The prognostic value of decrease in prognostic nutritional index in stage III non-small cell lung cancer patients during curative thoracic radiotherapy

Background: Curative thoracic radiotherapy (CTRT) with concurrent chemotherapy has been considered as standard treatment approach for stage-III non-small cell lung cancer (NSCLC). The hematological and esophageal toxicities that have been encountered during CTRT would affect the immunonutritional status of the patients. The aim of this study is to evaluate the prognostic value of the change in pre- and post-treatment prognostic nutritional index (PNI) in stage-III NSCLC patients. Methods: Eighty seven consecutive stage III NSCLC patients� data were collected. Pre-radiotherapy (RT) and post-RT PNI values were calculated and the impact of prognostic value of PNI change on overall survival (OS) was evaluated by univariate and multivariate Cox regression analyses. A cutoff value of PNI change was obtained by receiver operator characteristic (ROC) curve analysis. Results: The cutoff value was found to be a 22% decrease in PNI by ROC curve analysis in terms of effect on OS. The median OS of low and high PNI decrease groups were 22.5 and 16.5 months respectively (P = 0,001). In univariate and multivariate analyses PNI decrease of ? 22% was found to be an independent poor prognostic factor for OS (P = 0.012) and hazard ratio (95% confidence interval)= 2.05 (1.16�62). Conclusion: The PNI change would be a convenient parameter to assess the immunonutrition

Relevance of multi?disciplinary team approach in diagnosis and management of Stage III NSCLC

Lung cancer is reported as the leading cause of cancer?related mortality worldwide. Non?small cell lung cancer (NSCLC) constitutes 80%�% of all lung cancers. Diagnosis of NSCLC is a complex multistep process. The prognosis of NSCLC is poor as most of the patients are presented at the metastatic stage. The management of these patients needs the expertise of different specialists. A multidisciplinary team (MDT) comprising specialists from different disciplines has a substantial role in improving outcomes in these patients. This is feasible through extensive discussions, accurate evaluation of patients, reviewing medical records, implementing ideal treatment strategies, and merging local treatments with systemic treatment concepts. Therefore, the MDT approach for stage III NSCLC management can enable early treatment initiation, optimal treatment modalities, and reduce healthcare expenditure. Studies have shown that MDT can provide multimodality care facilitating the diagnosis and treatment of stage III NSCLC, resulting in survival benefit of these patients. Thus, it is imperative to collate scientific evidence to get an insight into the MDT approach in advanced NSCLC treatment. This review aims to summarize the impact of MDT on treatment rates, survival outcome, treatment guideline adherence, and quality of life (QoL) of stage III NSCLC patients.

Induction chemotherapy for unresectable Stage III non-small-cell lung cancer may improve survival of induction chemotherapy responders as predicted by elevated levels of carcinoembryonic antigen and cytokeratin fragment 19 and classification as stage N3 cancer

Aims: The aim of this study is to investigate patients with unresectable Stage III non-small-cell lung cancer (NSCLC) receiving radiotherapy with induction and concurrent pemetrexed or docetaxel plus cisplatin (PP/DP) chemotherapy and to identify the subgroup most likely to benefit from induction chemotherapy (IC). Subjects and Methods: Patients with unresectable measurable Stage III NSCLC received two cycles of PP/DP IC followed by concurrent chemoradiotherapy at a dose of 60–66 Gy. Statistical Analysis Used: Cox regression analysis was performed to evaluate the prognostic factors for survival; logistic regression analysis was used to evaluate the predictors for response to IC, and the receiver operating characteristic curves were used to evaluate the independent factors predicting response. Results: Eighty patients were included; the median survival time (MST) was 22.1 months. Partial response (PR) to IC was an independent prognostic factor for overall survival. For patients in the PR and stable disease groups, the MST was 36.7 and 19.5 months, respectively. The independent predictors of PR to IC included classification as stage N3 cancer, baseline carcinoembryonic antigen (CEA) levels >10 ng/ml, and cytokeratin fragment 19 (CYFRA21-1) levels >6 ng/ml. With each additional independent predictor, the likelihood of having have PR to IC increased. Conclusions: Radiotherapy with induction and concurrent PP/DP chemotherapy is feasible for patients with unresectable Stage III NSCLC. IC may improve the survival of IC responders, as predicted by elevated CEA and CYFRA21-1 levels and classification as stage N3 cancer. Additional randomized trials on IC may consider these predictors to tailor individualized treatments

To Compare the Effects of Adjuvant and Neoadjuvant Chemotherapy on Outcome of Stage III Carcinoma Breast.

At present, the ideal treatment of patients diagnosed to have carcinoma breast includes multimodal treatment therapy. However, the sequence of various modalities in the treatment of breast cancer varies according to the stage of the tumour at the time of presentation. Early breast cancer cases first undergo surgical treatment modality before systemic therapies, while advanced cases should undergo systemic therapies first followed by surgical interventions if possible. However, treatment of stage IIIA and IIIB patients (locally advanced disease) but having an operable lump poses a dilemma of whether to go for surgery first or systemic therapy first. We wanted to compare the outcome in terms of metastasis/recurrence between adjuvant and neo-adjuvant chemotherapy in selected cases of stage IIIA and stage IIIB carcinoma breast for a follow-up period of 1 year at a tertiary care hospital in central India.METHODSThis is a comparative observational study conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH) of Jawaharlal Nehru Medical College from October 2017 to Sept 2019, which included patients of TNM stage IIIA and IIIB breast carcinoma, half of whom were treated with adjuvant chemotherapy and other half treated with neoadjuvant chemotherapy along with standard surgical procedure like MRM/toilet mastectomy.RESULTSDistribution of patients according to presence of lymphovascular Invasion was done which was statistically non-significant. However, when disease recurrence or disease metastasis/mortality was compared with lymphovascular invasion in neo-adjuvant group, it was found to be statistically significant (p value=0.022) In the adjuvant group 90 % of patients belonged to stage IIIA while in neo-adjuvant group only 50 % patients belonged to stage IIIA. Rest patients in both group belonged to stage IIIB. This difference in adjuvant and neo-adjuvant group was statistically significant. (p=0.022) In comparison of outcome in both adjuvant and neo-adjuvant chemotherapy, 5% patients of adjuvant group developed metastasis and died succumbing to it while another 5 % developed recurrence during follow up. In the neo-adjuvant group 35% patients developed distant metastasis or died due to disease while another 5 % patient developed local recurrence in axilla for the disease. This difference in the outcome of two groups was statistically significant with p value of 0.013.CONCLUSIONSIn our study we found that for a locally advanced breast cancer patient (stage IIIA &B) with an operable breast lump, adjuvant chemotherapy is superior than neo-adjuvant chemotherapy with a significant p value of 0.013. Superior in terms of lesser distant metastasis/recurrence when we followed up the patient for 1 year after the completion of treatment.

Respuesta patológica completa, cirugía conservadora y recidivas a distancia en tumores localmente avanzados: resultados en 30 años de tratamiento neoadyuvante / Complete Pathologic Response, Breast Conserving Surgery and Distant Recurrence in Locally Advanced Breast Cancer: Results within 30 years of Neoadjuvant Therapy

Introducción La quimioterapia neoadyuvante (qtn) es el tratamiento inicial para pacientes con tumores localmente avanzados, permitiendo la evaluación de la sensibilidad in vivo a los agentes antineoplásicos y la planificación de estrategias quirúrgicas con resultados cosméticos favorables. Objetivos Comparar la tasa de respuesta patológica completa (pcr), la tasa de conversión a cirugía conservadora (tccc), el tiempo a la recaída a distancia (trad) y la supervivencia libre de enfermedad a distancia (sled) a 60 meses en pacientes con cáncer de mama Estadio III que fueron tratadas con qtn antes y después del año 2007 Material y método Se trata de un estudio observacional de cohortes retrospectivo en el que se analizaron registros de pacientes con cáncer de mama Estadio III operadas entre 1987 y 2016 que hubieran realizado qtn . Se constituyeron dos cohortes: en la primera se reunieron pacientes tratadas entre 1987 y 2006; en la segunda se agruparon aquellas tratadas entre 2007 y 2016. Se estableció esta diferencia dado que a partir de 2007 hubo cambios en la modalidad terapéutica: se administró la quimioterapia en forma continua antes de la cirugía y se introdujeron los taxanos y la terapia anti-her2 neu en los esquemas de qtn . En total se registraron 202 pacientes, 146 pertenecientes a la primera cohorte y 56 pertenecientes a la segunda. La mediana de edad y el tamaño tumoral fueron similares entre ambos grupos, mientras que en el segundo grupo observamos mayor porcentaje de tumores Grado 3 y mayor carga tumoral axilar. Resultados La tasa de pcr fue del 2% (n=3) para el primer grupo y de 13% (n=7) para el segundo (p=0,0022). La tasa de conversión a cirugía conservadora fue del 27% (n=20) para el primer grupo y del 41% (n=17) para el segundo, observándose un 14% más de cirugías conservadoras en este último (p=0,11). La mediana de trad fue de 33 meses para el primer grupo y de 46,5 meses para el segundo (p=0,044). La sled a 60 meses fue del 58% vs el 74% para el primer y segundo grupo respectivamente (p=0,039). Conclusiones Los cambios en la modalidad terapéutica en qtn en nuestra práctica se tradujeron en mayores tasas de pcr, mayor porcentaje de conversión a cirugía conservadora, mayor tiempo a la recidiva a distancia y mayor supervivencia libre de enfermedad a distancia

Introduction Neoadjuvant chemotherapy is the standard of care for patients with locally advanced breast cancer, allowing surgical planning with favorable cosmetic outcome and evaluation of in vivo response to antineoplastic agents. Objectives To compare pathologic complete response, breast conserving surgery conversion rates, time to distant relapse and distant recurrence free survival after 60 months in patients with Stage III breast cancer who received neoadjuvant chemotherapy before and after year 2007. Materials and method Observational retrospective cohort study analizing database and medical records of patients with Stage III breast cancer who had surgery after neoadjuvant therapy between 1987 and 2016. We divided the population into two cohorts, one with patients treated between 1987 and 2006, and another one with those ones treated between 2007 and 2016. We established that difference given that from 2007 and onwards there were major changes in treatment modality: chemotherapy was administered completely before surgery, and Taxane-containing regimens as well as Anti-her2 therapies were included. We registered 202 patients, 146 in the first group and 56 in the second. While median of age and tumor size were similar between groups, axillary tumor burden and histologic grade were higher in the second group. Results Pathologic complete response rate was 2% for the first group and 13% for the second (p=0.0022). Breast conserving surgery conversion rates were 27% vs 41%, with 14% more breast conserving surgeries in the second cohort. Median time to distant recurrence was 33 months vs 46.5 months (p=0.044) and distant recurrence free survival was 58% vs 74% (p=0.039) for groups 1 and two 2 respectively. Conclusions Changes in treatment modality in our practice resulted in better pcr outcomes, more breast conserving surgery conversion rates, longer time to distant relapse and a better distant recurrence free survival

S-1 Based Doublet as an Adjuvant Chemotherapy for Curatively Resected Stage III Gastric Cancer: Results from the Randomized Phase III POST Trial / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We conducted a randomized, multicenter, phase III trial to compare S-1 plus docetaxel (DS) with S-1 plus cisplatin (SP) as adjuvant chemotherapy for stage III gastric cancer patients. MATERIALS AND METHODS: Stage III gastric cancer patients who had received curative gastrectomy with D2 lymphadenectomy were randomized into equal groups to receive adjuvant chemotherapy of eight cycles of DS (S-1 70 mg/m2/day on days 1-14 plus docetaxel 35 mg/m2on days 1 and 8) every 3 weeks or SP (S-1 70 mg/m2/day on days 1-14 plus cisplatin 60 mg/m2on day 1) every 3 weeks. The primary endpoint was 3-year disease-free survival (DFS) rate. RESULTS: Between November 2010 and July 2013, 153 patients (75 patients to DS and 78 patients to SP) were enrolled from 8 institutions in Korea. After the capecitabine plus oxaliplatin was approved based on the CLASSIC study, itwas decided to close the study early. With a median follow-up duration of 56.9 months, the 3-year DFS rate between two groups was not significantly different (49.14% in DS group vs. 52.5% in SP group). The most common grade 3-4 adverse event was neutropenia (42.7% in DS and 38.5% in SP, p=0.351). SP group had more grade 3-4 anemia (1.3% vs. 11.5%, p=0.037), whereas grade 3-4 hand-foot syndrome (4.1% vs. 0%, p=0.025) and mucositis (10.7% vs. 2.6%, p=0.001) were more common in DS group. Fifty-one patients (68%) in DS group and 52 (66.7%) in SP group finished planned treatment. CONCLUSION: Our findings suggest that SP or DS is an effective and tolerable option for patients with curatively resected stage III gastric cancer.

EGFR Mutation Is Associated with Short Progression-Free Survival in Patients with Stage III Non-squamous Cell Lung Cancer Treated with Concurrent Chemoradiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to evaluate the relationship between epidermal growth factor receptor (EGFR) mutation and clinical outcomes in patients with stage III non-squamous cell lung cancer treated with definitive concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: From January 2008 to December 2013, the medical records of 197 patients with stage III non- squamous non-small cell lung cancer treated with definitive CCRT were analyzed to determine progression-free survival (PFS) and overall survival (OS) according to EGFR mutation status. RESULTS: Among 197 eligible patients, 81 patients were EGFR wild type, 36 patients had an EGFR mutation (exon 19 Del, n=18; L858R, n=9, uncommon [G719X, L868, T790M], n=9), and 80 patients had unknown EGFR status. The median age was 59 years (range, 28 to 80 years) and 136 patients (69.0%) were male. The median follow-up duration was 66.5 months (range, 1.9 to 114.5 months). One hundred sixty-four patients (83.2%) experienced disease progression. Median PFS was 8.9 months for the EGFR mutation group, 11.8 months for EGFR wild type, and 10.5 months for the unknown EGFR group (p=0.013 and p=0.042, respectively). The most common site of metastasis in the EGFR mutant group was the brain. However, there was no significant difference in OS among the three groups (34.6 months for EGFR mutant group vs. 31.9 months for EGFR wild type vs. 22.6 months for EGFR unknown group; p=0.792 and p=0.284). A total of 29 patients (80.6%) with EGFR mutation were treated with EGFR tyrosine kinase inhibitor (gefitinib, n=24; erlotinib, n=3; afatinib, n=2) upon progression. CONCLUSION: EGFR mutation is associatedwith short PFS and the brain is the most common site of distant metastasis in patients with stage III non- squamous cell lung cancer treated with CCRT.

Value of combined adjuvant chemotherapy and radiation on survival for stage III uterine cancer: is less radiation equal to more? / 부인종양

OBJECTIVE: Locally advanced endometrioid adenocarcinoma (LA-EAC) accounts for the majority of deaths for this cancer, yet there is no consensus on adjuvant treatment after surgery. Past studies suggest that combined modality treatment (CMT) may improve outcomes over treatment with chemotherapy (CT) or radiation therapy (RT, either external beam radiotherapy [EBRT] or vaginal brachytherapy [VBT]) alone. Using a large US-based population-based registry, we evaluated adjuvant CMT in LA-EAC and the relative benefit of regional EBRT compared to focused VBT. METHODS: We studied patients diagnosed with Stage III LA-EAC between 2004 and 2013 from the National Cancer Data Base (NCDB). We used Cox regression and a log-rank test to assess survival based on treatment with CT alone, EBRT alone, VBT alone, or CMT with EBRT and/or VBT. We used a χ2 test to compare covariates between patients receiving CMT with EBRT or VBT. RESULTS: Patients who received CMT had better survival than those who received CT or EBRT/VBT alone. Compared to CMT with VBT, patients who received CMT with EBRT were slightly older and had more advanced-stage or positive nodes, and fewer had lymph node surgery. We found no survival difference between CMT with EBRT and CMT with VBT even when categorizing patients as high or low risk according to age, grade, and stage (low-risk p=0.3460; high-risk p=0.2158). CONCLUSION: CMT was associated with superior survival outcomes compared to monotherapy. We observed no survival difference between radiation modalities in CMT, which highlights the effectiveness of a more focused treatment like brachytherapy.

¿Cuál es el rol de la cirugía en el tratamiento de un paciente con cáncer de la vesícula biliar estadio IIIb? / What is the role of surgery in the treatment of a patient with stage IIIb gallbladder cancer

El cáncer de la vesícula biliar (CaVB), es una neoplasias frecuente en nuestro país. La supervivencia (SV) global no supera el 40% a 5 años. La invasión de la túnica serosa y el estadio IIIB, se asocian a menor SV por considerarse una etapa avanzada de la enfermedad; por ello no hay consenso respecto del rol de la cirugía en estos casos. El objetivo de este artículo es analizar la evidencia existente respecto del rol de la cirugía en el tratamiento de un paciente con CaVB estadio IIIb. Se realizó una búsqueda sistemática de la evidencia disponible en la bases de datos Clinical Evidence, National Health Service, Health Technology Assessment, Tripdatabase, Cochrane Library y PubMed. Se buscaron a documentos de resumen de la evidencia (overviews, guías de práctica clínica (GPC, tablas GRADE), artículos secundarios (revisiones sistemáticas/RS) y artículos primarios (ensayos clínicos/EC y estudios observacionales/EO). Posteriormente, la evidencia se clasificó según la propuesta de la CEBM 2009. Se encontró un total de 420 documentos relacionados: 25 overviews, 15 tablas GRADE, 30 GPC, 37 RS, 99 EC y 214 EO. Al examinar en detalle todos los documentos; Se comprobó que sólo 17 estaban relacionados con los resultados del tratamiento quirúrgico de la CaVB en etapa III; y 5 se refieren a esta (3 EO, 1 GPC y una recomendación del NCI), pero ninguno al estadio IIIb. Existen pocos estudios relacionados, la mayor parte de ellos son de tipo retrospectivo, con un pequeño número de pacientes incluidos, de población y procedimientos quirúrgicos heterogéneos; por ende, es muy sacar conclusiones y realizar recomendaciones basadas en la evidencia existente.

Gallbladder cancer (GBC), is a common neoplasm in our country. The overall survival rate (OSR) does not exceed 40% at 5 years. The invasion of the serosa and IIIB stage, are associated with lower OSR seen it are an advanced stage of the disease, so there is no consensus on the role of surgery in this type ofpatients. The aim of this study is to analyze the existing evidence concerning the role of surgery in the treatment of a patient with stage IIIb GBC. A systematic search of available evidence in the databases Clinical Evidence, National Health Service, Health Technology Assessment, Tripdatabase, Cochrane Library and PubMed search was performed. Evidence summary documents (overviews, GRADE tables, Clinical Guidelines/CG), secondary articles (systematic reviews) and primary articles (Clinical trials/CT) and observational studies/OS) were searched. Subsequently, evidence was classified as proposed by EMBC 2009. A total of 420 related documents were found: 25 overviews, 15 GRADE tables, 30 CG, 37 SR, 99 CT and 214 OS. In reviewing at length all documents; It was verified that only 17 were related to results of surgical treatment of GC that stage III was mentioned and 5 refer to this (3 OS, 1 CG and a recommendation from NCI), but none of them to the IIIb stage. There are few related studies, most of them are retrospective, with a small number of patients included, heterogeneous population and surgical procedures; thereby, it is difficult to draw conclusions and make recommendations based on the evidence.

Comparison of long-term oncologic outcomes of stage III colorectal cancer following laparoscopic versus open surgery

PURPOSE: The oncologic outcomes after performing laparoscopic surgery (LS) compared to open surgery (OS) are still under debate and a concern when treating patients with colon cancer. The aim of this study was to compare the long-term oncologic outcomes of LS and OS as treatment for stage III colorectal cancer patients. METHODS: From January 2001 to December 2007, 230 patients with stage III colorectal cancer who had undergone LS or OS in this single center were assessed. Data were analyzed according to intention-to-treat. The primary endpoints were disease-free survival and overall survival. RESULTS: A total of 230 patients were entered into the study (114 patients had colon cancer-33 underwent LS and 81 underwent OS; 116 patients had rectal cancer-44 underwent LS and 72 underwent OS). The median follow-up periods for the colon and rectal cancer groups were 54 and 53 months, respectively. The overall conversion rate was 12.1% (n = 4) for colon cancer, and 4.5% (n = 2) for rectal cancer. Disease-free 5-year survival of colon cancer was 84.3% and 90% in LS group (LG) and OS group (OG), respectively, and that of rectal cancer was 83% and 74.6%, respectively (P > 0.05). Overall 5-year survival for colon cancer was 72.2% and 71.3% for LG and OG, respectively, and that for rectal cancer was 67.6% and 59.2%, respectively (P > 0.05). CONCLUSION: The long-term analyses for oncologic aspects of our study may confirm the safety of LS compared to OS in stage III colorectal cancer patients.

Minimal and mild endometriosis negatively impact on pregnancy outcome / Endometriose mínima e leve e seu impacto negativo sobre a gravidez

Endometriosis, a highly prevalent gynecological disease, can lead to infertility in moderate to severe cases. Whether minimal stages are associated with infertility is still unclear. The purpose of this systematic review is to present studies regarding the association between pregnancy rates and the presence of early stages of endometriosis. Studies regarding infertility, minimal (stage I, American Society of Reproductive Medicine [ASRM]) and mild (stage II, ASRM) endometriosis were identified by searching on the MEDLINE database from 1985 to September 2011 using the following MESH terms: endometriosis; infertility; minimal; mild endometriosis; pregnancy rate. 1188 articles published between January of 1985 and November of 2011 were retrieved; based on their titles, 1038 citations were excluded. Finally, after inclusion and exclusion criteria, 16 articles were selected to be part of this systematic review. Several reasons have been discussed in the literature to explain the impact of minimal endometriosis on fertility outcome, such as: ovulatory dysfunction, impaired folliculogenesis, defective implantation, decrease embryo quality, abnormal immunological peritoneal environment, and luteal phase problems. Despite the controversy involving the topic, the largest randomized control trial, published by Marcoux et al. in 1997 found a statistically different pregnancy rate after resection of superficial endometrial lesions. Earlier stages of endometriosis play a critical role in infertility, and most likely negatively impact pregnancy outcomes. Further studies into stage I endometriosis, especially randomized controlled trials, still need to be conducted.

RESUMO O objetivo desta revisão sistemática é apresentar estudos sobre a associação entre as taxas de gravidez e a presença de fases iniciais de endometriose. Estudos relacionados com a infertilidade e estágios mínimos e leves (estágios I,II, American Society of Reproductive Medicine [ASRM]) foram identificados por busca na base de dados MEDLINE, de 1985 a setembro de 2011. Os seguintes termos foram usados como palavras-chave: endometriose, infertilidade, taxa de gravidez; estágio mínimo; estágio leve de endometriose. Entre janeiro de 1985 e novembro de 2011, 1188 artigos foram recuperados; com base no título, 1038 citações foram excluídas e, finalmente, depois de critérios de inclusão e exclusão, 18 artigos foram selecionados para fazer parte desta revisão sistemática. Várias razões têm sido discutidas na literatura na tentativa de explicar o impacto da endometriose mínima no resultado da fertilidade, tais como: disfunção ovulatória, foliculogênese alterada prejudicada, defeito na implantação, baixa qualidade embrionária, ambiente peritoneal inflamatório e hostil e problemas da fase lútea. Apesar de toda polêmica envolvendo o tópico, o maior ensaio clínico randomizado foi publicado por Marcoux et al. Os autores encontraram uma taxa de gravidez estatisticamente significante após a ressecção de lesões superficiais de endometriose. Estágios iniciais de endometriose desempenham um papel crítico relacionado à infertilidade e, provavelmente proporcionam um impacto negativo nas taxas de gravidez em pacientes com endometriose. Outros estudos envolvendo estágios iniciais de endometriose, especialmente ensaios clínicos randomizados, ainda precisam ser realizados.

The 4+5th Extensor Compartmental Artery- Pedicled Vascularized Bone Graft in Lichtman Stage III Kienbock's Disease

PURPOSE: The purpose of this study was to evaluate the clinical results of the 4+5th extensor compartmental artery pedicled vascularized bone graft in advanced Lichtman stage III Kienbock's disease. MATERIALS AND METHODS: Eight patients with advanced Lichtman stage III Kienbock's disease who underwent the 4+5th extensor compartmental artery pedicled vascularized bone graft and followed up more than 1 year were analyzed retrospectively. There were 3 men and 5 women. The mean age was 43.6 years old. Two patients were Lichtman stage IIIA and six patients were IIIB. The clinical outcomes were evaluated with radiocarpal joint pain, range of motion, grip strength, carpal-height ratio, radioscaphoid angle, return to daily living activity and/or work. The mean follow up period was 38.5 months (range from 12 to 86 months). RESULTS: On last follow up, the pain was disappeared in 6 patients, and mild occasional pain was remained in 2 patients. Mean radiocarpal joint flexion and extension were 55 degrees and 60 degrees, 87% and 88% of the normal side, respectively. The carpal-height ratio was maintained or improved in 6 patients and slightly decreased in 2 patients. Radioscaphoid angle were improved or maintained in 7 patients. Mean grip strength was 67 lb, 93% of the normal side. All 8 patients returned to daily living activities and/or their previous works. CONCLUSION: The 4+5th extensor compartmental artery pedicled vascularized bone graft prevented the progression of disease and provided clinical improvement even in advanced Lichtman stage III Kienbock's disease.

Role of Postoperative Radiotherapy for Patients with Pathological Stage III Non-Small-Cell Lung Cancer after Curative Resection / 대한방사선종양학회지

PURPOSE: To evaluate the outcomes and prognostic factors of postoperative radiotherapy (PORT) for patients with pathological stage III non-small-cell lung cancer (NSCLC) at a single institution. MATERIALS AND METHODS: From 2000 to 2007, 88 patients diagnosed as having pathologic stage III NSCLC after curative resection were treated with PORT. There were 80 patients with pathologic stage IIIA and eight patients with pathologic stage IIIB in the AJCC 6th staging system. The majority of patients (n=83) had pathologic N2 disease, and 56 patients had single station mediastinal LN metastasis. PORT was administered using conventional technique (n=76) or three-dimensional conformal technique (n=12). The median radiation dose was 54 Gy (range, 30.6 to 63 Gy). Thirty-six patients received chemotherapy. Radiation pneumonitis was graded by the Radiation Therapy Oncology Group system, and other treatment-related toxicities were assessed by CTCAE v 3.0. RESULTS: Median survival was 54 months (range, 26 to 77 months). The 5-year overall survival (OS) and disease free survival (DFS) rates were 45% and 38%, respectively. The number of metastatic lymph nodes was associated with overall survival (hazard ratio, 1.037; p-value=0.040). The 5-year locoregional recurrence free survival (LRFS) and distant metastasis free survival (DMFS) rates were 88% and 48%, respectively. Multiple stations of mediastinal lymph node metastasis was associated with decreased DFS and DMFS rates (p-value=0.0014 and 0.0044, respectively). Fifty-one relapses occurred at the following sites: 10 loco-regional, 41 distant metastasis. Grade 2 radiation pneumonitis was seen in three patients, and symptoms were well tolerated with anti-tussive medication. Grade 2 radiation esophagitis was seen in 11 patients. There were no grade 3 or more severe complications associated with PORT. CONCLUSION: Our retrospective data show that PORT for pathological stage III NSCLC is a safe and feasible treatment and could improve loco-regional control. The number of metastatic lymph nodes and stations of mediastinal lymph node metastasis were analyzed as prognostic factors. Furthermore, efforts are needed to reduce distant metastasis, which is a major failure pattern of advanced stage NSCLC.

Total Number of Lymph Nodes Retrieved in Stage III Rectal Cancer Patient

PURPOSE: Adequate lymph node analysis is critical for appropriate staging in colorectal cancer. The aim of this study is to determine whether 12 or more nodes recovered in stage III rectal cancer results in improved oncologic outcomes. METHODS: Two hundred and forty-eight patients with stage III rectal cancer from 1995 through 2004 were reviewed. They were categorized into 2 subgroups by the number of nodes retrieved ( or =12), and oncologic outcomes in terms of 5-year overall and disease-free survival were analyzed for all patients, patients with American Joint Committee on Cancer (AJCC) N1 disease (N=145), and those with AJCC N2 (N=103). RESULTS: Five-year overall and disease-free survival was 79.0% and 58.4%, respectively. There was no significant difference in clincopathologic features between or =12 group. Although there was significant difference in overall survival and disease-free survival between the number ( or =12) of lymph nodes removed in N2 disease (P=0.043; P=0.022) in univariate analysis, the total number of lymph nodes retrieved was not a prognostic factor affecting survival in multivariate analysis. The N2 stage and lateral margin involvement were prognostic factors affecting survival in multivariate analysis. CONCLUSION: This study showed that the total number of lymph nodes analyzed for stage III rectal cancer is not a prognostic factor on overall or disease-free survival in multivariate analysis.

Expression of Alpha-catenin/E-cadherin and Clinical Significance of Metastatic Factors in Stage III Advanced Colon Cancer

PURPOSE: Among the cell adhesion molecules, alpha-catenin and E-cadherin play an important part in maintaining normal cell structure. The change in expression of cell adhesion molecules affects the invasion and metastasis of a tumor and the prognosis for patients. In this study, we evaluated the relationship between the expression of cell adhesion molecules and the histopathologic characteristics of stage III colon cancer. METHODS: The relationship between the immunohistochemical expression of cell adhesion molecules and tumor progression were statistically analyzed in 40 patients with stage III colon cancer. RESULTS: There were no statistically significant correlations between loss of membranous alpha-catenin and E-cadherin expressions and such variables as histologic differentiation and lymph node disease based on the criteria of the American Joint Committee on Cancer (AJCC). A significant correlation, however, existed between depth of mural invasion and loss of expressions of both alpha-catenin and E-cadherin (P=0.001 and P=0.002, respectively). Expressions of both alpha-catenin and E-cadherin were also significantly decreased in patients showing liver metastases during follow-up (P=0.019 and P=0.015, respectively). CONCLUSION: Immunohistochemical analyses of alpha-catenin and E-cadherin expressions may be available as predictors for distant metastasis, especially in stage III colon cancer. Such analyses may also help to identify appropriate therapeutic strategies and the need for intensive follow-up in patients with stage III colon cancer.

The Comparison of Survival Rates of Postoperative Adjuvant Chemotherapies in The Stage III Gastric Cancer Patients / 영남의대학술지

PURPOSE: Various postoperative adjuvant chemotherapy regimens have been proposed for the patients with advanced gastric cancer. The majority of clinical trials have shown no significant difference in the survival benefit. The aim of this study was to compare the survival rates of postoperative adjuvant chemotherapies used in stage III gastric cancer patients who received curative gastrectomy. MATERIALS AND METHODS: Between 1990 and 1999, a survival analysis was performed in 260 patients who received curative gastric resection and postoperative adjuvant chemotherapy. The patients were divided into four groups according to the chemotherapeutic regimens received. The groups were: the F group: furtulon alone, FM group: furtulon and mitomycin, FAM group: 5-FU, adriamycin and mitomycin, FLEP group: 5-FU, leucovorin, etoposide and cisplatin. The survival rates were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS: There were no differences among the groups of patients with regard to tumor characteristics except for lymph node metastasis and the ratio of metastasis to lymph nodes. In the FLEP group, the ratio of metastasis to lymph nodes was higher than in the other groups. The five and ten year survival rates of F, FM, FAM and FLEP were 51.9%, 28.9%, 59.5%, 49.8%, 66.1%, 57.4% and 30.0%, 27.5%, respectively. The univariate analysis showed that age, Borrmann type, lymph node metastasis, ratio of metastasis to lymph nodes, postoperative adjuvant chemotherapy and recurrence were significant factors for survival. For the multivariate analysis, recurrence, age, Borrmann type, ratio of lymph node metastasis and lymph node dissection were independent prognostic factors; however, the postoperative adjuvant chemotherapy was not an independent prognostic factor. CONCLUSION: The FAM regimen was the most beneficial postoperative adjuvant chemotherapy for improved survival rates; the FM regimen was the second and the FLEP regimen was the last. In order to determine the effectiveness of postoperative adjuvant chemotherapy in stage III gastric cancer, well designed prospective studies including a surgery only group will be needed.

The Comparison of Survival Rates of Postoperative Adjuvant Chemotherapies in The Stage III Gastric Cancer Patients / 영남의대학술지

PURPOSE: Various postoperative adjuvant chemotherapy regimens have been proposed for the patients with advanced gastric cancer. The majority of clinical trials have shown no significant difference in the survival benefit. The aim of this study was to compare the survival rates of postoperative adjuvant chemotherapies used in stage III gastric cancer patients who received curative gastrectomy. MATERIALS AND METHODS: Between 1990 and 1999, a survival analysis was performed in 260 patients who received curative gastric resection and postoperative adjuvant chemotherapy. The patients were divided into four groups according to the chemotherapeutic regimens received. The groups were: the F group: furtulon alone, FM group: furtulon and mitomycin, FAM group: 5-FU, adriamycin and mitomycin, FLEP group: 5-FU, leucovorin, etoposide and cisplatin. The survival rates were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS: There were no differences among the groups of patients with regard to tumor characteristics except for lymph node metastasis and the ratio of metastasis to lymph nodes. In the FLEP group, the ratio of metastasis to lymph nodes was higher than in the other groups. The five and ten year survival rates of F, FM, FAM and FLEP were 51.9%, 28.9%, 59.5%, 49.8%, 66.1%, 57.4% and 30.0%, 27.5%, respectively. The univariate analysis showed that age, Borrmann type, lymph node metastasis, ratio of metastasis to lymph nodes, postoperative adjuvant chemotherapy and recurrence were significant factors for survival. For the multivariate analysis, recurrence, age, Borrmann type, ratio of lymph node metastasis and lymph node dissection were independent prognostic factors; however, the postoperative adjuvant chemotherapy was not an independent prognostic factor. CONCLUSION: The FAM regimen was the most beneficial postoperative adjuvant chemotherapy for improved survival rates; the FM regimen was the second and the FLEP regimen was the last. In order to determine the effectiveness of postoperative adjuvant chemotherapy in stage III gastric cancer, well designed prospective studies including a surgery only group will be needed.

Interpositional Arthroplasty using Pronator Quadratus Pedicled Bone for the Treatment of Stage III Kienbock's Disease / 대한정형외과학회잡지

Between 1984 and 1996, 8 patients who were suffered from stage g Kienbock's disease underwent interpositional arthroplasty using pronator quadratus pedicled bone. Patients comprised 2 males and 6 females, with an average age of 33 years(range 19-47). Range of motion of the wrist, residual pain, grip strength, and carpal height ratio of the patients were analyzed. The follow-up period was between 1.5 years and 12.5 years(average 5.5 years). The arc of flexion-extension of the wrist was increased from average 74 degrees preoperatively to 96 degrees postoperatively. Among eight patients, five were free of pain and three had intermittent pain during heavy work. None of eight patients had any discomfort in daily work and changed his or her occupation. The grip strength was average 83% of the normal side. Carpal height ratio was average 0.48 preoperatively and was not changed postoperatively. Clinical results, assessed by Lichtman-Evans criteria, showed 4 good and 4 fair. The interpositional arthroplasty using pronator quadratus pedicled bone was considered as a very effective method for the treatment of stage III Kienbock's disease.

Evaluation of Clinicopathologic and Prognostic Significance of nm23 protein in stage III Gastric Adenocarcinoma / 대한내과학회지

OBJECTIVE: Gene expression of nm23 has been investigated in a number of tumors, including breast cancer, colon cancer, malignant melanoma, and hepatocellular carcinoma. Its down-regulation has been shown to be associated with metastasis or disease progression in some of the tumors. This study was carried out to define the relationship between nm23 protein expression and clinicopathological variables. METHODS: nm23 protein levels were investigated in 64 surgically resected specimens of stage III gastric cancer by immunohistochemical method, and association with clinicopathological parameters and survival rates were determined. RESULTS: The overall expression rates of nm23 was 68.7 %. There was no significant difference between nm23 protein expression and clinicopathological variables such as age, sex, stage, histology, tumor depth, number of metastatic nodes, tumor size, site and method of operation. Statistically, no significant differences between nm23 protein expression and overall survival rates were found. CONCLUSIONS: These results suggest that nm23 protein expression is an unsatisfactory prognostic indicator in stage III gastric adenocarcinoma.

The Efficacy of Induction Chemotherapy in Stage lll Non-Small Cell Lung Cancer / 대한방사선종양학회지

PURPOSE: This study was performed to analyze the efficacy of induction chemotherapy followed by radiation therapy in locally advanced non-small cell lung cancer. MATERIALS AND METHODS: Eighty patients with locally advanced non-small cell lung cancer treated from 1989 to 1995 at Pusan Paik hospital were analyzed retrospectively. Twenty-one patients were treated with induction chemotherapy followed by radiation therapy and Fifty-nine patients were treated with radiation therapy alone. Chemotherapy regimen consisted of cisplatin-based combination (2 or 3 drugs). All patients were treated by Co-60 or 6 MV linear accelerators. Radiation dose ranged from 50 Gy to 80 Gy (median, 64.8 Gy). We evaluated response rate, survival rate, and pattern of failure in both treatment groups. RESULTS: Overall response rate in induction chemotherapy group and radiotherapy alone group were 48% and 45%, respectively. Of the 80 patients, 46 patients were evaluable for pattern of failure. Initial failure pattern in induction chemotherapy group was as follows: 8 (67%) at locoregional, 4 (33) in distant metastasis. Radiation alone group was 21 (71%) and 5 (29%), respectively. Results showed no difference of distant failure between induction chemotherapy group and radiation alone group. The 1 and 2 year survival rate in induction chemotherapy group were 43% and 14%, respectively and in radiotherapy alone group, 31% and 7%, respectively (p=0.135). CONCLUSION: In stage lll non-small cell lung cancer, induction chemotherapy and radiation therapy showed increased tendency in survival with no statistical significance. Induction chemotherapy seems to have no effect of decreasing distant failure and no survival advantage compared with radiotherapy alone.