Background The prognostic significance of radiation dose to the lung or heart is unknown in esophageal cancer patients receiving neoadjuvant chemoradiotherapy followed by surgery (trimodal therapy). This study aimed to determine the association between lung and heart radiation dose volumes and prognosis of esophageal cancer after trimodal therapy. Methods This study reviewed 123 esophageal cancer patients treated with trimodal therapy in two tertiary institutions between 2010 and 2015. The dose-volume histogram parameter of Vx was defined as the percentage of total organ volume receiving a radiation dose of x (Gy) or more. Predictors of overall survival (OS) were identified using Cox regression models. Receiver-operating characteristic curves were used to select cut-off values for dose-volume. Results Median follow-up was 28.3 months (range: 4.7–92.8 months). Median OS and progression-free survival were 34.0 months (95% confidence interval [CI]: 27.4–40.6 months) and 24.8 months (95% CI, 18.9–30.7 months), respectively. Multivariate analyses showed that lung V20 (hazard ratio, 1.09; 95% CI: 1.04–1.14; p < 0.001) and lung V5 (hazard ratio, 1.02; 95% CI: 1.00–1.05; p = 0.03) were associated with OS when adjusting for surgical margin and pathological treatment response. The 5-year OS for patients with lung V20 ≤ 23% vs. patients with lung V20 > 23% was 54.4% vs. 5% ( p < 0.001) whereas that for patients with lung V5 ≤ 56% vs. patients with lung V5 > 56% was 81.5% vs. 23.4% ( p < 0.001). Mean heart dose showed no association with survival outcomes. Conclusions Lung radiation dose was independently associated with survival outcomes in esophageal cancer patients treated with neoadjuvant chemoradiotherapy and surgery. Electronic supplementary material The online version of this article (10.1186/s13014-019-1283-3) contains supplementary material, which is available to authorized users.

We aimed to determine the prognostic significance of cardiac dose and hematological immunity parameters in esophageal cancer patients after concurrent chemoradiotherapy (CCRT). During 2010–2015, we identified 101 newly diagnosed esophageal squamous cell cancer patients who had completed definitive CCRT. Patients' clinical, dosimetric, and hematological data, including absolute neutrophil count, absolute lymphocyte count, and neutrophil-to-lymphocyte ratio (NLR), at baseline, during, and post-CCRT were analyzed. Cox proportional hazards were calculated to identify potential risk factors for overall survival (OS). Median OS was 13 months (95% confidence interval [CI]: 10.38–15.63). Univariate analysis revealed that male sex, poor performance status, advanced nodal stage, higher percentage of heart receiving 10 Gy (heart V10), and higher NLR (baseline and follow-up) were significantly associated with worse OS. In multivariate analysis, performance status (ECOG 0 & 1 vs. 2; hazard ratio [HR] 3.12, 95% CI 1.30–7.48), heart V10 (> 84% vs. ≤ 84%; HR 2.24, 95% CI 1.26–3.95), baseline NLR (> 3.56 vs. ≤ 3.56; HR 2.36, 95% CI 1.39–4.00), and follow-up NLR (> 7.4 vs. ≤ 7.4; HR 1.95, 95% CI 1.12–3.41) correlated with worse OS. Volume of low cardiac dose and NLR (baseline and follow-up) were associated with worse patient survival.

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Background: The standard of care in operable oral cavity cancer is curative surgery followed by adjuvant therapy. However, adjuvant management of elderly patients with early-stage oral cavity squamous cell carcinoma (OCSCC) remains controversial. This study aims to identify predictors that will guide the adjuvant management in these patients.Methods: We retrospectively analyzed 85 patients who were older than 70 years and had received surgical intervention for early-stage OCSCC in our institution between 2007 and 2015. The Kaplan-Meier analysis and log-rank test were used to estimate the disease-free survival (DFS), overall survival (OS). The predictor for DFS and OS was evaluated through COX regression and receiver operating characteristic (ROC) curve analysis.Results: With a median follow-up time of 4.13 years, patients aged <77.82 years had better OS (P=0.032).Depth of invasion ≥3.25 mm was associated with poorer DFS (P=0.024).Conclusions: Elderly patients with early-stage OCSCC might experience disease progression after surgery. Prospective trials are warranted to investigate the benefit of adjuvant treatment.

Background: Preoperative chemoradiotherapy followed by radical resection is the standard treatment for locally unresectable rectal cancer. This study evaluated the prognostic relationship between preoperative hematological parameters and overall survival among rectal cancer patients receiving trimodal therapy.Methods: From January 2010 to December 2018, 96 patients with primary non-metastatic locally advanced rectal cancer underwent preoperative chemoradiotherapy followed by radical surgery at our institution. The patients' demographic characteristics, clinical and pathological variables, and hematologic parameters were collected retrospectively by reviewing medical records. The Cox proportional hazard model and Kaplan-Meier curve analysis were used to assess overall survival. The receiver operating characteristic curve with the Youden index was used to dichotomize continuous variables. Results:The median age was 58 years, with male predominance (72.9%); 74.0% were in the clinical T3 stage. All patients completed chemoradiotherapy to the whole pelvis and pelvic lymph nodes. Threedimensional conformal radiation therapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy were included in the study. All patients underwent surgical intervention 12 weeks after completing radiotherapy. The median OS for all patients was 65.0 (range, 7.0-138.0) months. The 3-year OS rate was 85.4% of all patients. Univariate analysis showed that preoperative white blood cell count (>5,200/μL vs. ≤5,200/μL, P=0.004), hemoglobin (P=0.030), peripheral platelet count (>217×10 3 /μL vs. ≤217×103 /μL, P=0.002), increased absolute neutrophil count (P=0.002), increased neutrophil-to-lymphocyte ratio (P=0.027)and a systemic immune-inflammation index (>656×10 9 /L vs. ≤656×10 9 /L, P=0.008) were associated with poor overall survival. On multivariate analysis, a preoperatively high systemic immune-inflammation index (P=0.016)and low hemoglobin levels (P=0.040) remained associated with reduced overall survival.Conclusions: Preoperative counts of white blood cells, peripheral platelets, absolute neutrophils, and the neutrophil-to-lymphocyte ratio and systemic immune-inflammation index were poor prognostic markers for overall survival in rectal cancer patients receiving radical surgery after preoperative chemoradiotherapy.However, a high preoperative hemoglobin level might predict a better prognosis, and the systemic immune-inflammation index might accurately predict survival outcomes in patients with rectal cancer after preoperative chemoradiotherapy.