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Recent studies report excellent local control (LC) and favorable toxicities of stereotactic ablative radiotherapy (SABR) for pulmonary metastasis (PM) from sarcoma. This study compared the LC and survival of SABR and metastasectomy for sarcoma PM. We analyzed the LC rates of 54 PMs treated with SABR between 2008 and 2022. For survival analysis, we compared 14 patients who received SABR as first-line treatment with 61 patients who underwent metastatectomy. For SABR-treated PMs, a median total dose of 55 Gy (range, 48–60) was administered over 3–10 fractions. Median follow-up for LC in SABR-treated PMs was 19.2 months (range, 0.8–124.0), and the 2-year LC rate was 92.2%. No patients experienced toxicities of grade 3 or higher. The median age of the patients in the survival analysis was 73 years (range, 42–83) in the SABR group and 54 years (range, 19–78) in the metastasectomy group (p < 0.001). PMs in the "gray zone" were more common in the SABR group (35.7%) than in the metastasectomy group (8.2%) (p = 0.029). The median follow-up for survival analysis was 44.8 months (interquartile range, 21.5–66.4). The 3-year rates of LC and overall survival were 92.3% and 57.3% in the SABR group and 89.2% and 75.9% in the metastasectomy group (p = 0.807, 0.224), respectively. The out-of-field intrapulmonary failure-free survival and extrapulmonary systemic failure-free survival rates at 3 years were not significantly different (p = 0.673, 0.386). SABR for sarcoma PM demonstrated excellent LC with acceptable toxicity. Survival rates of SABR were comparable to those of metastasectomy. [ABSTRACT FROM AUTHOR]

The relative frequency of primary cutaneous lymphoma (PCL) subtypes shows wide variation across different geographical regions. This retrospective study was conducted in a tertiary referral center located in Korea to describe the relative frequency, demographics, survival outcomes, and temporal trend in PCL. A total of 627 PCL cases diagnosed between January 1994 and December 2022 were included. The majority of PCL cases (87.2%) were of T-/NK-cell lineage (CTCL), while the remaining cases (12.8%) were B-cell lineage lymphomas (CBCL). The prevalence of mycosis fungoides (MF) in CTCL increased significantly over time, while other CTCL subtypes, including primary cutaneous extranodal NK/T-cell lymphoma and subcutaneous panniculitis-like T-cell lymphoma (SPTCL), decreased in frequency. Notably, the prevalence of CD4-positive small/medium T-cell lymphoproliferative disorder showed a substantial increase over time. Primary cutaneous marginal zone lymphoma was consistently the commonest CBCL subtype. Survival analysis demonstrated that CTCL had a more favorable 5-year overall survival (OS) than CBCL. OS rate of MF, SPTCL, and primary cutaneous peripheral T-cell lymphoma, NOS improved significantly over time. This study provides comprehensive insights into the dynamic change in the relative frequency and overall survival of PCL subtypes over time. [ABSTRACT FROM AUTHOR]

Objective: We developed a deep learning model for distinguishing radiation therapy (RT)-related changes and tumour recurrence in patients with lung cancer who underwent RT, and evaluated its performance. Methods: We retrospectively recruited 308 patients with lung cancer with RT-related changes observed on 18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG PET/CT) performed after RT. Patients were labelled as positive or negative for tumour recurrence through histologic diagnosis or clinical follow-up after 18F-FDG PET/CT. A two-dimensional (2D) slice-based convolutional neural network (CNN) model was created with a total of 3329 slices as input, and performance was evaluated with five independent test sets. Results: For the five independent test sets, the area under the curve (AUC) of the receiver operating characteristic curve, sensitivity, and specificity were in the range of 0.98–0.99, 95–98%, and 87–95%, respectively. The region determined by the model was confirmed as an actual recurred tumour through the explainable artificial intelligence (AI) using gradient-weighted class activation mapping (Grad-CAM). Conclusion: The 2D slice-based CNN model using 18F-FDG PET imaging was able to distinguish well between RT-related changes and tumour recurrence in patients with lung cancer. [ABSTRACT FROM AUTHOR]

Background: The real-world evidence about the efficacy of cytotoxic chemotherapy in desmoid tumors is still limited. We investigated the efficacy of chemotherapy in the treatment of recurrent or progressive desmoid tumors. Methods: The patients with desmoid tumors who had received cytotoxic chemotherapy between November 2007 and June 2020 in two tertiary hospitals in Korea were reviewed. Results: A total of 25 patients were included in the analysis. The most common primary tumor site was the intra-abdominal or pelvic cavity (56%), followed by the trunk and abdominal wall (24%), extremities (16%), and head and neck (4%). Sixty percent of the patients had familial adenomatous polyposis and 76% received doxorubicin plus dacarbazine. The objective response rate and disease control rate was 64% (95% confidence interval [CI]: 40.7–82.8) and 96% (95% CI: 77.2–99.9), respectively. With the median follow-up time of 55 months (95% CI: 41.0–68.2), the 3-year PFS rate was 65% (95% CI: 41.1–80.5), and the 3-year OS rate was 89% (95% CI: 63.8–97.3). Grade 3 or 4 hematologic adverse events were reported in 14 patients, all of which were manageable. Conclusion: Our real-world evidence suggests that doxorubicin-based cytotoxic chemotherapy can be an effective treatment option for recurrent and progressive desmoid tumors with respect to favorable clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Whether prior radiotherapy (RT) affects the response of EGFR-mutated non-small cell lung cancer (NSCLC) to EGFR tyrosine kinase inhibitor (TKI) remains elusive. Methods: Patients with EGFR-mutated NSCLC treated with EGFR TKIs who recurred after curative treatment at Asan Medical Center, Seoul, Korea were included. The progression-free survival (PFS) and overall survival (OS) from the initiation of EGFR TKI in patients who recurred after definitive RT were analyzed and compared to the outcomes of RT-naïve patients with advanced NSCLC treated with EGFR TKIs from previously reported prospective clinical trial results. Results: A total of 60 patients who recurred after definitive RT were included. The median age was 70 years (range, 38–88), with 24 patients (40.0%) being males. Among the 60 patients, 52 patients (86.7%) had exon 19 deletion or L858R mutation, with 49 patients (81.7%) receiving gefitinib as the first-line EGFR TKI. The median PFS and OS from the initiation of EGFR TKI were 10.4 months (95% confidence interval [CI], 7.4–13.2) and 21.3 months (95% CI, 13.4–28.8), respectively. Conclusion: The EGFR TKI efficacy in EGFR-mutated patients with NSCLC who recurred after RT was comparable with that in historic controls of RT-naïve patients with advanced NSCLC treated with EGFR TKIs, indicating that RT may not affect EGFR TKI efficacy. [ABSTRACT FROM AUTHOR]

A novel wide-field electron arc technique with a scatterer is implemented for widespread Kaposi's sarcoma (KS) in the distal extremities. Monte Carlo beam modeling for electron arc beams was established to achieve <2% deviation from the measurements, and used for dose calculation. MC-based electron arc plan was performed using CT images of a foot and leg mimicking phantom and compared with in-vivo measurement data. We enrolled one patient with recurrent KS on the lower extremities who had been treated with photon radiation therapy. The 4- and 6-MeV electron arc plans were created, and then compared to two photon plans: two opposite photon beam and volumetric modulated arc with bolus. Compared to the two photon techniques, the electron arc plans resulted in superior dose saving to normal organs beneath the skin region, although it shows inferior coverage and homogeneity for PTV. The electron arc treatment technique with scatterer was successfully implemented for the treatment of widespread KS in the distal extremities with lower radiation exposure to the normal organs beyond the skin lesions, which could be a treatment option for recurrent skin cancer in the extremities. [ABSTRACT FROM AUTHOR]

RH1 (2, 5-diaziridinyl-3-(hydroxymethy)-6-methyl-1, 4-benzoquinone) is a bioreductive anticancer drug. The mechanism underlying its therapeutic properties has not yet been elucidated. In this study, we aimed to determine whether RH1 exerts its anticancer effect via p53-mediated apoptosis and senescence in vitro and in vivo. RH1 displayed dose-dependent biphasic effects in vitro, i.e., it induced apoptosis at higher dose and senescence at lower dose accompanied by marked activation of p53. Thus, RH1 primarily induced cell death by apoptosis. The cytotoxicity of RH1 was inhibited in A549 cells treated with the p53-inhibitor pifithrin-α or transfected p53 siRNA and in human colon cancer HCT116 isogenic (p53−/−) cells. At sub-lethal doses of RH1, the cells survived and underwent senescence. The senescent cells showed flattened and enlarged morphology, and exhibited blue color in senescence-associated β-galactosidase staining. These changes were found to be related to p53. RH1-induced senescence decreased in A549-E6 cells (suppressed p53 level) and HCT 116 p53−/− cells. The growth of A549 xenograft tumors in nude mice was significantly delayed by intraperitoneal injection of RH1, and senescent cells were observed in these xenograft tumors. These results suggest that the in vivo anticancer therapeutic effect of RH1 is mediated by senescence via p53 activation. [ABSTRACT FROM AUTHOR]