Adjuvant postoperative radiation therapy for colonic carcinoma.

During the period 1971 to 1985, 220 patients with soft tissue sarcoma of the extremities, torso, and head-neck region were managed by radiation and resectional surgery at the Massachusetts General Hospital (MGH). Actuarial 5-year local control and disease-free survival rates were 86% and 70%, respectively. The success rate improved during this time period. Namely, the local control rates for 1971 to 1975, 1976 to 1980, and 1981 to 1985 were 81%, 81%, and 94%, respectively. For the same time periods, the 5-year disease-free survival rates were 64%, 70%, and 76%. One hundred thirty-one patients were treated with postoperative radiation, and 89 with preoperative radiation. In the most recent 5-year period, the local control rates were 91% and 97% for the two groups (number of patients being 50 and 57 in the post- and preoperative groups, respectively). Treatment by preoperative radiation appears to have a major advantage for patients with very large sarcomas, ie, greater than 15 cm in maximum dimension. None of our patients with local control of grade 1 sarcoma have developed distant metastasis (DM). In contrast, among patients with grade 2 or 3 sarcomas, there is a relentless and progressive increase in the frequency of DM with size of the primary lesion, namely, 6% at less than or equal to 2.5 cm, congruent to 60% at 15 to 20 cm, and congruent to 80% at greater than 20 cm.

2438: Relationship Between Primary Tumor Volume and Radiotherapeutic Outcome in Nasopharyngeal Carcinoma

Long-term Results of Intraoperative Radiation Therapy in the Management of Soft Tissue Sarcoma

Hypofractionated Accelerated Radiotherapy With Concurrent Chemotherapy For Locally Advanced Squamous Cell Carcinoma of the Head and Neck

Objective: We compared the influence of postoperative adjuvant chemotherapy with oral anticancer drugs (S-1 or uracil-tegafur [UFT]) and the influence of surgery alone on overall survival (OS) and disease-free survival (DFS) in patients with biliary tract cancer. Methods: This retrospective study included 108 patients with gallbladder cancer (n=22) or bile duct cancer (n=86), who underwent curative resection. The patients were divided into surgery alone (n=58), UFT (n=39; 400 mg/m2/day), and S-1 groups (n=11; 80 mg/m2, days 1–28, twice daily), and outcomes and adverse effects were compared. Results: The 2-year DFS rate was significantly higher in the S-1 group than in the surgery alone group for all patients (72.7% vs. 32.8%, p=0.046). For the patients with gallbladder cancer, the 2-year OS and DFS rates were significantly higher in the UFT group than in the surgery alone group (36.4% vs.0%, p=0.033 and 27.4% vs. 0% p=0.032, respectively; log-rank test). For patients with lymph node metastasis, the 2-year OS and DFS rates were significantly higher in the S-1 group than in the surgery alone group (71.4% vs. 18.2%, p=0.039 and 71.4% vs. 18.2%, p=0.026, respectively) Conclusion: Postoperative adjuvant chemotherapy might improve both the OS and DFS rates, particularly in patients with gallbladder cancer and those with biliary tract cancer and lymph node metastasis.

Background: Egyptian hospital–based statistics showed that head & neck carcinomas represent 18% of all cancers and mostly diagnosed at advanced stages. Our Clinical Oncology & Nuclear Medicine Department of Mansoura Faculty of Medicine serves a large rural area of the Delta region of Egypt. There is no previous study in our institution that focused on oral tongue carcinoma alone. This study aims in establishing the demographics, treatment outcome and prognostic factors of oral tongue squamous cell carcinoma (SCC).Methods: We retrospectively reviewed data of 50 cases with oral tongue SCC treated in our department from January 2014 to December 2016 to evaluate the demography, pathological characteristics, and therapeutic modalities. We estimated the survival rates during the entire follow-up period by the Kaplan–Meier method. The univariate and multivariate Cox proportional hazards analysis were performed for prognostic factors determination.Results: The median follow-up was 30 months (range: 4-45 months). The 3-year overall survival (OS) and disease-free survival (DFS) rates were 68% and 60% respectively. By univariate analysis, both advanced stages (III, IVA) and depth of invasion >0.5 cm were statistically significant as prognostic factors for 3-year DFS and OS rates. DFS rates were 34% vs. 98% for stage III and IVA vs. stage I and II respectively (p = 0.001); 52% vs. 78% for >0.5 cm vs. ≤0.5 cm depth of invasion (p = 0.003). OS rates were 36% vs. 99% for stage III and IVA vs. stage I and II respectively (p = 0.002); 52% vs. 80% for >0.5 cm vs. ≤0.5 cm depth of invasion (p = 0.001). Multivariate analysis of prognostic factors affecting 3-year DFS and OS rates confirmed the statistical significance of the same 2 factors.Conclusions: The majority of our patients were males below 60 years. Tumors were mainly found at stage III and were moderately differentiated. Vascular invasion and lymphatic permeation were uncommon. Staging and tumor invasion depth significantly affected the outcome. The 3-year OS and DFS were 68% and 60% respectively.

Objective To compare the efficacy between different modalities in the treatment of positive lymph nodes after radical resection for squamous cell carcinoma of thoracic esophagus (TESCC), and to explore the best treatment mode. The Kaplan-Meier method was used to calculate survival rates. The log-rank test and Cox model were used for univariate and multivariate prognostic analyses, respectively. Methods A retrospective analysis was performed among 548 patients with TESCC who were admitted to our hospital and had positive lymph nodes after radical resection. The efficacy of different treatment methods was evaluated. Propensity scores (PSM) were used to make 1-to-1 patient matching between different treatment groups to further analyze and figure out the best treatment model for patients. The Kaplan-Meier method was used to calculate the overall survival (OS) and disease-free survival (DFS) rates. The log-rank test was used for survival analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results In all patients, the 1-, 3-, and 5-year OS rates were 79.9%, 38.1% and 28.5%, respectively, while the 1-, 3-, and 5-year DFS rates were 68.5%, 39.8% and 32.5%, respectively. After 1-to-1 matching based on PSM, there were no differences in general clinical pathological data between the four groups. After PSM, there were significant differences in 1-, 3-, and 5-year OS and DFS rates between the surgery alone group, the postoperative radiotherapy group, the postoperative chemotherapy group, and the postoperative chemoradiotherapy (POCRT) group (P=0.000, 0.000). There were significant differences in OS and DFS rates between patients with stage N1, N2, and N3 disease (P=0.000, 0.000). The result of the Cox multivariate analysis showed that treatment method and N staging were two independent prognostic factors for OS and DFS (P=0.001, 0.000, 0.025, 0.016). Conclusions Patients with positive lymph nodes after radical resection for TESCC have a poor prognosis. Moreover, the prognosis becomes worse with the increase in metastatic lymph nodes. POCRT may improve the survival in those patients. Prospective studies are needed to further confirm those conclusions. Key words: Esophageal neoplasms/surgery; Esophageal neoplasms/postoperative adjuvant therapy; Prognosis; Propensity score matching

Tumor Volume as Outcome Predictor in Chemoradiation for Advanced Head and Neck Cancer

To compare the therapeutic effects of surgical hepatic resection (HR) and radiofrequency ablation (RFA) in treatment of primary hepatocellular carcinoma of 3-5 cm in diameter. The databases PubMed, CBMdisc, CNKI, WanFang Data and VIP databases were searched for controlled clinical trials on evaluating the efficacy between RFA and HR in treatment of primary hepatocellular carcinoma of 3-5 cm in diameter published from January 1990 to February 2014. Two reviewers independently screened the literature, extracted the data and assessed the methodological quality of the studies included. Then the meta-analysis was performed by using RevMan5.0 software. Eleven controlled clinical trials were included, including one randomized controlled trial and 10 non-randomized controlled trials. A total of 811 patients were involved: 404 patients were treated with RFA as the initial treatment and 407 patients with surgical resection. Meta-analysis showed that for a single lesion with diameter of 3-5 cm of primary hepatocellular carcinoma, the 3-， 5-year disease-free survival rates in HR group was significantly higher than those in RFA group (all P<0.05). There were no significant difference in the 1-， 3-， 5-year overall survival rates and 1-year disease-free survival rate between RFA group and HR group (P>0.05). For 1-2 nodules with diameters of 3-5 cm of primary hepatocellular carcinoma, the 3-， 5-year disease-free survival rates and 5-year overall survival rates in HR group was significantly higher than those in RFA group (all P<0.05). No significant difference in 1-， 3-year overall survival rates and 1-year disease-free survival rate was found between RFA group and HR group (P>0.05). For maximum nodule of 3-5 cm of multiple primary hepatocellular carcinoma, the 5-year overall survival rates in HR group was significantly higher than that in RFA group (all P<0.05). No significant difference in 1-， 5-year overall survival rates was noted between RFA group and HR group (P>0.05). For primary hepatocellular carcinoma of 3-5 cm in diameter, HR is better than RFA. For the limitation of quality and quantity of included studies, this conclusion needs to be confirmed by more high quality studies.

Tumor-induced acute intestinal obstruction is a severe complication that poses significant threats to patient life. Emergency surgery is a widely used treatment method, but this approach has certain limitations such as high mortality and complication rates. Developments in endoscopic and minimally invasive techniques have provoked interest in postoperative definitive resection or conservative treatment following colorectal stent placement. Hence, this study aims to explore the clinical efficacy and safety of endoscopic-guided, X-ray-assisted intestinal stent placement in colorectal cancer (CRC) with acute intestinal obstruction, and to provide clinicians with viable alternative treatment options to enhance patient care. This study included 69 CRC patients who received treatment at the Affiliated Jinhua Hospital, Zhejiang University School of Medicine, China, between August 2017 and August 2021. The control group (n = 38) underwent emergency laparotomy with one-stage resection and stoma formation, followed by a postoperative second-stage stoma closure every 3 to 6 months. Moreover, the experimental group (n = 31) underwent endoscopic stent placement followed by definitive surgery. The differences in various indicators were compared between groups. Additionally, the 1-year and 3-year overall survival (OS) rates and disease-free survival (DFS) rates were compared between groups. Successful placement of intestinal stents was achieved in all 31 patients, with acute intestinal obstruction relief within 24 to 48 hours. In the experimental group, stent placement effectively relieved intestinal obstruction, and a postoperative radical colon surgery was performed after 7 to 10 days. The experimental group had significantly lower rates of postoperative ventilator time, reduced time to oral intake, and fewer complication than the control group (p < 0.05). However, no significant differences were observed between groups regarding operation time, intraoperative blood loss, 1-year and 3-year OS rates, and 1-year and 3-year DFS rates (p > 0.05). Compared to emergency surgery, combined endoscopic and X-ray-guided colonic stent placement is an effective and safer method for alleviating acute intestinal obstruction in colorectal cancer. This study provides valuable insights to clinicians in selecting treatment options.

Between 1991 and 1993 we conducted a collaborative trial in adult acute lymphoblastic leukaemia, introducing an idarubicin (IDA)-containing regimen for induction and early consolidation, and increasing consolidation intensity with an autologous bone marrow transplantation phase (ABMT, patients aged <51 years) followed by further chemotherapy for 12 weeks and low-dose maintenance for 6 months (ABMT patients) or 18 months. 96 patients were evaluable for antileukaemic response after induction with vincristine-prednisone-L-asparaginase plus cumulative IDA 36 or 20 mg/m2 (IVAP-1 and IVAP-2), and for disease-free survival (DFS) after a minimum follow-up >3.5 years with an off-therapy interval >1.5 years. The response rate was 44% (7/16) with IVAP-1 and 90% (72/80) with IVAP-2 (P=0.0001), due to regimen-related toxicities. Post-remission therapy was administered as planned to most cases but protocol violation was registered in some patients eligible to ABMT and post-graft chemotherapy. The 5-year disease-free survival (DFS) rate was 31%. Multivariate analysis indicated that DFS was improved in patients receiving a transplant (11 allogeneic, DFS 70%; 32 ABMT, 36%; 37 neither, 17%; P < 0.001) and was negatively affected by high-risk features such as blast cell count >25x10(9)/l, T-cell or mature B-cell immunophenotype, and t(9;22)/t(4;11) (all P values <0.05). The 5-year DFS rate was 54% for 26 patients with no high-risk factor, 26% for 35 patients with any one, and 6% for 18 patients with any two (P<0.005). IVAP-2 brought about a high complete response rate and post-remission treatment including ABMT was feasible and modestly toxic. In spite of the short post-graft chemotherapy phase, the long-term DFS rate was good in cases with no high-risk feature. However, because autografting may be redundant in the standard-risk category, its role requires further investigation for high-risk cases.

Excellent Outcomes and Orbital Preservation for Advanced T4 Sinonasal Cancers Using Combined Chemotherapy, Intensity Modulated Radiation Therapy, and Surgery: Definitive Management of Head-and-Neck Squamous Cell Carcinoma

Low local recurrence rate without postmastectomy radiation in node-negative breast cancer patients with tumors 5 cm and larger

Objective To compare the efficacy between californium-252(252Cf)neutron intraluminal brachytherapy combined with external-beam radiotherapy with lead-shielding pelvic parallel opposing field technique and non-lead-shielding four-field box technique for cervical cancer. Methods A total of 52 patients with stage Ⅱa-Ⅲb cervical squamous cell carcinoma who were admitted to our hospital from 2004 to 2007 were enrolled as subjects and paired by clinical stage, age, tumor size, and degree of anemia. The 26 pairs of patients were divided into lead-shielding pelvic parallel opposing field group(lead-shielding group)and non-lead-shielding four-field box group(non-lead-shielding group). For all patients in both groups, 252Cf neutron brachytherapy was added in external-beam radiotherapy. The local control(LC), overall survival(OS), and disease-free survival(DFS)rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The difference in the incidence of late complications was analyzed using the McNemar method. Results There were significant differences in 5-year LC, OS, and DFS rates between the lead-shielding group and the non-lead-shielding group(85% vs. 81%,P=0.014; 89% vs. 73%, P= 0.013; 89% vs. 73%, P= 0.013). There was also significant difference in the incidence of late complications between the lead-shielding group and the non-lead-shielding group(12% vs. 23%, P= 0. 008). Conclusions When intraluminal brachytherapy combined with external-beam radiotherapy is used to treat cervical cancer, the centers of the front and back fields should be shielded by lead, regardless of whether the parallel opposing field technique or the four-field box technique is used. Key words: Cervical neoplasms/radiotherapy; Radiotherapy, external beam radiation; Radiotherapy, 252Cf neutron; Lead shielding

The Correlation Between the Astro Consensus Panel Definition of Biochemical Failure and Clinical Outcome for Patients with Prostate Cancer Treated with External Beam Irradiation