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18 "Jae Myoung Noh"
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Gastrointestinal cancer
Salvage Radiotherapy for Loco-regional Recurrence of Esophageal Cancer Following Surgery
Won Kyung Cho, Jae Myoung Noh, Dongryul Oh, Yong Chan Ahn, Jong-Mu Sun, Hong Kwan Kim, Young Mog Shim
Cancer Res Treat. 2025;57(1):165-173.   Published online July 26, 2024
DOI: https://doi.org/10.4143/crt.2024.191
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
There is few evidence regarding the optimal salvage treatment options for loco-reginal recurrence of esophageal cancer. This study aimed to evaluate the clinical outcomes of salvage radiotherapy (RT) in patients with loco-regional recurrence (LRR) after surgery for esophageal cancer.
Materials and Methods
We retrospectively reviewed 147 esophageal cancer patients who received salvage RT for loco-regional recurrence between 1996 and December 2019. A total dose of 60 Gy in 20 fractions was used for RT alone and 60-70 Gy in 30-35 fractions for concurrent chemoradiotherapy (CCRT).
Results
The patients’ median age was 65 years (range, 41 to 86 years). The median disease-free interval was 13.5 months (1.0 to 97.4 months). After a median 18.8 months follow-up, the 2-year overall survival (OS) and progression-free survival (PFS) rates were 38.1% and 25.9%, respectively. The median OS and PFS were 18.8 and 8.4 months, respectively. The CCRT could not improve OS compared to RT (p=0.336), but there was a trend of better PFS in the CCRT group. Regarding toxicities, the rate of grade 3 or higher toxicity was 10.9% occurring in 16 patients, and it was higher in patients who received CCRT than in the RT alone group (19.6% vs. 6.3%, p=0.023).
Conclusion
Salvage RT alone as well as CCRT could be effective in patients with locoregionally recurrent esophageal cancer.

Citations

Citations to this article as recorded by  
  • Salvage Chemoradiotherapy for Loco-Regional Recurrence of Esophageal Squamous Cell Carcinoma After Esophagectomy
    Atsuto Katano, Tomoki Kiritoshi, Subaru Sawayanagi, Hideomi Yamashita
    Journal of Clinical Medicine.2025; 14(5): 1540.     CrossRef
  • 2,817 View
  • 110 Download
  • 1 Web of Science
  • 1 Crossref
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Lung and Thoracic cancer
Adjuvant Pembrolizumab in Patients with Stage IIIA/N2 Non–Small Cell Lung Cancer Completely Resected after Neoadjuvant Concurrent Chemoradiation: A Prospective, Open-Label, Single-Arm, Phase 2 Trial
Junghoon Shin, Sehhoon Park, Kyung Hwan Kim, Eui-Cheol Shin, Hyun Ae Jung, Jong Ho Cho, Jong-Mu Sun, Se-Hoon Lee, Yong Soo Choi, Jin Seok Ahn, Jhingook Kim, Keunchil Park, Young Mog Shim, Hong Kwan Kim, Jae Myoung Noh, Yong Chan Ahn, Hongryull Pyo, Myung-Ju Ahn
Cancer Res Treat. 2024;56(4):1084-1095.   Published online April 30, 2024
DOI: https://doi.org/10.4143/crt.2024.084
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Optimal treatment for stage IIIA/N2 non–small cell lung cancer (NSCLC) is controversial. We aimed to assess the efficacy and safety of adjuvant pembrolizumab for stage IIIA/N2 NSCLC completely resected after neoadjuvant concurrent chemoradiation therapy (CCRT).
Materials and Methods
In this open-label, single-center, single-arm phase 2 trial, patients with stage IIIA/N2 NSCLC received adjuvant pembrolizumab for up to 2 years after complete resection following neoadjuvant CCRT. The primary endpoint was disease-free survival (DFS). Secondary endpoints included overall survival (OS) and safety. As an exploratory biomarker analysis, we evaluated the proliferative response of blood CD39+PD-1+CD8+ T cells using fold changes in the percentage of proliferating Ki-67+ cells from days 1 to 7 of cycle 1 (Ki-67D7/D1).
Results
Between October 2017 and October 2018, 37 patients were enrolled. Twelve (32%) and three (8%) patients harbored EGFR and ALK alterations, respectively. Of 34 patients with programmed cell death ligand 1 assessment, 21 (62%), nine (26%), and four (12%) had a tumor proportion score of < 1%, 1%-50%, and ≥ 50%, respectively. The median follow-up was 71 months. The median DFS was 22.4 months in the overall population, with a 5-year DFS rate of 29%. The OS rate was 86% at 2 years and 76% at 5 years. Patients with tumor recurrence within 6 months had a significantly lower Ki-67D7/D1 among CD39+PD-1+CD8+ T cells than those without (p=0.036). No new safety signals were identified.
Conclusion
Adjuvant pembrolizumab may offer durable disease control in a subset of stage IIIA/N2 NSCLC patients after neoadjuvant CCRT and surgery.

Citations

Citations to this article as recorded by  
  • Adjuvant immunotherapy improves survival in completely resected stage IB–III NSCLC: a systematic review and meta-analysis
    Hong Huang, Pengchen Bao, Hongyu Jin, Wenyang Li, Hui Shen, Zhen Qin, Ying Pan, Xinming Su, Delei Kong
    Frontiers in Oncology.2025;[Epub]     CrossRef
  • Advances in molecular pathology and therapy of non-small cell lung cancer
    Qing Huang, Yuanxiang Li, Yingdan Huang, Jingyi Wu, Wendai Bao, Chang Xue, Xiaoyu Li, Shuang Dong, Zhiqiang Dong, Sheng Hu
    Signal Transduction and Targeted Therapy.2025;[Epub]     CrossRef
  • A retrospective analysis of neoadjuvant chemotherapy in pneumonectomy for locally advanced central non–small cell lung cancer
    Yuchen Wang, Zhihang Dang, Pu Jiang, Zhifeng Li, Jin Yang, Kun Gao, Xiaona Chen, Jifang Yao
    PeerJ.2025; 13: e20007.     CrossRef
  • 4,978 View
  • 176 Download
  • 3 Web of Science
  • 3 Crossref
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The Incidence and Risk Factors of Chronic Pulmonary Infection after Radiotherapy in Patients with Lung Cancer
Yeonseok Choi, Jae Myoung Noh, Sun Hye Shin, Kyungjong Lee, Sang-Won Um, Hojoong Kim, Hongryull Pyo, Yong Chan Ahn, Byeong-Ho Jeong
Cancer Res Treat. 2023;55(3):804-813.   Published online January 3, 2023
DOI: https://doi.org/10.4143/crt.2022.1305
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to investigate cumulative incidence and risk factors associated with chronic pulmonary infection (CPI) development after radiotherapy for lung cancer.
Materials and Methods
We retrospectively analyzed 1,872 patients with lung cancer who received radiotherapy for lung cancer from 2010-2014, had a follow-up period of ≥ 3 months after radiotherapy, and did not have CPI at the time of radiotherapy. CPI was defined as pulmonary tuberculosis, non-tuberculous mycobacterial pulmonary disease, chronic pulmonary aspergillosis, or pulmonary actinomycosis. The cumulative incidence of CPI and overall survival (OS) were estimated using the Kaplan-Meier method, and a multivariable Cox proportional hazards analysis was performed to identify risk factors associated with CPI development.
Results
The median follow-up period was 2.3 years with OS rates of 55.6% and 37.6% at 2 and 5 years, respectively. CPI developed in 59 patients at a median of 1.8 years after radiotherapy, with cumulative incidence rates of 1.1%, 3.4%, 5.0%, and 6.8% at 1, 3, 5, and 7 years, respectively. A lower body mass index, interstitial lung disease, prior pulmonary tuberculosis, larger clinical target volume, history of lung cancer surgery or radiation pneumonitis, and use of inhaled corticosteroids were independent risk factors for CPI development.
Conclusion
The long-term survival rate of lung cancer patients receiving radiotherapy was not low, but the cumulative incidence of CPI gradually increased to 6.8% at 7 years after radiotherapy. Therefore, close monitoring of CPI development is required in surviving patients with risk factors.

Citations

Citations to this article as recorded by  
  • Chronic progressive pulmonary aspergillosis within the irradiated field after stereotactic body radiotherapy: two case reports
    Nao Mamuro, Noriko Kishi, Yukinori Matsuo, Masahiro Yoneyama, Hiroyuki Inoo, Minoru Inoue, Takashi Mizowaki
    International Cancer Conference Journal.2025; 14(2): 113.     CrossRef
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    Yujie Huang
    American Journal of Cancer Research.2025; 15(2): 781.     CrossRef
  • The Inter-Relationships Among the Risk Factors for Pulmonary Infection and the Diagnostic Utility of Inflammatory Markers in Patients with Non-Small Cell Lung Cancer
    Wenwen Qin, Tiebin You, Tai Guo, Ruixin Tian, Xiaoman Cui, Ping Wang
    Infection and Drug Resistance.2025; Volume 18: 1111.     CrossRef
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    Geling Teng, Feng Jin, Hua Zhang, Min Zhang
    Frontiers in Medicine.2025;[Epub]     CrossRef
  • Host Risk Factors for Tuberculosis
    Vahid Asgharzadeh, Seyyed Amin Seyyed Rezaei, Mohammad Asgharzadeh, Jalil Rashedi, Hossein Samadi Kafil, Hossein Jalaei Nobari, Ahmad Ali Khalili, Mortaza Raeisi, Mahdi Asghari Ozma, Behroz Mahdavi Poor
    Infectious Disorders - Drug Targets.2025;[Epub]     CrossRef
  • Interaction between Dectin-1 gene polymorphisms and low weight on the risk of invasive pulmonary aspergillosis in patients with lung cancer undergoing surgery
    Wenfang Jin, Yu Yao, Yanling Lv
    Discover Oncology.2025;[Epub]     CrossRef
  • Coexisting Lung Cancer and Pulmonary Tuberculosis: A Comprehensive Review From Incidence to Management
    Wendi Zhou, Hongxu Lu, Jiamin Lin, Jialou Zhu, Jizhen Liang, Yalin Xie, Jinxing Hu, Ning Su
    Cancer Reports.2025;[Epub]     CrossRef
  • Risk factors for pulmonary infection after thoracoscopic radical resection of lung cancer in elderly patients with diabetes mellitus
    Zi-Yuan Chen, Zhi-Qi Hong, Tie-Qiao Wang, Guo-Mei-Zhi Fu, Wen-Min Su, Cheng-Wei Zhou
    World Journal of Diabetes.2025;[Epub]     CrossRef
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    紫燕 姚
    Nursing Science.2025; 14(10): 1920.     CrossRef
  • Global trends, risk factors, and therapeutic associations of fungal pulmonary infections in lung cancer: A systematic review and meta-analysis
    Milad Sheervalilou1, Mostafa Ghanei1, Masoud Arabfard1
    Jornal Brasileiro de Pneumologia.2025; : e20250076.     CrossRef
  • Invasive aspergillosis complicated in a patient with non-small cell lung cancer harboring RET fusion during treatment with RET-TKIs: a case report and literature review
    Kaidiriye Setiwalidi, Yimeng Li, Yuyan Ma, Zhanpeng Hao, Yujia Zhao, Yuxin Zhang, Xuan Liang, Tao Tian, Zhiping Ruan, Yu Yao, Xiao Fu
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • 6,166 View
  • 199 Download
  • 8 Web of Science
  • 11 Crossref
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General
Targeted Liquid Biopsy Using Irradiation to Facilitate the Release of Cell-Free DNA from a Spatially Aimed Tumor Tissue
Jae Myoung Noh, Yeon Jeong Kim, Ho Yun Lee, Changhoon Choi, Won-Gyun Ahn, Taeseob Lee, Hongryull Pyo, Jee Hyun Park, Donghyun Park, Woong-Yang Park
Cancer Res Treat. 2022;54(1):40-53.   Published online May 25, 2021
DOI: https://doi.org/10.4143/crt.2021.151
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We investigated the feasibility of using an anatomically localized, target-enriched liquid biopsy (TLB) in mouse models of lung cancer.
Materials and Methods
After irradiating xenograft mouse with human lung cancer cell lines, H1299 (NRAS proto-oncogene, GTPase [NRAS] Q61K) and HCC827 (epidermal growth factor receptor [EGFR] E746-750del), circulating (cell-free) tumor DNA (ctDNA) levels were monitored with quantitative polymerase chain reaction on human long interspersed nuclear element-1 and cell line-specific mutations. We checked dose-dependency at 6, 12, or 18 Gy to each tumor-bearing mouse leg using 6-MV photon beams. We also analyzed ctDNA of lung cancer patients by LiquidSCAN, a targeted deep sequencing to validated the clinical performances of TLB method.
Results
Irradiation could enhance the detection sensitivity of NRAS Q61K in the plasma sample of H1299-xenograft mouse to 4.5- fold. While cell-free DNA (cfDNA) level was not changed at 6 Gy, ctDNA level was increased upon irradiation. Using double-xenograft mouse with H1299 and HCC827, ctDNA polymerase chain reaction analysis with local irradiation in each region could specify mutation type matched to transplanted cell types, proposing an anatomically localized, TLB. Furthermore, when we performed targeted deep sequencing of cfDNA to monitor ctDNA level in 11 patients with lung cancer who underwent radiotherapy, the average ctDNA level was increased within a week after the start of radiotherapy.
Conclusion
TLB using irradiation could temporarily amplify ctDNA release in xenograft mouse and lung cancer patients, which enables us to develop theragnostic method for cancer patients with accurate ctDNA detection.

Citations

Citations to this article as recorded by  
  • Modulating cell-free DNA biology as the next frontier in liquid biopsies
    Shervin Tabrizi, Carmen Martin-Alonso, Kan Xiong, Sangeeta N. Bhatia, Viktor A. Adalsteinsson, J. Christopher Love
    Trends in Cell Biology.2025; 35(6): 459.     CrossRef
  • Establishment of xenografts and methods to evaluate tumor burden for the three most frequent subclasses of pediatric-type diffuse high grade gliomas
    Leire Balaguer-Lluna, Nagore G. Olaciregui, Rosario Aschero, Claudia Resa-Pares, Sonia Paco, Maria Cuadrado-Vilanova, Victor Burgueño, Merce Baulenas-Farres, Carles Monterrubio, Alejandro Manzanares, Eva Rodríguez, Cinzia Lavarino, Jaume Mora, Angel M. Ca
    Journal of Neuro-Oncology.2025; 172(3): 599.     CrossRef
  • Early Dynamics of Circulating Tumor DNA Following Curative Hypofractionated Radiotherapy Related to Disease Control in Lung Cancer
    Kyungmi Yang, Jae Myoung Noh, Yeon Jeong Kim, Hongryull Pyo
    Diagnostics.2025; 15(10): 1198.     CrossRef
  • Improvement of the sensitivity of circulating tumor DNA-based liquid biopsy: current approaches and future perspectives
    Ekaterina S. Kuligina, Grigoriy A. Yanus, Evgeny N. Imyanitov
    Exploration of Targeted Anti-tumor Therapy.2025;[Epub]     CrossRef
  • The VIGILANCE Study Protocol: An Innovative Study to Identify Prognostic and Response Biomarkers in Patients with Stage III Non-Small-Cell Lung Cancer Treated with Curative-Intent Radiotherapy
    Ashley Horne, Amelia Payne, Harry Crawford, Clare Dempsey, Hitesh Mistry, Gareth Price, Corinne Faivre-Finn
    BioMed.2025; 5(4): 27.     CrossRef
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    Tina Moser, Ellen Heitzer
    Science.2024; 383(6680): 260.     CrossRef
  • Priming agents transiently reduce the clearance of cell-free DNA to improve liquid biopsies
    Carmen Martin-Alonso, Shervin Tabrizi, Kan Xiong, Timothy Blewett, Sainetra Sridhar, Andjela Crnjac, Sahil Patel, Zhenyi An, Ahmet Bekdemir, Douglas Shea, Shih-Ting Wang, Sergio Rodriguez-Aponte, Christopher A. Naranjo, Justin Rhoades, Jesse D. Kirkpatric
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  • Treatment Response Biomarkers: Working Toward Personalized Radiotherapy for Lung Cancer
    Ashley Horne, Ken Harada, Katherine D. Brown, Kevin Lee Min Chua, Fiona McDonald, Gareth Price, Paul Martin Putora, Dominic G. Rothwell, Corinne Faivre-Finn
    Journal of Thoracic Oncology.2024; 19(8): 1164.     CrossRef
  • Basic Science with Preclinical Models to Investigate and Develop Liquid Biopsy: What Are the Available Data and Is It a Fruitful Approach?
    Benedetta Cena, Emmanuel Melloul, Nicolas Demartines, Olivier Dormond, Ismail Labgaa
    International Journal of Molecular Sciences.2022; 23(10): 5343.     CrossRef
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    Kwang Seob Lee, Jieun Seo, Choong-Kun Lee, Saeam Shin, Zisun Choi, Seungki Min, Jun Hyuek Yang, Woo Sun Kwon, Woobin Yun, Mi Ri Park, Jong Rak Choi, Hyun Cheol Chung, Seung-Tae Lee, Sun Young Rha
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  • 299 Download
  • 8 Web of Science
  • 10 Crossref
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Head and Neck cancer
Re-irradiation with Moderate Hypo-fractionation Using Intensity Modulated Photon or Proton Radiation Therapy in Locally Recurrent Squamous Cell Carcinoma of Nasopharynx
Heerim Nam, Yong Chan Ahn, Kyungmi Yang, Dongryul Oh, Jae Myoung Noh
Cancer Res Treat. 2022;54(1):96-108.   Published online March 26, 2021
DOI: https://doi.org/10.4143/crt.2020.1349
AbstractAbstract PDFPubReaderePub
Purpose
This study aimed to analyze the treatment outcomes of locally recurrent nasopharyngeal cancer (NPC) patients following moderate hypo-fractionation re-irradiation (re-RT).
Materials and Methods
Sixty locally recurrent NPC patients underwent hypo-fractionation re-RT. Forty-eight point three percentage had rT3-4, and 30.0% did keratinizing squamous cell carcinoma. Intensity-modulated radiation therapy (IMRT), with or without intensity-modulated proton therapy (IMPT), was used in 66.7% of patients.
Results
With the median follow-up of 22 months (range, 2 to 254 months), 31 patients (51.7%) died, 38 (63.3%) developed further treatment failure, and 30 (50.0%) developed ≥ grade 3 toxicity (including seven grade 5) at time of analysis. The 2- and 5-year rates of overall survival, local failure-free survival, and ≥ grade 3 toxicity-free survival were 57.9% and 45.8%, 64.1% and 52.5%, and 54.8% and 44.9%, respectively. In multivariate analyses, worse factors for overall survival (OS) were iT3-4 (p=0.010) and age at re-RT ≥ 53 years (p=0.003), those for local failure-free survival (LFFS) were rT3-4 (p=0.022) and rN0-1 (p=0.035), and those for toxicity-free survival (TFS) were iT3-4 (p=0.020) and re-IMRT/IMPT (p=0.030), respectively. Cumulative dose or fraction size ≥ 3 Gy at re-RT, however, showed no significance for OS, LFFS and TFS.
Conclusion
Current re-RT with modern RT techniques by moderate hypo-fractionation scheme seemed feasible in treating locally recurrent NPC patients.

Citations

Citations to this article as recorded by  
  • Case Report: Unresectable recurrent nasopharyngeal cancer treated with immuno oncology
    Fabiano Flauto, Rosa Maria Di Crescenzo, Vincenzo Damiano
    Frontiers in Oncology.2025;[Epub]     CrossRef
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    Giulia Fontana, Matteo Pepa, Anna Maria Camarda, Mimoza Strikchani, Michela Meregaglia, Alessandro Vai, Alfredo Mirandola, Barbara Vischioni, Andrea Pella, Guido Baroni, Barbara Alicja Jereczek-Fossa, Marta Scorsetti, Marco Cianchetti, Elisa D’Angelo, Pie
    International Journal of Particle Therapy.2025; 16: 100745.     CrossRef
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    Helena Levyn, Fan Yang, Nancy Y. Lee
    Current Opinion in Otolaryngology & Head & Neck Surgery.2024; 32(1): 5.     CrossRef
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    Zi-Jian Lu, Ting Liu, Jie-Yi Lin, Sheng-Ting Pei, Ling Guo, Sai-Lan Liu, Hai-Qiang Mai
    Radiotherapy and Oncology.2023; 183: 109635.     CrossRef
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    Lei Gao, Anqi Zhang
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    Alexandre Santos, Scott Penfold, Peter Gorayski, Hien Le
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    JAMA Network Open.2021; 4(6): e2113205.     CrossRef
  • 8,223 View
  • 206 Download
  • 7 Web of Science
  • 7 Crossref
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Dummy Run of Quality Assurance Program before Prospective Study of Hippocampus-Sparing Whole-Brain Radiotherapy and Simultaneous Integrated Boost for Multiple Brain Metastases from Non-small Cell Lung Cancer: Korean Radiation Oncology Group (KROG) 17-06 Study
Eunah Chung, Jae Myoung Noh, Kyu Chan Lee, Jin Hee Kim, Weon Kuu Chung, Yang-Gun Suh, Jung Ae Lee, Ki Ho Seol, Hong Gyun Wu, Yeon Sil Kim, O Kyu Noh, Jae Won Park, Dong Soo Lee, Jihae Lee, Young Suk Kim, Woo-Yoon Park, Min Kyu Kang, Sunmi Jo, Yong Chan Ahn
Cancer Res Treat. 2019;51(3):1001-1010.   Published online October 15, 2018
DOI: https://doi.org/10.4143/crt.2018.415
AbstractAbstract PDFPubReaderePub
Purpose
Lung Cancer Subcommittee of Korean Radiation Oncology Group (KROG) has recently launched a prospective clinical trial (KROG 17-06) of hippocampus-sparing whole brain radiotherapy (HS-WBRT) with simultaneous integrated boost (SIB) in treating multiple brain metastases from non-small cell lung cancer. In order to improve trial quality, dummy run studies among the participating institutions were designed. This work reported the results of two-step dummy run procedures of the KROG 17-06 study.
Materials and Methods
Two steps tested hippocampus contouring variability and radiation therapy planning compliance. In the first step, the variation of the hippocampus delineation was investigated for two representative cases using the Dice similarity coefficients. In the second step, the participating institutions were requested to generate a HS-WBRT with SIB treatment plan for another representative case. The compliance of the treatment plans to the planning protocol was evaluated.
Results
In the first step, the median Dice similarity coefficients of the hippocampus contours for two other dummy run cases changed from 0.669 (range, 0.073 to 0.712) to 0.690 (range, 0.522 to 0.750) and from 0.291 (range, 0.219 to 0.522) to 0.412 (range, 0.264 to 0.598) after providing the hippocampus contouring feedback. In the second step, with providing additional plan priority and extended dose constraints to the target volumes and normal structures, we observed the improved compliance of the treatment plans to the planning protocol.
Conclusion
The dummy run studies demonstrated the notable inter-institutional variability in delineating the hippocampus and treatment plan generation, which could be decreased through feedback from the trial center.

Citations

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  • Radiotherapy trial quality assurance processes: a systematic review
    Chloe Brooks, Elizabeth Miles, Peter J Hoskin
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  • 10,385 View
  • 287 Download
  • 4 Web of Science
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Salvage Concurrent Chemo-radiation Therapy for Loco-regional Recurrence Following Curative Surgery of Non-small Cell Lung Cancer
Kyung Hwa Lee, Yong Chan Ahn, Hongryull Pyo, Jae Myoung Noh, Seung Gyu Park, Tae Gyu Kim, Eonju Lee, Heerim Nam, Hyebin Lee, Jong-Mu Sun, Jin Seok Ahn, Myung-Ju Ahn, Keunchil Park
Cancer Res Treat. 2019;51(2):769-776.   Published online September 11, 2018
DOI: https://doi.org/10.4143/crt.2018.366
AbstractAbstract PDFPubReaderePub
Purpose
This study is to report clinical outcomes of salvage concurrent chemo-radiation therapy (CCRT) in treating patients with loco-regional recurrence (LRR) following initial complete resection of non-small cell lung cancer.
Materials and Methods
Between February 2004 and December 2016, 127 patients underwent salvage CCRT for LRR. The median radiation therapy (RT) dose was 66 Gy and clinical target volume was to cover recurrent lesion with margin without elective inclusion of regional lymphatics. Majority of patients (94.5%) received weekly platinum-based doublet chemotherapy during RT course.
Results
The median follow-up time from the start of CCRT was 25 months. The median survival duration was 49 months, and overall survival (OS) rates at 2 and 5 years were 72.9% and 43.9%. The 2- and 5-year rates of in-field failure-free survival, distant metastasis free survival, and progression free survival were 82.4% and 73.8%, 50.4% and 39.9%, and 34.6% and 22.3%, respectively. Grade ≥ 3 radiation-related esophagitis and pneumonitis occurred in 14 (11.0%) and six patients (4.7%), respectively. On both univariate and multivariate analysis, higher biologically equivalent dose (BED10) (≥ 79.2 Gy10 vs. < 79.2 Gy10; hazard ratio [HR], 0.431), smaller CTV (≤ 80 cm3 vs. > 80 cm3; HR, 0.403), and longer disease-free interval (> 1 year vs. ≤ 1 year; HR, 0.489) were significantly favorable factors for OS.
Conclusion
The current study has demonstrated that high dose salvage CCRT focused to the involved lesion only was highly effective and safe. In particular, higher BED10, smaller CTV, and longer disease-free interval were favorable factors for improved survival.

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Feasibility of Selective Neck Irradiation with Lower Elective Radiation Dose in Treating Nasopharynx Cancer Patients
Won Kyung Cho, Dongryul Oh, Eonju Lee, Tae Gyu Kim, Hyebin Lee, Heerim Nam, Jae Myoung Noh, Yong Chan Ahn
Cancer Res Treat. 2019;51(2):603-610.   Published online July 18, 2018
DOI: https://doi.org/10.4143/crt.2018.240
AbstractAbstract PDFPubReaderePub
Purpose
This study aimed to report the clinical outcomes following selective neck irradiation (SNI) with lower elective radiation therapy (RT) dose in treating nasopharyngeal cancer (NPC) patients.
Materials and Methods
A total of 347 NPC patients received definitive RT according to our SNI policy and were retrospectively analyzed. The clinical target volumes (CTVs) were subdivided into CTV at high risk (CTV-HR) and CTV at low risk (CTV-LR). The typical doses to gross tumor volume (GTV), CTV-HR, and CTV-LR were 68.4-70.0 Gy, 54.0-60.0 Gy, and 36.0 Gy.
Results
With the median follow-up of 68.1 months (range, 2.3 to 197.1 months), the 5-year rates of loco-regional control and progression-free survival in all the patients were 85.0% and 70.8%, respectively. Thirty patients developed regional failure and the regional control rates at 3 and 5 years were 92.6% and 91.4%, respectively. The sites of regional failure in relation to the target volume were exclusively inside GTV/CTV-HR in 20, inside and outside GTV/CTVHR in three, and exclusively outside GTV/CTV-HR in seven, which were 5.7%, 0.9%, and 2.0% of total patients, respectively.
Conclusion
The clinical outcomes by the current SNI policy were feasible and comparable to those following classic elective nodal irradiation policy.

Citations

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EGFR Mutation Is Associated with Short Progression-Free Survival in Patients with Stage III Non-squamous Cell Lung Cancer Treated with Concurrent Chemoradiotherapy
Song Ee Park, Jae Myoung Noh, You Jin Kim, Han Sang Lee, Jang Ho Cho, Sung Won Lim, Yong Chan Ahn, Hongryull Pyo, Yoon-La Choi, Joungho Han, Jong-Mu Sun, Se Hoon Lee, Jin Seok Ahn, Keunchil Park, Myung-Ju Ahn
Cancer Res Treat. 2019;51(2):493-501.   Published online June 18, 2018
DOI: https://doi.org/10.4143/crt.2018.125
AbstractAbstract PDFPubReaderePub
Purpose
This study was conducted to evaluate the relationship between epidermal growth factor receptor (EGFR) mutation and clinical outcomes in patients with stage III non-squamous cell lung cancer treated with definitive concurrent chemoradiotherapy (CCRT).
Materials and Methods
From January 2008 to December 2013, the medical records of 197 patients with stage III non- squamous non-small cell lung cancer treated with definitive CCRT were analyzed to determine progression-free survival (PFS) and overall survival (OS) according to EGFR mutation status.
Results
Among 197 eligible patients, 81 patients were EGFR wild type, 36 patients had an EGFR mutation (exon 19 Del, n=18; L858R, n=9, uncommon [G719X, L868, T790M], n=9), and 80 patients had unknown EGFR status. The median age was 59 years (range, 28 to 80 years) and 136 patients (69.0%) were male. The median follow-up duration was 66.5 months (range, 1.9 to 114.5 months). One hundred sixty-four patients (83.2%) experienced disease progression. Median PFS was 8.9 months for the EGFR mutation group, 11.8 months for EGFR wild type, and 10.5 months for the unknown EGFR group (p=0.013 and p=0.042, respectively). The most common site of metastasis in the EGFR mutant group was the brain. However, there was no significant difference in OS among the three groups (34.6 months for EGFR mutant group vs. 31.9 months for EGFR wild type vs. 22.6 months for EGFR unknown group; p=0.792 and p=0.284). A total of 29 patients (80.6%) with EGFR mutation were treated with EGFR tyrosine kinase inhibitor (gefitinib, n=24; erlotinib, n=3; afatinib, n=2) upon progression.
Conclusion
EGFR mutation is associatedwith short PFS and the brain is the most common site of distant metastasis in patients with stage III non- squamous cell lung cancer treated with CCRT.

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The Effect of Hospital Case Volume on Clinical Outcomes in Patients with Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Analysis (KROG-1106)
Boram Ha, Kwan Ho Cho, Sung Ho Moon, Chang-Geol Lee, Ki Chang Keum, Yeon-Sil Kim, Hong-Gyun Wu, Jin Ho Kim, Yong Chan Ahn, Dongryul Oh, Jae Myoung Noh, Jong Hoon Lee, Sung Hwan Kim, Won Taek Kim, Young-Taek Oh, Min Kyu Kang, Jin Hee Kim, Ji-Yoon Kim, Moon-June Cho, Chul Seoung Kay, Jin Hwa Choi
Cancer Res Treat. 2019;51(1):12-23.   Published online February 5, 2018
DOI: https://doi.org/10.4143/crt.2017.273
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC).
Materials and Methods
Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS).
Results
At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170).
Conclusion
A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.

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    Wenyan Yao, Jiang Hu, Peixun Xu, Mengxue He, Yongwen Fang, Mingzhi Liu, Zongtai Li, Huilang He, Hui Liu, Wenzhao Sun, Senkui Xu
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    Stephanie Flukes, Rahul K. Sharma, Shivangi Lohia, Marc A. Cohen
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Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules
Won Kyung Cho, Jae Myoung Noh, Yong Chan Ahn, Dongryul Oh, Hongryull Pyo
Cancer Res Treat. 2016;48(4):1187-1195.   Published online March 9, 2016
DOI: https://doi.org/10.4143/crt.2015.391
AbstractAbstract PDFPubReaderePub
Purpose
High dose definitive radiation therapy (RT) alone is recommended to patients with cT1-3N0 non-small cell lung cancer, who are unfit for surgery or stereotactic RT. This study was conducted to evaluate the clinical outcomes and cost-effectiveness following RT alone using two different modest hypofractionation dose schemes. Materials and Methods Between 2001 and 2014, 124 patients underwent RT alone. From 2001 till 2010, 60 Gy in 20 fractions was delivered to 79 patients (group 1). Since 2011, 60 Gy in 20 fractions (group 2, 20 patients), and 60 Gy in 15 fractions (group 3, 25 patients) were selectively chosen depending on estimated risk of esophagitis.
Results
At follow-up of 16.7 months, 2-year rates of local control, progression-free survival, and overall survival were 62.6%, 39.1%, and 59.1%, respectively. Overall survival was significantly better in group 3 (p=0.002). In multivariate analyses, cT3 was the most powerful adverse factor affecting clinical outcomes. Incidence and severity of radiation pneumonitis were not different among groups, while no patients developed grade 2 esophagitis in group 3 (p=0.003). Under current Korean Health Insurance Policy, RT cost per person was 22.5% less in group 3 compared with others. Conclusion The current study demonstrated that 60 Gy in 15 fractions instead of 60 Gy in 20 fractions resulted in comparable clinical outcomes with excellent safety, direct cost saving, and improved convenience to the patients with tumors located at ≥ 1.5 cm from the esophagus.

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The Role of Neoadjuvant Chemotherapy in the Treatment of Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Study (KROG 11-06) Using Propensity Score Matching Analysis
Jin Ho Song, Hong-Gyun Wu, Bhum Suk Keam, Jeong Hun Hah, Yong Chan Ahn, Dongryul Oh, Jae Myoung Noh, Hyo Jung Park, Chang Geol Lee, Ki Chang Keum, Jihye Cha, Kwan Ho Cho, Sung Ho Moon, Ji-Yoon Kim, Woong-Ki Chung, Young Taek Oh, Won Taek Kim, Moon-June Cho, Chul Seung Kay, Yeon-Sil Kim
Cancer Res Treat. 2016;48(3):917-927.   Published online December 28, 2015
DOI: https://doi.org/10.4143/crt.2015.265
AbstractAbstract PDFPubReaderePub
Purpose
We compared the treatment results and toxicity in nasopharyngeal carcinoma (NPC) patients treated with concurrent chemotherapy (CCRT) alone (the CRT arm) or neoadjuvant chemotherapy followed by CCRT (the NCT arm). Materials and Methods A multi-institutional retrospective study was conducted to review NPC patterns of care and treatment outcome. Data of 568 NPC patients treated by CCRT alone or by neoadjuvant chemotherapy followed by CCRT were collected from 15 institutions. Patients in both treatment arms were matched using the propensity score matching method, and the clinical outcomes were analyzed.
Results
After matching, 300 patients (150 patients in each group) were selected for analysis. Higher 5-year locoregional failure-free survival was observed in the CRT arm (85% vs. 72%, p=0.014). No significant differences in distant failure-free survival (DFFS), disease-free survival (DFS), and overall survival were observed between groups. In subgroup analysis, the NCT arm showed superior DFFS and DFS in stage IV patients younger than 60 years. No significant difference in compliance and toxicity was observed between groups, except the radiation therapy duration was slightly shorter in the CRT arm (50.0 days vs. 53.9 days, p=0.018). Conclusion This study did not show the superiority of NCT followed by CCRT over CCRT alone. Because NCT could increase the risk of locoregional recurrences, it can only be considered in selected young patients with advanced stage IV disease. The role of NCT remains to be defined and should not be viewed as the standard of care.

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Tumor Volume Reduction Rate during Adaptive Radiation Therapy as a Prognosticator for Nasopharyngeal Cancer
Hyebin Lee, Yong Chan Ahn, Dongryul Oh, Heerim Nam, Jae Myoung Noh, Su Yeon Park
Cancer Res Treat. 2016;48(2):537-545.   Published online July 14, 2015
DOI: https://doi.org/10.4143/crt.2015.081
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study is to evaluate the prognostic significance of the tumor volume reduction rate (TVRR) measured during adaptive definitive radiation therapy (RT) for nasopharyngeal cancer (NPC).
Materials and Methods
We reviewed the RT records of 159 NPC patients treated with definitive RT with or without concurrent chemotherapy between January 2006 and February 2013. Adaptive re-planning was performed in all patients at the third week of RT. The pre- and mid-RT gross tumor volumes (GTVs) of the primary tumor and the metastatic lymph nodes were measured and analyzed for prognostic implications.
Results
After a median follow-up period of 41.5 months (range, 11.2 to 91.8 months) for survivors, there were 43 treatment failures. The overall survival and progression-free survival (PFS) rates at 5 years were 89.6% and 69.7%, respectively. The mean pre-RT GTV, mid-RT GTV, and TVRR were 45.9 cm3 (range, 1.5 to 185.3 cm3), 26.7 cm3 (1.0 to 113.8 cm3), and –41.9% (range, –87% to 78%), respectively. Patients without recurrence had higher TVRR than those with recurrence (44.3% in the no recurrence group vs. 34.0% in the recurrence group, p=0.004), and those with TVRR > 35% achieved a significantly higher rate of PFS at 5 years (79.2% in TVRR > 35% vs. 53.2% in TVRR ≤ 35%; p < 0.001). In multivariate analysis, TVRR was a significant factor affecting PFS (hazard ratio, 2.877; 95% confidence interval, 1.555 to 5.326; p=0.001).
Conclusion
TVRR proved to be a significant prognostic factor in NPC patients treated with definitive RT, and could be used as a potential indicator for early therapeutic modification during the RT course.

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    Ting-ting Yu, Sai-kit Lam, Lok-hang To, Ka-yan Tse, Nong-yi Cheng, Yeuk-nam Fan, Cheuk-lai Lo, Ka-wa Or, Man-lok Chan, Ka-ching Hui, Fong-chi Chan, Wai-ming Hui, Lo-kin Ngai, Francis Kar-ho Lee, Kwok-hung Au, Celia Wai-yi Yip, Yong Zhang, Jing Cai
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Carotid-Sparing TomoHelical 3-Dimensional Conformal Radiotherapy for Early Glottic Cancer
Chae-Seon Hong, Dongryul Oh, Sang Gyu Ju, Yong Chan Ahn, Jae Myoung Noh, Kwangzoo Chung, Jin Sung Kim, Tae-Suk Suh
Cancer Res Treat. 2016;48(1):63-70.   Published online March 6, 2015
DOI: https://doi.org/10.4143/crt.2014.265
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to investigate the dosimetric benefits and treatment efficiency of carotid-sparing TomoHelical 3-dimensional conformal radiotherapy (TH-3DCRT) for early glottic cancer. Materials and Methods Ten early-stage (T1N0M0) glottic squamous cell carcinoma patients were simulated, based on computed tomography scans. Two-field 3DCRT (2F-3DCRT), 3-field intensity-modulated radiation therapy (3F-IMRT), TomoHelical-IMRT (TH-IMRT), and TH-3DCRT plans were generated with a 67.5-Gy total prescription dose to the planning target volume (PTV) for each patient. In order to evaluate the plan quality, dosimetric characteristics were compared in terms of conformity index (CI) and homogeneity index (HI) for PTV, dose to the carotid arteries, and maximum dose to the spinal cord. Treatment planning and delivery times were compared to evaluate treatment efficiency.
Results
The median CI was substantially better for the 3F-IMRT (0.65), TH-IMRT (0.64), and TH-3DCRT (0.63) plans, compared to the 2F-3DCRT plan (0.32). PTV HI was slightly better for TH-3DCRT and TH-IMRT (1.05) compared to 2F-3DCRT (1.06) and 3F-IMRT (1.09). TH-3DCRT, 3F-IMRT, and TH-IMRT showed an excellent carotid sparing capability compared to 2F-3DCRT (p < 0.05). For all plans, the maximum dose to the spinal cord was < 45 Gy. The median treatment planning times for 2F-3DCRT (5.85 minutes) and TH-3DCRT (7.10 minutes) were much lower than those for 3F-IMRT (45.48 minutes) and TH-IMRT (35.30 minutes). The delivery times for 2F-3DCRT (2.06 minutes) and 3F-IMRT (2.48 minutes) were slightly lower than those for TH-IMRT (2.90 minutes) and TH-3DCRT (2.86 minutes). Conclusion TH-3DCRT showed excellent carotid-sparing capability, while offering high efficiency and maintaining good PTV coverage.

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Definitive Bimodality Concurrent Chemoradiotherapy in Patients with Inoperable N2-positive Stage IIIA Non-small Cell Lung Cancer
Jae Myoung Noh, Yong Chan Ahn, Hyebin Lee, Hongryull Pyo, BoKyong Kim, Dongryul Oh, Hyojung Park, Eonju Lee, Keunchil Park, Jin Seok Ahn, Myung-Ju Ahn, Jong-Mu Sun
Cancer Res Treat. 2015;47(4):645-652.   Published online February 12, 2015
DOI: https://doi.org/10.4143/crt.2014.144
AbstractAbstract PDFPubReaderePub
Purpose
This study was conducted to evaluate the treatment outcomes following definitive bimodality concurrent chemoradiotherapy (CCRT) in patients with inoperable N2-positive stage IIIA (N2- IIIA) non-small cell lung cancer (NSCLC). Materials and Methods From May 1997 to December 2012, 65 out of 633 patients with N2-IIIA NSCLC received bimodality therapy. The treatment modality was selected during/after neoadjuvant CCRT in 21 patients or primarily at diagnosis in 44 through a multidisciplinary consensus meeting. The median age was 65 years (range, 36 to 76 years). Sixty patients (92.3%) had clinically evident N2 disease, while 22 (33.8%) had multi-station N2 involvement. The median radiation therapy dose was 66 Gy in 33 fractions, while the dose was elevated to 72 Gy in 13 patients who had a treatment break due to delayed decision regarding resectability. The most frequent chemotherapy regimen was weekly paclitaxel or docetaxel plus cisplatin or carboplatin (54, 83.1%).
Results
During the median follow-up of 18.8 months (range, 1.6 to 173.1 months), 34 patients (52.3%) experienced disease progression, with distant metastasis being the most common first treatment failure pattern (23, 34.8%). The median and 2-year rates of progression-free survival were 18.8 months and 45.9%, respectively. The median and 2-year rates of overall survival were 28.6 months and 50.1%, respectively. Conclusion Definitive bimodality therapy in patients with N2-IIIA NSCLC demonstrated favorable outcomes, while trimodality therapy could be considered for candidates for less than pneumonectomy.

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Effect of Radiation Therapy Techniques on Outcome in N3-positive IIIB Non-small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy
Jae Myoung Noh, Jin Man Kim, Yong Chan Ahn, Hongryull Pyo, BoKyong Kim, Dongryul Oh, Sang Gyu Ju, Jin Sung Kim, Jung Suk Shin, Chae-Seon Hong, Hyojung Park, Eonju Lee
Cancer Res Treat. 2016;48(1):106-114.   Published online February 12, 2015
DOI: https://doi.org/10.4143/crt.2014.131
AbstractAbstract PDFPubReaderePub
Purpose
This study was conducted to evaluate clinical outcomes following definitive concurrent chemoradiotherapy (CCRT) for patients with N3-positive stage IIIB (N3-IIIB) non-small cell lung cancer (NSCLC), with a focus on radiation therapy (RT) techniques. Materials and Methods From May 2010 to November 2012, 77 patients with N3-IIIB NSCLC received definitive CCRT (median, 66 Gy). RT techniques were selected individually based on estimated lung toxicity, with 3-dimensional conformal RT (3D-CRT) and intensity-modulated RT (IMRT) delivered to 48 (62.3%) and 29 (37.7%) patients, respectively. Weekly docetaxel/paclitaxel plus cisplatin (67, 87.0%) was the most common concurrent chemotherapy regimen.
Results
The median age and clinical target volume (CTV) were 60 years and 288.0 cm3, respectively. Patients receiving IMRT had greater disease extent in terms of supraclavicular lymph node (SCN) involvement and CTV ≥ 300 cm3. The median follow-up time was 21.7 months. Fortyfive patients (58.4%) experienced disease progression, most frequently distant metastasis (39, 50.6%). In-field locoregional control, progression-free survival (PFS), and overall survival (OS) rates at 2 years were 87.9%, 38.7%, and 75.2%, respectively. Although locoregional control was similar between RT techniques, patients receiving IMRT had worse PFS and OS, and SCN metastases from the lower lobe primary tumor and CTV ≥ 300 cm3were associated with worse OS. The incidence and severity of toxicities did not differ significantly between RT techniques. Conclusion IMRT could lead to similar locoregional control and toxicity, while encompassing a greater disease extent than 3D-CRT. The decision to apply IMRT should be made carefully after considering oncologic outcomes associated with greater disease extent and cost.

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Potential Role of Adjuvant Radiation Therapy in Cervical Thymic Neoplasm Involving Thyroid Gland or Neck
Jae Myoung Noh, Sang Yun Ha, Yong Chan Ahn, Dongryul Oh, Seung Won Seol, Young Lyun Oh, Joungho Han
Cancer Res Treat. 2015;47(3):436-440.   Published online November 17, 2014
DOI: https://doi.org/10.4143/crt.2013.184
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study is to assess the clinicopathologic features, treatment outcomes, and role of adjuvant radiation therapy (RT) in cervical thymic neoplasm involving the thyroid gland or neck. Materials and Methods The medical and pathologic records of eight patients with cervical thymic neoplasm were reviewed retrospectively. All patients underwent surgical resection, including thyroidectomy or mass excision. Adjuvant RT was added in five patients with adverse clinicopathologic features. The radiation doses ranged from 54 Gy/27 fractions to 66 Gy/30 fractions delivered to the primary tumor bed and pathologically involved regional lymphatics using a 3-dimensional conformal technique. Results Eight cases of cervical thymic neoplasm included three patients with carcinoma showing thymus-like differentiation (CASTLE) and five with ectopic cervical thymoma. The histologic subtypes of ectopic cervical thymoma patients were World Health Organization (WHO) type B3 thymoma in one, WHO type B1 thymoma in two, WHO type AB thymoma in one, and metaplastic thymoma in one, respectively. The median age was 57 years (range, 40 to 76 years). Five patients received adjuvant RT: three with CASTLE; one with WHO type B3; and one with WHO type AB with local invasiveness. After a median follow-up period of 49 months (range, 11 to 203 months), no recurrence had been observed, regardless of adjuvant RT. Conclusion Adjuvant RT after surgical resection might be worthwhile in patients with CASTLE and ectopic cervical thymoma with WHO type B2-C and/or extraparenchymal extension, as similarly indicated for primary thymic epithelial tumors. A longer follow-up period may be needed in order to validate this strategy.

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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
AbstractAbstract PDFPubReaderePub
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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