Cancer Research and Treatment

Original Articles

Combined Transarterial Chemoembolization and External Beam Radiotherapy for Identifying Surgical Candidates for Hepatocellular Carcinoma with Macroscopic Vascular Invasion: A Propensity Score-Weighted Analysis: Sumin Lee, Jinhong Jung, Jonggi Choi, So Yeon Kim, Jin Hyoung Kim, Danbi Lee, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Gi-Won Song, Jin-hong Park, Sang Min Yoon; Received January 18, 2025 Accepted April 29, 2025 Published online May 22, 2025; DOI: https://doi.org/10.4143/crt.2025.076 [Accepted]

Abstract PDF: Purpose
To evaluate the role of hepatic resection in patients with objective responses after combined transarterial chemoembolization (TACE) and radiotherapy (RT) for hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI).
Materials and Methods
We retrospectively reviewed the patients treated with combined TACE and RT for HCC with MVI between 2010 and 2015. Some of the patients with objective responses underwent hepatic resection or liver transplantation; to investigate the impact of surgery, patients with objective responses who did not undergo surgery were selected as the control group. Survival outcomes were compared using a propensity score-based stabilized inverse probability of treatment weighting method.
Results
Out of the 170 patients with objective responses after combined TACE and RT, 41 patients underwent surgery, including 8 liver transplantations. The unweighted surgery group was younger and had a higher proportion of solitary tumors and unilateral vascular involvement. After adjustment, the 3-year overall survival (OS) rates were 61.0% and 28.6% in the surgery and non-surgery groups, respectively. The most important prognostic factor for OS was surgery (adjusted Cox hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.17–0.46; p<0.001). Complete response after TACE and RT (vs. partial response) was also a significant prognostic factor for OS (adjusted HR, 0.41; 95% CI, 0.27–0.61; p<0.001). There was no surgical mortality. Four patients (9.8%) required additional surgery due to bleeding or graft failure.
Conclusion
Hepatic resection was significantly associated with improved OS in patients who showed objective responses after receiving combined TACE and RT for HCC with MVI.

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Head and Neck cancer

Radiotherapy versus Surgery in Early-Stage HPV-Positive Oropharyngeal Cancer: Dong-Yun Kim, Hong-Gyun Wu, Jin Ho Kim, Joo Ho Lee, Soon-Hyun Ahn, Eun-Jae Chung, Keun-Yong Eom, Young Ho Jung, Woo-Jin Jeong, Tack-Kyun Kwon, Suzy Kim, Chan Woo Wee; Cancer Res Treat. 2022;54(2):406-416. Published online June 23, 2021; DOI: https://doi.org/10.4143/crt.2021.441

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aimed to compare the outcomes of primary radiotherapy (RT) versus surgery in early-stage human papilloma virus–positive oropharyngeal squamous cell carcinoma (hpv+OPC), and investigate the preoperative clinical factors that can predict the requirement for postoperative adjuvant treatment.
Materials and Methods
This multicenter study included 166 patients with American Joint Committee on Cancer 8th edition-Stages I-II hpv+OPC. Sixty (36.1%) and 106 (63.9%) patients underwent primary (concurrent chemo)radiotherapy [(CC)RT] and surgery, respectively. Seventy-eight patients (73.6%) in the surgery group received postoperative (CC)RT.
Results
With a median follow-up of 45.6 months for survivors, the 2-year overall survival (OS), progression-free survival (PFS), and locoregional control (LC) for RT/surgery were 97.8%/96.4%, 91.1%/92.0%, and 92.9%/93.3%, respectively. In multivariate analyses, patients with synchronous radiologic extranodal extension and conglomeration (ENEcong) of metastatic lymph nodes (LNs) showed significantly poorer OS (p=0.047), PFS (p=0.001), and LC (p=0.003). In patients undergoing primary surgery, two or more clinically positive LN metastases (odds ratio [OR], 5.15; p=0.004) and LN metastases with ENEcong (OR, 3.75; p=0.009) were predictors of postoperative chemoradiotherapy. No patient in the primary RT group demonstrated late severe toxicity whereas three (2.8%), one (0.9%), and one (0.9%) patient in the surgery group showed grade 3 dysphagia, grade 3 xerostomia, and fatal oral cavity bleeding.
Conclusion
We found no differences in OS, PFS, and LC between upfront RT and surgery in stage I-II hpv+OPC which warrants comparison through a prospective trial in the treatment de-escalation era. However, most early-stage hpv+OPC patients undergoing surgery received adjuvant (CC)RT. Pretreatment LN findings were prognostic and predictive for adjuvant treatment.

Citations

Citations to this article as recorded by

Definitive radio(chemo)therapy versus upfront surgery in the treatment of HPV-related localized or locally advanced oropharyngeal squamous cell carcinoma
Jérémy Baude, Caroline Guigou, David Thibouw, Noémie Vulquin, Mireille Folia, Guillaume Constantin, Jihane Boustani, Christian Duvillard, Sylvain Ladoire, Gilles Truc, Aurélie Bertaut, Cédric Chevalier, Scott M. Langevin
PLOS ONE.2024; 19(7): e0307658. CrossRef
INFLUENCE OF CONFORMAL RADIOTHERAPY IN COMBINATION WITH RADIOMODIFIERS ON THE CONTENT OF VEGF, COX-2, AND PGE-2 IN BLOOD SERUM OF PATIENTS WITH HEAD AND NECK SQUAMOUS CELL CARCINOMA
N. MITRYAYEVA, L. GREBINYK, S. ARTIUKH, N. BILOZOR, V. STARENKIY
Experimental Oncology.2024; 46(3): 253. CrossRef
Assessment of Radiologic Extranodal Extension Using Combinatorial Analysis of Nodal Margin Breakdown and Metastatic Burden in Oropharyngeal Cancer
Sungryeal Kim, Hannah Park, Se Hyun Yeou, Jin Roh, Yoo Seob Shin, Chul-Ho Kim, Eun Ju Ha, Jeon Yeob Jang
Cancers.2023; 15(13): 3276. CrossRef
Expanding the role of combined immunochemotherapy and immunoradiotherapy in the management of head and neck cancer (Review)
Chun Wei, Xiaojun Lan, Maona Qiu, Ran Cui, Qiuxia Fu, Shafiu Umar Shinge, Tobias Muluh, Ou Jiang
Oncology Letters.2023;[Epub] CrossRef

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