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Radiation-Induced Sarcoma: A 15-Year Experience in a Single Large Tertiary Referral Center.

Kyung Su KIM ; Ji Hyun CHANG ; Noorie CHOI ; Han Soo KIM ; Ilkyu HAN ; Kyung Chul MOON ; Il Han KIM ; Hak Jae KIM

Cancer Research and Treatment.2016;48(2):650-657. doi:10.4143/crt.2015.171

PURPOSE: The purpose of this study is to report on the incidence and the experience in management of radiation-induced sarcoma (RIS) at a large single center in Korea for 15 years. MATERIALS AND METHODS: We retrospectively reviewed the sarcoma registry of a large institution from January 2000 to April 2014. RESULTS: Out of the 3,674 patients listed in the registry, 33 patients (0.9%) diagnosed with RIS were identified. The median latency of RIS was 12.1 years. The number of cases of RIS increased from four cases in the years 2000-2003 to 14 cases in the years 2012-2014. The most common histology was osteosarcoma (36.4%). The median follow-up period was 23.1 months, the median overall survival (OS) of all patients was 2.9 years, and their 5-year survival rate was 44.7%. Univariate and multivariate analyses showed association of the age at diagnosis (p=0.01) and the treatment aim (p=0.001) with the OS. The median OS and the 5-year survival rate of patients treated with curative surgery (n=19) were 9.6 years and 65%, respectively, and of the conservatively treated patients, 0.7 years and 0% (n=14). Re-irradiation was delivered to nine patients, and radiation toxicity was observed in five patients. CONCLUSION: In this study, RIS accounted for 0.9% of the cases of sarcoma, with increasing incidence. Despite the association of curative resection with increased survival, it could be applied to only 58% of the patients. Considering the limited treatment options for RIS, conduct of a genetic study to identify the underlying mechanism of RIS is needed.
Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Neoplasms, Radiation-Induced ; Osteosarcoma ; Retrospective Studies ; Sarcoma* ; Survival Rate ; Tertiary Care Centers*

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Second Primary Cancer after Diagnosis and Treatment of Cervical Cancer.

Myong Cheol LIM ; Young Joo WON ; Jiwon LIM ; Yeon Joo KIM ; Sang Soo SEO ; Sokbom KANG ; Eun Sook LEE ; Jae Hwan OH ; Joo Young KIM ; Sang Yoon PARK

Cancer Research and Treatment.2016;48(2):641-649. doi:10.4143/crt.2014.326

PURPOSE: This study was conducted to investigate the incidence and survival outcomes of second primary cancers after the diagnosis of cervical cancer. MATERIALS AND METHODS: Data from the Korea Central Cancer Registry between 1993 and 2010 were reviewed and analyzed. Standardized incidence ratios (SIRs) of second primary cancers among women with cervical cancer were analyzed. Kaplan-Meier survival curves were constructed for cervical cancer patients with or without a second primary cancer. RESULTS: Among 72,805 women with cervical cancer, 2,678 (3.68%) developed a second primary cancer within a mean follow-up period of 7.34 years. The overall SIR for a second cancer was 1.08 (95% confidence interval, 1.04 to 1.12). The most frequent sites of second primary cancers were the vagina, bone and joints, vulva, anus, bladder, lung and bronchus, corpus uteri, and esophagus. However, the incidence rates of four second primary cancers (breast, rectum, liver, and brain) were decreased. The 5-year and 10-year overall survival rates were 78.3% and 72.7% in all women with cervical cancer, and for women with a second primary cancer, these rates were 83.2% and 65.5% from the onset of cervical cancer and 54.9% and 46.7% from the onset of the second primary cancer, respectively. CONCLUSION: The incidence rates of second primary cancers were increased in women with cervical cancer compared to the general population, with the exception of four decreasing cancers. The 10-year overall survival rates were decreased in cervical cancer patients with a second primary cancer.
Anal Canal ; Bronchi ; Cervix Uteri ; Diagnosis* ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Kaplan-Meier Estimate ; Korea ; Liver ; Lung ; Neoplasms, Second Primary* ; Rectum ; Survival Rate ; Urinary Bladder ; Uterine Cervical Neoplasms* ; Uterus ; Vagina ; Vulva

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Prognostic Value of Log Odds of Positive Lymph Nodes after Radical Surgery Followed by Adjuvant Treatment in High-Risk Cervical Cancer.

Jeanny KWON ; Keun Yong EOM ; In Ah KIM ; Jae Sung KIM ; Young Beom KIM ; Jae Hong NO ; Kidong KIM

Cancer Research and Treatment.2016;48(2):632-640. doi:10.4143/crt.2015.085

PURPOSE: The purpose of this study is to compare the prognostic efficacy of the number and location of positive lymph nodes (LN), LN ratio (LNR), and log odds of positive LNs (LODDs) in high-risk cervical cancer treated with radical surgery and adjuvant treatment. MATERIALS AND METHODS: Fifty high-risk patients who underwent radical hysterectomy and pelvic node dissection followed by adjuvant treatment were analyzed retrospectively. The patients had International Federation of Gynecology and Obstetrics (FIGO) stage IA2-IIB. Upper LN is defined as common iliac or higher LN, and LNR is the ratio of positive LNs to harvested LNs. LODDs is log odds between positive LNs and negative LNs. Radiotherapy was delivered to the whole pelvis with median 50.4 Gy/28 Fx± to the para-aortic regions. Platinum-based chemotherapy was used in most patients (93%). The median follow-up duration was 80 months. RESULTS: The 5-year disease-free survival (DFS) rate was 76.1%, and the overall survival (OS) rate was 86.4%. Treatment failure occurred in 11 patients, and distant failure (DF) was the dominant pattern (90.9%). In univariate analysis, significantly lower DFSwas observed in patients with perineural invasion, ≥ 2 LN metastases, LNR ≥ 10%, upper LN metastasis, and ≥ -1.05 LODDs. In multivariate analysis, ≥ -1.05 LODDs was the only significant factor for DFS (p=0.011). Of patients with LODDs ≥ -1.05, 40.9% experienced DF. LODDs was the only significant prognostic factor for OS as well (p=0.006). CONCLUSION: LODDs ≥ -1.05 was the only significant prognostic factor for both DFS and OS. In patients with LODDs ≥ -1.05, intensified chemotherapy might be required, considering the high rate of DF.
Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Gynecology ; Humans ; Hysterectomy ; Lymph Nodes* ; Multivariate Analysis ; Neoplasm Metastasis ; Obstetrics ; Pelvis ; Prognosis ; Radiotherapy ; Retrospective Studies ; Treatment Failure ; Uterine Cervical Neoplasms*

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Conditional Survival and Associated Prognostic Factors in Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy: A Retrospective Study at a Single Institution.

Minyong KANG ; Hyung Suk KIM ; Chang Wook JEONG ; Cheol KWAK ; Hyeon Hoe KIM ; Ja Hyeon KU

Cancer Research and Treatment.2016;48(2):621-631. doi:10.4143/crt.2015.220

PURPOSE: The purpose of this study is to evaluate the changes of conditional survival (CS) probabilities and to identify the prognostic parameters that significantly affect CS over time post-surgery in upper tract urothelial carcinoma (UTUC) patients. MATERIALS AND METHODS: A total of 330 patients were examined in the final analysis. Primary end point was conditional cancer-specific survival (CSS), overall survival (OS), and intravesical recurrence-free survival (IVRFS) after surgery. The Kaplan-Meier method was used for calculation of CS. Cox regression hazard ratio model was used to determine the predictors of CS. RESULTS: UTUC patients who had already survived 5 years after radical nephroureterectomy had a more favorable CS probability in all given survivorships compared to those with shorter survival times. Patients with unfavorable pathologic features showed a higher increment of 5-year conditional CSS and OS compared to their counterparts. For 5-year conditional CSS, several factors, including high-grade tumor, lymphovascular invasion, and tumor location showed significant association with risk elevation over time. Only age remained as a predictor of 5-year conditional OS with increased risk in all given survivorships. For 5-year IVRFS, no variables remained as significant predictive factors over time after surgery. CONCLUSION: Our study provides valuable information for practical survival estimation and relevant prognostic factors for patients with UTUC after surgery.
Carcinoma, Transitional Cell ; Effect Modifier, Epidemiologic ; Humans ; Retrospective Studies* ; Survival Rate ; Urinary Tract ; Urologic Surgical Procedures

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Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients.

Hoon Ah JANG ; Jin Wook KIM ; Seok Soo BYUN ; Sung Hoo HONG ; Young Jun KIM ; Young Hyun PARK ; Kyung Suk YANG ; Seok CHO ; Jun CHEON ; Seok Ho KANG

Cancer Research and Treatment.2016;48(2):612-620. doi:10.4143/crt.2014.122

PURPOSE: The study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups. MATERIALS AND METHODS: We reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR. RESULTS: The median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN. CONCLUSION: Our study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.
Body Mass Index ; Carcinoma, Renal Cell* ; Case-Control Studies* ; Comorbidity ; Disease-Free Survival ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Korea ; Nephrectomy* ; Prospective Studies ; Renal Insufficiency, Chronic

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Clinicopathological Features and Type of Surgery for Lynch Syndrome: Changes during the Past Two Decades.

Il Tae SON ; Duck Woo KIM ; Seung Yong JEONG ; Young Kyoung SHIN ; Myong Hoon IHN ; Heung Kwon OH ; Sung Bum KANG ; Kyu Joo PARK ; Jae Hwan OH ; Ja Lok KU ; Jae Gahb PARK

Cancer Research and Treatment.2016;48(2):605-611. doi:10.4143/crt.2015.092

PURPOSE: The Korean Hereditary Tumor Registry, the first and one of the largest registries of hereditary tumors in Korea, has registered about 500 families with hereditary cancer syndromes. This study evaluates the temporal changes in clinicopathologic features and surgical patterns of Lynch syndrome (LS) patients. MATERIALS AND METHODS: Data on 182 unrelated LS patients were collected retrospectively. The patients were divided into the period 1 group (registered in 1990-2004) and 2 (registered in 2005-2014). The clinical characteristics of the two groups were compared to identify changes over time. RESULTS: The period 1 group included 76 patients; the period 2 group, 106 patients. The mean ages at diagnosis were 45.1 years (range, 13 to 85 years) for group 1 and 49.7 years (range, 20 to 84 years) for group 2 (p=0.015). The TNM stage at diagnosis did not differ significantly-period 1 group: stage 0-I (n=18, 23.7%), II (n=37, 48.7%), III (n=19, 25.0%), and IV (n=2, 2.6%); period 2 group: stage 0-I (n=30, 28.3%), II (n=35, 33.0%), III (n=37, 34.9%), and IV (n=4, 3.8%). Extended resection was more frequently performed (55/76, 72.4%) in the period 1 group than period 2 (49/106, 46.2%) (p=0.001). CONCLUSION: Colorectal cancer in patients with LS registered at the Korean Hereditary Tumor Registry is still diagnosed at an advanced stage, more than two decades after registry's establishment. Segmental resection was more frequently performed in the past decade. A prompt nationwide effort to raise public awareness of hereditary colorectal cancer and to support hereditary cancer registries is required in Korea.
Colorectal Neoplasms ; Colorectal Neoplasms, Hereditary Nonpolyposis* ; Diagnosis ; Humans ; Korea ; Neoplastic Syndromes, Hereditary ; Registries ; Retrospective Studies

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Appendiceal Neuroendocrine, Goblet and Signet-Ring Cell Tumors: A Spectrum of Diseases with Different Patterns of Presentation and Outcome.

Walid SHAIB ; Kavya KRISHNA ; Sungjin KIM ; Michael GOODMAN ; Jonathan ROCK ; Zhengjia CHEN ; Edith BRUTCHER ; Charles III STALEY ; Shishir K MAITHEL ; Samih ABDEL-MISSIH ; Bassel F EL-RAYES ; Tanios BEKAII-SAAB

Cancer Research and Treatment.2016;48(2):596-604. doi:10.4143/crt.2015.029

PURPOSE: Appendiceal tumors are a heterogeneous group of diseases that include typical neuroendocrine tumors (TNET), goblet cell carcinoids (GCC), and atypical GCC. Atypical GCC are classified into signet-ring cell cancers (SRCC) and poorly differentiated appendiceal adenocarcinoids. The prognosis and management of these diseases is unclear because there are no prospective studies. The aim of this study is to assess the characteristics and outcome of appendiceal TNET, GCC, and SRCC patients. MATERIALS AND METHODS: Appendiceal TNET, GCC, and SRCC patients diagnosed between 1973 and 2011 were identified in the Surveillance Epidemiology and End Results (SEER) database. Demographics, type of surgery, and clinicopathologic characteristics were collected. Survival functions were estimated by the Kaplan-Meier method, and log-rank test was used to assess the difference in overall survival (OS) among the three histologies. RESULTS: The SEER database yielded 1,021 TNET patients, 1,582 with GCC, and 534 SRCC patients. TNET presented at a younger age (p < 0.001). Patients with SRCC presented with advanced stage disease (p < 0.001). The median OS (mOS) for GCC and TNET patients was not reached; mOS for SRCC was 24 months. Multivariate analysis stratified for stage revealed significantly longer survival for TNET and GCC than SRCC (p < 0.001). CONCLUSION: This is the largest report to date for appendiceal neuroendocrine tumor patients, suggesting a spectrum of diseases with different characteristics and outcomes. In this report, we present a treatment approach for this complex spectrum of disease, based on the experience of Ohio State and Emory Universities investigators.
Appendiceal Neoplasms ; Carcinoid Tumor ; Demography ; Disease Management ; Epidemiology ; Goblet Cells ; Humans ; Multivariate Analysis ; Neuroendocrine Tumors ; Ohio ; Prognosis ; Prospective Studies ; Research Personnel

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Surgery Alone Versus Surgery Followed by Chemotherapy and Radiotherapy in Resected Extrahepatic Bile Duct Cancer: Treatment Outcome Analysis of 336 Patients.

Jung Ho IM ; Jinsil SEONG ; Ik Jae LEE ; Joon Seong PARK ; Dong Sup YOON ; Kyung Sik KIM ; Woo Jung LEE ; Kyung Ran PARK

Cancer Research and Treatment.2016;48(2):583-595. doi:10.4143/crt.2015.091

PURPOSE: This study analyzed the outcomes of patients with resected extrahepatic bile duct cancer (EHBDC) in order to clarify the role of adjuvant treatments in these patients. MATERIALS AND METHODS: A total of 336 patients with EHBDC who underwent curative resection between 2001 and 2010 were analyzed retrospectively. The treatment types were as follows: surgery alone (n=168), surgery with chemotherapy (CTx, n=90), surgery with radiotherapy (RT) alone (n=29), and surgery with chemoradiotherapy (CRT, n=49). RESULTS: The median follow-up period was 63 months. The 5-year rates of locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for all patients were 56.5%, 59.7%, 36.6%, and 42.0%, respectively. In multivariate analysis, surgery with RT and CRT was a significant prognostic factor for LRFFS, and surgery with CTx was a significant prognostic factor for DMFS, and surgery with CTx, RT, and CRT was a significant prognostic factor for PFS (p < 0.05). Surgery with CTx and CRT showed association with superior OS (p < 0.05), and surgery with RT had marginal significance (p=0.078). In multivariate analysis of the R1 resection patients, surgery with CRT showed significant association with OS (p < 0.05). CONCLUSION: Adjuvant RT and CTx may be helpful in improving clinical outcomes of patients with resected EHBDC who have a high risk of disease recurrence, particularly R1 resection patients. Conduct of additional prospective, larger-scale studies will be required in order to confirm the benefit of adjuvant RT and CTx in these patients.
Bile Ducts, Extrahepatic* ; Biliary Tract Neoplasms ; Chemoradiotherapy ; Cholangiocarcinoma ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Prospective Studies ; Radiotherapy* ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Treatment Outcome*

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Do Biliary Complications after Hypofractionated Radiation Therapy in Hepatocellular Carcinoma Matter?.

Jeong Il YU ; Hee Chul PARK ; Do Hoon LIM ; Seung Woon PAIK

Cancer Research and Treatment.2016;48(2):574-582. doi:10.4143/crt.2015.076

PURPOSE: The purpose of this study is to evaluate the efficacy of hypofractionated radiation therapy (RT) in the treatment of unresectable hepatocellular carcinoma (HCC) after failure of transarterial chemoembolization (TACE) or in cases of refractory HCC, and to investigate biliary complications after hypofractionated RT. MATERIALS AND METHODS: We retrospectively enrolled patients with unresectable, TACE-unresponsive, or refractory HCC treated with hypofractionated RT between July 2006 and December 2012. The perihilar region was defined as the 1-cm area surrounding the right, left, and the common hepatic duct, including the gallbladder and the cystic duct. Significant elevation of total bilirubin was defined as an increase of more than 3.0 mg/dL, and more than two times that of the previous level after completion of RT. RESULTS: Fifty patients received hypofractionated RT and 27 (54%) had a tumor located within the perihilar region. The median follow-up period was 24.7 months (range, 4.3 to 95.5 months). None of the patients developed classic radiation disease symptoms, but four patients (8%) showed significant elevation of total bilirubin within 1 year after RT. During follow-up, 12 patients (24%) developed radiologic biliary abnormalities, but only two patients had toxicities requiring intervention. Estimated local progression-free survival, progression-free survival, and overall survival of the patients at 3-year post-hypofractionated RT were 89.7%, 11.2%, and 57.4%, respectively. CONCLUSION: Biliary complications associated with a higher dose exposure of hypofractionated RT were minimal, even in the perihilar region. Hypofractionated RT provided excellent local control and may be a valuable option for treatment of unresectable cases of TACE-unresponsive or refractory HCC.
Bilirubin ; Carcinoma, Hepatocellular* ; Cystic Duct ; Disease-Free Survival ; Dose Fractionation ; Follow-Up Studies ; Gallbladder ; Hepatic Duct, Common ; Humans ; Radiotherapy ; Retrospective Studies

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Endoscopic Criteria for Evaluating Tumor Stage after Preoperative Chemoradiation Therapy in Locally Advanced Rectal Cancer.

Kyung Su HAN ; Dae Kyung SOHN ; Dae Yong KIM ; Byung Chang KIM ; Chang Won HONG ; Hee Jin CHANG ; Sun Young KIM ; Ji Yeon BAEK ; Sung Chan PARK ; Min Ju KIM ; Jae Hwan OH

Cancer Research and Treatment.2016;48(2):567-573. doi:10.4143/crt.2015.195

PURPOSE: Local excision may be an another option for selected patients with markedly down-staged rectal cancer after preoperative chemoradiation therapy (CRT), and proper evaluation of post-CRT tumor stage (ypT) is essential prior to local excision of these tumors. This study was designed to determine the correlations between endoscopic findings and ypT of rectal cancer. MATERIALS AND METHODS: In this study, 481 patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection between 2004 and 2013 at a single institution were evaluated retrospectively. Pathological good response (p-GR) was defined as ypT ≤ 1, and pathological minimal or no response (p-MR) as ypT ≥ 2. The patients were randomly classified according to two groups, a testing (n=193) and a validation (n=288) group. Endoscopic criteria were determined from endoscopic findings and ypT in the testing group and used in classifying patients in the validation group as achieving or not achieving p-GR. RESULTS: Based on findings in the testing group, the endoscopic criteria for p-GR included scarring, telangiectasia, and erythema, whereas criteria for p-MR included nodules, ulcers, strictures, and remnant tumors. In the validation group, the kappa statistic was 0.965 (p < 0.001), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.362, 0.963, 0.654, and 0.885, respectively. CONCLUSION: The endoscopic criteria presented are easily applicable for evaluation of ypT after preoperative CRT for rectal cancer. These criteria may be used for selection of patients for local excision of down-staged rectal tumors, because patients with p-MR could be easily ruled out.
Chemoradiotherapy ; Cicatrix ; Constriction, Pathologic ; Endoscopy ; Erythema ; Humans ; Neoadjuvant Therapy ; Rectal Neoplasms* ; Retrospective Studies ; Sensitivity and Specificity ; Telangiectasis ; Ulcer

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