Cancer Research and Treatment

Original Articles

Lung and Thoracic cancer

Unraveling the Impact of Sarcopenia-Induced Lymphopenia on Treatment Response and Prognosis in Patients with Stage III Non–Small Cell Lung Cancer: Insights for Optimizing Chemoradiation and Immune Checkpoint Inhibitor: Joongyo Lee, Kyung Hwan Kim, Jina Kim, Chang Geol Lee, Jaeho Cho, Hong In Yoon, Yeona Cho; Cancer Res Treat. 2025;57(2):422-433. Published online October 30, 2024; DOI: https://doi.org/10.4143/crt.2024.493

Abstract PDF Supplementary Material PubReader ePub: Purpose
Sarcopenia is a poor prognostic factor in non–small cell lung cancer (NSCLC). However, its prognostic significance in patients with NSCLC receiving immune checkpoint inhibitors (ICIs) and its relationship with lymphopenia remain unclear. We aimed to investigate the prognostic role of sarcopenia and its effect on lymphocyte recovery in patients with stage III NSCLC treated with concurrent chemoradiotherapy (CCRT) followed by ICI.
Materials and Methods
We retrospectively evaluated 151 patients with stage III NSCLC who received definitive CCRT followed by maintenance ICI between January 2016 and June 2022. Sarcopenia was evaluated by measuring the skeletal muscle area at the L3 vertebra level using computed tomography scans. Lymphocyte level changes were assessed based on measurements taken before and during CCRT and at 1, 2, 3, 6, and 12 months post-CCRT completion.
Results
Even after adjusting for baseline absolute lymphocyte count through propensity score-matching, patients with pre-radiotherapy (RT) sarcopenia (n=86) exhibited poor lymphocyte recovery and a significantly high incidence of grade ≥ 3 lymphopenia during CCRT. Pre-RT sarcopenia and grade ≥ 3 lymphopenia during CCRT emerged as prognostic factors for overall survival and progression-free survival, respectively. Concurrent chemotherapy dose adjustments, objective response after CCRT, and discontinuation of maintenance ICI were also analyzed as independent prognostic factors.
Conclusion
Our results demonstrated an association between pre-RT sarcopenia and poor survival, concurrent chemotherapy dose adjustments, and impaired lymphocyte recovery after definitive CCRT. Moreover, CCRT-induced lymphopenia not only contributed to poor prognosis but may have also impaired the therapeutic efficacy of subsequent maintenance ICI, ultimately worsening treatment outcomes.

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Aggressive Local Ablative Radiotherapy Mitigates Progression Risk in Oligometastatic Lung Adenocarcinoma: Gowoon Yang, Kyung Hwan Kim, Chang Geol Lee, Min Hee Hong, Hye Ryun Kim, Yeona Cho, Hong In Yoon; Cancer Res Treat. 2024;56(1):115-124. Published online August 29, 2023; DOI: https://doi.org/10.4143/crt.2023.600

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to determine the role of local ablative radiotherapy (LART) in oligometastatic/oligoprogressive lung adenocarcinoma.
Materials and Methods
Patients (n=176) with oligometastatic lung adenocarcinoma treated with LART were identified, and those treated with LART at the initial diagnosis of synchronous oligometastatic disease (OMD group) or treated with LART when they presented with repeat oligoprogression (OPD group) were included.
Results
In the OMD group (n=54), the 1- and 3-year progression-free survival (PFS) were 50.9% and 22.5%, respectively, whereas the 1- and 3-year overall survival in the OPD group were 75.9% and 58.1%, respectively. Forty-one patients (75.9%) received LART at all gross disease sites. Tyrosine kinase inhibitor (TKI) use and all-metastatic site LART were significant predictors of higher PFS (p=0.018 and p=0.046, respectively). In patients treated with TKIs at the time of LART (n=23) and those treated with all-metastatic site LART, the 1-year PFS was 86.7%, while that of patients not treated with all-metastatic site LART was 37.5% (p=0.006). In the OPD group (n=122), 67.2% of the patients (n=82) maintained a systemic therapy regimen after LART. The cumulative incidence of changing systemic therapy was 39.6%, 62.9%, and 78.5% at 6 months, 1 year, and 2 years after LART, respectively.
Conclusion
Aggressive LART can be an option to improve survival in patients with oligometastatic disease. Patients with synchronous oligometastatic disease receiving TKI and all-metastatic site LART may have improved PFS. In patients with repeat oligoprogression, LART might potentially extend survival by delaying the need to change the systemic treatment regimen.

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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

Abstract PDF PubReader ePub

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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Surgical Versus Non‐Surgical Treatment of Advanced Oropharyngeal Squamous Cell Carcinoma: A Systematic Review and Meta‐Analysis
Megan K. Scharner, Johnny M. Owen, Shaun A. Nguyen, Alexandra E. Kejner, Jason G. Newman, Emily Brennan, W. Greer Albergotti
Head & Neck.2025;[Epub] CrossRef
Early Death in T3‐T4 Head and Neck Cancer: NCDB Comparison of Surgical vs. Non‐Surgical Approaches
Srivatsa Surya Vasudevan, Ivan A. Alvarez, Cherie‐Ann O. Nathan, John Pang
Head & Neck.2025;[Epub] CrossRef
Treatment de‐escalation for HPV+ oropharyngeal cancer: A systematic review and meta‐analysis
Fausto Petrelli, Andrea Luciani, Antonio Ghidini, Sara Cherri, Paolo Gamba, Marta Maddalo, Paolo Bossi, Alberto Zaniboni
Head & Neck.2022; 44(5): 1255. CrossRef
Ginsenoside Rd inhibits migration and invasion of tongue cancer cells through H19/miR-675-5p/CDH1 axis
Lu CHANG, Dongxu WANG, Shaoning KAN, Ming HAO, Huimin LIU, Zhijing YANG, Qianyun XIA, Weiwei LIU
Journal of Applied Oral Science.2022;[Epub] CrossRef
Postoperative Concurrent Chemoradiotherapy Versus Radiotherapy Alone for Advanced Oral Cavity Cancer in the Era of Modern Radiation Techniques
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
Superficial circumflex iliac artery perforator flap for tongue reconstruction after hemiglossectomy for cancer: A case report
Hong Loi Nguyen, Truong Phu M. Ho, Xuan Phu Tran, Thanh Xuan Nguyen
Oral and Maxillofacial Surgery Cases.2021; 7(2): 100219. CrossRef
Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy
Ambika Parmar, Michaelina Macluskey, Niall Mc Goldrick, David I Conway, Anne-Marie Glenny, Janet E Clarkson, Helen V Worthington, Kelvin KW Chan
Cochrane Database of Systematic Reviews.2021;[Epub] CrossRef
Larynx-preserving reconstruction after extended base of the tongue resection
Hideki Kadota, Junichi Fukushima, Sei Yoshida, Kenichi Kamizono, Muneyuki Masuda, Satoshi Toh, Ryuji Yasumatsu, Torahiko Nakashima, Takashi Nakagawa
Journal of Plastic, Reconstructive & Aesthetic Surgery.2020; 73(4): 740. 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

Abstract PDF PubReader ePub

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

Citations to this article as recorded by

Incidence, risk factors and outcomes of cataract surgery after plaque brachytherapy for posterior uveal melanoma
Viktor T. Gill, Gustav Stålhammar
Heliyon.2024; 10(1): e23447. CrossRef
Brachytherapy With 15- Versus 20-mm Ruthenium 106 Plaques Without Verification of Plaque Position Is Associated With Local Tumor Recurrence and Death in Posterior Uveal Melanoma
Gustav Stålhammar
International Journal of Radiation Oncology*Biology*Physics.2023; 117(5): 1125. CrossRef
The Role of Ruthenium Compounds in Neurologic Diseases: A Minireview
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
The Journal of Pharmacology and Experimental Therapeutics.2022; 380(1): 47. CrossRef
Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy
Gilda Cennamo, Daniela Montorio, Luca D’ Andrea, Antonio Farella, Elide Matano, Mario Giuliano, Raffaele Liuzzi, Maria Angelica Breve, Sabino De Placido, Giovanni Cennamo
Frontiers in Oncology.2022;[Epub] CrossRef
Uveal Melanoma: A Review of the Literature and Personal Experiences
Yong Joon Kim, Christopher Seungkyu Lee, Sung Chul Lee
Journal of Retina.2021; 6(2): 65. CrossRef
Prognostic Factors and Decision Tree for Long-Term Survival in Metastatic Uveal Melanoma
Daniel Lorenzo, María Ochoa, Josep Maria Piulats, Cristina Gutiérrez, Luis Arias, Jaume Català, María Grau, Judith Peñafiel, Estefanía Cobos, Pere Garcia-Bru, Marcos Javier Rubio, Noel Padrón-Pérez, Bruno Dias, Joan Pera, Josep Maria Caminal
Cancer Research and Treatment.2018; 50(4): 1130. CrossRef

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