Postoperative Radiotherapy Group Research Articles

Subgroups of parotid gland infiltrating ductal carcinoma benefit from postoperative radiotherapy: a population-based study.

To analyze the prognostic factors and the impact of postoperative radiotherapy (PORT) in parotid gland infiltrating ductal carcinoma (IDC). 252 patients diagnosed with parotid gland IDC were identified from the SEER database. Kaplan-Meier and Cox regression analysis was performed to evaluate the prognostic factors. Propensity score matching was applied then. Multivariate analysis showed old age and chemotherapy were independent risk factors in parotid gland IDC. Subgroup analysis demonstrated that overall survival (OS) rate of the PORT group was significantly superior to that of the no radiotherapy group in the T3-4 subgroup (p=0.049), N1 subgroup (p=0.019) and Tumor, Node, Metastasis (TNM) III subgroup (p=0.025). PORT improved survival of parotid gland IDC patients within T3-4, N1 and TNM III subgroups.

Survival after biochemical failure in prostate cancer treated with radiotherapy: Spanish Registry of Prostate Cancer (RECAP) database outcomes.

The clinical course in patients with prostate cancer (PCa) after biochemical failure (BF) has received limited attention. This study analyzes survival time from recurrence, patterns of progression, and the efficacy of salvage therapies in patients treated with radical or postoperative radiotherapy (RT). This is a multicenter retrospective comparative study of 1135 patients diagnosed with BF and treated with either radical (882) or postoperative (253) RT. Data correspond to the RECAP database. Clinical, tumor, and therapeutic characteristics were collected. Descriptive statistics, survival estimates, and comparisons of survival rates were calculated. Time to BF from initial treatment (RT or surgery) was higher in irradiated patients (51 vs 37months). At a median follow-up of 102months (14-254), the 8-year cause-specific survival (CSS) was 80.5%, without significant differences between the radical (80.1%) and postoperative (83.4%) RT groups. The 8-year metastasis-free survival rate was 57%. 173 patients (15%) died of PCa and 29 (2.5%) of a second cancer. No salvage therapy was given in 15% of pts. Only 5.5% of pts who underwent radical RT had local salvage treatment and 71% received androgen deprivation (AD) ± chemotherapy. The worst outcomes were in patients who developed metastases after BF (302pts; 26.5%) and in cases with a Gleason > 7. In PCa treated with radiotherapy, median survival after BF is relatively long. In this sample, no differences in survival rates at 8-years have been found, regardless of the time of radiotherapy administered. AD was the most common treatment after BF. Metastases and high Gleason score are adverse variables. To our knowledge, this is the first study to compare outcomes after BF among patients treated with primary RT vs. those treated with postoperative RT and to evaluate recurrence patterns, treatments administered, and causes of death. The results allow avoiding overtreatment, improving quality of life, without negatively affecting survival.

The role of postoperative radiotherapy for completely resected pIIIA-N2 non-small cell lung cancer patients with different clinicopathological features: a systemic review and meta-analysis.

Background: The role of postoperative radiotherapy (PORT) in completely resected pathological stage IIIA-N2 (pIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. This meta-analysis aimed to assess the effect of PORT in patients with pIIIA-N2 NSCLC on the basis of clinicopathological features.Methods: The PubMed, PubMed Central (PMC), Embase, Web of Science, and Cochrane Library were searched for relevant studies. The main outcomes were overall survival (OS) and disease-free survival (DFS), which were compared using the hazard ratio (HR).Results: One randomized trial and 12 retrospective studies were eligible for the analysis. PORT significantly improved both OS [HR = 0.85; 95% confidence interval (CI): 0.79-0.92] and DFS (HR = 0.57; 95% CI: 0.38-0.85) compared with non-PORT treatment in patients with multiple N2 metastases or multiple N2 station involvement. No significant difference in either OS (HR = 1.03; 95% CI: 0.86-1.24) or DFS (HR = 1.08; 95% CI: 0.70-1.65) was found between PORT and non-PORT groups for patients with single N2 station involvement. No significant heterogeneity was observed. No significant differences in OS were observed between PORT and non-PORT groups for patients of different ages, sex, tumor sizes or pT stages, and histological types.Conclusions: The findings of this meta-analysis supported a role for PORT in patients with completely resected pIIIA-N2 NSCLC having multiple N2 metastases and favored withholding PORT to patients with single N2 station involvement. Further prospective randomized controlled trials are needed to confirm the findings.

Evaluation of surgery plus postoperative radiotherapy or definitive radiotherapy in older patients with thoracic esophageal squamous cell cancer.

This study investigated the outcome of elderly patients (≥65 years) with thoracic esophageal squamous cell carcinoma (TESCC) treated with esophagectomy and postoperative radiotherapy (PORT) or definitive radiotherapy (DRT). One hundred and ninety patients (median age of 72 years) who received PORT (n = 68) or DRT (n = 122) for TESCC were analyzed. Majority of them showed locally advanced disease (T3/4: 70.5%, N+: 70.5%, Stage III: 51.6%). Compared to patients who received DRT, those who received PORT had lower Age-Adjusted Charlson Comorbidity Index (AACCI) scores (2.49 ± 0.61 vs. 3.73 ± 1.28, χ2 = 7.283; P = 0.000) and higher Karnofsky Performance Scale (KPS) (χ2 = 9.016; P = 0.003) and were of younger ages (68.90 ± 3.00 vs. 75.17 ± 5.71, χ2 = 9.925; P = 0.000). Overall survival (OS) was significantly higher in the PORT group (median, 61.2 months; 95% confidence interval [CI], 46.04-76.36) than in the DRT group (median, 24.37 months; 95% CI, 15.43-33.31). Multivariate analysis showed that treatment method (hazard ratio [HR]: 2.38, 95% CI, 1.46-3.90; P = 0.001), clinical T stage (HR: 0.57, 95% CI, 0.34-0.95; P = 0.031), and lymph node metastasis (HR: 0.51, 95% CI, 0.31-0.84; P = 0.008) were independent prognostic factors. Regarding subgroup analysis, OS of patients receiving PORT was significantly higher than that of DRT in the T3-4 group (HR: 2.98, 95% CI, 1.80-4.92; P = 0.000) and the N+ group (HR: 2.20, 95% CI, 1.26-3.83; P = 0.006). The efficacy of PORT for the treatment of elderly TESCC patients was superior to DRT. With regard to AACCI, KPS, and age, DRT is still a treatment option for elderly TESCC patients, especially for those >75 years of age.

Nomograms for predicting survival outcomes in patients with primary tracheal tumors: a large population-based analysis.

BackgroundThe aim of this study was to develop and validate reliable nomograms to predict individual overall survival (OS) and cancer-specific survival (CSS) for patients with primary tracheal tumors and further estimate the role of postoperative radiotherapy (PORT) for these entities.Patients and methodsA total of 405 eligible patients diagnosed between 1988 and 2015 were selected from the Surveillance, Epidemiology, and End Results database. All of them were randomly divided into training (n=303) and validation (n=102) sets. For the purpose of establishing nomograms, the Akaike information criterion was employed to select significant prognostic factors in multivariate Cox regression models. Both internal and external validations of the nomograms were evaluated by Harrell’s concordance index (C-index) and calibration plots. Propensity score matching (PSM) method was performed to reduce the influence of selection bias between the PORT group and the non-PORT group.ResultsTwo nomograms shared common variables including age at diagnosis, histology, N and M stages, tumor size, and treatment types, while gender was only incorporated in the CSS nomogram. The C-indices of OS and CSS nomograms were 0.817 and 0.813, displaying considerable predictive accuracy. The calibration curves indicated consistency between the nomograms and the actual observations. When the nomograms were applied to the validation set, the results remained reconcilable. Moreover, the nomograms showed superiority over the Bhattacharyya’s staging system with regard to the C-indices. After PSM, PORT was not associated with significantly better OS or CSS. Only squamous cell carcinoma (SCC) patients in the PORT group had improved OS compared to non-PORT group.ConclusionThe first two nomograms for predicting survival in patients with primary tracheal tumors were proposed in the present study. PORT seems to improve the prognosis of SCC patients, which needs further exploration.

Second primary malignancy risk after radiotherapy in rectal cancer survivors.

AIMTo investigate second primary malignancy (SPM) risk after radiotherapy in rectal cancer survivorsMETHODSWe used Taiwan’s National Health Insurance Research Database to identify rectal cancer patients between 1996 and 2011. Surgery-alone, preoperative short course, preoperative long course, and post-operative radiotherapy groups were defined. The overall and site-specific SPM incidence rates were compared among the radiotherapy groups by multivariate Cox regression, taking chemotherapy and comorbidities into account. Sensitivity tests were performed for attained-year adjustment and long-term survivors analysis.RESULTSA total of 28220 patients were analyzed. The 10-year cumulative SPM incidence was 7.8% [95% confidence interval (CI): 7.2%-8.2%] using a competing risk model. The most common sites of SPM were the lung, liver, and prostate. Radiotherapy was not associated with increased SPM risk in multi-variate Cox model (hazard ratio = 1.05, 95%CI: 0.91-1.21, P = 0.494). The SPM hazard remained unchanged in 10-year-survivors. In addition, no SPM risk difference was found between the preoperative radiotherapy and postoperative radiotherapy groups.CONCLUSIONIn this large population-based cohort study, we demonstrated that radiotherapy had no increase in SPM.

Postoperative Radiation Therapy (PORT) Is Safe and Effective in pIII-N2 Non-Small-Cell Lung Cancer (NSCLC) Receiving Pneumonectomy

For patients with pIII-N2 NSCLC who received pneumonectomy followed by adjuvant chemotherapy, there are few evidence on the use of PORT and its role remains controversial. This study is to evaluate the safety and efficacy of PORT for such population. Between Jan. 2004 and Dec. 2015, patients with stage pIII-N2 NSCLC who had undergone pneumonectomy followed by adjuvant chemotherapy with or without PORT in our institution were retrospectively reviewed. Platinum-based doublet chemotherapy of 4 cycles was used. Radiotherapy was performed by 3D-CRT/ IMRT to the total dose of 50-60 Gy. The effect of PORT on survival was evaluated by Kaplan-Meier method and log-rank test. Pearson chi-Square test was used to compare categorical variables between groups. Student-t test was used for normal distribution variables, and Mann-Whitney U test was used for non-normal distribution variables. Statistically significant difference was set as p<0.05. Totally 119 patients with stage pIII-N2 NSCLC were included in this study. Among them, 32 patients received sequential adjuvant chemotherapy and PORT (PORT group), and 87 patients received adjuvant chemotherapy alone (Control group). Clinical and pathological characteristics of patients between the two groups were comparable (p>0.05), which included age, gender, KPS, tumor site, preoperative lung function and pathological type, et al. R1/R2 resection of PORT group was significantly higher than that of Control group (25% vs. 8%, p=0.031). Grade 2 or above radiation induced acute or chronic pneumonitis was 2/ 32. No severe radiation induced heart injury was observed. There was no radiation toxicity related death. Of all the 119 patients, the median follow-up time was 25 months and median overall survival (mOS) was 46months. The median disease free survival (mDFS) was 15 months. OS in PORT group was significantly better than control group (not reached vs. 34 months, p=0.003), and so as to DFS (19 months vs. 13 months, p=0.003). PORT could also significantly increase local recurrence free survival (LRFS, p=0.012) and distant metastasis free survival (DMFS, p=0.047). In patients with R0 resection (n=104), OS and LRFS in PORT group were significantly higher than those in Control group, and postoperative radiotherapy tended to increase DFS and DMFS with curves not crossing. For paitients with R1/R2 resection (n=15), OS in PORT group was also significantly higher than that in Control group (not reach vs. 24 months, p=0.021). Compared with chemotherapy alone, adding radiotherapy significantly reduced local regional failure rate (39.1% vs. 15.6%, p=0.016), and distant metastasis was still the main cause of failure. For patients with stage pIII-N2 NSCLC after pneumonectomy followed by adjuvant chemotherapy, PORT was safe and could improve OS, DFS, LRFS and DMFS. Further verification of our result is needed in the future study.

Postoperative Radiation Therapy for Resected Stage IIIA-N2 Non-Small-Cell Lung Cancer: A Population Study from 1988 to 2014 Using the Surveillance, Epidemiology, and End Results Database

The use of postoperative radiotherapy(PORT) after resection of stage IIIA-N2 non-small-cell lung cancer(NSCLC) remains controversial. Large real-world data studies are absent regarding the value of PORT across different time periods as all treatment methods develop. We explored the effects of PORT on the survival of patients with resected stage IIIA-N2 NSCLC and assessed the temporal changes spanning 27 years. Within the Surveillance, Epidemiology, and End Results Database, we selected stage IIIA-N2 NSCLC patients who underwent a lobectomy or pneumectomy and coded as receiving PORT or never receiving radiation therapy over three time periods: 1988 to 1996, 1997 to 2005, 2006 to 2014. For each period, survival rates were assessed with Kaplan-Meier method, log-rank test and multivariable hazard ratios were estimated from Cox proportional hazards models. A total of 5568 patients (718, 2020, 2830 in period 1, 2, 3 respectively) were included, 45.4% of which received PORT. The yearly PORT use varied largely with the highest 74.4% in 1994 and the lowest 27.8% in 2005. Overall survival(OS) was significantly improved over the periods ( p<0.001) in the whole cohort, PORT group and non-PORT group, respectively. Median survivals in the three periods were 20 vs 14, 26 vs 24, 39 vs 33 months for PORT vs non-PORT group. The use of PORT had significant impact on survival in period 1(p<0.001) and 3(p=0.001) but not in period 2(p=0.256). However, in subgroup analysis, the OS benefit of PORT was significantly in each period in patients with 50% or more lymph node ratio(LNR, defined as number of positive nodes/ number of resected nodes): Period 1: hazard ratio(HR), 0.646; 95% confidence interval(CI): 0.482-0.865, p=0.003. Period 2: HR, 0.846; 95% CI: 0.717-0.998, p=0.047. Period 3: HR, 0.773; 95% CI: 0.634-0.942, p=0.011). This population-based study demonstrates significant improvements in OS of these selected resected stage IIIA-N2 NSCLC patients from 1988-2014. The benefits of PORT are not significantly in each time period but are lasting and stable throughout the years in patients with LNR of 50% or more, although other integrated factors such as the progress of surgery and medication may contribute to a better survival. Further investigations in other cohorts and prospective studies are warranted.

Postoperative Radiation Therapy Has No Effect in Improving the Survival of Patients Aged ≤55 Years with Completely Resected Pathological Stage IIIA-N2 Non-Small-Cell Lung Cancer

For patients with completely resected pathological stage IIIA–N2 non-small cell lung cancer (NSCLC), studies has shown that postoperative radiotherapy (PORT) does not improve survivals of elderly patients (＞65 years). However, the role of PORT for younger patients is not well defined. This study is to evaluate the effect of PORT on survivals as well as tumor control in patients ≤65 years. Between Jan. 2003 and Dec. 2015, patients, ≤65 years, with pIIIA–N2 NSCLC after complete resection in our single institution were retrospectively analyzed. The effect of PORT on overall survival (OS), disease free survival (DFS), loco-regional recurrence free survival (LRFS), and distant metastasis free survival (DMFS) was evaluated with Kaplan-Meier method and log-rank test. Multivariable Cox regression analysis was used to identify independent risk factors for death. Pearson chi-square test was used to compare the constituent ratios between groups. Propensity score-matched (PSM) analysis was conducted to generate comparable study arms. Statistically significant difference was set as p<0.05. Overall, 940 consecutive patients ≤65 years were enrolled. The median follow-up was 31.1 months. The median age was 55 years (range, 25–65 years). The characteristics were comparable between the PORT group and non-PORT group, except that more patients with ≥4 positive lymph nodes and receiving chemotherapy in the PORT group. The 3- and 5-year OS rates were 75.3% and 63.1%, respectively, in the PORT group, which were statistically significantly higher than 68.2% and 53.3% in the non-PORT group (p=0.023). The differences between the two groups were also significant in the DFS and LRFS rates (p=0.006 and 0.000, respectively), but not in the DMFS rate (p=0.062). After adjustment by PSM, PORT still resulted in significantly better survivals of OS, DFS, LRFS and DMFS than non-PORT group (p=0.009, 0.000, 0.000 and 0.000, respectively). Then patients were divided into younger group (≤50 years, n=269), middle-age group (51-55 years, n=218) and older group (56-65 years, n=453). PORT significantly improved the OS in the older group, The 3- and 5-year OS rates were 75.8% and 59.1% in the PORT group vs. 61.5% and 45.7% in the non-PORT group, respectively (p=0.019). The OS was not improved by PORT in the younger or middle-age groups (p=0.859 and 0.524, respectively). When the patients in the younger and middle-age groups was merged together (≤55 years), the OS was not improved by PORT neither (p=0.626). In multivariable analysis, PORT was not significantly associated with better prognosis of patients ≤55 years old (p=0.902). For patients with completely resected pIIIA–N2 NSCLC, PORT can significantly improve the OS of patients aged 56-65 years, but not in patients aged ≤55 years. The result needs to be validated in the future study.

Effect of Adjuvant Radiation Therapy on Survival in Resected Thoracic Esophageal Squamous Cell Carcinoma According to the 8th AJCC Stage System: Pooled Analysis of Two Cancer Centers in China

The objective of this study was to investigate the impact of postoperative radiotherapy on the overall survival (OS) after radical esophagectomy according to the eighth edition of AJCC esophageal cancer staging, using two large hospital-based datasets from two big cancer hospitals in the northern and southern China, individually. A total of 3,811 cases were enrolled in the analysis. The patients who received R0 esophagectomy pathologically were diagnosed with squamous cell carcinoma and with or without postoperative radiotherapy (PORT) were selected. The tumor stage T1b-4aN1-3M0 was determined according to the newly published AJCC 8th staging in all the analysis. The OS was analyzed using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was used to identify covariates associated with OS. PSM analysis was performed on gender, age, vascular thrombosis, pathological differentiation, and AJCC 8th staging to balance the treatment bias between the surgery group and the postoperative radiotherapy group. The median duration of follow-up was 65.7 months (95% CI: 63.8-67.5 months) using reverse Kaplan–Meier method. The 5-year survival rates of 2725 cases in no PORT group were 83.5%, 66.9%, 57.3%, 50.6%, 29.5%, and 11.3% in IB, IIA, IIB, IIIA, IIIB, and IVA (p < 0.001). Before PSM, PORT did not improve the OS. Further subgroup analysis found that PORT in patients with stage IIB, IIIB, IVA based on the AJCC 8th staging can significantly improve OS. After PSM, 990 patients were included in PORT and no PORT group. PORT could improve the OS significantly (median survival, 52.3 months and 31.0 months, respectively; HR 0.716, 95% CI 0.638-0.804, P<0.001). The subgroup analysis was consistent with that before PSM. PORT in stages IIB, IIIB, and IVA could improve the OS after PSM. Multivariate analysis showed that gender, differentiation, vascular cancer thrombosis, TNM stage and postoperative radiotherapy were independent prognostic factors for both before and after PSM. The prognosis of operable esophageal squamous cell carcinoma cancer can be predicted perfectly by using the AJCC 8th staging. Postoperative radiotherapy after R0 esophagectomy potentially improved the OS for patients with stage IIB, IIIB, and IVA, further prospective studies are needed to confirm these results.

Postoperative Radiation Therapy (PORT) May Not Improve Overall Survival (OS) of Patients with pIIIA-N2 Non-Small-Cell Lung Cancer (NSCLC) with Positive Surgical Margins

For pN+ NSCLC patients with positive surgical margins, the standard treatment is chemoradiotherapy. However, high level evidence is lacking. This study is to evaluate the effect of PORT on survivals of pIIIA-N2 NSCLC patients with positive surgical margins and identify the prognostic factors. Between Jan. 2003 and Dec. 2015, patients who had undergone lobectomy or pneumonectomy plus mediastinal lymph node dissection or systematic sampling in our single institution were respectively reviewed. Those with pIIIA–N2 NSCLC and positive surgical margins were included in this study. The Kaplan–Meier method was used to calculate survival rates, and the log-rank test was used to analyze differences between the groups. Multivariate analysis was done using the Cox hazard regression with entry factors of which the p-value <0.10. Statistically significant difference was set as p-value <0.05. Of all the 1547 pIIIA–N2 NSCLC patients, 113 were with positive surgical margins, including 76 with R1-resection and 37 with R2-resection. Of the 113 patients, 32 (28.3%) received radiotherapy. There was no significant difference in OS between patients with R1-resection and with R2-resection. The 5-year OS rates were 35.1% and 19.2% respectively (p=0.373). OS was more favorable for patients with less positive lymph nodes (p=0.039). In PORT group, the 3- and 5-year OS rates were 33.9% and 22.6% respectively, which were similar with 40.1% and 35.3% in non-PORT group (p=0.970). Subset analysis showed that for patients with R1-resection and non-squamous cell carcinoma (n=44), PORT trended to improve OS, with the 5-year OS rates of 35.7% versus 23.8% (p=0.082). In multivariate analysis with entry factors including age, the number of positive lymph nodes and different adjuvant therapies, there was no significant independent factor in predicting OS. For pIIIA-N2 NSCLC patients with positive surgical margins in our study, PORT does not improve OS, but trends to improve the OS of those with R1-resection and non-squamous cell carcinoma. Further study with a larger population is needed to validate our conclusion.

1580P - How advanced lung cancer patients are really treated at the population level? The Ontario, Canada experience

Background: Clinical trials define treatment recommendations but patients in the real world may be unable or unwilling to undergo treatments with demonstrated efficacy in fit patients. The Canadian Partnership Against Cancer has developed a model of lung cancer (LC) management (OncoSim-lung) in 2008 based on clinical trials data and expert advice. To credibly project the future clinical and economic impacts of cancer control measures using OncoSim, the model has been refined using real-world data. Methods: Treatment data by histology and stage were extracted from the Ontario Cancer Registry for LC cohorts diagnosed in 2010 and 2013. All incident cases that satisfied the IARC rule of a new primary were included. Missing or unknown stage cases were excluded. Clinical pathways were validated by oncologists from different disciplines across Canada. Results: The 2013 cohort included 8,086 staged LC: NSCLC (n = 7,143) Stage I 18.7%, II 8%, III/IIIa 11.4%, IIIb 4.9% IV 56.8%; SCLC (n = 943) limited 67.7%, extensive 32.3%. Of 813 stage III/IIIa patients, only 26% underwent surgery, 41% of whom received adjuvant chemotherapy or postoperative radical radiotherapy (16%); 13% received trimodality treatment. Of the 75% of Stage III not receiving surgery, 26% had NAT and 21% had palliative radiotherapy alone. Of those receiving active treatment, 20% received combined chemo +radiotherapy and 13% each had chemotherapy alone or radical radiotherapy alone. Of 356 stage IIIb patients, 17% had NAT, 28% received palliative radiotherapy and only 30% had chemo + radical radiotherapy. 18% had chemo alone. Of 4055 stage IV NSCLC, 47% had NAT, 24% received chemotherapy alone and 23% had palliative radiotherapy only. Of those who received first-line chemotherapy (n = 1059), 47% received second line chemotherapy and of those, 37% received third line therapy. Conclusions: Compared to prior expert opinion, there was a much lower frequency of chemo-radiotherapy in Stage III disease and a higher frequency of NAT across all stages of disease. The updated OncoSim model will now have a credible real-world base from which the impacts of new treatment interventions on survival and budget impact can be better estimated. Legal entity responsible for the study: Canadian Partnership Against Cancer. Funding: Canadian Partnership Against Cancer. Disclosure: All authors have declared no conflicts of interest.

Predictors of Early Recurrence Prior to Planned Postoperative Radiation Therapy for Oral Cavity Squamous Cell Carcinoma and Outcomes Following Salvage Intensified Radiation Therapy

To determine predictors and outcomes for oral squamous cell carcinoma (OSCC) patients who had early recurrence before commencement of postoperative radiation therapy (PORT). Retrospective review was performed for patients with OSCC treated with PORT between 2003 and 2015 after curative-intent surgery. Early recurrence was defined as tumor recurrence after surgical resection and before initiating planned PORT. Patients were classified into the following groups: (1) adjuvant PORT group (no early recurrence), (2) salvage PORT group (locoregional early recurrence), and (3) palliative PORT group (locoregional and distant early recurrence). For the whole cohort, multivariable analysis (MVA) was applied to identify predictors of early recurrence. In the salvage group, the post-PORT recurrence-free rate was estimated, and MVA was used to identify predictors of recurrence-free rate, disease-free survival, and overall survival (OS). Six hundred and one patients were identified, of whom 513 (85%) were treated with adjuvant PORT. Eighty-eight patients (15%) had early recurrence (28 of 88; 32% were biopsy proven) before PORT (70 in the salvage group and 18 in the palliative group). On MVA, oral tongue subsite, microscopic positive resection margin, pT3-4, and pN2-3 were associated with the development of early recurrence (P<.05 for all). The 3-year OS rates for patients with OSCC treated with adjuvant and salvage PORT were 71% (95% confidence interval [CI], 67%-75%) and 41% (95% CI, 30%-56%), respectively (P<.001; median follow-up was 3.4 and 2.9years, respectively). After salvage PORT, the 3-year recurrence-free rate was 36% (95% CI, 23%-47%). On MVA, extranodal extension and volume of early recurrent gross disease were associated with poor recurrence-free rate, disease-free survival, and OS (P<.05 for all). Early recurrences are not uncommon in patients with high-risk features, Further study is required to improve prediction and outcomes of this very high-risk group.

Benefit of adjuvant radiotherapy following narrow-margin hepatectomy in patients with intrahepatic cholangiocarcinoma that adhere to major vessels.

PurposeTo evaluate the role of adjuvant radiotherapy after narrow-margin (<1.0 cm) resection in patients with intrahepatic cholangiocarcinoma (ICC) adherent to major vessels.Patients and methodsThis retrospective study included 70 ICC patients. Forty-nine patients received narrow-margin (<1.0 cm) hepatectomy and 21 patients underwent wide-margin (≥1.0 cm) hepatectomy (Group C). Twenty-six of 49 were treated with postoperative radiotherapy (Group A), while the remaining 23 did not receive radiotherapy (Group B). Clinical outcomes were compared in the 3 groups. Toxicities of radiotherapy were evaluated.ResultsWith a median follow-up time of 42 months, the 3-year overall survival (OS) and disease-free survival rates were 55% and 44% for Group A, 20% and 10% for Group B, and 65% and 33% for Group C, respectively. The OS and disease-free survival in Groups A and C were comparable and improved compared to Group B (Group A vs B, P=0.011 and P=0.031; and Group C vs B, P=0.031 and P=0.105). Multivariate analysis showed that receiving narrow-margin resection only (adjusted hazard ratio: 3.73; 95% CI: 1.36–10.25; P=0.001) was a significant poor prognostic risk factor of OS. Group B experienced more intrahepatic recurrence and extrahepatic recurrence than Groups A and C. For Groups A and B, the 3-year intrahepatic recurrence rates were 36% vs 67% (P=0.133) and extrahepatic recurrence rates were 43% vs 65% (P=0.007). Only 2 patients in Group A suffered from grade 3 toxicities. No patient developed classic or nonclassic radiation-induced liver disease.ConclusionPostoperative radiotherapy following narrow-margin hepatectomy seems to be efficacious and well-tolerated in patients with ICC adjacent to major vessels.

Dermatofibrosarcoma protuberans – the impact of radiation therapy: a single institution series

AbstractBackgroundDermatofibrosarcoma protuberans (DFSP) is a locally aggressive intermediate malignancy.ObjectiveThe purpose of this retrospective analysis is to determine the efficacy of radiation therapy (RT) in local control of DFSP.Patients and methodsThe recurrence-free survival (RFS) for 45 patients treated for DFSP at our institution was estimated and compared between surgery alone and postoperative RT groups.ResultsAge range of the patients were in the third and fourth decades; males:females=2:1; most common site: anterior abdominal wall; tumours &gt;5 cm in size in 75%; low grade in 77·8%; margins positive in 31·8% and &lt;5 mm margins in 45·5%. Two-thirds of patients had at least one recurrence before presentation to our institution. RT dose was &gt;50 Gy in 88% of patients. The patients treated with postoperative RT had poorer prognostic factors compared with surgery alone: they were males (17 versus 13 patients), and presented with high-grade tumours (5 versus 1 patients), multiple recurrences prior to presentation (25 versus 20 patients) and positive or &lt;5 mm margins (22 versus 12 patients). Median follow-up for surgery alone group was 17 (1–152) months and for postoperative RT group, this was 54 (5–121) months. RFS at 5 years was 77·1% for surgery alone and 87·9% for postoperative RT group but was not statistically significant. The median time to recurrence was 4 years.ConclusionRT delays the time to recurrence in DFSP. RT improves the outcome of DFSP for recurrent tumours and with positive margins.

Omission of Postoperative Radiotherapy in Women Aged 65 Years or Older With Tubular Carcinoma of the Breast After Breast-Conserving Surgery.

To investigate the temporal trends of postoperative radiotherapy (RT) administration and the effects of omitting postoperative RT on breast cancer-specific survival (BCSS) in women aged ≥65 years with tubular carcinoma (TC) of the breast who received breast-conserving surgery (BCS). We included women aged ≥65 years with non-metastatic TC of the breast who underwent BCS between 2000 and 2013 using the Surveillance, Epidemiology, and End Results database. Statistical analyses were performed using chi-square tests, Kaplan-Meier analyses, Cox proportional hazards models, and a 1:1 propensity score matching (PSM). Before PSM, a total of 1,475 patients with tumor size ≤2 cm, node-negative disease, and estrogen receptor-positive disease were identified, including 927 (62.8%) underwent postoperative RT and 548 (37.2%) had postoperative omission of RT. The administration of postoperative RT steadily declined over the study period. Patients with younger age, larger tumor size, and other race/ethnicity were more likely to receive postoperative RT. The median follow-up duration was 85.0 months, the 5- and 10-year BCSS rates were 98.7 and 97.9%, respectively. The median BCSS was 161.9 and 165.0 months for patients with and without postoperative RT, respectively, and the corresponding 5-year BCSS rates were 98.5 and 98.8%, respectively (p = 0.134). Prognostic analysis indicated that postoperative RT was not associated with improved BCSS rates compared with RT omission (p = 0.134). After PSM, a total of 431 complete pairs were generated. In the matched population, the 5-year BCSS rates were 98.6 and 98.4% in non-postoperative RT and postoperative RT groups, respectively (p = 0.858). The univariate analyses also confirmed that the administration of postoperative RT was not associated with better BCSS (p = 0.858). The incidence of breast cancer-related death is probably sufficiently low to avoid postoperative RT in women aged ≥65 years with TC of the breast after BCS.

Male patients with resected IIIA-N2 non-small-cell lung cancer may benefit from postoperative radiotherapy: a population-based survival analysis.

Our analysis was performed to assess the efficacy of postoperative radiotherapy (PORT) on the survival for pathologic IIIA-N2 Non-small-cell lung cancer patients. We identified 2949patients from 2004 to 2013 in the SEER database. Propensity score-matching was used to reduce the selection bias. Overall survival (OS), cancer-specific survival (CSS) and the factors associated with survival prognosis were evaluated. There was no significant difference in OS and CSS between PORT and non-PORT groups. However, subgroup analysis revealed an OS (p=0.007) and CSS (p=0.006) detrimental for male patients not receiving PORT. Multivariate analysis showed that old age, male sex, high pathologic grade, squamous carcinoma, bigger tumor size and larger number of positive lymph nodes had a negative impact on survival. PORT could improve OS and CSS in male patients with resected IIIA-N2 non-small-cell lung cancer.

Trends and outcomes of neoadjuvant radiotherapy compared with postoperative radiotherapy for malignant breast cancer.

BackgroundAlthough neoadjuvant treatment has become the established approach for women with large primary tumors or locally advanced breast cancer for which immediate surgery is not the best approach, it may also stimulate cancer stem cell self-renewal and facilitate recurrence. We sought to determine the survival outcomes of preoperative radiotherapy (PRRT) compared with postoperative radiotherapy (PORT).Materials and MethodsThe Surveillance, Epidemiology, and End Results (SEER) registry was queried for patients who were diagnosed with breast cancer and underwent cancer-directed surgery. Survival analyses were performed with Cox proportional hazard regression for both overall survival (OS) and disease-specific survival (DSS), and 1:1 propensity score (PS) matching-adjusted competing risk analyses were conducted for DSS.ResultsWe first identified 1,111,218 eligible patients in 18 registries from 1973 to 2013 and found that, outside of the Utah registry, sequence patterns other than PORT were rarely used. Thus, we next identified eligible patients registered in Utah (n = 7,042) from 1988 to 2007. The treatment trends shifted abruptly in 1988. Compared with the PORT group, the PRRT group showed significantly higher risks of overall mortality (absolute difference, 22.4%; P < 0.001), breast cancer-specific mortality (absolute difference, 8.6%; P < 0.001), and cardiovascular disease-specific mortality (absolute difference, 11.5%; P = 0.021). Survival differences in treatment sequences were correlated with stage.ConclusionsSubstantial shifts in treatment patterns for malignant breast cancer were identified in Utah. Compared with PORT, PRRT showed significantly worse outcomes. These results could inform future standardized options for radiation sequence with surgery and further clinical trials.

Clinical characteristics, risk factors, and outcomes after adjuvant radiotherapy for patients with thymoma in the United States: analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry (1988–2013)

Purpose: The surgery with adjuvant radiation for the treatment of thymoma is still debated. The aim of this study was to examine the efficacy of postoperative radiotherapy (PORT) in a population-based registry of patients with thymoma.Materials and methods: We conducted a retrospective analysis of the Surveillance, Epidemiology, and End Results database to compare the outcomes of patients with thymoma who received surgery with or without PORT.Results: Among the 2234 patients of this study, the surgery with PORT group had a longer mean overall survival (OS) and cancer-specific survival (CSS) than did the surgery without PORT group (OS: 172.3 vs. 155.3 months, p = .005; CSS: 247.3 vs. 241.8 months, p = .04). PORT significantly improved OS and CSS of patients with stage III/IV disease, but decreased CSS for those with stage I/IIA disease. Although the surgery with PORT group had a higher rate of secondary cancers, the between-group difference in the disease-free interval was not significant.Conclusions: PORT provides a significant benefit for patients with thymoma, particularly those with advanced disease. However, it also increases the risk of a second malignancy. We suggest that treatment guidelines should adopt a more positive stance on the use of PORT.

Comparison of different treatment modalities in node-positive patients after radical resection for squamous cell carcinoma of the thoracic esophagus

Objective To compare the efficacy between different modalities in the treatment of positive lymph nodes after radical resection for squamous cell carcinoma of thoracic esophagus (TESCC), and to explore the best treatment mode. The Kaplan-Meier method was used to calculate survival rates. The log-rank test and Cox model were used for univariate and multivariate prognostic analyses, respectively. Methods A retrospective analysis was performed among 548 patients with TESCC who were admitted to our hospital and had positive lymph nodes after radical resection. The efficacy of different treatment methods was evaluated. Propensity scores (PSM) were used to make 1-to-1 patient matching between different treatment groups to further analyze and figure out the best treatment model for patients. The Kaplan-Meier method was used to calculate the overall survival (OS) and disease-free survival (DFS) rates. The log-rank test was used for survival analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results In all patients, the 1-, 3-, and 5-year OS rates were 79.9%, 38.1% and 28.5%, respectively, while the 1-, 3-, and 5-year DFS rates were 68.5%, 39.8% and 32.5%, respectively. After 1-to-1 matching based on PSM, there were no differences in general clinical pathological data between the four groups. After PSM, there were significant differences in 1-, 3-, and 5-year OS and DFS rates between the surgery alone group, the postoperative radiotherapy group, the postoperative chemotherapy group, and the postoperative chemoradiotherapy (POCRT) group (P=0.000, 0.000). There were significant differences in OS and DFS rates between patients with stage N1, N2, and N3 disease (P=0.000, 0.000). The result of the Cox multivariate analysis showed that treatment method and N staging were two independent prognostic factors for OS and DFS (P=0.001, 0.000, 0.025, 0.016). Conclusions Patients with positive lymph nodes after radical resection for TESCC have a poor prognosis. Moreover, the prognosis becomes worse with the increase in metastatic lymph nodes. POCRT may improve the survival in those patients. Prospective studies are needed to further confirm those conclusions. Key words: Esophageal neoplasms/surgery; Esophageal neoplasms/postoperative adjuvant therapy; Prognosis; Propensity score matching