The objective was to evaluate the survival outcomes associated with radiation therapy (RT) in cases of postoperative locoregional recurrence of upper tract urothelial carcinoma (UTUC) following radical nephroureterectomy (RNU). A total of 30 patients undergoing RT for local or regional recurrence of UTUC after RNU from 2002 to 2017 were enrolled. The median follow-up time for patients who survived was 5.9 years. The application of RT comprised two intents: (1) salvage RT for patients who did not respond to chemotherapy or who did not receive chemotherapy, and (2) consolidation RT for patients who showed complete or partial response to chemotherapy. Overall survival (OS) since recurrence, locoregional progression-free survival (LRPFS) after RT, and distant metastasis-free survival (DMFS) after RT were evaluated. Univariate Cox regression analysis was applied. The median OS since recurrence was 40.0 months, and the 5-year OS, LRPFS, and DMFS rates were 46.6

OBJECTIVES:In patients undergoing a radical hysterectomy, uterine corpus invasion worsens cervical cancer prognosis. However, the prognostic role of the invasion in locally advanced stages remains elusive. Due to the inadequacy of typical corpus biopsies, corpus invasion is diagnosed using magnetic resonance imaging (MRI). In this study, we investigated the prognostic role of MRI-detected uterine corpus invasion in patients undergoing radiotherapy for cervical cancer. METHODS:This retrospective analysis involved 259 patients without extrapelvic metastases, diagnosed with FIGO 2009 stages IB-IVA cervical carcinoma from January 2011 to December 2020. The corpus invasion extent was classified as exocervical-confined (group 1), endocervical (group 2), or uterine corpus invasion (group 3). The rates of overall survival, cancer-specific survival, locoregional recurrence, para-aortic lymph node recurrence, and extrapelvic metastases after pelvic radiotherapy were analyzed. Kaplan-Meier and Cox regression analyses were used to determine recurrence-associated risks. Optimal risk stratification was predicted using a receiver operating characteristic curve with the area under the curve. RESULTS:Groups 1, 2, and 3 included 66.0%, 18.9%, and 15.1% of patients, respectively. The 5-year para-aortic lymph node recurrence rates were 6.3%, 17.2%, and 34.2% (p < 0.001). Uterine corpus invasion was an independent factor for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence. Including uterine corpus invasion in the risk stratification led to higher areas under the curve for overall survival, cancer-specific survival, locoregional recurrence, extrapelvic metastases, and para-aortic lymph node recurrence than using single parameters. CONCLUSIONS:In cervical cancer, following pelvic radiotherapy, uterine corpus invasion is a significant prognostic factor. More-aggressive treatments such as extended-field radiotherapy, adjuvant chemotherapy, and immune checkpoint inhibitors as an alternative to standard pelvic radiotherapy with concurrent chemotherapy may be considered in these patients.

Outcomes and prognostic factors among patients with brain metastases (BM) have been widely studied, but seldom for the non-elderly. Heart rate variability (HRV) is a physiological phenomenon and has been shown as a survival prognostic factor in cancer patients. This study aimed to evaluate the outcomes and prognosis among non-elderly BM patients with the incorporation of HRV analysis. Forty non-elderly BM patients treated using whole brain radiotherapy (WBRT) were studied from January 2010 prospectively with 5-min electrocardiography (ECG) recordings. Individualized HRV was generated by the ECG, and the time domain HRV index SDNN was chosen for survival analysis. The median overall survival (OS) for the entire group was 6.21 months. Univariate analysis revealed that a KPS < 80 (p = 0.019) and an SDNN < 10 ms (p = 0.007) demonstrated statistical significance for OS; multivariate analysis confirmed that a KPS < 80 (p = 0.004; HR = 3.060, CI = 1.437–6.517) and an SDNN < 10 ms (p = 0.010; HR = 2.664, CI = 1.262–5.624) were independent prognostic factors. Prospective studies for risk stratification among non-elderly BM patients based on our results are warranted to validate our findings.

Purpose: To develop a multivariable normal tissue complication probability (NTCP) model to predict moderate to severe late rectal bleeding following intensity-modulated radiation therapy (IMRT). Methods and materials: Sixty-eight patients with localized prostate cancer treated by IMRT from 2008 to 2011 were enrolled. The median follow-up time was 56 months. According to the criteria of D'Amico risk classifications, there were 9, 20 and 39 patients in low, intermediate and high-risk groups, respectively. Forty-two patients were combined with androgen deprivation therapy. Fifteen patients had suffered from grade 2 or more (grade 2+) late rectal bleeding. The numbers of predictors for a multivariable logistic regression NTCP model were determined by the least absolute shrinkage and selection operator (LASSO). Results: The most important predictors for late rectal bleeding ranked by LASSO were platelet count, risk group and the relative volume of rectum receiving at least 65 Gy (V-65). The NTCP model of grade 2+ rectal bleeding was as follows: S = -17.49 + Platelets (1000/mu L) * (-0.025) + Risk group * Corresponding coefficient (low-risk group = 0; intermediate-risk group = 19.07; high-risk group = 20.41) + V-65 * 0.045. Conclusions: A LASSO-based multivariable NTCP model comprising three important predictors (platelet count, risk group and V-65) was established to predict the incidence of grade 2+ late rectal bleeding after IMRT.

To evaluate clinical outcomes and to identify prognostic factors in isolated para-aortic lymph node (PALN) recurrence, we retrospectively reviewed 65 patients who developed PALN recurrence as the first site of tumor progression from a total of 1521 patients who were treated with curative pelvic radiation therapy (RT) for uterine cervical carcinoma between May 1993 and January 2017. Forty-five of the 65 patients received salvage therapy. The median salvage PALN radiation dose was 54 Gy (range: 18 to 62 Gy). Prognostic factors for overall survival (OS) and distant metastases (DMs) were analyzed with univariate and multivariate Cox regression. The median follow-up period for surviving patients was 61 months (4-202 months). The median OS was 27.7 months (0.3-202 months). The highest level of PALN metastases at or above the L1 spinal level (hazard ratio [HR] 9.88, 95% confidence interval [CI] 3.44-28.38, P<0.001) and the presence of leg edema and/or back pain at recurrence (HR 3.25, 95% CI 1.57-6.75, P=0.002) were significantly associated with worse OS. A significantly higher incidence of DMs (HR 5.97, 95% CI 2.05-17.35, P=0.001) was found in the patients with a high level (≥L1) of PALN metastases. Salvage RT (HR 0.35, 95% CI 0.17-0.71, P=0.004) and restaging with positron emission tomography/computed tomography (PET/CT) (HR 0.2, 95% CI 0.04-0.93, P=0.039) were independent predictors of a better OS. In conclusion, a high level (≥L1) of PALN metastases predicts poor survival and a high rate of DMs. Periodic surveillance for early detection and restaging by PET/CT imaging to identify the optimal treatment at recurrence is recommended.

To scrutinize the pretreatment prognosticators on survival and late toxicities in a homogenous cohort of nasopharyngeal carcinoma (NPC) patients treated by simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT).

Purpose. To evaluate the differences in the treatment outcomes and complications between elderly patients and younger patients with uterine cervical cancer (CxCa).Methods and materials. From Apri11993 to December 2007, 138 CxCa patients aged >= 75 years (Elderly group) and 334 CxCa patients aged <60 years (Young group) who underwent definitive radiotherapy/chemoradiotherapy at our institution were reviewed. Two propensity score-matched cohorts of patients were selected from both age groups to evaluate the differences in the outcomes and complications. The overall survival (OS), cancer-specific survival (CSS), local failure (LF), distant failure (DF), late proctitis, and cystitis were compared between the age groups.Results. The median follow-up time for survivors was 60.6 months. A cohort of 99 pairs of patients was selected for the outcome comparison; there was a significant difference in the 5-year OS between the Elderly and Young groups (49.2% and 71.5%, respectively; p < 0.001) but no differences in CSS, LF, and OF. Another cohort of 79 pairs of patients was selected for complication analysis. Significant differences between the Elderly and Young groups were observed in the 5-year cumulative grade 2 proctitis (39.7% and 17.2%, respectively; p = 0.015) and grade 3 proctitis (18.1% and 62%, respectively; p = 0.040).Conclusions. Although OS was worse in the elderly patients, no differences were observed in CSS, LF, and DF. Meanwhile, elderly patients tended to have higher radiation-related proctitis than younger patients. A more conservative treatment strategy for elderly CxCa patients is reasonable in our future practice. (C) 2017 Elsevier Inc. All rights reserved.

To investigate the clinical efficacy and treatment toxicity of simultaneous integrated boost (SIB) intensity-modulated radiotherapy (IMRT) in nasopharyngeal carcinoma (NPC). Between Aug. 2009 and Dec. 2014, 219 consecutive non-metastatic NPC patients were treated with SIB-IMRT with or without combination of cisplatin-based chemotherapy at our institution. The stage distribution was I: 12.4%, II: 20.5%, III: 30.6%, and IV: 36.5%, respectively. The prescribed dose of high, middle and low risk area of plan target volume was 69.96 or 69.3 Gy, 59.4 Gy, and 52.8 Gy in 33 fractions, respectively. Acute and late toxicities were evaluated according to Common Terminology Criteria for Adverse Events version 4.0. Cox model was used to screen the prognostic factors of locoregional failure (LRF), distant metastasis (DM) and overall survival (OS). The median follow-up period was 42.4 months (range, 2.0-83.7 months). The 3-year actuarial LRF, DM, and OS rates were: 8.9%, 11.2%, and 87.4%, respectively. Cox regression analysis revealed stage T3-T4 to be an independent predictor for poor OS {HR: 2.7 [95% confidence interval (CI): 1.3-5.5]}; and N2-N3 to be independent predictors for a greater likelihood of LRF (HR: 9.0, 95% CI: 2.0-40.3), DM (HR: 2.9, 95% CI: 1.1-7.4), and poor OS (HR: 4.6, 95% CI: 1.9-11.4). Acute dermatitis and mucositis ≥ grade 3 occurred in 5.5% and 14.2% of patients, respectively. The 3 year cumulative incidence of ≥ grade 3 late toxicities was 5.7%. Our results prove that SIB-IMRT for the primary treatment of NPC achieved high locoregional control with a favorable acute/late toxicity profile.

BACKGROUND:This study investigated the therapeutic benefit of radical resection (SRR) for clinical T4b oral cavity squamous cell carcinoma (OSCC) with partial or complete response after radical chemoradiotherapy (CRT).METHODS:At the authors' institution, 79 patients with newly diagnosed non-metastatic T4b OSCC were treated with CRT from January 2009 to December 2014. All of them were irradiated using intensity-modulated radiotherapy (IMRT), with a radical dose (median 70 Gy; range 66-76 Gy) in the gross tumor area. Of the 65 cases achieving partial or complete response after CRT, 33 were treated further with SRR and 32 with adjuvant chemotherapy or observation. The locoregional control (LRC), overall survival (OS), and cancer-free survival (CFS) rates were compared between the two groups.RESULTS:The 3-year LRC, OS, and CFS rates were respectively 72.3, 75.1, and 72.6 % in the SRR group compared with 32.8, 47.7, and 44.3 % in the non-SRR group (p < 0.05). Multivariate analysis showed that SRR was the only statistically significant prognostic factor related to LRC, OS, and CFS. For those with SRR, pathologic downstaging was observed in 27 cases (81.8 %). Perioperative flap failure was observed in three cases (9.2 %) and neck wound necrosis in four cases (12.1 %).CONCLUSIONS:For T4b OSCC, incorporating SRR in the therapy is technically safe and has survival benefit, with a significant response after CRT applied by IMRT, with a radical dose in the gross tumor area.

38 Background: Brain metastasis (BM) develops in 10%-40% of patients with malignancies. Survival expectancy is critical for choosing an optimal treatment for BM patients. Previous reports have proposed different risk stratification systems based on clinical and image-related factors. Heart rate variability (HRV), a physiological factor, has also been reported as a novel prognosticator for BM patients. In this study, we proposed a novel risk stratification model for BM patients by incorporating HRV signals. Methods: Patients with BM referred to our department for palliative RT were prospective recruited. Those who were not suitable for HRV evaluation were excluded for analysis. A 5-minute ECG was acquired before treatment started for each patient for subsequent HRV signal analysis. All patients underwent WBRT for 30-37.5 Gy in 10-15 daily fractions. Local boost to gross intracranial tumors were performed selectively. The primary end-point for this study was overall survival (OS). Survival analysis was carried out by Kaplan-Meier method and factors were compared by log-rank test and cox-regression. A novel risk stratification model combining HRV index SDNN and KPS was proposed. Results: Total 62 patients were recruited from Jan 2010. The median follow-up time was 40.7 months for patients who were still alive. Only 1 patient (1.6%) met the criterion of RPA class I. The median OS for all patients was 4.5 months. Univariate and multivariate analysis revealed that SDNN ≥ 10ms and KPS ≥ 70 were independent survival prognosticators. For a selected group of patients (n = 29, Group 1, SDNN ≥ 10ms and KPS ≥ 70) the median OS was 9.9 months, which is significantly higher than the rest 33 patients (Group 2) as of 2.4 months. The 3-month/6-month OS rate in Group 1 and Group 2 were 82.8%/72.4% and 36.4%/24.2% (p < 0.001). Conclusions: Using physiological factors for risk stratification is novel. Our results demonstrated that a group of patients with potential longer survival could be selected by using HRV index and KPS. This group of patients should be considered differently in treatment selection. Further studies are warranted to validate our findings and improve the quality of care in patients with BM.

Objective: To compare the dose distributions of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) using the simultaneous integrated boost (SIB) technique with that of the traditional midline block (MB) technique for boosting the parametrium in patients with cervical cancer.Methods: Treatment plans using VMAT or IMRT with the SIB technique (VMAT-SIB and IMRT-SIB) and IMRT followed by the MB technique (IMRT-MB) were generated for each of the 10 patients with cervical cancer. For the SIB plans, 45-Gy and 50-Gy dose levels in 25 equal fractions were set for the pelvis planning target volume 45 (PTV45) and the parametrial boost volume (PTV50), respectively. For the IMRT-MB plans, the parametrium was sequentially boosted with the MB technique (5.4Gy in three fractions) after pelvic IMRT (PTV45).Results: Volume receiving 100% of the prescribed dose or more coverage of the PTV50 was significantly better for VMAT-SIB and IMRT-SIB than that for IMRT-MB (99.08 and 99.31% compared with 91.79%, respectively; p < 0.05). VMAT-SIB and IMRT-SIB both generated significantly greater doses to the organs at risk (OARs) except for the volume receiving 50Gy or more doses, which were significantly lower for the bladder and bowel. Comparable results were achieved with VMAT-SIB and IMRT-SIB.Conclusion: The VMAT-SIB and IMRT-SIB techniques are promising in terms of dose distributions and tumour coverage, although these approaches might result in slightly higher doses of radiation to the OARs.Advances in knowledge: This is the first study to examine the feasibility of the SIB technique using IMRT or VMAT to boost the parametrium. The techniques dosimetrically produced better target coverage but resulted in slightly higher doses to the OARs.

This study aimed to investigate the impact of treatment time‐related factors on outcomes and radiation proctitis in patients undergoing concurrent chemoradiotherapy (CCRT) for cervical cancer. From September 2001 to December 2012, 146 patients with stage IIB cervical squamous cell carcinoma treated with CCRT were reviewed from a prospective cohort. Patients who received the same dose (45 Gy) of external beam radiation therapy (EBRT) were included in the analysis (n = 125). The same equivalent dose of 2 Gy (EQD2) of high‐dose‐rate intracavitary brachytherapy (HDR‐ICBT) was delivered at either 4 fractions of 6 Gy or 6 fractions of 4.5 Gy. The effects of the overall treatment time (OTT) and interval between EBRT and HDR‐ICBT on the cancer‐specific survival (CSS), local recurrence (LR), and incidence of proctitis were compared. The treatment time‐related factors did not adversely affect the CSS and LR rates. The multivariate analyses did not identify the OTT as an independent factor of CSS (P = 0.839) and LR (P = 0.856). However, OTT ≤56 days (P = 0.026) was identified as the only independent factor of overall proctitis. The 5‐year Grade 2 or greater proctitis rates were 14.9% and 0% (P = 0.001) in patients with the EBRT to ICBT interval ≤5 days and >5 days, respectively. To reduce rectal damage without compromising prognosis, the gap between EBRT and HDR‐ICBT should exceed 5 days in cervical cancer patients undergoing CCRT. Strictly limiting the OTT to 56 days may result in radiation proctitis without improvements in prognosis.

Background: Pretreatment prognostic information is lacking for patients with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IB1 disease. Thus, we attempted to identify a high-risk subgroup among them prior to treatment. Methods: Cervical cancer FIGO stage IB1 patients who had received curative treatment with various modalities in our institute between January 2004 and December 2010 were enrolled. Pretreatment clinical parameters including age, squamous cell carcinoma antigen (SCC-Ag), carcinoembryonic antigen, hemoglobin (Hb) level, platelet count, histological type, and treatment modality were analyzed for treatment outcomes. Results: One hundred ninety-seven patients were included with a median follow-up of 66 months (range 6-119 months). In Cox regression analysis, only SCC histology (HR 0.457, 95% CI 0.241-0.967, p = 0.017) was an independent factor predicting better disease-free survival (DFS). Among SCC histology, patients with an Hb level less than 12 g/dl and a SCC-Ag level more than 3 ng/ml had worse treatment outcomes. The 5-year DFS rates were 89.2, 69.3, and 44.4% for the patients at low-risk (SCC, Hb >12 g/dl, SCC-Ag ≤3 ng/ml), intermediate-risk (non-SCC), and high-risk (SCC, Hb ≤12 g/dl, SCC-Ag >3 ng/ml), respectively (p < 0.001). Conclusion: Non-SCC and SCC histology with both anemia and high pretreatment SCC-Ag level were associated with recurrence. Further validation studies are warranted for clarification.

Purpose: To compare the treatment results of different radiotherapy protocols for glioblastoma multiforme (GBM). Materials and Methods: Between February 1995 and September 2012, 65 patients with GBM who treated with maximal surgical resection, followed by different external radiotherapy (RT) protocols were evaluated retrospectively. 27 patients (group 1) had received CCRT (concurrent chemoradiotherapy) with temozolomide (TMZ) administered orally at 75 mg/m^2 body surface area (BSA) daily from the first to the last day with local RT (6000 cGy/30 fractions), followed by adjuvant TMZ (150 to 200 mg/m^2 BSA, 5-day dosing and 23 days non-treatment) till the patient's death or progressive disease occurred. 24 patients (group 2) had received adjuvant RT alone with 6660-7000 cGy/33-35 fractions. 14 patients (group 3) had received field-in-field (FIF) boost protocol with RT consisted of daily fractions of 180 cGy to brain tumor site, followed by subsequently 70 cGy (total 250 cGy daily) to reduced field of tumor bed with a total dose of 6250-6500 cGy without other chemotherapy permission. The primary endpoint was overall survival (OS). Results: Median follow-up was 13.6 months (range, 3.6-67.1 months). Median OS and time to progression for 65 patients were 13.3 and 8.2 months, respectively. Median OS of group 1, 2 and 3 were 19.9, 12.6 and 10.4 months, respectively. The group 1 had significantly better OS than both group 2 (p = 0.03) and group 3 (p = 0.04). No significant difference in OS of group 2 and 3 (p = 0.06). Median progression free survival (PFS) did not differ significantly among group 1, 2 and 3 (median PFS: 9.8, 7.2 and 9.7 months, respectively; group 1 vs 2, group 2 vs 3, and group 3 vs 1, p = 0.09, 0.90 and 0.80, respectively). Patient ECOG PS (Eastern Cooperative Oncology Group performance status), GTR (gross tumor resection) or not and RT protocol were significantly correlated with overall survival on both univariate and multivariate analysis. Conclusions: Three independent predictors of survival were identified in our studies: ECOG PS, GTR or not and RT protocol. When independent prognostic factors were examined, advantageous median OS was found out for the patients whose ECOG PS were ≤ 2 and who had GTR, followed by TMZ during and after conventional RT (6000 cGy/30 fractions).

Patients with cervical cancer diagnosed with a para-aortic lymph node (PALN) metastasis by computed tomography (CT) scan were analyzed to identify associated prognostic factors. A total of 55 patients were reviewed, and 27 of these patients underwent extended-field radiotherapy (EFRT). The median PALN dose in patients receiving EFRT was 45 Gy (range, 27–57.6 Gy). Of the 55 patients, 28 underwent pelvic radiotherapy (RT); concurrent chemoradiotherapy (CCRT) was administered to 41 patients. The Kaplan–Meier method was used to calculate the actuarial rate. Multivariate analysis was performed using the Cox proportional hazards model. Five-year overall survival (OS) rates were 41% and 17.9% in patients undergoing EFRT and pelvic RT (P = 0.030), respectively. Age < 53 years (P = 0.023), FIGO Stage I–II (P = 0.002), and treatment with EFRT (P = 0.003) were independent predictors of better OS. The use of CCRT (P = 0.014), Stage I–II (P = 0.002), and treatment using EFRT (P = 0.036) were independent predictors of distant metastasis. In patients undergoing EFRT plus CCRT, the 5-year OS was 50%. Three-year PALN disease-free rates were 8.8%, 57.9% and 100% (P < 0.001) in CCRT patients who received PALN doses of 0 Gy, ≤45 Gy and ≥50.4 Gy, respectively. Although PALN metastasis is thought to be distant metastasis in cervical cancer, EFRT plus CCRT shows a good outcome, particularly in younger patients in an early FIGO stage. Cervical cancer with a PALN metastasis should not be considered incurable. Doses ≥50.4 Gy for treating PALN may result in better disease control.

Purpose: To investigate the role of galectin-1 in patients with cervical cancer after definitive radiation therapy.Methods and Materials: We reviewed 154 patients with International Federation of Gynecology and Obstetrics stage I-II squamous cell carcinoma. Patients underwent curative-intent radiation therapy. Paraffin-embedded tissues were analyzed using immunohistochemistry staining for galectin-1. The rates of cancer-specific survival (CSS), local recurrence (LR), and distant metastasis were compared among patient tissue samples with no, weak, and strong galectin-1 expression. The Kaplan-Meier method and the Cox proportional hazard model with hazard ratios and 95% confidence intervals (CIs) were used for univariate and multivariate analyses, respectively.Results: The areas under the curve for the intracellular expression scores of galectin-1 for both LR and CSS were significantly higher than those for stromal expression. There were no significant differences in the demographic data, such as stage and serum tumor markers, between patients with and without intracellular expression of galectin-1 in cancer tissue samples. Using multivariate analyses, the hazard ratios of LR and CSS were 2.60 (95% CI 1.50-4.52) (P=.001) and 1.94 (95% CI 1.18-3.19) (P=.010), respectively.Conclusion: Galectin-1 is an independent prognostic factor associated with LR and CSS in stage I-II cervical cancer patients undergoing definitive radiation therapy. Further studies targeting galectin-1 may improve the local control of cervical cancer. (C) 2013 Elsevier Inc.

BACKGROUND:To identify pretreatment carcinoembryonic antigen (CEA) levels as a risk factor for para-aortic lymph node (PALN) recurrence following concurrent chemoradiotherapy (CCRT) for cervical cancer.METHODS:From March 1995 to January 2008, 188 patients with squamous cell carcinoma (SCC) of the uterine cervix were analyzed retrospectively. No patient received PALN irradiation as the initial treatment. CEA and squamous cell carcinoma antigen (SCC-Ag) were measured before and after radiotherapy. PALN recurrence was detected by computer tomography (CT) scans. We analyzed the actuarial rates of PALN recurrence by using Kaplan-Meier curves. Multivariate analyses were carried out with Cox regression models. We stratified the risk groups based on the hazard ratios (HR).RESULTS:Both pretreatment CEA levels ≥ 10 ng/mL and SCC-Ag levels < 10 ng/mL (p < 0.001, HR = 8.838), SCC-Ag levels ≥ 40 ng/mL (p < 0.001, HR = 12.551), and SCC-Ag levels of 10-40 ng/mL (p < 0.001, HR = 4.2464) were significant factors for PALN recurrence. The corresponding 5-year PALN recurrence rates were 51.5%, 84.8%, and 27.5%, respectively. The 5-year PALN recurrence rate for patients with both low (< 10 ng/mL) SCC and CEA was only 9.6%. CEA levels ≥ 10 ng/mL or SCC-Ag levels ≥ 10 ng/mL at PALN recurrence were associated with overall survival after an isolated PALN recurrence. Pretreatment CEA levels ≥ 10 ng/mL were also associated with survival after an isolated PALN recurrence.CONCLUSIONS:Pretreatment CEA ≥ 10 ng/mL is an additional risk factor of PALN relapse following definitive CCRT for SCC of the uterine cervix in patients with pretreatment SCC-Ag levels < 10 ng/mL. More comprehensive examinations before CCRT and intensive follow-up schedules are suggested for early detection and salvage in patients with SCC-Ag or CEA levels ≥ 10 ng/mL.

Anaplastic thyroid cancer (ATC) is a rare malignancy with aggressive behavior and dismal outcome; the optimal treatment has not yet been determined. Debulky surgery followed by adjuvant radiotherapy (RT) has been reported to have better local control for locally advanced ATC. However, the technical limitations of conventional RT made it difficult to irradiate a homogenous and effective dose to the thyroid region. Recent advances in RT techniques such as intensity-modulated radiotherapy (IMRT) provided the potential to conquer the limitation. Additionally, IMRT using simultaneous integrated boost technique (SIB-IMRT) further improved the biologic and dosimetric advantages. As no previous literature has reported the use of this technique on locally advanced ATC, we report a 60-year-old female with ATC treated by debulky surgery and SIB-IMRT and review the literatures.

PURPOSE:To compare the treatment results of 2 fractionation schedules for high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer. METHODS AND MATERIALS:From June 2001 through January 2008, 267 patients with stage IB-IVA cervical cancer were enrolled in the study. All patients underwent 4-field pelvic irradiation and HDR-ICBT. The median central and parametrial doses were 39.6 Gy and 45 Gy, respectively. Patient underwent either 6 Gy×4 (HDR-4) (n=144) or 4.5 Gy×6 (HDR-6) (n=123) to point A of ICBT using 192Ir isotope twice weekly. The rates of overall survival, locoregional failure, distant metastasis, proctitis, cystitis, and enterocolitis were compared between HDR-4 and HDR-6. RESULTS:There were no significant differences in the demographic data between HDR-4 and HDR-6 except for total treatment time. The 5-year proctitis rates were 23.0% and 21.5% in HDR-4 and HDR-6 (P=.399), respectively. The corresponding rates of grade 2-4 proctitis were 18.7% and 9.6% (P=.060). The corresponding rates of grades 3-4 proctitis were 5.2% and 1.3% (P=.231). Subgroup analysis revealed that HDR-4 significantly increased grade 2-4 proctitis in patients aged≥62 years old (P=.012) but not in patients aged<62 years (P=.976). The rates of overall survival, locoregional failure, distant metastasis, cystitis, and enterocolitis were not significantly different between HDR-4 and HDR-6 schedules. CONCLUSION:The small fraction size of HDR-ICBT is associated with grade 2 proctitis without compromise of prognosis in elderly patients. This schedule is suggested for patients who tolerate an additional 2 applications of HDR-ICBT.