Cancer Research and Treatment

Original Articles

Hematologic malignancy

Long-term Clinical Efficacy of Radiotherapy for Patients with Stage I-II Gastric Extranodal Marginal Zone B-Cell Lymphoma of Mucosa-Associated Lymphoid Tissue: A Retrospective Multi-institutional Study: Jae Uk Jeong, Hyo Chun Lee, Jin Ho Song, Keun Yong Eom, Jin Hee Kim, Yoo Kang Kwak, Woo Chul Kim, Sun Young Lee, Jin Hwa Choi, Kang Kyu Lee, Jong Hoon Lee; Cancer Res Treat. 2025;57(2):570-579. Published online October 4, 2024; DOI: https://doi.org/10.4143/crt.2024.651

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to evaluate long-term treatment outcomes in patients with localized gastric mucosa-associated lymphoid tissue (MALT) lymphoma treated with radiotherapy (RT).
Materials and Methods
A total of 229 patients who received RT in 10 tertiary hospitals between 2010 and 2019 were included in this multicenter analysis. Response after RT was based on esophagogastroduodenoscopy after RT. Locoregional relapse-free survival (LRFS) and disease-free survival (DFS), and overall survival (OS) were evaluated.
Results
After a median follow-up time of 93.2 months, 5-year LRFS, DFS, and OS rates were 92.8%, 90.4%, and 96.1%, respectively. LRFS, DFS, and OS rates at 10 years were 90.3%, 87.7%, and 92.8%, respectively. Of 229 patients, 228 patients (99.6%) achieved complete remission after RT. Five-year LRFS was significantly lower in patients with stage IIE than in those with stage IE (77.4% vs. 94.2%, p=0.047). Patients with age ≥ 60 had significantly lower LRFS than patients with age < 60 (89.3% vs. 95.1%, p=0.003). In the multivariate analysis, old age (≥ 60 years) was a poor prognostic factor for LRFS (hazard ratio, 3.72; confidence interval, 1.38 to 10.03; p=0.009). Grade 2 or higher gastritis was reported in 69 patients (30.1%). Secondary malignancies including gastric adenocarcinoma, malignant lymphoma, lung cancer, breast cancer, and prostate cancer were observed in 11 patients (4.8%) after RT.
Conclusion
Patients treated with RT for localized gastric MALT lymphoma showed favorable 10-year outcomes. Radiation therapy is an effective treatment without an increased risk of secondary cancer. The toxicity for RT to the stomach is not high.

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SUVmax Predicts Disease Progression after Stereotactic Ablative Radiotherapy in Stage I Non-small Cell Lung Cancer: Yoo-Kang Kwak, Hee Hyun Park, Kyu Hye Choi, Eun Young Park, Soo Yoon Sung, Sea-Won Lee, Ji Hyun Hong, Hyo Chun Lee, Ie Ryung Yoo, Yeon Sil Kim; Cancer Res Treat. 2020;52(1):85-97. Published online May 17, 2019; DOI: https://doi.org/10.4143/crt.2019.007

Abstract PDF PubReader ePub

Purpose
Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) is gaining evidence as a predictive factor in non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is the standard treatment in early-stage NSCLC when a patient is unsuitable for surgery. We performed a study to assess the prognostic clinical significance of PET-CT after SABR in early-stage NSCLC.
Materials and Methods
Seventy-six patients with stage I NSCLC treated with SABR were investigated. Total radiation dose ranged from 36 to 63 Gy in three to eight fractions depending on tumor location and size. Respiratory motion control was implemented at simulation and during treatment. PET-CT prior to SABR was performed in 66 patients (86.8%).
Results
Median follow-up time was 32 months (range, 5 to 142 months). Local control rate at 1, 2, and 5 years were 95.9%, 92.8%, and 86.7%, respectively. Overall survival (OS) at 1, 2, and 5 years were 91.0%, 71.3%, and 52.1% respectively. Cause-specific survival at 1, 2, and 5 years were 98.6%, 93.1%, and 84.3% respectively. Tumor size and pre-SABR maximal standardized uptake value (SUVmax) demonstrated statistical significance in the Kaplan-Meier survival analyses with log-rank test. In multivariate analyses pre-SABR SUVmax remained statistically significant in correlation to OS (p=0.024; hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.2 to 8.8) and with marginal significance in regards to regional progression-free survival (p=0.059; HR, 32.5; 95% CI, 2.6 to 402.5).
Conclusion
Pre-SABR SUVmax demonstrated a predictive power in statistical analyses. Tumors with SUVmax above 6 at diagnosis were associated with inferior outcomes.

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Enhanced NSCLC subtyping and staging through attention-augmented multi-task deep learning: A novel diagnostic tool
Runhuang Yang, Weiming Li, Siqi Yu, Zhiyuan Wu, Haiping Zhang, Xiangtong Liu, Lixin Tao, Xia Li, Jian Huang, Xiuhua Guo
International Journal of Medical Informatics.2025; 193: 105694. CrossRef
Invasive Nodal Staging via Endobronchial Ultrasound and Outcome in Patients Treated with Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer – Results from a Single Institution Study
Benjamin George, Atallah Baydoun, Samar Bhat, Lauryn Bailey, Theodore Arsenault, Yilun Sun, Yuxia Zhang, Yiran Zheng, Prashant Vempati, Tarun Podder, Tithi Biswas
Clinical Lung Cancer.2024; 25(4): e181. CrossRef
Prognostic value of consolidation-to-tumor ratio on computed tomography in NSCLC: a meta-analysis
Yongming Wu, Wenpeng Song, Denian Wang, Junke Chang, Yan Wang, Jie Tian, Sicheng Zhou, Yingxian Dong, Jing Zhou, Jue Li, Ziyi Zhao, Guowei Che
World Journal of Surgical Oncology.2023;[Epub] CrossRef
Tumor to liver maximum standardized uptake value ratio of FDG-PET/CT parameters predicts tumor treatment response and survival of stage III non-small cell lung cancer
Pengfei Zhang, Wei Chen, Kewei Zhao, Xiaowen Qiu, Tao Li, Xingzhuang Zhu, Peng Sun, Chunsheng Wang, Yipeng Song
BMC Medical Imaging.2023;[Epub] CrossRef
Evaluation of response to stereotactic body radiation therapy for nonsmall cell lung cancer: PET response criteria in solid tumors versus response evaluation criteria in solid tumors
Jixia Han, Qi Song, Feng Guo, Rui Du, Henghu Fang, Jingbo Kang, Zejun Lu
Nuclear Medicine Communications.2022;[Epub] CrossRef
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Yu-Sen Huang, Jenny Ling-Yu Chen, Hsin-Ming Chen, Li-Hao Yeh, Jin-Yuan Shih, Ruoh-Fang Yen, Yeun-Chung Chang
BMC Cancer.2021;[Epub] CrossRef
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Giulia Riva, Sara Imparato, Giovanni Savietto, Mattia Pecorilla, Alberto Iannalfi, Amelia Barcellini, Sara Ronchi, Maria Rosaria Fiore, Chiara Paganelli, Giulia Buizza, Mario Ciocca, Guido Baroni, Lorenzo Preda, Ester Orlandi
The British Journal of Radiology.2021;[Epub] CrossRef
Prognostic value of metabolic signature on 18F-FDG uptake in breast cancer patients after radiotherapy
Jin Meng, Emmanuel Deshayes, Li Zhang, Wei Shi, Xiaomeng Zhang, Xingxing Chen, Xin Mei, Jinli Ma, Yizhou Jiang, Jiong Wu, Zhimin Shao, Xiaoli Yu, Zhaozhi Yang, Xiaomao Guo
Molecular Therapy - Oncolytics.2021; 23: 412. CrossRef
Parámetros cuantitativos de la PET/TC con 18F-FDG como factores pronósticos en el cáncer de pulmón localizado e inoperable
J.R. Infante, J. Cabrera, J.I. Rayo, C. Cruz, J. Serrano, M. Moreno, A. Martínez, P. Jiménez, A. Cobo
Revista Española de Medicina Nuclear e Imagen Molecular.2020; 39(6): 353. CrossRef
18F-FDG PET/CT quantitative parameters as prognostic factors in localized and inoperable lung cancer
J.R. Infante, J. Cabrera, J.I. Rayo, C. Cruz, J. Serrano, M Moreno, A. Martínez, P. Jiménez, A. Cobo
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition).2020; 39(6): 353. CrossRef

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Setup Error and Effectiveness of Weekly Image-Guided Radiation Therapy of TomoDirect for Early Breast Cancer: Mi Joo Chung, Guk Jin Lee, Young Jin Suh, Hyo Chun Lee, Sea-Won Lee, Songmi Jeong, Jeong Won Lee, Sung Hwan Kim, Dae Gyu Kang, Jong Hoon Lee; Cancer Res Treat. 2015;47(4):774-780. Published online February 13, 2015; DOI: https://doi.org/10.4143/crt.2014.189

Abstract PDF PubReader ePub

Purpose
This study investigated setup error and effectiveness of weekly image-guided radiotherapy (IGRT) of TomoDirect for early breast cancer. Materials and Methods One hundred and fifty-one breasts of 147 consecutive patients who underwent breast conserving surgery followed by whole breast irradiation using TomoDirect in 2012 and 2013 were evaluated. All patients received weekly IGRT. The weekly setup errors from simulation to each treatment in reference to chest wall and surgical clips were measured. Random, systemic, and 3-dimensional setup errors were assessed. Extensive setup error was defined as 5 mm above the margin in any directions.
Results
All mean errors were within 3 mm of all directions. The mean angle of gantry shifts was 0.6°. The mean value of absolute 3-dimensional setup error was 4.67 mm. In multivariate analysis, breast size (odds ratio, 2.82; 95% confidence interval, 1.00 to 7.90) was a significant factor for extensive error. The largest significant deviation of setup error was observed in the first week of radiotherapy (p < 0.001) and the deviations gradually decreased with time. The deviation of setup error was 5.68 mm in the first week and within 5 mm after the second week. Conclusion In this study, there was a significant association between breast size and significant setup error in breast cancer patients who received TomoDirect. The largest deviation occurred in the first week of treatment. Therefore, patients with large breasts should be closely observed on every fraction and fastidious attention is required in the first fraction of IGRT.

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Interstitial Lung Change in Pre-radiation Therapy Computed Tomography Is a Risk Factor for Severe Radiation Pneumonitis: Yun Hee Lee, Yeon Sil Kim, Sang Nam Lee, Hyo Chun Lee, Se Jin Oh, Seoung Joon Kim, Young Kyoon Kim, Dae Hee Han, Ie Ryung Yoo, Jin Hyung Kang, Suk Hee Hong; Cancer Res Treat. 2015;47(4):676-686. Published online February 13, 2015; DOI: https://doi.org/10.4143/crt.2014.180

Abstract PDF PubReader ePub

Purpose
We examined clinical and dosimetric factors as predictors of symptomatic radiation pneumonitis (RP) in lung cancer patients and evaluated the relationship between interstitial lung changes in the pre-radiotherapy (RT) computed tomography (CT) and symptomatic RP. Materials and Methods Medical records and dose volume histogram data of 60 lung cancer patients from August 2005 to July 2006 were analyzed. All patients were treated with three dimensional (3D) conformal RT of median 56.9 Gy. We assessed the association of symptomatic RP with clinical and dosimetric factors.
Results
With a median follow-up of 15.5 months (range, 6.1 to 40.9 months), Radiation Therapy Oncology Group grade ≥ 2 RP was observed in 14 patients (23.3%). Five patients (8.3%) died from RP. The interstitial changes in the pre-RT chest CT, mean lung dose (MLD), and V30 significantly predicted RP in multivariable analysis (p=0.009, p < 0.001, and p < 0.001, respectively). MLD, V20, V30, and normal tissue complication probability normal tissue complication probability (NTCP) were associated with the RP grade but less so for grade 5 RP. The risk of RP grade ≥ 2, ≥ 3, or ≥ 4 was higher in the patients with interstitial lung change (grade 2, 15.6% to 46.7%, p=0.03; grade 3, 4.4% to 40%, p=0.002; grade 4, 4.4% to 33.3%, p=0.008). Four of the grade 5 RP patients had diffuse interstitial change in pre-RT CT and received chemoradiotherapy. Conclusion Our study identified diffuse interstitial disease as a significant clinical risk for RP, particularly fatal RP. We showed the usefulness of MLD, V20, V30, and NTCP in predicting the incidence and severity of RP.

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Postoperative Radiotherapy Alone Versus Chemoradiotherapy in Stage I-II Endometrial Carcinoma: An Investigational and Propensity Score Matching Analysis: Jong Hoon Lee, Hyo Chun Lee, Sung Hwan Kim, Mi Joo Chung, Song Mi Jeong, Sung Jong Lee, Joo Hee Yoon, Dong Choon Park; Cancer Res Treat. 2015;47(2):298-305. Published online September 15, 2014; DOI: https://doi.org/10.4143/crt.2014.038

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Purpose
The purpose of this study was to compare the results of postoperative adjuvant radiotherapy (RT) and concurrent chemoradiotherapy (CRT) in stage I-II endometrial carcinoma. Materials and Methods We analyzed a total of 64 patients with surgically staged I-II endometrial carcinoma who were treated with postoperative adjuvant RT or concurrent CRT between March 1999 and July 2013. Thirty-two patients who received postoperative RT alone were matched with those who received postoperative CRT (n=32) in accordance to age, stage, and tumor histology. Overall survival and relapse-free survival, as well as toxicity of the RT and CRT arms were evaluated and compared. Results The 5-year overall survival rate was 90.0% for the RT arm and 91.6% for the CRT arm. There was no significant difference in overall survival between the two treatment arms (p=0.798). The 5-year relapse-free survival rate was 87.2% in the RT arm and 88.0% in the CRT arm. Again, no significant difference in relapse-free survival was seen between the two arms (p=0.913). In a multivariate analysis, tumor histology was an independent prognostic factor for relapse-free survival (hazard ratio, 3.67; 95% of CI, 2.34 to 7.65; p=0.045). Acute grade 3 or 4 hematologic toxicities in the CRT arm were significantly higher than in the RT alone arm (6.2% vs. 31.2%, p=0.010). Conclusion Adjuvant pelvic concurrent chemoradioherapy did not show superior results in overall survival and relapse-free survival compared to RT alone in stage I-II endometrial carcinoma.

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