Stage II Oral Tongue Cancer: Survival Impact of Adjuvant Radiation Based on Depth of Invasion

Objective To determine if adjuvant radiation therapy for patients with pT2N0 oral cavity tongue cancer affects overall survival. Study Design Retrospective cohort study. Setting National Cancer Database. Subjects and Methods Cases diagnosed between 2004 and 2013 with pathologic stage pT2N0 oral cavity tongue cancer with negative surgical margins were extracted from the National Cancer Database. Data were stratified by treatment received, including surgery only and surgery + postoperative radiation therapy. Univariate analysis was performed with a 2-sample t test, chi-square test, or Fisher exact test and log-rank test, while multivariate analysis was performed with Cox regression models adjusted for individual variables as well as a propensity score. Results A total of 934 patients were included in the study, with 27.5% of patients receiving surgery with postoperative radiation therapy (n = 257). In univariate analysis, there was no significant difference in 3-year overall survival between the patient groups ( P = .473). In multivariate analysis, there was no significant difference in survival between the treatment groups, with adjuvant radiation therapy having a hazard ratio of 0.93 (95% CI, 0.60-1.44; P = .748). Regarding tumors with a depth of invasion >5 mm, there was no survival benefit for the patients who received postoperative radiation therapy as compared with those who received surgery alone (hazard ratio = 0.93; 95% CI, 0.57-1.53; P = .769). Conclusion An overall survival benefit was not demonstrated for patients who received postoperative radiation therapy versus surgery alone for pT2N0 oral cavity tongue cancer, irrespective of depth of tumor invasion.

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Should Depth of Invasion Determine the Need for Postoperative Radiation Therapy in Early-Stage Oral Tongue Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.875 ◽

2018 ◽

Vol 102 (3) ◽

pp. e270

Author(s):

J.M. Mann ◽

D.A. Julie ◽

S. Mahase ◽

D. D'Angelo ◽

A.G. Wernicke ◽

...

Keyword(s):

Radiation Therapy ◽

Tongue Cancer ◽

Early Stage ◽

Depth Of Invasion ◽

Postoperative Radiation ◽

Oral Tongue ◽

Postoperative Radiation Therapy ◽

Oral Tongue Cancer

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The role for adjuvant radiotherapy in the treatment of hemangiopericytoma: a Surveillance, Epidemiology, and End Results analysis

Journal of Neurosurgery ◽

10.3171/2013.10.jns13113 ◽

2014 ◽

Vol 120 (2) ◽

pp. 300-308 ◽

Cited By ~ 33

Author(s):

Adam M. Sonabend ◽

Brad E. Zacharia ◽

Hannah Goldstein ◽

Samuel S. Bruce ◽

Dawn Hershman ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Radiation Therapy ◽

Survival Data ◽

Survival Benefit ◽

Radiation Treatment ◽

Univariate Analysis ◽

Adjuvant Radiation ◽

Significant Difference ◽

End Results

Object Central nervous system (CNS) hemangiopericytomas are relatively uncommon and unique among CNS tumors as they can originate from or develop metastases outside of the CNS. Significant difference of opinion exists in the management of these lesions, as current treatment paradigms are based on limited clinical experience and single-institution series. Given these limitations and the absence of prospective clinical trials within the literature, nationwide registries have the potential to provide unique insight into the efficacy of various therapies. Methods The authors queried the Surveillance Epidemiology and End Results (SEER) database to investigate the clinical behavior and prognostic factors for hemangiopericytomas originating within the CNS during the years 2000–2009. The SEER survival data were adjusted for demographic factors including age, sex, and race. Univariate and multivariate analyses were performed to identify characteristics associated with overall survival. Results The authors identified 227 patients with a diagnosis of CNS hemangiopericytoma. The median length of follow-up was 34 months (interquartile range 11–63 months). Median survival was not reached, but the 5-year survival rate was 83%. Univariate analysis showed that age and radiation therapy were significantly associated with survival. Moreover, young age and supratentorial location were significantly associated with survival on multivariate analysis. Most importantly, multivariate analysis using the Cox proportional hazards model showed a statistically significant survival benefit for patients treated with gross-total resection (GTR) in combination with adjuvant radiation treatment (HR 0.31 [95% CI 0.01–0.95], p = 0.04), an effect not appreciated with GTR alone. Conclusions The authors describe the epidemiology of CNS hemangiopericytomas in a large, national cancer database, evaluating the effectiveness of various treatment paradigms used in clinical practice. In this study, an overall survival benefit was found when GTR was accomplished and combined with radiation therapy. This finding has not been appreciated in previous series of patients with CNS hemangiopericytoma and warrants future investigations into the role of upfront adjuvant radiation therapy.

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Outcomes of adjuvant radiotherapy and lymph node dissection in elderly patients with pancreatic cancer treated with surgery and chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.332 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 332-332

Author(s):

Jessica Freilich ◽

Eric Albert Mellon ◽

Gregory M. Springett ◽

Ken Meredith ◽

Pamela Joy Hodul ◽

...

Keyword(s):

Pancreatic Cancer ◽

Radiation Therapy ◽

Lymph Node ◽

Lymph Nodes ◽

Univariate Analysis ◽

Adjuvant Radiation ◽

Lower Grade ◽

Postoperative Radiation Therapy ◽

T Stage ◽

Significant Difference

332 Background: To determine the effects of postoperative radiation therapy (PORT) and lymph node resection (LNR) on survival in patients age ≥ 70 with pancreatic cancer treated with surgery and chemotherapy. Methods: An analysis of patients with surgically resected pancreatic cancer who received chemotherapy from the SEER database from 2004-2008 was performed to determine association of PORT and LNR on survival. Survival curves were calculated according to the Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model. Results: We identified 961 patients who met inclusion criteria. The only significant difference between PORT patients and no PORT patients was age, median 75 and 76 years, respectively (p=0.007). Overall survival (OS) in PORT versus no PORT was not statistically different in the whole cohort (p=0.064), N0 (p=0.803) or N1 (p=0.0501). On univariate analysis (UVA) there was increased OS in patients with lower T stage (p<0.001), N0 status (p<0.001), lower AJCC stage (p<0.001) and lower grade (p<0.001). No OS difference was seen based on gender, location, or PORT. There was no difference in OS based on number of lymph nodes removed in all patients (p=0.74), N0 (p=0.59), and N1 (p=0.07). MVA for all patients revealed higher T stage, N1, and high grade were prognostic for worse mortality, while there was a trend for decreased mortality with PORT (p=0.052). In N0 patients, increased T-stage and grade were prognostic for worse survival, while PORT and number of lymph nodes removed were not. In N1 patients, higher T-stage and grade were prognostic for increased mortality, while increasing number of lymph nodes removed was associated with decreased mortality. PORT trended towards improved survival in N1 patients (p=0.06). Age, gender and tumor location were not prognostic for survival. Conclusions: Adjuvant radiation therapy and number of lymph nodes removed in patients age ≥70 does not seem to correlate with increased OS in surgically resected pancreatic cancer treated with chemotherapy. Future clinical trials will need to address age as a stratification factor for pancreatic cancer in the adjuvant setting.

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Prognostic Makers Including Immune and Inflammatory Factors Predict Outcomes in Patients Receiving Postoperative Radiation Therapy for Cholangiocarcinoma

10.21203/rs.3.rs-115857/v1 ◽

2020 ◽

Author(s):

Yuki Mukai ◽

Ryusei Matsuyama ◽

Madoka Sugiura ◽

Yasuhiro Yabushita ◽

Risa Taniuchi ◽

...

Keyword(s):

Radiation Therapy ◽

Prognostic Factors ◽

Univariate Analysis ◽

Inflammatory Factors ◽

External Irradiation ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy ◽

Lymphocyte Ratio ◽

Tumor Stages ◽

Significant Difference

Abstract Purpose: This study aimed to analyze treatment outcomes and prognostic markers, including immune and inflammatory factors, of postoperative radiation therapy (RT) administered to patients with cholangiocarcinoma (CCA).Methods: We retrospectively selected 59 patients with CCA who underwent surgery and postoperative RT with curative intent from 2004 to 2019. Patients received external irradiation (50 Gy in 25 fractions) using three-dimensional RT. Overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS), and locoregional control (LRC) rates of initial RT were assessed using the Kaplan–Meier method. Univariate and multivariate Cox proportional-hazards regression models were used to identify prognostic factors. We analyzed prognostic factors of inflammation, such as pre-RT platelet count, hemoglobin, lymphocyte count ratio (LCR) of the leukocyte count, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR).Results: Tumor stages were distributed as follows: I (n = 8), II (n = 25), III (n = 15), and IVA (n = 11). The median follow-up was 24 months. Two-year OS, CSS, PFS, and LRC rates were 59.5%, 62.0%, 40.1%, and 66.7%, respectively. Univariate analysis revealed that lower LCR was significantly associated with shorter PFS (P = 0.0446, hazard ratio (HR): 1.90, 95%, confidence interval (CI): 1.02–3.58). There was no significant difference between the median baseline values of PLR and NLR; and age ≥75, positive regional lymph node metastases (N+), and chemotherapy after RT were significantly associated with poor OS. Multivariate analysis revealed a significant association of N+ with OS, PFS and CSS and that lower LCR was significantly associated with PFS (HR: 0.481, CI: 0.252–0.905, p=0.0234). Among late toxicity events, two patients (3.38%) were suspected with therapy-related liver toxicity.Conclusions: LCR before RT was a prognostic factor for postoperative radiation therapy of patients with CCA.

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Impact of postoperative radiation therapy for deeply invasive oral cavity cancer upstaged to stage III

Head & Neck ◽

10.1002/hed.25498 ◽

2019 ◽

Vol 41 (5) ◽

pp. 1178-1183 ◽

Cited By ~ 2

Author(s):

John D. Cramer ◽

Sandeep Samant ◽

Dwight E. Heron ◽

Robert L. Ferris ◽

Seugwon Kim

Keyword(s):

Radiation Therapy ◽

Oral Cavity ◽

Oral Cavity Cancer ◽

Stage Iii ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy

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Postoperative Radiation Therapy for Parotid Mucoepidermoid Carcinoma

Case Reports in Oncological Medicine ◽

10.1155/2014/345128 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Meghan P. Olsen ◽

Allen O. Mitchell ◽

Edward F. Miles

Keyword(s):

Radiation Therapy ◽

Parotid Gland ◽

Mucoepidermoid Carcinoma ◽

Controlled Trials ◽

Adjuvant Radiation ◽

Low Grade ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy ◽

Randomized Controlled

Salivary gland cancers are rare and represent approximately 5% of all head and neck cancers and only 0.3% of all malignancies. The majority (75%) of salivary gland tumors occur in the parotid gland, and while benign lesions are more common, mucoepidermoid carcinoma (MEC) makes up 40–50% of malignant parotid gland tumors. No randomized controlled trials exist regarding the role of adjuvant radiation for patients who undergo surgical resection of low-grade MECs. Herein, we report two cases of successful postoperative radiation therapy in low-grade, pT2N0 MEC of the parotid gland. The role of adjuvant radiation therapy for patients with MEC of the parotid gland is based on data from institution reviews and lacks data from randomized controlled trials. Per our review of the literature, the pathological findings of positive surgical margins and/or perineural invasion in two patients with low-grade MEC of the parotid gland warranted adjuvant radiation for improved local control after partial parotidectomy. Both patients tolerated postoperative radiation therapy with only mild side effects and, at last follow-up, five years after completion of therapy, had no clinical or radiographic evidence of either local recurrence or distant metastasis.

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Laser Resection for Early Oral Cavity Cancer

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948709600515 ◽

1987 ◽

Vol 96 (5) ◽

pp. 556-560 ◽

Cited By ~ 11

Author(s):

Matthew J. Nagorsky ◽

Donald G. Sessions

Keyword(s):

Radiation Therapy ◽

Oral Cavity ◽

Complication Rate ◽

Oral Cavity Cancer ◽

Local Control Rate ◽

Tumor Control ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy ◽

Laser Excision ◽

High Level

Laser excision of early selected cancers of the oral cavity and pharynx is a well accepted and reported treatment. Postoperative radiation therapy is employed in patients with unfavorable pathologic findings and in patients expected to have a high recurrence and metastatic rate. In most patients the combination of laser excision and postoperative radiation therapy is well tolerated and results in satisfactory healing, excellent tumor control, and high-level posttreatment function. This report discusses the treatment and results in 28 patients treated for early cancer of the oral cavity and pharynx. The local control rate of 77% compares favorably with the reported results following either conventional or laser excision of these lesions. The overall complication rate was 39%, with a 25% rate for patients not receiving postoperative radiation therapy, and a 58% complication rate for patients treated with postoperative radiation.

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Limited Neck Volumes in Postoperative Radiation Therapy for Squamous Cell Carcinomas of the Oral Cavity

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2013.06.1137 ◽

2013 ◽

Vol 87 (2) ◽

pp. S431-S432

Author(s):

J.A. Contreras ◽

N.G. Rao ◽

A.M. Trotti ◽

J.J. Caudell

Keyword(s):

Radiation Therapy ◽

Oral Cavity ◽

Squamous Cell ◽

Squamous Cell Carcinomas ◽

Postoperative Radiation ◽

Postoperative Radiation Therapy

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Contemporary breast conservation patient outcomes for ductal carcinoma in situ and margins < 2 mm.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.559 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 559-559

Author(s):

Audree Tadros ◽

Benjamin D. Smith ◽

Yu Shen ◽

Heather Y. Lin ◽

Savitri Krishnamurthy ◽

...

Keyword(s):

Radiation Therapy ◽

Locoregional Recurrence ◽

Univariate Analysis ◽

Breast Conservation ◽

Adjuvant Radiation ◽

Adjuvant Radiation Therapy ◽

Margin Width ◽

Additional Surgery ◽

Significant Difference ◽

The Relationship

559 Background: Recent national consensus guidelines regarding optimal margin width for the management of DCIS have been published; however, controversy remains for managing margins <2mm. The relationship between margin width and locoregional recurrence (LRR) was determined in a contemporary cohort of patients. Methods: 1504 patients with DCIS undergoing definitive breast conserving surgery from 1996 to 2010 were analyzed for clinical and pathologic characteristics from a prospectively managed comprehensive academic cancer center database. Cox proportional hazard models were used to examine the relationship between margin width (<2mm or ≥2mm) and LRR by adjuvant radiation therapy (RT). Patients with positive margins (n=11) were excluded. Results: Overall, 3.4% of patients had a LRR at a median follow-up of 8.7 years. Univariate analysis of age, family history, grade, tumor size, comedonecrosis, RT, adjuvant hormonal therapy, ER status, and margin width found younger age (< 40 yr, p=0.02), no RT (n=299, p=0.005), and margin width <2mm(n=138, p=0.005) to be associated with LRR. The association between margin width and LRR differed by adjuvant radiation therapy status (p=0.02 for the interaction). There was no statistical significant difference in LRR for patients with margins <2mm vs ≥2 mm who received RT, (10-year LRR 6.0% vs 3.2%, respectively; HR 1.5, 95% CI 0.5-4.2, p=0.48). For patients who did not receive RT (n=299), those with margins < 2 mm were significantly more likely to develop a LRR than those with margins ≥2mm (10-year LRR 35.7% vs. 4.6%, respectively; HR 7.2, 95%CI 2.6-19.4, p=0.0001). Conclusions: In patients with <2mm margins receiving adjuvant radiation therapy, there is no difference in locoregional recurrence when compared to patients with ≥2mm margins. Additional surgery for wider margins of resection are not routinely justified in this group of patients but should be obtained for patients with <2mm margins who forego radiotherapy.

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