Evaluation of treatment outcomes and tolerability in older patients with rectal cancer treated with radiotherapy accompanied by the G-8 geriatric score: TROD13-003 multicenter study.

INTRODUCTION: The choice of treatment for rectal cancer often differs in older and younger patients, with the rate of radiotherapy use lower among older adults. In our daily practice, when evaluating a frail older patient with rectal cancer, we usually choose to give less treatment. This may be due to concern that the patient will not be able to tolerate radiotherapy. The Geriatric 8 score (G8GS) is a guide to evaluating treatment tolerability as it relates to frailty in older adults with cancer. The aim of this study was to evaluate treatment outcomes and tolerability in older patients with rectal cancer treated with radiotherapy (RT) accompanied by G8GS. MATERIALS AND METHODS: Patients aged 65 and older with stage I-III rectal adenocarcinoma who were treated with RT and had a G8 evaluation were included in this multicenter retrospective study. Prognostic factors related to G8GS were calculated using Chi-square and logistic regression tests and survival rates were calculated by the Kaplan-Meier test using the SPSS v24.0 software. All p-values ≤0.05 were considered statistically significant. RESULTS: A total of 699 patients from 16 national institutions were evaluated. The median age was 72 years (range 65-96), and the median follow-up was 43 (range 1-190) months. Four hundred and fifty patients (64%) were categorized as frail with G8GS ≤14 points. Frail patients had higher ages (p = 0.001) and more comorbidities (p = 0.001). Ability to receive concomitant and/or adjuvant chemotherapy rates were significantly higher in fit patients (p = 0.002 and p = 0.001, respectively). No significant difference was observed in terms of grade 3-4 early and late toxicity for both groups. Cancer-related death was higher (p = 0.003), and 5- and 8-year survival rates were significantly lower (p = 0.001), in the frail group. Age and being frail were significantly associated with survival. DISCUSSION: Radiotherapy is a tolerable and effective treatment option for older adults with rectal cancer even with low G8GS. Being in the frail group according to G8GS and having multiple comorbidities was negatively associated with survival. Addressing the medical needs of frail patients through a comprehensive geriatric assessment prior to radiotherapy may improve G8GS, allowing for standard treatment and increased survival rates.

The importance of mesorectum motion in determining PTV margins in rectal cancer patients treated with neoadjuvant radiotherapy.

New precision radiotherapy (RT) techniques reduce the uncertainties in localizing soft and moving tumors. However, there are still many uncontrollable internal organ movements. In our study, patients who underwent neoadjuvant chemoradiotherapy (NA-CRT) for rectal cancer were evaluated to determine inter-fraction mesorectum motion and dosimetric changes. Fourteen patients treated with NA-CRT for rectal cancer between 2014 and 2016 were included in the analysis. The mesorectum and clinical target volume (CTV) were delineated on planning computed tomography (CT) and cone-beam CT (CB-CT) scans. After planning with a volumetric modulated arc therapy (VMAT) plan, re-planning was performed on all CB-CTs. Finally, the volumetric and dosimetric changes of PTV and mesorectum were evaluated in all CB-CTs compared with the initial CT and VMAT plans. The geometrical center of mesorectum volume in CB-CTs had moved 1 (0.2-6.6), 1.6 (0.2-3.8) and 1.6 (0-4.9) mm in the x, y and z-axis respectively compared with the initial CT. The dosimetric parameters of PTV including D2, D95 and D98 on CB-CT showed a median 47.19 (46.70-47.80), 45.05 (44.18-45.68) and 44.69 (43.83-45.48) Gy and median 1% (1-2), 0% (0-2) and 1% (0-2) dosimetric change compared with the initial VMAT plan. In our study, we have shown that the mesorectum has moved up to 20 mm in the lateral and anterior-posterior direction and almost 10 mm in the superior/inferior direction during RT, causing a median of ~2% change in dosimetric parameters. Therefore, these movements must be considered in determining PTV margins to avoid dosimetric changes.

Outcome of Early-Stage Glottic Laryngeal Carcinoma Patients Treated with Radical Radiotherapy Using Different Techniques.

PURPOSE: The aim was to evaluate the treatment outcomes and prognostic characteristics of patients with early-stage glottic laryngeal carcinoma who underwent radical radiotherapy (RT) with different techniques. PATIENTS AND METHODS: Radiotherapy was applied using the 2D conventional technique between 1991 and 2004 (130 patients), 3DCRT until 2014 (125 patients), and by VMAT until January 2017 (44 patients). Clinical T stages were 38 (12.7%) for Tis, 209 (69.9%) for T1, and 52 (17.4%) for T2. Radiotherapy technique and energy, anterior commissure involvement, and stage were analyzed as prognostic factors. RESULTS: The median total dose was 66 (50-70) Gy, and median follow-up time was 72 (3-288) months; 5-year disease-specific survival (DSS) rates were 95.8%, 95.5%, and 88.6%, respectively, in Tis, T1, and T2 stages. In multivariate analyses, anterior commissure involvement was found significant for all survival and local control rates. The patients treated with VMAT technique had better local control and DSS rates. However, these results were not statistically significant. CONCLUSION: In early-stage laryngeal carcinomas, radical RT is a function sparing and effective treatment modality, regardless of treatment techniques.

Treatment outcomes of prostate cancer patients with Gleason score 8-10 treated with definitive radiotherapy : TROD 09-001 multi-institutional study.

PURPOSE: To validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8-10 disease treated with external beam radiotherapy (EBRT) + androgen deprivation therapy (ADT) in the modern era. METHODS: Institutional databases of biopsy proven 641 patients with GS 8-10 PCa treated between 2000 and 2015 were collected from 11 institutions. In this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. The inclusion criteria were, T1-T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70 Gy total irradiation dose to prostate ± seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT. RESULTS: The median follow-up time was 5.9 years (range 0.4-18.2 years); 5­year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (≥78 Gy) and longer ADT duration (≥2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9-10. CONCLUSIONS: Our results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9-10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving 'non-optimal treatment' (RT doses <78 Gy and ADT period <2 years) had the worst treatment outcomes.

Tumor deposits in salivary gland tumors.

Tumor deposits (TDs), identified in different types of carcinomas are associated with poor prognosis. Salivary gland tumors were evaluated for the first time for TDs in this series. Pathological and clinical features of 25 salivary gland carcinomas primarily treated surgically including neck dissection were determined and all cases were evaluated for TDs in dissection specimens. Seven patients (28%) had TDs. There was no difference for TDs when histological type, tumor grade, tumor localization, pT, pN stage, surgical margin, lymphovascular, perineural invasion, local recurrence, distant metastatic disease and overall survival were considered. Disease-free survival rates at 12 and 24 months were 52.5%, 28.6% and 73.3%, 57.1%, for cases with and without TDs (P = 0.463). Overall survival rates at 12 and 24 months for these groups were 85.7% and 57.1 versus 86.7% and 66.7% respectively (P = 0.916). Mean estimated recurrence-free survival time for all cases, TD negative and TD positive cases were: 171.86, 182.72 and 82.42 months, respectively. Mean estimated overall survival time for these groups were 175.80, 186.489 and 89.70 months, respectively. TDs were described in salivary gland tumors for the first time in this series and seem to be associated with poor prognosis requiring further evaluation in larger series.

Tumor deposits in head and neck carcinomas.

BACKGROUND: Tumor deposits, nodules in the peritumoral adipose tissue with no architectural residue of lymph node, have previously been described in colorectal adenocarcinomas. To date, however, there has been no examination of tumor deposits in head and neck squamous cell carcinoma (HNSCC). METHODS: Neck dissection specimens of 140 patients with HNSCC were reevaluated for tumor deposits. RESULTS: Tumor deposits were detected in 24 cases (17%). Cases with tumor deposits had more lymphatic invasion (p = .007), higher pathological N classification (p = .00), and more frequently showed distant metastasis (p = .003). Disease-free and overall survival were significantly shorter for tumor deposit positive cases (p = .016 and p = .005, respectively). Only tumor deposits were significant for overall survival. Tumor deposits increased the risk of recurrent disease 2294 times. Tumor deposits and pericapsular invasion were identified as independent prognostic markers; tumor deposits increased the risk of death from disease 3.4 times, whereas pericapsular invasion was associated with a 2.2-fold increase in the risk of death. CONCLUSION: These results highlight the existence of tumor deposits in neck dissection specimens of HNSCC and their association with poor prognosis. © 2015 Wiley Periodicals, Inc. Head Neck 38: E256-E260, 2016.

Pediatric laryngeal cancer with 5-year follow up: case report.

Larynx cancer is the commonest malignancy of upper aerodigestive tract. However, laryngeal cancer is extremely rare in childhood since these tumors are generally not suspected in the differential diagnosis of hoarseness, dysphagia and/or progressive airway obstruction in children; diagnosis can be made relatively late. In this report we would like to present a case of advanced stage pediatric laryngeal carcinoma who was treated with chemoradiotherapy and remained well on her 5-year follow-up.

Mature results of neoadjuvant chemotherapy followed by radiotherapy in nasopharyngeal cancer: is it really old fashioned?

Nasopharyngeal carcinoma (NPC) is known as a radiosensitive and chemosensitive tumor. The interest in neoadjuvant chemotherapy (NACT) has been refreshed in recent years due to promising results with more effective chemotherapeutic agents in head and neck tumors. The aim of this retrospective study is to evaluate the long-term toxicity and efficacy of NACT followed by radiotherapy (RT). From January 1995 to December 2002, 73 NPC patients were consecutively treated at Ege University Medical School Department of Radiation Oncology and the results were analyzed retrospectively. The NACT consisted of cisplatin 100 mg/m(2)/day and epirubicine 100 mg/m(2)/day, every 3 weeks. External radiotherapy by conventional fractionation was delivered 3 weeks after NACT. Response evaluated after NACT followed by radiotherapy showed 75% complete response (CR) rate. After a median follow-up time of 74 months, 32 relapses were noted. Most of the local failures were observed in 2 years (median 17 months) and the most common site for distant failure was bone. A total of 27 deaths had occurred due to uncontrolled disease. Xerostomia, soft tissue fibrosis and loss of sensorineural hearing were the most common long-term side effects. Only one treatment related death was observed and this patient died due to temporal lobe necrosis 22 months after the radiotherapy. The 5-year disease-free, distant metastasis-free and overall survival rates were 58, 77 and 68%, respectively. Current study showed that NACT with cisplatin and epirubicine followed by radiotherapy provided promising results with low toxicity in NPC patients.