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This post-hoc analysis was performed to report the impact of Image guided intensity modulated radiotherapy (IG-IMRT) and three-dimensional conformal radiotherapy (3D-CRT) across organ system and grades of toxicity within PARCER trial (NCT01279135). Primary endpoint of PARCER focused on grade ≥ 2 late gastrointestinal (GI) toxicity using Common Terminology Criteria for Adverse Events (CTCAE). We now analyze all adverse events using CTCAE and time and severity weighted toxicity reporting method (MOSES).MOSES was calculated separately for GI, genitourinary (GU)/GI, and any late toxicities (GI, GU, lymphedema, fatigue, vaginal stenosis, fibrosis and constitutional symptoms) by imputing proportionate time weightage to CTCAE. Cumulative MOSES (C-MOSES) for multiple system and multiorgan toxicity was determined. Difference in arms was analyzed as time-to-event and intention-to-treat analysis using CTCAE grade ≥ 1 and C-MOSES ≥ 0.70.We observed no difference in the 3-year cumulative incidence of CTCAE grade ≥ 1 GI, GI or GU, or any late toxicity between treatment arms. However, while using C-MOSES, HR of 0.59 (95% CI 0.38-0.92, p = 0.017), 0.68 (95% CI: 0.44-1.05, p = 0.08) and 0.72 (95% CI: 0.52-0.99, p = 0.04) was observed for GI, GI or GU, or any late toxicity within IG-IMRT respectively.This demonstrates superior discrimination of intervention effects using MOSES which demonstrates superiority of IG-IMRT.

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Authors’ original file for figure 2

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Additional file 1. Complementary materials on DVH statistical uncertainty for the peak-only and peak-and-valley approach and on the bending rods method.

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GI cancer is not one cancer but is a term for the group of cancers that affect the digestive system including gastric cancer (GC), colorectal cancer (CRC), hepatocellular carcinoma (HCC), esophageal cancer (EC), and pancreatic cancer (PC). Overall, the GI cancers are responsible for more cancers and more deaths from cancer than any other organ. 5 year survival of these cancers remains low compared to western world. Unlike the rest of the world where organ based specialities hepatobiliary, pancreatic, colorectal and esophagogastric exist , these cancers are managed in India by either a gastrointestinal surgeons, surgical oncologist, or a general surgeon with varying outcomes.The aim of this review was to collate data on GI cancers in indian continent. In colorectal cancers, data from tertiary care centres identifies the unique problem of mucinous and signet colorectal cancer. Results of rectal cancer resection in terms of technique (intersphincteric resection, extralevator aper, minimal invasive approach ) to be comparable with world literature. However long term outcome and data regarding colon cancers and nationally is needed. Gastric cancer at presentation are advanced and in surgically resected patients, there is need for a trial to compare chemoradiation vs chemotherapy alone to prevent loco regional recurrence. Data on minimal invasive gastric cancer surgery may be sparse for the same reason. Theree is a lot of data on surgical techniques and perioperatve outcomes in pancreatic cancer. There is a high volume of locally advanced gallbladder cancers with efforts on to decide whether neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy is better for down staging. Considering GI cancers, a heterogeneous disease with site specific treatment options and variable outcomes, the overall data and outcomes are extremely variable. Young patients with pathology unique to the Indian subcontinent (for example, signet ring rectal cancer, GBCs) need focussed attention. Solution for such pathology needs to come from the Indian continent itself. Joint efforts to improve outcomes for GI cancer can be integrated under the national cancer grid program.

PurposeTo retrospectively review the outcomes of adjuvant postoperative radiotherapy (PORT) following surgery in patients with advanced hypopharyngeal cancer treated at an academic tertiary referral center.MethodsData of patients treated with curative intent in a single radiotherapy unit over a 15-year period (1990-2004) with upfront surgery followed by PORT was retrieved from an electronic database. Local control (LC), locoregional control (LRC) and disease-free survival (DFS) were considered as outcome measures.ResultsThe study dataset constituted 159 patients with a median age of 55 years (range 30-79 years). Patients underwent either radical surgery (total laryngectomy with or without pharyngectomy) or voice-conserving surgery. All patients underwent appropriate comprehensive neck dissection. The median radiotherapy dose was 60 Gy (inter-quartile range 50-60 Gy). With a mean follow-up of 21 months (inter-quartile range 6-29 months), the 3-year LC, LRC, and DFS was 87.8%, 70.3% and 62.2% respectively. Cut margin negativity and pyriform sinus subsite predicted for improved LRC and DFS on univariate analysis. Cut margin status was the only independent predictor of outcome on multivariate analysis.ConclusionHypopharyngeal cancer characterized by advanced disease at presentation. Definitive surgery (either voice-conserving or radical) followed by adjuvant radiotherapy provides good LRC and DFS and continues to remain a valid upfront treatment option for advanced hypopharyngeal cancer. Cut margin status and primary subsite are important determinants of outcome.