5-year Local Control Research Articles

Significance of adding chemotherapy to radiotherapy in the treatment of T2N0 glottic cancer.

The prognosis for T2N0 glottic squamous cell carcinoma (SCC) is generally favorable, with a 5-year overall survival rate of 79%-96% achieved with radiotherapy (RT), the standard nonsurgical treatment for this condition. However, the local control rate for T2N0 glottic SCC treated with RT remains suboptimal, with a 5-year local control rate of only 65%-80%. Local residual disease or recurrence following RT for T2N0 glottic SCC often leads to difficulties in laryngeal preservation. When total laryngectomy is performed as a salvage surgery in such cases, patients lose their physiological ability to speak. Therefore, improving local control and laryngeal preservation rates through RT could substantially improve the quality of life of these patients. Attempts have been made to combine cytotoxic anticancer agents with RT to achieve better local control in patients with T2N0 glottic SCC. In Japan, several studies have evaluated the effects of combining S-1, an oral fluorinated pyrimidine, with RT in these patients. This review highlights the importance of adding chemotherapy to RT in the treatment of patients with T2N0 glottic SCC.

Survival, Tumor Control, and Safety Outcomes of Proton Therapy in Sinonasal Cancer Population: A Systematic Review and Meta-Analysis.

In sinonasal cancer (SNC), treatment with proton therapy (PT) provides excellent local control, especially after gross total resection. Because of the heterogeneity and rarity of this disease site, a comprehensive assessment of toxicity, survival, and control rates is lacking. Our primary objective was to assess the toxicity outcomes of PT in SNC patients, with a secondary aim of assessing survival and tumor control after PT. PubMed, Embase, EBSCO, Scopus, Science Direct, Web of Science, Ovid, Proquest, and Cochrane Library were searched from inception to August 2024 reporting PT acute and late toxicity, survival, and tumor control outcomes in SNC patients. A random-effect meta-analysis was used to assess the pooled safety, survival, and tumor control outcomes. The primary analysis was to report acute and late toxicity. The secondary aims included overall survival (OS), disease-free survival (DFS), local control (LC), regional control (RC), and distant metastasis control (DMC) rate. Fourteen studies were included for qualitative analysis. We pooled data from 756 patients who received PT for SNC. Among acute toxicity (AT), there was a 31.9% occurrence rate of grade ≥ 3 events, whereas within late toxicity (LT), grade ≥ 3 events occurred at a rate of 35.3%. Most LT (62.1%) were classified as grade 2, with the most frequent being ocular (24.8%) or neurological (18.4%) toxicities. The most common grade ≥ 3 toxicities were mucositis (15.3%) in AT and ocular toxicity (9.6%) in LT. The pooled 5-year OS, DFS, LC, RC, and DMC were 36.8%, 34.2%, 35.6%, 28.6%, and 54.3%, respectively. Our analysis demonstrates that PT-treated SNC patients experience acceptable rates of acute and LT consistent with other published outcomes with highly conformal radiation techniques. PT demonstrates favorable OS and DFS. Further prospective and comparative effectiveness research is needed to better quantify the magnitude of the benefit of PT or other forms of radiation modalities.

Resistance to Radiotherapy in Cancer.

Radiation therapy or radiotherapy is a medical treatment that uses high doses of ionizing radiation to eliminate cancer cells and shrink tumors. It works by targeting the DNA within the tumor cells restricting their proliferation. Radiotherapy has been used for treating cancer for more than 100 years. Along with surgery and chemotherapy, it is one of the three main and most common approaches used in cancer therapy. Nowadays, radiotherapy has become a standard treatment option for a wide range of cancers around the world, including lung, breast, cervical, and colorectal cancers. Around 50% of all patients will require radiotherapy, 60% of whom are treated with curative intent. Moreover, it is commonly used for palliative treatment. Radiotherapy provides 5-year local control and overall survival benefit in 10.4% and 2.4% of all cancer patients, respectively. The highest local control benefit is reported for cervical (33%), head and neck (32%), and prostate (26%) cancers. But no benefit is observed in pancreas, ovary, liver, kidney, and colon cancers. Such relatively low efficiency is related to the development of radiation resistance, which results in cancer recurrence, metastatic dissemination, and poor prognosis. The identification of radioresistance biomarkers allows for improving the treatment outcome. These biomarkers mainly include proteins involved in metabolism and cell signaling pathways.

Distinct patterns of osteoradionecrosis after photon-based radiotherapy and carbon ion radiotherapy for unresectable adenoid cystic carcinoma of the head and neck: case series from two institutions.

To present the clinical outcomes of two series of patients treated with carbon-ion radiotherapy (CIRT) and definitive photon radiotherapy (RT) for adenoid cystic carcinoma of the head and neck (HN-ACC). The first cohort of six patients was referred from Oslo University Hospital (OUS) to Centro Nazionale di Adroterapia Oncologica (CNAO, Pavia, Italy) for CIRT in 2014-2017. The second cohort included 18 patients treated with definitive photon RT at OUS in 2005-2017. The primary endpoint was an evaluation of osteoradionecrosis (ORN) in the two cohorts. The secondary endpoints were treatment efficacy by local control (LC), progression-free survival (PFS), and overall survival (OS). The tumor stage was T4 for all the patients in the CIRT group and 15 (84%) in the photon group. There were three (50%) patients with grade 3 ORN in the CIRT group compared to one (6%) with grade 3 ORN in the photon group (p = 0.05). The 5-year LC (95% CI), PFS, and OS rates in the CIRT group and the photon group were 33% (11-100) and 39% (19-76), 17% (9-100) and 23% (2-59), and 80% (52-100) and 50% (31-82), respectively. Half of the patients in the CIRT cohort experienced ORN requiring surgical management during the follow-up. Patients with ACC referred for CIRT often have a worse prognosis and more advanced disease than patients treated with photons. When returning from the referring center, these patients need close follow-up often in collaboration with treating centers to manage toxicity that impacts quality of life.

Transoral Laser Microsurgery Versus Radiotherapy for T1-T2 Glottic Cancer with Anterior Commissure Involvement: A Systematic Review and Meta-Analysis.

To identify the most effective treatment modality for achieving favorable outcomes in early glottic tumors with anterior commissure involvement (ACI). PubMed, Embase, Web of Science, and ScienceDirect. Random-effects proportional meta-analysis model is used to evaluate the oncological and functional outcomes of transoral laser microsurgery (TLM) versus radiation therapy (RT) in early glottic (T1-T2) cancer with ACI. From a total of 736 studies, 40 studies were included, comprising 2666 early glottic tumor patients with ACI. TLM (52%) and upfront RT (48%) were the primary treatment groups. TLM had better 5-year overall survival (OS) (84.5% [80.3%-88.0%] vs. 79.4% [75.7%-82.7%]). Similarly, TLM-treated patients had better 3-year pooled disease-free survival (DFS) compared with RT-treated patients (82.7% [77.1%-87.1%] vs. 73.3% [23.8%-96.0%]). TLM exhibited a better 5-year local control rate (LCR) than RT (77.2% vs. 71.6%). In our temporal analysis, TLM had a higher 5-year LCR than RT (78.2% vs. 63.5%) in 2001-2012, with similar rates in 2013-2024 (76.8% vs. 78.4%). TLM-treated patients had higher laryngeal preservation rates compared with RT patients (93% [90.6%-94.8%] vs. 87.6% [82.8%-91.2%]). Our meta-analysis is the first in the literature to compare the outcomes between TLM and RT-treated patients with ACI in early glottic tumors. TLM-treated patients appear to have superior 5-year OS and laryngeal preservation compared with upfront RT-treated patients. However, both TLM and RT exhibited comparable oncological outcomes in early glottic tumor patients with ACI during the recent period from 2013 to 2024. Laryngoscope, 2025.

Functional and oncological outcomes of transoral laser versus robotic surgery in supraglottic squamous cell carcinoma.

To compare the surgical, functional and oncological outcomes of Transoral Laser Microsurgery (TLM) and Transoral Robotic Surgery (TORS) for the treatment of supraglottic squamous cell carcinoma. Retrospective case series with prospective data. Tertiary Academic Medical Center. A chart-review analysis, with prospective follow-up was performed on 122 patients treated for a supraglottic squamous cell carcinoma with either TLM or TORS between 2003 and 2019. Patients were grouped according to the surgical technique used. Clinical, surgical, functional and oncological outcomes were compared, including local and regional controls, DFS, and OS, and postoperative complications. A total of 122 patients, including 47 treated with TLM and 75 with TORS. Negative margins were observed in n=12/47 (25.5%) of TLM cases and n=4/75 (5.3%) of TORS cases (p<0.05). There was no significant difference between the two techniques in terms of 5-year local and regional control, however a significant difference was found in disease-free survival and overall survival. The functional laryngeal preservation rate was 97.8% in the TLM group and 100% in the TORS group. Both techniques appear to be safe and effective, though TORS shows superiority in achieving negative margins compared to TLM. Therefore, the choice of technique should be tailored to available resources, surgical team preferences, and experience, while also considering the learning curves associated with each approach.

Supracricoid Partial Laryngectomy Versus Radiation Therapy for cT3N0M0 Glottic SCC: Outcomes in Candidates for Total Laryngectomy Responding Well to Induction Chemotherapy.

To evaluate whether supracricoid partial laryngectomy (SCPL) may be a viable alternative to radiation therapy (RT) for patients with glottic cT3N0M0 squamous cell carcinoma (SCC) who are surgical candidates for total laryngectomy (TL) and respond well to platinum-based induction chemotherapy. Retrospective case series review of 18 consecutive patients with cT3N0M0 glottic SCC, initially considered surgical candidates only for TL who showed a good response to platinum-based induction chemotherapy, managed at a French university teaching institution with either SCPL (n = 9) or RT (n = 9). The main endpoints were 10-year local control and laryngeal preservation. The secondary endpoints were 10-year survival, causes of death analysis, and univariate analysis of local control and survival. The 10-year actuarial local control, laryngeal preservation, survival rates were 77.8%, 88.9%, and 66.7% after SCPL, respectively, and 72.9%, 87.5%, and 33.3%, after RT without significant statistical differences. In univariate analysis none of the clinical variables under analysis were related to local control and survival. Our data suggest that SCPL may warrant further consideration as a treatment option for glottic cT3N0M0 SCC patients who respond well to platinum-based induction chemotherapy. However, additional prospective research is warranted given the retrospective, nonrandomized nature of the presented case series.

Radiotherapy & total neoadjuvant therapy for recurrent rectal cancer in previously irradiated patients, (RETRY): a multicenter prospective observational study

BackgroundLocal recurrence of rectal cancer (LRRC) previously treated with radiotherapy is associated with a poor prognosis. Historically, the integration of radiotherapy (RT) with surgery has improved the likelihood of complete resections (R0) and, consequently, enhanced survival. Unfortunately, many LRRC cases are not amenable to surgical intervention. The inclusion of chemotherapy (CHT) alongside advanced RT techniques including proton and carbon ion RT (CIRT) and stereotactic body radiation therapy (SBRT), has generated new treatment options. Therefore, there is a need for improved stratification of LRRC patients to enhance treatment outcomes. The RETRY is an integrated trial with the primary aim to explore if combining CHT with RT in all available modalities can enhance local control (LC) in LRRC patients, consequently improving survival.MethodsExperts from Italian centers specializing in rectal cancer and LRRC management collaborated to design a prospective multicenter observational study within the AIRO group for gastrointestinal malignancies. Eligible participants are adult LRRC patients who previously had pelvic RT, meet specific criteria, and are affiliated with the participating Italian centers. Specific criteria must be met for CIRT referral. A total of 88 patients will be enrolled over three years. The primary objective is to determine the 3-year LC rate. Secondary outcomes include assessing survival, quality of life, and R0 resection rates in surgery cases. A minimum dose of 40 Gy, conventional fractionation with concomitant fluoropyrimidine—with/without oxaliplatin-based CHT (CRT) is prescribed in neoadjuvant setting. Alternatively, the dose will vary from 35 to 40 Gy in 5 fractions based on clinical judgment, by SBRT. Both proton and photon therapies will be evaluated in these approaches. Surgery will be considered if deemed operable. In inoperable cases, CIRT with a dose of 40–60 Gy relative biological effectiveness (RBE) will be administered with a daily dose fraction ranging between 3 and 4.8 Gy RBE.DiscussionThe RETRY trial aims to investigate the combined effects of RT and CHT and when feasible the addition of surgery, to determine whether this comprehensive approach can result in improved survival and quality of life for LRRC patients.Trial registration number ClinicalTrials.gov (No. NCT05984576).

Stereotactic ablative radiotherapy for pulmonary metastasis from sarcoma: a retrospective comparison with metastasectomy.

Recent studies report excellent local control (LC) and favorable toxicities of stereotactic ablative radiotherapy (SABR) for pulmonary metastasis (PM) from sarcoma. This study compared the LC and survival of SABR and metastasectomy for sarcoma PM. We analyzed the LC rates of 54 PMs treated with SABR between 2008 and 2022. For survival analysis, we compared 14 patients who received SABR as first-line treatment with 61 patients who underwent metastatectomy. For SABR-treated PMs, a median total dose of 55Gy (range, 48-60) was administered over 3-10 fractions. Median follow-up for LC in SABR-treated PMs was 19.2months (range, 0.8-124.0), and the 2-year LC rate was 92.2%. No patients experienced toxicities of grade 3 or higher. The median age of the patients in the survival analysis was 73years (range, 42-83) in the SABR group and 54years (range, 19-78) in the metastasectomy group (p < 0.001). PMs in the "gray zone" were more common in the SABR group (35.7%) than in the metastasectomy group (8.2%) (p = 0.029). The median follow-up for survival analysis was 44.8months (interquartile range, 21.5-66.4). The 3-year rates of LC and overall survival were 92.3% and 57.3% in the SABR group and 89.2% and 75.9% in the metastasectomy group (p = 0.807, 0.224), respectively. The out-of-field intrapulmonary failure-free survival and extrapulmonary systemic failure-free survival rates at 3years were not significantly different (p = 0.673, 0.386). SABR for sarcoma PM demonstrated excellent LC with acceptable toxicity. Survival rates of SABR were comparable to those of metastasectomy.

ESHO 2-85. Hyperthermia as an adjuvant to radiation therapy in the treatment of advanced neck nodes: A randomized multicenter study by the European Society for Hyperthermic Oncology.

European Society for Hyperthermic Oncology (ESHO) 2-85 is a multicenter randomized trial investigating hyperthermia (HT) as an adjuvant to radiotherapy (RT) in treatment of locally advanced neck nodes. The trial never fulfilled recruitment and was stopped prematurely, and has not previously been published. Between January 1987 and February 1993, 64 evaluable neck nodes in 54 patients were included. Tumors were stratified according to institution and nodal size and randomly assigned to receive RT alone (2 Gy/fx, 5 fx/wk) to a total dose of 60-70 Gy, including boost, or the same RT followed once weekly by HT (aimed for 43°C for 60 min). The primary endpoint was persistent complete response (local control). Sixty-four tumors in 54 patients were evaluable, with a median observation of 17 months. Thirty-four tumors were randomized to RT alone and 30 to RT+HT. Compliance with RT was good. HT was associated with moderate to severe pain and discomfort in 38% of the treatments. In 57% of the heated patients at least one treatment achieved the target temperature. HT did not significantly increase radiation morbidity. The complete response rate was 53% in the RT versus 80% in the RT+HT group, and 3-year persistent local control rate was 32% for RT alone versus 53% for RT+HT; HR: 0.48 [0.23-0.98]. The ESHO 2-85 study demonstrated that addition of a weekly HT treatment to RT of advanced neck nodes significantly enhanced the persistent tumor control. The results substantiate the potential clinical benefit of hyperthermic oncology.

Application of spiral tracheoplasty in thyroid cancer with tracheal invasion

Objective: To explore the application of spiral tracheoplasty in the repair of large tracheal defects after the resection of trachea invaded by thyroid cancer. Methods: A retrospective analysis was performed on the clinical data of 11 patients, including 4 males and 7 females, aged from 36 to 67 years old, with large tracheal defects after tracheal resection due to thyroid papillary carcinoma invading the trachea in the Department of Otorhinolaryngology Head and Neck Surgery, Second Xiangya Hospital, Central South University from January 2019 to January 2022. The range of tracheal defects, time of tracheal reconstruction, postoperative complications and airway were recorded, and the patients were followed up for more than 24 months. Results: All patients underwent total thyroidectomy and tracheal resection and spiral reconstruction, and 2 of the cases underwent cricoid cartilage resection on the invaded side of cartilage. The tracheal defect accounted for 40%-60% of the circumference, and the lengths of the tracheal defects were 5.0 cm×7.5 cm and 6-9 tracheal rings, with 2 cases combined with partial defects of the cricoid cartilage. The reconstruction time was 30-60 min, with an average of 41.81 min. Among the 11 patients, 3 had recurrent laryngeal nerve paralysis, and 2 underwent tracheotomy. Four patients presented with hypocalcemia within one month after the operation. Followed up for 24-60 months, no tracheal stenosis occurred, the 2-year survival rate was 100%, the 2-year local control rate of the trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. Conclusion: Spiral tracheoplasty is a safe and effective method that can reduce the tension at the tracheal anastomosis and expand the tracheal cavity, which can be used for tracheal reconstruction after extensive resection of trachea invaded by locally advanced thyroid cancer.

Evaluating the efficacy of low-kV X-ray intraoperative radiotherapy in the treatment of locally advanced rectal cancer: a retrospective cohort study.

Patients with locally advanced rectal cancer (LARC) treated with surgery have a high risk of local recurrence. Intraoperative radiotherapy (IORT) is a promising method for treating locally advanced solid tumors, but there is limited research on the efficacy of IORT in treating LARC. This study aimed to evaluate the long-term efficacy of low-kV X-ray IORT in the treatment of LARC. In total, 69 LARC patients with stage tumor3-4node0-2metastasis0 (T3-4N0-2M0) treated with radical resection and low-kV X-ray IORT at our center from December 2015 to August 2023 were consecutively included in this retrospective cohort study. Basic patient characteristics, intraoperative and postoperative data, and early and late complications were recorded. A Kaplan-Meier (K-M) survival analysis was performed to analyze the overall survival (OS) and disease-free survival (DFS) of the patients. In total, 69 patients (median age, 64 years; 69.6% male) were enrolled in the study, and the median follow-up time was 47.5 months (range, 6.5-98.5 months). At the time of analysis, 15 patients had died (21.74%), 6 patients (8.70%) had been lost to follow-up, and 48 patients (69.57%) were alive. The 3-year OS and DFS rates were 89.42% and 71.47%, respectively. The local recurrence rate was 26.09%, and the 5-year local control, OS, and DFS rates were 78.90%, 68.59%, and 66.91%, respectively. The T stage of tumors was not predictive of either OS or DFS (P>0.05). However, different N stages and nerve/vascular invasion were found to be positively correlated with OS and DFS (P<0.05). Mortality within 30 days post-surgery was 0%. Early complications included anastomotic leak (5 cases, 7.25%), urinary retention (4 cases, 5.80%), diarrhea (7 cases, 10.14%), and bowel obstruction (4 cases, 5.80%), all of which were cured by conservative treatment. Late complications included ureteral obstruction (3 cases, 4.35%), bladder dysfunction (2 cases, 2.90%), sexual dysfunction (5 cases, 7.24%), and bowel obstruction (6 cases, 8.70%). Our findings suggest that low-kV X-ray IORT enhances local control and survival in LARC patients. Further research should be conducted in larger, prospective trials.

Defining Optimal Nodal Dose for Stage IIIC Cervical Cancer: An Institutional Audit of Patients Treated with Simultaneous Integrated Nodal Boost

ObjectiveTo assess radiation dose-response relationship for individual lymph nodes in patients with stage IIIC cervical cancer who are treated with simultaneous integrated boost (SIB).MethodsThis is a retrospective study in which patients with stage IIIC cervical cancer treated with (chemo)radiation who received simultaneous integrated nodal boost (SIB) and brachytherapy were evaluated with the primary aim of determining in-field nodal control. Secondary aims included estimation of local control (LC), disease free survival (DFS) and adverse events. Univariate analysis and multivariate analysis was performed for factors impacting nodal control, LC and DFS.ResultsOne hundred and fifty-one (151) nodes in 65 patients were included. The median number of lymph nodes and nodal volume was 2 (1–6) and 3.4 cc (1.8–6.8 cc) respectively. Median SIB dose was 55Gy/25# (53.7–55.0 Gy). At a median follow-up of 43 months the in-field nodal control was 99.3% (1/151). The 5-year LC, DFS and regional nodal control was 88.7, 66 and 85.6% respectively. The 5-year DFS for FIGO stage IIIC1 was 67.7% versus 43.5% for stage IIIC2 (p = 0.03) and lymph node volume >3cc was associated with reduced 5-year DFS (80.8% vs. 55%, p = 0.03) on univariate analysis. No factor was statistically significant on multivariate analysis. A vast majority of lymph node recurrences were observed in elective nodal regions outside the true pelvis that received lower contribution from brachytherapy.ConclusionNodal SIB doses of up to 55Gy/25#/ 5 weeks administered during chemoradiation are associated with 99.3% 5-year infield nodal control. A vast majority of nodal recurrences were observed in elective volumes that received a lower contribution from brachytherapy.

Outcomes of Management of Progressive Radiosurgery-Treated Brain Metastasis With Resection Followed by Pathology-Informed Management: A Retrospective Study

BACKGROUND AND OBJECTIVES: In patients treated with stereotactic radiosurgery (SRS) for brain metastases, follow-up imaging demonstrating progression may result from treatment effect/radionecrosis (RN) or tumor progression. We report long-term outcomes for a cohort of patients who demonstrated radiological progression on serial imaging after initial radiation and who underwent resection, at which point histology informed further management. METHODS: A retrospective chart review identified 76 patients with an associated 82 brain lesions between 2009 and 2022, that were initially treated with SRS, and then demonstrated suspicious imaging developing through at least 2 scan time points with either pathologic confirmation of tumor or RN. RESULTS: Of the 82 lesions, 55 lesions (67.1%) were found to be tumor and were treated with repeat radiation and 27 (32.9%) were found to have pathologically confirmed RN and conservatively managed. 14/27 lesions ultimately found to be radionecrotic required steroids preoperatively due to neurological symptoms. None of these lesions required further intervention with median postsurgery follow-up of 24.4 months (range 1-104 months). There were 55 instances (in 51 patients) of confirmed recurrent/progressive tumor who we treated with repeat aggressive radiation with either Cs-131 brachytherapy (12 [21.8%]) or SRS (43 [78.2%]). Among patients treated with reirradiation, the median follow-up to local failure was 15.2 months (95% CI 7.3-26.6 months). The 2-year local control rate was 79.5% (95% CI 68.3%-92.5%). CONCLUSION: These results support resection of radiosurgery-treated lesions with progression continuing through serial imaging, and this pathology-informed management results in excellent control of both RN and tumor progression after radiosurgery.

Final Results of a Multicenter Prospective Study of Stereotactic Body Radiation Therapy for Previously Untreated Solitary Primary Hepatocellular Carcinoma (The STRSPH Study).

To report final results of a prospective study of stereotactic body radiation therapy (SBRT) in patients with previously untreated solitary primary hepatocellular carcinoma (HCC). This prospective, single-arm, multicenter phase 2 trial recruited patients with HCC who were unsuitable for, or refused, surgery and radiofrequency ablation, with 3-year overall survival rates as the primary endpoint and survival outcomes and adverse events as secondary endpoints. The prescribed SBRT dose was 40 Gy in 5 fractions. The final data were analyzed in November 2022. Between 2014 and 2018, 36 patients (median age, 73.5 years) were registered; enrollment was closed before full recruitment due to slow accrual. Overall, 34 patients were analyzed for efficacy evaluation after excluding 2 patients. The median tumor size was 2.3 cm. The median follow-up times for all patients and for survivors were 49 and 56 months, respectively. The 3-year overall survival rate was 82% (95% confidence interval, 65%-92%). The 3-year local control rate was 93% (95% confidence interval, 76%-98%). Grade 3 or higher SBRT-related nonlaboratory toxicities were observed in 4 patients (11%). No grade 5 adverse events were observed. Final results of this phase 2 trial suggest the efficacy and safety of SBRT for newly diagnosed early-stage HCC that is unfit for other local therapies. Although this study was underpowered by the small number of registrations, the excellent results indicate that SBRT may be an alternative option for the management of early-stage HCC.

Postoperative high-dose-rate brachytherapy alone in stage T1-3N0M0 oral cancer with negative prognostic factors: a retrospective study

To evaluate treatment outcomes and toxicity in patients with stage T1-3N0M0 oral cancer treated with surgery followed by high-dose-rate brachytherapy (HDR-BT). Retrospective study of 50 patients with stage T1-T3N0 tongue and floor-of-mouth cancer who underwent tumour excision (+ elective neck dissection) followed by postoperative HDR-BT due to the presence of negative prognostic factors (close or positive resection margins, lymphovascular and/or perineural invasion, deep invasion). The plastic tube technique (dose: 18 x 3 Gy b.i.d.) was used. Survival outcomes, toxicity, and prognostic factors were evaluated. At a median follow-up of 81 months (range, 4-121), actuarial 5-year local control (LC), nodal control (NC) and progression-free survival (PFS) rates were 79%, 69%, and 64%. After salvage treatment (surgery + external beam radiotherapy), LC, NC, and PFS increased to 87%, 77%, and 72.3%, respectively. Five-year overall survival and cancer-specific survival (CSS) rates were 73% and 77%. Treatmentrelated toxicity included two cases of mandibular osteoradionecrosis and five cases of small soft tissue necrosis. T stage was significantly correlated with nodal control (p=0.02) and CSS (p=0.04). Tumour grade correlated with DFS (p=0.01). Postoperative HDR-BT 18 x 3 Gy b.i.d. seems to be an effective method in patients with T1-3N0M0 oral cancer with negative prognostic factors after tumour resection.

Outcomes After Stereotactic Body Radiation for Hepatocellular Carcinoma in Patients With Child-Pugh A Versus Child-Pugh B/C Cirrhosis

For patients with hepatocellular carcinoma (HCC), stereotactic body radiation therapy (SBRT) has emerged as a locoregional treatment. Our purpose was to report outcomes in patients with HCC with Child-Pugh A (CP A) versus Child-Pugh B or C (CP B/C) liver dysfunction treated with SBRT. A retrospective analysis of 80 patients with HCC, with a total of 94 tumors treated with SBRT, was conducted at a single institution. Outcomes were compared between patients with CP A (n = 51) and CP B/C (n = 29) liver dysfunction. Outcomes of interest included local control, overall survival (OS), and toxicity. Median tumor size was 3.2 cm. There were 59 tumors included in the CP A cohort and 35 tumors in the CP B/C cohort. Median radiation dose was 50 Gy in 5 fractions for the CP A cohort and 40 Gy in 5 fractions for the CP B/C cohort. The rates of pathologic complete response were similar between the 2 groups at 63% for the CP A group and 61% for the CP B/C group. The estimated 1-year local control rates were similar between the 2 groups at 93% for the CP A group and 91% for the CP B/C group (P = .59). The 1-year OS for the CP A group was 85%, whereas the 1-year OS for the CP B/C group was 61% (P = .19). There was a 5.9% rate of grade 3+ toxicity in the CP A group and a 20.7% rate of grade 3+ toxicity in the CPB/C group. Our findings suggest that SBRT is feasible and effective in patients with both CP A and CP B/C liver dysfunction with similar rates of local control and pathologic complete response despite lower radiation doses in the CP B/C cohort. In patients with more advanced CP B/C cirrhosis, toxicities were higher and must be weighed against possible treatment benefits. Further studies characterizing the optimal role of SBRT in patients with advanced cirrhosis are warranted.

A systematic review of stereotactic radiosurgery for metastatic spinal sarcomas.

Sarcomas metastasizing to the spine are a rare entity. Ideally an En-bloc resection is necessary to achieve durable local control (LC) rates. However, anatomical constraints often limit the degree of tumor resection. Because of this, other therapeutic modalities either replacing or as an adjuvant to resection are necessary. Stereotactic radiosurgery (SRS) is a reasonable candidate therapy. We conducted a systematic review of the literature using the following databases: PubMed, Science Direct, and Cochrane library. We used a combination of the following terms connected by boolean operators: "Metastatic Sarcoma, Sarcoma of the Spine, Spine Sarcoma, Metastasis, stereotactic radiosurgery, SRS." All retrospective and prospective cohorts, as well as randomized control trials reporting on patients with histopathologically confirmed metastatic sarcomas of the bony elements of the vertebrae, thecal sac, cord, or associated soft tissues of the spine were included. We excluded animal studies, case reports, case series, patients < 18 (pediatric cohorts), review articles and meta-analyses. No date filters were applied to our search. Our final analysis included 5 studies ranging from 2009 to 2024 reporting on 260 patients and 371 associated lesions. Leiomyosarcoma was the most frequently reported histologic subtype (60%). Most lesions were localized to the thoracic spine (48.6%). 75% of studies reported a median dose < 30Gy, and achieved biologically equivalent doses (BEDs) ranging from < 50-100. Pooled 1-year median survival was 64.5% (IQR: 61.8-75.10). Pooled 1-year median LC was 86% (IQR: 79.4-88.5). Three of five studies (60%) for OS and 4/5 (80%) for LC had data availability suitable for meta-analysis. The 1-year OS and LC rates proportions across these studies were 67% (proportion = 0.67, 95% CI: 0.57-0.75, p = 0.07, I2 = 63%), and 84% (proportion = 0.84, 95% CI: 0.78-0.89, p = 0.10, I2 = 52%) respectively. Median follow up across all studies was 18 months (IQR:12.7-31.3). SRS is a reasonable alternative therapy in either the up front, salvage or adjuvant setting which can facilitate durable LC.

Factors affecting D90 High-risk Clinical Target Volumes (HR-CTV dose) of intracavitary and interstitial brachytherapy in locally advanced cervical cancer

IntroductionIntracavitary brachytherapy (IC) alone covers a limited target volume; however, intracavitary and interstitial brachytherapy (IC/IS) can increase the dose coverage. We aim to assess the factors that impact D90 HR-CTV dose. We also assess clinical outcomes and toxicities for 3D image-based brachytherapy. Material and methodsWe included a total of 424 cervical cancer patients with FIGO stage IB1 to IVA who received chemoradiation and high-dose-rate brachytherapy between 2014 and 2023. Target delineation was per GEC-ESTRO guidelines with the aim to achieve total dose of ≥ 85Gy (D90 HR-CTV) in EQD2. Implantation, tumor size, lateral extension, and HR-CTV volume were analyzed. ResultsThe median follow-up time was 24 months (range 1 -107). The overall 2-year local control, progression free survival, and overall survival rate were 90.3%, 75% and 95.5%, respectively. Of 424 patients, 86.8% received a total dose of at least 85 Gy of D90 HR-CTV in EQD2. In multi-variate analysis, IC/IS brachytherapy and HR-CTV volume were significant factors associated with HR-CTV D90 ≥ 85Gy in EQD2 (p=0.012 and p=0.000, respectively). Subgroup analysis of patients with HR-CTV volume > 35 ml found that IC/IS was a significant factor in achieving HR-CTV D90 ≥ 85Gy in EQD2 (p=0.017). At the median follow-up, patients with D90 HR-CTV ≥ 85 Gy achieved local control rates of 72.08% in small volume (<20 cm3) group, 68.42% in intermediate volume (21-30 cm3) group, 71.68% in high intermediate volume (31-60 cm3) and 17.67% in larger volume (>60 cm3) group (p=0.005). Grade 3 toxicities including proctitis, cystitis and vaginal stenosis were 7.1%, 1.9% and 0.2%, respectively. ConclusionIC/IS brachytherapy may be used in patients with HR-CTV volumes greater than 35 ml to achieve total doses of D90 HR-CTV ≥ 85Gy in EQD2. IC/IS brachytherapy also provide good local control with favorable toxicity profile.

Analysis of results of radiotherapy for oropharyngeal cancer.

Smoking and alcohol consumption remain the two most important risk factors for the development of oropharyngeal tumours, but there is an increasing number of younger patients (age <50 years) with human papillomavirus (HPV) association origin, also known as positivity. The role of radiotherapy (RT) in the treatment of this disease is paramount. To describe the radiotherapy results for oropharyngeal tumours and to search for prognostic parameters that influence the response of these malignant lesions to radio-chemotherapy. 95 patients underwent definitive radio- or radio-chemotherapy (RCT) for histologically squamous cell, oropharyngeal carcinoma at our Institute between 1January 2019 and 31 December 2020, of which 51 (54%) received the latter. The mean age was 61.9 years (37-82 years) and the male-female ratio was 69:26. The average total dose was 69 Gy (range: 54-70 Gy). The 5-year local control (LC), cancer-specific survival (CCS), and overall survival (OS) calculated by the Kaplan-Meier method were 71, 69, and 58%, respectively. Forty-four cases (46%) were confirmed tohave HPV involvement. HPV positive (+) tumours showed significantly better behaviour compared to HPV negative (-) cases in LC, CCS and OS. Smoking had a significant negative effect on cure rates: LC, CCS and OS were better in non-smokers. A significant negative effect of smoking on survival was alsoobserved in HPV-associated cases. For HPV- lesions, RCT had a stronger effect on LC than RT alone(64 vs43%, P = 0.03). HPV-associated malignancies show better survival outcomes toradio ± chemotherapy than their HPV- counterparts. In all cases, smoking worsens the response to treatment. For HPV- tumours, chemotherapy with radiation, compared to irradiation alone, has a more significant effect on survival outcomes, whereas for HPV+ tumours this effect is less pronounced.