Cancer Research and Treatment

Original Articles

Association between Antipsychotic Drug and Survival in Patients with Lung Cancer Treated with Chemoradiotherapy: A Nationwide Korean Cohort Study: Dong-Yun Kim, In Gyu Hwang, Sun Mi Kim, Dae Ryong Kang, Tae-Hwa Go, Se Hwa Hong, Shin Young Park, Hyunho Lee, Jin Hwa Choi; Received June 12, 2024 Accepted February 5, 2025 Published online February 6, 2025; DOI: https://doi.org/10.4143/crt.2024.554 [Accepted]

Abstract PDF: Purpose
Antipsychotic drugs (APDs) can be used to relieve psychological symptoms in patients with cancer. We investigated the nationwide use of APDs during concurrent chemoradiotherapy (CCRT) for patients with lung cancer and its association with overall survival (OS).
Materials and Methods
The National Health Service database was used in this retrospective cohort study. Patients diagnosed with lung cancer between 2010 and 2020 who received cisplatin-based CCRT were included. The APDs included in the analysis were aripiprazole, quetiapine, olanzapine, risperidone, haloperidol, and chlorpromazine, and the APD prescription details included prescription time, dosage, and duration.
Results
Among the 23,099 patients with lung cancer treated with CCRT, 2,662 (11.5%) took APDs concurrently. Quetiapine (47.3%) and chlorpromazine (36.6%) were the frequently prescribed APDs. In the univariate analysis, patients prescribed APDs during CCRT had a significantly worse OS than those who did not take APDs. The 2-year OS rates for APD (+) and APD (-) patients were 20.4% and 36.4%, respectively (p < 0.001). Multivariable analyses revealed that APD prescription, male, age >80 years, and comorbidities, such as hypertension, myocardial infarction, and depressive disorder, significantly influenced OS. In patients who used APDs during CCRT, APD prescription timing (pre-CCRT vs. during CCRT), dosage (low vs. high) and duration (within 6 months vs. over 6 months) had no significant difference.
Conclusion
Overall, 11.5% of patients with lung cancer used APDs during CCRT. Patients who used APDs during CCRT had poorer survival than those who did not. Further studies are required to elucidate the effects of APDs on patients with cancer.

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Gastrointestinal cancer

Integrating Deep Learning–Based Dose Distribution Prediction with Bayesian Networks for Decision Support in Radiotherapy for Upper Gastrointestinal Cancer: Dong-Yun Kim, Bum-Sup Jang, Eunji Kim, Eui Kyu Chie; Cancer Res Treat. 2025;57(1):186-197. Published online August 2, 2024; DOI: https://doi.org/10.4143/crt.2024.333

Abstract PDF Supplementary Material PubReader ePub: Purpose
Selecting the better techniques to harbor optimal motion management, either a stereotactic linear accelerator delivery using TrueBeam (TBX) or magnetic resonance–guided gated delivery using MRIdian (MRG), is time-consuming and costly. To address this challenge, we aimed to develop a decision-supporting algorithm based on a combination of deep learning-generated dose distributions and clinical data.
Materials and Methods
We retrospectively analyzed 65 patients with liver or pancreatic cancer who underwent both TBX and MRG simulations and planning process. We trained three-dimensional U-Net deep learning models to predict dose distributions and generated dose volume histograms (DVHs) for each system. We integrated predicted DVH metrics into a Bayesian network (BN) model incorporating clinical data.
Results
The MRG prediction model outperformed the TBX model, demonstrating statistically significant superiorities in predicting normalized dose to the planning target volume (PTV) and liver. We developed a final BN prediction model integrating the predictive DVH metrics with patient factors like age, PTV size, and tumor location. This BN model an area under the receiver operating characteristic curve index of 83.56%. The decision tree derived from the BN model showed that the tumor location (abutting vs. apart of PTV to hollow viscus organs) was the most important factor to determine TBX or MRG. It provided a potential framework for selecting the optimal radiation therapy (RT) system based on individual patient characteristics.
Conclusion
We demonstrated a decision-supporting algorithm for selecting optimal RT plans in upper gastrointestinal cancers, incorporating both deep learning-based dose prediction and BN-based treatment selection. This approach might streamline the decision-making process, saving resources and improving treatment outcomes for patients undergoing RT.

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Gynecologic cancer

Plasma Cell-Free DNA in Uterine Cervical Cancer: Therapeutic Monitoring and Prognostic Values after Radical Radiotherapy: Jae Sik Kim, Sunah Yang, Kyeonghun Jeong, Dong-Yun Kim, Kwangsoo Kim, Hyun-Cheol Kang; Cancer Res Treat. 2023;55(2):659-670. Published online December 12, 2022; DOI: https://doi.org/10.4143/crt.2022.1440

Abstract PDF Supplementary Material PubReader ePub

Purpose
In the present study, we aimed to establish a liquid biopsy-based monitoring method using peripheral blood cell-free DNA (cfDNA) for patients with cervical cancer who underwent radical radiotherapy (RT).
Materials and Methods
Twenty-five patients with cervical cancer were prospectively recruited and treated with external beam RT and brachytherapy. In all patients, except one, chemotherapy was administered concurrently during RT. Whole peripheral blood samples were obtained at least twice from each patient. We performed next-generation sequencing (NGS) for the target-captured libraries (67 oncogenes and human papillomavirus [HPV] type 16/18) using 64 plasma cfDNA samples from the 25 participants. The ratio of HPV cfDNA and the variant allele frequency (VAF) in cfDNA was calculated, and their dynamic changes were monitored. The median follow-up duration was 25.4 months.
Results
In total, we identified 21,866 cfDNA variants. ARID1A and frameshift variants occupied the largest portion of altered genes and HIGH-grade variant types, respectively. In most cases, tumor shrinkage was followed by a decrease in the HPV ratio; however, an increase in HPV ratio indicated distant metastasis, despite the reduced tumor size. The initial HPV ratio reflecting the tumor burden was likely associated with treatment outcomes (p = 0.16). We did not determine a role for serial changes in the VAF in cfDNA.
Conclusion
Our findings suggest that the HPV cfDNA ratio, calculated after targeted NGS, may be valuable for monitoring and predicting treatment responses. Accordingly, further validation of these findings is warranted.

Citations

Citations to this article as recorded by

Cell-Free HPV-DNA in Screening, Diagnosis, Prognosis, and Treatment Response Monitoring of Cervical Cancer
Nayara Nascimento Toledo Silva, Ana Carolina Silva Santos, Isadora Oliveira Ansaloni Pereira, Glenda Nicioli da Silva, Angélica Alves Lima
Molecular Diagnosis & Therapy.2025;[Epub] CrossRef
Circulating cell-free DNA as a diagnostic and prognostic marker for cervical cancer
Preetiparna Parida, Gayathri Baburaj, Mahadev Rao, Shirley Lewis, Rama Rao Damerla
International Journal of Gynecological Cancer.2024; 34(2): 307. CrossRef
Prognostic value of circulating short-length DNA fragments in unresected glioblastoma patients
Arthur Daban, Ludivine Beaussire-Trouvay, Émilie Lévêque, Cristina Alexandru, Isabelle Tennevet, Olivier Langlois, Ovidiu Veresezan, Florent Marguet, Florian Clatot, Frédéric Di Fiore, Nasrin Sarafan-Vasseur, Maxime Fontanilles
Translational Oncology.2024; 42: 101897. CrossRef
Cervical Cancer Genetic Profile through Circulating Tumor DNA: What Can We Learn from Blood?
Sevastiani Antonouli, Valentina Di Nisio, Nikoletta Daponte, Athina-Ioanna Daponte, Alexandros Daponte
Biomolecules.2024; 14(7): 825. CrossRef
High throughput sequencing technology and its clinical application in circulating tumor DNA detection in patients with tumors.
Chonghe Xu, Dangui Zhou, Mei Zhu
Investigación Clínica.2024; 65(4): 476. CrossRef

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Head and Neck cancer

Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer: Dong-Yun Kim, Hong-Gyun Wu, Jin Ho Kim, Joo Ho Lee, Soon-Hyun Ahn, Eun-Jae Chung, Keun-Yong Eom, Young Ho Jung, Woo-Jin Jeong, Tack-Kyun Kwon, Suzy Kim, Chan Woo Wee; Cancer Res Treat. 2022;54(2):406-416. Published online June 23, 2021; DOI: https://doi.org/10.4143/crt.2021.441

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aimed to compare the outcomes of primary radiotherapy (RT) versus surgery in early-stage human papilloma virus–positive oropharyngeal squamous cell carcinoma (hpv+OPC), and investigate the preoperative clinical factors that can predict the requirement for postoperative adjuvant treatment.
Materials and Methods
This multicenter study included 166 patients with American Joint Committee on Cancer 8th edition-Stages I-II hpv+OPC. Sixty (36.1%) and 106 (63.9%) patients underwent primary (concurrent chemo)radiotherapy [(CC)RT] and surgery, respectively. Seventy-eight patients (73.6%) in the surgery group received postoperative (CC)RT.
Results
With a median follow-up of 45.6 months for survivors, the 2-year overall survival (OS), progression-free survival (PFS), and locoregional control (LC) for RT/surgery were 97.8%/96.4%, 91.1%/92.0%, and 92.9%/93.3%, respectively. In multivariate analyses, patients with synchronous radiologic extranodal extension and conglomeration (ENEcong) of metastatic lymph nodes (LNs) showed significantly poorer OS (p=0.047), PFS (p=0.001), and LC (p=0.003). In patients undergoing primary surgery, two or more clinically positive LN metastases (odds ratio [OR], 5.15; p=0.004) and LN metastases with ENEcong (OR, 3.75; p=0.009) were predictors of postoperative chemoradiotherapy. No patient in the primary RT group demonstrated late severe toxicity whereas three (2.8%), one (0.9%), and one (0.9%) patient in the surgery group showed grade 3 dysphagia, grade 3 xerostomia, and fatal oral cavity bleeding.
Conclusion
We found no differences in OS, PFS, and LC between upfront RT and surgery in stage I-II hpv+OPC which warrants comparison through a prospective trial in the treatment de-escalation era. However, most early-stage hpv+OPC patients undergoing surgery received adjuvant (CC)RT. Pretreatment LN findings were prognostic and predictive for adjuvant treatment.

Citations

Citations to this article as recorded by

Definitive radio(chemo)therapy versus upfront surgery in the treatment of HPV-related localized or locally advanced oropharyngeal squamous cell carcinoma
Jérémy Baude, Caroline Guigou, David Thibouw, Noémie Vulquin, Mireille Folia, Guillaume Constantin, Jihane Boustani, Christian Duvillard, Sylvain Ladoire, Gilles Truc, Aurélie Bertaut, Cédric Chevalier, Scott M. Langevin
PLOS ONE.2024; 19(7): e0307658. CrossRef
INFLUENCE OF CONFORMAL RADIOTHERAPY IN COMBINATION WITH RADIOMODIFIERS ON THE CONTENT OF VEGF, COX-2, AND PGE-2 IN BLOOD SERUM OF PATIENTS WITH HEAD AND NECK SQUAMOUS CELL CARCINOMA
N. MITRYAYEVA, L. GREBINYK, S. ARTIUKH, N. BILOZOR, V. STARENKIY
Experimental Oncology.2024; 46(3): 253. CrossRef
Assessment of Radiologic Extranodal Extension Using Combinatorial Analysis of Nodal Margin Breakdown and Metastatic Burden in Oropharyngeal Cancer
Sungryeal Kim, Hannah Park, Se Hyun Yeou, Jin Roh, Yoo Seob Shin, Chul-Ho Kim, Eun Ju Ha, Jeon Yeob Jang
Cancers.2023; 15(13): 3276. CrossRef
Expanding the role of combined immunochemotherapy and immunoradiotherapy in the management of head and neck cancer (Review)
Chun Wei, Xiaojun Lan, Maona Qiu, Ran Cui, Qiuxia Fu, Shafiu Umar Shinge, Tobias Muluh, Ou Jiang
Oncology Letters.2023;[Epub] CrossRef

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