Postoperative Radiotherapy For Stage Research Articles

Postoperative radiotherapy in stage I-III Merkel cell carcinoma

Background and aims: Postoperative radiotherapy (PORT) is currently recommended for the treatment of Merkel cell carcinoma. Nevertheless, deviations occur frequently due to the generally elderly and frail patient population. We aimed to evaluate the influence of PORT on survival in stage I-III MCC patients treated in the Netherlands. Methods: Patients were included retrospectively between 2013 and 2018. Fine-Gray method was used for cumulative incidence of recurrence and MCC-related death, cox regression was performed for overall mortality.

Survival comparison between postoperative and preoperative radiotherapy for stage I–III non-inflammatory breast cancer

To compare the survival benefit between preoperative and postoperative radiotherapy for stage I–III non-inflammatory breast cancer patients, we conducted a retrospective cohort study using surveillance, epidemiology and end results databases. Our study recruited patients who had been diagnosed with stage I–III breast cancer and underwent surgery and radiotherapy. The overall survival was calculated by Kaplan–Meier method. Cox risk model was used to determine the impact of radiotherapy according to stage, molecular subtype and other risk factors. Propensity score matching was used to balance measurable confounding factors. Of all the 411,279 enrolled patients varying from 1975 to 2016, 1712 patients received preoperative radiotherapy, and 409,567 patients received postoperative radiotherapy. Compared with the postoperative radiotherapy group, the preoperative radiotherapy group showed significantly higher risks of overall mortality and breast cancer-specific mortality. Survival differences in treatment sequences were correlated with stage, molecular subtypes and other risk factors. According to the results of this study, preoperative radiotherapy did not show a survival advantage, and postoperative radiotherapy is still the primary treatment. However, preoperative radiotherapy also has some theoretical advantages, such as phase reduction and recurrence reduction. Therefore, it is still worthy of further exploration.

Survival Comparisons between Breast Conservation Surgery and Mastectomy Followed by Postoperative Radiotherapy in Stage I-III Breast Cancer Patients: Analysis of the Surveillance, Epidemiology, and End Results (Seer) Program Database.

Background: This study aims to evaluate the overall and breast cancer-specific survival (BCSS) after breast-conserving surgery (BCS) plus radiotherapy (RT) compared with mastectomy plus RT in resectable breast cancer. Moreover, the aim is to also identify the subgroups who benefit from BCS plus RT and establish a predictive nomogram for stage II patients. Methods: Stage I–III breast cancer patients were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 1990 and 2016. Patients with available clinical information were split into two groups: BCS plus RT and mastectomy plus RT. Kaplan–Meier survival analysis, univariate and multivariate regression analysis, and propensity score matching were used in the study. Hazard ratio (HR) was calculated based on stratified Cox univariate regression analyses. A prognostic nomogram by multivariable Cox regression model was developed for stage II patients, and consistency index (C-index) and calibration curve were used to evaluate the accuracy of the nomogram in the training and validation set. Results: A total of 24,590 eligible patients were enrolled. The difference in overall survival (OS) and BCSS remained significant in stage II patients both before and after PSM (after PSM: OS: HR = 0.8536, p = 0.0115; BCSS: HR = 0.7803, p = 0.0013). In stage II patients, the survival advantage effect of BCS plus RT on OS and BCSS was observed in the following subgroups: any age, smaller tumor size (<1 cm), stage IIA (T2N0, T0–1N1), ER (+), and any PR status. Secondly, the C-indexes for BCSS prediction was 0.714 (95% CI 0.694–0.734). The calibration curves showed perfect agreement in both the training and validation sets. Conclusions: BCS plus RT significantly improved the survival rates for patients of stage IIA (T2N0, T0–1N1), ER (+). For stage II patients, the nomogram was a good predictor of 5-, 10-, and 15-year BCSS. Our study may help guide treatment decisions and prolong the survival of stage II breast cancer patients.

Postoperative radiotherapy in stage I–III Merkel cell carcinoma

BackgroundPostoperative radiotherapy (PORT) is currently recommended for the treatment of Merkel cell carcinoma. Nevertheless, deviations occur frequently due to the generally elderly and frail patient population. We aimed to evaluate the influence of PORT on survival in stage I-III MCC patients treated in the Netherlands. MethodsPatients were included retrospectively between 2013 and 2018. Fine-Gray method was used for cumulative incidence of recurrence and MCC-related death, cox regression was performed for overall mortality. Analyses were performed in patients with clinical (sentinel node biopsy [SN] not performed) stage I/II (c-I/II-MCC), pathologic (SN negative) stage I/II (p-I/II-MCC) and stage III MCC (III-MCC), separately. Propensity score matching (PSM) was performed to assess confounding by indication. ResultsIn total 182 patients were included, 35 had p-I/II-MCC, 69 had c-I/II-MCC and 78 had III-MCC. Median follow up time was 53.5 (IQR 33.4–67.4), 30.5 (13.0–43.6) and 29.3 (19.3–51.0) months, respectively. Multivariable analysis showed PORT to be associated with less recurrences and reduced overall mortality, but not with MCC-related mortality. In stage III-MCC, extracapsular extension (sub-distribution hazard [SDH] 4.09, p = 0.012) and PORT (SDH 0.45, p = 0.044) were associated with recurrence, and ≥ 4 positive lymph nodes (SDH 3.24, p = 0.024) were associated with MCC-related mortality. ConclusionsPORT was associated with less recurrences and reduced overall mortality in patients with stage I-III MCC, but not with MCC-related mortality. Trends in overall survival benefit are likely to be caused by selection bias suggesting further refinement of criteria for PORT is warranted, for instance by taking life expectancy into account.

Prognosis of severe lymphopenia after postoperative radiotherapy in non-small cell lung cancer: Results of a long-term follow up study

PurposeTo investigate the incidence and prognosis of severe radiation-induced lymphopenia (sRIL) after postoperative radiotherapy (PORT) for resected NSCLC. Patients and methodsBetween 1998 and 2017, 170 patients treated with PORT for NSCLC were retrospectively reviewed. Lymphopenia was divided into tertiles with severe lymphopenia defined as absolute lymphocyte counts (ALC) < 0.37 × 103/ul. ResultssRIL was observed in 32.3% of patients. Multivariable logistic regression analysis indicated sRIL was associated with planning target volume radiation fraction numbers (OR 1.09, p = 0.005) and total lung mean dose (OR 1.12, p = 0.006). With a median follow-up time of 12.2 years, the median progression-free survival and overall survival were 14.8 months and 28.4 months respectively in patients with sRIL, vs. 21.7 months (p = 0.008) and 48.3 months (p = 0.01) respectively in patients without sRIL. Multivariable analyses indicated sRIL significantly decreased OS (HR 1.95, p < 0.01). Since PORT for stage I-II NSCLC was done largely for positive margins, which may confound the contribution of severe RIL, we analyzed stage III separately and found that sRIL also significantly decreased OS (HR 1.88, p = 0.004) in multivariable analysis. ConclusionFor this long-term outcome study, severe RIL correlated with total lung mean dose and radiation fractionation numbers, and was a strong prognostic factor for poor survival in PORT patients, particularly in patients with stage III NSCLC, highlighting the importance of an intact immune system for post-radiation immunologic disease surveillance.

The role of postoperative radiotherapy in stage II and III thymoma: a Korean multicenter database study.

BackgroundComplete resection is a standard treatment for patients with Masaoka-Koga stages II and III thymoma, however the role of postoperative radiotherapy (PORT) is controversial. We analyzed data collected from 4 Korean hospitals to determine the effectiveness of PORT in stage II and III thymoma patients.MethodsBetween January 2000 and December 2013, 1,663 patients underwent surgery for thymic tumors at the 4 hospitals. Among them, 668 patients (527 with stage II and 141 with stage III) were investigated, among whom, 443 received PORT (335 with stage II and 108 with stage III). Propensity score matching (PSM) was performed, and 404 patients (346 with stage II and 58 with stage III) were selected.ResultsPerioperative characteristics were similar in the PORT and non-PORT groups after PSM. On survival analysis of stage II patients, the PORT and non-PORT groups showed no difference in either 5-year recurrence-free survival (RFS) (96.3% vs. 96.6%, P=0.622) or 5-year overall survival (OS) (94.6% vs. 93.8%, P=0.839). However, among stage III patients, the PORT group showed significantly better 5-year RFS (75.7% vs. 50.1%, P=0.040) and 5-year OS (86.5% vs. 54.7%, P=0.001). On multivariate Cox regression analysis, PORT was a significant positive prognostic factor in terms of both RFS (P=0.005) and OS (P=0.004) in patients with stage III thymomas, but not in those with stage II disease (P=0.987 and 0.968, respectively).ConclusionsPORT improved the RFS and OS in stage III thymoma patients, but showed no survival benefit in stage II patients.

Postoperative radiotherapy for stage II or III non–small cell lung from 1988 to 2014.

e20013 Background: In 2006 ASCO, Brian E. Lally et al. reported the association between survival and postoperative radiotherapy (PORT) in patients with resected non–small-cell lung cancer (NSCLC). We now undertook a update analysis using the latest data. Methods: Updated data were obtained by the Surveillance, Epidemiology and End Results database. We analyzed stage II or III NSCLC patients diagnosed between 1988 and 2014. Results: A total of 20645 patients were selected, with a median follow-up time of 3.3 years. Predictors for the use of PORT included age less than 50 years, higher AJCC stage, T3-4 tumor stage, larger tumor size, advanced node stage, greater number of lymph nodes involved, and a higher ratio of lymph nodes involved to lymph nodes sampled. On multivariate analysis, male sex, older age, T3-4 tumor stage, N2 node stage, fewer sampled lymph nodes, higher positive lymph nodes and higher ratio of lymph nodes involved to lymph nodes sampled had a negative impact on survival. PORT had a significant adverse effect on survival, regardless of all patients (P &lt; 0.001), or N0 subgroup ( P&lt; 0.001) or N1 subgroup (P&lt; 0.001). For N2 subgroup, PORT did not have a significant effect of on survival (P &lt; 0.117). This is different from the result Brian E. Lally et al. reported in ASCO 2006. Conclusions: Postoperative radiotherapy is detrimental to resected N0 or N1 NSCLC patients and should not be used routinely for such patients. The role of postoperative radiotherapy in the treatment of N2 tumours is not clear and may warrant further research.

Value of radiotherapy in addition to esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma: Analysis of surveillance, epidemiology, and end results database

To determine the value of radiotherapy in addition to esophagectomy for stage II and III TESCC. We searched the Surveillance, Epidemiology, and End Results (SEER) database for all cases of stage II‐III TESCC. Patients were grouped as those receiving pre‐ or postoperative radiotherapy plus esophagectomy and those receiving esophagectomy alone. Overall survival (OS) and cancer‐specific survival (CSS) were compared between the groups. Among the 3292 patients, multimodality treatments (pre‐ or postoperative radiotherapy plus surgery) were more effective than surgery alone (5‐year, OS: 17.3% vs 7.9%; P < 0.001; CSS: 51.8% vs 34.9%; P < 0.001). Among the patients receiving multimodality treatments, multivariate analyses revealed stage to be the most significant prognostic factor for OS (II vs III, HR, 0.726; P < 0.001), but the sequence of radiotherapy and surgery was only of the marginal significance (pre‐ vs postoperative, HR, 0.875; P = 0.093). Preoperative radiotherapy provided significantly better survival than postoperative radiotherapy in stage III disease (5‐year, OS: 13.0% vs 11.0%, P < 0.04; CSS: 49.2% vs 31.7%, P < 0.003), but not in stage II disease (5‐year OS: 23.5% vs 21.0%, P = 0.519; CSS: 62.0% vs 53.4%, P = 0.075). Radiotherapy in addition to esophagectomy provides better outcomes than esophagectomy alone for in stage II‐III TESCC. Preoperative radiotherapy followed by surgery appears to be the optimal treatment strategy in stage III TESCC.

Comparative survival analysis of preoperative and postoperative radiotherapy in stage II-III rectal cancer on the basis of long-term population data

This study compared long-term population-based survival outcomes of preoperative and postoperative radiotherapy (RT) approaches in rectal cancer. Patients with stage II-III rectal cancer between 1998 and 2013 were identified using the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and disease-specific survival (DSS) rates were estimated in propensity-matched study population according to the use of RT. Among the 28,320 eligible patients, a total of 18,400 patients were identified from propensity score matching process balancing the distribution of prognostic covariates. The 10-year OS and DSS rates were higher in patients with preoperative RT than the postoperative group (51.6% vs. 49.8% with P < 0.001, and 65.4% vs. 64.8% with P = 0.037, respectively). However, in multivariate analysis, selection of combined RT sequence did not affect the survival (hazard ratio [HR] 1.04 and 95% confidence interval [CI] 0.98−1.10 for OS; HR 0.97 and 95% CI 0.90−1.05 for DSS). Regarding hazard rate functions of cancer-specific mortality, the overall time-course risks after preoperative and postoperative RT were comparable. This study provides additional insight into the long-term prognostic implications of the two RT strategies, suggesting that the sequence of RT does not lead to differential survival in stage II-III rectal cancer.

The efficacy of postoperative radiotherapy for locally advanced rectal cancer without neoadjuvant therapy

Background: The 2018 guidelines for treatment of cancer by site recommended by the National Comprehensive Cancer Network (NCCN) does not include a specific treatment recommendation for rectal cancer patients who did not receive preoperative chemoradiotherapy. The study objective was to evaluate whether postoperative radiotherapy was effective for such patients. Methods: Survival was evaluated in 9,585 patients who underwent surgical resection for stage II or III rectal cancer and were registered in the Surveillance, Epidemiology, and End Results-Medicare database between 1992 and 2009. Overall survival (OS) benefit in propensity score (PS)-matched patient cohorts were estimated by Cox proportional hazards models. Results: After stratification by chemotherapy regimen, the difference in OS of stage III patients between the no-treatment and radiotherapy groups was significant (P Conclusions: The evidence obtained in this study does not support postoperative radiotherapy for stage II rectal cancer or stage III patients who received postoperative chemotherapy. The use of postoperative radiotherapy for stage III patients who did not receive postoperative chemotherapy could increase OS.

Use of adjuvant radiotherapy in women with stage I endometrioid adenocarcinoma of the uterus: A National Cancer Database study.

e17107Background: Randomized controlled trials have consistently shown that the use of post-operative radiotherapy in stage I endometrial cancer leads to a reduction in the incidence of pelvic recu...

Oral 2.02: The role of postoperative radiotherapy for stage I/II/III thymic tumor—results of chart database.

Background Postoperative radiotherapy for thymic tumor is still controversial. The object of the study is to evaluate the role of postoperative radiotherapy for stage I/II/III thymic tumor.

Significance of postoperative radiotherapy for stage II/III upper rectal cancer

Objective To investigate the value of postoperative adjuvant chemoradiotherapy (CRT) in the treatment of stage Ⅱ/Ⅲ upper rectal cancer. Methods A total of 3995 patients with rectal cancer were admitted to our hospital from 2000 to 2010. Among them, patients who were pathologically diagnosed with adenocarcinoma and underwent radical surgery were enrolled as subjects for retrospective analyses. Moreover, all selected patients had the lower margin of the tumor located within 10-16 cm from the anal verge, as determined by a colonofiberscope before surgery, and were pathologically staged as T3-4 or N0-2 M0 after surgery, according to the 7 th edition of American Joint Committee on Cancer tumor-node-metastasis staging system. Results A total of 547 patients were enrolled as subjects. The 5-year sample size was 249. In all patients, the 5-year overall survival (OS), disease-free survival, local recurrence-free survival (LRFS) , and distant metastasis-free survival rates were 79.0%, 76.8%, 94.0%, and 80.1%, respectively. One hundred and fifty-five patients were enrolled into either postoperative concurrent CRT group or postoperative non-CRT group, with the baseline characteristics balanced between the two groups by the propensity-score matching method (1:1). Patients who were staged as pT4b and had paracancerous nodules and lymph node metastases (stage N2) were enrolled into high-risk group. In the high-risk group, patients treated with postoperative CRT had significantly higher LRFS and OS rates than those treated with only surgery (96.3% vs. 82.0%, P = 0. 044; 81.6% vs. 59.1%, P=0.019). Conclusions Radical surgery achieves a good prognosis in patients with stage Ⅱ/Ⅲ upper rectal cancer, and postoperative CRT can further reduce the locoregional recurrence rate. Particularly, postoperative CRT/RT can substantially improve local and long-term outcomes in patients with high-risk factors. Key words: Upper rectal neoplasms/surgery; Upper rectal neoplasms/postoperative radiotherapy; Prognosis analysis

Postoperative radiotherapy for stage I breast cancer

Postoperative radiotherapy for stage I breast cancer

Sector Resection With or Without Postoperative Radiotherapy for Stage I Breast Cancer: 20-Year Results of a Randomized Trial

To investigate how radiotherapy (XRT) adds to tumor control using a standardized surgical technique with meticulous control of surgical margins in a randomized trial with 20 years of follow-up. Three hundred eighty-one women with pT1N0 breast cancer were randomly assigned to sector resection with (XRT group) or without (non-XRT group) postoperative radiotherapy to the breast. With follow-up through 2010, we estimated cumulative proportion of recurrence, breast cancer death, and all-cause mortality. The cumulative probability of a first breast cancer event of any type after 20 years was 30.9% in the XRT group and 45.1% in the non-XRT group (hazard ratio [HR], 0.58; 95% CI, 0.41 to 0.82). The benefit of radiotherapy was achieved within the first 5 years. After 20 years, 50.4% of the women in the XRT group died compared with 54.0% in the non-XRT group (HR, 0.92; 95% CI, 0.71 to 1.19). The cumulative probability of contralateral cancer or death as a result of cancer other than breast cancer was 27.1% in the XRT group and 24.9% in the non-XRT group (HR, 1.17; 95% CI, 0.77 to 1.77). In an anticipated low-risk group, the cumulative incidence of first breast cancer of any type was 24.8% in the XRT group and 36.1% in the non-XRT group (HR, 0.61; 95% CI, 0.35 to 1.07). Radiotherapy protects against recurrences during the first 5 years of follow-up, indicating that XRT mainly eradicates undetected cancer foci present at primary treatment. The similar rate of recurrences beyond 5 years in the two groups indicates that late recurrences are new tumors. There are subgroups with clinically relevant differences in risk.

PO-0749: Prognostic factors after postoperative radiotherapy in stage I-III uterine carcinosarcomas

PO-0749: Prognostic factors after postoperative radiotherapy in stage I-III uterine carcinosarcomas

P5-14-19: Ipsilateral Breast Tumor Recurrence Prediction with Web-Based Normogram in Korea.

Abstract Purpose Ipsilateral Breast Tumor Recurrence(IBTR!) 2.0 is web-based tool which predict the ten years risk of local recurrence after breast conserving theraphy. This tool integrates seven prognostic factors (patient age, margin status, lymphovascular invasion, tumor size, tumor grade, use of chemotherapy and hormonal therapy) for local recurrence with or without radiation theraphy. To validate IBTR! 2.0 for Korean breast cancer patients, Samsung Medical Center database was used between 1994 and 2001. Methods The IBTR! 2.0 nomogram was tested against 358 patients who underwent breast conserving surgery with radiation theraphy from Samsung Medical Center between 1994 and 2001. The individual dadabase which was entered into IBTR! 2.0 computer model generate predictive local recurrence rate. The mean predicted and observed 10-year estimates were compared for the entire cohort and for four groups predefined by nomogram-predicted risks: group 1: less than 3%; group 2: 3% to 5%; group 3: 5% to 10%; and group 4: more than 10%. Results IBTR! version 2.0 predicted an overall 10-year IBTR estimate of 5.5% (95% CI, 5.2 to 5.9), while the observed estimate was 7.69% (20 IBTR cases in 358 patients, 95% CI, 1.6 to 9.3; P=0.59). The predicted and observed IBTR estimates were: group 1 ( 2 cases in 67 patients): 2.3% versus 2.9%, P=0.53; group 2 (2 cases in 124 patients)): 3.9% versus 4.1%, P=0.18; group 3 (14 cases in 139 patinets): 7.3% versus 4.8%, P=0.13; and group 4 (2 cases in 28 patients): 12.15% versus 7.1%, P=0.61. Conclusion IBTR! 2.0 is acceptable nomogram for predicting 10 years local recurrence using Samsung medical Center database. This nomogram showed overestimation in group 3, 4, however did not showed statistical differences. This nomogram may assist patient counseling and medical decision making, but prior to using whole Korean patients, this model requires validation with multiple Korean sources.

Variations in Target Volume Definition for Postoperative Radiotherapy in Stage III Non–Small-Cell Lung Cancer: Analysis of an International Contouring Study

Postoperative radiotherapy (PORT) in patients with completely resected non-small-cell lung cancer with mediastinal involvement is controversial because of the failure of earlier trials to demonstrate a survival benefit. Improved techniques may reduce toxicity, but the treatment fields used in routine practice have not been well studied. We studied routine target volumes used by international experts and evaluated the impact of a contouring protocol developed for a new prospective study, the Lung Adjuvant Radiotherapy Trial (Lung ART). Seventeen thoracic radiation oncologists were invited to contour their routine clinical target volumes (CTV) for 2 representative patients using a validated CD-ROM-based contouring program. Subsequently, the Lung ART study protocol was provided, and both cases were contoured again. Variations in target volumes and their dosimetric impact were analyzed. Routine CTVs were received for each case from 10 clinicians, whereas six provided both routine and protocol CTVs for each case. Routine CTVs varied up to threefold between clinicians, but use of the Lung ART protocol significantly decreased variations. Routine CTVs in a postlobectomy patient resulted in V(20) values ranging from 12.7% to 54.0%, and Lung ART protocol CTVs resulted in values of 20.6% to 29.2%. Similar results were seen for other toxicity parameters and in the postpneumectomy patient. With the exception of upper paratracheal nodes, protocol contouring improved coverage of the required nodal stations. Even among experts, significant interclinician variations are observed in PORT fields. Inasmuch as contouring variations can confound the interpretation of PORT results, mandatory quality assurance procedures have been incorporated into the current Lung ART study.

Merkel cell carcinoma

Merkel cell carcinoma is a rare form of skin cancer of likely neuroendocrine origin wich affects mainly white population in sun-exposed areas. It is an aggressive tumor and survival is dependent on stage at the time of diagnosis. The staging evaluation include CT imaging and recently PET scan. Surgical excision with or without lymph node dissection, followed by postoperative radiotherapy in stage II disease, is the standard treatment of non metastatic disease. The role of adjuvant chemotherapy is still controversial. In patients with metastatic disease, chemotherapy regimens active in small cell lung cancer are generally used. The combination of cyclophosphamide, doxorubicin and vincristine (CAV) has an overall response rate of 75%, whereas the response rate of etoposide in combination with cisplatin or carboplatin is 60%. Experience with other therapeutic agents, such as tumor necrosis factor, interferon and octreotide is scanty. Recently, encouraging preliminary results with targeted agents have been reported. Our experience in 14 patients, four of whom treated with chemotherapy for advanced disease, is in agreement with literature

Postoperative Radiotherapy for Stage II or III Non–Small-Cell Lung Cancer Using the Surveillance, Epidemiology, and End Results Database

Postoperative Radiotherapy for Stage II or III Non–Small-Cell Lung Cancer Using the Surveillance, Epidemiology, and End Results Database