Postoperative Adjuvant Radiotherapy Research Articles

Oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer.

The aim of this study was to compare the long-term oncological results of patients with the diagnosis of prostate cancer who underwent open radical retropubic prostatectomy (RRP) and subsequent adjuvant (ART) or salvage radiotherapy (SRT). A total of 145 patients underwent open RRP for prostate cancer and subsequent ART or SRT postoperatively between 2010 and 2019. ART (n = 56) is defined as the group of patients with prostate-specific antigen (PSA) <0.2 ng/mL or with positive lymph nodes without PSA increase who received radiotherapy within the first 6 months of urinary continence. SRT (n = 89) is defined as the group of patients with PSA >0.2 ng/mL who received RT before PSA amounted to 0.5 ng/mL. Statistically no significant difference was found between groups in terms of age, prostate volume, final pathology Gleason scores, lymphadenectomy, duration of androgen deprivation therapy (ADT), time to relapse after radiotherapy, development of biochemical recurrence and disease progression. Extraprostatic extension, seminal vesicle invasion and surgical margin positivity were significantly higher in the ART group. No difference was found between the groups in terms of biochemical recurrence-free survival, while cancer-specific survival and overall survival rates were significantly higher in the SRT group. It was found that cancer-specific and overall survival was better in the SRT group. It will be more appropriate to follow-up until the recurrence and then to perform SRT after the relapse in the postoperative period.

Supraclavicular Artery Island Flap in Head-and-neck Reconstruction: Our Experience

Background: Reconstruction of head-and-neck cancer defects is a challenging task, keeping in mind the complexity of the defects. Locoregional pedicle flap reconstruction is not an inferior option. The supraclavicular flap gained popularity in 1997 to reconstruct mentosternal contractures in postburn patients. This is a perforator-based pedicled, axial, and fasciocutaneous flap based on the supraclavicular artery. This study aims to examine a series of cases with pedicled supraclavicular flap reconstruction in head-and-neck cancers. Methods: This study is a retrospective review of patient data from our institution from 2018 to 2020. A total of seven patients were included who underwent surgical resection for various head-and-neck cancers. Surgical defects were reconstructed with a supraclavicular islanded fasciocutaneous flap. Results: All patients underwent wide excision of the tumor following oncological principles, and four out of seven patients received postoperative adjuvant radiotherapy. Two patients with parotid tumors underwent facial skin excision along with total parotidectomy. Both cases were recurrent. One patient had partial necrosis of the distal part of the flap. Two patients required split-thickness skin graft for the closure of the donor site. Conclusion: Supraclavicular artery island flap (SCAIF) is one of the good reconstructive options for midline neck defects, simple oral cavity defects, and cheek skin defects. It is an excellent alternative to free tissue transfer with limited donor-site morbidity. Careful selection of patients is key to successful reconstruction using a SCAIF in the head-and-neck region.

High Grade Myxofibrosarcoma of Maxillary Sinus: A Case Report and Review of Literature.

Myxofibrosarcoma (MFS) is a soft tissue sarcoma that commonly occurs in late adult life. It is mainly located in the subcutaneous soft tissues of extremities characterized by a high recurrence rate at the original site. MFS of the head and neck is rare, while it occurrence in the maxilla is extremely rare.We report an atypical case of MFS of the maxilla in a 29-year-old male. The tumour was resected with adequate margin and following which post-operative adjuvant radiotherapy was given. This patient has been followed for 2 years to date and has remained disease free.The rarity, the aggressive nature of the pathology, the extent of the tumour and the complex neurovascular structures in close proximity to the site often lead to adverse outcomes. We will be discussing a rare case of a rapidly growing high grade maxillary sinus MFS in a young patient with a history of radiation exposure which posed as a diagnostic challenge. Our case may provide additional diagnostic and treatment experience with regards to managing maxillary sinus myxofibrosarcoma.

Addition of Postoperative Radiation Therapy After Preoperative Chemotherapy and Surgery in Patients With Locally Advanced Endometrial Cancer Is Associated With Improved Outcomes

PurposeOur purpose was to examine outcomes of patients with locally advanced endometrial cancer who undergo neoadjuvant chemotherapy followed by surgery (PreCT) with/without postoperative adjuvant radiation therapy. A secondary analysis of down staging and margin clearance was made with reference to those receiving upfront surgery and then adjuvant chemotherapy (PostCT). Methods and MaterialsThe National Cancer Database was queried for FIGO (The International Federation of Gynecology and Obstetrics) stage III/IV locally advanced endometrial cancer cases who underwent definitive surgery from 2010 to 2016 and received chemotherapy as part of their treatment. Cases were classified into 2 cohorts: preoperative chemotherapy +/- postoperative chemotherapy cohort (PreCT) and postoperative chemotherapy cohort (PostCT) for reference for margin assessment. Cases who received preoperative radiation therapy were excluded while those who received postoperative radiation were included in the analysis. Primary endpoints were overall survival (OS), surgical margin status, rate of downstaging, and effect of adjuvant radiation therapy on OS among the PreCT cohort. Univariable (UVA) and multivariable (MVA) Cox regression analyses were performed. ResultsA total of 13,369 cases were identified with 1059 in PreCT and 12,310 in PostCT cohorts. PreCT had lower OS than PostCT (UVA: hazard ratio [HR], 2.18; P < .001; MVA: HR, 1.873; P < .001). PreCT cases with negative margins, who presumably had unresectable tumors initially, also had worse OS compared with PostCT with negative margins (UVA: HR, 2.20; P < .001; MVA: HR, 1.84; P < .001); however, PreCT with negative margins had similar survival to PostCT with positive margins (UVA: HR, 0.825; P < .001; MVA: P = .885). The addition of radiation after surgery in the PreCT cohort was associated with improved survival (5-year OS 20.5% compared with 50%, respectively; UVA: HR, 0.450; P < .001; MVA: HR, 0.337; P < .001). Although fewer cases in PreCT had negative margins compared with PostCT (72% compared with 84%, P < .001), approximately 19% of cases in PreCT had lower pathologic T-stage compared with clinical T-stage and 11% had lower N-stage. ConclusionsNeoadjuvant chemotherapy was given in cases with worse oncologic prognostic factors, many of whom were likely unresectable at outset, compared with those who received postoperative chemotherapy. Although neoadjuvant chemotherapy is associated with tumor downstaging, survival is lower than with primary surgery probably because of these baseline differences. The addition of adjuvant radiation after surgery in cases who received preoperative chemotherapy is associated with improved survival.

Self-intensified synergy of a versatile biomimetic nanozyme and doxorubicin on electrospun fibers to inhibit postsurgical tumor recurrence and metastasis

Tumor-positive resection margins after surgery can result in tumor recurrence and metastasis. Although adjuvant postoperative radiotherapy and chemotherapy have been adopted in clinical practice, they lack efficacy and result in unavoidable side effects. Herein, a self-intensified in-situ therapy approach using electrospun fibers loaded with a biomimetic nanozyme and doxorubicin (DOX) is developed. The fabricated PEG-coated zeolite imidazole framework-67 (PZIF67) is demonstrated as a versatile nanozyme triggering reactions in cancer cells based on endogenous H2O2 and •O2−. The PZIF67-generated •OH induces reactive oxygen species (ROS) overload, implementing chemodynamic therapy (CDT). The O2 produced by PZIF67 inhibits the expression of hypoxia-up-regulated proteins, thereby suppressing tumor progression. PZIF67 also catalyzes the degradation of glutathione, further disturbing the intracellular redox homeostasis and enhancing CDT. Furthermore, the introduced DOX not only kills cancer cells individually, but also replenishes the continuously consumed substrates for PZIF67-catalyzed reactions. The PZIF67-weakened drug resistance strengthens the cytotoxicity of DOX. The combined application of PZIF67 and DOX also suppresses metastasis-associated genes. Both in vitro and in vivo results demonstrate that the self-intensified synergy of PZIF67 and DOX on electrospun fibers efficiently prevents postsurgical tumor recurrence and metastasis, offering a feasible therapeutic regimen for operable malignant tumors.

Primary vaginal sarcoma in a single center

ObjectivesTo investigate the clinical characteristics and prognosis of primary vaginal sarcoma. MethodsA retrospective analysis of patients with primary vaginal sarcoma treated at our center from 2000 to 2020 was conducted. ResultsFifteen patients were identified, among which 9 (60.0 %) patients had leiomyosarcoma, 2 (13.3 %) patients had Ewing's sarcoma, 2 (13.3 %) patients had rhabdomyosarcoma, 1 (6.7 %) patient had undifferentiated sarcoma, and 1 (6.7 %) patient had malignant peripheral schwannoma. Nine patients presented with vaginal mass that was the most common primary symptoms. Eleven patients received their primary surgery, and 7 of them received postoperative adjuvant chemotherapy or radiation therapy. The remaining 4 patients received initial chemotherapy and/or radiotherapy because of advanced stage. The distribution by stage was as follows: stage I in 10 patients, stage II in 1 patient, stage III in 2 patients and stage IV in 2 patients. The median follow-up was 43.7 months (10.1–137.5 months). Thirteen patients (86.7 %) had disease extent during follow-up, and among them, 11 patients (11/13, 84.6 %) developed local relapse or adjacent organ metastases, 1 patient (1/13, 7.7 %) developed liver metastases, and the remaining 1 patient (1/13, 7.7 %) developed lung metastases and local relapse during follow-up. Ten (10/13, 76.9 %) patients relapsed within 2 years after diagnosis. Eight patients (8/11, 72.7 %) with local recurrence or adjacent organ metastases received a secondary surgery treatment, and only 2 of them relapsed again. Two-year overall survival (OS) and 5-year OS were 80.0 % and 66.7 %, respectively. Patients with leiomyosarcoma had a tendency toward a better 5-year OS than those with other sarcomas (74.1 % vs 66.7 %, P = 0.307). ConclusionsPrimary vaginal sarcomas are aggressive neoplasms with different presenting characteristics. Surgery is the main treatment for primary vaginal sarcoma and for local relapse vaginal sarcoma.

Adjuvant Radiotherapy in Primary Adenoid Cystic Carcinoma of Trachea- A Case Series

Objective: Only 1% of all malignancies of the respiratory system are adenoid cystic carcinoma (ACC) of the trachea. ACC’s clinical course is frequently lengthy. Most patients first experience dyspnea, which looks like asthma or chronic bronchitis. The primary treatment choice is surgical resection followed by radiotherapy due to the small surgical margins of the tumor. When surgery is not an option, most cancers respond to radiotherapy, which frequently produces prolonged periods of remission. Method: We present three cases of primary ACC of the trachea. One case involved a 49-year-old man who had tracheal ACC treated surgically and then with radiation. Another 65-year-old female patient underwent surgical resection and adjuvant radiotherapy to treat her recurrent metastatic posterior thoracic wall tumor. At one month follow-up, our patient showed no evidence of disease, and a 38-year-old male presented with complaints of dry cough, breathlessness, and hemoptysis. Bronchoscopy showed a polypoidal growth obstructing more than 2/3rd of the tracheal lumen. The patient underwent excision of the tracheal tumor followed by adjuvant radiotherapy. Conclusion: Postoperative adjuvant radiotherapy plays an important role in management of ACC and it should be considered in all the patients of ACC to decrease the risk of recurrent disease.

WITHDRAWN: Primary vaginal sarcoma in a single center

To investigate the clinical characteristics and prognosis of primary vaginal sarcoma. A retrospective analysis of patients with primary vaginal sarcoma treated at our center from 2000 to 2020 was conducted. Fifteen patients were identified, among which 9 (60.0%) patients had leiomyosarcoma, 2 (13.3%) patients had Ewing's sarcoma, 2 (13.3%) patients had rhabdomyosarcoma, 1 (6.7%) patient had undifferentiated sarcoma, and 1 (6.7%) patient had malignant peripheral schwannoma. Nine patients presented with vaginal mass that was the most common primary symptoms. Eleven patients received their primary surgery, and 7 of them received postoperative adjuvant chemotherapy or radiation therapy. The remaining 4 patients received initial chemotherapy and/or radiotherapy because of advanced stage. The distribution by stage was as follows: stage I in 10 patients, stage II in 1 patient, stage III in 2 patients and stage IV in 2 patients. The median follow-up was 43.7months (10.1-137.5months). Thirteen patients (86.7%) had disease extent during follow-up, and among them, 11 patients (11/13, 84.6%) developed local relapse or adjacent organ metastases, 1 patient (1/13, 7.7%) developed liver metastases, and the remaining 1 patient (1/13, 7.7%) developed lung metastases and local relapse during follow-up. Ten (10/13, 76.9%) patients relapsed within 2years after diagnosis. Eight patients (8/11, 72.7%) with local recurrence or adjacent organ metastases received a secondary surgery treatment, and only 2 of them relapsed again. Two-year overall survival (OS) and 5-year OS were 80.0% and 66.7%, respectively. Patients with leiomyosarcoma had a tendency toward a better 5-year OS than those with other sarcomas (74.1% vs 66.7%, P=0.307). Primary vaginal sarcomas are aggressive neoplasms with different presenting characteristics. Surgery is the main treatment for primary vaginal sarcoma and for local relapse vaginal sarcoma.

Clinical features, radiological findings, and prognostic factors for primary intracranial chordoid meningioma.

Chordoid meningioma (CM) is an infrequent histologic subtype of meningiomas. Owing to its low occurrence, this subtype has been rarely described. Our subject was to explore the clinical features, radiological characteristics, and prognostic factors of primary intracranial chordoid meningioma. We reviewed the medical records and collected follow-up information of 34 cases who had been surgically treated and histologically diagnosed with CM at the Department of Neurosurgery, West-China Hospital of Sichuan University, from January 2009 to December 2021. Among all 7,950 meningioma cases, the proportion of primary intracranial CM was 0.43% (34/7,950). The median diagnosis age was 47 (ranging from 12 to 74) and the gender ratio (male to female) was 2.1:1. For radiological features, heterogeneous enhancement, skull base, and ventricular localization, cystic degeneration and dural tail sign were common in CM cases. In treatment, gross total resection (GTR) was achieved in 22/34 cases (64.7%) and subtotal resection (STR) was achieved in 12/34 cases (35.3%). Further, 11/34 patients (32.4%) had received postoperative adjuvant radiotherapy (RT). The follow-up duration ranged from 4 to 157 months after operation. The progression rate was 20.7% (6/29) and the median of PFS was 38 months. By survival analysis, accepting adjuvant radiotherapy and achieving GTR were correlated with longer progression-free survival for prognosis. CM is a rare subtype of meningiomas. In our series, it mainly involved adults and did not show a predilection for women compared with meningiomas in general. For a better prognosis, gross total resection and postoperative adjuvant radiotherapy are recommended. Nevertheless, due to the restriction of the series sample, patients lost for follow-up and inherent biases of a retrospective study, more cases and a shorter follow-up duration are needed for better management of chordoid meningioma.

Preoperative serum CA125 level and age at diagnosis: An effective prognosis prediction tool for patients with early-stage endometrial cancer.

To investigate the combined predictive value of the preoperative serum cancer antigen 125 (CA125) level and age at diagnosis among patients with early-stage endometrial cancer (EC) after initial treatment. We retrospectively analyzed data from patients with early-stage EC from 1999 to 2015 in multiple institutions in China. All 447 patients received postoperative adjuvant radiotherapy for FIGO 2009 stage I and II EC with complete data on preoperative serum CA125 levels. All patients were divided into four groups according to the ESMO-ESGO-ESTRO risk classification. The predictive probability of 5-year overall survival (OS) and the sensitivity and specificity of CA125 and age were calculated. The median follow-up time was 59 months (3-201 months). The 5-year OS and disease-free survival rates were 94.4% and 89.1%. Multivariate analysis showed that the preoperative CA125 level and age at diagnosis were independent prognostic factors for 5-year OS. The area under the curve for CA125 combined with age at diagnosis for 5-year OS was .692, and the corresponding sensitivity and specificity were 68.2% and 68.2% (p < .002), which were significantly better than the corresponding values for CA125 or age alone. After all 447 patients were divided into four groups according to CA125 combined with age, the 5-year OS of the elderly and higher CA125 group was only 73.7%. Although preoperative CA125 had limited sensitivity in predicting the prognosis for early-stage EC after initial treatment, it remains a useful serum marker for risk assessment of early-stage EC. Combining CA125 with age may increase its predictive sensitivity.

Non-pigmented villonodular synovitis of knee joint in a 11-year-old boy on long term steroids: a case report

&lt;p&gt;Pigmented villonodular synovitis (PVNS) is a rare condition, commonly affecting the knee joint and hip joint. It is seldomly seen in pediatric age group. Aetiology is unknown. Magnetic resonance imaging (MRI) is the imaging modality of choice. Managed by surgical resection of the synovium performed with an open, arthroscopic or combined approach. Post-operative adjuvant external beam radiotherapy have reduced recurrence rate. In this case report we are going to present a rare case of eleven-year-old boy on long term steroid intake, who presented with a history of pain and swelling of right knee joint with restriction of range of movements. MRI suggested extensive villonodular synovitis of knee joint. Diagnostic arthroscopy showed extensive villonodular synovitis of suprapatellar pouch, medial gutter, lateral gutter, intercruciate space, posterior-medial and posterior-lateral compartments and villi had atypical yellow fatty appearance. Extensive arthroscopic synovectomy was done and histopathology showed chronic synovitis. Post-operatively pain and swelling reduced and range of movements improved. Arthroscopic synovectomy is the most effective line of management for villonodular synovitis.&lt;/p&gt;

Local control results in extremity soft tissue sarcomas

Aim: The aim of this study is to investigate local control results and effective predictive factors in local control of extremity soft tissue sarcomas, retrospectively. Material and Method: 51 patients underwent postoperative adjuvant radiotherapy (RT) in Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital between October 2008-January 2022. Patients who underwent post-operative adjuvant RT were treated with 60-68 Gy in 2 phases from 2 Gy /day using conformal radiotherapy technique. IMA chemotherapy protocol was applied to 31.4% of the patients after radiotherapy. Results: The median follow up time was 46 months range (1-135). Recurrence was detected in 5 of the patients and the mean time of recurrence was 11.6 months (min: 3-max: 27). 10 patients developed metastasis at follow-up, the mean time until metastasis was 27 months (min: 18- max: 46). The mean overall survival (OS) was 103 (min:4-max:139) months and the OS of 2, 5 and 10 years were 93%, 65% and 60%, respectively. Disease-free survival (DFS) was 97 (min:4-max:139) months; 2, 5 and 10 years of DFS were 77%, 65% and 60%, respectively. The OS in patients aged ≥65 years old was significantly lower than in patients &amp;lt;65 years old (p=0.02). Overall and disease-free survival was significantly lower in patients undergoing chemotherapy (p=0.037 for overall survival, p=0.013 for disease-free survival). The occurrence of recurrence, metastasis or death within 3 years after the operation was significantly higher than after 3 years (p&amp;lt;0.001). Local failure was significantly higher in grade 3 tumors (p=0.05). All patients who recurred had grade 3 tumors. Metastasis and excitus were significantly higher in the follow-up of patients who underwent chemotherapy at one point during their treatment (p=0.027 for metastasis, p=0.042). Conclusion: While favorable local control results are obtained with adjuvant high dose-conformal radiotherapy in extremity sarcomas, close follow up is important for distant metastasis and local recurrence, especially in the first 3 years.

Patterns of Failure in Pediatric Craniopharyngioma with Surgery Alone

<h3>Purpose/Objective(s)</h3> Though pathologically benign, craniopharyngiomas are frequently recurrent even with complete surgical resection. Thus, postoperative adjuvant radiation therapy (RT) is often employed for durable local control, with conventional irradiation to the surgical bed of both cystic and solid components of the initial tumor. However, this carries risk of high morbidity in the form of late effects, including learning disabilities, neuroendocrine dysfunction, and secondary malignancy. There exists a potential opportunity to reduce radiotherapy-induced toxicity if radiotherapy can be constrained to the initial solid tumor bed and a minimal cystic component within the sellar region. Motivated by this, we sought to characterize the pattern of recurrence in craniopharyngiomas managed surgically without adjuvant therapy. <h3>Materials/Methods</h3> Medical records of 81 patients with craniopharyngioma diagnosed between 1979 and 2021 were reviewed. We identified a subset of patients treated with surgical resection alone who subsequently experienced local recurrence on surveillance MRI. Patients with unavailable pre-operative or recurrent imaging were excluded. Contours of both cystic and solid components of the initial tumor were created utilizing pre-operative MRI, and the recurrent tumor MRI was fused with these contours using deformable image registration. <h3>Results</h3> Fourteen patients who had received surgical resection without adjuvant RT were identified, with a median age of 10.1 years old. An endoscopic surgical approach was used in 8 (57.1%) patients, while open microsurgical approach was used in 6 (42.9%) patients; 3 (21.4%) resections were gross total resections, while 11 (78.6%) were considered near-total or subtotal resections. Median interval from date of initial surgery to first radiographic evidence of recurrence was 1.55 years. Local recurrence occurred purely in the initial cystic component of the tumor extent in 2 (14.3%) patients, was predominantly cystic and extending inferiorly to the initial solid component in 2 (14.3%) patients, and arising from the solid tumor resection bed in 10 (71.4%) patients. <h3>Conclusion</h3> A significant proportion of craniopharyngiomas recur within the cystic component of the initial tumor without adjuvant therapy, supporting continued incorporation of both solid and cystic components of the pre-surgical tumor extent in radiation therapy treatment plans.

Prospective Characterization of Circulating Tumor Cell Kinetics in Patients with Locoregional Head and Neck Cancer Receiving Definitive Therapy

<h3>Purpose/Objective(s)</h3> To characterize circulating tumor cell (CTC) kinetics in response to definitive or adjuvant therapy in patients with locoregional head and neck cancer and identify a profile of CTC kinetics that is associated with favorable disease response. <h3>Materials/Methods</h3> Patients with head and neck cancer of any subsite, excluding cutaneous malignancies, receiving definitive or post-operative adjuvant radiotherapy (RT) with or without concurrent chemotherapy were included. Induction chemotherapy was also permitted. Blood specimens were collected at baseline, during RT, and at routine follow-up visits. CTCs were captured and quantified using a nanotechnology-based assay functionalized with aEpCAM, aHER-2, and aEGFR to facilitate biomimetic cell rolling and dendrimer-mediated multivalent binding. Disease status was assessed per RECIST 1.1 criteria. CTC counts were reported and compared at various follow-up intervals for groups with and without complete response and progression. CTC counts were compared using the Wilcoxon signed rank test. <h3>Results</h3> 33 patients were enrolled with a median follow up of 15 months and median 6 CTC measurements per patient (range, 3-12). Histologies included squamous cell carcinoma (n=30), sinonasal undifferentiated carcinoma (n=1), high grade carcinoma with neuroendocrine features (n=1), and mucoepidermoid carcinoma (n=1). Subsites included the oropharynx (n=23), sinonasal (n=3), larynx (n=2), oral cavity (n=3), nasopharynx (n=1), and unknown primary (n=1). Of 23 oropharyngeal malignancies, 20 were HPV-associated. 25 patients received definitive chemoradiation (CRT), while 8 patients received surgical resection followed by risk-adapted adjuvant RT +/- chemotherapy. For patients treated with definitive CRT, median pre-treatment and end of treatment CTC counts were 77 CTCs/mL (range 7-849) and 22 CTCs/mL (range 2-209), respectively (P = 0.01). For patients treated with post-operative therapy, median pre-treatment and end of treatment CTC counts were 63 CTCs/mL (range 13-182) and 43 CTCs/mL (range 27-150), respectively (P = 0.17). Of 7 patients who developed disease progression and had CTC data available prior to the diagnosis of recurrence, 4 exhibited an increase in CTC counts near the time of progression. In comparison, 85% (17/20) of patients without evidence of disease progression had continued decline or stability of CTC counts following treatment, while the remaining 3 patients exhibited a transient increase in CTC counts. <h3>Conclusion</h3> Our data suggest that CTCs may serve as a biomarker for response to therapy in patients being treated for definitive management of locoregional head and neck cancer. Additional studies are warranted to further characterize their predictive and prognostic value.

Comparisons of Patient-Reported Quality of Life and Swallowing Scores of Mucosal Sparing Radiation vs. Standard of Care for Oropharyngeal Tumors

<h3>Purpose/Objective(s)</h3> We hypothesized mucosal sparing radiation therapy (MSRT) would result in improved patient-reported quality of life (QOL) and modified barium swallowing impairment scores (MBSImp) compared to standard of care (SOC) post-operative adjuvant radiation for human papillomavirus related (HPV) oropharyngeal squamous cell carcinoma (OPSCC). <h3>Materials/Methods</h3> The results of two institutional prospective studies, the SOC arm of MC1675 (DART) and a MSRT trial, were compared to assess for differences in QOL and MBSImp. Both trials were performed with patients undergoing transoral surgery with negative margins and neck dissection. The SOC was 60 Gy to the primary mucosal site and at-risk nodal regions while MSRT excluded the primary mucosal site primarily using proton therapy. Chemotherapy was delivered in both as indicated. Shared endpoints between the studies included EORTC HN-35 (HN35) at baseline, end of treatment (EOT), 3-, 6-, 12-, 24-, and 36-months posttreatment and MBSimp studies at baseline and 12 months posttreatment. Baseline adjusted mixed models, with adjustments for multiple comparisons, were utilized to test the effect of treatment arm over time and their interaction, with statistical significance set at p<0.05. <h3>Results</h3> 127 patients were included, 64 from the SOC and 63 from the MSRT trial. Significant differences in patient characteristics included smoking history, insurance coverage, use of chemotherapy, and pathologic T and N categories. After treatment, improved QOL scores were significantly associated with MSRT for HN35 domains: pain, swallowing, speech problems, trouble with social eating, trouble with social contact, less sexuality, opening mouth, dry mouth, pain killers, nutritional supplements, feeding tube, and weight loss. When considering the interaction between treatment and time, the largest QOL difference occurred acutely (<3 months post-RT) with significant differences in pain, swallowing, senses problems, speech problems, trouble with social eating, trouble with social contact, less sexuality, opening mouth, dry mouth, sticky saliva, and feeling ill. Better scores with MSRT for trouble with social eating, pain, and dry mouth persisted 3 months post-RT, while no significant differences remained 6 months post-RT. When adjusted for baseline patient characteristics MSRT was still associated with superior scores for swallowing, senses problems, trouble with social eating, less sexuality, and feeding tube use. MBSimp from baseline to 12 months post-RT showed worsening of oral impairment (imp) score and overall imp score for SOC but not for MSRT. At 12 months MSRT was associated with less oral imp and overall imp than SOC. <h3>Conclusion</h3> MSRT for HPV+ OPSCC is associated with higher QOL scores compared to current SOC treatment in the acute and subacute setting and higher MBSimp scores at 12 months. Adding MSRT to the DART regimen for select HPV OSCC patients will be further studied.

Clinicopathological characteristics and prognosis of gastric signet ring cell carcinoma.

BACKGROUNDThe clinicopathological features and prognosis of gastric signet ring cell carcinoma (GSRC) remain controversial, particularly with regard to sensitivity to postoperative adjuvant therapy.AIMTo compare the pathological features of GSRC with those of gastric adenocarcinoma of different degrees of differentiation and the differences in survival prognosis between the different disease processes.METHODSBy screening gastric cancer patients from 2010 to 2015 in the database of Surveillance, Epidemiology and End Results, and collecting the clinicopathological and prognostic data of gastric cancer patients who underwent surgery from January 2014 to December 2016 in the Second Affiliated Hospital of Nanchang University, we analyzed the general pathological characteristics of GSRC by the chi-square test. Univariate and multivariate analyses were conducted to compare the factors affecting the survival and prognosis of early and advanced gastric adenocarcinoma. The Kaplan-Meier curves were plotted to reveal the survival difference between early and advanced GSRC and different differentiated types of gastric adenocarcinoma. The prognosis model of advanced GSRC was established with R software, and the area under curve (AUC) and C-index were used to assess the accuracy of the model.RESULTSAnalysis of pathological features revealed that signet ring-cell carcinoma (SRC) was more frequently seen in younger (< 60 years), female, and White patients compared to non-SRC patients. SRC was less commonly associated with early gastric cancer (EGC) (23.60% vs 39.10%), lower N0 (38.61% vs 61.03%), and larger tumour sizes > 5 cm (31.15% vs 27.10%) compared to the differentiated type, while the opposite was true compared to the undifferentiated type. Survival prognostic analysis found no significant difference in the prognosis of SRC patients among EGC patients. In contrast, among advanced gastric cancer (AGC) patients, the prognosis of SRC patients was correlated with age, race, tumour size, AJCC stage, T-stage, and postoperative adjuvant therapy. The predictive model showed that the 3-year AUC was 0.787, 5-year AUC was 0.806, and C-index was 0.766. Compared to non-SRC patients, patients with SRC had a better prognosis in EGC [hazard ratio (HR): 0.626, 95% confidence interval (CI): 0.427-0.919, P < 0.05] and a worse prognosis in AGC (HR: 1.139, 95%CI: 1.030-1.258, P < 0.05). When non-SRC was divided into differentiated and undifferentiated types for comparison, it was found that in EGC, SRC had a better prognosis than differentiated and undifferentiated types, while there was no significant difference between differentiated and undifferentiated types. In AGC, there was no significant difference in prognosis between SRC and undifferentiated types, both of which were worse than differentiated types. A prognostic analysis of postoperative adjuvant therapy for SRC in patients with AGC revealed that adjuvant postoperative radiotherapy or chemotherapy significantly improved patient survival (34.6% and 36.2% vs 18.6%, P < 0.05).CONCLUSIONThe prognosis of SRC is better than that of undifferentiated type, especially in EGC, and its prognosis is even better than that of differentiated type. SRC patients can benefit from early detection, surgical resection, and aggressive adjuvant therapy.

Clinical Management of Embryonal Tumor with Multilayered Rosettes: The CCMC Experience.

Objective: Embryonal tumors with multilayered rosettes (ETMRs) are highly aggressive pediatric brain tumors with poor prognosis. No standard treatment strategy for them exists because of their rarity. This study aimed to share experiences on the clinical diagnosis and treatment of ETMRs at China Children’s Medical Center (CCMC). Methods: Patients who received a diagnosis of an ETMR between January 2017 and June 2020 were included. Clinical characteristics, such as age of onset, tumor size, stage, tumor site, treatment strategy, and clinical outcome, were retrospectively analyzed. Results: There were four boys and one girl within 4 years who received a diagnosis during this 4-year timeframe, and were thus included. The average age of morbidity was 29 months (range 16–66 months). The common clinical presentation was headaches and nausea caused by intracranial hypertension. All four patients were chromosome 19 microRNA cluster (C19MC) amplification positive. Two patients achieved complete remission, and one patient attained partial remission after multimodal treatment. Of the two deaths, one died from the rapid progression of the disease and another from tumor-related complications. Conclusion: ETMRs are extremely rare brain tumors with a high, early mortality in children. Surgery is the mainstream treatment for ETMRs. Some patients may also benefit from postoperative adjuvant chemotherapy and radiotherapy.

Intraoperative radiation therapy for locally advanced and recurrent head and neck cancer.

The purpose of the present study was to present a single institution experience with intraoperative radiation therapy (IORT) for patients with head and neck cancer (HNC). The present study included all patients with HNC treated consecutively with IORT at Loyola University Medical Center between January 2014 and December 2018. Charts were reviewed for patient and tumor characteristics, IORT technical details, IORT-induced adverse events and treatment outcomes. The study included 23 eligible patients. Median patient age was 66 years (range, 34-91 years). Tumor sites included the parotid gland (43%), lymph nodes (43%), oral tongue (9%) and ear (4%). A total of 48% of patients received IORT upfront with or without postoperative adjuvant external beam radiation therapy (EBRT), whereas 52% received salvage IORT after local tumor recurrence. The median prescribed IORT dose was 7.5 Gy (range, 5-14 Gy) in a single fraction prescribed to 5 mm depth with flat applicators (median diameter, 5 cm). A total of 92% of patients did not experience wound healing complications. One patient (4%) developed postoperative acute thromboembolic stroke and a second patient (4%) experienced protracted wound healing. At a median follow up of 36 months (range, 2-81 months), overall survival was 52%. In addition, 48% of patients were reported to have no evidence of disease, and although two had died of unrelated causes, 13% of patients were alive with disease and 39% died with the disease. The local-regional recurrence rate was 39% (median time to local recurrence, 11 months; range, 1-34 months), the rate of distant metastasis was 35% (median time to distant metastasis, 16 months; range, 4-40 months), and 21% of patients had both local-regional recurrence and distant metastases. The percentages of local-regional recurrence and distant metastases among patients receiving salvage IORT were 58 and 50% respectively, compared with 18 and 18% respectively in those receiving upfront IORT with or without adjuvant EBRT. In the present single institution retrospective study, it was concluded that IORT for patients with locally advanced and recurrent HNC was a safe treatment modality, with tumor control comparable to historical IORT data. Larger prospective studies are needed to further assess the utility of IORT in the management of locally advanced and recurrent HNC.

Intracranial solitary fibrous tumor/hemangiopericytoma: Role and choice of postoperative radiotherapy techniques

BackgroundIntracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a novel rare disease after the 2016 WHO reclassification. Surgery is the main treatment. Postoperative adjuvant radiotherapy is often used, but the effects of different radiotherapy techniques are still unclear. The purpose of this study was to analyze the effects of postoperative radiotherapy (PORT) and different radiotherapy methods on the efficacy of patients with intracranial SFT/HPC.Materials and methodsWe retrospectively analyzed 42 patients with intracranial SFT/HPC who underwent surgical treatment from 2008 to 2022, 20 of whom were treated with postoperative intensity-modulated radiotherapy (IMRT) and 22 with postoperative stereotactic radiosurgery (SRS). The Kaplan–Meier method was used to analyze the disease-free survival (DFS) of all the 42 patients receiving postoperative radiotherapy and the time to progression (TTP) of 22 of these patients experiencing recurrence. A multivariate Cox proportional hazards model was used to detect prognostic factors of survival.ResultsIn the analysis of PORT patients, the median DFS was 8.33 years for PORT IMRT patients and 3.04 years for PORT SRS patients. The 10-year DFS incidence was 46.0% in the PORT IMRT group and 27.5% in the SRS group. Among the 22 patients who relapsed, the median TTP of other patients was 1.25 years, of which 3 received radiotherapy alone and 1 received symptomatic treatment, while the median TTP of surgical and surgical combined with radiotheray patients were 1.83 and 2.49 years, respectively (p=0.035).ConclusionPORT IMRT could prolong DFS compared with PORT SRS. It indicated that PORT IMRT radiotherapy technology was a feasible option for SFT/HPC. Moreover, TTP results of relapsed patients showed that, surgery and surgery combined with radiotherapy treatments have no significant difference on TTP in relapsed patients, but both of them were better than other treatments.

The Clinical Features and Treatment Strategy of Parathyroid Cancer: A Retrospective Analysis

Objective To review the features and treatment of parathyroid cancer in our series. Explore the suitable extent of initial surgery and the effect of adjuvant radiotherapy in local recurrence. Methods Seven cases of parathyroid cancer presented from 2014 to 2021. The presenting features, diagnosis, and treatment are presented. Results Only two patients had multiple manifestations of hypercalcemia. Marked hypercalcemia, which was revealed to be an average of 13.9 mg/dl (range from 11.8 mg/dl to 15.8 mg/dl), was observed in four patients (57%). The others' serum calcium levels were in the normal range with an average of 9.9 mg/dl (range from 8.6 mg/dl to 10.8 mg/dl). All seven patients had hyperparathyroidism with an average of 733 pg/ml (range from 113 pg/ml to 3193 pg/ml). En bloc resection was performed in two patients with neighboring structure invasion, and four patients with complete tumor capsules underwent tumor resection with limited resection of the thyroid gland. Postoperative adjuvant radiotherapy appeared unsuccessful for local recurrence. Conclusion High calcium, high PTH, parathyroid occupation by ultrasound, and intraoperative invasion should be considered to have the possibility of parathyroid cancer. Open surgery is recommended and protecting tumor integration is the elementary surgery principle. The initial surgical extent should be decided by the invasion of the tumor. When PC has a local recurrence, the debulking surgery and adjuvant radiotherapy are always fake.