Locoregional Recurrence Research Articles

Impact of Margins on Outcomes in HPV-Related Oropharyngeal Squamous Cell Carcinoma Treated With Surgery Only.

This study aims to evaluate the prognostic impact of surgical margin status in HPV-related oropharyngeal squamous cell carcinoma (OPSCCa) and examine the potential for revising surgical margin standards in HPV+ OPSCCa. A retrospective cohort study. This study was conducted across 4 tertiary oncology centers. Charts of patients treated from 2010 to 2022 for HPV+ OPSCCa were reviewed. Eligible patients underwent surgery without adjuvant treatment for nonrecurrent, nonmetastatic HPV+ OPSCCa. Demographic, oncologic, treatment, and outcome data were collected. Patients with prior head and neck radiation or adjuvant therapy were excluded. Local control, locoregional recurrence (LRR), disease-free survival (DFS), and overall survival (OS) were compared based on surgical margins using the Kaplan-Meier method. Among 194 qualified cases, with a median follow-up of 41.63 months, most cases were pT1 (64.43%) or pT2 (34.54%). Recurrence occurred in 8.76% of patients, with most salvaged successfully. Analysis on univariable and multivariable modeling determined that margins less than 1 mm were considered close, and those ≥1 mm were considered clear. On multivariable modeling, surgical margins of <1 mm were associated with a hazard ratio of 3.69 (95% confidence interval [CI] 1.47-9.30) for LRR and 2.95 (95% CI 1.41-6.16) for DFS when compared to cases where margins were clear by 1 mm or greater. In this multi-institutional cohort of early-stage HPV+ OPSCCa treated surgically without adjuvant therapy, margins <1 mm were associated with worse LRR and DFS. This suggests that traditional definitions of close margins in HPV-negative disease may not apply to HPV+ OPSCCa, warranting a revised definition for surgical margin standards.

Comparison of Margin Quality for Intersegmental Plan Identification in Pulmonary Segmentectomy

Background and Objectives: Insufficient margin in lung cancer is associated with an increased locoregional recurrence rate. In pulmonary segmentectomy, two commonly used methods for identifying the intersegmental plane are inflation–deflation and indocyanine green dyeing. The aim of this study was to compare these two methods in terms of quality margins and to evaluate their superiority. Materials and Methods: A total of 63 patients who underwent segmentectomy via video-assisted thoracoscopic surgery (VATS) for pulmonary nodules and underwent preoperative planning with 3D modeling between October 2020 and February 2024 were included in this study. The location of the nodule and the distance to the intersegmental margins were virtually measured preoperatively using an open-source 3D modeling system. Patients were grouped according to the method of identifying the intersegmental margins. Group 1 included segmentectomies performed by the inflation–deflation method (n = 42), and Group 2 included segmentectomies performed by systemic indocyanine green (ICG) injection (n = 21). The area where the histopathological nodule was measured closest to the intersegmental margin was recorded. Values within (+/−10 mm) compared to the value measured in the three-dimensional model were considered successful. The obtained data were statistically compared between the groups. Results: There was no difference between the groups in terms of virtual and pathological margins. However, in terms of margin quality, the rate of deviation detected in the pathological margin compared to the measured virtual margin was significantly different between the groups (p = 0.04). Accordingly, the success rate was 64.3% in Group 1 and 90.5% in Group 2 (p = 0.05). In Group 1, the failure rate was highly against the adjacent parenchyma. There was no significant difference between the groups in the analysis of simple and complex segmentectomies. Conclusions: Intersegmental plane identification with indocyanine green increases the margin quality by defining resection margins closer to the virtual margins. In the inflation–deflation method, unnecessary parenchymal loss occurs due to disadvantages in identifying intersegmental margins.

Patterns of Recurrence after D2 Radical Surgery for Gastric Cancer: Implications for Postoperative Radiotherapy.

Patterns of Recurrence after D2 Radical Surgery for Gastric Cancer: Implications for Postoperative Radiotherapy.

Hypofractionated Versus Conventional Fractionated Radiotherapy for Patients with Triple Negative Breast Cancer: A Single Institution Randomized Trial

Introduction: Delivering hypofractionated radiotherapy schedules for patients with breast cancer is a growing interest. The current study aimed to determine whether hypofractionated radiotherapy is as effective and safe as conventional fractionated radiotherapy for patients with triple negative breast cancer, irrespective of lymph node status or surgical type. Methods: The current study is a randomized, open-label trial. A total of 148 female participants with non-metastatic triple negative breast cancer (TNBC) were recruited from January 2019 to December 2023. Eligible participants were randomly assigned (1:1) for hypofractionated schedule or conventional radiotherapy schedule. The trial included all non-metastatic TNBC eligible to adjuvant radiotherapy due to positively involved lymph nodes or high-risk features of the primary tumor. The 3- year Loco-regional recurrence free survival (RFS) was the primary end point. Results: At a median follow-up of 24 months, seven (5.3%) patients had developed locoregional recurrence, all of them in hypofractionated radiotherapy (RT) arm. The 3-year Loco-regional RFS rate was significantly higher in conventional RT arm compared to the hypofractionated RT arm (p &lt;0.001). The 3-year distant metastases free survival was not significantly differed in the two groups (p =0.121). The 3-year overall survival was 90.4%, with no significant difference between the groups (p= 0.091). Conclusion: The effectiveness of hypofractionated radiotherapy for disease control of triple-negative disease, irrespective of lymph node status or type of surgical interference remains questionable.

Breast cancer care for the aging population: a focus on age-related disparities in breast cancer treatment

ObjectiveBreast cancer is a significant health issue for women worldwide and poses unique challenges for all ages. Older women face many concerns about breast cancer treatment and outcomes. This study aims to compare breast cancer management and outcomes across various age groups within a single-center experience in a region with an aging population, focusing specifically on women aged 70 and older to identify potential disparities in treatment and prognosis.MethodsWe conducted a retrospective analysis of all female patients diagnosed with breast cancer at our local reference Breast Unit in northeastern Italy between January 2002 and July 2023. The primary outcome measures in this study were overall survival (OS), disease-free survival (DFS), cumulative loco-regional recurrences, and cumulative distant recurrences.ResultsThe study included 2478 women over 70 (31.12%), 4690 women aged between 45 and 69 (58.90%), and 795 women under 45 (9.98%). According to the study, older women were more likely to have advanced-stage cancer, whereas they received less aggressive treatment, including fewer adjuvant therapies and surgical interventions. We also observed worse prognoses in this group of patients if compared with women aged 45 to 69 years. Moreover, data showed that the incidence of breast cancer among older women has increased over time.ConclusionsOur findings highlight the need for tailored treatment strategies for older breast cancer patients to balance treatment efficacy with quality-of-life considerations. These findings call for a strategic reevaluation of treatment protocols and emphasize the importance of personalized care, particularly for older women, to improve outcomes without sacrificing the quality of life while maintaining maximum survival potential.

Fully Digital Workflow for an Immediate Implant-Retained Prosthesis Following Maxillectomy Resection Surgery.

This case report aimed to describe a digital workflow from 3D virtual surgical planning for tumor resection, maxillary implant placement, and an implant-retained prosthesis to fit the planned defect for immediate loading. A 68-year-old male was diagnosed with squamous cell carcinoma of the anterior maxilla. Intraoral scans and computed tomographs were taken preoperatively to digitally design and print a surgical resection guide, an implant placement guide, and a prosthetic bridge for immediate placement. The preoperative designed and manufactured prosthesis accurately matched the virtual surgical plan resection and implant positioning. The prosthesis could be placed and fixated for immediate loading. A 3-year follow-up found no locoregional recurrence, stability of the maxillary framework, and implants and prosthesis with a satisfactory aesthetic outcome. This case documents the importance of careful preoperative surgical planning and the opportunities for a fully digital workflow for oral cancer rehabilitation.

All segments are created equal: locoregional recurrence and survival after single versus multi-segment resection in patients with clinical stage IA ≤ 2 cm non-small cell lung cancer.

Compare oncologic outcomes between single-segment and multi-segment resections in patients with clinical stage IA1 and IA2 non-small cell lung cancer. A retrospective review (2011-2022) was conducted using a prospectively maintained database. Patients undergoing anatomical segmentectomy for clinical stage IA ≤ 2 cm non-small cell lung cancers were included. Patients were grouped into single-segment and multi-segment resections. Patients were excluded if they had neuroendocrine tumors, small cell lung cancer, underwent wedge resection, or lobectomy. The primary outcome was loco-regional recurrence. Secondary outcomes of disease-free survival, loco-regional recurrence-free survival, overall survival, pathologic upstaging, and perioperative complications were evaluated. 190 (63.8%) patients had single-segment resection and 108 (36.2%) had multi-segment resection. The single-segment resection group had smaller tumors (1.3 vs 1.45 cm, p = 0.02), but no significant difference in margin length (1.7 vs 2 cm, p = 0.15). Fewer lymph nodes were resected in single-segment resection (7 vs 10, p < 0.001), and a significantly lower rate of pathologic upstaging (4.2% vs 10.2%, p = 0.03) was observed compared with multi-segment resection. Nevertheless, loco-regional recurrence developed in 6.3% of patients after single-segment resection and 7.4% patients following multi-segment resection (p = 0.72). With a median follow-up duration of 40 months, five-year disease-free survival, loco-regional recurrence-free survival, and overall survival was 73%, 89%, and 87% following single-segment resection compared to 78%, 95%, and 84% after multi-segment resection. For patients with clinical stage IA non-small cell lung cancers ≤2 cm, loco-regional recurrence and survival is not different based on whether patients receive a single-segment or multi-segment resection.

Change in diffusion weighted imaging after induction chemotherapy outperforms RECIST guideline for long-term outcome prediction in advanced nasopharyngeal carcinoma

PurposeTo investigate change in diffusion weighted imaging (DWI) between pre-treatment (pre-) and after induction chemotherapy (post-IC) for long-term outcome prediction in advanced nasopharyngeal carcinoma (adNPC).Materials and methodsMean apparent diffusion coefficients (ADCs) of two DWIs (ADCpre and ADCpost−IC) and changes in ADC between two scans (ΔADC%) were calculated from 64 eligible patients with adNPC and correlated with disease free survival (DFS), locoregional recurrence free survival (LRRFS), distant metastases free survival (DMFS), and overall survival (OS) using Cox regression analysis. C-indexes of the independent parameters for outcome were compared with that of RECIST response groups. Survival rates between two patient groups were evaluated and compared.ResultsUnivariable analysis showed that high ΔADC% predicted good DFS, LRRFS, and DMFS p < 0.05), but did not predict OS (p = 0.40). Neither ADCpre nor ADCpost−IC (p = 0.07 to 0.97) predicted outcome. Multivariate analysis showed that ΔADC% independently predicted DFS, LRRFS, and DMFS (p < 0.01 to 0.03). Compared with the RECIST groups, the ΔADC% groups (threshold of 34.2%) showed a higher c-index for 3-year (0.47 vs. 0.71, p < 0.01) and 5-year DFS (0.51 vs. 0.72, p < 0.01). Compared with patients with ΔADC%<34.2%, patients with ΔADC%≥34.2% had higher 3-year DFS, LRRFS and DMFS of 100%, 100% and 100%, respectively (p < 0.05).ConclusionResults suggest that ΔADC% was an independent predictor for long-term outcome and was superior to RECIST guideline for outcome prediction in adNPC. A ΔADC% threshold of ≥ 34.2% may be valuable for selecting patients who respond to treatment for de-escalation of treatment or post-treatment surveillance.

Body composition as a potential biomarker of recurrence risk in patients with triple-negative breast cancer.

Triple-negative breast cancer (TNBC) patients are at increased risk for recurrence compared to other subtypes of breast cancer. Previous evidence showed that adiposity may contribute to worsened cancer control. Current measures of obesity, such as body-mass index (BMI), are poor surrogates of adiposity, while visceral-to-subcutaneous adiposity ratio (VSR), which can be measured from routine computed tomography (CT) imaging, is a direct adiposity measure. We hypothesized that VSR is a stronger predictor of recurrence compared with BMI in patients with TNBC. This study includes 162 women with stage I-III TNBC who completed standard of care therapy. Measures of body composition, including VSR, visceral adiposity (VA), and subcutaneous adiposity (SA), were estimated using a semi-automated quantitative imaging tool on CT images of the abdomen at the level of L2-L3. Anthropometric measures included BMI and waist circumference and were obtained from CT images. Associations of adiposity measures and recurrence risk were assessed using Fine and Gray competing risk models with death as a competing risk and age at diagnosis and clinical disease stage as covariates. During a median follow-up time of 7.1years, 55 patients had recurrence. The median BMI at baseline was 30.2 [Quartiles: 26.3-35.2]. Body composition was not associated with overall or locoregional recurrence. VSR was significantly associated with an increased risk of distant recurrence, with a subdistribution hazard ratio of 4.25 (95% CI: 1.06-17.02), p = 0.041. By contrast, BMI was not associated with any recurrence risk. Consistent with our hypothesis, VSR was associated with a significant risk of distant recurrence and therefore may be a prognostic biomarker. Future directions include interventions targeting VSR reduction among patients with TNBC and VSR-directed therapy modulation.

Chemotherapy before or after preoperative chemoradiotherapy and surgery for locally advanced rectal cancer: 5-year results of the CAO/ARO/AIO-12 trial - a general pairwise comparison.

Chemotherapy before or after preoperative chemoradiotherapy and surgery for locally advanced rectal cancer: 5-year results of the CAO/ARO/AIO-12 trial - a general pairwise comparison.

Mastectomy Alone or with Immediate Breast Reconstruction: Trend, Precipitating Factors, Patients Reported Outcome, and Oncologic Safety Analysis with and without Propensity Score Matching from 3759 Mastectomy Patients.

In the current study, we surveyed the trend of breast cancer operations in the past two decades and compared mastectomy alone or with immediate breast reconstruction (IBR) with the measurement of the outcome reported by patients and oncologic safety evaluation. A retrospective study surveyed the trends in breast cancer surgery methods at a single institution between January 2000 and December 2021. Clinical manifestations, outcomes, patient-reported outcome measures, and oncologic safety evaluations between mastectomy alone or with IBR were analyzed, with and without propensity score matching (PSM). The trend of breast cancer operations showed that breast-conserving surgery (BCS) and mastectomy with IBR were increasing while mastectomy alone was decreasing. Among the 3759 patients who underwent mastectomies, 1091 (29%) patients had mastectomy with IBR while 2668 (71%) received mastectomy alone. In multivariate analysis, age less than 45 years, breast magnetic resonance imaging before surgery, luminal A subtype, nipple-sparing mastectomy, oncoplastic reconstructive breast surgeon, and high-volume surgeon were important independent factors for mastectomy with IBR. Mastectomy with IBR was associated with better patient-reported cosmetic results than mastectomy alone and comparable to BCS. After PSM and a median follow-up of 106.1 months, there was no difference in Kaplan-Meier survival curve analysis between patients who underwent mastectomy alone or mastectomy with IBR in terms of locoregional recurrence, distant metastasis or overall survival. Mastectomy with IBR demonstrated better reported cosmetic outcomes and comparable oncologic safety compared to mastectomy alone. Independent factors promoting IBR were identified, which could help increase the breast reconstruction rate. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The impact of loco-regional treatment on ipsilateral breast cancer recurrence and outcomes in carriers of BRCA1/2 pathogenic variants.

Our previous data showed that carriers of germline BRCA1/2 pathogenic variants (PV) with breast cancer (BC) treated with mastectomy without post-mastectomy radiation therapy (PMRT) had higher rates of loco-regional recurrence (LRR) compared to those who underwent PMRT or breast-conserving therapy (BCT), despite earlier stage BC. Our aim was to verify our previous findings in a larger cohort. Clinical data were extracted from the medical records of BRCA1/2 mutation carriers with BC, treated at a single institution between 1/2006 and12/2022. The data included demographics, treatment modalities, and BC outcomes. A total of 464 patients with 484 primary tumors were analyzed. Of these, 48.3% mastectomies were performed: 66% (154) without PMRT (non-PMRT) and 34% (80) with PMRT; 51.8% (250) underwent BCT. The non-PMRT group had earlier disease stages at diagnosis (77.3% were Tis and T1N0 stage) compared to the PMRT and BCT groups (3.8% and 45%, respectively, p < 0.001). During the study period with a median follow-up time of 75 months (range 12-211), the LRR rate was 13% (20/154) in the non-PMRT cohort compared with 1.25% (1/80) in the PMRT group (p = 0.003), and 6.4% (16/250) in the BCT group (p = 0.03). Cumulative incidence of LRR at 5 and 15 years was 14.7%, and 16.6% in the non-PMRT, compared to 5.1% and 35% in the BCT group, respectively (p = 0.081). No significant difference in overall survival was observed (p = 0.202). The timing and rates of LRRs differ according to the loco-regional therapy, which might indicate a different etiology driving these events.

Factors associated with locoregional recurrence after neoadjuvant chemotherapy for breast cancer in a safety-net medical center.

The management of locally advanced breast cancer poses significant challenges, with contemporary strategies involving an approach that combines systemic and local treatment. The current study was performed to validate the clinical impression that locoregional recurrences have become increasingly uncommon after standardized multimodal treatment protocol.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.All authors and affiliations are correct. A retrospective analysis was performed using a single-institution database that included clinical, radiographic, and pathologic parameters for all non-metastatic and non-inflammatory breast cancer patients treated with neoadjuvant chemotherapy (NAC) from 2015 to 2023. Uni- and multivariable analyses were performed to define associations between clinical factors, recurrence, and RFS. The median age was 51years for 274 predominantly Hispanic (78%) patients, with a median follow-up of 38.1months. The recurrence rates were 4% local, 2% regional, and 18% distant. Median time from surgery to local recurrence was 8.2months and to regional recurrence was 9.7months. There were no locoregional clinical recurrences in 92 (34%) patients who had pCR or in 85 (31%) patients who had radiological complete response after NAC. Locoregional recurrences were uncommon > 12months after surgery. Five of 11 local recurrences occurred in patients who had a poor response to NAC (ypT4b). All 6 patients having regional recurrences had adjuvant radiation therapy, and only 2 occurred in patients who were pathologically node-negative (ypN0) post-NAC. Favorable responses to NAC were associated with excellent locoregional control rates. Results achieved for predominantly Hispanic patients at a safety net medical center were similar to those reported in prospective, randomized clinical trials.

Inflammatory breast cancer response to modern neoadjuvant chemotherapy: Tumor response and survival outcomes.

Inflammatory breast cancer response to modern neoadjuvant chemotherapy: Tumor response and survival outcomes.

Real-Life Cohort of Patients With Resected High-Risk Melanoma Treated by Adjuvant Anti-PD1 Therapy.

Programmed cell death protein-1 (PD1) antibodies are currently the standard treatment for resected high-risk melanoma, yet recurrence rate remains high. This real-life observational study aimed to describe the outcomes of patients with resected high-risk melanoma following adjuvant anti-PD1 immunotherapy and identify factors associated with recurrence risk. A total of 235 patients with resected stage III/IV melanoma treated with adjuvant nivolumab or pembrolizumab were included. Imaging scans and cerebral imaging were performed every 12 weeks to detect recurrences. Adverse events were collected. Univariate and multivariate analyses were performed to identify predictive factors of recurrence. Overall survival (OS) and recurrence-free survival (RFS) were estimated. Among the 235 patients, 103 experienced at least one recurrence (43%); first recurrences were predominantly locoregional (47%). Thepredictive factor for recurrence identified by multivariate analysis was ulceration (RR 2,03, 95% CI [1,20; 2,86]). RFS was estimated at 75% [70-81] at 12 months and at 64% [58-71] at 24 months. RFS at 12 months was significantly lower in patients with ulcerations (RFS at 83%) compared to those without ulceration (RFS at 66%), p < 0.01. Overall survival (OS) was estimated at 91% [87%-94%] at 12 months and 84% [79%-89%] at 24 months. The OS after a first recurrence was estimated at 69% [60%-80%] at 12 months and decreased to 43% [32%-57%] at 24 months. After a first locoregional recurrence, surgery with a year of adjuvant immunotherapy (40%) was the favoured therapeutic approach. For distant recurrences, clinical trial enrolment was preferred (21%). Double curative immunotherapy was the preferred strategy for cerebral recurrences (30%). In this cohort, nearly half of the patients underwent recurrences and RFS at 24 months was 64%. The RFS and OS data were comparable o those reported in the pivotal study Ulceration was the only significant predictive factor for recurrence, associated with decreased RFS at 24 months.

Controversies in vulvar cancer: revisiting the margin of error.

Despite an oftentimes radical surgical approach when treating patients with early-stage vulvar cancer, local recurrence occurs in approximately 40% of cases. Surgery in this setting can result in significant morbidity; however, treatment failure is associated with high mortality rates. Historically, many guidelines recommended a tumor-free margin ≥8 mm in the surgical treatment of vulvar cancer, although this is largely consensus-based and supported by a few small retrospective case series. Recently, numerous retrospective studies have found no association between a tumor-free margin of <8 mm and locoregional recurrence. Emerging evidence suggests that the presence of differentiated vulvar intra-epithelial neoplasia and lichen sclerosis at the pathologic margin may also play a role in local recurrence; however, data are retrospective and heterogenous, and the definition of what a "safe" tumor-free margin is remains unclear. However, increasing evidence has failed to demonstrate the beneficial role of re-excision or adjuvant radiation in the setting of margins of <8 mm. These additional treatments are associated with significant morbidity and have a negative impact on patients' quality of life; thus, they should be reserved solely for patients with positive margins. One of the main challenges in finding the ideal tumor-free margin is that the rarity of vulvar cancer makes prospective and randomized controlled trials difficult to conduct. Therefore, it is imperative that we make a concerted effort as a field to collaborate across nations and institutions, promote centralization of care for rare tumors, and prioritize future work to better understand the nature of this disease.

Melanoma Acral en Población Caucásica: Estudio de Cohorte sobre Factores Epidemiológicos, Clinicopatológicos y Pronósticos

Melanoma Acral en Población Caucásica: Estudio de Cohorte sobre Factores Epidemiológicos, Clinicopatológicos y Pronósticos

Spatial Radiomic Graphs for Outcome Prediction in Radiation Therapy-treated Head and Neck Squamous Cell Carcinoma Using Pretreatment CT.

Purpose To develop a radiomic graph framework, RadGraph, for spatial analysis of pretreatment CT images to improve prediction of local-regional recurrence (LR) and distant metastasis (DM) in head and neck squamous cell carcinoma (HNSCC). Materials and Methods This retrospective study included four public pre-radiotherapy treatment CT datasets of patients with HNSCC obtained from The Cancer Imaging Archive (images collected between 2003 and 2018). Computational graphs and graph attention deep learning methods were leveraged to holistically model multiple regions in the head and neck anatomy. Clinical features, including age, sex, and human papillomavirus infection status, were collected for a baseline model. Model performance in predicting LR and DM was evaluated via area under the receiver operating characteristic curve (AUC) and qualitative interpretation of model attention. Results A total of 3434 patients (61 years ± 11 [SD], 2774 male) were divided into training (n = 1576), validation (n = 379), and testing (n = 1479) datasets. RadGraph achieved AUCs of up to 0.83 and 0.90 for LR and DM prediction, respectively. RadGraph showed higher performance compared with the clinical baseline (AUCs up to 0.73 for LR prediction and 0.83 for DM prediction) and previously published approaches (AUCs up to 0.81 for LR prediction and 0.87 for DM prediction). Graph attention atlases enabled visualization of regions coinciding with cervical lymph node chains as important for outcome prediction. Conclusion RadGraph leveraged information from tumor and nontumor regions to effectively predict LR and DM in a large multi-institutional dataset of patients with radiation therapy-treated HNSCC. Graph attention atlases enabled interpretation of model predictions. Keywords: CT, Informatics, Neural Networks, Radiation Therapy, Head/Neck, Computer Applications-General (Informatics), Tumor Response, Head and Neck Squamous Cell Carcinoma, Locoregional Recurrence, Radiotherapy, Deep Learning, Radiomics Supplemental material is available for this article. © RSNA, 2025.

Leveraging Artificial Intelligence and Radiomics for Improved Nasopharyngeal Carcinoma Prognostication.

Nasopharyngeal carcinoma (NPC) typically presents as advanced disease due to the lack of significant symptoms in the early stages. Accurate prognostication is therefore challenging as current methods based on anatomical staging often lack the granularity to differentiate between patients with differing prognoses. This study investigates the potential of radiomics to improve the prediction of locoregional recurrence (LRR) and overall survival in patients with NPC. Radiomic features were extracted from radiotherapy planning CT scans for 294 NPC patients divided into training (n = 147) and validation (n = 147) sets. A feature selection step utilising feature clustering and mutual information classifier to select six key radiomic features was employed to reduce redundancy and improve interpretability. Models were trained using clinical data, radiomic features, and these in combination to predict 2-year LRR, with performance assessed on the left-out independent validation set. Combining radiomic features with clinical data resulted in the best performance for predicting 2-year LRR (Area Under the Curve, AUC 0.76) compared to prediction using clinical or radiomic features alone (mean AUC 0.56 and 0.57, respectively). Risk stratification based on the combined model was significant for LRR-free survival and overall survival (p < 0.01). Key radiomic features included tumour size, intensity distribution, overall textural patterns, and distribution of fine and coarse textured regions. Radiomics holds promise for improving NPC risk stratification, potentially allowing for personalised treatment strategies. The most important radiomics feature, maximum 2D diameter, suggests a need to reconsider tumour size as a prognostic criterion despite its current exclusion from TNM staging. Larger prospective studies are needed to validate these findings.

Phase II Evaluation of Ultra-Hypofractionated Postoperative Radiation Therapy for Breast Cancer: Toxicity and Efficacy in a Single-Center Nonrandomized Prospective Study.

To evaluate the toxicity profile and efficacy of postoperative ultra-hypofractionated radiation therapy in elderly patients with breast cancer. This is a nonrandomized, single-center, prospective Phase II trial. Patients with breast cancer older than 65 years were treated with ultra-hypofractionated radiation therapy in 5 fractions of 5.7 Gy on alternate days in the breast or chest wall, or regional lymph nodes. The primary end point was acute toxicity. A total of 60 patients were analyzed, with a median follow-up of 42.5 months (range, 13.8-66.2). Most patients presented pathologic stage I (56.6%, n = 34) or stage II (33.3%, n = 20) disease. Regional lymph node irradiation was performed in 22% (n = 13) of patients. During treatment, 51% (n = 31) of patients experienced grade 1 or 2 acute toxicity, with no cases of grade 3 acute toxicity reported. Late toxicity included 1.7% (n = 1) of patients developing grade 3 fibrosis and 1.7% (n = 1) developing grade 3 pneumonitis. Regional lymph node irradiation was not associated with a statistically significant increase in toxicity risk (P = .194). Cosmesis evaluations revealed no significant changes when comparing pretreatment assessments with evaluations at 10 weeks (P = .223) and 26 weeks (P = .615) post-treatment. Quality of life was not adversely affected, regardless of whether regional lymph nodes were irradiated. Recurrence rates included two patients with both locoregional and distant recurrence and five patients with distant recurrence. The 3-year disease-free survival probability was 81.7%, and the 3-year overall survival probability was 86.7%. This study demonstrates the safety of ultra-hypofractionated radiation therapy in terms of toxicity in patients with breast cancer. The findings for side effects, cosmesis, quality of life, and survival outcomes are consistent with those observed in moderately hypofractionated radiation therapy regimens, suggesting its use as a viable treatment option in this demographic.