Study On Radiotherapy Status Of Respiratory Tract And Breast Cancer

Prognostic Significance of A Positive FDG-PET in the Mediastinum for Patients with Pathologic NO-1Non-Small Cell Lung Cancer AbstractPurposeHistology is the "gold standard" for staging mediastinum. When positron emission tomography (PET) and histology are discordant, treatment recommendations are typically based on histology. We herein assess the prognostic implications of mediastinal PET/computed tomography (CT) findings in patients undergoing curative resection of non-small cell lung cancer (NSCLC) with histologically-negative mediastinal nodes.Patients and MethodsRecords of patients with a pre-operative PET/CT undergoing curative surgery, without adjuvant radiation, for pathologic T1-3N0-1NSCLC at University of North Carolina from2000-2006were reviewed. Local-regional/distant failure rates in patients with or without mediastinal abnormalities on pre-operative PET/CT were compared using logistic regression and log-rank tests.ResultsNinety patients were evaluable (all histologically-negative in mediastinum;44via both mediastinoscopy and surgery);13with a’ positive PET/CT in mediastinum, and77negative. Median follow-up was54.3months (range1-99). There were higher rates of local-regional (P=0.001) and distant failure (P<0.001) as well as death (P=0.001) in PET/CT-positive vs. PET/CT-negative group. In multivariable analysis (adjusting for other prognostic factors), positive PET/CT-findings in mediastinum remained prognostic for distant failure (P<0.001, HR:6.9) and were marginally prognostic for local-regional failure (P=0.093, HR:1.9).ConclusionsPositive findings on pre-operative PET/CT in mediastinum appear to have prognostic implications despite the mediastinal lymph nodes being negative histologically. The high rate of local-regional/distant failure suggests that post-operative RT and/or chemotherapy may be particularly helpful in patients with a positive mediastinum on pre-operative PET/CT. Prospective studies may better clarify the implications of a positive PET in mediastinum in patients with histologically-negative mediastinal nodes. Association between the Application of Regional Nodal Irradiation and the Risk of Radiation-Related Non-Breast Second Malignancy in Young Female Breast Cancer PatientsPurposeTo examine whether application of regional nodal irradiation increase the risk of radiation-related non-breast second malignancy in young female breast cancer patients.Patients and MethodsExcess absolute risk (EAR) per10,000person-year at risk for second radiation field related non-breast malignancies in young female (age20-45years old) patients with breast cancer was calculated from the using Surveillance, Epidemiology and End Results (SEER) database (1973-2008). Difference of its trend was compared using linear regression among the following three groups:patients with positive axillary lymph nodes (LN) treated by radiation therapy (RT) as a part of initial treatment, patients with negative LN treated by RT, and patients not treated by RT regardless of LN. Cumulative incidence of RT-related non-breast second malignancies was estimated in patients treated by postmastectomy RT from1992to2008and compared using Gray’s test among the following three groups of patients:those with more than three positive axillary LNs, one to three positive LNs, and negative LNs.ResultsIn20-30year-old group, no statistically significant difference was detected among axillary LN-positive patients treated by RT, LN-negative with RT and no RT (P=0.551), and also no statistically significant difference was found between LN-positive patients and LN negative ones (p=0.926). In31-40year-old and41-45year-old groups, marginally significant difference was found among the three group (P=0.052,0.054), yet no statistically significant difference was revealed between LN positive patients and LN negative ones (p=0.990,0.152). In addition, no statistically significant difference was observed among more than3LN positive,1-3LN positive and LN negative young patients with postmastectomy RT during1992-2008.(P=0.43)ConclusionBased on the large-scale patient database, we conclude that regional nodal irradiation may not increase RT-related non-breast second malignancy in young female breast cancer patients. The Use of Radiation Therapy Appears to Improve Outcome in Patients with Malignant Primary Tracheal Tumors:A SEER-Based Analysis AbstractPurposeTo conduct a matched pair analysis assessing the impact of radiotherapy in patients with resectable and unresectable primary malignant tracheal tumors using Surveillance, Epidemiology and End Results (SEER) database.Patients and MethodsThe SEER registry was used to identify every patient (or’case’) who received RT from1988-2007for primary malignant tracheal tumors, and to search for corresponding’controls’(not treated with RT), with the same prognostic and treatment factors (surgery on the trachea, disease extension, histology and gender). Overall survival (OS) was calculated with the Kaplan Meier methods. Results of OS and cumulative incidence of death due to tracheal cancer in the cases and controls, and in various subsets, were compared using log rank and Gray’s tests.ResultsTwo hundred and fifty-eight patients who received RT were identified, and78of these had appropriate matched controls identified, forming the basis of this analysis. In the78(+RT) cases, the median follow-up was60months (range,10to192) in the survivors, vs.55months (range,2to187) in the controls (no-RT group). Patients in RT group had significantly better OS, and a lower cumulative incidence of death from tracheal cancer than no-RT patients (P<0.05). Treatment with radiation was associated with improved survival in patients with squamous cell histology [P<0.0001], regional disease extension [P=0.030], or those that did not undergo resection [P=0.038]. There were four deaths in RT group and three in no-RT group attributed to cardiac and respiratory causes.ConclusionOur data suggests a survival benefit for the use of radiation therapy broadly for all patients with tracheal cancer. Nevertheless, the retrospective nature of this observational study limits its interpretation.