Local Relapse-free Survival Research Articles

The feasibility of contralateral lower neck sparing intensity modulation radiated therapy for nasopharyngeal carcinoma patients with unilateral cervical lymph node involvement

ObjectivesTo investigate the feasibility of contralateral lower neck sparing intensity modulation radiated therapy (IMRT) for nasopharyngeal carcinoma patients (NPC) with unilateral cervical lymph node metastasis. Materials and methodsRetrospective review of 546 patients with unilateral cervical lymph node metastasis treated between November 2009 and February 2012 at one institution. All patients were staged using magnetic resonance imaging and received radical IMRT. Patients were classified into two groups: the inferior border of the negative neck irradiation field only covered Levels III to Va in Group 1; the inferior border covered entire neck down to Levels IV to Vb in Group 2. ResultsMedian follow-up was 49.9months (range, 1.3–69.2months). Four-year overall survival (OS:89.3% vs. 88.9%, P=0.91), disease-free survival (DFS:81.7% vs. 81.0%, P=0.91), distant metastasis-free survival (DMFS:88.2% vs. 87.9%, P=0.95), local relapse-free survival (LRFS:96.7% vs. 94.7%, P=0.70) and nodal relapse-free survival (NRFS: 96.1% vs. 95.9%, P=0.94) were not significantly different between Group 1 and Group 2. Twenty-two patients developed cervical lymph node relapse; of whom 20/22 (91.0%) developed unilateral relapse within pretreatment positive neck. Only one patient developed out-of-field relapse, though this patient also relapsed within the neck irradiation field (Level II). No clinicopathological feature tested had significant prognostic value for NRFS in multivariate analysis. ConclusionsIn the IMRT and MRI era, contralateral lower neck sparing IMRT seems to be feasible for NPC patients with unilateral cervical lymph node metastasis.

Ten-year survival outcomes for patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: An analysis of 614 patients from a single center

ObjectivesIntensity-modulated radiotherapy (IMRT) has been applied in nasopharyngeal carcinoma (NPC) for nearly twenty years, while little is known about the ten-year survival outcomes. This study aimed at evaluating the 10-year survival outcomes for patients with NPC receiving IMRT. Materials and methodsData on 614 patients with newly diagnosed, non-disseminated NPC treated by IMRT between 2004 and 2008 were retrospectively reviewed. Survival outcomes stratified by tumor stage were compared. ResultsThe median follow-up duration was 112.7months (range, 7.6–156.8months) for the entire cohort. The 10-year local relapse-free survival rates for T1, T2 and T3 were 94.2%, 92.5% and 91.4% (P>0.05), respectively, and significantly higher than that of T4 disease (79.3%, P<0.05 for all rates). As N category increased from N0 to N3, the 10-year distant metastasis-free survival rates significantly decreased accordingly (P<0.01 for all rates). Furthermore, the 10-year overall survival rates were 100%, 87.1%, 75.5% and 55.6% for stage I, II, III and IV, respectively (P<0.05 except stage I and II). Multivariate analysis established tumor stage and age as independent prognostic factors. Late toxicities were assessable for 495 (80.6%) patients and most were Grade I/II damages. Xerostomia (387 of 489, 79.1%) and hearing impairment (212 of 495, 42.8%) remained the most troublesome. ConclusionIMRT could achieve satisfactory survival outcomes for NPC patients with acceptable late toxicities. However, distant control still remains poor, especially for patients with N3 disease.

Results of Dose-adapted Salvage Radiotherapy After Radical Prostatectomy Based on an Endorectal MRI Target Definition Model

To assess the outcome of patients treated with a dose-adapted salvage radiotherapy (SRT) protocol based on an endorectal magnetic resonance imaging (erMRI) failure definition model after radical prostatectomy (RP). We report on 171 relapsing patients after RP who had undergone an erMRI before SRT. 64 Gy were prescribed to the prostatic bed with, in addition, a boost of 10 Gy to the suspected local relapse as detected on erMRI in 131 patients (76.6%). The 3-year biochemical relapse-free survival (bRFS), local relapse-free survival, distant metastasis-free survival, cancer-specific survival, and overall survival were 64.2±4.3%, 100%, 85.2±3.2%, 100%, and 99.1±0.9%, respectively. A PSA value >1 ng/mL before salvage (P=0.006) and an absence of biochemical progression during RT (P=0.001) were both independently correlated with bRFS on multivariate analysis. No significant difference in 3-year bRFS was observed between the boost and no-boost groups (68.4±4.6% vs. 49.7±10%, P=0.251). A PSA value >1 ng/mL before salvage and a biochemical progression during RT were both independently correlated with worse bRFS after SRT. By using erMRI to select patients who are most likely expected to benefit from dose-escalated SRT protocols, this dose-adapted SRT approach was associated with good biochemical control and outcome, serving as a hypothesis-generating basis for further prospective trials aimed at improving the therapeutic ratio in the salvage setting.

Pretreatment hematologic markers as prognostic factors in patients with nasopharyngeal carcinoma: A systematic review and meta-analysis.

Background:Pretreatment hematologic parameters of the inflammatory response, including lymphocyte, neutrophil, and platelet counts, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio, and platelet-to-lymphocyte ratio, have emerged as prognostic factors for patients with cancer. This systematic review and meta-analysis aimed to summarize the association between the hematologic markers and prognosis of nasopharyngeal carcinoma (NPC).Methods:A systematic search of PubMed, Google Scholar, MEDLINE, EMBASE, Web of Science, and the Cochrane Library was conducted up to April 2016. Hazard ratios (HRs) with 95% confidence intervals (95% CIs) were extracted and synthesized to examine prognostic outcomes including cancer-specific survival (CSS), overall survival (OS), progression-free survival (PFS), distant metastasis-free survival, and local relapse-free survival (LRFS).Results:Fourteen studies comprising 11,651 NPC patients were ultimately included, and all eligible studies were conducted in East Asia. The OS, CSS, PFS, distant metastasis-free survival, and LRFS risks differed among patients according to hematologic marker levels. All of the parameters were associated with prognostic outcomes in patients with NPC. NLR and lymphocyte counts were most commonly reported. A high NLR was significantly associated with poor NPC prognosis (pooled HR 1.42, 95% CI 1.21–1.67 for CSS; pooled HR 1.77, 95% CI 1.41–2.23 for OS; pooled HR 1.67, 95% CI 1.36–2.06 for PFS; pooled HR 1.64, 95% CI 1.15–2.34 for LRFS). High lymphocyte count indicated favorable NPC prognosis (pooled HR 0.72, 95% CI 0.64–0.81 for OS; pooled HR 0.71, 95% CI 0.56–0.91 for PFS).Conclusions:Meta-analysis indicated that NLR and lymphocyte counts could be prognostic predictors in NPC for East Asian population. Patients with a high NLR or low lymphocyte count had poor prognosis. However, due to the limitation of included population, the conclusion was limited to East Asian patients only.

Influence of Cervical Node Necrosis of Different Grades on the Prognosis of Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy.

Background: To analyze the prognostic value of cervical node necrosis (CNN) observed on pretreatment magnetic resonance imaging (MRI) in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).Patients and Methods: The medical records of 1423 NPC patients with cervical node metastasis who underwent IMRT were retrospectively reviewed. Lymph nodes in the axial plane of pretreatment MRI were classified as follows: grade 0 CNN, no hypodense zones; grade 1 CNN, ≤33% areas showing hypodense zones; and grade 2, >33% areas showing hypodense zones.Results: CNN was detectable in 470/1423 (33%) patients. Of these 470 patients, 213 (15%) and 257 (18%) exhibited grade 1 and grade 2 CNN. The grade 0 and grade 1 CNN groups showed significant differences with regard to distant metastasis-free survival (DMFS), but not overall survival (OS), regional relapse-free survival (RRFS), local relapse-free survival (LRFS), and disease-free survival (DFS). Significant differences were observed among the grade 0 and grade 2 CNN groups with regard to OS, RRFS, LRFS, DMFS, and DFS. Moreover, OS, LRFS, RRFS, and DFS were significantly different between the grade 1 and grade 2 CNN groups, whereas DMFS showed no significant differences. Univariate and multivariate analyses revealed CNN on MRI as a significant negative prognostic factor for OS, LRFS, RRFS, DMFS, and DFS in NPC patients.Conclusions: NPC patients with CNN of different grades show various prognosis and failure patterns after IMRT. CNN on MRI can be adopted as a predictive factor for formulating individualized treatment plans for NPC patients.

Survival and Toxicities of IMRT Based on the RTOG Protocols in Patients with Nasopharyngeal Carcinoma from the Endemic Regions of China.

Background: This study evaluated the survival outcomes and toxicities of intensity-modulated radiation therapy (IMRT) based on the RTOG 0225/0615 RT protocols in patients with nasopharyngeal carcinoma (NPC) from a region of China where this tumor type is endemic.Methods: A total of 455 patients with non-metastatic, histologically-confirmed NPC were retrospectively reviewed. All patients were treated by IMRT using the RTOG 0225/0615 RT protocols; 91.1% (288/316) of patients with stage III-IVb NPC received concurrent chemotherapy +/- induction chemotherapy or adjuvant chemotherapy.Results: Estimated four-year overall survival (OS), failure free survival (FFS), local relapse free survival (LRFS), regional relapse free survival (RRFS) and distant metastasis free survival (DMFS) were 83.8%, 80.5%, 94.3%, 96.7% and 85.8%, respectively. T and N category were significant prognostic factors for OS, FFS, RRFS and DMFS; and T category, for LRFS. In-field failure was the major loco-regional failure pattern. During RT, 206 (45.3%) patients experienced acute grade 3-4 toxicities. The most common acute toxicity was mucositis; 124 (27.2%) patients experienced grade 3-4 mucositis; 46 (10.1%) experienced serious late toxicities. The most common late toxicity was MRI-detected radiation-induced temporal lobe necrosis (6.8%).Conclusions: The RTOG IMRT protocols are feasible for patients with NPC from the endemic regions of China.

Prognostic Value of Serum Lactate Dehydrogenase in Patients with Nasopharyngeal Carcinoma: a Meta-Analysis.

Serum-lactate dehydrogenase (S-LDH) is reported to be associated with poor survival in patients with nasopharyngeal carcinoma (NPC); however, the results are inconsistent. The aim of the study was to perform a meta-analysis to evaluate the prognostic value of S-LDH in patients with NPC. PubMed and Web of Science were searched for relevant studies, and the fixed-effects model was employed to pool the hazard risks (HRs) from individual studies when no substantial heterogeneity was detected; otherwise, the random-effects model was used. Heterogeneity and publication bias were also analyzed. A total of 18 studies involving 13,789 patients were included in the meta-analysis, serum LDH level was associated with worse outcome in NPC patients. The combined HR for overall survival (OS) was 1.86 (95% confidence interval [CI]: 1.66 - 2.08; p < 0.01), and the pooled HRs for disease-free survival (DFS), distant metastasisfree survival (DMFS), and distant local relapse-free survival (LRFS) were 1.64 (95% CI: 1.45 - 1.86), 2.64 (95% CI: 2.15 - 3.25), and 2.59 (95% CI: 1.74 - 3.87), respectively. Our results suggest that higher serum LDH level is associated with worse survival in patients with NPC, which is helpful for a personalized treatment strategy for NPC patients.

P2.05-007 Outcomes after Stereotactic Body Radiothrapy/Proton Beam Therapy or Wedge Resection for Stage I Non-Small-Cell Lung Cancer: Topic: Clinical Outcome

Recently, excellent results of stereotactic body radiotherapy (SBRT), proton beam therapy (PBT) for stage I non-small-cell lung cancer (NSCLC) have been reported, however any phase III trial comparing SBRT and surgery have not been completed yet. The aim of this study is to compare outcomes between SBRT, PBT and wedge resection (WR) for patients with peripheral stage I NSCLC who intolerable for anatomical resection, and analyze prognostic factors in this population. We retrospectively compared overall survival (OS), local recurrence rate (LRR), relapse-free survival (RFS) and cause-specific survival (CSS) between WR (n=172) and SBRT / PBT (n=188) for pathologically proven clinical stage I NSCLC in our institute from 2002 to 2015. Patients underwent WR were all high risk patients who intolerable for anatomical resection and achieved complete resection without any adjuvant therapy. Of radiation group (RT: SBRT+PBT), 56% was medically inoperable, with 44% refusing surgery. SBRT; 60 Gy in 8 fractions, PBT; 60-80 GyE in 10-20 fractions was prescribed. Propensity score matching was used to adjust the confounding effects in estimating treatment hazard ratios. 59 WR patients and 59 radiotherapy (RT) patients (SBRT 27, PBT 32) were matched blinded to outcome (1:1 ratio). There are 70 men and 48 women, median age was 81, and median follow-up period was 39 months. 3, 5 - year overall survival (OS) of WR and RT was 84.5%, 70.8% vs 89.7%, 59.6% (p=0.802), respectively. 3-year LRR, RFS, CSS were 94.7% vs 95.9% (p=0.751), 87.5% vs 75.6% (p=0.151) and 91.2% vs 93.9% (p=0.875), respectively. Multivariate analysis of prognostic factors for OS demonstrated any factors including treatment modality were not significant. Our results suggest that the treatment outcome of SBRT / PBT was equivalent to that of WR, SBRT / PBT may be alternative treatment in stage I NSCLC high risk patients.

Recommendations for Updating T and N Staging Systems for Nasopharyngeal Carcinoma in the Era of Intensity-Modulated Radiotherapy.

ObjectiveThe aim of this study was to compare the 2008 Chinese and the 7th edition of the American Joint Committee on Cancer (AJCC) staging systems for nasopharyngeal carcinoma and to provide proposals for updating T and N staging systems of the present staging system.MethodsBetween January 2007 and December 2012, a cohort of 752 patients with biopsy-proven, newly diagnosed, non-metastatic nasopharyngeal carcinoma who were treated with intensity-modulated radiotherapy were retrospectively analysed. Prognoses were compared by T stage, N stage, and clinical stage according to the two staging systems for overall survival (OS), local relapse-free survival (LRFS), and distant metastasis-free survival (DMFS).ResultsIn terms of both the T and N staging systems, the two current staging systems were comparable in predicting OS. The T classification of the 2008 Chinese staging system was better in predicting LRFS, while the N classification of the 7th edition AJCC staging system was superior in predicting DMFS. In the modern era of intensity-modulated radiotherapy, the staging system should be updated by down-staging the current stage T2 to T1, and it might be rational to merge subcategories N1 and N2.ConclusionsThe two current staging systems each had advantages in predicting prognosis. It seems reasonable to downstage T2 to T1 and to merge N1 and N2.

Prognostic factors and failure patterns in non-metastatic nasopharyngeal carcinoma after intensity-modulated radiotherapy.

BackgroundThe prognostic values of staging parameters require continual re-assessment amid changes in diagnostic and therapeutic methods. This study aimed to identify the prognostic factors and failure patterns of non-metastatic nasopharyngeal carcinoma (NPC) in the intensity-modulated radiotherapy (IMRT) era.MethodsWe reviewed the data from 749 patients with newly diagnosed, biopsy-proven, non-metastatic NPC in our cancer center (South China, an NPC endemic area) between January 2003 and December 2007. All patients underwent magnetic resonance imaging (MRI) before receiving IMRT. The actuarial survival rates were estimated using the Kaplan–Meier method, and survival curves were compared using the log-rank test. Multivariate analyses with the Cox proportional hazards model were used to test for the independent prognostic factors by backward eliminating insignificant explanatory variables.ResultsThe 5-year occurrence rates of local failure, regional failure, locoregional failure, and distant failure were 5.4, 3.0, 7.4, and 17.4%, respectively. The 5-year survival rates were as follows: local relapse-free survival, 94.6%; nodal relapse-free survival, 97.0%; distant metastasis-free survival, 82.6%; disease-free survival, 75.1%; and overall survival, 82.0%. Multivariate Cox regression analysis revealed that orbit involvement was the only significant prognostic factor for local failure (P = 0.011). Parapharyngeal tumor extension, retropharyngeal lymph node involvement, and the laterality, longest diameter, and Ho’s location of the cervical lymph nodes were significant prognostic factors for both distant failure and disease failure (all P < 0.05). Intracranial extension had significant prognostic value for distant failure (P = 0.040).ConclusionsThe key failure pattern for NPC was distant metastasis in the IMRT era. With changes in diagnostic and therapeutic technologies as well as treatment modalities, the significant prognostic parameters for local control have also been altered substantially.

Favorable Local Control From Consolidative Radiation Therapy in High-Risk Neuroblastoma Despite Gross Residual Disease, Positive Margins, or Nodal Involvement

Toreport the influence of radiation therapy (RT) dose and surgical pathology variables on disease control and overall survival (OS) in patients treated for high-risk neuroblastoma at a single institution. We conducted a retrospective study of 67 high-risk neuroblastoma patients who received RT as part of definitive management from January 2003 until May2014. At a median follow-up of 4.5years, 26 patients (38.8%) failed distantly; 4of these patients also failed locally. One patient progressed locally without distant failure. Local control was 92.5%, and total disease control was 59.5%. No benefit was demonstrated for RT doses over 21.6Gy with respect to local relapse-free survival (P=.55), disease-free survival (P=.22), or OS (P=.72). With respect to local relapse-free survival, disease-free survival, and OS, no disadvantage was seen for positive lymph nodes on surgical pathology, positive surgical margins, or gross residual disease. Of the patients with gross residual disease, 75% (6 of 8) went on to have no evidence of disease at time of last follow-up, and the 2 patients who failed did so distantly. Patients with high-risk neuroblastoma in this series maintained excellent local control, with no benefit demonstrated for radiation doses over 21.6Gy, and no disadvantage demonstrated for gross residual disease after surgery, positive surgical margins, or pathologic lymph node positivity. Though the limitations of a retrospective review for an uncommon disease must be kept in mind, with small numbers in some of the subgroups, it seems that dose escalation should be considered only in exceptional circumstances.

Clinical and functional results of laparoscopic intersphincteric resection for ultralow rectal cancer: is there a distinction between the three types of hand-sewn colo-anal anastomosis?

The purpose of this study is to compare the clinical and functional outcomes of three types of hand-sewn colo-anal anastomosis (CAA) after laparoscopic intersphincteric resection (Lap-ISR) for patients with ultralow rectal cancer. A total of 79 consecutive patients treated by Lap-ISR for low-lying rectal cancer in an academic medical center from June 2011 to February 2016. According to the distal tumor margin and individualized anal length, the patients underwent three types of hand-sewn CAA including partial-ISR, subtotal-ISR, and total-ISR. Of the 79 patients, 35.4% required partial-ISR, 43% adopted subtotal-ISR, and 21.5% underwent total-ISR. R0 resection was achieved in 78 patients (98.7%). In addition to distal resection margin, there were no significant differences in clinicopathological parameters and postoperative complications between the three groups. The type of hand-sewn CAA did not influence the 3-year disease-free survival (DFS) or local relapse-free survival (LFS). At 24-months follow-up, in spite of higher incontinence scores in total-ISR group, there were not statistically significant differences in functional outcomes including Wexner score or Kirwan grade between the groups. Nevertheless, patients with chronic anastomotic stricture showed worse anal function than those without the complication. The type of hand-sewn CAA after Lap-ISR may not influence oncological and functional outcomes, but chronic stricture deteriorates continence status.

Prognostic value and predictive threshold of tumor volume for patients with locally advanced nasopharyngeal carcinoma receiving intensity-modulated radiotherapy.

BackgroundGross target volume of primary tumor (GTV-P) is very important for the prognosis prediction of patients with nasopharyngeal carcinoma (NPC), but it is unknown whether the same is true for locally advanced NPC patients treated with intensity-modulated radiotherapy (IMRT). This study aimed to clarify the prognostic value of tumor volume for patient with locally advanced NPC receiving IMRT and to find a suitable cut-off value of GTV-P for prognosis prediction.MethodsClinical data of 358 patients with locally advanced NPC who received IMRT were reviewed. Receiver operating characteristic (ROC) curves were used to identify the cut-off values of GTV-P for the prediction of different endpoints [overall survival (OS), local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS)] and to test the prognostic value of GTV-P when compared with that of the American Joint Committee on Cancer T staging system.ResultsThe 358 patients with locally advanced NPC were divided into two groups by the cut-off value of GTV-P as determined using ROC curves: 219 (61.2%) patients with GTV-P ≤46.4 mL and 139 (38.8%) with GTV-P >46.4 mL. The 3-year OS, LRFS, DMFS, and DFS rates were all higher in patients with GTV-P ≤46.4 mL than in those with GTV-P > 46.4 mL (all P < 0.05). Multivariate analysis indicated that GTV-P >46.4 mL was an independent unfavorable prognostic factor for patient survival. The ROC curve verified that the predictive ability of GTV-P was superior to that of T category (P < 0.001). The cut-off values of GTV-P for the prediction of OS, LRFS, DMFS, and DFS were 46.4, 57.9, 75.4 and 46.4 mL, respectively.ConclusionIn patients with locally advanced NPC, GTV-P >46.4 mL is an independent unfavorable prognostic indicator for survival after IMRT, with a prognostic value superior to that of T category.

Neoadjuvant and Concurrent Chemotherapy Have Varied Impacts on the Prognosis of Patients with the Ascending and Descending Types of Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiotherapy.

PurposeTo compare the outcomes of patients with ascending type (T4&N0-1) and descending type (T1-2&N3) of nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT), neoadjuvant chemotherapy (NACT) + intensity-modulated radiotherapy (RT) or NACT + CCRT.MethodsRetrospective analysis of 839 patients with ascending or descending types of NPC treated at a single institution between October 2009 to February 2012. CCRT was delivered to 236 patients, NACT + RT to 302 patients, and NACT + CCRT to 301 patients.ResultsThe 4-year overall survival rate, distant metastasis-free survival rate, local relapse-free survival rate, nodal relapse-free survival rate, loco-regional relapse-free survival rate, and progression free survival rate were 75.2% and 73.4% (P = 0.114), 85.7% and 74.1% (P = 0.008), 88.8% and 97.1% (P = 0.013), 96.9% and 94.1% (P = 0.122), 86.9% and 91.2% (P = 0.384), 73.7% and 66.2% (P = 0.063) in ascending type and descending type. Subgroup analyses indicated that NACT + RT significantly improved distant metastasis-free survival rate and progression-free survival rate when compared with CCRT in the ascending type, and there were no significant differences between the survival curves of NACT +RT and NACT + CCRT. For descending type, there were no significant differences among the survival curves of NACT +RT, CCRT, and NACT + CCRT groups, and the survival benefit mainly came from CCRT.ConclusionsCompared with NACT + CCRT or CCRT, NACT + RT may be a reasonable approach for ascending type. Although concurrent chemotherapy was effective in descending type, NACT + CCRT may be a more appropriate strategy for descending type.

Clinical Features and Prognostic Factors of Patients With Nerve Sheath Tumors in the Cervical Spine.

A retrospective study was performed. The aim of the study was to illustrate the long-term follow-up results and discuss the possible factors that may affect outcomes of patients with cervical spinal nerve sheath tumors (CSNSTs). Nerve sheath tumors are the most common neoplasms in the spine, but minimal information was published in the literature, especially when regarding to prognostic factors due to the benign nature. The objective of our study was to present long-term follow-up results and discuss the possible factors that may affect outcomes of patients with CSNSTs. A retrospective analysis of patients with CSNSTs was performed by survival analysis. The local relapse-free survival (LRFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method to identify potential prognostic factors. Factors with P values ≤0.1 were subjected to multivariate analysis by Cox regression analysis. P values ≤0.05 were considered statistically significant. A total of 169 patients with CSNSTs were included in the study. All patients received surgical treatment. The mean follow-up period was 72.1 months (median 62.0, range 1-158). Local recurrence was detected in 14 patients after surgery in our center, whereas death occurred in 9 patients with a mean follow-up of 27.2 months (median 24, range 1-84). The statistical analyses suggested that resection mode and pathology type were independent prognostic factors for LRFS and OS. In addition, postoperative recurrence was an adverse independent factor to OS. Total resection could significantly improve the LRFS and OS for patients with CSNSTs, whereas malignant CSNST was associated with worse prognosis. Moreover, postoperative recurrence was an adverse independent factor to OS. 4.

A new T staging system for nasopharyngeal carcinoma based on magnetic resonance imaging and intensity-modulated radiotherapy

Objective To establish a new T staging system for nasopharyngeal carcinoma (NPC) based on magnetic resonances imaging (MRI) and intensity-modulated radiotherapy (IMRT). Methods A retrospective analysis was performed on the clinical data of 608 patients who were newly diagnosed with non-metastatic NPC by MRI and treated with IMRT in our hospital from 2008 to 2010. All patients were staged according to the 7th edition of the UICC/AJCC staging system for NPC. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The Cox regression model was used for multivariate analyses. To deal with the deficiency in the current UICC/AJCC staging system, a new T staging system for NPC was established and systematically evaluated. Results The 5-year follow-up rate was 94.5%. The 5-year overall survival (OS), disease-free survival, local relapse-free survival (LRFS), and distant metastasis-free survival rates were 81.5%, 80.1%, 86.0%, and 81.1%, respectively. The univariate and multivariate analyses showed that the anatomic structures of nasopharynx, parapharyngeal space, and skull base were influencing factors for the OS rate (P=0.000-0.045). New T staging criteria were proposed based on the risk differences and survival curves: stage T1: invasion of the nasopharynx, parapharyngeal space, oropharynx, nasal cavity, skull base, and internal pterygoid muscle; stage T2: invasion of the external pterygoid muscle, paranasal sinus, intracalvarium, infratemporal fossa, and cranial nerves. The proposed T staging system achieved a good separation in both OS and LRFS curves. Conclusions The proposed new T staging system gives an objective prognostic prediction in patients with NPC, which provides an exploratory attempt toward a new clinical staging system for NPC. Key words: Nasopharyngeal neoplasms/intensity-modulated radiotherapy; Magnetic resonances imaging; Hazard discrimination; T staging system; Prognosis

Treatment of angiosarcoma at a single institution

Objective To analyze the survival and prognostic factors in the treatment of angiosarcoma. Methods A retrospective study was performed on clinical data of 30 patients pathologically diagnosed with angiosarcoma who were admitted to our hospital from 1988 to 2015 and had complete follow-up data. In those patients, 18 patients received comprehensive treatment, containing 9 patients treated with surgery plus radiotherapy, 4 patients with surgery plus chemoradiotherapy, and 5 with surgery plus chemotherapy; 12 patients received non-comprehensive treatment, containing 11 patients treated with surgery alone and 1 patient radiotherapy alone. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The Cox regression model was used for multivariate prognostic analyses. Results The 1-, 2-, and 5-year sample sizes were 29, 26, and 18, respectively. The 1-, 2-, and 5-year overall survival (OS) rates were 70.1%, 49.1%, and 40.9%, respectively; the 1-, 2-, and 5-year local relapse-free survival rates were 52.8%, 44.0%, and 35.2%, respectively; the 1-, 2-, and 5-year distant metastasis-free survival rates were 81.6%, 68.0%, and 56.7%, respectively. The multivariate analysis showed that tumor site, tumor size, staging, and visible tumor residue after initial treatment were prognostic factors for OS (P=0.027, 0.027, 0.011, 0.000); In the patients with stage Ⅰ or Ⅱ disease, the comprehensive treatment achieved a significantly lower local-relapse rate than the individual treatment (P=0.006); gender, age, staging, and tumor site were prognostic factors for distant metastasis (P=0.028, 0.011, 0.015, 0.022). Conclusions Early diagnosis and early treatment are recommended for angiosarcoma, which has high local recurrence and distant metastasis rates. Comprehensive treatment (surgery plus radiotherapy and/or chemotherapy) is recommended for patients with stage Ⅰ or Ⅱ disease. Tumor site, tumor size, staging, and visible tumor residue after initial treatment are prognostic factors. Key words: Angiosarcomas/surgery; Angiosarcomas/radiotherapy; Angiosarcomas/chemotherapy; Prognosis

HLA-B alleles and nasopharyngeal carcinoma in Xinjiang, China: relationship and clinical significance

Objective To explore the relationship between HLA-B allele polymorphisms and nasopharyngeal carcinoma (NPC) in Xinjiang, China and its clinical significance. Methods A total of 226 patients were assigned to NPC group, while 207 healthy volunteers were assigned to control group. PCR amplification with sequence-specific primers was used to determine HLA-B alleles. Comparison of HLA-B allele frequency between the above two groups, between Han and Uygur populations, and between patients with various clinical characteristics of NPC was made by chi-square test. The Kaplan-Meier method was used to calculate the survival rates and the log-rank univariate analysis was used to explore the relationship between survival rates and HLA-B allele frequency. Results In all the subjects or Han population alone, the allele frequency of HLA-B*46 in the NPC group was significantly higher than that in the control group (P=0.000; P=0.000). In Uygur population, however, there was no significant difference in the allele frequency of HLA-B*46 between the NPC group and the control group (P>0.05). In the patients with NPC, those less than 30 years old had a significantly higher allele frequency of HLA-B*44 than those no less than 30 years old (P=0.029); those with differentiated non-keratinizing carcinoma had a significantly higher allele frequency of HLA-B*48 than those with undifferentiated non-keratinizing carcinoma (P=0.029); those with stage T1+ T2 disease had a significantly higher allele frequency of HLA-B*48 than those with stage T3+ T4 disease (P=0.029). The 5-year overall survival, disease-free survival, distant metastasis-free survival, and local relapse-free survival rates had no relationship with the expression of HLA-B*46, HLA-B*44, or HLA-B*48 in NPC patients (all P>0.05). Conclusions HLA-B*46 allele is probably a NPC susceptibility gene in Han population in Xinjiang. HLA-B*44 is probably associated with early age of onset, while HLA-B*48 is probably associated with the pathological type and T stage of NPC. Therefore, HLA-B alleles are probably associated with the development and progression of NPC. Key words: Nasopharyngeal carcinoma; HLA-B gene; Clinic characteristics; Prognosis

A multicentre randomised clinical trial of chemoradiotherapy plus hyperthermia versus chemoradiotherapy alone in patients with locally advanced cervical cancer

Purpose: To evaluate the effectiveness of whole-pelvic hyperthermia (HT) added to standard chemoradiotherapy (CRT) in locally advanced cervical cancer (CC), by investigating the clinical response and survival of patients treated with cisplatin-based CRT vs. CRT with HT (CRT + HT).Materials and methods: This study was conducted at five hospitals in Japan between September 2001 and March 2015 in patients with the International Federation of Gynecology and Obstetrics stage IB (bulky)–IVA CC undergoing definitive CRT. After giving a written informed consent, patients were randomly allocated to two treatment groups: CRT and CRT + HT group. Overall survival (OS), disease-free survival (DFS), local relapse-free survival (LRFS), complete response (CR) rate and tolerability were evaluated.Results: In total, 101 patients were treated. Patient characteristics, total dose of cisplatin and radiotherapy were similar for both groups. Although not statistically significant, the 5-year OS, DFS and LRFS in the CRT + HT group (77.8%, 70.8% and 80.1%, respectively) were better than those in the CRT group (64.8%, 60.6% and 71.0%, respectively). CR was significantly more likely to be achieved in patients in the CRT + HT group than in the CRT group (88% vs. 77.6%; adjusted odds ratio, 3.993; 95% confidence interval, 1.018–15.67; p = .047). CRT + HT was well tolerated and caused no additional acute or long-term toxicity compared with CRT alone.Conclusions: HT combined with CRT improved the CR rate of CRT in patients with locally advanced CC, however, could not improve survival outcomes. Further studies in larger samples are warranted.

Waiting time for radiation therapy after breast-conserving surgery in early breast cancer: a retrospective analysis of local relapse and distant metastases in 615 patients

BackgroundPostoperative radiotherapy after breast-conserving surgery (BCS) is the standard in the management of breast cancer. The optimal timing for starting postoperative radiation therapy has not yet been well defined. In this study, we aimed to evaluate if the time interval between BCS and postoperative radiotherapy is related to the incidence of local and distant relapse in women with early node-negative breast cancer not receiving chemotherapy.MethodsWe retrospectively analyzed clinical data concerning 615 women treated from 1984 to 2010, divided into three groups according to the timing of radiotherapy: ≤60, 61–120, and >120 days. To estimate the presence of imbalanced distribution of prognostic and treatment factors among the three groups, the χ2 test or the Fisher exact test were performed. Local relapse-free survival, distant metastasis-free survival (DMFS), and disease-free survival (DFS) were estimated with the Kaplan–Meier method, and multivariate Cox regression was used to test for the independent effect of timing of RT after adjusting for known confounding factors. The median follow-up time was 65.8 months.ResultsDifferences in distribution of age, type of hormone therapy, and year of diagnosis were statistically significant. At 15-year follow-up, we failed to detect a significant correlation between time interval and the risk of local relapse (p = 0.09) both at the univariate and the multivariate analysis. The DMFS and the DFS univariate analysis showed a decreased outcome when radiotherapy was started early (p = 0.041 and p = 0.046), but this was not confirmed at the multivariate analysis (p = 0.406 and p = 0.102, respectively).ConclusionsOur results show that no correlation exists between the timing of postoperative radiotherapy and the risk of local relapse or distant metastasis development in a particular subgroup of women with node-negative early breast cancer.