scholarly journals CT-based Radiomic Analysis for Prediction of Treatment Response of Salvage Chemoradiotherapy for Loco-regional Lymph Node Recurrence After Curative Esophagectomy

2021 ◽  
Author(s):  
Liang Gu ◽  
Xinwei Guo ◽  
Hongxue Ye ◽  
Shaobin Zhou ◽  
Yangchen Liu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Local Recurrence ◽  
Treatment Response ◽  
Local Control ◽  
Therapeutic Response ◽  
Recurrence Time ◽  
Training Cohort ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Curative Esophagectomy

Abstract Objective: To investigate the capability of computed tomography (CT) radiomic features to predict the therapeutic response and local control of the loco-regional recurrence lymph node (LN) after curative esophagectomy by chemoradiotherapy (CRT).Methods: This retrospective study included 129 LN from 77 patients (training cohort: 102 LN from 59 patients; validation cohort: 27 LN from 18 patients) with postoperative esophageal squamous cell carcinoma (ESCC). The region of the tumor was contoured in pretreatment contrast-enhanced CT images. The least absolute shrinkage and selection operator (LASSO) with logistic regression was used to identify radiomic predictors in the training cohort. Model performance was evaluated using the area under the receiver operating characteristic curves (AUC). The Kaplan-Meier method was used to determine the local recurrence time of cancer.Results: Seven features were selected to construct a radiomics model for predicting therapeutic response. The AUCs in the training and validated cohorts were 0.777 (95%CI: 0.667–0.878) and 0.765(95%CI: 0.556–0.975), respectively. A significant difference of radiomic score (Rad-score) between the response and non-response was observed in the two cohorts (P < 0.001, 0.034, respectively). Two features were identified for classifying whether to relapse in two years. AUC was 0.857(95%CI: 0.780–0.935) in the training cohort. The local control time of the high Rad-score group was higher than the low group in both cohorts (P < 0.001 and 0.025, respectively). After the Cox regression analysis, the Rad-score indicated high-risk factors for local recurrence within two years.Conclusions: The radiomics approach can be used as a potential imaging biomarker to predict treatment response and local control of recurrence LN in ESCC patients.

Reduced local recurrence of a single brain metastasis through microscopic total resection

2009 ◽  
Vol 110 (4) ◽  
pp. 730-736 ◽  
Author(s):  
Heon Yoo ◽  
Young Zoon Kim ◽  
Byung Ho Nam ◽  
Sang Hoon Shin ◽  
Hee Seok Yang ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Brain Metastasis ◽  
Tumor Cells ◽  
Group Versus ◽  
Brain Parenchyma ◽  
Tumor Control ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Single Brain Metastasis ◽  
Adjacent Brain

Object The goal of this study was to evaluate the therapeutic impact of the resection of metastatic brain tumor cells infiltrating adjacent brain parenchyma. Methods Between July 2001 and February 2007, 94 patients (67 males and 27 females, with a mean age of 55.0 ±12.0 years) underwent resection of a single brain metastasis, followed by systemic chemotherapy with or without radiotherapy. In 43 patients with tumors located in noneloquent areas, the authors performed microscopic total resections (MTRs) that included tumor cells infiltrating adjacent brain parenchyma, and they pathologically confirmed during surgery that the resection margins were free of tumor cells (MTR group). In 51 patients with lesions in eloquent locations, gross-total resections (GTRs) were performed without the removal of neighboring brain parenchyma (GTR group). The 2 groups were then compared for local recurrence and survival. Results The MTR group had better local control of the tumor than did the GTR group; 10 (23.3%) of 43 patients in the MTR group and 22 (43.1%) of 51 patients in the GTR group had a local recurrence (p = 0.04). The median time to tumor progression in the MTR group could not be calculated using the Kaplan-Meier method, whereas it was 11.4 months in the GTR group. The 1- and 2-year respective local recurrence rates were 29.1 and 29.1% in the MTR group and 58.6 and 63.2% in the GTR group (p = 0.01). Multivariate analysis showed that the MTR procedure was associated with a decreased risk of local recurrence (p = 0.003). A Cox regression analysis revealed that the hazard ratio for a local recurrence in the MTR group versus the GTR group was 3.14 (95% CI 1.47–6.72, p = 0.003). There was no significant difference in the local recurrence rate between the MTR group without radiotherapy (10 [30.3%] of 33) and the GTR group with postoperative radiotherapy (5 [26.3%] of 19). Conclusions The results in this study suggest that MTRs including tumor cells infiltrating adjacent brain parenchyma for a single brain metastasis provide better local tumor control.

scholarly journals Development and validation of a radiomics-based model to predict local progression-free survival after chemo-radiotherapy in patients with esophageal squamous cell cancer

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
He-San Luo ◽  
Ying-Ying Chen ◽  
Wei-Zhen Huang ◽  
Sheng-Xi Wu ◽  
Shao-Fu Huang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Local Recurrence ◽  
Squamous Cell ◽  
Cox Regression ◽  
Validation Cohort ◽  
Cell Cancer ◽  
Clinical Factors ◽  
Free Survival ◽  
Training Cohort ◽  
Cox Regression Analysis

Abstract Purpose To develop a nomogram model for predicting local progress-free survival (LPFS) in esophageal squamous cell carcinoma (ESCC) patients treated with concurrent chemo-radiotherapy (CCRT). Methods We collected the clinical data of ESCC patients treated with CCRT in our hospital. Eligible patients were randomly divided into training cohort and validation cohort. The least absolute shrinkage and selection operator (LASSO) with COX regression was performed to select optimal radiomic features to calculate Rad-score for predicting LPFS in the training cohort. The univariate and multivariate analyses were performed to identify the predictive clinical factors for developing a nomogram model. The C-index was used to assess the performance of the predictive model and calibration curve was used to evaluate the accuracy. Results A total of 221 ESCC patients were included in our study, with 155 patients in training cohort and 66 patients in validation cohort. Seventeen radiomic features were selected by LASSO COX regression analysis to calculate Rad-score for predicting LPFS. The patients with a Rad-score ≥ 0.1411 had high risk of local recurrence, and those with a Rad-score < 0.1411 had low risk of local recurrence. Multivariate analysis showed that N stage, CR status and Rad-score were independent predictive factors for LPFS. A nomogram model was built based on the result of multivariate analysis. The C-index of the nomogram was 0.745 (95% CI 0.7700–0.790) in training cohort and 0.723(95% CI 0.654–0.791) in validation cohort. The 3-year LPFS rate predicted by the nomogram model was highly consistent with the actual 3-year LPFS rate both in the training cohort and the validation cohort. Conclusion We developed and validated a prediction model based on radiomic features and clinical factors, which can be used to predict LPFS of patients after CCRT. This model is conducive to identifying the patients with ESCC benefited more from CCRT.

scholarly journals Examining the use of radiation therapy for cholangiocarcinoma: benefits through modern techniques

2020 ◽  
Author(s):  
Felix Gattermann ◽  
Michael Oertel ◽  
Sergiu Scobioala ◽  
Christian Wilms ◽  
Hartmut Schmidt ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Recurrence ◽  
Local Control ◽  
Progression Free Survival ◽  
Blood Parameters ◽  
Series Data ◽  
Treatment Situation ◽  
Effective Combination ◽  
Significant Difference ◽  
Definitive Surgery

Abstract BackgroundCholangiocarcinoma (CCA) is a rare malignant tumor of the bile duct epithelium. At first diagnosis, only a minority of patients is eligible for surgery, which is regarded as the only curative treatment. This study examines the role of radiation therapy (RT) and chemoradiotherapy (CRT) in the definitive and adjuvant treatment situation.MethodsThe monocentric retrospective analysis included 39 patients (31 males, 8 females) with CCA undergoing 53 RT series. Data was collected from January 2005 to September 2018. There were 11 cases of CRT, 6 of which were definitive. Surgery was either palliative (n=6) or radical (n=15).ResultsAfter RT, median overall survival (OS) was 10.4 months (mo; 95% confidence interval [CI] 6.6-14.2), median progression-free survival (PFS) was 5.6 mo (95% CI 3-8.2), median duration of local control (DOLC) was 8.9 mo (95% CI 4.7-13.1) and 1-year OS rate was 44.7%. There was a significant difference between patients with and without locoregional lymph node metastasis (OS: 4.3 mo vs. 15.4 mo, p=0.031; PFS: 2.1 mo vs. 11.5 mo, p<0.0005; DOLC: 4.2 mo vs. 12.3 mo, p=0.02). After treatment of a primary tumor, DOLC was about twice as long as in the recurrent situation (10.4 mo vs. 5.4 mo, p=0.032). Conservative therapy significantly elevated the risk of local recurrence compared to radical surgery in univariate (HR 11.04, p=0.004) and multivariate (HR 98.34, p=0.024) analysis. Tomotherapy may be advantageous with respect to local recurrence and survival.Side effects were mostly classified as grade I-II according to CTCAE. There were 10 toxicities of grade III and 4 of grade IV, all affecting blood parameters. Termination of RT and increased glutamic pyruvic transaminase (GPT) were significantly less frequent after stereotactic body radiation therapy and hypofractionation.ConclusionRT can achieve local control in patients with CCA. However, since overall prognosis remains poor, effective combination therapies are needed. Toxicities of RT are manageable but require close clinical and laboratory follow-up.

scholarly journals Radiotherapy for local recurrence of non-small-cell lung cancer after lobectomy and lymph node dissection—can local recurrence be radically cured by radiation?

2020 ◽  
Vol 50 (4) ◽  
pp. 425-433
Author(s):  
Yukihiro Terada ◽  
Mitsuhiro Isaka ◽  
Hideyuki Harada ◽  
Hayato Konno ◽  
Hideaki Kojima ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Local Recurrence ◽  
Small Cell Lung Cancer ◽  
Lymph Node Dissection ◽  
Local Control ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Node Dissection ◽  
Small Cell Lung

Abstract Background There is no standard therapeutic approach for local recurrence of non-small cell lung cancer (NSCLC) after complete resection. We investigated the outcomes of radiotherapy (RT) for patients with local recurrence. Methods We reviewed 46 patients who underwent curative-intent RT for local recurrence after lobectomy or pneumonectomy accompanied with mediastinal lymph node dissection between 2002 and 2014. We analyzed overall survival (OS), progression-free survival (PFS), local control, tumour response and the re-recurrence pattern. Results Among the 46 patients, 16 received concurrent chemotherapy. The median follow-up period was 48 months. The response rate was 91%. The 5-year OS and local control rates were 47.9 and 65.3%, respectively, and the 5-year PFS rate was 22.8%. Female sex and complete response to radiation were favourable prognostic factors. Of the 33 patients with recurrence after radiation, 32 (97%) had distant metastasis. Conclusions Although RT for local recurrence has high efficacy, distant relapse after radiation remains a major issue. Therefore, combination systemic therapy for local recurrence at any site should be further investigated. Since it is difficult to achieve a radical cure for local recurrence using RT, further study, for the administration of post-operative adjuvant therapy, is recommended.

Definitive Chemoradiotherapy in Elderly Cervical Cancer Patients: A Multiinstitutional Analysis

2017 ◽  
Vol 27 (7) ◽  
pp. 1446-1454 ◽  
Author(s):  
Ozan Cem Guler ◽  
Sezin Yuce Sari ◽  
Sumerya Duru Birgi ◽  
Melis Gultekin ◽  
Ferah Yildiz ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Prognostic Factors ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Local Control ◽  
External Beam Radiation ◽  
Significant Prognostic Factor ◽  
Definitive Chemoradiotherapy ◽  
Beam Radiation ◽  
Significant Difference

ObjectiveThe aim of the study was to investigate the prognostic factors for survival and treatment-related toxicities in older (≥65 years) cervical cancer patients treated with definitive chemoradiotherapy. In addition, we sought to compare the outcomes between the older elderly (≥75 years) and their younger old counterparts (age, 65–74 years).Materials and MethodsWe retrospectively reviewed medical records from 269 biopsy-proven nonmetastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at the departments of radiation oncology in 2 different universities. The prognostic factors for survival, local control, and distant metastasis (DM) were analyzed.ResultsThe median follow-up time was 38.8 months (range, 1.5–175.5 months) for the entire cohort and 70.0 months (range, 6.1–175.7 months) for survivors. The 2- and 5-year overall survival (OS), disease-free survival (DFS), and cause-specific survival rates were 66% and 42%, 63% and 39%, and 72% and 55%, respectively. Patients 75 years or older showed significantly worse OS compared with patients aged 65 to 74 years but showed no significant difference in DFS. The 2- and 5-year local control rates were 86% and 71%, respectively. The incidences of DMs at 2 and 5 years were 22% and 30%, respectively. In multivariate analysis, vaginal infiltration and lymph node metastasis were predictive of OS, DFS, local recurrence, and DM. Concomitant chemotherapy was predictive of OS, DFS, and local recurrence, and larger tumor (>4 cm) was a significant prognostic factor for local recurrence. None of the patients had toxicity that necessitated the discontinuation of radiotherapy. All patients were evaluable for acute toxicity, and no grade higher than 3 adverse events occurred during external beam radiation therapy or brachytherapy.ConclusionsAlthough age limited the delivery of aggressive treatment, concurrent chemoradiotherapy in elderly patients associated with improved outcomes similar as in younger counterparts without increasing serious acute and late toxicities.

scholarly journals Clinical impact of abdominal versus mediastinal metastases as a prognostic factor for poor outcomes following esophageal cancer surgery: a retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yutaka Miyawaki ◽  
Hiroshi Sato ◽  
Shuichiro Oya ◽  
Hirofumi Sugita ◽  
Yasumitsu Hirano ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Regression Analysis ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Systemic Recurrence ◽  
Significant Difference

Abstract Background Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear. Methods We retrospectively analyzed the association of postoperative survival with clinical mediastinal LNM (cMLNM) and abdominal LNM (cALNM) in 157 patients who underwent radical EC surgery at our hospital between May 2012 and March 2018. Results A significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p = 0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p = 0.0007 and 0.021, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p = 0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p = 0.000 and 0.015, respectively). Conclusion cALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten the CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.

scholarly journals Development and Validation of a Radiomics-based Model to Predict Local Progression-free Survival After Chemo-radiotherapy in Patients With Esophageal Squamous Cell Cancer

2021 ◽  
Author(s):  
He-San Luo ◽  
Ying-Ying Chen ◽  
Sheng-Xi Wu ◽  
Shao-Fu Huang ◽  
Hong-Yao Xu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Local Recurrence ◽  
Squamous Cell ◽  
Cox Regression ◽  
Validation Cohort ◽  
Cell Cancer ◽  
Clinical Factors ◽  
Free Survival ◽  
Training Cohort ◽  
Cox Regression Analysis

Abstract Purpose: To develop a nomogram model for predicting local progress-free survival (LPFS) in esophageal squamous cell carcinoma (ESCC) patients treated with chemoradiotherapy. Methods: We collected the clinical data of ESCC patients treated with CCRT in our hospital. Eligible patients were randomly divided into training cohort and validation cohort. The least absolute shrinkage and selection operator (LASSO) with COX regression was performed to select optimal radiomics features calculating Rad-score for predicting LPFS in the training cohort. The univariate and multivariate analysis were performed to identify the predictive clinical factors for developing a nomogram model. The C-index was used to assess the performance of the predictive model and calibration curve was used to evaluate the accuracy.Results: A total of 221 ESCC patients were included in our study, with 155 patients in training cohort and 66 patients in validation cohort. After LASSO COX regression analysis, seventeen radiomics features were selected to calculate Rad-score for predicting LPFS. The patients with a Rad-score≥0.1411 had high risk of local recurrence, and those with a Rad-score<0.1411 had low risk of local recurrence. Multivariate analysis showed that N stage, CR status and Rad-score were independent predictive factors for LPFS. A nomogram model was built based on the result of multivariate analysis. The C-index of the nomogram was 0.745 (95%CI: 0.7700 -0.790) in training cohort and 0.723(95%CI：0.654-0.791) in validation cohort. The 3-year LPFS rate predicted by the nomogram model was highly consistent with the actual 3-year LPFS rate both in the training cohort and the validation cohort.Conclusion: We developed and validated a prediction model based on radiomics features and clinical factors, which can be used to predict LPFS of patients after CCRT. This model is conducive to making individualized chemoradiotherapy strategy and providing scientific basis for subsequent intensive adjuvant therapy for ESCC patients.

scholarly journals Influence of marginal and segmental bony resection on the local control of oral Squamous cell carcinoma involving the mandible

2019 ◽  
Vol 18 (4) ◽  
pp. 801-807
Author(s):  
Mohammad Deedarul Alam
Keyword(s):  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Oral Squamous Cell Carcinoma ◽  
Oral Cavity ◽  
Cell Carcinoma ◽  
Local Control ◽  
Squamous Cell ◽  
Segmental Resection ◽  
Marginal Group ◽  
Significant Difference

Background and objective: Marginal or segmental resection of bone are often required for tumor removal in oral squamous cell carcinoma patients to secure adequate margin. The present study aims to evaluate the surgical outcome and post-operative complication of both group of patients and also assesses the local control of the disease in the oral cavity. Methods: In this prospective study, 32 patients who were treated with marginal or segmental jaw resection for oral squamous cell carcinoma of the lower part of oral cavity was undertaken within September 2008 to August 2013.There were 9 males and 23 females with a median age of 40.5 years. Twenty patients underwent marginal and 12 patients had segmental resection of the mandible. Distribution of the subject by age, sex, primary site of lesion, pathologic tumor stage, presence of mandibular invasion, pathologic cervical lymph node stage and feature of post- operative complications were analyzed prospectively. Results: According to this study, the mandible was involved in 83.3% of patient with segmental resection and 15% of patients with marginal resection. Buccal mucosa was mostly involved site in marginal group (60%) and retro molar trigon was highly involved site with segmental group (41.7%). In marginal group 30% cases was involved with stage1 and 70% was stage2; in segmental group 25% cases were stage2 and 67.7% were stage3. Statistically significant difference was exist in pathological cervical node stage(p<0.05). Mandibular invasion was significantly more in segmental group (p<0.05). Soft tissue surgical margins were positive in 4 patients (20%) in the marginal group and in 3 patients (25%) in the segmental group. Negative neck lymph node was found in 20 (63%) cases and positive neck node was found in 12 (37%) cases, of which four patients, including 2(15%) cases in the marginal group and 2(8.3%) cases in the segmental group was died. Trismus and mastication problems were found higher in segmental than marginal resection group. Conclusion: Marginal resection of mandible is effective for patient with oral squamous cell carcinoma in the early stage. Post-operative outcome and local control of disease in segmental group were slightly higher than marginal group. Positive surgical margin status and bone invasion was found as the most important predictor of local control of the diseases in patient with oral squamous cell carcinoma. Bangladesh Journal of Medical Science Vol.18(4) 2019 p.801-807

Extended lymphadenectomy and adjuvant chemotherapy in muscle-invasive bladder cancer treated by radical cystectomy.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 287-287
Author(s):  
Peter J. Bostrom ◽  
Tuomas Mirtti ◽  
Martti Nurmi ◽  
Matti Laato ◽  
Bas W.G. Van Rhijn ◽  
...  
Keyword(s):  
Lymph Node ◽  
Adjuvant Chemotherapy ◽  
Lymph Node Dissection ◽  
Cox Regression ◽  
Interaction Model ◽  
Node Dissection ◽  
Cox Regression Analysis ◽  
Survival Difference ◽  
Significant Difference ◽  
The University

287 Background: Level 1 evidence is weak for adjuvant chemotherapy (AC) after cystectomy, but surveys indicate physicians refer patients for AC more frequently than for neoadjuvant chemotherapy (NC). The exact benefit of an extended pelvic lymph node dissection (ePLND) remains debated. We addressed the issue of AC and ePLND analyzing two academic centers RC databases with opposite approaches, one using ePLND and AC, the other performing a limited lymph node dissection and no AC. Methods: Two ethics approved RC databases including consecutive BC patients undergoing RC at the University Health Network, Canada and the University of Turku, Finland were studied. Excluding non-urothelial cases and patients receiving NC, 563 patients were available for analysis. Clinicopathological variables, rate and extent of PLND and rate of adjuvant cisplatin-based chemotherapy were analyzed using the χ2-test. Kaplan-Meier method and multivariate Cox regression analysis were used to analyze survival. Results: In Toronto, patients had more extensive PLNDs (>10 nodes removed, 58% vs. 8%, p<0.001), higher rate of nodal metastases (26% vs. 7%, p<0.001), and received more often AC (21% vs. 1%, p<0.001). Positive margin rates were similar (4% in both centers). No BC specific survival difference was demonstrated in ≤ pT2a or in pT4a tumors. There was a trend for improved survival in pT2b tumors (10y BC specific survival 65% vs. 42%, p=0.23) and a significant difference favouring the Toronto cohort in pT3a and pT3b tumors (55% vs. 31%, p=0.025; 43% vs. 28% p=0.06, respectively). In multivariate analysis, N-stage (HR 2.5, 95% CI 1.5-4.1; p<0001) and ePLND (HR 0.53, 95% CI 0.31-0.93, p=0.026) significantly affected disease specific survival. The benefit of AC did not reach significance (HR 0.61, 95% CI 0.36-1.05, p=0.072). An interaction model combining ePLND and AC was significantly related to improved outcome (HR 0.49, 95% CI 0.26-0.92, p=0.026). Conclusions: Despite not being randomized, using 2 study cohorts that received completely opposite managements in terms of ePLND and AC, our results support that ePLND and AC may offer a survival advantage in T2b and especially in T3 BC treated with RC.

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