Radical radiotherapy in patients with cervix uteri carcinoma: experience of Ondokuz Mayis University.

BACKGROUND: Radical radiotherapy is the standard treatment for patients with locally advanced cervix uteri carcinoma (FIGO stage IB2-IVA). Worldwide, incidence and mortality rates vary among regions because of differences in lifestyles and treatment standards. Herein, we evaluated the outcomes of radical radiotherapy in patients with locally advanced cervix uteri carcinoma from the middle Black Sea region of Turkey. METHODS: We retrospectively reviewed the records of 64 consecutive patients with locally advanced cervix uteri carcinoma who were treated from January 2013 to 2016 in our radiation oncology department. All patients staging and radiotherapy planning were performed with modern imaging techniques including magnetic resonance imaging and positron-emission-tomography/computed tomography before radical radiotherapy. Thereafter, all of them were treated with external beam radiotherapy and concurrent cis-platinum-based chemotherapy followed by three-dimensional intra-cavitary high-dose-rate brachytherapy. RESULTS: The median age at diagnosis was 54.5 years. The median follow-up period was 21 months. Acute grade 3 toxicity was detected in 3.1% of patients. Late toxicity was not detected in any patient. The 1- and 3-year progression-free survival rates were 83.6 and 67.5%, respectively. The 1- and 3-year overall survival rates were 95.7 and 76.9%, respectively. The most important prognostic factor was the FIGO stage. Distant metastasis was the most common cause of death in patients with locally advanced cervix uteri carcinoma despite radical radiotherapy. CONCLUSIONS: In patients with locally-advanced cervix uteri carcinoma from the middle Black Sea region of our developing country, acceptable toxicity and survival rates are achieved similar to the recent literature from developed countries with using of modern staging, planning and radical radiotherapy techniques. However, recurrence was mostly in the form of distant metastases and further investigations on systemic therapies are required.

Who would be the winner? A prognostic nomogram for predicting the benefit of postoperative radiotherapy ± chemotherapy in patients with locally advanced gastric cancer: TROD-02-01 study.

OBJECTIVES: We aimed to develop a basic, easily applicable nomogram to improve the survival prediction of the patients with stage II/III gastric cancer (GC) and to select the best candidate for postoperative radiotherapy (RT). METHODS: In this multicentric trial, we retrospectively evaluated the data of 1597 patients with stage II/III GC after curative gastrectomy followed by postoperative RT ± chemotherapy (CT). Patients were divided into a training set (n = 1307) and an external validation set (n = 290). Nomograms were created based on independent predictors identified by Cox regression analysis in the training set. The consistency index (C-index) and the calibration curve were used to evaluate the discriminative ability and accuracy of the nomogram. A nomogram was created based on the predictive model and the identified prognostic factors to predict 5-year cancer-specific survival (CSS) and progression-free survival (PFS). RESULTS: The multivariate Cox model recognized lymph node (LN) involvement status, lymphatic dissection (LD) width, and metastatic LN ratio as covariates associated with CSS. Depth of invasion, LN involvement status, LD width, metastatic LN ratio, and lymphovascular invasion were the factors associated with PFS. Calibration of the nomogram predicted both CSS and PFS corresponding closely with the actual results. In our validation set, discrimination was good (C-index, 0.76), and the predicted survival was within a 10% margin of ideal nomogram. CONCLUSIONS: In our relatively large cohort, we created and validated both CSS and PFS nomograms that could be useful for underdeveloped or developing countries rather than Korea and Japan, where the D2 gastrectomy is routinely performed. This could serve as a true map for oncologists who must make decisions without an experienced surgeon and a multidisciplinary tumor board.

Dosimetric Comparison of Three Different Radiotherapy Techniques in Antrum-Located Stomach Cancer

Background: The current optimal radiotherapy (RT) planning technique for stomach cancer is controversial. The design of RT for stomach cancer is difficult and differs according to tumor localization. Dosimetric and clinical studies have been performed in patients with different tumor localizations. This may be the main source of inconsistencies in study results. For this reason, we attempted to find the optimal RT technique for patients with stomach cancer in similar locations. Methods: This study was based on the computed tomography datasets of 20 patients with antrum-located stomach cancer. For each patient, treatments were designed using physical wedge-based conformal RT (WB-CRT), field-in-field intensity-modulated RT (FIF-IMRT), and dynamic intensity-modulated RT (IMRT). The techniques were compared in terms of expected target volume coverage and the dose to organs at risk (OAR) using a dose-volume histogram analysis. Results: FIF-IMRT was the most homogenous technique, with a better homogeneity index than WBCRT (p<0.001) or IMRT (p<0.001). However, IMRT had a better conformity index than WBCRT (p<0.001) or FIF-IMRT (p<0.001). Additionally, all OAR, including the kidneys, liver, and spinal cord, were better protected with IMRT than with WBCRT (p=0.023 to <0.001) or FIF-IMRT (p=0.028 to <0.001). Conclusions: In comparison to FIF-IMRT and WBCRT, IMRT appears to be the most appropriate technique for antrum-located stomach cancer. To establish whether IMRT is superior overall will require clinical studies, taking into account differences in both tumor localization (cardia, body, and antrum) and organ movement in patients with stomach cancer.