Effect of Adjuvant Chemotherapy after Complete Resection for Pathologic Stage IB Lung Adenocarcinoma in High-Risk Patients as Defined by a New Recurrence Risk Scoring Model / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We conducted a retrospective analysis to determine if adjuvant chemotherapy prolongs overall survival in patients with pathologic stage IB lung adenocarcinoma who had undergone complete resection and were defined as high-risk by a newly developed recurrence risk scoring model. MATERIALS AND METHODS: Patients who underwent curative resection for stage IB lung adenocarcinoma were analyzed with a newly developed recurrence risk scoring model and divided into a low-risk group and a high-risk group. The patients in the high-risk group were retrospectively divided into two groups based on whether they underwent adjuvant chemotherapy or observation. Recurrence-free survival and overall survival were compared between these two groups. RESULTS: A total of 328 patients who underwent curative resection between 2000 and 2009 were included in this study, of whom 110 (34%) received adjuvant chemotherapy and 218 (67%) underwent observation without additional treatment. According to our risk model, 167 patients (51%) were high-risk and 161 (49%) were low-risk. The 5-year recurrence-free survival rates and overall survival were 84.4% and 91.5% in low-risk patients and 53.9% and 74.7% in high-risk patients (p < 0.001). In high-risk patients, the 5-year overall survival rates were 77% among patients who underwent observation and 87% among those who underwent adjuvant chemotherapy (p=0.019). CONCLUSION: Adjuvant chemotherapy prolonged overall survival among high-risk patients who had undergone complete resection for stage IB lung adenocarcinoma.

Cost-utility analysis of treatments for stage IB cervical cancer / 부인종양

OBJECTIVE: To analyze the cost-utility of two common clinical practices for stage IB cervical cancer patients from provider and societal viewpoints. METHODS: A decision tree model was conducted to examine value for expenditure between the following: (1) radical hysterectomy with pelvic lymph node dissection (RHPLND) with or without postoperative adjuvant therapy according to the risk of recurrence and (2) concurrent chemoradiotherapy (CCRT). The relevant studies were identified to extract the probability data, and meta-analysis was performed. Direct medical costs were estimated from hospital database and medical records review. Direct non-medical costs and utility parameters were obtained through interviews with patients to estimate quality-adjusted life years (QALYs) outcome. The time horizon was according to the life expectancy of Thai women. RESULTS: From provider viewpoint, RHPLND and CCRT resulted in approximate costs of US $5,281 and US $5,218, respectively. The corresponding costs from societal viewpoint were US $6,533 and US $6,335, respectively. QALYs were 16.40 years for RHPLND and 15.94 years for CCRT. The estimated incremental cost effectiveness ratio of RHPLND in comparison to CCRT from provider and societal viewpoints were US $100/QALY and US $430/QALY, respectively. RHPLND had more cost-effectiveness than CCRT if patients did not need adjuvant therapy. The most effective parameter in model was a direct medical cost of CCRT. At the current ceiling ratio in Thailand, RHPLND provides better value for money than CCRT, with a probability of 75%. CONCLUSION: RHPLND is an efficient treatment for stage IB cervical cancer. This advantage is only for patients who require no adjuvant treatment.

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer / 부인종양

OBJECTIVE: To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer. METHODS: We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010. RESULTS: About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT. CONCLUSION: Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

Comparison of outcomes between radical hysterectomy followed by tailored adjuvant therapy versus primary chemoradiation therapy in IB2 and IIA2 cervical cancer / 부인종양

OBJECTIVE: To compare survival outcomes and treatment-related morbidities between radical hysterectomy (RH) and primary chemoradiation therapy (CRT) in patients with bulky early-stage cervical cancer. METHODS: We selected 215 patients with stage IB2 and IIA2 cervical cancer (tumor diameter > 4 cm on magnetic resonance imaging) who underwent RH followed by tailored adjuvant therapy (n=147) or primary CRT (n=68) at two tertiary referral centers between 2001 and 2010. RESULTS: About twenty nine percent of patients were cured by RH alone and these patients experienced the best survival outcomes with the lowest morbidity rates. After the median follow-up times of 40 months, 27 RH (18.4%) and 20 CRT (29.4%) patients had recurrence (p=0.068) and 23 (15.6%) and 17 (25%) patients died of disease (p=0.101). The 5-year progression-free survival were 77% and 66% (p=0.047), and the 5-year overall survival were 78% and 67% (p=0.048) after RH and primary CRT, respectively. In multivariate analysis, patients who received primary CRT was at higher risk for tumor recurrence (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.24 to 4.14; p=0.008) and death (OR, 3.02; 95% CI, 1.53 to 5.98; p=0.001) than those who received RH. Grade 3-4, early (17% vs. 30.9%, p=0.021) and late (1.4% vs. 8.8%, p=0.007) complications were significantly less frequent after RH than primary CRT. CONCLUSION: Thirty percent of patients were cured by RH alone. A treatment outcome was better in this retrospective study in terms of morbidity and survival. Randomized trials are needed to confirm this result.

Prognostic factors of cervical cancer stage IB2 treated surgically / 대한산부인과학회지

OBJECTIVE: This study was performed to identify pathologic and clinical risk factors that predicted survival in cervical cancer stage IB2 patients treated surgically. METHODS: The records of 52 patients with cervical cancer IB2 who underwent radical hysterectomy with pelvic lymph node dissection from 1997 to 2003 were reviewed retrospectively. Clinical and pathologic variables included age, tumor size (TS), histologic type, involvement of resection margin, parametrium invasion, lymph node metastasis (LN), lymph-vascular space invasion, depth of invasion, treatment modality and adjuvant radiation therapy (RTx). Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by Cox's proportional hazards model. RESULTS: In the present study, median follow up was 46.5 months. With regard to the 2-year disease free survival rate and the 5-year survival rate, univariate analysis revealed no significant differences in subgroups according to age, histologic type, resection margin, parametrium, lymph-vascular space invasion, depth of invasion and treatment modality. Tumor size (p=0.0024), lymph node metastasis (p=0.0007) and radiation therapy (p=0.0398) significantly affected the 2-year disease free survival rate in univariate analysis. They (TS: p=0.0001, LN: p=0.0023, RTx: p=0.0428) also significantly affected 5-year survival rate in univariate analysis. Tumor size (RR 35.87, CI 2.94-438.26, p=0.01) and lymph node metastasis (RR 16.6, CI 1.36-202.05, p=0.03) affected 5-year survival rate in multivariate analysis. CONCLUSION: In patients with cervical cancer stage IB2 who underwent operation regardless adjuvant radiation therapy, the important independent prognostic factors were tumor size and LN metastasis.

Neoadjuvant chemotherapy in stage IB2 cervical cancer / 부인종양

OBJECTIVE: This retrospective study was purposed to evaluate the effects (clinico-pathologic findings and treatment outcomes) of neoadjuvant chemotherapy in management of cervical carcinoma stage IB2 (tumor diameter>4 cm) METHODS: 22 surgically treated patients due to cervical cancer IB2 between January 1993 and December 2001 were abstracted. They were divided into two groups; the one group (neoadjuvant chemotherapy group) was treated with preoperative neoadjuvant chemotherapy [taxol-cisplatin or bleomycin, vincristin, mitomycin and cisplatin (BOMP), 2-3 cycles] and the other group was treated by primary radical hysterectomy. Clinico-pathologic factors were reviewed and statistically analyzed and compared. RESULTS: There was no significant difference in age, tumor size, and histopathologic type between two groups (p>0.05). After surgery, lymph node, lymphovascular space invasion (LVSI), parametrial invasion, margin involvement, and recurrence rate had no significant difference between two groups (p>0.05). But in neoadjuvant chemotherapy group, postoperative adjuvant chemotherapy or radiation therapy was significantly less needed (p=0.0073). CONCLUSION: The needs of postoperative adjuvant treatment (chemotherapy or radiation therapy) in neoadjuvant chemotherapy group were less than in non-neoadjuvant chemotherapy group, even though there was no difference in clinico-pathologic factors and prognosis between two groups.

Prognostic factors of stage IB1 cervical cancer treated surgically / 부인종양

OBJECTIVE: To determine pathologic variables associated with disease free interval and overall survival of patients with stage IB1 cervical cancer who underwent radical hysterectomy and pelvic lymph node dissection. METHODS: The records of 91 patients with stage IB1 cervical carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy from 1997 to 2003 at Gil Medical Center were reviewed retrospectively. Clinical and pathologic variables including tumor size, histologic type, involvement of resection margin, parametrium invasion, lymph node metastasis, lymph-vascular space invasion (LVSI), depth of invasion and age were analyzed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by Cox's proportional hazards model. RESULTS: Univariate analysis revealed no significant differences in subgroups according to age, tumor size, histologic type and lymph-vascular space invasion (LVSI). However, significant differences in disease free interval were found in subgroups according to lymph node metastasis and depth of invasion. There were significant differences in overall survival in only subgroups according to lymph node metastasis. Multivariate analysis revealed that lymph node metastasis was the only independent significant prognostic factor. CONCLUSION: These results show that lymph node metastasis was the only independent prognostic factor in stage IB1 cervical cancer managed surgically.

Clinical Analysis of Stage Ib Gastric Cancer

PURPOSE: The aim of this study was to clarify the clinicopathological differences between T1N1M0 and T2N0M0, particularly the survival rates, and the role of chemotherapy in the stage Ib gastric cancer. METHODS: From January 1992 to December 1999, 118 cases were confirmed as having stage Ib gastric cancer in the Korea University Medical Center. Among them 31 patients were classified as being T1N1M0 and the other 87 cases were T2N0M0. The clinicopathological features and the prognosis were evaluated retrospectively. RESULTS: The overall 5-year survival rate of the stage Ib gastric cancer patients was 94%. Overall 5-year survival rates in T1N1M0 and T2N0M0 were 100% and 91%, respectively. Though T1N1M0 group showed better prognosis, there was no significant difference between two groups (P=0.14). D1, D2, and D2+alpha resections were performed in 28 cases (23.7%), 81 (68.6%), and 9 (7.6%), respectively, and there was no difference in the survival rate (P>0.05). The 5-year survival rates were analyzed according to whether or not they had received chemotherapy. There was a 98% 5-year survival rate with those who had chemotherapy and a 90% 5-year survival rate with those who had not had chemotherapy, but there was no significant difference between them (P=0.18). In the T2N0M0 group, the 5 year survival rates of patients with or without chemotherapy were 97% and 86%, respectively, but there was no significant difference (P=0.16). CONCLUSION: Though T1N1M0 group showed a better prognosis than the T2N0M0 group, there was no significant difference between the two groups (P=0.14). There was no significant survival difference between D1, D2, or D2+alpha procedures. It appears that post operative intravenous chemotherapy does not affect the prognosis of stage Ib gastric cancer, and the role of the chemotherapy in patients with T2N0M0 diseases is minimal.

The outcome of the cervical cancer (stage Ib1) treated by radical surgery with and without neoadjuvant chemotherapy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this retrospective study was to evaluate the effect of neoadjuvant chemotherapy followed by radical surgery compared with conventional radical surgery in stage Ib1 cervical cancer as to operative complications, the rate of lymph node metastasis, recurrence and overall five-year survival rates. METHODS: The study materal (98 cases of stage Ib1 cervical cancer) was divided into two groups; The one group was neoadjuvant chemotherapy (Cisplatin + 5-FU) followed by radical surgery (n = 41) and the other was the conventional radical surgery (n = 57) group. Reviewing records of operative and pathological reports and clinical findings, the outcome was statistically analyzed and compared. RESULTS: As to the complication, bladder dysfuntion was more frequent in neoadjuvant chemotherapy group, statistically significant.(43.9% vs 22.8%, P=0.034). No significant difference was found in the incidence of lymphnode metastasis (17% vs 17.5%, P=0.779) and overall five year survial rates(85.3% vs 87.7%, P=0.735). CONCLUSION: No benefical effect of neoadjuvant chemotherapy could be found on stage Ib1 cervical cancer in this retrospective study. However, well controlled longterm prospective study will be need to get firm conclusion.

Optimum Dose Combination of External Radiation and High Dose Rate ICR in FIGO IB Uterine Cervical Cancer / 대한치료방사선과학회지

PURPOSE: To assess the efficacy of high dose rate - intracavitary radiotherapy (HDR-ICR) in the radiotherapy of FIGO stage IB squamous cell carcinoma of uterine cervix and to determine the optimum dose combination xheme of external radiotherapy and ICR to achieve acceptable local control without severe complication. METHODS AND MATERIALS: One hundred and sixty two patients with FIGO stage Ib squamous cell carcinoma of uterine cervix who received definitive radiotherapy between May 1979 and December 1990 were retrospectively analyzed. All the patients received external radiotherapy combined with HDR-ICR. External dose of 40-46 Gy in 4.5-5 weeks was given to whole pelvis(median 45 Gy) and ICR dose of 30-39 Gy in 10-13 times was given to the point A. Midline shielding was done after 20-45 Gy of external radiotherapy(median 40 Gy). Summation of external dose plus ICR dose to the point A range were 64.20-95.00 Gy, and mean was 83.94 Gy. We analyzed the local control rate, survival rate, and late complication rate. RESULTS: Initial complete response rate was 99.4% for all patients. Overall 5-year survival rate was 91.1% and 5-year disease free survival rate was 90.9%. Local failure rate was 4.9% and distant failure rate was 4.3% Tumor size was the only significant prognostic factor. When tumor size greater than 3cm, 5-year survival rate was 92.6% and less than 3cm, that was 79.6%, Late complication rate was 23.5% with 18.5% of rectal complication and 4.9% of bladder complication. Mean rectal dose summation of external midline dose plus ICR rectal point dose was lower in the patients without rectal complication(74.88 Gy) than those with rectal complication (78.87 Gy). Complication rate was inceased with low rate of improvement of survival rate when summation of external midline dose plus point A or point R dose by ICR was greater than 70-75 Gy. CONCLUSION: The definitive radiation therapy using high dose rate ICR in FIGO stage IB uterine cervical cancer is effective treatment modality with good local control and survival rate without severe complication.

Therapeutic Results of Surgery and Radiation Therapy in Younger Patients with Stage IB Cervical Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate the prognostic importance of age in patients with Stage IB cervical cancer, we examined the relationship between age and survival in patients. METHODS AND MATERIALS: Retrospective analysis was performed on 107 patients were treated with surgery followed by postoperative radiotherapy or radiation alone between October 1983 and August 1993 and 28 patients with Stage IB cervical cancer treated with surgery alone between January 1989 and August 1993 at Inje University Seoul Paik Hospital. Patients ranged in age from 26 to 74 (median 48) and were followed for a median period of 39 months. Patients were divided into two groups; Group A comprising 32 patients withage 40. Both Group A and Group B patients were comparable with respect to all covariables studied. RESULTS: The overall 5-year survival and the disease free 5-year survival for the 107 patients studied were 85.2% and 82.1% respectively. The overall survival for group A and Group B was 92% and 83%, respectively(p>0.05). The disease free 5-year survival for Group A and Group B was 82.3% and 82.6%, respectively(p>0.05). There was no difference in both local and distant failure in Group A and Group B. CONCLUSION: On the basis of the this analysis it is concluded that age alone is a poor indicator of prognosis and should not be used as an indication for adjuvant treatment.

Postoperative radiotherapy for stage IB carcinoma of the uterine cervix

Sixty patients, treated with postoperative radiation therapy following radical hysterectomy and pelvic lymphadenectomy for stage lb carcinoma of the uterine cervix between Jan. 1980 and Dec. 1984 at Department of Radiation Oncology, Yonsei University College of Medicine, were retrospectively analysed. The minimum follow-up period was 5 years. The indications for postoperative radiotherapy were positive pelvic lymph node (34 pts), a large tumor size more than 3 cm in longest diameter (18 pts), positive surgical margin (10 pts), deep stromal invasion (10 pts), and lymphatic permeation (9 pts). The overall 5-year survival rate was 81.8%. The univariate analysis of prognostic factors disclosed tumor size (less than 3cm, greater than or equal to 3cm) and the status of the surgical margin (positive, negative) as significant factors (tumor size; 88.1% vs 6.3%, surgical margin; 85.5% vs 60%, p less than 0.05). Age (less than or equal to 40, greater than 40 yrs) was marginally significant (90.2% vs 73.1%, p less than 0.1). Multivariate analysis clarified two independent prognostic factors; tumor size (p = 0.010) and surgical margin (p = 0.004). Analysis of the tumor factors with the radiation dose disclosed a better survival rate for patients with a positive surgical margin who were given over 50 Gy than for those who were given below 50 Gy in patients (4/4, 100% vs 2/6, 33.4%; p = 0.06). Significant complications requiring surgical correction were not observed. In conclusion, it is believed that the status of the surgical margin and tumor size both have important prognostic significance, and that a radiation dose over 50 Gy is advisable for patients with a positive surgical margin.