Yeon-Joo Kim

Single-Dose Versus Fractionated Stereotactic Radiotherapy for Brain Metastases

PURPOSEnTo evaluate the efficacy of stereotactic radiotherapy in patients with brain metastases by comparing two different treatment regimens, single-dose radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT).nnnMETHODS AND MATERIALSnBetween November 2003 and December 2008, 98 patients with brain metastases were included. Fifty-eight patients were treated with SRS, and forty were treated with FSRT. Fractionated stereotactic radiotherapy was used for large lesions or lesions located near critical structures. The median doses were 20 Gy for the SRS group and 36 Gy in 6 fractions for the FSRT group.nnnRESULTSnWith a median follow-up period of 7 months, the median survival was 7 months for all patients, with a median of 6 months for the SRS group and 8 months for the FSRT group (p = 0.89). Local progression-free survival (LPFS) rates at 6 months and 1 year were 81% and 71%, respectively, for the SRS group and 97% and 69%, respectively, for the FSRT group (p = 0.31). Despite the fact that FSRT was used for large lesions and lesions in adverse locations, LPFS was not inferior to SRS. Toxicity was more frequently observed in the SRS group than in the FSRT group (17% vs. 5%, p = 0.05).nnnCONCLUSIONSnBecause patients treated with FSRT exhibited similar survival times and LPFS rates with a lower risk of toxicity in comparison to those treated with SRS, despite the fact that FSRT was used for large lesions and lesions in adverse locations, we find that FSRT can particularly be beneficial for patients with large lesions or lesions located near critical structures. Further investigation is warranted to determine the optimal dose/fractionation.

Surgical stress after robot-assisted distal gastrectomy and its economic implications

There is a lack of reports evaluating the outcomes of robotic gastrectomy and conventional laparoscopic surgery. The aim of this study was to compare the surgical stress response and costs of robot‐assisted distal gastrectomy (RADG) with those of laparoscopy‐assisted distal gastrectomy (LADG).

Phase 3 Trial of Postoperative Chemotherapy Alone Versus Chemoradiation Therapy in Stage III-IV Gastric Cancer Treated With R0 Gastrectomy and D2 Lymph Node Dissection

PURPOSEnTo compare chemotherapy alone with chemoradiation therapy in stage III-IV(M0) gastric cancer treated with R0 gastrectomy and D2 lymph node dissection.nnnMETHODS AND MATERIALSnThe chemotherapy arm received 5 cycles of fluorouracil and leucovorin (FL), and the chemoradiation therapy arm received 1 cycle of FL, then radiation therapy of 45 Gy concurrently with 2 cycles of FL, followed by 2 cycles of FL. Intent-to-treat analysis and per-protocol analyses were performed.nnnRESULTSnBetween May 6, 2002 and June 29, 2006, a total of 90 patients were enrolled. Forty-four were randomly assigned to the chemotherapy arm and 46 to the chemoradiation therapy arm. Treatment was completed as planned by 93.2% of patients in the chemotherapy arm and 87.0% in the chemoradiation therapy arm. Overall intent-to-treat analysis showed that addition of radiation therapy to chemotherapy significantly improved locoregional recurrence-free survival (LRRFS) but not disease-free survival. In subgroup analysis for stage III, chemoradiation therapy significantly prolonged the 5-year LRRFS and disease-free survival rates compared with chemotherapy (93.2% vs 66.8%, P=.014; 73.5% vs 54.6%, P=.056, respectively).nnnCONCLUSIONSnAddition of radiation therapy to chemotherapy could improve the LRRFS in stage III gastric cancer treated with R0 gastrectomy and D2 lymph node dissection.

Phase II trial of proton beam accelerated partial breast irradiation in breast cancer

BACKGROUND AND PURPOSEnHere, we report the results of our phase II, prospective study of proton beam accelerated partial breast irradiation (PB-APBI) in patients with breast cancer after breast conserving surgery (BCS).nnnMATERIALS AND METHODSnThirty patients diagnosed with breast cancer were treated with PB-APBI using a single-field proton beam or two fields after BCS. The treatment dose was 30 cobalt gray equivalent (CGE) in six CGE fractions delivered once daily over five consecutive working days.nnnRESULTSnAll patients completed PB-APBI. The median follow-up time was 59 months (range: 43-70 months). Of the 30 patients, none had ipsilateral breast recurrence or regional or distant metastasis, and all were alive at the last follow-up. Physician-evaluated toxicities were mild to moderate, except in one patient who had severe wet desquamation at 2 months that was not observed beyond 6 months. Qualitative physician cosmetic assessments of good or excellent were noted in 83% and 80% of the patients at the end of PB-APBI and at 2 months, respectively, and decreased to 69% at 3 years. A good or excellent cosmetic outcome was noted in all patients treated with a two-field proton beam at any follow-up time point except for one. For all patients, the mean percentage breast retraction assessment (pBRA) value increased significantly during the follow-up period (p=0.02); however, it did not increase in patients treated with two-field PB-APBI (p=0.3).nnnCONCLUSIONSnPB-APBI consisting of 30 CGE in six CGE fractions once daily for five consecutive days can be delivered with excellent disease control and tolerable skin toxicity to properly selected patients with early-stage breast cancer. Multiple-field PB-APBI may achieve a high rate of good-to-excellent cosmetic outcomes. Additional clinical trials with larger patient groups are needed.

Immunohistochemical study identifying prognostic biomolecular markers in nasopharyngeal carcinoma treated by radiotherapy

We evaluated the predictive significance of 14 reported markers using immunohistochemical study in nasopharyngeal carcinoma.

Phase I dose-escalation study of proton beam therapy for inoperable hepatocellular carcinoma.

Purpose The purpose of this study is to determine the optimal dose of proton beam therapy (PBT) in hepatocellular carcinoma (HCC) patients. Materials and Methods Inoperable HCC patients who had naïve, recurrent, or residual tumor to treatment were considered eligible for PBT. Patients received PBT with 60 GyE in 20 fractions (dose level 1; equivalent dose in 2 Gy fractions [EQD2], 65 GyE10); 66 GyE in 22 fractions (dose level 2; EQD2, 71.5 GyE10); or 72 GyE in 24 fractions (dose level 3; EQD2, 78 GyE10). Dose-limiting toxicity was determined by grade ≥ 3 acute toxicity. Results Twenty-seven patients were enrolled; eight, seven, and 12 patients were treated with dose levels 1, 2, and 3, respectively. Overall, treatment was well tolerated, with no dose-limiting toxicities. The complete response (CR) rates of primary tumors after PBT for dose levels 1, 2, and 3 were 62.5% (5/8), 57.1% (4/7), and 100% (12/12), respectively (p=0.039). The 3-and 5-year local progression-free survival (LPFS) rates among 26 patients, excluding one patient who underwent liver transplantation after PBT due to its probable significant effect on disease control, were 79.9% and 63.9%, respectively, and the 3-and 5-year overall survival rates were 56.4% and 42.3%, respectively. The 3-year LPFS rate was significantly higher in patients who achieved CR than in those who did not (90% vs. 40%, p=0.003). Conclusion PBT is safe and effective and an EQD2 ≥ 78 GyE10 should be delivered for achievement of local tumor control.

Randomized clinical trial of preoperative skin antisepsis with chlorhexidine gluconate or povidone–iodine

Skin antiseptic agents are used to prevent surgical‐site infection (SSI); few trials have reported the superiority of any specific agent in clean‐contaminated abdominal surgery. This RCT was designed to compare the effectiveness of chlorhexidine gluconate and povidone–iodine.

Comparison of Lower Extremity Edema in Locally Advanced Cervical Cancer: Pretreatment Laparoscopic Surgical Staging with Tailored Radiotherapy Versus Primary Radiotherapy

BackgroundThis study investigated the clinical manifestations of lower extremity edema (LEE) in locally advanced cervical cancer patients treated with two different strategies.MethodsIn total, 79 cervical cancer survivors with International Federation of Gynecology and Obstetrics stage IB2-IIB were included. Six survivors with stage IB1 and who had been suspicious for lymph node metastasis on pretreatment image also were included. Forty-two patients received radiotherapy after pretreatment laparoscopic surgical staging (Group 1), and 43 patients received primary radiotherapy (Group 2). The patients’ medical records and survey results of the Korean version of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ-K) were analyzed.ResultsThe incidence of LEE was higher in Group 1 than in Group 2 (69.0 vs. 11.6xa0%; Pxa0<xa00.001). The duration of LEE was longer in Group 1 (mean 77.3 vs. 9.4xa0months). At the time of survey, 47.6xa0% of the patients in Group 1 were clinically diagnosed with lymphedema compared with no patients in Group 2. In GCLQ-K, the mean symptom cluster scores for general swelling (0.74 vs. 0.09; Pxa0<xa00.001), limb swelling (0.22 vs. 0.00; Pxa0=xa00.006), and heaviness (0.45 vs. 0.23; Pxa0=xa00.033) were significantly higher in Group 1. One patient in Group 1 developed lymphedema-related angiosarcoma that was diagnosed at 7.8xa0years after surgery.ConclusionsPatients with cervical cancer who underwent radiotherapy after laparoscopic surgical staging more commonly experienced LEE and related symptoms than patients who underwent primary radiotherapy. As LEE decreases patients’ quality of life, it should be considered during patient consultation and surveillance.

No correlation between pretreatment serum CEA levels and tumor volume in locally advanced rectal cancer patients.

BACKGROUNDnAlthough serum carcinoembryonic antigen (CEA) levels reflect tumor volume in rectal cancer patients intrapersonally, it is unclear interpersonally. We determined the correlation between pretreatment serum CEA levels and tumor volume.nnnMETHODSnA total of 489 patients with locally advanced primary rectal cancer who underwent preoperative chemoradiotherapy followed by surgery between October 2001 and April 2007 were retrospectively evaluated. CEA levels were measured by chemiluminescent microparticle immunoassay, and magnetic resonance (MR) volumetry was performed using MR data. The correlation between CEA levels and tumor volume was assessed using linear regression analysis and one-way analysis of variance. The prognostic values of CEA levels and tumor volume for survival were evaluated.nnnRESULTSnThere was no significant correlation between CEA levels and tumor volume. The five-year overall survival and disease-free survival were 89.0%, 80.6% and 82.9%, and 72.0%, 70.0% and 60.3% in patients with CEA levels of ≤3 ng/ml, >3-10 ng/ml, and >10 ng/ml, respectively. Tumor volume had no prognostic value for either overall survival or disease-free survivalnnnCONCLUSIONSnPretreatment serum CEA levels were not correlated with tumor volume. While there was no correlation between tumor volume and survival, there was a positive correlation between CEA levels and survival.