Postoperative Radiotherapy Group Research Articles

Surgery alone without adjuvant radiation therapy for high or intermediate-grade salivary gland cancer

Introduction: Postoperative radiation therapy (RT) is recommended for completely resected T1-2 salivary gland cancer (SGC), if the tumor pathology is adenoid cystic carcinoma, intermediate, or high-grade tumors. In this case series, we reviewed cases of intermediate or high-grade SGC, managed with curative surgery alone without adjuvant RT, and compared those outcomes with pathology- and tumor stage-matched SGC, treated with surgery and postoperative RT. Methods: We retrieved cases of intermediate or high-grade tumors arising from the major salivary glands treated with surgery alone without adjuvant RT (N = 29) from the institutional SGC database. The main reasons for no adjuvant RT and treatment outcomes were reviewed in detail. In addition, we established the tumor pathology (grade)- and tumor stage (T1-2N0M0)-matched cases treated with surgery and postoperative RT as comparison groups (N = 59), to investigate relative treatment outcomes. Results: The overall treatment outcome was 82.7% disease-specific survival (DSS) at a median follow-up of 41 months, with a 10.3% incidence of systemic metastasis in intermediate or high-grade SGCs treated with surgery alone. The primary reasons for not receiving adjuvant RT were no recommendation by the surgeon (37.9%) and patient refusal of RT (27.6%). Comparisons of the surgery alone and surgery with postoperative RT in tumor pathology (grade)- and tumor stage-matched groups revealed similar treatment outcomes; 100% DSS at 35-50 months in the surgery alone group and 90-100% DSS at 37-60 months in the surgery and postoperative RT group. Meanwhile, patients with advanced SGCs (T3-4 or N+) treated with surgery alone had a DSS of 50.0% at a median follow-up of 63 months, and systemic metastasis was the main cause of treatment failure (37.5%). Conclusion: Our findings suggest that surgery alone may yield favorable outcomes for a specific subset of early-stage, intermediate- to high-grade salivary gland cancers (SGC) without any adverse pathological features. Further studies are warranted to validate this approach.

Patterns of Regional Failure in Patients With Oral Cavity Squamous Cell Carcinoma After Radical Surgery: Insight for Neck Management Optimization.

Regional failure (RF) in oral cavity squamous cell carcinoma (OCSCC) is associated with poor outcomes, yet its detailed pattern and its relationship with corresponding neck management strategies remain inadequately defined. This study aims to provide insights for optimizing neck management in OCSCC patients through a comprehensive analysis of RF patterns. A retrospective review was conducted on patients with OCSCC who underwent radical surgery with or without postoperative radiotherapy (PORT) between 2015 and 2018. Detailed mapping of the initial metastasis and RF patterns was performed and correlated with the corresponding neck management approaches. A total of 147 patients and 294 necks were included in the analysis. RF was identified as the predominant pattern of failure (5-year rate: 19.8%), with pN+ being the most notable risk factor for regional failure-free survival (RFFS). Compared to the Surgery group, the Surgery+PORT group demonstrated a significantly lower RF rate beyond the dissected region (6.5% vs. 20.0%, p = 0.03) and a numerically lower RF rate beyond the upper neck (5.2% vs. 12.9%, p = 0.10). In dissected necks, RF at level IV accounted for 47.3% of all RF occurrences. The "dissected and irradiated" necks exhibited a lower RF rate than the "dissected-alone" necks (8.7% vs. 13.4%), particularly at level IV (2.2% vs. 8.5%) and Vb (1.1% vs. 3.7%). When compared to the "untreated" necks, the "irradiated-alone" necks showed reduced RF at almost all levels. The significant rate of RF in the lower neck warrants particular attention in OCSCC management. Prophylactic irradiation to the lower neck may play a critical role in enhancing regional control and improving patient outcomes.

Postoperative radiotherapy and survival outcomes in pN2 non-small-cell lung cancer with positive surgical margins: An updated review of the National Cancer Database.

e20010 Background: The role of postoperative radiotherapy (PORT) in non-small-cell lung cancer (NSCLC) remains controversial, particularly in patients with positive surgical margins (PSM). The 2022 Lung ART trial, a phase III study involving 501 European patients, found that mediastinal PORT did not improve disease-free survival (DFS) compared to no PORT; however, patients with PSMs were excluded from the trial. In 2020, Yuan et al. published a retrospective study in China on 113 pIIIA-N2 NSCLC patients with PSMs treated between 2003 and 2015, reporting no overall survival (OS) benefit with PORT. A subset analysis suggested a nonsignificant OS improvement in R1 resected patients receiving PORT with chemotherapy (52.4 months with PORT vs. 22.6 months without PORT, p=0.127). Since ASCO’s 2021 recommendation against routine PORT in completely resected pN2 NSCLC, no specific guidelines have addressed its use in patients with PSMs, highlighting the need for further research in this subgroup. Methods: The National Cancer Data Base (NCDB) was queried for M0 patients who underwent surgery for NSCLC with PSM (R1+R2), pathologic N2 status and those who received adjuvant chemotherapy from 2004-2017. Patients were stratified based on the administration of PORT, and cases with missing data were excluded. Survival outcomes were assessed using the SAS LIFETEST procedure. Multivariate analysis was not conducted as the NCDB does not capture performance status or re-resection data and residual confounding may influence results. Results: Of all the 7561 pN2 NSCLC patients identified, 818 had PSMs (R1+R2). After excluding patients with missing data, a total of 603 patients were included in the univariate analysis (PORT, n = 300; no PORT, n = 303). In this subgroup, the median OS was 27.53 months in the PORT group and 20.37 months in the non-PORT group (p=0.2175). Conclusions: In patients with PSMs and pN2 NSCLC who received adjuvant chemotherapy, PORT was associated with a numerical improvement in median OS; however, this difference was not statistically significant. The NCDB lacks critical data on re-resection, performance status, and key aspects of radiation quality, including dose, intent, and treatment volume, all of which may influence survival outcomes. These limitations underscore the need for prospective studies to better define the role of PORT, particularly in the R1 subgroup.

Association of different treatment modalities for rectal cancer and second primary urinary system neoplasms, findings from SEER

This study aimed to evaluate the risk of secondary primary urinary system neoplasms (SPUNs) in patients undergoing different treatment strategies during the perioperative period of rectal cancer (RC) and evalue survial prognostsis of SPUNs. The data were sourced from the US SEER database from 1975 to 2020. A total of 85,799 RC patients who underwent surgical treatment were included and divided into four groups: surgery alone (S), surgery plus chemoradiotherapy (SCR), surgery plus radiotherapy (SR), and surgery plus chemotherapy (SC). The results showed significant differences in the cumulative incidence of SPUNs among the four groups, with higher rates in patients receiving radiotherapy and chemotherapy. Both chemotherapy and radiotherapy increased the incidence of secondary primary bladder cancer (SPBC), and radiotherapy also elevated the incidence of secondary primary urethral cancer (SPUaC). However, there was no obvious association between chemoradiotherapy and the incidence of secondary primary kidney cancer (SPKC) or secondary primary ureteral cancer (SPUrC). Risk analysis indicated that the independent risk factors for SPBC were age, year of diagnosis, and postoperative radiotherapy, while race was a protective factor. For SPKC, the independent risk factors were age and year of diagnosis. No significant influencing factors were found for SPUrC, and postoperative radiotherapy was an independent risk factor for SPUaC. The relative risk (RR) of SPBC increased with the prolongation of the latency period after chemoradiotherapy. The RR value of radiotherapy was related to the year of diagnosis, reaching the highest from 1975 to 1984, and was the highest in the 18–50 age group after radiotherapy. Survival analysis revealed differences in cancer-specific survival (CSS) and overall survival (OS) among the four groups, with lower survival rates in patients receiving postoperative radiotherapy. After propensity score matching (PSM), only the overall survival rate of SPUNs patients in the postoperative radiotherapy group was lower than that of patients with original primary urological neoplasms (OPUNs). In conclusion, chemoradiotherapy during the perioperative period of RC is associated with the risk of SPUNs, and its benefits and risks need to be weighed in clinical decision-making.

Postoperative Radiotherapy for Medullary Thyroid Cancer: A Meta-Analysis of Survival and Recurrence Outcomes.

Medullary thyroid cancer (MTC) is a rare thyroid carcinoma that often presents at an advanced stage. The efficacy of adjuvant postoperative radiotherapy (PORT) in treating MTC remains a topic of debate. We aimed to assess whether PORT enhances survival outcomes in patients with MTC. We conducted a systematic review of databases, including EMBASE, PubMed, Cochrane Library, and CINAHL to identify relevant studies. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival (OS) and local recurrence-free survival (LRFS) were extracted, and pooled analyses were performed using random-effects models. Ten studies were finally included. Two separate pooled analyses of OS revealed no statistically significant differences between the PORT and observation groups (HR 1.59, 95% CI 0.87-2.92 and HR 1.67, 95% CI 0.92-3.02, including two different National Cancer Database studies with overlapping periods, respectively). Similarly, no significant differences were noted for LRFS (HR 0.90, 95% CI 0.44-1.82; I2 = 0%, p = 0.442). Although PORT did not demonstrate significant differences in survival outcomes compared to observation, personalized treatment considerations are essential due to heterogeneity among high-risk patients. Further prospective studies are required to define optimal adjuvant treatment strategies for MTC.

The impact of EGFR mutation and PD-L1 status on the efficacy of postoperative radiotherapy in stage III-pN2 NSCLC

BackgroundThe role of postoperative radiotherapy (PORT) for patients with completely resected stage III-pN2 non-small-cell lung cancer (NSCLC) remains controversial. PORT is not routinely recommended for patients with completely resected stage III-pN2 NSCLC. Therefore, identifying the population that could benefit from PORT is urgently needed.MethodsWe retrospectively enrolled 251 patients with completely resected stage III-pN2 NSCLC at our institution between 2018 and 2023. The Kaplan–Meier curves and log-rank tests were used to analyze disease-free survival (DFS) and overall survival (OS). Risk factors were identified using univariate and multivariate Cox regression analyses. The cumulative incidence rates of locoregional recurrence (LRR) were calculated via competing risk analyses and compared using the Gray test.ResultsA total of 251 patients were enrolled in the study, with the median follow-up of 24.9 months. Among overall patients, 61 patients underwent PORT, and 190 patients did not. Although patients in the PORT group exhibited a trend toward longer DFS, the difference was not statistically significant (median DFS: 39.1 vs. 35.5 months; HR 0.58, 95% CI 0.35–0.97; p = 0.072). Subgroup analyses revealed that PORT significantly prolonged DFS both in EGFR wild-type patients (median DFS: 35.3 vs. 18.3 months; HR 0.33, 95% CI 0.17–0.62; p = 0.002) and in PD-L1 positive patients (median DFS: 35.3 vs.16.4 months; HR 0.35, 95% CI 0.16–0.74; p = 0.029). In contrast, no significant DFS or OS benefits were observed in EGFR mutant patients or PD-L1 negative patients. Furthermore, PORT was associated with the significantly lower risk of LRR in overall patients (HR 0.39, 95% CI 0.16–0.97; p = 0.043), EGFR wild-type patients (HR 0.25, 95% CI 0.09–0.68; p = 0.007), and PD-L1 positive patients (HR 0.15, 95% CI 0.03–0.70; p = 0.016). PORT did not confer a locoregional control benefit in EGFR mutant patients (HR 0.58, 95% CI 0.07–4.58; p = 0.61) or PD-L1 negative patients (HR 1.02, 95% CI 0.27–3.82; p = 0.98).ConclusionFor patients with completely resected stage III-pN2 NSCLC, PORT significantly improves DFS and reduces the risk of LRR in EGFR wild-type patients or PD-L1 positive patients. The EGFR and PD-L1 status may serve as biomarkers to identify the population that could benefit from PORT.

Should We Do Postoperative Radiotherapy After Keloid Excision as Soon as Possible? A Systematic Review and Meta-Analysis.

There is no consensus on the timing of postoperative radiotherapy for keloid. We conducted this meta-analysis to investigate the appropriate time of radiotherapy for keloid in the first 24 hours after operation and identify the potential risk factors. A systematic review and meta-analysis were conducted on observational studies by searching PubMed, Embase, and the Cochrane Library. The pooled estimate of the keloid recurrence rate was calculated using a random-effects model. Subgroup analyses were conducted based on time, overtime, BED, length, and location of keloid. Eight observational studies with 507 keloids met the inclusion criteria, and 7 studies were finally included in this study after sensitivity analysis. The recurrence rate was lower in the 2 hours postoperative radiotherapy group (7% CI 2-14%) than in the 6 hours postoperative radiotherapy group (16%, CI 3-36%) (P<0.01). In HDR subgroup analysis, the 2 hours group was better than the 6 hours group ((5%, CI 1-14%) versus (16%, CI 3-36.1%) (P<0.01). Subgroup analysis based on BED indicated that the BED 30 group (5%, CI 1-14%) had a lower recurrence rate than the BED 20 group (6%, CI 0-21%) and the BED 15 group (26%, CI 19-33%) (P<0.01). The keloid length >5cm subgroup (10.4%, CI 0.4-29%) showed a higher recurrence rate than the keloid length <5 cm group (9.9%, CI 0-41%) (P=0.011). Immediate postoperative radiotherapy within 2 hours significantly decreased recurrence rate than postoperative radiotherapy within 6 hours. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effectiveness of Postoperative Irradiation in Patients with cN0 Early Breast Cancer Treated with Sentinel Lymph Node Surgery.

To evaluate the effectiveness of postoperative irradiation (POI) for patients with cN0 early breast cancer, we retrospectively analyzed the cases of 650 consecutive breast cancer patients who underwent sentinel lymph node (SLN)-guided surgery (2005-2022) at our hospital. In this cohort, 53% (278/521) of the patients who underwent breast conservative surgery (BCS) and 96% (124/129) of those treated with mastectomy did not receive POI. The patients who underwent BCS were treated with POI using opposing tangential field irradiation. A false negative (FN) SLN was retrospectively defined as a negative metastasis in SLN plus positive recurrence in the axillary lymph nodes. Recurrence was detected in 83 patients. A logistic regression analysis revealed that the nuclear grade (odds ratio [OR] 1.69), POI (OR 0.41), and postoperative hormone therapy (OR 0.40) were each significantly related to recurrence. The 26.1% (12/46) FN rate of the non-POI patients decreased to 5.8% (1/17) compared to those treated with POI. The rate of axillary recurrence was significantly lower in the POI group (0.4%) versus the non-POI group (2.7%) (p=0.0355). The rate of locoregional recurrence was also significantly lower in the POI group (2.0%) versus the non-POI group (13.4%) (p<0.0001). No significant difference was observed in the rate of distant recurrence between the POI (4.0%) and non-POI (3.3%) (p=0.831) groups. These results indicated that the postoperative opposing tangential field irradiation of conserved breast tissue inhibited recurrence in the axillary lymph nodes.

The role of postoperative radiotherapy for invasive thymic epithelial tumors: a single-center experience.

Surgery is the primary treatment modality for thymic epithelial tumors (TETs). However, the efficacy of postoperative radiotherapy (PORT) in the management of thymoma remains a topic of debate. This study aimed to evaluate the role of PORT in improving clinical outcomes for patients with thymoma. We retrospectively analyzed data from patients who underwent surgery for TETs at the Cardiovascular Thoracic Surgery Department, Tianjin Medical University General Hospital from October 2001 to July 2021. Patients classified as Masaoka-Koga stage II to IVA were included in the study. The impact of PORT on relapse-free survival (RFS) and overall survival (OS) was assessed using the Kaplan-Meier method and Cox proportional hazards regression analysis. A total of 211 thymoma patients were included in this study, among whom 141 cases (66.8%) underwent PORT. Overall, PORT was not associated with a significant improvement in OS or RFS in the entire cohort. However, in patients with locally advanced disease, PORT for Masaoka-Koga stage III-IVA thymoma was significantly associated with improved OS (P=0.01), although it did not result in a significant improvement in RFS (P=0.12). Subgroup analyses revealed that PORT significantly improved OS (P=0.042) in patients with Masaoka-Koga stage III thymoma. Furthermore, among patients with tumor-node-metastasis (TNM) stage III thymoma [according to the Union for the International Cancer Control (UICC) TNM Classification, 8th Edition], the PORT group exhibited significantly better RFS (P=0.03) and OS (P=0.01). Cox regression analysis demonstrated that TNM stage was the only statistically significant factor influencing OS in univariate analysis among patients with aggressive thymoma [TNM stage I-II vs. TNM stage III, hazard ratio (HR): 5.669, 95% confidence interval (CI): 1.347-23.852, P=0.02]. In addition, PORT was the only statistically significant factor influencing OS in univariate analysis for patients with TNM stage III thymoma (PORT vs. non-PORT, HR: 13.646, 95% CI: 1.522-122.356, P=0.02). PORT plays a significant role in the management of thymoma patients. For patients with Masaoka-Koga stage II thymoma, the potential benefits of PORT require further investigation. In patients with Masaoka-Koga stage III-IVA thymoma, PORT is associated with improved OS but does not appear to prevent disease recurrence. Additionally, among TNM stage III patients, the PORT group demonstrated significantly better RFS and OS. TNM stage is a potentially independent prognostic factor for survival in patients with aggressive thymoma, while PORT represents a critical prognostic factor for survival in patients with TNM stage III thymoma.

Postoperative radiotherapy improves long-term survival in HER2-positive metastatic breast cancer: real-world evidence from the latest SEER database.

To evaluate the role of Postoperative Radiotherapy (PORT) in HER2-positive metastatic breast cancer (MBC) in the context of targeted therapy and clarify the subgroups that may benefit from PORT. Clinical data of female patients with HER2-positive MBC from the surveillance, epidemiology, and end results (SEER) database for the years 2016-2020 were collected according to established inclusion and exclusion criteria. The impact of PORT on patient survival was assessed, and subgroup analyses were performed to identify populations with potential benefits from PORT. A total of 541 patients from the SEER database were included in the analysis. The 3-year overall survival (OS) of the PORT group was significantly higher than that of the non-PORT group. (86.7% vs. 80.2%, P = 0.011). Multivariate analysis revealed that race and PORT were independent prognostic factors. Black patients and those who received PORT had longer overall survival (OS) (P < 0.05). Subgroup analysis suggested that PORT further improved OS in patients with mastectomy, advanced TN stage, high tumor grade, positive hormone receptor status, and multiple metastatic organs (P < 0.05). PORT further improves the survival of HER2-positive MBC. Subgroup analysis suggests that patients with locally advanced stage (T3-4, N2-3), Grade III, HR-positive status, bone-and-visceral metastasis, and those who have undergone mastectomy benefit significantly.

The Oncological Outcome of Postoperative Radiotherapy in Patients with Node-Negative Early-Stage (T1/T2/N0) Oral Squamous Cell Carcinoma and Perineural Invasion: A Meta-Analysis

Objective: To evaluate the impact of postoperative radiotherapy (PORT) on oncological outcomes in node-negative early-stage oral squamous cell carcinoma (OSCC) with perineural invasion (PNI). Methods: A systematic review and meta-analysis was conducted using the PubMed, EMBASE, and Scopus databases for the period from 2000 to 2024. Studies comparing PORT versus observation in pN0 early-stage OSCC with PNI were included. Oncological outcomes assessed included overall survival (OS), disease-free survival (DFS), and local control (LC). A random-effects model was used to calculate log odds ratios, and heterogeneity was assessed using tau2, chi2, and I2 statistics. Results: Seven retrospective studies comprising 522 patients (281 PORT, 241 no-PORT) were included. The 3-year overall survival (OS) was 86.3% in the PORT group compared to 71.1% in the no-PORT group (logOR = −1.03, p = 0.0012), while the 5-year OS was 88.1% versus 77.3% (logOR = −0.97, p = 0.0061). Disease-free survival (DFS) also favored PORT, with 3-year DFS at 86.3% versus 58.1% (logOR = −1.19, p &lt; 0.001) and 5-year DFS at 86.3% versus 55% (logOR = −0.78, p = 0.003). Local control (LC) was higher in the PORT group, with 3-year LC rates of 89% compared to 72.2% in the no-PORT group (logOR = −1.13, p = 0.025). Conclusions: PORT significantly improves OS, DFS, and LC in node-negative early-stage OSCC with PNI as the sole adverse feature.

Postoperative Radiation With or Without Concurrent Chemotherapy for Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma With Multiple Intermediate Risks: A Propensity Score-Matched Study.

The benefit of postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone remains unclear for resected locally advanced head and neck squamous cell carcinoma (LA-HNSCC) patients with intermediate risk(s) such as pT3 or pT4 primary, pN2 or pN3 nodal disease, nodal disease in levels IV or V, perineural invasion (PNI), and lymphovascular invasion (LVI). This study aims to evaluate the benefits of postoperative CRT in patients with multiple intermediate risks. LA-HNSCC patients who underwent curative surgery with intermediate risk at our institution were identified. A propensity score-matched (PSM) method was performed using treatment, sex, age, AJCC staging, LVI, and PNI as covariates. A total of 162 eligible patients were identified. After PSM, 48 patients were classified into CRT and RT groups, respectively. Baseline characteristics and treatment were well balanced. In the CRT group, most patients received cisplatin-CRT (67%). Patients with 1, 2, and ≥ 3 intermediate risk factors exhibited significantly different event-free survival (EFS) (7.2 vs. 3.8 vs. 1.9 years; p = 0.007), with a trend towards differences in overall survival (OS) (p = 0.068). The median OS of the postoperative RT and CRT groups was not significantly different (4.5 vs. 5.0 years; p = 0.950). Similarly, the median EFS was not significantly different (p = 0.634). No EFS and OS benefits were demonstrated in patients with ≥ 2 intermediate risk factors treated with CRT compared to RT alone. In our PSM study, LA-HNSCC patients with intermediate risk(s) did not benefit from postoperative CRT compared to RT alone. Although patients with multiple intermediate risks had significantly worse survivals, postoperative CRT did not improve OS and EFS. The results of this study may support avoiding unnecessary acute and late toxicity associated with adding chemotherapy to postoperative RT in patients with intermediate risk(s).

Dosimetric effects of bladder volume changes in MR-guided radiotherapy for cervical cancer

PurposeBladder volume variations during radiotherapy can significantly influence dose distribution to both target volumes and surrounding organs-at-risk (OARs). This study aims to assess the dosimetric impact of variable bladder volume on the clinical target volume (CTV) and OARs in cervical cancer patients undergoing MR-guided radiotherapy.MethodA total of 27 cervical cancer patients were included in this study: 12 received radical radiotherapy, and 15 underwent postoperative radiotherapy. All patients were treated with the Elekta Unity MR-linac system. The dose requirement was 95–100% of the prescribed dose to the PTV(45 Gy/25 sessions/5 weeks). Daily images were acquired at the time of treatment using the MR-linac. For this study, MR images from the first three treatments of each patient were selected to contour the CTV and OAR (bladder, small bowel, rectum, right and left lateral femoral heads), and the treatment plan was recalculated using the Monaco TPS. The dosimetric effects of bladder volume changes on the CTV and OAR were analyzed by SPSS.ResultRegarding the dosimetric effects on the CTV, in the postoperative radiotherapy group, D98 and D95 of the CTV decreased as the bladder filled. In contrast, for patients undergoing radical radiotherapy, the mean dose of the CTV increased from 5223.55 cGy to 5273.93 cGy as the bladder filled. For the dosimetric effects on the bladder, in the postoperative radiotherapy group, V30 and V20 of the bladder decreased as the bladder filled. In the radical radiotherapy group, the minimum dose of the bladder decreased with increasing bladder volume, but the maximum dose increased from 5347.68 cGy to 5581.63 cGy. For the rectum and small bowel, in the postoperative radiotherapy group, changes in bladder volume did not significantly affect the dose of the small bowel and rectum. However, in the radical radiotherapy group, the minimum and mean doses to the rectum and the D2 of the small bowel decreased with bladder filling.ConclusionThis study evaluated the dosimetric and volumetric impact of bladder filling on the Clinical Target Volume (CTV) and Organs at Risk (OAR) using daily magnetic resonance (MR) images from the MR-linac. The findings indicate that variations in bladder filling significantly affect dose distribution to both the CTV and OAR.

Postoperative radiotherapy for stage pIIIA-N2 non-small cell lung cancer patients undergoing sublobar resection: A retrospective cohort study

This study assesses the effect of postoperative radiotherapy on survival outcomes in patients diagnosed with stage pIIIA-N2 non-small cell lung cancer (NSCLC) after sublobar resection. Data of patients with stage pIIIA-N2 NSCLC who underwent sublobar resection were extracted from the Surveillance, Epidemiology, and End Results database spanning from 2000 to 2020. Patients were divided into 2 groups: postoperative radiotherapy and observation. Cancer-specific survival (CSS) and overall survival (OS) were analyzed and compared between the 2 groups. A total of 444 patients were included in the study, with 210 (47.3%) receiving postoperative radiotherapy and 234 (52.7%) with observation. The CSS (hazard ratio [HR] = 0.99, 95% confidence interval [CI]: 0.78–1.26; P = .926) and OS (HR = 0.93, 95% CI: 0.75–1.15; P = .512) did not show significant differences between the postoperative radiotherapy and observation groups. Subgroup analysis of patients receiving postoperative chemotherapy revealed comparable CSS (HR = 1.24, 95% CI: 0.89–1.71; P = .203) and OS (HR = 1.12, 95% CI: 0.85–1.49; P = .425) between the 2 groups. Similarly, for patients without postoperative chemotherapy, CSS (HR = 1.11, 95% CI: 0.66–1.84; P = .699) and OS (HR = 1.08, 95% CI: 0.68–1.71; P = .740) were not significantly different between the 2 groups. Postoperative radiotherapy does not improve survival in patients with stage pIIIA-N2 NSCLC following sublobar resection.

Clinical treatment strategy for pT3N0 laryngeal squamous cell carcinoma

Objective:To investigate optimal treatment strategy for pT3N0 laryngeal squamous cell carcinoma（SCC）. Methods:A retrospective study of 150 patients with pT3N0 laryngeal SCC treated in the First Affiliated Hospital of Chongqing Medical University was performed. The efficacies of partial laryngectomy and total laryngectomy, as well as surgery alone and postoperative radiotherapy were evaluated. The overall survival（OS）, disease specific survival（DSS） and disease-free survival（DFS） were analyzed with statistical package from SPSS. Results:Among the 108 patients with glottic laryngeal SCC, there were no significant differences in OS, DSS and DFS between the partial laryngectomy group and the total laryngectomy group（Log-rank=0.184, 0.010 and 0.051, P>0.05）. Similarly, there were no significant differences in OS, DSS and DFS between the surgery-alone group and postoperative radiotherapy group（Log-rank=0.214, 0.251 and 0.003, P>0.05）. Among the 38 patients with supraglottic laryngeal SCC, the OS in the total laryngectomy group was significantly higher than that in the partial laryngectomy group（Log-rank=7.338, P=0.007）. The DSS and DFS in the total laryngectomy group were higher than in the partial laryngectomy group, but the differences were not statistically significant（Log-rank=0.895 and 1.792; P>0.05）. The DFS in the postoperative radiotherapy group was significantly higher than in the surgery-alone group（Log-rank=7.172, P=0.007）, but there were no significant differences in OS and DSS between these two groups（Log-rank=0.010 and 0.876, P>0.05）. Conclusion:For pT3N0 glottic laryngeal cancer patients, the efficacy of partial laryngectomy is comparable to total laryngectomy, same as surgery alone and postoperative radiotherapy. For pT3N0 supraglottic laryngeal cancer patients, total laryngectomy could improve the overall survival, and postoperative radiotherapy could reduce the recurrence. Prospectively randomized study with large samples is still needed.

Protocol for a multicentre, prospective, open-label, randomised controlled trial to compare PROs and safety outcomes between preoperative and postmastectomy radiotherapy in locally advanced breast cancer patients with immediate reconstruction via a deep inferior epigastric perforator flap (CAPPELLA) in China

IntroductionDespite its therapeutic advantages, postmastectomy radiotherapy (PMRT) increases the risk of complications and often leads to poor cosmesis in women undergoing breast reconstruction. Preoperative radiotherapy followed by skin-sparing mastectomy and...

Dosimetric differences between online adapt-to-position and offline adapt-to-shape plans for adaptive radiotherapy in cervical cancer

Radiation therapy plays a significant role in the treatment of cervical cancer. Additionally, more adaptive workflows using ATP are being implemented in the daily radiotherapy of our organization. Herein, we aimed to investigate the dosimetric differences between online ATP and offline ATS plans for magnetic resonance (MR)-guided adaptive radiotherapy in patients with cervical cancer and determine radiotherapy modalities that address clinical requirements. In total, 25 patients with cervical cancer were enrolled in this study, with 13 in the radical radiotherapy group and 12 in post-operative radiotherapy group. We aimed for the clinical target volume (CTV) to be covered by 95 &amp;ndash; 100% of the prescribed dose (50 Gy/25 sessions/5 weeks). MR-Linac was performed daily during treatment, and the images were rigidly aligned with the local computed tomography to generate an online ATP plan. MR images acquired during the first three sessions were selected to recontour the CTV and organs at risk (OAR). Furthermore, an offline ATS plan was generated. In the radical radiotherapy group, the CTV, D98, D95 (5024.65 &amp;plusmn; 23.34 vs. 4995.50 &amp;plusmn; 14.99 cGy), and Dmean of the ATS were superior compared with those of the ATP. The Dmax was lower in the ATS plan than in the ATP plan. In the post-operative radiotherapy group, the CTV, Dmean, D98, and D95 (5052.61 &amp;plusmn; 67.87 vs. 5014.41 &amp;plusmn; 24.68 cGy) were better in the ATS plan than in the ATP plan. When evaluating the OAR in the radical radiotherapy group, the minimum doses to the bladder and rectum were greater in the ATS plan than in the ATP plan. In the post-operative radiotherapy group, the V20 of the bladder and rectum were lower in the ATS plan than in the ATP plan. Therefore, ATS is well suited for post-operative radiotherapy, whereas ATP is better suited for radical radiotherapy. Furthermore, ATP can effectively address the clinical requirements of daily workflows.

Preoperative versus postoperative radiotherapy for localized soft tissue sarcoma treated with curative intent in a French tertiary center “SARCLOC”

BackgroundSoft tissue sarcomas of the extremities (E-STS) are rare and heterogeneous. Treatment combines surgery with preoperative or postoperative radiotherapy (RT) for deep, large, or high-grade tumors. We evaluate the effectiveness and toxicity in E-STS patients treated at our institution from 2015 to 2021.Materials and methodsThis retrospective, single-center study, compared clinical and therapeutic characteristics, toxicities, and surgical complications by radiotherapy type. Local recurrence-free survival (LRFS), overall survival (OS), and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method.ResultsWe included 158 patients; 124 (78%) received preoperative RT. The two groups (preoperative RT vs. postoperative RT) differed significantly in terms of median tumor size (111 vs. 67.5 mm, p < 0.01), perivascular involvement (51% vs. 29%, p = 0.03), and bone contact (32% vs. 12%, p = 0.02), but not in grade (grade 2 or 3: 65% vs. 74%, p = 0.72). Median follow-up was 2.9 vs. 5.1 years. Two-year LRFS was 82% [95%CI: 74–88] for both groups; OS was 87% [95%CI: 80–92] vs. 88% [95%CI: 71–95]; and RFS was 72% [95%CI: 63–79] vs. 70% [95%CI: 52–83]. Postoperative complications were 53% vs. 35%, with wound disruption at 39% vs. 15% and infections at 29% vs. 6%. Grade 2 or higher dermatitis was 16% vs. 29%, and RT discontinuation rates were 4% vs. 12% for the two groups, respectively.ConclusionDespite poorer prognostic factors in the preoperative RT group, LRFS and OS were comparable to those in the postoperative RT group. Postoperative complications were more frequent with preoperative RT, and treatment discontinuation was more common postoperatively.

Comparison of postoperative radiotherapy and definitive radiotherapy for non-metastatic adenoid cystic carcinoma of the head and neck, a propensity score matching based on the SEER database.

Treating patients with head and neck adenoid cystic carcinoma (HNACC) presents surgical problems in various scenarios. Limited studies explore definitive radiation's impact on patient survival, with inadequate data correlating it to postoperative radiotherapy. Using the Surveillance, Epidemiology, and End Results (SEER) program, we conducted an objective analysis to evaluate the impact of definitive radiation on the survival of HNACC patients without distant metastases, aiming to uncover its nuanced pros and cons. This study conducted a comprehensive analysis of individuals diagnosed with HNACC within the SEER database from 2000 to 2023. Disease-specific survival (DSS) and overall survival (OS) were evaluated using diverse statistical methods. Propensity score matching (PSM) reduced covariate variations and selection biases, allowing for comparisons of postoperative and definitive radiotherapy groups. A total of 2,072 patients were encompassed within this study. The postoperative radiotherapy group yielded significant advantages in OS and DSS (P<0.001). In matched cohorts, the 5-year prognostic OS stood at 55% and 37%, respectively, while DSS figures were 65% and 46%, correspondingly. In advanced T4 cases, DSS differences lacked significance (P=0.42). Additionally, the outcomes of OS and DSS were notably influenced by variables such as T-stage, N-stage, tumor stage, and chemotherapy. Surgical intervention remains a pivotal component of comprehensive treatment for patients diagnosed with operable HNACC. Definitive radiation is appropriate for less treatable situations, particularly in local advanced HNACC. Systemic treatment may assist HNACC patients at risk of distant metastases.

Postoperative radiotherapy after extirpative surgery may not improve survival in patients with Masaoka-Koga stage IIB thymoma: a propensity-matched study based on the SEER database

BackgroundThe exact role of postoperative radiotherapy (PORT) in patients with Masaoka-Koga stage IIB thymoma following extirpative surgery (defined as radical surgery or total thymectomy) is still under debate. This study was designed to evaluate the effect of PORT on survival in patients with stage IIB thymoma following extirpative surgery in a population-based registry.MethodsPatients with Masaoka-Koga stage IIB thymoma who underwent extirpative surgery between 2000 and 2019 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. One-to-one propensity score matching (PSM) with Kaplan-Meier and Cox regression analyses were used to assess overall survival (OS) and cancer-specific survival (CSS). To identify potential patients who may benefit from PORT, exploratory subgroup analyses on survival and further analyses stratified by Asian patients were performed.ResultsA total of 273 eligible patients were included, 164 (60.1%) in the PORT group and 109 (39.9%) in the non-PORT group. After 1:1 PSM, OS and CSS were not significantly different between the two groups. The 10-year OS and CSS rates were 83.5% in the PORT group vs. 80.1% in the non-PORT group (P=0.95) and 97.8% vs. 97.7% (P=0.31), respectively. The multivariate analyses further demonstrated no significant association between PORT and either OS [hazard ratio (HR) =1.219, P=0.53] or CSS (HR =2.304, P=0.32). Exploratory subgroup analyses revealed that PORT did not significantly improve survival in any subgroup of patients with stage IIB thymoma, and further analyses based on the Asian patients yielded the same negative results.ConclusionsAccording to the SEER database, adding PORT to extirpative surgery may not improve survival in patients with Masaoka-Koga stage IIB thymomas.