Postoperative Radiation Treatment Research Articles

Immediate Implants in Fibulas: Does the Implant to Fibula Osteotomy Distance Impact Early Implant Failure?

BackgroundWhen placing dental implants in the free fibula flap, the osteotomy cut edge poses a unique challenge in that an optimal distance has not yet been established. PurposeThe study aimed to measure the association between implant-to-fibula osteotomy edge distance and early implant failure in patients who received free fibula flap reconstruction with immediate implants. Study DesignA retrospective cohort study was designed and implemented. The study population was composed of patients who underwent free fibula flap transfer with immediate dental implant placement for the treatment of benign or malignant conditions of the head and neck from 2015 to 2022 at John Peter Smith Hospital. Subjects were excluded if the implant was in the middle of the free flap bordered by adjacent implants, was >10mm from the osteotomy edge, or had insertional torque values of ≤30 Ncm. Predictor VariablePrimary predictor variable was the implant distance in millimeters from the fibula osteotomy edge. Outcome VariablePrimary outcome variable was early implant failure, defined as implant exfoliation noted by the patient or failure due to implant movement or pain necessitating explantation within 6 months of placement. CovariatesThe covariates were age, sex, diabetes diagnosis, American Society of Anesthesiologists classification, smoking status, history of head and neck radiation, pathology treated, and if postoperative radiation treatment was received. AnalysesA generalized estimating equations (GEE) model was used to assess the relation between the primary predictor and outcome. A p-value of <0.05 was considered statistically significant. ResultsThe sample was composed of 48 subjects who had 130 implants placed, with early failures occurring in 5 implants (3.9%) in 3 subjects. The mean age of the sample was 49 years (SD 20) and 29 (60%) were male. The mean implant distances for early failures and non-failures were 3.5 mm (SD 1.04) and 4.3 mm (SD 1.5), respectively. There was a statistically significant relation between implant distance and early implant failure (P = .005, OR 0.6, 95% CI 0.39 to 0.85). ConclusionsThis study found that shorter distances between the implant and the edge of the fibula osteotomy are associated with early implant failure.

Risk Factors for Surgical Site Infections and the Effects of Betadine Irrigation and Intrawound Vancomycin Powder on Infection Rates in Spine Tumor Surgery.

Background Surgical site infection (SSI) following spine tumor surgery results in delays in radiation therapy and the initiation of systemic treatment.The study aims to assess risk factors for SSI in malignancy-related spinal infections and rates of infection observed in a single center with the use of betadine irrigation (BI) and intrawound vancomycin powder (IVP). Methods Spine tumor patients managed from 11/2012 to 11/2023 were identified using a surgical database (JotLogs, Efficient Surgical Apps, Portland, Maine). Inclusion criteria were patients receiving BI and IVP and alive at 30 days post-op.Exclusion criteria were patients not receiving a combination of BI and IVP due to allergies and mortality within 30 days of surgery. Patient demographics, histology, history of pre-operative and post-operative radiation treatment history, tumor location, procedure type, number of procedures per patient, SSI, wound culture results, and mortality were collected. Results One hundred two patients undergoing 130 procedures had an SSI rate of 3.85% (5/130).There were 18.6% primary and 81.4% metastatic tumors.Demographics were average age 59.5 years old (range 7-92), 60.8% male, 39.2% female, White 88.2%, Black 9.8%, and others 2%.Pre-operative radiation therapy was significantly associated with the risk of SSI (p=0.005). Percutaneous instrumentation did not lead to a significant difference in infection rates (p=0.139).There was no significant difference in infection rates between primary and metastatic tumors (p=0.58). Multivariable regression analysis revealed pre-operative radiation (OR: 18.1; 95%CI: 1.9-172.7; p=0.009) as the statistically significant independent risk factor. Conclusions Pre-operative radiation therapy remains a risk factor for SSI. However, percutaneous instrumentation did not lead to SSI, and there was no significant difference in infection rates between primary and metastatic tumors.SSI rate was3.85%in patients who had a combination of BI and IVPin spine tumor surgery.

Long-Term Follow-Up of Post Radiation Complete Sinus Opacification in Sinonasal Cancer Patients.

Treatment of sinonasal malignancies most often requires primary or postoperative radiation treatment. Post radiation sinonasal morbidity has been previously described; however, none addressed post-radiation sinus obstruction. Our objective was to investigate the long-term outcomes of post radiation complete isolated sinus opacification (CISO). A retrospective analysis of sinonasal cancer patients treated with radiation therapy during the years 2002 to 2022. Clinical, imaging and treatment data were collected from patients' medical records. Only patients with at least 12 months of follow-up and available imaging for review were included. Out of 109 patients, 37 patients were identified to meet the inclusion criteria. Mean follow-up was 58 months. 35% of patients were diagnosed with persistent post radiation CISO with a mean onset of 4 months. All these patients remained asymptomatic, and their imaging remained stable during follow-up with none developing an expanding mucocele. Ethmoid sinus tumor involvement was found to be more prevalent in the CISO group (62% vs. 25%, p-value = 0.048) as well as chemotherapy/immunotherapy (54% vs. 38%, p-value = 0.046). Multivariant analysis revealed that ethmoid sinus involvement (OR = 9.516, p-value = 0.047) and adjuvant therapy, either chemotherapy/immunotherapy (OR = 10.75, p-value = 0.036) were found to be a predictive factor for complete opacification. Our study revealed that a substantial number of post-radiation patients develop a stable and persistent CISO, often in the frontal and sphenoid sinuses. These patients remained asymptomatic, and none required surgical intervention during nearly 5 years of follow-up. 4 Laryngoscope, 2024.

99: Postoperative Radiotherapy in Treatment of Dupuytren's Contracture

99: Postoperative Radiotherapy in Treatment of Dupuytren's Contracture

Survival Analysis and Correlates with Molecular Epidemiology: 10-Year Retrospective Series of High-Grade Glioma in Pakistan.

High-grade gliomas are malignant, recurring primary central nervous system (CNS) tumors requiring extensive postoperative chemotherapy and radiation treatment. Isocitrate dehydrogenase (IDH), 1p19q, and ATRX mutations significantly influence survival and response to chemotherapy, as seen in many extensive studies from the Global North. This study aims to report data from the local region regarding progression-free survival and overall survival in light of molecular characteristics. A 10-year retrospective series was conducted at the Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, with 285 patients presenting from 2008 to 2018. Prospective follow-up data was collected, and complete molecular profiles were available for patients presenting from 2010 onwards. Survival analysis was conducted through the Kaplan-Meier method, with log-rank reported. 70.53% (201) of patients were male, with a mean age at diagnosis of 43.33 ± 15.1 years. 265 patients within the cohort completed postoperative radiotherapy, while 141 patients underwent chemotherapy (procarbazine, lomustine, and vincristine, or temozolomide). Mean survival, in months, within the cohort was as follows: glioblastoma (14.1), anaplastic astrocytoma (27.5), and anaplastic oligodendroglioma (39.8). Survival curves showed a lower survival for IDH wild-type (P < 0.0001), ATRX mutated (P = 0.029), and 1p19q non-deleted (P = 0.008) tumors from Pakistan. Our findings quantified long-term survival outcomes for high-grade glioma from Pakistan, analyzing the various treatment patterns. Of particular importance, molecular sub-classification significantly predicted survival outcomes for IDH, ATRX, and 1p19 co-deletion mutations. Expanding brain tumor epidemiology will benefit assessing the efficacy of regional oncological centers and establishing standards of care.

Intracranial hemangiopericytoma: long-term surgical outcomes

BACKGROUND: According to 2021 WHS Classification, intracranial hemangiopericytomas or solitary fibrous tumors are rare meningeal neoplasms involving blood vessels and soft tissues. Such neoplasms are commonly classified as malignant due to their aggressive growth, metastasizing beyond the cranial cavity, and frequent recurrencies. Since these tumors rarely occur in neurosurgical patients, publications in Russian do not cover big cohorts of patients whose conditions would be assessed during both early and late observation periods.&#x0D; AIM: The present study analyzed our experience in surgical treatment of hemangiopericytomas and its long-term results.&#x0D; METHODS: The study was arranged as a single-center, pro-and retrospective trial that included hemangiopericytomas patients (n=17), whose tumors of different grades of malignancy (13) were operated at the Federal Neurosurgical Center in Novosibirsk from 2013 to 2021. The follow-up estimates included survivability; physical status (Karnofskys Scale); radicality; metastatic foci; need for postoperative chemo-and radiation therapy; adjuvant therapy effect on patients survivability, and delaying time to relapse.&#x0D; RESULTS: In total, 17 patients were included. 11 of them underwent total hemangiopericytomas removal (65%), and 6 subtotal removal (35%). Their survivability within the first year after the operation was 100%. As for the 5-year follow up, only 8 patients out of 17 were available, their mean observation time comprising 64.7 months. The 5-year survivability was 75% (6 out of 8 patients). A relapse occured in 3 out of 17 (17.5%). The mean delaying time comprised 67 months. 6 out of 17 patients (35%) underwent radiation therapy. Among the patients with total and subtotal removals who underwent postoperative radiation treatment neither a relapse nor tumor growth nor metastases were found.&#x0D; CONCLUSION: Intracranial hemangiopericytoma is a rare malignant space-occupying neoplasm. Considering our experience and published data, its treatment requires aggressive tactics that includes a radical removal of the tumor followed by early irradiation of the tumors residual volume or bed either in a proton accelerator or a gamma-knife facility notwithstanding its malignancy grade. It is also recommended to extend the follow-up period for such patients to 1015 years that should include annual cancer screening to detect local relapses and metastases.

Socio-economic disparities influence likelihood of post-operative radiation to resection cavities of metastatic brain tumors.

Irradiating the surgical bed of resected brain metastases improves local and distant disease control. Over time, stereotactic radiosurgery (SRS) has replaced whole brain radiotherapy (WBRT) as the treatment standard of care because it minimizes long-term damage to neuro-cognition. Despite this data and growing adoption, socio-economic disparities in clinical access can result in sub-standard care for some patient populations. We aimed to analyze the clinical and socio-economic characteristics of patients who did not receive radiation after surgical resection of brain metastasis. Our sample was obtained from Clinformatics® Data Mart Database and included all patients from 2004 to 2021 who did or did not receive radiation treatment within sixty days after resection of tumors metastatic to the brain. Regression analysis was done to identify factors responsible for loss to adjuvant radiation treatment. Of 8362 patients identified who had undergone craniotomy for resection of metastatic brain tumors, 3430 (41%) patients did not receive any radiation treatment. Compared to patients who did receive some form of radiation treatment (SRS or WBRT), patients who did not get any form of radiation were more likely to be older (p = 0.0189) and non-white (p = 0.008). Patients with Elixhauser Comorbidity Index ≥3 were less likely to receive radiation treatment (p < 0.01). Fewer patients with household income ≥ $75,000 did not receive radiation treatment (p < 0.01). Age, race, household income, and comorbidity status were associated with differential likelihood to receive post-operative radiation treatment.

Patterns of Failure for Poor Response to Neoadjuvant Chemotherapy in Gastric Cancer

Peri-operative chemotherapy has emerged as the standard of care in the treatment of locally advanced gastric cancer. Improved treatment strategies are needed for patients with a poor response to neoadjuvant chemotherapy and postoperative chemoradiation has been proposed as a potential method of treatment intensification. We aimed to describe the patterns of failure for patients with no or partial response (NR, PR) to pre-operative chemotherapy. We retrospectively reviewed charts of patients with locally advanced gastric cancer treated at our institution from 2008 to 2022 with pre-operative chemotherapy followed by surgery with a D2 resection. We excluded patients who received pre-operative or post-operative radiation therapy, or patients who had a complete response (CR) following neoadjuvant chemotherapy. Cumulative incidence of locoregional failure (LRF) and distant metastases (DM) were calculated from the time of diagnosis with competing risk analysis with death as a competing risk and censored at the last follow up. Overall survival (OS) was analyzed using Kaplan-Meier. A total of 57 patients were identified and 60% are male. Median follow-up time was 31.3 months (range 6.9-181.5 months), and the median age at diagnosis was 68 years old (range 30-86). The most used pre-operative chemotherapy regimen was FLOT (38.6%), followed by FOLFOX (29.8%), and ECF/ECX/EOX (19.3%), and a majority of patients (57.9%) received adjuvant chemotherapy. The most common histology was adenocarcinoma (85.9%), and 61.4% of patients had poorly differentiated disease. Thirty-three (57.9%), and 9 patients (15.8%) were characterized as PR and NR to neoadjuvant therapy by pathology, respectively. The distribution of pathologic stages following neoadjuvant chemotherapy were as follows: 17 patients (29.8%) with Stage IA-B, 12 patients (21.1%) with Stage IIA-B, 15 patients (26.3%) with Stage IIIA, 9 patients (15.8%) with Stage IIIB, and 3 patients (5.3%) with Stage IIIC disease. Two patients had positive lymph nodes with a T0 primary tumor. Median OS was 51.4 months (95% confidence interval [CI] 39.8-68.4) for the entire cohort, and 92.1 months (95% CI 34.6-73.0) versus 42.8 months (95% CI 23.1-88.0) for patients with a PR, and NR, respectively (p = 0.14). The 2-year cumulative incidence of LRF and DM was 7.4% (95% CI 0.4-14.3) and 36.3% (95% CI 23.6-49.1), respectively. Of the five patients who experienced LRF, three of the patients also eventually or concurrently developed DM. 60% of these patients would have had their first site of recurrence covered by standard post-operative radiation treatment volumes. Patients with locally advanced gastric cancer who do have less than a CR to chemotherapy have poor outcomes due to high rates of DM. Adjuvant locoregional therapy such as radiation is unlikely to affect survival while DM is the predominant pattern of progression. Further studies are needed to identify adjuvant therapies to improve distant control.

¿Cuál es el fraccionamiento estándar en la irradiación del cáncer de mama?

Radiotherapy (RT) after breast-conserving surgery for breast cancer (BC) has been shown to reduce local recurrence rates and mortality. The conventional treatment of postoperative radiotherapy was 50 to 50.4 Gy, administered in 25 to 28 fractions over a period of 5 to 6 weeks. In the last 20 years, there is clinical evidence to consider hypofractionated treatment regimens safe and effective. Moderate hypofractionation, administered over 3 weeks, can be considered the standard of care after conservative surgery or mastectomy, as well as in irradiation of lymph node areas, with similar results regarding local control and survival and with effects on acute and chronic normal tissue. , similar or smaller. Ultrahypofractionated treatment, administered in 5 sessions, for 1 or 5 weeks, is a safe and effective treatment after conservative surgery and mastectomy without reconstruction. Early results have been reported that ultrahypofractionated treatment in 1 week is safe when lymph node areas are irradiated.

Neoadjuvant camrelizumab plus chemotherapy for locally advanced cervical cancer (NACI Study): a study protocol of a prospective, single-arm, phase II trial

IntroductionNeoadjuvant chemotherapy (NACT) is an emerging approach for locally advanced cervical cancer (LACC). However, the clinical response and postoperative adjuvant radiation or chemoradiation trimodality treatment resulted in controversy. PD-1 inhibitors...

The effect of hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine on ­self-­assessment of depression manifestations in women receiving radiotherapy after surgical ­treatment of uterine cancer

Background. The detection of cancer and its subsequent treatment contribute to the development of depression. This circumstance illustrates the need for proactive prevention of affective status disorders in cancer patients, its dynamic control and timely correction.&#x0D; Aim. Comparative analysis of the effect of hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine (methylethylpyridinol, ethylmethylhydroxypyridine malate, ethylmethylhydroxypyridine succinate) on the dynamics of self-assessment of depression manifestations in women recieving radiation therapy after surgical treatment of uterine cancer.&#x0D; Material and methods. A short-term, prospective, simple blind, placebo-controlled, randomized study of the effect of methylethylpyridinol, ethylmethylhydroxypyridine malate and ethylmethylhydroxypyridine succinate on the severity of depression symptoms in patients receiving radiation therapy after extended extirpation of the uterus with appendages was performed. The study was completed by 96 patients. Course two-week administration of drugs in almost equimolar single doses (0.830.88 mmol) was started simultaneously with radiation therapy. The treatment effectiveness was assessed using the Beck Depression Inventory 2 and 4 weeks after the start of the study. Statistical comparison of related samples was carried out using the Friedman test and post hoc analysis using the paired Wilcoxon test with the Bonferroni correction. Independent samples were compared using the KruskalWallis test with a post hoc analysis using the DanBonferroni test.&#x0D; Results. Radiation therapy was found to cause a clinically significant increase in the severity of depressive symptoms in 14 and 28 days after the start of the study (p 0.010). Two-week administration of methylethylpyridinol, ethylmethylhydroxypyridine malate, and ethylmethylhydroxypyridine succinate reduced the severity of depressive symptoms to the normal level (p 0.001), mainly due to a decrease in the severity of symptoms of the cognitive-affective cluster (p 0.001). The studied drugs with equal severity prevented the escalation of depression symptoms according to the Beck Depression Inventory (p ˃0.05).&#x0D; Conclusion. Hydrochloric, malic and succinic salts of 2-ethyl-6-methyl-3-oxypyridine are equally effective in preventing the development of depression during postoperative radiation treatment of patients with ute-rine cancer.

Long-Term Outcome of Surgery and Radiation Treatment for Craniopharyngioma

<h3>Purpose/Objective(s)</h3> Treatment of craniopharyngioma, a rare but benign neoplasm, typically entails gross total resection (GTR) or subtotal resection followed by adjuvant radiation (STR-RT). We analyzed progression free survival (PFS) in the adult population undergoing gross total resection versus subtotal resection followed by radiotherapy (RT). <h3>Materials/Methods</h3> A retrospective review was conducted on 67 consecutive patients who were treated for craniopharyngioma. All patients received surgical resection. Patients that had STR also received postoperative radiation treatment. A median dose of 54 Gy (50.4 – 54 Gy) was used with typical dose per fraction of 1.8 Gy five times per week. Three patients were excluded from analysis due to death shortly after surgery (n=1) and no adjuvant RT following STR (n=2) for a total of 64 patients. Regular follow up examinations included contrast MRI scans, physical exams, and clinical evaluation. <h3>Results</h3> Median age was 43 years (19 – 79 years). GTR was achieved in 35 patients and STR-RT in 30 patients. Median tumor size of GTR was 8.64 cm³ (range 1.8 – 40.1 cm³, mean 13.7 cm³) and 19.6 cm³ (range 2.5 – 116.3 cm³, mean 26.2 cm³) for STR-RT (p = 0.03). At a median follow up of 84 months (4 – 255 months) local control rate for all patients treated with GTR or STR-RT was 89.3% at 2 years, 80.1% at 5 years and 73.9% at 10 years. There was one death a week following initial surgery and 2 patients who had STR with no adjuvant RT both had local failure requiring additional intervention at 9 and 26 months. Of 35 patients that had GTR, local control was 91.4% at 2 years, 74.3% at 5 years, and 65.7% at 10 years. Of 12 patients with GTR requiring additional intervention with surgery, RT, or both 100% (n = 12) are stable at last follow up. For the 30 patients with STR-RT local control was 86.7% at 2 years, 86.7% at 5 years and 83.3% at 10 years. 5 patients that underwent STR and adjuvant RT required additional surgical intervention with 100% of patients (n = 5) stable at last follow up. The hazard ratio of STR and RT compared to GTR is 0.49 (CI 0.19 – 1.26), with no significant difference of progression free survival (p = 0.33). <h3>Conclusion</h3> Long term results for patients with craniopharyngioma that underwent subtotal resection followed by radiotherapy demonstrate equivalent local control as compared to gross total resection.

Endoscopic transnasal surgery in optic pathway gliomas located in the chiasma-hypothalamic region: case series of ten patients in a single-center experience and endoscopic literature review.

Optic pathway gliomas (OPGs) constitute approximately 3-5% of childhood intracranial tumors. In this study, the authors presented their experience of using the endoscopic endonasal approach to treat patients with OPG located in the chiasma-hypothalamic region and aimed to use the infrachiasmatic corridor in the endoscopic endonasal approach as an alternative to the transcranial approach in the surgical necessity of OPGs. We retrospectively analyzed the data of ten patients diagnosed with OPG histopathologically among 3757 cases who underwent endoscopic endonasal surgery between August 1997 and March 2021 at Kocaeli University Faculty of Medicine Pituitary Research Center and Department of Neurosurgery. Mean follow-up period 48.5months. During the postoperative follow-up period, 3 of these 10 patients underwent reoperation due to tumor recurrence. Combined (endoscopic endonasal approach + transcranial approach) approach was applied to 2 patients in the same session. Surgical and clinical outcomes were evaluated in detail. Ten patients with a mean patient age of 20.6 ± 11.4 were included in this study. The most common complaint was visual impairment. After surgery, improvement in visual impairment was observed in five patients. No increase in postoperative visual impairment was observed in any of the patients. Postoperative panhypopituitarism was not observed in any of the patients. STR resection was performed in 5 patients and NTR resection in 5 patients. No additional treatment was required during follow-up in 4 of 5 patients who underwent NTR. A total of 6 patients received postoperative radiotherapy treatment. In gliomas located in the chiasma-hypothalamic region, appropriate patient selection and endoscopic endonasal surgical treatment may contribute to the elimination of symptoms due to the mass effect of the tumor. It may also contribute to keeping the disease under control with targeted adjuvant therapies by clarifying the pathological diagnosis of the lesion.

The effect of antioxidant drugs on the self-assessment of clinical symptoms in women during radiation therapy after surgical treatment of endometrial cancer: Placebo-controlled randomized trial

Aim. Comparative analysis of the effect of methylethylpiridinol (Emoxipine), ethylmethylhydroxypyridine malate (Ethoxidol) and ethylmethylhydroxypyridine succinate (Mexidol) on the self-assessment of nonspecific clinical symptoms in women receiving adjuvant radiation therapy after radical surgical treatment of uterine body cancer.&#x0D; Materials and methods. A short-term, prospective, simple blind, placebo-controlled, randomized study of the effect of 14-day course use of emoxipine (150 mg [0.87 mmol] per day intravenously), ethoxidol (225 mg [0.83 mmol] per day intravenously) and mexidol (225 mg [0.88 mmol] daily intravenously) on the dynamics of self-assessment of nonspecific clinical symptoms in patients during radiotherapy after surgical treatment of endometrial cancer was conducted. Self-assessment of clinical symptoms and quality of life (QOL) was studied using the MDASI questionnaire (M.D. Anderson Symptom Inventory). The emotional complaints were assessed using the Giessen questionnaire.&#x0D; Results. The 14-day use of Emoxipine, Ethoxidol and Mexidol in almost eqimolar single doses prevented the negative impact of radiation therapy on the self-assessment of clinical symptoms and QOL according to MDASI. This was manifested by a significant decrease in weakness, sadness and depression, as well as the prevention of nausea and appetite disorders during radiation therapy. At the same time, the emotional coloring of stomach and heart complaints, exhaustion and pressure of complaints decreased according to the Giessen questionnaire. The positive effect of Emoxipine, Ethoxidol and Mexidol on the self-assessment of the clinical condition and the emotional coloring of the corresponding complaints was accompanied by an improvement in such components of QOL as general activity, mood, ability to work, relationships with other people and ability to enjoy life. The studied drugs did not differ in the intensenty of the identified effects.&#x0D; Conclusion. Emoxipine, Ethoxidol and Mexidol significantly improve the multidimensional self-assessment of the clinical condition of patients receiving radiation therapy after surgical treatment of endometrial cancer. The results obtained allow us to consider Emoxipine, Ethoxidol and Mexidol as equally effective means of maintenance therapy at the stage of postoperative radiation treatment of patients with endometrial cancer.

Pharmacoeconomic analysis of the efficacy of emoxypine, ethoxydol and mexidol used to improve the quality of life of women receiving radiotherapy after uterine corpus cancer surgery

The results of the previous study (Volchegorsky I.A., Vazhenin A.V., Alekseeva A.P., 2022) allow us to consider emoxypine, ethoxydol and mexidol as equally effective maintenance therapy means that improve the quality of life at the stage of postoperative radiation treatment of patients with uterine corpus cancer. In such a situation, the decision on the purchase of an optimal drug by a medical institution is closely related to the market price of the drug and the cost-effectiveness pharmacoeconomic indicator, which makes it possible to select a drug from the analyzed group based on the minimum cost of the "unit of effect". Objective: to conduct a comparative analysis of the cost of the "unit of effect" of emoxypine, ethoxydol and mexidol, used to improve the quality of life of women receiving radiation therapy af ter surgical treatment of uterine corpus cancer.

Updates on the APBI-IMRT-Florence Trial (NCT02104895) Technique: From the Intensity Modulated Radiation Therapy Trial to the Volumetric Modulated Arc Therapy Clinical Practice

Several phase 3 trials have demonstrated partial breast irradiation noninferiority compared with whole breast irradiation in terms of local control and similar or reduced toxicity. During recent years, especially owing to the COVID-19 pandemic, a growing interest in 5-fraction regimens emerged. The APBI-IMRT-Florence trial (NCT02104895) schedule (30 Gy in 5 fractions) might represent an appealing treatment option, being both a safe and effective partial breast irradiation schedule, with long-term reported results. The aim of this report is to support planners interested in implementing this technique and to warrant equal access to postoperative radiation treatment for most early breast cancer patient candidates. We report the current delivery technique optimized from the original protocol and the updated dose constraints for plan optimization. We also report a statistical analysis of dosimetric parameters on 50 patients treated in consecutive fractions. Treatment-related toxic effects were assessed using the acute radiation morbidity scoring criteria and late radiation morbidity scoring scheme from the Radiation Therapy Oncology Group and the European Organisation for Research and Treatment of Cancer. The mean volume of ipsilateral breast was 731 cm3 (standard deviation ± 450; range, 151-2205) and the mean planning target volume (PTV) was 139 cm3 (standard deviation ± 48; range, 55-259). There was good correlation between ipsilateral breast V15Gy and the ratio between the PTV and ipsilateral breast volume (R2 = .911). At a median follow-up of 4.5 years, 32% of patients (n = 16) developed any grade 1 acute toxic effect. No grade >1 toxic effect was observed. Sixteen percent of patients (n = 8) developed any grade 1 late toxic effect. No grade >1 toxic effect was observed. Physician-assessed cosmesis was reported as excellent (84%), good (14%), and fair (2%). The schedule of 30 Gy in 5 consecutive fractions might represent a safe, easy-to-deliver, and cost-effective option for appropriately selected patients affected by early breast cancer.

Results from a prospective, randomised study on (accelerated) preoperative versus (conventional) postoperative radiotherapy in treatment of patients with resectable squamous cell carcinoma of the oral cavity – The ARTSCAN 2 study

Background and purposeAn earlier prospective randomised multicentre study (ARTSCAN) in head and neck cancer patients that compared conventionally fractionated radiotherapy (CF) with accelerated radiotherapy (AF) was inconclusive. In the subgroup of oral cavity squamous cell cancer (OCSCC) a large absolute, but not statistically significant, difference in local control was seen in favour of AF. This difference was more pronounced in resectable tumours. The finding raised the hypothesis that AF could be beneficial for OCSCC patients. In addition, the longstanding controversy on pre- or postoperative radiotherapy was addressed. Materials and methodsPatients with OCSCC, judged to withstand and likely benefit from combined therapy, were recruited. Subjects were randomised to either preoperative AF with 43 fractions given as a concomitant boost with two fractions/day to the tumour bearing volume to a total dose of 68 Gy in 4.5 weeks followed by surgery, or primary surgery with postoperative CF, total dose 60 or 66 Gy in 6–7 weeks. For patients whose tumours had high-risk features, 66 Gy and concomitant cisplatin was prescribed. Results250 patients were randomised. Median follow-up was 5 years for locoregional control (LRC) and 9 years for overall survival (OS). There were no statistically significant differences between the two treatment arms regarding LRC and OS. LRC at five years was 73% (95% CI, 65–82) in preoperative AF and 78% (95% CI, 70–85) in postoperative CF.Toxicity was more pronounced in preoperative AF. ConclusionThis study does not support that AF prior to surgery improves outcome in oral cavity cancer compared with postoperative CF.

An equity-based narrative review of barriers to timely postoperative radiation therapy for patients with head and neck squamous cell carcinoma.

ObjectivesThe majority of patients with head and neck squamous cell carcinoma (HNSCC) do not commence postoperative radiation treatment (PORT) within the recommended 6 weeks. We explore how delayed PORT affects survival outcomes, what factors are associated with delayed PORT initiation, and what interventions exist to reduce delays in PORT initiation.MethodsWe conducted a PubMed search to identify articles discussing timely PORT for HNSCC. We performed a narrative review to assess survival outcomes of delayed PORT as well as social determinants of health (SDOH) and clinical factors associated with delayed PORT, using the PROGRESS‐Plus health equity framework to guide our analysis. We reviewed interventions designed to reduce delays in PORT.ResultsDelayed PORT is associated with reduced overall survival. Delays in PORT disproportionately burden patients of racial/ethnic minority backgrounds, Medicaid or no insurance, low socioeconomic status, limited access to care, more comorbidities, presentation at advanced stages, and those who experience postoperative complications. Delays in PORT initiation tend to occur during transitions in head and neck cancer care. Delays in PORT may be reduced by interventions that identify patients who are most likely to experience delayed PORT, support patients according to their specific needs and barriers to care, and streamline care and referral processes.ConclusionsBoth SDOH and clinical factors are associated with delays in timely PORT. Structural change is needed to reduce health disparities and promote equitable access to care for all. When planning care, providers must consider not only biological factors but also SDOH to maximize care outcomes.

NEIM-05. [GA68]DOTATATE PET/MRI-BASED RADIOSURGICAL RESPONSE ASESSMENT IN MENINGIOMA

Abstract PURPOSE Postoperative PET/MRI with [68Ga]-DOTATATE can differentiate residual meningioma from postsurgical change, aid in target delineation, and portend a more favorable dosimetry with decreased PTV and organ-at-risk dose. Our purpose was to demonstrate utility of DOTATATE PET/MR for radiosurgical treatment (RT) response assessment in meningiomas. METHODS Patients underwent postoperative radiation treatment planning using DOTATATE PET/MRI as part of our IRB-approved prospective trial. Both DOTATATE PET and gadolinium-enhanced T1 weighted MR imaging were incorporated in RT-planning. All patients underwent follow-up DOTATATE PET/MRI at 6-12 months following completion of radiosurgery. Maximum absolute standardized uptake value (SUV) and SUV ratio (SUVR) of lesion/ superior sagittal sinus SUV were obtained. RANO criteria were applied to determine significance of change in size. Statistical analyses were performed using paired t-tests. RESULTS 13 patients (15% WHO-I, 54% WHO-II, 23% WHO-III, 8% WHO grade unknown) were followed postoperatively with pre- and post-RT DOTATATE PET/MRI. 29 meningiomas were treated. 46% (6/13) of subjects received SBRT and 54% (7/13) received SRS. Post-RT DOTATATE PET/MRI demonstrated a 46.4% SUV decrease (p-value = 0.0001) and a 60.8% SUVR decrease (p-value &amp;lt; 0.0001). Of 21 measurable lesions, the size product decreased by 21%; while this decrease was statistically significant (p-value = 0.0008), it was below the 25% decrease defined as clinically significant by RANO guidelines. To date, all patients remain stable radiographically without evidence of recurrence (mean follow-up post RT: 14 months; range: 6-24 months). CONCLUSIONS DOTATATE PET SUV and SUVR demonstrated marked, significant decrease post radiosurgery. Lesion size decrease was statistically significant but not clinically significant by RANO criteria. DOTATATE PET/MR thus represents a promising approach to aid in response assessment for radiosurgically treated meningiomas. Longer-term follow-up is needed to determine the correlation between the degree of post-RT SUV and/or SUVR decrease and progression-free-survival.

Thymomas: Analysis of Histological Subtypes and Staging in Patients with Surgical Treatment in Two Reference Centers in Argentina

Background: Thymomas are a heterogeneous group of tumors which represent the most frequent tumor of the anterior mediastinum. Aims: To describe the clinical, histological, surgical and oncological characteristics of a cohort of patients with a diagnosis of thymoma surgically treated in two centers in Argentina and to evaluate the possibility of retrospectively implementing the 8th edition of TNM staging. Materials and Methods: 180 patients with thymoma surgically treated over a period of 41 years were studied. The following variables were analysed: age, sex, presence of myasthenia gravis at diagnosis, Masaoka staging (1994), TNM staging of thymus tumors, Histological classification (WHO 2015), neoadjuvant treatment with chemotherapy, post-operative radiation treatment and clinical evolution of myasthenia gravis defined according to the modified Osserman classification. Results: 96 men and 84 women were analysed. Median age 51 years (range 13-85). 85% of the patients analysed came from the public sphere. When analysing the institutional distribution by Masaoaka-Koga stage and TNM, a higher proportion of stages I was observed for both staging systems. Most myasthenic patients belonged to the WHO B2 histological classification (49%, p=0.04) and 15 patients received neoadjuvant treatment prior to surgery to improve the chances of resection, most of them classified as stages III of Masaoka (p=0.002) or IIIa of the TNM stage (p=0.001). 74 (46%) cases received post-operative RT when they presented Masaoka Koga stages II (p=0.000) and IIIa or more advanced TNM staging (p=0.000). 76% of the patients presented remission or stability of symptoms after surgical treatment and only 3/6 died due to myasthenic crisis in the immediate post-operative period. Conclusion: As reported in the literature, we have observed a higher frequency of B2 thymomas and their association with Myasthenia gravis. The histological criteria of the WHO 2015 classification, based on the ITMIG recommendations, favour precision in the definition of subtypes. The retrospective implementation of the 8th edition of TNM staging highlights the need to standardize protocols for pathological and surgical studies.