Cancer Research and Treatment

Original Articles

Lung and Thoracic cancer

Sublobar Resection versus Stereotactic Body Radiation Therapy for Clinical Stage I Non–Small Cell Lung Cancer: A Study Using Data from the Korean Nationwide Lung Cancer Registry: Jeonghee Yun, Jong Ho Cho, Tae Hee Hong, Kyungmi Yang, Yong Chan Ahn, Hong Kwan Kim, Korean Association for Lung Cancer, Korea Central Cancer Registry; Cancer Res Treat. 2023;55(4):1171-1180. Published online April 17, 2023; DOI: https://doi.org/10.4143/crt.2022.1581

Abstract PDF Supplementary Material PubReader ePub: Purpose
Stereotactic body radiotherapy (SBRT) had been increasingly recognized as a favorable alternative to surgical resection in patients with high risk for surgery. This study compared survival outcomes between sublobar resection (SLR) and SBRT for clinical stage I non–small cell lung cancer (NSCLC).
Materials and Methods
Data were obtained from the Korean Association of Lung Cancer Registry, a sampled nationwide database. This study retrospectively reviewed 382 patients with clinical stage I NSCLC who underwent curative SLR or SBRT from 2014 to 2016.
Results
Of the patients, 43 and 339 underwent SBRT and SLR, respectively. Patients in the SBRT group were older and had worse pulmonary function. The 3-year overall survival (OS) rate was significantly better in the SLR group compared with the SBRT group (86.6% vs. 57%, log-rank p < 0.001). However, after adjusting for age, sex, tumor size, pulmonary function, histology, smoking history, and adjuvant therapy, treatment modality was not an independent prognostic factor for survival (hazard ratio, 0.99; 95% confidence interval, 0.43 to 2.77; p=0.974). We performed subgroup analysis in the following high-risk populations: patients who were older than 75 years; patients who were older than 70 years and had diffusing capacity of lung for carbon monoxide ≤ 80%. In each subgroup, there were no differences in OS and recurrence-free survival between patients who underwent SLR and those who received SBRT.
Conclusion
In our study, there were no significant differences in terms of survival or recurrence between SBRT and SLR in medically compromised stage I NSCLC patients. Our findings suggest that SBRT could be considered as a potential treatment option for selected patients.

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General

Recent Trends of Medical Expenses Associated with Radiation Therapy in Korea Based on HIRA Big Data: Jeong Eun Lee, Kyungmi Yang, Yong Chan Ahn, Won Park, Seung Jae Huh; Cancer Res Treat. 2023;55(3):758-765. Published online January 30, 2023; DOI: https://doi.org/10.4143/crt.2022.389

Abstract PDF Supplementary Material PubReader ePub

Purpose
We aimed to determine the trends in the use of radiotherapy (RT) and the expenses associated with it in South Korea.
Materials and Methods
The statistical data of the claims and reimbursement records provided on the Health and Insurance Review and Assessment Service website were utilized. This included information such as the number of patients, fractions, medical expenses according to treatment codes, in/outpatient, sex, age, and regions of hospitals. We analyzed data from 2016 to 2020.
Results
With a growing RT infrastructure and an increase in the number of radiation oncologists, the expenses for RT were 605.5 million USD in 2020, which had increased 1.5 times from 394.7 million USD in 2016. This growth was mainly because of the increased usage of advanced RT techniques. Furthermore, the proportion of intensity-modulated radiation therapy (IMRT) expenses in the total expenses increased by 1.6 times from 48.8% in 2016 to 76.9% in 2020. Advanced techniques were used more commonly in older individuals or children. However, the proportion of IMRT expenses increased mostly in young women. Additionally, geographical differences in RT use and expense were observed, although the gap in the IMRT fractions decreased among the regions.
Conclusion
Recent medical expenses associated with RT in Korea have increased in tandem with technological advances and changes in demographics.

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Large institutional experience of early outcomes and dosimetric findings with postoperative stereotactic partial breast irradiation in breast cancer
Jee Suk Chang, Jeongshim Lee, Frank A. Vicini, Jin Sung Kim, Jihun Kim, Seo Hee Choi, Ik Jae Lee, Yong Bae Kim
Radiotherapy and Oncology.2024; 191: 110066. CrossRef

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Special Article

Physical and Biological Characteristics of Particle Therapy for Oncologists: Hwa Kyung Byun, Min Cheol Han, Kyungmi Yang, Jin Sung Kim, Gyu Sang Yoo, Woong Sub Koom, Yong Bae Kim; Cancer Res Treat. 2021;53(3):611-620. Published online June 16, 2021; DOI: https://doi.org/10.4143/crt.2021.066

Abstract PDF PubReader ePub

Particle therapy is a promising and evolving modality of radiotherapy that can be used to treat tumors that are radioresistant to conventional photon beam radiotherapy. It has unique biological and physical advantages compared with conventional radiotherapy. The characteristic feature of particle therapy is the “Bragg peak,” a steep and localized peak of dose, that enables precise delivery of the radiation dose to the tumor while effectively sparing normal organs. Especially, the charged particles (e.g., proton, helium, carbon) cause a high rate of energy loss along the track, thereby leading to high biological effectiveness, which makes particle therapy attractive. Using this property, the particle beam induces more severe DNA double-strand breaks than the photon beam, which is less influenced by the oxygen level. This review describes the general biological and physical aspects of particle therapy for oncologists, including non-radiation oncologists and beginners in the field.

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David I. Thwaites, Dale A. Prokopovich, Richard F. Garrett, Annette Haworth, Anatoly Rosenfeld, Verity Ahern
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Guangsheng Li, Ningyi Ma, Weiwei Wang, Jian Chen, Jingfang Mao, Guoliang Jiang, Kailiang Wu
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Clinical indications and future directions of carbon-ion radiotherapy: a narrative review
Seo Hee Choi, Woong Sub Koom, Hong In Yoon, Kyung Hwan Kim, Chan Woo Wee, Jaeho Cho, Yong Bae Kim, Ki Chang Keum, Ik Jae Lee
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Mohamed El-Tanani, Syed Arman Rabbani, Areeg Anwer Ali, Ibrahim Ghaleb Ali Alfaouri, Hamdi Al Nsairat, Israa Hamid Al-Ani, Alaa A. Aljabali, Manfredi Rizzo, Dimitrios Patoulias, Mohammad Ahmed Khan, Suhel Parvez, Yahia El-Tanani
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Birgit Flechl, Lisa Konrath, Carola Lütgendorf-Caucig, Milana Achtaewa, Eugen B. Hug, Petra Georg
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Particle radiotherapy for breast cancer
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Barbara Vischioni, Rossana Ingargiola, Maria Bonora, Sara Ronchi, Anna Maria Camarda, Stefania Russo, Eleonora Rossi, Giuseppe Magro, Alfredo Mirandola, Ester Orlandi
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Original Articles

General

Patterns of Proton Beam Therapy Use in Clinical Practice between 2007 and 2019 in Korea: Sung Uk Lee, Kyungmi Yang, Sung Ho Moon, Yang-Gun Suh, Gyu Sang Yoo; Cancer Res Treat. 2021;53(4):935-943. Published online May 17, 2021; DOI: https://doi.org/10.4143/crt.2021.409

Abstract PDF Supplementary Material PubReader ePub

Purpose
Proton beam therapy (PBT) is a state-of-the-art technology employed in radiotherapy (RT) for cancer patients. This study characterized how PBT has been used in clinical practice in Korea.
Materials and Methods
Patients who received any type of RT between 2007 and 2019 were identified from the radiation oncology registry of the two PBT facilities operating in Korea (National Cancer Center and Samsung Medical Center). The chi-square test was used to identify patient- and treatment-related characteristics associated with the receipt of PBT.
Results
A total of 54,035 patients had been treated with some form of RT in the two institutions, of whom 5,398 received PBT (10.0%). The number of patients who receive PBT has gradually increased since PBT first started, from 162 patients in 2007 to 1,304 patients in 2019. Among all types of cancer, PBT use in liver cancer has been steadily increasing from 20% in 2008-2009 to 32% in 2018-2019. In contrast, that in prostate cancer has been continuously decreasing from 20% in 2008-2009 to < 10% in 2018-2019. Male sex, very young or old age, stage I-II disease, residency in non-capital areas, a definitive setting, a curative treatment aim, enrollment in a clinical trial, re-irradiation and insurance coverage were significantly associated with the receipt of PBT (all p < 0.05).
Conclusion
Since PBT started in Korea, the number of patients receiving PBT has increased to more than 1,000 per year and treatment indications have expanded. Liver cancer is the most common primary tumor among all PBT cases in Korea.

Citations

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“Particle therapy - future for the Baltic states?” – synthesis of the expert workshop report
Kristaps Paļskis, Erika Korobeinikova, Dace Bogorada-Saukuma, Anna Maria Camarda, Rebecca Taylor, Elena Benedetto, Edgars Mamis, Maija Radziņa, Andrejs Ērglis, Diana Adliene, Manjit Dosanjh, Maurizio Vretenar, Toms Torims
Health and Technology.2024; 14(5): 965. CrossRef
Proton Therapy in The Treatment of Head And Neck Cancers- Review
Kamila Bała, Yana Samovich, Karolina Dorobisz
Current Oncology Reports.2024; 26(11): 1380. CrossRef
PTCOG international survey of practice patterns and trends in utilization of proton therapy for breast cancer
J. Isabelle Choi, Camille Hardy-Abeloos, Alicia Lozano, Alexandra Hanlon, Carlos Vargas, John H. Maduro, Julie Bradley, Birgitte Offersen, Bruce Haffty, Mark Pankuch, Richard Amos, Nalee Kim, Shannon M. MacDonald, Youlia Kirova, Robert W. Mutter
Clinical and Translational Radiation Oncology.2024; 48: 100847. CrossRef
Recent trends in radiotherapy use for major cancers in Korea
Kyungmi Yang, Jeong Eun Lee, Won Park, Yong Chan Ahn, Seung Jae Huh
Japanese Journal of Clinical Oncology.2023; 53(12): 1177. 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

Abstract PDF PubReader ePub

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

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Case Report: Unresectable recurrent nasopharyngeal cancer treated with immuno oncology
Fabiano Flauto, Rosa Maria Di Crescenzo, Vincenzo Damiano
Frontiers in Oncology.2025;[Epub] CrossRef
Radiation oncology for the rhinologist
Helena Levyn, Fan Yang, Nancy Y. Lee
Current Opinion in Otolaryngology & Head & Neck Surgery.2024; 32(1): 5. CrossRef
Identifying the prognostic value of MRI-based tumor response and predicting the risk of radio-resistance in re-radiotherapy for locally recurrent nasopharyngeal carcinoma
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
Low-dose radiotherapy effects the progression of anti-tumor response
Lei Gao, Anqi Zhang
Translational Oncology.2023; 35: 101710. CrossRef
The Role of Hypofractionation in Proton Therapy
Alexandre Santos, Scott Penfold, Peter Gorayski, Hien Le
Cancers.2022; 14(9): 2271. CrossRef
Toxicity Profiles and Survival Outcomes Among Patients With Nonmetastatic Nasopharyngeal Carcinoma Treated With Intensity-Modulated Proton Therapy vs Intensity-Modulated Radiation Therapy
Xingzhe Li, Sarin Kitpanit, Anna Lee, Dennis Mah, Kevin Sine, Eric J. Sherman, Lara A. Dunn, Loren S. Michel, James Fetten, Kaveh Zakeri, Yao Yu, Linda Chen, Jung Julie Kang, Daphna Y. Gelblum, Sean M. McBride, Chiaojung J. Tsai, Nadeem Riaz, Nancy Y. Lee
JAMA Network Open.2021; 4(6): e2113205. CrossRef

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Radiation Therapy Outcome and Clinical Features of Duodenal-Type Follicular Lymphoma: Hansang Lee, Dongryul Oh, Kyungmi Yang, Young Hyeh Ko, Yong Chan Ahn, Won Seog Kim, Seok Jin Kim; Cancer Res Treat. 2019;51(2):547-555. Published online July 10, 2018; DOI: https://doi.org/10.4143/crt.2018.190

Abstract PDF Supplementary Material PubReader ePub

Purpose
Duodenal-type follicular lymphoma (FL) is a rare variant of FL. There is still no consensus on the initial treatment, and clinical features including endoscopic findings are not familiar to most physicians. The objective of this study was to evaluate the outcome of patients who were initially treated with radiation therapy for duodenal-type FL.
Materials and Methods
We retrospectively analyzed 20 patients who were consecutively diagnosed with duodenaltype FL between 2008 and 2017. All patients received radiation therapywith curative intent.
Results
The median age of the patients was 52 years (range, 26 to 66 years), and females were predominant. Most patients (n=18, 90%) had stage I disease, and were diagnosed by a regular health examination in an asymptomatic state. The histological grade was one in 19 patients (95%), and the endoscopic findings were diffuse nodular (n=8), whitish granular (n=8), and mixed pattern (n=4). Radiation therapy was delivered to 17 patients with 24 Gy in 12 fractions, and to three patients with 30.6-36 Gy in 18 fractions. All patients were evaluated with endoscopy for response to radiation therapy, and complete response was achieved in 19 patients (95%). At the time of analysis, all patients survived without any evidence of late toxicities related with radiation therapy.
Conclusion
Taken together, radiation therapy alone could be effective in controlling duodenal lesion. A further study with longer follow-up duration is warranted to confirm our findings.

Citations

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Ahmed Alnughmush, Riad El Fakih, Ruah Alyamany, Nasir Bakshi, Saud Alhayli, Mahmoud Aljurf
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Duodenal Polyposis: An Incidental Finding of Duodenal-Type Follicular Lymphoma
Rachael Hagen, Jasmine Tidwell, Emily Weng, Steven A Goldenberg, Anjiya Shaikh
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Increased Risk of Diabetes after Definitive Radiotherapy in Patients with Indolent Gastroduodenal Lymphoma
Jong Yun Baek, Do Hoon Lim, Dongryul Oh, Heerim Nam, Jae J Kim, Jun Haeng Lee, Byung-Hoon Min, Hyuk Lee
Cancer Research and Treatment.2022; 54(1): 294. CrossRef
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M. Varanese, A. Lauro, I. Lattina, D. Tripodi, T. Daralioti, S. Khouzam, I. R. Marino, V. Stigliano, V. D’Andrea, S. Frattaroli, S. Sorrenti
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Incidentally Found Mucosal Nodularity on the Second Portion of Duodenum
Joo Hyun Lim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(2): 163. CrossRef
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Makoto Saito, Akio Mori, Shihori Tsukamoto, Takashi Ishio, Emi Yokoyama, Koh Izumiyama, Masanobu Morioka, Takeshi Kondo, Hirokazu Sugino
World Journal of Gastrointestinal Oncology.2022; 14(8): 1552. CrossRef
Linfoma folicular duodenal primario: reporte de caso y revisión de la literatura
Lázaro Antonio Arango Molano, Andrés Sánchez Gil, Ileana Rocío Bautista Parada
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What do we know about duodenal‐type follicular lymphoma? From pathological definition to treatment options
Guilherme Duffles Amarante, Graham Collins, Vanderson Rocha
British Journal of Haematology.2020; 188(6): 831. CrossRef
Scientific Advances and the Evolution of Diagnosis, Subclassification and Treatment of Lymphoma
Judith A. Ferry
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Development of diffuse large B-cell lymphoma from duodenal type follicular lymphoma: a retrospective study of 23 cases
Masuho Saburi, Yoshiyuki Kondo, Masao Ogata, Yasuhiro Soga, Miyuki Abe, Kuniko Takano, Kazuhiro Kohno, Takayuki Nagai, Toshiyuki Nakayama
International Journal of Hematology.2020; 112(5): 658. CrossRef
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Kyu Hye Choi, Han Hee Lee, Seung-Eun Jung, Kyung-Sin Park, Joo-Hyun O, Young-Woo Jeon, Byung-Ock Choi, Seok-Goo Cho
Radiation Oncology.2020;[Epub] CrossRef

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