• Radiation Oncology Journal
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• 제36권4호
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• pp.325-331
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• 2018

Purpose: Soft tissue sarcoma (STS) is a rare and heterogeneous cancer with over 50 known subtypes. It is difficult to understand the role of adjuvant treatment in STS. We aimed to determine the benefits of adjuvant treatment for a rare STS subset: non-extremity STS with moderate chemosensitivity. Materials and Methods: We reviewed medical records from Pusan National University Hospital and Kosin University Gospel Hospital, which had detailed pathological reports on patients diagnosed between 2006 and 2016. The most important inclusion criterion was resection with curative intent. We grouped STS by chemosensitivity based on reported data and analyzed non-extremity STS with moderate chemosensitivity. Results: We investigated 142 patients with 20 pathological subtypes of STS. Eighty-six patients had extremity STS and 56 had non-extremity STS. Thirty-eight of 56 patients were categorized as having moderate chemosensitivity. Seventeen of 38 patients (44.7%) received adjuvant radiotherapy and 14 (36.8%) received adjuvant chemotherapy. A log-rank test showed longer disease-free survival (DFS) in the adjuvant radiotherapy group than in the group treated without adjuvant radiotherapy (not reached vs. 1.468 years, p = 0.037). Multivariate Cox proportional hazard analysis, with covariates including age, stage, resection margin, adjuvant chemotherapy, and adjuvant radiotherapy, revealed that adjuvant radiotherapy was associated with longer DFS (odds ratio = 0.369, p = 0.045). Overall survival was not correlated with adjuvant radiotherapy. Conclusion: Adjuvant radiotherapy may be associated with longer DFS in patients with non-extremity STS with moderate chemosensitivity.

• Journal of Gastric Cancer
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• 제23권1호
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• pp.194-206
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• 2023

Although continuous improvement in the treatment outcome of localized gastric cancer has been achieved through early screening, diagnosis, and treatment and the active application of surgery and adjuvant chemotherapy, the necessity of adjuvant radiotherapy (RT) remains controversial. In this review, based on the results of two recently published randomized phase III studies (Adjuvant Chemoradiation Therapy In Stomach Cancer 2 and ChemoRadiotherapy after Induction chemoTherapy of Cancer in the Stomach) and a meta-analysis of six randomized trials including these two studies, the role of adjuvant RT in gastric cancer was evaluated and discussed, especially in patients who underwent curative gastrectomy with D2 lymphadenectomy. This article also reported the possible indications for adjuvant RT in the current clinical situation and in future research to enable patientspecific treatments according to the risk of recurrence.

• Radiation Oncology Journal
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• 제35권4호
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• pp.359-367
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• 2017

Purpose: This study sought to identify potential candidates for adjuvant radiotherapy and patterns of regional failure in patients who underwent curative-intent surgery for gallbladder cancer. Materials and Methods: Records for 70 patients with gallbladder cancer who underwent curative resection at a single institution between 2000 and 2016 were analysed retrospectively. No patients received adjuvant radiotherapy. Initial patterns of failure were evaluated. Regional recurrence was categorized according to the definitions of lymph node stations suggested by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Results: Median follow-up was 23 months. Locoregional recurrence as any component of first failure occurred in 29 patients (41.4%), with isolated locoregional recurrence in 13 (18.6%). Regional recurrence occurred in 23 patients, and 77 regional recurrences were identified. Commonly involved regional stations were #13, #12a2, #12p2, #12b2, #16a2, #16b1, #9, and #8. Independent prognostic factors for locoregional recurrence were ${\geq}pT2$ disease (hazard ratio [HR], 5.510; 95% confidence interval [CI], 1.260-24.094; p = 0.023) and R1 resection (HR, 6.981; 95% CI, 2.378-20.491; p < 0.001). Conclusion: Patients with pT2 disease or R1 resection after curative surgery for gallbladder cancer may benefit from adjuvant radiotherapy. Our findings on regional recurrence may help physicians construct a target volume for adjuvant radiotherapy.

• Journal of Gastric Cancer
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• 제12권4호
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• pp.205-209
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• 2012

In gastric adenocarcinoma, high rates of loco-regional recurrences have been reported even after complete resection, and various studies have been tried to find the role of postoperative adjuvant therapy. Among them, Intergroup 0116 trial was a landmark trial, and demonstrated the definite survival benefit in adjuvant chemoradiotherapy, compared with surgery alone. However, the INT 0116 trial had major limitation for global acceptance of the INT 0116 regimen as an adjuvant treatment modality because of the limited lymph node dissection. Lately, several randomized studies that were performed to patients with D2-dissected gastric cancer were published. This review summarizes the data about patterns of failure after surgical resection and the earlier prospective studies, including INT 0116 study. Author will introduce the latest studies, including ARTIST trial and discuss whether external beam radiotherapy should be applied to patients receiving extended lymph node dissection and adjuvant chemotherapy.

• Radiation Oncology Journal
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• 제31권2호
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• pp.72-80
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• 2013

Purpose: We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. Materials and Methods: We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. Results: The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). Conclusion: Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.

• Archives of Plastic Surgery
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• 제39권5호
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• pp.497-503
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• 2012

Background Postmastectomy adjuvant therapy is used to prevent locoregional recurrence and improve overall breast cancer specific survival rates. However, it can adversely affect the cosmetic results of reconstruction. Therefore, the authors examined flap stability and patients' satisfaction with immediate breast reconstruction after adjuvant therapy. Methods We retrospectively reviewed the medical records of 204 patients from January 2006 to November 2011. For complication rates, the authors categorized the patients who underwent the immediate breast reconstruction into 4 groups: adjuvant chemotherapy and radiotherapy group, adjuvant chemotherapy only group, adjuvant radiotherapy only group, and the group that did not undergo adjuvant therapy. For comparison of patients' satisfaction, the study was performed with an additional 16 patients who had undergone delayed breast reconstruction. Results Regarding complication rates, the group that had undergone adjuvant therapy showed no significant difference compared to the group that did not undergo adjuvant therapy. In evaluating the patients' satisfaction, there was no significant difference. Conclusions Even after adjuvant therapy, immediate breast reconstruction showed good results with respect to flap stability and patients' satisfaction. Immediate breast reconstruction and adjuvant therapy is a safe and useful option for breast cancer patients.

• Radiation Oncology Journal
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• 제34권4호
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• pp.265-272
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• 2016

Purpose: The purpose of this study is to evaluate the treatment outcomes of adjuvant radiotherapy using vaginal brachytherapy (VB) with a lower dose per fraction and/or external beam radiotherapy (EBRT) following surgery for patients with stage I endometrial carcinoma. Materials and Methods: The subjects were 43 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer who underwent adjuvant radiotherapy following surgery between March 2000 and April 2014. Of these, 25 received postoperative VB alone, while 18 received postoperative EBRT to the whole pelvis; 3 of these were treated with EBRT plus VB. The median EBRT dose was 50.0 Gy (45.0-50.4 Gy) and the VB dose was 24 Gy in 6 fractions. Tumor dose was prescribed at a depth of 5 mm from the cylinder surface and delivered twice per week. Results: The median follow-up period for all patients was 57 months (range, 9 to 188 months). Five-year disease-free survival (DFS) and overall survival (OS) for all patients were 92.5% and 95.3%, respectively. Adjuvant radiotherapy was performed according to risk factors and stage IB, grade 3 and lymphovascular invasion were observed more frequently in the EBRT group. Five-year DFS for EBRT and VB alone were 88.1% and 96.0%, respectively (p = 0.42), and 5-year OS for EBRT and VB alone were 94.4% and 96%, respectively (p = 0.38). There was no locoregional recurrence in any patient. Two patients who received EBRT and 1 patient who received VB alone developed distant metastatic disease. Two patients who received EBRT had severe complications, one each of grade 3 gastrointestinal complication and pelvic bone insufficiency fracture. Conclusion: Adjuvant radiotherapy achieved high DFS and OS with acceptable toxicity in stage I endometrial cancer. VB (with a lower dose per fraction) may be a viable option for selected patients with early-stage endometrial cancer following surgery.

• Radiation Oncology Journal
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• 제19권4호
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• pp.327-334
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• 2001

목적 : 직장암에 대한 수술 단독 또는 수술후 방사선치료를 받은 환자를 대상으로 골반종양제어율과 생존율, 합병증 발생률, 예후인자 등을 후향적으로 비교 분석하여 방사선치료의 역할을 평가한다. 대상 및 방법 : 1982년 2월부터 1996년 12월까지 총 212명의 환자가 modified Astler-Coiler 병기 $B2\~C3$ 직장암으로 진단되어 근치적목적의 수술단독 또는 수술후 방사선치료를 시행하였는데, 이중 39.6 Gy 미만의 방사선치료를 받은 18명을 제외한 194명을 대상으로 하였다. 104명은 수술후 방사선치료를 받았고 90명은 수술 단독을 시행하였다. 방사선치료는 일일 조사량 $1.8\~2.0\;Gy$로 주 5회씩 전골반강에 $39.6\~55.8\;Gy$ (평균:49.9 Gy)를 조사하였고 필요시 원발 종양 절제부위에 $5.4\~10\;Gy$를 추가 조사하였다. 생존율과 골반종양제어율의 산출은 Kaplan-Meier방법으로, 이들의 통계적 유의성검증은 Log-rank test로 하였다. 다요인 분석은 Cox proportional hazards model을 이용하였다. 결과 : 전체 환자의 5년 생존율 및 무병 생존율은 각각 $53\%,\;49\%$이었다. 수술단독군과 방사선치료 추가군의 5년 생존율은 각각 $63\%$와 $45\%$로 유의한 차이를 보였다(p=0.03). 그러나 이러한 차이는 방사선치료 추가군에서 진행된 병기의 환자가 더 많이 분포함에 기인한 것으로 생각되었다(p<0.05 by $\chi^2-test$). 수술단독군과 방사선치료 추가군의 5년생존율은 병기 B2+3, C1, C2+3 군에서 각각 $68\%$ 대 $55\%$ (p=0.09), $100\%$ 대 $100\%,\;40\%$ 대 $33\%$ (p=0.71)로 두 군간의 유의한 차이는 없었다. 위의 병기별 5년 무병생존율은 각각 $65\%$ 대 $49\%$ (p=0.14), $100\%$ 대 $100\%,\;33\%$ 대 $31\%$ (p=0.46)로 역시 유의한 차이는 없었다. 전체 환자의 5년 골반종양제어율은 $72.5\%$이었다. 수술단독군과 방사선치료 추가군의 골반종양제어율은 각각 $71\%,\;74\%$이었다(p=0.41). 병기 B2+3, C1, C2+3군에서 수술달독군과 방사선치료 추가군의 골반종양제어율은 각각 $79\%$ 대 $75\%$ (p=0.88), $100\%$ 대 $100\%,\;44\%$ 대 $68\%$ (p=0.01)이었다. 전체 환자를 대상으로 다요인 분석을 시행한 결과 생존율과 무병생존율에 병기만이 유의하였고 두 치료 군에서도 역시 병기가 유의한 인자로 나타났다. 전체환자에서 골반종양제어율에 유의한 예후인자로 다요인분석을 시행한 결과 병기와 수술방법이 유의하였다. 수술단독군에서는 병기만이 유의하였고 방사선치료 추가군에서는 수술방법만이 유의하여 복부회음절제술군의 골반종양재발률이 높았다. 결론 : 본 후향적 연구에서 수술 후 보조적 방사선치료를 시행하여 수술단독군에 비해 병기 C2+3군에서 골반종양제어율이 향상되었음을 알 수 있었다. 그러나 병기 B2이상의 모든 환자에서 골반종양제어율 뿐만 아니라 생존율의 향상을 가져오기 위해서는 최근 효용성이 널리 입증된 연속주사법의 5-FU를 포함한 동시적 항함화학방사선 병용요법이 시도되어야 할 것으로 생각된다.

• 대한종양외과학회지
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• 제14권2호
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• pp.108-115
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• 2018

Purpose: This study aimed to compare the results of treatment with adjuvant trastuzumab for 9 months versus 12 months in human epidermal growth factor 2 (HER2)-positive breast cancer patients. The primary endpoint was disease-free survival. Secondary endpoints included cardiac safety, tolerability, and overall survival. Methods: The study included 60 non-metastatic HER2-positive breast cancer patients. All study patients underwent surgery, received adjuvant chemotherapy, radiotherapy and hormonal therapy if indicated. Thirty patients were randomized in each group. Group I patients received adjuvant trastuzumab for 12 months, while group II patients received adjuvant trastuzumab for 9 months. Patients were assessed by clinical examination and Echocardiography during treatment. Results: After median follow-up of 12 months, 90% of the patients in group I were disease free and 83.3% of patients in group II were disease free (P=0.402). All studied population in both groups I and II were alive at the end of the 1-year follow-up period after the completion of adjuvant trastuzumab treatment thus overall survival is 100%. Conclusion: Trastuzumab is tolerable and its side effects are reversible. Nine months of adjuvant trastuzumab treatment is more cost effective than the standard 12 months.

• Journal of Korean Neurosurgical Society
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• 제58권3호
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• pp.211-216
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• 2015

Objectives : Although surgical resection is used to treat meningeal hemangiopericytoma (MHPC), there is a high risk of subsequent recurrence. This study investigated factors associated with treatment outcomes and recurrence in patients who had undergone surgical resection of intracranial MHPC. Methods : Fifteen patients underwent surgical treatments performed by one senior neurosurgeon between 1997 and 2013. Clinical data, radiologic images, surgical outcomes, recurrence, and other relevant characteristics were reviewed and analyzed. Results : Fifteen patients were included in the analysis, 12 (80%) of whom had tumors in the supratentorial region, and 3 (20%) of whom had tumors in the infratentorial region. Complete resection was achieved in all 15 patients, and 3 (20%) patients were administered radiosurgery and conventional radiotherapy after surgery as adjuvant radiotherapy. Three patients developed recurrence, 2 of whom had not received adjuvant radiotherapy. In 1 of the patients who had not received adjuvant radiotherapy, recurrence developed at the original tumor site, 81 months after surgery. The other 2 recurrences occurred at other sites, 78 and 41 months after surgery. The 5- and 10-year overall survival rates were 88.3%, while the 5- and 10-year recurrence-free survival rates were 83% and 52%, respectively. Additionally the mean Ki-67 index differed significantly between patients who did and did not develop recurrence (43% vs. 14%; p=0.001). Conclusion : Because of the high risk of MHPC recurrence, MHPC tumors should be completely resected, whenever feasible. However, even when complete resection is achieved, adjuvant radiotherapy might be necessary to prevent recurrence.