Adjuvant External Beam Radiotherapy Research Articles

Carcinoma colon masquerading as bleeding per vagina.

Isolated vaginal metastasis from colorectal cancer is a rare entity with very few reports in the literature. Here we report a patient who presented with bleeding per vagina from a vaginal mucosal lesion. Biopsy of the vaginal lesion indicated a metastatic adenocarcinoma from a colorectal primary. Further workup of the patient with colonoscopy and Positron emission tomography (PET CT) indicated a primary in the sigmoid colon. As the patient had a single site of metastasis, she was planned for definitive management. The colonic primary, as well as the vaginal deposit were managed surgically. Further, the patient received adjuvant chemotherapy as well as adjuvant external beam radiation to the site of the vaginal lesion. Vaginal metastases from colorectal primary are usually part of systemic dissemination with multiple metastatic sites and hence has poor prognosis. When the patient presents with an isolated metastasis in the vagina., the survival appears reasonable as per the few reports available in the literature. Due to the rarity of the presentation, there are no standard treatment guidelines available. Surgical management, radiation and adjuvant chemotherapy have been used in varying combinations in the reports available in the literature. To conclude, vaginal metastasis should be included in the differential diagnosis of patients presenting with vaginal bleeding, especially with a history of colorectal carcinoma. Available limited evidence suggests that isolated vaginal metastasis from colorectal cancer that is amenable to local surgical resection has a reasonable outcome. Hence, isolated vaginal metastasis should be treated with curative intent in a multidisciplinary context like other sites of oligometastatic disease.

PDOC-08 THE CLINICAL CHARACTERISTICS OF CHILDREN WITH CRANIOPHARYNGIOMA AND THEIR MANAGEMENT IN UGANDA: A RETROSPECTIVE REVIEW

Abstract BACKGROUND Craniopharyngiomas are benign brain tumors that mostly arise in the sellar/suprasellar region. Histologically though benign, these tumors can locally infiltrate with involvement of surrounding structures. They have a 5-year survival rate of above 80% in High Income Countries (HIC). Craniopharyngioma management includes surgery, radiotherapy and intracystic treatments, which requires a multi-disciplinary team. The morbidity associated with treatment must be weighed against tumor recurrence and quality of life after treatment. Endocrine deficiencies, especially growth hormone deficiency and visual deficits are common presenting features. OBJECTIVE To describe the clinical characteristics and management of children with craniopharyngioma managed at Mulago National Referral Hospital from March 2019 to December 2023. METHODOLOGY: A retrospective descriptive study was conducted among patients< 18 years of age, admitted to the Mulago National Referral Hospital (MNRH) from March 2019 to December 2023 with a radiological diagnosis of a craniopharyngioma. RESULTS A total of 151 children with a diagnosis of a brain tumor during this period were identified and of these 40 (26%) were diagnosed with craniopharyngioma. The median age was 8.4 years and 22 (55%) were males. Only 2 children had maximal safe resection (sub-total resection), one of whom later received adjuvant external beam radiotherapy. Thirty-eight patients had insertion of Ommaya reservoirs as their tumors were predominantly cystic. Two patients received intracystic bleomycin and 11 received radical external beam radiotherapy. Twenty-seven patients had no additional therapy after Ommaya reservoir placement. Fifteen (39%) of the patients had endocrine deficits with hypothyroidism, hypocortisolism and growth hormone deficiency being the most common. The median follow-up time was 1.45 years. The overall survival was 67.5%, 95%CI (42.5-83.5). CONCLUSION Management of patients with craniopharyngioma in Uganda is mostly conservative with the aim of intervention to preserve quality of life. Limited access to radiation therapy contributed to the poorer survival compared to HIC.

Retinoblastoma with and without Extraocular Tumor Extension: A Global Comparative Study of 3435 Patients

PurposeTo study the treatment, and outcomes of children with retinoblastoma (RB) with extraocular tumor extension (RB-EOE) and compare them with RB without extraocular tumor extension (RB-w/o-EOE). DesignMulticenter intercontinental collaborative prospective study from 2017 to 2020. RB-EOE cases included those with overt orbital tumor extension in treatment-naïve patients. Cases with microscopic orbital extension detected post-enucleation were excluded from the study. ParticipantsA total of 319 children with RB-EOE and 3116 children with RB-w/o-EOE Intervention(s)Chemotherapy, enucleation, exenteration, radiotherapy. Main outcomes(s)Systemic metastasis and death. ResultsOf the 3435 RB patients included in this study, 309 (9%) were from low-income countries, 1448 (42%) from lower-middle income, 1012 (29%) from upper-middle income, and 666 (19%) patients from high-income countries. There was an inverse relationship between the percentage of RB-EOE and national income level, with 96 (31%) patients from low-income countries, 197 (6%) lower middle-income, 20 (2%) upper-middle income, and 6 (1%) patients from high-income countries (p=0.0001). The outcomes were statistically significant for RB-EOE compared to RB-w/o-EOE: systemic metastasis (32% vs 4% respectively; p=0.0001) and metastasis-related death (63% vs 6% respectively; p=0.0001). Multimodal treatment was the most common form of treatment (n=177; 54%) for RB-EOE, with most cases undergoing a combination of intravenous chemotherapy and enucleation (n=97; 30%). Adjuvant external beam radiotherapy after surgery (enucleation/orbital exenteration) was given in only 68 (21%) cases. Kaplan-Meier analysis for systemic metastasis and metastasis-related death in RB-EOE was 28% and 57% at 1 year, 29% and 60% at 2 years, and 29% and 61% at 3 years, respectively. Cox regression analysis revealed that the risk for death from RB-EOE was greater in patients aged >4 years than <2 years (hazard ratio (HR)=2.912; p<0.001) and for unimodal (surgery or intravenous chemotherapy) and bimodal (surgery and intravenous chemotherapy) treatment than trimodal treatment (surgery, intravenous chemotherapy and external beam radiotherapy) (HR=2.023; p=0.004 and HR 1.819; p=0.027 respectively). ConclusionRetinoblastoma with extraocular tumor extension is associated with a higher risk for metastasis and death. Patients with RB-EOE are likely to benefit from trimodal treatment (intravenous chemotherapy, surgery, and external beam radiotherapy) rather than treatment protocols excluding external beam radiotherapy.

Pathological complete response of locally advanced triple-negative breast cancer: case report

Background. Triple-negative breast cancer is the most aggressive molecular subtype among breast malignancies. Due to the high proliferative activity of tumor cells and the lack of targets for targeted therapy, neoadjuvant chemotherapy plays the main role in complex treatment of this subtype. The optimal time to start neoadjuvant chemotherapy is defined as less than 8 weeks. Delays in time to treatment initiation may adversely affect treatment outcomes, as well as cause local or systemic disease progression. Achieving complete pathological response after neoadjuvant chemotherapy reduces the relative risk of relapse by more than 70 %, which, in turn, leads to a significant improvement in long-term survival of these patients. Description of the clinical case. A 32-year-old woman came to the clinic 15 months after being diagnosed with triple-negative breast cancer. The patient was treated with alternative medicine methods for 15 months, and upon admission to the hospital, the patient had pronounced local tumor growth with massive decay, tumor lysis syndrome and nutritional disorders. We decided to perform neoadjuvant chemotherapy: 12 cycles of weekly paclitaxel + carboplatin, followed by 4 cycles of dose-dense doxorubicin + cyclophosphamide. Chemotherapy resulted in a significant reduction in tumor size and improvement of health status of the patient. There were no clinically significant side effects requiring hospitalization or dose reduction. Upon completion of neoadjuvant treatment, the patient underwent mastectomy. The histological examination revealed a complete pathological response of the primary tumor and regional lymph nodes. The patient underwent adjuvant external beam radiation therapy. The patient is alive 3 years after diagnosis and 1.5 years after treatment completion. She plans delayed breast reconstruction with contralateral breast augmentation. Conclusion. This is a rare case of locally advanced triple-negative breast cancer with pathological complete response to neoadjuvant chemotherapy 15 months after diagnosis.

A high Ki-67 labeling index and high thyroglobulin doubling rate are significant predictors of excision-site recurrence of papillary thyroid carcinoma following airway resection for locally curative surgery.

Papillary thyroid carcinoma (PTC) occasionally invades the trachea and requires airway resection. Tracheal excision site recurrence (ESR) is a serious problem. We investigated predictors of ESR in patients with PTC who underwent airway resection for locally curative surgery. We enrolled 149 patients with PTC who underwent airway resection (median age at the initial surgery: 67years), including partial-thickness resection (n=73) or full-thickness resection (n=76), for grossly curative surgery. The median postoperative follow-up period was 93months. To date, 11 patients (6.7%) underwent ESR: 6 underwent full-thickness resection and 5 underwent partial-thickness resection. The time to ESR ranged from 14 to 113months (median: 57months) after the initial surgery. None of the 11 ESR patients underwent adjuvant external beam radiotherapy (EBRT) and none of the 4 airway resection patients who underwent EBRT developed ESR. The 5- and 10-year ESR rates were 4.3% and 11.3%, respectively. In the multivariate analysis (forward-backward stepwise selection method), a Ki-67 labeling index (LI) ≥5% (p=0.048) and the thyroglobulin doubling rate (Tg-DR) >0.33/year (p=0.009) (for Tg-antibody negative cases) were independent predictors of ESR. Nine of the 11 patients underwent ESR resection and only one developed a second recurrence. A high Ki-67 LI was a static predictor, and high Tg-DR was a dynamic predictor, of ESR in patients with PTC following airway resection. In such patients, careful postoperative monitoring for ESR is necessary and adjuvant therapies, such as EBRT, may be considered.

Intraoperative radiation therapy for early-stage breast cancer.

Intraoperative radiotherapy (IORT) offers more convenience compared to external beam radiotherapy (EBRT) following breast-conserving surgery for early-stage breast cancer. This study describes the implementation of IORT at a metropolitan academic cancer center. Demographics, tumor characteristics, margin status, adjunct EBRT, and cosmetic results were retrospectively analyzed in patients undergoing BCS with IORT. IORT consists of 20 gray delivered to the partial mastectomy cavity. From 2015 to 2020, 171 patients (65.5% African American) were included. Histologically, 104 (60.8%) patients had invasive ductal carcinoma (IDC), while 67 (39%) patients had DCIS only. Seventeen (15.9%) patients with IDC and 12 (8.6%) patients with DCIS had positive margins. There were 15 ipsilateral breast recurrences (8.8%) and three patients (20%) developed systemic disease. Twenty-five patients (14.6%) underwent adjuvant EBRT. The local recurrence-free survival at 60 months from date of IORT was 89.4% (95% CI 82.7%-93.6%). For overall survival (OS), 168 (98.2%) patients were alive at a median follow-up of 51.4 months, and three total deaths were recorded. IORT is a highly desirable and convenient alternative to EBRT for early-stage breast cancer especially for patients with poor compliance. IORT has an acceptable ipsilateral recurrence while not precluding adjunct EBRT based upon the final pathologic report.

The current role of adjuvant radiotherapy in management of medullary thyroid carcinoma: A single institute analysis.

Medullary thyroid carcinoma (MTC) accounts for only about 5% of total thyroid cancers. It usually presents as an advanced disease carrying a poor prognosis than well-differentiated thyroid cancers. While the treatment of choice is surgery, the role of adjuvant radiotherapy is still unclear. This retrospective study aims to understand the role of adjuvant radiotherapy in MTC and its effect on survival. We did a retrospective two study to estimate the effect of adjuvant external beam radiotherapy (EBRT) on survival outcomes in MTC. A total of 30 patients who were diagnosed with nonmetastatic MTC during the period 2015 to 2020 were included in the study. Fifteen patients underwent only total thyroidectomy with cervical lymph node dissection. Rest 15 patients received adjuvant EBRT following surgery. A median dose of 60 Gy in 30 fractions, 2 Gy per fraction, 5 days per week, was given by conventional radiotherapy technique. Survival outcomes were estimated using Kaplan-Meier method. A univariate analysis using log rank test was performed to estimate the association of various prognostic factors including age, sex, tumor size, nodal involvement, and surgical resection status on survival outcomes. Median age of presentation in our study is 47 years (inter quartile range: 36-55 years). Median follow-up time is 4 years. Male to female ratio is 2:3-70% of patients presented with T3 lesions and 77% with N1b disease. There was no significant difference in overall survival (OS) in patients who received adjuvant RT following surgery in comparison to patients who underwent only surgery (92.9% vs. 71.4% P value = 0.202). Similarly, there was no improvement in locoregional recurrence-free survival (LRFS) (100% vs. 85.7%, P value-0.157), Distant metastasis-free survival (DMFS) (64.3% vs. 71.4%, P value = 0.725), and Disease-free survival (DFS) (64.3% vs. 64.3%, P value = 0.91). Age, gender, nodal involvement, and surgical resection status (R0, R1, R2) did not have any effect on survival outcomes. DFS (100% vs. 63.6% P value = 0.008), LRFS (100% vs. 94.7% P value = 0.002), and DMFS (100% vs. 63.2% P value = 0.006) were significantly better in T2 lesions compared to advanced lesions. Adjuvant EBRT failed to show any significant improvement in survival outcomes and locoregional control in MTC. Further prospective randomized clinical trials are needed to validate the role of EBRT in MTC. Clinicians should proceed with caution before advising adjuvant radiotherapy in MTC and make an informed decision after weighing the pros and cons of giving adjuvant EBRT.

Serum Calcium Level at Diagnosis Can Predict Lethal Prostate Cancer Relapse.

Background/Objectives: The most important prognostic factors in curatively treated prostate cancer are T and N stage, histology, grade group and initial PSA. A recent study found that men with blood calcium levels at the high end of the normal range are over two-and-a-half times more likely to develop fatal prostate cancer than those with lower calcium levels. However, there is limited evidence regarding the prognostic value of calcium levels at the time of prostate cancer diagnosis. We aimed to determine whether a calcium level in the upper range of normal values has any prognostic value in curatively treated prostate cancer. Methods: We conducted a retrospective analysis of 84 consecutive patients with prostate cancer who underwent curative-intent radiotherapy-either as primary treatment or adjuvant therapy-using external beam radiotherapy with or without brachytherapy. We analyzed all pertinent prognostic factors that could potentially impact disease-free survival. Results: The study revealed that calcium levels at diagnosis significantly predict disease-free survival, whereas the initial PSA level did not hold prognostic significance-likely due to interference from benign prostatic hyperplasia. Conclusions: If our findings are validated, calcium levels at the time of prostate cancer diagnosis could be incorporated into future predictive and prognostic models.

The use of adjuvant radiotherapy in resected adult intracranial atypical meningioma in United States: A SEER analysis.

27 Background: It is unclear whether adjuvant external beam radiotherapy (EBRT) in atypical meningiomas after surgical resection provided overall survival advantage. Although meta-analysis were previously reported, there is heterogeneity in the included studies. With lack of prospective trial, we rely on observational data for management. This project aims to determine if the addition of adjuvant EBRT after resection compared to resection alone in atypical meningioma is associated with better prolonged survival among patients within United States. Methods: The National Cancer Institute Surveillance, Epidemiology and End Results database was queried for list of patients diagnosed with atypical meningioma from 2000 to 2020 according to International Classification of Disease (ICD) for Oncology, third edition with morphology codes 9539/0 and 9539/1.This was limited to intracranial location. Rate of dying among those receiving adjuvant EBRT after surgery for atypical meningiomas was compared to the rate of dying of those who had resection alone without adjuvant EBRT postoperatively. Other covariates included, age at diagnosis, gender, marital status, race, tumor laterality, tumor site, tumor, extent of resection and household median income. Chi-squared test was used to test the association between institution of adjuvant EBRT and other co-variates for categorical variable. Cox-proportional analysis was used to test the association between adjuvant EBRT and death. Observed survival was estimated using Kaplan-Meyer method. Survival curves were generated for both cohorts and log rank test was performed. Results: A total of 3,328 patients were included in analysis.1,004(30.17%) patients received adjuvant EBRT and 767(23.05%) died in the entire cohort. Rate of dying in the entire cohort is 43.84 per 1,000 person-years. Death rate for patients receiving adjuvant EBRT is 44.95 per 1,000 person-years, while patients who did not receive adjuvant EBRT had a death rate of 40.95 per 1,000 person-years. Patients aged 80 years or older, divorced and separated tend not to receive adjuvant EBRT, while patients with tumor size of 51-100mm and 101-200mm are more likely to receive adjuvant RT. Crude rate ratio among those patients receiving RT compared to the rate of those who did not receive adjuvant RT is 0.91 (95% CI: 0.76-1.07). Adjusting for possible confounders did not change the rate ratio between adjuvant EBRT compared to resection alone. Extent of resection did not modify the effect of adjuvant RT to death (likelihood ratio test-0.363). Survival analysis using Kaplan Meier curve showed no difference whether a patient received adjuvant EBRT or not (log rank test-0.238). Conclusions: There is no clear evidence on the survival benefit for use of adjuvant EBRT in resected atypical meningioma compared resection alone. This is true both in incomplete and completely resected atypical meningiomas.

Adjuvant external beam radiotherapy combined with brachytherapy for intermediate-risk cervical cancer

ObjectivePatients with intermediate-risk cervical cancer receive external beam radiotherapy (EBRT) as adjuvant treatment. It is commonly administered with brachytherapy without proven benefits. Therefore, we evaluated the frequency of brachytherapy use,...

LARYNGOPHARYNGEAL RECONSTRUCTION IN A PREGNANT WOMAN: A CLINICAL CASE

Relevance: Cancer in pregnancy is a very serious clinical condition that seriously affects women and their families, as well as the medical staff who provide care. Diagnostic and therapeutic solutions must balance the appropriate treatment with the risk to the fetus. In developed countries, cancer in pregnant women has become more common over the past 30 years due to an increase in the number of older women giving birth. Melanoma, lymphoma, leukemia, and cancers of the breast, cervix, ovaries, gastrointestinal tract, and genitourinary system are the most common malignant neoplasms in pregnant women. Head and neck cancers are rare in pregnancy. A total of 3 cases of locally advanced laryngopharyngeal cancer were recorded in patients aged 23 to 28 years in 2017-2023 at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. This article describes a case of advanced squamous cell carcinoma of the laryngeal region in a young pregnant woman and also discusses the diagnosis and treatment of head and neck cancer in pregnant women. The study aimed to describe a clinical case of squamous cell carcinoma of the larynx in a pregnant patient. Methods: The description of a clinical case presents data from laboratory, instrumental, and physical research methods of a pregnant patient with hypopharynx squamous cell carcinoma, who was examined, treated, and followed up at the State Clinical Hospital of the Akimat of Astana Multidisciplinary Medical Center. The patient was diagnosed with IVA laryngopharyngeal cancer T4aN2cM0. Grade III dysphagia. Laryngeal stenosis. Grade II cachexia” and received three courses of neoadjuvant polychemotherapy. Then, she underwent surgical intervention in the volume of laryngopharyngectomy and reconstructive surgery using a free radial flap and was administered adjuvant external beam radiation therapy. Results: The article presents the results of laryngopharyngectomy for locally advanced squamous cell carcinoma of the hypopharynx. The postoperative period was without complications, the patient was discharged 14 days after surgery in satisfactory condition and continued adjuvant radiation therapy. Conclusions: The reviewed clinical case demonstrates the importance of an integrated approach to treating laryngopharyngeal cancer, including effective reconstruction of postoperative defects using free fasciocutaneous flaps.

CP-08. THE CLINICAL CHARACTERISTICS OF CHILDREN WITH CRANIOPHARYNGIOMA AND THEIR MANAGEMENT IN UGANDA: A RETROSPECTIVE REVIEW

Abstract BACKGROUND Craniopharyngiomas are benign brain tumors that mostly arise in the sellar/suprasellar region. Histologically though benign, these tumors can locally infiltrate with involvement of surrounding structures. They have a 5-year survival rate of above 80% in High Income Countries (HIC). Craniopharyngioma management includes surgery, radiotherapy and intracystic treatments and requires a multi-disciplinary team. The morbidity associated with treatment must be weighed against tumor recurrence and quality of life after treatment. Endocrine deficiencies, especially growth hormone deficiency and visual deficits are common presenting features. OBJECTIVE To describe the clinical characteristics and management of children with craniopharyngioma managed at Mulago National Referral Hospital from March 2019 to December 2023. METHODOLOGY A retrospective descriptive study was conducted among patients&amp;lt; 18 years of age, admitted to the Mulago National Referral Hospital (MNRH) from March 2019 to December 2023 with a radiological diagnosis of a craniopharyngioma. RESULTS A total of 151 children with a diagnosis of a brain tumor during this period were identified and of these 40 (26%) were diagnosed with craniopharyngioma. The median age was 8.4 years and 22 (55%) were males. Only 2 children had maximal safe resection (sub-total resection), one of whom later received adjuvant external beam radiotherapy. Thirty-eight patients had insertion of ommaya reservoirs as their tumors were predominantly cystic. Two patients received intracystic bleomycin and 11 received radical external beam radiotherapy. Twenty-seven patients had no additional therapy after ommaya reservoir placement. Fifteen (39%) of the patients had endocrine deficits with hypothyroidism, hypocortisolism and growth hormone deficiency being the most common. The median follow-up time was 1.45 years. The overall survival was 67.5%, 95%CI(42.5-83.5). CONCLUSION Management of patients with craniopharyngioma in Uganda is mostly conservative with the aim of intervention to preserve quality of life. Limited access to radiation therapy contributed to the poorer survival compared to HIC.

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 7. Adjuvant External Beam Radiotherapy and Systemic Chemotherapy Following Thyroidectomy 2024

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 7. Adjuvant External Beam Radiotherapy and Systemic Chemotherapy Following Thyroidectomy 2024

Single Institution Experience in the Management of Locally Advanced (pT4) Differentiated Thyroid Carcinomas

BackgroundLocally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of patients with T4 DTC who underwent multidisciplinary evaluation and treatment is reported. The main study endpoints were the oncologic outcome, complication rates, and risk factors for tumor recurrence.Patients and MethodsAll DTC cases operated between 2009 and 2021 were reviewed and T4 DTC cases were identified. En bloc resection of inferior laryngeal nerve (ILN), tracheal, and/or internal jugular vein (IJV) was performed in cases of massive infiltration. In cases of pharyngoesophageal junction (PEJ) invasion, the shaving technique was always applied.ResultsAmong 4775 DTC cases, 60 were T4. ILN infiltration was documented in 45 cases (en bloc resection in 9), tracheal infiltration in 14 (tracheal resection in 2), PEJ invasion in 11 (R0 resection in 7 cases and < 1 cm residual tissue in 4 cases), IJV resection in 6, and laryngeal in 2. In total, 11 postoperative ILN palsy, 23 transient hypoparathyroidisms, and 2 hematomas requiring reoperation were registered. Final histology showed 7 pN0, 22 pN1a, and 31 pN1b tumors. Aggressive variants were observed in 47 patients. All but 1 patient underwent radioiodine treatment, 12 underwent adjuvant external beam radiation therapy (EBRT), and 2 underwent chemotherapy. At a median follow-up of 58 months, no tumor-related death was registered, and seven patients required reoperation for recurrence. Tracheal invasion was the only significant factor negatively impacting recurrence (p = 0.045).ConclusionsA multidisciplinary approach is essential for the management of T4 DTC. Individualized and balanced surgical strategy and adjuvant treatments, in particular EBRT, ensure control of locally advanced disease with acceptable morbidity.

Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy.

Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis. Postoperative adjuvant external radiation therapy (RT) has been shown to effectively prevent recurrence after liver cancer resection. However, there are multiple RT techniques available, and the differential effects of these techniques in preventing postoperative liver cancer recurrence require further investigation. To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival (OS) and disease-free survival (DFS) and to determine the optimal strategy. This study involved network meta-analyses and followed the PRISMA guidelines. The data of qualified studies published before July 10, 2023, were collected from PubMed, Embase, the Web of Science, and the Cochrane Library. We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints. The magnitudes of the effects were determined using risk ratios with 95% confidential intervals. The results were analyzed using R software and STATA software. A total of 12 studies, including 1265 patients with hepatocellular carcinoma (HCC) after liver resection, were included in this study. There was no significant heterogeneity in the direct paired comparisons, and there were no significant differences in the inclusion or exclusion criteria, intervention measures, or outcome indicators, meeting the assumptions of heterogeneity and transitivity. OS analysis revealed that patients who underwent stereotactic body radiotherapy (SBRT) after resection had longer OS than those who underwent intensity modulated radiotherapy (IMRT) or 3-dimensional conformal RT (3D-CRT). DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS. Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT. HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT. IMRT, a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT, may be a preferred option.

Multicentric Assessment of Safety and Efficacy of Combinatorial Adjuvant Brain Metastasis Treatment by Intraoperative Radiation Therapy and Immunotherapy

PurposeFollowing surgical resection of brain metastases (BMs), intraoperative radiation therapy (IORT) provides a promising alternative to adjuvant external beam radiation therapy (EBRT) by enabling superior organ at risk preservation, reduction of in-hospital times and timely admission to subsequent systemic treatments, which increasingly comprise novel targeted immunotherapeutic approaches. We sought to assess safety and efficacy of IORT in combination with immune checkpoint inhibitors (ICIs) and other targeted therapies (TTs). MethodsIn a multicentric approach incorporating individual patient data from six international IORT centers, all patients with BMs undergoing IORT were retrospectively assessed for combinatorial treatment with ICIs/TTs and evaluated for toxicity and cumulative rates, including wound dehiscence, radiation necrosis (RN), leptomeningeal spread (LMS), local control (LC), distant brain progression (DBP) and estimated overall survival (OS). ResultsA total of 103 lesions with a median diameter of 34 mm receiving IORT combined with immunomodulatory systemic treatment or other TTs were included. The median follow up was 13.2 (1.2-102.4) months and the median IORT dose was 25 (18-30) Gy prescribed to the applicator surface. There was one grade 3 adverse event related to IORT recorded (2.2%). A 4.9% cumulative RN rate was observed. The 1-year LCR was 98.0% and the 1-year DBP-free rate 60.0%. Median time to DBP was 5.5 (1.0-18.5) months in the subgroup of patients experiencing DBP and the cumulative LMS rate was 4.9%. The median estimated OS was 26 (1.2-not reached) months with a 1-year survival rate of 74.0%. Early initiation of IT/TT was associated with a non-significant trend towards improved DBP rate and OS. ConclusionThe combination of ICIs/TT with IORT for resected BMs does not seem to increase toxicity, while yielding encouraging local control outcomes in the difficult-to-treat subgroup of larger BMs. Time gaps between surgery and systemic treatment could be shortened or avoided. The definitive role of IORT in local control after BM resection will be defined in a prospective trial.

Second Malignancy Probabilities in Patients With Breast Cancer Treated With Conventional Versus Hypofractionated External Beam Radiation Therapy in the Adjuvant Setting

AimsFor women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT. Materials and methodsUsing the National Cancer Database, we carried out a retrospective cohort analysis of women diagnosed with non-metastatic, stage 0–III breast cancer from 2004 to 2017. All patients had a lumpectomy or mastectomy and a follow-up time of at least 60 months after diagnosis. The probability of second malignancies in women receiving adjuvant cEBRT or hEBRT was compared using multivariable logistic regression adjusting for sociodemographic, geographical, clinical and treatment factors, allowing for relative (but not absolute) comparison of second malignancy risk. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up time were also conducted. ResultsOf the 125 228 women in our study, 115 576 (92.3%) received cEBRT and 9652 (7.71%) received hEBRT. The median age of the cohort was 60 (interquartile range 51–68) years at diagnosis and the median follow-up time was 99.61 (interquartile range 77.5–128.49) months. Upon adjusting for sociodemographic and clinical factors, patients who received hEBRT had no difference in relative risk than patients who received cEBRT (odds ratio 0.937, 95% confidence interval 0.869–1.010, P = 0.091). In analyses stratified by year of diagnosis, and stratified by length of follow-up, there was no difference in second malignancy probability between patients who completed hEBRT and patients who completed cEBRT. ConclusionsIn this analysis of over 120 000 women with non-metastatic breast cancer, hEBRT was not associated with different odds of developing second malignancies compared with cEBRT. Our findings may inform patient counselling in the choice of radiation regimens for breast cancer and further support the safety of hypofractionated regimens for breast cancer.

Adjuvant External Beam Radiotherapy and Histopathologic Prognostic Factors in Tall Cell Papillary Thyroid Carcinoma

Differentiated thyroid cancer is a diverse disease, with histopathologic characteristics contributing to prognosis and treatment decisions. Tall cell variant of papillary thyroid cancer (TCV-PTC) carries a poor prognosis relative to other histologies, with first site of failure most often in the neck. Several small studies suggest there may be a disease control benefit to adjuvant external beam radiotherapy (EBRT) for certain high-risk DTC populations; however, data is limited. In this study we aim to shed light on both histopathologic prognostic factors and survival outcomes of patients with TCV-PTC carcinoma treated with surgery followed by EBRT and Radioactive Iodine (RAI) or RAI alone. We hypothesize that EBRT with RAI leads to better disease control than RAI alone. Patients with TCV-PTC diagnosed between 1997-2020 at a single institution were included in the analysis. TNM staging was standardized to AJCC 8th edition. Demographics, staging, and histologic characteristics were compared between the two treatment groups using T-tests and Fisher's exact tests. Kaplan-Meier survival analyses were performed between patients receiving EBRT vs. RAI alone for disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS), along with Cox Proportional Hazards analysis. A total of 93 patients were included. Of these patients, 22 received adjuvant RAI and EBRT, and 71 received RAI alone. There was no statistical difference in race, gender, tall cell percentage in the pathology specimen, TNM stage, AJCC group stage, or disease recurrence in patients receiving EBRT vs. RAI alone. However, those receiving EBRT were significantly older (RAI mean age (SD): 50.6 (18.7), EBRT mean age (SD): 59.7 (14.4), p = 0.02) and length of follow-up was shorter for the EBRT cohort (RAI mean (SD): 8.80 (5.81) years, EBRT mean (SD): 4.53 (2.14) years, p < 0.01). Multifocal disease (HR: 3.04, 95% CI: 1.30 - 7.08, p = 0.01) and soft tissue invasion (HR: 2.93, 95% CI: 1.28 - 6.75, p = 0.01) were associated with decreased DFS, whilst age (HR 1.08, 1.01 - 1.15: p = 0.03) was associated with decreased CSS; tall cell percentage in the pathology specimen, extra-thyroidal extension, vascular invasion, and positive surgical margin were not significant for either metric. There was no statistical difference in DFS (p = 0.5), CSS (p = 0.3), or OS (p = 0.6) between patients that received EBRT and RAI vs. RAI alone. DFS, CSS, and OS were not different between patients who received EBRT compared to RAI only in this high-risk subgroup of patients. Short interval follow-up for the EBRT group and significant age differences between the EBRT and RAI cohorts may confound results. Given the significant association of advanced age with CSS, an expanded, age-matched cohort analysis is underway.

Disease Control and Toxicity Outcomes after Intraoperative HDR Brachytherapy for Neck Recurrences in Patients Previously Irradiated Head and Neck Cancer

Despite recent advances in local and systemic therapies for head and neck squamous cell carcinomas (HNSCC), the most common types of treatment failure remain local and regional. Patients with HNSCC also have a higher risk of developing secondary head and neck tumors due to a field cancerization phenomenon. Treatment of these recurrences poses a challenge, particularly in patients having previously received full dose external beam radiotherapy (EBRT) to the head and neck region. This study evaluates the clinical outcomes of intraoperative Harrison-Anderson-Mick applicator (HAM) HDR brachytherapy (BT) after salvage neck dissection for neck recurrences in patients previously irradiated for HNSCC. All patients having received HAM BT for HNSCC neck recurrences at a single institution were identified. Demographic, treatment, disease control and toxicity data were collected retrospectively. Toxicity was graded as per Common Terminology Criteria for Adverse events version 5. The Kaplan Meier method was used to assess overall survival (OS) and ipsilateral regional control (IRC) from the time of HAM BT. Nineteen patients with regional recurrence of HNSCC were treated with HAM BT Ir-192 between July 2006 and June 2022, with a median follow-up for survival of 51.4 months (range: 2.5-186.7). The median BT dose was 12.5 Gy delivered intraoperatively at 5 mm tissue depth/1 cm from source. Fifteen patients (78.9%) also received postoperative EBRT to a median dose of 46 Gy in 23 fractions and 13 (68.4%) received systemic therapy. Six patients (31.6%) developed ipsilateral neck recurrences (4 who had adjuvant EBRT and 2 who did not), 2 patients had primary site recurrences and 5 patients developed distant metastases. In terms of acute toxicity, 4 patients had grade 3 dysphagia requiring feeding tube (FT) placement and one patient required surgical intervention for wound necrosis. In terms of late toxicity, 2 additional patients required FT placement and 1 was able to have it removed. No grade 4+ late toxicities were noted. The IRC at the site of HAM BT at 1 year was 71.5% and 63.6% at 5 years. The 1-year OS was 81.3% and 5-year OS was 40.9%. Intraoperative HAM BT resulted in favorable rates of IRC with acceptable toxicity in the reirradiation setting for HNSCC.

Effect of Radiation Therapy on Composition of Lymphocyte Populations in Patients with Primary Breast Cancer.

Radiation therapy (RT) is an important step in the treatment of primary breast cancer as it is one of the leading contributors to cancer incidence among women. Most patients with this disease acquire radiation-induced lymphopenia in the early post-radiation period; however, little is known about the effect of RT on the composition of lymphocyte populations in such patients. This study was aimed at investigating the effect of adjuvant remote RT-performed in the classical mode for patients with primary breast cancer-on the main components of cell-mediated immunity (major lymphocyte populations), including those in patients receiving chemotherapy. Between 2020 and 2022, 96 patients with stage I-III breast cancer were included in this study. All patients in the final stage of complex treatment received RT via a 3D conformal technique (3DCRT). The clinical target volume of this RT included the breast or chest wall and locoregional lymphatics. Flow cytometry was used to assess the levels and phenotypes of circulating lymphocytes before and after RT (no more than 7 days before and after RT). The evaluation of the impact of polychemotherapy (PCT) was conducted to determine whether it was a risk factor for the onset of radio-induced lymphopenia (RIL) in the context of RT. When assessing the immune status in the general group of patients (n = 96), before the start of adjuvant external beam radiotherapy (EBRT), the average number of lymphocytes was 1.68 ± 0.064 × 109/L; after the course of adjuvant EBRT, it decreased to 1.01 ± 0.044 × 109/L (p < 0.001). When assessing the absolute indicators of cellular immunity in the general group of patients with BC after a course of adjuvant EBRT, significant dynamics were revealed by the changes in all cell populations of lymphocytes (paired t-test, p < 0.05). The adaptive immune system in breast cancer patients changed in the early post-radiation period. The absolute levels of B-, T- and natural killer cells significantly reduced after RT regardless of whether the patients previously underwent chemotherapy courses. RT for patients with primary breast cancer should be considered in clinical management because it significantly alters lymphocyte levels and should be considered when assessing antitumor immunity, as significant changes in T-cell immunity have been observed. In addition, the identified changes are critical if specific targeted therapy or immunotherapy is needed.