Locoregional Recurrence In Patients Research Articles

Prediction of central lymph node metastasis in patientswith thyroid papillary microcarcinoma

Background/aim: The purpose of this study was to analyze the clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) and predictive factors for central lymph node metastasis (CLNM).Materials and methods: Patients diagnosed as having PTC and PTMC were evaluated. Clinical and laboratory parameters were recorded.Results: The mean age at diagnosis was 47.3 +- 11.9 years. Of all 223 patients, 91 (40.8%) had lymph nodes removed, 29 of whom had lymph node metastasis and 24 of whom had only CLNM. Univariate analysis revealed that central lymph node metastasis was associated with male sex, presence of bilaterality, presence of extrathyroidal extension, and tumor size (P = 0.033, P = 0.027, P < 0.001, P < 0.001, respectively). However, multivariate logistic regression analysis showed that sex, age, tumor size, multifocality, bilaterality, extrathyroidal extension, clinical suspicion, and chronic lymphocytic thyroiditis were not significantly correlated with an increased risk for CLNM.Conclusion: Lymph node metastasis is known to be a significant predictor of locoregional recurrence in patients with PTC and PTMC. Further prospective studies are needed to identify the extent of surgery such as central lymph node dissection in patients with PTC or PTMC.

Incidence, Patterns, and Predictors of Locoregional Recurrence in Colon Cancer.

Locoregional recurrence (LR) in colon cancer is uncommon but often incurable, while the factors associated with it are unclear. The purpose of this study was to identify patterns and predictors of LR after curative resection for colon cancer. All patients who underwent colon cancer resection with curative intent between 1994 and 2008 at a tertiary referral center were identified from a prospectively maintained institutional database. The association of LR with clinicopathologic and treatment characteristics was determined using univariable and multivariable analyses. A total of 1397 patients were included with a median follow-up of 7.8years; 635 (45%) were female, and the median age was 69years. LR was detected in 61 (4.4%) patients. Median time to LR was 21months. On multivariable analysis, the independent predictors of LR were disease stage [hazard ratio (HR) for Stage II 4.6, 95% confidence interval (CI) 1.05-19.9, HR for Stage III 10.8, 95% CI 2.6-45.8], bowel obstruction (HR 3.8, 95% CI 1.9-7.4), margin involvement (HR 4.1, 95% CI 1.9-8.6), lymphovascular invasion (HR 1.9, 95% CI 1.06-3.5), and local tumor invasion (fixation to another structure, perforation, or presence of associated fistula, HR 2.2, 95% CI 1.1-4.5). Adjuvant chemotherapy was not associated with reduced LR in patients with either Stage II or Stage III tumors. Adherence to oncologic surgical principles in colon cancer resection results in low rates of LR, which is associated with tumor-dependent factors. Recognition of these factors can help to determine appropriate postoperative surveillance.

Prognostic Factors for Locoregional Recurrence in Patients with Thoracic Esophageal Squamous Cell Carcinoma Treated with Radical Two-Field Lymph Node Dissection: Results from Long-Term Follow-Up.

To aim of this study was to determine the clinical and biological prognostic factors for locoregional recurrence (LRR) in patients with thoracic esophageal squamous cell carcinoma (ESCC) undergoing radical two-field lymph node dissection (2FLD). A total of 462 patients diagnosed with thoracic ESCC underwent radical esophagectomy between March 2001 and May 2010 at Sun Yat-Sen University Cancer Center. Clinical characteristics, CD44 expression, and tumor-infiltrating lymphocyte (TIL) levels were evaluated in 198 patients who underwent R0 dissection with long-term follow-up. Partial Cox regression analysis with leave-one-out cross-validation was performed to validate the selected risk factors. With a median follow-up of 54months, the 5-year local failure-free survival (LFFS) rate of 198 patients was 62.5%. Multivariate analysis revealed that T stage (p=0.043), pathological positive tumor above the carina (p=0.000), CD44 expression level (p=0.045) and TIL level (p=0.007) were prognostic factors for LFFS, while the Cox model with risk scores had an area under the curve value of 83.6% for the prediction of 5-year LFFS. The best cut-off value (sum score=11.19) was used to determine the high- and low-risk groups, with patients at high risk having a significantly shorter 5-year LFFS than patients at low risk (p=0.000). The LRR pattern revealed significantly high incidences of recurrent disease at the supraclavicular and cervical sites, mediastinum (above the carina), and anastomosis. Our predictive model was able to distinguish between patients at high risk for LRR and patients at low risk for LRR. LRR primarily involved the upper thorax and this area must be considered in future study designs for radical trimodality treatment.

Roles of squamous cell cancer antigen, cytokeratin 21-1 fragment, and carcinoembryonic antigen in the diagnosis and prognosis of postoperative locoregional recurrence in esophageal carcinoma

Background: Locoregional recurrence (LR) is the major cause for poor response after radical resection in patients with esophageal carcinoma (EC). Therefore, early diagnosis and positive treatment is crucial for the extension of overall survival in EC patients. We aim to investigate the feasibility of squamous cell cancer antigen (SCC-Ag), cytokeratin 21-1 fragment (CYFRA21-1), and carcinoembryonic antigen (CEA) in the diagnosis of postoperative LR in patients with EC, and the correlation between their expression and the prognosis of the disease. Methods: Sixty-two EC patients with postoperative LR were included, and thirty normal individuals served as normal control. Serum SCC-Ag, CYFRA21-1and CEA were determined before and one month after treatment. SCC-Ag level was evaluated using chemiluminescent microparticle immunoassay. CYFRA21-1 was determined using the chemiluminescence assay. CEA was determined using the direct chemiluminescence assay. The patients received radiotherapy and/or chemoradiotherapy. The survival rates were measured using Kaplan-Meier method, and was tested using Logrank analysis. Multiple logic regression analysis was used for the analysis of prognostic factors. Results: Remarkable elevation was noticed in serum SCC-Ag (t=4.79, P 0.05). The SCC-Ag and CYFRA21-1 other than CEA were related to the pathological staging of EC patients with postoperative LR. The median overall survival was 12.0 months (95% CI, 8.98–15.02). The survival rates at 1, 2, 3 and 5 years were 46.1%, 19.7%, 12.3%, and 8.2%, respectively. The serum SCC-Ag and CYFRA21-1 were decreased after radiotherapy and/or chemoradiotherapy in patients with postoperative LR (t=3.24, P 0.05). Among the EC patients with postoperative LR before radiotherapy or chemoradiotherapy, the survival of patients negative for SCC-Ag and CYFRA21-1 showed significantly longer disease-free interval compared to those for these markers (χ 2 =5.92, P<0.05; χ 2 =4.92, P<0.05). Among the EC patients with postoperative LR after radiotherapy or chemoradiotherapy, the survival of patients negative for SCC-Ag showed signifcantly longer disease-free interval compared to that with positivity for this marker (χ 2 =5.30, P<0.05). Multiple logic regression analysis indicated no independent risk factors for the postoperative LR of patients with EC. Conclusions: Our results indicate that serum SCC-Ag and CYFRA21-1 contribute to the diagnosis of postoperative LR in EC patients. Besides, radiotherapy and/or chemotherapy is beneficial to the extension of survival in these patients.

Outcomes of patients with inflammatory breast cancer treated by breast-conserving surgery.

Inflammatory breast cancer (IBC) is rare and associated with a poor prognosis. Following neoadjuvant chemotherapy or endocrine therapy, the multidisciplinary team selected a small number of patients for breast-conservation therapy (BCT). The aim of this study was to determine the outcome of IBC patients treated with BCT in Edinburgh. Between January 1999 and December 2013, thirty-five women with IBC were treated by BCT. The median follow-up was 80months. The 5-year actuarial survival for the 35 patients was 70.3%. Median survival for 20 neoadjuvant chemotherapy patients was 12.9years (95% CI 7.6, 18.1), and for 14 patient neoadjuvant endocrine therapy patients, it was 11.8years (95% CI 1.1, 22.6) (p=0.34). Five patients developed locoregional recurrence (LRR) between 11 and 72months after BCT (median 37months). Three had breast only recurrence, one patient had both breast and axillary recurrence, and one developed axillary recurrence. The 5-year LR-free survival was 87.5% (95% CI 76.0, 99.0). In 4 of the 5 patients with LRR, systemic metastases were diagnosed within 6months and survival post-LRR in these 4 patients was short. IBC is not an absolute contraindication to BCT. LRR in patients after BCT appears part of widespread recurrent disease rather than inadequate local treatment. Multicentre data should be collected to confirm that women with IBC who have a good response to systemic therapy may be offered BCT in the knowledge that in a larger series our observations are confirmed.

Clinical and Biological Prognostic Factors for Locoregional Recurrence in Patients With Thoracic Esophageal Squamous Cell Carcinoma Treated With Radical 2-field Lymph Node Dissection: Results From Long-term Follow-up

Clinical and Biological Prognostic Factors for Locoregional Recurrence in Patients With Thoracic Esophageal Squamous Cell Carcinoma Treated With Radical 2-field Lymph Node Dissection: Results From Long-term Follow-up

Roles of squamous cell cancer antigen, cytokeratin 21-1 fragment, and carcinoembryonic antigen in the diagnosis and prognosis of postoperative locoregional recurrence in esophageal carcinoma

Background: Locoregional recurrence (LR) is the major cause for poor response after radical resection in patients with esophageal carcinoma (EC). Therefore, early diagnosis and positive treatment is crucial for the extension of overall survival in EC patients. We aim to investigate the feasibility of squamous cell cancer antigen (SCC-Ag), cytokeratin 21-1 fragment (CYFRA21-1), and carcinoembryonic antigen (CEA) in the diagnosis of postoperative LR in patients with EC, and the correlation between their expression and the prognosis of the disease.

Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases: Long-term Follow-up From the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 Randomized Trial.

The early results of the American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated no difference in locoregional recurrence for patients with positive sentinel lymph nodes (SLNs) randomized either to axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. We now report long-term locoregional recurrence results. ACOSOG Z0011 prospectively examined overall survival of patients with SLN metastases undergoing breast-conserving therapy randomized to undergo ALND after SLND or no further axillary specific treatment. Locoregional recurrence was prospectively evaluated and compared between the groups. Four hundred forty-six patients were randomized to SLND alone and 445 to SLND and ALND. Both groups were similar with respect to age, Bloom-Richardson score, Estrogen Receptor status, adjuvant systemic therapy, histology, and tumor size. Patients randomized to ALND had a median of 17 axillary nodes removed compared with a median of only 2 SLNs removed with SLND alone (P < 0.001). ALND, as expected, also removed more positive lymph nodes (P < 0.001). At a median follow-up of 9.25 years, there was no statistically significant difference in local recurrence-free survival (P = 0.13). The cumulative incidence of nodal recurrences at 10 years was 0.5% in the ALND arm and 1.5% in the SLND alone arm (P = 0.28). Ten-year cumulative locoregional recurrence was 6.2% with ALND and 5.3% with SLND alone (P = 0.36). Despite the potential for residual axillary disease after SLND, SLND without ALND offers excellent regional control for selected patients with early metastatic breast cancer treated with breast-conserving therapy and adjuvant systemic therapy.

Effectiveness and Safety of CT-Guided Iodine-125 Seed Brachytherapy for Postoperative Locoregional Recurrence in Patients with Non-Small Cell Lung Cancer

Effectiveness and Safety of CT-Guided Iodine-125 Seed Brachytherapy for Postoperative Locoregional Recurrence in Patients with Non-Small Cell Lung Cancer

Locoregional recurrence following breast cancer surgery in the trastuzumab era: A systematic review by subtype

Increasing evidence suggests that molecular subtype influences locoregional recurrence (LRR) of breast cancer. Previous systematic reviews that evaluated the quantitative influence of subtype on LRR predated the use of Trastuzumab. This study assessed the impact of subtype on LRR in a contemporary treatment era. A comprehensive search for all published studies assessing LRR according to breast cancer subtype was performed. Only studies with patients treated with Trastuzumab were included. Relevant data were extracted from each study for systematic review. Primary outcome was LRR related to breast cancer subtype. In total, 11,219 patients were identified from seven studies. Overall LRR rate was 3.44%. The lowest LRR rates were in luminal A (1.7%), and the highest rates were in triple-negative (7.4%) subtypes. There were significantly lower risks of LRR in patients with luminal A subtype compared with luminal B [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.38–0.76; p < 0.0004], HER2/neu-overexpressing (OR 0.32, 95% CI 0.24–0.45; p < 0.0001) and triple-negative breast cancers (OR 0.25, 95% CI 0.19–0.32; p < 0.0001). There were significant differences in LRR between the luminal B and HER2/neu-overexpressing breast cancers (OR 0.61, 95% CI 0.41–0.89; p = 0.0145). The reduced risk in HER2/neu overexpressing compared with triple-negative breast cancers approached statistical significance (OR 0.75, 95% CI 0.55–1.03; p = 0.0933). Significant variations in LRR occur across breast cancer subtypes, with lowest rates in luminal cancers and highest rates in triple-negative breast cancers. Low levels of LRR highlight advances in breast cancer management in the contemporary era.

Metastatic Lymph Node Ratio of Central Neck Compartment Has Predictive Values for Locoregional Recurrence in Papillary Thyroid Microcarcinoma.

ObjectivesThis study aimed to evaluate the significance of metastatic lymph node ratio (the ratio between the metastatic lymph node and the harvested lymph nodes; MLNR) in the central neck for the prediction of locoregional recurrence in patients with papillary thyroid microcarcinoma.MethodsAfter reviewing medical records of papillary thyroid microcarcinoma patients who received total thyroidectomy with central neck node dissection, 573 consecutive adult patients were enrolled in this study, with a follow-up period of more than 36 months. Regarding the risk of recurrence, multivariate analyses were performed with the following variables; sex, age, multiplicity of the primary tumor, presence of pathological extrathyroidal extension, the level of postoperative stimulated serum thyroglobulin, the number of harvested lymph nodes, the number of lymph node metastasis and MLNR.ResultsThe MLNR showed a predictive significance for the locoregional recurrence (P<0.05). Most recurrences were occurred in the lateral neck (n=12, 80%) with a median interval of 20 months. The lowest cutoff value of the MLNR for a meaningful separation of disease recurrence was 0.44 (hazard ratio, 8.86; 95% confidence interval, 1.49 to 52.58; P=0.001).ConclusionWhen the MLNR is higher than 0.44, there is an increased risk of locoregional recurrence mostly in the lateral neck. Therefore, MLNR of the central neck in a permanent or frozen biopsy may be helpful in decision making in the extent of thyroidectomy and/or the need for contralateral central neck lymph nodes dissection.

Effectiveness and safety of CT-guided 125I seed brachytherapy for postoperative locoregional recurrence in patients with non–small cell lung cancer

PurposeTo retrospectively evaluate the effectiveness and safety of CT-guided 125I seed brachytherapy (CTISB) in 38 non–small cell lung cancer (NSCLC) patients with locoregional recurrence (LRR). Methods and MaterialsIn total, we analyzed 38 NSCLC patients with LRR treated with percutaneous CTISB in our hospital between 2001 and 2008; among them, 15 also received combined chemotherapy: 1–6 cycles (median, 2) of platinum-based regimens. The change in tumor volume was evaluated based on followup contrast material-enhanced CT or positron emission tomography scans. ResultsThe median Day 0 dosimetry was as follows: The volume treated with the prescription dose (V100) was 96.3% (90.1–123.5%), and the minimum dose received by at least 90% of the tumor volume (D90) was 124.8 Gy (116.0–130.7 Gy). The median duration of the followup period calculated from the first CTISB treatment was 22.5 months (range, 8–98 months). Two months after CTISB, complete response, partial response, and progressive disease were observed in 50%, 37%, and 8% of patients, respectively. Median overall survival (OS) after CTISB was 21 months (95% confidence interval, 7.4–34.6), and the rates of 2-year OS, progression-free survival, and local control were 47.4%, 39.5%, and 83.5%, respectively. Both univariate and multivariate analysis indicated that D90 was significant prognostic factors for OS and progression-free survival. ConclusionFor selected NSCLC patients with limited LRR, CTISB is effective and can provide a high rate of local cancer control with minimal trauma.

Patterns and predictors of locoregional recurrence following neoadjuvant chemoradiation for esophageal cancer.

173 Background: Despite neoadjuvant chemoradiation (nCRT) followed by esophagectomy for locally advanced esophageal cancer, locoregional recurrences (LRR) are common. Specific risk factors for LRR have yet to be identified. Methods: Patients with esophageal cancer who were treated with nCRT and esophagectomy were identified from a single institution, prospectively maintained database(1996-2013). Timing and locations of recurrences were described and predicting factors of LRR were analyzed. Results: Out of 456 patients treated with nCRT for esophageal cancer, 167 patients developed known recurrence. Locoregional and distant recurrences were observed in 69(15.1%) and 140(30.9%) patients, respectively. Median recurrence-free survival was 38.5 months with a median follow-up of 30.4 months. Sixty-eight patients(40.7%) developed recurrence at multiple sites. The median time to recurrence was 13.5 months and survival following recurrence was only 8.0 months in the 27 patients(16.2%) with solitary LRR. Overall survival in patients with solitary LLR was 23.6 months, compared to 20.8 months in all patients who developed distant recurrence. Univariate analysis identified lymph node ratio &gt; 0.5(OR 2.42, p = 0.030), non-complete pathologic response(OR 1.90, p = 0.022), positive margins(OR 3.58, p = 0.028) and lymphovascular invasion(OR 2.82, p = 0.001) as significant predicting factors for LRR. While perineural invasion(p = 0.055), nodal stage(0.053) and use of adjuvant therapy(p = 0.060) approached significance, other factors such as tumor stage, type of surgery (Ivor-Lewis vs transhiatal), radiation dose and use of IMRT were not significant predictors of LRR. Only lymphovascular invasion was an independent predictor of LRR. Conclusions: Prognosis following LRR in patients with esophageal cancer treated with nCRT is poor but is better than in patients who develop distant recurrence. High lymph node ratio, positive margin status, non-complete pathologic response and the presence of lymphovascular invasion are predictive of LRR following nCRT for esophageal cancer.

Impact of microscopic extra-nodal extension (ENE) on locoregional recurrence following curative surgery for papillary thyroid carcinoma.

The presence of microscopic extra-nodal extension (ENE) may increase locoregional recurrence (LRR) in papillary thyroid carcinoma (PTC). We aimed to evaluate the association between microscopic ENE, response to initial therapy and LRR risk following total thyroidectomy, therapeutic neck dissection, and radioactive iodine (RAI) ablation in PTC. Of the 369 eligible PTC patients, 264 (71.5%) did not have microscopic ENE (group I) while 105 (28.5%) did (group II). All presented with clinical nodal metastasis (cN1) and underwent therapeutic neck dissection and RAI ablation. Biochemical incompleteness meant post-ablation stimulated thyroglobulin (sTg) >10 ng/ml. Multivariate analyses were conducted to identify independent factors for LRR. Biochemical incompleteness was significantly more common group II (43.8% vs. 17.4%, P < 0.05). The 10-year locoregional free-survival was significantly worse in group II than I (52.0% vs. 86.2%, P = 0.005). After adjusting for other significant factors, age <45 (P < 0.05), multifocality (P < 0.05), presence of ENE (P = 0.027) were independent risk factors of LRR. The number and size of positive lymph nodes were not independent factors. Patients with microscopic ENE were significantly more likely to have biochemical incompleteness after initial therapy. After adjusting for other significant primary and nodal characteristics, microscopic ENE was an independent factor for LRR in patients with cN1. J. Surg. Oncol. 2016;113:526-531. © 2016 Wiley Periodicals, Inc.

326P Tumor heterogeneity in 18F-FDG PET/CT as a biomarker for prediction of treatment response and locoregional recurrence in patients with pharyngeal cancer treated with chemoradiotherapy

326P Tumor heterogeneity in 18F-FDG PET/CT as a biomarker for prediction of treatment response and locoregional recurrence in patients with pharyngeal cancer treated with chemoradiotherapy

Revision of margins under frozen section in oral cancer: a retrospective study of involved margins in pT1 and pT2 oral cancers

Operative assessment of the resection margins by frozen section is routine in many hospitals, but the usefulness of the technique relies on its sensitivity, specificity, sampling errors, and errors associated with relocation of involved margins. Its usefulness is indicated by assessment of overall survival and locoregional recurrence in patients whose margins were initially involved but were successfully revised after frozen section compared with those of the patients whose initially-involved margins were not revised. Patients with consecutive primary pT1, pT2 oral squamous cell carcinoma in whom initial resection resulted in involved margins were selected from the patients treated during the period January 2010 to December 2011 at a tertiary cancer hospital in India. The outcome of patients whose revision of margins after frozen section was successful was compared with that of patients who had “false negative” results after frozen section. Sixty-eight patients had involved margins after initial resection, of whom 42 (62%) had successful revision after frozen section (clear margins group). The remaining 26 patients (38%) had “false negative” results on frozen section, and had no further revision (invaded margins group). Local recurrence was more common in the invaded margins group, although not significantly so in this short retrospective series (p=0.08). The risk of death was greater in patients with local recurrence, hazard ratio (HR) 4.74 (95% CI 1.79 to 12.61, p=0.002). However, overall survival (p=0.073), incidence of locoregional recurrence (p=0.59) and neck recurrence (p=1.0), did not differ significantly between the groups.

Progress in the surgical management of breast cancer: Present and future

Recognition of differing risks of locoregional recurrence (LRR) in breast cancer patients based on estrogen receptor, progesterone receptor, and HER2 status, coupled with a reduction in LRR in patients receiving adjuvant systemic therapy, offers the opportunity to tailor surgical treatment and reduce the morbidity of therapy. New guidelines for margins in breast-conserving therapy of tumor not touching ink and avoidance of axillary dissection in sentinel node positive patients undergoing breast-conserving therapy are examples of this approach which have entered practice. Increased use of neoadjuvant therapy offers the opportunity to identify which patients are responsive to chemotherapy prior to surgery, potentially allowing further tailoring of treatment, and ongoing clinical trials will address the question of the extent of axillary surgery and radiotherapy after neoadjuvant therapy in patients with and without pathologic complete response.

PTH-336 Effects of lower doses of dca on radiosensitisation of colorectal cancer cells in vitro

Introduction Neoadjuvant radiotherapy confers a well-established benefit in locoregional recurrence for patients with locally invasive rectal cancer. However, only around 50% experience significant downstaging of their tumour. Radiation-associated toxicity renders dose escalation unachievable. Dichloroacetate (DCA) is a generic drug shown to modify tumour metabolism reversing the Warburg effect and inducing apoptosis and may potentially enhance the effect of radiation. This study aimed to investigate the effects of DCA at lower doses in combination with radiotherapy on the survival of CRC cell lines, and any possible synergistic DNA damage. Method CRC cells (LoVo) and control cells (HEK 293) treated with DCA (2,5,10 mM) and irradiation (0,4,8 Gy). Influences of the combination treatment on cell survival were analysed using MTT assays and clonogenic assays and the induction of DNA damage by quantifying gamma-H2AX foci. Statistical analyses were performed using GraphPad, differences between DCA-treated and vehicle control groups were assessed using the Mann-Whitney U test. Results DCA (5 mM) significantly reduced the survival of CRC cells in combination with 4 Gy and 8 Gy (P = 0.0244, 0.0078, respectively). DCA (10 mM) significantly reduced survival of CRC cells in in combination with 4 Gy and 8 Gy (P DCA (5 mM) significantly increased the mean number of DNA double-strand breaks (DSB) per CRC cell in combination with 4 Gy and 8 Gy (P = 0.0041, 0.023, respectively). In unirradiated CRC cells, all the DCA doses (2, 5, 10 mM) significantly increased the mean number of DSB’s per CRC cell (P Conclusion Lower doses of DCA may have an additive killing effect in combination with radiation in CRC cells. A similar picture of sensitivity was seen in normal cell line demonstrating that DCA is not completely harmless. Increasing doses of DCA associated with increased levels of DSB’s in CRC cells and it may be a potential mechanism behind DCA. Further research is warranted exploring the mechanism behind the effects of DCA and as a potential adjunct in the management of rectal cancers. Disclosure of interest None Declared.

The Impact of Preoperative Radiation Therapy on Locoregional Recurrence in Patients with Stage IV Rectal Cancer Treated with Definitive Surgical Resection and Contemporary Chemotherapy

PurposeDefinitive resection of primary rectal cancers is frequently incorporated, with or without preoperative radiotherapy and perioperative chemotherapy, in the management of selected patients with metastatic rectal adenocarcinoma. This study reviews the impact of preoperative radiotherapy and perioperative chemotherapy on locoregional recurrence and overall survival in these patients. Methods and MaterialsThis retrospective study with an Institutional Review Board (IRB) waiver included 109 patients with metastatic rectal adenocarcinoma who underwent definitive primary resection between 1998 and 2011. In addition to resection, 64 patients were treated with preoperative radiotherapy and perioperative chemotherapy and 45 patients were treated with perioperative chemotherapy alone. Radiotherapy dose was typically 50.4 Gy. Baseline variables were compared using chi-square and unpaired t tests. Overall survival was calculated using Kaplan-Meier method. Univariate and multivariate analyses were performed using Cox proportional hazards regression. ResultsThere were no significant baseline differences between the two groups. There was no significant difference in locoregional recurrence (10.9 vs. 11.1 %; p = 0.90) or overall survival (34.5 vs. 34.8 months; p = 0.89) for patients treated with preoperative radiotherapy compared to those treated with perioperative chemotherapy alone, respectively. Patients who underwent radiotherapy were less likely to have a positive margin (10.9 vs. 20.0 %; p = 0.19), lymphovascular invasion (32.8 vs. 53.3 %; p = 0.03), and pathologic stage N2 disease (25.0 vs. 42.2 %; p = 0.02). Grade 2 postoperative complications were more common in the preoperative radiotherapy group (32.8 vs. 15.6 %; p = 0.04). Multivariate analysis demonstrated that patients with poorly differentiated tumors (HR 2.19; p = 0.009) and those that did not undergo liver-directed therapy (HR 2.20; p = 0.005) had inferior survival. ConclusionsLocoregional recurrence is modest in patients with metastatic rectal adenocarcinoma receiving definitive primary resection, irrespective of the use of radiotherapy. Preoperative radiotherapy may enhance pathologic downstaging at the expense of increased grade 2 postoperative complications. Its use should be reserved for patients at high risk for locoregional recurrence.

Progesterone receptor status and clinical outcome in breast cancer patients with estrogen receptor-positive locoregional recurrence.

The aim of this retrospective multicenter study was to evaluate the impact of progesterone receptor (PgR) loss on locoregional recurrence in patients with estrogen receptor (ER)-positive primary breast cancer and ER-positive locoregional recurrence. Eight Italian oncology centers collected data from consecutive patients with ER-positive breast cancer and a subsequent ER-positive locoregional recurrence. Data were available for 265 patients diagnosed with breast cancer between 1990 and 2009. Median metastasis-free survival was 111 months in patients with PgR-positive primary tumors and locoregional recurrence (PgRpos), 38 months in patients with PgR-negative primary tumors and locoregional recurrence (PgRneg), and 63months in patients with PgR-positive primary tumors and PgR-negative locoregional recurrence (PgRloss). In multivariate analysis, PgR status was independently associated with metastasis-free survival, with a hazard ratio of 2.84 (95% CI 1.34-6.00) for PgRneg compared with PgRpos, and 2.93 (95% CI: 1.51-5.70) for PgRloss compared with PgRpos. PgR absence was found to be a negative prognostic factor in breast cancer patients with ER-positive locoregional recurrence. Thus, PgR status could be a biological marker in ER-positive recurrent breast cancer.