Postoperative Adjuvant Concurrent Chemoradiotherapy Research Articles

Comorbidity, Radiation Duration, and Pretreatment Body Muscle Mass Predict Early Treatment Failure in Taiwanese Patients with Locally Advanced Oral Cavity Squamous Cell Carcinoma after Completion of Adjuvant Concurrent Chemoradiotherapy.

Few prospective cohort trials have evaluated the potential risk factors of early treatment failure of locally advanced oral cavity squamous cell carcinoma (LAOCSCC) patients following the completion of postoperative adjuvant concurrent chemoradiotherapy (CCRT). We collected clinicopathological variables, nutrition-inflammatory markers and total body composition data assessed by dual-energy X-ray absorptiometry (DXA) before and after CCRT. A factor analysis was used to reduce the number of DXA-derived parameters. Cox proportional hazard models were applied to determine the risk factors associated with early treatment failure defined as tumor progression or death within 180 days of CCRT completion. A total of 69 patients were eligible for analysis. After CCRT, the body weight, body mass index, nutritional markers, and muscle mass decreased, whereas C-reactive protein level increased. Five factors reflecting different body composition statuses were identified. A total of 21 patients (30.4%) developed early treatment failure. Comorbidities (hazard ratio ((HR)), 2.699; 95% confidence interval ((CI)), 1.005–7.913; p = 0.044), radiation duration (HR, 1.092; 95% CI, 1.015–1.174; p = 0.018) and the pretreatment body muscle mass (HR, 0.578; 95% CI, 0.345–0.957; p = 0.037) independently contributed to early treatment failure. Comorbidities, longer radiation duration, and lower pretreatment body muscle mass are predictive factors for early treatment failure in LAOCSCC patients following postoperative adjuvant CCRT completion.

Nasopharyngeal mucoepidermoid carcinoma: a rare tumor in nasopharynx

<p class="abstract">Mucoepidermoid carcinoma (MEC) is a malignant epithelial salivary gland neoplasm which consists of a mixture of mucin-producing columnar cells, epidermoid (squamous) cells and polygonal intermediate cells. Salivary gland-type carcinomas are extremely rare to be found in the nasopharynx. A 46-year-old lady presented with bilateral progressive nasal blockage and occasional epistaxis for 3 years. However, there was no neck swelling. Nasoendoscopy revealed a huge nasopharyngeal mass. Tissue biopsy in clinic setting reported of inverted papilloma. Computed tomography shows large irregular heterogenously enhancing mass in nasopharynx. Posterior septectomy was done for the access and endoscopic excision of nasopharyngeal tumor was performed. Histopathological examination confirmed the tumor is mucoepidermoid carcinoma. Postoperative adjuvant concurrent chemoradiotherapy with total of 66 Gy was commenced in view of concern of possible residual microscopic disease. Nasopharynx is an uncommon site for MEC. MEC patients seldom has enlarged neck node at presentation.Nasopharyngeal salivary gland-type carcinomas does not commonly cause cranial nerve palsy compared to nasopharyngeal carcinoma (NPC). In cases with huge nasopharyngeal mass without neck nodes and cranial nerves involvement, MEC can be a differential diagnosis. Surgical removal of gross disease and concurrent chemoradiotherapy as an adjuvant treatment for likely residual microscopic disease is the standard treatment for nasopharyngeal mucoepidermoid carcinoma.</p>

Adjuvant therapy for resected pN2 non-small cell lung cancer: sequence is not all that matters.

We appreciate the comments from Zhao and Ng (1) regarding our recent National Cancer Database (NCDB) study comparing survival outcomes after postoperative adjuvant concurrent chemoradiotherapy (CRT) versus sequential chemotherapy followed by postoperative radiotherapy (C→PORT) for locally advanced or incompletely resected non-small cell lung cancer (NSCLC).

Improved overall survival and mortality in head and neck cancer with adjuvant concurrent chemoradiotherapy in national databases.

Many studies have demonstrated the advantage of postoperative concurrent chemoradiotherapy (CRT) over radiotherapy (RT) alone in locoregional control, but few have examined overall survival with respect to national databases. The literature was searched for eligible randomized controlled trials. The Surveillance, Epidemiology, and End Results (SEER) Database and National Cancer Data Base (NCDB) were searched for 5-year overall survival data. Twenty-eight studies were examined and demonstrated 44% greater locoregional control (relative risk [RR] = 0.56; 95% confidence interval [CI] = 0.46-0.68) and 12% overall survival benefit (RR = 0.88; 95% CI = 0.81-0.98) with postoperative adjuvant CRT compared to adjuvant RT. Overall SEER survival was 45.0% in 1973, rising to 53.2% in 2005. The NCDB documents a similar increase in overall survival from 45.5% in 1994 to 53.4% in 2005. The literature shows mortality benefit of adjuvant CRT in patients with advanced head and neck cancer, reflected in SEER and NCDB.

Impact of the Addition of Concurrent Chemotherapy to Pelvic Radiotherapy in Surgically Treated Stage IB1-IIB Cervical Cancer Patients With Intermediate-Risk or High-Risk Factors: A 13-Year Experience

To identify groups of patients who derive clinical benefit from postoperative adjuvant concurrent chemoradiotherapy (CCRT), we retrospectively investigated the survival outcomes of surgically treated early-stage cervical cancer patients. We reviewed the medical records of 316 patients with FIGO stage IB1-IIB cervical cancer who had been treated with adjuvant radiotherapy (RT) (n = 124, RT group) or adjuvant CCRT (n = 192, CCRT group) after radical hysterectomy between January 1996 and December 2009. Of these, 187 patients displayed high-risk prognostic factors (high-risk group), and 129 displayed intermediate-risk prognostic factors (intermediate-risk group). Sixty patients with 1 intermediate-risk prognostic factor who received no adjuvant therapy were also identified and used as controls (NFT group). Survival was calculated using the Kaplan-Meier method and compared using the log-rank test. In the high-risk group, adjuvant CCRT was significantly superior to RT alone with regard to recurrence rate, progression-free survival (PFS), and overall survival. In the intermediate-risk group, CCRT was superior to RT with regard to recurrence rate and PFS in patents with 2 or more risk factors. Among the patients with only 1 intermediate-risk factor, although no survival benefit of CCRT over RT was observed, addition of adjuvant treatment resulted in significantly improved PFS compared with the NFT group in patients with deep stromal invasion (log-rank, P = 0.012). Postoperative CCRT improved the prognosis of FIGO stage IB1-IIB cervical cancer patients in the high-risk group and patients who displayed 2 or more intermediate-risk factors. Patients who displayed deep stromal invasion alone also derived clinical benefit from adjuvant treatment.

Epstein–Barr virus infection and plasma transforming growth factor-β1 levels in head and neck cancers

Conclusions. In addition to the correlation of transforming growth factor (TGF)-β1 levels to the radiation toxicity, both Epstein–Barr virus (EBV) infection and postoperative status play roles in the change in plasma TGF-β1 levels in patients with head and neck cancers. Objectives. To assess the parameters involved in the change in plasma TGF-β1 level during concurrent chemoradiotherapy (CCRT). Patients and methods. Blood samples (n=307) before, during, and after treatment were obtained from 39 patients with head and neck cancers treated with definitive or adjuvant CCRT. In situ hybridization (ISH) was used to identify EBV-encoded RNA (EBER) in tissues from the primary tumor or metastatic lymph nodes. Plasma TGF-β1 level, white blood cell (WBC), and platelet count were assayed immediately before the first fraction of radiotherapy (RT), once a week during RT, and at the end of the RT course. The grades of mucositis and dermatitis were recorded weekly during CCRT. Results. Pretreatment TGF-β1 level and radiation toxicity were found to be significantly correlated with the increase of the plasma TGF-β1 level during CCRT (p<0.05), but correlation of platelet count was only found in patients whose tumors were EBV-positive (p=0.0042), and WBC count in those treated with postoperative adjuvant CCRT (p=0.004).

Postoperative adjuvant concurrent chemoradiotherapy improves survival rates for high-risk, early stage cervical cancer patients

Objective This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high-risk early cervical cancer (stages IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. Methods From July 1994 to June 2001, we retrospectively reviewed the medical records of 151 patients who had undergone radical abdominal hysterectomy with pelvic lymphadenectomy and paraaortic lymph nodes dissection at Ajou University Hospital for early cervical cancer (stages IA2, IB, IIA). CCRT was performed in 30 patients with high-risk factors such as positive pelvic lymph nodes, parametrial involvement, or positive surgical margins. Adjuvant chemotherapy consisted of cisplatin (70 mg/m 2 on day 1) and 5-fluorouracil (5-FU; 1000 mg/m 2 on days 2–5) for four cycles every 4 weeks beginning 2–3 weeks after surgery. Pelvic radiotherapy was started concurrently at the second and third cycle of chemotherapy. We also analyzed the recurrence pattern and survival rates of 114 patients (control group) who received no adjuvant therapy after surgery. The mean follow-up period was 49 months (24–98 months). Results There were recurrences in three patients after CCRT (10%) and in five patients in the control group (4.4%). The actuarial 5-year overall survival rates for patients in CCRT and control group were 96.7% vs. 97.7%, respectively. The progression-free survival rates were 88.7% for the high-risk group and 95.4% for the non-high-risk group. Conclusions This study confirms good local control and 5-year overall and progression-free survival rates in high-risk cervical cancer patients after CCRT, which is comparable with the results of the control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stages IA2–IIA cervical cancer patients with high-risk factors.

Postoperative adjuvant therapy in early invasive cervical cancer patients with histopathologic high-risk factors.

The purpose of this study is to evaluate the efficacy of postoperative adjuvant therapy in preventing treatment failure after primary treatment with surgery in early invasive cervical cancer patients associated with the following histopathologic high-risk factors: lymph node metastasis (either macroscopic or microscopic), parametrial extension, lymphovascular permeation and depth of invasion > or =10 mm. Postoperative adjuvant concurrent chemoradiotherapy (PCCRT), postoperative adjuvant chemotherapy (PCT), or postoperative adjuvant radiotherapy (PRT) alone was administered to the 80 early invasive cervical cancers with at least one of the high-risk factors. Each of 61 patients received three to six cycles of chemotherapy at intervals of approximately 3 weeks. Twenty three patients were treated with PCCRT, 38 patients were treated with PCT alone, and 19 patients received PRT. The 5-year survival rates of patients with macroscopic lymph node metastasis were 66.7% and 35.7% in PCCRT and PRT, respectively. With microscopic lymph node metastasis, the 5-year survival rates were 83.3%, 60.0%, and 70.1% in PCCRT, PCT, and PRT, respectively. With parametrial extension, the 5-year survival rate was 58.1% in PCCRT. The 5-year survival rates of patients with lymphovascular permeation were 100%, 90.9%, and 66.7% in PCCRT, PCT, and PRT, respectively. With depth of invasion > or =10 mm, the 5-year survival rates were 100% and 91.3%, in PCCRT and PCT, respectively. PCCRT appears to be superior to PRT or PCT alone in early invasive cervical cancer patients with histopathologic high-risk factors.