Survival benefit of re-irradiation in esophageal Cancer patients with Locoregional recurrence: a propensity score-matched analysis.

BACKGROUND: To investigate the treatment failure pattern and factors influencing locoregional recurrence of esophageal squamous cell carcinoma (ESCC) and examine patient survival with re-irradiation (re-RT) after primary radiotherapy. METHODS: We retrospectively analyzed 87 ESCC patients treated initially with radiotherapy. Failure patterns were classified into regional lymph node recurrence only (LN) and primary failure with/without regional lymph node recurrence (PF). Patients received either re-RT or other treatments (non-re-RT group). Baseline covariates were balanced by a propensity score model. Overall survival (OS) and toxicities were assessed as outcomes. RESULTS: The median follow-up time was 87 months. Thirty-nine patients received re-RT. Failure pattern and re-RT were independent prognostic factors for OS (P = 0.040 and 0.015) by Cox multivariate analysis. Re-RT with concomitant chemotherapy showed no survival benefit over re-RT alone (P = 0.70). No differences in characteristics were found between the groups by Chi-square tests after propensity score matching. The Cox model showed that failure pattern and re-RT were prognostic factors with hazard ratios (HR) of 0.319 (P = 0.025) and 0.375 (P = 0.002), respectively, in the matched cohort. Significant differences in OS were observed according to failure pattern (P = 0.004) and re-RT (P < 0.001). In the re-RT and non-re-RT groups, 9.09% and 3.03% of patients experienced tracheoesophageal fistulas, and 15.15% and 3.03% of patients developed pericardial/pleural effusion, respectively (P > 0.05). The incidence of radiation pneumonitis was higher in the re-RT group (24.24% vs. 6.06%, P = 0.039), but no cases of pneumonia-related death occurred. CONCLUSIONS: Re-RT improved long-term survival in patients with locoregional recurrent ESCC. Despite a high incidence of radiation pneumonitis, toxicities were tolerable.

Long-term follow-up and prognostic factors for advanced thymic carcinoma.

The aim of this study was to evaluate the long-term survival outcomes in patients with advanced thymic carcinoma and identify prognostic factors influencing the survival. We retrospectively analyzed 90 consecutive patients with pathologically confirmed advanced thymic carcinoma (Masaoka III and IV) in our institute, from December 2000 to 2012. Age, sex, clinical characteristics, laboratory findings, Masaoka and tumor node metastasis staging, pathologic grade, and treatment modalities were analyzed to identify prognostic factors associated with the progress-free survival (PFS) and the overall survival (OS) rates. Statistical analysis was conducted using SPSS, version 19.0 (SPSS, Inc, Chicago, IL). A total of 73 (81.1%) male and 17 (18.9%) female patients participated in the study. The median follow-up time was 75 months (range, 20-158 months). The 5-year PFS and OS rates were 23.6% (95% confidence interval [CI], 14.6%-33.8%) and 35.7% (95% CI, 25.1%-46.4%), respectively. The multivariate Cox regression model analysis showed that factors improving the PFS were the normal lactate dehydrogenase (LDH) level (P<0.001), Masaoka III stage (P=0.028), and radiotherapy (RT) (P<0.001). The LDH (P<0.001), T stage (P<0.001), and the pathologic grade (P=0.047) were independently prognostic of OS. Long-term follow-up of the advanced thymic carcinoma showed poor outcomes of PFS and OS. LDH, Masaoka stage, and RT affected the PFS, and LDH, T stage, and pathologic grade seemed to affect the OS. Establishing a better staging system for predicting outcomes would be warranted.

[Measurement of setup error in conformal radiotherapy for nasopharyngeal carcinoma].

BACKGROUND & OBJECTIVE: Setup error is the key factor in determining the margin of planning target volume (M(PTV)) for conformal radiotherapy of nasopharyngeal carcinoma (NPC). This study was to establish a method using radiopaque fiducial markers which were embedded in occlusal splint ("occlusal splint method") to acquire setup errors to calculate M(PTV) in CRT for NPC. METHODS: The occlusal splint method was performed in 22 NPC patients who received CRT. Setup errors were calculated by comparing the coordinates of 3 fiducial markers read from portal images with those read from computed tomography (CT) data. According to the formulation, the size of MPTV with or without consideration of organ motion was also calculated. RESULTS: The standard deviations of systematic errors (Sigma) were 1.13 mm, 1.47 mm, and 1.31 mm in X (medio-lateral), Y (antero-posterior) and Z (cranio-caudal) axes, respectively; the standard deviations of random errors were 0.81 mm, 0.45 mm, and 0.80 mm in X, Y, and Z axes, respectively. Without consideration of organ motion, the sizes of M(PTV) were 3.40 mm, 3.98 mm, and 3.83 mm in X, Y, and Z axes, respectively; with consideration of organ motion, the sizes of M(PTV) were 3.75 mm, 4.35 mm, and 4.16 mm in X, Y, and Z axes, respectively. CONCLUSION: Using the "occlusal splint method", each institution can precisely calculate setup error data, and stipulate the size of M(PTV) adequate to one's own situation.