Adjuvant External Beam Radiotherapy Research Articles

Chemoradiation in Periampullary Carcinoma after Whipple’s Pancreatico-duodenectomy

The role of adjuvant chemoradiation in periampullary carcinoma after Whipple’s pancreatico-duodenectomy is not well defined. The aim of this audit was to evaluate the efficacy of adjuvant chemoradiation after Whipple’s pancreatico-duodenectomy in periampullary carcinoma. Between January 1991 to December 2016, the 151 curatively resected patients of periampullary carcinoma were prospectively planned for adjuvant chemoradiation. All patients were planned for adjuvant external beam radiotherapy to a dose of 45-50.4 Gy/ 25-28 fractions in 5-5½ weeks to tumor bed and lymph node drainage area along with either 5-fluorouracil(5-FU) 370mg/m2 I.V. weekly or day 1-5 at 4 weekly or oral Capecitabine 1650mg/m2 daily delivered concurrently during radiation therapy and as adjuvant following completion of radiation therapy. The results were analyzed in October 2019. Of the 151 patients with resected periampullary carcinoma, there were 104 males and 47 females and size of tumor ranges from 0.5 cm to 8 cm(median =2 cm). The median age of patients was 52 years. ; 127 (84 %) were ampullary tumors and 24 (16 %) were non-ampullary including duodenum and distal bile duct. Based on histology and operative findings (such as poorly differentiated histology, positive surgical margin, lymph node positivity and /or pancreatic infiltration) the patients were categorized into high risk group (n= 131, 86.8%) and remaining in low risk group (n=20, 13.2%). The 5-FU chemotherapy (weekly/monthly) was given in 112 patients (74.2%) while oral Capecitabine was given in 20 patients(13.2%) and 19 patients (12.6%) received no chemotherapy and radiation therapy. The median and 5-year overall survival in whole group was 26 months and 26%. According to risk categorization, in low risk group and high-risk group the median survival is 31 vs. 26 months and 5-year Overall is 40% vs. 23.6 % respectively; p-value = 0.19). Among high risk group, 113 patients received chemoradiation and 18 did not. The 5-year OS in this high risk group treated with chemoradiation is 26% vs. 5.6% without RT (p=0.30) and median survival is 27 vs. 21 months respectively. Chemoradiation Toxicities were assessed in all 132 patients who received adjuvant treatment. Two patients died of acute hematological toxicity of chemoradiation during treatment. Local recurrence (37%) followed by distant metastasis to liver and other sites (20.5%) were predominant site of failure and 20% died of other non- specific causes and 4 died of chronic radiation gastroduodenitis with gastrointestinal bleeding with intestinal obstruction, out of them, two had necrosis and perforation of duodenum. Adjuvant chemoradiation is effective and well tolerated in high risk periampullary carcinoma and improves the overall survival, although no significant difference was found between chemoradiation and non chemoradiaion group as number of patients in non RT group were very few.

The incidence of hypothyroidism in patients of head and neck carcinoma treated with radiotherapy and added risk of hypothyroidism with the addition of chemotherapy

AbstractBackground:Head and neck cancer (HNC) is the most common malignancy in the Indian males. Most of the cases of HNC present in locally advanced stage and requires a multidisciplinary management approach. Radical or adjuvant external beam radiotherapy (EBRT) is one of the important integral components of the management of HNC.Aim:To find the incidence of hypothyroidism (HT) in patients of HNC treated with radiotherapy with or without concurrent chemotherapy.Methods:A prospective, single institutional longitudinal observational study conducted at the department of radiotherapy, Institute of Post Graduate Medical Education and Research, Kolkata.Results:In this study, data of 118 patients were analysed. The median age at presentation was 56 years. The most common primary site of malignancy was oral cavity (39%). The patients were stage I, stage II and stage III as 11, 37·3 and 51·7% respectively. The median dose of EBRT was 66 Gy. HT statistically significantly correlated with primary site of malignancy (p = 0·001), dose of EBRT (p = 0·005). At the end of follow-up of 6 months, 39·8% developed HT.Conclusion:The thyroid gland is an important organ at risk while considering EBRT to neck region. The inclusion of thyroid function test in routine follow-up is mandated.

Robot-assisted radical prostatectomy in the Middle East: A report on the perioperative outcomes from a tertiary care centre in Lebanon

ABSTRACT Objective To report on the surgical, oncological and early functional outcomes of robot-assisted radical prostatectomy (RARP) at our tertiary care centre, as there is a scarcity of reports on outcomes of robotic surgery from the Middle East. Patients and methods We reviewed the electronic health records for patients undergoing RARP between 2013 and 2019 at the American University of Beirut Medical Center. We collected patients’ demographics and preoperative oncological factors including prostate-specific antigen (PSA), clinical oncological stage, and World Health Organization (WHO) grade. PSA persistence, biochemical recurrence (BCR) and positive surgical margin (PSM) were reported. Complications were categorised by Clavien–Dindo grade. Moreover, the postoperative oncological outcomes including the rates of adjuvant and salvage androgen-deprivation therapy (ADT) and external-beam radiation therapy (EBRT), chemotherapy, and metastasis were reported. Additionally continence and potency results were retrieved. Results For the designated period, 250 patients underwent RARP of which 182 (72.8%) underwent lymph node dissection. The median (interquartile range) anaesthesia time was 330 (285–371) min and the estimated blood loss was 200 (200–300) mL. The overall complication rate was 8%, with 2% Clavien–Dindo Grade III–IV complications. The PSM and BCR rates were 21.6% and 6.4%, respectively. Adjuvant ADT and EBRT was administered to 7.2% of the patients. Functional data was available for 112 patients. Continence was 68%, 82% and 97% of the patients at 3, 6 and 12 months, respectively. For 65 patients who had bilateral nerve sparing potency was 37%, 60% and 83% at 3, 6 and 12 months, respectively. Conclusion This is the largest RARP series from the Middle East. The surgical, oncological and functional outcomes are consistent with those published in the literature. This confirms the safety and efficacy of applying robotic technology in our region during the implementation phase. Abbreviations: ADT: androgen-deprivation therapy; AJCC: American Joint Committee on Cancer; AUBMC: American University of Beirut Medical Center; BCR: biochemical recurrence; CPT: Current Procedural Terminology; EBRT external beam radiation therapy; IQR, interquartile ranges; LOS: length of stay; PLND: pelvic lymph node dissection; PSM: positive surgical margin; (O)(RA)RP, (open) (robot-assisted) radical prostatectomy

Salvage low-dose-rate brachytherapy for local recurrences after prostatectomy and adjuvant or salvage external beam irradiation: Feasibility study on five patients and literature review

PurposeTo assess the feasibility and tumor outcome of re-irradiation with low-dose-rate brachytherapy for macroscopic local recurrences after radical prostatectomy (RP) followed by adjuvant or salvage external beam radiation therapy (EBRT). Methods and MaterialsBetween 2011 and 2018, five men with histologically proven local failure within the prostate (4) or seminal vesicle bed (1) after RP and adjuvant or salvage EBRT (median dose: 67.5 Gy) underwent a salvage brachytherapy (S-BT). The median delay after EBRT was 86 months (range 75–234). Two patients were castration-resistant at the time of S-BT. The gross tumor volume was defined on a multiparametric MRI and transrectal US imaging. Echo-guided transperineal implants of Iodine-125 seeds were optimized with a per-operative dosimetry and delivered with the seed-selectron. ResultsA high conformity was achieved with a high dose to the CTV (D95% > 145 Gy in all but one) and very low dose to the rectum, urethra, and bladder. With a median followup of 21 months, all but one patient experienced nodes and/or bone metastases. Local control was achieved in 3/4 of evaluable patients (local failure distant to the treated volume in one). To date, no Grade 2 or more late toxicities were observed. ConclusionFor selected patients, focal local recurrence brachytherapy after PR and EBRT appears technically feasible and safe, but the efficacy remains uncertain as the majority of patients quickly relapsed at other sites. Large prospective studies are still required to better select patients who will benefit from this strategy.

Non-metastatic ductal adenocarcinoma of the prostate: pattern of care from an uro-oncology multidisciplinary group.

To retrospectively review our 20year experience of multidisciplinary management of non-metastatic ductal prostate cancer (dPC), a rare but aggressive histological subtype of prostate cancer whose optimal therapeutic approach is still controversial. Histologically confirmed dPC patients undergoing primary, curative treatment [radical prostatectomy (RP), external beam radiotherapy (EBRT), and androgen deprivation therapy (ADT)] were included, and percentage of ductal and acinar pattern within prostate samples were derived. Survival outcomes were assessed using the subdistribution hazard ratio (SHR) and Fine-and-Gray model. From January 1997 to December 2016, 81 non-metastatic dPC fitted selection criteria. Compared to surgery alone, SHR for progression-free survival and cancer-specific mortality were 2.8 (95% CI 0.6-13.3) and 1.3 (95% CI 0.1-16.2) for exclusive EBRT, 2.7 (95% CI 0.6-13.0) and 6.5 (95% CI 0.6-69.8) for adjuvant EBRT, 4.9 (95% CI 0.7-35.5) and 5.8 (95% CI 0.5-65.6) for salvage EBRT post-prostatectomy recurrence, and 3.2 (95% CI 0.7-14.0) and 3.9 (95% CI 0.3-44.1) for primary ADT (P = 0.558; P = 0.181), respectively. Comparing multimodal treatment and monotherapy confirmed the above trends. Local recurrence more typically occurred in pure dPC patients, mixed histology more frequently produced metastatic spread (29.6% relapse in total, P = 0.026). Albeit some limitations affected the study, our findings support the role of local treatment to achieve better disease control and improve quality of life. Different behavior, with typical local growth in pure dPC, higher distant metastatization in the mixed form, might influence treatment response. Given its poor prognosis, we recommend multidisciplinary management of dPC.

Impact of different adjuvant treatment approaches on survival in stage III endometrial cancer: A population-based study

BackgroundPatients with International Federation of Gynaecology and Obstetrics (FIGO) stage III endometrial cancer (EC) have a substantial risk of adverse outcomes. After surgery, adjuvant therapy is recommended with external beam radiotherapy (EBRT), chemotherapy (CT) or both EBRT and CT. Recent trials suggest that EBRT + CT is superior to EBRT or CT alone but also results in more toxicity. We have compared the outcome of different adjuvant treatments in a population-based cohort to identify subgroups that benefit most from EBRT + CT. MethodsAll patients diagnosed with FIGO stage III EC and treated with surgery in 2005–2016 were identified from the Netherlands Cancer Registry. The primary outcome was overall survival (OS); associations with adjuvant treatment were analysed using Cox regression analysis. ResultsAmong 1241 eligible patients, EBRT + CT was associated with a better OS than CT (hazard ratio [HR] = 1.84, 95% confidence interval [CI] = 1.34–2.52) and EBRT alone (HR = 1.37, 95% CI = 1.05–1.79). In stage IIIC, there was a significant benefit of EBRT + CT compared with CT or EBRT alone. In stage IIIA–B, there was no difference between EBRT + CT or EBRT alone. In endometrioid EC (EEC) and carcinosarcomas, EBRT + CT was associated with a better OS than CT or EBRT alone. For uterine serous cancers, there was no survival benefit of EBRT + CT over CT. In all analysis by stage and histology, any adjuvant treatment was superior to no adjuvant therapy. ConclusionsIn this population-based study, adjuvant EBRT + CT was associated with improved OS compared with CT or EBRT alone in FIGO stage IIIC EC, EEC and carcinosarcoma. This suggests that application of EBRT + CT in stage III should be further stratified according to these subgroups.

Analysis of Systemic Inflammatory Factors and Survival Outcomes in Endometrial Cancer Patients Staged I-III FIGO and Treated with Postoperative External Radiotherapy.

Background: The causal link between elevated systemic inflammation biomarkers and poor survival has been demonstrated in cancer patients. However, the evidence for this correlation in endometrial cancer (EC) is too weak to influence current criteria of risk assessment. Here, we examined the role of inflammatory indicators as a tool to identify EC patients at higher risk of death in a retrospective observational study. Methods: A total of 155 patients surgically diagnosed with EC stage I-III FIGO 2009 and treated with postoperative External Beam Radiotherapy (EBRT) ± brachytherapy and chemotherapy according to ESMO-ESTRO-ESGO recommendation for patients at high risk of recurrence at the Gustave Roussy Institut, France, and Hospital Clínic, Spain, between 2008 and 2017 were evaluated. The impact of pre-treatment Neutrophil-to-Lymphocyte Ratio (NLR ≥ 2.2), Monocyte-to-Lymphocyte Ratio (MLR ≥ 0.18), Systemic Immune-Inflammatory Index (SII ≥ 1100) and lymphopenia (<1.0×109/L) on overall survival (OS), cancer-specific survival and progression-free survival was evaluated. Subsequently, a cohort of 142 patients within high-advanced risk groups according to ESMO-ESGO-ESTRO classification was evaluated. Results: On univariate analysis, NLR (HR = 2.2, IC 95% 1.1–4.7), SII (HR = 2.2, IC 95% 1.1–4.6), MLR (HR = 5.0, IC 95% 1.1–20.8) and lymphopenia (HR = 3.8, IC 95% 1.6–9.0) were associated with decreased OS. On multivariate analysis, NLR, MLR, SII and lymphopenia proved to be independent unfavorable prognostic factors. Conclusions: lymphopenia and lymphocytes-related ratio are associated with poorer outcome in surgically staged I-III FIGO EC patients classified as high risk and treated with adjuvant EBRT and could be considered at cancer diagnosis. External validation in an independent cohort is required before implementation for patients’ stratification.

MP53-06 RADIOTHERAPY AFTER RADICAL PROSTATECTOMY: EFFECT OF TIMING OF POST-PROSTATECTOMY RADIATION ON FUNCTIONAL OUTCOMES

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy (MP53)1 Apr 2020MP53-06 RADIOTHERAPY AFTER RADICAL PROSTATECTOMY: EFFECT OF TIMING OF POST-PROSTATECTOMY RADIATION ON FUNCTIONAL OUTCOMES Heather Huelster*, Aaron Laviana, Daniel Joyce, Tatsuki Koyama, Zhiguo Zhao, Li-Ching Huang, Karen Hoffman, Ralph Conwill, David Penson, and Daniel Barocas Heather Huelster*Heather Huelster* More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Daniel JoyceDaniel Joyce More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , Zhiguo ZhaoZhiguo Zhao More articles by this author , Li-Ching HuangLi-Ching Huang More articles by this author , Karen HoffmanKaren Hoffman More articles by this author , Ralph ConwillRalph Conwill More articles by this author , David PensonDavid Penson More articles by this author , and Daniel BarocasDaniel Barocas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000915.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The timing of radiation after prostatectomy is controversial, and its effect on patient-reported sexual, urinary, and bowel function is unknown. This study seeks to compare outcomes after radical prostatectomy (RP) and post-prostatectomy radiation as well as elucidate the timing of radiation to allow optimal recovery of function. METHODS: The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based study of men with localized prostate cancer. Patient-reported functional outcomes were measured using the 26-item Expanded Prostate Index Composite (EPIC-26) at baseline and 6, 12, 36, and 60 months after enrollment. Functional outcomes were compared using multivariable models controlling for baseline demographic and clinical characteristics. RESULTS: Among 1482 CEASAR participants initially treated with RP for clinically localized prostate cancer, 11.5% (N=170) received adjuvant (N=57) or salvage (N=113) external beam radiotherapy. Men who received post-RP radiotherapy had worse scores in all domains compared to RP alone at 5 years of follow up. Compared to men treated with RP alone in an adjusted linear model, salvage radiation was associated with significantly worse domain scores for sexual function (-11.1, 95%CI [-17.0, - 5.3], p<0.001), incontinence (-7.6, [-13.6, -1.6], p=0.014), urinary irritation (-6.1, [-9.7, -2.4], p=0.001), bowel function (-4.5, [-7.4, -1.7], p=0.002), and hormonal function (-3.3, [-6.0, -0.6], p=0.017). Adjuvant radiation was associated with significantly worse incontinence (-11.9, [-20.7, -3.1], p=0.008), urinary irritation (-5.9, [-11.2, -0.6], p=0.030), and hormonal function (-7.3, [-13.6, -1.0], p=0.023) domain scores compared to RP alone at 5 years of follow up. On multivariable regression analysis, radiotherapy administered at 24 months after RP was associated with the smallest decline in sexual domain score, with an adjusted mean difference of -5.3 points (p=0.016) from post-RP baseline. CONCLUSIONS: In men with localized prostate cancer, post-prostatectomy radiation was associated with significantly worse EPIC-26 sexual, urinary, and bowel function domain scores at 5 years compared to RP alone. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e783-e784 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Heather Huelster* More articles by this author Aaron Laviana More articles by this author Daniel Joyce More articles by this author Tatsuki Koyama More articles by this author Zhiguo Zhao More articles by this author Li-Ching Huang More articles by this author Karen Hoffman More articles by this author Ralph Conwill More articles by this author David Penson More articles by this author Daniel Barocas More articles by this author Expand All Advertisement PDF downloadLoading ...

External beam radiotherapy versus vaginal brachytherapy in patients with stage II endometrial cancer: a systematic review and meta-analysis

ObjectiveThe choice of adjuvant treatment for women with stage II endometrial cancer is challenging, given the known increase in morbidity with external beam radiation compared with vaginal brachytherapy, and the...

Post-mastectomy immediate breast reconstruction and adjuvant radiotherapy: long term results of a mono institutional experience.

The aim of this paper is to investigate the outcome of patients treated with mastectomy, immediate breast reconstruction (IBR) and post-mastectomy radiotherapy (PMRT) and the risk of late complications. All patients had post-mastectomy, immediate reconstructive surgical procedure by using autologous abdominal implant; tissue expander (TE)/permanent prosthesis (PP); or even combined procedures. Adjuvant external beam radiotherapy treatment (EBRT) was delivered to the reconstructed chest wall and supraclavicular nodes, for a total dose of 50Gy in 25 fractions. The Kaplan-Meyer analysis evaluates patients' rate of late side effects, Overall Survival (OS), Progression Free survival (PFS), Local-regional free survival (LRFS) and Metastasis Free Survival (MFS). The univariate analysis investigates the correlation between late toxicity and related factors. Between November 2003 and October 2016, 91 breast cancer patients were treated with IBR and PMRT. Twenty-three (25.3%) patients experimented late toxicity. Overall, 16 (17.6%) patients experienced late complications which required a surgical approach. The 1- 2- 5- years late toxicity rates were 96.6%, 87.1% and 77.9%, respectively. The type of reconstruction was not statistically related with late toxicity rate (P = 0.35). The median follow-up period was 59months (range 6-142months). Median OS was not reached, the 1- 2- 5-years OS rates were 100%, 95.4% and 81% respectively. This study underlines that the type of reconstruction does not influence late toxicity rate. Moreover, IBR followed by adjuvant radiotherapy, has showed acceptable late toxicity profile and no influence on OS.

Could a Personalized Strategy Using Accelerated Partial Breast Irradiation be an Advantage for Elderly Patients? A Systematic Review of the Literature and Multidisciplinary Opinion.

Introduction. Elderly patients are underrepresented from a majority of clinical trials and the choice of the best treatment becomes a challenge. The optimal treatment should be personalized and based on a multidisciplinary approach that includes radiation oncologists, surgeons, geriatricians, medical oncologists, social workers, and support services. The global evaluation of the patients and the creation of nomograms may facilitate the definition of long-term treatment benefits minimizing the use of unnecessary therapy. Material and Method. A systematic research using PubMed, Scopus, and Cochrane library was performed to identify full articles analyzing the efficacy of APBI in elderly patients with breast cancer. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Results Seven papers fulfilled the eligibility criteria. The number of evaluated patients was 405 and the median age was 77.7 years. The disease-free survival (DFS) range was 96.1%–100%, the grade 3-4 toxicity range was 0%–6.6%, the cancer-specific survival (CSS) range was 97.9%–100%, and the overall survival (OS) range was 87%–100%. All studies reported excellent/good cosmetic results in a range of 74% to 99%. Conclusion Accelerated partial breast irradiation (APBI) results in a safe and effective substitute for the adjuvant external beam radiotherapy in selected elderly early-stage breast cancer patients. Based on the relatively low toxicity, APBI should be advised in selected patients with life expectancies larger than 5–10 years.

Adjuvant external beam radiotherapy for surgically resected, nonmetastatic anaplastic thyroid cancer.

EBRT in resected, nonmetastatic anaplastic thyroid cancer (ATC) remains undefined. We evaluated patterns/outcomes with EBRT and chemotherapy in this setting. This retrospective analysis included patients identified from the National Cancer Database with nonmetastatic ATC from 2004 to 2014 who underwent non-palliative resection. Our analysis included 496 patients, including 375 who underwent adjuvant EBRT (among whom 198 received concurrent chemotherapy). The median age was 68 years. On MVA, EBRT was associated with sex (OR 0.5, 95% CI 0.3-0.8, P = .002) and income (OR 2.2, 95% CI 1.4-3.3, P < .001). EBRT was associated with longer OS on UVA (12.3 vs 9.1 months, P = .004) and MVA (HR 0.7 [CI 0.6-0.9], P = .004). Concurrent chemoradiation was associated with longer OS on UVA (14.0 vs 9.1 months, P = .003) and MVA (HR 0.6 [CI 0.5-0.8], P < .001). Adjuvant EBRT is associated with longer OS in resected, nonmetastatic ATC, with additional improved survival with concurrent chemotherapy.

Solitary Fibrous Tumors of the Lacrimal Drainage System With Variable Orbital and Sinonasal Extensions: Combined External and Endoscopic Surgical Approach.

To report techniques and outcomes of a combined external and endoscopic surgical approach in the management of solitary fibrous tumors of the lacrimal drainage system with variable orbital and sinonasal extensions. Biopsy proven cases of solitary fibrous tumors of the lacrimal drainage system involving the lacrimal sac and the nasolacrimal ducts with an orbital, sinonasal, or intranasal extension were studied. Parameters assessed include patient demographics, clinical presentation and course, operative techniques, complications, postoperative adjuvant therapies and outcomes. The technique is described in 3 patients. Two patients had massive orbital extension and one had gross sinonasal extension. Nasolacrimal duct extension was involved in all the patients with intranasal extension in 2 patients. External approach was used to access the lacrimal sac and the orbital components while the endoscopic approach was used to assess the orbital clearance and manage the sinonasal extension and the nasolacrimal duct excision up to the inferior meatus. Following complete excision, additional biopsies were performed from the adjacent bones and sinonasal tissues. A detailed histopathology with immunohistochemistry is essential for not only the diagnosis but also to assess the margin clearance. There were no major postoperative complications. All the patients were advised for postoperative adjuvant external beam radiotherapy. At the last follow-up, none of the patients had any clinical or endoscopic evidence of a recurrence. A combined external and endoscopic approach en-block excision is most suitable management modality for solitary fibrous tumors involving the lacrimal sac and the nasolacrimal ducts with orbital and sinonasal extension.

Impact of 6 MV photons and mixed beam (6 MV and 15 MV) photons on the dose distribution in high-grade gliomas using three-dimensional conformal radiotherapy technique - A Retrospective Analysis

Background and Aim: The present study focused on the impact of 6 MV photons and mixed beam (6 MV and 15 MV) photons on dose distribution in high-grade gliomas using three-dimensional conformal radiotherapy (3DCRT) technique. The suitability of using different photon beam energies was evaluated with respect to dose distribution. Materials and Methods: A total of 24 patients of high-grade glioma treated on linear accelerator were enrolled and evaluated in this retrospective study. All patients had undergone total/subtotal resection of tumor. These patients were treated with postoperative adjuvant external beam radiotherapy on a linear accelerator using 3DCRT technique. Treatment plans were generated using 6 MV and a combination of both 6 MV and 15 MV photon beams. All plans were generated using suitable planning objectives, and dose constraints which were identical across the plans, except the beam energy. The plans were analyzed in terms of their target coverage, conformity, and normalized dose range. Results: In 16 patients out of 24, the treatment plans were generated using 6 MV photons, the normalization dose was well within 5%–7% of the dose prescribed. In the remaining 8 patients, the normalized dose was >107%, and in these cases, the use of mixed beam plans yielded a better dose distribution with normalized dose between 101% and 105%. Conformity index (CI) values were between 1.2 and 1.98. CI mean was 1.59. Conclusions: The use of mixed beams in 3DCRT technique may be considered as an alternative, especially in a scenario where pure 6 MV photons do not yield homogeneous dose distribution within the normalized range, and in centers where intensity-modulated radiation therapy and field-in-field technique are not available.

Effectiveness of radiotherapy for head and neck skin cancers: a single-institution study.

PurposeExternal beam radiotherapy (EBRT) is a useful option to treat head and neck skin cancer patients who are not indicated for surgery. In this study, we evaluated the treatment outcomes of EBRT in an Asian population.Materials and MethodsThe records from 19 head and neck skin cancer patients (10 with squamous cell carcinoma and 9 with basal cell carcinoma) who were treated with definitive or adjuvant EBRT from 2009 to 2017 were retrospectively reviewed. The radiotherapy doses administered ranged from 50 to 66 Gy (median, 55 Gy) with 2.0–2.75 Gy per daily fraction (median, 2.5 Gy). The T stage at presentation was as follows: Tis (1 patient), T1 (11 patients), T2 (6 patients), and T3 (1 patient). None had regional lymph node disease or distant metastasis at presentation. The local failure-free survival (LFFS) rates, toxicity, and cosmetic results were analyzed.ResultsThe median age was 75.5 years (range, 52.6 to 92.5 years). The median follow-up duration from the completion of radiotherapy was 44.9 months (range, 5.8 to 82.6 months). One local failure occurred in a patient with a 2.1-cm posterior neck squamous cell carcinoma at 32.5 months after radiotherapy (1/19, 5.3%). The 3-year LFFS rate was 91.7%. No patients died from skin cancer during follow-up, and no grade 3 complications occurred. The cosmetic outcomes were excellent for 16 (84.2%) and good for 3 (15.8%) of the 19 patients.ConclusionEBRT offers good local control and cosmetic outcomes in patients with head and neck skin cancer, with no grade 3 complications.

Haemoptysis: a presentation of papillary thyroid carcinoma

Papillary thyroid carcinomas can be retrospectively diagnosed in patients, who are having metastatic disease with an occult primary lesion. A sixty-year-old female patient was investigated for haemoptysis and was found to have a tracheal lesion. Biopsy revealed a papillary carcinoma of the thyroid. Patient underwent total thyroidectomy with excision of the tracheal lesion and was followed up by adjuvant external beam radiotherapy (EBRT) and radioactive iodine (RAI) treatment. The detailed history, examination and investigations of neck and upper aerodigestive tract (ADT) are important for correct diagnosis of papillary thyroid microcarcinoma.

Management of urethral stricture due to prostate cancer and colorectal cancer radiotherapy: a systematic review

Background: Prostate and colorectal cancer are the second and third most common cancer in male. Radiotherapy is performed as treatment option for both cancers. Thus, lead to the increasing case of radiotherapy-induced urethral stricture. Recurrent stricture post-correction commonly occurs.Methods: Six relevant English literatures were found throughout online database published between 2011-2017. PICO is used to identify components of clinical evidence to create systematic review. Subjects include 222 radiotherapy-induced urethral stricture patients due to prostate and colorectal cancer who undergone various treatment modality options.Results: Radiotherapy modality performed in sample population were External Beam Radiotherapy (EBRT) (44.1%), Brachytherapy (BT) (31.5%), EBRT/BT (16.2%), Adjuvant EBRT (6.8%), salvage EBRT (0.9%), and proton beam (0.5%). Strictures were found in bulbomembranous-urethra (64.4%), bulbar-urethra (17.1%), posterior-urethra (10.8%), membranous-urethra (5.4%), vesico-urethra (1.4%), and pan-urethra (0.9%). Known mean onset for urethral-induced radiotherapy is 5.6 years. Treatment options include anastomosis urethroplasty (61.3%), Buccal Mucosa Graft Urethroplasty (23.4%), urolume stent (10.8%), penile island flap onlay (2.2%), Genital fasciocutaneous skin flap (1.4%), and perineal flap urethroplasty (0.9%). Known mean onset for urethral stricture recurrence is 10.8 months.Conclusion: Urethral strictures commonly occur after radiation therapy for prostate and colorectal cancer. Urethroplasty is the preferable treatment option. The recurrence onset for urethral stricture post urethroplasty is shorter than urethral strictures in general.

Peer Influence on Physician Use of Shorter Course External Beam Radiation Therapy for Patients with Breast Cancer

PurposeSocial contagion among physicians may affect the dissemination of innovative and high-value cancer care. We applied social contagion theory to investigate the role of physician peer influence on the use of short courses of external beam radiation therapy (EBRT) for patients with breast cancer. Methods and MaterialsUsing a cohort of Medicare beneficiaries with breast cancer, we constructed physician peer groups based on patient-sharing relationships. Outcomes were a patient’s receipt of (1) moderately hypofractionated adjuvant EBRT after breast-conserving surgery and (2) short-course palliative EBRT for bone metastases. Using a longitudinal design, we used mixed-effects logistic regression to examine the association between physician peer group rate of short-course EBRT in 2011 to 2012 (T1) and patients’ receipt of short-course EBRT in 2013 to 2014 (T2). ResultsDuring T2, a total of 17,248 patients received adjuvant therapy (32.3% moderately hypofractionated) from 3235 physicians in 1202 physician peer groups. Compared with patients treated within peer groups in which no moderately hypofractionated adjuvant EBRT was used in T1, patients treated by a physician in a peer group with higher T1 use of moderately hypofractionated adjuvant EBRT were more likely to receive moderately hypofractionated adjuvant EBRT in T2 (adjusted odds ratio = 2.03; 95% confidence interval, 1.62-2.54, vs adjusted odds ratio = 2.61; 95% confidence interval, 2.04-3.35, for peer groups where 21%-46% and 47%-100% of radiation oncologists used moderately hypofractionated adjuvant EBRT in T1, respectively, compared with peer groups with no use of moderately hypofractionated adjuvant EBRT). In contrast, there was no significant relationship between T1 peer group use and T2 receipt of short-course palliative EBRT for bone metastases. ConclusionsPhysician peer groups significantly influenced use of short-course EBRT in adjuvant therapy but not in palliative therapy for patients with breast cancer.

Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy

ObjectiveTo compare the prevalence of patient-reported lower-extremity lymphedema (LEL) with sentinel lymph node (SLN) mapping versus comprehensive lymph node dissection (LND) for the surgical management of newly diagnosed endometrial carcinoma. MethodsPatients who underwent primary surgery for endometrial cancer from 01/2006-12/2012 were mailed a survey that included a validated 13-item LEL screening questionnaire in 08/2016. Patients diagnosed with LEL prior to surgery and those who answered ≤6 survey items were excluded. ResultsOf 1275 potential participants, 623 (49%) responded to the survey and 599 were evaluable (180 SLN, 352 LND, 67 hysterectomy alone). Median BMI was similar among cohorts (P = 0.99). External-beam radiation therapy (EBRT) was used in 10/180 (5.5%) SLN and 35/352 (10%) LND patients (P = 0.1). Self-reported LEL prevalence was 27% (49/180) and 41% (144/352), respectively (OR, 1.85; 95% CI, 1.25–2.74; P = 0.002). LEL prevalence was 51% (23/45) in patients who received EBRT and 35% (170/487) in those who did not (OR, 1.95; 95% CI, 1.06–3.6; P = 0.03). High BMI was associated with increased prevalence of LEL (OR, 1.04; 95% CI, 1.02–1.06; P = 0.001). After controlling for EBRT and BMI, LND retained independent association with an increased prevalence of LEL over SLN (OR, 1.8; 95% CI, 1.22–2.69; P = 0.003). Patients with self-reported LEL had significantly worse QOL compared to those without self-reported LEL. ConclusionsThis is the first study to assess patient-reported LEL after SLN mapping for endometrial cancer. SLN mapping was independently associated with a significantly lower prevalence of patient-reported LEL. High BMI and adjuvant EBRT were associated with an increased prevalence of patient-reported LEL.

Extraneural metastatic anaplastic ependymoma: a systematic review and a report of metastases to bilateral parotid glands.

Anaplastic ependymoma with extraneural metastases is associated with a poor clinical outcome. Metastatic spread to the parotid gland is a rare clinical entity that requires multidisciplinary intervention. Herein, we present a systematic review of anaplastic ependymoma with extraneural metastases and report on a case with metastases to both parotid glands. Electronic databases were searched from their inception to February 2019. Inclusion criteria included reports of anaplastic ependymoma with extraneural metastasis. Studies were excluded if the tumor grade was not reported. A case illustration is provided. The search yielded 15 cases of anaplastic ependymoma with extraneural metastases, including the present case. Mean age at diagnosis was 15 years. The initial tumor location was predominantly supratentorial (93.3%). All cases demonstrated leptomeningeal seeding before extraneural metastasis. Mean survival from initial diagnosis was 4.5 years. Metastasis to the parotid gland occurred in 2 cases, including the present case. We present a 17-year-old female patient who underwent gross total resection of a supratentorial, paraventricular anaplastic ependymoma followed by adjuvant external beam radiation therapy. The patient developed recurrent leptomeningeal seeding, treated with Gamma Knife radiosurgery over a 5-year period. She returned with a parotid mass and cervical lymphadenopathy and underwent parotidectomy and modified radical neck dissection. She continued to experience recurrences, including the left parotid gland, and was ultimately placed in hospice care. Anaplastic ependymoma with extraneural metastasis is rare. A combination of repeated surgical resection, radiation therapy, and chemotherapy can be used to manage recurrent and metastatic disease, but outcomes remain poor.