To establish prediction models to predict 2-year overall survival (OS) and stratify patients with different risks based on radiomics features extracted from magnetic resonance imaging (MRI) and computed tomography (CT) before definite chemoradiotherapy (dCRT) in locally advanced esophageal squamous cell carcinoma (ESCC). Patients with locally advanced ESCC were recruited. We extracted 547 radiomics features from MRI and CT images. The least absolute shrinkage and selection operator (LASSO) for COX algorithm was used to obtain features highly correlated with survival outcomes in the training cohort. Based on MRI, CT, and the hybrid image data, three prediction models were built. The predictive performance of the radiomics models was evaluated in the training cohort and verified in the validation cohort using AUC values. A total of 192 patients were included and randomized into the training and validation cohorts. In predicting 2-year OS, the AUCs of the CT-based model were 0.733 and 0.654 for the training and validation sets. The MRI radiomics-based model was observed with similar AUCs of 0.750 and 0.686 in the training and validation sets. The AUC values of hybrid model combining MRI and CT radiomics features in predicting 2-year OS were 0.792 and 0.715 in the training and validation cohorts. It showed significant differences in 2-year OS in the high-risk and low-risk groups divided by the best cutoff value in the hybrid radiomics-based model. The hybrid radiomics-based model demontrated the best performance of predicting 2-year OS and can differentiate the high-risk and low-risk patients.

AbstractNewly diagnosed patients with high-risk acute graft-versus-host disease (aGVHD) often experience poor clinical outcomes and low complete remission rates. Ruxolitinib with corticosteroids showed promising efficacy in improving response and failure free survival in our phase I study. This study (ClinicalTrials.gov: NCT04061876) sought to evaluate the safety and effectiveness of combining ruxolitinib (RUX, 5 mg/day) with corticosteroids (1 mg/kg/day methylprednisolone, RUX/steroids combined group) versus using methylprednisolone alone (2 mg/kg/day, steroids-only group). Newly diagnosed patients with intermediate- or high-risk aGVHD were included, with risk levels classified by either the Minnesota aGVHD Risk Score or biomarker assessment. Patients were randomized in a ratio of 1:1 into 2 groups: 99 patients received RUX combined with methylprednisolone, while the other 99 received methylprednisolone alone as the initial treatment. The RUX/steroids group showed a significantly higher overall response rate (ORR) on day 28 (92.9%) compared to the steroids-only group (70.7%, Odds Ratio [OR] = 5.8; 95% Confidence Interval [CI], 2.4–14.0; P < 0.001). Similarly, the ORR on day 56 was higher in the RUX/steroids group (85.9% vs. 46.5%; OR = 7.07; 95% CI, 3.36–15.75; P < 0.001). Additionally, the 18-month failure-free survival was significantly better in the RUX/steroids group (57.2%) compared to the steroids-only group (33.3%; Hazard Ratio = 0.46; 95% CI, 0.31–0.68; P < 0.001). Adverse events (AEs) frequencies were comparable between both groups, with the exception of fewer grade 4 AEs in the RUX/steroids group (26.3% vs. 50.5% P = 0.005). To our knowledge, this study is the first prospective, randomized controlled trial to demonstrate that adding ruxolitinib to the standard methylprednisolone regimen provides an effective and safe first-line treatment for newly diagnosed high-risk acute GVHD.

Purpose/Objective(s) We aim to evaluate dynamic survival of limited-stage small cell lung cancer (LS-SCLC) treated with intensity-modulate radiation therapy (IMRT) in the first-line chemoradiotherapy (CRT) era. Materials/Methods This retrospective cohort study reviewed 821 LS-SCLC patients who underwent chemoradiotherapy with IMRT. Conditional survival and annual hazard rates were used to evaluate the dynamic survival. The clinical prognostic factors were estimated by Cox regression proportional analysis. The corresponding conditional survival of each factor was calculated, with IPTW used to balance other confounding factors. The differences of conditional survival were evaluated by standardized differences (D value). Sensitivity analysis was also conducted. Results The median follow-up of the entire cohort was 66 months (95% CI：62.20-69.80). 3-year survival rates raised from 45.47% (95% CI: 42.1%-48.9%) at diagnosis to 93.01% (95% CI: 88.4%-97.7%) at year five for conditional overall survival and from 30.31% (95% CI: 27.2%-33.5%) to 90.71% (95% CI: 83.9%-97.5%) at year five for conditional progression-free survival. The annual hazard rates for patients reach the highest point between year 1 to year 2 for death and drop continuously for progression. Supraclavicular metastasis, smoking history, sequence of chemoradiotherapy were clinical prognostic factors at diagnosis, while the difference remained or disappeared in the follow-up for OS and PFS. Results in subgroup of patients achieved CR and PR was consistent. Conclusion In the first-line chemoradiotherapy era, the survival probability for LS-SCLC increased and progression probability decreased over time. The influence of prognostic factors at initial diagnosis may change in the long-term follow-up.

Purpose/Objective(s) Simultaneous integrated boost radiotherapy delivered a definitive dose to gross tumor volume and a decreased dose to clinical tumor volume and organ at risk. This study aimed to determine whether the simultaneous integrated boost is noninferior to conventional radiotherapy limited-stage small cell lung cancer (LS-SCLC). Materials/Methods This randomized, non-inferiority, open-label, phase 3 study was done in a single center in China. Patients aged 18–75 years who had cytologically or histologically confirmed LS-SCLC were eligible. Patients were randomly assigned (1:1) to receive conventional fractionated radiotherapy (PTV = 60 Gy/2 Gy/30 F) or Simultaneous integrated boost radiotherapy (PGTV = 60.2 Gy/2.15 Gy/28 F, and PTV = 50.4 Gy/1.8 Gy/28 F) with either concurrent or sequential EP/EC chemotherapy. Patients were randomly assigned (1:1), with block randomization (block sizes of 8) and stratified by the timing of TRT. The primary endpoint was progression-free survival, defined as time from randomization until death from any cause, analyzed by modified intention to- treat, and a 10% margin was used to establish non-inferiority (equivalent to a hazard ratio < 1.34). This trial is registered at ClinicalTrials.gov, number NCT04500145 and is currently in follow-up. Results Between February 7, 2017, and March 14, 2023, there were 321 patients who were enrolled and randomly assigned to conventional fractionated radiotherapy group (n = 163) and simultaneous integrated boost radiotherapy (n = 158). At a median follow-up of 56 months (95% CI = 52.18-59.81), median progression-free survival was 16 months (95% CI = 11-27) in the conventional fractionated radiotherapy group versus 16 months (95% CI = 10-21) in the simultaneous integrated boost radiotherapy group (hazard ratio for progression in SIB group 1.00 [95% CI = 0.77-1.30]; P = 0.97). The 2-year progression-free survival was 42.7% and 38.1% (absolute difference -1.2%, 95% CI = -8.8% to 11.2%; P = 0.01 for non-inferiority). The incidence of 3-4 acute radiation pneumonitis in the groups were 7.6% and 2.4%, respectively (P = 0.030), with no significant difference in other acute toxicities. In the dose parameters, a decreased V20 (median = 22.81 Gy vs 21.00 Gy) and D-mean (median = 13.37 Gy vs 12.06 Gy) of lungs in SIB group was observed (Both P < 0.001). Conclusion Simultaneous integrated boost radiotherapy was non-inferior to conventional fractionated radiotherapy in treatment efficacy and results in less 3-4 acute radiation pneumonitis, which might associate with decreased lung dose. Our findings suggest that simultaneous integrated boost radiotherapy could be considered as standard of care.

Objective:To analyze the treatment efficacy, safety and dose parameters of optimized hippocampus-avoidance prophylactic cranial irradiation (HA-PCI) in limited-stage small cell lung cancer (LS-SCLC) and explore the corresponding dosimetric parameters under the condition of narrowing the hippocampus avoidance region as hippocampus region plus 2 mm in three dimensions.Methods:Clinical data of patients with LS-SCLC receiving HA-PCI (hippocampus avoidance region defined as hippocampus region plus 2 mm in three dimensions) in Cancer Hospital Chinese Academy of Medical Sciences from August 2014 to June 2020 were retrospectively analyzed. Dose parameters of HA-PCI and adverse events were analyzed using descriptive statistics analysis. Changes of neurocognitive function, such as mini-mental state examination (MMSE) and Hopkins verbal learning test-revised (HVLT-R) scores, were evaluated by analysis of variance and Kruskal-Wallis H test. Overall survival (OS), progression-free survival (PFS) and intracranial PFS (iPFS) were calculated using Kaplan-Meier method. The cumulative incidence of local-regional recurrence (LRR), extracranial distant metastases (EDM), and locoregional recurrence (LR) were investigated under competing risk analysis. Results:A total of 112 patients were included, the median follow-up time was 50 months (95% CI: 45.61-54.38). The median volume of hippocampus was 4.85 ml (range: 2.65-8.34 ml), with the average dose ≤9 Gy in 106 patients (94.6%), ≤8 Gy in 92 patients (82.1%). The median volume of hippocampus avoidance area was 15.00 ml (range: 8.61-28.06 ml), with the average dose ≤12 Gy in 109 patients (97.3%), ≤10 Gy in 101 patients (90.2%). The 2-year cumulative LRR, EDM, LR rates were 16.9%, 23.2% and 28.5%, respectively. The 5-year cumulative LRR, EDM, LR rates were 23.2%, 26.9% and 33.3%, respectively. The 2-year iPFS, PFS and OS rates were 66.1% (95% CI: 57.9%-75.4%), 53.6% (95% CI: 45.1%-63.7%) and 80.4% (95% CI: 73.3%-88.1%), respectively. The most common grade I-Ⅱ adverse events were nausea (33.9%) and dizziness (31.3%), and only 1 patient developed grade Ⅲ nausea and dizziness. MMSE ( n=57) and HVLT-R tests ( n=56) showed no significant decline. Conclusions:Optimized HA-PCI can achieve similar dose limitation with favorable efficacy and light toxicity. No significant decline is observed in short-term neurocognitive function in evaluable patients.

Purpose/Objective(s) We aimed to investigate the timing of once-daily thoracic radiotherapy (TTRT) in patients with limited-stage small cell lung cancer (LS-SCLC) in the first-line concurrent chemoradiotherapy era. Materials/Methods A total of 445 patients with LS-SCLC receiving concurrent chemoradiotherapy were reviewed. Nonlinear analysis by restricted cubic splines was used to determine the relationship between timing of TRT (TTRT) and PFS or OS. OS and PFS in different TTRT groups were compared using log-rank tests and multivariable analyses. The cumulative incidence of locoregional recurrence (LRR), brain metastases (BM), and extracranial distant metastases (EDM) were investigated using competing risk analyses. Adverse events were also compared. Results The median duration of follow-up was 64 months. There was a non-linear relationship between TTRT and PFS (P = 0.002) or OS (P < 0.001). When TRT started from 31 days to 63 days, improved 5-year PFS (37.0%; P = 0.001) and OS (49.7%; P < 0.001) and decreased 5-year EDM (27.9%; P = 0.009) were achieved compared with the ≤30-day group (19.5%; 32.0%; 43.3%) and >63-day group (23.7%; 24.2%; 43.5%). However, no significant difference in overall survival was observed in groups divided by actual chemotherapy cycle. A downward trend was seen in the incidence of myelosuppression of grade 3–4 in different TTRT groups (P = 0.04). Conclusion Appropriate treatment timing window might exist in once-daily TRT with concurrent chemotherapy. Delaying in combination of TRT and prescribed chemotherapy cycle may impair the survival outcomes.

EDRIC was an independent prognostic factor for survival. Higher doses of radiation to the immune system were associated with tumor progression and death after the PORT of NSCLC. The organ at risk for the immune system should be considered during radiotherapy planning.

GTV contouring variability was seen between T1c, T2f and T2 sequences. The coincidence of T1+c and T2f was better than T1+c and T2 in BMs. Since reductions in volume and changes of lesion center was observed during HFRT, the use of MR-guided radiation therapy (RT) and treatment adaptation is needed. The optimal timing for treatment plan modification might be when the course of treatment reaches 2/3 for most large BMs. Further research to find out patients who may benefit form MR-guided adaptive RT is ongoing.

TRT is well-tolerated and effective for selected ES-SCLC patients in the modern era of immunotherapy. Prospective trials are still needed to further evaluate the combination of TRT and immunotherapy for patients with ES-SCLC.

Objective: To compare the incidence of radiation-related toxicities between conventional and hypofractionated intensity-modulated radiation therapy (IMRT) for limited-stage small cell lung cancer (SCLC), and to explore the risk factors of hypofractionated radiotherapy-induced toxicities. Methods: Data were retrospectively collected from consecutive limited-stage SCLC patients treated with definitive concurrent chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2022. The enrolled patients were divided into two groups according to radiation fractionated regimens. Common Terminology Criteria for Adverse Events (CTCAE, version 5.0) was used to evaluate the grade of radiation esophagus injuries and lung injuries. Logistic regression analyses were used to identify factors associated with radiation-related toxicities in the hypofractionated radiotherapy group. Results: Among 211 enrolled patients, 108 cases underwent conventional IMRT and 103 patients received hypofractionated IMRT. The cumulative incidences of acute esophagitis grade ≥2 [38.9% (42/108) vs 35.0% (36/103), P=0.895] and grade ≥ 3 [1.9% (2/108) vs 5.8% (6/103), P=0.132] were similar between conventional and hypofractionated IMRT group. Late esophagus injuries grade ≥2 occurred in one patient in either group. No differences in the cumulative incidence of acute pneumonitis grade ≥2[12.0% (13/108) vs 5.8% (6/103), P=0.172] and late lung injuries grade ≥2[5.6% (6/108) vs 10.7% (11/103), P=0.277] were observed. There was no grade ≥3 lung injuries occurred in either group. Using multiple regression analysis, mean esophageal dose ≥13 Gy (OR=3.33, 95% CI: 1.23-9.01, P=0.018) and the overlapping volume between planning target volume (PTV) and esophageal ≥8 cm(3)(OR=3.99, 95% CI: 1.24-12.79, P=0.020) were identified as the independent risk factors associated with acute esophagitis grade ≥2 in the hypofractionated radiotherapy group. Acute pneumonitis grade ≥2 was correlated with presence of chronic obstructive pulmonary disease (COPD, P=0.025). Late lung injuries grade ≥2 was correlated with tumor location(P=0.036). Conclusions: Hypofractionated IMRT are tolerated with manageable toxicities for limited-stage SCLC patients treated with IMRT. Mean esophageal dose and the overlapping volume between PTV and esophageal are independently predictive factors of acute esophagitis grade ≥2, and COPD and tumor location are valuable factors of lung injuries for limited-stage SCLC patients receiving hyofractionated radiotherapy. Prospective studies are needed to confirm these results.

PORT significantly improved the DFS and LRFS in patients with N2a2 and significantly improved the DFS, LRFS, and OS in patients with N2b. Patients with N2a1 could not benefit from PORT.

This randomized trial did not find a higher probability of survival improvement in patients with ES-SCLC receiving cTRT of 45 Gy in 15 fractions compared with 30 Gy in 10 fractions. In contrast, there was an increase in toxicity, especially radiation pneumonitis. Additional randomized studies investigating the role of cTRT in ES-SCLC after a response to chemoimmunotherapy are warranted.

Purpose/Objective(s)Previous studies showed that prophylactic cranial irradiation (PCI) reduced brain metastases and improved overall survival of patients with limited-stage small-cell lung cancer (LS-SCLC). However, brain magnetic resonance imaging (MRI), currently recognized as the preferred modality for brain metastases detection, was not routinely used for staging and reassessment in previous trials. This retrospective study aimed to reevaluate the role of PCI for LS-SCLC patients in the modern MRI era.Materials/MethodsWe retrospectively reviewed LS-SCLC patients treated with definitive chemoradiotherapy (≥4 cycles of chemotherapy and thoracic intensity-modulated radiotherapy [IMRT]) between 2006 and 2014 in our center. Patients who responded to initial therapy were included and subsequently reassessed for brain metastases by MRI. The cumulative incidence of brain metastases was estimated using the Fine-Grey competing risks regression model. The overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox proportional hazards model.ResultsWe enrolled 177 patients in this study, of which 79 were treated by PCI and 98 were not (non-PCI). The median follow-up was 76.0 months (95% confidence interval, 71.2-80.8 months). All patients achieved complete response (n = 50, 28.2%) or partial response (n = 127, 71.8%) to initial chemoradiotherapy. The cumulative incidence of brain metastases in the PCI group was lower than in the non-PCI group (6.6% vs. 30.0% at 2 years, 12.2% vs. 31.0% at 5 years, P = 0.004). 5-year PFS in the PCI group was significantly higher than in the non-PCI group (45.3% vs. 26.5%, P = 0.002). However, 5-year OS of 48.8% and 39.2% in the PCI and non-PCI groups, respectively, were similar (P = 0.255). In the multivariate analysis, treatment response (P<0.001) and PCI (P = 0.038) were independent prognostic factors for PFS. Stratification analysis revealed that PCI did not improve 5-year PFS for patients with partial response to initial therapy (26.6% vs. 19.7%, P = 0.234).ConclusionIn the Modern Era with MRI Surveillance, PCI is associated with a lower incidence of brain metastases and improved PFS while OS benefit wasn't observed. Patients achieving partial response to initial therapy did not gain PFS benefit from PCI. Prospective trials are still needed to further evaluate the utility of PCI for patients with LS-SCLC.

Purpose/Objective(s) Accounting for 13-15% of lung cancer, small cell lung cancer (SCLC) is typically characterized by more extensive local invasion and more frequent metastases compared with other subtypes. Although SCLC is sensitive to chemoradiotherapy, 25% of the patients with limited stage SCLC would meet local regional relapse. Although thoracic radiation had significantly improved local control, primary tumor recurrence is common in clinic. So far, we had little acquaintance of the local relapse details to help us to make progress in the thoracic radiation. To investigate the patterns of patients with local regional recurrence and the prognosis of primary tumor recurrence, we proposed this study. Materials/Methods We searched patients with pathological diagnosis of SCLC, with disease of limited stage, received systemic chemotherapy and thoracic intensity modulate radiotherapy at our center with available follow-up records between August 1st, 2006 and May 31st,2014. Patients with intrapulmonary recurrence or regional lymph nodes recurrence by the last follow up time, without diffused lung metastasis were selected. All the patients received involved field thoracic radiotherapy with dose of 2Gy per fraction per day. Data regarding patient demographics and treatments. The first local recurrent sites were recorded. Local regional relapse time was calculated from the first day of the treatment delivery to the diagnosis of primary tumor or regional lymph nodes. Overall survival was calculated from the first day of the diagnosis of local relapse to the death using Kaplan Meir Method. Results We identified 482 patients with a diagnosis of limited stage SCLC. Among these, 125 patients fulfilled the eligibility criteria. The median dose of radiotherapy is 60Gy. The median local relapse time was 12.97 months. Primary tumor recurrence, ipsilateral hilar and/or mediastinal lymph node recurrence, contralateral hilar and/or lymph node recurrence, and supraclavicular lymph node recurrence, were observed in 92 patients (73.6%), 49 patients (39.2%), 1 patient (0.8%) and 13 patients (10.4%), respectively. There were 26 patients with multisite local recurrence. Out-field relapse was observed in 6 patients (4.8%). The median follows up time was 34.7 months. After second line therapies, the median survival time for these patients diagnosed as recurrent disease was 10.5 months. Of the 92 patients with primary tumor recurrence, 25 patient received re-radiation and 39 patients also met distant metastasis. Median survival time of patients with primary tumor recurrence is slightly shorter than the others (9.9months vs. 12.0months). Conclusion For patients with limited stage SCLC who received chemoradiotherapy, primary tumor recurrence is still the leading course in local regional relapses and accompanied by worse survival. Accordingly, simultaneous integrated boost might be taken into consideration to primary tumor. Involved field radiation is reasonable with low out-field local recurrence.

Purpose/Objective(s) The optimal role of radiotherapy (PORT) after complete thymectomy for thymoma remains controversial. We investigate the role of postoperative radiotherapy in the complete resection of Masaoka-Koga stage Ⅱ/Ⅲ thymoma with precision radiotherapy techniques. Materials/Methods From January 2000 to December 2017, patients with Masaoka-Koga stage Ⅱ/Ⅲ thymoma who underwent complete resection or complete surgical resection and underwent radiotherapy with precision techniques were included and analyzed. Clinical, pathological, therapeutic and follow-up information was collected. Kaplan-Meier estimates of overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS), and univariate and multivariate Cox proportional hazards regression analyses were performed. Results A total of 244 patients met the selection criteria, 142 (58.1%) of whom were received PORT. Of these, 172 (70.5%) patients with stage Ⅱ thymoma, 72 patients (29.5%) with stage Ⅲ. The median follow-up was 76 months. The 5-year and 10-year OS in the surgical and PORT groups were 93.8% vs 95.4% and 83.6% vs 86.9%, respectively (p=0.34), while the DSS was 93.8% vs 99.0% and 86.3% vs 93.9%, respectively (p=0.038), and the DFS was 85.0% vs 76.9% and 75.9% vs 65.5%, respectively (p=0.65). In stage Ⅲ patients,5-year and 10-year OS was 83.0% vs 95.8%, 54.4% vs 84.4% (HR 0.31, p=0.038) and DSS was 83.0% vs 97.6%, 54.4% vs 91.8% (HR 0.14, p=0.002) for surgery alone vs the PORT group. On multivariate analysis, stage Ⅲ was associated with poorer OS (HR 2.36, p=0.045) and DSS (HR 3.61, p=0.020), and PORT were associated with better DSS (HR=0.26, p=0.012). Conclusion Masaoka-Koga stage Ⅱ/Ⅲ thymoma complete resection after radiotherapy with precision radiotherapy techniques resulted in improved DSS but not significant improvement in OS and DFS; Subgroup analysis showed a more pronounced benefit of PORT in stage Ⅲ patients, with benefits in DSS and OS, suggesting that postoperative radiotherapy can be beneficial in more advanced thymoma.

MoS2 has attracted considerable attention owing to its unusual and intriguing potential applications in optoelectronic devices. In this study, the absorption properties of a simple one-dimensional (1D) layered structure composed of monolayer MoS2 are analyzed by transfer matrix method. The dielectric permittivity of monolayer MoS2 is employed using the Lorentz model. The influences contributed to the period of the structure and the incident angle are numerically investigated. Our results indicate that a tunable multi-band (broadband) absorber can be achieved by using such a 1D layered structure. A multi-band (broadband) absorption phenomenon can be obtained by increasing the period of the structure. Furthermore, the absorption peaks and broadband absorptance spectra have blue-shifted as the incident angle increases.

Purpose/Objective(s) Recently published phase III trials showed that postoperative radiotherapy (PORT) did not improve the survival of patients with pN2 non-small-cell lung cancer (NSCLC) after complete resection. However, the effect of PORT for pN2 NSCLC with different EGFR status remains unclear. Materials/Methods From 2010 to 2019, consecutive patients with pN2 NSCLC after complete resection and adjuvant chemotherapy who had detection of EGFR status were retrospectively analyzed. PORT was administered using IMRT at 2 Gy per fraction up to 50 Gy over 5 weeks. Patients were categorized into 4 groups according to EGFR status and treatment: Group 1 (EGFR wild type with PORT), Group 2 (EGFR wild type without PORT), Group3 (EGFR-mutated with PORT), Group 4 (EGFR-mutated without PORT). The Kaplan-Meier method and log-rank test were used to evaluate the disease-free survival (DFS), overall survival (OS), locoregional relapse free survival (LRFS), and distant metastasis free survival (DMFS). Results Totally 575 patients were enrolled. 264 patients (45.9%) were EGFR wild type, including 96 with PORT and 168 without PORT. 311 patients (54.1%) were EGFR-mutated, including 109 with PORT and 202 without PORT. The median DFS was 28.4 months in Group 1 and 17.3 months in Group 2 (HR 0.70, 95% CI 0.52-0.96, p=0.032). The median OS was not reached in Group 1 and Group 2 (HR 0.75, 95%CI 0.46-1.21, p=0.263). LRFS was statistically higher in Group 1 than Group 2 (HR 0.64, 95%CI 0.43-0.96, p=0.041). However, no significant difference was shown in DMFS (HR 0.75, 95%CI 0.54-1.04, P=0.097). Group 3 and Group 4 showed median DFS of 20.2 months and 25.7 months (HR 1.113, 95% CI 0.84-1.53, p=0.402), respectively. The median OS was not reached in either Group 3 or Group 4 (HR 0.64, 95% CI 0.33-1.21, p=0.201). LRFS was not significantly different (HR 0.83, 95% CI 0.53-1.31, p=0.45) in Group3 vs Group4, neither was DMFS (HR 1.15, 95%CI 0.85-1.57, p=0.73). Conclusion For completely resected pN2 NSCLC, PORT can improve DFS and LRFS in EGFR wild type patients. However, PORT may not prolong survival in EGFR-mutated patients. Prospective randomized clinical trials are needed for validation.

Purpose/Objective(s) There has been a steady increase in the incidence of esophageal squamous cell carcinoma (ESCC) among elderly patients. The optimal treatment approach of elderly ESCC patients was still vague. Materials/Methods Between March 2017 and April 2020, 339 patients were screened in 10 centers in China; 184 and 146 patients were randomized into the S-1 based chemoradiotherapy followed by S-1 monotherapy (CRT-CT arm) or radiotherapy alone (RT arm). CRT-CT arm consisted simultaneous integrated boost radiotherapy (SIB-RT) (dose, 59.92 Gy/50.4 Gy) in 28 daily fractions administered using intensity-modulated radiotherapy or volumetric modulated arc therapy. S-1 was orally administered (40–60 mg/m2) concurrently with radiotherapy and 4–8 weeks later, for up to four 3-week cycles at the same dose. RT arm performed SIB-RT alone with the same radiotherapy dose. The primary endpoint was overall survival (OS) of the intention-to-treat (ITT) population. Results In the ITT population, 63.9% and 24.8% had T3 and T4 stage disease, and 68.8% had nodal metastases. The median OS was 27.8 months in the CRT-CT arm and 20.8 months in the RT arm and the OS rates were 72.5% vs 62.8% at 1 year; 55.2% vs 43.7% at 2 years; 45.5% vs 33.7% at 3 years ((hazard ratio, 0.75; 95% CI, 0.56–0.99; P = 0.041). The median PFS was 19.5 months in the CRT-CT arm and 11.5 months in the RT arm. Time dependent cox regression model revealed Charlson comorbidity index, BMI and cumulative chemotherapy cycles were independent prognostic factors associated with OS. OS and PFS of patients treated with 5–6 cycles of chemotherapy were superior to those of the patients treated with 0 (treated with radiotherapy alone), 1–2 and 3–4 cycles. There was no significant increase in the incidence of toxicities higher than grade 3 in the CRT-CT arm. Grades 4 and 5 toxicities were reported in 2.8% and 2.8%, respectively, of the CRT-CT arm compared with 0% and 4.2%, respectively, of the RT arm Conclusion Oral S-1 chemotherapy administered with SIB-RT is highly recommended for elderly patients with inoperable ESCC as an alternative treatment modality that improves survival outcomes with a more favorable side-effects profile.

Objective:Simultaneous integrated boost radiation technique in limited-stage small cell lung cancer is lack of evidence. This prospective study aims to evaluate whether the simultaneous integrated boost is as efficacious and safe as conventional fractionated radiotherapy.Methods:Patients diagnosed with treatment-naive and confirmed limited-stage SCLC were eligible. Participants were randomly assigned (1: 1) to receive simultaneous integrated boost radiotherapy (PGTV 60.2 Gy/2.15 Gy/28F, PTV 50.4 Gy/1.8 Gy/28F) or conventional fractionated radiotherapy (PTV 60 Gy/2 Gy/30F). The primary endpoint was 2-year progression-free survival, and the secondary endpoints were 2-year overall survival, 2-year local-regional recurrence-free survival and toxicity.Results:Between February 2017 and July 2019, 231 patients were enrolled. We analyzed 216 patients whose follow-up time was more than 2 years or who had died, among whom 106 patients in the conventional fractionated radiotherapy group and 110 patients in the simultaneous integrated boost radiotherapy group. The median follow-up time was 37 months (95% CI: 35.2-38.7). The 2-year progression-free survival rates were 45.2% vs. 38.2%( HR=1.22, 95% CI: 0.87-1.72, P=0.2). The 2-year overall survival rates were 73.5% vs. 60.9%( HR=1.35, 95% CI: 0.90-2.04, P=0.14). The 2-year local-regional recurrence-free survival rates were 68.7% vs. 69.9%( HR=0.98, 95% CI: 0.62-1.56, P=1.0). Multivariate analysis showed that early radiotherapy yielded better 2-year progression-free survival, overall survival and local-regional recurrence-free survival than delayed radiotherapy in two groups ( HR=1.69, 95% CI: 1.18-2.41, P=0.003; HR=1.72, 95% CI: 1.09-2.70, P=0.018; HR=1.66, 95% CI: 1.01-2.73, P=0.046). Tumor staging was an influencing factor of overall survival (stage Ⅲ vs. stage Ⅰ-Ⅱ, HR=3.64, 95% CI: 1.15-11.57, P=0.028). The most common grade 3-4 adverse events were myelosuppression (21.7% vs. 15.4%, P=0.83), radiation pneumonitis (4.7% vs. 2.7%, P=0.44) and radiation esophagitis (3.8% vs. 1.8%, P=0.51). Conclusions:Simultaneous integrated boost radiotherapy yields equivalent efficacy and toxicities to conventional fractionated radiotherapy for limited-stage small cell lung cancer. Early radiotherapy can enhance clinical prognosis.