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Matthew E. Nielsen, Bruce J. Trock, and Patrick C. Walsh

Table 1 Biochemical Recurrence-Free Survival Rates in Adjuvant Radiotherapy Trials Subgroups based on standard prognostic factors, including PSADT, Gleason score, surgical margin status, and pathologic stage, were evaluated for interactions

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Corbin D. Jacobs, Daniel J. Rocke, Russel R. Kahmke, Hannah Williamson, Gita Suneja, and Yvonne M. Mowery

papillomavirus. The objective of this analysis is to determine the association between adjuvant radiotherapy (RT) and overall survival (OS) for resected ARSCC based on adverse pathologic features. Methods: Adult subjects in the National Cancer Database

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Vishruth K. Reddy, Varsha Jain, Sriram Venigalla, William P. Levin, Robert J. Wilson II, Kristy L. Weber, Anusha Kalbasi, Ronnie A. Sebro, and Jacob E. Shabason

centers, larger tumor size (>5 cm), and tumors arising in the extremities ( Table 2 ). Figure 2. Trends in receipt of neoadjuvant or adjuvant RT. Abbreviation: RT, radiation therapy. Table 2. Factors Associated With Receipt of Neoadjuvant Versus Adjuvant

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David Scott Miller, Gini Fleming, and Marcus E. Randall

. Gynecol Oncol 1990 ; 36 : 166 – 171 . 10 Kuoppala T Maenpaa J Tomas E . Surgically staged high-risk endometrial cancer: randomized study of adjuvant radiotherapy alone vs. sequential chemo-radiotherapy . Gynecol Oncol 2008 ; 110 : 190

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Paul F. Engstrom, Juan Pablo Arnoletti, Al B. Benson III, Yi-Jen Chen, Michael A. Choti, Harry S. Cooper, Anne Covey, Raza A. Dilawari, Dayna S. Early, Peter C. Enzinger, Marwan G. Fakih, James Fleshman Jr., Charles Fuchs, Jean L. Grem, Krystyna Kiel, James A. Knol, Lucille A. Leong, Edward Lin, Mary F. Mulcahy, Sujata Rao, David P. Ryan, Leonard Saltz, David Shibata, John M. Skibber, Constantinos Sofocleous, James Thomas, Alan P. Venook, and Christopher Willett

Group . Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials . Lancet 2001 ; 358 : 1291 – 1304 . 83 Peeters KCMJ Marijnen CAM Nagtegaal ID . The TME trial after a median follow-up of 6

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Michelle T. Ashworth and Adil Daud

chest, abdomen, and pelvis identified no other lesions, and results of a complete right inguinal lymph node dissection were negative. The patient was treated with adjuvant radiotherapy (XRT), complicated by a nonhealing ulcer for 1 year and persistent

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Frank Qian Zhan, Vathani Sharon Packianathan, and Nathalie Charlotte Zeitouni

1999 ; 85 : 2589 – 2595 . 14 Veness MJ Perera L McCourt J . Merkel cell carcinoma: improved outcome with adjuvant radiotherapy . ANZ J Surg 2005 ; 75 : 275 – 281 . 15 Richetta AG Mancini M Torroni A . Total spontaneous

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Kilian E. Salerno

In the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer, among adjuvant radiotherapy options for whole-breast irradiation after breast-conserving surgery, hypofractionation is preferred. For the use of accelerated partial-breast irradiation, the NCCN Guidelines have adopted the updated definition of “suitability” used by the American Society for Radiation Oncology. Regional nodal irradiation is indicated—either in the setting of breast-conserving surgery or after mastectomy—for women with ≥4 positive nodes and should be strongly considered for 1 to 3 positive lymph nodes and select patients with node-negative disease deemed at high risk for recurrence.

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Samuel W. Beenken and Marshall M. Urist

Merkel cell carcinoma (MCC) or neuroendocrine carcinoma of the skin is uncommon, often aggressive, and has a poor prognosis. Complete surgical excision with histologic documentation of clear resection margins is recommended for the primary cancer. Retrospective analysis of clinical data strongly suggests that adjuvant radiotherapy improves local control of MCC, but no evidence has been published that it prolongs survival. Sentinel lymph node biopsy is a useful method of determining the need for regional lymph node dissection in stage I patients. Chemotherapy regimens similar to those employed for small cell carcinoma of the lung have been recommended for advanced MCC. Patients often show an initial response to therapy, but it is usually short-lived. The three-year overall survival for patients with MCC is 31%. Before an improvement in long-term survival can be realized, early detection, appropriate use of surgery and radiation therapy, and the development of effective systemic chemotherapy are required.

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Francis P. Worden and Huan Ha

Squamous cell carcinomas of the oropharynx account for approximately 25% of all head and neck squamous cell malignancies. Most patients present with locally advanced tumors and require a multimodality approach to treatment, with input from qualified surgeons and radiation and medical oncologists. For organ preservation, concurrent chemoradiotherapy is usually preferred over surgery with adjuvant radiotherapy. Controversies regarding management of particular populations of locally advanced oropharyngeal tumors exist, including whether to include induction chemotherapy before chemoradiation, the use of biologic agents as radiation sensitizers, and how best to manage the neck after definitive treatment. Additionally, infection with human papilloma virus (HPV), particularly HPV-16, is now an established risk factor for head and neck cancer. Most cases involve the oropharynx, and prognosis seems to be much better than for patients with non–HPV- and tobacco-related tumors. Given the distinct differences between these HPV and non–HPV-related cancers, controversy also exists regarding the management of these patient populations, with the concern that HPV-related malignancies may be overtreated. Unfortunately, these and other questions concerning the management of locally advanced oropharyngeal cancers are outstanding. Hence, it is critical that eligible patients are screened for and encouraged to participate in clinical trials.