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Wang RS, Chow MS, Gordon AJ, Santacatterina M, Vaezi AE, Tam MM, Givi B. Adjuvant Radiotherapy in Moderately Advanced (T3) Oral Cavity Cancers. Laryngoscope 2024; 134:2236-2242. [PMID: 37937735 DOI: 10.1002/lary.31161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/06/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To investigate the impact of adjuvant radiotherapy in isolated locally advanced oral cavity cancers (pT3N0M0) without adverse features. METHODS We selected all patients from the National Cancer Database (2004-2019) who underwent surgical treatment where the final pathology was T3N0M0 with negative margins. Demographics, details of treatment, and outcomes were abstracted. The impact of radiotherapy on survival was assessed with univariable, multivariable, and propensity score-matched analyses. RESULTS We identified 571 patients in our survival cohort. Most were male (348, 60.9%), and median age was 65. Less than one-third (176, 30.8%) received adjuvant radiotherapy. The median length of follow-up was 29 months. Overall, adjuvant radiotherapy was associated with improved survival (87.2% vs. 77.7%, at 2 years, p < 0.01). On multivariable analysis controlling for age and comorbidities, this survival difference persisted (HR: 0.62, 95% CI: 0.43-0.90, p = 0.01). In a propensity score-matched population of 278 patients matched on age and comorbidities, adjuvant radiotherapy was still associated with longer survival (87.4% vs. 78.5%, p = 0.014). CONCLUSION In our study, adjuvant radiotherapy was associated with improved survival in completely excised locally advanced oral cavity tumors (T3N0M0). However, a significant proportion of patients do not receive adjuvant radiotherapy. These findings highlight the need for continued efforts to promote guideline-recommended care. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2236-2242, 2024.
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Affiliation(s)
- Ronald S Wang
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael S Chow
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Alex J Gordon
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | | | - Alec E Vaezi
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Moses M Tam
- Department of Radiation Oncology, NYU Langone Health, New York, New York, USA
| | - Babak Givi
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Festa BM, Costantino A, Pace GM, Petruzzi G, Campo F, Pellini R, Spriano G, De Virgilio A. Impact of Adjuvant Radiotherapy in Squamous Cell Carcinoma of the Oral Cavity with Perineural Invasion. Laryngoscope 2024; 134:2019-2027. [PMID: 37975480 DOI: 10.1002/lary.31148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Current guidelines indicate postoperative radiotherapy (PORT) in oral squamous cell carcinoma (OSCC) with perineural invasion (PNI), however, its real benefit has never been proven. The aim of our study is to investigate the benefit of PORT in OSCC patients with PNI in terms of survival and disease control. DATA SOURCES The Pubmed/MEDLINE, Cochrane Library, and Scopus databases. REVIEW METHODS Patients with PNI + OSCC treated with primary surgery were extracted from the included studies. The pooled logHR was calculated by comparing patients who underwent PORT to those who underwent only observation for overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional control (LRC). RESULTS About 690 patients with primary OSCC and PNI were included from nine studies. 374 (54.2%) patients underwent PORT, while 316 (45.8%) underwent observation. Analyses showed non-significant difference between the two groups for OS (HR: 1.01; 95% CI: 0.38-2.69), DSS (HR: 2.03; 95% CI: 0.54-7.56), and LRC (HR: 0.89; 95% CI: 0.53-1.50). They showed a significant difference in terms of DFS (HR: 0.86; 95% CI: 0.77-0.97). CONCLUSION The real benefit of PORT in OSCC patients with PNI is still unclear, although it may have a positive impact on DFS. Clinicians should consider individual patient's characteristics, tumor factors, and treatment goals when deciding whether to recommend PORT. Further studies are needed to clarify which entity of PNI really benefits from PORT. LEVEL OF EVIDENCE NA Laryngoscope, 134:2019-2027, 2024.
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Affiliation(s)
- Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gerardo Petruzzi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
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Hong SA, Armstrong AT, Snow K, Walker RJ, Massa ST. Association of adjuvant radiation and survival in human papilloma virus-positive oropharynx squamous cell carcinoma with lymphovascular invasion as the sole adverse pathologic feature. Head Neck 2024; 46:1043-1050. [PMID: 38511301 DOI: 10.1002/hed.27740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/18/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Postoperative radiotherapy radiation therapy (PORT) for early-stage human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) with positive lymphovascular invasion (LVI) has an unclear association with overall survival (OS). METHODS This retrospective cohort study queried the National Cancer Database for surgically treated, T1-2, N0-1 HPV+ OPSCC from 2010 to 2019. Primary exposures were LVI and PORT, and the main outcome was 5-year OS. Odds ratios and hazard ratios (HR) with 95% confidence intervals (CIs) were generated using multivariable models and Cox proportional hazard models, respectively. RESULTS Of 2768 patients, average age was 59.3 years, 2207 (79.7%) were male, and 386 (13.9%) had LVI. Of patients with LVI as their sole adverse pathologic feature, 220 (57.0%) received PORT, which was not associated with 5-year OS (HR, 1.13; CI, 0.65-1.19). CONCLUSIONS Patients with surgically treated, early-stage HPV+ OPSCC and positive LVI as their only pathologic adverse feature may not require PORT.
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Affiliation(s)
- Scott A Hong
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Austin T Armstrong
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Katherine Snow
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Ronald J Walker
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
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Pershad AR, Thakkar PG, Goodman JF, Joshi A, Steinberg SM, Allen CT, Floudas CS. Risk of recurrence after neoadjuvant chemotherapy and transoral robotic surgery in patients with oropharynx cancer that avoid adjuvant radiation. Cancer Med 2024; 13:e7146. [PMID: 38581118 PMCID: PMC10997843 DOI: 10.1002/cam4.7146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND De-escalation strategies for newly-diagnosed p16-positive oropharyngeal squamous cell carcinoma (p16+ OPSCC), aim to reduce treatment-related morbidity without compromising disease control. One strategy is neoadjuvant cisplatin and docetaxel chemotherapy (NAC + S) before transoral robotic surgery, with pathology-based risk-adapted adjuvant treatment. METHODS We examined the recurrence-free survival (RFS) for patients who received NAC + S. RESULTS Comparing outcomes in 103 patients between 2008 and 2023, 92% avoided adjuvant treatment and showed significantly higher 2-year recurrence-free survival (RFS) compared to those with adjuvant treatment (95.9% vs. 43.8%, p = 0.0049) CONCLUSION: Our findings suggest that pathology-based risk-adapted omission of adjuvant treatment following NAC + S does not appear to elevate recurrence risk and that NAC may identify patients with favorable tumor biology, yielding a 2-year RFS probability exceeding 95% without adjuvant treatment. Further, the study identifies a patient subset experiencing disease recurrence despite triple modality therapy. Despite limitations, including a retrospective design and modest sample size, the data advocate for controlled NAC + S studies.
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Affiliation(s)
- Alisha R. Pershad
- Division of Otolaryngology‐Head and Neck SurgeryThe George Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Punam G. Thakkar
- Division of Otolaryngology‐Head and Neck SurgeryThe George Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Joseph F. Goodman
- Division of Otolaryngology‐Head and Neck SurgeryThe George Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Arjun Joshi
- Division of Otolaryngology‐Head and Neck SurgeryThe George Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Seth M. Steinberg
- Astrix Technology, LLC, contractor to Biostatistics and Data Management Section, Office of the Clinical DirectorNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Clint T. Allen
- Surgical Oncology Program, Center for Cancer ResearchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Charalampos S. Floudas
- Center for Immuno‐Oncology, Center for Cancer ResearchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
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Ravi P, Kwak L, Devlies W, Xie W, Chipidza F, Yang X, Bubley G, Kaplan I, Kibel AS, Nguyen P, Taplin ME. Adjuvant and salvage radiotherapy after neoadjuvant therapy and radical prostatectomy for high-risk localized prostate cancer. Prostate 2024; 84:342-348. [PMID: 38041475 DOI: 10.1002/pros.24653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND We sought to describe patterns of delivery of adjuvant (aRT) and salvage RT (sRT) in patients who underwent RP after receiving neoadjuvant androgen receptor pathway inhibitor (ARPI) before radical prostatectomy (RP) for high-risk localized prostate cancer (HRLPC). METHODS Two hundred eighteen patients treated on phase 2 neoadjuvant trials between 2006 and 2018 at two academic centers were evaluated. aRT and sRT were defined as receipt of RT with a PSA of ≤0.1 or >0.1 ng/mL, respectively. Primary outcomes were biochemical recurrence (BCR), defined as time from aRT/sRT to a PSA rising to >0.1 ng/mL, and metastasis-free survival (MFS) after RT. RESULTS Twenty-three (11%) and 55 (25%) patients received aRT and sRT respectively. Median PSA at start of aRT and sRT was 0.01 and 0.16 ng/mL, and median duration from RP to RT was 5 and 14 months, respectively. All aRT patients had NCCN high-risk disease, 30% were pN1 and 43% had positive surgical margins; 52% had prostate bed RT. Fifty-one percent of sRT patients had biopsy Gleason 9-10, 29% were pT2 and 9% had positive surgical margins; 63% had RT to the prostate bed/pelvis. At a median follow-up of 5.3 and 3.0 years after aRT and sRT, 3-year freedom from BCR was 55% and 47%, and 3-year MFS was 56% and 53%, respectively. CONCLUSIONS aRT was infrequently used in patients who received neoadjuvant ARPI before RP for HRLPC. Outcomes of aRT and sRT were similar but generally poor. Studies evaluating intensified systemic therapy approaches with postoperative RT in this high-risk population are needed.
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Affiliation(s)
- Praful Ravi
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lucia Kwak
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Wout Devlies
- Department of Urology, KU Leuven, Leuven, Belgium
| | - Wanling Xie
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Fallon Chipidza
- Department of Radiation Oncology, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Xiaoyu Yang
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Glenn Bubley
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Irving Kaplan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Adam S Kibel
- Department of Urology, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Paul Nguyen
- Department of Radiation Oncology, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | - Mary-Ellen Taplin
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Banerjee S, Mahajan I, Ghose A, Boussios S, Chakraborty S. A rare case of metaplastic breast carcinoma from India: Towards precision oncology. Cancer Rep (Hoboken) 2024; 7:e1997. [PMID: 38421154 PMCID: PMC10903326 DOI: 10.1002/cnr2.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/13/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Metaplastic Breast Cancer (MpBC) is an exceedingly rare entity, accounting for less than 1% of all malignant breast tumours. Predominantly triple-negative, they are notorious for their chemoresistance, high rates of recurrence and decreased disease-free survival (DFS). All this contributes significantly to BC mortality and results in poor prognostic implications. Limited evidence has led to a lacuna of specific treatment guidelines for this entity and hence remains an uncharted territory for clinicians. CASE We report a case of a 46 year old premenopausal female with left-sided metaplastic triple negative T3N2aM0 BC with mesenchymal differentiation (high grade) whom we treated with neoadjuvant chemotherapy, primary surgery in the form of extreme oncoplasty and adjuvant radiotherapy by Telecobalt machine. Contrary to the expected aggressive course of the disease and poor prognosis of treatment, the patient is presently in remission without progression for over 2 years of follow up. CONCLUSION Limited experience in management of this pathological entity warrants the need for more research on it, with a special focus on targeted therapy. Discussing possibilities of a tailored approach, rather than a one-size-fits-all approach may aid in paving the path for the future of MpBC treatment.
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Affiliation(s)
- Soirindhri Banerjee
- Department of Radiation OncologyInstitute of Post Graduate Medical Education & Research and SSKM HospitalKolkataIndia
| | - Ishika Mahajan
- Department of Haematology and OncologyLincoln County Hospital, United Lincolnshire Hospitals TrustLincolnUK
| | - Aruni Ghose
- Department of Medical OncologyBarts Cancer Centre, St. Bartholomew's Hospital, Barts Health NHS TrustLondonUK
- Department of Medical OncologyMount Vernon Cancer Centre, East and North Hertfordshire NHS TrustLondonUK
- Department of Medical OncologyMedway NHS Foundation TrustKentUK
- United Kingdom and Ireland Global Cancer NetworkLondonUK
- Immuno‐Oncology Clinical NetworkKentUK
| | - Stergios Boussios
- Department of Medical OncologyMedway NHS Foundation TrustKentUK
- Faculty of Life Sciences and MedicineSchool of Cancer and Pharmaceutical Sciences, King's College LondonLondonUK
- Kent and Medway Medical SchoolUniversity of KentCanterburyUK
- AELIA OrganisationThessalonikiGreece
| | - Shivam Chakraborty
- Depatment of PathologyInstitute of Post Graduate Medical Education & Research and SSKM HospitalKolkataIndia
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7
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Schulze AK, Hoskin TL, Mrdutt MM, Mutter RW, Hieken TJ. Repeat sentinel lymph node surgery for locally recurrent breast cancer after prior mastectomy. J Surg Oncol 2024; 129:461-467. [PMID: 37929785 DOI: 10.1002/jso.27496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Current NCCN guidelines discourage repeat sentinel lymph node (SLN) surgery in patients with local recurrence (LR) of breast cancer following prior mastectomy. This study addresses the feasibility and therapeutic impact of this approach. METHODS We identified 73 patients managed with repeat SLN surgery for post-mastectomy isolated LR. Lymphatic mapping was performed using radioisotope with or without lymphoscintigraphy and/or blue dye. Successful SLN surgery was defined as retrieval of ≥1 SLN. RESULTS SLN surgery was successful in 65/73 (89%), identifying a median of 2 (range 1-4) SLNs, with 10/65 (15%) SLN-positive. Among these, 5/10 (50%) proceeded to ALND. In unsuccessful cases, 1/8 (13%) proceeded to ALND. Seven of 10 SLN-positive patients and 50/55 SLN-negative patients received adjuvant radiotherapy. Chemotherapy was administered in 31 (42%) and endocrine therapy in 50 of 57 HR+ patients (88%). After 28 months median follow-up, eight patients relapsed with the first site local in two, distant in five, and synchronous local/distant in one. No nodal recurrences were observed. CONCLUSIONS SLN surgery for patients with LR post-mastectomy is feasible and informative. This approach appears oncologically sound, decreases axillary dissection rates and may be used to tailor adjuvant radiation target volumes and systemic therapies.
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Affiliation(s)
- Amy K Schulze
- Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tanya L Hoskin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Mary M Mrdutt
- Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert W Mutter
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tina J Hieken
- Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Patel AM, Haleem A, Maxwell R, Lukens JN, Lin A, Brody RM, Brant JA, Carey RM. Choice of Adjuvant Radiotherapy Facility in Major Salivary Gland Cancer. Laryngoscope 2024. [PMID: 38400788 DOI: 10.1002/lary.31352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Undergoing surgery and adjuvant radiotherapy (aRT) at the same facility has been associated with higher overall survival (OS) in head and neck squamous cell carcinoma. Our study investigates whether undergoing surgery and aRT at the same academic facility is associated with higher OS in major salivary gland cancer (MSGC). METHODS The 2006-2018 National Cancer Database was queried for patients with MSGC undergoing surgery at an academic facility and then aRT. Multivariable binary logistic and Cox proportional hazards regression models were implemented. RESULTS Of 2801 patients satisfying inclusion criteria, 2130 (76.0%) underwent surgery and aRT at the same academic facility. Residence in a less populated area (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.16-2.45), treatment without adjuvant chemotherapy (aOR 1.97, 95% CI 1.41-2.76), and aRT duration (aOR 1.02, 95% CI 1.01-1.04) were associated with undergoing surgery and aRT at different facilities on multivariable logistic regression adjusting for patient demographics, clinicopathologic features, and adjuvant therapy (p < 0.01). Five-year OS was higher in patients undergoing surgery and aRT at the same academic facility (68.8% vs. 61.9%, p < 0.001). Undergoing surgery and aRT at different facilities remained associated with worse OS on multivariable Cox regression (aHR 1.41, 95% CI 1.10-1.81, p = 0.007). CONCLUSION Undergoing surgery and aRT at the same academic facility is associated with higher OS in MSGC. Although undergoing surgery and aRT at the same academic facility is impractical for all patients, academic physicians should consider same-facility treatment for complex patients who would most benefit from clear multidisciplinary communication. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Afash Haleem
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Russell Maxwell
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otolaryngology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
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El-Hajj VG, Ghaith AK, Nguyen RH, Al-Saidi NN, Hoang H, Graepel SP, Elmi-Terander A, Lehrer EJ, Brown P, Bydon M. Analysis of demographics and the impact of adjuvant radiotherapy on a nationwide cohort of patients with high-grade spinal meningiomas. Neurooncol Adv 2024; 6:vdae018. [PMID: 38410135 PMCID: PMC10896623 DOI: 10.1093/noajnl/vdae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Background Although typically benign, 5% of spinal meningiomas (SMs) present with higher-grade features (World Health Organization grades 2 and 3). High-grade SMs are poorly studied and the role of adjuvant radiotherapy in their management remains controversial. We hence aimed to study the demographic characteristics of this rare tumor and investigate the outcomes associated with the use of surgery with adjuvant therapy in contrast to surgery alone. Methods The National Cancer Database was queried for patients with SMs from 2004 to 2017. Basic statistics were used to identify differences between low- and high-grade tumors in terms of baseline characteristics. Surgery with and without adjuvant radiotherapy were compared after (1:1) propensity-score matching. Kaplan-Meier survival analysis was conducted to study overall survival. All analyses were performed on R. Results A total of 13 184 patients diagnosed with SMs were included, of whom only 5% (n = 669) had high-grade SMs. Patients with high-grade SMs presented at a younger median age (57 years [IQR: 44-68] versus 65 years [54-75]; P < .001) and were more commonly males (33% vs 20%; P < .001). After propensity-score matching, survival analysis revealed similar overall survival outcomes in patients with high-grade SM undergoing both surgery and radiotherapy as compared to those only receiving surgery (P = .19). Conclusions This study reveals major demographic differences between high- and low-grade SMs. There were no benefits associated with the use of adjuvant radiotherapy. However, due to confounding, overall survival outcomes between patients receiving surgery alone and those receiving surgery with adjuvant radiotherapy are not causally interpretable.
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Affiliation(s)
- Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan H Nguyen
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Neil Nazar Al-Saidi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Harry Hoang
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen P Graepel
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
| | - Eric J Lehrer
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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10
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Mizuta Y, Kozono Y, Asai M, Sekiyama K, Yoshioka Y, Higuchi T. Vaginal malignant peripheral nerve sheath tumor treated with complete surgical resection and postoperative radiation therapy. J Obstet Gynaecol Res 2024; 50:133-138. [PMID: 37844578 DOI: 10.1111/jog.15817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are neoplasms originating from or differentiating into nerve sheaths of peripheral nerves. Vaginal origin is rare, with only six vaginal primary cases reported to date. A 55-year-old woman presented to our hospital with a 7 cm vulvar mass. Tumor biopsy results were suspicious of sarcoma, and pelvic magnetic resonance imaging and hysterofiberscopy showed that the tumor originated from the lower vagina. The mass was transvaginally excised, and histological examination confirmed the diagnosis of a vaginal MPNST with negative surgical margins. The patient underwent radiotherapy because the risk of recurrence was high, owing to the large tumor size and high mitotic index. The patient remained recurrence-free for 1 year after the primary treatment. This is the first case of a high-risk vaginal MPNST that avoided early disease recurrence with additional radiotherapy after complete tumor resection.
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Affiliation(s)
- Yuka Mizuta
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Mayu Asai
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Yumiko Yoshioka
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
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Pfister P, Müller SLC, Eberhardt AL, Rodriguez M, Menzi N, Haug M, Schaefer DJ, Kappos EA, Ismail T. Impact of Adjuvant Radiotherapy on Free Flap Volume in Autologous Breast Reconstruction: A Scoping Review. J Clin Med 2023; 13:217. [PMID: 38202224 PMCID: PMC10779607 DOI: 10.3390/jcm13010217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
In autologous breast reconstruction, a sufficient flap volume is fundamental to restore breast shape and ensure an aesthetic outcome. After mastectomy, postoperative irradiation is regularly indicated in the oncological treatment algorithm. When administering radiation therapy after autologous reconstruction, the tissue transferred is inherently irradiated. Although there is evidence that points to a reduction in flap volume after adjuvant radiotherapy, the data have been contradicting and inconclusive. To address this anecdotal evidence, we performed a scoping review of the current literature that addresses the effect of radiotherapy on breast flap volume. Six two-armed studies, comprising a total of 462 patients, reported on the effect of adjuvant radiotherapy on free flap volume changes. Of those, two studies found a significant negative impact of radiotherapy on free flap volume, while the other four studies did not. Reported flap volume changes ranged from no change to a reduction of 26.2%, measured up to two years postoperatively. The selected studies contain varying patient numbers, follow-up timepoints, types of flaps, and measuring methods, contributing to a relatively high heterogeneity. While we present some evidence suggesting a significant impact of adjuvant radiotherapy on breast flap volume, future studies are needed to further investigate this potential correlation.
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Affiliation(s)
- Pablo Pfister
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
| | - Seraina L. C. Müller
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
| | - Anna-Lena Eberhardt
- Department of Radiation Oncology, University Hospital Basel, 4031 Basel, Switzerland
| | - Medea Rodriguez
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
| | - Nadia Menzi
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
| | - Martin Haug
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Dirk J. Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Elisabeth A. Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
| | - Tarek Ismail
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland (M.R.); (N.M.); (M.H.); (D.J.S.); (E.A.K.); (T.I.)
- Faculty of Medicine, University of Basel, 4031 Basel, Switzerland
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12
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Sghier AB, Samba S, Bouabid M, Berhili S, Moukhlissi M, Mezouar L. A rare presentation of esthesioneuroblastoma: a case report and review of the literature. Pan Afr Med J 2023; 46:111. [PMID: 38465014 PMCID: PMC10924622 DOI: 10.11604/pamj.2023.46.111.42205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/07/2023] [Indexed: 03/12/2024] Open
Abstract
Esthesioneuroblastoma is a rare malignant tumor developing from the olfactory neuroepithelium. It represents less than 5% of all cancers of the nasal cavity. We are going to report the observation of a patient followed at the regional oncology center of Oujda in Morocco who presented a locally advanced esthesioneuroblastoma. Treatment consisted of surgical resection followed by adjuvant radiotherapy on the tumor bed. Currently, the patient is in good control of his disease.
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Affiliation(s)
- Ahmed Ben Sghier
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Soumiya Samba
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Meriem Bouabid
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Soufiane Berhili
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Mohammed Moukhlissi
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
| | - Loubna Mezouar
- Radiotherapy Department University Mohamed VI Hospital, Faculty of Medicine and Pharmacy, Mohamed First University Oujda, Oujda, Morocco
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13
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Aldaly M, Hussien A, El-nadi IM, Laz NI, Said ASA, Al-Ahmad MM, Hussein RRS, Rabie ASI, Shaaban AH. A Comparison of 3D Conformal and Deep Inspiratory Breath Holding vs. 4D-CT Intensity-Modulated Radiation Therapy for Patients with Left Breast Cancer. Cancers (Basel) 2023; 15:5799. [PMID: 38136343 PMCID: PMC10742267 DOI: 10.3390/cancers15245799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Multimodality is required for the treatment of breast cancer. Surgery, radiation (RT), and systemic therapy were traditionally used. Pharmacotherapy includes different drug mechanisms, such as chemotherapy, hormone therapy, and targeted therapies, alone or in combination with radiotherapy. While radiation offers numerous benefits, it also has certain harmful risks. such as cardiac and pulmonary toxicity, lymphedema, and secondary cancer. Modern radiation techniques have been developed to reduce organs at risk (OAR) doses. MATERIALS AND METHODS This study is a prospective feasibility trial conducted at the Fayium Oncology Center on patients with left breast cancer receiving adjuvant locoregional radiotherapy after either breast conservative surgery (BCS) or modified radical mastectomy (MRM). This study aimed to assess the proportion of patients who are fit both physically and intellectually to undergo breast radiotherapy using the deep inspiratory breath-holding (DIBH) technique, comparing different dosimetric outcomes between the 3D dimensional conformal with DIBH and 4D-CT IMRT plans of the same patient. RESULTS D95 of the clinical target volume (CTV) of the target is significantly higher in the 3D DIBH plan than in the IMRT plan, with an average of 90.812% vs. 86.944%. The dosimetry of the mean heart dose (MHD) in the 4D-CT IMRT plan was significantly lower than in the 3D conformal with the DIBH plan (2.6224 vs. 4.056 Gy, p < 0.0064), and no significant difference between the two plans regarding mean left anterior descending artery (LAD) (14.696 vs. 13.492 Gy, p < 0.58), maximum LAD (39.9 vs. 43.5 Gy, p < 0.35), and V20 of the ipsilateral lung (18.66% vs. 16.306%, p < 0.88) was observed. Internal mammary chain (IMC) irradiation was better in the 4D-CT IMRT plan. CONCLUSIONS Radiotherapy of the breast and chest wall with the 4D-CT IMRT technique appears not to be inferior to the 3D conformal with the DIBH technique and can be used as an alternative to the 3D conformal with the DIBH technique in patients meeting the exclusion criteria for performing the DIBH maneuver concerning coverage to target volumes or unacceptably high doses to OAR.
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Affiliation(s)
- Moustafa Aldaly
- Department of Clinical Oncology, Faculty of Medicine, Kasr AL Ainy, Cairo University, Cairo 11956, Egypt;
| | - Azza Hussien
- Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt; (A.H.); (I.M.E.-n.); (A.H.S.)
| | - Inas Mohsen El-nadi
- Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt; (A.H.); (I.M.E.-n.); (A.H.S.)
| | - Nabila Ibrahim Laz
- Department of Chest, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt;
| | - Amira S. A. Said
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef 62511, Egypt;
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi P.O. Box 112612, United Arab Emirates
| | - Mohammad M. Al-Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi P.O. Box 112612, United Arab Emirates
| | - Raghda R. S. Hussein
- Department of Clinical Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni Suef 62511, Egypt;
| | - Al Shaimaa Ibrahim Rabie
- Department of Clinical Pharmacy, Faiyum Oncology Center, Faiyum 63511, Egypt
- Department of Clinical Nutrition, Health Insurance Authority, Faiyum 63511, Egypt
| | - Ahmed Hassan Shaaban
- Department of Clinical Oncology, Faculty of Medicine, Beni-Suef University, Beni Suef 62511, Egypt; (A.H.); (I.M.E.-n.); (A.H.S.)
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Patni A, Rastogi M, Gandhi AK, Mishra VK, Srivastava AK, Sharma V, Agarwal A, Khurana R, Hadi R, Sapru S, Mishra SP. Toxicities and clinical outcome of adjuvant dysphagia optimized versus standard intensity-modulated radiotherapy for post-operative oral cavity cancers: A prospective comparative study. Head Neck 2023; 45:3119-3128. [PMID: 37814926 DOI: 10.1002/hed.27541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/23/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND We prospectively assessed acute and late toxicity in post-operative oral cavity squamous cell carcinoma (PO-OCSCC) treated with adjuvant dysphagia optimized intensity-modulated radiotherapy (Do-IMRT) versus standard IMRT (S-IMRT). MATERIAL AND METHODS Fifty-six patients of PO-SCC without indications of concurrent chemotherapy were alternatively allocated to adjuvant Do-IMRT (n = 28) versus S-IMRT (n = 28) arms. High- and low-risk planning target volume received 60 and 54 Gy, respectively, in 30 fractions over 6 weeks. Dysphagia aspiration-related structures (DARS) were contoured in both arms. While dosimetric constraints were given in Do-IMRT arm, doses to DARS were only observed without dose constraints in S-IMRT arm. Acute and late toxicity were assessed by common terminology criteria for adverse events (CTCAE) v5.0 and RTOG criteria, respectively. RESULTS The primary site of disease was buccal mucosa (64% vs. 53%) and oral tongue (21% vs. 32%), in Do-IMRT and S-IMRT, respectively. The mean doses to DARS was significantly less with Do-IMRT (all p < 0.001) as compared to S-IMRT. Median follow-up was 24.2 months. Grade ≥2 oral pain was less in the Do-IMRT arm (50% vs. 78.6%, p = 0.05). Grade ≥2 late dysphagia at 2 years were significantly less in Do-IMRT arm (0% vs. 17.9%, p = 0.016). Two-year locoregional control was 89.2% in Do-IMRT and 78.5% in S-IMRT (p = 0.261). CONCLUSION DARS can be spared in PO-OCSCC patients treated with Do-IMRT without compromising coverage of the target volumes. Limiting doses to DARS leads to lesser acute and late toxicity without compromising locoregional control.
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Affiliation(s)
- Ayushi Patni
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Madhup Rastogi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Ajeet Kumar Gandhi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Vachaspati Kumar Mishra
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Anoop Kumar Srivastava
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Vikas Sharma
- Department of Surgical Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Akash Agarwal
- Department of Surgical Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Rohini Khurana
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Rahat Hadi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Shantanu Sapru
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Surendra Prasad Mishra
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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15
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Hasterok M, Szołtysik M, Nowicka Z, Goc B, Gräupner D, Majewski W, Rasławski K, Rajwa P, Jabłońska I, Magrowski Ł, Przydacz M, Krajewski W, Masri O, Miszczyk M. Rectum and Bladder Toxicity in Postoperative Prostate Bed Irradiation: Dose-Volume Parameters Analysis. Cancers (Basel) 2023; 15:5334. [PMID: 38001594 PMCID: PMC10670737 DOI: 10.3390/cancers15225334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Although prostate cancer treatment is increasingly effective, its toxicities pose a major concern. The aim of our study was to assess the rate of adverse events (AEs) and the prognostic value of dose-volume histogram (DVH) parameters for the occurrence of treatment toxicity in patients treated with post-prostatectomy prostate bed radiotherapy (RT). The AEs were scored according to the CTCAE v.5.0. The rectum and bladder were contoured according to the RTOG Guidelines. The DVH parameters were assessed using data exported from the ECLIPSE treatment-planning system. Genitourinary (GU) and gastrointestinal (GI) toxicity were analysed using consecutive dose thresholds for the percentage of an organ at risk (OAR) receiving a given dose and the QUANTEC dose constraints. A total of 213 patients were included in the final analysis. Acute grade 2 or higher (≥G2) GU AEs occurred in 18.7% and late in 21.3% of patients. Acute ≥G2 GI toxicity occurred in 11.7% and late ≥G2 in 11.2% of the patients. Five patients experienced grade 4 AEs. The most common adverse effects were diarrhoea, proctitis, cystitis, and dysuria. The most significant predictors of acute ≥G2 GI toxicity were rectum V47 and V46 (p < 0.001 and p < 0.001) and rectum wall V46 (p = 0.001), whereas the most significant predictors of late ≥G2 GI AEs were rectum wall V47 and V48 (p = 0.019 and p = 0.021). None of the bladder or bladder wall parameters was significantly associated with the risk of acute toxicity. The minimum doses to bladder wall (p = 0.004) and bladder (p = 0.005) were the most significant predictors of late ≥G2 GU toxicity. Postoperative radiotherapy is associated with a clinically relevant risk of AEs, which is associated with DVH parameters, and remains even in patients who fulfil commonly accepted dose constraints. Considering the lack of survival benefit of postoperative adjuvant RT, our results support delaying treatment through an early salvage approach to avoid or defer toxicity.
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Affiliation(s)
- Maja Hasterok
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Monika Szołtysik
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Mazowiecka 15, 92-215 Lodz, Poland;
| | - Bartłomiej Goc
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Donata Gräupner
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Wojciech Majewski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Konrad Rasławski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Paweł Rajwa
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Department of Urology, Medical University of Silesia, 3-go Maja 13-15, 41-800 Zabrze, Poland
| | - Iwona Jabłońska
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Łukasz Magrowski
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Krakow, Poland;
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, 50-556 Wrocław, Poland;
| | - Oliwia Masri
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
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16
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Bernaola-Paredes WE, Rodrigues ML, Carvalho HP, dos Santos Bitencourt F, Coutinho MC, D’Almeida Costa F, Vallejo-Rosero KA, Marquez-Zambrano JA, Pellizzon ACA. Reconstructive surgery and adjuvant radiotherapy for the multimodal approach in oral cancer: a single cancer centre experience. Ann Med Surg (Lond) 2023; 85:5314-5322. [PMID: 37915680 PMCID: PMC10617813 DOI: 10.1097/ms9.0000000000001357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/17/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance Ablative surgery for oral cancer, irrespective of the histological subtype, causes large tissue defects, functional and aesthetic damage. Microsurgical free flaps have been widely used in reconstruction after resection, with satisfactory success rates in conjunction with adjuvant radiotherapy (RT). This study aims to describe our clinical institutional experience based on the multimodal treatment performed in four cases diagnosed with oral squamous cell carcinoma with the use of different microvascular free flaps and RT. Case series presentation Four patients underwent reconstructive microsurgery after surgical resection of oral cancer, using three types of free flap: radial forearm fasciocutaneous, osteomyocutaneous fibular, and anterolateral thigh musculocutaneous flaps; RT was performed in Case 2 and Case 3. In the period of 3 years after microsurgical reconstruction and RT, flaps remain clinically stable without failure signs in full patients submitted to multimodal treatment. Clinical discussion After resection of oral carcinomas, extensive tissue defects can be successfully treated with reconstructive microsurgery using different types of microvascular free flaps. RT for locoregional control is a feasible option and did not seem to interfere with the survival of flaps. Conclusion An enhance long-term follow-up to assess overall and disease-free survival rates and quality of life must be carried out; however, cohort studies would be necessary for better understanding of the role of each treatment in the multimodal scheme.
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Affiliation(s)
| | | | | | | | | | | | | | - Jose Agustin Marquez-Zambrano
- Department of Oral Pathology, School of Dentistry and Rehabiliation Sciences, San Sebastian University, Santiago, Chile
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17
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Rades D, Eggert MC, Janssen S, Yu NY. Whole-breast Radiotherapy With Boost for Node-negative Breast Cancer: Conventional vs. Hypo-fractionation. In Vivo 2023; 37:2628-2633. [PMID: 37905665 PMCID: PMC10621455 DOI: 10.21873/invivo.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM Many breast cancer patients receive adjuvant radiotherapy. Tumor bed boost may reduce risk of local failure in high risk patients. We compared hypofractionated whole-breast irradiation (WBI) plus boost (HF+boost) and conventionally fractionated WBI plus boost (CF+boost). PATIENTS AND METHODS One-hundred-and-twenty-eight patients receiving HF-WBI (40 Gy in 15 fractions) plus boost (group A) were matched to 127 patients receiving CF-WBI (50.4 Gy in 28 fractions) plus boost (group B), utilizing 10 characteristics. RESULTS Grade ≥2 dermatitis rates were 16.4% in group A vs. 44.1% in group B (p<0.0001), and grade ≥2 pneumonitis rates were 1.6% vs. 2.4% (p=0.68). Four-year rates of local control, metastases-free survival, and overall survival were 100% vs. 99% (p=0.81), 98% vs. 100% (p=0.29), and 98% vs. 100% (p=0.17), respectively. CONCLUSION HF+boost was associated with significantly less grade ≥2 dermatitis with similar disease control and survival.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Marie C Eggert
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
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18
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Jiang HT, Wang P, Wang JW, Liu J, Tang C, Zhang G, Pan JY, Geng HF, Wu N. Endoscopic transsphenoidal approach in resection of intracranial clivus chondrosarcoma: A case report. Oncol Lett 2023; 26:498. [PMID: 37854870 PMCID: PMC10580017 DOI: 10.3892/ol.2023.14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023] Open
Abstract
Intracranial primary chondrosarcomas are rare, accounting for <0.15% of all intracranial tumors, but exhibit a high risk of recurrence. Due to the rarity of this condition, it has proven difficult to establish efficacy-based treatment guidelines. The present study details a case of clivus chondrosarcoma exhibiting no recurrence following surgical resection using an endoscopic transsphenoidal approach and postoperative adjuvant radiotherapy. A 41-year-old female presented with primary symptoms of left eye esotropia, scotoma of the left nasal visual field and double vision. Preoperative cranial magnetic resonance imaging revealed a lesion on the clivus, which was initially diagnosed as chordoma. However, clivus chondrosarcoma was ultimately diagnosed based on intraoperative findings and postoperative histopathology. The tumor was totally resected and 25 doses of adjuvant radiotherapy with planning gross tumor volume (60 Gy) and planning clinical target volume (50 Gy) were administered for 5 weeks. The patient was discharged at 12 days post-surgery with no obvious postoperative complications. Over the 28-month follow-up period, there was no evidence of recurrence, which may be due to the successful use of combined gross total resection and adjuvant radiotherapy. Therefore, surgical resection using an endoscopic transsphenoidal approach and postoperative adjuvant radiotherapy is an effective method for treating intracranial clivus chondrosarcoma.
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Affiliation(s)
- Hao Tian Jiang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
- Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Pan Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
- Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Jun Wei Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
| | - Jie Liu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
- Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Chao Tang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
- Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Gang Zhang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
- Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Jin Yu Pan
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
| | - Hao Fei Geng
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 401147, P.R. China
| | - Nan Wu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, P.R. China
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19
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Eggert MC, Yu NY, Rades D. Radiation Dermatitis and Pneumonitis in Patients Irradiated for Breast Cancer. In Vivo 2023; 37:2654-2661. [PMID: 37905621 PMCID: PMC10621417 DOI: 10.21873/invivo.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND/AIM Adjuvant radiotherapy (RT) for breast cancer can be associated with acute dermatitis (ARD) and pneumonitis (RP). Prevalence and risk factors were characterized. PATIENTS AND METHODS This study included 489 breast cancer patients receiving adjuvant RT with conventional fractionation (CF) ± sequential or simultaneous integrated boost, or hypo-fractionation ± sequential boost. RT-regimen and 15 characteristics were investigated for grade ≥2 ARD and RP. RESULTS Prevalence of grade ≥2 ARD and RP was 25.3% and 2.5%, respectively. On univariate analyses, ARD was significantly associated with CF and radiation boost (p<0.0001), age ≤60 years (p=0.008), Ki-67 ≥15% (p=0.012), and systemic treatment (p=0.002). On multivariate analysis, RT-regimen (p<0.0001) and age (p=0.009) were associated with ARD. Chronic inflammatory disease was significantly associated with RP on univariate (p=0.007) and multivariate (p=0.016) analyses. CONCLUSION Risk factors for grade ≥2 ARD and RP were determined that may help identify patients who require closer monitoring during and after RT.
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Affiliation(s)
- Marie C Eggert
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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20
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Ângelo DF, Maffia F, Teschke M, Sanz D, Galrito M, Cardoso H, Marques R, Nabuco C. Considerations for the Use of Alloplastic Temporomandibular Joint Replacement in Irradiated Patients: Report of an Off-Label Indication. J Clin Med 2023; 12:6612. [PMID: 37892750 PMCID: PMC10607587 DOI: 10.3390/jcm12206612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/04/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Custom-made alloplastic temporomandibular joint replacement (ATMJR) is not validated in irradiated patients. However, in specific situations, after previous reconstructive surgical failures, the authors hypothesized the role of a customized ATMJR after radiotherapy. METHODS A 65-year-old male patient was referred to Instituto Português da Face-Lisbon, Portugal-after failed attempts of mandibular reconstruction secondary to oral carcinoma resection and partial hemi-mandibulectomy plus radiotherapy of 60 total Grays. Primary reconstruction was performed with fibula free flap. Due to failure, secondary reconstructions were performed with osteosynthesis plate without success. The patient was unable to have adequate mastication and deglutition due to a severe crossbite. The authors treated the patient with an extended customized alloplastic temporomandibular joint replacement (F0M2). RESULTS With 3 years of follow-up, the patient showed an improvement in masticatory function, mandibular motion, pain levels, and overall quality of life. No complications were observed related to ATMJR. CONCLUSIONS The presented case described how ATMJR, although not a validated option after radiotherapy, can be considered to restore functionality in complex cases with bone and soft tissues problems.
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Affiliation(s)
- David Faustino Ângelo
- Instituto Português da Face, 1050-227 Lisbon, Portugal; (D.S.); (M.G.); (H.C.); (R.M.); (C.N.)
- Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, 2430-028 Marinha Grande, Portugal
| | - Francesco Maffia
- Instituto Português da Face, 1050-227 Lisbon, Portugal; (D.S.); (M.G.); (H.C.); (R.M.); (C.N.)
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | | | - David Sanz
- Instituto Português da Face, 1050-227 Lisbon, Portugal; (D.S.); (M.G.); (H.C.); (R.M.); (C.N.)
| | - Marta Galrito
- Instituto Português da Face, 1050-227 Lisbon, Portugal; (D.S.); (M.G.); (H.C.); (R.M.); (C.N.)
| | - Henrique Cardoso
- Instituto Português da Face, 1050-227 Lisbon, Portugal; (D.S.); (M.G.); (H.C.); (R.M.); (C.N.)
| | - Rute Marques
- Instituto Português da Face, 1050-227 Lisbon, Portugal; (D.S.); (M.G.); (H.C.); (R.M.); (C.N.)
| | - Carlos Nabuco
- Instituto Português da Face, 1050-227 Lisbon, Portugal; (D.S.); (M.G.); (H.C.); (R.M.); (C.N.)
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21
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Han T, Shi M, Chen Q, Chen D, Hao J. Effect of adjuvant radiotherapy after breast-conserving surgery in elder women with early-stage breast cancer: a propensity-score matching analysis. Front Oncol 2023; 13:1012139. [PMID: 37901322 PMCID: PMC10613027 DOI: 10.3389/fonc.2023.1012139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/14/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose The study aimed to explore the role of adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) in elder women with early-stage breast cancer (BC). Methods BC patients with 70-79 years of age, stage T1-2N0-1M0, undergoing BCS were screened in the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2015. The clinicopathological characteristics were balanced with propensity-score matching (PSM) method. Kaplan-Meier curves and Cox regression analyses were performed to determine the impact of adjuvant RT on BC patients. Results Ultimately, 12,310 patients treated with adjuvant RT and 4837 patients treated with no RT, were involved in the analysis. Overall, patients treated with adjuvant RT was associated with a better breast cancer-specific survival (BCSS) (HR: 1.980 [1.596- 2.456], P < 0.001) and overall survival (OS) (HR: 2.214 [1.966- 2.494], P < 0.001) than those who did not undergo RT. After 1:1 PSM, adjuvant RT still performed advantage in both BCSS (HR: 1.918 [1.439- 2.557], P < 0.001) and OS (HR: 2.235 [1.904- 2.624], P < 0.001). In the multivariate COX analysis of BCSS, widowed, divorced and separated patients, tumor grade III, T2 stage, N1 stage, no RT, molecular subtypes with luminal B and triple negative were associated with a shorter BCSS (P < 0.05). In the multivariate COX analysis of OS, age ≥74 years, widowed, divorced and separated patients, tumor grade II/III, T2 stage, no RT, no chemotherapy, molecular subtypes with triple negative were associated with a shorter OS (P < 0.05). Furthermore, the advantages of adjuvant RT were observed in all subgroup analysis. Conclusion Adjuvant RT after BCS can improve both BCSS and OS in elderly patients with early-stage BC. Additionally, all subgroups analysis-derived BCSS and OS were in support of RT.
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Affiliation(s)
- Tingting Han
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mingwei Shi
- Department of Oncology, Hefei BOE Hospital, Hefei, China
| | - Qiwei Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dongbo Chen
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jiqing Hao
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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22
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Alonso-Espías M, Gorostidi M, Gracia M, García-Pineda V, Diestro MD, Siegrist J, Hernández A, Zapardiel I. Role of Adjuvant Radiotherapy in Patients with Cervical Cancer Undergoing Radical Hysterectomy. J Pers Med 2023; 13:1486. [PMID: 37888097 PMCID: PMC10608331 DOI: 10.3390/jpm13101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
The benefit of adjuvant radiotherapy (RT) after radical hysterectomy in patients with cervical cancer remains controversial. The aim of this study was to determine adjuvant RT's impact on survival in accordance with Sedlis criteria. Patients with early-stage cervical cancer undergoing radical hysterectomy between 2005 and 2022 at a single tertiary care institution were included. A multivariate analysis was performed to determinate if RT was an independent prognostic factor for recurrence or death. We also analysed whether there was a statistically significant difference in overall survival (OS) between patients who met only one or two Sedlis criteria, depending on whether they received adjuvant RT or not. 121 patients were included in this retrospective study, of whom 48 (39.7%) received adjuvant RT due to the presence of unfavourable pathological findings. In multivariate analysis, RT was not found to be a statistically significant prognostic factor for OS (p = 0.584) or disease-free survival (DFS) (p = 0.559). When comparing patients who met one or two Sedlis criteria, there were no statistically significant differences in OS between RT and no adjuvant treatment in either group. Since the selection of patients with cervical cancer eligible for surgery is becoming more accurate, adjuvant RT might not be necessary for patients with intermediate risk factors.
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Affiliation(s)
- María Alonso-Espías
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain; (M.A.-E.); (M.G.); (V.G.-P.); (M.D.D.); (J.S.); (A.H.); (I.Z.)
| | - Mikel Gorostidi
- Gynecologic Oncology Unit, Donostia University Hospital, 20014 San Sebastian, Spain
| | - Myriam Gracia
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain; (M.A.-E.); (M.G.); (V.G.-P.); (M.D.D.); (J.S.); (A.H.); (I.Z.)
| | - Virginia García-Pineda
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain; (M.A.-E.); (M.G.); (V.G.-P.); (M.D.D.); (J.S.); (A.H.); (I.Z.)
| | - María Dolores Diestro
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain; (M.A.-E.); (M.G.); (V.G.-P.); (M.D.D.); (J.S.); (A.H.); (I.Z.)
| | - Jaime Siegrist
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain; (M.A.-E.); (M.G.); (V.G.-P.); (M.D.D.); (J.S.); (A.H.); (I.Z.)
| | - Alicia Hernández
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain; (M.A.-E.); (M.G.); (V.G.-P.); (M.D.D.); (J.S.); (A.H.); (I.Z.)
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, 28046 Madrid, Spain; (M.A.-E.); (M.G.); (V.G.-P.); (M.D.D.); (J.S.); (A.H.); (I.Z.)
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Antunac K, Mayer L, Banovic M, Beketic-Oreskovic L. Correlation of High-Sensitivity Cardiac Troponin I Values and Cardiac Radiation Doses in Patients with Left-Sided Breast Cancer Undergoing Hypofractionated Adjuvant Radiotherapy with Concurrent Anti-HER2 Therapy. Curr Oncol 2023; 30:9049-9062. [PMID: 37887554 PMCID: PMC10605836 DOI: 10.3390/curroncol30100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
Anti HER2 therapy and left breast adjuvant radiation therapy (RT) can both result in cardiotoxicity. The aim of this study was to evaluate the influence of radiation dose on cardiac structures on the values of the early cardiotoxicity marker high-sensitivity cardiac troponin I (hscTnI) in patients with HER2-positive left breast cancer undergoing adjuvant concomitant antiHER2 therapy and radiotherapy, and to establish a correlation between the hscTnI values and cardiac radiation doses. Sixty-one patients underwent left breast hypofractionated radiotherapy in parallel with anti-HER2 therapy: trastuzumab, combined trastuzumab-pertuzumab or trastuzumab emtansine (T-DM1). The hscTnI values were measured prior to and upon completion of radiotherapy. A significant increase in hscTnI was defined as >30% from baseline, with the second value being 4 ng/L or higher. Dose volume histograms (DVH) were generated for the heart, left ventricle (LV) and left anterior descending artery (LAD). The hscTnI levels were corelated with radiation doses on cardiac structures. An increase in hscTnI values was observed in 17 patients (Group 1). These patients had significantly higher mean radiation doses for the heart (p = 0.02), LV (p = 0.03) and LAD (p = 0.04), and AUC for heart and LV (p = 0.01), than patients without hscTnI increase (Group 2). The patients in Group 1 also had larger volumes of heart and LV receiving 2 Gy (p = 0.01 for both) and 4 Gy (p = 0.02 for both). LAD differences were observed in volumes receiving 2 Gy (p = 0.03), 4 Gy (p = 0.02) and 5 Gy (p = 0.02). The increase in hscTnI observed in patients receiving anti-HER2 therapy after adjuvant RT was positively associated with radiation doses on the heart, LV and LAD.
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Affiliation(s)
- Katarina Antunac
- Division of Oncology and Radiotherapy, University Hospital for Tumours, Sestre Milosrdnice University Hospital Centre, Ilica 197, 10000 Zagreb, Croatia;
| | - Ljiljana Mayer
- Department of Medical Biochemistry in Oncology, University Hospital for Tumours, Sestre Milosrdnice University Hospital Centre, Ilica 197, 10000 Zagreb, Croatia;
| | | | - Lidija Beketic-Oreskovic
- Division of Oncology and Radiotherapy, University Hospital for Tumours, Sestre Milosrdnice University Hospital Centre, Ilica 197, 10000 Zagreb, Croatia;
- Department of Clinical Oncology, School of Medicine University of Zagreb, Salata 3 B, 10000 Zagreb, Croatia
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24
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Ryu H, Song C, Kim J, Jeon JH, Cho S, Kim K, Jheon S, Kim SH, Kim YJ, Lee JS. Role of prognostic nutritional index in postoperative radiotherapy for non-small cell lung cancer. Thorac Cancer 2023; 14:2859-2868. [PMID: 37594010 PMCID: PMC10542465 DOI: 10.1111/1759-7714.15074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The prognostic nutritional index (PNI) is known to be correlated with clinical outcomes in non-small cell lung cancer (NSCLC) patients. However, its role has not been studied in patients who have undergone postoperative radiotherapy (PORT). This study aimed to investigate the relationship between PNI and survival and recurrence in NSCLC patients with PORT. METHODS We reviewed 97 stage I-III NSCLC patients who received PORT between January 2006 and December 2016 at our institution. We obtained PNI values for both pre-RT (within 1 month before PORT) and post-RT (within 2 months after PORT) by using serum albumin and lymphocyte count. A cutoff value for PNI was determined by the receiver operating characteristic curve (ROC). The median follow-up period was 52.8 months. RESULTS The ROC curve of post-RT PNI exhibited a higher area under the curve (AUC 0.68, cut-off: 47.1) than that of pre-RT PNI (AUC 0.55, cutoff: 50.3), so the group was divided into high post-RT PNI (> 47.1) and low post-RT PNI ( ≤ 47.1). The five-year overall survival rate (OS) was 66.2% in the high post-RT group, compared with 41.8% in the low post-RT PNI group (p = 0.018). Those with both low pre-RT and low post-RT PNI had the worst five-year OS of 31.1%. Post-RT PNI (HR 0.92, p = 0.003) was an independent risk factor for mortality. CONCLUSIONS PNI after PORT was significantly associated with survival. This finding suggests that PNI can be used as a prognostic marker.
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Affiliation(s)
- Hyejo Ryu
- Department of Radiation OncologySeoul National University HospitalSeoulSouth Korea
| | - Changhoon Song
- Department of Radiation OncologySeoul National University Bundang HospitalSeongnamSouth Korea
| | - Jae‐Sung Kim
- Department of Radiation OncologySeoul National University Bundang HospitalSeongnamSouth Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnamSouth Korea
| | - Sukki Cho
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnamSouth Korea
| | - Kwhanmien Kim
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnamSouth Korea
| | - Sanghoon Jheon
- Department of Thoracic and Cardiovascular SurgerySeoul National University Bundang HospitalSeongnamSouth Korea
| | - Se Hyun Kim
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Yu Jung Kim
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
| | - Jong Seok Lee
- Department of Internal MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
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25
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Katano A, Minamitani M, Ohira S, Yamashita H. Failure Patterns of Recurrence in Patients With Localized Esthesioneuroblastoma Following Surgery and Adjuvant Radiotherapy Without Elective Nodal Irradiation. Cureus 2023; 15:e46523. [PMID: 37927675 PMCID: PMC10625395 DOI: 10.7759/cureus.46523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Esthesioneuroblastoma (ENB), a rare malignancy arising from the olfactory epithelium, poses clinical challenges owing to its propensity for local invasion and recurrence. Its management typically involves surgical resection and adjuvant radiotherapy. However, debate persists regarding the optimal treatment strategy, particularly the use of elective nodal irradiation (ENI). This study aimed to investigate recurrence patterns in patients with localized ENB treated with surgery and adjuvant radiotherapy without ENI. METHODS Our retrospective analysis included patients who underwent surgery followed by adjuvant radiotherapy for treatment of ENB between January 2011 and November 2022. Patients with incomplete data or who had received neoadjuvant radiotherapy were excluded. Patient characteristics, radiotherapy data (type, dose, and duration), and follow-up data were collected. Recurrence patterns were evaluated, and overall survival (OS), disease-free survival (DFS), and local control rates were determined using the Kaplan-Meier method. RESULTS Twelve patients with ENB (median age, 56 years) were included. Most had stage C disease. The median radiation dose was 60 Gy, and the median treatment duration was six weeks. Only one death was confirmed during the observation period, and the five-year DFS rates were 64.3%. Local control was achieved in 11 patients, with only one experiencing local recurrence. Regional lymph node recurrence occurred in three patients and was successfully managed via neck dissection. The timing of recurrence varied, emphasizing the importance of long-term surveillance. CONCLUSION Adjuvant radiotherapy without ENI is a viable treatment option for ENB, resulting in favorable local control and OS outcomes. Regional lymph node metastases were observed but effectively managed via salvage therapy. Prospective studies with larger cohorts are warranted to confirm the effectiveness of this treatment strategy and to define optimal radiotherapy fields.
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Affiliation(s)
- Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, JPN
| | - Masanari Minamitani
- Department of Comprehensive Radiation Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, JPN
| | - Shingo Ohira
- Department of Comprehensive Radiation Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, JPN
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, JPN
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Vuković D, Budimir Mršić D, Jerković K, Benzon B, Tadić T. Pre-Existing Interstitial Lung Abnormalities in Patients with Head and Neck Squamous Cell Carcinoma and Their Follow Up after Therapy. Diagnostics (Basel) 2023; 13:2908. [PMID: 37761274 PMCID: PMC10529031 DOI: 10.3390/diagnostics13182908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/03/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Interstitial lung abnormalities (ILAs) are incidentally found nondependent parenchymal abnormalities affecting more than 5% of any lung zone and are potentially related to interstitial lung disease and worsening post-treatment outcomes in malignancies and infectious diseases. The aim of this study was to determine the prevalence and type of ILA changes in patients with head and neck squamous cell carcinoma (HNSCC) and their change in the follow-up period. This retrospective single-center study included 113 patients with newly diagnosed HNSCC who underwent lung MSCT prior to treatment. ILAs were reported in 13.3% of patients on pretreatment MSCT. Patients with ILAs were significantly older (median 75 vs. 67 years). ILAs were most prevalent in lower zones (73.3%) (p = 0.0045). The most reported ILA subtype was subpleural non-fibrotic (60%) (p = 0.0354). Reticulations were the most frequently described pattern (93.3%) (p < 0.0001). Progression of ILAs was reported in almost 30% of patients after receiving therapy. Patients with pre-existing ILAs were more likely to develop radiation-induced lung fibrosis after adjuvant radiotherapy (p = 0.0464). In conclusion, ILA's incidence, distribution and presentation were similar to previous research conducted in other special cohorts. Our research suggests a possible association of more frequent radiation pneumonitis with ILA changes in patients with HNSCC, which should be further investigated.
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Affiliation(s)
- Danica Vuković
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (D.B.M.); (T.T.)
| | - Danijela Budimir Mršić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (D.B.M.); (T.T.)
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia;
- University Department of Health Studies, University of Split, Ruđera Boškovića 35, 21000 Split, Croatia
| | - Kristian Jerković
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (D.B.M.); (T.T.)
| | - Benjamin Benzon
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia;
| | - Tade Tadić
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Split, Šoltanska 2, 21000 Split, Croatia; (D.V.); (D.B.M.); (T.T.)
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia;
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27
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Taguchi A, Kato K, Hara K, Furusawa A, Nakajima Y, Ishizawa C, Tanikawa M, Sone K, Mori M, Shimada M, Okamoto A, Takekuma M. Heterogeneous treatment effects of adjuvant therapy for patients with cervical cancer in the intermediate-risk group. Cancer Med 2023; 12:18557-18567. [PMID: 37584239 PMCID: PMC10557871 DOI: 10.1002/cam4.6460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/29/2023] [Accepted: 08/06/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The efficacy of adjuvant therapy for patients with cervical cancer with intermediate risk (CC-IR) remains controversial. We examined the impact of adjuvant therapy on survival outcomes in patients with CC-IR and evaluated the heterogeneous treatment effects (HTEs) of adjuvant therapies based on clinicopathologic characteristics. METHODS We retrospectively analyzed a previous Japanese nationwide cohort of 6192 patients with stage IB-IIB cervical cancer who underwent radical hysterectomy. We created two pairs of propensity score-matched treatment/control groups to investigate the treatment effects of adjuvant therapies: (1) adjuvant therapy versus non-adjuvant therapy; (2) chemotherapy versus radiotherapy conditional on adjuvant therapy. Multivariate analyses with treatment interactions were performed to evaluate the HTEs. RESULTS Among the 1613 patients with CC-IR, 619 and 994 were in the non-treatment and treatment groups, respectively. Survival outcomes did not differ between the two groups: 3-year progression-free survival (PFS) rates were 88.1% and 90.3% in the non-treatment and treatment groups, respectively (p = 0.199). Of the patients in the treatment group, 654 and 340 received radiotherapy and chemotherapy, respectively. Patients who received chemotherapy had better PFS than those who received radiotherapy (3-year PFS, 90.9% vs. 82.9%, p = 0.010). Tumor size was a significant factor that affected the treatment effects of chemotherapy; patients with large tumors gained better therapeutic effects from chemotherapy than those with small tumors. CONCLUSION Adjuvant therapy is optional for some patients with CC-IR; however, chemotherapy can be recommended as adjuvant therapy, particularly for patients with large tumors.
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Affiliation(s)
- Ayumi Taguchi
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
- Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Kosuke Kato
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Konan Hara
- Department of EconomicsUniversity of ArizonaTucsonArizonaUSA
| | - Akiko Furusawa
- Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
- Department of GynecologyShizuoka Cancer Center HospitalShizuokaJapan
| | - Yujiro Nakajima
- Department of Radiological SciencesKomazawa UniversityTokyoJapan
| | - Chihiro Ishizawa
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
- Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases CenterKomagome HospitalTokyoJapan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Muneaki Shimada
- Department of Obstetrics and GynecologyTohoku University School of MedicineSendaiJapan
| | - Aikou Okamoto
- Department of Obstetrics and GynecologyThe Jikei University School of MedicineTokyoJapan
| | - Munetaka Takekuma
- Department of GynecologyShizuoka Cancer Center HospitalShizuokaJapan
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Patil R, Uzzaman L, Kelly C, Kovarik J, Jackson M, Paterson C, Munro SP, Wilson A, Iqbal MS. Role of Adjuvant Radiotherapy in Acinic Cell Carcinoma of the Salivary Glands: A Systematic Review. Clin Oncol (R Coll Radiol) 2023; 35:e489-e497. [PMID: 37355414 DOI: 10.1016/j.clon.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
A systematic review was carried out to evaluate if adjuvant radiotherapy for acinic cell carcinomas (ACCs) of salivary glands improves survival. Twelve retrospective studies published between 2000 and 2020 that analysed the effect of radiotherapy on salivary gland neoplasms and ACCs of salivary glands and met the inclusion criteria were included in the review. The overall quality of the studies was moderate to low. There was no high-quality evidence for improved survival with radiotherapy for ACCs of the salivary gland. Some evidence suggests that there may be an advantage for patients with high-grade tumours, but these data should be interpreted with caution due to the small number of patients and low-quality evidence. Good quality of evidence is lacking. Recommendation for adjuvant radiotherapy for tumours with poor prognostic factors will require discussion and shared decision-making with the patients.
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Affiliation(s)
- R Patil
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - L Uzzaman
- Department of Otolaryngology - Head and Neck Surgery, The Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Kovarik
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Jackson
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - C Paterson
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK; University of Glasgow, Glasgow, UK
| | - S P Munro
- Newcastle University Medical School, Newcastle upon Tyne, UK
| | - A Wilson
- Department of Oral and Maxillofacial Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - M S Iqbal
- Newcastle University, Newcastle upon Tyne, UK.
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Trakolis L, Petridis AK. Interdisciplinary Therapeutic Approaches to Atypical and Malignant Meningiomas. Cancers (Basel) 2023; 15:4251. [PMID: 37686527 PMCID: PMC10486693 DOI: 10.3390/cancers15174251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Meningiomas have the highest incidence among brain tumors. In contrast to benign tumors that constitute the majority of this tumor entity, the treatment of aggressive meningiomas (WHO Grade 2 and 3) is more challenging, requiring gross total removal of the tumor and the affected dura and adjuvant radiotherapy. Sometimes the location and/or the configuration of the tumor do not favor radical surgical resection without endangering the patient's clinical condition after surgery and pharmacological therapy has, until now, not been proven to be a reliable alternative. Discussion: In this narrative review, we discuss the current literature with respect to the management of meningiomas, discussing the importance of the grade of resection in the overall prognosis of the patient and in the planning of adjuvant therapy. Conclusions: According to the location and size of the tumor, radical resection should be taken into consideration. In patients with aggressive meningiomas, adjuvant radiotherapy should be performed after surgery. In cases of skull base meningiomas, a maximal, though safe, resection should take place before adjuvant therapy. An interdisciplinary approach is beneficial for patients with primary or recurrent meningioma.
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Affiliation(s)
- Leonidas Trakolis
- Department of Neurosurgery, Agios Loukas Clinic Thessaloniki, 55236 Thessaloniki, Greece;
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An N, Cui L, Yang X. Low RPMB indicates better disease-free survival of adjuvant radiotherapy after radical surgery in thymoma. Am J Transl Res 2023; 15:5457-5468. [PMID: 37692947 PMCID: PMC10492043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The current use of adjuvant radiotherapy in thymoma (THYM) following radical surgery is primarily based on clinical factors and is a subject of ongoing debate. METHODS We developed a new biomarker, promotor methylation burden of Deoxyribonucleic acid repair genes (RPMB), to identify patients who may benefit from adjuvant radiotherapy after complete resection in THYM. RPMB quantitatively measures the promoter methylation level of Deoxyribonucleic acid (DNA) repair genes. RESULTS The methylation profile of 124 patients and corresponding clinical data were retrieved from The Cancer Genome Atlas (TCGA) database. The methylation level of DNA repair genes (DRGs) was found to be significantly hypomethylated juxtaposed to other genes across the whole human genome (all P < 0.001). THYM patients with higher RPMB tended to be female (P = 1.114×10-12) and have a more advanced Masaoka stage (P = 0.034). Kaplan-Meier analysis showed that high RPMB could significantly predict a poor disease-free survival (DFS) in THYM patients who received adjuvant radiotherapy after complete resection (HR = 5.750, 95% CI: 1.213-27.251, P = 0.013). Furthermore, Cox regression analysis indicated that RPMB was the only prognostic factor significantly associated with DFS after adjuvant radiotherapy (P = 0.028). CONCLUSIONS Low RPMB may be a potential indicator to identify suitable patients who can benefit from adjuvant radiotherapy in THYM, sparing others from treatment toxicity.
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Affiliation(s)
- Ning An
- Department of Radiation Oncology, The Affiliated Hospital of Qingdao UniversityQingdao 266003, Shandong, China
| | - Li Cui
- Department of Oncology, The People’s Hospital of Pingyi CountyLinyi 273399, Shandong, China
| | - Xue Yang
- Department of Medical Oncology, The Affiliated Hospital of Qingdao UniversityQingdao 266003, Shandong, China
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Angulo JC, Téllez C, Giammò A, González-Enguita C, Schoenburg S, Queissert F, Szczesniewski J, González R, Romero A, Gonsior A, Martins FE, Antunes-Lopes T, Cruz F, Rourke K. Results of Adjustable Trans-Obturator Male System in Patients with Prostate Cancer Treated with Prostatectomy and Radiotherapy: A Multicenter Study. J Clin Med 2023; 12:4721. [PMID: 37510835 PMCID: PMC10380664 DOI: 10.3390/jcm12144721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Treatment of male stress incontinence in patients with prostate cancer treated with radical prostatectomy and adjuvant pelvic radiation is a therapeutic challenge. The efficacy and safety of the adjustable trans-obturator male system (ATOMS) in these patients is not well established, despite the general belief that outcomes are worse than in patients without radiation. (2) Methods: Retrospective multicenter study evaluating patients treated with silicone-covered scrotal port (SSP) ATOMS implant after radical prostatectomy and radiotherapy in nine different institutions between 2016 and 2022. The primary endpoint was dry patient rate, defined as pad-test ≤ 20 mL/day. The secondary endpoints were complication rate (defined using Clavien-Dindo classification), device removal and self-perceived satisfaction using the Patient Global Impression of Improvement (PGI-I) scale. Wilcoxon rank-sum test, Fisher's exact test and logistic regression were performed using stepwise method with a 0.15 entry and 0.1 stay criteria. (3) Results: 223 patients fulfilled the criteria for inclusion and 12 (5.4%) received salvage prostatectomy after radiation and 27 (12.1%) previous devices for stress incontinence. After ATOMS adjustment, 95 patients (42.6%) were dry and 36 (16.1%) had complications of any grade (grade I, n = 20; grade II, n = 11; grade III, n = 5) during the first 3 months postoperatively. At a mean of 36 ± 21 months follow-up, the device was explanted in 26 (11.7%) patients. Regarding self-perceived satisfaction with the implant, 105 of 125 patients (84%) considered themselves satisfied (PGI-I 1 to 3). In the univariate analysis, dryness was associated to younger age (p = 0.06), primary prostatectomy (p = 0.08), no previous incontinence surgery (p = 0.02), absence of overactive bladder symptoms (p = 0.04), absence of bladder neck stricture (p = 0.001), no need of surgical revision (p = 0.008) and lower baseline incontinence severity (p = 0.0003). Multivariate analysis identified absence of surgical revision (p = 0.018), absence of bladder neck stricture (p = 0.05), primary prostatectomy (p = 0.07) and lower baseline incontinence severity (p < 0.0001) were independent predictors of dryness. A logistic regression model was proposed and internally validated. (4) Conclusions: ATOMS is an efficacious and safe alternative to treat male incontinence after radical prostatectomy and adjuvant radiotherapy. Factors predictive of dryness are identified in this complex scenario to allow for better patient selection.
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Affiliation(s)
- Javier C Angulo
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Carlos Téllez
- Clinical Department, Faculty of Biomedical Science, Universidad Europea, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Alessandro Giammò
- Department of Neuro-Urology, CTO/Spinal Cord Unit, AOU Città Della Salute e Della Scienza di Torino, Via Zuretti 24, 10126 Torino, Italy
| | - Carmen González-Enguita
- Department of Urology, Hospital Fundación Jiménez Díaz, Av. de Los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Sandra Schoenburg
- Department of Urology and Kidney Transplantation, Martin Luther University, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Fabian Queissert
- Department of Urology and Pediatric Urology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
| | - Juliusz Szczesniewski
- Department of Urology, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
| | - Raquel González
- Department of Urology, Hospital Fundación Jiménez Díaz, Av. de Los Reyes Católicos, 2, 28040 Madrid, Spain
| | - Antonio Romero
- Department of Urology, Hospital Universitario Morales Meseguer, Avd. Marqués de Los Vélez s/n., 30008 Murcia, Spain
| | - Andreas Gonsior
- Klinik und Poliklinik für Urologie, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Francisco E Martins
- Department of Urology, Centro Hospitalar Universitário de Lisboa Norte, Hospital Santa María, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Tiago Antunes-Lopes
- Department of Urology, Centro Hospitalar São João and Faculty of Medicine of University Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- I3S Institute, R. Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Francisco Cruz
- Department of Urology, Centro Hospitalar São João and Faculty of Medicine of University Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- I3S Institute, R. Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Keith Rourke
- Department of Urology, Alberta University, Hospital Edmonton, 8440 112 St. NW, Edmonton, AB T6G 2B7, Canada
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Allignet B, Pou P, Izarn F, Ray-Coquard I, Blay JY, Dufresne A, Brahmi M, Bouhamama A, Meeus P, Vaz G, Gouin F, Meurgey A, Karanian M, Moncharmont C, Waissi W, Sunyach MP. Efficacy and Safety of Adjuvant Radiotherapy in Re-excised Soft-tissue Sarcoma After Unplanned Resection. Oncologist 2023; 28:633-639. [PMID: 36971503 PMCID: PMC10322143 DOI: 10.1093/oncolo/oyad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/21/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The objective of this study was to evaluate the efficacy and safety of adjuvant radiotherapy (aRT) in patients with soft-tissue sarcoma (STS) re-excised after unplanned tumor resection (UPR). MATERIALS AND METHODS From 2000 to 2015, we retrospectively evaluated patients with STS of limb or trunk who underwent post-UPR re-excision in our expert center and received or not aRT. RESULTS Median follow-up was 121 months (IQR 94-165). Among the 145 patients, 37 were not treated with aRT (no-RT) and 108 received aRT with a median radiation dose of 50 Gy (IQR 50-60). At 10 years, patients in the aRT and no-RT groups showed a cumulative incidence of local failure (10y-LF) of 14.7% and 37.7%, and a local recurrence-free survival (10y-LRFS) of 61.3% and 45.8%, respectively. Multivariate analysis identified aRT and age ≥70 years as independent predictors of both LF and LRFS, while grade 3 and deep-seated tumor were independent predictors of LRFS. In overall population, 10-year distant metastasis-free survival (10y-DMFS) and overall survival (10y-OS) were 63.7% and 69.4%. In multivariate analyses, age ≥70 years, grade 3, and deep-seated lesion were associated with shorter DMFS and OS. Acute severe adverse events were not significantly increased in aRT group (14.8% vs. 18.1%, P = .85) but dramatically increased if radiation dose exceeded 50 Gy (risk ratio 2.96 compared to ≤50 Gy, P = .04). CONCLUSION In STS patients re-excised after UPR, 50 Gy aRT was safe and associated with reduced LF and longer LRFS. It seems to be beneficial even in absence of residual disease or in absence of initial adverse prognostic factors.
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Affiliation(s)
- Benoît Allignet
- Corresponding author: Benoît Allignet, MD, Department of Radiation Oncology, Centre Léon Bérard, Lyon, France. Tel: +33 4 26 55 26 77; Fax: +33 4 78 78 51 40;
| | - Paul Pou
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
- Department of Radiation Oncology, Ramsay Générale de Santé, Centre de Radiothérapie Haute Savoie Nord, Contamine Sur Arve, France
| | - Floriane Izarn
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Armelle Dufresne
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Mehdi Brahmi
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Pierre Meeus
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Gualter Vaz
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Francois Gouin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Marie Karanian
- Department of Biopathology, Centre Léon Bérard, Lyon, France
| | | | - Waisse Waissi
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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Holtkamp LHJ, Lo SN, Thompson JF, Spillane AJ, Stretch JR, Saw RPM, Shannon KF, Nieweg OE, Hong AM. Adjuvant radiotherapy after salvage surgery for melanoma recurrence in a node field following a previous lymph node dissection. J Surg Oncol 2023; 128:97-104. [PMID: 36971691 PMCID: PMC10952220 DOI: 10.1002/jso.27245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/15/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Adjuvant radiotherapy (RT) can be given to melanoma patients following salvage surgery for node field recurrence after a previous regional node dissection, but the value of this treatment strategy is poorly documented. This study evaluated long-term node field control and survival of patients treated in this way in an era before effective adjuvant systemic therapy became available. METHODS Data for 76 patients treated between 1990 and 2011 were extracted from an institutional database. Baseline patient characteristics, treatment details and oncological outcomes were analysed. RESULTS Adjuvant RT with conventional fractionation (median dose 48 Gy in 20 fractions) was given to 43 patients (57%) and hypofractionated RT (median dose 33 Gy in 6 fractions) to 33 patients (43%). The 5-year node field control rate was 70%, 5-year recurrence-free survival 17%, 5-year melanoma-specific survival 26% and 5-year overall survival 25%. CONCLUSIONS Salvage surgery with adjuvant RT achieved node field control in 70% of melanoma patients with node field recurrence following a prior node dissection. However, disease progression at distant sites was common and survival outcomes were poor. Prospective data will be required to assess outcomes for contemporary combinations of surgery, adjuvant RT and systemic therapy.
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Affiliation(s)
- Lodewijka H. J. Holtkamp
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Department of Surgical OncologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Serigne N. Lo
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - John F. Thompson
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Andrew J. Spillane
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of SurgeryRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Jonathan R. Stretch
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Robyn P. M. Saw
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Kerwin F. Shannon
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Omgo E. Nieweg
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Melanoma and Surgical OncologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Angela M. Hong
- Melanoma Institute AustraliaThe University of SydneyNorth SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Radiation OncologyChris O'Brien LifehouseSydneyNew South WalesAustralia
- GenesisCare Radiation OncologyMater HospitalSydneyNew South WalesAustralia
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Rafi M, Kumar R, Thomas KC, George NA, George PS, Ramadas K. Treatment Outcomes of Adenoid Cystic Carcinomas of the Head and Neck Region-A Single-Institution Experience. South Asian J Cancer 2023; 12:256-262. [PMID: 38047047 PMCID: PMC10691909 DOI: 10.1055/s-0042-1758682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Malu RafiObjectives This study was undertaken to evaluate the characteristics and treatment outcomes of patients with adenoid cystic carcinomas of the head and neck region treated at a tertiary cancer center in south India. Materials and Methods This was a retrospective study done on patients treated at the institute between 2004 and 2011. Clinicopathological details and treatment outcomes were captured from the treatment records to estimate the treatment outcomes and factors affecting them. Results There were a total of 140 patients with mean age of presentation of 46 years and a median follow-up of 65 months. The most common single site of presentation was the oral cavity. One-hundred eighteen patients (84.3%) underwent primary surgical resection in which 38% had negative surgical margins. Ninety-nine patients were given adjuvant radiotherapy and 18 patients received radical radiotherapy, mostly for surgically inaccessible and inoperable tumors. Median time to recurrence and distant metastasis was 37 and 34 months, respectively. The overall survival and disease-free survival estimate using the Kaplan-Meier method were 92.3 and 71.9%, respectively, at 5 years. Surgical removal of the primary tumor and the nodal stage had the most significant impact on the overall survival outcomes of these patients. Conclusion Surgery remains the most impactful treatment modality in the management of these rare epithelial tumors. The use of adjuvant radiotherapy may help to tackle the issues of perineural spread and inadequate surgical margins in technically difficult sites. Radical radiotherapy also has impressive response rates.
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Affiliation(s)
- Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Rejnish Kumar
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | | | - Nebu Abraham George
- Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Preethi Sara George
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Kunnambath Ramadas
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
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Gao H, Wang Y, Jiang Z, Shi G, Hu S, Ai J, Wang Z, Wei Y. Association of survival with adjuvant radiotherapy for pN0 esophageal cancer. Aging (Albany NY) 2023; 15:3158-3170. [PMID: 37184977 DOI: 10.18632/aging.204677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION This study was conducted to elucidate the link between adjuvant radiotherapy and survival in pathologic node-negative (pN0) esophageal cancer patients with upfront esophagectomy. METHODS From 2000 to 2016, patients with pN0 esophageal cancer who underwent upfront esophagectomy were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The association of high-risk covariates with survival after adjuvant radiotherapy was evaluated using propensity score matching and multivariate analysis. RESULTS We identified 3197 patients, 321 (10.0%) underwent postoperative radiotherapy and 2876 (90.0%) underwent esophagectomy alone. In the unmatched cohort, postoperative radiotherapy was associated with a statistically significant but modest absolute decrease in survival outcomes (P < 0.001). In the matched cohort, the survival differences disappeared. Additionally, adjuvant radiotherapy was linked to a 5-year overall survival (OS) benefit for patients with the pT3-4N0 disease (34.8% vs. 27.7%; P = 0.008). Adjuvant radiotherapy for pT3-4N0 disease with tumor length ≥3 cm, adenocarcinoma, and evaluated lymph node count <12 was shown to independently function as a risk factor for improved OS, as per a multivariate analysis (P < 0.01). CONCLUSIONS This population-based trial showed that high-risk patients with pT3-4N0 esophageal cancer had better OS following upfront esophagectomy followed by radiotherapy therapy. This discovery may have major significance in the use of adjuvant radiotherapy following upfront esophagectomy in patients with pN0 esophageal cancer.
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Affiliation(s)
- Huijiang Gao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuanyong Wang
- Department of Thoracic Surgery, Tangdu Hospital of Air Force Military Medical University, Xi’an, China
| | - Zhihui Jiang
- Department of General Surgery, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Guodong Shi
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shiyu Hu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiangshan Ai
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaofeng Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yucheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Ju W, Zhang Y, Liu Y, Sun J, Li J, Dong M, Sun Q, Shi W, Zhao T, Zhou Z, Huang Y, Zhou X, Zhu D, Dou S, Zhang Z, He Y, Zhang C, Xia R, Zhu G, Zhong L. Can adjuvant radiotherapy be omitted for oral cavity cancer patients who received neoadjuvant therapy and surgery? A retrospective cohort study. Int J Surg 2023; 109:879-886. [PMID: 36999830 PMCID: PMC10389426 DOI: 10.1097/js9.0000000000000353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/09/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Surgery and postoperative adjuvant therapy comprise the standard treatment for locally advanced resectable oral squamous cell carcinoma (LAROSCC), while preoperative neoadjuvant therapy is being explored without sufficient confirmation of improved survival. De-escalation regimens after neoadjuvant therapy, such as those omitting adjuvant radiotherapy, may provide comparable or better outcomes, suggesting rigorous assessment of adjuvant therapy outcomes is needed in LAROSCC patients. The authors thus performed this retrospective study in LAROSCC patients who received neoadjuvant therapy and surgery, to compare the outcomes for overall survival (OS) and locoregional recurrence-free survival (LRFS) between the adjuvant radiotherapy (radio) and nonradiotherapy (nonradio) cohorts. MATERIALS AND METHODS Patients diagnosed with LAROSCC who received neoadjuvant therapy and surgery were enrolled and divided into radio and nonradio cohorts to determine whether adjuvant radiotherapy could be omitted after neoadjuvant therapy and surgery. RESULTS From 2008 to 2021, 192 patients were enrolled. No significant differences were found in OS or LRFS between the radio and nonradio patient cohorts. The 10-year estimated OS rates were 58.9 versus 44.1% in radio versus nonradio cohorts, while 10-year estimated LRFS rates were 55.4 versus 48.2%, respectively. For clinical stage III patients, 10-year OS rates were 62.3 versus 62.6% (radio vs. nonradio), and estimated 10-year LRFS rates were 56.5 versus 60.7% (radio vs. nonradio). Multivariate Cox regression modeling of postoperative variables showed pathologic response of primary tumor and pathologic regional lymph nodes staging were associated with survival, while the adjuvant radiotherapy exposure was not included in the model due to nonsignificance. CONCLUSION These findings support further prospective evaluation of adjuvant radiotherapy omission, and suggest that de-escalation trials are warranted for LAROSCC surgery patients who received neoadjuvant therapy.
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Affiliation(s)
- Wutong Ju
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Yiyi Zhang
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Ying Liu
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | | | | | | | | | - Wentao Shi
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University
| | - Tongchao Zhao
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Zhihang Zhou
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Yingying Huang
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Xinyu Zhou
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Dongwang Zhu
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Shengjin Dou
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Zhiyuan Zhang
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Yue He
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Chenping Zhang
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | | | - Guopei Zhu
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Laiping Zhong
- Departments of Oral and Maxillofacial-Head and Neck Oncology
- National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology
- Shanghai Research Institute of Stomatology, Shanghai, People’s Republic of China
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Dahbi Z, Elmejjabar R, Alami R, Kouhen F. Testicular Radiotherapy: A Challenging Irradiation Site. Cureus 2023; 15:e37638. [PMID: 37200663 PMCID: PMC10187590 DOI: 10.7759/cureus.37638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/20/2023] Open
Abstract
Testicular radiation therapy is a crucial component of the overall treatment of certain neoplasms. Yet, it remains challenging due to the unique anatomic location of the testicles, their specific radiation tolerance, and the lack of a standardized treatment workflow. In this article, we present the case of a 78-year-old patient with primary testicular lymphoma and describe the technical aspects of his radiation therapy. The challenge was to achieve a comfortable, reproducible, and effective treatment position while protecting the penis and covering the superficial layers of the scrotum. We used a total body restraint system and performed a second simulated CT scan with a bolus. The entire scrotum was delineated as the clinical target volume, with an additional 1 cm margin to obtain the planning target volume. This case highlights the importance of careful planning and personalized treatment approaches in testicular irradiation and underscores the need for further research and standardization in this complex irradiation site.
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Affiliation(s)
- Zineb Dahbi
- Radiotherapy, International University Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Reyzane Elmejjabar
- Radiotherapy, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Rim Alami
- Radiotherapy, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Fadila Kouhen
- Radiation Oncology, Mohammed VI University of Health Sciences, Casablanca, MAR
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Şendoğan F, Turan T, Keser F, Hancilar T, Atis G, Yildirim A. Oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer. Cent European J Urol 2023; 76:109-115. [PMID: 37483851 PMCID: PMC10357821 DOI: 10.5173/ceju.2023.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/28/2023] [Accepted: 02/12/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The aim of this study was to compare the long-term oncological results of patients with the diagnosis of prostate cancer who underwent open radical retropubic prostatectomy (RRP) and subsequent adjuvant (ART) or salvage radiotherapy (SRT). Material and methods A total of 145 patients underwent open RRP for prostate cancer and subsequent ART or SRT postoperatively between 2010 and 2019. ART (n = 56) is defined as the group of patients with prostate-specific antigen (PSA) <0.2 ng/mL or with positive lymph nodes without PSA increase who received radiotherapy within the first 6 months of urinary continence. SRT (n = 89) is defined as the group of patients with PSA >0.2 ng/mL who received RT before PSA amounted to 0.5 ng/mL. Results Statistically no significant difference was found between groups in terms of age, prostate volume, final pathology Gleason scores, lymphadenectomy, duration of androgen deprivation therapy (ADT), time to relapse after radiotherapy, development of biochemical recurrence and disease progression. Extraprostatic extension, seminal vesicle invasion and surgical margin positivity were significantly higher in the ART group. No difference was found between the groups in terms of biochemical recurrence-free survival, while cancer-specific survival and overall survival rates were significantly higher in the SRT group. Conclusions It was found that cancer-specific and overall survival was better in the SRT group. It will be more appropriate to follow-up until the recurrence and then to perform SRT after the relapse in the postoperative period.
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Affiliation(s)
- Furkan Şendoğan
- Department of Urology, Sisli Memorial Hospital, Istanbul, Turkey
| | - Turgay Turan
- Department of Urology, Turgutlu State Hospital, Manisa, Turkey
| | - Ferhat Keser
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Tayfun Hancilar
- Department of Radiation Oncology, Istanbul Okan University, Istanbul, Turkey
| | - Gokhan Atis
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
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Mazzini C, Vicini G, Di Leo L, Massi D, Rizzo S, Giansanti F. Anatomical and Functional Outcomes after Endoresection and Adjuvant Ruthenium Brachytherapy for Uveal Melanoma: A Single-Center Experience. Life (Basel) 2023; 13:902. [PMID: 37109431 PMCID: PMC10146230 DOI: 10.3390/life13040902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE To evaluate the anatomical and functional outcomes of endoresection and adjuvant ruthenium (Ru)-106 brachytherapy for uveal melanoma (UM). METHODS Retrospective case series of 15 UM patients (15 eyes) treated at our center (Careggi University Hospital, Florence). RESULTS Six patients (40%) were male and nine were female (60%). The mean age of patients at the time of treatment was 61.6 years (±19.41). The mean BCVA at baseline was 20/50. In all cases UM originated from the choroid. The mean tumor thickness at baseline was 7.14 mm (±2.05), and the mean largest basal diameter was 11.2 mm (±1.92). A concurrent retinal detachment was diagnosed in 11 patients (73.3%). Two patients (13.3%) showed vitreous seeding at baseline. Eleven patients (73.3%) were treated with primary endoresection, while four patients (26.7%) were treated with a "salvage endoresection" after primary treatment failure (previous radiation treatment). The mean follow-up time was 28.9 months (±10.6). Thirteen out of fifteen patients were alive and showed no evidence of local recurrence or distance metastasis at the last follow-up visit. The treatment achieved local control of the disease in 14 out of 15 cases (93.3%). In one case, the patient underwent enucleation for disease recurrence. The overall survival rate at the end of the follow-up was 93.3%. The mean BCVA at last follow-up visit was 20/40. Treatment was well tolerated, without significant complications. CONCLUSIONS Endoresection and adjuvant Ru-106 brachytherapy is a valuable conservative option for selected UM patients and can be used both as a primary treatment and as a salvage therapy. It can control melanoma and avoid enucleation, reduce radiation-related complications, and provide tumor tissue for chromosomal analysis and prognostic testing.
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Affiliation(s)
- Cinzia Mazzini
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
| | - Giulio Vicini
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Laura Di Leo
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Daniela Massi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, 50139 Florence, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
- Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy
| | - Fabrizio Giansanti
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
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Ishizawa C, Taguchi A, Tanikawa M, Honjo H, Nishijima A, Eguchi S, Miyamoto Y, Sone K, Tsuruga T, Mori M, Osuga Y. Effect of pelvic radiotherapy on patients with stage IB‑IIA cervical cancer after radical hysterectomy: A single‑center retrospective study. Oncol Lett 2023; 25:112. [PMID: 36817060 PMCID: PMC9932628 DOI: 10.3892/ol.2023.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
The effects of post-operative adjuvant radiotherapy (RT) on intermediate-risk patients with cervical cancer have not been fully elucidated. Therefore, the present study aimed to investigate the impact of RT on intermediate-risk cervical cancer. The data of 112 patients with stage IB and IIA cervical cancer treated with radical hysterectomy between January 2009 and December 2018 were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), and the frequency of adverse events were compared between patients with and without adjuvant RT (RT+ and RT-, respectively). Subgroup analyses of PFS based on tumor size, cervical stromal invasion, lymphovascular space invasion and histology [squamous cell carcinoma (SCC) vs. non-SCC] were performed. Among the 112 patients, 41 received adjuvant RT. Although there were no significant differences in OS or PFS between the RT+ and RT- groups, the frequency of adverse events was much higher in the RT+ group. Patients in the RT+ group also had more recurrent risk factors than those in the RT- group. Based on the subgroup analyses, although no significant differences were observed between any of the groups, RT demonstrated a different impact on PFS between SCC and non-SCC: No difference was observed in the SCC group, whereas patients in the RT+ group tended to have poorer prognoses compared to those in the RT- group of the non-SCC group. These results suggest that the impact of post-operative RT on stage IB and IIA cervical cancer is limited and is accompanied by increased adverse events. The eligibility of patients for post-operative RT should be carefully determined based on the therapeutic effect of RT in each subgroup.
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Affiliation(s)
- Chihiro Ishizawa
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Ayumi Taguchi
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan,Correspondence to: Dr Ayumi Taguchi, Department of Obstetrics and Gynecology, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan, E-mail:
| | - Michihiro Tanikawa
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Harunori Honjo
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Akira Nishijima
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Satoko Eguchi
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Yuichiro Miyamoto
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Tetsushi Tsuruga
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Mayuyo Mori
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo Hospital, Tokyo 113-8655, Japan
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Li B, Liu J, Wu G, Zhu Q, Cang S. Evaluation of adjuvant therapy for T1-2N1miM0 breast cancer without further axillary lymph node dissection. Front Surg 2023; 9:905437. [PMID: 36684123 PMCID: PMC9852515 DOI: 10.3389/fsurg.2022.905437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/12/2022] [Indexed: 01/09/2023] Open
Abstract
Background For breast cancer (BC) with sentinel lymph node micrometastases (SLNMs), there are limited data to guide the selection of postoperative adjuvant therapy. This study aimed to identify target populations who might benefit most from adjuvant therapy and examine prognostic factors among patients with T1-2N1miM0 BC with one or two SLNMs who underwent sentinel lymph node biopsy (SLNB) alone. Methods There were 7,423 patients diagnosed with T1-2N1miM0 BC between 2010 and 2015, and patients with one or two SLNMs were extracted from the Surveillance, Epidemiology, and End Results database. All the patients underwent SLNB alone without further axillary lymph node dissection, and they were stratified according to adjuvant therapy. The statistical significance of categorical variables was analyzed using the χ 2 test. Univariable and multivariable Cox analyses were used to analyze characteristics predictive of Breast-cancer-specific survival and overall survival (OS). Kaplan-Meier methods with the log-rank test was analyzed to compare survival difference between the different treatments. Results Adjuvant chemotherapy and radiotherapy improved 5-year OS rates. Multivariate analysis revealed that age ≥70 years, high grade, T2 stage, triple-negative subtype, and absence of radiotherapy were poor prognostic factors for OS. Patients who received breast-conserving surgery (BCS), and those with invasive ductal carcinoma (IDC), luminal A, luminal B, or basal-like subtype, and T1c or T2 stage benefited from adjuvant radiotherapy. Patients who received BCS, and those with IDC, luminal A subtype, and T1b, T1c, or T2 stage benefited from adjuvant chemotherapy. Conclusion Our findings provide a clinical evaluation of treatment choice after surgery, which may help clinicians make individualized clinical decisions.
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Affiliation(s)
- Baiyu Li
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou, China,Department of Oncology, People's Hospital of Zhengzhou University, Zhengzhou, China,Department of Oncology, People's Hospital of Henan, University, Zhengzhou, China
| | - Jianbo Liu
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou, China,Department of Oncology, People's Hospital of Zhengzhou University, Zhengzhou, China,Department of Oncology, People's Hospital of Henan, University, Zhengzhou, China
| | - Guangyin Wu
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou, China,Department of Oncology, People's Hospital of Zhengzhou University, Zhengzhou, China,Department of Oncology, People's Hospital of Henan, University, Zhengzhou, China
| | - Qingyao Zhu
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou, China,Department of Oncology, People's Hospital of Zhengzhou University, Zhengzhou, China,Department of Oncology, People's Hospital of Henan, University, Zhengzhou, China,Correspondence: Shundong Cang Qingyao Zhu
| | - Shundong Cang
- Department of Oncology, Henan Provincial People's Hospital, Zhengzhou, China,Department of Oncology, People's Hospital of Zhengzhou University, Zhengzhou, China,Department of Oncology, People's Hospital of Henan, University, Zhengzhou, China,Correspondence: Shundong Cang Qingyao Zhu
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Argalácsová S, Křížová Ľ, Matějů M, Svobodová D, Vočka M. Radiation-Induced Lymphopoenia and Treatment Outcome in Hereditary Breast Cancer Patients. Folia Biol (Praha) 2023; 69:91-98. [PMID: 38206774 DOI: 10.14712/fb2023069030091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Many breast cancer (BC) predisposition genes encode proteins involved in DNA damage repair (DDR). Identification of germline pathogenic va-riants (PV) in DDR genes raises the question whether their presence can influence the treatment outcomes and potential radiation-induced toxicity in their carriers treated by adjuvant radiotherapy, which has not yet been answered conclusively. We retrospectively examined records of 213 BC patients treated by adjuvant radiotherapy, including 39 (18.3 %) BRCA1/2 PV carriers, 25 carriers (11.7 %) of PV in other breast cancer-predisposing genes, and 149 (70 %) non-carriers. Our goal was to examine 5-year disease-free survival (5y DFS) rates among the study groups and determine the impact of radiotherapy-induced lymphopoenia (RIL) on this outcome. While we found no significant difference in 5y DFS between non-carriers and carriers of BRCA mutations (86.4 % vs 78.4 % P = 0.24) or between non-carriers and other studied mutations (86.4 % vs 93.3 %; P = 0.27), respectively, we observed that the entire group of PV carriers had a significantly lower proportion of patients without RIL (P = 0.04) than the non-carriers. In contrast, subsequent analyses indicated a non-significant trend toward an increased 5y DFS in PV carriers with RIL. Our single-centre study indicated that the presence of PV in BC patients has an insignificant impact on DFS but can reduce the risk of RIL associated with adjuvant radiotherapy. It remains unclear whether this may result from the paradoxical activation of anti-tumour immunity in PV carriers with higher lymphocyte consumption resulting from higher immune effectiveness.
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Affiliation(s)
- Soňa Argalácsová
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
| | - Ľudmila Křížová
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Martin Matějů
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Dominika Svobodová
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Michal Vočka
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
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Li XF, Ma RQ, Wu X, Gan L, Peng ZY, Qian J. Adjuvant therapy for orbital non-rhabdomyosarcoma soft tissue sarcoma: comparison of long-term outcome between radiotherapy and chemotherapy. Int J Ophthalmol 2023; 16:402-410. [PMID: 36935785 PMCID: PMC10009604 DOI: 10.18240/ijo.2023.03.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/12/2023] [Indexed: 03/06/2023] Open
Abstract
AIM To illustrate clinicopathological features of orbital non-rhabdomyosarcoma soft tissue sarcoma (NRSTS), and to compare the treatment outcome between postoperative radiotherapy (RT) and chemotherapy in a retrospective analysis nearly 20y. METHODS A retrospective cohort study of 56 patients with orbital NRSTS were reviewed, 34 of whom received postoperative RT, and 22 received postoperative chemotherapy. The clinicopathological features, local recurrence, metastases, and survival data were recorded. Survival analysis was performed using the Kaplan-Meier method. RESULTS During follow-up (111.8mo, ranged 8-233mo) for 56 patients, 19 patients of them developed local recurrence, and 7 patients developed distant metastases. Fifteen patients died during follow-up period. Overall survival rates considering the whole study group was 78.57% at 5y, and 72.16% at 10y after the initial diagnosis. Compared with chemotherapy, RT was associated with lower risk of local recurrence [hazard ratio for RT vs chemotherapy, 0.263, 95% confidence interval (CI), 0.095-0.728, P=0.0015]; with lower risk of distant metastasis (hazard ratio for RT vs chemotherapy, 0.073, 95%CI, 0.015-0.364, P=0.0014); and with lower risk of death from disease (hazard ratio for RT vs chemotherapy, 0.066, 95%CI, 0.022-0.200, P<0.0001). The 5-year survival rate in RT group was 97.06% compared to 50% in chemotherapy group. CONCLUSION In patients with orbital NRSTS, postoperative RT provides better control of local recurrence, distant metastasis, and death from disease than chemotherapy. RT is the more preferrable adjuvant therapy compared to chemotherapy possibly.
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Affiliation(s)
- Xiao-Feng Li
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200031, China
| | - Rui-Qi Ma
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200031, China
| | - Xue Wu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lu Gan
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200031, China
| | - Zhi-Yu Peng
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200031, China
| | - Jiang Qian
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai 200031, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai 200031, China
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Gao RW, Routman DM, Harmsen WS, Ebrahimi S, Foote RL, Ma DJ, Neben-Wittich M, McGee LA, Patel SH, Moore EJ, Choby GW, Tasche KK, Price KA, Gamez ME, Lester SC. Adenoid cystic carcinoma of the head and neck: Patterns of recurrence and implications for intensity-modulated radiotherapy. Head Neck 2023; 45:187-196. [PMID: 36222355 DOI: 10.1002/hed.27223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We seek to inform radiotherapy (RT) delivery for adenoid cystic carcinoma of the head and neck (ACC) by evaluating RT techniques and recurrence patterns. METHODS We identified patients with ACC treated with curative-intent RT from 2005 to 2021. Imaging was reviewed to determine local recurrence (LR). RESULTS Ninety-one patients were included. The 5-year LR risk was 12.2% (6.6-22.7). One patient each experienced a marginal and out-of-field recurrence. Patients receiving >60 Gy postoperatively had a 5-year LR risk of 0% compared to 10.7% (4.2-27.2) with ≤60 Gy. Those receiving 70 and <70 Gy definitively had a 5-year LR risk of 15.2% (2.5-91.6) and 33.3% (6.7-100.0), respectively. No patients had regional nodal failure. CONCLUSIONS Modern, conformal RT for ACC results in low rates of LR. Doses >60 and 70 Gy may improve control in the postoperative and definitive settings, respectively. Elective nodal treatment can be omitted in well-selected patients.
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Affiliation(s)
- Robert W Gao
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - William S Harmsen
- Department of Biostatistics & Information, Mayo Clinic, Rochester, Minnesota, USA
| | - Sasha Ebrahimi
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Eric J Moore
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret W Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall K Tasche
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine A Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mauricio E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Kolářová I, Melichar B, Vaňásek J, Sirák I, Petera J, Horáčková K, Pohanková D, Šinkorová Z, Hošek O, Vošmik M. Special Techniques of Adjuvant Breast Carcinoma Radiotherapy. Cancers (Basel) 2022; 15. [PMID: 36612294 DOI: 10.3390/cancers15010298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Modern radiotherapy techniques are designed to permit reduced irradiation of healthy tissue, resulting in a diminished risk of adverse effects and shortened recovery times. Several randomized studies have demonstrated the benefits of increased dosage to the tumor bed area in combination with whole breast irradiation (WBI). Conventional WBI treatment following breast-conserving procedures, which required 5-7 weeks of daily treatments, has been reduced to 3-4 weeks when using hyperfractionated regimens. The dosage administration improves local control, albeit with poorer cosmesis. The method of accelerated partial breast irradiation (APBI) shortens the treatment period whilst reducing the irradiated volume. APBI can be delivered using intraoperative radiation, brachytherapy, or external beam radiotherapy. Currently available data support the use of external beam partial breast irradiation in selected patients. Modern radiotherapy techniques make it possible to achieve favorable cosmesis in most patients undergoing immediate breast reconstruction surgery, and studies confirm that current methods of external beam radiation allow an acceptable coverage of target volumes both in the reconstructed breast and in the regional lymphatic nodes.
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Bandyopadhyay A, Ghosh AK, Chhatui B, Bagchi B, Das D, Choudhury A, Rahamatulla S. Pattern of locoregional failure in postoperative cases of locally advanced carcinoma of buccal mucosa treated with unilateral versus bilateral neck radiation: lesson learned from a basic practice setup. Rep Pract Oncol Radiother 2022; 27:990-1000. [PMID: 36632292 PMCID: PMC9826651 DOI: 10.5603/rpor.a2022.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/28/2022] [Indexed: 12/12/2022] Open
Abstract
Background Carcinoma of buccal mucosa forms a sizeable percentage of the diagnosed oral cavity cancers in India. There is limited data on elective treatment of the contralateral neck for well-lateralized carcinoma with no involved nodes in the contralateral neck. We conducted this study to compare locoregional control in patients treated with unilateral vs. bilateral neck irradiation. Materials and methods 48 patients with carcinoma of buccal mucosa were selected. Patients were divided into unilateral and bilateral arms based on radiation treatment of the ipsilateral or bilateral neck. All patients received adjuvant radiation with Cobalt 60 unit. Patient-specific and follow-up data were collected from records and dosimetric data from treatment planning system (TPS). Chi-square and unpaired t-test was used to compare data between arms and Kaplan Meier plot; Cox regression was used for survival analysis. Results After a median follow-up of 23 months, 15 (31.3%) patients had developed disease recurrence, 8 and 7 in the unilateral and bilateral arms, respectively (p = 0.591). There was no contralateral neck failure during the follow-up period. The 2-year disease-free survival was 68.2% and 72.2% in the unilateral and bilateral arms, respectively. Among risk factors for disease recurrence, depth of invasion (DOI), delay in starting radiation and planning target volume (PTV) coverage were significant contributing factors. Cox multivariate regression suggested DOI and delay in starting radiation to be significant prognostic factors for disease-free survival (DFS). Conclusion Bilateral neck radiation does not provide any advantage over ipsilateral neck radiation for properly selected well lateralized buccal mucosal squamous cell carcinoma. Ipsilateral neck radiation facilitates better sparing of organs at risk.
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Affiliation(s)
- Anis Bandyopadhyay
- Department of Radiotherapy, Nil Ratan Sarkar Medical College and Hospital, Kolkata, India
| | | | | | - Bidisha Bagchi
- Department of Radiotherapy, Medical College Kolkata, India
| | - Dhiman Das
- Siliguri District Hospital, Darjeeling, India
| | | | - Sk Rahamatulla
- Department of Radiotherapy, Medical College Kolkata, India
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47
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Zalay O, Yan M, Sigurdson S, Malone S, Vera-Badillo FE, Mahmud A. Adjuvant Radiotherapy for Upper Tract Urothelial Carcinoma: Systematic Review and Meta-Analysis. Curr Oncol 2022; 30:19-36. [PMID: 36661651 PMCID: PMC9858283 DOI: 10.3390/curroncol30010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Upper tract urothelial carcinoma (UTUC) is a rare form of malignancy comprising only 5% of urothelial cancers. The mainstay of treatment is radical nephroureterectomy (RNU) with bladder cuff excision. Neoadjuvant or adjuvant chemotherapy is often used in locally advanced disease. The role of adjuvant radiotherapy (RT), however, remains controversial. To further explore the potential role of adjuvant RT, we performed a systematic review and meta-analysis of the literature from 1990 to present. METHODS AND MATERIALS We identified 810 candidate articles from database searches, of which 67 studies underwent full-text review, with final inclusion of 20 eligible studies. Among the included studies, there were no randomized controlled trials and a single prospective trial, with the remainder being retrospective series. We performed quantitative synthesis of the results by calculating the pooled odds ratios (OR) for the primary outcome of locoregional recurrence (LRR) and secondary outcomes of overall survival (OS), cancer-specific survival (CSS) and distant recurrence (DR). RESULTS Adjuvant RT, which was mostly prescribed for locally advanced or margin-positive disease following RNU, significantly reduced locoregional recurrence risk OR 0.43 (95% CI: 0.23-0.70), and the effect remained significant even following subgroup analysis to account for adjuvant systemic therapy. The effect of adjuvant RT on 3-year OS, 5-year CSS and DR was non-significant. However, 5-year OS was unfavourable in the adjuvant RT arm, but study heterogeneity was high, and analysis of small-study effects and subgroups suggested bias in reporting of outcomes. CONCLUSIONS Adjuvant RT in the setting of locally advanced UTUC improves locoregional control following definitive surgery, but does not appear to improve OS. Higher-quality studies, ideally randomized controlled trials, are needed to further quantify its benefit in this setting, and to explore multi-modal treatments that include systemic agents given concomitantly or sequentially with RT, which may offer an OS benefit in addition to the locoregional control benefit of RT.
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Affiliation(s)
- Osbert Zalay
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Michael Yan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada
| | - Samantha Sigurdson
- Department of Oncology, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Shawn Malone
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Francisco Emilio Vera-Badillo
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
- Canadian Cancer Trials Group, Queen’s Cancer Research Institute, Kingston, ON K7L 2V5, Canada
| | - Aamer Mahmud
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada
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48
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Ryu H, Wu HG, Lee KE, Chung EJ, Ahn SH, Park YJ, Choi HS. Effect of postoperative radiotherapy for patients with differentiated thyroid cancer. Clin Endocrinol (Oxf) 2022; 98:803-812. [PMID: 36535908 DOI: 10.1111/cen.14865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We evaluated the efficacy and safety of postoperative radiotherapy (PORT) for differentiated thyroid cancer (DTC) with high risk features. MATERIALS AND METHODS This retrospective study analyzed 187 patients treated for DTC from 1985 to 2019. DTC referred to nonanaplastic thyroid cancer originating from follicular cells. PORT was defined as the administration of external beam radiation to the thyroid and regional lymph nodes following surgery for initially diagnosed DTC. The patients were included in the analysis if they received PORT or exhibited any of the following features: (a) pT4 or pN1b according to the 8th American Joint Committee on Cancer, (b) poorly differentiated thyroid cancer (PDTC), or (c) unfavourable variants such as anaplastic foci and etc. After 1:1 propensity matching, a total of 108 patients were analyzed according to PORT receipt. The median follow-up duration of the matched group was 10.4 years. RESULTS After matching, most of the variables became balanced, but the PORT group still had more PDTC and DTC with anaplastic foci. Radioactive iodine (RAI) was less frequently administered in the PORT group. PORT yielded a significantly higher 5-year locoregional recurrence free survival (LRFS) than the No PORT group (5-year LRFS 86.1% vs. 72.7%, p = 0.022), but the 10-year cancer specific survival (CSS) was similar between them (97.8% vs. 85.9%, p = 0.122). The multivariable analysis indicated that PORT was a favourable prognostic factor (Hazard ratio 0.3, 95% Confidence interval 0.1-0.8, p = 0.02) for LRFS, but not for CSS. Among 133 patients without PORT for initial disease, 39 of them received salvage surgery followed by salvage PORT. No severe toxicity after PORT was reported. CONCLUSION PORT reduced locoregional recurrence in DTC patients without severe toxicity. PORT can be an effective and safe treatment to improve locoregional control in DTC with high risk features. However, further study is warranted to identify those who can benefit from PORT.
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Affiliation(s)
- Hyejo Ryu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Center, Institute of Radiation Medicine, Seoul National University, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Chungang University Gwangmyeong Hospital, Gyeong-gi, Korea
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49
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Vinh-Hung V, Gorobets O, Adriaenssens N, Van Parijs H, Storme G, Verellen D, Nguyen NP, Magne N, De Ridder M. Lung-Heart Outcomes and Mortality through the 2020 COVID-19 Pandemic in a Prospective Cohort of Breast Cancer Radiotherapy Patients. Cancers (Basel) 2022; 14. [PMID: 36551726 DOI: 10.3390/cancers14246241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
We investigated lung-heart toxicity and mortality in 123 women with stage I-II breast cancer enrolled in 2007-2011 in a prospective trial of adjuvant radiotherapy (TomoBreast). We were concerned whether the COVID-19 pandemic affected the outcomes. All patients were analyzed as a single cohort. Lung-heart status was reverse-scored as freedom from adverse-events (fAE) on a 1-5 scale. Left ventricular ejection fraction (LVEF) and pulmonary function tests were untransformed. Statistical analyses applied least-square regression to calendar-year aggregated data. The significance of outliers was determined using the Dixon and the Grubbs corrected tests. At 12.0 years median follow-up, 103 patients remained alive; 10-years overall survival was 87.8%. In 2007-2019, 15 patients died, of whom 11 were cancer-related deaths. In 2020, five patients died, none of whom from cancer. fAE and lung-heart function declined gradually over a decade through 2019, but deteriorated markedly in 2020: fAE dipped significantly from 4.6-4.6 to 4.3-4.2; LVEF dipped to 58.4% versus the expected 60.3% (PDixon = 0.021, PGrubbs = 0.054); forced vital capacity dipped to 2.4 L vs. 2.6 L (PDixon = 0.043, PGrubbs = 0.181); carbon-monoxide diffusing capacity dipped to 12.6 mL/min/mmHg vs. 15.2 (PDixon = 0.008, PGrubbs = 0.006). In conclusion, excess non-cancer mortality was observed in 2020. Deaths in that year totaled one-third of the deaths in the previous decade, and revealed observable lung-heart deterioration.
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50
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Han W, Chang X, Zhang W, Yang J, Yu S, Deng W, Ni W, Zhou Z, Chen D, Feng Q, Liang J, Hui Z, Wang L, Gao S, Lin Y, Chen X, Chen J, Xiao Z. Effect of Adjuvant Radiation Dose on Survival in Patients with Esophageal Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14235879. [PMID: 36497360 PMCID: PMC9736548 DOI: 10.3390/cancers14235879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background: For patients with esophageal squamous cell carcinoma (ESCC) treated with surgery alone, the incidence of local-regional recurrence remains unfavorable. Postoperative radiotherapy (PORT) has been associated with increased local-regional recurrence-free survival (LRFS), although its application is limited by concerns of PORT-related toxicities. Methods: Among 3591 patients with ESCC analyzed in this study, 2765 patients with T3-4N0 and T1-4N1-3 lesions and specific local-regional status information were analyzed in a subsequent analysis of adjuvant radiation dose (aRTD) effect. Application of the restricted cubic spline regression model revealed a non-linear relationship between aRTD and survival/radiotoxicity. Linear regression analysis (LRA) was performed to evaluate correlations between LRFS and overall survival (OS)/ disease-free survival (DFS). Results: For patients staged T1−2N0, T1−2N1−3, T3−4N0, and T3−4N1−3, 5-year OS in PORT and non-PORT groups were 77.38% vs. 72.91%, p = 0.919, 52.35% vs. 46.60%, p = 0.032, 73.41% vs. 61.19%, p = 0.005 and 38.30% vs. 25.97%, p < 0.001. With aRTD escalation, hazard ratios (HRs) of OS/DFS declined until aRTD exceeded 50Gy, then increased, whereas that of LRFS declined until aRTD exceeded 50 Gy, then remained steady. HR of treatment-related mortality was stable until aRTD exceeded 50 Gy, then increased. LRA revealed strong correlations between LRFS and OS/DFS (r = 0.984 and r = 0.952, respectively). An absolute 1% advancement in LRFS resulted in 0.32% and 0.34% improvements in OS and DFS. Conclusions: An aRTD of 50Gy was well-tolerated, with favorable survival resulting from PORT-related LRFS improvement in patients staged T3−4N0 or T1-4N1−3. Further stratification analyses based on tumor burden would help determine potential PORT-beneficiaries.
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Affiliation(s)
- Weiming Han
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao Chang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Wencheng Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jingsong Yang
- Department of Radiation Oncology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shufei Yu
- Department of Radiation Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wei Deng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Wenjie Ni
- Department of Radiation Oncology, Beijing Shijitan Hospital, Capital Medical University, Ninth School of Clinical Medicine, Beijing 100038, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lvhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu Lin
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Xiaohui Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Junqiang Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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