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Review Article
Intensity-Modulated Radiation Therapy for Uterine Cervical Cancer to Reduce Toxicity and Enhance Efficacy – an Option or a Must?: A Narrative Review
Sea-Won Lee, Aeran Kim, Sung Jong Lee, Sung Hwan Kim, Jong Hoon Lee
Cancer Res Treat. 2024;56(1):1-17.   Published online August 30, 2023
DOI: https://doi.org/10.4143/crt.2023.562
AbstractAbstract PDFPubReaderePub
Radiotherapy (RT) is a fundamental modality in treatment of cervical cancer. With advancement of technology, conventional RT used for external beam radiotherapy (EBRT) for over half a century has been rapidly replaced with intensity-modulated radiation therapy (IMRT) especially during the last decade. This newer technique is able to differentiate the intensity of radiation within the same field, thus reduces the inevitable exposure of radiation to normal organs and enables better dose delivery to tumors. Recently, the American Society for Radiation Oncology has released a guideline for RT in cervical cancer. Although a section of the guideline recommends IMRT for the purpose of toxicity reduction, a thorough review of the literature is necessary to understand the current status of IMRT in cervical cancer. This narrative review updates the recent high-level evidences regarding the efficacy and toxicity of IMRT and provides a better understanding of the most innovative techniques currently available for EBRT enabled by IMRT.

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  • Long term clinical outcomes of cervical cancer patients who were recommended surgery but did not undergo it: A SEER database study
    Zhaoming Zhang, Hongfu Zhao, Guanghui Cheng
    European Journal of Surgical Oncology.2024; 50(10): 108572.     CrossRef
  • Treatment of secondary uterine malignancy following radiotherapy for cervical cancer: a study based on the SEER database
    Xiaojing Tong, Yunyun Xiao, Haozhen Li, Hang Zhang, Jiawen Li
    BMC Women's Health.2024;[Epub]     CrossRef
  • 4,339 View
  • 309 Download
  • 2 Web of Science
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Original Articles
Breast cancer
Quality Assessment and Trend for Breast Cancer Treatment Practice across South Korea Based on Nationwide Analysis of Korean Health Insurance Data during 2013-2017
Kyu Hye Choi, Soo-Yoon Sung, Sea-Won Lee, Ye Won Jeon, Sung Hwan Kim, Jong Hoon Lee
Cancer Res Treat. 2023;55(2):570-579.   Published online December 5, 2022
DOI: https://doi.org/10.4143/crt.2022.882
AbstractAbstract PDFPubReaderePub
Purpose
Quality assessment of breast cancer treatment in South Korea showed the upward standardization of the grade since 2013, but treatment disparities still have existed. This study analyzed the five year trend between 2013 and 2017 in the assessment of breast cancer treatment practice using the Korean health insurance data.
Materials and Methods
All the medical records including surgery, chemotherapy, and radiotherapy for 7,354 patients a year on average were evaluated. Twenty indices were consisted of one structural, 17 process-related, and 2 result-related factors. We calculated the coefficient of variation (CV) annually to determine the variation in adherence rate of evaluation indices according to the type of institution (advanced vs. general hospital vs. clinic).
Results
Based on the initial assessment in 2013, 10 out of 20 indicators showed significant variation among the types of institutions with a CV of less than 0.1%. Six of them had a CV decline of less than 0.1%. The CV was still 0.1% or higher in the four indicators, including the composition of professional staff, the implementation of target therapy, the average length of hospital stay, and the hospitalization cost. Regarding the first-grade of assessment, there was a statistically significant relationship between the institution type (p=0.029) and region (metropolitan vs. province, p<0.001).
Conclusion
There were disparities in the structural and systemic treatment factors depending on the institutional type. The quality improvement of the regional institutions and multidisciplinary experts for breast cancer is necessary.

Citations

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  • Contrasting income-based inequalities in incidence and mortality of breast cancer in South Korea, 2006–2015
    Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang, Kyunghee Jung-Choi
    Epidemiology and Health.2024; : e2024074.     CrossRef
  • 4,023 View
  • 96 Download
  • 1 Crossref
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The Pattern of Care for Brain Metastasis from Breast Cancer over the Past 10 Years in Korea: A Multicenter Retrospective Study (KROG 16-12)
Jae Sik Kim, Kyubo Kim, Wonguen Jung, Kyung Hwan Shin, Seock-Ah Im, Hee-Jun Kim, Yong Bae Kim, Jee Suk Chang, Jee Hyun Kim, Doo Ho Choi, Yeon Hee Park, Dae Yong Kim, Tae Hyun Kim, Byung Ock Choi, Sea-Won Lee, Suzy Kim, Jeanny Kwon, Ki Mun Kang, Woong-Ki Chung, Kyung Su Kim, Ji Ho Nam, Won Sup Yoon, Jin Hee Kim, Jihye Cha, Yoon Kyeong Oh, In Ah Kim
Cancer Res Treat. 2022;54(4):1121-1129.   Published online December 31, 2021
DOI: https://doi.org/10.4143/crt.2021.1083
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We aimed to investigate manifestations and patterns of care for patients with brain metastasis (BM) from breast cancer (BC) and compared their overall survival (OS) from 2005 through 2014 in Korea.
Materials and Methods
We retrospectively reviewed 600 BC patients with BM diagnosed between 2005 and 2014. The median follow-up duration was 12.5 months. We categorized the patients into three groups according to the year when BM was initially diagnosed (group I [2005-2008], 98 patients; group II [2009-2011], 200 patients; and group III [2012-2014], 302 patients).
Results
Over time, the median age at BM diagnosis increased by 2.2 years (group I, 49.0 years; group II, 48.3 years; and group III, 51.2 years; p=0.008). The percentage of patients with extracranial metastasis was 73.5%, 83.5%, and 86.4% for group I, II, and III, respectively (p=0.011). The time interval between BC and BM was prolonged in patients with stage III primary BC (median, 2.4 to 3 years; p=0.029). As an initial brain-directed treatment, whole-brain radiotherapy alone decreased from 80.0% in 2005 to 41.1% in 2014. Meanwhile, stereotactic radiosurgery or fractionated stereotactic radiotherapy alone increased from 13.3% to 34.7% during the same period (p=0.005). The median OS for group I, II, and III was 15.6, 17.9, and 15.0 months, respectively, with no statistical significance.
Conclusion
The manifestations of BM from BC and the pattern of care have changed from 2005 to 2014 in Korea. However, the OS has remained relatively unchanged over the 10 years.

Citations

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  • Comparison of initial and sequential salvage brain-directed treatment in patients with 1–4 vs. 5–10 brain metastases from breast cancer (KROG 16–12)
    Jae Sik Kim, Kyubo Kim, Wonguen Jung, Kyung Hwan Shin, Seock-Ah Im, Hee-Jun Kim, Yong Bae Kim, Jee Suk Chang, Jee Hyun Kim, Doo Ho Choi, Yeon Hee Park, Dae Yong Kim, Tae Hyun Kim, Byung Ock Choi, Sea-Won Lee, Suzy Kim, Jeanny Kwon, Ki Mun Kang, Woong-Ki C
    Breast Cancer Research and Treatment.2023; 200(1): 37.     CrossRef
  • 6,254 View
  • 182 Download
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SUVmax Predicts Disease Progression after Stereotactic Ablative Radiotherapy in Stage I Non-small Cell Lung Cancer
Yoo-Kang Kwak, Hee Hyun Park, Kyu Hye Choi, Eun Young Park, Soo Yoon Sung, Sea-Won Lee, Ji Hyun Hong, Hyo Chun Lee, Ie Ryung Yoo, Yeon Sil Kim
Cancer Res Treat. 2020;52(1):85-97.   Published online May 17, 2019
DOI: https://doi.org/10.4143/crt.2019.007
AbstractAbstract PDFPubReaderePub
Purpose
Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) is gaining evidence as a predictive factor in non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is the standard treatment in early-stage NSCLC when a patient is unsuitable for surgery. We performed a study to assess the prognostic clinical significance of PET-CT after SABR in early-stage NSCLC.
Materials and Methods
Seventy-six patients with stage I NSCLC treated with SABR were investigated. Total radiation dose ranged from 36 to 63 Gy in three to eight fractions depending on tumor location and size. Respiratory motion control was implemented at simulation and during treatment. PET-CT prior to SABR was performed in 66 patients (86.8%).
Results
Median follow-up time was 32 months (range, 5 to 142 months). Local control rate at 1, 2, and 5 years were 95.9%, 92.8%, and 86.7%, respectively. Overall survival (OS) at 1, 2, and 5 years were 91.0%, 71.3%, and 52.1% respectively. Cause-specific survival at 1, 2, and 5 years were 98.6%, 93.1%, and 84.3% respectively. Tumor size and pre-SABR maximal standardized uptake value (SUVmax) demonstrated statistical significance in the Kaplan-Meier survival analyses with log-rank test. In multivariate analyses pre-SABR SUVmax remained statistically significant in correlation to OS (p=0.024; hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.2 to 8.8) and with marginal significance in regards to regional progression-free survival (p=0.059; HR, 32.5; 95% CI, 2.6 to 402.5).
Conclusion
Pre-SABR SUVmax demonstrated a predictive power in statistical analyses. Tumors with SUVmax above 6 at diagnosis were associated with inferior outcomes.

Citations

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  • Enhanced NSCLC subtyping and staging through attention-augmented multi-task deep learning: A novel diagnostic tool
    Runhuang Yang, Weiming Li, Siqi Yu, Zhiyuan Wu, Haiping Zhang, Xiangtong Liu, Lixin Tao, Xia Li, Jian Huang, Xiuhua Guo
    International Journal of Medical Informatics.2025; 193: 105694.     CrossRef
  • Invasive Nodal Staging via Endobronchial Ultrasound and Outcome in Patients Treated with Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer – Results from a Single Institution Study
    Benjamin George, Atallah Baydoun, Samar Bhat, Lauryn Bailey, Theodore Arsenault, Yilun Sun, Yuxia Zhang, Yiran Zheng, Prashant Vempati, Tarun Podder, Tithi Biswas
    Clinical Lung Cancer.2024; 25(4): e181.     CrossRef
  • Prognostic value of consolidation-to-tumor ratio on computed tomography in NSCLC: a meta-analysis
    Yongming Wu, Wenpeng Song, Denian Wang, Junke Chang, Yan Wang, Jie Tian, Sicheng Zhou, Yingxian Dong, Jing Zhou, Jue Li, Ziyi Zhao, Guowei Che
    World Journal of Surgical Oncology.2023;[Epub]     CrossRef
  • Tumor to liver maximum standardized uptake value ratio of FDG-PET/CT parameters predicts tumor treatment response and survival of stage III non-small cell lung cancer
    Pengfei Zhang, Wei Chen, Kewei Zhao, Xiaowen Qiu, Tao Li, Xingzhuang Zhu, Peng Sun, Chunsheng Wang, Yipeng Song
    BMC Medical Imaging.2023;[Epub]     CrossRef
  • Evaluation of response to stereotactic body radiation therapy for nonsmall cell lung cancer: PET response criteria in solid tumors versus response evaluation criteria in solid tumors
    Jixia Han, Qi Song, Feng Guo, Rui Du, Henghu Fang, Jingbo Kang, Zejun Lu
    Nuclear Medicine Communications.2022;[Epub]     CrossRef
  • Assessing tumor angiogenesis using dynamic contrast-enhanced integrated magnetic resonance-positron emission tomography in patients with non-small-cell lung cancer
    Yu-Sen Huang, Jenny Ling-Yu Chen, Hsin-Ming Chen, Li-Hao Yeh, Jin-Yuan Shih, Ruoh-Fang Yen, Yeun-Chung Chang
    BMC Cancer.2021;[Epub]     CrossRef
  • Potential role of functional imaging in predicting outcome for patients treated with carbon ion therapy: a review
    Giulia Riva, Sara Imparato, Giovanni Savietto, Mattia Pecorilla, Alberto Iannalfi, Amelia Barcellini, Sara Ronchi, Maria Rosaria Fiore, Chiara Paganelli, Giulia Buizza, Mario Ciocca, Guido Baroni, Lorenzo Preda, Ester Orlandi
    The British Journal of Radiology.2021;[Epub]     CrossRef
  • Prognostic value of metabolic signature on 18F-FDG uptake in breast cancer patients after radiotherapy
    Jin Meng, Emmanuel Deshayes, Li Zhang, Wei Shi, Xiaomeng Zhang, Xingxing Chen, Xin Mei, Jinli Ma, Yizhou Jiang, Jiong Wu, Zhimin Shao, Xiaoli Yu, Zhaozhi Yang, Xiaomao Guo
    Molecular Therapy - Oncolytics.2021; 23: 412.     CrossRef
  • Parámetros cuantitativos de la PET/TC con 18F-FDG como factores pronósticos en el cáncer de pulmón localizado e inoperable
    J.R. Infante, J. Cabrera, J.I. Rayo, C. Cruz, J. Serrano, M. Moreno, A. Martínez, P. Jiménez, A. Cobo
    Revista Española de Medicina Nuclear e Imagen Molecular.2020; 39(6): 353.     CrossRef
  • 18F-FDG PET/CT quantitative parameters as prognostic factors in localized and inoperable lung cancer
    J.R. Infante, J. Cabrera, J.I. Rayo, C. Cruz, J. Serrano, M Moreno, A. Martínez, P. Jiménez, A. Cobo
    Revista Española de Medicina Nuclear e Imagen Molecular (English Edition).2020; 39(6): 353.     CrossRef
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High-Dose Thoracic Re-irradiation of Lung Cancer Using Highly Conformal Radiotherapy Is Effective with Acceptable Toxicity
Ji Hyun Hong, Yeon-Sil Kim, Sea-Won Lee, So Jung Lee, Jin Hyung Kang, Suk Hee Hong, Ju-Young Hong, GeumSeong Cheon
Cancer Res Treat. 2019;51(3):1156-1166.   Published online November 29, 2018
DOI: https://doi.org/10.4143/crt.2018.472
AbstractAbstract PDFPubReaderePub
Purpose
Thoracic re-irradiation (re-RT) of lung cancer has been challenged by the tolerance doses of normal tissues. We retrospectively analyzed local control, overall survival (OS) and toxicity after thoracic re-RT using highly conformal radiotherapy, such as intensity modulated radiotherapy and stereotactic body radiotherapy.
Materials and Methods
Thirty-one patients who received high-dose thoracic re-RT were analyzed. Doses were recalculated to determine biologically equivalent doses. The median interval to re-RT was 15.1 months (range, 4.4 to 56.3 months), the median initial dose was 79.2 Gy10 (range, 51.75 to 150 Gy10), and the median re-RT dose was 68.8 Gy10 (range, 43.2 to 132 Gy10).
Results
Eighteen (58.1%) and eleven (35.5%) patients showed loco-regional recurrence and distant metastasis, respectively, after 17.4 months of median follow-up. The 1-year and 2-year local control rates were 60.2% and 43.7%, respectively. The median loco-regional recurrence-free-survival (LRFS) was 15.4 months, and the median OS was 20.4 months. The cumulative and re-RT biologically equivalent dose for α/β=10 (BED10) doses were the most significant prognostic factors. Cumulative BED10 ≥145 Gy10 and re-RT BED10≥68.7 Gy10 were significantly associated with longer OS (p=0.029 and p=0.012, respectively) and LRFS (p=0.003 and p=0.000, respectively). The most frequent acute toxicity was grade 1-2 pulmonary toxicity (41.9%). No acute grade 3 or higher toxicities occurred.
Conclusion
Our results show that high-dose thoracic re-RT of lung cancer can be safely delivered using highly conformal radiotherapy with favorable survival and acceptable toxicity. An optimal strategy to select patients who would benefit from re-RT is crucial in extending the indications and improving the efficacy with a sufficiently high dose.

Citations

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  • ACR-ARS Practice Parameter for the Performance of Proton Beam Therapy
    Steven J. Frank, Indra J. Das, Charles B. Simone, Brian J. Davis, Curtiland Deville, Zhongxing Liao, Simon S. Lo, Susan L. McGovern, Rahul R. Parikh, Michael Reilly, William Small, Naomi R. Schechter
    International Journal of Particle Therapy.2024; 13: 100021.     CrossRef
  • Ultra-Hypofractionated Re-Irradiation with Anti-PD-1 Immunotherapy for Locoregionally Recurrent (after Radical Chemo-Radiotherapy) Non-Small Cell Lung Cancer
    Konstantinos Filippatos, Ioannis M. Koukourakis, Stavros Anevlavis, Axiotis Giaktzidis, Michael I. Koukourakis
    Cancers.2023; 15(20): 5083.     CrossRef
  • Re-irradiation for intra-thoracic tumours and extra-thoracic breast cancer: dose accumulation, evaluation of efficacy and toxicity based on a literature review
    Dorota Gabrys, Roland Kulik, Agnieszka Namysł-Kaletka
    The British Journal of Radiology.2022;[Epub]     CrossRef
  • High Dose Thoracic Re-Irradiation and Chemo-Immunotherapy for Centrally Recurrent NSCLC
    Brane Grambozov, Markus Stana, Bernhard Kaiser, Josef Karner, Sabine Gerum, Elvis Ruznic, Barbara Zellinger, Raphaela Moosbrugger, Michael Studnicka, Gerd Fastner, Felix Sedlmayer, Franz Zehentmayr
    Cancers.2022; 14(3): 573.     CrossRef
  • Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer
    Kyungmi Yang, Yang-Gun Suh, Hyunju Shin, Hongryull Pyo, Sung Ho Moon, Yong Chan Ahn, Dongryul Oh, Eunah Chung, Kwanghyun Jo, Jae Myoung Noh
    Life.2022; 12(2): 292.     CrossRef
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    Radiation Oncology Journal.2021; 39(1): 24.     CrossRef
  • Thoracic re-irradiation with 3D-conformal or more advanced techniques: A systematic review of treatment safety by the Re-irradiation Study Group of the Italian Association of Radiation and Oncology AIRO
    Marta Maddalo, Elisa D’Angelo, Francesco Fiorica, Angela Argenone, Melissa Scricciolo, Salvatore Cozzi, Alessia Nardangeli, Francesco Dionisi, Gianluca Costantino, Stefano Vagge, Antonio Pontoriero, Vittorio Donato, Mariangela Massaccesi
    Critical Reviews in Oncology/Hematology.2021; 167: 103500.     CrossRef
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    BMJ Open.2021; 11(11): e052542.     CrossRef
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    Kelly C. Paradis, Martha M. Matuszak
    Seminars in Radiation Oncology.2020; 30(3): 204.     CrossRef
  • Reirradiation at local relapse of non-small cell lung cancer
    D.V. Gogolin, I.A. Gulidov, Y.S. Mardynsky, T.Y. Antonenko, A.Y. Buksha
    Onkologiya. Zhurnal imeni P.A.Gertsena.2020; 9(3): 48.     CrossRef
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A Novel Prognostic Nomogram for Predicting Risks of Distant Failure in Patients with Invasive Breast Cancer Following Postoperative Adjuvant Radiotherapy
Yu Jin Lim, Sea-Won Lee, Noorie Choi, Jeanny Kwon, Keun-Yong Eom, Eunyoung Kang, Eun-Kyu Kim, Jee Hyun Kim, Yu Jung Kim, Se Hyun Kim, So Yeon Park, In Ah Kim
Cancer Res Treat. 2018;50(4):1140-1148.   Published online December 7, 2017
DOI: https://doi.org/10.4143/crt.2017.508
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to identify predictors for distant metastatic behavior and build a related prognostic nomogram in breast cancer.
Materials and Methods
A total of 1,181 patients with non-metastatic breast cancer between 2003 and 2011 were analyzed. To predict the probability of distant metastasis, a nomogram was constructed based on prognostic factors identified using a Cox proportional hazards model.
Results
The 7-year overall survival and 5-year post-progression survival of locoregional versus distant recurrence groups were 67.6% versus 39.1% (p=0.027) and 54.2% versus 33.5% (p=0.043), respectively. Patients who developed distant metastasis showed early and late mortality risk peaks within 3 and after 5 years of follow-up, respectively, but a broad and low risk increment was observed in other patients with locoregional relapse. In multivariate analysis of distant metastasis-free interval, age (≥ 45 years vs. < 45 years), molecular subtypes (luminal A vs. luminal B, human epidermal growth receptor 2, and triple negative), T category (T1 vs. T2-3 and T4), and N category (N0 vs. N1 and N2-3) were independently associated (p < 0.05 for all). Regarding the significant factors, a well-validated nomogram was established (concordance index, 0.812). The risk score level of patients with initial brain failure was higher than those of non-brain sites (p=0.029).
Conclusion
The nomogram could be useful for predicting the individual probability of distant recurrence in breast cancer. In high-risk patients based on the risk scores, more aggressive systemic therapy and closer surveillance for metastatic failure should be considered.

Citations

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    Audrey Shiner, Alex Kiss, Khadijeh Saednia, Katarzyna J. Jerzak, Sonal Gandhi, Fang-I Lu, Urban Emmenegger, Lauren Fleshner, Andrew Lagree, Marie Angeli Alera, Mateusz Bielecki, Ethan Law, Brianna Law, Dylan Kam, Jonathan Klein, Christopher J. Pinard, Ale
    Genes.2023; 14(9): 1768.     CrossRef
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    Yuqian Feng, Yiting Zhang, Yuying Xiang, Kaibo Guo, Huimin Jin, Shanming Ruan, Zhuoya Guan
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    Cancer Research and Treatment.2018; 50(4): 1260.     CrossRef
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The Impact of Surgical Timing on Pathologic Tumor Response after Short Course and Long Course Preoperative Chemoradiation for Locally Advanced Rectal Adenocarcinoma
Sea-Won Lee, Jong Hoon Lee, In Kyu Lee, Seong Taek Oh, Dae Yong Kim, Tae Hyun Kim, Jae Hwan Oh, Ji Yeon Baek, Hee Jin Chang, Hee Chul Park, Hee Cheol Kim, Eui Kyu Chie, Taek-Keun Nam, Hong Seok Jang
Cancer Res Treat. 2018;50(3):1039-1050.   Published online November 21, 2017
DOI: https://doi.org/10.4143/crt.2017.252
AbstractAbstract PDFPubReaderePub
Purpose
A pooled analysis of multi-institutional trials was performed to analyze the effect of surgical timing on tumor response by comparing short course concurrent chemoradiotherapy (CCRT) with long course CCRT followed by delayed surgery in locally advanced rectal cancer.
Materials and Methods
Three hundred patients with cT3-4N0-2 rectal adenocarcinoma were included. Long course patients from KROG 14-12 (n=150) were matched 1:1 to 150 short course patients from KROG 10-01 (NCT01129700) and KROG 11-02 (NCT01431599) according to stage, age, and other risk factors. The primary endpoint was to determine the interval between surgery and the last day of neoadjuvant CCRT which yields the best tumor response after the short course and long course CCRT. Downstaging was defined as ypT0-2N0M0 and pathologic complete response (ypCR) was defined as ypT0N0M0, respectively.
Results
Both the long and short course groups achieved lowest downstaging rates at < 6 weeks (long 20% vs. short 8%) and highest downstaging rates at 6-7 weeks (long 44% vs. short 40%). The ypCR rates were lowest at < 6 weeks (both long and short 0%) and highest at 6-7 weeks (long 21% vs. short 11%) in both the short and long course arms. The downstaging and ypCR rates of long course group gradually declined after the peak at 6-7 weeks and those of the short course group trend to constantly increase afterwards.
Conclusion
It is optimal to perform surgery at least 6 weeks after both the short course and long course CCRT to obtain maximal tumor regression in locally advanced rectal adenocarcinoma.

Citations

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    Jung Hoon Bae, Jumyung Song, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
    Diseases of the Colon & Rectum.2023; 66(6): 785.     CrossRef
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    Jung Hoon Bae, Jumyung Song, Ri Na Yoo, Ji Hoon Kim, Bong-Hyeon Kye, In Kyu Lee, Hyeon-Min Cho, Yoon Suk Lee
    Biomedicines.2023; 11(6): 1556.     CrossRef
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    M. Yu. Fedyanin
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    Wang Qiaoli, Huang Yongping, Xiong Wei, Xu Guoqiang, Ju Yunhe, Liu Qiuyan, Li Cheng, Guo Mengling, Li Jiayi, Xiong Wei, Yang Yi
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    Yongjun Yu, Yuwei Li, Chen Xu, Zhao Zhang, Xipeng Zhang
    Revista Española de Enfermedades Digestivas.2018;[Epub]     CrossRef
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Setup Error and Effectiveness of Weekly Image-Guided Radiation Therapy of TomoDirect for Early Breast Cancer
Mi Joo Chung, Guk Jin Lee, Young Jin Suh, Hyo Chun Lee, Sea-Won Lee, Songmi Jeong, Jeong Won Lee, Sung Hwan Kim, Dae Gyu Kang, Jong Hoon Lee
Cancer Res Treat. 2015;47(4):774-780.   Published online February 13, 2015
DOI: https://doi.org/10.4143/crt.2014.189
AbstractAbstract PDFPubReaderePub
Purpose
This study investigated setup error and effectiveness of weekly image-guided radiotherapy (IGRT) of TomoDirect for early breast cancer. Materials and Methods One hundred and fifty-one breasts of 147 consecutive patients who underwent breast conserving surgery followed by whole breast irradiation using TomoDirect in 2012 and 2013 were evaluated. All patients received weekly IGRT. The weekly setup errors from simulation to each treatment in reference to chest wall and surgical clips were measured. Random, systemic, and 3-dimensional setup errors were assessed. Extensive setup error was defined as 5 mm above the margin in any directions.
Results
All mean errors were within 3 mm of all directions. The mean angle of gantry shifts was 0.6°. The mean value of absolute 3-dimensional setup error was 4.67 mm. In multivariate analysis, breast size (odds ratio, 2.82; 95% confidence interval, 1.00 to 7.90) was a significant factor for extensive error. The largest significant deviation of setup error was observed in the first week of radiotherapy (p < 0.001) and the deviations gradually decreased with time. The deviation of setup error was 5.68 mm in the first week and within 5 mm after the second week. Conclusion In this study, there was a significant association between breast size and significant setup error in breast cancer patients who received TomoDirect. The largest deviation occurred in the first week of treatment. Therefore, patients with large breasts should be closely observed on every fraction and fastidious attention is required in the first fraction of IGRT.

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