Cancer Research and Treatment

Original Articles

Lung and Thoracic cancer

Upfront Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy in Elderly Patients with Brain Metastases from Non–Small Cell Lung Cancer: A Retrospective Analysis of a 10-Year Bi-institutional Experience: Myungsoo Kim, Jihye Cha, Hun Jung Kim, Woo Chul Kim, Jeongshim Lee; Cancer Res Treat. 2025;57(1):47-56. Published online July 3, 2024; DOI: https://doi.org/10.4143/crt.2024.223

Abstract PDF PubReader ePub: Purpose
Stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) are increasingly used as initial therapies for brain metastases (BM). We aimed to assess the outcomes of SRS/FSRT in patients aged ≥ 65 years who had 1-10 BM from non–small cell lung cancer (NSCLC).
Materials and Methods
We retrospectively reviewed 91 elderly NSCLC patients with 222 BM who were treated with SRS/FSRT at two institutions between 2010 and 2020. The primary endpoint was overall survival (OS) after SRS/FSRT. In addition, in-field local control (IFLC) within the treated field was evaluated. Statistical analysis was performed to identify the prognostic factors affecting OS and IFLC.
Results
During a median follow-up of 18 months, the median OS was 32 months. The 1- and 2-year survival rates were 69.8% and 56.1%, respectively. In multivariate analysis, the NSCLC-specific graded prognostic assessment (GPA) score (p=0.007) and administration of systemic therapy (p=0.039) were defined as prognosticators affecting OS. The median IFLC period was 31 months, and the 1- and 2-year IFLC rates were 75.9% and 57.6%, respectively. The total BM volume (p=0.042) significantly affected IFLC. No severe adverse events were reported after SRS/FSRT.
Conclusion
SRS/FSRT is an effective upfront treatment option for BM arising from NSCLC in elderly patients, with a good OS without severe side effects. Higher GPA score and active systemic treatment were associated with improved OS, indicating that elderly patients are significant candidates for SRS/FSRT.

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Breast cancer

Effect of Postoperative Radiotherapy after Primary Tumor Resection in De Novo Stage IV Breast Cancer: A Multicenter Retrospective Study (KROG 19-02): Yeon Joo Kim, Yeon-Joo Kim, Yong Bae Kim, Ik Jae Lee, Jeanny Kwon, Kyubo Kim, Jihye Cha, Myungsoo Kim, In Young Jo, Jung Hoon Kim, Jaehyeon Park, Jin Hee Kim, Juree Kim, Kyung Hwan Shin, Su Ssan Kim; Cancer Res Treat. 2022;54(2):478-487. Published online July 12, 2021; DOI: https://doi.org/10.4143/crt.2021.632

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Purpose
This study aimed to investigate the impact of postoperative radiotherapy (PORT) in de novo metastatic breast cancer (dnMBC) patients undergoing planned primary tumor resection (PTR) and to identify the subgroup of patients who would most benefit from PORT.
Materials and Methods
This study enrolled 426 patients with dnMBC administered PTR alone or with PORT. The primary and secondary outcomes were overall and progression-free survival (OS and PFS), respectively.
Results
The median follow-up time was 53.7 months (range, 3.1 to 194.4). The 5-year OS and PFS rates were 73.2% and 32.0%, respectively. For OS, clinical T3/4 category, triple-negative breast cancer (TNBC), postoperative chemotherapy alone were significantly poor prognostic factors, and administration of PORT failed to show its significance. Regarding PFS, PORT was a favorable prognostic factor (hazard ratio, 0.64; 95% confidence interval, 0.50 to 0.82; p < 0.001), in addition to T1/2 category, ≤ 5 metastases, and non-TNBC. According to the multivariate analyses of OS in the PORT group, we divided the patients into three groups (group 1, T1/2 and non-TNBC [n=193]; group 2, T3/4 and non-TNBC [n=171]; and group 3, TNBC [n=49]), and evaluated the effect of PORT. Although PORT had no significance for OS in all subgroups, it was a significant factor for good prognosis regarding PFS in groups 1 and 2, not in group 3.
Conclusion
PORT was associated with a significantly better PFS in patients with dnMBC who underwent PTR. Patients with clinical T1/2 category and non-TNBC benefited most from PORT, while those with TNBC showed little benefit.

Citations

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Letter to the editor for the article“Tumor margin irregularity degree is an important preoperative predictor of adverse pathology for clinical T1/2 renal cell carcinoma and the construction of predictive model”
Yaping Miao, Lexin Wang, Ping Chen, Jiaan Lu, Guanhu Yang, Hao Chi
World Journal of Urology.2024;[Epub] CrossRef
The prognostic differences and the effect of postmastectomy radiotherapy between post‐chemotherapy ypT1‐2ypN1 and de novo pT1‐2N1 breast cancer
Tian Yang, Xiaorong Zhong, Jun Wang, Zhongzheng Xiang, Yuanyuan Zeng, Siting Yu, Zelei Dai, Ningyue Xu, Ting Luo, Lei Liu
Cancer Medicine.2023; 12(7): 8112. CrossRef
Impact of high dose radiotherapy for breast tumor in locoregionally uncontrolled stage IV breast cancer: a need for a risk-stratified approach
Nalee Kim, Haeyoung Kim, Won Park, Won Kyung Cho, Tae Gyu Kim, Young-Hyuck Im, Jin Seok Ahn, Yeon Hee Park, Ji-Yeon Kim
Radiation Oncology.2023;[Epub] CrossRef
Machine learning predicts the prognosis of breast cancer patients with initial bone metastases
Chaofan Li, Mengjie Liu, Jia Li, Weiwei Wang, Cong Feng, Yifan Cai, Fei Wu, Xixi Zhao, Chong Du, Yinbin Zhang, Yusheng Wang, Shuqun Zhang, Jingkun Qu
Frontiers in Public Health.2022;[Epub] CrossRef
Factors Influencing Prognosis in Patients with De Novo Stage IV Breast Cancer: A Systematic Review and Meta-Analysis
Meilin Zhang, Zining Jin, Yingying Xu, Bo Chen, Jian Song, Muyao Li, Feng Jin, Ang Zheng
SSRN Electronic Journal .2022;[Epub] CrossRef

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Head/neck cancer

Intensity-Modulated Radiotherapy-Based Reirradiation for Head and Neck Cancer: A Multi-institutional Study by Korean Radiation Oncology Group (KROG 1707): Jeongshim Lee, Tae Hyung Kim, Yeon-Sil Kim, Myungsoo Kim, Jae Won Park, Sung Hyun Kim, Hyun Ju Kim, Chang Geol Lee; Cancer Res Treat. 2020;52(4):1031-1040. Published online July 7, 2020; DOI: https://doi.org/10.4143/crt.2020.310

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Purpose
The benefits of reirradiation for head and neck cancer (HNC) have not been determined. This study evaluated the efficacy of reirradiation using intensity-modulated radiotherapy (IMRT) for recurrent or second primary HNC (RSPHNC) and identified subgroups for whom reirradiation for RSPHNC is beneficial.
Materials and Methods
A total of 118 patients from seven Korean institutions with RSPHNC who underwent IMRT-based reirradiation between 2006 and 2015 were evaluated through retrospective review of medical records. We assessed overall survival (OS) and local control (LC) within the radiotherapy (RT) field following IMRT-based reirradiation. Additionally, the OS curve according to the recursive partitioning analysis (RPA) suggested by the Multi-Institution Reirradiation (MIRI) Collaborative was determined.
Results
At a median follow-up period of 18.5 months, OS at 2 years was 43.1%. In multivariate analysis, primary subsite, recurrent tumor size, interval between RT courses, and salvage surgery were associated with OS. With regard to the MIRI RPA model, the class I subgroup had a significantly higher OS than class II or III subgroups. LC at 2 years was 53.5%. Multivariate analyses revealed that both intervals between RT courses and salvage surgery were prognostic factors affecting LC. Grade 3 or more toxicity and grade 5 toxicity rates were 8.5% and 0.8%, respectively.
Conclusion
IMRT-based reirradiation was an effective therapeutic option for patients with RSPHNC, especially those with resectable tumors and a long interval between RT courses. Further, our patients' population validated the MIRI RPA classification by showing the difference of OS according to MIRI RPA class.

Citations

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Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database
Chiara Scolari, André Buchali, Achim Franzen, Robert Förster, Paul Windisch, Stephan Bodis, Daniel R. Zwahlen, Christina Schröder
Frontiers in Oncology.2023;[Epub] CrossRef
Double trouble: A cohort study of re-irradiation and laryngectomy – Severity of and risk for pharyngocutaneous fistula
Jeffrey M. Weinberger, Narmeen abd el Qadir, Nir Hirshoren
Oral Oncology.2022; 134: 106069. CrossRef
Current radiotherapy for recurrent head and neck cancer in the modern era: a state-of-the-art review
Yue Li, Yuliang Jiang, Bin Qiu, Haitao Sun, Junjie Wang
Journal of Translational Medicine.2022;[Epub] CrossRef
Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck: A Big and Intriguing Challenge Which May Be Resolved by Integrated Treatments Combining Locoregional and Systemic Therapies
Franco Ionna, Paolo Bossi, Agostino Guida, Andrea Alberti, Paolo Muto, Giovanni Salzano, Alessandro Ottaiano, Fabio Maglitto, Davide Leopardo, Marco De Felice, Francesco Longo, Salvatore Tafuto, Giuseppina Della Vittoria Scarpati, Francesco Perri
Cancers.2021; 13(10): 2371. CrossRef
Re-irradiation for recurrent or second primary head and neck cancer
Hye In Lee, Jin Ho Kim, Soon-Hyun Ahn, Eun-Jae Chung, Bhumsuk Keam, Keun-Yong Eom, Woo-Jin Jeong, Ji-Won Kim, Chan Woo Wee, Hong-Gyun Wu
Radiation Oncology Journal.2021; 39(4): 279. CrossRef

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Identification of Prognostic Risk Factors for Transient and Persistent Lymphedema after Multimodal Treatment for Breast Cancer: Myungsoo Kim, Kyung Hwan Shin, So-Youn Jung, Seeyoun Lee, Han-Sung Kang, Eun Sook Lee, Seung Hyun Chung, Yeon-Joo Kim, Tae Hyun Kim, Kwan Ho Cho; Cancer Res Treat. 2016;48(4):1330-1337. Published online February 3, 2016; DOI: https://doi.org/10.4143/crt.2015.463

Abstract PDF PubReader ePub

Purpose
The purpose of this study is to identify risk factors for transient lymphedema (TLE) and persistent lymphedema (PLE) following treatment for breast cancer. Materials and Methods A total of 1,073 patients who underwent curative breast surgery were analyzed. TLE was defined as one episode of arm swelling that had resolved spontaneously by the next followup; arm swelling that persisted over two consecutive examinations was considered PLE.
Results
At a median follow-up period of 5.1 years, 370 cases of lymphedema were reported, including 120 TLE (11.2%) and 250 PLE (23.3%). Initial grade 1 swelling was observed in 351 patients, of which 120 were limited to TLE (34%), while the other 231 progressed to PLE (66%). All initial swelling observed in TLE patients was classified as grade 1. In multivariate analysis, chemotherapy with taxane and supraclavicular radiation therapy (SCRT) were associated with development of TLE, whereas SCRT, stage III cancer and chemotherapy with taxane were identified as risk factors for PLE (p < 0.05). The estimated incidence of TLE among initial grade 1 patients was calculated using up to three treatment-related risk factors (number of dissected axillary lymph nodes, SCRT, and taxane chemotherapy). The approximate ratios of TLE and PLE based on the number of risk factors were 7:1 (no factor), 1:1 (one factor), 1:2 (two factors), and 1:3 (three factors). Conclusion One-third of initial swelling events were transient, whereas the other two-thirds of patients experienced PLE. Estimation of TLE and PLE based on known treatment factors could facilitate prediction of this life-long complication.

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Lymphatic remapping by long-term lymphoscintigraphy follow-up in secondary lymphedema after breast cancer surgery
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The effect of exercise and educational programs for breast cancer patients on the development of breast cancer-related lymphoedema: secondary endpoint from a randomized controlled trial in the Setouchi Breast Project-10
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Taxanes and Breast Cancer‐Related Lymphedema
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The Use of Ultrasound Imaging for Upper Extremity Lymphedema after Breast Cancer: A Systematic Review
Elena Canales-Lachén, Ángel Asunsolo, Oscar J. Manrique, Javier Blázquez, Purificación Holguín, Andrés A. Maldonado
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Aomei Shen, Qian Lu, Xin Fu, Xiaoxia Wei, Liyuan Zhang, Jingru Bian, Wanmin Qiang, Dong Pang
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Xiaozhen Liu, Kewang Sun, Hongjian Yang, Lingli Xia, Kefeng Lu, Xuli Meng, Yongfeng Li
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Derly C. Munoz, Sarah S. Virk, Oluwadamilola T. Oladeru, Pamela Clevenger, Tracy L. Hollen, Mariam W. Hanna, Lisa R. P. Spiguel
Current Breast Cancer Reports.2023; 15(3): 242. CrossRef
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Bettina Boeer, Anna Seller, Birgitt Schoenfisch, Ute krainick-Strobel, Andreas Dietrich, Sara Y. Brucker, Diethelm Wallwiener, Andreas Niess, Markus Hahn
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Sander Bekeschus, Fariba Saadati, Steffen Emmert
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Prediction of breast cancer-related lymphedema risk after postoperative radiotherapy via multivariable logistic regression analysis
Jae Sik Kim, Jin Ho Kim, Ji Hyun Chang, Do Wook Kim, Kyung Hwan Shin
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Invited Commentary from the Authors of: Kuruvilla AS, et al. Risk Factors Associated With Postmastectomy Breast Cancer Lymphedema: Amulticenter Retrospective Analysis
Annet S. Kuruvilla
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Yan-fei Liu, Jun-E Liu, Yi Zhu, Yim Wah Mak, Hui Qiu, Li-hui Liu, Shen-shen Yang, Shao-hua Chen
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Abiye Mussie, Maria C. Medor, Sylia Mohand-Said, Andrea M. Ibrahim, Carolyn Nessim, Moein Momtazi
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Li-Wei Tsai, Yi-Hsuan Lee, Chiao Lo, Huang-Chun Lien, Ming-Yang Wang, I-Shiow Jan, Ruoh-Fang Yen, Fu-Chang Hu, Chiun-Sheng Huang
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Ann Marie Flores, Jason Nelson, Lee Sowles, Rebecca G Stephenson, Kathryn Robinson, Andrea Cheville, Antoinette P Sander, William J Blot
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Elevated levels of eEF1A2 protein expression in triple negative breast cancer relate with poor prognosis
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Adjuvant Treatment after Surgery in Stage IIIA Endometrial Adenocarcinoma: Mee Sun Yoon, Seung Jae Huh, Hak Jae Kim, Young Seok Kim, Yong Bae Kim, Joo-Young Kim, Jong-Hoon Lee, Hun Jung Kim, Jihye Cha, Jin Hee Kim, Juree Kim, Won Sup Yoon, Jin Hwa Choi, Mison Chun, Youngmin Choi, Kang Kyoo Lee, Myungsoo Kim, Jae-Uk Jeong, Sei Kyung Chang, Won Park; Cancer Res Treat. 2016;48(3):1074-1083. Published online October 29, 2015; DOI: https://doi.org/10.4143/crt.2015.356

Abstract PDF PubReader ePub

Purpose
We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group. Materials and Methods A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancertreated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed.
Results
Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively). Conclusion We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.

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Practice patterns and survival in FIGO 2009 stage 3B endometrial cancer
Jessica Jou, Lindsey Charo, Marianne Hom-Tedla, Katherine Coakley, Pratibha Binder, Cheryl Saenz, Ramez N. Eskander, Michael McHale, Steven Plaxe
Gynecologic Oncology.2021; 163(2): 299. CrossRef
Treatment strategies for endometrial cancer: current practice and perspective
Yeh C. Lee, Stephanie Lheureux, Amit M. Oza
Current Opinion in Obstetrics & Gynecology.2017; 29(1): 47. CrossRef

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Breast Cancer–Related Lymphedema after Neoadjuvant Chemotherapy: Myungsoo Kim, In Hae Park, Keun Seok Lee, Jungsil Ro, So-Youn Jung, Seeyoun Lee, Han-Sung Kang, Eun Sook Lee, Tae Hyun Kim, Kwan Ho Cho, Kyung Hwan Shin; Cancer Res Treat. 2015;47(3):416-423. Published online November 17, 2014; DOI: https://doi.org/10.4143/crt.2014.079

Abstract PDF PubReader ePub

Purpose
The risk for lymphedema (LE) after neoadjuvant chemotherapy (NCT) in breast cancer patients has not been fully understood thus far. This study is conducted to investigate the incidence and time course of LE after NCT. Materials and Methods A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database. Results At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were grade 3. The overall 5-year cumulative incidence of LE was 42%. LE first occurred within 6 months after surgery in 62%; 1 year in 77%; 2 years in 91%; and 3 years in 96%. In a multivariate analysis, age (hazard ratio [HR], 1.66; p < 0.01) and the number of dissected ALNs (HR, 1.68; p < 0.01) were independent risk factors for LE. Patients with both of these risk factors showed a significantly higher 5-year cumulative incidence of LE compared with patients with no or one risk factor (61% and 37%, respectively; p < 0.001). The addition of adjuvant chemotherapy did not significantly correlate with LE. Conclusion LE after NCT, surgery, and SCRT developed early after treatment, and with a high incidence rate. More frequent surveillance of arm swelling may be necessary in patients after NCT, especially during the first few years of follow-up.

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Impact of neoadjuvant chemotherapy on breast cancer-related lymphedema after axillary lymph node dissection: a retrospective cohort study
Miaomiao Jia, Lihui Pan, Haibo Yang, Jinnan Gao, Fan Guo
Breast Cancer Research and Treatment.2024; 204(2): 223. CrossRef
Incidence and risk factors of breast cancer-related lymphedema in Korea: A nationwide retrospective cohort study
Ha Rim Ahn, Hyeong Eun Jeong, Choyun Jeong, Sang Yull Kang, Sung Hoo Jung, Hyun Jo Youn, Jong Seung Kim
International Journal of Surgery.2024;[Epub] CrossRef
Incidence of lymphedema related to various cancers
Marie-Eve Letellier, Marize Ibrahim, Anna Towers, Geneviève Chaput
Medical Oncology.2024;[Epub] CrossRef
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