Predictors of Extra-Pulmonary Metastatic Disease in Patients with Recurrent Lung Cancer

Background: Lung cancer is one of the leading causes of cancer-related mortality worldwide. Its poor prognosis is associated with late detection and high recurrence rates. We aimed to determine if certain imaging characteristics of lung cancer recurrence were predictors of extra-pulmonary metastatic disease.Methods: We conducted a retrospective study of all patients at our institution with lung cancer recurrence detected on post-treatment imaging between January 2014-October 2019. Research ethics board approval was obtained. Included patients underwent pre-treatment imaging, surgical resection, and post-treatment imaging. Imaging characteristics and pathological findings of the pulmonary lesions were analyzed. Univariate logistic regression was performed to assess for potential predictors of extra-pulmonary metastatic disease. The variables evaluated were age, gender, original and recurrent lesion size and imaging characteristics, recurrence location, presence of chest wall or mediastinal invasion, lymphadenopathy, and malignancy subtype. Results: 76 patients were included (33 males; mean age 70.9, standard deviation [SD] 7.7). The primary lesions were adenocarcinoma (N=50), squamous cell carcinoma (N=21), and other (N=5). The mean time to recurrence was 24.3 months (SD=18.8) from date of surgical excision. The two significant predictors of extra-pulmonary metastatic disease were: having >1 recurrent lesion (odds ratio [OR], 8.1; p=0.004), and the presence of suspicious lymphadenopathy at the time of recurrence (OR, 14.1; p<0.001).Conclusion: In lung cancer recurrence, the presence of >1 recurrent lesion and suspicious lymphadenopathy at the time of recurrence were significant predictors of extra-pulmonary metastatic disease. These findings may help guide the risk stratification and management of patients with recurrent lung cancer.

Limited recurrence distance of glioblastoma under modern radiotherapy era

Background The optimal treatment volume for Glioblastoma multiforme (GBM) is still a subject of debate worldwide. The current study was aimed to determine the distances between recurring tumors and the edge of primary lesions, and thereby provide evidence for accurate target area delineation. Methods Between October 2007 and March 2019, 68 recurrent patients with GBM were included in our study. We measured the distance from the initial tumor to the recurrent lesion of GBM patients by expanding the initial gross tumor volume (GTV) to overlap the center of recurrent lesion, with the help of the Pinnacle Treatment Planning System. Results Recurrences were local in 47(69.1%) patients, distant in 12(17.7%) patients, and both in 9(13.2%) patients. Factors significantly influencing local recurrence were age (P = 0.049), sex (P = 0.049), and the size of peritumoral edema (P = 0.00). A total number of 91 recurrent tumors were analyzed. All local recurrences occurred within 2 cm and 94.8% (55/58) occurred within 1 cm of the original GTV based on T1 enhanced imaging. All local recurrences occurred within 1.5 cm and 98.3%(57/58) occurred within 0.5 cm of the original GTV based on T2-FLAIR imaging. 90.9% (30/33) and 81.8% (27/33) distant recurrences occurred >3 cm of T1 enhanced and T2-Flair primary tumor margins, respectively. Conclusions The 1 cm margin from T1 enhanced lesions and 0.5 cm margin from T2-Flair abnormal lesions could cover 94.8 and 98.3% local recurrences respectively, which deserves further prospective study as a limited but effective target area.

Salvage chemoradiation therapy for recurrence after radical surgery or palliative surgery in esophageal cancer patients: a prospective, multicenter clinical trial protocol

Background Currently, adjuvant therapy is not recommended for patients with thoracic esophageal squamous cell cancer (TESCC) after radical surgery, and a proportion of these patients go on to develop locoregional recurrence (LRR) within 2 years. Besides, there is no evidence for salvage chemoradiation therapy (CRT) in patients with residual tumor after esophagectomy (R1/R2 resection). In addition, factors like different failure patterns and relationship with normal organs influence the decision for salvage strategy. Here, we aimed to design a modularized salvage CRT strategy for patients without a chance of salvage surgery according to different failure patterns (including R1/R2 resection), and further evaluated its efficacy and safety. Methods Our study was designed as a one arm, multicenter, prospective clinical trial. All enrolled patients were stratified in a stepwise manner based on the nature of surgery (R0 or R1/2), recurrent lesion diameter, involved regions, and time-to-recurrence, and were further assigned to undergo either elective nodal irradiation or involved field irradiation. Then, radiation technique and dose prescription were modified according to the distance from the recurrent lesion to the thoracic stomach or intestine. Ultimately, four treatment plans were established. Discussion This prospective study provided high-level evidence for clinical salvage management in patients with TESCC who developed LRR after radical surgery or those who underwent R1/R2 resection. Trial registration Prospectively Registered. ClinicalTrials.govNCT03731442, Registered November 6, 2018.

Salvage Chemoradiation Therapy for Recurrence After Radical Surgery or Palliative Surgery in Esophageal Cancer Patients: A Prospective, Multicenter Clinical Trial Protocol

Background: Currently, adjuvant therapy is not recommended for patients with thoracic esophageal squamous cell carcinoma (TESCC) after radical surgery, and a proportion of these patients go on to develop locoregional recurrence (LRR) within 2 years. Besides, there is no evidence for salvage chemoradiation therapy (CRT) in patients with residual tumor after esophagectomy (R1/R2 resection). In addition, factors like different failure patterns and relationship with normal organs influence the decision for salvage strategy. Here, we aimed to design a modularized salvage CRT strategy for patients without a chance of salvage surgery according to different failure patterns (including R1/R2 resection), and further evaluated its efficacy and safety.Methods: Our study was designed as a one arm, multicenter, prospective clinical trial. All enrolled patients were stratified in a stepwise manner based on the nature of surgery (R0 or R1/2), recurrent lesion diameter, involved regions, and time-to-recurrence, and were further assigned to undergo either elective nodal irradiation or involved field irradiation. Then, radiation technique and dose prescription were modified according to the distance from the recurrent lesion to the thoracic stomach or intestine. Ultimately, four treatment plans were established.Discussion: This prospective study provided high-level evidence for clinical salvage management in patients with TESCC who developed LRR after radical surgery or those who underwent R1/R2 resection. Trial registration: ClinicalTrials.gov, NCT03731442, Registered 12 Octomber2018, https://clinicaltrials.gov/NCT03731442

Limited Recurrence Distance of Glioblastoma Under Modern Radiotherapy Era

Background: The optimal treatment volume for Glioblastoma multiforme (GBM) is still a subject of debate worldwide. The current study was aimed to determine the distances between recurring tumors and the edge of primary lesions, and thereby provide evidence for accurate target area delineation.Methods: Between October 2007 and March 2019, 68 recurrent patients with GBM were included in our study. We measured the distance from the initial tumor to the recurrent lesion of GBM patients by expanding the initial gross tumor volume (GTV) to overlap the center of recurrent lesion, with the help of the Pinnacle Treatment Planning System.Results: Recurrences were local in 56(82.3%) patients, distant in 21(30.9%) patients, and both in 9(13.2%) patients. Factors significantly influencing local recurrence were age (P = 0.049), sex (P = 0.049), and the size of peritumoral edema (P = 0.00). A total number of 91 recurrent tumors were analyzed. All local recurrences occurred within 2cm and 94.8% (55/58) occurred within 1cm of the original GTV based on T1 enhanced imaging. All local recurrences occurred within 1.5 cm and 98.3%(57/58) occurred within 0.5 cm of the original GTV based on T2-FLAIR imaging. 90.9% (30/33) and 81.8% (27/33) distant recurrences occurred ＞3 cm of T1 enhanced and T2-Flair primary tumor margins, respectively. Conclusions: The 1cm margin from T1 enhanced lesions and 0.5cm margin from T2-Flair abnormal lesions could cover 94.8% and 98.3% local recurrences respectively, which deserves further prospective study as a limited but effective target area.