Prognostic significance of XXXX volume in locally recurrent @entity189 treated with salvage intensity-modulated radiotherapy.

@entity1 @entity137 @entity5 @entity189 @entity3 @entity204
INTRODUCTION: To evaluate the prognostic value of gross @entity5 volume (TV) in @entity1 with locally recurrent, nonmetastatic @entity189 . METHODS: Between 2001 and 2012, 291 consecutive @entity1 with locally recurrent, nonmetastatic @entity189 underwent salvage IMRT were retrospectively reviewed. The correlations between TV and recurrent T classification were analyzed. Survival analyses were performed. Receiver operating characteristic (ROC) curves were calculated to identify cut-off point of TV. The Akaike information criterion and Harrell's concordance index (c-index) were utilized to test the prognostic value. RESULTS: The median TV significantly increased with advancing recurrent T classification (P<0.001). The 5-year overall survival rate was 33.2% for the entire cohort. On multivariate analysis, TV was an independent negative prognostic factor for distant @entity3 -free survival (hazard ratio =1.013, P =0.003), overall survival (hazard ratio = 1.015, P<0.001) and @entity137 -related @entity204 (hazard ratio = 1.014, P<0.001). The 5-year overall survival rates were 63.1% and 20.8% for @entity1 with a TV < 22 cm3 and TV >= 22 cm3, respectively (P < 0.001). In @entity1 with TV <22 cm3, locoregional failure is the leading cause of @entity204 . In @entity1 with TV>= 22 cm3, distant @entity3 rate is higher and occurred within short term after local recurrence; meanwhile, radiation-induced injuries became more common and led to half of deaths in this group. The Akaike information criterion and c-index analyses indicated that the predictive ability of recurrent T classification improved when combined with TV. CONCLUSIONS: Our data suggests TV is a significant prognostic factor for predicting the distant @entity3 , overall survival and @entity137 -related @entity204 of @entity1 with locally recurrent, nonmetastatic @entity189 after salvage IMRT. TV should be considered when designing personalized salvage treatments for these @entity1 . For @entity1 with bulky local recurrent @entity5 , radiation may need to be de-emphasized in favor of systemic treatment or best supportive care.
