Radiotherapy In High-risk Patients Research Articles

Role of Postoperative Radiotherapy on High-Risk Stage pIIIA-N2 Non-Small Cell Lung Cancer Patients After Complete Resection and Adjuvant Chemotherapy: A Retrospective Cohort Study.

The aim of the study was to assess the effectiveness of postoperative radiotherapy in high-risk patients with stage pIIIA-N2 non-small cell lung cancer (NSCLC) following complete resection and adjuvant chemotherapy. Data from NSCLC patients within the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. The study examined the association between lymph node ratio (LNR) and both cancer-specific survival (CSS) and overall survival (OS) using restricted cubic spline curves. Patients were categorized into high- and low-risk groups based on established LNR cut-off values, and survival outcomes were compared between those receiving postoperative radiotherapy and those who did not within the high-risk group. The study included 1,690 patients. An LNR threshold of 0.29 was identified for both CSS and OS. Patients with an LNR ≥ 0.29 demonstrated significantly worse CSS (hazard ratio (HR) = 1.56, 95% confidence interval (CI): 1.37 - 1.78; P < 0.001) and OS (HR = 1.44, 95% CI: 1.28 - 1.62; P < 0.001) compared to those with an LNR < 0.29. In the high-risk group (LNR ≥ 0.29), postoperative radiotherapy did not significantly affect CSS (HR = 0.98, 95% CI: 0.82 - 1.17; P = 0.809) or OS (HR = 0.95, 95% CI: 0.81 - 1.11; P = 0.533). LNR is a significant prognostic factor in patients with stage pIIIA-N2 NSCLC post complete resection and adjuvant chemotherapy. A higher LNR (≥ 0.29) is associated with poorer CSS and OS. However, postoperative radiotherapy does not confer survival benefits in these high-risk patients. Our findings suggest that postoperative radiotherapy should not be routinely performed in this subgroup. Further research is required to explore effective treatment strategies for these patients.

Socio-Economic Status in Risk of Acute Adverse Events Following Radiotherapy

Socio-economic status (SES) are known to influence cancer patient outcomes. The purpose of this study is to evaluate whether SES affected the short-term clinical experience of patients treated with radiotherapy (RT) during the pandemic. This was a single institution, retrospective cohort quality improvement study. The primary endpoint consisted of adverse events (AEs) defined as an unplanned admission to a drop-in radiation-nursing clinic (RNC) or the institution's emergency department (ED) within 90 days of a radiation course. Adult cancer patients who received external beam RT from April 1, 2019, to March 31, 2022 were included. Patients were classified into two periods: treated prior to the pandemic (pre-COVID), and during the pandemic (COVID era), with a cutoff date of March 31, 2020. SES, age, RT intent (curative, palliative, SBRT), regimen (conventional fractionation and hypofractionation), disease site, and sex were included as co-variables. SES was obtained by matching a patient's postal code with a provincial data tool with four distinct dimensions: 1) residential instability, 2) material deprivation, 3) ethnic concentration, and 4) dependency. For each SES dimension, a score of 1-5 (best-worst) is assigned to individuals. A backward stepwise multivariable logistic regression analysis was performed to analyze the variables and identify the factors that were significantly associated (p<0.05) with increased risk of AEs. Institutional ethics review board exemption was obtained. Across the 3-year period, 15715 patients (5499 pre-COVID and 10216 COVID era patients) were identified and included in the analyses, and 5756 AEs were observed. The analyses revealed that patient age (p<0.001), disease site (p<0.001), treatment intent (p<0.001) and treatment regimen (p = 0.005) were associated with the risk of developing AEs. AEs risk was correlated with the treatment period (pre-COVID vs. COVID era) (p<0.001) and material deprivation (p = 0.027). Adjusting for the other variables, patients who were least materially deprived were at lower risk (Odds Ratio (OR) = 0.88, 95% CI [0.78-0.98]) of developing AEs than patients who were most materially deprived. Patient sex (p>0.1), residential instability (p = 0.069), ethnic concentration (p>0.5) and dependency (p>0.5) were not associated with AEs risk. Patients with more (SES score 1-4 vs 5) residential instability (p<0.001; OR = 0.82, 95% CI [0.74-0.90]) and less (SES score 1 vs 2-5) material deprivations (p = 0.006; OR = 0.76, 95% CI [0.66-0.88]) were at reduced the risk of ED visits. SES was not associated with RNC visits. In a universal health care system, SES (residential instability and material deprivation) were associated with the increased risk of ED within 90 days of RT. Proactive care and virtual monitoring during the 90-day period after RT in high-risk patients may reduce ED visits. ED visits beyond our tertiary institution are being gathered to address this study limitation.

A Fifteen Years Audit of Endometrial Cancer Referred for Adjuvant Treatment to a Tertiary Care Hospital in Northern India

Introduction: Endometrial cancer is the seventh most common cancer in women worldwide with Age Standardised Incidence Rate (ASIR) of 8.4 per lac. In Indian subcontinent, the incidence is lesser and the ASIR is 2.1/100,000 women. However, its incidence is on the steady rise in developing part of the world including India. Surgery is the primary treatment and adjuvant radiotherapy is given in patients with high-risk of recurrence and significant change has happened in the management in the last 20 years. From India limited literature is available for management practices for endometrial cancer. Aim: To assess the referral patterns, demography, staging, surgical practices, adjuvant treatment and follow-up policies for endometrial cancer in a tertiary care hospital in northern India. Materials and Methods: A retrospective cross-sectional study was done for patients having endometrial cancer treated between January 2000- December 2015 in a tertiary care hospital in northern India in January 2022. A total of 93 patients having endometrial cancer were referred for radiotherapy. For these patients, their referral patterns, demography, staging, surgical practices, adjuvant treatment and follow-up policies were analysed, retrospectively. Disease Free Survival (DFS) and Overall Survival (OS) were computed by Kaplan-Meier method. Results: The median age at presentation was 55 years. Postmenopausal vaginal bleeding was the commonest symptom 78 (83.87%). Ultrasonography 23 (24.73%) was the preferred first imaging modality. Type 1 endometroid carcinoma was 75 (80.64%) and total abdominal hysterectomy with bilateral salpingo-oophrectomy was done in 82 (88.17%). Adjuvant External Beam Radiotherapy (EBRT) with Brachytherapy (BT) was given in 61 (65.59%), EBRT alone in 7(7.52%) and BT alone given in 11 (11.83%). Median EBRT dose was 50.4 Gy. Vaginal cylinder applicator was used in 69 (95.83%) out of 72 patients receiving BT. A 6.0 Gy/# to a total of 2 fractions were given in 57 (79.16%). Median treated length of vagina was 3 cm (range 2-8 cm). Five year DFS and OS was 25% and 25% and 64% and 62% respectively in worst and best case scenario. Ten (10.75%) patients, all having high-risk had multiple visceral and local recurrence. Conclusion: In patients with endometrial cancer, total abdominal hysterectomy with bilateral salpingo-oophrectomy is commonest surgical practice with adjuvant radiotherapy in high-risk patients. In a developing country like India, assuring uniformity of treatment protocols is a challenging task.

Role of Adjuvant Regional Nodal Irradiation in Resected Melanoma: A Secondary Analysis of SWOG S1404

<h3>Purpose/Objective(s)</h3> Results from TROG 02.01 demonstrated that adjuvant radiotherapy (RT) in high-risk melanoma patients is associated with improved locoregional control (LRC). The aim of our study is to evaluate the role of adjuvant RT in standard risk (SR), high risk (HR) and ultra-high risk (UHR) melanoma patients in the immunotherapy era. S1404 randomized resected stage III and stage IV melanoma patients to standard of care adjuvant immunotherapy or pembrolizumab after surgery. <h3>Materials/Methods</h3> We retrospectively analyzed the data for 1239 patients enrolled in S1404. We stratified the patients according to SR (no high-risk features), HR (defined according to TROG 02.01 trial) and UHR (extracapsular extension with 5 or more positive nodes or 4 cm or greater nodal size). Recurrence free survival (RFS) and time to regional recurrence (TtRR) were primary outcomes; distant metastasis free survival (DMFS) was a secondary outcome. RFS was estimated using the Kaplan-Meier method and associations with the outcome were evaluated using Cox regression models. TtRR and DMFS were estimated with cumulative incidence curves and associations with the outcome were evaluated using cause-specific regression models. <h3>Results</h3> Of 1239 patients analyzed, 136 patients (11%) completed RT. The most common RT regimen used was 30 Gy/5 fractions (37%) followed by 48 Gy/20 fractions (31%). Fifty three percent of patients were HR per TROG02.01. More HR patients received RT compared to SR (16 % versus 6%; p-value <= 0.001). Among the patients who received RT 76/136 (56%) were advanced stage (Stage IIIC/ resected Stage IV) compared with those who did not 390/1103 (35%); p value <= 0.001. Similarly macroscopic lymph node involvement was significantly higher in RT group, 89/136 (65%) versus 457/1103 (41%); p value <=0.001. TtRR was significantly longer for patients who completed RT (all comers: 9% RR @ 4 year no RT vs 1% @ 4 year with RT; p value = 0.015). For high-risk patients, TtRR was longer for patients who received RT regardless of PD1 status (12% RR @ 4 year no RT vs 2% @ 4 year with RT; p value = 0.009). No significant difference in value of RT was seen based on anatomic nodal site, study arm or BRAF mutation status. Among patients treated with pembrolizumab, a trend toward RFS benefit was seen in patients treated with RT (HR = 1.54, 95% confidence interval 0.94-2.53; p=0.085). There was no significant difference in DMFS between those who completed RT versus not. <h3>Conclusion</h3> Our study validated the results of previous studies and suggests consideration of adjuvant RT in high-risk patients regardless of planned adjuvant immunotherapy for improved LRC. We recommend the use of adjuvant RT in patients with macroscopic nodal involvement with extracapsular extension or with heavy nodal burden even in the immunotherapy era.

Bone Marrow Suppression during Postoperative Radiation for Bladder Cancer and Comparative Benefit of Proton Therapy-Phase 2 Trial Secondary Analysis.

PurposeFor patients with high-risk bladder cancer (pT3+ or N+), local regional failure remains a challenge after chemotherapy and cystectomy. An ongoing prospective phase 2 trial (NCT01954173) is examining the role of postoperative photon radiation therapy for high-risk patients using volumetric modulated arc therapy. Proton beam therapy (PBT) may be beneficial in this setting to reduce hematologic toxicity. We evaluated for dosimetric relationships with pelvic bone marrow (PBM) and changes in hematologic counts before and after pelvic radiation therapy and explored the potential of PBT treatment plans to achieve reductions in PBM dose.Materials and MethodsAll enrolled patients were retrospectively analyzed after pelvic radiation per protocol with 50.4 to 55.8 Gy in 28 to 31 fractions. Comparative PBT plans were generated using pencil-beam scanning and a 3-beam multifield optimization technique. Changes in hematologic nadirs were assessed using paired t test. Correlation of mean nadirs and relative PBM dose levels were assessed using the Pearson correlation coefficient (CC).ResultsEighteen patients with a median age of 70 were analyzed. Mean cell count values after radiation therapy decreased compared with preradiation therapy values for white blood cells (WBCs), absolute neutrophil count (ANC), absolute lymphocyte count (all P < .001), and platelets (P = .03). Increased mean PBM dose was associated with lower nadirs in WBC (Pearson CC −0.593, P = .02), ANC (Pearson CC −0.597, P = .02), and hemoglobin (Pearson CC −0.506, P = .046), whereas the PBM V30 to V40 correlated with lower WBC (Pearson CC −0.512 to −0.618, P < .05), and V20 to V30 correlated with lower ANC (Pearson CC −0.569 to −0.598, P < .04). Comparative proton therapy plans decreased the mean PBM dose from 26.5 Gy to 16.1 Gy (P < .001) and had significant reductions in the volume of PBM receiving doses from 5 to 40 Gy (P < .001).ConclusionIncreased PBM mean dose and V20 to V40 were associated with lower hematologic nadirs. PBT plans reduced PBM dose and may be a valuable strategy to reduce the risk of hematologic toxicity in these patients.

Efficacy of NSAIDs versus radiotherapy for heterotopic ossification prophylaxis following total hip arthroplasty in high-risk patients: a systematic review and meta-analysis

The aims of this systematic review were: (1) to investigate the prophylactic effect of radiotherapy (RT) and NSAIDs in high-risk patients following total hip arthroplasty (THA); and (2) to compare the efficacy of non-selective and COX-II selective NSAIDs in preventing post-THA HO, utilising a meta-analysis of randomised control studies. The PubMed, Embase, and Cochrane Databases were searched for articles regarding HO following THA in March 2019. Studies were included if they contained data regarding HO incidence after THA or contained data regarding HO prophylaxis comparison of NSAIDs and/or RT in terms of dosage or duration. 24 studies reported on populations that were not at high-risk for HO. These studies reported between 47.3% and 90.4% of their patient populations had no HO formation; between 2.8% and 52.7% had mild formation; and between 0.0% and 10.4% had severe formation. A total of 13 studies reported on populations at high-risk for HO. Studies analysing RT in high-risk patients reported between 28.6% and 97.4% of patients developed no HO formation; between 1.9% and 66.7% developed mild HO formation; and between 0.0% and 11.9% developed severe HO formation. Studies analysing NSAID treatment among high-risk populations reported between 76.6% and 88.9% had no HO formation; between 11.1% and 23.4% had mild HO formation, and between 0.0% and 1.8% had severe HO formation. 9 studies were identified as randomised control trials and subsequently used for meta-analysis. The relative risk for COX-II in developing any HO after THA was not significantly different compared to non-selective NSAIDs (RR 1.00; CI, 0.801-1.256; p = 0.489). NSAIDs prophylaxis for HO may have better efficacy than RT in high-risk patients following THA. Non-selective and COX-II selective NSAIDs have comparable efficacy in preventing HO. Factors such as medical comorbidities and side-effect profile should dictate the prophylaxis recommendation.

ASCO virtual meeting 2020: highlights head and neck cancer

SummaryAt the ASCO 2020 virtual meeting, multiple clinically relevant studies were presented addressing open questions in the head and neck cancer field: Are de-escalation strategies feasible in low risk patients? What is the appropriate platinum dose in combination with radiotherapy in high-risk patients suffering from locally advanced disease? Is immunotherapy the first line standard of care for all patient in the recurrent/metastatic setting? This article summarizes the most significant head and neck cancer studies presented at the ASCO 2020 virtual meeting and discusses the data in the context of the current literature.

Breast Adjuvant Radiotherapy Amid the COVID-19 Crisis in a Hub Cancer Center, Lombardy, Italy

Introduction: During the COVID-19 pandemic, Lombardy (Northern Italy) Regional Health Council created hubs for cancer care, meant to be SARS-CoV-2-free pathways for cancer patients. The workflow of breast cancer (BC) radiotherapy (RT) in one of the hubs is presented here. Methods: Candidates to adjuvant RT during the pandemic peak of March-April 2020 were compared to those treated in the same period of 2019, and patient volume, deferral rate, and type of RT were analyzed. Statistics were calculated with χ² or Fisher exact tests for categorical variables, and the Wilcoxon rank test for continuous variables. Results: In March-April 2020 the BC patient volume increased by 28% compared to the same period in 2019 (scheduled patients: 175 vs. 137) and amid travel restrictions it was kept high (treated patients: 136 vs. 133), mainly due to an influx from across Lombardy. RT schemes basically did not change, being already centered on hypofractionation. The increase of median time (67 vs. 74.5 days in 2019 and 2020, respectively) to the commencement of RT for low-risk patients was clinically negligible yet statistically significant (p = 0.03), and in line with the pertinent recommendations. No significant difference was found in the time interval between treatments and RT for high-risk patients. Concomitant chemoradiotherapy was avoided throughout the pandemic peak. Twenty-one women (13.6%) delayed either computed tomography simulation or RT commencement mainly because of COVID-19-related concerns and mobility restrictions. Conclusion: The workload for BC was high during the pandemic peak. Hubs allowed the continuation of oncologic treatments, while mitigating the strain on frontline COVID-19 hospitals.

Adjuvant intensity modulated whole-abdominal radiation therapy for high-risk patients with ovarian cancer FIGO stage III: final results of a prospective phase 2 study

BackgroundTo assess late toxicity, quality of life and oncological outcome after consolidative whole abdominal radiotherapy (WART) following cytoreductive surgery and carboplatin/paclitaxel chemotherapy in high risk patients with advanced ovarian cancer FIGO stage III using IMRT (Intensity modulated radiation therapy).MethodsThe OVAR-IMRT-02 study is a multi-center single-arm phase-II-trial. Twenty patients with optimally debulked ovarian cancer stage FIGO III with complete remission after chemotherapy were treated with intensity modulated WART. A total dose of 30 Gy in 20 fractions was applied to the entire peritoneal cavity. Primary endpoint was treatment tolerability; secondary objectives were acute and chronic toxicities, quality of life, rates of therapy disruption/abortion, progression-free survival (PFS) and overall survival (OS).ResultsAll patients completed treatment and 10/20 patients (50%) reached the final study follow-up of 36 months. Late side effects consisted of °1-°2 lower limb edema (44.5%), with one patient (5.6%) showing °3 edema. Three patients (16.7%) showed elevated gamma-Glutamyltransferase. There were no severe late side effects regarding renal or hepatic function or any gastrointestinal toxicity greater than °2. During WART, mean global health status decreased by 18.1 points (95%-CI: 7.1–29.0), but completely normalized after 6 months. The same trend was observed for the function scale scores. Kaplan-Meier-estimated 1-, 2- and 3-year PFS was 74, 51 and 40%, respectively. 1-, 2- and 3-year OS was 89, 83 and 83%, respectively.ConclusionsIntensity modulated WART after aggressive surgery and carboplatin/paclitaxel chemotherapy is associated with an acceptable risk of acute and late toxicity and minor impact on long-term quality of life. Together with the promising results for PFS and OS, intensity modulated WART could offer a new therapeutic option for consolidation treatment of patients with advanced ovarian cancer.Trial registrationThe study is registered with ClinicalTrials.gov (NCT01180504). Registered 12 August 2010 – retrospectively registered.

Bilateral Wilms tumor with neonatal onset and the importance of prenatal diagnosis

Wilms tumor (WT) occurs in 1:10.000 live births and affects mainly the unilateral kidney. The National Wilms Tumor Study Group registered 6832 patients with WT from 1969 to January 1993, out of whom only 11 patients (0.16%) were newborns. Since 1969, 14 cases of prenatal diagnosis of WT have been reported in literature, two of which were bilateral WT. Currently, the patients’ survival rate is greater than 90%, owing to a combination of surgery, chemotherapy, and radiotherapy for high-risk patients. We report a case of bilateral WT, undiagnosed during the prenatal period due to the incomplete evaluation of the abdomen with ultrasonography. The newborn was vaginally delivered at 40 weeks’ gestational age with a good perinatal adaptation. Suddenly, during the night the newborn showed respiratory distress, bradycardia and then respiratory arrest. For this reason, he was ventilated, intubated and subjected to conventional mechanical ventilation. Despite the normal cardiac ultrasonography, the health care providers suspected a cyanotic congenital heart disease with duct dependency. After a gradual resumption of the oximetry and blood pressure, the infant was transported by the neonatal emergency transport system to the Cardiac Pediatric Surgery Department of a level III hospital. There, the clinical condition became extremely serious and the infant died of asystole. During autopsy, two large tumoral masses were found in both kidneys, also the characterization of the tumors was done through histological exam, which confirmed the diagnosis of WT. A prenatal diagnosis of WT is very important because the families can take advantage of prenatal counseling to understand the risks of continuing the pregnancy and to evaluate the need for abortion, while health care providers can prepare to face a difficult delivery. The review of the literature suggests that prenatal diagnosis of bilateral WT is possible. During prenatal age, the complete assessment of the abdomen with ultrasonography and Eco-Color-Doppler can reveal kidney anomalies and raise suspicion of diseases with urinary malformations.

Adjuvant Intensity Modulated Whole-Abdominal Radiation Therapy for High-Risk Patients With Ovarian Cancer (International Federation of Gynecology and Obstetrics Stage III): First Results of a Prospective Phase 2 Study

To assess treatment tolerance and toxicity rates of consolidative whole-abdominal radiation therapy (WART) following cytoreductive surgery and carboplatin/paclitaxel chemotherapy in high-risk patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage III) using intensity modulated radiation therapy. The OVAR-IMRT-02study is a multicenter, single-arm, phase 2 trial. Twenty patients with optimally debulked ovarian cancer (International Federation of Gynecology and Obstetrics stage III) with complete remission after chemotherapy were treated with intensity modulated WART as a consolidation therapy. A total dose of 30Gy in 20 fractions of 1.5Gy was applied to the entire peritoneal cavity. The primary endpoint was treatment tolerability, defined as lack of any Common Terminology Criteria for Adverse Events grade 4 toxicity within 10weeks after start of treatment; secondary objectives were acute and chronic toxicity, quality of life, rates of therapy disruption and abortion, and progression-free and overall survival. Intensity modulated WART resulted in excellent coverage of the whole peritoneal cavity, with effective sparing of all organs at risk. The primary analysis included all 20 enrolled patients, of whom 19 did not experience Common Terminology Criteria for Adverse Events grade 4 toxicity. Only 1 patient experienced acute grade 4 hematologic toxicity. Thus, the tolerability rate of intensity modulated WART was significantly higher than 70%. No gastrointestinal acute toxicities higher than grade 2 have been observed. During WART, mean global health status decreased by 18.1 points (95% confidence interval 7.1, 29.0). Six weeks after WART, global health status had already increased, with a mean score difference of 4.6 (95% confidence interval -11.1, 20.4) compared with baseline. Similar characteristics were observed for all function scale scores. Intensity modulated WART after aggressive surgery and carboplatin/paclitaxel chemotherapy is associated with an acceptable risk of acute toxicity and a treatment tolerability rate significantly higher than 70%. Together with our knowledge about clinical feasibility, meaning excellent coverage of the planning target volume and effective sparing of organs at risk, intensity modulated WART could offer a new therapeutic option for consolidation treatment of patients with advanced ovarian cancer.

The role of adjuvant radiotherapy in pathologically node positive prostate cancer.

28 Background: The postoperative management of prostate cancer with regional lymph nodal involvement (LNI) is controversial. Prospective evidence to guide the role of radiotherapy (RT) in this setting does not exist. Randomized studies demonstrate an improvement in disease-related outcomes with adjuvant RT in high-risk patients without LNI following prostatectomy (RP). Retrospective evidence supports the selective use of RT with LNI following extended pelvic lymph node dissection. It is unclear if this experience is generalizable to practice in the United States where extended dissection is uncommon. We sought to identify patients with LNI who may derive a survival benefit following adjuvant RT. Methods: The National Cancer Data Base was queried for M0 patients with prostate adenocarcinoma who underwent RP with pathologic LNI. Adjvuant RT was defined as delivered within 6 months following RP. Kaplan-Meier, log-rank test, and multivariable Cox proportional hazards regression were performed with overall survival (OS) as the primary outcome. Propensity score matching (PSM) was employed to further reduce treatment selection bias. Results: 7,902 patients diagnosed between 2003-2011 were eligible for analysis; 1,439 (18.2%) received RT. RT was more frequently employed in patients with lower Charlson-Deyo Comorbidity Score, higher T stage, &lt;5 nodes examined, ≥50% nodal positivity ratio, Gleason 8-10, ≥20 PSA, positive surgical margin, and &lt;65 years of age (all p &lt; 0.05). Five year OS was 87.6% vs. 85% in those receiving RT vs. not (p = 0.075). With androgen deprivation (ADT) (n = 3,265), 5-year OS was 87.2% vs. 82.7% in those receiving RT vs. not (p = 0.004). In multivariable analysis, the use of RT was independently associated with improved OS (HR 0.73, 95% CI 0.59-0.89, p = 0.002). 894 remained in each cohort following PSM. In this analysis, RT remained associated with OS (HR 0.66, 95% CI 0.51-0.85, p = 0.002). Conclusions: Adjuvant RT was associated with improved OS following RP in patients with LNI in this large generalizable retrospective analysis. This effect appears stronger in those receiving ADT. This series is the largest describing adjuvant RT in this population. In the absence of prospective evidence, these results may help guide therapy in this setting.

Our results of postoperative radiation therapy in patients with salivary gland cancer

This study aims to evaluate our single center experience in patients with a salivary gland tumor receiving postoperative radiation therapy (RT). Between January 1996 and December 2011, the records of 34 salivary gland tumor patients who were operated and referred to our clinic for adjuvant RT were retrospectively analyzed. Radiation therapy was applied to the primary tumor and lymphatics at a median dose of 60 Gy (54 to 60 Gy) with 1.8-2 Gy/fraction. The median follow-up was 38 months (range, 3 to 204 months). The most common site of involvement was the parotid gland in 21 patients (62%), followed by the submandibular gland in 11 patients (%24) and minor salivary gland in two patients (9%). Five-year overall survival (OS) was 49% (range, 3 to 206 months) and disease free survival (DFS) was 61% (range, 1 to 173 months). Six patients had local or regional recurrences (18%), while 13 patients (38%) had distant metastasis. A tumor size larger than 4 cm, over six weeks referral time to RT, and existence of metastatic lymph node were found to be poor prognostic factors for OS (p=0.023, p=0.039, respectively), and DFS (p=0.046). While extracapsular involvement significantly reduced the DFS and OS (p=0.022, p=0.050, respectively), overall RT time affected DFS alone (p=0.046). We recommend adjuvant RT in high-risk patients operated due to a salivary gland tumor.

Long‐term outcomes of surgery followed by radiation therapy for minor salivary gland carcinomas

Postoperative radiation therapy is often used in patients with high-risk salivary gland carcinomas. In this study we evaluated the outcomes and prognostic factors in patients with minor salivary gland cancers treated with adjuvant radiation therapy. Retrospective cohort study. We performed a retrospective analysis of 90 patients treated with curative intent. Median follow-up was 71 months. Fifty-eight patients (64%) had adenoid cystic carcinomas, 22 (24%) had adenocarcinomas, and 10 (11%) had mucoepidermoid cancers. Primary disease site included 39 (43%) sinonasal, 35 (39%) oral cavity, 10 (11%) oropharynx, and six (7%) others. Twenty-seven patients (30%) were treated with intensity-modulated radiation therapy. Eight local, four neck, and 24 distant relapses were detected. Local control rates at 5 and 10 years were 90% and 88%, respectively. Advanced T stage was associated with worse local control. Distant metastasis rates were 24% and 28% at 5 and 10 years, respectively. Tumor stage, histology, perineural invasion, and lymphovascular space invasion were significant predictors of distant metastasis on univariate analysis. However, on multivariate analysis only the American Joint Committee on Cancer stage was significant. Overall survival rates were 76% and 63% at 5 and 10 years, respectively. More advanced T stage and N stage correlated with worse overall survival. Tumor stage remains the best predictor for locoregional and distant disease control of minor salivary gland cancers. Postoperative radiation therapy for high-risk patients results in excellent long-term locoregional disease control. Further work is needed to improve systemic control.

Sarcoma de partes blandas

Soft tissue sarcoma (STS) are the most frequent sarcomas. They constitute a heterogeneous of rare solid tumors of mesenchymal cell origin with distinct clinical and pathological features. More than 50 subtypes have been identified. Some of them like Kaposi and GIST (Gastrointestinal Stromal Tumors) have their own behavior and treatment, and they are not included in this article. The anatomic site of the primary disease represents an important variable that influences treatment and outcome. A pretreatment biopsy for the diagnosis and grading should be performed by an experience surgeon or radiologist and analyzed by a pathologist with sarcoma expertise. Surgery is the standard primary treatment and margins must be thoroughly evaluated after surgery. The guidelines recommend consideration of postoperative radiotherapy in high risk patients. STS most commonly metastasize to the lungs. In selected patients, metastasectomy can improve survival, but the rest must be treated with palliative chemotherapy.

Safety and Efficacy of Definitive Split-Course Hypofractionated Radiation Therapy in High-Risk Patients With Head-and-Neck Cancer

Safety and Efficacy of Definitive Split-Course Hypofractionated Radiation Therapy in High-Risk Patients With Head-and-Neck Cancer

The effect of local excision and adjuvant radiotherapy for patients with stage I rectal cancer

Objective To evaluate the long-term survival and treatment failure patterns for patients with stage Ⅰ adenocarcinoma in the lower rectum after local excision with or without adjuvant radiotherapy.Methods From Jan.2000 to Dec.2008,Seventy-seven patients with rectal cancer received local excision.Among them,41 received adjuvant radiotherapy.Fifty-four patients were pathologically proven as T1,the other 23 as T2.Patients were classified into low-and high-risk groups according to tumor grade,the length of tumor,surgical margin,circumference ratio of tumor/rectum and T stage.Survival rates and prognostic factors were estimated by Kaplan-Meier method,and comparisons were made by the Logrank test.Results Fourty patients were followed up more than 5 years.The 5-year locoregional recurrence-free survival (LRFS)and overall survival (OS) rates were 83％ and 82％ for the whole group.There were no significant differences in 5-year LRFS and OS rates in low-risk patients between local excision alone and local excision followed by adjuvant radiotherapy ( 86％ ∶ 83％,x2 =0.29,P =0.588 and 100％ ∶ 100％,x2 =1.50,P =0.221 ).In high-risk patients,the 5-year LRFS were similar (80％ ∶ 82％,x2 =0.27,P =0.600),but the OS were significantly different (92％∶ 66％,x2 =4.64,P =0.031 ) between local excision alone and local excision followed by adjuvant radiotherapy.By univariate analysis,large tumor size,positive margin,poor differentiation,tumor located less than 5 cm from anal verge and pT2 stage were poor prognostic factors for OS.The overall relapse rate for the whole group was 29％,and 70％ of them were locoregional relapse.The 5-year OS for patients treated with radical salvage surgery after local relapse was 69％.Conclusions For stage Ⅰ lower-sited rectal cancer,low-risk patients can achieve good result after local excision alone.The role of adjuvant radiotherapy in high-risk patients needs further evaluation.Local relapse is the main cause of failure,and salvage surgery after local relapse can provide long-term survival. Key words: Rectal neoplasms/surgery; Rectal neoplasms/radiotherapy; Prognosis

Outcomes with External Beam Partial Breast Irradiation and Concurrent Chemotherapy (PBICC) Compared to Whole Breast Irradiation and Sequential Chemotherapy (WBISC) in Triple Negative Breast Cancer (TNBC) Patients

chemotherapy, or radiotherapy) for breast cancer. The study was approved by the Cancer Foundation of China Institutional Review Board. Results:Amongthe4,211patientsenrolled,3760patientswhoreceivedmastectomyandaxillarydissectionwereanalyzedinthis study. Of them, 675 patients (18.0%) received PMRT. Of the 3760 patients, 3083 had available staging information and were divided into three groups based on the risk of recurrence. There were 1090 patients (35.4%) in high-risk group (T3-4Nany and TanyN2-3), 721 (23.4%) in intermediate-risk group (T1-2N1) and 1272 (41.3%) in low-risk group (T1-2N0). 38.8% of patients in high-risk group, 12.8% in intermediate-risk group and 4.8% in low-risk group received PMRT. There was a trend for increasing use of radiotherapy in high-risk patients from year 1999 to 2008 (27.7%, 32.6%, 28.7%, 32.5%, 42.9%, 42.7%, 47.7%, 46.7%, 45.1%, 37.9%, respectively). Among 665 patients who received PMRTand had available radiation data, chest wall was irradiated in 88.9%, supraclavicular node in 91.6%, axilla in 29.9% and internal mammary chain in 44.8% of the patients. There was a decrease trend in irradiating internal mammary chain from year 1999 to 2008 (81.8%, 61.2%,53.1%, 54.5%, 54.1%,56.6%, 35.3%, 32.6%, 25.5%, 25.3%, respectively). Conclusions: The overall compliance to postmastectomy radiotherapy guideline is reasonable except that there is a significant underuse of PMRT in high-risk group patients. Further study is warranted to investigate the reasons for this non-compliance. AuthorDisclosure:S.Wang:None.Y. Li:None.B. Zhang:None.Z.Tang:None.X. Xie:None.H. Yang:None.J. He:None.J. Li:

Postoperative accelerated radiotherapy (POPART) versus conventional postoperative radiotherapy (CPORT) in squamous cell head and neck cancer: A multicenter prospective randomized study of the Dutch Head and Neck Cooperative Study Group.

5508 Background: In head and neck squamous cell carcinoma (HNSCC), the overall treatment time of radiation (OTT) is significantly associated with locoregional control (LRC), which is consistent with rapid repopulation of cancer clonogens during radiotherapy. However, the importance of the OTT in the postoperative setting is less clear. Therefore, the main objective of this phase III study was to determine the value of reduction of the OTT of postoperative radiotherapy in high risk patients primarily treated with surgery. Methods: Patients with HNSCC treated with curative surgery and with high risk factors for locoregional recurrence (i.e., positive surgical margins and/or extranodal spread) were randomly assigned to receive either standard postoperative radiotherapy (SPORT) at 2 Gy/fraction/day, 5 days/week to 66 Gy/33 fractions/7 weeks or postoperative accelerated radiotherapy (POPART) with 2 Gy/fraction/day, 5 days per week, to 20 Gy followed by 1.8 Gy/fraction/day and 1.3 Gy/fraction per day to a boost field as a second daily treatment to 66.5 Gy/40 fractions/5 weeks.The primary endpoint was locoregional tumor control (LRC). Secondary endpoints were overall survival, acute and late toxicity and quality of life. Results: From December 2004 to October 2008, 148 patients were enrolled in the study (74 pts for SPORT and 74 pts for POPART). The two study-arms were well balanced with regard to the most important prognostic factors. No significant differences were noted with regard to acute and late toxicity, although there was a trend towards more use of pain medication among patients treated with POPART. At 3 years, the locoregional control rate was 77% after POPART compared to 76% with SPORT (HR: 0.86, CI 0.42-1.76; p=0.68). The 3-year overall survival rate was 71% with POPART compared to 63% with SPORT (HR:0.93, CI 0.54-1.61; p=0.81). Conclusions: A reduction in the OTT of postoperative radiotherapy in patients with HNSCC with adverse factors for locoregional failure does not improve outcome in terms of locoregional control and overall survival. No significant financial relationships to disclose.

Radiothérapie chez les patients à haut risque après prostatectomie radicale : postopératoire ou de rattrapage ?

The use of immediate postoperative and salvage radiotherapy in high-risk patients after radical prostatectomy for prostate cancer remains controversial. Immediate postoperative radiotherapy improves biochemical and clinical progression-free survival in randomised trials. Metastasis-free survival and overall survival were seen to be improved in a recently updated randomised trial. On the basis of retrospective data only, salvage radiotherapy is effective against biochemical relapse after prostatectomy. The adjunction of androgen deprivation therapy to immediate postoperative or salvage radiotherapy is only supported by retrospective data. The results of the ongoing, prospective, randomized trials will hopefully enable accurate comparison of immediate postoperative radiotherapy with salvage radiotherapy and assessment of the value of androgen deprivation therapy.