Patterns Of Local-regional Failure Research Articles

Patterns of Local-Regional Failure (LRF) in Completely Resected pⅢA-N2 Non-Small Cell Lung Cancer (NSCLC) after Adjuvant Chemotherapy and Postoperative Radiotherapy (PORT)

Patterns of Local-Regional Failure (LRF) in Completely Resected pⅢA-N2 Non-Small Cell Lung Cancer (NSCLC) after Adjuvant Chemotherapy and Postoperative Radiotherapy (PORT)

Patterns of Local-Regional Failure in Completely Resectable IIIA-N2 Non-Small Cell Lung Cancer: Implications for Postoperative Radiation Target Volumes Design

This study aimed to analyze patterns of local-regional failure (LRF) in completely resected pIIIA-N2 non-small cell lung cancer (NSCLC) to guide the design of target volumes for postoperative radiotherapy (PORT). From Jan. 2003 to Jan. 2015, consecutive patients with pIIIA-N2 NSCLC who had undergone complete resection with or without adjuvant chemotherapy in our hospital were retrospectively reviewed. Those who had received no PORT, with margin-negative resection and exact failure patterns were included in this study. Patterns were constructed to illustrate sites of first failure on the basis of the location of primary tumor. The clinicopathological factors related to LRF were assessed. With a median follow-up of 27 months, 554 of 1024 patients (54.1%) experienced treatment failure. Of the 233 patients with LRF as the first event, the most frequent site of LRF was the ipsilateral lymph node station 4 (16.3%), followed by lymph node station 7 (10.8%), ipsilateral lymph node station 2 (10.7%) and bronchial stump (9.5%). For left-sided lung cancer, the most common LRF site was 4L (13.8%), followed by 4R (12.2%), bronchial stump (11.4%), 7 (10.3%) and 6 (9.4%). For right-sided lung cancer, the most common site was 4R (18.2%), followed by 2R (15.3%), 7 (11.0%), right supraclavicular fossa (10.1%) and bronchial stump (8.1%). Patients with squamous cell carcinoma were more likely to experience bronchial stump recurrence than those with non-squamous cell carcinoma (35.5% vs. 19.1%, p=0.006). While, the patterns of failure in the hilum, mediastinum and supraclavicular fossa did not differ significantly between squamous cell carcinoma and non-squamous cell carcinoma. Patients with preoperative cN2 were more likely to have recurrence of the contralateral hilum than those with cN0-1 (7.4% vs. 1.0%, p=0.03). No difference in patterns of LRF was observed among T1, T2 and T3. Adjuvant chemotherapy had no significant impact on patterns of LRF. For patients with completely resected pIIIA-N2 NSCLC, the ipsilateral lymph node station 4, 7, 2 and bronchial stump are the most common LRF sites. Besides, LRF of 4R and 6 for left-lung cancer and contralateral hilum for cN2 disease is more common, which should also be included in PORT.

Patterns of Local-Regional Failure After Intensity Modulated Radiation Therapy or Passive Scattering Proton Therapy With Concurrent Chemotherapy for Non-Small Cell Lung Cancer

We compared differences in patterns of locoregional failure, and the influence of adaptive planning on those patterns, in patients who received passive scattering proton therapy (PSPT) versus intensity modulated photon therapy (IMRT) for non-small cell lung cancer. Treatment simulation computed tomography scans and dose distributions were registered with images depicting the recurrence. Local failure (LF) was defined as failure within the internal target volume (ITV); marginal failure (MF) as failure between the ITV and planning target volume (PTV) plus a 10-mm margin (PTV+10mm); and regional failure (RF) as outside the PTV+10mm. Weekly during-treatment 4-dimensional computed tomography simulation and verification plans were obtained for all patients. Adaptive plans were developed if the verification plan showed deviations in protocol-specified dose distribution, and failure locations were recorded for those patients as well. Of the 212 patients analyzed, most (152 [72%]) had no failure; of the 60 patients with failure, 27 (45%) had LF (within the ITV), 23 (38%) had MF (between the ITV and PTV+10mm), and 10 (17%) had RF (>10mm outside the PTV). MF rates were no different for IMRT patients (16 of 136 [12%]) or PSPT patients (7 of 76 [9%], log-rank P=.558). The only independent predictor of MF on Cox proportional hazards analysis was T3-4 status. Large tumors and use of PSPT independently predicted the need for adaptive planning. Although 5-year overall survival rates were poorer for patients with large tumors versus small tumors (P<.001), the rates were similar for patients with large tumors who received adaptive planning versus small tumors. No differences in LF, MF, or RF patterns were found for IMRT versus PSPT. Proton therapy more often required adaptive planning, and the techniques used for adaptive planning did not compromise tumor control. Response to chemoradiation by larger tumors predicted favorable survival.

Patterns of local-regional failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma

Objective To investigate the dosimetric patterns of local-regional after intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC), and to provide a clinical basis for further improvement in the therapeutic effect for NPC. Methods The patterns of local-regional in 364 previously untreated NPC patients without distant metastasis who were admitted to our hospital from December 2007 to April 2012 were analyzed. The failures were classified as failure if Vrecur within the 95% isodose curve (V95%) was ≥95%, failure if V95% was less than 95% and not less than 20%, or failure if V95% was<20%. The Kaplan-Meier method was used to calculate survival rates. Results The median follow-up was 40 months (range 3-84 months). The 3-year local failure-free survival, regional failure-free survival, distant metastasis-free survival, overall survival, and progression-free survival were 94.1%, 95.4%, 86.5%, 90.9%, and 78.7%, respectively. A total of 35 patients experienced local-regional recurrence, and in-field recurrence, marginal recurrence, and out-field accounted for 81.1%, 8.1%, and 10.8%, respectively. Conclusions In-field failures are the main dosimetric patterns of local-regional recurrence after IMRT for NPC, suggesting that radiation resistance of tumor cells is an important reason for local-regional failure. Key words: Nasopharyngeal neoplasms/intensity-modulated radiotherapy; Recurrence; Patterns of local-regional failure; Dosimetric analysis

Patterns of Local-Regional Failure in Completely Resected Stage IIIA(N2) Non-Small Cell Lung Cancer Cases: Implications for Postoperative Radiation Therapy Clinical Target Volume Design

To analyze patterns of local-regional failure (LRF) for completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) patients treated in our hospital and to propose a clinical target volume (CTV) for postoperative radiation therapy (PORT) in these patients. From 2005 to 2011, consecutive patients with pT1-3N2 NSCLC who underwent complete resection in our hospital but who did not receive PORT were identified. The patterns of first LRF were assessed and evaluated as to whether these areas would be encompassed by our proposed PORT CTV. With a median follow-up of 24 months, 173 of 250 patients (69.2%) experienced disease recurrence. Of the 54 patients with LRF as the first event, 48 (89%) had recurrence within the proposed PORT CTV, and 6 (11%) had failures occurring both within and outside the proposed CTV (all of which occurred in patients with right-lung cancer). Ninety-three percent of failure sites (104 of 112) would have been contained within the proposed PORT CTV. For left-sided lung cancer, the most common lymph node station failure site was 4R, followed by 7, 4L, 6, 10L, and 5. For right-sided lung cancer, the most common site was station 2R, followed by 10R, 4R, and 7. LRF following complete surgery was an important and potentially preventable pattern of failure in stage IIIA(N2) patients. Ipsilateral superior mediastinal recurrences dominated for right-sided tumors, whereas left-sided tumors frequently involved the bilateral superior mediastinum. Most of the LRF sites would have been covered by the proposed PORT CTV. A prospective investigation of patterns of failure after PORT (following our proposed CTV delineation guideline) is presently underway and will be reported in a separate analysis.

Patterns of Local-Regional Failure in Completely Resected Stage IIIa (N2) Non-Small Cell Lung Cancer Patients: Implications for Postoperative Radiation Therapy Target Volumes

There is a need to evaluate the mediastinal nodal involvement risk based on primary location of tumors and standardize the clinical target volume (CTV) for postoperative radiation therapy (PORT) in completely resected stage N2 patients. Thus we reviewed patterns of locoregional failure for completely resected stage IIIa (N2) patients and examined whether they were consistent with the proposed PORT fields.

Patterns of failure following trimodality therapy for locally advanced esophageal cancer (EC).

88 Background: Patterns of local-regional failure (LRF) after neoadjuvant chemoradiotherapy (CRT) and surgery for locally-advanced EC are poorly defined. Methods: This study reviewed pts treated with CRT followed by surgery for M0 esophageal cancer from 1995-2009. Staging and regional nodes (supraclavicular (SCV) through celiac) were defined based on AJCC 7th edition. Patterns of first failure were analyzed. LRF included: 1) initially involved nodal failure (INF), 2) initially uninvolved (subclinical) nodal failure (SNF), and/or 3) anastomotic. Abdominal para-aortic failure (PAF) at or below the superior mesenteric artery was scored separately. Isolated SNF or PAF was defined as no other local or distant failure. Actuarial local-regional control (LRC), event-free survival (EFS), and overall survival (OS) were estimated by the Kaplan-Meier method. Results: 156 patients were identified with a median age of 60 years. Primary location was upper in 1%, middle 17%, lower 32% and gastroesophageal junction (GEJ) 50% (Adeno: 79%; SCC: 21%). Staging included EUS (73%), CT (46%), and/or PET/CT (54%). 40% had stage II and 60% stage III disease. Concurrent CRT was primarily cisplatin/taxane and/or 5-FU-based. Primary RT fields (median dose: 45Gy) encompassed the tumor with an approximate 5 cm proximal and distal margin and included standard regional nodes. Boost fields (median total dose: 50.4Gy) encompassed gross disease with a 2 cm margin. Surgical technique was transhiatial (28%), Ivor-Lewis (47%), or tri-incisional (25%) with a median of 8 nodes dissected. Median f/u was 1.3 years. 2-yr LRC, EFS, and OS were 83%, 36%, and 49%. 2-yr SNF was 15% (n=14); anastomotic failure was 7% (n=7). SNFs were SCV (n=5), mediastinal (n=12), and/or celiac (n=3). 95% of SNFs were outside or near the margin of the primary RT fields. 2-yr isolated SNF was 3% (n=3), PAF was 11% (n=9), and isolated PAF 6% (n=5). Conclusions: SNF is the most common type of LRF after tri-modality therapy for locally-advanced EC. A limited subset of patients experience isolated SNF or PAF as first disease recurrence. The potential benefit of targeting additional SN or PA regions with RT is small and likely eclipsed by high rates of distant failure.

Involved-field radiotherapy for patients with limited small cell lung cancer: Patterns of local-regional failure and feasibility

7554 Background: To investigate the feasibility of the involved-field radiotherapy in patients with limited-stage small cell lung cancer (LSCLC) according to the patterns of local failure, focused on the first local-regional failure. Methods: Two clinical phase II studies for patients with LSCLC treated at our institute between 1997 and 2007 were reviewed. All patients received combined chemotherapy (CHT) with cisplatin and etoposide, and thoracic RT (TRT) was generally delivered sequentially following one to three cycles of CHT and consisted of either 56 Gy in 40 fractions for 4 weeks or 55 Gy in 22 fractions for 4–5 weeks. TRT fields encompassed primary tumor volume (post-CHT) and the involved nodal areas (pre- and post-CHT) without elective node irradiation. The local-regional failure was defined as failure within thoracic cavity and supraclavicular fossa except for pleural effusion, which was then divided into two subtypes: in-field and out-field failure according to the first occurred site in the planning target volume or not. Results: There were 89 patients completed the planed regimen and eligible for evaluating patterns of failure, 54 patients (57%) in 56 Gy cohort and 35 patients(43%) in 55 Gy cohort. The media cycles of CHT were 6 (4–8). The overall survival and local progression-free survival rates for 89 patients at 2 years were 56% and 71%, respectively, with a median survival of 25.6 months. 56 patients (63%) developed distant metastases and 21 patients (24%) developed local-regional failures: 12 in-field and 9 out-field. 8 out of 9 out-field failures occurred in the ipsilateral supraclavicular fossa, and the media duration to the end of TRT was 6 mouths (5–14). Comparing the 56 Gy and 55 Gy cohorts, the rates of any thoracic, in-field and out-field failures were no difference significantly. Conclusions: Thoracic radiotherapy using involved-field technique in patients with LSCLC resulted in a high failure rate of the supraclavicular fossa. Whether improving accuracy for the initial evaluation of clinical stage could reduce out-field failure in supraclavicular fossa need to be investigated. No significant financial relationships to disclose.

Patterns of local regional failure in head and neck cancer treated with IMRT

Patterns of local regional failure in head and neck cancer treated with IMRT

11 Patterns of local-regional failure following parotid sparing conformal and multisegmental intensity modulated radiotherapy for head and neck cancer

11 Patterns of local-regional failure following parotid sparing conformal and multisegmental intensity modulated radiotherapy for head and neck cancer