Postoperative Radiotherapy Research Articles

Oral Cavity Squamous Cell Carcinoma: Impact of Clear Margin Distance on Locoregional Control in Patients Undergoing Postoperative Radiotherapy.

We congratulate Lang and colleagues for their study investigating the impact of resection margin (RM) size on locoregional control (LC) outcomes, overall survival (OS), progression-free survival (PFS), and treatment-related toxicity in 162 patients with oral cavity squamous cell carcinoma (OCSCC) who received postoperative radiotherapy (PORT).1 In this study, 77 (47.5%), 22 (13.6%), and 63 (38.9%) patients had involved (5 mm) RM, respectively. A RM of ≤5 mm was found to be a significant predictor for worse LC (HR 2.6), but not for OS (HR 1.2) or PFS (HR 1.2). The findings of this study provide important insights into how the status of RM affects the local control and survival outcomes of OCSCC patients who undergo PORT. However, we have two concerns that we believe need to be addressed to interpret the results more comprehensively and guide future research on this critical topic.

Condyle Preservation in Patients With Mandibular Resection Is Associated With Enhanced Quality of Life and Function.

Operative treatment of advanced mandibular tumors may require excision of a portion of the mandible including the condyle. It is not clear how condylar excision affects postoperative quality of life (QoL). The study purpose was to measure the association between operative management of the condyle and postoperative health-related QoL and temporomandibular joint (TMJ) function. This prospective cohort study included patients with benign mandibular lesions who underwent hemi-mandibulectomy and were treated at Taleghani and Imam Hossein Hospitals in Tehran, Iran. Patients were excluded from the study if they had a history of preoperative or postoperative radiotherapy and chemotherapy, previous TMJ surgery or trauma, autoimmune diseases that affect TMJ function, bruxism or clenching, previous TMJ problems such as DJD, failed to return for follow-up, or refused study enrollment. The predictor variable was operative management of the condyle and it was grouped into 2 levels, preserved or resected. The primary outcome was the oral health-associated QoL, which was determined using the Oral Health Impact Profile-14 questionnaire. Secondary outcome variables included maximum mouth-opening values, visual analog scale pain score, joint clicking, and joint crepitus. Outcome variables were determined pretreatment, immediately postsurgery, and 6 and 12months postsurgery. Age, sex, and defect size were the study covariates. Repeated measures ANOVA was conducted to compare QoL questionnaire scores, maximum mouth opening, and visual analog scale pain scores (P<.05). The sample was composed of 46 subjects. Mean age was 46±13.1years in both groups and 25 patients (54%) were male. Presurgery QoL scores were 79.22±1.72 for the resection group and 82.38±1.21 for the preservation group (P=.6). At 12months postsurgery, QoL, maximum mouth-opening, and pain scores were 65.89±3.82, 31.56±2.30, and 5.44±2.45 for the resection group, while the preservation group showed significantly better scores with 78.69±2.10, 40.77±2.20, and 1.15±0.90, respectively (P<.001 for all). Condyle preservation in resection treatments is associated with higher QoL scores, reduced TMJ pain, and increased maximum mouth opening. Preservation of the condyle should be considered during surgery whenever possible.

Treatment Outcomes of Canine Orbital Meningiomas in Seven Cases.

Although intracranial and spinal cord meningioma prognoses have been reported, few studies have evaluated the outcomes and prognoses of orbital and optic nerve meningiomas in dogs. We aimed to evaluate the outcomes of canine orbital meningiomas. The seven dogs included were cytologically or histopathologically diagnosed with meningiomas. Four underwent first-line surgery; three received postoperative radiation therapy. The remaining three underwent first-line radiation therapy; however, 372 days after radiation therapy, one dog underwent surgery as the lesion progressed in size. Five dogs underwent surgical resection, had incomplete resections, and died during the observation period, with a median survival time of 943 days (range 668-1083 days). The two surviving dogs were followed up for 119 and 1083 days. Local recurrence was detected in three of the five dogs at 478, 660, and 814 days. The median progression-free survival was 569 days (range 262-814 days). Although keratoconjunctivitis (grade 2) was observed in one dog that underwent eye-sparing radiation therapy, no serious side effects were observed in the other dogs. Our results suggest that surgery and radiation therapy may play an important role in the treatment of orbital meningiomas and may offer longer survival than that of brain or spinal cord meningiomas.

Effects of axillary dose restriction on plan quality and acute radiation dermatitis in breast cancer radiotherapy.

Axillary dose restriction (ADR) is rarely implemented in breast cancer radiotherapy by radiation oncologists to minimize exposure to organs at risk (OARs), particularly the axilla. This prospective randomized controlled study aims to evaluate the efficacy of ADR in improving plan quality (PQ) and its impact on acute radiation dermatitis (ARD) in breast cancer radiotherapy. The study recruited breast cancer patients who required postoperative radiotherapy but did not have an indication for axillary irradiation. Delineation and dosimetric assessment of the axilla (Axilla Levels I-III and Axillary Cavity) were performed in all cases, with ADR implemented randomly. ADR involved restricting the mean axilla dose to 40-45 Gy during radiotherapy. The outcomes assessed included the ARD grades (both overall and axillary) and dose-volume parameters of PQ including skin V35. The study enrolled 87 patients, who were randomly divided into two groups: Group I (50 patients) received ADR, while Group C (37 patients) did not. ADR was found to be significantly associated with reduced exposure doses to the axilla and ipsilateral lung, specifically in patients with modified radical mastectomy (MRM). Results of other PQ parameters, such as D95, V93, V95, V100, V107 for the planning target volume (PTV), V30, Dmean for the heart, Dmax for the spinal cord, and V5 for the ipsilateral lung, demonstrated potential benefits in alleviating doses to these OARs while maintaining optimized PQ, although these results were not statistically significant. However, no statistically significant correlation between ADR and severe ARD (≥ Grade 2) or skin V35 was established, either in the total patient population or in subgroups. Additionally, a multivariable logistic regression for severe ARD was conducted, with ADR and skin V35 included as predictive factors. Only older age was found to be significantly associated with severe ARD. Implementing ADR in breast cancer radiotherapy not only protects the axilla and ipsilateral lung but also maintains optimized PQ, specifically in MRM patients, though it shows no evidence of alleviating ARD. Adopting ADR may be considered a valuable option in breast cancer radiotherapy.

Development of a Prognostic Nomogram Incorporating the Naples Prognostic Score for Postoperative Oral Squamous Cell Carcinoma Patients.

The Naples prognostic score (NPS) and its relation to the prognosis of oral squamous cell carcinoma (OSCC) have been inconclusive. This study aimed to investigate the correlation between NPS and the prognosis of postoperative OSCC patients. Additionally, the study sought to develop a new nomogram for predicting disease-free survival (DFS) and overall survival (OS). The study included 576 OSCC patients who underwent surgical treatment at two hospitals between August 2008 and June 2018. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors. Subsequently, two nomograms were developed to predict DFS and OS based on these factors and underwent rigorous validation. The median DFS and OS were 31.5 months and 36.5 months, respectively. Significant differences in DFS and OS were observed among patients with different NPS scores. Adjuvant radiotherapy, age-adjusted Charlson comorbidity index (ACCI), extranodal extension (ENE), NPS, American Joint Committee on Cancer (AJCC) stage, surgical safety margin, eastern cooperative oncology group performance status (ECOG PS), and systemic inflammation score (SIS) were identified as independent predictors of DFS and OS. In the training cohort, the nomogram's concordance index (C-index) for predicting DFS and OS was 0.701 and 0.693, respectively. In the validation group, the corresponding values were 0.642 and 0.635, respectively. Calibration plots confirmed a high level of agreement between the model's predictions and actual outcomes. Decision curve analysis (DCA) demonstrated the nomogram's good clinical utility. Additionally, patients in the low-risk group did not benefit from adjuvant radiotherapy, while those in the medium-risk and high-risk group could benefit from adjuvant radiotherapy. NPS significantly influences the prognosis of OSCC patients following surgery. The nomogram developed in this study holds significant clinical application potential. The low-risk subgroup of patients was not required to undergo postoperative radiotherapy.

Cancer-field surgery for endometrial cancer by robotic peritoneal mesometrial resection and targeted compartmental lymphadenectomy (PMMR+TCL).

Cancer-field surgery by peritoneal mesometrial resection and targeted compartmental lymphadenectomy (PMMR+TCL) for the treatment of endometrial cancer (EC) aims at optimal locoregional tumor control without the need for adjuvant radiotherapy. In a previous publication we could demonstrate the feasibility of the method and presented encouraging first oncologic data. Following up our 2021 publication, we present data on the treatment of EC by PMMR+TCL in much larger cohort and with longer follow-up. One hundred and thirty-five patients with EC International Federation of Gynecology and Obstetrics (FIGO) I-IV (75.6% FIGO I) underwent cancer field surgery via PMMR+TCL for EC in the years 2016-2023. Mean follow-up in our cohort was 27.5 months (0, 83; 19.7). The procedure was feasible and safe with favorable intra-and postoperative complication rates. Even though 50.4% of patients had an indication for postoperative radiotherapy following national and international guidelines, the rate of postoperative irradiation administered was 10.4%. The overall recurrence rate was 8.1% and we observed 2 (1.5%) isolated locoregional recurrences. Our results confirm the feasibility and safety of PMMR+TCL in EC patients. Oncologic data are very encouraging and hint at a superior locoregional control without adjuvant irradiation. Larger studies with longer follow-up will be needed to confirm these results.

Aortic Intimal Sarcoma Diagnosed by Surgical Resection: A Case Report

Aortic intimal sarcoma is a rare disease with no established treatment and a poor prognosis. A 70-year-old man who underwent surgery for a mass shadow extending from the ascending aorta to the left common carotid artery on contrast-enhanced computed tomography was diagnosed with intimal sarcoma and underwent postoperative radiotherapy (66 Gy/33 Fr). Three brain metastases were identified after 1.5 months. No recurrence or enlargement was noted for four months following gamma knife radiosurgery and chemotherapy. To our knowledge, this is the first report of gamma knife radiosurgery delaying the progression of aortic intimal sarcoma.

Personalized treatment strategies for breast adenoid cystic carcinoma: A machine learning approach.

Breast adenoid cystic carcinoma (BACC) is a rare subtype of breast cancer that accounts for less than 0.1% of all cases. This study was designed to assess the efficacy of various treatment approaches for BACC and to create the first web-based tool to facilitate personalized treatment decisions. The Surveillance, Epidemiology, and End Results (SEER) database was used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five Machine Learning (ML) algorithms to predict the 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of ML models. We also performed a Kaplan-Meier (K-M) survival analysis. This study included 1212 patients. The median age was 60 years, with most tumors being localized and less than 2cm in size. The 5-year overall survival (OS) rates were highest for surgery+radiotherapy (RT) (94.9%) and lowest for surgery+chemotherapy (CTX)+RT (80.1%). Positive estrogen receptor (ER) status and younger age were associated with better survival outcomes. ML models identified key predictive features for survival, including age, nodal status, and ER status. Age, lymph node metastasis, and ER status are crucial prognostic indicators for BACC. Although postoperative RT enhances survival, the advantages of adjuvant CTX are uncertain, implying that it may be eschewed to avert adverse effects. Our online tool offers essential resources for prognostication and treatment optimization.

Dosimetric differences between online adapt-to-position and offline adapt-to-shape plans for adaptive radiotherapy in cervical cancer

Radiation therapy plays a significant role in the treatment of cervical cancer. Additionally, more adaptive workflows using ATP are being implemented in the daily radiotherapy of our organization. Herein, we aimed to investigate the dosimetric differences between online ATP and offline ATS plans for magnetic resonance (MR)-guided adaptive radiotherapy in patients with cervical cancer and determine radiotherapy modalities that address clinical requirements. In total, 25 patients with cervical cancer were enrolled in this study, with 13 in the radical radiotherapy group and 12 in post-operative radiotherapy group. We aimed for the clinical target volume (CTV) to be covered by 95 &amp;ndash; 100% of the prescribed dose (50 Gy/25 sessions/5 weeks). MR-Linac was performed daily during treatment, and the images were rigidly aligned with the local computed tomography to generate an online ATP plan. MR images acquired during the first three sessions were selected to recontour the CTV and organs at risk (OAR). Furthermore, an offline ATS plan was generated. In the radical radiotherapy group, the CTV, D98, D95 (5024.65 &amp;plusmn; 23.34 vs. 4995.50 &amp;plusmn; 14.99 cGy), and Dmean of the ATS were superior compared with those of the ATP. The Dmax was lower in the ATS plan than in the ATP plan. In the post-operative radiotherapy group, the CTV, Dmean, D98, and D95 (5052.61 &amp;plusmn; 67.87 vs. 5014.41 &amp;plusmn; 24.68 cGy) were better in the ATS plan than in the ATP plan. When evaluating the OAR in the radical radiotherapy group, the minimum doses to the bladder and rectum were greater in the ATS plan than in the ATP plan. In the post-operative radiotherapy group, the V20 of the bladder and rectum were lower in the ATS plan than in the ATP plan. Therefore, ATS is well suited for post-operative radiotherapy, whereas ATP is better suited for radical radiotherapy. Furthermore, ATP can effectively address the clinical requirements of daily workflows.

Long-Term Complications in Patient-Specific Plates for Maxillary Reconstruction.

Virtual surgical planning (VSP) allows for optimal reconstruction of maxillary defects with fibula free flaps. Current data are limited regarding long-term complications of patient-specific plates (PSPs) in this setting. Our objective was to determine long-term complications of PSPs in maxillary reconstruction using fibula free flaps. A retrospective chart review was performed on patients undergoing maxillary reconstruction with a fibula free flap and PSP between January 2010 to July 2022. The primary outcomes were plate-related complications, which were defined as plate exposure, fracture, removal or evidence of loose screws. Secondary outcomes were wound infection, nonunion, or flap failure. A total of 39 patients underwent fibular reconstruction of maxillary defects using PSP. The average age was 56 years, with 56% of patients being female. There were 14 (35.8%) patients with plate-related complications, 10 (25.6%) underwent plate removal, 12 (30.8%) developed exposed hardware, 2 (5.1%) had loose screws, and none had a plate fracture. The average time to plate removal was 2.76 ± 1.94 years. With regard to age, sex, tobacco or alcohol use, diabetes, hypothyroidism, preoperative radiation therapy, number of fibula segments, type of cancer, postoperative radiation therapy, or whether the patient underwent orodental rehabilitation, there were no significant differences between patients who did and did not experience plate complications. VSP allows for patient-specific reconstruction of maxillary defects with a fibula free flap that remains stable in the majority of patients. In the long term, up to 25% of patients may require plate removal, but the reconstruction remains stable. Level 4.

Adjuvant Sequential Chemotherapy for Salivary Duct Carcinomas: A Retrospective Comparative Analysis.

This study aimed to report the efficacy and safety of adjuvant sequential chemotherapy after definitive treatment of salivary duct carcinoma (SDC) compared with the standard treatment alone (surgery with postoperative radiation therapy). This was a retrospective study of pathologically confirmed 135 SDC patients (study period 2009 to 2022). After curative surgery and adjuvant radiation therapy, 55 of 135 patients decided to receive additional chemotherapy (OP + RT + chemo group), while 80 opted for surgery and radiation (OP + RT group). Treatment outcomes of overall survival (OS), disease-free survival (DFS), and distant metastasis-free survival (DMFS) were compared using a propensity score matching (PSM) analysis. Adjuvant chemotherapy consisted of three cycles of cisplatin-based regimen, which was well tolerated in most patients with minimal adverse events. Multivariable analyses indicated that the addition of chemotherapy did not improve OS (p = 0.05), DFS (p = 0.386), and DMFS (p = 0.735), although there was a trend toward favoring adjuvant chemotherapy in terms of OS. With PSM analysis, OS (OP + RT + chemo to OP + RT, hazard ratio [HR] = 0.40, 95% confidence interval [95% CI] = 0.12-1.29, p = 0.126), DFS (HR = 0.69, 95% CI = 0.30-1.56, p = 0.367), and DMFS (HR = 0.96, 95% CI = 0.46-1.99, p = 0.903) were not statistically different. Current cisplatin-based adjuvant chemotherapy did not significantly improve treatment outcomes of SDC patients over the surgery and adjuvant radiation. Further development or clinical studies are required to improve the outcomes of SDC, including chemotherapeutic, biomarkers, immune checkpoint inhibitors, or treatment strategies.

Radiotherapy for Rectal Cancer and Radiation-Induced Malignancies from Epidemiological and Dosimetric Data

Preoperative or postoperative radiation therapy is broadly employed in patients with rectal carcinoma. Radiotherapy directs high-energy beams of ionizing radiation toward the tumor area to destroy cancer cells. High radiation doses are needed for cell killing. The radiation exposure of the healthy tissues/organs may lead to carcinogenesis. This study describes the evolving role of radiotherapy in rectal cancer management. The present report also reviews epidemiological and dosimetric studies related to the radiation-induced second malignancies from pelvic radiotherapy. Some epidemiological studies have concluded that the second-cancer risk in patients subjected to radiation therapy does not increase compared to unexposed rectal cancer patients. Other researchers found an elevated or a marginally increased probability for second-cancer induction. Dosimetric studies reported cancer risk estimates for critical organs or tissues in the near and far periphery of the treatment volume. Useful information about the effect of the treatment parameters such as the irradiation technique, photon beam energy, and fractionation schedule on the organ-specific second-cancer risk was derived from the dose data analysis. The knowledge of these effects is needed for the selection of the optimal treatment parameters enabling a reduction in the resultant risk of carcinogenesis.

Clinicopathological features and prognostic analysis of synchronous mucinous metaplasia and neoplasia of the female genital tract

Objective: Synchronous mucinous metaplasia and neoplasia of the female genital tract (SMMN-FGT) occurring at multiple sites during the same period of time is extremely rare, and the aim of this study was to investigate the clinicopathologic features of SMMN-FGT and its relationship with prognosis. Methods: We retrospectively analyzed the clinicopathological features and follow-up records of 25 cases of SMMN-FGT diagnosed from January 2012 to October 2022 in the case database of Obstetrics and Gynecology Hospital of Fudan University. Results: The median age at onset was 46 years old, respectively. Clinical manifestations included irregular vaginal bleeding or drainage, pelvic pain, and ovarian cysts, etc. Germline genetic test confirmed Peutz-Jeghers syndrome (P-J syndrome) in two patients. All patients underwent surgery, and 13 patients had postoperative adjuvant radiotherapy and/or chemotherapy. The most frequent site of lesion was the cervix (21 cases), with 11, 10 and 16 cases occurring in the endometrium, fallopian tubes and ovaries, respectively. Six cases involved three sites simultaneously, and only one case had all four sites involved at the same time. Among the 9 cases with P53 mutation phenotype, 6 cases had gastric-type mucinous adenocarcinoma, 2 cases had lobular endocervical glandular hyperplasia, and 1 case had mucinous adenocarcinoma, whereas all the minimally deviated adenocarcinomas had wild phenotype of P53. The median follow-up time was 59 months, during which 3 cases died and 6 cases developed local recurrence or distant metastasis. According to our analysis, postoperative recurrence or metastasis was correlated with the FIGO stage of the disease, the number of lesion sites and the severe degree of the uterine lesions (P＜0.05). Conclusions: SMMN-FGT has a relatively good clinical prognosis, and even advanced patients can benefit from surgery and adjuvant therapy. In young patients, the ovaries may be preserved if no evidence of lesions are seen after adequate evaluation. In SMMN-FGT, gastric-type mucinous adenocarcinoma occurring in the cervix may have a better prognosis than gastric-type mucinous adenocarcinoma of the cervix alone, so the accurate diagnosis of SMMN-FGT is critical for clinical management.

Impact of the Spinal Instability Neoplastic Score on Postoperative Prognosis in Patients with Metastatic Cancer of the Cervical Spine.

Background: Although the Spinal Instability Neoplastic Score (SINS) is widely utilized to evaluate spinal instability, its prognostic value for survival in patients with cervical spinal metastases remains unclear. This study investigated the association between the SINS and survival outcomes in patients with metastatic cervical spine cancer. Methods: This retrospective cohort study included 106 patients who underwent surgery for metastatic cervical spine cancer at a single institution between 1995 and 2023. Patients were divided into two groups: high SINS (≥13) and low-to-moderate SINS (0-12). Overall survival (OS) was the primary outcome and was analyzed using Kaplan-Meier estimates and Cox regression. Secondary outcomes included changes in Eastern Cooperative Oncology Group Performance Status (ECOG-PS), operation time, estimated blood loss, and postoperative complications. Results: The median OS was significantly shorter in the high SINS group compared to the low-to-moderate SINS group (5.3 months versus 8.6 months; p = 0.023). A high SINS was independently associated with increased mortality risk (hazard ratio [HR], 1.959; 95% CI, 1.221-3.143; p = 0.005). Lung cancer (HR, 4.004; 95% CI, 1.878-8.535; p < 0.001) and rectal cancer (HR, 3.293; 95% CI, 1.126-9.632; p = 0.029) were predictive of worse survival, whereas postoperative chemotherapy (HR, 0.591; 95% CI, 0.381-0.917; p = 0.019) and radiotherapy (HR, 0.531; 95% CI, 0.340-0.827; p = 0.005) were associated with improved survival. Changes in the ECOG-PS and postoperative complication rates were not significantly different between the groups. Conclusions: A high SINS was associated with significantly shorter survival in patients with metastatic cervical spine cancer, reflecting both mechanical instability and tumor aggressiveness.

Clinical and dosimetric feasibility of sparing submandibular gland in patients with oral cavity squamous cell carcinoma

Background To investigate the incidence of submandibular gland (SMG) involvement and explore the feasibility of sparing SMG in the oral cavity squamous cell carcinoma (OSCC). Methods This study retrospectively analyzed patients between January 2018 to October 2022. Ten patients with tongue squamous cell carcinoma receiving postoperative radiotherapy were replanned to investigate the feasibility of sparing SMG. The dose constraint for the SMG was a mean dose (Dmean) <39 grey (Gy). Results A total of 238 patients were identified and 105 had metastatic neck lymph nodes. Level II was the most common site of metastasis (n = 94, 89.5%), followed by level IB (n = 37, 35.2%), level III (n = 26, 24.8%), level IA (n = 3, 2.6%), and level IV (n = 2, 1.9%). A total of 50 metastatic lymph nodes were located at the level IB, of which 18 (36.0%), 29 (58.0%), and 3 (6%) were located in the lateral, anterior, and inferior aspect of the SMG. No metastatic lymph nodes were found within or on the medial aspect of the SMG. The Dmean of the SMG was <39 Gy in all patients with a Dmean of 38.8 Gy. The median dose of PTV54 D95% was 53.8 Gy, which met the prespecified allowable coverage goal. Conclusions Our study suggests that SMG involvement is rare in OSCC. With strict imaging and clinical evaluation, sparing SMG during radiotherapy is feasible.

Adult Cerebellopontine Angle Medulloblastoma: A Systematic Review of Clinical Features, Management Approaches, and Patient Outcomes.

The aim of this study was to systematically review the existing individual patient data in the literature on adult cerebellopontine angle (CPA) medulloblastoma (MB) and characterize the patient presentation, management strategies used, and oncological outcomes of this rare entity to guide future clinical practice. Following PRISMA guidelines, a systematic review was conducted by searching PubMed, EMBASE, Web of Science, and Cochrane databases from inception to 19 June 2024. Studies regarding adult patients with histologically confirmed MB radiographically confirmed to be located in the CPA were included. Clinical data were synthesized, and predictors of outcomes were evaluated. Twenty-seven studies with 42 adult CPAMB patients were included. The median age was 32 years (range: 19-56). Headaches (81%), cranial neuropathy (90%), cerebellar dysfunction (79%), and nausea/vomiting (50%) were typical presenting features. The predominant histological subtype was the classic variant. Maximal safe surgical resection was performed, most commonly using a retrosigmoid approach, and 60% of cases received a gross total resection. Most patients received adjuvant treatment (93%), typically chemoradiotherapy. The recurrence rate was 11% after a median of 18 months of follow-up. Relatively high survival rates of 96%, 85%, and 85% were observed at 1, 3, and 5 years, respectively. Patients who received adjuvant therapy had significantly better recurrence and greater overall survival outcomes. These results support the consideration of MB in young adult patients presenting with CPA tumors with radiographical features suggestive of hypercellularity and the utilization of a management strategy of maximal safe resection plus post-operative craniospinal irradiation along with chemotherapy to optimally treat these rare patients.

Patterns of care for vulvar cancer and insights from revised FIGO staging: a retrospective study

BackgroundThe objective of this study was to evaluate the clinicopathological characteristics and patterns of care among women diagnosed with vulvar malignancy at a tertiary care teaching institute. Additionally, the study aimed to analyse the implications of revised FIGO staging system on stage shift and patient outcomes.MethodsA retrospective observational study was conducted, wherein hospital records of biopsy-proven cases of vulvar cancers managed over a period of 10 years were comprehensively reviewed. The assignment of FIGO staging was performed utilizing both 2009 and 2021 FIGO staging systems for comparative analysis. Statistical analysis was performed using STATA version 17. Survival curves were constructed using the Kaplan-Meier method, with differences assessed using the log-rank test. Additionally, multivariable analysis was conducted using the Cox proportional hazard model.ResultsA total of 82 cases meeting the inclusion criteria were enrolled in the study. Management patterns varied widely, with the majority undergoing surgery (73.2%), followed by definitive radiotherapy with or without chemotherapy (10.9%), neoadjuvant radiotherapy and subsequent surgery (4.9%), and palliative care (10.9%). Post-operative radiotherapy was administered in 31.7% of cases. The disease-specific recurrence rate was found to be 32.9%, and the mortality rate was 30.5%. The median Disease-Free Survival (DFS) was 17 months (interquartile range [IQR]: 1–36 months), while the Overall Survival (OS) was 27 months (IQR: 9–52 months). Upon application of the 2021 staging system, a stage shift was observed in 18% of cases of advanced vulvar cancer. The 3-year DFS and OS were reduced for stage IIIA and stage IVA, while showing improvement for stage IIIB.ConclusionsThe revised FIGO 2021 staging system offers enhanced simplicity in its application within clinical practice and demonstrates improved correlation with prognosis. Approximately 18% cases experienced restaging under the updated system.Trial registration numberNot applicable.

Preoperative versus postoperative radiotherapy for localized soft tissue sarcoma treated with curative intent in a French tertiary center “SARCLOC”

BackgroundSoft tissue sarcomas of the extremities (E-STS) are rare and heterogeneous. Treatment combines surgery with preoperative or postoperative radiotherapy (RT) for deep, large, or high-grade tumors. We evaluate the effectiveness and toxicity in E-STS patients treated at our institution from 2015 to 2021.Materials and methodsThis retrospective, single-center study, compared clinical and therapeutic characteristics, toxicities, and surgical complications by radiotherapy type. Local recurrence-free survival (LRFS), overall survival (OS), and recurrence-free survival (RFS) were estimated using the Kaplan–Meier method.ResultsWe included 158 patients; 124 (78%) received preoperative RT. The two groups (preoperative RT vs. postoperative RT) differed significantly in terms of median tumor size (111 vs. 67.5 mm, p < 0.01), perivascular involvement (51% vs. 29%, p = 0.03), and bone contact (32% vs. 12%, p = 0.02), but not in grade (grade 2 or 3: 65% vs. 74%, p = 0.72). Median follow-up was 2.9 vs. 5.1 years. Two-year LRFS was 82% [95%CI: 74–88] for both groups; OS was 87% [95%CI: 80–92] vs. 88% [95%CI: 71–95]; and RFS was 72% [95%CI: 63–79] vs. 70% [95%CI: 52–83]. Postoperative complications were 53% vs. 35%, with wound disruption at 39% vs. 15% and infections at 29% vs. 6%. Grade 2 or higher dermatitis was 16% vs. 29%, and RT discontinuation rates were 4% vs. 12% for the two groups, respectively.ConclusionDespite poorer prognostic factors in the preoperative RT group, LRFS and OS were comparable to those in the postoperative RT group. Postoperative complications were more frequent with preoperative RT, and treatment discontinuation was more common postoperatively.

The role of radiotherapy in intracranial hemangiopericytoma/solitary fibrous tumors : ATurkish Society for Radiation Oncology Central Nervous System Tumors Group Study (TROD 07-008).

Intracranial hemangiopericytomas (HPC) are rare tumors. Radiotherapy (RT) is frequently performed after surgery, depending on tumor size, location, and the type of resection. Moreover, RT is preferred as an effective treatment for local recurrence and metastasis. With this multicenter study, we aimed to investigate the effectiveness of postoperative RT in intracranial HPC patients using modern RT techniques. Patients aged 16years and older who underwent RT for histologically confirmed intracranial HPC were evaluated retrospectively. Forty-four patients from 17institutions were included. Demographic characteristics of the patients, pathological findings, and prognostic factors were documented. The Kaplan-Meier method was used for local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS). The interval for survival analyses was calculated according to the end date of RT. Univariate and multivariate analysis methods were used for factors associated with survival and recurrence. Median age was 42years (16-71) and 70% of the patients were male. The most common initial symptoms were pain (47.7%) and vision problems (15.9%). Asupratentorial location was observed in 79.5% of patients. The median maximum tumor dimension was 4.7 (1.6-14) cm. Gross total (GTR) and subtotal resection (STR) were performed in 43.2% and 47.7% of patients, respectively. Adjuvant RT commenced amedian of 6 (2-16) weeks after surgery. Postoperative RT was administered using conventionally fractionated intensity-modulated radiotherapy (IMRT) or stereotactic radiosurgery (SRS). Atotal median dose of 60(38-66) Gy in amedian of 30(19-33) fractions was used for patients treated with IMRT and atotal median dose of 24(12-25) Gy in amedian of 3(1-5) fractions was used for patients treated with SRS. Local recurrence occurred in 9patients and locoregional recurrence in 2patients at amedian of 48months (range 26-143 months) after RT. Reoperation and reirradiation were applied to 5patients, reirradiation to 4patients, and reoperation to 2patients as salvage treatments. Reirradiation was administered at amedian dose of 35 (13.5-54) Gy using amedian of 5 (1-30) fractions. At amedian follow-up of 63 (6-262) months, 5‑year LC was 68.7%, DMFS 87.2%, PFS 60.8%, and OS 95.7%. The presence of residual macroscopic tumor before RT was associated with lower LC (p = 0.01) and shorter PFS (p = 0.04). In the presence of residual tumor before RT, 5‑year LC decreased from 92.9% to 46.7%, while 5‑year PFS decreased from 81.1% to 43.5% compared to patients with GTR. The presence of postoperative tumor was associated with alower LC rate in Cox regression analyzes (p = 0.02). The hazard ratio was 6.2 (1.2-30). However, the effect of residual disease before RT on OS was not statistically significant. Adjuvant radiotherapy is performed in the majority of patients with HPC, especially in cases where GTR cannot be performed. In our study, postoperative macroscopic residual tumor was found to be the only factor affecting LC and PFS in patients undergoing adjuvant RT, but its effect on OS was not shown. This may be due to the effectiveness of reoperation and/or reirradiation in the presence of recurrence after RT.

Ladies project: large database in endometrial cancers for a personalized treatment.

To compare Italian use with current international guidelines and to evaluate oncological outcomes and toxicity patterns of adjuvant radiation therapy (RT) for endometrial cancer (EC) in Italian women. To conduct a retrospective multicentre Italian study a large database was set up. Inclusion criteria were: accrual between 2010 and 2020, treatment with surgery, post-operative external beam RT (EBRT) and/or interventional radiotherapy (IRT) associated or not with adjuvant chemotherapy. Oncological outcomes, acute and late toxicities were analysed according to RT schedule and risk group. A total of 1848 patients, from 16 Italian RT centres were enrolled (median age 65 years, range 27-88). All patients received post-operative RT associated with chemotherapy in 31%. Patients were stratified on the basis of standard risk factors (Bosse et al. in Eur J Cancer 51:1742-50, 2015). After merging intermediate and high-intermediate risk classes into one intermediate group and including advanced and oligometastatic disease in the high-risk group, the low-risk group encompassed 124 patients, the intermediate-risk 1140, and the high risk 576. No low-risk patient developed local relapse (LR). Multivariate analysis showed that intermediate risk patients had a 2.5-fold increased risk of LR if treated with IRT alone vs EBRT-IRT boost. RT schedule did not impact significantly on LR in high risk patients. All acute toxicity parameters were highest in patients who received EBRT with simultaneous integrated boost (EBRT-SIB) and lowest in patients who received only IRT (p < 0.0001). Late toxicity was highest patients who received EBRT-SIB and lowest in those who were given EBRT with sequential boost (p < 0.0001). This retrospective study showed that Italian administration of adjuvant RT for EC is in accordance with current international guidelines. IRT alone for low-risk patients and EBRT associated with vaginal IRT remain standard adjuvant approaches for EC.