Prevalence of NUT carcinoma in head and neck: Analysis of 362 cases with literature review.

BACKGROUND: Nuclear protein in testis (NUT) carcinoma is a poorly differentiated carcinoma defined by the presence of NUT gene rearrangement. In the head and neck, the true prevalence of NUT carcinoma is unknown. METHODS: We retrospectively investigated NUT expression with clinicopathologic features in 362 patients of poorly differentiated or undifferentiated carcinomas in the head and neck, and reviewed the literature reports. RESULTS: Four (4/362, 1.1%) cases showed strong nuclear expression for NUT-specific monoclonal antibody, and all these tumors were in the sinonasal tract (4/40, 10%). The clinical outcome and histology were diverse unlike previously described. Although previous studies reported different frequency results according to study subjects, frequencies in sinonasal tract are relatively constant (10/80, 12.5%). CONCLUSIONS: This is the largest study on the prevalence of NUT carcinoma in head and neck areas. It is important to include in the differential diagnosis of poorly differentiated carcinoma, particularly in the sinonasal tract.

Extra-nodal natural killer/T cell lymphoma in elderly patients: the impact of aging on clinical outcomes and treatment tolerability.

Extra-nodal natural killer/T cell lymphoma (ENKTL) is rare in elderly patients, and its clinical course is unclear. The efficacy and tolerability of non-anthracycline-based treatments as a standard regimen in elderly patients have not been fully investigated. This study assessed the impact of aging on clinical outcomes and treatment tolerability. We retrospectively analyzed 51 patients aged ≥60 years who were diagnosed with ENKTL from January 1998 to December 2012. We defined new treatments as non-anthracycline regimens (etoposide, ifosfamide, mesna, cisplatin, and dexamethasone (VIPD); etoposide, ifosfamide, mesna, dexamethasone, and L-asparaginase (VIDL); methotrexate, leucovorin, etoposide, ifosfamide, mesna, dexamethasone, and L-asparaginase (MIDLE); ifosfamide, methotrexate, etoposide, and prednisolone (IMVP16/PD); or methotrexate, leucovorin, etoposide, ifosfamide, mesna, dexamethasone, and L-asparaginase (SMILE), with or without radiation therapy). The median age was 66 years (60-83 years). Twenty patients were diagnosed at advanced stage, and 18 had poor performance status. The overall survival and progression-free survival were 6.7 and 5.2 months, respectively. Clinical outcomes of patients with early disease were superior to those of patients with advanced disease. Among patients who received new treatments, concurrent chemoradiation therapy (CCRT) for localized disease was tolerable, although 37.5 % of patients with advanced disease who received SMILE discontinued chemotherapy due to intolerability. Elderly patients with ENKTL have poor prognostic factors compared to younger patients. In particular, patients with advanced disease have extremely poor prognosis due to inability to tolerate treatment and rapid progression of disease.

Comparison of weekly versus triweekly cisplatin delivered concurrently with radiation therapy in patients with locally advanced nasopharyngeal cancer: A multicenter randomized phase II trial (KCSG-HN10-02).

PURPOSE: Triweekly delivery of cisplatin concurrent with a course of radiation therapy (RT) has been the standard regimen for treatment of locally advanced nasopharyngeal carcinoma (NPC) despite a high level of concern regarding treatment-related complications. We conducted a randomized phase II study to compare weekly and triweekly cisplatin delivery during RT with respect to efficacy and toxicity profiles. MATERIAL AND METHODS: Patients with locally advanced NPC (stage II-IVb) were randomly assigned to a regimen of either seven doses of cisplatin (40 mg/m(2)) given once a week or three doses of cisplatin (100mg/m(2)) given every 3 weeks concurrently during RT. RESULTS: Of 109 eligible patients, 53 were assigned to the weekly regimen and 56 to the triweekly regimen. The two groups were comparable with respect to demographic and clinical characteristics. There were no significant differences in mean RT dose (68.3 Gy vs. 67.3 Gy, p=0.559) and mean cisplatin dose (248.9 mg/m(2)vs. 256.6 mg/m(2), p=0.433) between the two regimens. The primary endpoint was 3-year progression-free survival, which was not different between the regimens (64.9% vs. 63.8%, p=0.074). Overall, the occurrence of grade 3-4 toxicities was similar between the two arms (47.2% vs. 39.3%, p=0.443). Quality of life (QoL) related to functional outcomes 3 weeks after treatment completion was better for the weekly regimen. CONCLUSIONS: Although no definitive conclusions can be made, a once-weekly cisplatin regimen appears to be associated with improved QoL and is not inferior to the standard triweekly regimen with respect to efficacy and toxicity profiles.

The first private-hospital based proton therapy center in Korea; status of the Proton Therapy Center at Samsung Medical Center.

PURPOSE: The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. MATERIALS AND METHODS: The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. RESULTS: The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. CONCLUSION: The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.

The effect of cyclooxygenase-2 expression on tumor volume response in patients treated with radiotherapy for uterine cervical cancer.

We investigated the correlation between Cyclooxygenase-2 (COX-2) expression and the tumor response in patients with cervical cancer that were treated with curative radiotherapy (RT). Fifty-seven patients with squamous cell carcinoma were treated with concurrent radiochemotherapy (CRCT, n=29) or RT alone (n=28). The response of each patient was evaluated by three serial Magnetic Resonance Imaging examinations: before the start of RT, at four weeks after the start of RT (mid-RT) and at four weeks after the completion of RT (post-RT). Forty-three patients had positive COX-2 expression. The COX-2 negative patients achieved a higher rate of complete response (CR) at mid-RT than did the COX-2 positive patients (28.6% vs. 7.0%, P=0.054), but not at post-RT (64.3% vs. 69.8%). The initial tumor volume was a significant predictor of CR at mid-RT (P=0.003) and post-RT (P=0.004). The multivariate analysis showed that the initial tumor volume (at mid-RT and post-RT) and CRCT (at post-RT) were significant predictors of CR; however, the COX-2 expression was not. In conclusion, the COX-2 expression status has no significant correlation with the tumor response. Further studies on the changes in COX-2 expression levels during RT may be helpful for determination of its role in the tumor response to treatment and patient prognosis.

Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma.

BACKGROUND: We report the results of radiotherapy for abdominal lymph node metastasis from hepatocellular carcinoma (HCC). METHODS: From 1998 to 2004, 45 cases were treated with radiotherapy (RT), with a dose between 30 and 55 Gy. The radiation response, overall survival, prognostic factors, and complications were evaluated. RESULTS: Thirty-nine cases were able to be evaluated for response: 10 cases showed complete response; 21 cases showed a partial response; and 8 cases showed stable disease. The overall response rate was 79.5%. The response rate was 87.5% for patients receiving >or=40 Gy(10) (biologically effective dose, alpha/beta = 10) and 42.9% for patients receiving <40 Gy(10) (P = 0.02). The median survival time was 10 months for responders and 6 months for nonresponders (P = 0.01). The absence of other concurrent distant metastasis and controllable primary HCC were significant prognostic factors. RT induced gastric or duodenal ulcer development in nine patients. All of these patients had received more than 50 Gy(10), and these complications were not detected among patients receiving <50 Gy(10) (0% vs 37.5%, P < 0.01). CONCLUSIONS: RT was an effective treatment modality, and the absence of concurrent distant metastasis and controllable primary tumor were significant prognostic factors. However, considering the high rate of RT-induced morbidity, 40 Gy(10) to 50 Gy(10) might be the optimal RT dose.