Postoperative radiotherapy is associated with improved overall survival for alveolar ridge squamous cell carcinoma with adverse pathologic features

Background: Alveolar ridge (AR) squamous cell carcinoma (SCC) is poorly represented on prospective clinical trials. Adjuvant management is extrapolated from more common head and neck SCC, including those with a stronger influence from the human papillomavirus. The objective of this analysis is to determine the association between adjuvant radiotherapy (RT) and overall survival (OS) for resected ARSCC based on adverse pathologic features. Methods: Adult subjects in the National Cancer Database diagnosed with invasive nonmetastatic ARSCC between 2010–2014 were identified. Exclusion criteria included prior malignancy, no/unknown surgery, unknown receipt of RT, RT dose <50 Gy or >80 Gy, RT fractions >68, T1–2N0 disease without identifiable NCCN-defined risk factors (positive margin, lymphovascular invasion, pT3–4, N2–3, extranodal extension, or level IV/V nodal metastasis), and unknown/missing NCCN risk factor data. Log-rank test stratified by RT and Cox regression analyses with respect to OS were performed. Results: 1,450 subjects met inclusion criteria, of which 825 (57%) received RT. Median follow-up was 27 months. Adjuvant RT was associated with improved OS (72% vs 65% at 2 years, log-rank P=.004). Stratified by number of NCCN-defined risk factors, adjuvant RT was associated with improved OS for subjects with 2 (74% vs 58% at 2 years, log-rank P<.001) and ≥3 (54% vs 29% at 2 years, log-rank P<.001) risk factors. Adjuvant RT was significantly associated with improved OS on univariate (HR, 0.80; 95% CI, 0.68–0.94; P=.008) and multivariate (HR, 0.72; 95% CI, 0.60–0.87; P=.001) analyses, the latter adjusted for age, comorbidity score, and adverse pathologic features. Each NCCN-defined risk factor, high tumor grade, primary tumor ≥3 cm, and ≥5% nodal positivity (number of pathologic nodes positive among nodes resected) were significantly associated with worse OS on univariate and multivariate analyses. Conclusions: Adjuvant RT for resected ARSCC with adverse pathologic features is associated with significantly improved OS. Subjects with a primary tumor ≥3 cm, high tumor grade, and ≥5% nodal positivity in addition to the NCCN-defined risk factors should be considered for adjuvant RT.

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The Overall Survival of Non-Small Cell Lung Cancer Patients Group pN2 after Radical Surgery and Postoperative Radiotherapy

Medical Radiology and radiation safety ◽

10.12737/1024-6177-2020-65-1-42-47 ◽

2020 ◽

Vol 65 (1) ◽

pp. 42-47

Author(s):

V. Sotnikov ◽

G. Panshin ◽

V. Solodkiy ◽

V. Chkhikvadze ◽

V. Kharchenko ◽

...

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Squamous Cell Carcinoma ◽

Small Cell Lung Cancer ◽

Cell Carcinoma ◽

Squamous Cell ◽

Cell Lung Cancer ◽

Postoperative Radiotherapy ◽

Small Cell ◽

Small Cell Lung

Purpose: Comparative analysis of the overall survival (OS) in different subgroups of the patients with non-small cell lung cancer (NSCLC) with affected mediastinal lymph nodes (pN2) after surgical and combined treatment using postoperative radiotherapy (PORT). Material and methods: A comparative assessment of the overall survival of 243 patients with NSCLC stages IIIA, IIIB (pT1–4N2M0) was carried out: the I group – 79 patients after radical (R0) surgical treatment (lobe/bilobectomy, pulmonectomy with ipsilateral mediastinal lymph node dissection) and the second group – 164 patients after the combined modality therapy with the same volume of surgery and postoperative radiotherapy in the mode of hypofractionation (daily dose 3 Gy, 5 times a week, TD = 36–39 Gy (EQD2 = 43.2–46.8 Gy, α/β = 3) or classical fractionation (2 Gy, 5 times a week, TD = 44 Gy). We analyzed subgroups of men and women, patients younger than 60 years and older, with central and peripheral cancer, squamous cell carcinoma and adenocarcinoma, with different gradation of tumors according to the criterion T (pT1–4). Results: In the compared groups, 2-year and 5-year OS was significantly higher in the PORT group (62.4 and 31.6 vs 44.8 % and 12.3 %, p = 0.0028), at the expense of male patients (62.4 and 31.6 % vs 44.8 and 12.3 %, p = 0.0028), patients with central cancer (59.2 and 43.7 % vs 36.3 % and n/a, p = 0.0023), patients with squamous cell carcinoma (64.0 % and 43.1 % vs 42.3 % and 6.7 %, p = 0.0006), patients older than 60 years (74.8 and 46.2 % vs 45.1 % and n/a, p = 0.007). A more detailed analysis revealed that PORT significantly increased 2- and 5-year OS in the central squamous cell carcinoma of the lung (67.3 and 53.0 % vs. 33.3 and 0 %, respectively, p = 0.0013), and in pT3–4 tumors (2-year OS 57.1 vs. 36.4 %, respectively, p = 0.0102). There was only a tendency of increasing OS after the PORT in T2 tumors (5-year OS 31.1 vs 15.4 %, respectively, p = 0.1319). In T1 tumors, no differences in OS were found, possibly due to the small number of cases (27). In peripheral squamous cell carcinoma there was a statistically insignificant increasing of 5-year OS – 7 %. There was no significant differences in OS survival were obtained in central and peripheral lung adenocarcinoma between the I and II groups. Conclusion: In the patients with non-small cell lung cancer pN2, radically operated (R0) in the volume of lobe/bilobectomy, pulmonectomy with ipsilateral mediastinal lymph node dissection, PORT can be recommended for central squamous cell carcinoma pT1–4. In the patients with peripheral squamous cell carcinoma, PORT can be discussed for the patients with individually assessed high risk of the locoregional relapse. PORT, within the scope of irradiation and total doses used in this study, has no age restrictions. The feasibility of PORT for radically operated patients with pN2 lung adenocarcinoma requires further study.

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R406 – Treatment of Squamous Cell Carcinoma of the Hypopharynx

Otolaryngology ◽

10.1016/j.otohns.2008.05.560 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P179-P179

Author(s):

Helma Maria Chedid ◽

Carlos Neutzling Lehn

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Postoperative Radiotherapy ◽

Clinical Stage ◽

Disease Free Survival ◽

Developed Countries ◽

Free Survival ◽

Disease Free

Problem Squamous cell carcinoma of the hypopharynx has been diagnosed at a late stage, including in developed countries, thus denoting worse prognosis. An association between surgery and radiotherapy is the standard treatment for advanced clinical stages. Our aim was to assess the clinical and treatment factors of tumors of the hypopharynx that were treated surgically and with postoperative radiotherapy. Methods This was a retrospective study on 174 patients, among whom two patients were in clinical stage (CS) I, four in CS II, 46 in CS III, and 122 in CS IV. Among these, 222 neck dissections were performed, of which 48 were bilateral. Statistic analysis: Kaplan-Meier methods. Results The mean follow-up was 31 months, and histological examinations showed that two patients were pT1, 15 pT2, 100 pT3 and 57 pT4. With regard to lymph nodes, 25 patients were pN0 and 149 patients were pN+. The disease-free survival in CS III was 75%, versus 28% in CS IV (p=0.001). The disease-free survival was 35% and the overall survival was 28%. Conclusion Surgical treatment for tumors of the hypopharynx occurred in advanced CS, with disease-free survival of 35%. Significance The overall survival and disease free-survival among patients with squamous cell carcinoma of the hypopharynx undergoing surgery.

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Postoperative Concurrent Chemoradiotherapy Versus Postoperative Radiotherapy in High-Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck: The Randomized Phase III TROG 05.01 Trial

Journal of Clinical Oncology ◽

10.1200/jco.2017.77.0941 ◽

2018 ◽

Vol 36 (13) ◽

pp. 1275-1283 ◽

Cited By ~ 49

Author(s):

Sandro Virgilio Porceddu ◽

Mathias Bressel ◽

Michael Geoffrey Poulsen ◽

Adam Stoneley ◽

Michael John Veness ◽

...

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

High Risk ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Postoperative Radiotherapy ◽

Cutaneous Squamous Cell Carcinoma ◽

Phase Iii ◽

Disease Free

Purpose To report the results of the Trans Tasman Radiation Oncology Group randomized phase III trial designed to determine whether the addition of concurrent chemotherapy to postoperative radiotherapy (CRT) improved locoregional control in patients with high-risk cutaneous squamous cell carcinoma of the head and neck. Patients and Methods The primary objective was to determine whether there was a difference in freedom from locoregional relapse (FFLRR) between 60 or 66 Gy (6 to 6.5 weeks) with or without weekly carboplatin (area under the curve 2) after resection of gross disease. Secondary efficacy objectives were to compare disease-free survival and overall survival. Results Three hundred twenty-one patients were randomly assigned, with 310 patients commencing allocated treatment (radiotherapy [RT] alone, n = 157; CRT, n = 153). Two hundred thirty-eight patients (77%) had high-risk nodal disease, 59 (19%) had high-risk primary or in-transit disease, and 13 (4%) had both. Median follow-up was 60 months. Median RT dose was 60 Gy, with 84% of patients randomly assigned to CRT completing six cycles of carboplatin. The 2- and 5-year FFLRR rates were 88% (95% CI, 83% to 93%) and 83% (95% CI, 77% to 90%), respectively, for RT and 89% (95% CI, 84% to 94%) and 87% (95% CI, 81% to 93%; hazard ratio, 0.84; 95% CI, 0.46 to 1.55; P = .58), respectively, for CRT. There were no significant differences in disease-free or overall survival. Locoregional failure was the most common site of first treatment failure, with isolated distant metastases as the first site of failure seen in 7% of both arms. Treatment was well tolerated in both arms, with no observed enhancement of RT toxicity with carboplatin. Grade 3 or 4 late toxicities were infrequent. Conclusion Although surgery and postoperative RT provided excellent FFLRR, there was no observed benefit with the addition of weekly carboplatin.

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Adverse pathologic features in early oral squamous cell carcinoma and the role of postoperative radiotherapy—a review

Oral Surgery Oral Medicine Oral Pathology and Oral Radiology ◽

10.1016/j.oooo.2017.03.002 ◽

2017 ◽

Vol 124 (1) ◽

pp. 24-31 ◽

Cited By ~ 8

Author(s):

Narayana Subramaniam ◽

Deepak Balasubramanian ◽

Samskruthi Murthy ◽

Shashikant Limbachiya ◽

Krishnakumar Thankappan ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Postoperative Radiotherapy ◽

Pathologic Features

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Development and validation of an individualized immune prognostic model in stage I–III lung squamous cell carcinoma

Scientific Reports ◽

10.1038/s41598-021-92115-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Qi-Fan Yang ◽

Di Wu ◽

Jian Wang ◽

Li Ba ◽

Chen Tian ◽

...

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Prognostic Model ◽

Lung Squamous Cell Carcinoma ◽

Risk Groups ◽

Stage I ◽

Tissue Samples ◽

Mutation Burden

AbstractLung squamous cell carcinoma (LUSC) possesses a poor prognosis even for stages I–III resected patients. Reliable prognostic biomarkers that can stratify and predict clinical outcomes for stage I–III resected LUSC patients are urgently needed. Based on gene expression of LUSC tissue samples from five public datasets, consisting of 687 cases, we developed an immune-related prognostic model (IPM) according to immune genes from ImmPort database. Then, we comprehensively analyzed the immune microenvironment and mutation burden that are significantly associated with this model. According to the IPM, patients were stratified into high- and low-risk groups with markedly distinct survival benefits. We found that patients with high immune risk possessed a higher proportion of immunosuppressive cells such as macrophages M0, and presented higher expression of CD47, CD73, SIRPA, and TIM-3. Moreover, When further stratified based on the tumor mutation burden (TMB) and risk score, patients with high TMB and low immune risk had a remarkable prolonged overall survival compared to patients with low TMB and high immune risk. Finally, a nomogram combing the IPM with clinical factors was established to provide a more precise evaluation of prognosis. The proposed immune relevant model is a promising biomarker for predicting overall survival in stage I–III LUSC. Thus, it may shed light on identifying patient subset at high risk of adverse prognosis from an immunological perspective.

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Proton beam radiotherapy of locally advanced or recurrent conjunctival squamous cell carcinoma: experience of the CATANA Centre

Journal of Radiotherapy in Practice ◽

10.1017/s1460396920000953 ◽

2020 ◽

pp. 1-8

Author(s):

Roberto Milazzotto ◽

Rocco Luca Emanuele Liardo ◽

Giuseppe Privitera ◽

Luigi Raffaele ◽

Vincenzo Salamone ◽

...

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Proton Beam ◽

Squamous Cell ◽

Locally Advanced ◽

Disease Free Survival ◽

Proton Beam Radiotherapy ◽

Conjunctival Squamous Cell Carcinoma ◽

The Impact

Abstract Aim: Conjunctival squamous cell carcinoma (SCC) is a rare tumour of the ocular region and microscopic radical surgical is difficult. There are no single guidelines for therapeutic management and the role of radiation therapy is not clearly defined although conventionally photon or electron beams are used. Proton beam radiotherapy (PBRT) is a new option for a conservative approach and allows good sparing of the organs at risk. Materials and methods: After surgical resection, we collected 15 cases treated at our institution with PBRT. The dose delivered was between 48 and 60 Gy relative biological effectiveness (RBE), with fractions of 12–15 Gy RBE. Results: After an average period of 48 months, the patients achieved excellent disease control (overall survival and disease-free survival: 86·6%), with minimal acute and late toxicity. Findings: In this work, we present our experience on the use of PBRT technique in SCC treatment. A larger sample of patients is needed to draw conclusions about the impact of this treatment on disease recurrence and overall survival.

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Outcomes of Post-Operative Treatment with Concurrent Chemoradiotherapy (CRT) in High-Risk Resected Oral Cavity Squamous Cell Carcinoma (OCSCC): A Multi-Institutional Collaboration

Current Oncology ◽

10.3390/curroncol28040221 ◽

2021 ◽

Vol 28 (4) ◽

pp. 2409-2419

Author(s):

Arslan Babar ◽

Neil M. Woody ◽

Ahmed I. Ghanem ◽

Jillian Tsai ◽

Neal E. Dunlap ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

High Risk ◽

Oral Cavity ◽

Cell Carcinoma ◽

Squamous Cell ◽

Demographic Data ◽

Disease Free Survival ◽

Total Sample ◽

High Dose ◽

Pathologic Features

Adjuvant chemoradiation (CRT), with high-dose cisplatin remains standard treatment for oral cavity squamous cell carcinoma (OCSCC) with high-risk pathologic features. We evaluated outcomes associated with different cisplatin dosing and schedules, concurrent with radiation (RT), and the effect of cumulative dosing of cisplatin. An IRB-approved collaborative database of patients (pts) with primary OCSCC (Stage I–IVB AJCC 7th edition) treated with primary surgical resection between January 2005 and January 2015, with or without adjuvant therapy, was established from six academic institutions. Patients were categorized by cisplatin dose and schedule, and resultant groups compared for demographic data, pathologic features, and outcomes by statistical analysis to determine disease free survival (DFS) and freedom from metastatic disease (DM). From a total sample size of 1282 pts, 196 pts were identified with high-risk features who were treated with adjuvant CRT. Administration schedule of cisplatin was not significantly associated with DFS. On multivariate (MVA), DFS was significantly better in patients without perineural invasion (PNI) and in those receiving ≥200 mg/m2 cisplatin dose (p < 0.001 and 0.007). Median DFS, by cisplatin dose, was 10.5 (<200 mg/m2) vs. 20.8 months (≥200 mg/m2). Our analysis demonstrated cumulative cisplatin dose ≥200 mg/m2 was associated with improved DFS in high-risk resected OCSCC pts.

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Epigenetic Alterations Associated with the Overall Survival and Recurrence Free Survival among Oral Squamous Cell Carcinoma Patients

Journal of Clinical Medicine ◽

10.3390/jcm9041035 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1035 ◽

Cited By ~ 1

Author(s):

Yasmen Ghantous ◽

Aysar Nashef ◽

Imad Abu-Elnaaj

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Oral Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Clinical Features ◽

Squamous Cell ◽

Methylation Status ◽

Recurrence Free Survival ◽

Epigenetic Alterations ◽

Free Survival

Oral squamous cell carcinoma (OSCC) is a fatal disease caused by complex interactions between environmental, genomic, and epigenetic alterations. In the current study, we aimed to identify clusters of genes whose promoter methylation status correlated with various tested clinical features. Molecular datasets of genetic and methylation analysis based on whole-genome sequencing of 159 OSCC patients were obtained from the The Cancer Genome Atlas (TCGA) data portal. Genes were clustered based on their methylation status and were tested for their association with demographic, pathological, and clinical features of the patients. Overall, seven clusters of genes were revealed that showed a significant association with the overall survival/recurrence free survival of patients. The top ranked genes within cluster 4, which showed the worst prognosis, primarily acted as paraneoplastic genes, while the genes within cluster 6 primarily acted as anti-tumor genes. A significant difference was found regarding the mean age in the different clusters. No significant correlation was found between the tumor staging and the different clusters. In conclusion, our result provided a proof-of-principle for the existence of phenotypic diversity among the epigenetic clusters of OSCC and demonstrated the utility of the use epigenetics alterations in devolving new prognostic and therapeutics tools for OSCC patients.

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