Aim:This study aims to evaluate the usage of brain metastases (BM) tumor volume and sphericity as prognostic factors in local control (LC) after stereotactic radiosurgery (SRS) for limited number (1-4) BM from nonsmall cell lung cancer (NSCLC). Methods:We retrospectively reviewed 80 patients, with 141 BM, who were treated with SRS from 2012 to 2017. Local failure was defined as an increase in lesion size after SRS. LC and overall survival (OS) were estimated using Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis. Results:The median clinical and radiographic follow-up was 11.2 and 9.0 months, respectively.The median BM tumor volume was 0.31 cm 3 (0.01-21.64 cm 3 ) and the median tumor sphericity was 0.76 (0.39-0.95). The median LC of the entire cohort was 28.8 months. LC rate at last followup was achieved in 84.4% of patients (35.5% CR, 35.5% PR, and 13.5% SD). LC was 83.8% at 1 year and 56.3% at 2 years. On multivariate analysis, only sphericity (P < .001) and volume (P = .004) were found to be a strong predictor for LC. The median OS of the entire cohort was 24.1 months.On multivariate analysis, only GPA score was found to be a predictor for OS.Conclusion: BM tumor sphericity and volume were found to be strong predictors for LC. Tumor sphericity and volume should be taken into consideration when treating patients with BM and when designing future prospective studies and developing prognostic indices. K E Y W O R D Sbrain metastases, cyberknife, stereotactic radiosurgery, tumor sphericity, tumor volume
The incidence of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) has increased, and staging and optimal therapeutic approaches are challenging. A questionnaire survey was conducted to investigate the controversial treatment policy of stage T2 OPC according to the N category and determine the opinions of multidisciplinary experts in Korea. Materials and MethodsFive OPC scenarios were developed by the Subcommittee on Oropharyngeal Treatment Guidelines of the Korean Society for Head and Neck Oncology and distributed to experts of multidisciplinary treatment hospitals. ResultsSixty-five experts from 45 institutions responded. For the HPV-positive T2N0M0 scenario, 67.7% of respondents selected surgery followed by definitive concurrent chemoradiotherapy (CCRT) or radiotherapy alone. For the T2N1M0 HPV-positive scenario, there was a notable difference in the selection of primary treatment by expert specialty; 53.9% of respondents selected surgery and 39.8% selected definitive CCRT as the primary treatment. For the T2N3M0 advanced HPVpositive scenario, 50.0% of respondents selected CCRT and 33.3% considered induction chemotherapy (IC) as the primary treatment. CCRT and IC were significantly more frequently selected for the HPV-related OPC cases (p=0.010). The interdepartmental variability showed that the head and neck surgeons and medical oncologists favored surgery, whereas the radiation oncologists preferably selected definitive CCRT (p < 0.001). ConclusionIn this study, surgery was preferred for lymph node-negative OPC, and as lymph node metastasis progressed, CCRT tended to be preferred, and IC was administered. Clinical practice CANCER RESEARCH AND TREATMENT (CRT) 4 Korean Cancer Association This article is protected by copyright. All rights reserved.patterns by stage and HPV status showed differences according to expert specialty.Multidisciplinary consensus guidelines will be essential in the future.
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