PurposeThis study evaluated the efficacy of extended field irradiation (EFI) in patients with locally advanced cervical cancer without para-aortic nodal involvement.Materials and MethodsA total of 203 patients with locally advanced cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stage, IB2-IIIB) treated with radiotherapy at Keimyung University Dongsan Medical Center from 1996 to 2010 were retrospectively analyzed. The median patient age was 59 years (range, 29 to 83 years). None of the patients had para-aortic node metastases. Of the 203 patients, 88 underwent EFI and 115 underwent irradiation of the pelvis only. Concurrent chemoradiotherapy (CCRT) was administered to 133 patients. EFI field was used for treatment of 26 patients who received radiotherapy alone and 62 who received CCRT.ResultsThe median follow-up period was 60 months. The 2- and 5-year overall survival (OS) rates were 87.8% and 73.5%, respectively, and the 2- and 5-year disease-free survival rates were 81.7% and 75.0%, respectively, however, no survival differences were observed between the two treatment field groups. EFI tended to increase OS in the radiotherapy alone group, but not in the CCRT group.ConclusionThese findings suggest that EFI does not have a significant effect in patients with locally advanced cervical cancer, especially in patients receiving CCRT. Conduct of additional studies will be required in order to confirm these findings.

The mechanical properties of cells are considered promising biomarkers for the early detection of cancer and the testing of drug efficacy against it. Nevertheless, generalized correlations between drug resistance and the nano-mechanical properties of cancer cells are yet to be defined due to the lack of necessary studies. In this study, we conducted atomic force microscopy (AFM)-based nano-mechanical measurements of cisplatinsensitive (A2780) and cisplatin-resistant (A2780cis) ovarian cancer cells. The difference in the efficacy of cisplatin between A2780 and A2780cis was confirmed in the 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay. We observed that the cisplatin-resistant ovarian cancer cells were more motile than cisplatin-sensitive cells based on the results of the wound closure experiment, and the AFM experiments showed that drug resistance induced nano-mechanical stiffening of the ovarian cancer cells. Increased mechanical stiffness caused by cisplatin resistance was consistent with the confocal microscopy images showing more distinct actin stress fibers in A2780cis than in A2780 cells. The down regulation of vinculin implicated the actin-driven elongation as a major motile mode for A2780cis cells. Our results consistently indicated that the acquisition of drug resistance in ovarian cancer cells induces an extensive reorganization of the actin cytoskeleton, which governs the cellular mechanical properties, motility, and possibly intracellular drug transportation.Key words atomic force microscopy (AFM); ovarian cancer; drug resistance; Young's modulus; nanomechanics Ovarian cancer is the leading cause of cancer-related mortality in gynecological malignancies. Little or no specific symptom at the early stage of ovarian cancer hinders the early diagnosis and contributes to the high mortality rate.1) The standard treatment of ovarian cancer is cytoreduction surgery, followed by platinum-based chemotherapy. However, most patients experience re-occurrence of cancer within 2 years of the initial treatment because of cancer cells' acquisition of resistance against platinum-based chemotherapy. A 5-year survival rate of the advanced ovarian cancer patients is reported to be only about 30%, 2) and the acquisition of cisplatin resistance is recognized as a major obstacle against the successful treatment of ovarian cancer. There are still many unresolved questions about how cancer cells become desensitized to chemotherapy.Recent advances in biomechanical studies suggest that the cellular mechanical compliance plays a crucial role in tumorigenesis and cancer progression. [3][4][5] In recent years, atomic force microscopy (AFM) is finding more attention in the field of biology and pharmaceutics.6-8) Especially, AFM-based nano-mechanics is recognized as a useful tool for detecting mechanical responses from local nanometer-sized domains of a cell.9-11) Changes in mechanical properties during pathological progressions have been investigated using AFM, 12,13) and abnorm...

PurposeTo evaluate survival rates and prognostic factors related to treatment outcomes after bladder preserving therapy including transurethral resection of bladder tumor, radiotherapy (RT) with or without concurrent chemotherapy in bladder cancer with a curative intent.Materials and MethodsWe retrospectively studied 50 bladder cancer patients treated with bladder-preserving therapy at Keimyung University Dongsan Medical Center from January 1999 to December 2010. Age ranged from 46 to 89 years (median, 71.5 years). Bladder cancer was the American Joint Committee on Cancer (AJCC) stage II, III, and IV in 9, 27, and 14 patients, respectively. Thirty patients were treated with concurrent chemoradiotherapy (CCRT) and 20 patients with RT alone. Nine patients received chemotherapy prior to CCRT or RT alone. Radiation was delivered with a four-field box technique (median, 63 Gy; range, 48.6 to 70.2 Gy). The follow-up periods ranged from 2 to 169 months (median, 34 months).ResultsThirty patients (60%) showed complete response and 13 (26%) a partial response. All patients could have their own bladder preserved. Five-year overall survival (OS) rate was 37.2%, and the 5-year disease-free survival (DFS) rate was 30.2%. In multivariate analysis, tumor grade and CCRT were statistically significant in OS.ConclusionTumor grade was a significant prognostic factor related to OS. CCRT is also considered to improve survival outcomes. Further multi-institutional studies are needed to elucidate the impact of RT in bladder cancer.

PurposeThe purpose of this study was to evaluate the prognostic value of the lymph node ratio (LNR), which was defined as the proportion of involved nodes of all dissected nodes, in pN1 breast cancer.Materials and MethodsWe retrospectively analyzed the clinical data of patients with pN1 breast cancer (N = 144) treated at Keimyung University Dongsan Medical Center, Daegu, Korea between 2001 and 2010. The median age was 46 years (range, 27 to 66 years). The LNR was 0.01–0.15 (low LNR) in 130 patients and >0.15 (high LNR) in 14 patients. Sixty-five patients (45.1%) had T1 tumors, 74 (51.4%) had T2 tumors, and 5 (3.5%) had T3 tumors. Eighty-eight patients (61.1%) underwent total mastectomy and 56 (38.9%) underwent partial mastectomy. Fifty-nine patients (41.0%) underwent radiotherapy and 12 (8.3%) underwent regional radiotherapy. The median follow-up period was 65 months.ResultsThe 5- and 10-year disease-free survival (DFS) rates were 92.7% and 82.4%, respectively. Univariate analyses revealed that high LNR (p = 0.004), total mastectomy (p = 0.006), no local radiotherapy (p = 0.036), and stage T2 or T3 (p = 0.010) were associated with worse DFS. In multivariable analysis, only high LNR (p = 0.015) was associated with worse DFS.ConclusionHigh LNR is an independent prognostic factor in pN1 breast cancer and could be an indication for adjuvant radiotherapy in these patients.

Purpose:To identify possible predictors of pathologic complete response (pCR) of rectal cancer after preoperative concurrent chemoradiotherapy (CCRT).Materials and Methods:We conducted a retrospective review of 53 patients with rectal cancer who underwent preoperative CCRT followed by radical surgery at a single center between January 2007 and December 2012. The median radiotherapy dose to the pelvis was 54.0 Gy (range, 45.0 to 63.0 Gy). Five-fluorouracil-based chemotherapy was administered via continuous infusion with leucovorin.Results:The pCR rate was 20.8%. The downstaging rate was 66%. In univariate analyses, poor and undifferentiated tumors (p = 0.020) and an interval of ≥7 weeks from finishing CCRT to surgery (p = 0.040) were significantly associated with pCR, while female gender (p = 0.070), initial carcinoembryonic antigen concentration of <5.0 ng/dL (p = 0.100), and clinical stage T2 (p = 0.100) were marginally significant factors. In multivariate analysis, an interval of ≥7 weeks from finishing CCRT to surgery (odds ratio, 0.139; 95% confidence interval, 0.022 to 0.877; p = 0.036) was significantly associated with pCR, while stage T2 (odds ratio, 5.363; 95% confidence interval, 0.963 to 29.877; p = 0.055) was a marginally significant risk factor.Conclusion:We suggest that the interval from finishing CCRT to surgery is a predictor of pCR after preoperative CCRT in patients with rectal cancer. Stage T2 cancer may also be an important predictive factor. We hope to perform a robust study by collecting data during treatment to obtain more advanced results.