Clinical significance of radiotherapy in patients with primary uterine carcinosarcoma: a multicenter retrospective study (KROG 13-08) / 부인종양

OBJECTIVE: To investigate the role of radiotherapy (RT) in patients who underwent hysterectomy for uterine carcinosarcoma (UCS). METHODS: Patients with the International Federation of Gynecology and Obstetrics stage I–IVa UCS who were treated between 1990 and 2012 were identified retrospectively in a multi-institutional database. Of 235 identified patients, 97 (41.3%) received adjuvant RT. Twenty-two patients with a history of previous pelvic RT were analyzed separately. Survival outcomes were assessed using the Kaplan-Meier method and Cox proportional hazards model. RESULTS: Patients with a previous history of pelvic RT had poor survival outcomes, and 72.6% of these patients experienced locoregional recurrence; however, none received RT after a diagnosis of UCS. Univariate analyses revealed that pelvic lymphadenectomy (PLND) and para-aortic lymph node sampling were significant factors for locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS). Among patients without previous pelvic RT, the percentage of locoregional failure was lower for those who received adjuvant RT than for those who did not (28.5% vs. 17.5%, p=0.107). Multivariate analysis revealed significant correlations between PLND and LRRFS, distant metastasis-free survival, and DFS. In subgroup analyses, RT significantly improved the 5-year LRRFS rate of patients who did not undergo PLND (52.7% vs. 18.7% for non-RT, p<0.001). CONCLUSION: Adjuvant RT decreased the risk of locoregional recurrence after hysterectomy for UCS, particularly in patients without surgical nodal staging. Given the poorer locoregional outcomes of patients previously subjected to pelvic RT, meticulous re-administration of RT might improve locoregional control while leading to less toxicity in these patients.

Role of External Beam Radiotherapy in Patients with Locally Advanced Papillary Thyroid Cancer / 대한내분비외과학회지

PURPOSE: External beam radiotherapy (EBRT) plays a controversial role in the management of differentiated thyroid cancer. We reviewed the outcomes of patients at our institution who had been treated with EBRT for advanced differentiated thyroid cancer. METHODS: Subjects included 35 patients who received thyroidectomy and EBRT at Yonsei University Wonju College of Medicine, Wonju Christian Hospital under the diagnosis of papillary thyroid cancer from January 1989 to September 2011. RESULTS: The 5 year overall locoregional control rate was 74.4%. No significant differences were found in locoregional progression- free survival for patients with complete resection, microscopic residual disease, or gross residual disease. CONCLUSION: The results of our study have shown that EBRT is effective for locoregional control of selected locally advanced papillary thyroid cancer, even with gross residual disease.

Radiotherapy in Supraglottic Carcinoma: With Respect to Locoregional Control and Survival / 대한방사선종양학회지

PURPOSE: A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. MATERIALS AND METHODS: From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage I, II, III, IVA, IVB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2~79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0~93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage I and IVB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0~68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0~59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (+-lymph node dissection), three had a supraglottic horizontal laryngectomy (+-lymph node dissection), and one had a primary excision alone. RESULTS: The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage I+I, III+V were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+T) vs radiotherapy alone (RT) in stage II, III, IVA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (P<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage I, II, III, IVA, IVB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+T vs RT in stage II, III, IVA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (P<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (P<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. CONCLUSION: In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted.

Results of Postoperative Radiation Therapy in 77 Patients of Breast Cancer / 대한암학회지

PURPOSE: This retrospective study was performed to evaluate the effect of postoperative adjuvant radiation therapy of breast cancer on survival, failure patterns and to identify unfavorable prognostic factors. MATERIALS AND METHODS: Seventy-seven patients were analysed retrospectively. Median follow up period was 72 months. According to AJCC system, fifty-eight patients (75%) were advanced than Stage IIb. Among 77 patients, 66 patients (86%) received mastectomy and axillary LN dissection and the other 11 patients (14%) received partial mastectomy and axillary LN dissection. Postoperative radiation therapy with 6 MV X-ray was given to the chest wall and regional lymphatics with total dose of 50 to 55 Gy. Fifty-five patients (71%) received CMF or CAF chemotherapy prior to or after radiation therapy. RESULTS: The 5 year and 10 year survival rate were 64.4% and 51.3%, respectively and 5 year and 10 year disease free survival rate were 57.6% and 47.5%, respectively. Median survival duration was 91 months. Of the 77 patients, 59 patients were evaluable for pattern of failure. Of these, eighteen patients (31%) failed. Initial failure pattern was as follow: 7 (12%) at locoregional, 3 (5%) in distant metastasis, 8 (14%) with locoregional and distant metastasis. But the pattern of final failure at the time of last follow up was contrasted. Distanf failure was the predominant pattern of failure with 29% of patients. Overall survival and disease free survival was significantly influenced by 6 factors with univariated analysis (p<0.05): AJC Stage, T stage, N Stage, number of involved axilliary LN, SCL LN mets, failure pattern. By multivariate analysis the survival difference continued to be significant in 3 factors : T stage, number of involved axillary LN, failure pattern. CONCLUSION: These data demonstrate high locoregional control and survival rate using the combination of surgery and radiotherapy for the patients with locally advanced breast cancer. But predominant failure pattern was distant dissemination. Therefore more effective systemic therapy is needed to improve overall survival.

Radiation therapy of nasopharyngeal cancers / 영남의대학술지

Radiotherapeutically, nasopharyngeal caner is an important disease in Korea. Because of its blind anatomic location, early detection is relatively uncommon. Clinically, most of cases are locally advanced and nodal involvements are common. Recently better understanding of nature of the disease and improvement of radio – therapy technique permit better treatment result, including locoregional control and survival rate, and minimal normal tissue damages comparing with previously published date. We analyzed 31 patients of pathologically proven and previously untreated naso – pharyngeal carcinoma with different treatment techniques, retrospectively. Minimal and maximal follow up period of the survivor is 6 months and 68 months, respectively. Thirteen patients with squamous cell carcinoma are included in this analysis. The median age is 49 years (range from 20 to 64 years). Twenty two patients are stage III. Eleven patients are treated with radiotherapy alone and 20 are treated with combined modalities treatment. The degree of response after radiotherapy are categorized by 3-classes, i,e. complete response, partial response. In spite of similarities of complete response rate and 1-year survival rate between two different treatment techniques, those patients with undifferentiated carcinoma appear to benefit from the adjuvant chemotherapy. In addition, systemic failure is more suggest that adjuvant therapy in the radiotherapeutic management of nasopharyngeal cancer needs additional research according to histologic types and future extensive clinical trials.