Chai Hong Rim

Stereotactic body radiation therapy (SBRT) is a noninvasive, high-precision radiation technique that delivers a high dose to the tumor in a limited number of fractions, typically five or fewer, and is increasingly used as a curative-intent option for hepatocellular carcinoma (HCC), particularly when surgical resection, liver transplantation, or local ablative therapies are not feasible. Although domestic and international guidelines have incorporated SBRT into the treatment algorithm for HCC, the lack of comprehensive evidence and expert opinion regarding patient selection, pretreatment evaluation, treatment planning and delivery, complication management, and post-treatment follow-up has resulted in substantial variation in clinical practice. Accordingly, expert consensus-based practical recommendations for SBRT were developed by a group of radiation oncologists, hepatologists, and radiologists from the Research Committee of the Korean Liver Cancer Association, based on expert surveys, a comprehensive review of evidence-based literature, and a modified Delphi process. Encompassing the entire clinical workflow of liver SBRT, these recommendations are intended to provide practical guidance for the safe and effective implementation of SBRT in patients with HCC.

Background: Diet is a modifiable factor of substantial interest to breast cancer survivors, but evidence regarding the relationship between overall diet quality and cancer recurrence remains limited. The Anti-Cancer Food Scoring system (ACFS) was developed to quantify the anticancer or carcinogenic potential of foods and meals on an evidence-based basis. This study explored whether ACFS measured after breast cancer treatment was associated with subsequent recurrence. Methods: We conducted an exploratory cohort analysis including 87 patients with an available first ACFS assessment, follow-up duration, and recurrence status. At each dietary assessment, 24-hour dietary recall interviews were performed on two separate days to reflect weekday and weekend intake. Consumed foods were mapped to the ACFS framework, which scores food components according to food-element codes, evidence grades, and food exchange units (FEUs). Overall ACFS at the first assessment was calculated as a weekly average weighted 5:2 for weekday and weekend scores. Associations with recurrence were analyzed using univariable Cox proportional hazards regression with ACFS modeled continuously per 30-point increase; KaplanMeier and log-rank analyses were additionally performed using an exploratory cutoff of 300. Results: Mean overall ACFS was 342.6 (SD 39.8), and median follow-up for the recurrence analysis was 34.9 months (IQR 27.1-41.3). Seven any-recurrence events and six distantrecurrence events occurred. For any recurrence, risk tended to decrease per 30-point increase in ACFS (HR 0.60, 95% CI 0.35-1.02; p=0.057). Event rates were 5.5% (4/73) in the ACFS ≥300 group and 21.4% (3/14) in the ACFS <300 group, with a log-rank p value of 0.045. For distant recurrence, the HR per 30-point increase in ACFS was 0.54 (95% CI 0.31-0.97; p=0.038), and the ACFS <300 group had a higher risk than the ≥300 group (HR 5.53, 95% CI 1.12-27.40; p=0.036). The log-rank p value for distant recurrence-free survival was 0.018. Conclusions: In this small exploratory cohort, lower ACFS was associated with a higher recurrence risk, with the clearest signal observed for distant recurrence. Larger cohorts, longer follow-up, and multivariable adjustment are needed before ACFS can be used for prognostic assessment or clinical decision-making.

PurposeGuidelines from the aromatase inhibitor era for early breast cancer (EBC) treatment recommend maintaining a body mass index (BMI) below 25. In the current era of cyclin-dependent kinase (CDK) 4/6 inhibitors, now standard in metastatic breast cancer (MBC), limited data exist on treatment outcomes in obese patients. This study investigates how adiposity affects the treatment outcome of CDK 4/6 inhibitors in patients with hormone receptor–positive, human epidermal growth factor receptor 2–negative MBC.Materials and MethodsWe searched PubMed, MEDLINE, and Embase databases, assessing efficacy outcomes such as progression-free survival (PFS) based on obesity markers, including BMI and visceral adipose tissue (VAT) index.ResultsTwelve studies were reviewed, with seven studies and 1,812 patients included in a pooled meta-analysis. Among patients with BMI ≥ 25, modest improvement in PFS was observed, with a pooled hazard ratio (HR) of 0.944 (95% confidence interval [CI], 0.909 to 0.980; p=0.003). Besides, add-on analysis using VAT to define obesity revealed a notable PFS improvement, with a pooled HR of 0.452 (95% CI, 0.256 to 0.798; p=0.006).ConclusionWhile BMI-defined obesity showed slight PFS improvement with CDK 4/6 inhibitors and endocrine therapy, using VAT to define obesity revealed significant PFS gains. This highlights the need for further research on biomarker to clarify the role of adiposity in MBC, which may differ from its impact in EBC.

Lymph node metastasis (LNM) of hepatocellular carcinoma (HCC) carries a poor prognosis; however, no standard treatment has been established. Radiotherapy (RT) has demonstrated favorable tumor response, with the advantage of being less affected by anatomical hindrances. Databases were searched up to April 2024. The inclusion criteria were: (1) ≥5 patients with HCC LNM, (2) studies that performed external RT, and (3) reporting survival or response rate (RR). The main effect measures are pooled 1- and 2-year overall survival (OS) rates, response rate (RR) and grade ≥3 complications. Twelve studies involving 825 patients were included. The pooled 1-year OS rate and 2-year OS rate were 49.3% (95% confidence interval [CI]: 39.2%-59.4%) and 24.5% (95% CI: 17.0%-34.0%), respectively. The median OS ranged from 5.8 to 29.7 months, with a median value of 9.7 months. In one study, 14.7% of patients were prescribed an immunoagent. In other studies, some patients received sorafenib, but no specific systemic therapy was performed for the majority. The pooled RR was 75.1% (95% CI: 66.9%-81.8%). The pooled RR of high dose and low dose groups was 83.8% (95% CI: 76.3-89.3) vs. 55.6% (95% CI: 44.4-66.3), respectively (p<0.001). The pooled rate of grade ≥3 gastrointestinal toxicity was 3.7% (95% CI: 2.1%-6.6%). RT is an effective and feasible palliative option for HCC LNM. Further researches of combined treatment with novel systemic agents are necessary.

During the celebration of the 50th anniversary of the founding of the Korean Cancer Association, articles published in Cancer Research and Treatment from 2004 to 2023 were assessed based on the subject and design of each study. Based on this analysis, trends in domestic cancer research were inferred and directions were suggested for the future development of Cancer Research and Treatment.

Background: The prognosis for patients with lung cancer bone metastases has improved with the use of novel systemic agents. These patients might need surgery or radiotherapy to alleviate symptoms or maintain function. However, there is currently no disease specific algorithm to guide multidisciplinary decisions. Methods: The inclusion criteria encompassed studies with ≥10 patients offering multivariate analysis data on survival that were published after 2000 until September 2023. Clinical factors were categorized based on their characteristics and the pooled hazard ratios (HRs) for each category were calculated. A treatment algorithm was proposed based on clinical importance and the pooled HRs. Results: Fifteen studies involving 3759 patients with lung cancer bone metastases were included. The median survival ranged between 1.8–28.3 months (median: 12.4). Among the studies involving patients with EGFR+ or treated with TKIs, the median survival ranged between 19.5–28.3 months. The most reported significant factor was ECOG performance (nine studies) followed by chemotherapy use (six studies). In the pooled analyses, the pooled HR [95% confidence interval (CI)] of the EGFR status category was 2.109 (1.345–3.305); the ECOG performance category was 2.007 (1.536–2.622); the visceral metastases category was 2.060 (1.370–3.098); the bone metastases characteristics category (e.g., multiplicity, weight-bearing bone metastases) was 1.910 (1.443–2.527); the body weight category was 1.805 (1.334–2.442); the anti-absorbants category was 1.784 (1.448–2.196); the systemic treatment category was 1.695 (1.407–2.041); the skeletal-related event category was 1.616 (1.063–2.458); the smoking status category was 1.530 (1.306–1.793); the gender category was 1.482 (1.270–1.729); and the histology category was 1.450 (1.186–1.772). Conclusions: Oncological prognoses are influenced by various interrelated factors. Our treatment algorithm supports multidisciplinary strategies for managing NSCLC bone metastases, considering the complex factors influencing prognosis.

Background: This study observed the clinical outcome of radiotherapy to extensive intrahepatic targets for advanced hepatocellular carcinoma (HCC) in a single institution. Methods: From September 2009 to July 2021, patients who underwent fractionated radiotherapy to a planning target volume (PTV) of over 100 ml with biological effective dose >30 Gy₁₀ for advanced HCC were enrolled. Overall survival (OS) and radiation-induced liver toxicity (RILD) were evaluated. RILD was defined as an increase in Child-Pugh (CP) score ≥2 or liver function tests ≥2.5 times at 3 months after the end of radiotherapy. Results: A total of 136 patients were evaluated. Eighty-nine patients had portal vein tumor thrombus (PVTT), 37 patients were in CP B stage, and the median radiation dose to PTV was 48.8 Gy₁₀. The median OS was 12.3 months. The factors most affecting OS were PVTT (P = 0.001), PTV (>500 ml, P = 0.001), incomplete coverage of the intrahepatic tumor (P = 0.004), and CP B (P = 0.006) in Cox regression. RILD occurred in 22.4% of the patients and was affected by PVTT (P = 0.003), PTV (P = 0.010), pretreatment bilirubin levels (>1.5 mg/ml, P = 0.016), and the mean normal liver dose (MNLD) (≥ EQD₂ 18 Gy₃, P = 0.021) in binary logistic regression. As the PTV was in excess of >500 ml, RILD developed in 30.2% of patients and the prognostic importance of pretreatment bilirubin levels (P = 0.006) and the MNLD (P = 0.014) increased. Conclusions: As PTV is more extensive, the bilirubin level and the MNLD have to be taken into consideration for safe radiotherapy, in addition to the traditional prognostic factors.

PurposeThere is increasing interest in the efficacy of stereotactic ablative radiotherapy (SABR) for treating colorectal cancer (CRC) patients with oligometastases (OM), recently. The purpose of this meta-analysis was to evaluate local control (LC), progression-free survival (PFS), and overall survival (OS) of CRC patients with pulmonary OM treated with SABR and toxicities.Materials and MethodsStudies that reported SABR for CRC patients with pulmonary OM were searched from MEDLINE and Embase. Treatment outcomes including LC, PFS, OS, and toxicities of grade 3 or higher were assessed.ResultsA total of 19 studies with 1,668 patients were chosen for this meta-analysis. Pooled 1-, 2-, and 3-year LC rates were 83.1%, 69.3%, and 63.9%, respectively. PFS rates were 44.8%, 26.5%, and 21.5% at 1, 2, and 3 years, respectively. OS rates at 1-, 2-, and 3-year were 87.5%, 69.9%, and 60.5%, respectively. The toxicity rate of grade 3 or higher was 3.6%. The effect of dose escalation was meta-analyzed using available studies.ConclusionApplication of SABR to CRC patients with pulmonary OM achieved modest local control with acceptable toxicity according to the present meta-analysis. Further studies establishing the clinical efficacy of SABR are guaranteed.

Background: Interest in the oligometastatic prostate cancer (OMPC) is increasing, and various clinical studies have reported the benefits of metastasis-directed radiation therapy (MDRT) in OMPC. However, the recognition regarding the adopted definitions, methodologies of assessment, and therapeutic approaches is diverse among radiation oncologists. This study aims to evaluate the level of agreement for issues in OMPC among radiation oncologists. Methods: We generated 15 key questions (KQs) for OMPC relevant to definition, diagnosis, local therapies, and endpoints. Additionally, three clinical scenarios representing synchronous metastatic prostate cancer (mPC) (case 1), metachronous mPC with visceral metastasis (case 2), and metachronous mPC with castration-resistance and history of polymetastasis (case 3) were developed. The 15 KQs were adapted according to each scenario and transformed into 23 questions with 6–9 per scenario. The survey was distributed to 80 radiation oncologists throughout the Republic of Korea. Answer options with 0.0–29.9%, 30–49.9%, 50–69.9%, 70–79.9%, 80–89.9%, and 90–100% agreements were considered as no, minimal, weak, moderate, strong, and near perfect agreement, respectively. Results: Forty-five candidates voluntarily participated in this study. Among 23 questions, near perfect (n = 4), strong (n = 3), or moderate (n = 2) agreements were shown in nine. For the case recognized as OMPC with agreements of 93% (case 1), near perfect agreements on the application of definitive radiation therapy (RT) for whole metastatic lesions were achieved. While ≥70% agreements regarding optimal dose-fractionation for metastasis-directed RT (MDRT) has not been achieved, stereotactic body RT (SBRT) is favored by clinicians with higher clinical volume. Conclusion: For the case recognized as OMPC, near perfect agreement for the application of definitive RT for whole metastatic lesions was reached. SBRT was more favored as a MDRT by clinicians with a higher clinical volume.