Purpose: Recent data indicate consolidative radiation therapy improves progression-free survival (PFS) for patients with oligometastatic non-small cell lung cancer (NSCLC). Data on long-term outcomes are limited. Methods and Materials: This prospective, multicenter, single-arm, phase 2 trial was initiated in 2010 and enrolled patients with oligometastatic NSCLC. Oligometastatic disease was defined as a maximum of 5 metastatic lesions for all disease sites, including no more than 3 active extracranial metastatic lesions. Limited mediastinal lymph node involvement was allowed. Patients achieving a partial response or stable disease after 3 to 6 cycles of platinum-based chemotherapy were treated with CRT to the primary and metastatic sites of disease, followed by observation alone. The primary endpoint was PFS, with secondary endpoints of local control, overall survival (OS), and safety. Results: Twenty-nine patients were enrolled between October 2010 and October 2015, and 27 were eligible for consolidative radiation therapy. The study was closed early because of slow accrual but met its primary endpoint for success, which was PFS >6 months (P < .0001). The median PFS (95% confidence interval) was 11.2 months (7.6-15.9 months), and the median OS was 28.4 months (14.5-45.8 months). Survival outcomes were not significantly different for patients with brain metastases (P = .87 for PFS; P = .12 for OS) or lymph node involvement (P = .74 for PFS; P = .86 for OS). Conclusions: For patients with oligometastatic NSCLC, chemotherapy followed by consolidative radiation therapy without maintenance chemotherapy was associated with encouraging long-term outcomes. (C) 2018 Elsevier Inc. All rights reserved.

The optimal treatment paradigm for patients with oligometastatic non-small cell lung cancer (NSCLC) remains controversial. While primary systemic therapy is essential to maintain disease control, the role for subsequent local therapy is less well-defined. This prospective, multi-institutional phase II study was conducted to evaluate the potential survival benefit of radiotherapy to the chest and/or sites of oligometastatic disease after first-line chemotherapy. Twenty-six patients with metastatic NSCLC and ≤5 total lesions underwent a median 4 (range 3-6) cycles of first-line chemotherapy. Patients with partial response or stable disease by RECIST criteria were eligible. This was followed by radiotherapy to the primary tumor (if not previously treated) and/or up to 3 additional extracranial sites. No maintenance chemotherapy was administered. Eleven patients (42%) had brain metastases previously treated with surgery or stereotactic radiosurgery with or without whole brain radiotherapy followed by confirmation of intracranial disease control prior to registration. Radiotherapy techniques included stereotactic body radiotherapy (SBRT) or conventionally fractionated radiotherapy to the primary (median 60 Gy, range 50-70.2 Gy) and/or metastatic sites (median 50 Gy, range 27-60). The trial was closed early due to slow accrual; herein we report the results of patients enrolled prior to study closure. Progression-free survival (PFS) and overall survival (OS) were evaluated using Kaplan-Meier method. Mean age was 65 years (range 42-83). Primary histology was adenocarcinoma in 16 (62%) and squamous cell carcinoma in 6 (23%). The median number of lesions treated was 2 (range 1-4), including the primary site (89%), non-primary lung (27%), bone (15%), adrenal (12%), spine/paraspinal (12%), liver (8%), and other (12%). Median progression-free survival was 11 months (95% CI 7.4-15.9) and 5-year PFS was 29%. Of the 21 (81%) patients that experienced disease progression, the site of progression was identified in 18. Site of initial failure was distant in 9 (35%) patients, intracranial in 6 (23%), both local and distant in 2 (8%) and local alone in 1 (4%). Seven (27%) patients were alive at last follow-up. Median overall survival was 22.2 months (95% CI 13.3-45.8) and 5-year OS was 29%. In this prospective, phase II study, patients receiving consolidative/ablative radiotherapy after first-line chemotherapy for oligometastatic NSCLC demonstrated favorable disease-free and overall survival outcomes. Further prospective study evaluating more aggressive local therapies to carefully selected patients is warranted.

9047 Background: Unselected patients with stage 4 lung cancer who receive front line platinum based chemotherapy and maintenance chemotherapy have demonstrated a PFS less than 6 months with very few patients alive at 5 years. Patients with a small number of metastatic lesions may have a different biology, and aggressive local treatment of oligometastases is an active area of investigation. Methods: Patients were required to have stable disease or response after 3-6 cycles of platinum based chemotherapy and PS 0-2. Oligometastatic disease was defined as a maximum number of 5 metastatic lesions for all disease sites including no more than 3 active extracranial metastatic lesions. Limited mediastinal lymph node involvement was allowed. Results: 29 patients were enrolled between 10/2010 and 10/2015. 3 patients were excluded from analysis due to concerns regarding eligibility/treatment response. Despite closing early due to slow accrual, the study met its primary endpoint for success which was PFS greater than 6 months. The median PFS (95% CI) was 11.0 months (7.4-15.9 months) and the median OS was 22.2 months (13.3-45.7 months). The 1-year, 3-year, and 5-year OS were 73%, 35%, and 29%. Conclusions: Patients with oligometastatic NSCLC who received platinum based chemotherapy followed by oligometastatic consolidative radiation without maintenance chemotherapy demonstrated prolonged disease control and overall survival. Clinical trial information: nct01185639.

Purpose: To review the outcomes of a prospective management approach using ipsilateral neck radiotherapy in the treatment of node-positive squamous cell carcinoma of the tonsil with a well-lateralized primary lesion.Methods and Materials: Between August 2003 and June 2007, 20 patients who presented with squamous cell carcinoma of the tonsil, without involvement of the base of the tongue or midline soft palate, and with Stage N1-N2b disease were prospectively treated with radiotherapy to the primary site and ipsilateral neck. In addition, 18 patients received concurrent chemotherapy. The actuarial freedom from contralateral nodal and in-field progression was determined. Acute and late toxicity were prospectively evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3, and Radiation Therapy Oncology Group criteria.Results: The nodal disease was Stage NI in 4 patients, N2a in 3 patients, and N2b in 13 patients. At a median follow-up 19 months (range, 12-40), no in-field or contralateral nodal recurrences had been observed. The 2-year freedom from distant metastasis rate was 87.4%. The actuarial 2-year disease-free and overall survival rates were both 79.5%. Late Radiation Therapy Oncology Group grade 2 xerostomia occurred in I patient (5%). No late Grade 3 or greater toxicity was observed. No patient was feeding tube dependent at their last follow-up visit.Conclusion: In carefully selected patients with node-positive, lateralized tonsillar cancer, treatment of the ipsilateral neck and primary site does not appear to increase the risk of contralateral nodal failure and reduces late morbidity compared with historical controls. Although the outcomes with ipsilateral radiotherapy in the present series were promising, these findings require longer follow-up and validation in a larger patient cohort. (C) 2009 Elsevier Inc.

Introduction:Outcomes data treating patients with oligometastatic (⩽5 metastases) non-small cell lung carcinoma (NSCLC) with hypofractionated image-guided radiotherapy (HIGRT) are limited.Methods:Consecutive oligometastatic NSCLC patients were reviewed from a prospective database. Patients were included if all active diseases were treated with HIGRT. Lesions that had received prior radiation or had radiographic/metabolic resolution after chemotherapy were not treated with HIGRT. Local control of all treated lesions, distant control, progression-free survival (PFS), overall survival (OS), and control of individual lesions (LeC) were calculated.Results:Twenty-five patients with median of 2 treated oligometastatic lesions were included. Median follow-up was 14 months. Median age was 66 years. Nineteen patients received systemic therapy before HIGRT and 11 had progressive disease after their most recent systemic therapy before HIGRT. Median OS and PFS were 22.7 and 7.6 months. The 18 months local control, distant control, OS, and PFS were 66.1%, 31.7%, 52.9%, and 28.0%. Greater than two sites treated with HIGRT, nonadenocarcinoma histology, prior systemic therapy, and progression after systemic therapy were associated with worse PFS. Sixty-two individual lesions of median size 2.7 cm were treated. For extracranial lesions, median total and fraction dose were 50 and 5 Gy. Median standard equivalent dose in 2 Gy fractions for extracranial lesions was 64.6 Gy yielding 18 months LeC of 70.7%. Standard equivalent dose ≥64.6 Gy increased LeC (p = 0.04). Two patients experienced grade 3 toxicity.Conclusions:HIGRT for oligometastatic NSCLC provides durable LeC and may provide long-term PFS in some patients. Future HIGRT studies should optimize patient selection and integration with systemic therapy.

The last 30 years have ushered in a convincing argument that combining chemotherapeutic drugs, with actions against specific aspects of the cancer cell cycle or DNA, with ionizing radiation results in clinically meaningful improvements in locoregional control and survival in many epithelial cancers and gliomas. Many patients with locally advanced cancers will receive radiation with concurrent chemotherapy or biologic agents. We continue to optimize drug combinations and sequencing with radiation, and newer agents have emerged targeting specific cancer pathways, such as the epidermal growth factor receptor (EGFR) and vascular endothelial growth factor receptor (VEGFR) pathways.

A 40-year-old premenopausal woman with a new diagnosis of invasive lobular carcinoma occurring in a background of lobular carcinoma in situ presents to a multidisciplinary second opinion clinic.

Purpose: To analyze the pathology, outcomes, and prognostic factors in patients with high-grade glioma undergoing reoperation after radiotherapy (RT).Methods and Materials: Fifty-one patients with World Health Organization Grade 3-4 glioma underwent reoperation after prior RT. The median close of prior RT was 60 Gy, and 84% received chemotherapy as part of their initial treatment. Estimation of the percentage of necrosis and recurrent tumor in each reoperation specimen was performed. Pathology was classified as RT necrosis if >= 80% of the specimen was necrotic and as tumor recurrence if >= 20% was tumor. Predictors of survival were analyzed using log rank comparisons and Cox proportional hazards regression.Results: The median interval between the completion of RT and reoperation was 6.7 months (range, 1-59 months). Pathologic analysis showed RT necrosis in 27% and recurrence in 73% of cases. Thirteen patients required a reoperation for uncontrolled symptoms. Among them, 1 patient (8%) had pathology showing RT necrosis, and 12 (92%) had tumor recurrence. Median survival after reoperation was longer for patients with RT necrosis (21.8 months vs. 7.0 months, p = 0.047). In 7 patients with Grade 4 tumors treated with temozolomide-based chemoradiation with RT necrosis, median survival from diagnosis and reoperation were 30.2 months and 21.8 months, respectively.Conclusions: Patients with RT necrosis at reoperation have improved survival compared with patients with tumor recurrence. Future efforts to intensify local therapy and increase local tumor control in patients with high-grade glioma seem warranted. (C) 2011 Elsevier Inc.

Journal of Surgical OncologyVolume 102, Issue 3 p. 207-208 Editorial SBRT for unresectable HCC: A familiar tune? Kyle E. Rusthoven MD, Corresponding Author Kyle E. Rusthoven MD kyle.rusthoven@uchsc.edu Department of Radiation Oncology, University of Colorado, Aurora, Colorado1665 Aurora Ct, Aurora, CO 80045.Search for more papers by this authorMichael D. Hasselle MD, Michael D. Hasselle MD Department of Radiation Oncology, University of Chicago, Chicago, IllinoisSearch for more papers by this author Kyle E. Rusthoven MD, Corresponding Author Kyle E. Rusthoven MD kyle.rusthoven@uchsc.edu Department of Radiation Oncology, University of Colorado, Aurora, Colorado1665 Aurora Ct, Aurora, CO 80045.Search for more papers by this authorMichael D. Hasselle MD, Michael D. Hasselle MD Department of Radiation Oncology, University of Chicago, Chicago, IllinoisSearch for more papers by this author First published: 18 August 2010 https://doi.org/10.1002/jso.21609Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume102, Issue31 September 2010Pages 207-208 RelatedInformation

PURPOSE:To determine the maximal tolerated biologic dose intensification of radiotherapy using fractional dose escalation with temozolomide (TMZ) chemotherapy in patients with newly diagnosed glioblastoma multiforme.METHODS AND MATERIALS:Patients with newly diagnosed glioblastoma multiforme after biopsy or resection and with adequate performance status, bone marrow, and organ function were eligible. The patients underwent postoperative intensity-modulated radiotherapy (IMRT) with concurrent and adjuvant TMZ. All patients received a total dose of 60 Gy to the surgical cavity and residual tumor, with a 5-mm margin. IMRT biologic dose intensification was achieved by escalating from 3 Gy/fraction (Level 1) to 6 Gy/fraction (Level 4) in 1-Gy increments. Concurrent TMZ was given at 75 mg/m(2)/d for 28 consecutive days. Adjuvant TMZ was given at 150-200 mg/m(2)/d for 5 days every 28 days. Dose-limiting toxicity was defined as any Common Terminology Criteria for Adverse Events, version 3, Grade 3-4 nonhematologic toxicity, excluding Grade 3 fatigue, nausea, and vomiting. A standard 3+3 Phase I design was used.RESULTS:A total of 16 patients were accrued (12 men and 4 women, median age, 69 years; range, 34-84. The median Karnofsky performance status was 80 (range, 60-90). Of the 16 patients, 3 each were treated at Levels 1 and 2, 4 at Level 3, and 6 at Level 4. All patients received IMRT and concurrent TMZ according to the protocol, except for 1 patient, who received 14 days of concurrent TMZ. The median number of adjuvant TMZ cycles was 7.5 (range, 0-12). The median survival was 16.2 months (range, 3-33). One patient experienced vision loss in the left eye 7 months after IMRT. Four patients underwent repeat surgery for suspected tumor recurrence 6-12 months after IMRT; 3 had radionecrosis.CONCLUSIONS:The maximal tolerated IMRT fraction size was not reached in our study. Our results have shown that 60 Gy IMRT delivered in 6-Gy fractions within 2 weeks with concurrent and adjuvant TMZ is tolerable in selected patients with a T(1)-weighted enhancing tumor <6 cm.

e18049 Background: Outcomes data on treatment of oligometastatic (OM) non-small cell lung carcinoma (NSCLC) with hypofractionated image guided radiotherapy (HIGRT) are limited. Methods: Consecutive OM NSCLC patients were reviewed. Treatment of all active disease was required. Lesions receiving prior radiation or with radiographic/metabolic resolution after chemotherapy were inactive, and did not receive HIGRT. Time to progression (TTP) was defined as time from the start of HIGRT to any failure. Local failure was defined as ≥20% increase in size on single dimensional axial measurement. Lesion control (LC), TTP, progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Multivariate analysis (MVA) was performed using Cox proportional hazards regression. Results: Of 26 patients screened, 24 met the inclusion criteria. Median follow-up was 12.4 months. Median age was 66 yrs. Ten patients had adenocarcinoma, 14 had newly diagnosed stage IV disease, and 11 received HIGRT for progressive disease (PD) after chemo. Eighteen patients received systemic therapy prior to HIGRT, having received an average of 1.3 regimens. Seventeen patients received HIGRT to all disease and 7 received treatment to active disease only. A median of 2 (range 1-5) OM lesions were treated per patient. Median OS and TTP were 16.7, and 8.1 months, respectively. The 1 yr OS and PFS were 76.7% and 48.1%, respectively. On MVA, newly diagnosed stage IV disease independently predicted TTP (HR 0.22, p = 0.04). Fifty-eight individual lesions were treated, with a median size of 2.65cm (range 0.6 to 9.6 cm). Median total and fraction dose were 42 (range 18-70) and 8 Gy (range 3.5-18), respectively. The 1 yr LC was 84%. The calculated median standard equivalent dose (SED) in 2 Gy fractions was 64.6 Gy for extracranial lesions. SED ≥ 64.6 Gy was associated with a trend towards increased control (18 mo LC 89 vs 52%, p = 0.06). Two patients experienced grade 3 toxicity. Conclusions: Treatment of OM NSCLC with HIGRT is safe and provides durable LC when sufficient doses are used. Future studies should be aimed at optimizing patient selection for HIGRT and integration with systemic therapy. No significant financial relationships to disclose.

Purpose: To determine the maximal tolerated dose of bortezomib with concurrent external beam radiation therapy in patients with incurable solid malignant tumors requiring palliative therapy.Methods and Materials: An open label, dose escalation, phase I clinical trial evaluated the safety of three dose levels of bortezomib administered intravenously (1.0 mg/m(2), 1.3 mg/m(,)(2) and 1.6 mg/m(2)/ dose) once weekly with concurrent radiation in patients with histologically confirmed solid tumors and a radiographically appreciable lesion suitable for palliative radiation therapy. All patients received 40 Gy in 16 fractions to the target lesion. Dose-limiting toxicity was the primary endpoint, defined as any grade 4 hematologic toxicity, any grade >= 3 nonhematologic toxicity, or any toxicity requiring treatment to be delayed for >= 2 weeks.Results: A total of 12 patients were enrolled. Primary sites included prostate (3 patients), head and neck (3 patients), uterus (1 patient), abdomen (1 patient), breast (1 patient), kidney (1 patient), lung (1 patient), and colon (1 patient). The maximum tolerated dose was not realized with a maximum dose of 1.6 mg/m(2). One case of dose-limiting toxicity was appreciated (grade 3 urosepsis) and felt to be unrelated to bortezomib. The most common grade 3 toxicity was lymphopenia (10 patients). Common grade 1 to 2 events included nausea (7 patients), infection without neutropenia (6 patients), diarrhea (5 patients), and fatigue (5 patients).Conclusions: The combination of palliative external beam radiation with concurrent weekly bortezomib therapy at a dose of 1.6 mg/m(2) is well tolerated in patients with metastatic solid tumors. The maximum tolerated dose of once weekly bortezomib delivered concurrently with radiation therapy is greater than 1.6 mg/m(2). (C) 2010 Elsevier Inc.

Purpose: Standard therapy for stage I and II diffuse large B-cell lymphoma consists of combined modality therapy with anthracycline-based chemotherapy, anti-CD20 antibody, and radiation therapy (RT). Curative approaches without RT typically utilize more intensive and/or protracted chemotherapy schedules. Anthracycline-based chemotherapy regimens are associated with a dose-dependent risk of left ventricular systolic dysfunction. We hypothesize that patients treated without RT, i.e., those who are treated with greater total chemotherapy cycles and hence cumulative anthracycline exposure, are at increased risk of cardiac mortality.Methods and Materials: The rate of cardiac-specific mortality (CSM) was analyzed in patients with stage I and II diffuse large B-cell lymphoma diagnosed between 1988 and 2004 by querying the National Cancer Institute Surveillance, Epidemiology, and End-Results database. Analyzable data included gender, age, race, stage, presence of extranodal disease, and RT administration.Results: A total of 15,454 patients met selection criteria; 6,021 (39%) patients received RT. The median follow-up was 3-6 months (range, 6-180 months). The median age was 64 years. The actuarial incidence rates of CSM at 5, 10, and 15 years were 4.3%, 9.0%, and 13.8%, respectively, in patients treated with RT vs. 5.9%, 10.8% and 16.1%, respectively, in patients treated without RT (p < 0.0001; hazard ratio, 1.35; 95% confidence interval [CI]: 1.16-1.56). The increase in cardiac deaths for patients treated without RT persisted throughout the follow-up period. On multivariate analysis, treatment without RT remained independently associated with an increased risk of CSM (Cox hazard ratio, 1.32; 95% CI: 1.13-1.54; p = 0.0005).Conclusions: Increased anthracycline exposure in patients treated only with chemotherapy regimens may result in an increase in cardiac deaths, detectable only through analysis of large sample sizes. Confirmatory evaluation through meta-analysis of randomized data and design of large prospective trials is warranted. (C) 2010 Elsevier Inc.

Purpose: To evaluate the toxicity of pelvic intensity-modulated radiotherapy (IMRT) with hypofractionated simultaneous integrated boost (SIB) to the prostate for patients with intermediate- to high-risk prostate cancer.Methods and Materials: A retrospective toxicity analysis was performed in 30 consecutive patients treated definitively with pelvic SIB-IMRT, all of whom also received androgen suppression. The IMRT plans were designed to deliver 70 Gy in 28 fractions (2.5 Gy/fraction) to the prostate while simultaneously delivering 50.4 Gy in 28 fractions (1.8 Gy/fraction) to the pelvic lymph nodes. The National Cancer Institute Common Terminology Criteria for Adverse Events, version 3.0, was used to score toxicity.Results: The most common acute Grade 2 events were cystitis (36.7%) and urinary frequency/urgency (26.7%). At a median follow-up of 24 months, late toxicity exceeding Grade 2 in severity was uncommon, with two Grade 3 events and one Grade 4 event. Grade 2 or greater acute bowel toxicity was associated with signficantly greater bowel volume receiving >= 25 Gy (p = .04); Grade 2 or greater late bowel toxicity was associated with a higher bowel maximal dose (p = .04) and volume receiving >= 50 Gy (p = .02). Acute or late bladder and rectal toxicity did not correlate with any of the dosimetric parameters examined.Conclusion: Pelvic IMRT with SIB to the prostate was well tolerated in this series, with low rates of Grade 3 or greater acute and late toxicity. SIB-IMRT combines pelvic radiotherapy and hypofractionation to the primary site and offers an accelerated approach to treating intermediate- to high-risk disease. Additional follow-up is necessary to fully define the long-term toxicity after hypofractionated, whole pelvic treatment combined with androgen suppression. (C) 2009 Elsevier Inc.

PURPOSE: Favorable dosimetric results have been reported using intraoperative inverse optimization (IO) for permanent pros(ate brachytherapy. The clinical implications of these improvements in dosimetry are unclear. We review toxicity and early biochemical outcomes for patients implanted using IO technique.METHODS AND MATERIALS: Between 2001 and 2007, 165 patients received permanent prostate implants using real-time 10 and had >= 3 months of followup. Dose constraints for inverse planning were: the prostate Volume receiving 100% of the prescription dose [prostate V-100] was > 95%; the dose received by 90% of the gland [prostate D-90] was within the 140-180 by dose range, the volume of urethra receiving 150% of the prescription close [urethra V-150] was < 30%; and the Volume of rectal wall receiving 110% of the prescription dose [rectal V-110] was < 1.0 cc. Toxicity was prospectively scored using the Radiation Therapy Oncology Group toxicity scale and the International Prostate Symptom Score questionnaire. Biochemical control was determined using the nadir + 2 ng/mL definition.RESULTS: Mean followup was 30 months (range, 6-63 months). Risk classification was low risk in 89% and intermediate risk in 11%. Iodine-125 Sources were used for 161 implants and palladium-103 sources for four implants. The median number of seeds and total activity implanted were 61 and 999 MBq, respectively, for a median prostate volume of 33.6 cc. Late GU and GI morbidity was uncommon. Among patients with at least 24 months followup, 16% had persistent Grade 2-3 urinary morbidity. Grade 2 rectal bleeding Occurred in I patient (0.6%). Biochemical failure has Occurred in only 4 patients at last followup.CONCLUSIONS: IO technique for prostate brachytherapy is associated with low rate,, of late morbidity and excellent early biochemical control. Additionally, the number of seeds and total implanted activity required to achieve a high-quality implant are lower compared with historical controls. (C) 2009 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

INTRODUCTION:The pattern of failure (POF) after first-line systemic therapy in advanced non-small cell lung cancer (NSCLC) is unknown. We evaluate the POF in this setting to estimate the potential value of consolidative stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS:The records of consecutive NSCLC patients presenting to the University of Colorado, Denver (UCD) between January 2005 and June 2008 were reviewed. Patients with measurable advanced stage NSCLC who received first-line systemic therapy and follow-up at UCD were eligible. In these patients, sites of disease at maximal response were evaluated for theoretical SBRT eligibility, based on institutional criteria. All patients were followed to extracranial progression. The POF was categorized as local (L) for lesions known prior to treatment or distant (D) for new lesions. RESULTS:Among 387 consecutive lung cancer patients (all stages), 64 met the eligibility criteria and 34 were SBRT-eligible. Among all eligible patients, first extra-cranial progression was L-only in 64%, D-only in 9% and L + D in 27%. Among SBRT-eligible patients, POF was L-only in 68%, D-only in 14% and L + D in 18%. In SBRT-eligible patients, time to first progression was 3.0 months in those with L-only failure versus 5.7 month in those with any D failure (HR 0.44; 95% CI 0.22-0.90). CONCLUSIONS:The predominant POF in patients with advanced NSCLC after first-line systemic therapy is local-only. The current analysis suggests that SBRT could improve time to progression in a substantial proportion of patients. The estimated increase in time to progression using this approach would be approximately 3 months.

Purpose: To evaluate the survival and patterns of relapse for patients with squamous cell carcinoma (SCC) of the oral tongue.Patients and Methods: Between 1999 and 2007, 50 patients with SCC of the oral tongue were treated at the University of Colorado Denver. Of the 50 patients, 38 had newly diagnosed SCC of the oral tongue (13 with stage I-II and 25 with stage III-IV disease), and 12 presented with locally recurrent SCC. Of the 50 patients, 49 were treated with initial surgery and 1 with definitive chemoradiotherapy. Adjuvant radiotherapy or chemoradiotherapy was administered to 42 patients after surgery. Of the 13 patients with newly diagnosed stage HI disease, 7 did not receive adjuvant therapy. The actuarial locoregional control, freedom from distant relapse, and survival were determined using the Kaplan-Meier method, and comparisons were made using the log-rank test.Results: The median follow-up was 29 months (range 4 to 95) for living patients. The 2-year locoregional control and freedom from distant relapse rate was 58% and 83%, respectively. Locoregional control was particularly low among patients with stage I-II disease, for whom the 2-year locoregional control rate was only 35%. The median survival time and 2-year survival rate for all patients was 42 months and 65%, respectively. The 2-year survival rate for patients with stage I-II oral tongue cancer was 77% compared with 52% for patients with stage III-IV disease (P = .04).Conclusions: Despite aggressive therapy, patients with SCC of the oral tongue have a low rate of local tumor control and survival, particularly among those with stage I-II disease. These patients should be considered for inclusion in clinical trials evaluating novel postoperative therapies. (C) 2010 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 68:584-589, 2010