Role Of Adjuvant Radiotherapy Research Articles

Prognostic Factors and Patterns of Relapse in Ewing Sarcoma Patients Treated With Chemotherapy and R0 Resection

To identify prognostic factors and patterns of relapse for patients with Ewing sarcoma who underwent chemotherapy and R0 resection without radiation therapy (RT). We reviewed the medical records of patients who underwent surgical resection at our institution between 2000 and 2013 for an initial diagnosis of Ewing sarcoma. The associations of demographic and clinical factors with local control (LC) and patient outcome were determined by Cox regression. Time to events was measured from the time of surgery. Survival curves were estimated by the Kaplan-Meier method and compared by the log-rank test. A total of 66 patients (median age 19 years, range 4-55 years) met the study criteria. The median follow-up was 5.6 years for living patients. In 43 patients (65%) for whom imaging studies were available, the median tumor volume reduction was 73%, and at least partial response by Response Evaluation Criteria in Solid Tumors was achieved in 17 patients (40%). At 5 years, LC was 78%, progression-free survival (PFS) was 59%, and overall survival (OS) was 65%. Poor histologic response (necrosis ≤95%) was an independent predictor of LC (hazard ratio [HR] 6.8, P=.004), PFS (HR 5.2, P=.008), and OS (HR 5.0, P=.008). Metastasis on presentation was also an independent predictor of LC (HR 6.3, P=.011), PFS (HR 6.8, P=.002), and OS (HR 6.7, P=.002). Radiologic partial response was a predictor of PFS (HR 0.26, P=.012), and postchemotherapy tumor volume was associated with OS (HR 1.06, P=.015). All deaths were preceded by distant relapse. Of the 8 initial local-only relapses, 5 (63%) were soon followed by distant relapse. Predictors of poor postrecurrence survival were time to recurrence <1 year (HR 11.5, P=.002) and simultaneous local and distant relapse (HR 16.8, P=.001). Histologic and radiologic response to chemotherapy were independent predictors of outcome. Additional study is needed to determine the role of adjuvant radiation therapy for patients who have poor histologic response after R0 resection.

Survival benefit for adjuvant radiation therapy in minor salivary gland cancers

The goal of the current study is to investigate the role of adjuvant radiation therapy (adjuvant RT) in minor salivary gland tumors (mSGT) using an established national database. The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients treated with or without adjuvant RT for mSGT from 1988 to 2008. Regression analyses were performed to identify factors associated with improved overall survival (OS). Most tumors were located within the oral cavity (75%) followed by nasal cavity/paranasal sinuses (15%). Multivariate Cox analysis showed that adjuvant RT was associated with better OS compared to surgery alone. Using logistic regression analysis, we provide a novel web based tool for predicting survival impact of adjuvant RT in patients with mSGT. Adjuvant RT is associated with improved survival in patients with mSGT and adverse clinicopathologic factors such as advanced T/N category, adenoid cystic histology, high grade, and nasopharynx location.

The Role of Adjuvant Radiotherapy in Atypical (Who Grade II) Meningiomas: Meta-Analysis and Systematic Review of Literature

Introduction: Well recognized as the most common nonglial CNS tumors, Meningiomas is now believed to be the commonest primary CNS neoplasm in adults constituting 35.6% of all primary CNS tumors with an incidence of 7.44 per 100,000 population according to the latest U.S. population study. Recent revisions to the Histopathological classification of meningiomas have resulted in an exponential increase in the diagnosis of Grade II tumors. The role of upfront adjuvant radiotherapy in WHO grade II remains controversial especially following gross total resection. The aim of this study is to analyze the role of adjuvant radiotherapy in WHO grade II meningiomas Methods: The literature was extensively reviewed using SCOPUS, PubMed, MEDLINE (EBSCO), Wiley InterScience Journals (includes Cochrane), ScienceDirect (Elsevier), and Oxford University Press. We used the search terms “atypical meningioma” or “WHO grade II Meningioma” and “radiotherapy,” “radiation therapy” or “stereotactic radiotherapy.” We included all studies on patients with grade II meningioma who followed the release of the WHO 2000 classification. Our exclusion criteria were as follows: (1) Primary radiation therapy, (2) studies with no specified number of grade II tumors, (3) those with no confirmed histopathological grading or grading that predates the WHO 2000 classification, and (4) outcome reported on mixed grades II and III cohorts. We extracted demographic (age and gender) and tumor characteristics (location and grade), therapies (extent of resection and radiotherapy), and outcome data (recurrence and survival). Results: A total of 23 studies were included in our final analysis (n = 1575) of which 45.93% were males. Tumor location was distributed as convexity 40.1%, parasagittal/falcine 27.4% and other, including skull base 32.4%. Overall PFS at 5 and 10 years was 55.5% (n = 753) and 39.1% (n = 556), respectively. Meta-analysis of 12 studies directly comparing ART to surgery alone, revealed a combined relative risk in favor of ART (RR, 0.734; 95% CI, 0.31–1.19; p = 0.041). Subgroup analysis showed a trend for earlier progression following subtotal resection (STR) as compared with gross total resection (GTR) regardless of ART. Recurrence rates were comparable after STR with and without ART (42.5 vs. 42.9%, p = 0.966). Nevertheless, there was a significant reduction in recurrence rates with ART following GTR (27.4 vs. 16.3%, p = 0.0363). Conclusion: On the basis of this literature review, it seems that WHO grade II meningiomas are associated with 55.5 and 39.1% progression free survival at 5 and 10 years, respectively, despite treatment. Subgroup analysis indicated gross total resection followed by radiotherapy stands the best chances of preventing or delaying recurrence in these tumors. It is therefore our recommendation to aim for GTR followed by radiotherapy until a multicenter randomized controlled trial in the future confirms otherwise.

The Role of Adjuvant Radiotherapy in the Treatment of Atypical Meningiomas: Implications in Strategic Management of Skull Base Meningiomas

Introduction: WHO grade II atypical meningiomas (AM) have a tendency to recur after resection. Adjuvant radiotherapy (RT) is often used to minimize the risk of recurrence. However, there is no definitive consensus as to the efficacy of RT, particularly after a gross total resection (GTR).

Perspective on “The Role of Adjuvant Radiotherapy After Gross Total Resection of Atypical Meningiomas”

AMs are World Health Organization grade II tumors that demonstrate increased mitotic activity (4 or more mitoses within any 10 consecutive high-power fields under 40 objective magnification) and/or 3 or more of the following properties: sheet-like growth, spontaneous necrosis, hypercellularity, prominent nucleoli, and presence of small cellswith a high nucleus-to-cytoplasm ratio. Four AM variants are reported: atypical, chordoid, clear-cell, and atypical with brain invasion (7).

Surgery and adjuvant therapy in gallbladder cancer: A single-institution experience.

405 Background: Gallbladder cancer is a highly fatal disease with a high rate of recurrence even when diagnosed at an early stage. Because of its relative rarity, there are currently no established algorithms to guide therapy after cholecystectomy. To explore the value of adjuvant therapy with chemotherapy and radiation, we evaluated patients with resected gallbladder cancer treated at our institution. Methods: Patients diagnosed with gallbladder cancer who underwent cholecystectomy (simple or radical) between 2000 and 2010 were identified using our cancer registry. Retrospective chart review was performed for clinicopathologic data, including age, stage, grade, type of surgery, margin status, and type and duration of adjuvant therapy. The primary endpoint was overall survival (OS). Univariate (UVA) and multivariate (MVA) analysis was performed with Cox logistic regression analyses. Results: We identified 73 patients with a median followup for all patients of 28.2 months. The majority of patients were female (74%) and underwent radical cholecystectomy (64%). Positive margins and adjuvant radiation therapy were documented in 21% and 37%, respectively. The majority of patients did not receive any adjuvant therapy (53.4%). Median OS for all patients was 41.3 months. There was a survival benefit associated with patients undergoing radical cholecystectomy followed by adjuvant radiation (median OS 48.4 months vs. 22.3 months; HR 0.35; 95% CI: 0.13–0.98; p=0.0448) compared to simple cholecystectomy alone. On UVA, increasing age and positive margins were significantly associated with worse OS, while radical cholecystectomy was associated with improved OS. On MVA, increasing age, male gender, poorly differentiated tumor, and positive margins were associated with worse OS, while adjuvant radiation was associated with improved OS (p=0.0113). Conclusions: Our analysis supports the role for adjuvant radiation therapy in resected gallbladder cancer. Multi-institutional prospective studies should be performed to evaluate the optimal treatment strategy. Biomarker analysis might also help determine the subset of patients who would benefit from combined chemoradiation.

Multi-institutional analysis of T3 subtypes and adjuvant radiotherapy effects in resected T3N0 non-small cell lung cancer patients.

PurposeWe evaluated the prognostic significance of T3 subtypes and the role of adjuvant radiotherapy in patients with resected the American Joint Committee on Cancer stage IIB T3N0M0 non-small cell lung cancer (NSCLC).Materials and MethodsT3N0 NSCLC patients who underwent resection from January 1990 to October 2009 (n = 102) were enrolled and categorized into 6 subgroups according to the extent of invasion: parietal pleura chest wall invasion, mediastinal pleural invasion, diaphragm invasion, separated tumor nodules in the same lobe, endobronchial tumor <2 cm distal to the carina, and tumor-associated collapse.ResultsThe median overall survival (OS) and disease-free survival (DFS) were 55.3 months and 51.2 months, respectively. In postoperative T3N0M0 patients, the tumor size was a significant prognostic factor for survival (OS, p = 0.035 and DFS, p = 0.035, respectively). Patients with endobronchial tumors within 2 cm of the carina also showed better OS and DFS than those in the other T3 subtypes (p = 0.018 and p = 0.016, respectively). However, adjuvant radiotherapy did not cause any improvement in survival (OS, p = 0.518 and DFS, p = 0.463, respectively). Only patients with mediastinal pleural invasion (n = 25) demonstrated improved OS and DFS after adjuvant radiotherapy (n = 18) (p = 0.012 and p = 0.040, respectively).ConclusionThe T3N0 NSCLC subtype that showed the most favorable prognosis is the one with endobronchial tumors within 2 cm of the carina. Adjuvant radiotherapy is not effective in improving survival outcome in resected T3N0 NSCLC.

Atypical meningioma: randomized trials are required to resolve contradictory retrospective results regarding the role of adjuvant radiotherapy.

The role of postoperative radiation (RT) in atypical meningioma remains controversial. We report a retrospective review of outcomes and prognostic factor analysis in 158 patients treated between 2000 and 2010, and extensively review the literature. Following resection, 23 patients received immediate RT, whereas 135 did not. Median progression-free survival (PFS) with and without RT was 59 (range 43-86) and 88 (range 64-123) months. For Simpson grade (G) 1-3 resection, with and without RT, median PFS was 48 (2-80) versus 96 (88-123) months and for Simpson G4, it was 59 (6-86) versus 47 (15-104) months (P = 0.4). The rate of 5-year overall survival (OS) with and without RT was 89% and 83%, respectively. On univariate analysis, Simpson G4 (HR 3.2, P = 0.0006) and brain invasion (HR 2.2, P = 0.03) were significantly associated with progression, whereas age >60 years (HR 9.7, P = 0.002), mitoses >5 per 10 high-power field (0.2, P = 0.0056), and Simpson G4 (HR 2.4, P = 0.07) were associated with higher risk of death. We summarized 22 additional reports, which provide very divergent results regarding the benefit of RT. In our series, adjuvant RT is surprisingly associated with worse PFS and OS, and this is more likely to be due to selection bias of referring tumors with more aggressive characteristics such as elevated Ki-67 and brain invasion for adjuvant RT, rather than a direct causal effect of adjuvant RT. Although there is a trend toward improved PFS with adjuvant RT after subtotal resection, no improvement was noted in OS. Multivariate analysis did not yield statistical significance for any of the factors including Simpson grades of resection, adjuvant RT, or six pathological defining features. The relatively divergent results in the literature are most likely explained by patient selection variability; therefore, randomized trials to adequately address this question are clearly necessary.

Role of adjuvant radiation in the management of central neurocytoma: Experience from a tertiary cancer care center of India.

Neurocytoma (NC) is a rare benign neuronal tumor. A complete excision remains curative for most of these tumors, but atypical histology and extra-ventricular location often necessitates adjuvant therapy. We intended to explore the clinico-pathological features and treatment outcome in patients of NC in our institute. Medical records were reviewed and data collected on NC over a 6-year period (2006-2012) from the departmental archives. Disease free survival (DFS) was analyzed by Kaplan-Meier method. A total of 18 patients met the study criteria. Fourteen patients had intra-ventricular neurocytoma (IVNC), right lateral ventricle being the most common site of origin. Gross total resection and near total resection were achieved in eight cases each whereas tumor decompression and biopsy could be done in two cases. On post-operative histopathological examination, eight patients were found to have atypical NC while 10 patients had typical NC. All patients underwent adjuvant radiation. The median dose of post-operative radiation was 56 Gy. All patients were alive at their final follow-up. One patient had both clinical and radiological evidence of local relapse. In the evaluable patients (n = 18), after a median follow-up of 35 months the DFS rate at 2 years and 3 years are 100% and 83% respectively. Use of adjuvant radiation to a total dose of 56 Gy enhances the local control and achieves superior survival in patients of NC. Use of 3D conformal planning techniques may help us to achieve better therapeutic ratio in patients with NC.

Radiotherapy treatment of large esophageal leiomyosarcoma: A case report.

Leiomyosarcoma of the esophagus is a rare type of tumor, characterized by a malignant phenotype and smooth muscle histology. Previously, barium studies have been used to identify areas of luminal narrowing, expansile intraluminal masses or large intramural masses with ulceration or tracking. Furthermore, endoscopic biopsies appear to be associated with a high false negative rate, particularly in cases where the mucosa is intact. The optimal treatment strategy is surgical resection, while the role of adjuvant radiotherapy and chemotherapy is controversial. In addition, the prognosis of patients with leiomyosarcoma of the esophagus is improved compared with patients suffering from squamous esophageal cancer. The present study described the case of a 48-year-old woman who presented with dysphagia and was diagnosed with a large leiomyosarcoma of the esophagus. The patient was successfully treated with radiotherapy and remains disease-free two years after the completion of treatment. In addition, the present study conducted a review of the relevant literature, reporting previous cases of esophageal leiomyosarcoma and potential strategies for the management of this disease.

Cystosarcoma phyllodes: Pathological enigma: A retrospective review of 162 cases.

Phyllodes tumor (PT) is a rare fibroepithelial neoplasm comprising <1% of all breast tumors. Clinical spectrum ranges from benign (B), borderline (BL), and locally recurrent to malignant (M) and metastatic type. The aim of our study was to analyze the clinicopathological factors, compare treatment options, and evaluate outcome in patients with PT. We retrospectively reviewed 162 women with PT. The surgical intervention varied from simple excision (lumpectomy)/wide local excision (WLE) in benign cases to simple/modified radical or radical mastectomy (SM/MRM/RM) in malignant and recurrent tumors. Out of 162 patients, B, BL, and M were 95 (58.64%), 29 (18%), and 38 (23.45%), respectively. Mean age, duration of lump, and size were 38 ± 8 years, 28 ± 10 months, and 12 ± 5 cm, respectively. Recurrence rate with B, BL, and M was 15.78%, 41.37%, and 55.26%, respectively (P = 0.00001). As compared to WLE (22%), SM (23.8%), and MRM/RM (14.2%), recurrence was higher with lumpectomy (48.9%) (P = 0.004). Positive correlation was found between recurrence rate with the size of tumor (P = 0.008) and also number of recurrence with holoprosencephaly (P = 0.047). There was no association between the number of recurrences and size of tumor (P = 0.63). Malignant PT was seen in 38 (24%) and distant metastasis was seen in 7 (18%). Mean duration of follow-up was 42 months. WLE with negative margins should be the initial surgery for PT. The role of adjuvant radiotherapy and chemotherapy is uncertain. PT is pathological enigma. Till date, no factors can accurately predict the recurrence and outcome. PT is known for unpredictable behavior and high recurrence rates, hence long-term follow-up is advised.

Prognostic Impact of Interim and Final PET in Primary Mediastinal Large B-Cell Lymphoma Treated with Intensive Etoposide-Based Therapy

Abstract Background: Primary mediastinal large B-cell lymphoma (PMBCL) is a rare subtype of diffuse large B-cell lymphoma with typical clinical, pathological and genetic features. No standard frontline protocol is widely accepted and role of adjuvant radiotherapy is not established yet. New intensive etoposide-based (DA-EPOCH; Dunleavy K, NEJM 2013) regimens with added rituximab show survival benefit but certain patients are still at risk of early treatment failure. As residual masses (CT) after therapy are frequent, assessment of tumor metabolic response is of utmost importance. Complete metabolic response (CMR) measured by positron emission tomography (PET) has high predictive value after intensive treatment (Martelli M, JCO 2014), but the role of interim scans is unclear. Aim: To analyze the prognostic impact of interim and final whole-body PET-CT fusion scans using visual and Deauville criteria in PMBCL patients receiving intensive etoposide-based regimens with rituximab. Patients: Thirty-four consecutive PMBCL patients were treated in a single center from 5/2005 to 6/2013. The median age at diagnosis was 32.5 (19-73) years; male-to-female ratio 0.62:1. Ann Arbor stages I through IV were observed in 1, 19, 3 and 11 patients, respectively. Large mediastinal mass (≥11cm) was present in 19 (56%) patients. Thirteen patients (38%) had concurrent extranodal disease but unaffected bone marrow. IPI and age-adjusted IPI scores were: low 16 (47%) and 8 (24%), low-intermediate 11 (32%) and 11 (32%), high-intermediate 5 (15%) and 12 (35%), and high 2 (6%) and 3 (9%) patients, respectively. All patients received rituximab; intensive etoposide-doxorubicin-based therapy was given to 30 (88%; sequential n=29, MegaCHOP-ESHAP n=1), intensified CHOP (PACEBO) to 1 and CHOP to 3 patients. Treatment was consolidated with ASCT (BEAM 200) in high-risk bulky cases with extranodal involvement (n=20, 59%). Involved-field radiotherapy was used in only 9 (26%) patients. Whole-body PET-CT scans were planned after 2nd chemotherapy cycle (interim; iPET-2) and treatment completion (final; fPET). The PET results were expressed as positive/negative (IHP; Juweid ME, JCO 2007) and 5-point Deauville scale (D1-5; Meignan M, Leuk Lymphoma 2014). Treatment response was assessed using revised criteria (Cheson BD, JCO 2007). Results: After treatment, 28 (82%) patients achieved complete remission (CR), one partial remission, three stable disease and two progressed. Seventeen CR patients (61%) had residual mass on CT (median longest diameter 40mm). After a median follow-up of 58.7 months, 8 (24%) patients relapsed or progressed and 6 (18%) of them died. Five-year overall survival (5-y OS) reached 81.2% (95% CI 0.68-0.95), 5-year progression survival (5-y PFS) was 75.5% (95% CI 0.61-0.90). There were 27 (79%) and 33 (97%) cases assessable with iPET-2 and fPET, respectively. Using visual criteria, iPET-2 was negative in 10/27 (37%) and fPET in 28/33 (85%) cases. With Deauville criteria, iPET-2 scores were D1-2 in 6 (22%), D3 in 4 (15%) and D4-5 in 17 (63%) cases, and fPET scores D1-2 in 19 (58%), D3 in 8 (24%) and D4-5 in 6 (18%). All visually negative iPET-2 were scored as D1-3. In fPET, there was only one discordant case (visually negative scored as D4). Visually negative (D1-3) iPET-2 was associated with superior 5-y OS (34% vs 100%, p=0.08) and 5-y PFS (65% vs 100%, p=0.049). Visually negative visual fPET was linked with superior 5-y OS (20% vs 96.0%, p&lt;0.01) and 5-y PFS (20% vs 88.6%); D1-3 with 5-y OS (33.3% vs 95.8%, p&lt;0.01) and 5y-PFS (33.3% vs 88.2%, p&lt;0.01). Negative (NPV) and positive (PPV) predictive values for PFS were 100% and 35.3% for iPET-2 and 89.3% (visual), 90.0% (D) and 80% (visual), 66.7% (D) for fPET, respectively. Residual PET(-) mass have no impact on OS (p=0.47) or PFS (p=0.85). Conclusion: Early CMR resulted in excellent survival and superior NPV (100%). However, two thirds of iPET-positive patients may achieve long remission (PPV is low). Final PET brings twice higher PPV but despite relatively high NPV, more than 10% of fPET-negative patients relapse later. Visual and Deauville scales are comparable; intermediate (D3) results should be considered negative. Thus, iPET-2 identifies good responders and may serve as an indicator for tailored therapy. Further studies including tumor metabolic volume analysis are needed for better early identification of poor responders. Acknowledgment: LF-2014-001 Figure 1 Figure 1. Disclosures Procházka: Takeda pharmaceuticals: Speakers Bureau; Roche: Honoraria, travel grants, travel grants Other.

Potential Role of Adjuvant Radiation Therapy in Cervical Thymic Neoplasm Involving Thyroid Gland or Neck.

PurposeThe purpose of this study is to assess the clinicopathologic features, treatment outcomes, and role of adjuvant radiation therapy (RT) in cervical thymic neoplasm involving the thyroid gland or neck.Materials and MethodsThe medical and pathologic records of eight patients with cervical thymic neoplasm were reviewed retrospectively. All patients underwent surgical resection, including thyroidectomy or mass excision. Adjuvant RT was added in five patients with adverse clinicopathologic features. The radiation doses ranged from 54 Gy/27 fractions to 66 Gy/30 fractions delivered to the primary tumor bed and pathologically involved regional lymphatics using a 3-dimensional conformal technique.ResultsEight cases of cervical thymic neoplasm included three patients with carcinoma showing thymus-like differentiation (CASTLE) and five with ectopic cervical thymoma. The histologic subtypes of ectopic cervical thymoma patients were World Health Organization (WHO) type B3 thymoma in one, WHO type B1 thymoma in two, WHO type AB thymoma in one, and metaplastic thymoma in one, respectively. The median age was 57 years (range, 40 to 76 years). Five patients received adjuvant RT: three with CASTLE; one with WHO type B3; and one with WHO type AB with local invasiveness. After a median follow-up period of 49 months (range, 11 to 203 months), no recurrence had been observed, regardless of adjuvant RT.ConclusionAdjuvant RT after surgical resection might be worthwhile in patients with CASTLE and ectopic cervical thymoma with WHO type B2-C and/or extraparenchymal extension, as similarly indicated for primary thymic epithelial tumors. A longer follow-up period may be needed in order to validate this strategy.

Malignant phyllodes tumor of the breast: treatment and prognosis.

Surgery remains the mainstay of the treatment in patients with malignant phyllodes tumor of the breast (MPTB); however, the extent of surgery (breast conserving surgery [BCS] versus mastectomy) and the role of adjuvant radiotherapy have been controversial. We report a single institution's experience with MPTB. We discuss controversial therapeutic aspects of this rare tumor. Seventy patients with MPTB treated primarily with surgery were evaluated. The mean age was 50years (21-76), and the mean size of the tumor was 6cm. Thirty-four (48.6%) patients were treated with total mastectomy, and 36 (51.4%) were treated with BCS (lumpectomy or wide local excision). Microscopic surgical margins were free of tumor in all cases. In 64 (91.4%) patients, margins were ≥1cm. Remaining 6 (8.6%) patients treated with BCS margins were <1cm and subsequently radiotherapy was performed. Among 70 patients, 58 (82.9%) had no evidence of disease (NED) after 5years. The extent of surgery was not significantly related to the 5-year NED survival rates (82.4% in patients who underwent mastectomy and 83.3% in patients who underwent BCS only or BCS with adjuvant irradiation). The 5-year NED survival rates in BCS (tumor-free margin ≥1cm) and BCS with irradiation (tumor-free margin <1cm) groups were identical (83.3%). Our data support the potential use of BCS in patients with MPTB. Mastectomy is indicated only if tumor-free margins cannot be obtained by BCS. Adjuvant radiotherapy may be considered if tumor-free margins are <1cm.

The Role of Adjuvant Radiation Therapy in the Treatment of Type B3 Thymoma

The Role of Adjuvant Radiation Therapy in the Treatment of Type B3 Thymoma

Use of Adjuvant Radiation Therapy in the Management of Acinar Cell Carcinoma of the Pancreas: Results From the Survival, Epidemiology, and End Results Database

Acinar cell carcinoma (ACC) is an extremely rare cancer of the pancreas, accounting for less than 1 % of non-endocrine pancreatic tumors. The role for adjuvant radiation therapy (RT) in the management of this disease is unknown. The Survival, Epidemiology, and End Results 18 database, November 2012 submission, was queried for ACC of the pancreas reported between the years of 1998 and 2010. Baseline characteristics were compared with the chi-squared test. Overall survival (OS) and cause-specific survival (CSS) were estimated using the Kaplan–Meier method. Cox proportional hazard modeling was performed for multivariate analysis of factors associated with OS and CSS. Analyses were performed using SPSS, version 20. Two hundred nineteen patients with acinar cell carcinoma were identified. Median follow-up was 11 months. Median patient age was 66 (range 4–92). One hundred fourteen patients (52.1 %) had locoregional disease, while 105 patients (47.9 %) had metastatic disease at diagnosis. Median OS for all patients was 14 months (95 % confidence interval (CI) 9.24–18.77 months), and median CSS was 17 months (95 % CI 10.37–23.63 months). For patients with non-metastatic disease, median OS was 38 months (95 % CI 28.43–47.57). Among patients with non-metastatic disease, the use of adjuvant radiation was associated with increased median OS (56 months [95 % CI 21.67–90.33]), compared to patients not treated with radiation (27 months [95 % CI 4.06–49.94]), p = 0.046. Use of adjuvant radiation was associated with increased cause-specific survival (66 vs. 40 months), but this was not statistically significant (p = 0.104). On multivariate analysis, use of surgery and adjuvant radiation were both associated with improved OS for patients with non-metastatic disease (hazard ratio (HR) 0.517, p = 0.034 and HR 0.423, p = 0.009, respectively). Both surgery and radiation were associated with non-statistically significant improvement in ACC cause-specific survival, HR = 0.606 (95 % CI = 0.314–1.170), p = 0.136 and HR = 0.501 (95 % CI = 0.249–1.009), p = 0.053, respectively. Surgical resection with curative intent followed by adjuvant RT is associated with excellent long-term overall survival in patients with non-metastatic local-regional acinar cell carcinoma of the pancreas.

Defining the Role of Adjuvant External Beam Radiotherapy on Resected Adenocarcinoma of the Ampulla of Vater

The role of adjuvant radiotherapy in the treatment of ampullary carcinoma (AC) remains unclear. We hypothesized that adjuvant radiotherapy (RT) does not improve survival following resection for AC. The SEER database was queried for patients with non-metastatic AC who underwent surgery (S) from 2004 to 2010. Propensity score (PS) modeling was applied to create balanced cohorts of patients that would be equally likely to receive RT. Cox proportional hazard models were used to compare survival. Of 1,287 patients, 329 (25.6 %) received adjuvant RT. Unadjusted median overall survival (OS) for patients receiving adjuvant RT compared to S alone was 27 vs. 36 months (p = 0.14). Patients receiving RT were younger (63 vs. 69 years, p < 0.001), had more advanced tumors (69 vs. 53 % T3/T4, p < 0.001), and had more frequent lymph node metastasis (73 vs. 40 %, p < 0.001). Adjuvant RT failed to improve both overall survival (27 vs. 29 months, p = 0.58) and disease-specific survival (36 vs. 40 months, p = 0.92) in propensity-matched cohorts, although certain imbalances remained between treatment groups. Adjuvant RT does not confer a survival benefit for patients with ampullary tumors. The lack of disease-specific survival benefit suggests that it may also not be beneficial to prevent local recurrences.

Merkel cell carcinoma: what makes a difference?

BackgroundMerkel cell carcinoma (MCC) is a cutaneous neuroendocrine tumor that may spread via lymphatics and can therefore be staged with sentinel lymph node biopsy (SLNB). MCC is radiosensitive and chemosensitive, although the role of adjuvant therapy is still unclear. We examined the impact of different treatments on the outcome of MCC. MethodsWe performed a retrospective review of state cancer registry data from California, Oregon, and Washington of patients diagnosed with primary skin MCC between 1988 and 2012 (n = 4,038). Data were analyzed using Cox regression and Kaplan–Meier methods to examine disease-specific survival. ResultsPatients with positive nodes or no documented nodal evaluation had worse survival compared with node-negative patients. No nodal evaluation had decreased survival compared with lymph node evaluation by SLNB. Completion lymph node dissection conferred improved survival in patients with a positive SLNB. In clinically node-negative patients who had a positive SLNB, radiation and chemotherapy did not affect survival. ConclusionsLymph node evaluation is an important component to MCC treatment. The role of adjuvant radiation and chemotherapy needs further evaluation.

Thymic Epithelial Tumors: Analysis of Prognostic Factors with Emphasis on the Role of Adjuvant Radiation Therapy

Background: The prognostic impacts of histopathological classification, Masaoka staging system, extent of surgery, and adjuvant treatment approaches in thymic epithelial tumors (TETs) were investigated. Material and Methods: Records of 22 patients were retrospectively reviewed. Total thymectomy was performed on 5 patients and thymectomy on 17. Complete resection was achieved for 14 patients. Radiation therapy (RT) was considered for all patients with stage III or IV disease and all patients undergoing incomplete resections. Results: Local control had been achieved in all patients and all were alive with no evidence of disease (ANED) at 0.2-7.8 years (median, 2.3 years). Of 4 patients with stage II disease, 2 (favorable group) had undergone complete resections and 2 (intermediate group) had undergone incomplete resections. Those undergoing incomplete resections had received RT. Of these 4 patients, all were ANED. All 4 patients with Masaoka stage III disease that were involved in the study had undergone incomplete resections and had received RT. Also, these patients were ANED. Conclusions: Patients with TETs undergoing less than complete resections might be referred for RT in the postoperative setting, while the role of RT in patients undergoing complete resections remains unclear.

Adjuvant radiotherapy for extremity and trunk wall atypical lipomatous tumor/well-differentiated LPS (ALT/WD-LPS): a French Sarcoma Group (GSF-GETO) study.

The role of adjuvant radiotherapy (RT) in the management of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WD-LPS) remains controversial. Two hundred eighty-three patients with operable ALT/WD-LPS, no history of previous cancer, chemotherapy (CT) or RT, treated between 1984 and 2011 registered in the Conticabase database were included and described. Overall (OS), progression-free survival (PFS) and time to local relapse (TTLR) were evaluated from the time of first treatment. Three of 20 centers enrolled 58% of the patients. Median age at diagnosis was 61 (range 25-94) years, 147 patients (52%) were males, 222 (78%) patients had their primary tumor located in an extremity while 36 (13%) and 25 (9%) had tumors involving the girdle and the trunk wall, respectively. The median size of primary tumors was 17 cm (range 2-48 cm). Adjuvant RT was given to 132 patients (47%). Patients who received adjuvant RT had larger tumors (P = 0.005), involving more often the distal limbs (P < 0.001). Use of adjuvant RT varied across centers and along the study period. Other characteristics were balanced between the two groups. Median follow-up was 61.7 months. None of the patients developed metastasis during follow-up. The 5-year local relapse-free survival rates were 98.3% versus 80.3% with and without adjuvant RT, respectively (P < 0.001). Once stratified on time period (before/after 2003), adjuvant RT, tumor site and margin status (R0 versus other) were independently associated with TTLR. No OS difference was observed (P = 0.105). In this study, adjuvant RT following resection of ALT/WD-LPS was associated with a reduction of LR risk.