Concurrent chemotherapy and reduced - dose cranial spinal irradiation followed by conformal posterior fossa tumor bed boost for average - risk medulloblastoma: efficacy and patterns of failure

PURPOSE:To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated withconcurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.METH-ODS AND MATERIALS:Thirty-three patients with average risk(defined as<==1.5 cm(2)of residual tumorafter resection,age>3 years,and no involvement of the cerebrospinal fluid or spine)medulloblastoma werediagnosed at our institution between January 1994 and December 2001.They were enrolled in an institutional

Patterns of cancer recurrence in localized resected hepatocellular carcinoma

BACKGROUND： Tumor resection in non-metastatic hepato- cellular carcinoma （HCC） patients with adequate liver reserve offers a potential cure, but has a high 5-year recurrence rate. We analyzed the patterns of cancer relapse after partial hepa- tectomy to guide post-operative management.

Pattern of Failure and Treatment Results in Triple Negative Breast Cancer Patients

Background: Triple negative breast cancer (TNBC) tends to present aggressively with rapid progression and poor survival. Methods: We retrospectively reviewed patients’ files to define TNBC patients’ characteristics, predictive and prognostic factors, pattern of recurrence and survival. Results: 965 cases were identified. 147 patients (15.2%) were TNBC. 71.1% patients were premenopausal. T2, T3, T4 tumors represented 46.1%, 32% and 14.1%, respectively. N0, N1, N2, N3 disease represented 18.5%, 50.9%, 27.8% and 2.8%, respectively. Stages II, III & IV constituted 34.1%, 44.2% and 15.5%, respectively. 31.5% patients received neoadjuvant chemotherapy with 17.7% complete pathological response. 19.5%, 35.9%, 44.6% patients had unknown, ≤20 and >20 Ki67, respectively. Among non-metastatic patients (n = 108), 21.3% patients developed relapse with median time to relapse of 11 months. 78.3% of them had visceral (88.3% lung) metastasis, 13% bone metastasis, 21.7% brain metastasis and 13% LRR. There is significantly high risk of relapse in patients with large tumor size [T4: 66.75%, T3: 22.9%, T2: 16.7%, T1: 0% (p = 0.002)], positive LNs [N3: 100%, N2: 37.9%, N1: 15.1%, N0: 4.3% (p 0.001)] and Ki67 [>20: 31.6% versus 10.8% for Ki67 ≤ 20 (P = 0.007)]. Multivariate analysis revealed only T4 and N2-3 were significantly associated with high probability for relapse (P = 0.022 & 0.038). The 3-year DFS and OS were 73.2% and 75% respectively. For metastatic patients (n = 20), the m PFS was 7 months and m OS 1.5 years. Conclusion: Our data confirms the aggressive nature of TNBC with significant risk of relapse for patients with large tumor and positive lymph nodes. Maintenance metronomic capecitabine, neoadjuvant/adjuvant immunotherapy could be beneficial for non-metastatic patients. Lungs and brain were the most common sites of distant failure with poor survival that necessitates administration of molecular biomarkers (BRCA mutations, PD-L1 expression and microsatellite instability) for patients’ selection for novel targeted therapy.

Treatment results and prognostic analysis of 1093 primary nasopharyngeal carcinoma: the experience of a single institution of Guangzhou in the beginning of the 21st century

Objective： To analyze the treatment results of primary nasopharyngeal carcinoma （NPC） treated in our institution in the beginning of the 21st century to identify key failures and late effects for refining future treatments. Methods： 1093 patients with primary NPC treated during December 2001 and June 2003 were retrospectively analyzed. The distribution according to the AJCC/UICC （2002 edition） staging system was stage Ⅰ in 5.8%, stage Ⅱ 40.2%, stage Ⅲ 32.7% and stage Ⅳa-b 21.3%. Four different ERT techniques were used： fluoroscopy simulation conventional radiotherapy （CR） in 74.3% of patients, computer tomography simulation conventional radiotherapy （CT-sim CR） 14.2%, three-dimensional conformal radiotherapy （3D-CRT） 6.3%, intensity modulated radiotherapy （IMRT） 5.2%. In the whole series, 46.7% of patients had additional treatment with chemotherapy. Results： The 4-year local failure-free rate （LFFR）, nodal failure-free rate, distant metastasis-free rate, progression-free survival and overall survival （OS） was 89.6%, 96.1%, 85.9%, 73.0% and 82.4%, respectively. The stage was the most important prognostic factor. The 4-year OS and LFFR of patients treated by CR, CT-sim CR, 3D-CRT and IMRT was 80.2%, 89.8%, 89.8%, 92.4% and 87.7%, 96.4%, 91.0%, 96.5%, respectively. The morbidity and degree of xerostomia and trismus were lower in the patients treated by 3D-CRT and IMRT than by CR and CT-sim CR. Conclusion： Treatment results of primary NPC in our institution have been substantially improved. Distant metastasis is the main failure. The CT simulation and conformal radiotherapy can enhance the OS and LFFR, and conformal radiotherapy can reduce the morbidity and degree of late effects.

Pattern of Recurrence in Radically Treated Triple Negative Breast Cancer Patients

Background: In India approximately 20% of the patients with breast cancer are triple receptor negative. Owing to the aggressive nature and shorter disease-free survival judicious follow up and identification of failure pattern will benefit the patient. Similar studies have been conducted among non-Hispanic population and in China. This study aims to identify failure pattern in radically treated breast cancer patients who are triple receptor negative among Indian population. Methods: This prospective observational study was conducted in the Department of Radiation Oncology, a tertiary cancer centre in Kerala, India. The objective was to record the pattern of recurrence among triple negative breast cancer patients who completed their planned radical treatment. 171 patients with triple negative breast cancer were included in the study. Patients who completed the planned radical treatment were kept under regular follow up. Details of clinical examination and investigations during the follow up were recorded periodically. Results: Out of 171 patients 30 patients had a recurrence of disease. Median age of the population was 53 years. Among the 30 patients who had a recurrence, 16 patients (53%) had systemic relapse and 14 patients (47%) had locoregional relapse. Lung was found to be the most common site of distant metastasis (37%). Ipsilateral chest wall was found to be the most common site of locoregional relapse (50%). 6 months disease free survival was found to be 91.8% and 1-year disease free survival was found to be 70.2%. Conclusion: Among radically treated triple negative breast cancers relapses, systemic recurrence was more than locoregional recurrences.