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Colonoscopy and fecal immunochemical test (FIT) are commonly used screening methods for the detection of colorectal cancer (CRC), but their effects on survival have not been compared. We compared survival outcomes in patients with CRC according to the exposure history to colonoscopy or FIT before diagnosis of CRC.We performed a nationwide population-based retrospective cohort study using Korean national-insurance claims data. In total, 24 875 patients with CRC diagnosed in 2012 were included. The patients were divided into three groups in terms of examinations performed during the 10 years prior to CRC diagnosis: the colonoscopy group, the FIT group, and the never-screened group. Survival outcomes were compared among the three groups. The colonoscopy group and FIT group were matched using propensity score-matching method.The cohort consisted of 9619 patients in the colonoscopy group, 6936 patients in the FIT group, and 8320 patients in the never-screened group. The 5-year overall survival rates were 74.1% in the colonoscopy group, 65.9% in the FIT group, and 59.6% in the never-screened group (P 0.001). The adjusted hazard ratios for death were 0.56 (95% confidence interval [CI], 0.53-0.59) in the colonoscopy group and 0.78 (95% CI, 0.74-0.82) in the FIT group compared with the never-screened group. In the matched cohort, the adjusted hazard ratios for death was 0.76 (95% CI, 0.72-0.81) in the colonoscopy group compared with the FIT group.Colonoscopy is a more effective method for reducing mortality in patients with CRC compared with FIT.

Human papillomavirus (HPV)-related oropharyngeal cancer differs from HPV-negative oropharyngeal cancer in terms of etiology, epidemiology, and prognosis. Younger and lower comorbidity patient demographics and favorable prognosis allow HPV-related oropharyngeal cancer patients to anticipate longer life expectancy. Reducing long-term toxicities has become an increasingly important issue. Treatment deintensification to reduce toxicities has been investigated in terms of many aspects, and the reduction of radiotherapy (RT) dose in definitive treatment, replacement of platinum-based chemotherapy with cetuximab, response-tailored dose prescription after induction chemotherapy, and reduction of adjuvant RT dose after transoral surgery have been evaluated. We performed a literature review of prospective trials of deintensification for HPV-related oropharyngeal cancer. In phase II trials, reduction of RT dose in definitive treatment showed comparable survival outcomes to historical results. Two phase III randomized trials reported inferior survival outcomes for cetuximab-based chemoradiation compared with cisplatin-based chemoradiation. In a randomized phase III trial investigating adjuvant RT, deintensified RT showed noninferior survival outcomes in patients without extranodal extension but worse survival in patients with extranodal extension. Optimal RT dosage and patient selection require confirmation in future studies. Although many phase II trials have reported promising outcomes, the results of phase III trials are needed to change the standard treatment. Since high-level evidence has not been established, current deintensification should only be performed as part of a clinical study with caution. Implementation in clinical practice should not be undertaken until evidence from phase III randomized trials is available.

The endoscopic findings of diffuse large B cell lymphoma have various presentations. In our case, the patient had developed multiple elevated central ulceration lesions, and the peripheral elevated portion had a heaped-up margin. The margin had a sharp, smooth edge that was not infiltrative and could be confused with a simple gastric ulcer. Endoscopists should be aware of the possibility of multiple lymphoma ulcers with heaped-up margins. We present some unusual endoscopic features of lymphoma, which are easily misdiagnosed as gastric ulcers.

Purpose: The exact role of adjuvant chemotherapy has yet to be elucidated in rectal cancer after preoperative chemoradiotherapy (CRT) and total mesorectal excision (TME). Thus, we assess the significance of positive surgical margin and perineural invasion (PNI) associated with adjuvant chemotherapy in patients with rectal cancer.Methods: This multi-institutional retrospective study included 1799 patients with rectal cancer at cT3-4N0-2M0. All patients received preoperative CRT with a dose of 50.4 Gy and curative TME. Patients were divided into two groups according to the status of surgical margin and PNI. The high-risk group had a positive margin and/or perineual invasion. The low-risk group showed no positive margin or PNI. Propensity-score matching analysis was performed to balance baseline characteristics of the two groups, and a total of 928 patients with 464 in each arm were evaluated.Results: The high-risk group showed significant differences in overall survival (OS, 73.4% vs. 53.9%, P < 0.01) and recurrence-free survival (RFS, 52.7% vs. 40.9%, P = 0.01) at five years between the adjuvant chemotherapy arm and observation arm. The low-risk group showed no significant differences in 5-year OS (86.6% vs. 75.3%, P = 0.61) and RFS (66.9% vs. 53.1%, P = 0.75) between the two arms. Multivariate analyses showed that age, pathologic N stage, and adjuvant chemotherapy were significantly correlated with OS and RFS in the high-risk group (all P < 0.05).Conclusion: Adjuvant chemotherapy improved OS and RFS more significantly in rectal cancer patients with positive surgical margin or PNI than in those with negative surgical margin and PNI.

The role of radiosurgery has become further accentuated in the era of targeted agents (TA). Thus, the neurologic outcome of radiosurgery in brain metastasis (BM) of non-small cell lung cancer (NSCLC) was reviewed. We analyzed 135 patients with BM of NSCLC who were administered Cyberknife radiosurgery (CKRS) as either initial or salvage therapy. We evaluated local failure (LF), intracranial failure (IF), and neurological death (ND) due to BM. Primary outcome was neurological death-free survival (NDFS). Median follow-up was 16.2 months. Median CKRS dose of 22 Gy was administered to median 2 targets per patient. Among 99 deaths, 14 (14%) were ND. Upfront treatment for BM included CKRS alone in 85 patients (63%), CKRS + TA in 26 patients (19%), and WBRT in 24 patients (18%). No patients or tumor related factors were associated with ND. However, the type of upfront treatment for BM was significantly associated with ND [HR 0.07 (95% CI 0.01–0.57) for CKRS + TA, HR 0.56 (95% CI 0.19–1.68) for CKRS alone] compared with the WBRT group (P = 0.01). The 2-year NDFS rates for the CKRS + TA, CRKS alone, and WBRT groups were 94%, 87%, and 78%, respectively (P = 0.03). Upfront CKRS showed significantly higher 2-year LF-free survival rate (P

96 Background: The optimal short-course chemotherapeutic regimen for rectal cancer has not been clearly defined until now. KROG 10-01 and KROG 11-02 prospective trials investigated the efficacy and safety of one- and two-week chemoradiotherapy (CRT), respectively. We compare and report long-term outcomes by pooling data from two prospective trials for one- and two-week schedules of preoperative CRT and curative surgery in rectal cancer. Methods: Patients eligible for KROG 10-01 and KROG 11-02 involved those with clinical T3-4N0-2M0 rectal cancers. They received preoperative CRT and total mesorectal excision. Patients in KROG 10-01 received radiation of 25 Gy in 5 fractions during one week with 5-fluorouracil/leucovorin. Patients in KROG 11-02 received radiation of 33 Gy in 10 fractions during two weeks with oral capecitabine. Results: A total of 150 patients consisting of 70 patients from KROG 10-01 and 80 patients from KROG 11-02 were collectively analyzed. With a median follow-up time of 89.2 months, the 5-year overall survival (OS) rate was 86.5% in one-week CRT and 85.3% in two-week CRT ( P = 0.84). The 5-year recurrence-free survival (RFS) rate was 83.5% in one-week CRT and 77.1% in two-week CRT ( P = 0.45). One patient (1.4%) in one-week CRT and eleven patients (13.8%) in two-week CRT exhibited pathologic complete regression (ypT0N0M0) after radiotherapy ( P = 0.01). Downstaging (ypT0-2N0M0) occurred in 20 patients (28.2%) in one-week CRT and 27 patients (33.8%) in two-week CRT ( P = 0.50 ). One-week CRT arm had significantly higher acute hematologic (12.8% vs. 3.8%, P = 0.040) and non-hematologic (38.6% vs. 16.3%, P = 0.002) toxicities than two-week CRT arm. Conclusions: Both one- and two-week schedules of CRT showed favorable survival outcomes after seven years of follow-up. But, two-week course achieved more increased tumor response and decreased acute toxicity rather than one-week course. Clinical trial information: KROG 10-01 is registered at ClinicalTrials.gov (number, NCT01129700 ) and KROG 11-02 is registered at ClinicalTrials.gov (number, NCT01431599 ).

Additional file 1: S1 Table. Operational definitions used in this study. a) Chemotherapy suitable for small-cell lung cancer. S2 Table. Reliability of the operational criteria used for small-cell lung cancer staging. LD-SCLC, limited-disease small-cell lung cancer; ED-SCLC, extensive-disease small-cell lung cancer; OD, operational definition; PPV, positive predictive value; NPV, negative predictive value

Background: Small-cell lung cancer (SCLC) is a highly proliferative, rapidly growing tumor with a poor prognosis, even in cases of limited disease (LD). Timely and accurate high-intensity therapy is necessary. For concurrent chemoradiotherapy (CCRT), etoposide/platinum (EP)-based regimens are recommended, although irinotecan/platinum (IP)-based regimens are also effective with radiotherapy. This large-scale, retrospective, nationwide cohort study aimed to analyze the efficacy of CCRT in patients with LD-SCLC.Methods: Population data registered between January 2008 and December 2018 were extracted from the Health Insurance Review and Assessment Service of Korea database. Survival outcomes of 4,446 LD-SCLC patients who received CCRT were analyzed.Results: Patients who received EP-CCRT (n = 4,187) showed better progression-free survival (PFS: 11.2 months) and overall survival (OS: 22.2 months) than did those who received IP-CCRT (n = 259; PFS: 9.6 months, P = 0.0477; OS: 16.4 months, P P = 0.0170) in platinum-resistant relapsed patients; the opposite was observed for platinum-sensitive relapsed patients (OS: EP, 17.2 months; IP, 6.6 months; P Conclusion: In the Korean population, the effects of EP-CCRT on OS and PFS are significantly more favorable than those of IP-CCRT.

Objectives: Despite complete surgical resection, 30–40% of patients with stage I–IIA non-small-cell lung cancer (NSCLC) have recurrences. We aimed to elucidate the effect of lymphovascular invasion (LVI) on the prognosis and patterns of recurrence in patients with pathologically confirmed T1–2N0 NSCLC. Methods: We evaluated 381 patients who underwent complete resection and were diagnosed with pathologic T1–2N0 NSCLC between March 2000 and January 2012. Local recurrence, nodal recurrence, and distant metastasis were defined and analyzed. Results: LVI was present in 72 patients (18.9%). The 5-year disease-free survival (DFS) for all patients was 69.9%. Patients with LVI showed a significant decrease in 5-year DFS (47.3 vs. 74.4%, p < 0.001). LVI was a significant prognostic predictor in multivariate analysis (p = 0.003). The patients with LVI showed a significantly increased 5-year cumulative incidence of nodal recurrence (22.5 vs. 8.7%, p < 0.001) and distant metastasis (30.4 vs. 14.9%, p = 0.004). However, no difference was shown between the two groups in the 5-year cumulative incidence of local recurrence (p = 0.416). Conclusions: LVI is a negative prognostic factor in patients with stage I–IIA NSCLC. The presence of LVI significantly increases the risk of nodal and distant recurrence.

// Yoo-Kang Kwak 1 , Byung-Ock Choi 1 , Kyu Hye Choi 1 , Jong Hoon Lee 2 , Soo Yoon Sung 2 and Yun Hee Lee 3 1 Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea 2 Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea 3 Department of Radiation Oncology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Korea Correspondence to: Byung-Ock Choi, email: choibo6714@gmail.com Keywords: primary central nervous system lymphoma; lymphoma; radiotherapy; palliation; survival Received: September 15, 2017 Accepted: October 27, 2017 Published: November 10, 2017 ABSTRACT The standard treatment for primary central nervous system (CNS) lymphoma is based on chemotherapy. However, there are patients who are not indicated for chemotherapy and when left untreated, the expected functional outcomes for these patients are devastating since the disease causes various neurologic symptoms. Therefore, we assessed the effects of radiotherapy as an alternative therapy in primary CNS lymphoma. Thirty-two patients were diagnosed with primary CNS lymphoma and treated with radiotherapy alone. Patients received whole brain radiotherapy (WBRT) to a median dose of 30 Gy (range, 14.4–50 Gy) and the median total radiotherapy dose was 50 Gy (range, 30–54 Gy). The status on neurologic symptoms before and after radiotherapy was inquired during the regular follow-ups. The progression-free survival (PFS) and overall survival (OS) rates for the enrolled patients were calculated. The median follow-up time was 21 months. All but one of the patients presented with neurologic symptoms. The most common symptoms were hemiparesis and headache. After radiotherapy, these symptoms were relieved in 27 patients (84.4%). The median PFS and OS rates were 15.8 and 16.3 months, respectively. Twenty patients (62.5%) experienced recurrent disease at follow up and among them, fifteen patients (46.9%) had intracranial recurrence. The median intracranial PFS was 19.3 months. Untreated primary CNS lymphoma causes neurologic deficits and the survival after only supportive care is poor. Therefore, when chemotherapy is unfeasible, an alternative treatment should be applied and radiotherapy can be a practical option.

Purpose We retrospectively reviewed the results of radiotherapy for localized ocular adnexal MALT lymphoma (OAML) to investigate the risk factors of cataract. Methods Sixty-seven patients with stage IE OAML treated with radiotherapy at Seoul St. Mary's Hospital from 2001 to 2016 were included. Median treatment dose was 30 Gy. Lens protection was done in 52 (76%) patients. Radiation therapy (RT) extent was as follows: superficial (82.1%), tumor mass (4.5%), and entire orbital socket (13.4%). The risk factors for symptomatic cataract were analyzed using the Cox proportional hazard model. Results Median follow-up time was 50.9 months (range, 1.9 to 149.4 months). All patients were alive at the time of analysis. There were 7 recurrences and there was no local recurrence. Median time to recurrence was 40.4 months. There were 14 cases of symptomatic cataract. Dose >30 Gy had hazard ratio of 3.47 for cataract (p = 0.026). Omitting lens protection showed hazard ratio of 4.10 (p = 0.008). Conclusions RT achieves excellent local control of ocular MALT lymphoma. Consideration of RT-related factors such as lens protection and radiation dose at the stage of RT planning may reduce the risk of RT-induced cataract after radiotherapy.

Purpose The purpose of this study was to investigate the predictable value of pretreatment 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) in radiotherapy (RT) for patients with hepatocellular carcinoma (HCC) or portal vein tumor thrombosis (PVTT). Materials and Methods We conducted a retrospective analysis of 36 stage I-IV HCC patients treated with RT. 18F-FDG PET-CT was performed before RT. Treatment target was determined HCC or PVTT lesions by treatment aim. They were irradiated at a median prescription dose of 50 Gy. The response was evaluated within 3 months after completion of RT using the Response Evaluation Criteria in Solid Tumors (RECIST). Response rate, overall survival (OS), and the pattern of failure (POF) were analyzed. Results The response rate was 61.1%. The statistically significant prognostic factor affecting response in RT field was maximal standardized uptake value (maxSUV) only. The high SUV group (maxSUV ≥ 5.1) showed the better radiologic response than the low SUV group (maxSUV < 5.1). The median OS were 996.0 days in definitive group and 144.0 days in palliative group. Factors affecting OS were the %reduction of alpha-fetoprotein (AFP) level in the definitive group and Child-Pugh class in the palliative group. To predict the POF, maxSUV based on the cutoff value of 5.1 was the only significant factor in distant metastasis group. Conclusion The results of this study suggest that the maxSUV of 18F-FDG PET-CT may be a prognostic factor for treatment outcome and the POF after RT. A %reduction of AFP level and Child-Pugh class could be used to predict OS in HCC.

Definitive chemoradiotherapy (CRT) followed by brachytherapy is a standard treatment for locally advanced cervical cancer. During CRT, marked reduction of cervical tumor is often observed in magnetic resonance imaging (MRI). The primary aim of this study was to assess the association between tumor response in MRI using FIGO classification and clinical outcomes.Multi-institutional data were retrospectively reviewed to identify the significance of MR tumor response on tumor recurrence and patient survival. 225 patients with histologically confirmed squamous cell carcinoma of the cervix, staged as FIGO Ib2-IVa on initial pelvic MRI, were included. Post-CRT MRI was performed median 35days after the beginning of CRT and before brachytherapy. A median 54Gy of external radiation was given with weekly cisplatin during CRT.112 (49.7%) of the 225 patients showed a positive response in post-CRT MRI and were named the responsive arm. After a median follow-up time of 36.2months, the responsive arm had significantly lower para-aortic recurrence (7.5% vs. 12.4%; p=0.04) and distant metastasis (13.2% vs. 27.6%; p=0.03) rates than did the non-responsive arm. The responsive arm had significantly higher 3-year cause-specific survival rate (94.6% vs. 81.1%, p0.01) than did the non-responsive arm. In the multivariate analysis, tumor size (hazard ratio, 1.91 and 95% confidence interval, 1.07-3.43; p=0.028) and positive MR response (hazard ratio, 1.75 and 95% confidence interval, 1.06-2.27; p=0.045) were significant factors for recurrence-free survival CONCLUSION: Early tumor response evaluation with MRI using FIGO classification effectively predicted distant tumor metastasis and disease-specific survival in locally advanced cervical cancer.

// Sea-Won Lee 1,3 , Kyung Hwan Shin 1 , Eui Kyu Chie 1 , Jin Ho Kim 1 , Seock-Ah Im 1 , Wonshik Han 1 , Dong-Young Noh 1 , Hyeon Woo Lim 2 , Tae Hyun Kim 2 , Keun Seok Lee 2 , Eun Sook Lee 2 , Soo Yoon Sung 3 and Kyubo Kim 4 1 Seoul National University, College of Medicine, Seoul, Korea 2 Research Institute and Hospital, National Cancer Center, Goyang, Korea 3 Catholic University of Korea, College of Medicine, Seoul, Korea 4 Ewha Womans University, School of Medicine, Seoul, Korea Correspondence to: Kyung Hwan Shin, email: // Keywords : early breast cancer, risk factor, hypofractionation Received : June 07, 2016 Accepted : August 26, 2016 Published : August 30, 2016 Abstract Purpose: Accelerated whole breast irradiation (AWBI) and conventional whole breast irradiation (CWBI) were compared to determine whether AWBI is as effective as CWBI in patients with early breast cancer and adverse prognostic features. Patients and methods: We included 330 patients who underwent breast-conserving surgery (BCS) and post-operative radiation therapy (RT) using AWBI for pT1-2 and pN0-1a breast cancer from 2007 to 2010. These patients were matched with 330 patients who received CWBI according to stage, age (±3 years), and the year of BCS. AWBI of 39 Gy and CWBI of 50.4 Gy were given in 13 and 28 fractions, respectively. Results: Median follow-up time was 81.9 months. There were no statistically significant differences between the AWBI and CWBI groups in terms of age, stage, tumor grade, or molecular subtype. More patients with Ki-67 index ≥ 14% were present in the AWBI group (AWBI 47.0% vs. CWBI 10.3%; P

783 Background: Predicting treatment response of preoperative chemoradiotherapy (CRT) in patients with rectal cancer is important for physicians to guide a patient to the relevant treatment. We evaluate the change of white blood cell (WBC) count before and during CRT if it is associated with susceptibility to the CRT and affects tumor response. Methods: Medical records of 641 patients with rectal cancer who received preoperative CRT followed by curative surgery were retrospectively reviewed. Complete blood cell counts were measured weekly before and during the radiation therapy. We assessed the pre-CRT/nadir ratio of WBC count for the treatment response to CRT and recurrence-free survival. Results: The enrolled patients were divided into two groups of high WBC ratio (HWR) and low WBC ratio (LWR) with the cutoff value of 0.49, which was found by receiver operating characteristic curve (Sensitivity, 0.38 and 1-Specificity, 0.22; p=0.007). In 641 patients, 490 (76.4%) were HWR group and 151 (23.6%) were LWR group. Complete pathologic response rates were 12.2% in HWR group and 23.8% in LWR group, respectively (p=0.001). Downstaging rates of each group were 37.8% and 48.3%, respectively (p=0.02). In the logistic regression analysis, CEA level over 5ng/ml (Adjusted OR 0.566, 95% CI 0.351-0.912; p=0.019) and HWR (Adjusted OR 0.412, 95% CI 0.256-0.663; p=0.001) were significant adverse factors of the pathologic complete response. The 5-year recurrence-free survival rate was significantly higher in LWR group than in HWR group (67.6% and 83.3%; p=0.001). Conclusions: Low WBC ratio predicts a good tumor response to the preoperative CRT, and is significantly associated with an improved recurrence-free survival in rectal cancer.

Purpose To investigate the patterns of care for patients with nasopharyngeal carcinoma (NPC) in South Korea. Materials and Methods A multi-institutional retrospective study was performed (Korean Radiation Oncology Group [KROG] 11-06) on a total of 1,445 patients from 15 institutions. Results Of the 1,445 patients, more than half were stages III (39.9%) and IV (35.8%). In addition to patterns of care, we also investigated trends over time with the periods 1988-1993, 1994-2002, and 2003-2011. The frequencies of magnetic resonance imaging and positron emission tomography-computed tomography were markedly increased in the third period compared to previous 2 periods. Concurrent chemoradiation (CCRT) was performed on 894 patients (61.9%), neoadjuvant chemotherapy on 468 patients (32.4%), and adjuvant chemotherapy on 366 patients (25.3%). Of stage II-IV patients, CCRT performed on 78.8% in 2003-2011 compared to 15.0% in 1988-1993. For patients treated with CCRT, cisplatin was the most commonly used agent in 81.3% of patients. Over the periods of time, commonly used radiotherapy (RT) techniques were changed from 2-dimensional RT (1988-1993, 92.5%) to 3-dimensional RT (2003-2011, 35.5%) or intensity-modulated RT (IMRT; 2003-2011, 56.5%). Median RT doses given to primary tumors, high-risk lymphatics, and low-risk lymphatics were 70.0 Gy, 58.1 Gy, and 48.0 Gy, respectively. Adoption of IMRT increased the dose per fraction and escalated total radiation dose. Conclusion Assessment of the patterns of care for NPC patients in South Korea demonstrated that management for NPC including diagnostic imaging, treatment regimen, RT techniques and dose schedule, advanced in accordance with the international guidelines.

736 Background: To elucidate the toxicity and survival outcome of neoadjuvant chemoradiotherapy (CRT) followed by curative total mesorectal excision (TME) in elderly rectal cancer patients compared to younger patients. Methods: A total of 1232 rectal cancer patients who received neoadjuvant CRT and curative surgery were collected from 7 tertiary institutions. After propensity-score matching, 310 patients of < 70 years for younger arm and 310 patients of ≥ 70 years for elderly arm were identified, respectively and matched with 1:1 manner. Treatment response and toxicity, surgical outcome, recurrence, and survival were assessed and compared between two arms. Results: The two younger (< 70 years) and elderly (≥ 70 years) arms were well-matched and had similar baseline characteristics. Median ages were 58 years for younger arm and 74 years for elderly arm, respectively. Pathologic complete response rates were not significantly different between younger arm and elderly arm (17.1% vs. 14.8%, P = 0.443). The 5-year recurrence-free survival (70.0% vs. 69.8%, P = 0.773) and overall survival (79.5% vs. 82.9%, P = 0.270) rates were not significantly different between two arms. Adjuvant chemotherapy after surgery was less frequently delivered to elderly arm than younger arm (69.0% vs. 83.9%, P = 0.773). Grade 3 or higher acute hematologic toxicity was observed more frequently in elderly arm than in younger arm (9.0% vs. 16.1%, P = 0.008 ), but late complication was not significantly increased in elderly arm (2.6% vs. 4.5%, P = 0.193). Conclusions: Despite an increased acute toxicity, elderly rectal cancer patients with good performance status would have equivalent tumor response and recurrence-free survival compared to younger patients.