Prognostic Factor For Locoregional Control Research Articles

Prognostic Factors for Locoregional Control in Early-Stage Oral Tongue Squamous Cell Carcinoma Treated with Partial Glossectomy and Elective Neck Dissection

Prognostic Factors for Locoregional Control in Early-Stage Oral Tongue Squamous Cell Carcinoma Treated with Partial Glossectomy and Elective Neck Dissection

The Pre-Treatment Platelet-to-Lymphocyte Ratio as a Prognostic Factor for Loco-Regional Control in Locally Advanced Rectal Cancer

Chronic inflammatory reactions have been proven to represent relevant mechanisms for the development and progression of cancer in numerous tumor entities. There is evidence that the platelet-to-lymphocyte ratio (PLR) is associated with the prognostic outcome. In rectal cancer, the prognostic role of this parameter has not yet been conclusively clarified. The aim of this study was to further clarify the prognostic significance of the pre-treatment PLR in patients with locally advanced rectal cancer (LARC). In the present study, 603 patients with LARC, who were treated with neoadjuvant chemoradiotherapy (nCRT) and subsequent surgical resection between 2004 and 2019, were retrospectively evaluated. The influence of clinico-pathological and laboratory factors on locoregional control (LC), metastasis-free survival (MFS) and overall survival (OS) was investigated. In univariate analyses, high PLR was significantly associated with worse LC (p = 0.017) and OS (p = 0.008). In multivariate analyses, the PLR remained an independent parameter for the LC (HR = 1.005, 95% CI: 1.000-1.009, p = 0.050). Pre-treatment lactate dehydrogenase (LDH) (HR: 1.005 95% CI:1.002-1.008; p = 0.001) and carcinoembryonic antigen (CEA) (HR: 1.006, 95% CI:1.003-1.009; p < 0.001) were independent predictors for MFS; additionally, age (HR: 1.052, 95% CI:1.023-1.081; p < 0.001), LDH (HR: 1.003, 95% CI:1.000-1.007; p = 0.029) and CEA (HR: 1.006, 95% CI:1.003-1.009; p < 0.001) independently predicted OS. Pre-treatment PLR before nCRT is an independent prognostic factor for LC in LARC, which could be used to further individualize tumor treatment.

Prognostic factors in sinonasal cancers: A multicenter pooled analysis.

6092 Background: Sinonasal cancers (SC) are heterogeneous diseases. Despite multimodality treatment, overall survival (OS) remains unsatisfactory. We aimed to identify prognostic factors (PFs) associated with patterns of failure and OS in non-metastatic SC (nmSC). Methods: We retrospectively reviewed a pooled dataset of nmSC from Princess Margaret (Canada) and Catalan Institute of Oncology (Spain) treated with definitive surgery ± postop radiotherapy (RT) or RT ± chemo according to institutional protocols between 2010-2019. In squamous cell carcinoma (SCC), HPV status was tested by p16 staining, and HPV DNA (ISH or PCR) if equivocal. The primary goal was to assess the association of tumor histology, stage (by 7th edition TNM), and other clinicopathological variables on locoregional control (LRC), distant control (DC) and OS. Actuarial rates were calculated with Kaplan–Meier (KM) method. Multivariable analysis (MVA) calculated hazard ratios (aHR) adjusted for histology type, T-/N-categories, and primary treatment. Results: Out of 342 pts, median age was 62 years (y) (range 21-96), Male:Female = 212:130, 95% had ECOG 0-1. Tumor histology types were: 192 (56%) SCC (p16+: 35; p16-/untested: 157), 40 (12%) adenocarcinoma (AD), 33 (10%) sinonasal undifferentiated carcinoma or sinonasal neuroendocrine tumors (SNUC/SNEC), 28 (8%) malignant melanoma (MM), 27 (8%) esthesioneuroblastoma (ES) and 22 (6%) adenoid cystic carcinoma (ACC). Median follow up was 3.6 y (range 0.1-11.3). Three-year actuarial rates for each endpoint are included in table. The PFs for LRC by MVA were: SNUC/SNEC (vs SCC) histology, T3-4 (vs T1-2: aHR 2.4, p = &lt; 0.01) and N+ (vs N-: aHR 1.7, p = 0.02) diseases. The PFs for DC were: MM (vs SCC) and SNUC/SNEC (vs SCC) histology, and T3-4 (vs T1-2: aHR 6.0, p = 0.01) disease. The PFs for OS were: MM (vs SCC) histology, older age (aHR 1.0, p &lt; 0.01), T3-4 (vs T1-2: aHR 5.6, p &lt; 0.01), and N+ (vs N-: aHR 2.5, p &lt; 0.01) disease. There was no difference in primary surgery vs RT in any outcome endpoint (all p &gt; 0.05). p16+ SCC had a marginally higher LRC but similar DC and OS vs p16-/untested SCC (table). Conclusions: This large multicentre cohort of nmSC shows different patterns of relapse and survival with different tumor histologies. Our results suggest that individualization of treatment and follow-up strategies by histologic type is recommended to optimize outcomes in these orphan diseases. [Table: see text]

Pathological responses to low-dose irradiation and Pepleomycin in Oral squamous cell carcinoma are predictive of Locoregional control

BackgroundThe prognosis of advanced oral cancer remains dismal. While multimodal therapy is beneficial, maintaining the quality of life of long-term survivors is important. Therefore, risk-adapted treatment regimens need to be designed. We herein investigated whether pathological responses in oral cancer patients treated with preoperative chemoradiotherapy predict locoregional recurrence.MethodsWe retrospectively reviewed the data of 51 oral cancer patients who received preoperative radiotherapy and concurrent pepleomycin, followed by curative surgery at our institution between January 2009 and June 2018. Each patient received preoperative external beam irradiation to the primary tumor and lymphatics (2 Gy per day for approximately 3 weeks) concurrent with pepleomycin (2.5 mg/day). Surgery was performed approximately 3–4 weeks after the completion of preoperative chemoradiotherapy. Pathological responses were defined based on the grading system of Oboshi and Shimosato.ResultsEight, 22, 16, and 5 patients had Oboshi and Shimosato grades 2a, 2b, 3, and 4, respectively. Favorable pathological responses (grades 3 and 4) were observed in 41.2% of patients (21 out of 51 patients). The pathological response and number of pathological lymph node metastases were identified as significant prognostic factors for locoregional control in the univariate analysis. Three-year locoregional control rates were 100 and 56.6% in patients with favorable and unfavorable pathological responses, respectively.ConclusionsThe present study demonstrated that pathological tumor responses to preoperative chemoradiotherapy are a useful predictive factor for locoregional control.

Expression of CD44, EGFR, p16, and their mutual combinations in patients with head and neck cancer: Impact on outcomes of intensity-modulated radiation therapy.

Progress in radiation treatment of head and neck squamous cell carcinoma (HNSCC) deserves the studies focused on molecular predictors that would help to enhance individually tailored treatment. p16/epidermal growth factor receptor (EGFR)/cluster of differentiation-44 (CD44) was immunohistochemically analyzed in 165 HNSCC patients. In the entire group and the p16 negative cohort, better 3-year overall survival and locoregional control correlated with p16 positivity, CD44, and EGFR negativity were observed. Combined analysis revealed the worst results in the CD44+/p16-, EGFR+/p16-, and EGFR+/CD44+ groups and in the EGFR+/CD44+ within p16 negative cohort. Multivariate analysis found tumor stage, Karnofsky index, p16, and CD44 as prognostic factors of overall survival and clinical stage, and p16 as a prognostic factor for locoregional control. Clinical stage and Karnofsky index affected overall survival and tumor stage. EGFR affected locoregional control in the p16 negative subgroup. Our study confirmed the negative effect of CD44 and EGFR and the positive effect of p16 on radiotherapy results.

High-dose versus standard-dose radiation therapy for cervical esophageal cancer: Retrospective single-institution study.

To evaluate the role of definitive radiotherapy using higher-than-standard-dose radiation of 50 Gy for carcinoma of the cervical esophagus (CCE). We reviewed 79 patients with stage I-III CCE, treated between 2000 and 2012. Patients received 5-fluorouracil/cisplatin-based chemotherapy concurrently and were divided into high-dose (≥59.4 Gy, n = 44) and standard-dose (<59.4 Gy, n = 35) groups. The median follow-up was 35 months for surviving patients. The high-dose group had significantly better 3-year local (90.0% vs 60.4%, P = .001) and locoregional (70.4% vs 45.3%, P = .04) control. Progression-free (45.4% vs 37.5%, P = .32) and overall (58.4% vs 49.1%, P = .69) survival rates were not different. High-dose radiation was an independent prognostic factor for locoregional control (P = .04). No differences in late toxicities (esophageal stenosis or tracheoesophageal fistula) were observed. High-dose radiation for CCE improves local and locoregional control, without increasing severe toxicities.

Prolonged Overall Treatment Time and Lack of Skin Rash Negatively Impact Overall Survival in Locally Advanced Head and Neck Cancer Patients Treated with Radiotherapy and Concomitant Cetuximab.

Cetuximab, a chimeric monoclonal antibody against EGFR sensitizes tumors to radiotherapy (RT), but is associated with skin and mucosal toxicity. We report outcomes and tolerance of definitive RT in association with cetuximab in patients with locally advanced squamous cell carcinoma (LASCC) of the head and neck. Between 2006 and 2011, 92 consecutive patients with LASCC of the head and neck were treated with RT and concomitant weekly cetuximab. Median age was 61.7years. Most patients presented with oropharyngeal tumors (52.2%) and stage IV disease (77.2%). Sixty-nine patients received at least 7cycles of cetuximab. Cetuximab was stopped at the first infusion following allergic reactions in four patients. During RT, 37% of patients developed grade≥3 dermatitis; grade≥2 cetuximab-induced rash occurred in 43 patients (46.7%). Severe mucositis (grade≥3) affected 57.6% of patients. Ten percent of patients did not receive the full course of RT, and temporary discontinuation due to acute toxicity was frequent and affected 37 patients (53%). The median RT overall treatment time (OTT) in patients with interrupted RT was 56days (47-75) compared to 51days (47-65) in patients who did not require toxicity-related radiation interruptions (p<0.05). After a median follow-up of 17.5months (1.3-107.6) for all patients, median overall survival was 17.9months (95% CI: 12.7-23.2), and loco-regional control (LRC) was 9.2months (95% CI: 3.9-14.4). On multivariate analysis, hemoglobin concentration and occurrence of rash grade≥2 were independent prognostic factors for LRC (p=0.023 and p=0.006, respectively). Lack of rash and extended OTT negatively impacted overall survival (p=0.048 and 0.052, respectively). Skin and mucosal toxicity remains an issue in patients with LASCC of the head and neck treated with concomitant cetuximab and RT. Severe toxicity leads to treatment interruptions and prolonged overall treatment time, with consequent decreased overall survival in these patients.

Outcomes and prognostic factors for surgery followed by modern radiation therapy in parotid gland carcinomas.

To evaluate the outcomes and prognostic factors in patients with parotid gland cancers treated with adjuvant radiotherapy with or without chemotherapy. Eighty-five patients with parotid gland cancers were identified between October 2001 and September 2011. The median radiation dose was 66 Gy (range, 9-76 Gy). The outcomes assessment included overall survival, locoregional control, distant metastasis-free survivaland disease-free survival. The stage distribution was 20 patients(23.5%) in stage I, 28 (32.9%) stage II, 14 (16.5%) stage III and 23 (27.1%) stage IV. Fifty-five patients (64.7%) had positive margins and 23 patients (27.1%) had close margins (<0.5 cm). Lymph node extracapsular spreading occurred in nine patients. The adjuvant therapy included radiotherapy alone in 47 patients (55.3%) and concurrent chemoradiotherapyin 38 patients (44.7%). With a median follow-up of 4.5 years (range, 0.4-11 years), the 5-year overall survival, locoregional control, distant metastasis-free survival and disease-free survival were 82.0, 88.4, 82.4 and 77.5%, respectively. Based on multivariate analysis, N1/N2 was a significant negative prognostic factor for distant metastasis-free survival, disease-free survival and overall survival. Perineural invasion was a significant negative prognostic factor for locoregional control, distant metastasis-free survival and disease-free survival. Patients 50 years or older had significantly worse distant metastasis-free survival, disease-free survival and overall survival. Surgery and radiotherapy treatment could achieve excellent outcomes in a modern cohort. However, N1/N2, perineural invasion and age ≥50 years, but not positive margins, are significant factors associated with a worse prognosis.

Role of Neck Dissection in Locoregionally Advanced Head and Neck Cancer Treated with Primary Chemoradiotherapy

1.1. Introduction: Planned neck dissection after chemoradiotherapy (CRT) in locoregionally advanced head and neck cancer is controversial. The objective of the present study was to evaluate the influence of neck dissection on the long-term locoregional control and survival of patients with stage III-IV head and neck squamous cell carcinoma (HNSCC) after primary CRT. 1.2. Methods/Patients: We retrospectively analysed locoregional control, locoregional relapse-free survival (LRFS), and overall survival (OS) in 67 patients with locally-advanced HNSCC treated with exclusive CRT at our department between January 1998 and December 2013. 1.3. Results: Complete clinical response was achieved in 36 of 67 patients (53.7%), partial response > 50% in 17 pts (25.4%), stable disease in 3 (4.5%); 9 patients (13.4%) developed disease progression during treatment. At a median follow-up of 35 months, LRFS and OS were 100% in patients with complete response and neck dissection versus 77.9% and 79.8%, respectively, in patients who did not undergo neck dissection (p = ns). The only independent prognostic factor for locoregional control was complete response to CRT. 1.4. Conclusions: Patients who achieve a complete clinical response to CRT have a very low risk of isolated neck recurrence and, therefore, planned neck dissection may not be justified in such cases. Clinical and radiographic identification of patients with residual disease following CRT who could benefit from neck dissection remains challenging.

Reirradiation and hyperthermia for irresectable locoregional recurrent breast cancer in previously irradiated area: Size matters

Background/purposeTreatment options for irresectable locoregional recurrent breast cancer in previously irradiated area are limited. Hyperthermia, elevating tumor temperature to 40–45°C, sensitizes radio-and-chemotherapy. Four hundred and fourteen patients treated with reirradiation+hyperthermia (reRT+HT) in the AMC(n=301) and the BVI(n=113), from 1982 to 2005 were retrospectively analyzed for treatment response, locoregional control (LC) and prognostic factors for LC and toxicity. Patients/methodsAll patients received previous irradiation (median 50Gy). reRT consisted of 8×4Gy-2/week (AMC) or 12×3Gy-4/week (BVI). Hyperthermia was added once (AMC)/twice (BVI) a week. ResultsOverall clinical response rate was 86%. The 3-year LC rate was 25%.The number of recurrence episodes, distant metastases (DM), tumor site, tumor size, time to recurrence and treatment year were significant for LC.Acute ⩾grade 3 toxicity occurred in 24% of patients. Actuarial late ⩾grade 3 toxicity was 23% at 3-years. In multivariable analysis reRT fraction dose was significantly related to late ⩾grade 3 toxicity. ConclusionreRT+HT is an effective curative and palliative treatment option for patients with irresectable locoregional recurrent breast cancer in previously irradiated area. Early referral, treatment of chest wall recurrences ⩽5cm in the absence of distant metastases, provided the highest local control rates. The cumulative effects of past and present treatments should be accounted for by adjusting treatment protocol to minimize toxicity.

Survival benefit of adjuvant radiotherapy in stage III and IV bladder cancer: results of 170 patients.

Background:Radical cystectomy (RC) with or without neoadjuvant chemotherapy is the standard treatment for muscle-invasive bladder cancers. However, the locoregional recurrence rate is still significantly higher for locally advanced cases post-RC. The underuse of postoperative radiotherapy (PORT) in such cases after RC is related mainly to a lack of proven survival benefit. Here we are reporting our long-term Egyptian experience with bladder cancer patients treated with up-front RC with or without conformal PORT.Patients and methods:This retrospective study included 170 locally advanced bladder cancer (T3–T4, N0/N1, M0) patients who had RC performed with or without PORT at Damietta Cancer Institute during the period of 1998–2006. The treatment outcomes and toxicity profile of PORT were evaluated and compared with those of a non-PORT group of patients.Results:Ninety-two patients received PORT; 78 did not. At median follow-up of 47 months (range, 17–77 months), 33% locoregional recurrences were seen in the PORT group versus 55% in the non-PORT group (P<0.001). The overall distant metastasis rate in the whole group was 39%, with no difference between the two groups. The 5-year disease-free survival for the whole group of patients was 53%±11%, which was significantly affected by additional PORT, and 65%±13% compared with 40%±9% for the non-PORT group (P=0.04). The pathological subtypes did not affect 5-year disease-free survival significantly (P=0.9). The 5-year overall survival was 44%±10%. Using multivariate analysis, PORT, stage, and extravesical extension (positive surgical margins) were found to be important prognostic factors for locoregional control. Stage and lymph node status were important prognosticators for distant metastasis control.Conclusion:PORT was found to be a safe and effective tool in decreasing local recurrence rates and improving disease-free survival.

Prognostic value of hypoxia-associated markers in advanced larynx and hypopharynx squamous cell carcinoma.

To determine the prognostic value of hypoxia-associated markers carbonic anhydrase-9 (CA-9) and hypoxia-inducible factor-1α (HIF-1α) in advanced larynx and hypopharynx squamous cell carcinoma (SCCa) treated by organ preservation strategies. Retrospective cohort study. Pretreatment CA-9 and HIF-1α expression, clinicopathologic data, and tumor volume were analyzed in a series of 114 patients with T3-4 SCCa larynx or hypopharynx treated by (chemo)radiation. Adverse prognostic factors for locoregional control were T4 classification (P = 0.008), and for disease-specific survival were CA-9 positivity (P = 0.039), T4 classification (P = 0.001), larger tumor volume (P = 0.004), N1-3 classification (P = 0.002), and pretreatment hemoglobin < 13.0 g/dl (P = 0.014). With increasing CA-9 expression, there was a trend to increasing tumor recurrence (P trend = 0.009) and decreasing survival (P trend = 0.002). On multivariate analysis, independent variables were T4 classification (hazard ratio [HR] 13.54, P = 0.01) for locoregional failure, and CA-9 positivity (HR = 8.02, P = 0.042) and higher tumor volume (HR = 3.33, P = 0.007) for disease-specific mortality. This is the first study to look specifically at T3 and T4 SCCa larynx and hypopharynx for a relationship between hypoxia-associated marker expression and clinical outcome. Pretreatment immunohistochemical CA-9 expression is an adverse prognostic factor for disease-specific survival, indicating that CA-9 expression may confer a more aggressive tumor phenotype.

A nomogram to predict loco-regional control after re-irradiation for head and neck cancer

Background and purposeLoco-regionally recurrent head and neck cancer (HNC) in the setting of prior radiotherapy carries significant morbidity and mortality. The role of re-irradiation (re-RT) remains unclear due to toxicity. We determined prognostic factors for loco-regional control (LRC) and formulated a nomogram to help clinicians select re-RT candidates. Material and methodsFrom July 1996 to April 2011, 257 patients with recurrent HNC underwent fractionated re-RT. Median prior dose was 65Gy and median time between RT was 32.4months. One hundred fifteen patients (44%) had salvage surgery and 172 (67%) received concurrent chemotherapy. Median re-RT dose was 59.4Gy and 201 (78%) patients received IMRT. Multivariate Cox proportional hazards were used to identify independent predictors of LRC and a nomogram for 2-year LRC was constructed. ResultsMedian follow-up was 32.6months. Two-year LRC and overall survival (OS) were 47% and 43%, respectively. Recurrent stage (P=0.005), non-oral cavity subsite (P<0.001), absent organ dysfunction (P<0.001), salvage surgery (P<0.001), and dose >50Gy (P=0.006) were independently associated with improved LRC. We generated a nomogram with concordance index of 0.68. ConclusionRe-RT can be curative, and our nomogram can help determine a priori which patients may benefit.

The Prognostic Role of the Neutrophil-to-Lymphocyte Ratio in Oropharyngeal Carcinoma Treated with Chemoradiotherapy

BACKGROUNDThe aim of the study is to investigate the prognostic role of pre-treatment of markers of the systemic inflammatory response (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and albumin) in patients with oropharyngeal carcinoma treated with chemoradiotherapy.METHODSA total of 251 patients with oropharyngeal squamous cell cancer treated with chemoradiotherapy between 2004 and 2010 were retrospectively identified. NLR, PLR, and albumin were recorded from baseline blood parameters. NLR threshold of >5 and PLR thresholds of ≤150, >150 and ≤300, and >300 were used for analysis.RESULTSMedian follow-up was 46 months (range 9–98). The 3 year overall survival, local control, regional control, and distant control were 70%, 85%, 87%, and 87%, respectively. On multivariate analysis, locoregional control was associated with T stage (HR 3.3 (95% CI 1.5–6.9), P = 0.002) and NLR (HR 2.1 (95% CI 1.1–3.9), P = 0.023). Overall survival was associated with T stage (HR 2.47 (95% CI 1.45–4.2), P = 0.001) and grade (HR 0.61 (95% CI 0.38–0.99), P = 0.048). PLR and albumin were not significantly associated with disease outcomes or survival.CONCLUSIONSThe NLR is an independent prognostic factor for locoregional control in oropharyngeal cancer treated with chemoradiotherapy.

Five-year outcome of concurrent radiotherapy and chemotherapy in Saudi women with locally advanced cervical cancer: single-institution experience

BACKGROUND AND OBJECTIVESWe aimed to evaluate long-term treatment outcomes and toxicity profile of combined radiotherapy and chemotherapy in Saudi women with locally advanced cervical cancer.DESIGN AND SETTINGSRetrospective study in a tertiary care cancer center in Riyadh, Saudi Arabia.METHODS AND MATERIALSThe medical records of patients with histopathologically proven, locally advanced cervical cancer were analyzed. These patients received three-dimensional conformal radiotherapy with concurrent chemotherapy followed by high dose rate brachytherapy in our center between July 2007 and April 2012. The data regarding the safety profile, response rates, occurrence of locoregional or distant failure, disease-free survival, and overall survival rates were recorded.RESULTSThe median follow-up period was 60 months (range, 8–66) for 74 patients. The median age of study population was 52.3 years (32–78), and the stage IIB was the predominant stage (49 patients [66.2%]). A total of 45 patients (60.9%) had radiologic-positive pelvic ± para-aortic lymphadenopathy. The 5-year locoregional and distant control rates were 84.3% and 78.5%, respectively. The 5-year disease-free and overall survival rates were 75.7% and 64.5%, respectively. Stage, nodal status, and hemoglobin levels were found to be important prognostic factors for locoregional and distant control. Acute grade 3 hematological and nonhematological toxicities were seen in 4 (5.4%) and 4 (5.4%) patients. Late toxicities were mild, and only 1 (1.4%) patient presented with subacute intestinal obstruction.CONCLUSIONConcurrent chemoradiation in Saudi women with locally advanced cervical cancer showed better locoregional and distant control and survival rates with minimal toxicity.

Survival Pattern and Prognostic Factors of Patients With Squamous Cell Carcinoma of the Tongue: A Retrospective Analysis of 210 Cases

The aim of this article was to retrospectively analyze squamous cell carcinoma (SCC) of the tongue to determine the tumor characteristics, treatment, and prognostic factors that may influence the survival of patients with this disease. A total number of 210 patients with SCC of the tongue, who were treated at the First Teaching Hospital of Xinjiang Medical University from January 1997 to December 2007, were retrospectively analyzed to calculate the survival rates and determine the predictors of survival. Tumor characteristics and treatment patterns were investigated for locoregional recurrence, as well as the 3- and 5-year overall and disease-specific survival after primary treatment. Patients who had undergone only the operation had a longer survival than those who had undergone the operation and radiotherapy or had been treated using RT/CRT alone (OR = 3.5, 95% CI = 1.1 to 11.3, P = .033). The 5-year overall survival, disease-specific survival, and locoregional relapse free survival rates were 44.4%, 47.7%, and 40.0%, respectively. Cox's multivariate analyses showed that the tumor invasion depth, perineural invasion, resection margin, treatment, and clinical stages were independent prognostic factors for 5-year survival (P < .05). Deep invasion (>9 mm) was the predominant independent prognostic factor for locoregional control and survival after the diagnosis of oral tongue SCC. To achieve higher survival rates, surgery should be considered, even for advanced tongue cancer patients with deep tumor invasion depth.

Patterns of Failure and Prognostic Factors for Locoregional Recurrence after Radical Surgery in Upper Urinary Tract Transitional Cell Carcinoma: Implications for Adjuvant Radiotherapy

Aims: We investigated the patterns of failure and prognostic factors for locoregional control (LRC) in patients with upper urinary tract (UUT) transitional cell carcinoma (TCC) treated with radical surgery to evaluate the role of adjuvant radiotherapy. Materials and Methods: We retrospectively reviewed the medical records of 76 patients with TCC of the renal pelvis and ureter without distant metastasis who underwent curative-intent surgery. No locoregional or distant failure occurred in 19 patients with pTa-1 tumor, and we evaluated patterns of failure and prognostic factors in 57 patients with pT2 or more tumors. Adjuvant chemotherapy was applied in 25 patients. Results: Recurrences occurred in a total of 23 patients, and 20 of these experienced some kind of locoregional failure during follow-up. The overall crude and initial isolated locoregional recurrence rates were 35 and 28%, respectively. In pT2 patients, all 4 recurrences were isolated locoregional recurrences, and 3 of them were successfully salvaged with chemoradiotherapy. Patients with pT3-4 or who were positive for nodal disease (N+) had a lower rate of LRC and worse prognosis after recurrences. On multivariate analysis, incomplete surgery, venous invasion and squamous metaplasia were identified as independent prognostic factors for LRC. Conclusions: Initial loco-regional recurrence was commonly detected by routine computed tomography in locally advanced UUT-TCC. Incomplete surgery, venous invasion and squamous meta-plasia were independently associated with poor LRC. Active postoperative adjuvant treatment such as concurrent chemoradiotherapy could be considered in pT3-4 or N+ patients with adverse risk factors.

唾液腺悪性腫瘍の放射線治療

In the radiotherapy for salivary gland malignant tumors the postoperative radiotherapy is often used to prevent locoregional recurrences. In some cases where the surgical operation is impracticable the radiotherapy can be performed alone. And the elective neck radiotherapy effectively prevents nodal relapses and is advised for select patients at high risk for regional failure. In some researches the prognostic importance of a large number of patients has been studied. In these researches the postoperative radiotherapy for salivary gland malignant tumors is a strong prognostic factor for locoregional control and disease-specific survival. In order to enhance the locoregional control rate the postoperative radiotherapy is strongly recommended for cases of perineural invasion, close or incomplete margin, bone invasion, large （T3-） tumor, and recurrence. The recommended dose is over 60 Gy and the doses higher than 66 Gy enhanced the locoregional control rate （＞60 ％）. Complications due to the radiotherapy for salivary gland malignant tumors, including xerostomia, hearing loss,and mastoiditis influence the quality of patient’s life. New modality of the radiotherapy, such as intensity-modulated radiotherapy and particle beam radiotherapy, will reduce the risk of the complications due to the radiotherapy for salivary gland malignant tumors.

Predictive value of fluorodeoxyglucose uptake in head and neck cancer: importance of standardization

In the past the majority of patients with advanced stage head and neck squamous cell carcinoma (HNSCC) were treated with a combination of surgery and radiotherapy, often at the expense of functional and cosmetic morbidity, and thus reduced quality of life. Nowadays, in an attempt to decrease the morbidity, non-surgical treatments for advanced HNSCC are increasingly applied with considerable complete remission rates. It appeared that new radiation schemes (accelerated or hyperfractionated) and combinations of chemotherapy and radiotherapy all increase remission rates. When starting an organ sparing non-surgical therapy for functionally inoperable HNSCC (i.e. too high morbidity of surgical treatment expected), salvage surgery is held in reserve for residual or recurrent disease. However, salvage surgery with curative intent is only possible in about half of such patients. Moreover, the complication rate of salvage surgery after chemoradiation is high, with wound healing problems as a well-known complication. Since non-surgical treatment itself is also associated with acute and long-term side effects, leading to compromised quality of life, patients undergoing primary non-surgical treatment (radiotherapy with or without chemotherapy) followed by salvage surgery are exposed to cumulative morbidity of all treatment modalities. Another important disadvantage of surgery for residual or recurrent tumour after radiotherapy is the fact that although it may be indicated postoperative radiotherapy is mostly no longer possible, limiting the oncological outcome of this treatment. Because salvage treatment after (chemo)radiation carries a questionable prognosis but a high incidence of complications, (chemo)radiation may not be the choice of treatment in all patients with advanced HNSCC. A reliable predictor of outcome after chemoradiation is needed to select patients who are likely to benefit from non-surgical treatment. Valuable predictive factors provide information on the outcome of therapy in an individual patient allowing avoidance of over- as well as undertreatment. In the present context, better selection may refrain a substantial number of patients from futile extensive and toxic treatment (radiation with or without chemotherapy), decrease the complication rate of surgical treatment and reserve radiotherapy for a postoperative setting if indicated. Conventional prognostic factors for locoregional control include T-stage, N-stage and tumour site, grade and volume. The predictive value of molecular biological markers is currently under investigation. Tumour metabolism is another potential prognostic factor and can be studied with positron emission tomography (PET). Up-regulation of glucose uptake through overexpression of glucose transporters is an early event in malignant transformation. 18Fluoro-2-deoxyglucose (FDG) is the most widely used PET tracer in oncologic PET studies and can be used to measure the glucose metabolism in malignant tissues. Quantification of tracer uptake can be done in several ways, from pure visual analysis to simple calculations of uptake level using a Standardized Uptake Value (SUV; ie. the ratio of measured activity in a static scan obtained e.g. 60 min after FDG injection over the injected dose and

Prognostic Impact of Erythropoietin Expression and Erythropoietin Receptor Expression on Locoregional Control and Survival of Patients Irradiated for Stage II/III Non-Small-Cell Lung Cancer

Prognostic factors can guide the physician in selecting the optimal treatment for an individual patient. This study investigates the prognostic value of erythropoietin (EPO) and EPO receptor (EPO-R) expression of tumor cells for locoregional control and survival in non-small-cell lung cancer (NSCLC) patients. Fourteen factors were investigated in 62 patients irradiated for stage II/III NSCLC, as follows: age, gender, Karnofsky performance score (KPS), histology, grading, TNM/American Joint Committee on Cancer (AJCC) stage, surgery, chemotherapy, pack years (average number of packages of cigarettes smoked per day multiplied by the number of years smoked), smoking during radiotherapy, hemoglobin levels during radiotherapy, EPO expression, and EPO-R expression. Additionally, patients with tumors expressing both EPO and EPO-R were compared to those expressing either EPO or EPO-R and to those expressing neither EPO nor EPO-R. On univariate analysis, improved locoregional control was associated with AJCC stage II cancer (p < 0.048), surgery (p < 0.042), no smoking during radiotherapy (p = 0.024), and no EPO expression (p = 0.001). A trend was observed for a KPS of >70 (p = 0.08), an N stage of 0 to 1 (p = 0.07), and no EPO-R expression (p = 0.10). On multivariate analysis, AJCC stage II and no EPO expression remained significant. No smoking during radiotherapy was almost significant. On univariate analysis, improved survival was associated with N stage 0 to 1 (p = 0.009), surgery (p = 0.039), hemoglobin levels of ≥12 g/d (p = 0.016), and no EPO expression (p = 0.001). On multivariate analysis, N stage 0 to 1 and no EPO expression maintained significance. Hemoglobin levels of ≥12 g/d were almost significant. On subgroup analyses, patients with tumors expressing both EPO and EPO-R had worse outcomes than those expressing either EPO or EPO-R and those expressing neither EPO nor RPO-R. EPO expression of tumor cells was an independent prognostic factor for locoregional control and survival in patients irradiated for NSCLC. EPO-R expression showed a trend. Patients with tumors expressing both EPO and EPO-R have an unfavorable prognosis.