Postoperative Chemoradiotherapy Group Research Articles

The management of metastatic neck nodes following induction chemotherapy in N2/3 classification hypopharyngeal carcinoma.

For patients with less chemosensitive neck nodes, poor prognosis after chemoradiotherapy (CRT) could be predicted and neck dissection is needed. Ninety-two N2/3 hypopharyngeal carcinoma patients were retrospectively studied. According to response after induction chemotherapy (ICT), patients were treated with neck dissection followed by concurrent CRT (CCRT) (group 1), surgery plus postoperative CRT (group 2), or CCRT for primary and regional sites (group 3). Overall survival and disease-free survival rates of group 1 were significantly higher than group 2 (p=0.038, p=0.031) and group 3 (both p=0.018). Regional control rate of group 1 was significantly higher than group 3 (p=0.041). There were no significant differences between groups 1 and 2 regarding local and regional control (p=0.746, p=0.302). Neck dissection followed by CCRT is the best choice for patients with responsive primary but nonresponsive nodes.

Impact of neoadjuvant chemoradiotherapy on the local recurrence and distant metastasis pattern of locally advanced rectal cancer: a propensity score-matched analysis.

Background:Previous studies have demonstrated different predominant sites of distant metastasis between patients with and without neoadjuvant chemoradiotherapy (NCRT). This study aimed to explore whether NCRT could influence the metastasis pattern of rectal cancer through a propensity score-matched analysis.Methods:In total, 1296 patients with NCRT or post-operative chemoradiotherapy (PCRT) were enrolled in this study between January 2008 and December 2015. Propensity score matching was used to correct for differences in baseline characteristics between the two groups. After propensity score matching, the metastasis pattern, including metastasis sites and timing, was compared and analyzed.Results:After propensity score matching, there were 408 patients in the PCRT group and 245 patients in the NCRT group. NCRT significantly reduced local recurrence (4.1% vs. 10.3%, P = 0.004), but not distant metastases (28.2% vs. 27.9%, P = 0.924) compared with PCRT. In both the NCRT and PCRT groups, the most common metastasis site was the lung, followed by the liver. The NCRT group developed local recurrence and distant metastases later than the PCRT group (median time: 29.2 [18.8, 52.0] months vs. 18.7 [13.3, 30.0] months, Z = –2.342, P = 0.019; and 21.2 [12.2, 33.8] vs. 16.4 [9.3, 27.9] months, Z = –1.765, P = 0.035, respectively). The distant metastases occurred mainly in the 2nd year after surgery in both the PCRT group (39/114, 34.2%) and NCRT group (21/69, 30.4%). However, 20.3% (14/69) of the distant metastases appeared in the 3rd year in the NCRT group, while this number was only 13.2% (15/114) in the PCRT group.Conclusions:The predominant site of distant metastases was the lung, followed by the liver, for both the NCRT group and PCRT group. NCRT did not influence the predominant site of distant metastases, but the NCRT group developed local recurrence and distant metastases later than the PCRT group. The follow-up strategy for patients with NCRT should be adjusted and a longer intensive follow-up is needed.

Neoadjuvant versus Postoperative Chemoradiotherapy is Associated with Improved Survival for Patients with Resectable Gastric and Gastroesophageal Cancer

The optimal timing of chemoradiotherapy (CRT) for patients with localized gastric cancer remains unclear. This study aimed to compare the survival outcomes between neoadjuvant and postoperative CRT for patients with gastric and gastroesophageal junction (GEJ) cancer. This retrospective study analyzed 152 patients with gastric (42%) or GEJ (58%) adenocarcinoma who underwent definitive surgical resection and received either neoadjuvant or postoperative CRT between 2005 and 2017 at the authors' institution. The primary end point of the study was overall survival (OS). The median follow-up period was 37.5months. Neoadjuvant CRT was performed for 102patients (67%) and postoperative CRT for 50 patients (33%). The patients who received neoadjuvant CRT were more likely to be male and to have a GEJ tumor, positive lymph nodes, and a higher clinical stage. The median radiotherapy (RT) dose was 50.4Gy for neoadjuvant RT and 45.0Gy for postoperative RT (p<0.001). The neoadjuvant CRT group had a pathologic complete response (pCR) rate of 26% and a greater rate of R0 resection than the postoperative CRT group (95% vs. 76%; p=0.002). Neoadjuvant versus postoperative CRT was associated with a lower rate of any grade 3+ toxicity (10% vs. 54%; p<0.001). The multivariable analysis of OS showed lower hazards of death to be independently associated neoadjuvant versus postoperative CRT (hazard ratio [HR] 0.57; 95% confidence interval [CI] 0.36-0.91; p=0.020) and R0 resection (HR 0.50; 95% CI 0.27-0.90; p=0.021). Neoadjuvant CRT was associated with a longer OS, a higher rate of R0 resection, and a lower treatment-related toxicity than postoperative CRT. The findings suggest that neoadjuvant CRT is superior to postoperative CRT in the treatment of gastric and GEJ cancer.

Re-evaluation of controversial issues in the treatment of cT3N0-2 rectal cancer: a 10-year cohort analysis using propensity-score matching

Although neoadjuvant treatment is thought to provide optimal local control for stage II and III rectal cancers, many patients have been reported cured by total mesorectal excision (TME), alone or with additional chemotherapy (CTX). This study retrospectively evaluated outcomes in 2643 patients with cT3N0-2 rectal cancers undergoing curative TME during 2005-2015. Recurrence and survival outcomes were measured in three propensity-score matched groups, consisting of patients who underwent preoperative chemoradiotherapy (CRT) with postoperative CTX (NAPOC), postoperative CRT (POCRT), and exclusively postoperative CTX (EPOCT). Near-complete or complete TME was conducted in more than 95.9% of patients and 80% of scheduled dose of postoperative CTX was completed in 99%. Except for higher SR rate in the POCRT group than the NAPOC group (p = 0.008), 5-year cumulative local and systemic recurrence (LR and SR) rates were 4.9% and 15.2% for cT3N0, and 4.2% and 21% for cT3N1-2 patients (LR, p = 0.703; SR, 0.065), respectively, with no significant differences associated with treatment exposure (p = 0.11-1). The 5-year cumulative disease-free (75.6% vs 65.7%, p = 0.018) and overall survival (87.1% vs 79.4%, p = 0.018 each) rates were higher in the NAPOC group than the POCRT group with cT3N1-2. However, any significant survival differences were not identified between the NAPOC and EPOCT groups according to tumor sub-stages or locations (p = 0.395-0.971). We found any treatment modalities including competent TME and postoperative adjuvant CTX efficiently reducing LR generating robust survival outcome in the propensity-matched cohorts, demanding further randomized controlled trials by clinical sub-stages II-III.

Adjuvant chemoradiotherapy for patients with pathologic node-positive esophageal cancer following radical resection is associated with improved survival.

BackgroundDepending on the pathological stage, patients with esophageal squamous cell carcinoma (ESCC) can experience poor prognosis after surgery. This study was designed to analyze the effect of various treatments on prognosis in pathologic node-positive esophageal cancer patients who undergo radical surgery.MethodsWe evaluated 210 pathologic stage IIb–IIIc patients (pT1-4aN + M0) who had undergone esophagectomy for thoracic ESCC from January 2013 to October 2015 at our institute. Surgery alone was applied in 65 patients, postoperative chemotherapy alone was applied in 112 patients, and postoperative adjuvant chemoradiotherapy was applied in 33 patients. Kaplan­-Meier and Cox regression analysis were used to compare overall survival (OS) and disease-free survival (DFS). A nomogram was constructed to visualize the multivariate Cox regression analysis model.ResultsThe median follow-up period was 49.4 months. The 3- and 5-year OS rates of the patients in the surgery group, postoperative chemotherapy group, postoperative chemoradiotherapy group were 55.4%, 61.6%, and 75.8%, and 30.1%, 44.0%, and 63.0% respectively. The 3- and 5-year DFS rates of the patients in the surgery group, postoperative chemotherapy group, postoperative chemoradiotherapy group were 44.6%, 52.7%, and 72.7%, and 20.0%, 24.1%, and 39.4%, respectively. Both the OS and DFS of the patients in the postoperative chemoradiotherapy group were better than those of the patients in the surgery and postoperative chemotherapy group. Among them, the OS of the postoperative radiotherapy group was longer than that of the surgery group (P=0.011) and the postoperative chemotherapy group (P=0.190), while the DFS of postoperative chemoradiotherapy group was longer than that of the surgery group and postoperative chemotherapy group, but the difference was not statistically significant (P>0.05).ConclusionsThis study showed that postoperative adjuvant chemoradiotherapy could improve 3-year OS and DFS compared with treatment using surgery alone or postoperative chemotherapy alone. However, an evaluation of long-term prognosis requires a longer follow-up.

Preoperative Chemoradiotherapy Versus Postoperative Chemoradiotherapy for Patients With Locally Advanced Gastric Cancer: A Retrospective Study Based on Propensity Score Analyses.

PurposeAlthough adjuvant chemoradiotherapy (CRT) used to be recommended as a standard of care for locally advanced gastric cancer, this suggestion has been strongly challenged recently. However, clear evidence regarding the optimization of radiotherapy is lacking. The purpose of this study was to compare the effectiveness of preoperative CRT versus that of postoperative CRT for resectable or potentially resectable gastric cancer.MethodsFrom January 2005 to December 2017, patients with clinical stage III/IVa (i.e., T3-4aN+M0 or T4bNxM0) locally advanced gastric cancer were retrospectively identified. Survival after preoperative CRT and postoperative CRT was assessed by unadjusted, propensity score matching (PSM) and inverse probability of treatment weight (IPTW) analyses. Moreover, exploratory subgroup analyses were performed, and toxicity and patterns of failure were also investigated.ResultsThe median follow-up time was 32.5 months. A total of 82 and 463 patients were enrolled in the preoperative and postoperative CRT groups, respectively. After propensity score matching, preoperative CRT was associated with improved overall survival (OS) and disease-free survival (DFS) compared with postoperative CRT (3-year OS: 72.6 vs. 54.4%, log-rank p = 0.0021; 3-year DFS: 61.7 vs. 44.7%, log-rank p = 0.002). The unadjusted and IPTW analyses yielded consistent results. A complete pathologic response was achieved in 13.4% of the preoperative CRT group. Although the incidence of grade 3 or 4 adverse effects and surgical complications were similar between the two groups, significantly fewer patients experienced treatment interruptions or dose reductions due to toxic effects in the preoperative CRT setting than in the postoperative CRT setting (3.7 vs. 10.6%, p = 0.049).ConclusionsCompared with postoperative CRT, preoperative CRT was associated with improved OS and DFS, superior treatment compliance and comparable surgical complications for patients with locally advanced gastric cancer. Our findings provide important evidence for the optimal combination modalities of surgery and CRT in the absence of randomized clinical data.

Postoperative Concurrent Chemoradiotherapy versus Postoperative Radiotherapy Alone for Larynx Squamous Cell Carcinoma Patients with Lymphovascular Invasion: A Propensity Score Matching Study.

PurposeTo date, no guidelines have been proposed for the ideal treatment of postoperative larynx squamous cell carcinoma (LSCC) patients with lymphovascular invasion due to a lack of similar studies. The present study was conducted to compare the survival and toxicity in LSCC patients with lymphovascular invasion receiving either postoperative radiotherapy (PORT) or postoperative chemoradiotherapy (POCRT). The results can be applied for more appropriate treatment of these patients.Patients and MethodsThree hundred eighty-eight eligible LSCC patients with lymphovascular invasion were enrolled in this retrospective study. Survival and treatment-related toxicities were compared in the POCRT and PORT group using propensity score matching (PSM) methodology (1:1).ResultsFive-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) of all patients were 48.7%, 58.2%, and 56.0%, respectively. Significantly, higher RFS rates (P=0.040) were found in the POCRT group than the PORT group in the PSM cohort. In the multivariate analysis, higher OS, DSS, and RFS rates were observed in the POCRT group than the PORT group (P=0.049, 0.024, and 0.011 respectively). Patients in the POCRT group presented more acute toxicities than those in the PORT group such as hematological toxicities (25.0% vs 0.9%, P<0.001) and mucositis (35.0% vs 19.1%, P=0.002).ConclusionIn the context of no ideal treatment for LSCC patients with lymphovascular invasion, the present study proposes POCRT as a preferable modality compared with PORT, as POCRT was associated with higher RFS rates. Higher RFS, DFS, and OS rates were also observed in the POCRT group in the multivariate analysis.

Postoperative chemoradiotherapy is superior to postoperative chemotherapy alone in squamous cell lung cancer patients with limited N2 lymph node metastasis

BackgroundThe aim of the present study was to assess the efficacy of postoperative chemoradiotherapy (POCRT) following surgery in non-small-cell lung cancer patients with N2 lymph node metastasis (N2-NSCLC).MethodsThe clinical data of patients with N2-NSCLC treated with POCRT or postoperative chemotherapy (pCT) alone were retrospectively collected and reviewed. The overall survival (OS) rates were analyzed utilizing the Kaplan-Meier method and compared by the log-rank test. Cox regression analysis was used to determine factors significantly associated with survival. Propensity score matching (PSM) analysis was used to compensate for differences in baseline characteristics and OS was compared after matching.ResultsBetween 2004 and 2014, a total of 175 patients fulfilled the inclusion criteria, 60 of whom were treated with POCRT, while 115 were administered pCT. The 1, 3 and 5-year OS rates in the POCRT and pCT groups were 98.3 vs. 86.1%, 71.7 vs. 53.0% and 45.7 vs. 39.0%, respectively (P = 0.019). Compared with pCT, POCRT improved OS in patients with squamous cell subtype (P = 0.010), no lymphovascular invasion (P = 0.006), pN2a (P = 0.006) or total number of metastatic lymph nodes ≤7 (P = 0.016). After PSM, these survival differences between POCRT and pCT remained significant in patients with squamous cell lung cancer (P = 0.010).ConclusionsPOCRT following complete resection may be beneficial for patients with squamous cell lung cancer, particularly those with limited nodal involvement.

EP1.18-09 Analysis of the Role of Postoperative Radiotherapy in Pathological N2 Non-Small Cell Lung Cancer with Propensity Score Matching

N2 non-small cell lung cancer (NSCLC) is a heterogeneous disease. For operable patients with postoperative N2 non-small cell lung cancer, the optimum adjuvant treatment strategy is still in dispute. Our aim was to assess the efficacy of conbine postoperative chemoradiotherapy (POCRT) or postoperative chemotherapy (PCT) alone following surgery in pathological N2 non-small cell lung cancer using propensity score matching, and to explore the factors influencing the prognosis. Between 2004 and 2014, a total of 175 patients fulfilled the inclusion criteria. The initiation of PCT started later than 2 weeks after the operation. The regimens of PCT in the present study included a cisplatin-based regimen and were administered for at least 2 cycles. POCRT was executed sequentially or sandwiched with PCT with three-dimensional conformal radiotherapy(3D-CRT) or intensity-modulated radiotherapy technique(IMRT). The prescription dose to clinical target volume (CTV) was 50 (range 44-60) Gy, Data were analyzed using SPSS version 24.0. Survival curves were produced using the Kaplan-Meier estimator method and compared with the log-rank test. Univariable and multivariable analyses of clinical characteristics. All available patient and tumor variables were compared using the χ2 test. Propensity score matching (PSM) analyses were used to compensate for differences in baseline characteristics between the POCRT and PCT groups to confirm the survival difference. The survival of the two groups was followed up and the effect of postoperative radiotherapy was analyzed. The median survival time was 57 vs 40 months in the POCRT and PCT groups, and the 1, 3 and 5-year OS rates in the POCRT and pCT groups were 98.3 vs. 86.1%, 71.7 vs.53.0% and 45.7 vs. 39.0%, respectively (P=0.019). Exploratory subgroup analysis found that compared with PCT, POCRT improved OS in patients with squamous cell subtype (P=0.010), no lymphovascular invasion (P=0.006), pN2a (P=0.006) or total number of metastatic lymph nodes ≤7 (P=0.016). Following PSM, a total of 113 events were identified in both the POCRT and PCT groups, with 60 and 53 patients in each group, respectively. There was no significant difference in the general clinical data between the two groups after matching. The median survival time was 57 vs 63 months in the POCRT and PCT groups after matching, and the 1, 3 and 5-year OS rates in the POCRT and PCT groups were 98.3 vs. 92.5%, 71.7 vs. 64.2% 和 45.7 vs. 50.7% respectively, with no significant difference (P=0.463). Following PSM, the survival differences between POCRT and PCT in the various subgroups were not statistically significant, except in patients with squamous cell lung cancer (P=0.010), there was also a trend toward an increase in the overall survival of pN2-NSCLC with pN2a (P = 0.196) or total number of metastatic lymph nodes ≤7 (P=0.367). Univariate and multivariate analyses indicated that T stage, total number of MLNs and POCRT were independent factors affecting OS. POCRT following complete resection clearly demonstrated superior survival compared with pCT. And POCRT may be specifically recommended to N2 patients with squamous cell lung cancer, particularly those with limited nodal involvement and T4 disease.

Are the indications for postoperative radiotherapy in the NCCN guidelines for patients with gastric adenocarcinoma too broad? A study based on the SEER database

BackgroundThe types of patients with gastric adenocarcinoma (GA) for whom postoperative radiotherapy can improve the disease-specific survival rate (DSS) remain controversial. This study aims to explore the ideal indications.MethodsPatients in the Surveillance, Epidemiology, and End Results (SEER) database with T3–4Nx or TxN+ GA from January 1988 to December 2012 were included and divided into a postoperative chemoradiotherapy group (Group R) and a postoperative chemotherapy group (Group C). We established a nomogram to predict DSS and then divided entire patient cohort into low-risk and high-risk groups based on the DSS predicted by the nomogram.ResultsThe Cox multiple regression analysis demonstrated that various risk factors affected DSS for Group R. Based on these risk factors, a nomogram for predicting DSS was established. The decision curve indicated that the best clinical effect could be obtained when the threshold probability was 0–58%. The patients were then divided into low-risk (< 69 points) and high-risk (≥ 69 points) groups according to the five-year DSS predicted. DSS was significantly better for Group R than for Group C for high-risk patients (P < 0.001) but was similar for low-risk patients (P = 0.732).ConclusionAt present, the National Comprehensive Cancer Network (NCCN) guidelines may include an overly broad range of indications for postoperative radiotherapy for patients with GA. For intestinal GA patients with a postoperative pathologic stage of T1 N1 who are younger than 65 years, have had more than 15 lymph nodes dissected, and have received postoperative chemotherapy, postoperative radiotherapy should not be recommended.

Sarcopenia is poor prognostic factor in older patients with locally advanced rectal cancer who received preoperative or postoperative chemoradiotherapy.

Sarcopenia is associated with low muscle mass and low physical performance. Here, we performed to evaluate the sarcopenia as prognostic factor and treatment outcomes in older patients with locally advanced rectal cancer (LARC) who received preoperative or postoperative chemoradiotherapy (CRT).LARC patients aged ≥65 years who received either preoperative or postoperative CRT were analyzed retrospectively. Preoperative or postoperative CRT consisted of 50.4 Gy and fluoropyrimidine. Surgery was performed at 6 weeks after CRT completion. Postoperative CRT was performed at 4 weeks after surgery. One month after surgery or CRT, adjuvant chemotherapy was given. Overall survival (OS) and disease free survival (DFS), local recurrence (LR), and prognostic factor were evaluated.Thirty patients received preoperative CRT and 35 patients received postoperative CRT. Five-year OS rate, 5-year DFS rate, or 5-year LR rate was not significantly different between preoperative and postoperative CRT groups (69.0%, 58.5%, and 3.4% vs 73.6%, 67.9%, and 6.9%, P = .56, P = .37, and P = .77, respectively). Age, sex, stage, CEA level, or timing of CRT did not affect OS. However, 5-year OS rate of patients with sarcopenia was significantly lower than those without sarcopenia (38.0% vs 92.5%, P < .001). Multivariate analysis showed that sarcopenia was the only independent prognostic factor for overall survival (OS) (hazard ratio [HR]: 6.08, P = .001).There was no difference in survival between preoperative CRT and postoperative CRT in older patients with LARC. Sarcopenia is a poor prognostic factor in older patients with LARC who received preoperative or postoperative CRT.

Preoperative chemoradiotherapy versus postoperative chemoradiotherapy for local advanced gastric or Siewert II/III GEJ cancer: A retrospective analysis.

115 Background: Radiation therapy has improved survival in gastric cancer in some randomized trials. However, post-operative fields have been difficult tolerate, and completion rates have been low. Preoperative therapy may afford the opportunity to radical therapy, and potentially improve the resectability in advanced patients. Methods: Patients with Siewert II/III GE junction or gastric cancer treated at Massachusetts General Hospital were evaluated with Institutional Review Board approval. Clinical parameters and prognostic factors including gender, age, clinical stage, pathological stage, radiation parameters, concurrent chemotherapy, non-radiation chemotherapy, toxicity and survival were included in the analysis. Results: From Jul 2005 to Jan 2017, we enrolled 88 patients had chemoradiotherapy (CRT) and surgery, 48 preoperative and 40 postoperative CRT patients. In the preoperative group, 16.7% (8/48) had nodes outside a standard D2 dissection range, and the pathologic complete regression (pCR) rate was 18.8% (9/48). Median preoperative and postoperative radiation dose was 50.4 Gy and 45 Gy. Two-drug regimen was the most commonly used preoperative concurrent chemotherapy: 60.5% and single drug was the most commonly used postoperative concurrent chemotherapy: 97.5%. Except concurrent chemotherapy, 25 preoperative CRT patients received induction FOLFOX (median 8 cycles); 9 postoperative CRT patients also received 5-FU and 23 received FOLFOX (or EOX) chemotherapy. The estimated 3-year relapse-free survival (RFS) and overall survival (OS) in the preoperative and postoperative group was 51% vs. 34.3% (p = 0.286), and 71.2% vs. 45.9% (p = 0.179), respectively. In preoperative CRT group, there was more hematological toxicity but less gastrointestinal toxicity than postoperative CRT group, more distant metastasis but less peritoneal recurrence rate. Conclusions: Compared to postoperative chemoradiotherapy, preoperative chemoradiotherapy option has the trend of better tolerance, higher RFS and OS in patients with local advanced gastric cancer. Different chemoradiotherapy strategy may lead to different recurrence patterns.

Matched case-control analysis comparing oncologic outcomes between preoperative and postoperative chemoradiotherapy for rectal cancer.

PurposeTo investigate patterns of recurrence and oncologic outcomes after recurrence between preoperative and postoperative chemoradiotherapy (CRT).MethodsRecords of patients with stage II or III locally advanced rectal cancer seen between January 2000 and December 2010 were analyzed. The outcomes for patients undergoing preoperative CRT followed by radical resection (n = 466) were compared with outcomes of patients matched for sex, age, and stage who had surgery and then postoperative CRT (n = 466). Recurrence rates and sites, treatment of recurrence, and oncologic outcomes after recurrence were investigated. The rate of sphincter preservation and permanent stoma formation were also evaluated.ResultsRecurrence occurred in 124 and 140 patients in the pre- and postoperative CRT groups, respectively. The local and systemic recurrence rates were 3.6% and 20.8%, respectively, in the preoperative CRT group and 3.0% and 25.3%, respectively, in the postoperative CRT group (P = 0.245). Time to recurrence was longer in the postoperative CRT group (19 months vs. 24.2 months, P = 0.029). The overall rates of sphincter preservation (sphincter preservation operation and postoperative permanent stoma formation) did not significantly different between the two groups (P = 0.381). The 5-year overall survival rate after recurrence did not differ between the two groups (25.6% vs. 18.6%, P = 0.051).ConclusionPreoperative and postoperative CRT are both safe and suitable treatment methods for rectal cancer, so the choice can be tailored to the patient's situation.

The influence of the metastasis pattern of mediastinal lymph nodes on the postoperative radiotherapy's efficacy for the IIIA-pN2 non-small-cell lung cancer: a retrospective analysis of 220 patients.

ObjectiveThe use of postoperative radiotherapy (PORT) remains controversial for Stage IIIA-N2 non-small-cell lung cancer (NSCLC) patients, a possible reason is that IIIA-pN2 NSCLC diseases are a heterogeneous group with different clinicopathologic features. The aim of this research was to prove whether the mediastinal lymph nodes’ (LNs) skipping status could indicate the necessity of the PORT for the pN2 NSCLC patients.MethodsThe skip metastasis was defined as pN0N2 (no N1 LN involved), and nonskip metastasis was pN1N2 (one or more N1 LNs involved). Patients were divided into two groups: LNs nonskip and LNs skip, and postoperative chemoradiotherapy (POCRT) and postoperative chemotherapy. Then, the LN nonskip and LN skip groups were further divided into subgroups: POCRT and point of care testing (POCT) for subgroup analysis.ResultsThere were 220 cases included in the analysis, and 43 of them received PORT. On univariate analysis, the median 3-year progression-free survival (PFS) was, respectively, 16 months (27.7%) for the LN skip group and 11 months (15.3%) for the LN nonskip group (P=0.001). The median 3-year overall survival (OS) was, respectively, 35 months (47.0%) for the LN skip group and 27 months (38.7%) for the LN nonskip group (P=0.025). The median 3-year local recurrence-free survival (LRFS) was, respectively, 25 months (41.0%) for the LN skip group and19 months (29.9%) for the LN nonskip group (P=0.014). The median 3-year distant metastasis-free survival (DMFS) was, respectively, 22 months (32.5%) for the LN skip group and 15 months (20.4%) for the LN nonskip group (P=0.013). The median 3-year PFS was, respectively, 17 months (25.6%) for the POCRT group and 12 months (18.6%) for the POCT group (P=0.037). Although the POCRT group showed better OS, LRFS, and DMFS than the POCT group, the results showed no statistical significance. In subgroup analysis, there was no statistical significance in the Kaplan–Meier analysis between subgroups, but it showed that POCRT resulted in better PFS, OS, and DMFS in both LN skip and LN nonskip subgroups; this advantage was more obvious in the LN skip subgroup.ConclusionThe LN skip status is closely related to the survival of the IIIA-N2 NSCLC disease, and the LN skip patients may get more benefit in PFS and LRFS than the LN nonskip patients from PORT.

Adding concurrent chemotherapy to postoperative radiotherapy improves locoregional control but Not overall survival in patients with salivary gland adenoid cystic carcinoma-a propensity score matched study.

PurposeTo compare the long-term outcomes in patients with salivary gland adenoid cystic carcinoma (SGACC) treated with post-operative chemoradiotherapy (POCRT) versus post-operative radiotherapy (PORT).MethodsWe retrospectively reviewed the records of 91 SGACC patients treated with surgery followed by PORT (n = 58) or POCRT (n = 33) between 2000 and 2013. Treatment outcomes between groups were compared using propensity score matching (1:1 nearest neighbor).ResultsThe median radiation dose was 66 Gy, and patients were followed up for a median of 71 months. Cisplatin-based concurrent regimens were the most commonly used chemotherapy schedules. In the entire study cohort, patients undergoing POCRT showed a trend toward higher locoregional control (LRC) rates than those treated with PORT alone at both 5 and 8 years (97 and 97 % versus 84 and 79 %, respectively; P = .066). Distant metastases were the most common form of treatment failure and occurred in 31 (34 %) patients (PORT, n = 17; POCRT, n = 14). After propensity score matching (33 pairs), patients receiving POCRT had 5- and 8 year LRC rates of 97 and 97 %, respectively, compared with 79 and 67 % for patients treated with PORT alone (P = .017). The two groups did not differ significantly in terms of distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS). However, a significantly better opioid-requiring pain-free survival (ORPFS) was achieved in POCRT group (P = .038). Subgroup analyses revealed that patients with stage III − IV disease (P = .040 and .017), positive surgical margins (P = .011 and .050), or perineural invasion (P = .013 and .035) had significantly higher 5- and 8 year LRC and ORPFS when treated with POCRT, respectively.ConclusionsIn SGACC patients, adding concurrent chemotherapy to PORT may increase LRC and ORPFS rates, particularly in presence of stage III − IV disease, positive surgical margins, or perineural invasion. However, no significant differences in DMFS, DFS, and OS were observed.

Value of postoperative adjuvant radiotherapy for pT3N0 rectal cancer

Objective To evaluate the value of adjuvant radiotherapy after radical resection for pT3N0 rectal cancer. Methods The clinical data of 125 patients with pT3N0 rectal cancer who were diagnosed and given total mesorectal excision in our hospital from 2003 to 2010 were retrospectively analyzed. All patients received postoperative adjuvant chemotherapy, while 40 out of them received postoperative adjuvant radiotherapy in addition. Survival rates were estimated using the Kaplan-Meier method, and univariate prognostic analysis was performed using the log-rank test. Multivariate analysis of influencing factors for local recurrence(LR)rate was performed using the Cox regression model. Results The 5-year sample size was 35. The 5-year overall survival(OS)and disease-free survival(DFS)rates were 82. 3% and 72. 4%, respectively. There was no significant difference in the 5-year OS rate between the postoperative chemoradiotherapy group and the postoperative chemotherapy group(12% vs. 83%, P= 0.911). Multivariate analysis suggested that the number of lymph nodes and perirectal fat infiltration were independent prognostic factors for LR rate(P = 0. 045 ;P = 0. 021). There was no significant difference in LR rate between the low-risk group(no high-risk factors)and the high-risk group(the number of high-risk factors ≥1)(2. 5% vs.11.8%, P=0. 060). Conclusions Postoperative radiotherapy cannot improve the OS and LR rates for pT3N0 rectal cancer without any high-risk factors. The value of postoperative adjuvant radiotherapy for pT3N0 rectal cancer needs further evaluation. Key words: Rectal neoplasms/post-operative radiotherapy; Rectal neoplasms/post-operative chemotherapy; Prognosis factors

Significance of postoperative radiotherapy for stage II/III upper rectal cancer

Objective To investigate the value of postoperative adjuvant chemoradiotherapy (CRT) in the treatment of stage Ⅱ/Ⅲ upper rectal cancer. Methods A total of 3995 patients with rectal cancer were admitted to our hospital from 2000 to 2010. Among them, patients who were pathologically diagnosed with adenocarcinoma and underwent radical surgery were enrolled as subjects for retrospective analyses. Moreover, all selected patients had the lower margin of the tumor located within 10-16 cm from the anal verge, as determined by a colonofiberscope before surgery, and were pathologically staged as T3-4 or N0-2 M0 after surgery, according to the 7 th edition of American Joint Committee on Cancer tumor-node-metastasis staging system. Results A total of 547 patients were enrolled as subjects. The 5-year sample size was 249. In all patients, the 5-year overall survival (OS), disease-free survival, local recurrence-free survival (LRFS) , and distant metastasis-free survival rates were 79.0%, 76.8%, 94.0%, and 80.1%, respectively. One hundred and fifty-five patients were enrolled into either postoperative concurrent CRT group or postoperative non-CRT group, with the baseline characteristics balanced between the two groups by the propensity-score matching method (1:1). Patients who were staged as pT4b and had paracancerous nodules and lymph node metastases (stage N2) were enrolled into high-risk group. In the high-risk group, patients treated with postoperative CRT had significantly higher LRFS and OS rates than those treated with only surgery (96.3% vs. 82.0%, P = 0. 044; 81.6% vs. 59.1%, P=0.019). Conclusions Radical surgery achieves a good prognosis in patients with stage Ⅱ/Ⅲ upper rectal cancer, and postoperative CRT can further reduce the locoregional recurrence rate. Particularly, postoperative CRT/RT can substantially improve local and long-term outcomes in patients with high-risk factors. Key words: Upper rectal neoplasms/surgery; Upper rectal neoplasms/postoperative radiotherapy; Prognosis analysis

Effect of adjuvant chemoradiotherapy on survival in primary small cell carcinoma of esophagus (SCCE) patients: An analysis of multicenter clinical outcomes.

e15125 Background: To retrospectively evaluate the therapy pattern and survival in patients with dissection of primary SCCE. Methods: This study included 119 patients from seven centers in Middle and Western China who underwent radical section of SCCE. Forty six of them were treated with postoperative chemoradiotherapy (POCRT), and 73 of them with postoperative chemotherapy (POCT) alone. The median radiation dose to clinical target volume (CTV) was 50 Gy (varying between 44 and 52 Gy), while the cycles of platinum-based chemotherapy ranged from two to eight with a median of four. Results: The 5-year OS and DFS were 14.5% and 11.7% of all patients, respectively. The median OS and DFS of all patients were 17.0(95%CI: 13.2-20.8) and 10.0(95%CI: 7.3-12.3) months, respectively. The 5-year OS and DFS were 22.0% and 20.0%, respectively, in the POCRT group, and 9.3% and 6.4%, respectively, in the POCT group (P=0.003 for OS and P=0.007 for DFS). There was significant difference in LRFS, favoring the POCRT group (5-year LRFS 74.3% vs. 42.0%, P=0.010), while the 5-year DRFS was 34.1% for the POCRT group comparing to 15.5% for the POCT group (P=0.039).In a multivariate analysis, treatment with more than four cycles of chemotherapy was associated with significantly better OS (HR=0.553, 95% CI, 0.347 to 0.881, P=0.0128) and DFS (HR=0.594, 95% CI, 0.386 to 0.914, P=0.0177). Tumor size less than 3cm was a poor prognostic factor for both overall survival and disease-free survival. Conclusions: Compared with chemotherapy alone, adjuvant treatment with both radiotherapy and chemotherapy improves survival in patients with completely resected SCCE. Future study of treatment modality with radiotherapy and chemotherapy is warranted.

Patterns of failure in patients with locally advanced rectal cancer receiving pre-operative or post-operative chemoradiotherapy

BackgroundWe investigated patterns of failure in patients with locally advanced rectal cancer (LARC) according to chemoradiotherapy (CRT) timing: pre-operative versus post-operative. Also, patterns of failure, particularly distant metastasis (DM), were analyzed according to tumor location within the rectum.MethodsIn total, 872 patients with LARC who had undergone concurrent CRT and radical surgery between 2001 and 2007 were analyzed retrospectively. Concurrent CRT was administered pre-operatively (cT3–4) or post-operatively (pT3–4 or pN+) in 550 (63.1%) and 322 (36.9%) patients, respectively. Median follow-up period was 86 (range, 12–133) months for 673 living patients. Local recurrence (LR) was defined as any disease recurrence within the pelvis, and any failure outside the pelvis was classified as a DM. Only the first site of recurrence was scored.ResultsIn total, 226 (25.9%) patients developed disease recurrence. In the pre-operative CRT group, the incidences of isolated LR, combined LR and DM, and isolated DM were 17, 21, and 89 patients, respectively. In the post-operative CRT group, these incidences were 8, 15, and 76 patients, respectively. LR within 2 years constituted 44.7% and 60.9% of all LRs in the pre-operative and post-operative CRT groups, respectively. Late (> 5 years) LR comprised 13.2% and 4.3% of all LRs in the pre-operative and post-operative CRT groups, respectively. The lung was the most common DM site (108/249, 43.4%). Lung or para-aortic lymph node metastasis developed more commonly from low-to-mid rectal tumors while liver metastasis developed more commonly from upper rectal tumors. Lung metastasis occurred later than liver metastasis (n = 54; 22.6 ± 15.6 vs. 17.4 ± 12.1 months; P = 0.035).ConclusionsThis study showed that LARC patients receiving pre-operative CRT tended to develop late LR more often than those receiving post-operative CRT. Further extended follow-up than is conventional may be necessary in LARC patients who are managed with optimized multimodal treatments, and the follow-up strategy may need to be individualized according to tumor location within the rectum.

Effect on survival of postoperative therapy in patients with primary small cell carcinoma of esophagus (SCCE): An analysis of multicenter clinical outcomes.

e14648 Background: To retrospectively evaluate the therapy pattern and survival in patients with dissection of primary SCCE. Methods: This study included 89 patients from four centers in southwest China who underwent radical section of SCCE without any preoperative therapy. 36 were treated with postoperative chemoradiotherapy (POCRT), and 53 with postoperative chemotherapy (POCT) alone. The radiation dose to clinical target volume (CTV) was 50 Gy (varying between 44 and 52 Gy), while the cycles of platinum-based chemotherapy ranged from two to six with a median of four. Results: The 5-year overall survival rate (OS) and 5-year disease-free survival rate (DFS) were 16.4% and 14.3% for all patients,respectively. The 5-year overall survival rate was 21.5% in the POCRT group, and 12.9% in the POCT group (p=0.013). The 5-year DFS was 21.3% in POCRT group and 9.3% in POCT group (p=0.028). There was significant difference in 5-year local recurrence-free survival (LRFS) between POCRT and POCT (LRFS: 74.6% vs. 45.3%, p=0.022), while no difference for 5-year distant recurrence-free survival (DRFS: 37.3% vs. 17.4%, p=0.101). Subgroup analysis revieled that there were obvious difference in 5-year OS and DFS between patients received radiotherapy less than 75 days after surgery and ≥ 75 days (OS: 35.6% vs. 8.6%, p=0.046; DFS: 24.9% vs. 7.3%, p=0.020), while received radiotherapy less than 75 days after surgery have worse DRFS (p=0.041). In a multivariate analysis, age ≥59 years was associated with significantly worse OS while with lymph node involved infulence DFS. Tumor size more than 3cm, absence of radiotherapy and less than 4 cycles chemotherapy were poor prognostic factors for both overall survival and disease-free survival. Conclusions: Our analysis shows that postoperative chemotherapy improved OS and DFS in patients with dissection of SCCE, while radiotherapy was given less than 75 days after surgery may improve DRFS and OS. In those patients received postoperative chemotherapy less than 4 cycles is the most important characteristic associated with decreased survival.