Jen-Fu Yang

Long-Term Breast Cancer Patient Outcomes After Adjuvant Radiotherapy Using Intensity-Modulated Radiotherapy or Conventional Tangential Radiotherapy

AbstractThe aim of the article is to analyze breast cancer patient clinical outcomes after long-term follow-up using intensity-modulated radiotherapy (IMRT) or conventional tangential radiotherapy (cRT).We retrospectively reviewed patients with stage 0–III breast cancer who received breast conserving therapy between April 2004 and December 2007. Of the 234 patients, 103 (44%) were treated with IMRT and 131 (56%) were treated with cRT. A total prescription dose of 45 to 50 Gy (1.8–2 Gy per fraction) was delivered to the whole breast. A 14 Gy boost dose was delivered in 7 fractions. The median follow-up was 8.2 years.Five of 131 (3.8%) cRT-treated patients and 2 of 103 (1.9%) IMRT-treated patients had loco-regional failure. The 8-year loco-regional failure-free survival rates were 96.7% and 97.6% (P = 0.393) in the cRT and IMRT groups, respectively, whereas the 8-year disease-free survival (DFS) rates were 91.2% and 93.1%, respectively (P = 0.243). Patients treated with IMRT developed ≥ grade 2 acute dermatitis less frequently than patients treated with cRT (40.8% vs 56.5%; P = 0.017). There were no differences in late toxicity.IMRT reduces ≥ grade 2 acute skin toxicity. Local control, DFS, and overall survival were equivalent with IMRT and cRT. IMRT can be considered a standard technique for breast cancer treatment.

Survival and prognostic factors for patients with advanced hepatocellular carcinoma after stereotactic ablative radiotherapy

Objective To evaluate the survival outcomes and prognostic factors of patients with advanced hepatocellular carcinoma (HCC) who underwent stereotactic ablative radiotherapy (SABR). Methods This retrospective study evaluated patients with advanced HCC who underwent SABR between December 2007 and July 2015. All patients had Barcelona Clinic Liver Cancer stage C disease and Child–Turcotte–Pugh (CTP) class A–B function. In-field control (IFC), overall survival (OS), prognostic factors, and toxicity were evaluated. Results In this study of 89 patients, the 3-year IFC rate was 78.1%, and the 1-year and 3-year OS rates were 45.9% and 24.3%, respectively. The multivariate analysis revealed that CTP class, the presence of main portal vein tumor thrombosis, and the presence of extrahepatic spread were independent predictors of OS. The expected median OS values among patients with ≥2, 1, and 0 predictors were 4.2, 8.6, and 26.4 months, respectively (p <0.001). Conclusions SABR may be useful for patients with advanced HCC, and patient selection could be based on the CTP classification, main portal vein tumor thrombosis, and extrahepatic spread.

Stereotactic ablative radiotherapy for patients with unresectable or medically inoperable cholangiocarcinoma

Purpose The role of stereotactic ablative radiotherapy (SABR) in patients with unresectable or medically inoperable cholangiocarcinoma remains unclear. We examined the efficacy and safety of SABR in this group of patients. Methods From January 2008 to December 2014, 15 patients with 17 lesions were included in this study. The lesions included 14 intrahepatic, 1 hilar, and 2 distal bile duct tumors. Three patients were classified as medically inoperable because of old age or multiple comorbidities. Tumors measured 0.8-13 cm (median, 3.6 cm). The median prescribed dose was 45 Gy delivered in 5 fractions over 5 consecutive days. Results The median follow-up period for surviving patients was 29.9 months. Objective responses were observed for 10 of 17 tumors (58.8%), including 3 complete responses (17.6%). The median survival duration was 12.6 months, and the 1- and 2-year overall survival rates were 50.3% and 14.4%, respectively. The 1- and 2-year in-field failure-free rates were 61.5% and 30.8%, respectively. For patients with biologically effective doses (BEDs) exceeding 75 Gy10, the 1- and 2-year overall survival rates were 58.3% and 33.3%, respectively, compared to 20.0% and 0%, respectively for those with BEDs lower than 75 Gy10. Radiation-induced liver disease did not develop in any patient. Acute toxicities were generally mild and tolerable. Conclusions Stereotactic ablative radiotherapy could be an alternative treatment for unresectable or medically inoperable cholangiocarcinoma. Further dose escalation may be considered to optimize local control.

Oral tegafur-uracil as metronomic therapy following intravenous FOLFOX for stage III colon cancer

The purpose of this study was to estimate the impact of metronomic therapy with oral tegafur-uracil (UFUR) following an intravenous FOLFOX regimen as surgical adjuvant chemotherapy on the overall survival (OS) and disease-free survival (DFS) of stage III colon cancer patients. From the retrospective database of patients who underwent a surgical resection for colorectal cancer at the Tri-Service General Hospital from October 2008 through December 2014, stage III colon carcinomas treated with radical R0 resection were reviewed. One hundred thirty two patients were treated with a FOLFOX regimen (comparison group), and 113 patients were treated with the same regimen followed by additional oral UFUR (UFUR group). The clinical characteristics and mean age of the comparison and UFUR groups were similar. Furthermore, for all study patients, DFS was not significantly different between the two groups. However, 5-year OS rates were 86.8% and 68.5% in the UFUR and comparison groups, respectively (p = 0.0107). Adding UFUR to a FOLFOX regimen was found to significantly improve the OS in patients with stage III colon cancer. UFUR as a maintenance therapy following FOLFOX regimen as an alternative therapeutic option for the treatment of stage III colon cancer patients.

Is Stereotactic Body Radiotherapy Better Than Radiofrequency Ablation for the Treatment of Hepatocellular Carcinoma

TO THE EDITOR: Wahl et al performed a retrospective, singleinstitution pilot study to compare radiofrequency ablation (RFA) with stereotactic body radiotherapy (SBRT) in patients with inoperable and nonmetastatic hepatocellular carcinoma (HCC). The authors showed comparable overall survival (OS) between RFA and SBRT. In addition, the rate of freedom from local progression for tumors measuring

Lower Urinary Tract Infection and Subsequent Risk of Prostate Cancer: A Nationwide Population-Based Cohort Study

2 cmwas better with SBRT than with RFA in the patients with HCC. These findings support the use of SBRT in patients with HCC. However, we have two concerns regarding the treatment of patients with HCC in their study. The assessment of the treatment response in patients with HCC has remained an issue for decades. Optimal criteria for the evaluation of the treatment response are those that can be used as a surrogate assessment of survival. In patients with HCC, considering the ablative effect of tumor-directed treatments, such as RFA, transcatheter arterial chemoembolization, and radiotherapy, which can lead to tumor necrosis rather than tumor shrinkage, criteria based solely on dimensional measurements may not appropriately reflect the true treatment response. The European Association for the Study of the Liver (EASL) guidelines and the modified Response Evaluation Criteria in Solid Tumors (mRECIST) take into account tumor necrosis, in contrast to the WHO criteria and the original RECIST criteria, which do not consider tumor necrosis. Several studies have reported that radiologic responses evaluated using the EASL guidelines and mRECIST criteria have good concordance and that the responses have a good correlation with survival. Price et al compared imaging tools for HCC evaluation after SBRT, and these authors supported the use of the EASL guidelines. In the study by Wahl et al, the original RECIST criteria were used for treatment evaluation. We believe that the data with respect to local progression may have been distorted as a result of the use of the original RECIST criteria. We suggest that the EASL guidelines or mRECIST criteria should be used, because these may be more suitable for clinical application than the original RECIST criteria. In the study by Wahl et al, the proportion of patients receiving liver transplantation was higher in the RFA cohort than in the SBRT cohort. Was liver transplantation performed before RFA or SBRT? If not, subsequent liver transplantation can simultaneously cure both cancer and underlying liver diseases in patients with HCC, with 5-year OS rates . 70% and low recurrence rates in selected patients. Considering the substantial impact of liver transplantation on survival, OS estimation should be performed with caution. In the study by Wahl et al, the OS may have been overestimated, especially in the RFA cohort. We suggest that patients with subsequent liver transplantation should be censored from the day when the procedure was performed for survival estimation. With accurate perception of normal liver radiation tolerance and the advancement of radiation technology, SBRT has emerged as a good treatment option for unresectable, locally advanced, or recurrent HCC. Wahl et al clarified the size dependency in HCC treatment and strengthened the usefulness of SBRT. However, previous findings were based on a nonrandomized study design. Therefore, current criteria and national guidelines do not consider SBRT as the primary strategy. To confirm the benefits of SBRTand provide evidence for its use as a primary strategy for HCC treatment, effort should be directed at prospective, multi-institutional randomized trials in the future.

Comparison Between Child-Turcotte-Pugh and Albumin-Bilirubin Scores in Assessing the Prognosis of Hepatocellular Carcinoma After Stereotactic Ablative Radiation Therapy

Purpose We investigated whether lower urinary tract infection (LUTI), including cystitis or urethritis, is associated with an increased risk of developing prostate cancer (PCa), in a nationwide population-based cohort study. Methods We identified 14,273 men newly diagnosed with LUTI (9347 with cystitis, and 4926 with urethritis) between 1998 and 2011, from the Taiwan Longitudinal Health Insurance Database 2000. Each patient was randomly frequency-matched with 4 men without LUTI, based on age and index year of diagnosis. Cox’s proportional hazard regression analysis was performed to estimate the effect of LUTI on the PCa risk. Results The risk of developing PCa was significantly higher in the cystitis cohort (adjusted HR = 1.46, 95% CI = 1.20–1.78) and in the urethritis cohort (adjusted HR = 1.72, 95% CI = 1.26–2.34) than in the group without LUTI. Further analyses indicated that patients with more than 5 medical visits for LUTI per year had a significantly greater risk of developing PCa. Conclusion We found that cystitis or urethritis may play an etiological role in the development of PCa in Taiwanese men, particularly in those with repeated medical visits for cystitis or urethritis. Further studies are warranted on the association between LUTI and PCa in other countries, particularly where the prevalence of PCa is high.