Hypofractioned radiotherapy versus conventional radiotherapy for the treatment of multiform glioblastoma in adults over 70 years old

AbstractAim:Multiform glioblastoma (MG) represents 70% of all gliomas, with half of patients older than 65 years with median survival of 12–18 months, hypofractionation seeks to reduce the intensity and duration of treatment without impacting on survival rates. The objective was to determine the global survival and recurrence-free survival of adults over 70 years old with MG treated with hypofractionated radiotherapy and standard scheme. The review of patients older than 70 years treated with radiotherapy from 2013 to 2016 was performed.Results:Twenty-four patients were analysed, with a median follow-up of 239 days, and there is no difference in overall survival 12·3 versus 10·5 months (p = 0·55) and recurrence-free survival 8·3 versus 3·4 months (p = 0·48) between both schemes, conventional versus hypofractioanted, respectively.Conclusion:The results in this study show that hypofractionated scheme could be comparable in overall survival and recurrence-free survival to conventional fractionation, but a longer patients’ trial should be done.

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An open-labeled, multicentric clinical study of cetuximab combined with intensity-modulated radiotherapy (IMRT) plus concurrent chemotherapy in locoregionally advanced (LA) nasopharyngeal carcinoma (NPC): A 2-year follow-up report.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5535 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5535-5535 ◽

Cited By ~ 3

Author(s):

Chun-yan Chen ◽

Chong Zhao ◽

Li Gao ◽

Jin-yi Lang ◽

Jian-ji Pan ◽

...

Keyword(s):

Overall Survival ◽

Disease Free Survival ◽

Concurrent Chemotherapy ◽

Stage Iii ◽

Chinese Patients ◽

Recurrence Free Survival ◽

Spontaneous Bleeding ◽

Cervical Lymph Nodes ◽

Free Survival

5535 Background: To evaluate the safety and efficacy outcomes of concurrent cetuximab plus IMRT and cisplatin in Chinese patients with LA NPC. Methods: Patients with primary stage III-IVb (UICC/AJCC 2002 staging system) and non-keratinizing NPC were enrolled in this prospective, multicentric, phase II study. Cisplatin (80mg/m2,q3week) and cetuximab (400mg/m2 one w before radiation, and then 250mg/m2/w) were given concurrently. The prescription dose of IMRT to GTVnx (primary tumor in nasopharynx) was 66 Gy - 75.9 Gy, GTVnd (positive cervical lymph nodes) was 60 Gy - 70Gy, The response rate was evaluated according to RECIST 1.0 criteria, and adverse events (AEs) were graded according to NCI CTCAE V3.0 criteria. Results: From July 2008 to April 2009, 100 patients were enrolled (74 male), with median age of 43 years. The proportion of stage III, IVa and IVb patients were 71%, 22% and 7% respectively. 99% of enrolled patients completed the planned treatment. AEs were within the expected range and manageable. No toxic death occurred during the treatment. Acneiform skin eruptions, mucositis, in-field dermatitis, xerostomia and neucopenia were the most common seen AEs, with 64% grade 2/3 acneiform eruptions, 26% grade 2/3 in-field dermatitis, 90% ≥ grade 2 mucositis (2 cases of grade 4 mucositis with spontaneous bleeding), 40% ≥ grade 2 xerostomia and 8% grade 2/3 neucopenia. With a median follow-up time of 23.5 months, the 2 year overall survival (OS), disease-free survival (DFS), local recurrence-free survival, regional (cervical lymph node) recurrence free survival and distant metastasis-free survival rates for the ITT population were 91%, 89%, 90%, 90% and 89%, respectively Multivariate analysis showed that N stage was the only prognostic factor for OS (p=0.0392, HR=2.946) and DFS (p=0.0062, HR=4.246) in these patients. Conclusions: Cetuximab combined with IMRT plus concurrent cisplatin in patients with LA NPC shows satisfactory 2-year locoregional control rate and 2-year overall survival. The combination seems to be well tolerated with a manageable side-effect profile.

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Intraoperative versus external beam boost for breast cancer: A matched-pair analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1120 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1120-1120 ◽

Cited By ~ 1

Author(s):

Elena Sperk ◽

Daniela Astor ◽

Grit Welzel ◽

Axel Gerhardt ◽

Marc Suetterlin ◽

...

Keyword(s):

Overall Survival ◽

Local Recurrence ◽

Breast Conserving Surgery ◽

Matched Pair ◽

Recurrence Free Survival ◽

Free Survival ◽

Matched Pair Analysis ◽

Pair Analysis ◽

Local Recurrence Free Survival

1120 Background: After breast conserving surgery, radiotherapy leads to a better overall survival. In addition to whole breast radiotherapy (WBRT) a boost to the tumor bed leads to a better local control. The tumor bed boost is usually added after WBRT or can be done intraoperative (IORT). Belletti et al. (Clin Cancer Res., 2008) described positive effects, an antitumoral effect and modulation of microenvironment after IORT with 50kV x-rays. A matched pair analysis was performed to investigate the impact of IORT boost on overall survival compared to standard external beam boost. Methods: Between 2002 – 2009, 370 patients were treated for breast cancer with WBRT + boost (external beam (EBRT) boost n = 146, IORT boost n =224). A matched pair analysis (1:1 propensity score matching for age, TNM, grading, hormonal treatment and chemotherapy) for overall survival and local recurrence free survival could be done for 53 pairs. All patients underwent breast conserving surgery and WBRT with 46-50Gy. 53 patients received an EBRT boost with 16Gy (2Gy/fraction, dedicated linear accelerator) and 53 patients received an IORT boost with 20Gy (INTRABEAM system, 50kV x-rays). Median follow-up was 6 months (range, 1-77 months) for the EBRT boost patients and 56 months (range, 2-97 months) for IORT boost patients. Kaplan Meier estimates were performed for overall survival and local recurrence free survival. Results: IORT boost patients had a longer follow-up than EBRT boost patients. Despite the difference in follow-up times, there was a strong trend towards better overall survival after IORT boost (90.2% vs. 62.3%, p = 0.375). One local recurrence was present in each group (EBRT boost after 15 months, local recurrence free survival 95%; IORT boost after 12 months, local recurrence free survival 98.1%). Conclusions: IORT given as a boost seems to have a positive impact on overall survival in breast cancer patients after breast conserving surgery. To identify such an effect a prospective randomized trial should be conducted.

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The efficacy of adjuvant imatinib therapy in improving the prognosis of patients with colorectal gastrointestinal stromal tumourss

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925061432 ◽

2015 ◽

Vol 97 (3) ◽

pp. 215-220 ◽

Cited By ~ 1

Author(s):

Y Li ◽

X Meng

Keyword(s):

Overall Survival ◽

Survival Time ◽

Survival Rates ◽

Control Group ◽

Imatinib Treatment ◽

Recurrence Free Survival ◽

Adjuvant Imatinib ◽

Logrank Test ◽

Free Survival ◽

The One

Introduction Although it has now been accepted that imatinib is a valid treatment for gastrointestinal stromal tumour (GIST) patients in the adjuvant setting, information on its clinical efficacy in improving the prognosis for patients with colorectal GISTs is limited. Methods The clinical and follow-up records of 42 colorectal GIST patients who underwent surgical resection at our institution between January 2004 and December 2013 were reviewed retrospectively. The effect of postoperative imatinib treatment on recurrence free survival and overall survival time was analysed with the Kaplan–Meier method and the multivariate Cox proportional hazards model. Results Sixteen patients were assigned to imatinib treatment (imatinib group) after surgical tumour resection while twenty-six patients did not receive any adjuvant treatment (control group). The one, three and five-year recurrence free survival rates were 100%, 90% and 77% respectively. This was significantly higher than in the control group (92%, 53% and 36%) (logrank test, p=0.012). The one, three and five-year overall survival rates were 100%, 91% and 68% in the imatinib group compared with 96%, 77% and 39% in the control group (logrank test, p=0.021). Analysis with the multivariate Cox regression model yielded similar results on the efficacy of adjuvant imatinib in prolonging both recurrence free survival (hazard ratio [HR]: 0.23, 95% confidence interval [CI]: 0.07–0.80) and overall survival (HR: 0.20, 95% CI: 0.05–0.91). Conclusions Adjuvant imatinib therapy seems to be effective in decreasing the risk of tumour occurrence and prolonging the overall survival time in colorectal GIST patients.

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15-year Follow-up of Comparing Mastoscopic and Conventional Axillary Dissection in Breast Cancer: A Multicentres, Randomized Controlled Trial

10.21203/rs.3.rs-35580/v1 ◽

2020 ◽

Author(s):

Chengyu Luo ◽

Guang Cao ◽

wenbin Guo ◽

Jie Yang ◽

Qiuru Sun ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Survival Rates ◽

Disease Free Survival ◽

Axillary Lymph ◽

Term Survival ◽

Free Survival ◽

Significant Difference ◽

Disease Free

Abstract Backgroud: Longer follow-up was necessary to testify the exact value of mastoscopic axillary lymph node dissection (MALND).Methods：From January 1, 2003 to December 31, 2005,1027 patients with operable breast cancer were randomly assigned to two groups: MALND and CALND. 996 eligible patients were enrolled. The end points are disease free survival and overall survival.Results：The final cohort of 996 patients was followed for an average of 184 months. The distribution of all events was fairly similar between two groups of patients. The incidence of local in-breast events did not differ in a significant manner between two cohorts. Similarly, the rate of distant metastases was not significantly different with 30.0% in MLND and 32.6% in CALND. And no significant difference was observed in other primary tumor between two groups (p=0.46). Patients who remain alive with no event comprise a total of 37.2% in MALND and 35.4% in CALND. Other primary cancers and deaths from other causes were distributed equally between two groups. The 15-year disease-free survival rates were41.1 percent for the MALND group and 39.6 percent for the CALND group (p=0.79). MALND was found to be not inferior for overall survival (P =0.54). The 15-year overall survival rates were 49.5 percentafter MALND and 51.2 percentafter CALND (p=0.86). Probability of overall survival was not significantly different between two groups.Conclusions：MALND does not increase unfavorable events, and also does not affect the long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery.

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Combination therapy with PD-1 blockade and radiofrequency ablation for recurrent hepatocellular carcinoma：A retrospective study

10.21203/rs.3.rs-385663/v1 ◽

2021 ◽

Author(s):

Xiaofei Wang ◽

Shu Chen ◽

Huaqiang Bi ◽

Feng Xia ◽

Kai Feng ◽

...

Keyword(s):

Overall Survival ◽

Retrospective Study ◽

Radiofrequency Ablation ◽

Survival Rate ◽

Combination Therapy ◽

Multivariate Analyses ◽

Survival Rates ◽

Recurrence Free Survival ◽

Free Survival ◽

Tumor Number

Abstract Background: The aim of this study was to evaluate whether combined therapy with PD-1 blockade (anti-PD-1) and radiofrequency ablation (RFA) was superior to RFA monotherapy for recurrent hepatocellular carcinoma (HCC).METHODS: A total of 127 patients who underwent anti-PD-1 plus RFA treatment (n = 41) or RFA alone treatment (n = 86) for recurrent HCC were enrolled in this retrospective study. Clinical data including post-RFA HCC recurrence (the primary end point), overall survival (OS) (the secondary end point), adverse events and toxic effects were retrospectively analyzed.RESULTS: The 1-year recurrence-free survival rates for the anti-PD-1 plus RFA and RFA groups were 36.6% and 16.3%, respectively. The corresponding overall survival rates for the two groups were 95.1% and 74.4%, respectively. There were statistically significant differences between the two groups in recurrence-free survival rate (P = 0.002) or overall survival rate (P = 0.008). Tumor number, TNM stage and anti-PD-1 treatment were demonstrated to be important factors associated with 1-year recurrence-free survival probability by univariate and multivariate analyses. Univariate and multivariate analyses demonstrated that tumor number, TNM stage and anti-PD-1 treatment were significant prognostic factors for OS. RFA treatment-related adverse events were pleural effusion requiring drainage and mild or moderate increase in body temperature. Grade 3 or higher events related to anti-PD-1 treatment occurred in 12.8% (6) patients and were infrequent.CONCLUSIONS: Combination therapy of anti-PD-1 plus RFA was superior to RFA alone in improving survival for recurrent HCC.

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The effect of complete surgical staging and adjuvant chemotherapy on survival in stage I, grade 1 and 2 endometrioid ovarian carcinoma

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-003112 ◽

2021 ◽

pp. ijgc-2021-003112

Author(s):

Brenna E Swift ◽

Allan Covens ◽

Victoria Mintsopoulos ◽

Carlos Parra-Herran ◽

Marcus Q Bernardini ◽

...

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Adjuvant Chemotherapy ◽

Stage I ◽

Low Grade ◽

Recurrence Free Survival ◽

Free Survival ◽

Stage Ia ◽

Endometrioid Ovarian Cancer

ObjectivesTo assess the effect of complete surgical staging and adjuvant chemotherapy on survival in stage I, low grade endometrioid ovarian cancer.MethodsThis retrospective study was conducted at two cancer centers from July 2001 to December 2019. Inclusion criteria were all stage I, grade 1 and 2 endometrioid ovarian cancer patients. Patients with mixed histology, concurrent endometrial cancer, neoadjuvant chemotherapy, and patients who did not undergo follow-up at our centers were excluded. Clinical, pathologic, recurrence, and follow-up data were collected. Cox proportional hazard model evaluated predictive factors. Recurrence-free survival and overall survival were calculated using the Kaplan-Meier method.ResultsThere were 131 eligible stage I patients: 83 patients (63.4%) were stage IA, 5 (3.8%) were stage IB, and 43 (32.8%) were stage IC, with 80 patients (61.1%) having grade 1 and 51 (38.9%) patients having grade 2 disease. Complete lymphadenectomy was performed in 34 patients (26.0%), whereas 97 patients (74.0%) had either partial (n=22, 16.8%) or no (n=75, 57.2%) lymphadenectomy. Thirty patients (22.9%) received adjuvant chemotherapy. Median follow-up was 51.5 (95% CI 44.3 to 57.2) months. Five-year recurrence-free survival was 88.0% (95% CI 81.6% to 94.9%) and 5 year overall survival was 95.1% (95% CI 90.5% to 99.9%). In a multivariable analysis, only grade 2 histology had a significantly higher recurrence rate (HR 3.42, 95% CI 1.03 to 11.38; p=0.04). There was no difference in recurrence-free survival (p=0.57) and overall survival (p=0.30) in patients with complete lymphadenectomy. In stage IA/IB, grade 2 there was no benefit of adjuvant chemotherapy (p=0.19), and in stage IA/IB, low grade without complete surgical staging there was no benefit of adjuvant chemotherapy (p=0.16). Twelve patients (9.2%) had recurrence; 3 (25%) were salvageable at recurrence and are alive with no disease.ConclusionsPatients with stage I, low grade endometrioid ovarian cancer have a favorable prognosis, and adjuvant chemotherapy and staging lymphadenectomy did not improve survival.

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Six Year Follow-Up Results of a Phase II Study of Imatinib in Late Chronic Phase (L-CP) Chronic Myeloid Leukemia (CML) Post Interferon-A (IFN) Refractoriness/Intolerance.

Blood ◽

10.1182/blood.v108.11.428.428 ◽

2006 ◽

Vol 108 (11) ◽

pp. 428-428 ◽

Cited By ~ 1

Author(s):

Hagop M. Kantarjian ◽

Charles Sawyers ◽

Andreas Hochhaus ◽

Charles A. Schiffer ◽

Francois Guilhot ◽

...

Keyword(s):

Overall Survival ◽

Blast Crisis ◽

Survival Rates ◽

Chronic Phase ◽

Dose Intensity ◽

Long Term Outcomes ◽

Duration Of Treatment ◽

Laboratory Values

Abstract Background: Imatinib is a selective inhibitor of the Bcr-Abl tyrosine kinase indicated for the treatment of all phases of Ph+ CML. This study updates the results up to more than 60 months (mos) after last patient (pt) started treatment. Methods: Imatinib 400 mg/d was first administered to 454 patients with L-CP CML between December 1999 and May 2000. Median time since diagnosis was 34 months (mos). Pts had received a median of 14 mos of prior IFN treatment before entering the study but were hematologically (n=133) or cytogenetically resistant/refractory (n=160) or intolerant (n=161) to IFN. Dose escalation up to 800 mg/d was allowed for lack of efficacy. Pts were evaluated for best major and complete cytogenetic response (MCyR and CCyR), time to progression to accelerated phase (AP) or blast crisis (BC), and overall survival (OS). Beyond July 31, 2002, no adverse events or laboratory values were collected. Results: As of July 31, 2005, median duration of treatment was 60 mos (with average of 48 mos). A total of 244 (54%) pts had their dose increased to 600 or 800 mg/d, 42% received 800 mg/d at least once. Of 227 pts who are still on treatment, 85 (37%) had their dose increased to 600 mg/d or 800 mg/d for lack of efficacy. Overall actual dose intensity was 444 mg/d (median 400mg/d). The table below summarizes reasons for discontinuation, best observed responses rates and estimated long term outcomes at 60 mos. n (%) [95% conf. intervals] N=454 Still on treatment 227 (50) Discontinued 227 (50) Unsatisfactory therapeutic effect 117 (26) Deaths from any cause 18 (4) AEs & abnormal laboratory values 33 (7) BMT 5 (1) Withdrew consent/Lost/Others 54 (12) Pts with MCyR (incl CCyR) 304 (67) Pts with CCyR 259 (57) % Estimated freedom of progression to AP/BC at 60 mos 69% [64–74] % Estimated OS at 60 mos 79% [75–83] The MCyR (CCyR) rate was 57% (48%) for hematologic failures to IFN, 70% (60%) in cytogenetic failures to IFN and 72% (62%) in IFN intolerant pts. A CCyR was achieved after more than 36 mos of treatment in 28 pts; 22 (79%) of these pts had achieved CCyR after dose increase to 600 or 800 mg. Landmark analyses confirmed the effect of cytogenetic responses on long-term outcomes. The estimated survival rates free of AP/BC at 60 mos were 91%, 82%, 77%, 62% and 42% for pts who by 12 months achieved CCyR, PCyR, Minor CyR, Minimal CyR and no CyR, respectively (p<0.001). This corresponds to a rate of 88% in pts with MCyR at 12 mos. The estimated overall survival rates at 60 mos were 93%, 92%, 88%, 71% and 64% for pts who achieved CCyR, PCyR, Minor CyR, Minimal CyR and no CyR at this landmark, respectively (p<0.001). This corresponds to an overall survival rate of 93% in patients who had achieved MCyR at 12 mos. Conclusion: Imatinib substantially improves the duration of CP-CML in pts who previously failed IFN. The follow-up confirms the beneficial effect of cytogenetic responses on long-term outcomes with imatinib. These results will be updated for the meeting to include 72 mos data up to July 31, 2006.

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The prolonged use of temozolomide in glioblastoma patients

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v24i2.1391 ◽

2018 ◽

Vol 24 (2) ◽

pp. 107-112

Author(s):

Maurício Coelho Neto ◽

Luis Fernando Moura Da Silva ◽

Ricardo Ramina ◽

Marcelo Oliveira ◽

Mônica Lima

Keyword(s):

Overall Survival ◽

Survival Rates ◽

Progression Free Survival ◽

Tumor Grade ◽

Karnofsky Performance Scale ◽

Surgical Removal ◽

Strong Positive Correlation ◽

Duration Of Treatment ◽

Free Survival ◽

Logistic Regression Models

The temozolomide protocol established in 2005 increased overall survival rates in patients with glioblastoma. It defined a treatment period of 6 months, but most neuro-oncological centers prescribe more than this, reaching up to 3 years of continuous therapy. The objective of this paper was to compare duration of treatment in groups of patients and analyze the overall survival in each group. Retrospectively, 54 patients were evaluated with glioblastoma operated on from 2004 to 2009. All data were statistically analyzed using Kaplan-Meier curves, ANOVA test, multivariate logistic regression models and Pearson´s correlation. Analyses consisted on age, gender, Karnofsky Performance Scale (KPS) at diagnosis, side and localization of tumor, grade of surgical removal, period of use of temozolomide until recurrence, progression-free survival, KPS after recurrence and overall survival. According to uni and multi-varied analysis there was no statistic significant correlation between survival and age < 45, gender, KPS at diagnosis, and grade of resection. The overall survival in 6, 12, 18 and 24 months were 96.3%, 72.6%, 58.1% and 43.5% respectively. The length of treatment with temozolomide before recurrence showed strong positive correlation (r=0.66) with survival up to 15 months. Also, a correlation (r=0.64) between length of use of temozolomide and progression free-survival was found. Patients receiving treatment with temozolomide presented longer survival when compared with those not treated with it. Longer survival (p=0.04) was observed in those treated more than 12 months. This series could clearly show longer survival in patients treated with 15-cicles over patients treated with 6 or 12-cicles.

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Surgery for convexity meningioma: Simpson Grade I resection as the goal

Journal of Neurosurgery ◽

10.3171/2012.9.jns12294 ◽

2012 ◽

Vol 117 (6) ◽

pp. 999-1006 ◽

Cited By ~ 76

Author(s):

Bernt Filip Hasseleid ◽

Torstein R. Meling ◽

Pål Rønning ◽

David Scheie ◽

Eirik Helseth

Keyword(s):

Overall Survival ◽

Survival Rates ◽

Observation Time ◽

University Hospitals ◽

Who Grade ◽

Free Survival ◽

Simpson Grade ◽

Hazard Ratios ◽

Total Observation

Object Recently the relevance of Simpson resection grade as a prognostic factor for recurrence of WHO Grade I meningiomas was challenged, contradicting many previous scientific reports and traditional neurosurgical teaching. The objective of this study was to determine whether the predictive value of Simpson resection grade is outdated or remains valid with respect to meningioma recurrence and overall survival. Methods All patients at least 16 years old who underwent primary craniotomies for convexity meningiomas at Oslo University–affiliated hospitals (Rikshospitalet and Ullevål University Hospitals) in the period between January 1, 1990, and January 27, 2011, were included. Overall survival and retreatment-free survival rates were correlated with patient- and surgery-specific factors. Results Three hundred ninety-one consecutive patients were included in the study. The median patient age was 60.1 years (range 19–92 years). The female-to-male ratio was 2.1:1. The WHO grades were Grade I in 353 (90.3%), Grade II in 22 (5.6%), and Grade III in 16 (4.1%). The follow-up rate was 100%. Median follow-up time was 7.1 years (range 0.0–20.9 years) and total observation time was 3147 patient-years. The 1-, 5-, and 10-year overall survival rates were 96%, 89%, and 78%, respectively. Age, sex, WHO grade, and Simpson grade were significantly associated with overall survival. The 1-, 5-, and 10-year retreatment-free survival rates were 99%, 94%, and 90%, respectively. Simpson resection grade and WHO grade were significantly associated with retreatment-free survival. The hazard ratios for retreatment after combined Simpson resection Grades II+III and IV+V were 4.9- and 13.2-times higher than after Simpson Grade I resection, respectively. Conclusions Simpson Grade I resection should continue to be the goal for convexity meningiomas.

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Dural Invasion Predicts the Laterality and Development of Neck Metastases in Esthesioneuroblastoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1625977 ◽

2018 ◽

Vol 79 (05) ◽

pp. 495-500 ◽

Cited By ~ 1

Author(s):

John Marinelli ◽

Jamie Van Gompel ◽

Michael Link ◽

Eric Moore ◽

Kathryn Van Abel ◽

...

Keyword(s):

Overall Survival ◽

Survival Rates ◽

Regional Recurrence ◽

Recurrence Free Survival ◽

Cervical Lymph Nodes ◽

Term Survival ◽

Free Survival ◽

Tertiary Referral Center ◽

Neck Disease ◽

Neck Metastases

Objectives Neck metastases in patients with esthesioneuroblastoma (ENB) constitute the most significant predictor of poor long-term survival. Recently, researchers discovered the existence of dural lymphatic channels that drain to the cervical lymph nodes. From this physiologic basis, we hypothesized that patients with ENB who develop dural invasion (DI) would exhibit a proclivity for neck metastases. Design Retrospective review. Setting Tertiary referral center. Participants All patients treated for ENB from January 1, 1994 to December 31, 2015. Main Outcome Measures Incidence, laterality, and recurrence rate of neck metastases by DI status. Results Sixty-one patients were identified (38% female; median age 49, range, 10–80), 34 (56%) of whom had DI and 27 (44%) did not. Of patients with DI, 50% presented with or developed neck disease following treatment compared with just 22% of those without DI (p = 0.026). Bilateral neck disease was more common in patients with DI (11/34, 32%) compared with those without (2/27, 7%) (p = 0.018). Five-year regional recurrence-free survival rates were 88% for those without and 64% for those with DI (p = 0.022). Kadish C patients with DI were more likely to develop regional recurrence when compared with Kadish C without DI and Kadish A/B (p = 0.083). Further, Kadish C patients with DI displayed worse overall survival than Kadish C without DI and Kadish A/B. Kadish D patients displayed the worst overall survival. The difference in overall survival among these four groups was significant (p < 0.001). Conclusion DI by ENB is associated with increased incidence of cervical nodal metastases, bilateral neck disease, worse regional recurrence-free survival, and poorer overall survival. These data support the division of Kadish C by DI status.

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