Cancer Research and Treatment

Original Articles

Long-Term Clinical Efficacy of Radiotherapy for Patients with Stage I-II Gastric Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue: A Retrospective Multi-Institutional Study: Jae Uk Jeong, Hyo Chun Lee, Jin Ho Song, Keun Yong Eom, Jin Hee Kim, Yoo Kang Kwak, Woo Chul Kim, Sun Young Lee, Jin Hwa Choi, Kang Kyu Lee, Jong Hoon Lee; Received July 16, 2024 Accepted October 1, 2024 Published online October 4, 2024; DOI: https://doi.org/10.4143/crt.2024.651 [Accepted]

Abstract PDF: Purpose
To evaluate long-term treatment outcomes in patients with localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma treated with radiation therapy (RT).
Materials and Methods
A total of 229 patients who received RT in ten tertiary hospitals between 2010 and 2019 were included in this multi-center analysis. Response after RT was based on esophagogastroduodenoscopy after RT. Locoregional relapse-free survival (LRFS) and disease-free survival (DFS) were evaluated.
Results
After a median follow-up time of 93.2 months, 5-year LRFS, DFS, and OS rates were 92.8%, 90.4%, and 96.1%, respectively. LRFS, DFS, and OS rates at 10 years were 90.3%, 87.7%, and 92.8%, respectively. Of 229 patients, 228 (99.6%) patients achieved complete remission after RT. Five-year LRFS was significantly lower in patients with stage IIE than in those with stage IE (77.4% vs. 94.2%, p=0.047). Patients with age ≥ 60 had significantly lower LRFS than patients with age < 60 (89.3% vs. 95.1%, p=0.003). In the multivariate analysis, old age (≥ 60 years) was a prognostic factor for LRFS [hazard ratio (HR) of 3.72 and confidence interval (CI), 1.38-10.03; p=0.009). Grade 2 or higher gastritis was reported in 69 (30.1%) patients. Secondary malignancies including gastric adenocarcinoma, malignant lymphoma, lung cancer, breast cancer, and prostate cancer were observed in 11 (4.8%) patients after RT.
Conclusion
Patients treated with RT for localized gastric MALT lymphoma showed favorable 10-year outcomes. Radiation therapy is an effective treatment without an increased risk of secondary cancer. The toxicity for radiotherapy to the stomach is not high.

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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; Received February 29, 2024 Accepted July 2, 2024 Published online July 3, 2024; DOI: https://doi.org/10.4143/crt.2024.223 [Epub ahead of print]

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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Gastrointestinal cancer

Risk Factors for Distant Metastasis in Extrahepatic Bile Duct Cancer after Curative Resection (KROG 1814): Younghee Park, Tae Hyun Kim, Kyubo Kim, Jeong Il Yu, Wonguen Jung, Jinsil Seong, Woo Chul Kim, Jin Hwa Choi, Ah Ram Chang, Bae Kwon Jeong, Byoung Hyuck Kim, Tae Gyu Kim, Jin Hee Kim, Hae Jin Park, Hyun Soo Shin, Jung Ho Im, Eui Kyu Chie; Cancer Res Treat. 2024;56(1):272-279. Published online July 31, 2023; DOI: https://doi.org/10.4143/crt.2023.616

Abstract PDF PubReader ePub: Purpose
Risk factors predicting distant metastasis (DM) in extrahepatic bile duct cancer (EHBDC) patients treated with curative resection were investigated.
Materials and Methods
Medical records of 1,418 EHBDC patients undergoing curative resection between Jan 2000 and Dec 2015 from 14 institutions were reviewed. After resection, 924 patients (67.6%) were surveilled without adjuvant therapy, 297 (21.7%) were treated with concurrent chemoradiotherapy (CCRT) and 148 (10.8%) with CCRT followed by chemotherapy. To exclude the treatment effect from innate confounders, patients not treated with adjuvant therapy were evaluated.
Results
After a median follow-up of 36.7 months (range, 2.7 to 213.2 months), the 5-year distant metastasis-free survival (DMFS) rate was 57.7%. On multivariate analysis, perihilar or diffuse tumor (hazard ratio [HR], 1.391; p=0.004), poorly differentiated histology (HR, 2.014; p < 0.001), presence of perineural invasion (HR, 1.768; p < 0.001), positive nodal metastasis (HR, 2.670; p < 0.001) and preoperative carbohydrate antigen (CA) 19-9 ≥ 37 U/mL (HR, 1.353; p < 0.001) were significantly associated with inferior DMFS. The DMFS rates significantly differed according to the number of these risk factors. For validation, patients who underwent adjuvant therapy were evaluated. In patients with ≥ 3 factors, additional chemotherapy after CCRT resulted in a superior DMFS compared with CCRT alone (5-year rate, 47.6% vs. 27.7%; p=0.001), but the benefit of additional chemotherapy was not observed in patients with 0-2 risk factors.
Conclusion
Tumor location, histologic differentiation, perineural invasion, lymph node metastasis, and preoperative CA 19-9 level predicted DM risk in resected EHBDC. These risk factors might help identifying a subset of patients who could benefit from additional chemotherapy after resection.

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A Survey for the Hospital Utilization of Cancer patients in Inchon: Woo Chul Kim, Yun Chul Hong, Yoo Kyung Pu, Jae Hwan Oh, Joo Young Kim, Ze Hong Woo, Tae Hoon Lee, Heechoul Ohrr, Don Hee Ahn, John J K Loh; J Korean Cancer Assoc. 1999;31(2):386-395.

Abstract PDF: PURPOSE
The purpose of this study was to evaluate the hospital utilization of cancer patients in Inchon and to assess the feasibility of Inchon Cancer Registry (ICR).
MATERIALS AND METHODS
We used two data sources from Korean Central Cancer Registry (KCCR) and Korean Medical Insurance (KMI) for analysis.
RESULTS
KCCR data analysis showed that 50.8% of cancer patients visited hospitals in Seoul, 46% visited hospitals in Inchon, and 2.6% in other areas at first visit. The analysis of KMI data showed that 43% of cancer patients visited hospital in Seoul, 38.5% visited hospitals in Inchon, and 18.5% in other areas at first visit. From these results, we found many cancer patients visited hospitals located in Seoul. We estimated that 52.1% would be missed when we performed cancer registry project in Inchon area alone from the KCCR data analysis. On the other hand, 60% would be missed from the KMI data. However, if we used registration data at the nation-wide level and actively registered cancer patient data in Inchan, expected unregistration rates would be 5%.
CONCLUSION
Even though registration rate to KCCR was relatively low (74%) in Inhon and many patients were treated in other area, we are convinced that almast all cancer patients would be registered because most cancer patients visited at least one of the cancer registry hospitals at the nation-wide level. Therefore, if ICR used KCCR and encouraged the hospitals in Inchon to actively participate in cancer registration, the population-based cancer registration in Inchon would be possible.

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