Effect of Radiation Therapy Techniques on Outcome in N3-positive IIIB Non-small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to evaluate clinical outcomes following definitive concurrent chemoradiotherapy (CCRT) for patients with N3-positive stage IIIB (N3-IIIB) non-small cell lung cancer (NSCLC), with a focus on radiation therapy (RT) techniques. MATERIALS AND METHODS: From May 2010 to November 2012, 77 patients with N3-IIIB NSCLC received definitive CCRT (median, 66 Gy). RT techniques were selected individually based on estimated lung toxicity, with 3-dimensional conformal RT (3D-CRT) and intensity-modulated RT (IMRT) delivered to 48 (62.3%) and 29 (37.7%) patients, respectively. Weekly docetaxel/paclitaxel plus cisplatin (67, 87.0%) was the most common concurrent chemotherapy regimen. RESULTS: The median age and clinical target volume (CTV) were 60 years and 288.0 cm3, respectively. Patients receiving IMRT had greater disease extent in terms of supraclavicular lymph node (SCN) involvement and CTV > or = 300 cm3. The median follow-up time was 21.7 months. Fortyfive patients (58.4%) experienced disease progression, most frequently distant metastasis (39, 50.6%). In-field locoregional control, progression-free survival (PFS), and overall survival (OS) rates at 2 years were 87.9%, 38.7%, and 75.2%, respectively. Although locoregional control was similar between RT techniques, patients receiving IMRT had worse PFS and OS, and SCN metastases from the lower lobe primary tumor and CTV > or = 300 cm3were associated with worse OS. The incidence and severity of toxicities did not differ significantly between RT techniques. CONCLUSION: IMRT could lead to similar locoregional control and toxicity, while encompassing a greater disease extent than 3D-CRT. The decision to apply IMRT should be made carefully after considering oncologic outcomes associated with greater disease extent and cost.

Impact of lymph node ratio as a valuable prognostic factor in gallbladder carcinoma, focusing on stage IIIB gallbladder carcinoma / 대한외과학회지

PURPOSE: It is increasingly being recognized that the lymph node ratio (LNR) is an important prognostic factor for gallbladder carcinoma patients. The present study evaluated predictors of tumor recurrence and survival in a large, mono-institutional cohort of patients who underwent surgical resection for gallbladder carcinoma, focusing specifically on the prognostic value of lymph node (LN) status and of LNR in stage IIIB patients. METHODS: Between 2004 and 2011, 123 patients who underwent R0 radical resection for gallbladder carcinoma at the Chonnam National University Hwasun Hospital were reviewed retrospectively. Patients were staged according to the American Joint Committee on Cancer 7th edition, and prognostic factors affecting disease free survival, such as age, sex, comorbidity, body mass index, presence of preoperative symptoms, perioperative blood transfusion, postoperative complications, LN dissection, tumor size, differentiation, lymph-vascular invasion, perineural invasion, T stage, presence of LN involvement, N stage, numbers of positive LNs, LNR and implementation of adjuvant chemotherapy, were statistically analyzed. RESULTS: LN status was an important prognostic factor in patients undergoing curative resection for gallbladder carcinoma. The total number of LNs examined was implicated with prognosis, especially in N0 patients. LNR was a powerful predictor of disease free survival even after controlling for competing risk factors, in curative resected gallbladder cancer patients, and especially in stage IIIB patients. CONCLUSION: LNR is confirmed as an independent prognostic factor in curative resected gallbladder cancer patients, especially in stage IIIB gallbladder carcinoma.

Results of Radio-thermotherapy in Stage IIIb Uterine Cervical Cancer Local response, survival rate and analysis of prognostic factor / 대한암학회지

PURPOSE: This retrospective study was conducted to obtain local response and survival rates, and to analyze prognostic factors affecting survival of patients treated with radio-thermotherapy for stage IIIb uterine cervical cancer. MATERIALS AND METHODS: From May 1992 to Dec. 1996, 24 patients treated with radio-thermo therapy for stage IIIb uterine cervical cancer at department of Radiation Oncology in Kosin Medical College, Kosin University were enrolled. Radiotherapy used 6~10 MV linear accelerator was performed in whole pelvis with 4 portals box technique by conventional (180~200 cGy/ fraction, 5 fraction/week) method in 5 patients (20.8%) or hyperfractionated (120~135 cGy/fr., 2 fr./day, 10 fr./wk) in 19 patients (79.2%). Total dose of A-point was 67~112 Gy (median: 77.27 Gy). Hyperthermia used 8 MHz radiofrequency capacitive heating device was applied in pelvic area with 2~3 sessions per wk. Each course started within 15 to 20 minutes after radio therapy and took 40 to 60 minutes. Local progression free (LPFS), disease free (DFS) and overall (OS) rates were calculated in survival analysis. Statistics was calculated by Kaplan-Meier Method in survival and Log-rank test in statistical significance. Multivariate analysis for prognostic factor was applied to Cox Regression model. Follow-up duration was 6~82 months (median: 25 months). RESULTS: Overall local response rate was 95.8% (45.8% in CR/50.0% in PR). Five year LPFS, DFS, OS were 48.6%, 31.7%, 67.1%, respectively. In univariate analysis, an age was the signi ficant prognostic factor in terms of OS (p=0.03), but was insignificant in LPFS and DFS. In multivariate analysis, none of evaluated factors are important in LPFS, DFS or OS. CONCLUSION: Radio-thermotherapy for stage IIIb uterine cervical cancer did not increase 5 year LPFS, DFS and OS in spite of higher local response rate. Age was the only significant factor for OS in univariate analysis.

Result of Radiation Therapy of the Cervix Cancer Stage IIIB / 대한치료방사선과학회지

From September 1985 through September 1989, 56 patients with stage IIIB carcinoma of the cervix were treated with radiation therapy with curative aim. The overall survival at 5 year was 38%. The survival rate was better for patients treated with combined external radiotherapy and high dose rate intracavitary radiotherapy than with external radiotherapy alone. No significant survival difference was observed between the unilateral and bilateral parametrial extension of the tumor. Seventeen patients experienced recurrence within the irradiated field with a loco-regional recurrence rate of 30%. Ten patients had complications (18%). The complications were mild in three, moderate in four, and severe in three patients. A study was made on the relationship between the fraction numbers of intracavitary radiotherapy, vaginal packing and the complication rate, respectively. In this analysis author observed that the significant treatment factor influencing the survival of cervical cancer was the use of intracavitary radiation, and meticulous vaginal packing could decrease the late complication rate of radiotherapy of the conical cancer.