Cancer Research and Treatment

Original Articles

Gastrointestinal cancer

A Phase II Study of Preoperative Chemoradiotherapy with Capecitabine Plus Simvastatin in Patients with Locally Advanced Rectal Cancer: Hyunji Jo, Seung Tae Kim, Jeeyun Lee, Se Hoon Park, Joon Oh Park, Young Suk Park, Ho Yeong Lim, Jeong Il Yu, Hee Chul Park, Doo Ho Choi, Yoonah Park, Yong Beom Cho, Jung Wook Huh, Seong Hyeon Yun, Hee Cheol Kim, Woo Yong Lee, Won Ki Kang; Cancer Res Treat. 2023;55(1):189-195. Published online June 8, 2022; DOI: https://doi.org/10.4143/crt.2021.1527

Purpose
The purpose of this phase II trial was to evaluate whether the addition of simvastatin, a synthetic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, to preoperative chemoradiotherapy (CRT) with capecitabine confers a clinical benefit to patients with locally advanced rectal cancer (LARC).
Materials and Methods
Patients with LARC (defined by clinical stage T3/4 and/or lymph node positivity) received preoperative radiation (45-50.4 Gy in 25-28 daily fractions) with concomitant capecitabine (825 mg/m2 twice per day) and simvastatin (80 mg, daily). Curative surgery was planned 4-8 weeks after completion of the CRT regimen. The primary endpoint was pathologic complete response (pCR). The secondary endpoints included sphincter-sparing surgery, R0 resection, disease-free survival, overall survival, the pattern of failure, and toxicity.
Results
Between October 2014 and July 2017, 61 patients were enrolled; 53 patients completed CRT regimen and underwent total mesorectal excision. The pCR rate was 18.9% (n=10) by per-protocol analysis. Sphincter-sparing surgery was performed in 51 patients (96.2%). R0 resection was achieved in 51 patients (96.2%). One patient experienced grade 3 liver enzyme elevation. No patient experienced additional toxicity caused by simvastatin.
Conclusion
The combination of 80 mg simvastatin with CRT and capecitabine did not improve pCR in patients with LARC, although it did not increase toxicity.

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Short- and long-term outcomes of neoadjuvant chemotherapy compared with neoadjuvant chemoradiotherapy for locally advanced rectal cancer: an updated meta-analysis
Yue Guo, Zhifeng Guo, Jiaojiao Zhang, Guowu Qian, Wangquan Ji, Linlin Song, Zhe Guo, Zhuo Han
BMC Gastroenterology.2025;[Epub] CrossRef
A randomized phase II/III trial of rosuvastatin with neoadjuvant chemo-radiation in patients with locally advanced rectal cancer
Prachi S. Patil, Avanish Saklani, Naveena A. N. Kumar, Ashwin De’Souza, Rahul Krishnatry, Snehal Khanvilkar, Mufaddal Kazi, Reena Engineer, Vikas Ostwal, Anant Ramaswamy, Munita Bal, Priya Ranganathan, Ekta Gupta, Sanjeev Galande
Frontiers in Oncology.2025;[Epub] CrossRef
Effects of Hyperlipidemia on Osseointegration of Dental Implants and Its Strategies
Haiyang Sun, Shuhuai Meng, Junyu Chen, Qianbing Wan
Journal of Functional Biomaterials.2023; 14(4): 194. CrossRef

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Breast cancer

The Pattern of Care for Brain Metastasis from Breast Cancer over the Past 10 Years in Korea: A Multicenter Retrospective Study (KROG 16-12): Jae Sik Kim, Kyubo Kim, Wonguen Jung, Kyung Hwan Shin, Seock-Ah Im, Hee-Jun Kim, Yong Bae Kim, Jee Suk Chang, Jee Hyun Kim, Doo Ho Choi, Yeon Hee Park, Dae Yong Kim, Tae Hyun Kim, Byung Ock Choi, Sea-Won Lee, Suzy Kim, Jeanny Kwon, Ki Mun Kang, Woong-Ki Chung, Kyung Su Kim, Ji Ho Nam, Won Sup Yoon, Jin Hee Kim, Jihye Cha, Yoon Kyeong Oh, In Ah Kim; Cancer Res Treat. 2022;54(4):1121-1129. Published online December 31, 2021; DOI: https://doi.org/10.4143/crt.2021.1083

Abstract PDF Supplementary Material PubReader ePub

Purpose
We aimed to investigate manifestations and patterns of care for patients with brain metastasis (BM) from breast cancer (BC) and compared their overall survival (OS) from 2005 through 2014 in Korea.
Materials and Methods
We retrospectively reviewed 600 BC patients with BM diagnosed between 2005 and 2014. The median follow-up duration was 12.5 months. We categorized the patients into three groups according to the year when BM was initially diagnosed (group I [2005-2008], 98 patients; group II [2009-2011], 200 patients; and group III [2012-2014], 302 patients).
Results
Over time, the median age at BM diagnosis increased by 2.2 years (group I, 49.0 years; group II, 48.3 years; and group III, 51.2 years; p=0.008). The percentage of patients with extracranial metastasis was 73.5%, 83.5%, and 86.4% for group I, II, and III, respectively (p=0.011). The time interval between BC and BM was prolonged in patients with stage III primary BC (median, 2.4 to 3 years; p=0.029). As an initial brain-directed treatment, whole-brain radiotherapy alone decreased from 80.0% in 2005 to 41.1% in 2014. Meanwhile, stereotactic radiosurgery or fractionated stereotactic radiotherapy alone increased from 13.3% to 34.7% during the same period (p=0.005). The median OS for group I, II, and III was 15.6, 17.9, and 15.0 months, respectively, with no statistical significance.
Conclusion
The manifestations of BM from BC and the pattern of care have changed from 2005 to 2014 in Korea. However, the OS has remained relatively unchanged over the 10 years.

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Comparison of initial and sequential salvage brain-directed treatment in patients with 1–4 vs. 5–10 brain metastases from breast cancer (KROG 16–12)
Jae Sik Kim, Kyubo Kim, Wonguen Jung, Kyung Hwan Shin, Seock-Ah Im, Hee-Jun Kim, Yong Bae Kim, Jee Suk Chang, Jee Hyun Kim, Doo Ho Choi, Yeon Hee Park, Dae Yong Kim, Tae Hyun Kim, Byung Ock Choi, Sea-Won Lee, Suzy Kim, Jeanny Kwon, Ki Mun Kang, Woong-Ki C
Breast Cancer Research and Treatment.2023; 200(1): 37. CrossRef

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Carcinoembryonic Antigen Improves the Performance of Magnetic Resonance Imaging in the Prediction of Pathologic Response after Neoadjuvant Chemoradiation for Patients with Rectal Cancer: Gyu Sang Yoo, Hee Chul Park, Jeong Il Yu, Doo Ho Choi, Won Kyung Cho, Young Suk Park, Joon Oh Park, Ho Yeong Lim, Won Ki Kang, Woo Yong Lee, Hee Cheol Kim, Seong Hyeon Yun, Yong Beom Cho, Yoon Ah Park, Kyoung Doo Song, Seok-Hyung Kim, Sang Yun Ha; Cancer Res Treat. 2020;52(2):446-454. Published online September 25, 2019; DOI: https://doi.org/10.4143/crt.2019.261

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of this study was to investigate the role of carcinoembryonic antigen (CEA) levels in improving the performance of magnetic resonance imaging (MRI) for the prediction of pathologic response after the neoadjuvant chemoradiation (NCRT) for patients with rectal cancer.
Materials and Methods
We retrospectively reviewed the medical records of 524 rectal cancer patients who underwent NCRT and total mesorectal excision between January 2009 and December 2014. The performances of MRI with or without CEA parameters (initial CEA and CEA dynamics) for prediction of pathologic tumor response grade (pTRG) were compared by receiver-operating characteristic analysis with DeLong’s method. Cox regression was used to identify the independent factors associated to pTRG and disease-free survival (DFS) after NCRT.
Results
The median follow-up was 64.0 months (range, 3.0 to 113.0 months). On multivariate analysis, poor tumor regression grade on MRI (mrTRG; p < 0.001), initial CEA (p < 0.001) and the mesorectal fascia involvement on MRI before NCRT (mrMFI; p=0.054) showed association with poor pTRG. The mrTRG plus CEA parameters showed significantly improved performances in the prediction of pTRG than mrTRG alone. All of mrTRG, mrMFI, and initial CEA were also identified as independent factors associated with DFS. The initial CEA further discriminated DFS in the subgroups with good mrTRG or that without mrMFI.
Conclusion
The CEA parameters significantly improved the performance of MRI in the prediction of pTRG after NCRT for patients with rectal cancer. The DFS was further discriminated by initial CEA level in the groups with favorable MRI parameters.

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Clinical outcomes of neoadjuvant chemoradiotherapy followed by total mesorectal excision in locally advanced rectal cancer with mesorectal fascia involvement
Jeong Ha Lee, Nalee Kim, Jeong Il Yu, Gyu Sang Yoo, Hee Chul Park, Woo-Yong Lee, Seong Hyeon Yun, Hee Cheol Kim, Yong Beom Cho, Jung Wook Huh, Yoon Ah Park, Jung Kyong Shin, Joon Oh Park, Seung Tae Kim, Young Suk Park, Jeeyun Lee, Won Ki Kang
Radiation Oncology Journal.2024; 42(2): 130. CrossRef
Predicting the response to neoadjuvant chemoradiation for rectal cancer using nomograms based on MRI tumour regression grade
S. Qin, Y. Chen, K. Liu, Y. Li, Y. Zhou, W. Zhao, P. Xin, Q. Wang, S. Lu, H. Wang, N. Lang
Cancer/Radiothérapie.2024; 28(4): 341. CrossRef
Body composition parameters combined with blood biomarkers and magnetic resonance imaging predict responses to neoadjuvant chemoradiotherapy in locally advanced rectal cancer
Jianguo Yang, Qican Deng, Zhenzhou Chen, Yajun Chen, Zhongxue Fu
Frontiers in Oncology.2023;[Epub] CrossRef
Pretreatment blood biomarkers combined with magnetic resonance imaging predict responses to neoadjuvant chemoradiotherapy in locally advanced rectal cancer
Xinyu Shi, Min Zhao, Bo Shi, Guoliang Chen, Huihui Yao, Junjie Chen, Daiwei Wan, Wen Gu, Songbing He
Frontiers in Oncology.2022;[Epub] CrossRef
Clinical implication and management of rectal cancer with clinically suspicious lateral pelvic lymph node metastasis: A radiation oncologist’s perspective
Gyu Sang Yoo, Hee Chul Park, Jeong Il Yu
Frontiers in Oncology.2022;[Epub] CrossRef
High-Resolution T2-Weighted MRI to Evaluate Rectal Cancer: Why Variations Matter
Kirsten L Gormly
Korean Journal of Radiology.2021; 22(9): 1475. CrossRef
MRI Assessment of Complete Response to Preoperative Chemoradiation Therapy for Rectal Cancer: 2020 Guide for Practice from the Korean Society of Abdominal Radiology
Seong Ho Park, Seung Hyun Cho, Sang Hyun Choi, Jong Keon Jang, Min Ju Kim, Seung Ho Kim, Joon Seok Lim, Sung Kyoung Moon, Ji Hoon Park, Nieun Seo
Korean Journal of Radiology.2020; 21(7): 812. CrossRef

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Impact of Regional Nodal Irradiation for Breast Cancer Patients with Supraclavicular and/or Internal Mammary Lymph Node Involvement: A Multicenter, Retrospective Study (KROG 16-14): Kyubo Kim, Yuri Jeong, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Su Ssan Kim, Chang-Ok Suh, Yong Bae Kim, Doo Ho Choi, Won Park, Jihye Cha, Mison Chun, Dong Soo Lee, Sun Young Lee, Jin Hee Kim, Hae Jin Park, Wonguen Jung; Cancer Res Treat. 2019;51(4):1500-1508. Published online March 15, 2019; DOI: https://doi.org/10.4143/crt.2018.575

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of this study was to evaluate the treatment outcomes of radiotherapy (RT) for breast cancer with ipsilateral supraclavicular (SCL) and/or internal mammary (IMN) lymph node involvement.
Materials and Methods
A total of 353 patients from 11 institutions were included. One hundred and thirty-six patients had SCL involvement, 148 had IMN involvement, and 69 had both. All patients received neoadjuvant systemic therapy followed by breast-conserving surgery or mastectomy, and postoperative RT to whole breast/chest wall. As for regional lymph node irradiation, SCL RT was given to 344 patients, and IMN RT to 236 patients. The median RT dose was 50.4 Gy.
Results
The median follow-up duration was 61 months (range, 7 to 173 months). In-field progression was present in SCL (n=20) and/or IMN (n=7). The 5-year disease-free survival (DFS) and overall survival rates were 57.8% and 75.1%, respectively. On multivariate analysis, both SCL/IMN involvement, number of axillary lymph node ≥ 4, triple-negative subtype, and mastectomy were significant adverse prognosticators for DFS (p=0.022, p=0.001, p=0.001, and p=0.004, respectively). Regarding the impact of regional nodal irradiation, SCL RT dose ≥ 54 Gy was not associated with DFS (5-year rate, 52.9% vs. 50.9%; p=0.696) in SCL-involved patients, and the receipt of IMN RT was not associated with DFS (5-year rate, 56.1% vs. 78.1%; p=0.099) in IMN-involved patients.
Conclusion
Neoadjuvant chemotherapy followed by surgery and postoperative RT achieved an acceptable in-field regional control rate in patients with SCL and/or IMN involvement. However, a higher RT dose to SCL or IMN RT was not associated with the improved DFS in these patients.

Citations

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Clinical outcomes after post-operative radiotherapy for breast cancer patients presenting with ipsilateral supraclavicular metastasis: considerations on the cranial border of irradiation field
Xiaofang Wang, Xiaomeng Zhang, Li Zhang, Jin Meng, Wei Shi, Xingxing Chen, Zhaozhi Yang, Xin Mei, Xiaoli Yu, Zhen Zhang, Zhimin Shao, Xiaomao Guo, Jinli Ma
Breast Cancer.2025; 32(1): 144. CrossRef
Outcomes and Trends in Axillary Management of Stage cN3b Breast Cancer Patients
Julia M. Selfridge, Zachary Schrank, Chris B. Agala, David W. Ollila, Kristalyn K. Gallagher, Dana L. Casey, Philip M. Spanheimer
Annals of Surgical Oncology.2025; 32(3): 2070. CrossRef
Internal mammary regional management after neoadjuvant therapy in breast cancer
Zhao Bi, Chun-Hui Zheng, Tong-Yue Ren, Yong-Sheng Wang
International Journal of Surgery.2024;[Epub] CrossRef
Oncological outcomes in patients with residual triple-negative breast cancer after preoperative chemotherapy
Hyunki Park, Haeyoung Kim, Won Park, Won Kyung Cho, Nalee Kim, Tae Gyu Kim, Young-Hyuck Im, Jin Seok Ahn, Yeon Hee Park, Ji-Yeon Kim, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Jonghan Yu, Byung Joo Chae, Sei Kyung Lee, Jai-Min Ryu
Radiation Oncology Journal.2024; 42(3): 210. CrossRef
Clinical audit of breast cancer patients treated with helical tomotherapy for irradiation of the internal mammary chain
Garima Shrivastav, Debanjali Datta, Tabassum Wadasadawala, Pallavi Rane, Subhajit Panda, Rima Pathak, Libin Scaria, Revathy Krishnamurthy, Rajiv Sarin
Journal of Radiotherapy in Practice.2023;[Epub] CrossRef
The optimal regional irradiation volume for breast cancer patients: A comprehensive systematic review and network meta-analysis of published studies
Wei-Xiang Qi, Lu Cao, Cheng Xu, Gang Cai, Jiayi Chen
Frontiers in Oncology.2023;[Epub] CrossRef
Contemporary Outcomes After Multimodality Therapy in Patients With Breast Cancer Presenting With Ipsilateral Supraclavicular Node Involvement
Kevin Diao, Lauren M. Andring, Carlos H. Barcenas, Puneet Singh, Huong (Carisa) Le-Petross, Valerie K. Reed, Jay P. Reddy, Elizabeth S. Bloom, Neelofur R. Ahmad, Lauren L. Mayo, George H. Perkins, Melissa P. Mitchell, Kevin T. Nead, Welela Tereffe, Benjam
International Journal of Radiation Oncology*Biology*Physics.2022; 112(1): 66. CrossRef
Locoregional Management and Prognostic Factors in Breast Cancer With Ipsilateral Internal Mammary and Axillary Lymph Node Involvement
Lauren M. Andring, Kevin Diao, Susie Sun, Miral Patel, Gary J. Whitman, Pamela Schlembach, Isadora Arzu, Melissa M. Joyner, Simona F. Shaitelman, Karen Hoffman, Michael C. Stauder, Benjamin D. Smith, Wendy A. Woodward
International Journal of Radiation Oncology*Biology*Physics.2022; 113(3): 552. CrossRef
Yesterday, Today and Tomorrow – Are We Any Closer to Knowing Which Patients Will Benefit from Adjuvant Internal Mammary Nodal Irradiation?
C.A. Johnson, J. Evans
Clinical Oncology.2022; 34(8): 534. CrossRef
Dynamics of circulating tumor DNA during postoperative radiotherapy in patients with residual triple-negative breast cancer following neoadjuvant chemotherapy: a prospective observational study
Haeyoung Kim, Yeon Jeong Kim, Donghyun Park, Woong-Yang Park, Doo Ho Choi, Won Park, Won kyung Cho, Nalee Kim
Breast Cancer Research and Treatment.2021; 189(1): 167. CrossRef
Cervical Lymph Node Involvement above the Supraclavicular Fossa in Breast Cancer: Comparison with Stage IIIC (KROG 18-02)
Jae Sik Kim, Kyubo Kim, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Su Ssan Kim, Yong Bae Kim, Jee Suk Chang, Doo Ho Choi, Won Park, Tae Hyun Kim, Mison Chun, Jihye Cha, Jin Hee Kim, Dong Soo Lee, Sun Young Lee, Hae Jin Park
Journal of Breast Cancer.2020; 23(2): 194. CrossRef
Aggressive Surgical Excision of Supraclavicular Lymph Node Did Not Improve the Outcomes of Breast Cancer With Supraclavicular Lymph Node Involvement (KROG 16-14)
Kyubo Kim, Su Ssan Kim, Kyung Hwan Shin, Jin Ho Kim, Seung Do Ahn, Doo Ho Choi, Won Park, Sun Young Lee, Mison Chun, Jin Hee Kim, Yong Bae Kim, Jihye Cha, Hae Jin Park, Dong Soo Lee, Wonguen Jung
Clinical Breast Cancer.2020; 20(1): 51. CrossRef
Combined Therapy Can Improve the Outcomes of Breast Cancer with Isolated Supraclavicular Lymph Node Involvement

Tianyi Ma, Yan Mao, Haibo Wang
Cancer Management and Research.2020; Volume 12: 11857. CrossRef

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Korean First Prospective Phase II Study, Feasibility of Prone Position in Postoperative Whole Breast Radiotherapy: A Dosimetric Comparison: Yoonsun Chung, Jeong Il Yu, Won Park, Doo Ho Choi; Cancer Res Treat. 2019;51(4):1370-1379. Published online February 18, 2019; DOI: https://doi.org/10.4143/crt.2018.423

Abstract PDF PubReader ePub

Purpose
This first Korean prospective study is to evaluate the feasibility of prone breast radiotherapy after breast conserving surgery for left breast cancer patients who have relatively small breast size and we present dosimetric comparison between prone and supine positions.
Materials and Methods
Fifty patients underwent two computed tomography (CT) simulations in supine and prone positions. Whole breast, ipsilateral lung, heart, and left-anterior-descending coronary artery were contoured on each simulation CT images. Tangential-fields treatment plan in each position was designed with total 50 Gy in 2-Gy fractions, and then one of the positions was designated for the treatment by comparing target coverage and dose to normal organs. Also, interfractional and intrafractional motion was evaluated using portal images.
Results
In total 50 patients, 32 cases were decided as prone-position–beneficial group and 18 cases as supine-position–beneficial group based on dosimetric advantage. Target dose homogeneity was comparable, but target conformity in prone position was closer to optimal than in supine position. For both group, prone position significantly increased lung volume. However, heart volumewas decreased by prone position for prone-position–beneficial group but was comparable between two positions for supine-position–beneficial group. Lung and heart doses were significantly decreased by prone position for prone-position–beneficial group. However, prone position for supine-position–beneficial group increased heart dose while decreasing lung dose. Prone position showed larger interfractional motion but smaller intra-fractional motion than supine position.
Conclusion
Prone breast radiotherapy could be beneficial to a subset of small breast patients since it substantially spared normal organs while achieving adequate target coverage.

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Long-Term Results of Intensity Modulated Radiotherapy (IMRT) with Helical Tomotherapy in Non-Metastatic Breast Cancer Patients: Final Analysis
Pierre Loap, Abdelkarim Uakkas, Sofiane Allali, Jihane Bouziane, Alain Fourquet, Youlia Kirova
Cancers.2025; 17(3): 544. CrossRef
Чи є положення лежачи на животі безпечним для органів ризику при променевій терапії молочної залози? Клінічний випадок та огляд літератури
Sumeyra Oz, Aslı Sabah, Ilyas Anıl Kılınc, Oguzhan Bascik, Yunus Babayigit, Ipek Sucak, Yasemin Celik, Cengiz Kurtman
Practical oncology.2024; 6(2): 22. CrossRef
Dosimetric analysis of six whole-breast irradiation techniques in supine and prone positions
Dong Wook Kim, Chae-Seon Hong, Junyoung Son, Se Young Kim, Ye-In Park, Mijoo Chung, Weon Kuu Chung, Min Cheol Han, Jihun Kim, Hojin Kim, Jin Sung Kim
Scientific Reports.2024;[Epub] CrossRef
Current Cardioprotective Strategies for the Prevention of Radiation-Induced Cardiotoxicity in Left-Sided Breast Cancer Patients
Vasiliki Nikovia, Evangelos Chinis, Areti Gkantaifi, Maria Marketou, Michalis Mazonakis, Nikolaos Charalampakis, Dimitrios Mavroudis, Kornilia Vasiliki Orfanidou, Antonios Varveris, Chrysostomos Antoniadis, Maria Tolia
Journal of Personalized Medicine.2023; 13(7): 1038. CrossRef
Prone versus supine free-breathing for right-sided whole breast radiotherapy
Odile Fargier-Bochaton, Xinzhuo Wang, Giovanna Dipasquale, Mohamed Laouiti, Melpomeni Kountouri, Olena Gorobets, Nam P. Nguyen, Raymond Miralbell, Vincent Vinh-Hung
Scientific Reports.2022;[Epub] CrossRef
Long-term follow-up results of intensity-modulated radiotherapy with helicoïdal tomotherapy for non-metastatic breast cancers: Single centre experience
Z. Zolcsak, P. Loap, A. Fourquet, Y.M. Kirova
Cancer/Radiothérapie.2022; 26(5): 654. CrossRef
A study of skin marker alignment using different diamond‐shaped light fields for prone breast external‐beam radiation therapy
Huijun Xu, Sally B. Cheston, Arun Gopal, Baoshe Zhang, Shifeng Chen, Suhong Yu, Andrea Hall, Sara Dudley
Journal of Applied Clinical Medical Physics.2022;[Epub] CrossRef
Comparative analysis of dosimetry and predictive somatotype parameters of prone and supine whole-breast irradiation among Chinese women after breast-conserving surgery
Yi Gao, Li Wang, Han Bai, Xiang Pan, Lan Li, Li Chang, Yaoxiong Xia, Wenhui Li, Yu Hou
Frontiers in Oncology.2022;[Epub] CrossRef
Prone position versus supine position in postoperative radiotherapy for breast cancer
Junming Lai, Fangyan Zhong, Jianxiong Deng, Shuang Hu, Ruoyan Shen, Hui Luo, Yongbiao Luo
Medicine.2021; 100(20): e26000. CrossRef
The cardiac toxicity of radiotherapy – a review of characteristics, mechanisms, diagnosis, and prevention
Tianhui Wei, Yufeng Cheng
International Journal of Radiation Biology.2021; 97(10): 1333. CrossRef
Evaluation of critical organ dosimetry with focus on heart exposure in supine versus prone patient positioning for breast irradiation
Sager Omer, Beyzadeoglu Murat, Dincoglan Ferrat, Demiral Selcuk, Uysal Bora, Gamsiz Hakan, Ozcan Fatih, Colak Onurhan, Dirican Bahar
Journal of Surgery and Surgical Research.2020; 6(1): 087. CrossRef
Setup uncertainties and the optimal imaging schedule in the prone position whole breast radiotherapy
Shengyu Yao, Yin Zhang, Ke Nie, Bo Liu, Bruce G. Haffty, Nisha Ohri, Ning J. Yue
Radiation Oncology.2019;[Epub] CrossRef

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Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418): Gyu Sang Yoo, Won Park, Jeong Il Yu, Doo Ho Choi, Yeon-Joo Kim, Kyung Hwan Shin, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha; Cancer Res Treat. 2019;51(3):1041-1051. Published online November 1, 2018; DOI: https://doi.org/10.4143/crt.2018.424

Abstract PDF PubReader ePub

Purpose
We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy.
Materials and Methods
We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups.
Results
The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly.
Conclusion
There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.

Citations

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Investigation of the clinical benefits of regular breath-holding training utilizing surface guided radiation therapy technology for patients with left breast cancer
Hongming Li, Zheng Miao, Jie Shen, Jianing Xiao, Zhiwei Yang, Wei Tian, Xiansong Sun, Zhen Zhou, Jing Shen, Jie Qiu
Journal of Radiation Research and Applied Sciences.2025; 18(2): 101393. CrossRef
21-gene recurrence score in predicting the outcome of postoperative radiotherapy in T1-2N1 luminal breast cancer after breast-conserving surgery
Shang-Jin Xie, Run-Jie Wang, San-Gang Wu, Fu-Xing Zhang
The Breast.2024; 74: 103679. CrossRef
Assessing Radiation Effects on Chemo-Treated BT20 and 4T1 Breast Cancer, and Neuroblastoma Cell Lines: A Study of Single and Multiple-Cell Ionization via Infrared Laser Trapping
Mulugeta S. Goangul, Daniel B. Erenso, Ying Gao, Li Chen, Kwame O. Eshun, Gisela Alvarez, Horace T. Crogman
Radiation.2024; 4(1): 85. CrossRef
Overall survival after mastectomy versus breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis
Kiran K Rajan, Katherine Fairhurst, Beth Birkbeck, Shonnelly Novintan, Rebecca Wilson, Jelena Savović, Chris Holcombe, Shelley Potter
BJS Open.2024;[Epub] CrossRef
Radiotherapy dosimetry and radiotherapy related complications of immediate implant-based reconstruction after breast cancer surgery
Yu Zhang, Fuxiu Ye, Yun Teng, Jin Zheng, Chunlu Li, Ruilan Ma, Haichen Zhang
Frontiers in Oncology.2023;[Epub] CrossRef
Does Breast-Conserving Surgery with Radiotherapy have a Better Survival than Mastectomy? A Meta-Analysis of More than 1,500,000 Patients
Gabriel De la Cruz Ku, Manish Karamchandani, Diego Chambergo-Michilot, Alexis R. Narvaez-Rojas, Michael Jonczyk, Fortunato S. Príncipe-Meneses, David Posawatz, Salvatore Nardello, Abhishek Chatterjee
Annals of Surgical Oncology.2022; 29(10): 6163. CrossRef
Protocol for the postoperative radiotherapy in N1 breast cancer patients (PORT-N1) trial, a prospective multicenter, randomized, controlled, non-inferiority trial of patients receiving breast-conserving surgery or mastectomy
Tae Hoon Lee, Ji Hyun Chang, Bum-Sup Jang, Jae Sik Kim, Tae Hyun Kim, Won Park, Yong Bae Kim, Su Ssan Kim, Wonshik Han, Han-Byoel Lee, Kyung Hwan Shin
BMC Cancer.2022;[Epub] CrossRef
Risk factors to identify the indication for regional nodal irradiation in T1-2N1M0 breast cancer: A joint analysis of 4,243 real-world cases from two institutions
Guang-Yi Sun, Ge Wen, Yu-Jing Zhang, Yu Tang, Hao Jing, Hui Fang, Jian-Yang Wang, Jiang-Hu Zhang, Xu-Ran Zhao, Si-Ye Chen, Yong-Wen Song, Jing Jin, Yue-Ping Liu, Yuan Tang, Shu-Nan Qi, Ning Li, Bo Chen, Ning-Ning Lu, Ye-Xiong Li, Shu-Lian Wang
Frontiers in Oncology.2022;[Epub] CrossRef
Chemo-treated 4T1 breast cancer cells radiation response measured by single and multiple cell ionization using infrared laser trap
Endris Muhammed, Li Chen, Ying Gao, Daniel Erenso
Scientific Reports.2019;[Epub] CrossRef

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9 Crossref

Breast Conservation Therapy Versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer: Pooled Analysis of KROG 14-18 and 14-23: Kyubo Kim, Hae Jin Park, Kyung Hwan Shin, Jin Ho Kim, Doo Ho Choi, Won Park, Seung Do Ahn, Su Ssan Kim, Dae Yong Kim, Tae Hyun Kim, Jin Hee Kim, Jiyoung Kim; Cancer Res Treat. 2018;50(4):1316-1323. Published online January 8, 2018; DOI: https://doi.org/10.4143/crt.2017.575

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Purpose
The aim of this study is to compare the treatment outcomes of breast conserving surgery (BCS) plus radiotherapy (RT) versus mastectomy for patients with pT1-2N1 triple-negative breast cancer (TNBC).
Materials and Methods
Using two multicenter retrospective studies on breast cancer, a pooled analysis was performed among 320 patients with pT1-2N1 TNBC. All patients who underwent BCS (n=212) receivedwhole breast RTwith orwithoutregional nodal RT,while nonewho underwent mastectomy (n=108)received it. All patients received taxane-based adjuvant chemotherapy. The median follow-up periods were 65 months in the BCS+RT group, and 74 months in the mastectomy group.
Results
The median age of all patients was 48 years (range, 24 to 70 years). Mastectomy group had more patients with multiple tumors (p < 0.001), no lymphovascular invasion (p=0.001), higher number of involved lymph node (p=0.028), and higher nodal ratio ≥ 0.2 (p=0.037). Other characteristics were not significantly different between the two groups. The 5-year locoregionalrecurrence-free, disease-free, and overall survivalrates of BCS+RT group versus mastectomy group were 94.6% versus 87.7%, 89.5% versus 80.4%, and 95.0% versus 87.8%, respectively, and the differences were statistically significant after adjusting for covariates (p=0.010, p=0.006, and p=0.005, respectively).
Conclusion
In pT1-2N1 TNBC, breast conservation therapy achieved better locoregional recurrencefree, disease-free, and overall survival rates compared with mastectomy.

Citations

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Breast conserving surgery combined with radiation therapy offers improved survival over mastectomy in early-stage breast cancer
Elizaveta Vasilyeva, Alan Nichol, Brendan Bakos, Anise Barton, Michelle Goecke, Elaine Lam, Erin Martin, Caroline Lohrisch, Elaine McKevitt
The American Journal of Surgery.2024; 231: 70. CrossRef
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Andrii Zhygulin, Artem Fedosov
Plastic and Reconstructive Surgery - Global Open.2024; 12(5): e5789. CrossRef
Treatment Outcomes after Postoperative Radiotherapy in Triple-Negative Breast Cancer: Multi-Institutional Retrospective Study (KROG 17-05)
Jin Kim, Sang Byun, Myeongsoo Kim, Kyung Shin, Dong Kim, Han Lee, Tae Kim, Yeon Kim, Yong Kim, Jee Chang, Kyubo Kim, Sun Lee
Journal of Personalized Medicine.2024; 14(9): 941. CrossRef
Recent Advances in Targeted Nanocarriers for the Management of Triple Negative Breast Cancer
Rajesh Pradhan, Anuradha Dey, Rajeev Taliyan, Anu Puri, Sanskruti Kharavtekar, Sunil Kumar Dubey
Pharmaceutics.2023; 15(1): 246. CrossRef
Breast-Conserving Therapy is Associated with Improved Survival Without an Increased Risk of Locoregional Recurrence Compared with Mastectomy in Both Clinically Node-Positive and Node-Negative Breast Cancer Patients
Elizaveta Vasilyeva, Jeremy Hamm, Alan Nichol, Kathryn V. Isaac, Amy Bazzarelli, Carl Brown, Caroline Lohrisch, Elaine McKevitt
Annals of Surgical Oncology.2023; 30(11): 6413. CrossRef
Postmastectomy Radiation Therapy in Patients With Minimally Involved Lymph Nodes: A Review of the Current Data and Future Directions
Bum-Sup Jang, Kyung Hwan Shin
Journal of Breast Cancer.2022; 25(1): 1. CrossRef
A Review of Current treatment for Triple-Negative Breast Cancer (TNBC)
Wahyuni Wahyuni, Ajeng Diantini, Mohammad Ghozali, Sahidin I
Research Journal of Pharmacy and Technology.2022; : 409. CrossRef
Long non-coding RNA MRPS30 divergent transcript can be detected in the cytoplasm of triple-negative breast cancer cells and is targeted by microRNA-130b
Dongtao Wang, Qiang Song, Tianyong Zhao, Fang Wang, Yang Yu, Jing Qi, Pengfei Lyu, Xiangyang Duan
Bioengineered.2022; 13(3): 5954. CrossRef
Breast-conserving surgery versus mastectomy for older women with triple-negative breast cancer: population-based study
Waruiru Mburu, Shalini Kulasingam, James S Hodges, Beth A Virnig
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Determining prognostic factors and optimal surgical intervention for early-onset triple-negative breast cancer
Yi-Zi Zheng, Yan Liu, Zhen-Han Deng, Guo-Wen Liu, Ni Xie
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Postoperative Radiotherapy Contributes to the Survival Benefit of Breast-Conserving Therapy over Mastectomy
Chu-Ying Chen, Si-Yue Zheng, Gang Cai, Cheng Xu, Rong Cai, Min Li, Kun-Wei Shen, Xiao-Song Chen, Dan Ou, Wei-Xiang Qi, Lu Cao, Jia-Yi Chen, Weiren Luo
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M.V. Pavlushenko, R.V. Liubota, R.I. Vereshchako, O.S. Zotov, M.F. Anikusko, I.I. Liubota
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Breast conservation therapy confers survival and distant recurrence advantage over mastectomy for stage II Triple Negative Breast cancer
Rebekah Macfie, Cynthia Aks, Kathryn Panwala, Nathalie Johnson, Jennifer Garreau
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Outcomes after breast-conserving surgery or mastectomy in patients with triple-negative breast cancer: meta-analysis
A Fancellu, N Houssami, V Sanna, A Porcu, C Ninniri, M L Marinovich
British Journal of Surgery.2021; 108(7): 760. CrossRef
Are the Outcomes of Breast Conservation Surgery Inferior to Those of Mastectomy in Patients with Stage II-IIIA Triple-Negative Breast Cancer?
Seungju Lee, Hyun Yul Kim, Youn Joo Jung, Hyun-June Paik, Dong-Il Kim, Chang Shin Jung, Seok-Kyung Kang, Jee Yeon Kim, Seokwon Lee, Youngtae Bae
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Marina Marchetti, Cinzia Giaccherini, Giovanna Masci, Cristina Verzeroli, Laura Russo, Luigi Celio, Roberta Sarmiento, Sara Gamba, Carmen J. Tartari, Erika Diani, Alfonso Vignoli, Paolo Malighetti, Daniele Spinelli, Nicole M. Kuderer, Federico Nichetti, M
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International Journal of Molecular Sciences.2020; 21(17): 6337. CrossRef
Radiotherapy plays an important role in improving the survival outcome in patients with T1–2N1M0 breast cancer – a joint analysis of 4262 real world cases from two institutions
Guang-Yi Sun, Ge Wen, Yu-Jing Zhang, Yu Tang, Hao Jing, Jian-Yang Wang, Jiang-Hu Zhang, Yong Yang, Xu-Ran Zhao, Si-Ye Chen, Jing Jin, Yong-Wen Song, Yue-Ping Liu, Hui Fang, Hua Ren, Yuan Tang, Shu-Nan Qi, Ning Li, Bo Chen, Ning-Ning Lu, Shu-Lian Wang, Ye-
BMC Cancer.2020;[Epub] CrossRef
Mastectomy or Breast-Conserving Therapy for Early Breast Cancer in Real-Life Clinical Practice: Outcome Comparison of 7565 Cases
Stefanie Corradini, Daniel Reitz, Montserrat Pazos, Stephan Schönecker, Michael Braun, Nadia Harbeck, Christiane Matuschek, Edwin Bölke, Ute Ganswindt, Filippo Alongi, Maximilian Niyazi, Claus Belka
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Redefining the Positive Circumferential Resection Margin by Incorporating Preoperative Chemoradiotherapy Treatment Response in Locally Advanced Rectal Cancer: A Multicenter Validation Study: Joo Ho Lee, Eui Kyu Chie, Seung-Yong Jeong, Tae-You Kim, Dae Yong Kim, Tae Hyun Kim, Sun Young Kim, Ji Yeon Baek, Hee Jin Chang, Min Ju Kim, Sung Chan Park, Jae Hwan Oh, Sung Hwan Kim, Jong Hoon Lee, Doo Ho Choi, Hee Chul Park, Sung-Bum Kang, Jae-Sung Kim; Cancer Res Treat. 2018;50(2):506-517. Published online May 24, 2017; DOI: https://doi.org/10.4143/crt.2016.607

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Purpose
This study was conducted to validate the prognostic influence of treatment response among patients with positive circumferential resection margin for locally advanced rectal cancer.
Materials and Methods
Clinical data of 197 patientswith positive circumferentialresection margin defined as ≤ 2 mm after preoperative chemoradiotherapy followed by total mesorectal excision between 2004 and 2009were collected forthis multicenter validation study. All patients underwent median 50.4Gy radiationwith concurrentfluoropyrimidine based chemotherapy. Treatmentresponse was dichotomized to good response, including treatmentresponse of grade 2 or 3, and poor response, including grade 0 or 1.
Results
After 52 months median follow-up, 5-year overall survival (OS) for good responders and poor responders was 79.1% and 48.4%, respectively (p < 0.001). In multivariate analysis, circumferential resection margin involvement and treatment response were a prognosticator for OS and locoregional recurrence-free survival. In subgroup analysis, good responders with close margin showed significantly better survival outcomes for survival. Good responders with involved margin and poor responders with close margin shared similar results, whereas poorresponderswith involved margin hadworst survival (5-year OS, 81.2%, 57.0%, 50.0%, and 32.4%, respectively; p < 0.001).
Conclusion
Among patients with positive circumferential resection margin after preoperative chemoradiotherapy, survival of the good responders was significantly better than poor responders. Subgroup analysis revealed that definition of positive circumferential resection margin may be individualized as involvement for good responders, whereas ≤ 2 mm for poor responders.

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Tailored Strategy for Locally Advanced Rectal Carcinoma (GRECCAR 4): Long-term Results From a Multicenter, Randomized, Open-Label, Phase II Trial
Philippe Rouanet, Eric Rullier, Bernard Lelong, Philippe Maingon, Jean-Jacques Tuech, Denis Pezet, Florence Castan, Stephanie Nougaret
Diseases of the Colon & Rectum.2022; 65(8): 986. CrossRef
Colorectal Cancer Surgery Quality in Manitoba: A Population-Based Descriptive Analysis
Iresha Ratnayake, Jason Park, Natalie Biswanger, Allison Feely, Grace Musto, Kathleen Decker
Current Oncology.2021; 28(3): 2239. CrossRef

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4 Web of Science
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Prognostic Impact of Elective Supraclavicular Nodal Irradiation for Patients with N1 Breast Cancer after Lumpectomy and Anthracycline Plus Taxane-Based Chemotherapy (KROG 1418): A Multicenter Case-Controlled Study: Haeyoung Kim, Won Park, Jeong Il Yu, Doo Ho Choi, Seung Jae Huh, Yeon-Joo Kim, Eun Sook Lee, Keun Seok Lee, Han-Sung Kang, In Hae Park, Kyung Hwan Shin, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha; Cancer Res Treat. 2017;49(4):970-980. Published online January 4, 2017; DOI: https://doi.org/10.4143/crt.2016.382

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Purpose
This study was conducted to evaluate the impact of supraclavicular lymph node radiotherapy (SCNRT) on N1 breast cancer patients receiving post-lumpectomy whole-breast irradiation (WBI) and anthracycline plus taxane-based (AT) chemotherapy.
Materials and Methods
We performed a case-control analysis to compare the outcomes of WBI and WBI plus SCNRT (WBI+SCNRT). Among 1,147 patients with N1 breast cancer who received post-lumpectomy radiotherapy and AT-based chemotherapy in 12 hospitals, 542 were selected after propensity score matching. Patterns of failure, disease-free survival (DFS), distant metastasis-free survival (DMFS), and treatment-related toxicity were compared between groups.
Results
A total of 41 patients (7.6%) were found to have recurrence. Supraclavicular lymph node (SCN) failure was detected in three patients, two in WBI and one in WBI+SCNRT. All SCN failures were found simultaneously with distant metastasis. There was no significant difference in patterns of failure or survival between groups. The 5-year DFS and DMFS for patients with WBI and WBI+SCNRT were 94.4% versus 92.6% (p=0.50) and 95.1% versus 94.5% (p=0.99), respectively. The rates of lymphedema and radiation pneumonitis were significantly higher in the WBI+SCNRT than in the WBI.
Conclusion
We did not find a benefit of SCNRT for N1 breast cancer patients receiving AT-based chemotherapy.

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Patient-Reported Outcomes Between Whole-Breast Plus Regional Irradiation and Whole-Breast Irradiation Only in pN1 Breast Cancer After Breast-Conserving Surgery and Taxane-Based Chemotherapy: A Randomized Phase 3 Clinical Trial (KROG 17-01)
Nalee Kim, Won Park, Haeyoung Kim, Won Kyung Cho, Sung Ja Ahn, Mi Young Kim, Shin-Hyung Park, Ik Jae Lee, Inbong Ha, Jin Hee Kim, Tae Hyun Kim, Kyu Chan Lee, Hyung-Sik Lee, Tae Gyu Kim, Kyung Hwan Shin, Jong Hoon Lee, Jinhong Jung, Oyeon Cho, Yong Bae Kim
International Journal of Radiation Oncology*Biology*Physics.2025; 121(2): 341. CrossRef
De-escalation of regional nodal irradiation fields in pT1-2N1 breast cancer patients after breast conserving surgery: retrospective real-world clinical experience
Ji Hyun Hong, Jin-Ho Song, Kyu-Hye Choi, Shin Woo Kim, Woo-Chan Park, Jieun Lee, Ahwon Lee, Jun Kang, Byung-Ock Choi
Frontiers in Oncology.2025;[Epub] CrossRef
The optimal regional irradiation volume for breast cancer patients: A comprehensive systematic review and network meta-analysis of published studies
Wei-Xiang Qi, Lu Cao, Cheng Xu, Gang Cai, Jiayi Chen
Frontiers in Oncology.2023;[Epub] CrossRef
Protocol for the postoperative radiotherapy in N1 breast cancer patients (PORT-N1) trial, a prospective multicenter, randomized, controlled, non-inferiority trial of patients receiving breast-conserving surgery or mastectomy
Tae Hoon Lee, Ji Hyun Chang, Bum-Sup Jang, Jae Sik Kim, Tae Hyun Kim, Won Park, Yong Bae Kim, Su Ssan Kim, Wonshik Han, Han-Byoel Lee, Kyung Hwan Shin
BMC Cancer.2022;[Epub] CrossRef
What Is High-risk Breast Cancer With Pathologically Negative Lymph Nodes for Regional Recurrence?
Sang-Won Kim, Won Kyung Cho, Doo Ho Choi, Haeyoung Kim, Oyeon Cho, Won Park, Mison Chun
International Journal of Radiation Oncology*Biology*Physics.2021; 111(4): 992. CrossRef
Regional nodal irradiation in pT1-2N1 breast cancer patients treated with breast-conserving surgery and whole breast irradiation
Shin-Hyung Park, Jae-Chul Kim
Radiation Oncology Journal.2020; 38(1): 44. CrossRef
Prediction of nodal staging in breast cancer patients with 1-2 sentinel nodes in the Z0011 era
Fabio Corsi, Luca Sorrentino, Sara Albasini, Daniela Bossi, Carlo Morasso, Laura Villani, Marta Truffi
Medicine.2020; 99(35): e21721. CrossRef
Locoregional recurrence patterns in women with breast cancer who have not undergone post-mastectomy radiotherapy
Xuran Zhao, Yu Tang, Shulian Wang, Yong Yang, Hui Fang, Jianyang Wang, Hao Jing, Jianghu Zhang, Guangyi Sun, Siye Chen, Jing Jin, Yongwen Song, Yueping Liu, Bo Chen, Shunan Qi, Ning Li, Yuan Tang, Ningning Lu, Hua Ren, Yexiong Li
Radiation Oncology.2020;[Epub] CrossRef
Comparison of Dose Distribution in Regional Lymph Nodes in Whole-Breast Radiotherapy vs. Whole-Breast Plus Regional Lymph Node Irradiation: An In Silico Planning Study in Participating Institutions of the Phase III Randomized Trial (KROG 1701)
Haeyoung Kim, Heejung Kim, Won Park, Jong Yun Baek, Sung Ja Ahn, Mi Young Kim, Shin-Hyung Park, Ik Jae Lee, Inbong Ha, Jin Hee Kim, Tae Hyun Kim, Kyu Chan Lee, Hyung-Sik Lee, Tae Gyu Kim, Jin Ho Kim, Jong Hoon Lee, Jinhong Jung, Oyeon Cho, Jee Suk Chang,
Cancers.2020; 12(11): 3261. CrossRef
Clinical Significance of Lymph-Node Ratio in Determining Supraclavicular Lymph-Node Radiation Therapy in pN1 Breast Cancer Patients Who Received Breast-Conserving Treatment (KROG 14-18): A Multicenter Study
Jaeho Kim, Won Park, Jin Kim, Doo Choi, Yeon-Joo Kim, Eun Lee, Kyung Shin, Jin Kim, Kyubo Kim, Yong Kim, Sung-Ja Ahn, Jong Lee, Mison Chun, Hyung-Sik Lee, Jung Kim, Jihye Cha
Cancers.2019; 11(5): 680. CrossRef
Breast Conservation Therapy Versus Mastectomy in Patients with T1-2N1 Triple-Negative Breast Cancer: Pooled Analysis of KROG 14-18 and 14-23
Kyubo Kim, Hae Jin Park, Kyung Hwan Shin, Jin Ho Kim, Doo Ho Choi, Won Park, Seung Do Ahn, Su Ssan Kim, Dae Yong Kim, Tae Hyun Kim, Jin Hee Kim, Jiyoung Kim
Cancer Research and Treatment.2018; 50(4): 1316. CrossRef

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Postmastectomy Radiotherapy in Patients with pT1-2N1 Breast Cancer Treated with Taxane-Based Chemotherapy: A Retrospective Multicenter Analysis (KROG 1418): Yeon-Joo Kim, Won Park, Boram Ha, Boram Park, Jungnam Joo, Tae Hyun Kim, In Hae Park, Keun Seok Lee, Eun Sook Lee, Kyung Hwan Shin, Haeyoung Kim, Jeong Il Yu, Doo Ho Choi, Seung Jae Huh, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha; Cancer Res Treat. 2017;49(4):927-936. Published online December 26, 2016; DOI: https://doi.org/10.4143/crt.2016.508

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of this study was to evaluate the impact of postmastectomy radiotherapy (PMRT) on loco-regional recurrence-free survival (LRRFS), disease-free survival (DFS), and overall survival (OS) in pT1-2N1 patients treated with taxane-based chemotherapy.
Materials and Methods
We retrospectively reviewed the medical data of pathological N1 patients who were treated with modified radical mastectomy and adjuvant taxane-based chemotherapy in 12 hospitals between January 2006 and December 2010.
Results
We identified 714 consecutive patients. The median follow-up duration was 69 months (range, 1 to 114 months) and the 5-year LRRFS, DFS, and OS rates were 97%, 94%, and 98%, respectively, in patients who received PMRT (PMRT [+]). The corresponding figures were 96%, 90%, and 96%, respectively, in patients who did not receive PMRT (PMRT [–]). PMRT had no significant impact on survival. Upon multivariable analysis, only the histological grade (HG) was statistically significant as a prognostic factor for LRRFS and DFS. In a subgroup analysis of HG 3 patients, PMRT (+) showed better DFS (p=0.081).
Conclusion
PMRT had no significant impact on LRRFS, DFS, or OS in pT1-2N1 patients treated with taxane-based chemotherapy. PMRT showed a marginal benefit for DFS in HG 3 patients. Randomized studies are needed to confirm the benefit of PMRT in high risk patients, such as those with HG 3.

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Does Post-Mastectomy Radiotherapy Confer Survival Benefits on Patients With 1-3 Clinically Positive Lymph Nodes Rendered Pathologically Negative After Neoadjuvant Systemic Chemotherapy: Consensus from A Pooled Analysis?
Munaser Alamoodi
European Journal of Breast Health.2024; 20(2): 81. CrossRef
Effect of postmastectomy radiotherapy on T1-2N1M0 triple-negative breast cancer
Lin-Yu Xia, Wei-Yun Xu, Yan Zhao, Sudeep Gupta
PLOS ONE.2022; 17(6): e0270528. CrossRef
Suggestion for the omission of post-mastectomy chest wall radiation therapy in patients who underwent skin-sparing/nipple-sparing mastectomy
Nalee Kim, Won Park, Won Kyung Cho, Hae Young Kim, Doo Ho Choi, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Jonghan Yu, Byung Joo Chae, Se Kyung Lee, Jai Min Ryu, Goo-Hyun Mun, Jai-Kyong Pyon, Byung-Joon Jeon
The Breast.2022; 66: 54. CrossRef
Post-mastectomy radiation therapy in breast cancer patients with 1–3 positive lymph nodes: No one size fits all
Majd Kayali, Joseph Abi Jaoude, Arafat Tfayli, Nagi El Saghir, Philip Poortmans, Youssef H. Zeidan
Critical Reviews in Oncology/Hematology.2020; 147: 102880. CrossRef
The survival benefit of postmastectomy radiotherapy for breast cancer patients with T1-2N1 disease according to molecular subtype
Jinli Wei, Yizhou Jiang, Zhimin Shao
The Breast.2020; 51: 40. CrossRef
The effect of postmastectomy radiotherapy in node-positive triple-negative breast cancer
Lei Zhang, Ru Tang, Jia-Peng Deng, Wen-Wen Zhang, Huan-Xin Lin, San-Gang Wu, Zhen-Yu He
BMC Cancer.2020;[Epub] CrossRef
Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418)
Gyu Sang Yoo, Won Park, Jeong Il Yu, Doo Ho Choi, Yeon-Joo Kim, Kyung Hwan Shin, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha
Cancer Research and Treatment.2019; 51(3): 1041. CrossRef
Effect of postmastectomy radiotherapy on triple-negative breast cancer with T1-2 and 1-3 positive axillary lymph nodes: a population-based study using the SEER 18 database
Jie Zhang, Xiao-Xiao Wang, Jun-Yu Lian, Chuan-Gui Song
Oncotarget.2019; 10(50): 5245. CrossRef
Local and regional recurrence following mastectomy in breast cancer patients with 1–3 positive nodes: implications for postmastectomy radiotherapy volume
Shin-Hyung Park, Jeeyeon Lee, Jeong Eun Lee, Min Kyu Kang, Mi Young Kim, Ho Yong Park, Jin Hyang Jung, Yee Soo Chae, Soo Jung Lee, Jae-Chul Kim
Radiation Oncology Journal.2018; 36(4): 285. CrossRef

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Analysis of BRIP1 Variants among Korean Patients with BRCA1/2 Mutation-Negative High-Risk Breast Cancer: Haeyoung Kim, Dae-Yeon Cho, Doo Ho Choi, Gee Hue Jung, Inkyung Shin, Won Park, Seung Jae Huh, Seok Jin Nam, Jeong Eon Lee, Won Ho Gil, Seok Won Kim; Cancer Res Treat. 2016;48(3):955-961. Published online January 19, 2016; DOI: https://doi.org/10.4143/crt.2015.191

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Purpose
The aim of the current study is to assess the spectrum of genetic variation in the BRIP1 gene among Korean high-risk breast cancer patients who tested negative for the BRCA1/2 mutation.
Materials and Methods
Overall, 235 Korean patientswith BRCA1/2 mutation–negative high-risk breast cancerwere screened for BRIP1 mutations. The entire BRIP1 gene was analyzed using fluorescent-conformation sensitive gel electrophoresis. In silico analysis of BRIP1 variants was performed using PolyPhen-2 and SIFT.
Results
A total of 20 sequence alterations including 12 exonic and eight intronic variantswere found. Among the 12 exonic variants, 10 were missense and two were silent mutations. No protein-truncating mutation was found among the tested patients. Among the 10 missense variants, four (p.L263F, p.L340F, p.L474P, and p.R848H) were predicted to be pathogenic by both PolyPhen-2 and SIFT, and these variants were found in five patients. Of the four missense variants, p.L263F, p.L474P, and p.R848H localize to regions between the helicase motifs, while p.L340F resides in an iron-sulfur domain of BRIP1.
Conclusion
No protein-truncating mutation in BRIP1 was found among the tested patients. The contribution of BRIP1 variants is thought to be minor in Korean non-BRCA1/2 high-risk breast cancer.

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Amrita Bhat, Gh. Rasool Bhat, Sonali Verma, Bhanu Sharma, Divya Bakshi, Deepak Abrol, Supinder Singh, Raies Ahmed Qadri, Ruchi Shah, Rakesh Kumar
Journal of Biochemical and Molecular Toxicology.2021;[Epub] CrossRef
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Diana C. Odermatt, Wei Ting C. Lee, Sebastian Wild, Stanislaw K. Jozwiakowski, Eli Rothenberg, Kerstin Gari, Andrew Deans
PLOS Genetics.2020; 16(6): e1008740. CrossRef
Helicase-inactivating BRIP1 mutation yields Fanconi anemia with microcephaly and other congenital abnormalities
Lara Kamal, Sarah B. Pierce, Christina Canavati, Amal Abu Rayyan, Tamara Jaraysa, Orit Lobel, Suhair Lolas, Barbara M. Norquist, Grace Rabie, Fouad Zahdeh, Ephrat Levy-Lahad, Mary-Claire King, Moien N. Kanaan
Molecular Case Studies.2020; 6(5): a005652. CrossRef
Variants of cancer susceptibility genes in Korean BRCA1/2 mutation-negative patients with high risk for hereditary breast cancer
Ji Soo Park, Seung-Tae Lee, Eun Ji Nam, Jung Woo Han, Jung-Yun Lee, Jieun Kim, Tae Il Kim, Hyung Seok Park
BMC Cancer.2018;[Epub] CrossRef
Mutation status of RAD51C,PALB2 and BRIP1 in 100 Japanese familial breast cancer cases without BRCA1 and BRCA2 mutations
Katsutoshi Sato, Mio Koyasu, Sachio Nomura, Yuri Sato, Mizuho Kita, Yuumi Ashihara, Yasue Adachi, Shinji Ohno, Takuji Iwase, Dai Kitagawa, Eri Nakashima, Reiko Yoshida, Yoshio Miki, Masami Arai
Cancer Science.2017; 108(11): 2287. CrossRef
Mutational analysis of FANCJ helicase
Manhong Guo, Venkatasubramanian Vidhyasagar, Tanu Talwar, Ahmad Kariem, Yuliang Wu
Methods.2016; 108: 118. CrossRef

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Outcome of Local Excision Following Preoperative Chemoradiotherapy for Clinically T2 Distal Rectal Cancer: A Multicenter Retrospective Study (KROG 12-06): Jae Myoung Noh, Won Park, Jae-Sung Kim, Woong Sub Koom, Jin Hee Kim, Doo Ho Choi, Hee Chul Park; Cancer Res Treat. 2014;46(3):243-249. Published online July 15, 2014; DOI: https://doi.org/10.4143/crt.2014.46.3.243

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Purpose
The aim of this study was to examine the clinical implications of a pathologically complete response after neoadjuvant chemoradiotherapy (CRT) followed by local excision for patients with cT2 rectal cancer who refused radical surgery. Materials and Methods Seventeen patients with cT2 primary rectal cancer within 6 cm from the anal verge who received neoadjuvant CRT and local excision because of patient refusal of radical surgery or poor performance status were included. Two patients had clinical involvement of a regional lymph node. Preoperative radiotherapy was delivered to the whole pelvis at a dose of 44 to 50.4 Gy in 22 to 28 fractions. All patients underwent transanal excision and eight patients (47%) received postoperative chemotherapy. Results Ten patients (59%) achieved ypT0. At a median follow-up period of 75 months (range, 22 to 126 months), four (24%) patients developed recurrence (two locoregional and two distant). The 5-year disease-free survival of all patients was 82%, and was higher in patients with ypT0 (90%) than in patients with ypT1-2 (69%, p=0.1643). Decreased disease-free survival was also observed in patients receiving capecitabine compared with 5-fluorouracil (54% vs. 100%, p=0.0298). Conclusion Local excision could be a feasible alternative to radical surgery in patients with ypT0 after neoadjuvant CRT for cT2 distal rectal cancer without further radical surgery.

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Annals of Surgical Treatment and Research.2019; 96(2): 78. CrossRef
Neoadjuvant chemoradiation followed by transanal local excision for T2 rectal cancer confers equivalent survival benefit as traditional transabdominal resection
Oliver K. Jawitz, Mohamed A. Adam, Megan C. Turner, Brian F. Gilmore, John Migaly
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Clinical Outcomes of Local Excision Following Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer: Nam Kwon Lee, Dae Yong Kim, Sun Young Kim, Jae Hwan Oh, Won Park, Doo Ho Choi, Taek-Keun Nam, Kyung-Ja Lee; Cancer Res Treat. 2014;46(2):158-164. Published online April 15, 2014; DOI: https://doi.org/10.4143/crt.2014.46.2.158

Abstract PDF PubReader ePub

Purpose

To evaluate the treatment outcomes of local excision following preoperative chemoradiotherapy in patients with locally advanced rectal cancer who have not undergone radical surgery for any reason.

Materials and Methods

The data of 27 patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy followed by local excision were analyzed retrospectively. The primary endpoint was the 5-year relapse-free survival rate, and the secondary endpoint was the pattern of recurrence.

Results

The median follow-up time was 81.8 months (range, 28.6 to 138.5 months). The 5-year local relapse-free survival (LRFS), distant metastasis-free survival (DMFS), relapse-free survival (RFS), and overall survival (OS) were 88.9%, 81.1%, 77.8%, and 85.0%, respectively. Six (22%) patients developed treatment failure; one (4%) patient had local recurrence only, three (11%) patients had distant recurrence only, and two (7%) patients had both. The 5-year LRFS, DMFS, RFS, and OS for patients with ypT0-1 compared with ypT2-3 were 94.1% vs. 77.8% (p=0.244), 94.1% vs. 55.6% (p=0.016), 88.2% vs. 55.6% (p=0.051), and 94.1% vs. 66.7% (p=0.073), respectively.

Conclusion

Local excision following preoperative chemoradiotherapy may be an alternative treatment for highly selected patients with locally advanced rectal cancer who have achieved ypT0-1 after preoperative chemoradiotherapy.

Citations

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Organ‐saving surgery for rectal cancer after neoadjuvant chemoradiation: Analysis of failures and long‐term results
Maurizio Cosimelli, Pietro Ursi, Raffaello Mancini, Giada Pattaro, Pasquale Perri, Chiara Parrino, Valerio De Peppo, Maria Grazia Diodoro, Andrea Balla, Gian Luca Grazi
Journal of Surgical Oncology.2020; 121(2): 375. CrossRef
Local excision for ypT2 rectal cancer following preoperative chemoradiation therapy: it should not be justified
Kwan Mo Yang, Seok-Byung Lim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Chang Sik Yu, Jin Cheon Kim
International Journal of Colorectal Disease.2018; 33(4): 487. CrossRef
Are We Predicting Disease Progress of the Rectal Cancer Patients without Surgery after Neoadjuvant Chemoradiotherapy?
Bo Young Oh, Jung Wook Huh, Woo Yong Lee, Yoon Ah Park, Yong Beom Cho, Seong Hyeon Yun, Hee Cheol Kim, Ho-Kyung Chun
Cancer Research and Treatment.2018; 50(3): 634. CrossRef
Total Mesorectal Excision Versus Local Excision After Favorable Response to Preoperative Chemoradiotherapy in “Early” Clinical T3 Rectal Cancer: A Propensity Score Analysis
Young Seob Shin, Chang Sik Yu, Jin-hong Park, Jin Cheon Kim, Seok-Byung Lim, In Ja Park, Tae Won Kim, Yong Sang Hong, Kyu-pyo Kim, Sang Min Yoon, Ji Hyeon Joo, Jong Hoon Kim
International Journal of Radiation Oncology*Biology*Physics.2017; 99(1): 136. CrossRef
Controversial issues in radiotherapy for rectal cancer: a systematic review
Jong Hoon Kim
Radiation Oncology Journal.2017; 35(4): 295. CrossRef
Local excision of low rectal cancer treated by chemoradiotherapy: is it safe for all patients with suspicion of complete tumor response?
Clotilde Debove, Nathalie Guedj, Ecoline Tribillon, Léon Maggiori, Magaly Zappa, Yves Panis
International Journal of Colorectal Disease.2016; 31(4): 853. CrossRef
Seven low-mass ions in pretreatment serum as potential predictive markers of the chemoradiotherapy response of rectal cancer
Kangsan Roh, Seung-Gu Yeo, Byong Chul Yoo, Kyung-Hee Kim, Sun Young Kim, Min-Jeong Kim
Anti-Cancer Drugs.2016; 27(8): 787. CrossRef
A Systematic Review of Local Excision After Neoadjuvant Therapy for Rectal Cancer: Are ypT0 Tumors the Limit?
Sally Hallam, David E. Messenger, Michael G. Thomas
Diseases of the Colon & Rectum.2016; 59(10): 984. CrossRef
Definitive high-dose radiotherapy with concurrent chemotherapy for locally advanced rectal cancer
Min-Jeong Kim, Eun Seok Kim, Seung-Gu Yeo
Medicine.2016; 95(40): e5059. CrossRef
Association of pretreatment serum carcinoembryonic antigen levels with chemoradiation-induced downstaging and downsizing of rectal cancer
SEUNG-GU YEO
Molecular and Clinical Oncology.2016; 4(4): 631. CrossRef
The Role of Fibrinogen as a Predictor in Preoperative Chemoradiation for Rectal Cancer
Jong Hoon Lee, Jong Hee Hyun, Dae Yong Kim, Byong Chul Yoo, Ji Won Park, Sun Young Kim, Hee Jin Chang, Byung Chang Kim, Tae Hyun Kim, Jae Hwan Oh, Dae Kyung Sohn
Annals of Surgical Oncology.2015; 22(1): 209. CrossRef
Oncologic Outcomes according to the Treatment Strategy in Radiologic Complete Responders after Neoadjuvant Chemoradiation for Rectal Cancer
Soo Young Lee, Chang Hyun Kim, Young Jin Kim, Hyeong Rok Kim
Oncology.2015; 89(6): 311. CrossRef

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Prognostic Value of Different Patterns of Squamous Cell Carcinoma Antigen Level for the Recurrent Cervical Cancer: Bae Kwon Jeong, Seung Jae Huh, Doo Ho Choi, Won Park, Duk Soo Bae, Byoung-Gie Kim; Cancer Res Treat. 2013;45(1):48-54. Published online March 31, 2013; DOI: https://doi.org/10.4143/crt.2013.45.1.48

Abstract PDF PubReader ePub

PURPOSE
In some unusual cases, in patients with cervical cancer, an elevation of squamous cell carcinoma antigen (SCC-Ag) was not observed at diagnosis but was observed on recurrence, or vice versa. The objective of this study was to identify patient-, disease-, and treatment-related factors associated with this unusual level of SCC-Ag, and to determine whether SCC-Ag is a useful tumor marker in such patients.
MATERIALS AND METHODS
Among 129 patients with recurrence, 14 who showed a normal SCC-Ag level at diagnosis but an elevated level at recurrence were classified as group I; 22 patients with an elevated SCC-Ag level at diagnosis but not at recurrence were classified as group II; and 76 patients with an elevated SCC-Ag level at both diagnosis and recurrence were classified as group III.
RESULTS
In univariate analysis, unusual SCC-Ag showed statistically significant relationships with pathology and biochemical response to treatment. However, in the multivariate analysis, none of the clinicopathologic factors showed a statistical relationship with unusual levels of SCC-Ag. The 5-year disease-free survival rates for groups I, II, and III were 7.1%, 9.1%, and 0% (p=0.418), and the 5-year overall survival rates were 34.3%, 58.4%, and 33.3% (p=0.142), respectively.
CONCLUSION
The value of SCC-Ag has been confirmed in all patients; thus, check of SCC-Ag level at follow-up should be considered. Although no statistically significant differences were observed among the groups, we conclude that patients with a high initial SCC-Ag and elevated SCC-Ag at relapse have poor prognosis due to high SCC-Ag level.

Citations

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Chufan Wu, Xiaojuan Lv, Fangfang Wang, Qing Xu, Hanmei Lou, Xiaojing Zhang
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Kazuto Nakamura, Soichi Yamashita, Keiko Kigure, Toshio Nishimura, Ikuro Ito, Anri Azuma, Kohshiro Nakao, Ken Ando, Tatsuya Kanuma
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Prognostic Effect of Primary Recurrence Patterns in Squamous Cervical Carcinoma After Radical Surgery
Zongkai Zhang, Long Jiang, Rui Bi, Xiaohua Wu, Guihao Ke, Jun Zhu
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Can serial evaluation of serum SCC-Ag-level predict tumor recurrence and patient survival in squamous-cell carcinoma of uterine cervix treated with definitive chemoradiotherapy? A multi-institutional analysis
Kyu Hye Choi, Mina Yu, Songmi Jeong, Jong Hoon Lee
International Journal of Clinical Oncology.2020; 25(7): 1405. CrossRef
Preoperative SCC-Ag as a predictive marker for the use of adjuvant chemotherapy in cervical squamous cell carcinoma with intermediate-risk factors
Hong-tao Guo, Xue-han Bi, Ting Lei, Xiao Lv, Guang Yao, Yao Chen, Chang Liu
BMC Cancer.2020;[Epub] CrossRef
Significance of elevated SCC-Ag level on tumor recurrence and patient survival in patients with squamous-cell carcinoma of uterine cervix following definitive chemoradiotherapy: a multi-institutional analysis
Kyu Hye Choi, Sea-Won Lee, Mina Yu, Songmi Jeong, Jeong Won Lee, Jong Hoon Lee
Journal of Gynecologic Oncology.2019;[Epub] CrossRef
Prognostic Role of Squamous Cell Carcinoma Antigen in Cervical Cancer: A Meta-analysis
Zhenhua Liu, Hongtai Shi
Disease Markers.2019; 2019: 1. CrossRef
The association between serum squamous cell carcinoma antigen and recurrence and survival of patients with cervical squamous cell carcinoma: A systematic review and meta-analysis
Chuenkamon Charakorn, Kunlawat Thadanipon, Sawarat Chaijindaratana, Sasivimol Rattanasiri, Pawin Numthavaj, Ammarin Thakkinstian
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Peng Chen, Liang Jiao, Dan-Bo Wang
Oncology Letters.2017; 13(3): 1235. CrossRef
C14ORF166 overexpression is associated with pelvic lymph node metastasis and poor prognosis in uterine cervical cancer
Weijing Zhang, Jianping Ou, Fangyong Lei, Teng Hou, Shu Wu, Chunhao Niu, Liqun Xu, Yanna Zhang
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The assessment of the prognostic value of tumor markers and cytokines as SCCAg, CYFRA 21.1, IL-6, VEGF and sTNF receptors in patients with squamous cell cervical cancer, particularly with early stage of the disease
Beata Kotowicz, Malgorzata Fuksiewicz, Joanna Jonska-Gmyrek, Mariusz Bidzinski, Maria Kowalska
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Guoxing Zhou, Xiao Chen, Fei Tang, Jie Zhou, Yibin Wang, Zhongqiu Wang
International Journal of Gynecological Cancer.2016; 26(2): 361. CrossRef
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Gynecologic Oncology.2013; 131(3): 655. CrossRef

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Comparison of Radiation Therapy and Combined Chemotherapy and Radiation Therapy for Locally Advanced Head and Neck Cancer: Gyu Taeg Lee, Jae Ho Byun, Kwon Hwangbo, Ji Oh Mok, Eun Seuk Kim, Jong Ho Won, Seung Ho Baick, Doo Ho Choi, Dae Sik Hong, Hee Sook Park; J Korean Cancer Assoc. 1997;29(4):616-622.

Abstract PDF: PURPOSE
In locally advanced head and neck cancer, radiation therapy is currently unsatisfactory because the end result is often limited regional disease control and survival. A clinical study was carried out to compare the effectiveness between the radiation therapy and the combined chemotherapy and radiation therapy.
MATERIALS AND METHOD
Thirty-six patients with previously untreated, locally advanced squamous cell carcinoma of the head and neck were treated with radiotherapy alone and combined chemo-radiotherapy. Induction chemotherapy was administered 2~3 cycles, consisting of intravenous cisplatin (100 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2/day for 5 days as a continuous infusion) every 4 weeks followed by 7~8 weeks of radiation therapy for a total dose of 60~75 Gy. RESULTS: 1) Among 36 locally advanced head and neck cancer, 17 patients received radiation therapy alone and 19 patients received combined chemo-radiotherapy, respectively. 2) Response rate was 47% (complete response 29%, and partial response 18%) in radiation therapy group and 79% (complete response 37%, and partial response 42%) in combined chemo-radiotherapy group (p<0.05). 3) In median survival, radiation therapy group was 13 months and combined chemo- radiotherapy group was 15 months. Both groups were not significantly different (p>0.05). 4) Treatment related mortality was not noted, but the toxic effects were seen on the half cases of the both groups. Grade II toxicities were similar between the two arms.
CONCLUSION
Combined chemotherapy and radiation therapy was more effective in local control but not superior in survival than radiation therapy alone. Continuous evaluation and identification of proper sequence for the therapeutic modality is supposed to prolong the survival of patients.

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