Postoperative Chemoradiotherapy Research Articles

Positron Emission Tomography-Computed Tomography Response-Guided Chemoradiotherapy For Anaplastic Thyroid Cancer

Although chemoradiotherapy (CRT) is an important component of multi-modal treatment for anaplastic thyroid cancer (ATC), responses are unpredictable. We report preliminary results of protocol-based, early Positron Emission Tomography-Computed Tomography (PET-CT) response-guided CRT for ATC. Histology-confirmed ATC patients underwent systemic evaluation including PET-CT. Intensity-modulated radiotherapy (IMRT) delivered 30 daily fractions of 2.2 Gy to gross tumor and metastatic lymph nodes, 2.0 Gy to postoperative tumor bed and/or high-risk areas of microscopic disease, and 1.8 Gy to regional nodal areas. Concurrent paclitaxel (70 mg/m2) was delivered on days 1, 8, and 15 every 4 weeks. After 18 fractions of CRT, interim response analysis consisting of second PET-CT and simulation CT was conducted for adaptive treatment plan: lenvatinib 10 mg per day was added when showing progression, whereas CRT was terminated at 25 fractions and followed by surgical resection when gaining resectability. Common Terminology Criteria for Adverse Events version 4.0 was used, and overall survival (OS) was measured from the day of diagnosis. Thirty-three patients were treated between August 2016 and April 2019. Median follow-up was 5.6 months (range, 1.6-28.9). In Group A, 7 patients (1 stage IVA, 5 IVB, and 1 IVC) completed postoperative CRT: all patients are alive with median follow-up of 21.5 months (range, 6.4-28.9), except for 1 who received lenvatinib for lung metastases and survived for 16.1 months. No grade ≥3 toxicities were reported except for grade 3 dermatitis in 1 patient. In Group B, 8 patients (all stage IVB) underwent definitive CRT: 5 received surgical resection after 25 (n = 3) and 30 (n = 2) fractions, and 1 refused treatment at 41.8 Gy. Grade 3 dermatitis (n = 2) and febrile neutropenia (n = 2) were reported, and one died of pneumonia after completing CRT. In Group C, 18 patients with distant metastases received palliative CRT: grade 3 dermatitis (n = 1) and grade 4 (n = 1) and grade 3 (n = 3) febrile neutropenia were reported. Four patients did not complete CRT and died of disease progression (n = 3) and aspiration pneumonia (n = 1), while 4 died of pneumonia and chemoport infection after completing CRT. Median survival (MS) was not reached in Group A and was 8.5 and 4 months for Group B and C, respectively. For 12 patients who received surgery before or after CRT, MS was not reached and 2-year OS was 66%. Among 26 patients who were treated for gross disease, 9 (34.6%) showed partial response within the RT field during CRT. Among the 5 patients who underwent surgery after CRT, no residual or near total tumor necrosis was reported in 3. Response evaluation during CRT may allow effective treatment intensification or de-intensification for ATC. Resection before or after CRT allowed long-term survival. A phase II trial with enhanced toxicity-monitoring is under development.

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.

Treatment sequence, hospital practice patterns, and completion of multimodality therapy for locally advanced gastric cancer.

14 Background: Optimal oncologic care for patients with locally advanced gastric cancer includes multimodality therapy (MMT). While both perioperative chemotherapy and postoperative chemoradiotherapy are recommended, it is unclear whether one approach is more effective for ensuring patients complete MMT. Methods: National cohort study of 5,450 patients with locally advanced gastric cancer (i.e.: ≥cT2 and/or cN+) treated at 983 hospitals within the National Cancer Data Base (2006-15). Patients were categorized as having surgery first or chemotherapy first (patients not undergoing resection after chemotherapy or not receiving adjuvant after surgery were included based on intent-to-treat). MMT was defined as surgical resection with either neoadjuvant chemotherapy or adjuvant chemoradiotherapy. Hospitals were categorized into terciles based on utilization of chemotherapy first: 1.) predominantly chemotherapy first; 2.) mixed pattern; 2.) predominantly surgery first. The association between patient-level treatment, hospital practice pattern, and MMT completion was evaluated using multivariable hierarchical regression and the association with overall risk of death using multivariable Cox shared frailty modeling. Results: Overall, 55.5% of surgery first and 64.8% of chemotherapy first patients completed MMT (p<0.001) and five-year survival for those completing MMT was 45.5% and 46.6%, respectively (log-rank, p=0.91). At the patient-level, chemotherapy first was significantly associated with MMT completion (Odds Ratio [OR] 1.61 [1.39– 1.86]). By comparison, relative to mixed hospitals, care at surgery first hospitals was associated with MMT completion (OR 1.32 [1.08 – 1.59]), which was due to differences in case-mix and the proportion of patients not receiving resection after chemotherapy (surgery first hospitals—4.1%; mixed hospitals—19.0%; chemotherapy first hospitals—29.4%, p<0.001). MMT by either approach was associated with lower risk of death (ref—surgery only; chemotherapy first – Hazard Ratio [HR] 0.77 [0.68 – 0.86]; surgery first – HR 0.77 [0.68 – 0.87]) while hospital practice pattern was not. Conclusions: The type of MMT strategy is less important than ensuring patients complete MMT. After accounting for treatment drop-outs (which are substantial with either strategy), chemotherapy first appears more effective in the general community for ensuring patients complete MMT. National guidelines should be modified to emphasize neoadjuvant over surgery first MMT strategies.

The Clinicopathological and Imaging Characteristics of Primary Hepatic Carcinosarcoma and a Review of the Literature.

PurposeTo improve the understanding of hepatic carcinosarcoma (HCS) by analyzing radiological imaging data and clinicopathological features.Materials and MethodsA retrospective analysis was performed on four patients with HCS confirmed immunohistochemically. The analysis included three males and one female, aged 29 to 64 years. Four patients underwent computed tomography (CT) scans, and one underwent magnetic resonance imaging (MRI) scans simultaneously.ResultsThree patients had a history of hepatitis B, cirrhosis or fibrosis, and two patients had schistosomiasis. Two cases tested positive for elevated serum carbohydrate antigen (CA) 19–9. The maximum diameters of the lesions ranged from 7.8 to 9.0cm. Pathologically, the carcinomatous and sarcomatous elements in two patients could not be classified, one of the patients had cholangiocellular carcinoma (CCC) and undifferentiated sarcoma, the other had hepatocellular carcinoma (HCC) and undifferentiated pleomorphic sarcoma (UPS). All tumors showed heterogeneous density/intensity, accompanied by vast cystic changes and necrosis, with two cases having cystic septations. Capsule formation was not identified. The margins of the radiological images showed irregular ring enhancement. One case presented continuous progressive enhancement, one case with “fast in fast washout” and two cases with “fast in late washout”. Lymphonodus metastasis, satellite nodules, vascular embolism, and organ invasion (hepatic flexure of the colon) were identified.ConclusionHCS is a rare, high-grade malignancy with poor prognosis. The preoperative diagnosis is expected to improve by carefully analyzing the imaging features of the patients in combination with their clinical characteristics. Radical resection and postoperative chemoradiotherapy can improve the survival rate of patients.

Treatment Selection and Survival Outcomes in Locally Advanced Proximal Gastric Cancer: A National Cancer Data Base Analysis.

Background: We aimed to assess long-term survival between locally advanced proximal gastric cancer (LAPGC) patients who underwent proximal gastrectomy (PG) and those who underwent total gastrectomy (TG) to evaluate the optimal extent of resection and adjuvant therapy.Materials and Methods: Patients diagnosed with locally advanced proximal gastric adenocarcinoma were selected from the National Cancer Data Base (2004–2015) in America. Survival analysis was performed via Kaplan-Meier and Cox proportional hazards models.Results: A total of 4,381 eligible patients were identified, 1,243 underwent PG and 3,138 underwent TG. Patients in TG group had a poor prognosis (hazard ratio [HR] = 1.13, 95% confidence interval [CI]: 1.03–1.25) compared with those in PG group. Moreover, postoperative chemoradiation therapy was associated with improved overall survival compared to surgery alone (HR = 0.71, 95% CI: 0.53–0.97) in LAPGC patients who had PG, while preoperative chemotherapy (HR = 0.74, 95% CI: 0.59–0.92) was associated with improved survival among patients who had TG.Conclusions: Our study suggested that LAPGC patients underwent PG experienced better long-term outcomes than those underwent TG. It also suggested that multimodality treatment of LAPGC, including preoperative chemotherapy followed by TG or postoperative chemotherapy followed by PG, should be considered to achieve better long-term outcomes.

How Should We Approach Locally Advanced Squamous Cell Carcinoma of Head and Neck Cancer Patients Ineligible for Standard Non-surgical Treatment?

Cisplatin has been established as one of the most important agents in multidisciplinary treatment for head and neck cancer (HNC). However, since HNC patients are often elderly and typically have several comorbidities, a limited number of patients can tolerate high-dose cisplatin in real-world HNC populations. We will provide a review of therapeutic alternatives to high-dose cisplatin-based treatment in the setting of definitive and postoperative chemoradiotherapy (CRT) or induction chemotherapy. Clinical criteria for CDDP ineligibility have been discussed in HNC. When considering cisplatin-based chemotherapy as part of a non-surgical approach, precise evaluation of the patient's physical condition, nutritional status, and comorbidities is needed. Upfront surgery is an important option with high curability, if a de-intensified non-surgical approach is estimated to be unavoidable. Although no prospective data are available regarding alternatives to definitive cisplatin-based combination therapy for patients undergoing a non-surgical approach, cetuximab, carboplatin, or split-dose cisplatin-based regimens may be employed for cisplatin-ineligible patients in clinical practice. The combination of immune checkpoint inhibitors with radiotherapy may be a promising novel approach, and some trials are currently targeting the specific cohort of patients ineligible for high-dose cisplatin. There are no standard treatments for patients ineligible for high-dose cisplatin. A personalized treatment strategy should be proposed based on the individual benefit-to-risk ratio of each treatment option in patients ineligible for the standard of care. Prospective clinical trials for cisplatin-ineligible patients with locally advanced HNC still need to be performed.

Patterns of recurrence in patients with curative resected rectal cancer according to different chemoradiotherapy strategies: Does preoperative chemoradiotherapy lower the risk of peritoneal recurrence?

The present study aimed to compare the pattern of distant recurrence between patients with non-metastatic rectal cancer treated with pre-operative (OP) and those treated with post-operative (post-OP) chemoradiotherapy (CRT). A total of 631 patients with newly diagnosed non-metastatic rectal cancer who had received pre-OP or post-OP CRT with curative intent surgery between August 2008 and April 2015 were identified. Inverse probability of treatment weighting (IPTW) was performed to account for baseline differences between the two arms. Overall, 449 and 182 patients were treated with pre-OP and post-OP CRT, respectively. Sex, tumor location, clinical tumor stage, CRT regimen and adjuvant chemotherapy regimen were significantly different between the two arms. The median follow-up duration was 55.4 months (range, 53.7-57.1). The 5-year distant recurrence-free survival (RFS) rates and 5-year overall survival (OS) rates were not significantly different between the pre-OP and post-OP CRT arms (RFS, 67.5 vs. 71.6%, P=0.595 and OS, 81.9 vs. 77.0%, P=0.449), and no difference was observed in the distant recurrence patterns. Following IPTW, there was still no difference in distant RFS (pre-OP vs. post-OP CRT; hazard ratio (HR)=0.62; P=0.911), but pre-OP CRT was significantly associated with lower peritoneal recurrence (pre-OP vs. post-OP CRT; HR, 0.13; P=0.032). In addition, there was no significant difference in OS between the two arms (pre-OP vs. post-OP CRT; HR, 0.85; P=0.665). In conclusion, although distant RFS was not significantly different between the two arms, pre-OP CRT was significantly associated with a lower risk of peritoneal recurrence than post-OP CRT in patients non-metastatic rectal cancer.

Radiomics of rectal cancer for predicting distant metastasis and overall survival.

BACKGROUNDRectal cancer (RC) patient stratification by different factors may yield variable results. Therefore, more efficient prognostic biomarkers are needed for improved risk stratification, personalized treatment, and prognostication of RC patients.AIMTo build a novel model for predicting the presence of distant metastases and 3-year overall survival (OS) in RC patients.METHODSThis was a retrospective analysis of 148 patients (76 males and 72 females) with RC treated with curative resection, without neoadjuvant or postoperative chemoradiotherapy, between October 2012 and December 2015. These patients were allocated to a training or validation set, with a ratio of 7:3. Radiomic features were extracted from portal venous phase computed tomography (CT) images of RC. The least absolute shrinkage and selection operator regression analysis was used for feature selection. Multivariate logistic regression analysis was used to develop the radiomics signature (Rad-score) and the clinicoradiologic risk model (the combined model). Receiver operating characteristic curves were constructed to evaluate the diagnostic performance of the models for predicting distant metastasis of RC. The association of the combined model with 3-year OS was investigated by Kaplan-Meier survival analysis.RESULTSA total of 51 (34.5%) patients had distant metastases, while 26 (17.6%) patients died, and 122 (82.4%) patients lived at least 3 years post-surgery. The values of both the Rad-score (consisted of three selected features) and the combined model were significantly different between the distant metastasis group and the non-metastasis group (0.46 ± 0.21 vs 0.32 ± 0.24 for the Rad-score, and 0.60 ± 0.23 vs 0.28 ± 0.26 for the combined model; P < 0.001 for both models). Predictors contained in the combined model included the Rad-score, pathological N-stage, and T-stage. The addition of histologic grade to the model failed to show incremental prognostic value. The combined model showed good discrimination, with areas under the curve of 0.842 and 0.802 for the training set and validation set, respectively. For the survival analysis, the combined model was associated with an improved OS in the whole cohort and the respective subgroups.CONCLUSIONThis study presents a clinicoradiologic risk model, visualized in a nomogram, that can be used to facilitate individualized prediction of distant metastasis and 3-year OS in patients with RC.

Primary congenital choledochal cyst with squamous cell carcinoma: a case report

Cases of extrahepatic bile duct carcinoma are mostly adenocarcinomas and extrahepatic bile duct squamous cell carcinomas are rare. We report here a case of choledochal squamous cell carcinoma in a young woman who underwent surgery and chemotherapy. The woman presented with abdominal discomfort. A physical examination showed tenderness in the upper abdomen. Laboratory tests showed elevated direct bilirubin, total bilirubin, and C-reactive protein levels. Abdominal computed tomography and magnetic resonance imaging showed a cystic-solid mixed soft tissue mass in the common bile duct. Pain symptoms in the patient were not relieved and surgical treatment was performed. Postoperative pathological results showed a choledochal cyst complicated by squamous cell carcinoma. The patient was treated by biliary intestinal anastomosis followed by chemotherapy. However, the patient developed liver metastasis and recurrence at a 6-month follow-up. Primary congenital bile duct cysts with squamous cell carcinoma are extremely rare. Surgical resection is the main treatment option for choledochal squamous cell carcinoma. Postoperative chemoradiotherapy can be used, but the efficacy is poor and chemotherapy does not significantly prolong the patient’s survival.

1436P Comparison of perioperative chemotherapy versus postoperative chemoradiation therapy for operable stomach cancer: A western Canadian province experience

The standard approaches for resectable gastric cancer involve postoperative chemoradiation (PCR) or perioperative chemotherapy (PC). Limited evidence is available regarding comparable efficacy and toxicities of the two approaches. There are no randomized trials to address this question. In this population based cohort study, we compare the efficacy and toxicities of PCR with PC.

118: Association of PIK3CA Status with Clinicopathologic Factors and Outcome in Patients with Cervical Cancer Treated with Primary Surgery with or Without Postoperative Adjuvant Chemoradiotherapy

118: Association of PIK3CA Status with Clinicopathologic Factors and Outcome in Patients with Cervical Cancer Treated with Primary Surgery with or Without Postoperative Adjuvant Chemoradiotherapy

Survival impact of delaying postoperative chemoradiotherapy in newly-diagnosed glioblastoma patients.

BackgroundMaximal safe resection followed by adjuvant chemoradiotherapy (CRT) with temozolomide (TMZ) is the standard treatment for newly diagnosed glioblastoma multiforme (GBM) patients. Time of initiation of postoperative adjuvant therapy has been demonstrated to impact on prognosis. For GBM patients, the optimal interval between definitive surgery and CRT is still uncertain. Current study aims to find whether the delayed initiation of CRT after surgery has a negative impact on patients’ outcome.MethodsSixty-six consecutively patients with newly-diagnosed GBM treated with surgery and adjuvant CRT from April 2014 to September 2019 at Ruijin Hospital School of Medicine Shanghai Jiaotong University were retrospectively reviewed. The impact of postoperative time from surgery to adjuvant treatment on patient’s overall survival (OS) and progression-free survival (PFS) were evaluated by univariate Log-rank test and multivariate Cox regression analysis. Factors including age, Karnofsky performance status (KPS), maximum diameter of primary tumor, extent of resection, isocitrate dehydrogenase (IDH) mutation status and O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation status were also analyzed in Cox regression model.ResultsThe median OS for patients who started CRT less than 6 weeks (n=48) and more than 6 weeks (n=18) were 26.6 months (95% CI: 18.3–34.9) and 15.7 months (95% CI: 9.2–22.3) (P=0.001). The median PFS for the short interval group was 16.3 months (95% CI: 14.7–18.0) and for the long interval group was 9.1 months (95% CI: 4.7–13.4) (P=0.006). On multivariate Cox regression analysis, high KPS and initiation of CRT less than 6 weeks were two independent prognostic factors for better OS and PFS (all P<0.05).ConclusionsInitiation of adjuvant CRT beyond 6 weeks contributed to worse survival in GBM patients, therefore CRT should be initiated within 6 weeks after surgery.

LincRNA-p21 Levels Relates to Survival and Post-Operative Radiotherapy Benefit in Rectal Cancer Patients.

LincRNA-p21 is a long non-coding RNA involved in the p53 pathway and angiogenesis regulation that acts as prognostic marker in several tumors. In the present study, we aimed to analyze the clinical value of lincRNA-p21 in 177 resected stage I–III colorectal cancer (CRC) patients. Tumor and normal paired tissue and plasma samples from tumor-draining mesenteric veins and paired peripheral veins were analyzed. LincRNA-p21 expression was determined by RTqPCR and correlated with disease-free (DFS) and overall survival (OS). LincRNA-p21 was downregulated in tumor versus normal tissue (p = 0.0012). CRC patients with high lincRNA-p21 expression had shorter DFS (p = 0.0372) and shorter OS (p = 0.0465). Of note, the major prognostic impact was observed in the subset of rectal cancer patients where patients with high lincRNA-p21 levels had worse DFS (p = 0.0226) and OS (p = 0.0457). Interestingly, rectal cancer patients with high lincRNA-p21 benefited from post-operative chemoradiotherapy, as indicated by a longer OS in the group of high lincRNA-p21 patients receiving post-operative chemoradiotherapy (p = 0.04). Finally, patients with high lincRNA-p21 levels in mesenteric vein (MV) had shorter OS (p = 0.0329). LincRNA-p21 is a marker of advanced disease and worse outcome in CRC. Moreover, rectal cancer patients with high lincRNA-p21 levels could benefit from post-operative chemoradiotherapy, and plasmatic-lincRNA-p21 is a promising liquid biopsy biomarker.

Multi-Parametric Deep Learning Model for Prediction of Overall Survival after Postoperative Concurrent Chemoradiotherapy in Glioblastoma Patients.

This study aimed to investigate the performance of a deep learning-based survival-prediction model, which predicts the overall survival (OS) time of glioblastoma patients who have received surgery followed by concurrent chemoradiotherapy (CCRT). The medical records of glioblastoma patients who had received surgery and CCRT between January 2011 and December 2017 were retrospectively reviewed. Based on our inclusion criteria, 118 patients were selected and semi-randomly allocated to training and test datasets (3:1 ratio, respectively). A convolutional neural network–based deep learning model was trained with magnetic resonance imaging (MRI) data and clinical profiles to predict OS. The MRI was reconstructed by using four pulse sequences (22 slices) and nine images were selected based on the longest slice of glioblastoma by a physician for each pulse sequence. The clinical profiles consist of personal, genetic, and treatment factors. The concordance index (C-index) and integrated area under the curve (iAUC) of the time-dependent area-under-the-curve curves of each model were calculated to evaluate the performance of the survival-prediction models. The model that incorporated clinical and radiomic features showed a higher C-index (0.768 (95% confidence interval (CI): 0.759, 0.776)) and iAUC (0.790 (95% CI: 0.783, 0.797)) than the model using clinical features alone (C-index = 0.693 (95% CI: 0.685, 0.701); iAUC = 0.723 (95% CI: 0.716, 0.731)) and the model using radiomic features alone (C-index = 0.590 (95% CI: 0.579, 0.600); iAUC = 0.614 (95% CI: 0.607, 0.621)). These improvements to the C-indexes and iAUCs were validated using the 1000-times bootstrapping method; all were statistically significant (p < 0.001). This study suggests the synergistic benefits of using both clinical and radiomic parameters. Furthermore, it indicates the potential of multi-parametric deep learning models for the survival prediction of glioblastoma patients.

＜Editors' Choice＞ Impact of maintenance of postoperative performance status on survival in elderly patients over 70 with high-grade astrocytoma.

ABSTRACTThis study aimed to identify the elderly generation with the worst prognoses for high-grade astrocytoma and find independent predictors of good outcomes. We conducted a retrospective analysis of 91 patients, ≥65 years old, with anaplastic astrocytoma or glioblastoma. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method and compared using log-rank test or multivariate Cox regression analysis. We included 21 (23%) and 70 (77%) patients aged 65–69 years and ≥70 years. In the two generations, significant differences were found in the Charlson comorbidity index, extent of resection, chemoradiotherapy (CRT) as adjuvant therapy, and radiation dose (all P < 0.05). The median PFS was 9.9 and 6.9 months in patients aged 65–69 and ≥70 years (P = 0.10). The median OS was 22.8 and 11.6 months in patients aged 65–69 and ≥70 years (P = 0.009). In the multivariate analyzes in patients ≥70 years, only postoperative Karnofsky performance status (KPS) scores ≥70 were significantly related to prolonged PFS (hazard ratio [HR]: 0.48, P = 0.04), and postoperative KPS, CRT as adjuvant therapy, and salvage therapy were significantly related to prolonged OS (HR: 0.45, P = 0.03, HR: 0.38, P = 0.002, and HR: 0.43, P = 0.01, respectively). In conclusion, in patients ≥70 with high-grade astrocytoma, OS was significantly shorter compared to those aged 65–69. Postoperative KPS score was significantly related to prolonged PFS and OS. Postoperative CRT and salvage therapy at recurrence may be effective in the selected elderly.

Determining whether postoperative chemoradiotherapy is required in patients with pathologic T3N0 rectal cancer with negative resection margin.

This study aimed to identify the risk factors for locoregional recurrence (LR) and determine possible candidates for postoperative concurrent chemoradiotherapy (CCRT) in pathologic T3N0 (pT3N0) rectal cancer patients with a negative resection margin after total mesorectal excision (TME). Data from 365 patients who had pT3N0 rectal cancer between 2003 and 2012 in the Samsung Medical Center were reviewed. All patients underwent upfront surgery without preoperative treatment. Postoperative management involved either no adjuvant therapy (n = 122), chemotherapy alone (n = 100), or CCRT (n = 143). The median follow-up duration was 71 months. The 5-year overall survival, disease-free survival, and LR-free survival (LRFS) rates were 95.9%, 86.9%, and 96.3%, respectively. When comparing the three groups (surgery alone [n = 122], chemotherapy alone [n = 100], and CCRT [n = 143]), there was no significant difference in LRFS among them (94.0%, 93.4%, and 99.2%, respectively; p = 0.20). However, when patients were stratified by risk factors (distance from anal verge ≤ 5 cm and distal resection margin [DRM] ≤ 2 cm), the 5-year LRFS improved by more than 10% by adding CCRT (98.9% with CCRT vs. 87.4% without CCRT, p = 0.006) in those with more than one risk factor. Postoperative CCRT did not affect the 5-year LRFS (100% with CCRT vs. 99.0% without CCRT, p = 0.66) in patients with no risk factors. Postoperative CCRT significantly decreased LR in patients with pT3N0 rectal cancer with a negative resection margin but having a distance from the anal verge ≤ 5 cm or DRM ≤ 2 cm.

Risk stratification of postoperative recurrence in hypopharyngeal squamous-cell carcinoma patients with nodal metastasis.

To explore lymph node-related risk factors and investigate the benefit of different adjuvant therapy strategies in hypopharyngeal squamous-cell carcinoma (HPSCC) patients with nodal metastasis (N +). We conducted a retrospective review covering 266 HPSCC patients with nodal metastasis. Kaplan-Meier curves and Cox proportional hazard models were utilized to evaluate recurrence-free survival (RFS) and independent risk factors. pT3-T4, extranodal extension, lymphovascular invasion, and lower lymph node involvement were high-risk factors leading to poorer RFS in N + HPSCC patients. Patients were classified into three groups based on the recursive-partitioning analysis (RPA). Postoperative chemoradiation significantly improved RFS in patients in the high-risk group (p < 0.001). For patients in the low- and intermediate-risk groups, the application of adjuvant therapies showed no significant benefit on RFS (p = 0.74 and 0.53, respectively). The novel risk stratification for N + HPSCC patients can predict the risk of postoperative recurrence effectively. Adjuvant chemoradiation is preferred for patients in the high-risk group as it lowers risk of recurrence. Conversely, for patients in the low- and intermediate-risk groups, regular observation and follow-up strategies are a valid form of treatment.

Clinical Features and Outcomes of Primary Spinal Cord Glioblastoma: A Single-Center Experience and Literature Review

We aim to elucidate the clinical characteristics of patients with primary spinal cord glioblastoma (PSC GBM) and prognostic factors for their outcomes. A cohort of 11 patients with pathologically diagnosed PSC GBM from our center were retrospectively reviewed. The clinical, radiologic, operative, and molecular information were recorded, and univariate analysis was performed to identify prognostic factors. The patient cohort included 5 males (45.5%) and 6 females (54.5%) with a median age of 26 years (range, 9-69 years). The median duration of the preoperative symptoms was 4.0 months (range, 0.5-120 months). Subtotal resection was achieved in 8 patients (72.7%) and partial resection in 3 (27.3%). Two patients (18.2%) underwent postoperative adjuvant chemoradiotherapy, 2 patients underwent (27.3%) chemotherapy only, and 6 patients (54.5%) neither. Two patients underwent additional therapy with bevacizumab. After a mean follow-up of 12.4 months (range, 1-33 months), Kaplan-Meier plot showed that the median progression-free survival and overall survival were 6.0 (range, 0.5-12.0) months and 12.0 (range, 1.0-33.0) months, respectively, and 1-year survival was 31.8%. Age at diagnosis and duration of the preoperative symptoms were confirmed as prognostic factors of progression-free survival and overall survival in univariate analysis (P < 0.05). Despite aggressive treatment, PSC GBM still has a dismal prognosis and leads to severe neurologic deficit. Age at diagnosis and duration of the preoperative symptoms were confirmed as prognostic factors, yet the role of adjuvant radiochemotherapy and extent of resection are still unclear, necessitating further research.

The analysis of absorbed dose by pancreas during gastric cancer radiotherapy

Introduction: The toxicity of radiotherapy is a very important issue in the everyday work of radiation oncologist. The tolerance to certain doses of radiotherapy in organs at risk determines the safety of radiotherapy. Despite the increasing number of publications concerning the injury of the pancreas after radiotherapy, this organ does not have common directives. We decided to reanalyse our previously published data in terms of the dose of radiation absorbed by the pancreas to determine a dose-effect relationship with the use of radiation-induced hypoamylasaemia and hypolipasaemia. Materials and methods: We reanalysed a group of 127 gastric cancer patients after preoperative or postoperative chemoradiotherapy who were treated with a total dose of 45 Gy administered in 25 fractions. To identify the absorbed doses, the pancreas was contoured based on the CT scans used for radiotherapy planning and divided into anatomical parts: the head, the body and the tail. Results: We found that 80% of the whole pancreatic volume absorbed at least 44.5 Gy. The body, tail and head absorbed 100%, 90% and 70% of the abovementioned dose, respectively. The mean dose absorbed by the whole pancreas ranged from 32 to 48 Gy, with a mean of 44 Gy. A total dose of 45 Gy administered to gastric cancer patients can lead to subclinical insufficiency of the pancreas (hypolipasaemia and hypoamylasaemia). This dose is not able to cause symptomatic damage to the pancreas.

Treatment Outcomes for Primary Retromolar Trigone Carcinoma: A Single Institution Experience.

Retromolar trigone (RMT) is a rare location for oral cavity cancers. RMT cancers are aggressive malignancies that mostly present at an advanced stage. In this study, we aimed to evaluate treatment outcomes in patients who underwent initial radical surgical resection and postoperative radiotherapy or chemoradiotherapy with a diagnosis of primary RMT squamous cell carcinoma in our institution. The study included 20 primary RMT tumor patients out of 191 oral cavity cancer cases treated from January 2010 through December 2019. We retrospectively analyzed treatment details, histopathology reports, postoperative clinical course and survival outcomes. The mean age at presentation was 59.4 years. Eighty percent of all patients were either stage 3 or stage 4. We performed mandibular resection in 14 patients (70%) and partial maxillectomy in eight patients (40%). Nineteen patients (95%) underwent unilateral neck dissection. The incidence of metastatic cervical lymph node was 13/20 (65%). Overall survival (OS) and disease-free survival (DFS) rates during follow-up (mean 26.3 months) were 60% and 75%, respectively. There was statistical significance between presence of multilevel metastatic lymph nodes and OS (p=0.013). DFS and OS of early stage and advanced stage groups were 100% vs 75% and 100% vs 50%, respectively, with no statistical significance (p=0.189 and p=0.084). The survival of advanced stage RMT cancer is poor despite appropriate treatment. Bone involvement that necessitates resection is common due to the proximity of the tumor to the mandible and the maxilla. Multilevel positive cervical lymph nodes and advanced stage are poor prognostic factors.