developed in-transit metastasis (UPS) (8.3%). Three patients with angiosarcoma developed local recurrence (43%), two of whom remained tumor free following re-excision. Two angiosarcoma patients died from distant metastases (29%). Both DFSP and especially angiosarcoma lesions exhibited extensive subclinical growth. Recurrence rates of cutaneous sarcomas following three-dimensional histology are low. Local recurrences are readily manageable by re-excision. Angiosarcoma is characterized by extensive superficial growth, aggressive biological behavior, and predominantly hematogenous spread.

Patterns of Local or Regional Recurrence after Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma

Patterns of Local or Regional Recurrence after Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma

A Pilot Feasibility Study of Definitive Concurrent Chemoradiation with Pencil Beam Scanning Proton Beam in Combination with 5-fluorouracil and Mitomycin-c for Carcinoma of the Anal Canal

Definitive chemoradiation (CRT) with concurrent 5-fluorouracil (5-FU) and mitomycin-C (MMC) is standard of care for patients with localized squamous cell cancer (SCC) of the anal canal. Treatment, however, can result in significant acute and late toxicity. Pencil beam scanning proton therapy (PBS-PT) holds the potential to improve dose delivery and spare non-target tissues. Preliminary preclinical dosimetric data suggests that treatment with PBS-PT will significantly decrease radiation dose to normal tissue structures compared to conventional 3D treatment planning and IMRT. This is a multi-institutional pilot study evaluating the feasibility of definitive concurrent CRT with PBS-PT in combination with 5-FU and MMC for carcinoma of the anal canal. Patients were enrolled on an NCI sponsored, prospective, multi-institutional, single arm pilot study (NCT 01858025). Key eligibility included: ECOG 0-2, age 18+, histologically confirmed invasive SCC of the anal canal, clinically staged T1-4, N0-3. Pts were treated with PBS proton RT per RTOG 0529 RT dose schema; for T1-2, N0: 50.4 Gy to primary CTV, 42 Gy to elective LNs in 28 fractions; for T3+ or N+: 54 Gy to primary CTV, 50.4-54 Gy to involved LN, and 45 Gy to elective LNs. Pts received concurrent 5-FU/MMC on day 1 and 29. The primary objective of this study was to establish feasibility of PBS-PT with concurrent 5-FU/MMC, which was defined as grade 3+ dermatologic toxicity less than 48% (reported grade 3+ dermatologic toxicity from RTOG 98-11). The secondary objective of this study was to determine the rates of overall grade 3+ toxicities, clinical complete response (cCR) rate and patterns of local regional tumor recurrence. From February 2014 to April 2017, 25 patients were prospectively enrolled between two academic institutions, all of whom were analyzed. 23 pts (92%) completed treatment per protocol, 2 pts died on treatment (1 due to sepsis, 1 due to sudden cardiac death). Median time to completion of treatment was 42 days (range 38-49). The Grade 3+ radiation dermatitis was 24% (Table 1). The clinical complete response rate was 80%. With a median follow-up of 23.7 months (range 11.8-46.4) among the 21 patients still alive, the 2-year local control, colostomy-free survival, progression-free survival, and overall survival are 95%, 75%, 80% and 83%, respectively. In our prospective, multi-institutional pilot study of PBS-PT with concurrent 5-FU/MMC, PBS-PT was found to be feasible. While felt to be unrelated to proton radiation therapy, two patient deaths on this small study highlights treatment related risks of this effective yet toxic regimen.Abstract 125; TableCategoryGrade 1Grade 2Grade 3Grade 4Grade 5Hematologic05 (20%)4 (16%)7 (28%)0Gastrointestinal4 (16%)12 (48%)9 (36%)00Radiation dermatitis2 (8%)16 (64%)6 (24%)00Fatigue10 (40%)11 (44%)3 (12%)00Genitourinary12 (48%)4 (16%)1 (4%)00Anorexia8 (32%)6 (24%)000Pulmonary/Respiratory2 (8%)1 (4%)000Worst Overall03 (12%)14 (56%)7 (28%)1 (4%) Open table in a new tab

Subventricular Zone (SVZ) Radiation Dose and Outcomes in Patients with Glioblastoma Multiforme (GBM)

The relationship of glioblastoma multiforme (GBM) to neural stem cell regions in the human subventricular zone (SVZ) remains an active area of investigation. Variable findings regarding radiation dosage and tumor control patterns have been described. To investigate this, we looked at patients treated with radiation therapy and concurrent temozolomide to see if incidental dose to the SVZ impacted treatment outcomes. We further subdivided the SVZ into 4 zones, to see if dose to specific zones may better correlate with outcomes. We retrospectively identified all patients at our institution between 2014 and 2016 that were treated for pathologically confirmed GBM and received radiation therapy to a dose of 60 Gy with concurrent temozolomide, without enrollment on clinical trial. 45 patients were identified. The bilateral SVZ (SVZb) was contoured on treatment plans as a 3-mm margin around the ventricles and subdivided into four bilateral zones (frontal (SVZf), insular (SVZin), parietal occipital (SVZpo) and anterior temporal (SVZat). The ipsilateral zone closest to the tumor was classified as the proximal SVZ compartment. Median LC and OS were 7.7 months and 14.9 months, respectively. The median age was 58 years (range: 23-79 years) and median KPS was 80. 24 patients (53%) underwent GTR, 14 patients STR (31%) and 7 were biopsied (15.6%). Two patients had documented IDH mutations. The tumors were lateralized to the right (n=21) and left (n=24) cerebral hemispheres and located in the frontal (n=12), parietal (n=11), temporal (n=17), occipital (n=2) and multifocal (n=3) lobes. Median SVZi dose was 49.9 Gy (range: 26.5-60.9 Gy), proximal SVZ compartment median dose was 60.3 Gy (range: 11.2-62.0 Gy) and the ipsilateral SVZat median dose was 58.0 Gy (range: 3.7 Gy-61.7 Gy). We did not see a difference in LC associated with dose to the SVZi when analyzed as dose >43 Gy (LC at 6 months, 44% vs. 55%, p=0.42) or as a continuous variable (p=0.67). Dose >60 Gy to the proximal SVZ compartment was also not associated with LC (p=0.29) or OS (p=0.38). Median dose >60 Gy to the SVZat was associated with a trend towards detriment in LC (6 months, 56% vs. 38%, p=0.07) and a significant decrease in OS (6 months, 73% vs. 37%, p=0.01). On multivariate analysis, when including age (p<0.01, HR 1.04) and extent of resection (GTR vs. STR/biopsy, p=0.72), SVZat continued to be independently significant (p<0.01, HR 4.5). Our data suggests that greater dose to the SVZi may not change local recurrence patterns in patients with GBM. There however seems to be a suggestion that dose >60 Gy to the SVZat may result in a decrease in OS. We hypothesize that this may be due to increased dose to the hippocampal stem cell regions. Further investigation is needed to confirm the results of this study.

Local Cancer Recurrence: The Realities, Challenges, and Opportunities for New Therapies.

Locoregional recurrence negatively impacts both long-term survival and quality of life for several malignancies. For appropriate-risk patients with an isolated, resectable, local recurrence, surgery represents the only potentially curative therapy. However, oncologic outcomes remain inferior for patients with locally recurrent disease even after macroscopically complete resection. Unfortunately, these operations are often extensive, with significant perioperative morbidity and mortality. This review highlights selected malignancies (mesothelioma, sarcoma, lung cancer, breast cancer, rectal cancer, and peritoneal surface malignancies) in which surgical resection is a key treatment modality and local recurrence plays a significant role in overall oncologic outcome with regard to survival and quality of life. For each type of cancer, the current, state-of-the-art treatment strategies and their outcomes are assessed. The need for additional therapeutic options is presented given the limitations of the current standard therapies. New and emerging treatment modalities, including polymer films and nanoparticles, are highlighted as potential future solutions for both prevention and treatment of locally recurrent cancers. Finally, the authors identify additional clinical and research opportunities and propose future research strategies based on the various patterns of local recurrence among the different cancers.

Oncologic impact of local recurrence in resected pancreatic cancer: its topographic preference in local recurrence patterns according to tumor location

Introduction: The role of extended surgery and adjuvant therapy to control local recurrence is still controversial. Little is known about the oncologic impact of local recurrence and the pattern of recurrence according to tumor location. Methods: From July 1992 to December 2016, patients who underwent curative-intent surgery for pancreatic ductal adenocarcinoma were retrospectively reviewed. Results: 76.5% (n = 289) of the 378 patients had recurrence during the follow-up period (median 29.0 month [1.3∼139.2]). There was no recurrence in 92 (24.3%) patients. The first recurrence pattern was local in 83 (22.0%) patients, systemic in 152 (40.2%) patients, and loco-systemic in 51 (13.5%) patients. The 5-year survival rates according to recurrence pattern were 76.6% (no recurrence), 10.3% (local), 16.9% (systemic), and 11.3% (loco-systemic). Neoadjuvant chemoradiation was helpful in lowering local recurrence (24.7% vs. 16.0%, p = 0.038), but not systemic recurrence. Remnant pancreas, common hepatic artery, celiac trunk, and paraaortic area were the common sites of frequent local recurrence. However, the superior mesenteric artery (38 vs. 7, p = 0.005) and portal vein (34 vs. 2, p < 0.001) were more frequent local recurrence sites for the head tumor, and the surgical bed was the one for the body and tail tumor (1 vs. 7, p = 0.002). Conclusion: Local recurrence of pancreatic cancer has an oncologic impact similar to systemic recurrence. Because of anatomical relationship of the pancreas and the surrounding organs, there are frequent sites of local recurrence depending on the location of the tumor. Further investigation is necessary to effectively control local recurrence.

The impact of tumor differentiation on perioperative outcomes and patterns of recurrence following preoperative therapy for resectable pancreatic adenocarcinoma

Background: Tumor differentiation affects local invasion and patient survival in many cancers. The impact of pancreatic ductal adenocarcinoma (PDAC) differentiation on patterns of recurrence and complications following preoperative therapy and pancreatectomy is poorly defined. Methods: A retrospective analysis of a prospectively maintained database was conducted of all patients who underwent pancreatectomy for PDAC from 2011–2015 following preoperative therapy (chemotherapy, radiation, or combination). Differences in clinicopathologic characteristics, operative details, perioperative complications, overall (OS) and recurrence-free survival (RFS) were compared between patients stratified by tumor differentiation (moderate or poor). Results: Among 156 pancreatectomy patients, 112 (72%) had moderately differentiated (MD) tumors and 44 (28%) poorly differentiated (PD) tumors. The groups had similar demographics, median CA19-9, co-morbidity index, and type of preoperative therapy. Tumor size, T and N stage, lymph node ratio, and incidence of lymphovascular invasion were similar, while perineural invasion was more common in PD than MD tumors(91% vs 76%, p = 0.03). There were no differences in the incidence of Clavien-Dindo grade III/IV complications, rates of grade B or C post-operative pancreatic fistulae or delayed gastric emptying. There were no differences in median OS (32 vs 48 months, p = 0.86), median RFS(16 vs 36 months, p = 0.17), or patterns of recurrence (local, regional, or distant) between MD and PD tumors. Conclusions: Poorly differentiated PDAC is characterized by more frequent or persistent perineural invasion relative to moderately differentiated tumors following preoperative therapy. However, tumor differentiation has no impact on postoperative patterns of local or distant tumor recurrence or the incidence or severity of post-operative complications.Tabled 1Complications Table

Local recurrence patterns after postoperative stereotactic radiation surgery to resected brain metastases: A quantitative analysis to guide target delineation

PurposeIn the treatment of resected metastatic brain disease, a recent phase 3 trial by the North Central Cancer Treatment Group (N107C/CEC.3) surprisingly found that the local control rate for whole-brain radiation therapy was better than that of stereotactic radiation surgery (SRS). To optimize target delineation, we performed a quantitative analysis of local failure patterns after postoperative SRS. Methods and materialsPatients with brain metastases who were treated with surgery and SRS to the cavity were evaluated. Local failure was defined by pathologic confirmation or magnetic resonance imaging evidence of progression leading to further overlapping radiation therapy. T1 postgadolinium magnetic resonance imaging scans that were taken preoperatively and at recurrence were co-registered to the simulation computed tomography. Three volumes were compared: (1) Preoperative tumors, (2) resection cavities that were originally contoured as clinical target volumes for SRS, and (3) recurrent tumors. Overlap volume histograms quantified the proximity of the three volumes to the meninges. ResultsIn the cohort of 173 patients, 18 patients experienced local failure in 19 resection cavities. The original SRS target volume overlapped with a median of 69.6% of the recurrent tumor. When the entire preoperative tumor was included, the overlap with the recurrent tumor increased to a median of 76.8%. Recurrent tumors were closer to the meninges than corresponding preoperative tumors (P = .03) but a median 8.2 mm expansion of the target volume from the meninges was needed to increase overlap with the recurrent tumor to 90%. Increases in overlap with the recurrent tumor were achieved most efficiently by uniformly expanding the contoured cavity and a median 2.8 mm expansion covered 90% of the recurrent tumor. ConclusionsOur quantitative analysis of recurrence patterns suggests that a larger 3 mm uniform expansion of the SRS target volume substantially increases coverage of the volume that is later occupied by the recurrent tumor and may provide improved local control. The extent of the preoperative tumor in the target volume or expanding the target volume from the meninges provides little benefit.

Differences in recurrence and survival of extremity liposarcoma subtypes

BackgroundLiposarcomas can be divided into four subtypes and are most frequently located in the extremities. There are currently no studies comparing the clinical outcomes, such as local recurrence and distant metastasis, between the distinct subtypes of primary LPS of the extremity specifically. MethodsRetrospective databases of two expertise centres (Rotterdam-R, Warsaw-W) of patients with liposarcoma located in the extremities from 1985 to 2015 were used to analyse 5-year local recurrence-free survival (5y-LRFS), 5-year distant metastasis-free survival (5y-DMFS) and 5-year overall survival (5y-OS). ResultsWe identified 456 patients: 192 well-differentiated liposarcomas (WDLPS), 172 myxoid liposarcomas (MLPS), 54 pleomorphic liposarcomas (PLPS), 23 dedifferentiated liposarcomas (DDLPS) and 15 other subtypes. The frequency of (neo)adjuvant radiotherapy (R: 34.5% vs. W: 78.4%) and R0-resections (R: 41.0% vs. W: 84.1%) differed between the datasets. Local recurrences (LR) were observed most frequently in DDLPS (5y-LRFS 62.4%), followed by PLPS (71.4%), WDLPS (77.0%) and MLPS (84.5%, p = 0.054). Distant metastases (DM) were most commonly observed in PLPS (5y-DMFS 46.9%), followed by MLPS (74.0%), DDLPS (86.3%) and WDLPS (97.3%). 5y-OS was poorest in patients with PLPS (47.6%) and DDLPS (54.4%), followed by MLPS (79.7%) and WDLPS (92.4%, p < 0.001). Male gender significantly increased the risk of LR and DM. The subtypes MLPS and PLPS were significant prognostic factors for DM and OS. Additionally, DDLPS and age had significant impact on OS. ConclusionIn the largest cohort of extremity LPS patients reported to date, LPS subtypes show distinct patterns of LR, DM and OS, stressing that 'extremity LPS′ is not a single entity.

OC-0161: Patterns of Local Recurrence in Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08)

OC-0161: Patterns of Local Recurrence in Malignant and Borderline Phyllodes Tumors of the Breast (KROG 16-08)

Long-term results of CT-guided percutaneous radiofrequency ablation of inoperable patients with stage Ia non-small cell lung cancer: A retrospective cohort study

BackgroundThis study was performed to retrospectively evaluate the 10-year overall survival (OS), progression-free survival (PFS), and local control rates of patients with inoperable stage Ia non-small cell lung cancer (NSCLC) who underwent computed tomography (CT)-guided radiofrequency ablation (RFA) in a single center. Materials and methodsFifty patients with inoperable NSCLC underwent RFA between 2004 and 2016. Thoracic surgeons evaluated the patients and performed RFA under CT guidance. Follow-up CT and positron emission tomography/CT scans were obtained. Local control rates and recurrence patterns were analyzed. ResultsSeventy-three lesions in 50 patients (M:F = 22:28; median age: 73 years; range: 52–82 years) were treated with CT-guided RFA. The mean lesion size was 2.2 cm (range: 1–3 cm). No procedure-related deaths occurred. Low-grade fever was the most common post-ablation complication, with an incidence rate of 36%. The 1-, 2-, 3-, 5-, and 10-year OS rates of patients with Ia NSCLC were 96.0%, 86.5%, 67.1%, 36.3%, and 1%, respectively, and the 1-, 2-, 3-, and 5-year PFS rates were 94.0%, 77.5%, 43.5%, and 10.8%, respectively. The most common pattern of recurrence was local, and 15 patients with recurrence were treated with repeat RFA. Tumor size <2.0 cm was associated with a significantly improved 3-year survival rate of 78.9%. ConclusionCT-guided RFA is feasible and well tolerated by inoperable patients with inoperable stage Ia NSCLC.

The impact of rectal cancer tumor height on recurrence rates and metastatic location: A competing risk analysis of a national database

BackgroundThe impact of rectal cancer tumor height on local recurrence and metastatic spread is unknown. The objective was to evaluate the impact of rectal cancer tumor height from the anal verge on metastatic spread and local recurrence patterns. MethodsThe Norwegian nationwide surgical quality registry was reviewed for curative rectal cancer resections from 1/1/1996-12/15/2006. Cancers were stratified into five height groups: 0–3 cm, >3–5 cm, >5–9 cm, >9–12 cm, 12 cm–HI. Competing risk and proportional hazards models assessed the relationship between tumor height and patterns of metastasis and survival. Results6859 patients were analyzed. After median follow-up of 52 months (IQR 20–96), 26.7% (n = 1835) experienced recurrence. With tumors >12 cm, the risk of liver metastases increased (crude HR 1.49, p = 0.03), while lung metastases decreased (crude HR 0.66, p = 0.03), and risk of death decreased (crude HR 0.81, p = 0.001) The cumulative incidence of pelvic recurrence were highest for the low tumors (p = 0.01). Median time to liver metastases was 14months (IQR 7–24), lung metastases 25months (IQR 13–39), pelvic recurrence 19months (IQR10-32), (p < 0.0001). Time to metastases in liver and lungs were significantly associated with tumor height (p < 0.001) ConclusionThere are distinct differences in metastatic recurrence patterns and time to recurrence from different anatomic areas of the rectum. In crude analyses, tumor height impacted metastatic spread to the liver and lungs. However, when adjusting for treatment variables, the hazard of metastatic spread to the liver and lungs are limited. Nevertheless, time to metastases in liver and lungs is significantly impacted by tumor height. Venous drainage of the rectal cancer may be a significant contributor of rectal cancer metastatic spread, but further research is warranted.

A pilot feasibility study of definitive concurrent chemoradiation with pencil beam scanning proton beam in combination with 5-fluorouracil and mitomycin-c for carcinoma of the anal canal.

733 Background: Definitive chemoradiation (CRT) with concurrent 5-fluorouracil (5-FU)/mitomycin C (MMC) for anal cancer yields high rates of long term survival. However, CRT has significant acute and long term toxicity. Pencil beam scanning proton beam (PBS-PT) may potentially reduce this toxicity. This is a pilot study evaluating the feasibility of definitive concurrent CRT with PBS-PT with 5-FU/MMC for anal cancer. Methods: Pts were enrolled on an NCI sponsored, prospective, multi-institutional, pilot study (NCT 01858025). Key eligibility were ECOG 0-2, age 18+, invasive SCC of the anal canal, clinically staged T1-4, N0-3. Pts were treated per RTOG 0529 RT schema; for T1-2, N0: 50.4 Gy to primary CTV, 42 Gy to elective LNs; for T3+ or N+: 54 Gy to primary CTV, 50.4-54 Gy to involved LN, and 45 Gy to elective LNs. Pts received 5-FU/MMC on day 1 and 29. The primary objective of this study was to determine feasibility of PBS-PT with 5-FU/MMC, determined if grade 3+ dermatologic toxicity is &lt; 48% (grade 3+ dermatologic toxicity from RTOG 98-11). The secondary endpoint was rates of overall grade 3+ toxicities, clinical complete response (cCR) rate and patterns of local regional tumor recurrence. Results: Between February 2014 to April 2017, we enrolled 25 patients into our study, all of whom were analyzed. 23 pts (92%) completed treatment per protocol, 2 pts died on treatment due to underlying comorbidities. Median time to completion of treatment was 42 days (range 38-49). The Grade 3+ radiation dermatitis was 24% (Table 1). With a median follow-up of 17.6 months (range 7.7-42.0) among the 21 patients still alive, the 1 year local control, progression-free survival, and overall survival are 100%, 83% and 87%, respectively. Conclusions: In our prospective, pilot study of PBS-PT with concurrent 5-FU/MMC, PBS-PT was found to be feasible. While felt to be unrelated to the study, the two Grade 5 adverse events on this small study highlights potentially treatment related risks of this effective yet toxic regimen. Clinical trial information: NCT01858025. [Table: see text]

Prognostic Factors and Local Recurrence Pattern in Breast Phyllodes Tumors: A Nomogram Based on Retrospective Cohort Study of 404 Cases

This study investigate the effect of clinico-pathologic features, surgical approaches, and adjuvant radiotherapy on prognosis and to explore independent prognostic factors related to postoperative recurrence-free survival (RFS) in patients with breast phyllodes tumors (PTBs). A retrospective analysis was conducted in Fudan University Shanghai Cancer Center. The relationship of clinico-pathologic features, surgical treatment, and adjuvant radiotherapy with prognosis was analyzed. According to their histological type, benign PTBs were classified as a low-risk group while borderline and malignant PTBs were classified as a high-risk group. The Cox regression model was adopted to identify factors affecting postoperative RFS in the two groups and a nomogram was made to predict recurrence-free survival at 1, 3 and 5 years. Of the 404 patients, 168 (41.6%) had benign PTB, 184 (45.5%) had borderline PTB, and 52 (12.9%) had malignant PTB. Fifty-five patients experienced postoperative local recurrence, including 6 benign cases, 26 borderline cases, and 22 malignant cases; the three histological types of PTB had local recurrence rates of 3.6%, 14.1%, and 42.3%, respectively. Stromal cell atypia was an independent prognostic factor for RFS in the low-risk group while surgical approach and tumor border were independent prognostic factors for RFS in the high-risk group, patients received simple excision and with infiltrative tumor border have a higher recurrence rate. A nomogram developed based on clinico-pathologic features and surgical approaches could predict recurrence-free survival at 1, 3 and 5 years. Histological grade and degree of stromal malignancy were closely associated with postoperative local recurrence of PTB. For high-risk patients, this predictive nomogram based on tumor border, tumor residue, mitotic activity, and degree of stromal cell hyperplasia and atypia can be applied for patient counselling and clinical management. The efficacy of adjuvant radiotherapy is still uncertain.

Local Recurrence Patterns Following Postoperative Stereotactic Radiosurgery to Resected Brain Metastases: A Quantitative Analysis to Guide Target Delineation

Local Recurrence Patterns Following Postoperative Stereotactic Radiosurgery to Resected Brain Metastases: A Quantitative Analysis to Guide Target Delineation

Characteristics of the local recurrence pattern after curative resection and values in target region delineation in postoperative radiotherapy for lower thoracic esophageal squamous cell cancer.

BackgroundThe aim of this study was to investigate the patterns and influencing factors of local‐regional recurrence of lower thoracic esophageal squamous cell carcinoma (TESCC) after curative resection and to delineate the clinical target volume (CTV) of postoperative radiotherapy (PORT).MethodsFrom January 2009 to December 2013, the clinical data of patients who experienced local‐regional recurrence after curative esophagectomy were collected and analyzed to determine local‐regional recurrence patterns and to evaluate whether a proposed T‐shaped PORT CTV could cover regions of local‐regional failure.ResultsA total of 108 patients were eligible for this study. All patients experienced postoperative recurrence of lower TESCC. The time to local‐regional failure varied from one to 52 months (average 13.4 ± 11.0). Among the 108 patients, 127 recurrence sites were detected as the first recurrence event: 37 cases in the bilateral supraclavicular region, 56 in the upper mediastinum, 14 in the middle mediastinum, 15 in the upper abdominal lymph nodes, and five cases of anastomotic recurrence. The proposed PORT CTV could successfully cover 89 (82.4%) out of the 108 recurrences and 84.2% of the sites (107/127) of recurrence in our sample.ConclusionLocal‐regional recurrence of lower TESCC is mainly distributed in the supraclavicular, upper‐middle mediastinum, anastomotic stoma, and upper abdominal lymph node regions. The proposed T‐shaped PORT CTV field could cover over 80% of local‐regional failure in our sample; therefore, we suggest that PORT should focus on this area.