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17 "Ki Chang Keum"
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Original Articles
Outcomes of Stereotactic Body Radiation Therapy for Large Uveal Melanoma: A Retrospective Analysis of Asian Population
Jong Won Park, Seowoong Jun, Ki Chang Keum, Christopher Seungkyu Lee, Kyung Hwan Kim
Received June 20, 2024  Accepted December 28, 2024  Published online December 31, 2024  
DOI: https://doi.org/10.4143/crt.2024.580    [Accepted]
AbstractAbstract PDF
Purpose
To investigate the clinical outcomes of stereotactic body radiation therapy (SBRT) in patients with large uveal melanoma (UM).
Materials and Methods
We conducted a retrospective review of 64 consecutive patients with UM treated with Cyberknife at Yonsei Cancer Center from September 2015 to October 2021. The median radiation dose was 60 Gy (range 48-64 Gy) administered in four fractions every alternate day. The local failure-free rate (LFFR), distant metastasis-free rate (DMFR), progression-free survival (PFS), and overall survival (OS) were assessed using the Kaplan–Meier method and log-rank test. Cox regression analysis was performed to analyze the predictive factors affecting survival outcomes and the factors associated with vision loss.
Results
The median tumor diameter and height were 11.5 mm and 8.4 mm, respectively. After a median follow-up of 32.1 months (range 4.9–89.9), the 3-year LFFR, DMFR, PFS, and OS were 89.5%, 70.5%, 65.5%, and 89.4%, respectively. Enucleation was performed in 13 (20.3%) patients, with three cases attributed to disease progression. A larger tumor diameter was associated with significantly worse DMFR (HR=1.35, p=0.015) and OS (HR=1.49, p=0.026) in the multivariate analysis. Regarding visual prognosis, 41 (64.1%) patients had baseline visual acuity ≥20/200, but only 4 (6.3%) patients maintained visual acuity ≥20/200 by the final follow-up. Initial visual acuity ≥20/40 (HR 0.45, p=0.030) was the single favorable significant factor predicting visual retention ≥20/200 in multivariate analysis.
Conclusion
SBRT using CyberKnife demonstrated a comparable local control rate to that observed in historical studies for patients with large UM. Distant metastasis and treatment-related ocular toxicity remain the limitations of this treatment.
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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.

Citations

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  • Accumulated Dose Deviation of Rotational and Residual Setup Errors on Nasopharyngeal Carcinoma Using MIM Treated by Helical Tomotherapy
    Wenyan Yao, Jiang Hu, Peixun Xu, Mengxue He, Yongwen Fang, Mingzhi Liu, Zongtai Li, Huilang He, Hui Liu, Wenzhao Sun, Senkui Xu
    Technology in Cancer Research & Treatment.2023;[Epub]     CrossRef
  • Systematic Review and Meta-analysis of the Association Between Radiation Therapy Treatment Volume and Patient Outcomes
    Jerry Ye Aung Kyaw, Alice Rendall, Erin F. Gillespie, Tom Roques, Laurence Court, Yolande Lievens, Alison C. Tree, Chris Frampton, Ajay Aggarwal
    International Journal of Radiation Oncology*Biology*Physics.2023; 117(5): 1063.     CrossRef
  • The Influence of Hospital Volume on the Outcomes of Nasopharyngeal, Sinonasal, and Skull-Base Tumors: A Systematic Review of the Literature
    Stephanie Flukes, Rahul K. Sharma, Shivangi Lohia, Marc A. Cohen
    Journal of Neurological Surgery Part B: Skull Base.2022; 83(03): 270.     CrossRef
  • A Comprehensive Analysis of Treatment Management and Survival Outcomes in Nasopharyngeal Carcinoma
    Khodayar Goshtasbi, Brandon M. Lehrich, Jack L. Birkenbeuel, Arash Abiri, Jeremy P. Harris, Edward C. Kuan
    Otolaryngology–Head and Neck Surgery.2021; 165(1): 93.     CrossRef
  • Hospital volume and physician volume in association with survival in patients with nasopharyngeal cancer after radiation therapy
    Tzu-Yu Lai, Chiu-Mei Yeh, Yu-Wen Hu, Chia-Jen Liu
    Radiotherapy and Oncology.2020; 151: 190.     CrossRef
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Prognoses and Clinical Outcomes of Primary and Recurrent Uveal Melanoma
Jee Hung Kim, Su-Jin Shin, Soo Jin Heo, Eun-Ah Choe, Chang Gon Kim, Minkyu Jung, Ki Chang Keum, Jin Sook Yoon, Sung Chul Lee, Sang Joon Shin
Cancer Res Treat. 2018;50(4):1238-1251.   Published online December 28, 2017
DOI: https://doi.org/10.4143/crt.2017.534
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Uveal melanoma has a very poor prognosis despite successful local primary tumor treatment. In this study, we investigated prognostic factors that more accurately reflected the likelihood ofrecurrence and survival and delineated a prognostic model that could effectively identify different risk groups based on initial clinical parameters.
Materials and Methods
Prognostic factors associated with distant recurrence, recurrence-free survival (RFS), progression-free survival, and overall survival from distant recurrence to death (OS2) were analyzed in 226 patients with stage I-III uveal melanoma who underwent primary local therapy.
Results
Forty-nine patients (21.7%) had distant recurrences, which occurred most frequently in the liver (87.7%). In a multivariate analysis, local radiotherapy improved RFS among patients with multiple recurrence risk factors relative to excision (not reached vs. 19.0 months, p=0.004). Patients with BRCA1-associated protein-1 (BAP1)‒negative primary tumors showed a longer RFS duration after primary treatments, while those with BAP1-negative metastatic tissues had a shorter OS2 compared to those with BAP1-positive tumors, both not statistically insignificance (RFS: not reached vs. 82.0 months, p=0.258; OS2: 15.7 vs. 24.4 months, p=0.216). Male sex (hazard ratio [HR], 3.79; p=0.012), a short RFS (HR, 4.89; p=0.014), and a largest metastatic tumor linear diameter ≥ 45 mm (HR, 5.48; p=0.017) were found to correlate with worse post-recurrence survival.
Conclusion
Risk factors could be used to classify uveal melanoma cases and subsequently direct individual treatment strategies. Furthermore, metastasectomy appears to contribute to improved survival outcomes.

Citations

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  • Favorable Outcomes of Patients With High-Risk Uveal Melanoma Treated With a Novel Linear Accelerator-Based Frameless Fractionated Stereotactic Radiosurgery
    Louis Cappelli, Mehak M. Khan, Carol L. Shields, Sara E. Lally, Muhammad Sharif, Haisong Liu, Yingxuan Chen, Jade Park, Tingting Zhan, Wenyin Shi
    American Journal of Ophthalmology.2025; 271: 417.     CrossRef
  • Uveal Melanoma: Comprehensive Review of Its Pathophysiology, Diagnosis, Treatment, and Future Perspectives
    Merve Kulbay, Emily Marcotte, Raheem Remtulla, Tsz Hin Alexander Lau, Manuel Paez-Escamilla, Kevin Y. Wu, Miguel N. Burnier
    Biomedicines.2024; 12(8): 1758.     CrossRef
  • Impact of Metastatic Pattern on Survival in Patients with Posterior Uveal Melanoma: A Retrospective Cohort Study
    Tine G. Hindso, Peter S. Jensen, Mette B. Sjøl, Kristoffer Nissen, Camilla W. Bjerrum, Eric von Benzon, Carsten Faber, Steen F. Urbak, Marco Donia, Inge M. Svane, Eva Ellebaek, Steffen Heegaard, Karine Madsen, Jens F. Kiilgaard
    Cancers.2024; 16(19): 3346.     CrossRef
  • Identification of a prognostic six-immune-gene signature and a nomogram model for uveal melanoma
    Binghua Yang, Yuxia Fan, Renlong Liang, Yi Wu, Aiping Gu
    BMC Ophthalmology.2023;[Epub]     CrossRef
  • Prognostic Value of the Radiomics-Based Model in the Disease-Free Survival of Pretreatment Uveal Melanoma: An Initial Result
    Yaping Su, Xiaolin Xu, Fang Wang, Panli Zuo, Qinghua Chen, Wenbin Wei, Junfang Xian
    Journal of Computer Assisted Tomography.2023; 47(1): 151.     CrossRef
  • Uveal melanoma pathobiology: Metastasis to the liver
    Prisca Bustamante, Léo Piquet, Solange Landreville, Julia V. Burnier
    Seminars in Cancer Biology.2021; 71: 65.     CrossRef
  • Malignant uveal melanoma with metastatic recurrence to the pancreas: A case report
    Wei‐Chun Weng, Tzung‐Jiun Tsai, Wen‐Chi Chen, Jin‐Shiung Cheng, Wei‐Chih Sun
    Advances in Digestive Medicine.2021; 8(3): 178.     CrossRef
  • Role of somatic mutations and chromosomal aberrations in the prognosis of uveal melanoma in a Spanish patient cohort
    Paula Silva‐Rodríguez, Manuel Bande, Daniel Fernández‐Díaz, Nerea Lago‐Baameiro, María Pardo, María José Blanco‐Teijeiro, Fernando Domínguez, Lourdes Loidi, Antonio Piñeiro
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    Laura Ling Ying Tan, Jiancheng Hong, Wei Lin Goh, Esther Wei Yin Chang, Valerie Shiwen Yang, Eileen Poon, Nagavalli Somasundaram, Mohamad Farid, Anita Sook Yee Chan, Jason Yongsheng Chan
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    O. V. Khomyakova
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Survival and Functional Outcome after Treatment for Primary Base of Tongue Cancer: A Comparison of Definitive Chemoradiotherapy versus Surgery Followed by Adjuvant Radiotherapy
Sangjoon Park, Yeona Cho, Jeongshim Lee, Yoon Woo Koh, Se-Heon Kim, Eun Chang Choi, Hye Ryun Kim, Ki Chang Keum, Kyung Ran Park, Chang Geol Lee
Cancer Res Treat. 2018;50(4):1214-1225.   Published online December 26, 2017
DOI: https://doi.org/10.4143/crt.2017.498
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to compare the clinical and functional outcomes in patients with primary base of tongue (BOT) cancer who received definitive radiotherapy (RT) or surgery followed by radiotherapy (SRT).
Materials and Methods
Between January 2002 andDecember 2016, 102 patientswith stage I-IVB primary BOT cancer underwent either definitive RT (n=46) or SRT (n=56), and treatment outcomeswere compared between two groups. The expression of p16 was also analyzed.
Results
The RT group had more patients with advanced T stage (T3-4) disease (58.7% vs. 35.7%, p=0.021) and who received chemotherapy (91.3% vs. 37.5%, p < 0.001) than the SRT group. At a median followup of 36.9 months (range, 3.3 to 181.5 months), the 5-year overall survival (OS) and disease-free survival (DFS) were 75.5% and 68.7%, respectively. With respect to treatment group, the 5-year OS and DFS in the RT and SRT groups did not differ significantly (OS, 68.7% vs. 80.5%, p=0.601; DFS, 63.1% vs. 73.1%, p=0.653). In multivariate analysis, OS differed significantly according to p16 expression (p16-negative vs. p16- positive; hazard ratio [HR], 0.145; 95% confidence interval [CI], 0.025 to 0.853; p=0.033). Regarding DFS, p16 expression (p16-negative vs. p16-positive; HR, 0.164; 95% CI, 0.045 to 0.598; p=0.006) showed a significant effect in multivariate analysis. Functional defects (late grade ≥ 3 dysphagia or voice alteration) were more frequently reported in the SRT than in the RT group (16.1% vs. 2.2%, p=0.021).
Conclusion
Despite advanced disease, patients in the RT group showed comparable survival outcomes and better functional preservation than those in the SRT group.

Citations

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    Tae Hyung Kim, In-Ho Cha, Eun Chang Choi, Hye Ryun Kim, Hyung Jun Kim, Se-Heon Kim, Ki Chang Keum, Chang Geol Lee
    Frontiers in Oncology.2021;[Epub]     CrossRef
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Ruthenium-106 Brachytherapy with or without Additional Local Therapy Shows Favorable Outcome for Variable-Sized Choroidal Melanomas in Korean Patients
Yeona Cho, Jee Suk Chang, Jin Sook Yoon, Sung Chul Lee, Yong Bae Kim, Joo Ho Kim, Ki Chang Keum
Cancer Res Treat. 2018;50(1):138-147.   Published online March 24, 2017
DOI: https://doi.org/10.4143/crt.2016.391
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to report clinical outcomes of ruthenium-106 (106Ru) brachytherapy with or without additional local therapy for choroidal melanomas in Korean patients.
Materials and Methods
A total of 88 patients diagnosed with choroidal melanomas were treated with 106Ru brachytherapy between 2006 and 2012. Patients were divided into two groups according to their tumor height: a large group (≥ 6 mm, n=50) and a small group (< 6 mm, n=38). Most patients in the large group received combined therapy with local excision and/or transpupillary thermotherapy. In general, 85-95 Gy was administered to the apex of the tumor, while 100 Gy was administered to the point 2-6 mm from the outer surface of the sclera for patients undergoing combined therapy.
Results
The median follow-up duration was 30 months. The 3-year local control rate was significantly higher in the small group than in the large group (94% vs. 70%, p=0.047). The free from distant metastasis (FFDM) rate and the overall survival (OS) rate were also higher in patients in the small group (3-year FFDM, 97% vs. 76%; p=0.031 and 3-year OS, 97% vs. 72%; p=0.036). A total of 13 patients underwent enucleation. The eye-preservation rate was also higher in the small group (3-year eye-preservation rate, 94% vs. 70%; p=0.050), and tumor height was a significant prognostic factor for eye-preservation.
Conclusion
106Ru brachytherapy showed favorable outcomes in small choroidal melanomas in Korean patients. Although additional local treatment could improve eye-preservation rate for large tumors, other strategies should be considered for disease control.

Citations

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    Viktor T. Gill, Gustav Stålhammar
    Heliyon.2024; 10(1): e23447.     CrossRef
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    Fátima Virgínia Gama Justi, Gabriella Araújo Matos, Juan de Sá Roriz Caminha, Cássia Rodrigues Roque, Edinilton Muniz Carvalho, Márcio Wilker Soares Campelo, Ludmila Belayev, Luiz Gonzaga de França Lopes, Reinaldo Barreto Oriá
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  • 5 Web of Science
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Radiotherapy Versus Cordectomy in the Management of Early Glottic Cancer
Seung Yeun Chung, Kyung Hwan Kim, Ki Chang Keum, Yoon Woo Koh, Se-Heon Kim, Eun Chang Choi, Chang Geol Lee
Cancer Res Treat. 2018;50(1):156-163.   Published online March 17, 2017
DOI: https://doi.org/10.4143/crt.2016.503
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to compare the treatment outcomes of definitive radiotherapy (RT) with cordectomy in patients with early glottic cancer.
Materials and Methods
A total of 165 patientswhowere diagnosedwith T1/2 squamous cell carcinoma of the glottic larynx between January 2006 and December 2012 were retrospectively analyzed. A total of 112 patients received RT and 53 patients received cordectomy. Local control (LC), disease-free survival (DFS), overall survival (OS), and larynx preservation rates after RT and cordectomy were investigated.
Results
The median follow-up period was 77.7 months (range, 10.7 to 127.0 months). The 3- and 5-year LC rates were 91.9% and 89.9%, respectively, for the RT group, and 82.8% and 73.2%, respectively, for the cordectomy group (p=0.006). The 3- and 5-year DFS rates were 87.5% and 83.7%, respectively, for the RT group and 79.2% and 68.0%, respectively, for the cordectomy group (p=0.046). No significant differences were identified in the 5-year OS (92.8% vs. 90.6%, p=0.713) or larynx preservation rates (98.2% vs. 97.2%, p=0.831) between groups. The major failure pattern was local failure (n=26), followed by regional (n=3) and distant failure (n=2). Multivariate analysis of LC showed that T2 stage (p=0.012) and receiving cordectomy as initial treatment (p=0.001) were significantly associated with poorer LC.
Conclusion
RT resulted in higher rates of LC and DFS compared to cordectomy for early glottic cancer. Treatment with radiotherapy is feasible and should be encouraged for both T1 and T2 glottic cancer.

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Patterns of Care for Radiotherapy in the Neoadjuvant and Adjuvant Treatment of Gastric Cancer: A Twelve-Year Nationwide Cohort Study in Korea
Jee Suk Chang, Young Choi, Jaeyong Shin, Kyung Hwan Kim, Ki Chang Keum, Hyo Song Kim, Woong Sub Koom, Eun-Cheol Park
Cancer Res Treat. 2018;50(1):118-128.   Published online March 8, 2017
DOI: https://doi.org/10.4143/crt.2016.575
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Although Korea has the highest incidence of gastric cancer worldwide and D2-lymphadenectomies are routinely performed, radiotherapy (RT) practice patterns have not been well studied. Therefore, we examined RT usage trends for neoadjuvant/adjuvant patients and identified factors associated with RT. We also examined survival benefits and net medical cost advantages of adding RT.
Materials and Methods
Patients diagnosed with gastric cancer who underwent gastrectomy from 2002-2013 were identified using National Health Insurance Service-National Sample Cohort.
Results
Annually, 30.9 cases per 100,000 population in crude rate underwent gastrectomy in 230 hospitals and 49.8% received neoadjuvant/adjuvant therapy in 182 hospitals. For neoadjuvant/adjuvant patients, postoperative chemo-RT was administered in 4% of cases in 26 hospitals. No significant trends regarding treatment type were observed over time. Having undergone RT was inversely associated with being ≥ 60 years old and having a low income. Having undergone RT was positively related to having a Charlson comorbidity index ≥ 4, hospital location and hospital volume (≥ 2,000 beds). Significant portions of patients treated with RT in this nation (52%) were concentrated in one large-volume hospital. Use of RT linked to increased cost of primary treatment, yet not to reduced overall medical expense. RT did not influence both on overall and disease-specific survivals after adjusting for potential confounders (p > 0.05).
Conclusion
RT was uncommonly utilized as adjuvant or neoadjuvant treatment by physicians in Korea. Despite intrinsic drawback in this data, we did not find either survival benefit or net medical cost advantage by adding RT in adjuvant treatment.

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Comparison of the Clinical Outcomes of Patients with Squamous Cell Carcinoma of the Tonsil Receiving Postoperative Ipsilateral Versus Bilateral Neck Radiotherapy: A Propensity Score Matching Analysis (KROG 11-07)
Youngkyong Kim, Kwan Ho Cho, Sung Ho Moon, Chang Geol Lee, Ki Chang Keum, Sang-wook Lee, Yong Chan Ahn, Dongryul Oh, Yeon-Sil Kim, Yong Kyun Won, Hong-Gyun Wu, J. Hun Hah, Young-Taek Oh
Cancer Res Treat. 2017;49(4):1097-1105.   Published online February 9, 2017
DOI: https://doi.org/10.4143/crt.2016.425
AbstractAbstract PDFPubReaderePub
Purpose
The impact of postoperative ipsilateral neck radiotherapy (INRT) versus bilateral neck radiotherapy (BNRT) on the clinical outcomes of patients with tonsillar squamous cell carcinoma was analyzed retrospectively.
Materials and Methods
Between October 2001 and June 2012, 241 patients with T1-2 and N0-N2b tonsillar carcinoma from 16 institutes underwent postoperative INRT (n=84) or BNRT (n=157) following a tonsillectomy. Seventy patientswere identified from each group by propensity score matching and compared in terms of the overall survival (OS), disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS) rates calculated using the Kaplan-Meier method with a log-rank test.
Results
The median follow-up was 55 months (range, 3 to 133 months). The survival outcomes in the INRT and BNRT groupswere similar: 5-year OS (92.8% vs. 94.0%, p=0.985), DFS (80.5% vs. 94.2%. p=0.085), LRRFS (88.1% vs. 97.1%, p=0.083), and DMFS (92.7% vs. 97.0%, p=0.370). Subgroup analysis revealed no contralateral neck recurrence in 61 patients with T1-2N0-2a regardless of the treatment groups. For 79 patients with N2b, contralateral neck recurrence was more common in the INRT group than in the BNRT group (7.9% vs. 0.0%), but the difference was not significant (p=0.107). The overall grade ≥ 2 toxicities were lower in the INRT group: acute (45.7% vs. 74.3%, p=0.001) and late (4.3% vs. 31.4%, p < 0.001), respectively.
Conclusion
INRT is an attractive strategy for patients with T1-2N0-2a tonsillar carcinoma compared to BNRT. For patients with N2b, there was a small risk of contralateral neck recurrence when treated with INRT, but its impact on the OS was limited with successful salvage treatment.

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Tumor Stage-Related Role of Radiotherapy in Patients with an External Auditory Canal and Middle Ear Carcinoma
Jinhyun Choi, Se-Heon Kim, Yoon Woo Koh, Eun Chang Choi, Chang Geol Lee, Ki Chang Keum
Cancer Res Treat. 2017;49(1):178-184.   Published online July 4, 2016
DOI: https://doi.org/10.4143/crt.2016.165
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study was to evaluate the clinical outcomes of patients treated with radiotherapy (RT) for a carcinoma of the external auditory canal (EAC) and middle ear.
Materials and Methods
The records of 32 patients who received RT from 1990 to 2013 were reviewed retrospectively. The Pittsburgh classification was used to stage all the cancers (early stage, T1/T2 [n=12]; advanced stage, T3/T4 or N positive [n=20]). Twenty-one patients (65.6%) were treated with postoperative RT and 11 patients (34.4%) were treated with definitive RT. The median radiation doses for postoperative and definitive RT were 60 Gy and 64.8 Gy, respectively. Chemotherapy was administered to seven patients (21.9%).
Results
The 5-year overall survival and disease-free survival rates for all patients were 57% and 52%, respectively. The disease control rates for the patients with early stage versus advanced stage carcinomawere 55.6% (5/9) and 50% (6/12) in the postoperative RT group and 66.7% (2/3) and 37.5% (3/8) in the definitive RT group, respectively. Overall, 15 cases (14 patients, 46.7%) experienced treatment failure; these failures were classified as local in four cases, regional in one case, and distant in 10 cases. The median follow-up period after RT was 51 months (range, 7 to 286 months).
Conclusion
Patients with early stage carcinoma achieved better outcomes when definitive RT was used. Advanced stage carcinoma patients experienced better outcomes with postoperative RT. The high rate of distant failure after RT, with or without surgery, reflected the lack of a consensus regarding the best therapeutic approach for treating carcinoma of the EAC and middle ear.

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Erratum
ERRATUM: Role of Chemotherapy in Stage II Nasopharyngeal Carcinoma Treated with Curative Radiotherapy
Min Kyu Kang, Dongryul Oh, Kwan Ho Cho, Sung Ho Moon, Hong-Gyun Wu, Dae-Seog Heo, Yong Chan Ahn, Keunchil Park, Hyo Jung Park, Jun Su Park, Ki Chang Keum, Jihye Cha, Jun Won Kim, Yeon-Sil Kim, Jin Hyoung Kang, Young-Taek Oh, Ji-Yoon Kim, Sung Hwan Kim, Jin-Hee Kim, Chang Geol Lee
Cancer Res Treat. 2016;48(1):425-425.   Published online January 10, 2016
DOI: https://doi.org/10.4143/crt.2014.141.2
Corrects: Cancer Res Treat 2015;47(4):871
PDFPubReaderePub
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Original Articles
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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The Clinical Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography (PET) to Predict Oncologic Outcomes and PET-Based Radiotherapeutic Considerations in Locally Advanced Nasopharyngeal Carcinoma
Hong In Yoon, Kyung Hwan Kim, Jeongshim Lee, Yun Ho Roh, Mijin Yun, Byoung Chul Cho, Chang Geol Lee, Ki Chang Keum
Cancer Res Treat. 2016;48(3):928-941.   Published online December 11, 2015
DOI: https://doi.org/10.4143/crt.2015.275
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We investigated 18F-fluorodeoxyglucose positron emission tomography (PET)-derived parameters as prognostic indices for disease progression and survival in locally advanced nasopharyngeal carcinoma (NPC) and the effect of high-dose radiotherapy for a subpopulation with PET-based poor prognoses.
Materials and Methods
Ninety-seven stage III and Iva-b NPC patients who underwent definitive treatment and PET were reviewed. For each primary, nodal, and whole tumor, maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) were evaluated.
Results
Based on the C-index (0.666) and incremental area under the curve (0.669), the whole tumor TLGwas the most useful predictorfor progression-free survival (PFS); thewhole tumor TLG cut-off value showing the best predictive performance was 322.7. In multivariate analysis, whole tumor TLG was a significant prognostic factor for PFS (hazard ratio [HR], 0.3; 95% confidence interval [CI], 0.14 to 0.65; p=0.002) and OS (HR, 0.29; 95% CI, 0.11 to 0.79; p=0.02). Patients with low whole tumor TLG showed the higher 5-year PFS in the subgroup for only patients receiving intensity modulated radiotherapy (77.4% vs. 53.0%, p=0.01). In the subgroup of patients with high whole tumor TLG, patients receiving an EQD2 ≥ 70 Gy showed significantly greater complete remission rates (71.4% vs. 33.3%, p=0.03) and higher 5-year OS (74.7% vs. 19.6%, p=0.02).
Conclusion
Our findings demonstrated that whole tumor TLG could be an independent prognostic factor and high-dose radiotherapy could improve outcomes for NPC showing high whole tumor TLG.

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18F-FDG/PET May Help to Identify a Subgroup of Patients with T1-T2 Breast Cancer and 1-3 Positive Lymph Nodes Who Are at a High Risk of Recurrence after Mastectomy
Jee Suk Chang, Jeongshim Lee, Hyun Jung Kim, Kyung Hwan Kim, Mijin Yun, Seung Il Kim, Ki Chang Keum, Chang-Ok Suh, Yong Bae Kim
Cancer Res Treat. 2016;48(2):508-517.   Published online September 9, 2015
DOI: https://doi.org/10.4143/crt.2015.172
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study is to assess the utility of positron emission tomography (PET) for predicting recurrence among patients with T1-T2/N1 breast cancer who were treated with mastectomy. Materials and Methods Of 712 consecutive patients with T1-T2/N1 breast cancer treated during 2003-2012, 109 had undergone preoperative 18F-fluorodeoxyglucose/PET and were included. Metabolic (maximum standardized uptake value [SUVmax]), volumetric (metabolic tumor volume [MTV]), and combined (total lesion glycolysis [TLG]) indices were measured. The resulting values were analyzed and compared with clinical outcome.
Results
At the median follow-up of 46.7 months, the 3-year relapse-free survival (RFS) rate was 95.2%. SUVmax (area under curve, 0.824) was more useful than MTV or TLG as a means of identifying patients at high risk for any recurrence. In multivariate analysis, SUVmax remained an independent risk factor for RFS (p=0.006). Using the method of Contal and O’Quigley, a SUVmax threshold of 5.36 showed the best predictive performance. The PET-based highrisk group (≥ 5.36 in either breast or nodes) had more T1c-T2, high-grade, hormone-receptor negative, and invasive ductal carcinoma tumors than the low-risk group (< 5.36 in both breast and nodes). The prognosis was much worse when high SUVmax (≥ 5.36) was detected in nodes (p < 0.001). In the no-radiotherapy cohort, the PET-based high-risk group had increased risk of locoregional recurrence when compared to the low-risk group (p=0.037). Conclusion High SUVmax on preoperative PET showed association with elevated risk of locoregional recurrence and any recurrence. Pre-treatment PET may improve assessments of recurrence risk and clarify indications for post-mastectomy radiotherapy in this subset of patients.

Citations

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  • Prognostic Value of Neutrophil-to-Lymphocyte Ratio and Early Standardized Uptake Value Reduction in Patients With Breast Cancer Receiving Neoadjuvant Chemotherapy
    Soong June Bae, Sung Gwe Ahn, Jung Hwan Ji, Chih Hao Chu, Dooreh Kim, Janghee Lee, Soeun Park, Chihwan Cha, Joon Jeong
    Journal of Breast Cancer.2022; 25(6): 485.     CrossRef
  • Significance of Metabolic Tumor Volume at Baseline and Reduction of Mean Standardized Uptake Value in 18F-FDG-PET/CT Imaging for Predicting Pathological Complete Response in Breast Cancers Treated with Preoperative Chemotherapy
    Tomoko Higuchi, Yukie Fujimoto, Hiromi Ozawa, Ayako Bun, Reiko Fukui, Yoshimasa Miyagawa, Michiko Imamura, Kazuhiro Kitajima, Koichiro Yamakado, Yasuo Miyoshi
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    Ryusuke Murakami, Yoshimitsu Fukushima, Hitomi Tani, Kotomi Iwata, Shinichiro Kumita, Maki Nakai, Tomoko Kurita, Keiko Yanagihara, Hiroyuki Takei, Miyuki Matsubara
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Overexpression of SOX2 Is Associated with Better Overall Survival in Squamous Cell Lung Cancer Patients Treated with Adjuvant Radiotherapy
Hong In Yoon, Kyu Hyun Park, Eun-Jung Lee, Ki Chang Keum, Chang Geol Lee, Chul Hoon Kim, Yong Bae Kim
Cancer Res Treat. 2016;48(2):473-482.   Published online August 12, 2015
DOI: https://doi.org/10.4143/crt.2015.116
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study is to investigate the prognostic significance of SOX2 gene amplification and expression in patients with American Joint Committee on Cancer stage III lung squamous cell carcinoma (SCC) who underwent surgery followed by adjuvant radiotherapy.
Materials and Methods
Pathological specimens were obtained from 33 patients with stage III lung SCC treated with surgery followed by adjuvant radiotherapy between 1996 and 2008. SOX2 gene amplification and protein expression were analyzed using fluorescent in situ hybridization and immunohistochemistry, respectively. Patients were divided into two groups according to their SOX2 gene amplification and protein expression status. Kaplan-Meier estimates and a Cox proportional hazards model were used to identify the prognostic factors affecting patient survival.
Results
The median follow-up period for surviving patientswas 58 months (range, 5 to 102 months). SOX2 gene amplification was observed in 22 patients and protein overexpression in 26 patients. SOX2 overexpression showed significant association with SOX2 gene amplification (p=0.002). In multivariate analysis, SOX2 overexpression was a significant prognostic factor for overall survival (OS) (hazard ratios [HR], 0.1; 95% confidence interval [CI], 0.002 to 0.5; p=0.005) and disease-free survival (DFS) (HR, 0.15; 95% CI, 0.04 to 0.65; p=0.01). Age (HR, 0.33; 95% CI, 0.11 to 0.98; p=0.046) and total radiation dose (HR, 0.13; 95% CI, 0.02 to 0.7; p=0.02) were the independent prognostic factors for OS and DFS. Patients with SOX2 amplification did not show a longer OS (p=0.95) and DFS (p=0.48).
Conclusion
Our data suggested that SOX2 overexpression could be used as a positive prognostic factor in patients with stage III lung SCC receiving adjuvant radiotherapy.

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Definitive Chemoradiotherapy Versus Surgery Followed by Adjuvant Radiotherapy in Resectable Stage III/IV Hypopharyngeal Cancer
Jun Won Kim, Mi Sun Kim, Se-Heon Kim, Joo Hang Kim, Chang Geol Lee, Gwi Eon Kim, Ki Chang Keum
Cancer Res Treat. 2016;48(1):45-53.   Published online March 13, 2015
DOI: https://doi.org/10.4143/crt.2014.340
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study is to compare the treatment outcomes for locally advanced resectable hypopharyngeal cancer between organ-preserving chemoradiotherapy (CRT) and surgery followed by radiotherapy (SRT).
Materials and Methods
We reviewed 91 patients with stage III/IV hypopharyngeal squamous cell carcinoma treated with radiotherapy (RT). In the CRT group (n=34), 18 patients were treated with concurrent CRT and 16 patients with induction chemotherapy plus concurrent CRT. In the SRT group (n=57), six patients were treated with total laryngopharyngectomy, 34 patients with total laryngectomy (TL) and partial pharyngectomy (PP), and 17 patients with PP, which were followed by adjuvant radiotherapy (n=41) or CRT (n=16). The median RT dose was 70 Gy for CRT and 59.4 Gy for SRT.
Results
Five-year local control (84.1% vs. 90.9%), and disease-free survival (DFS, 51.0% vs. 52.7%) and overall survival (OS, 58.6% vs. 56.6%) showed no significant difference between the CRT and SRT groups. The functional larynx-preservation rate was higher in the CRT group (88.2% vs. 29.8%). Treatment-related toxicity, requiring surgical intervention, occurred more frequently in the SRT group (37% vs. 12%). In the SRT group, TL resulted in a significantly higher DFS than larynx-sparing surgery (63.9% vs. 26.5%, p=0.027). Treatment outcome of the SRT group improved when only patients with TL were considered (n=40); however, 5-year OS (67.1% vs. 58.6%, p=0.830) and DFS (63.9% vs. 51.0%, p=0.490) did not improve significantly when compared to the CRT group.
Conclusion
Organ preserving CRT provided a treatment outcome that is comparable to SRT for locally advanced hypopharyngeal cancer, while offering an opportunity for functional larynx-preservation and reduced treatment-related toxicity.

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Role of Chemotherapy in Stage II Nasopharyngeal Carcinoma Treated with Curative Radiotherapy
Min Kyu Kang, Dongryul Oh, Kwan Ho Cho, Sung Ho Moon, Hong-Gyun Wu, Dae-Seog Heo, Yong Chan Ahn, Keunchil Park, Hyo Jung Park, Jun Su Park, Ki Chang Keum, Jihye Cha, Jun Won Kim, Yeon-Sil Kim, Jin Hyoung Kang, Young-Taek Oh, Ji-Yoon Kim, Sung Hwan Kim, Jin-Hee Kim, Chang Geol Lee
Cancer Res Treat. 2015;47(4):871-878.   Published online February 13, 2015
DOI: https://doi.org/10.4143/crt.2014.141
Correction in: Cancer Res Treat 2016;48(1):425
AbstractAbstract PDFPubReaderePub
Purpose
To define the role of neoadjuvant and concurrent chemotherapy in stage II nasopharyngeal carcinoma, we compared the treatment outcomes of patients treated with curative radiotherapy with or without chemotherapy. Materials and Methods From 2004 to 2011, 138 patients with American Joint Committee on Cancer (AJCC) 2002 stage II nasopharyngeal carcinoma were treated with curative radiotherapy in 12 hospitals in South Korea. Treatment methods included radiotherapy alone in 34 patients, neoadjuvant chemotherapy followed by radiotherapy alone in seven, concurrent chemoradiotherapy in 80, and neoadjuvant chemotherapy followed by concurrent chemoradiotherapy in 17. Adjuvant chemotherapy was used in 42 patients. Total radiation dose ranged from 64 Gy to 74.2 Gy (median, 70 Gy).
Results
Median follow-up was 48 months (range, 7 to 97 months) for all patients. At the last followup, 13 patients had died and 32 had experienced treatment failure; locoregional failure occurred in 14, distant failure in 16, and both in two. Five-year locoregional relapse-free survival, distant metastasis-free survival, progression-free survival, and overall survival were 86.2%, 85.5%, 74.4%, and 88.2%, respectively. Multivariate analyses showed that the significant prognostic factors were concurrent chemotherapy and N stage for locoregional relapse-free survival, concurrent chemotherapy for progression-free survival, and age and N stage for overall survival. Neither neoadjuvant nor concurrent chemotherapy improved distant metastasis-free survival. Conclusion Concurrent chemotherapy significantly improved 5-year locoregional relapse-free survival and progression-free survival in stage II nasopharyngeal carcinoma. However, neoadjuvant chemotherapy failed to improve either.

Citations

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    Pei-Jing Li, Hao-Yuan Mo, Dong-Hua Luo, Wei-Han Hu, Ting Jin
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    Xin-Bin Pan, Shi-Ting Huang, Kai-Hua Chen, Xiao-Dong Zhu
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Concurrent Chemoradiotherapy of Locally Advanced Pancreatic Carcinoma and Effects of Hyperthemia
Myung Wook Kim, Kyung Hee Lee, Jae Bok Chung, Jin Sil Sung, Hye Ran Lee, Jin Hyuk Chil, Hyun Cheol Chung, Woo Cheol Kim, Ki Chang Keum, Joo Hang Kim, Jae Kyung Roh, Byung Soo Kim
J Korean Cancer Assoc. 1994;26(4):561-567.
AbstractAbstract PDF
The prognosis of pancreati cancer is still poor in spite of advance in surgical treatment and parasurgical adjuvant management. Eighteen patients with histologically confirmed locally advanced adenocarcinoma of the pancreas were received radiation(5000cGy)+5-FU. Patients were treated with 5-FU 200 mg/m IV bolus, 1 hour before irradiation each day. In some patients, within 30 minutes after radiotherapy, hyperthemia was added to above protocol two times weekly. Median survival of total patients was 9.5months. Median survival with RT+ 5-FU was 12.7months from the date of treatment. Median survival with hyperthemia added group was 7.6months, but the survival dif- ference was not significant statistically. The side effects were acceptable. There were no episodes of any life threatening toxicities.
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