A Multicenter Retrospective Analysis of Survival Outcome Following Postoperative Chemoradiotherapy in Non–Small-Cell Lung Cancer Patients With N2 Nodal Disease Page 321
B. Zou, Y. Xu, T. Li, W. Li, B. Tang, L. Zhou, L. Li, Y. Liu, J. Zhu, M. Huang, J. Wang, L. Ren, Y. Gong, G. Che, L. Liu, M. Hou, and Y. Lu
Current, post-operative chemotherapy (POCT) is accepted as a standard care for patients with pN2 nonsmall cell lung cancer (NSCLC) who have received completely resection, but the addition of post-operative radiotherapy (PORT) to chemotherapy (POCRT) is not administrated broadly. One key factor is that we do not have convincing evidence so far whether the patients with pN2 benefit from PORT though our retrospective data demonstrated some important clues.
Patients with N2 disease are often regarded as a subgroup with a poor prognosis. Earlier studies including trial of ANITA (Int J Radiat Oncol Biol & Phys. 2008, 72: 695) or by Keller (NJEM, 2000, 343: 1217) varied in design and selection criteria, which cause either covering stage Ib to IIIa or serving PORT alone as control arm. Our study focused on the stage III patients with pN2. All the patients received POCT, of 104 cases did POCRT. It demonstrated the benefits of PORT in the cohort of patients with pN2 by comparing POCRT with POCT.
Of course, prospect randomized clinical trial is highly warranted. It is the reason why the multicenter randomized studies on N2+ are undergoing not only in France (ClinicalTrials.gov identifier: NCT00410683) but also in China (ClinicalTrials.gov identifier: NCT00880971).
Radiotherapy Can Decrease Locoregional Recurrence and Increase Survival in Mastectomy Patients With T1 to T2 Breast Cancer and One to Three Positive Nodes With Negative Estrogen Receptor and Positive Lymphovascular Invasion Status Page 516
P. S. Yang, C. M. Chen, M. C. Liu, J. M. Jian, C. F. Horng, M. J. Liu, B. L. Yu, M. Y. Lee, and C. W. Chi
There is consensus regarding post-mastectomy radiotherapy in breast cancer patients with tumor size >5cm, four or more involved axillary lymph nodes, yet no clear definition in patients with tumor <5 cm and one to three positive nodes (T1–2 N1). From this study, we showed that radiotherapy reduced the locoregional recurrence in patients with the following characteristics: age <40 years, T2 stage, high nuclear grade, negative ER status, and presence of LVI. Furthermore, we found radiotherapy increase the 5-year overall survival from 43.7% to 87.1% in T1–2 N1 breast cancer patients with negative ER status and presence of LVI.
Depletion of Securin Induces Senescence after Irradiation and Enhances Radiosensitivity in Human Cancer Cells Regardless of Functional p53 Expression Page 566
This article reports that securin expression plays an important role in determining the proportion of human colorectal and breast cancer cells undergoing radiation-induced apoptosis or senescence, which has been considered as a tumor suppressive mechanism that stringently inhibits replication of cancer cells. Depletion of securin impairs DNA repair after irradiation, increasing DNA damage and promoting senescence regardless of functional p53 expression. The knockdown of securin may contribute to a novel radiotherapy protocol for the treatment of human cancer cells that are resistant to irradiation.
Optimization of Collimator Trajectory in Volumetric Modulated Arc Therapy: Development and Evaluation for Paraspinal SBRT Page 591
P. Zhang, L. Happersett, Y. Yang, Y. Yamada, G. Mageras, and M. Hunt
Volumetric modulated arc therapy (VMAT) is an emerging technique that significantly improves treatment delivery efficiency without compromising dosimetric quality. This article describes a novel paradigm, Coll-VMAT, which incorporates dynamic collimator rotation into VMAT planning in addition to standard MLC aperture and dose rate optimization. The collimator trajectory is designed to align MLC leaf travel direction with the primary orientation of the organs at risk. A treatment planning study of five paraspinal stereotactic body radiation therapy patients demonstrates that Coll-VMAT plans are superior in both target coverage and cord sparing compared to standard VMAT (fixed collimator angle) and intensity modulated radiation therapy plans.
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