Adjuvant External Beam Radiotherapy Research Articles

Evaluating the Role of Adjuvant Radiation Therapy in Node-Positive Male Breast Cancer Patients Using the NCDB

<h3>Purpose/Objective(s)</h3> The survival benefit associated with adjuvant external beam radiation therapy (EBRT), following mastectomy and breast conserving surgery, in the treatment of female patients with lymph node-positive (LN+) breast cancer is well established. Treatment of LN+ male breast cancer is largely extrapolated from randomized clinical trials and meta-analyses including females only. This study retrospectively examines the impact of adjuvant EBRT, after either mastectomy or breast conserving surgery, in LN+ male breast cancer patients using data from the National Cancer Database (NCDB). We hypothesize that a survival benefit will also be seen in LN+ male breast cancer patients receiving adjuvant EBRT. <h3>Materials/Methods</h3> The NCDB was queried for male patients with a diagnosis of invasive breast cancer who were pathologically node positive from 2004 to 2017. Patients were excluded if they had metastatic disease at time of diagnosis or pathologically node negative disease. We included males irrespective of type of surgery performed, including mastectomy, lumpectomy, sentinel lymph node biopsy, and/or axillary lymph node dissection. Cohorts were separated based upon treatment with or without EBRT. Cox regression was used for multivariate survival analyses taking into account patient's insurance, Charlson-Deyo-Comorbidity score, hormone receptor status, age at diagnosis, number of LNs involved, and if adjuvant chemotherapy and/or hormone therapy were delivered. <h3>Results</h3> A total of 7,558 men were identified, with 3,852 (51%) having received EBRT (cohort 1a) and 3,706 who did not receive EBRT (cohort 1b). See the table below for some of the patient characteristics. Numbers listed in the table represent the total number of patients with percentages of each cohort in parenthesis. Five-year overall survival was 72.3% for those who received EBRT in comparison to 64.6% for those who did not receive EBRT. When using multi-variate survival analysis, the hazard ratio for cohort 1b as compared to cohort 1a was 1.30 (p <0.01), signifying that those who did not receive EBRT were 30% more likely to die in comparison to those who did receive EBRT. <h3>Conclusion</h3> There appears to be an overall survival benefit associated with adjuvant EBRT in LN+ male breast cancer patients, despite those patients presenting with higher stage. Consideration for adjuvant radiation therapy in LN+ male breast cancer patients should be discussed.

Salvage Interstitial Brachytherapy for Treatment of Recurrent Endometrial Cancers in the Vagina: 7-Year Single Institution Experience

<h3>Purpose/Objective(s)</h3> Interstitial brachytherapy (ISBT) is an effective, accepted treatment for vaginal recurrence of endometrial cancer (EC). This study reviews a large tertiary institution's experience and presents outcomes for recurrent EC in the vagina treated with ISBT. <h3>Materials/Methods</h3> Patients who underwent salvage ISBT for vaginal recurrence of EC from January 1, 2014 - August 31, 2021, were included. Patients with second primaries or distant metastases at diagnoses were excluded. Initial disease factors, treatment details, recurrence and salvage treatment details were recorded. Actuarial outcomes calculated include overall survival (OS), local (LF), nodal (NF), and distant failure (DF). <h3>Results</h3> Forty-two patients were included; median age was 67; most initial cancers were adenocarcinoma (81%; 34/42), grade 1 (43%; 16/37), and stage IA (62%; 24/39). Initial treatment included adjuvant external beam radiation (EBRT) (17%), vaginal vault BT (19%), EBRT plus vaginal vault BT (7%) and chemotherapy (12%). Median time from surgery to recurrence was 14 months. At recurrence, 19% (8/42) had lymph node involvement and 7% (3/42) distant metastases. For salvage, 26% (11/42) of patients received ISBT alone, 74% (31/42) EBRT plus ISBT and 29% (12/42) sequential chemotherapy. Thirty-nine cases used interstitial technique while 3 had interstitial technique then multi-channel cylinder for remaining fractions. The most common prescription for salvage ISBT alone was 42 Gy in 6 fractions while in combination with EBRT was 21 Gy in 3 fractions. Mean ISBT HRCTV D90 was 37.56 Gy, mean dose to Rectum D2cc 27.42 Gy and Bladder D2cc 19.85 Gy. Mean ISBT and EBRT HRCTV D90 was 77.65 Gy, mean dose to Rectum D2cc 67. 46 Gy and Bladder D2cc 61.98 Gy. Median follow-up after salvage BT was 20 months (range: 0-84). For patients undergoing salvage EBRT and ISBT, 2-year OS, LF, DF was 85.6%, 24% and 37.6%, respectively. With salvage ISBT alone, 2-year OS, LF, DF was 83.3%, 16.7% and 54.3%, respectively. Four patients received repeat BT for second vaginal recurrence. One patient experienced grade 3/4 late toxicity of radiation proctitis and small bowel obstruction. <h3>Conclusion</h3> ISBT is an effective treatment for recurrent EC of the vagina, with acceptable toxicities. Salvage BT alone is an option for patients with previous or contraindication to pelvic radiation.

Locally Advanced, pT4 Well-Differentiated Thyroid Cancer in Young Patients – A Population-Based Study

<h3>Purpose/Objective(s)</h3> Locally advanced, non-metastatic pT4 well-differentiated thyroid cancer (WDTC) diagnosed at age <55 years is considered to be Stage I disease by the American Joint Committee on Cancer (AJCC) 8^th edition staging system implying excellent cause-specific survival (CSS) outcomes of ≥95% at 10 years. There are no published outcomes however on this specific cohort of patients, and they may be underrepresented in published outcome series as they comprise of <5% of all WDTC patients. Thus, the objective was to determine the recurrence and survival outcomes of this cohort. <h3>Materials/Methods</h3> We conducted a population-based retrospective study of all patients with pT4 WDTC diagnosed at age <55 years, treated in our province from 1985 to 2013 were extracted. Demographic and treatment factors were extracted. The primary endpoints were cumulative incidence of locoregional recurrence (LRR), cause-specific survival (CSS) and overall survival (OS). Competing risk Fine-Grays analysis and Cox-proportional hazards model was used. <h3>Results</h3> There were 218 patients (median follow up 18.2 years) with 137 under the age of 45. Patients were all treated with thyroidectomy. Most patients had papillary histology (95.9%). Adjuvant radioactive iodine was administered in 88% of cases, and 43% received adjuvant external-beam radiotherapy (EBRT). The 15-year LRR was 21%. On multivariate analysis, there was a trend towards EBRT receipt and lower LRR (HR:0.47, p=0.06). Of the patients who did not receive EBRT, but had a LRR (n=19), 11 were salvaged (with RAI, EBRT, and surgery) and only two died of WDTC (both from LRR). For the cohort as a whole, the 15-year CSS was 96%. There were four deaths secondary to LRR and seven deaths from distant disease. Advanced age, larger tumor size, higher T stage, and presence of LVI were associated with worse CSS (all p<0.05), though we note the limited number of events limit the conclusions from our multivariate analysis. The 15-year OS was 93%. Older age, tumor size, and lymphovascular invasion were significantly associated with worse OS (all p<0.05). On multivariate analysis, EBRT receipt was not associated with improved CSS or OS. <h3>Conclusion</h3> Despite very locally advanced disease, patients with non-metastatic pT4 WDTC, <55 years at diagnosis, have favorable long-term outcomes. Further prospective studies of adjuvant EBRT are needed in this population.

Post-enucleation outcomes of patients with uveal melanoma in Scotland.

To investigate post-enucleation outcomes and assess the effect of extrascleral extension (ESE) on these outcomes for patients with uveal melanoma (UM) managed at a tertiary referral centre in Scotland. Retrospective review of all cases of UM managed by the Scottish Ocular Oncology Service for which enucleation was undertaken between 13/03/2008 and 31/12/2020. Primary outcomes were length of survival, time-to-metastasis (TTM) and local recurrence rate. Secondary outcomes were the effects of the presence of ESE, ESE size, and the use of adjuvant external beam radiotherapy (EBRT) on the primary outcomes. Of 172 enucleated UMs, 32 (18.6%) had ESE. Over a median follow-up period of 33.7 months (range = 1.1-163.7 months), 91 (52.9%) patients died. The median length of all-cause survival of 54.1 months (range = 1.1-163.7 months). One-year, 5-year, and 10-year survival rates were 84.8%, 49.1%, and 30.9%, respectively. Eighty-four (49.7%) patients had metastatic disease. The median TTM of 42.2 months (range = 0.4-106.8 months). Proportions of patients who developed metastases within 1-year, 5-years and 10-years post-enucleation were 22.7%, 52.8%, and 71.8%, respectively. There was one instance of local orbital recurrence. ESE was associated with a significantly shorter length of survival (p = 0.03). There was a trend towards a shorter length of survival and TTM with ESE > 5 mm and those who received adjuvant EBRT. ESE was present in one-sixth of our cohort and was associated with a significantly shorter length of survival, particularly in the presence of ESE > 5 mm or high-risk characteristics warranting adjuvant EBRT. This data will aid prognostication of the patients in our service.

Intraoperative radiation therapy for locally advanced and recurrent head and neck cancer.

The purpose of the present study was to present a single institution experience with intraoperative radiation therapy (IORT) for patients with head and neck cancer (HNC). The present study included all patients with HNC treated consecutively with IORT at Loyola University Medical Center between January 2014 and December 2018. Charts were reviewed for patient and tumor characteristics, IORT technical details, IORT-induced adverse events and treatment outcomes. The study included 23 eligible patients. Median patient age was 66 years (range, 34-91 years). Tumor sites included the parotid gland (43%), lymph nodes (43%), oral tongue (9%) and ear (4%). A total of 48% of patients received IORT upfront with or without postoperative adjuvant external beam radiation therapy (EBRT), whereas 52% received salvage IORT after local tumor recurrence. The median prescribed IORT dose was 7.5 Gy (range, 5-14 Gy) in a single fraction prescribed to 5 mm depth with flat applicators (median diameter, 5 cm). A total of 92% of patients did not experience wound healing complications. One patient (4%) developed postoperative acute thromboembolic stroke and a second patient (4%) experienced protracted wound healing. At a median follow up of 36 months (range, 2-81 months), overall survival was 52%. In addition, 48% of patients were reported to have no evidence of disease, and although two had died of unrelated causes, 13% of patients were alive with disease and 39% died with the disease. The local-regional recurrence rate was 39% (median time to local recurrence, 11 months; range, 1-34 months), the rate of distant metastasis was 35% (median time to distant metastasis, 16 months; range, 4-40 months), and 21% of patients had both local-regional recurrence and distant metastases. The percentages of local-regional recurrence and distant metastases among patients receiving salvage IORT were 58 and 50% respectively, compared with 18 and 18% respectively in those receiving upfront IORT with or without adjuvant EBRT. In the present single institution retrospective study, it was concluded that IORT for patients with locally advanced and recurrent HNC was a safe treatment modality, with tumor control comparable to historical IORT data. Larger prospective studies are needed to further assess the utility of IORT in the management of locally advanced and recurrent HNC.

Coexisting Papillary and Anaplastic Thyroid Cancer: Elucidating the Spectrum of Aggressive Behavior.

Anaplastic thyroid carcinoma (ATC) is a rare and lethal form of thyroid cancer. Overall prognosis is unclear when it arises focally in a background of papillary thyroid cancer (PTC). Clinicopathologic features and outcomes of tumors with coexisting PTC and ATC histologies (co-PTC/ATC) were categorized. The National Cancer Database was queried for histologic codes denoting PTC, ATC, and co-PTC/ATC, defined as Grade 4 PTC, diagnosed from 2004 to 2017. Clinicopathologic features, OS, and treatment outcomes were analyzed by histologic type. A total of 386,862 PTC, 763 co-PTC/ATC, and 3,880 ATC patients were identified. Patients with co-PTC/ATC had clinicopathologic features in-between those of PTC and ATC, including rates of tumor size >4 cm, extrathyroidal extension, and distant metastases. On multivariable Cox proportional hazards modeling, age >55 years, Charlson-Deyo score ≥2, positive lymph nodes, lymphovascular invasion, distant metastases, and positive surgical margins were associated with worse OS, whereas radioactive iodine (RAI) and external beam radiation therapy (EBRT) were associated with improved OS, irrespective of margin status. OS was worse for co-PTC/ATC than for PTC but better than for ATC and differed based on the presence or absence of "aggressive" tumor features, including lymph node positivity, lymphovascular invasion, distant metastases, and positive surgical margins. Survival of patients with co-PTC/ATC is dependent on the presence of aggressive clinicopathologic features and lies within a spectrum between that of PTC and ATC. Adjuvant RAI and EBRT treatment may be beneficial, even after R0 resection.

CERVANTES: an international randomized trial of radical surgery followed by adjuvant (chemo) radiation versus no further treatment in patients with early-stage, intermediate-risk cervical cancer (CEEGOG-CX-05; ENGOT-CX16)

BackgroundThe role of adjuvant treatment in the intermediate-risk group of patients with early-stage cervical cancer is controversial and is supported by a single randomized Gynecologic Oncology Group (GOG) 92 study...

Quality of adjuvant radiation therapy and impact on overall survival of patients with lymph node positive squamous cell carcinoma of the vulva (420)

Quality of adjuvant radiation therapy and impact on overall survival of patients with lymph node positive squamous cell carcinoma of the vulva (420)

Glassy cell carcinoma of the cervix (GCCC): a single institution review of treatment patterns and outcomes (184)

Glassy cell carcinoma of the cervix (GCCC): a single institution review of treatment patterns and outcomes (184)

Comparison of rates of vaginal brachytherapy vs. external beam radiation post-hysterectomy for endometrial cancer patients in rural vs. urban settings (459)

<b>Objectives:</b> The GOG-99 trial published in 2004 demonstrated that patients with high-intermediate risk endometrial cancer benefit from adjuvant external beam radiation therapy (EBRT) post-hysterectomy to decrease the risk of recurrence. The PORTEC-2 trial was then published in 2010, which was an open-label, non-inferiority randomized control trial that compared vaginal brachytherapy (VBT) to EBRT for patients with high-intermediate risk endometrial cancer. This trial demonstrated non-inferiority of VBT compared to EBRT with no significant difference in vaginal or locoregional recurrence, overall survival, and disease-free survival. However, it did show a significant decrease in grade 1-2 gastrointestinal toxicities in the VBT group. VBT is now the standard of care given its decreased toxicity but is also notably less time-consuming for patients. Our objective was to identify if there was a difference in the administration of VBT versus EBRT for endometrial cancer patients post-hysterectomy in rural versus urban locations. <b>Methods:</b> This is a retrospective cohort study based on the SEER 18 dataset of the US National Cancer Institute. Women with localized endometrial cancer post-hysterectomy were included in this study. The SEER dataset defines a localized tumor as a tumor confined to the organ of origin without extending beyond the primary organ. Data were collected from 2011 to 2018, given that PORTEC-2 was published in 2010. Urban versus rural population was defined by the rural-urban continuum codes. Women were excluded if they received both VBT and EBRT or if a rural-urban continuum code was not provided. Statistical analysis was completed with relative risk and confidence interval calculation. <b>Results:</b> In total, 10,840 women were included. There were 9813 women identified in metropolitan counties; 22% (<i>n</i>=2136) received EBRT post-hysterectomy for localized endometrial cancer, whereas 78% underwent VBT. There were 1027 women identified in nonmetropolitan counties, 22% (<i>n</i>=230) received EBRT and 78% (<i>n</i>=797) received VBT. When comparing metropolitan versus nonmetropolitan counties, there was no statistical difference between rates of EBRT versus VBT, with a relative risk of 1.16 (95% CI: 0.91-1.16, p=0.64). There were 125 women identified in completely rural counties, 21% (<i>n</i>=26) received EBRT and 79% (<i>n</i>=99) received VBT. There was no statistical difference in rates of radiation therapy between completely rural and metropolitan counties, with a relative risk of 0.95 (95% CI: 0.67-1.34, p=0.77). <b>Conclusions:</b> Living in a nonmetropolitan county or even a completely rural county was not associated with a difference in receiving EBRT versus VBT in patients with localized endometrial cancer status post-hysterectomy compared to rates in metropolitan counties. It could be inferred that even though rural counties may have fewer medical resources, patients are still receiving the standard of care in regard to radiation therapy for endometrial cancer.

Intraoperative radiation therapy for early-stage breast cancer: a single-institution experience.

BackgroundTo assess outcomes and toxicity after low-energy intraoperative radiotherapy (IORT) for early-stage breast cancer (ESBC).Materials and methodsWe reviewed patients with unilateral ESBC treated with breast-conserving surgery and 50-kV IORT at our institution. Patients were prescribed 20 Gy to the surface of the spherical applicator, fitted to the surgical cavity during surgery. Patients who did not meet institutional guidelines for IORT alone on final pathology were recommended adjuvant treatment, including additional surgery and/or external-beam radiation therapy (EBRT). We analyzed ipsilateral breast tumor recurrence, overall survival, recurrence-free survival and toxicity.ResultsAmong 201 patients (median follow-up, 5.1 years; median age, 67 years), 88% were Her2 negative and ER positive and/or PR positive, 98% had invasive ductal carcinoma, 87% had grade 1 or 2, and 95% had clinical T1 disease. Most had pathological stage T1 (93%) N0 (95%) disease. Mean IORT applicator dose at 1-cm depth was 6.3 Gy. Post-IORT treatment included additional surgery, 10%; EBRT, 11%; adjuvant chemotherapy, 9%; and adjuvant hormonal therapy, 74%. Median total EBRT dose was 42.4 (range, 40.05–63) Gy and median dose per fraction was 2.65 Gy. At 5 years, the cumulative incidence of ipsilateral breast tumor recurrence was 2.7%, the overall survival rate was 95% with no breast cancer-related deaths, and the recurrence-free survival rate was 96%. For patients who were deemed unsuitable for postoperative IORT alone and did not receive recommended risk-adapted EBRT, the IBTR rate was 4.7% versus 1.7% (p = 0.23) for patients who were either suitable for IORT alone or unsuitable and received adjuvant EBRT. Cosmetic toxicity data was available for 83%, with 7% experiencing grade 3 breast toxicity and no grade 4–5 toxicity.ConclusionsIORT for select patients with ESBC results in acceptable outcomes in regard to ipsilateral breast tumor recurrence and toxicity.

Direct intracranial invasion of eccrine spiradenocarcinoma of the scalp: a case report and literature review

BackgroundEccrine spiradenocarcinoma (SC), also known as malignant eccrine spiradenoma, is a rare malignant cutaneous adnexal neoplasm arising from long-standing benign eccrine spiradenoma. Malignant skin tumors rarely show direct intracranial invasion. However, once the intracranial structure is infiltrated, curative excision with sufficient margins can become extremely difficult, particularly when the venous sinuses are involved. No effective adjuvant therapies have yet been established. Here, we report an extremely rare case of scalp eccrine SC with direct intracranial invasion, which does not appear to have been reported previously.Case presentationAn 81-year-old woman presented with a large swelling on the parietal scalp 12 years after resection of spiradenoma from the same site. The tumor showed intracranial invasion with involvement of the superior sagittal sinus and repeated recurrences after four surgeries with preservation of the sinus. The histopathological diagnosis was eccrine SC. Adjuvant high-precision external beam radiotherapy (EBRT) proved effective after the third surgery, achieving remission of the residual tumor. The patient died 7 years after the first surgery for SC.ConclusionsScalp SC with direct intracranial invasion is extremely rare. Radical resection with tumor-free margins is the mainstay of treatment, but the involvement of venous sinuses makes this unfeasible. High-precision EBRT in combination with maximal resection preserving the venous sinuses could be a treatment option for local tumor control.

Intraoperative radiation therapy for locally advanced and recurrent head and neck cancer.

6058 Background: Intraoperative Radiation Therapy (IORT) allows precise delivery of radiation therapy (RT) to a limited target area at high risk of cancer recurrence while minimizing RT to nearby organs at risk. IORT may be particularly beneficial for patients with locally recurrent head and neck cancer (HNC) in a previously irradiated field and for locally advanced HNC cases, in which obtaining negative surgical margins may be difficult. This study aims to present a single institution experience with IORT for HNC patients. Methods: This study included HNC patients treated consecutively with IORT at our institution between 2014 and 2018. Charts were reviewed for patients’ and tumors’ characteristics, IORT technical details, IORT-induced adverse events, and treatment outcomes. Results: The study included 23 eligible patients. Median patient age was 66 (range 33-91). Tumor sites included parotid gland (43%), lymph nodes (43%), oral tongue (9%), and ear (4%). 52% of patients received IORT upfront with or without postoperative adjuvant external beam radiation therapy (EBRT), while 48% received salvage IORT after local tumor recurrence. The median prescribed IORT dose was 7.5 Gy (range 5-14 Gy) in a single fraction prescribed to 5 mm depth with Flat applicators (median diameter of 5 cm). 92% of patients did not experience wound healing complications. One patient (4%) developed postoperative acute thromboembolic stroke, a second patient (4%) experienced protracted wound healing. At a median follow-up of 36 months (range 2-81), 42% of patients presented with no evidence of disease (NED), overall survival was 54%, 13% of patients were alive with disease, and 46% died with disease. Local-regional recurrence rate was 39% (median time to local recurrence was 18 months, range 2-60), rate of distant metastasis was 43% (median time to distant metastasis was 23 months, range 5-60), and 30% of patients had both local-regional recurrence and distant metastases. The percent of local-regional recurrence and distant metastases among patients receiving salvage IORT was 64% and 73% respectively, compared to 23%, and 15% respectively in those receiving upfront IORT with or without adjuvant EBRT. Conclusions: In this single institution chart review study, IORT to locally advanced and recurrent HN cancer patients was a safe treatment modality, with tumor control comparable to historical EBRT data. Larger prospective studies are needed to further assess the utility of IORT in the management of locally advanced and recurrent HN cancer.

To Radiate or Not to Radiate? Adjuvant External Beam Radiation Therapy for Nonanaplastic Thyroid Cancer

Nonanaplastic thyroid cancers, which include differentiated and medullary thyroid cancers, account for more than 95% of thyroid cancer cases, and the majority are often curable if diagnosed at an early stage. 1 Davies L. Welch H.G. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA. 2006; 295: 2164-2167 Crossref PubMed Scopus (2634) Google Scholar The use of adjuvant external beam radiation therapy (EBRT) following surgery in patients with nonanaplastic thyroid cancers is uncommon because of its treatment-related morbidity and a paucity of evidence from prospective clinical trials on its efficacy. The indications for its use are still controversial. The current guidelines recommend that EBRT should be considered in patients with gross residual disease postoperatively, those with evidence of aerodigestive invasion, and/or those undergoing multiple and frequent operations because of locally advanced disease. 2 Haugen B.R. Alexander E.K. Bible K.C. et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26: 1-133 Crossref PubMed Scopus (7355) Google Scholar ,3 Tuttle R.M. Haddad R.I. Ball D.W. et al. Thyroid carcinoma, version 2.2014. J Natl Compr Canc Netw. 2014; 12: 1671-1680 Crossref PubMed Scopus (119) Google Scholar Trends in Adjuvant External Beam Radiation Therapy for Nonanaplastic Thyroid Cancer in California, 2003-2017Endocrine Practice Vol. 28Issue 7PreviewExternal beam radiation therapy (EBRT) is rarely used to treat patients with differentiated or medullary thyroid cancer. Although EBRT is generally administered to patients with high-risk or unresectable diseases, neither its indications for the use nor the associated outcomes are well-defined. We used a statewide cohort to assess the trends in EBRT use and postradiation outcomes in California. Full-Text PDF

Trends in Adjuvant External Beam Radiation Therapy for Nonanaplastic Thyroid Cancer in California, 2003-2017

BackgroundExternal beam radiation therapy (EBRT) is rarely used to treat patients with differentiated or medullary thyroid cancer. Although EBRT is generally administered to patients with high-risk or unresectable diseases, neither its indications for the use nor the associated outcomes are well-defined. We used a statewide cohort to assess the trends in EBRT use and postradiation outcomes in California. MethodsA population-based study of patients within the California Cancer Registry who underwent EBRT after surgery for nonanaplastic thyroid cancer (2003-2017) was conducted. The primary outcome was the annual utilization rate of EBRT. The secondary outcomes included Kaplan-Meier analysis for cause-specific survival and identifying factors associated with improved survival after EBRT. ResultsAmong the 57 607 patients with nonanaplastic thyroid cancer from 2003 to 2017, 344 (0.6%) patients received EBRT. EBRT was utilized in 0.4% of papillary, 1.1% of follicular, and 7.7% of medullary thyroid cancers in California. Overall, 99 (28.8%) patients treated with EBRT died of thyroid cancer. The 10-year cause-specific survival of all patients with thyroid cancer after EBRT was 61.5% (95% CI: 54.8%-69.1%) and that of patients without distant disease was 80.3% (95% CI: 73.5%-87.8%). The survival outcomes varied by tumor size, histology, disease stage, patient age at diagnosis, and the presence of extrathyroidal extension (P < .05). ConclusionsThe use of adjuvant EBRT for nonanaplastic thyroid cancer remained stable and low in California from 2003 to 2017. The comparative efficacy of EBRT was not discernible in this study, but disease control appeared durable in select patients. Well-controlled observational studies and/or prospective studies are needed to better define which patients benefit from EBRT.

Will the collaboration of surgery and external radiotherapy open new avenues for hepatocellular carcinoma with portal vein thrombosis?

Portal invasion of hepatocellular carcinoma (HCC) occurs in 12.5%-40% of patients diagnosed with cancer and yields poor clinical outcomes. Since it is a common cause of inoperability, sorafenib was regarded as the standard treatment for HCC in the Barcelona Clinic of Liver Cancer guidelines. However, the median survival of the Asian population was only approximately 6 mo, and the tumor response rate was less than moderate (< 5%). Various locoregional modalities were performed, including external beam radiotherapy (EBRT), transarterial chemoembolization, hepatic arterial infusion chemotherapy, and surgery, alone or in combination. Among them, EBRT is a noninvasive method and can safely treat tumors involving the major vessels. Palliative EBRT has been commonly performed, especially in East Asian countries, where locally invasive HCC is highly prevalent. Although surgery is not commonly indicated, pioneering studies have demonstrated encouraging results in recent decades. Furthermore, the combination of neo- or adjuvant EBRT and surgery has been recently used and has significantly improved the outcomes of HCC patients, as reported in a few randomized studies. Regarding systemic modality, a combination of novel immunotherapy and vascular endothelial growth factor inhibitor showed results superior to that of sorafenib as a first-line agent. Future clinical trials investigating the combined use of these novel agents, surgery, and EBRT are expected to improve the prognosis of HCC with portal invasion.

Indications of external beams radiation for thyroid cancer.

The use of external beam radiation therapy (EBRT) for the treatment of the different histologic subtypes of thyroid cancer is a matter of debate. This article provides an up-to-date review on the current evidence concerning the benefits of EBRT in thyroid cancer in specific indications. Based on retrospective studies, adjuvant EBRT lessens the risk of locoregional recurrence in locally advanced differentiated thyroid cancer (DTC) and medullary thyroid cancer (MTC) with high-risk features. The effect of EBRT on overall survival remains uncertain. EBRT should also be part of the multimodality treatment in anaplastic thyroid cancer (ATC), as it improves survival rates in incompletely resected ATC. The role of EBRT in thyroid cancer remains unclear. To date, no randomized control studies are available. Retrospective data showed improved outcomes in patients with high-risk features for locoregional recurrence.

Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors.

This study investigated the efficacy of a vaginal dilator (VD) for the treatment of radiation-induced vaginal stenosis (VS) and the effect of a VD on sexual quality of life.Fifty three patients with endometrial or cervical cancers participated in this prospective observational study. All participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined 4 times after radiotherapy (RT) and were also asked to complete a validated sexual function-vaginal changes questionnaire. SPSS version 20 and Minitab version 16 were used for the statistical analysis. The statistical significance was set at P < .05.The VS grading score decreased and the comfortably insertable VD size gradually increased throughout a year of VD use; all patients with initial grade 3 showed a VS of grade 2 after 12 months of VD use and 65.8% of the patients with initial grade 2 demonstrated a final VS of grade 1, while 77.8% of the participants who started with the first size of VD reached the third size after 12 months. Starting VD therapy ≤3 months after the end of RT was associated with a significant decrease in VS. A total of 60.9% of participants reported that they did not feel their vaginas were too small during intercourse after 12 months of dilation, whereas only 11.5% gave the same answer before starting dilation. Furthermore, 47.17% rated their satisfaction with their sexual life 5 out of 7 and only 3.77% gave a score of 3 after 12 months of dilation.Endometrial and cervical cancer survivors are encouraged to use VD to treat VS and for sexual rehabilitation after RT. This study recommends starting vaginal dilation no more than 3 months after treatment at least 2 to 3 times a week for 10 to 15 minutes over 12 months. However, larger, well-designed randomized clinical trials should be conducted to develop specific guidelines for VD use and efficacy in VS and sexual sexual quality of life after RT.

Relationship of carbohydrate metabolism indicators during adjuvant radiotherapy and survival in patients with glioblastoma

To study carbohydrate metabolism in patients with glioblastoma during adjuvant external beam radiation therapy and its impact on survival. The study included 66 patients with glioblastoma (Karnofsky score ≥80%) who underwent hypofractionated adjuvant external beam radiation therapy (single focal dose 2.5-3Gr). Patients received dexamethasone 4-8 mg daily throughout the entire course of irradiation. High level of glycated hemoglobin (HbA1c) was observed in 33.3% of patients with glioblastoma undergoing irradiation. Cumulative survival was 17 months (95% CI 13.7-20.3). Two indicators had a significant negative impact on cumulative survival: age of patients (HR 1.04; 95% CI 1.01-1.08; p=0.02) and level of HbA1c (HR 1.94; 95% CI 1.23-3.06; p=0.005). Cumulative survival was significantly (p=0.022) higher in patients younger 53 years compared to older people (18 months and 14 months, respectively). Cumulative survival was 20 months among patients whose HbA1c did not exceed the upper reference value (<5.8%). Survival was higher (p=0.017) in these ones compared to patients with HbA1c ≥5.8% (13 months). According to multivariate Cox regression model, high HbA1c was the only significant negative predictor of cumulative survival (HR 3.35; 95% CI 1.14-9.81; p=0.027). High HbA1c is unfavorable predictor of cumulative survival in patients with glioblastoma and Karnofski score ≥80% undergoing adjuvant hypofractionated irradiation regardless their age.

Intra-cavitary brachytherapy in endometrial carcinoma: experience with cobalt-60 source.

PurposeTo report vaginal cuff brachytherapy (VCB) dosimetry parameters and clinical outcomes of patients with localized endometrial cancer treated with adjuvant high-dose-rate (HDR) brachytherapy using a cobalt-60 (60Co) source.Material and methodsBetween 2011 and 2017, we identified patients with endometrial cancer treated with surgery and adjuvant VCB. Dosimetry variables analyzed included D2cc, D1cc, and D0.1cc for organs at risk (OARs) and distance from cylinder surface to 150% and 200% isodose line in vaginal mucosa. Local relapse (LR), regional relapse (RR), distant metastasis (DM), progression-free survival (PFS), and overall survival (OS) were analyzed using Kaplan-Meier, and log-rank test was applied to assess differences between groups. Toxicity evaluation was tested for possible cross-correlation within dosimetric parameters using Pearson r test and stepwise multivariate linear regression.ResultsWe identified 93 suitable patients. Mean age at diagnosis was 66 years (range, 45-85 years). Most patients had endometrioid adenocarcinoma (61.3%), followed by papillary-serous carcinoma (11.8%). 71% of patients presented with FIGO stage I (35.5% IA and 35.5% IB), 11.8% were stage II, and 17.2% were stage III. Adjuvant external beam radiotherapy (EBRT) (range, 46-50.4 Gy) was used in 53.8% of patients, and adjuvant chemotherapy in 38.7%. Median follow-up was 39 months (range, 5-84 months). Three-year OS and PFS were 87.5% and 85.5%, respectively. LR was seen in 2.2% of cases, RR in 7.5%, and DM in 12.9%. Mean rectum D2cc/D0.1cc were 88.1% and 116%, and mean bladder D2cc/D0.1cc were 79.2% and 103.2%, respectively. The most common acute toxicity was vaginal mucositis (8.9% ≥ G2), and the most frequent chronic toxicity was vaginal stenosis (25.3% ≥ G1).ConclusionsAdjuvant high-dose-rate VCB with 60Co source for patients with endometrial cancer is well tolerated, with clinical and toxicity outcomes comparable to those reported with iridium-192 (192Ir) source.