Palliative Radiotherapy Research Articles

Prognostic impact of local recurrence and timing of palliative radiotherapy in patients with unresectable recurrent rectal cancer.

132 Background: The standard treatment for unresectable recurrent rectal cancer (URRC) is chemotherapy (CTx) regardless of local recurrence (LR). Approximately 80% of patients with LR experience LR-related pain, making these patients difficult to treat, especially the timing of radiotherapy (RT). However, the impact of LR and the appropriate timing of palliative RT on prognosis in patients with URRC remains unclear. Methods: This retrospective study included patients with URRC who had an ECOG Performance Status (PS) of 0–2 and received fluoropyrimidines plus oxaliplatin and/or irinotecan as first-line CTx between September 2006 and December 2020 at a single institution. Patients were divided into two groups: patients with LR (LR+) and patients without LR (LR−). Progression-free survival (PFS), overall survival (OS), and post-progression survival (PPS) after first-line CTx were compared between the two groups. The association between receiving palliative RT for LR-related symptoms until disease progression after first-line CTx and the proportion of patients receiving subsequent second-line CTx was also evaluated in the LR+ group. Multivariate Cox analysis, including variables with p < 0.10 in univariate analyses, was performed for PPS. Results: The LR+ and LR− groups included 49 and 99 patients, respectively. No significant differences in the baseline characteristics were detected between the two groups, except liver metastasis, which occurred less frequently in the LR+ group. OS and PPS were shorter in the LR+ group compared with the LR- group (median OS, 33.4 vs. 48.2 months; hazard ratio [HR], 1.52; p = 0.05; median PPS, 17.2 vs. 23.5 months; HR, 1.77; p = 0.01). PFS was similar between the two groups (median PFS, 13.0 vs. 15.8 months; HR, 1.18; p = 0.39). Fewer patients in the LR+ group received second-line CTx compared with the LR- group (68 vs. 83%, p = 0.06). The proportions of patients with PS ≥ 1 (78 vs. 52%, p = 0.007) and PS deterioration at progression after first-line CTx (59 vs. 27 %, p = 0.002) were higher in the LR+ group compared with the LR group-. The most common cause of PS deterioration in the LR+ group was LR-related pain (77%). Among patients with LR-related pain, the proportion of patients receiving subsequent second-line CTx was numerically lower in patients who did not receive palliative RT than in patients who did receive palliative RT until disease progression after first-line CTx (75 vs. 54%, p = 0.23). Multivariate analysis revealed that receiving subsequent second-line CTx was an independent prognostic factor for PPS in LR+ patients (adjusted HR, 4.77; p = 0.006). Conclusions: The presence of LR is associated with poor prognosis in URRC, which may be due to worsening PS caused by LR-related symptoms and the lower proportion of subsequent CTx. Thus, palliative RT should be recommended more actively when LR becomes symptomatic.

Prophylactic Radiotherapy Of MInimally Symptomatic Spinal Disease (PROMISSeD): study protocol for a randomized controlled trial

BackgroundEarly palliative/pre-emptive intervention improves clinical outcomes and quality of life for patients with metastatic cancer. A previous signal-seeking randomized controlled trial (RCT) demonstrated that early upfront radiotherapy to asymptomatic or minimally symptomatic high-risk osseous metastases led to reduction in skeletal-related events (SREs), a benefit driven primarily by subgroup of high-risk spine metastasis. The current RCT aims to determine whether early palliative/pre-emptive radiotherapy in patients with high-risk, asymptomatic or minimally symptomatic spine metastases will lead to fewer SREs within 1 year.MethodsThis is a single-center, parallel-arm, in-progress RCT in adults (≥ 18 years) with ECOG performance status 0–2 and asymptomatic or minimally symptomatic (not requiring opioids) high-risk spine metastases from histologically confirmed solid tumor malignancies with > 5 sites of metastatic disease on cross-sectional imaging. High-risk spine metastases are defined by the following: (a) bulkiest disease sites ≥ 2 cm; (b) junctional disease (occiput to C2, C7-T1, T12-L2, L5-S1); (c) posterior element involvement; or (d) vertebral body compression deformity > 50%. Patients are randomized 1:1 to receive either standard-of-care systemic therapy (arm 1) or upfront, early radiotherapy to ≤ 5 high-risk spine lesions plus standard-of-care systemic therapy (arm 2), in the form of 20–30 Gy of radiation in 2–10 fractions. The primary endpoint is SRE, a composite outcome including spinal fracture, spinal cord compression, need for palliative radiotherapy, interventional procedures, or spinal surgery. Secondary endpoints include (1) surrogates of health care cost, including the number and duration of SRE-related hospitalizations; (2) overall survival; (3) pain-free survival; and (4) quality of life. Study instruments will be captured pre-treatment, at baseline, during treatment, and at 1, 3, 6, 12, and 24 months post-treatment. The trial aims to accrue 74 patients over 2 years to achieve > 80% power in detecting difference using two-sample proportion test with alpha < 0.05.DiscussionThe results of this RCT will demonstrate the value, if any, of early radiotherapy for high-risk spine metastases. The trial has received IRB approval, funding, and prospective registration (NCT05534321) and has been open to accrual since August 19, 2022. If positive, the trial will expand the scope and utility of spine radiotherapy.Trial registrationClinicalTrials.Gov NCT05534321. Registered September 9, 2022.Trial statusVersion 2.0 of the protocol (2021-KOT-002), revised last on September 2, 2022, was approved by the WCG institutional review board (Study Number 1337188, IRB tracking number 20223735). The trial was first posted on ClinicalTrials.Gov on September 9, 2022 (NCT05534321). Patient enrollment commenced on August 19, 2022, and is expected to be completed in 2 years, likely by August 2024.

Robust optimization of a radiotherapy pretreatment preparation workflow

Objective. Increasing cancer incidence, staff shortage and high burnout rate among radiation oncologists, medical physicists and radiation technicians are putting many departments under strain. Operations research (OR) tools could optimize radiotherapy processes, however, clinical implementation of OR-tools in radiotherapy is scarce since most investigated optimization methods lack robustness against patient-to-patient variation in duration of tasks. By combining OR-tools, a method was developed that optimized deployment of radiotherapy resources by generating robust pretreatment preparation schedules that balance the expected average patient preparation time (F mean) with the risk of working overtime (RoO). The method was evaluated for various settings of an one-stop shop (OSS) outpatient clinic for palliative radiotherapy. Approach. The OSS at our institute sees, scans and treats 3–5 patients within one day. The OSS pretreatment preparation workflow consists of a fixed sequence of tasks, which was manually optimized for radiation oncologist and CT availability. To find more optimal sequences, with shorter F mean and lower RoO, a genetic algorithm was developed which regards these sequences as DNA-strands. The genetic algorithm applied natural selection principles to produce new sequences. A decoder translated sequences to schedules to find the conflicting fitness parameters F mean and RoO. For every generation, fitness of sequences was determined by the distance to the estimated Pareto front of F mean and RoO. Experiments were run in various OSS-settings. Main results. According to our approach, the expected F mean of the current clinical schedule could be reduced with 37%, without increasing RoO. Additional experiments provided insights in trade-offs between F mean, RoO, working shift length, number of patients treated on a single day and staff composition. Significance. Our approach demonstrated that OR-tools could optimize radiotherapy resources by robust pretreatment workflow scheduling. The results strongly support further exploration of scheduling optimization for treatment preparation also outside a one-stop shop or radiotherapy setting.

Outcomes in dogs undergoing surgical stabilization and non-stereotactic radiation therapy for axial and appendicular bone tumors.

Information on dogs that undergo radiation therapy (RT) with non-stereotactic protocols in addition to surgical stabilization with implant placement for treatment of bone tumors is limited. Our primary objectives were to describe the clinical characteristics as well as short- and long-term outcomes, including complications, function, and disease progression, in dogs that underwent both surgical stabilization with implant placement and non-stereotactic RT for local treatment of a bone tumor. A bi-institutional retrospective case series was performed. Eight client-owned dogs that underwent both surgical stabilization with implant placement and non-stereotactic RT for local treatment of a bone tumor were included. Tumor types included osteosarcoma or suspected osteosarcoma (5), plasma cell tumor (2), and grade 3 fibrosarcoma (1). Radiation protocols were hypofractionated (palliative intent) in 5 dogs and fractionated (definitive intent) in 3 dogs. Five dogs experienced complications following both RT and surgery, including grade 1 complications in two dogs, a grade 2 complication in one dog, both grade 1 and 2 complications in one dog, and both grade 2 and 3 complications in one dog. Clinical signs subjectively improved in all dogs that had outcomes relative to function documented post-surgery/RT (7). Of these 7 dogs, 4 maintained long-term improvement in function and clinical signs, whereas 3 experienced subsequent recurrence/progression of clinical signs at a median of 133 days (range 91-186) postoperatively in association with biomechanical complications (screw loosening), surgical site infection, and local disease progression in 1 dog each; subsequent treatment resulted in improved clinical signs for each of these 3 dogs, such that overall good long-term functional outcomes were experienced. No dogs required amputation or additional vertebral surgery as salvage for local disease control or palliation. The median progression free interval was 206 days (range 25-1078), and the median survival time was 253 days (range 122-1078) with 1 additional dog lost to follow-up at 575 days. Two dogs experienced local disease progression, and 6 dogs experienced systemic disease progression; both dogs that developed local disease progression received palliative intent RT protocols. In this cohort, dogs with primary bone tumors that underwent surgical stabilization with implant placement and hypofractionated or fractionated non-stereotactic RT for local treatment had a low incidence of major complications, good limb function and ambulation post-treatment, and relatively prolonged survival times despite disease progression.

An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared With Conventional Palliative RT for Spinal Metastases

Purposexx.xx was a multicenter randomized controlled phase 2/3 trial conducted in Canada and Australia. Patients with painful spinal metastases were randomized to either 24 Gy/2 stereotactic body radiotherapy (SBRT) or 20 Gy/5 conventional external beam radiotherapy (CRT). The study met its primary endpoint demonstrating superior complete pain response rates (CRR) at 3 months following SBRT (35%) vs CRT (14%). SBRT planning and delivery is resource intensive. Given its benefits in xx.xx, we performed an economic analysis to determine the incremental cost-effectiveness of SBRT compared to CRT. MethodsThe trial recruited 229 patients. Cost-effectiveness was assessed using a Markov model taking into account observed survival, treatments costs, including retreatment, and quality of life (QoL) over the lifetime of the patient. The EORTC-QLU-C10D was used to determine QoL values. Transition probabilities for outcomes were from available patient data. Health system costs were from the Canadian health care perspective and based on 2021 Canadian dollars (CDN). The incremental cost-effectiveness ratio (ICER) was expressed as the ratio of incremental cost to quality-adjusted life years (QALY). Impact of parameter uncertainty was investigated using deterministic and probabilistic sensitivity analyses. RESULTSThe base case for SBRT compared to CRT had an ICER of $9,040CDN per QALY gained. Sensitivity analyses demonstrated that the ICER was most sensitive to variations in the utility assigned to the “No local failure” ($5,457CDN to $241,051CDN per QALY), adopting low and high estimates of utility) and the cost of the SBRT (ICERs ranging from $7,345 to $123,361CDN per QALY). It was more robust to variations in assumptions around survival and the response rate. ConclusionsSBRT is associated with higher upfront costs compared to CRT. The ICER shows that, within the Canadian health care system, SBRT with 2 fractions is likely to be cost-effective relative to CRT.

Abstract A002: Genotype-directed synthetic cytotoxicity of ATR inhibition with radiotherapy

Abstract The DNA damage response is crucial for the efficacy of radiotherapy (RT), prompting efforts to target this pathway with radiosensitizers to improve outcomes. Early clinical trials evaluating this approach, however, have failed to yield evidence of benefit in unselected populations. Here we demonstrate that a genotype-directed combination of DNA repair inhibition and RT can unleash the significant therapeutic benefit of this approach in pre-clinical models and present first experience from a Phase I/II trial (NCT05566574) testing this concept. Using CRISPR/Cas9, we created isogenic murine models (Atm-/- and WT) in 4T1 breast and CT26 colorectal cancer models, and then studied the synergy between camonsertib and RT across genotypes. In vitro, camonsertib radio-sensitized both Atm-/- and WT models, but was more potent and synergistic in Atm-/- models. In the orthotopically implanted 4T1 model, the combination of camonsertib (30 mg/kg, 3 days on; 4 days off) with RT (20Gy x 1) significantly delayed tumor growth in Atm-/- tumors compared to WT (p &amp;lt; 0.001; n=10 mice per group). Overall survival (OS) also improved in mice with Atm-/- tumors (20% alive at 150 days) vs. WT (0% alive; p &amp;lt; 0.001; log-rank test). Similar results were observed using other RT dose-fractionations (4Gy x 5 daily, 6Gy x 3, 8Gy x 2) with camonsertib. In the flank-implanted CT26 model, Atm-/- tumors had markedly improved response to combination therapy with 7/8 mice achieving a complete response (CR) compared to only 1/8 WT tumors (p&amp;lt;0.001). OS was also significantly improved with 87% of mice with CT26 Atm-/- tumors cured compared to 0% of CT26 WT tumors (p &amp;lt; 0.001). To evaluate the genotype-specificity for synergy from combination therapy, we performed similar experiments in a 4T1 Brca1-/- model, a key mediator of homologous recombination, and observed an absence of synergy, consistent with our hypothesis. Analysis of the microenvironment of 4T1 Atm-/- treated with combination therapy by flow cytometry did not reveal significant increases in CD4 or CD8 T-cells compared to vehicle nor increases in activated CD8 T-cells (Ki67+, PD1+, or GzmB+) suggesting the therapeutic benefit was primarily mediated by cell intrinsic effects. Similarly, re-challenge experiments in cured mice did not identify strong evidence of immunologic memory, again suggesting a modest immunologic role for efficacy of combination therapy in this setting. Based on these results, we initiated a Phase I/II study of camonsertib with RT (4Gy x 5) in patients with metastatic cancer that require palliative RT and have mutations in ATM (pathogenic or variant of unknown significance). The first two patients with pathogenic ATM mutant tumors enrolled in the Phase I portion of the study have demonstrated metabolic CR to combination therapy on PET scan. Overall, our findings suggest that genotype-directed concurrent radio-sensitization could represent a novel approach to develop more effective combinatorial synthetic cytotoxic RT-based treatments. Further research to test this hypothesis is ongoing. Citation Format: Victor Ng, Sonali Sinha, Ardijana Novaj, Jennifer Ma, Niamh McDermott, Ana Longhini, Rui Gardner, Ezra Rosen, Simon Powell, Diana Mandelker, Atif Khan, Jeremy Setton, Anne Roulston, Stephen Morris, Maria Koehler, Nancy Lee, Jorge Reis-Filho, Nadeem Riaz. Genotype-directed synthetic cytotoxicity of ATR inhibition with radiotherapy [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: DNA Damage Repair: From Basic Science to Future Clinical Application; 2024 Jan 9-11; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2024;84(1 Suppl):Abstract nr A002.

Survival analysis of palliative radiotherapy in patients with HER-2+ metastatic breast cancer.

Whether radiotherapy can improve the long-term survival of HER-2+ metastatic breast cancer remains unclear. We launched this study to explore the effect of HER-2+ metastatic breast cancer patients through anti-HER-2 targeted therapy + radiotherapy. 488 HER-2 + metastatic breast cancer patients who received anti-HER2 targeted ± local radiotherapy from March 2006 to September 2021 were retrospectively collected. Patients were divided into a radiotherapy group (n=207) and a non-radiotherapy group (n=281) based on whether they received radiotherapy or not. 1: 1 propensity matching analysis was used to determine two groups of patients with similar baselines. Before matching, the radiotherapy group (n=207) had a median overall survival (mOS) of 51.7 months (48.8-63.8), which was superior to the non-radiotherapy group's (n=281) mOS of 33.9 months (27.9-39.9) (P < 0.0001). Moreover, the radiotherapy group exhibited better 1-year (94.6% vs 83.9%), 3-year (70.8% vs 45.5%), and 5-year (43.3% vs 25.0%) survival rates compared to the control group. Propensity score matching analysis identified 135 pairs of baseline-matched patients. In the matched groups, the mOS was 57.2 (44.5-69.8) months in the radiotherapy group (n=135) and 34.1 (27.5-40.6) months in the non-radiotherapy group (n=135), showing a statistically significant difference (P < 0.0001). Additionally, the radiotherapy group demonstrated 1-, 3-, and 5-year survival rates of 93.2%, 71.5%, and 46.9%, respectively, while those in the non-radiotherapy group were 89.4%, 45.8%, and 22.2%, respectively. Multivariate Cox analysis revealed that the presence of brain metastasis, liver metastasis, and radiotherapy were identified as independent predictive factors significantly associated with OS. In patients with HER-2 positive metastatic breast cancer, radiotherapy was associated with better survival benefits compared to those who did not receive radiotherapy.

Survival Following Palliative Radiotherapy for Head and Neck Squamous Cell Carcinoma: Examining Treatment Indications in Elderly Patients.

This study investigated the survival outcomes of patients with head and neck squamous cell carcinoma (HNSCC) undergoing palliative radiotherapy, particularly focusing on challenges and factors associated with older age, providing insights into appropriate palliative radiotherapy use in this demographic. A retrospective study was conducted using electronic medical records of 73 patients with HNSCC who were deemed unsuitable for curative therapy. Palliative radiotherapy involved a uniform dose of 30 Gy in 10 fractions. Survival analysis was performed using Kaplan-Meier method, and multivariate analysis identified significant prognostic factors. The median overall survival was 7.5 months, with no significant difference between age groups. Karnofsky performance status (KPS) >70 correlated with favorable survival. Multivariate analysis confirmed KPS as an independent prognostic factor (hazard ratio=1.949, p=0.031). The results of this study align with those of previous studies, emphasizing the importance of palliative radiotherapy for HNSCC treatment. Optimal dose fractionation regimens remain undetermined, and tailored approaches that consider factors, such as age and performance status are crucial. Individualized, comprehensive assessments and supportive care measures enhance patient well-being, reflecting palliative care principles.

Comparison of Palliative Fractionated Radiotherapy to Thorax in Non-small Cell Lung Carcinoma: A Prospective Comparative Study

Background: Most patients of lung carcinoma come into the OPD with advance disease and with moderate to severe symptoms. Palliative Radiotherapy to chest can relieve symptoms arising due to intrathoracic pathology. Timing and fractionation schedule is very important for symptomatic relief and response. Time to come the effect of RT is 3 months. The aim of this study is to investigate survival after PTR and evaluate symptomatic relief and adverse effects of RT. Methods: Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of January 2022 to October 2022 at ATRCTRI Bikaner (Rajasthan). We noted pathology, tumor, node, and metastasis (TNM) classification of malignant tumors, stage, indication, starting date, schedule for PTR, completed yes/no, performance status (PS) and time of death. Results: Out of total 86 patients 12 patients did not complete RT. Rest 74 patients who received PTR included in the study, 30 patients (40%) died within 30 days and 15 patients died within 3 months of treatment. Only 20 patients remained alive at 6 months. More Symptomatic relief seen with 20 Gy in 5 fractions. More Survival seen with PS 1-2 and 30Gy/10fraction. Dyspnea, hemoptysis, and SVC syndrome were the most frequent indications for PTR in our study. Almost every patient noted for &gt;1 indication. Fractionated schedule 30Gy/10F used more frequently in good PS patients.Conclusions: Our study shows that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 1-2 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 1-2 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for comparatively shorter fractionation size or best supportive palliative care.&#x0D;

Assessment of sleep characteristics using Fitbit Charge 4 in head and neck cancer patients undergoing palliative chemotherapy and radiotherapy: a prospective observational study.

Sleep disturbance is prevalent among cancer patients. The quantification of this sleep disturbance is missing, especially in palliative care settings. The aim of this study was to study the sleep patterns of the patients undergoing palliative chemotherapy and radiotherapy for head and neck cancer (HNC) using a Fitbit Charge 4 sleep-tracking device. Prospective observational study. A total of 110 HNC patients undergoing palliative chemotherapy and radiotherapy at a tertiary care teaching hospital in Central India. Forty-four percent of patients had a poor sleep score (less than 60). Average sleep duration was 218.66 ± 139.05 min; non-rapid eye movement (NREM) sleep duration 197.7 ± 115.91 (light NREM 171.36 ± 104 and deep NREM 23.36 ± 16.73); REM sleep duration was 30.44 ± 34.14 min. The Pittsburgh Sleep Quality Index was 10.23 ± 3.45, which indicated sleep deprivation over the past 1 month. Moderate levels of anxiety, depression, confusion, and distress existed in the cohort. Statistically significant but weak correlation existed between sleep score, anxiety, and depression. Strong correlation existed between distress score and sleep score. Confusion score did not have a significant correlation with sleep score. HNC patients in palliative care settings were chronically sleep deprived. Sleep architecture was also disturbed. Moderate levels of anxiety, depression, confusion, and distress existed in the studied cohort; these psychosocial disturbances had a weak correlation with the sleep score and are likely to be multifactorial. Institutional Ethics Committee number: IHEC-LOP/2020/IM0349. The study has been registered with clinical trial registry of India with registration number CTRI/2021/03/032400 (http://www.ctri.in).

Thoracic radiation in combination with erlotinib-results from a phase 2 randomized trial.

Radiotherapy (RT) can be used to reduce symptoms and maintain open airways for patients with non-small cell lung cancer when systemic treatment is not sufficient. For some patients, tumor control is not achieved due to radioresistance. Concurrent inhibition of epidermal growth factor receptors has been proposed as a strategy to overcome radioresistance but may increase toxicity. We performed a randomized trial to assess the efficacy, tolerance, and quality of life of concurrent erlotinib and palliative thoracic RT for patients with advanced non-small cell lung cancer. Patients were randomized 1:1 to RT alone (arm A) or in combination with erlotinib (arm B). A computed tomography (CT) scan at baseline and one at 4-12 weeks after inclusion was used to evaluate treatment response. Adverse events were registered during treatment and the subsequent 30 days. Health-related quality-of-life questionnaires were completed by the patients at baseline, weeks 2, 6, and 20. A total of 114 patients were included. Of the 74 patients with CT scans available for evaluation of treatment effect, there were no significant differences in tumor size reduction between the two groups: median 14.5% reduction in the control arm A and 17.0% in the erlotinib arm B (p = 0.68). Overall survival was not significantly different between the two treatment arms: 7.0 and 7.8 months in arm A and arm B, respectively (log-rank p = 0.32). There was no significant increase in adverse events in the experimental arm, other than what is expected from erlotinib treatment alone. Overall, patients reported similar quality of life in both treatment arms. Concurrent erlotinib and palliative thoracic RT for patients with advanced non-small cell lung cancer was well tolerated but did not improve the efficacy of the RT. ClinicalTrials.gov, identifier NCT02714530.

A-400 - The treatment of elderly patients with locally advanced or metastatic cutaneous squamous cell carcinoma using Cemiplimab monotherapy or Cemiplimab associated with palliative radiotherapy: A single centre experience from the United Kingdom

A-400 - The treatment of elderly patients with locally advanced or metastatic cutaneous squamous cell carcinoma using Cemiplimab monotherapy or Cemiplimab associated with palliative radiotherapy: A single centre experience from the United Kingdom

Palliative radiotherapy in patients with inoperable/chemo unfit carcinoma gallbladder - a phase II pilot study

Palliative radiotherapy in patients with inoperable/chemo unfit carcinoma gallbladder - a phase II pilot study

Palliative Radiotherapy for Symptomatic Primary Tumors in Patients With Locally Advanced Breast Cancer.

Breast cancer remains a significant health concern for women, with a significant number of women facing unresectable, symptomatic, and advanced disease that severely affects their quality of life. Palliative radiotherapy (RT) is a well-established modality for managing such cases and alleviating symptoms. Recent advancements in systemic therapies and the resulting increase in long-term survival rates have not only heightened the need for retreatment in certain patients, but have also emphasized the importance of achieving durable local control. Additionally, inconsistencies in RT referral timing and variations in disease severity and extent contribute to diverse RT objectives and expected outcomes. The optimal dose fractionation for RT remains underexplored. Furthermore, a deeper understanding of breast radiobiology, along with the introduction of ultra- and moderately hypofractionated regimens and the widespread adoption of conformal techniques such as intensity-modulated RT, has diversified the approaches in RT dose and target volume. This review aimed to provides a comprehensive summary of the current evidence on the efficacy, outcomes, and toxicity profiles of palliative RT for symptomatic breast cancer. It highlights the need for more optimized regimens and further research to address the evolving treatment landscape and differing expectations of patients and physicians regarding RT.

Increased pain after palliative radiotherapy: not only due to cancer progression.

Increased pain after palliative radiotherapy: not only due to cancer progression.

Comparative efficacy of palliative radiotherapy dose schedules in advanced bladder cancer-associated gross hematuria.

Gross hematuria (GH) in advanced/inoperable bladder cancer patients causes significant morbidity. Patients frequently need multiple transfusions. Hypofractionated radiotherapy (RT) has been shown to be effective in symptom palliation. In this study, we explore the efficacy of various fractionation regimens in these patients. This single institute retrospective analysis was conducted on 60 consecutive patients treated with palliative RT. Fractionation (single versus multiple) and biologically equivalent doses (BED; high ≥36 Gy versus low <36 Gy) were used to compare the efficacy of various fractionation regimens. The primary outcome was the difference in objective response rate (ORR) between various strata at 2, 4, 8 and 12 weeks. Major secondary outcomes were differences in ORR according to Eastern Cooperative Oncology Group (ECOG) performance status (PS) and tumour node metastases (TNM) stage, and the proportion of patients requiring re-transfusion(s) at 12 weeks. Data were analysed using SPSS 23. Overall ORR at 2, 4, 8 and 12 weeks was 86%, 77%, 67% and 55%, respectively. There was no statistically significant difference in response rates between single or multi-fraction, or high versus low BED groups (All p = >0.05). Moreover, ECOG PS (p = 0.11) or TNM stage (p = 0.58) also had no impact on the response rate at 12 weeks. Nearly one-third (31%) of patients required further transfusions at 12 weeks. RT is an effective modality to control GH. No difference in ORR was found between single fractions versus multiple fractions, or high versus low BED regimens. Single fraction RT can be offered to these patients considering low cost, patient convenience and minimal side effects.

Treatment of follicular lymphoma with a focus on radiotherapy

PurposeTo describe the overall treatment patterns of follicular lymphoma (FL) in a single tertiary institution, with a focus on the outcomes of radiotherapy treatment in this group of patients. Methods and materialsRetrospective analysis on 177 patients with FL registered from 1996 to 2011 and followed up to October 2017. Diagnosis was confirmed by histology and staging by clinical examination and imaging with positron emission tomography (PET) or computed tomography (CT) scan. Demographics, clinicopathological characteristics, treatment details and clinical outcomes were reviewed. ResultsFifty-five patients (31%) had early stage and 122 (69%) had advanced stage FL. Median follow-up was 7 years and 7.5 years for early and advanced FL respectively. For advanced stage, median overall survival (OS) was 12.9 years, 5-year and 10-year OS were 77% and 63%, and 5-year and 10-yr PFS were 57% and 40% respectively. In multivariable model, moderate FLIPI, palliative RT and anti-CD20 targeted therapy were significantly associated with OS when comparing with those with high FLIPI score, no RT and no anti-CD20 targeted therapy respectively. For early stage, median OS has not reached, 5-year and 10-year OS were 79% and 74% and 5-year and 10-year progression free survival (PFS) were 64% and 52% respectively. Stage 2 non-contiguous disease had significantly poorer survival than stage 1 patients in multivariable (HR 8.19, 95%CI 1.86 – 35.98) analysis. Overall, 49 of 177 patients (27.7%) had any form of radiotherapy as part of their treatment for FL. There were no in-field alone relapses seen in all cases treated with RT. 10% in early FL had G3-4 acute toxicities with RT whilst there was no G3-4 late toxicities. In advanced FL, there were no G3-4 acute toxicities with consolidation RT and 1 G3 with salvage RT. ConclusionFL has effective response rates to RT both in early and advanced FL. We demonstrated that: 1) stage 2 disease has poorer outcomes than stage 1 disease with stage 2 non-contiguous disease having the poorest outcomes, indicating the need for more aggressive treatment strategies for this group of patients; 2) there were no in-field alone relapses seen in all cases treated with RT; 3) overall, there is a general under-utilization of RT concurring with the literature. New prospective studies are therefore warranted to shed light on improving the utility of RT for patients with FL. With advances in molecular medicine, imaging and treatment approaches, there is potential for better stratification of different patient groups for more localized versus systemic treatments.

Exploring the value of structured narrative feedback within the Serious Illness Conversation-Evaluation Exercise (SIC-Ex): a qualitative analysis

ObjectivesThe Serious Illness Conversation Guide (SICG) has emerged as a framework for conversations with patients with a serious illness diagnosis. This study reports on narratives generated from open-ended questions of...

Spatially fractionated radiotherapy : introduction into clinical practice

Spatially fractionated radiotherapy is a new concept involving partial irradiation of tumor volumes. Different techniques are described: mini-beam and micro-beam radiotherapy (pre-clinical) and LATTICE radiotherapy (L-RT) (clinical). Although L-RT is emergent in clinical practice and its evidence is still limited, it has still revealed excellent outcomes. At least three clinical situations can be discussed: definitive palliative radiotherapy, dose escalation (boost) or salvage radiotherapy. The interaction between L-RT and the immune system is still under investigation. Preclinical observations have already demonstrated a strong interaction, with tumor response dependent on immune system stimulation and the generation of an abscopal effect.

Palliative radiotherapy for pancreatic cancer.

Palliative radiotherapy for pancreatic cancer.