Radiotherapy For Local Control Research Articles

Health disparities among patients with Ewing sarcoma in Florida.

e18549 Background: Ewing sarcoma (ES) is the second most common malignant bone tumor in children and young adults. Although usually localized, subclinical metastatic disease is often present. Treatment includes multi-agent chemotherapy with surgery or radiation for local control. Though overall survival (OS) has improved to 70% for localized disease, mortality from recurrent or metastatic disease remains high. Although, ES is most common among Non-Hispanic White adolescent males, prior population-based ES studies utilizing Surveillance, Epidemiology, and End Results (SEER) have shown increased mortality among White Hispanics, Blacks, and those of low socioeconomic status (SES). Florida is not part of SEER but is home to a unique population with high proportions of immigrants and Hispanics of distinct backgrounds including Cubans, Puerto Ricans, and South Americans that contrasts to the Mexican Hispanic majority in other US states. As there are no prior population-based studies examining ES in Florida, the role of racial/ethnic disparities on outcomes among this diverse patient population remains unknown. By utilizing the Florida Cancer Data System (FCDS) for ES patients, this study will assess overall racial/ethnic disparities, evaluate the impact of racial/ethnic disparities on OS, and compare ES incidence rates in Florida with national SEER-21 rates to assess risk. Methods: This retrospective secondary analysis examined all patients diagnosed with ES (2005-2018) in Florida (n = 411) and SEER-21 (n = 1,513). Age-adjusted incidence (AAI) with 95% confidence interval (95%CI) was analyzed for the entire group and OS was estimated using Kaplan-Meier survival analysis. Univariable and multivariable analyses using Cox regression models were performed for variables of interest—race/ethnicity, age, sex, year of diagnosis, site of disease, staging, SES, and insurance type. Adjusted hazard ratio (aHR) with 95%CI were calculated. Results: Per the FCDS, there was a higher incidence of ES in Hispanic males (AAI 2.6; 95%CI: 2.0-3.2 per 1,000,000; n = 84) as compared to the SEER (1.2; 1.1-1.4; n = 250). Among non-metastatic ES, Hispanics had an increased risk for cancer-related mortality compared to Non-Hispanic Whites (aHR 2.9; 95%CI: 1.46-5.74; p =0.002), after adjusting for all other variables. In the full model (all cases regardless of stage at diagnosis), older age and distant metastasis were statistically significant factors for poor OS while SES and insurance status were not. Conclusions: Hispanics in Florida are of interest for ES with a higher-than-expected incidence compared to the US and remarkably worse survival for non-metastatic disease compared to Non-Hispanic Whites. Further in-depth studies are needed to examine why this disparity exists, but it is potentially multifactorial. This is the first known study for ES health disparities in Florida and provides updated national data for comparison.

Osteogenic Sarcoma of the Head and Neck: Is Chemotherapy Needed?

Head and neck osteosarcoma (HNOS) is a rare subtype of sarcoma that most commonly arises in the mandible or maxilla. Treatment for HNOS typically involves a multidisciplinary and multimodal approach depending on the size, grade, and histological subtype. Surgery by sarcoma-experienced head and neck surgeons and orthopedic oncologists remains a crucial component of treatment in all subtypes of HNOS, particularly for those with low-grade histology, which can be treated definitively with surgical resection if negative margins are obtained. Negative surgical margins are of utmost prognostic importance, and neoadjuvant or adjuvant radiation should be considered in patients with positive (or anticipated positive) margins/residual postoperative disease. Current data favors the use of (neo)adjuvant chemotherapy in patients with high-grade HNOS to improve overall survival but must be individualized to weigh benefits and risks of the short- and long-term effects of treatment. Our center uses a multidisciplinary treatment plan and notes anecdotal improvement in treatment outcomes with a combined surgical and ifosfamide-containing chemotherapeutic approach with radiotherapy for local control if positive margins. Large volume cohorts and adequate randomized control trials assessing the efficacy of chemotherapy in HNOS are scant and additional research and multi-institutional collaboration are needed to study polychemotherapeutic and radiation treatment regimens and outcomes more adequately.

A phase II study of risk-based stratification after chemotherapy combined with PD-1 antibody: Two various bladder-sparing modalities for muscle invasive bladder cancer therapy (ReBirth).

TPS580 Background: Neoadjuvant chemotherapy plus radical cystectomy is the standard for cisplatin-eligible patients with cT2-4aN0M0 muscle invasive bladder cancer, however, some of them desperately need innate bladder. Developments in the last two decades suggest that well-documented Trimodal therapy(TMT) demonstrated durable oncologic control and long-term survival in selected patients. Nevertheless, personalized treatment based on responses of systematic treatment and biomarker are currently lacking. Additionally, concerning a balance between non-inferiority of hypofractionated radiation therapy in local control and late toxicity, the specified dose regimen combined with immunotherapy is worth exploring. "ReBirth" study was designed to evaluate the efficacy and tolerability of two various bladder-sparing modalities with risk-based stratification after chemotherapy combined with PD-1 antibody. Methods: This is a single-arm, phase II trial that includes cT2-4aN0-1M0 patients who aged 18-85 years and histologically confirmed bladder urothelial carcinoma. Other key inclusion criteria: no prior anti PD-(L)1 therapy; ECOG 0-2 and cisplatin eligible. The trial consists of two stages. In the first stage, eligible patients will receive tislelizumab 200 mg in day 1 (D1), cisplatin 70 mg/m2 D1, and gemcitabine 1000 mg/m2 D1 and D8 every 21 days for four cycles. Patients will then be divided into two cohorts in the second stage based on the cystoscopy, urine cytology, and imaging combined with utDNA (urine tumor DNA). Patients who achieve clinical complete response (cT0, cTa) will enter into cohort 1 and treated with tislelizumab 200 mg IV Q3 for up to 6 months, while patients who did not achieve clinical complete response will enter into cohort 2 and treated with tislelizumab 200 mg IV Q3W for up to 6 months and chemoradiotherapy for whole bladder 44Gy/16 fractionation, if lymph node is positive, it can be dosed to the maximum tolerable dose, such as tumor boost 11Gy/4fractionation, combined with DDP as radiosensitizer. The primary endpoint is BIDFS (bladder intact disease-free survival) at one year, which is defined as time from initiation of protocol therapy until the development of muscle-invasive bladder cancer recurrence, regional pelvic recurrence, distant metastases, bladder cancer-related death, or cystectomy. Secondary endpoints include metastatic free survival rate at two years, BIDFS at two years and safety graded according to CTCAE V5.0. Tissue samples will be collected for genomic profiling and utDNA will be collected and examined for biomarker exploring in this bladder preservation therapy. Till Sep.2022, 5 of planned 30 patients have been enrolled. Clinical trial information: NCT05531123 .

Metastatic breast cancer to oesophagus: a case report and review of the literature

Abstract Background: Secondary oesophageal carcinoma from a breast primary is an infrequent phenomenon. Given the rarity of this presentation, there is a general lack of consensus on management guidelines. Materials and methods: Herein, we report a case of a 65-year-old female presented with dysphagia, 14 years post-surgery for breast cancer. She was diagnosed with oesophageal metastases and was treated with combination of systemic chemotherapy, hormonal therapy and local radiotherapy. Our patient tolerated the treatment well and achieved a significant symptomatic improvement post-radiotherapy. We also performed a review of literature on oesophageal metastases from breast primary, aiming to improve the diagnostic accuracy and treatment efficacy in this rare presentation. Conclusions: We conclude that patients who present with persistent dysphagia post-breast cancer treatment should undergo an endoscopic ultrasound (EUS)-guided fine-needle biopsy (FNB) to rule out oesophageal metastasis. We suggest systemic chemotherapy with hormonal therapy and radiotherapy for local control as a management of choice in this condition. Even though prognosis is difficult to predict in these patients, this combined modality of treatment seems to achieve better overall survival.

Preoperative spinal angiography decreases risk of spinal ischemia in pediatric posterior thoracic tumor resection.

Resection of pediatric posterior thoracic tumors (PTTs) can be complicated by Artery of Adamkiewicz (AKA) injury. Post-op spinal ischemia occurs in approx. 3.2% of patients, typically due to iatrogenic vascular injury. Pre-op angiography (PSA) may help to avoid this complication. Herein, we aim to evaluate outcomes after initiation of routine PSA prior to PTT resection. A single-institution retrospective review identified 25 children (< 18years) treated for PTTs from 2009 to 2021. PTTs included: posterior mediastinum, paraspinal thorax and posterior chest wall tumors. PSA patients were compared to those without pre-operative angiography (NA). Demographics, perioperative and long-term outcomes and event-free survival (EFS) were assessed. Prior to 2012, eleven patients were treated without PSA. However, the last developed post-operative paraplegia secondary to spinal ischemia. Since this event, PSA has become routine for all PTTs (n = 14) identifying six AKAs and nine accessory spinal arteries. Resection was performed in ten (90.1%) NA patients and eight (57.1%) PSA patients. Based on PSA findings, resection was not offered to six patients and planned partial resection was performed in three patients. Five PSA patients required radiation therapy for local control vs two NA patients. There were no differences in recurrence or overall EFS. PSA aids in identifying patients with high-risk thoracic vascular anatomy and may prevent risk of post-operative paraplegia associated with PTT resection.

Impact of radiotherapy for local control in T3 N0 rectal cancer managed with total mesorectal excision: A systematic review and meta-analysis.

3604 Background: Total mesorectal excision (TME) significantly improved rectal cancer outcomes. Radiotherapy (RT) is recommended for T3N0 rectal cancers, though benefit has not been demonstrated in combination with TME for this specific population. This meta-analysis could provide evidence to ameliorate toxicities from treatment. Methods: Randomized clinical trials and observational studies published until October 18, 2020 were identified via PubMed and Embase. Objective: To determine whether RT decreased the risk of local recurrence (LR) in T3N0 rectal cancer managed with TME. Study Selection and Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were observed for literature search, extraction, and screening. Studies with LR data specific to T3N0M0 rectal cancer, treated with and without RT, were included. Reviews, non-English articles, and non-TME studies were excluded. Newcastle Ottawa Scale (NOS) evaluated quality. Meta-analysis was done with a random-effects model. Main outcome: Meta-analysis of the relative risk of LR was conducted. Results: 7,246 studies were screened, 134 full-text studies assessed for eligibility, 5 studies were included in the final analysis. No randomized data reported results specific to our study population. Five retrospective cohort studies involving 932 participants reported LR outcomes. The median follow-up ranged from 38.4 months up to 71 months. Four studies took place in Asia (797 participants) and one in North America (135 participants) (Table). Quality according to NOS ranged from 7–9. The estimated average relative risk for LR at 5 years was 0.63 (95% CI 0.31–1.29; I2=41.8%) when RT was used. Conclusions: This meta-analysis’ supports that there is no clear benefit to LR with the addition of RT in T3N0 patients with rectal adenocarcinoma undergoing TME. As meta-analysis was limited to retrospective cohort studies, there is concern for bias. Registration Prospero number CRD42020216058 .[Table: see text]

SBRT in non-spine bone metastases: a literature review.

Stereotactic Body Radiotherapy (SBRT) is a technique for delivering high doses of radiation to tumors while preserving the normal tissues located around this area. Bone metastases are frequent in cancer patients. They can be distressingly painful or may cause pathological fractures. Radiation therapy is a fundamental aspect of treatment for bone metastases. The objective of this study is to analyze the literature on non-spine bone metastasis treated with SBRT, including immobilization, volume delineation, dose and fractionation, local control, side effects, and assessment of response after treatment. Full-text articles written in English language and published in the last 10 years were included in this review and were accessible on PubMed and MEDLINE. We examined 78 articles. A total of 40 studies were included in this review. Most were retrospective studies. The articles included were evaluated for content and validation. The immobilization systems and imaging tests used for tumor delimitation were variable between studies. The use of CTV (Clinical Target Volume) has not been defined. Doses and fractions were variable from 15 to 24Gy/1 fraction to 24-50Gy in 3-5 fractions, with local control being around 90% with a low rate of side effects. We review state of the art in SBRT non-spine metastases. SBRT can result in better local control and pain management in non-spine bone metastases patients. We need more research in volume delineation determining whether or not to use CTV and the role of MRI in volume contouring, optimal doses, and fractionation according to histology and a reliable response assessment tool. Studies that compare SBRT to conventional radiotherapy in local control and pain control are needed.

Low-grade soft-tissue sarcomas: What is an adequate margin for local disease control?

BackgroundWhilst the resection margin is an established factor predictive of local control of soft-tissue sarcomas (STSs), the adequacy of margin width for low-grade STSs has been rarely described. We aimed to investigate the margin adequacy and its prognostic relevance in low-grade STSs. Methods109 patients who underwent surgical treatment for a low-grade STS were studied. The prognostic value of margin status was evaluated according to the R–, R+1–classification, and width in millimetres. ResultsThe 10-year local recurrence (LR) rates were 6%, 27%, 54% in R0, R1, and R2, respectively (p < 0.001), according to the R–classification. The R+1–classification resulted in a decreased LR rate in R1, but no major differences in LR rates in R0 and R2; 7%, 14%, 54% in R0, R1, and R2, respectively (p < 0.001). When classified by metric distance, 10-year LR rates were 0%, 8%, and 38% by ≥ 2.0 mm, 0.1–1.9 mm, and 0 mm margins, respectively (p < 0.001). Patients with close margins (0.1–1.9 mm) who received adjuvant radiotherapy had a trend toward lower LR risk than those without radiotherapy (10-year, 4% vs. 12%; p = 0.406). The 5 and 10-year disease-specific mortality was 9% and 13%, respectively; margin width was not associated with disease-specific mortality but LR was a poor prognostic factor for survival (p = 0.003). ConclusionWhilst negative margin provided local control over 90%, excellent local control was achieved with microscopic margins ≥2 mm. The role of margins is more important than radiotherapy in local control. Margins do not determine survival, but LR is associated with a poor prognosis.

Effect of neoadjuvant chemotherapy and early chemotherapeutic response evaluation for low/intermediated-risk mid-low stage II/III rectal cancer: A prospective, open-label, single-arm, phase II trial.

e16133 Background: Neoadjuvant chemoradiotherapy (NCRT) is the standard of care for stage II/III rectal cancer (RC) for its local-control effect. As advancement in surgery, local relapse was no longer the primary cause of failures, especially in low/intermediated-risk stage II/III RCs, in which benefit of radiotherapy in local control wasn’t shown in our previous trial. Distant relapse has become the major form of recurrences, and occurs at an increased rate when chemotherapy was delayed. This trial explores the effect of neoadjuvant chemotherapy (NCT), and the possibility of early assessment of chemotherapeutic response in low/intermediated-risk stage II/III RCs. Methods: This prospective, single arm, phase II trial planned to enroll 60 low/intermediate-risk stage II/III mid-low RCs (low: cT3a-bN0-1M0 MRF(-); mid: cT3a-c or T4aN0-1M0). 4 cycles of CAPOX NCT were scheduled. Rectal MRI, transanal US, endoscopy, CT were examined prior to treatment and after every two cycles. The primary outcome was the clinicopathological response, defined as pathological TRG0-1, TRG2 without tumor length increase, or TRG3 with tumor length regression over 30%. This study was approved by the Ethics Committees of West China Hospital and registered at ClinicalTrials.gov (NCT03666442). Results: From Dec. 2017 to Oct. 2019, 61 eligible patients were enrolled. Two patients received 3 cycles and 2 had only 2 cycles of chemotherapy due to intolerable adverse effects; 57 cases finished 4 cycles. In pathological evaluation, 13 patients (21.3%) were complete response (pTRG0) with one positive node in one patient; 5 cases were pTRG1; 26 were pTRG2; 17 had no response (pTRG3). 48 cases (78.7%) were responders. In the ROC curve predicting the responder via the 2-cycle regression in tumor length, the AUC was 0.864 (95%CI (0.764,0.963), p &lt; 0.001), and the best cutoff regression rate after 2 cycles NCT was 27%. With this cutoff, the sensitivity was 83.3%; specificity was 84.6%; accuracy was 83.6%; positive likelihood ratio was 5.42; negative likelihood ratio was 0.20. Conclusions: NCT achieve more favorable pCR and tumor response rate in low/intermediated-risk stage II/III RCs, comparing to previous studies. The tumor regression after 2 cycles NCT had good accuracy in diagnosing the chemotherapeutic response. This early assessed chemosensitivity may become another feature for tailored use of neoadjuvant treatments, further cohort study will be conducted. Clinical trial information: NCT03666442 .

Radiotherapy in the treatment of extracranial hemangiopericytoma/solitary fibrous tumor: Study from the Rare Cancer Network

Background and purposeThe role of radiotherapy (RT) in the treatment of hemangiopericytoma/solitary fibrous tumor (HPC/SFT) is still under debate. We aimed at investigating whether radiotherapy can improve the results in patients operated for extracranial HPC/SFT. Materials and methodsData from patients with HPC/SFT, treated from 1982 to 2012, were retrospectively reviewed within the Rare Cancer Network framework. Actuarial local control (LC), disease-free survival (DFS), metastasis-free survival (MFS) and overall survival (OS) were calculated with Kaplan-Meyer method. Patient and tumor parameters were analyzed by univariate and multivariate analysis. ResultsOf 114 HPC/SFT, 58 (50.9%) occurred in the extremities/superficial trunk and 56 (49.1%) in intra-thoracic/retroperitoneum. Seventy-eight patients (68.4%) underwent surgery only (Sx), and 36 (31.6%) Sx and RT (Sx + RT). Median RT dose was 60 Gy (range 45–68.4 Gy) in 1.6–2.2 Gy fractions. In the extremities/superficial trunk group of patients, actuarial 5-year LC rates were 50.4% after Sx and 91.6% after Sx + RT (p < 0.0001) for LC, and 50.4% after Sx and 83.1% after Sx + RT (p = 0.008) for DFS. In the intra-thoracic/retroperitoneum group of patients, actuarial 5-year rates were 89.3% after Sx and 77.8% after Sx + RT (p = 0.99) for LC, and 73.8% after Sx and 77.8% after Sx + RT (p = 0.93) for DFS. At multivariate analysis, the addition of RT resulted in better LC and DFS in the whole series. The advantage was confirmed for LC in the group of patients affected by extremity/superficial trunk tumors. ConclusionAddition of RT to Sx could improve the prognosis, in terms of LC and DFS, essentially in patients with extremities/superficial trunk tumor locations.

Breath-hold versus mid-ventilation in SBRT of adrenal metastases.

To improve local control in radiotherapy of adrenal metastases precise dose delivery without increasing toxicity is vital. Decreasing the Clinical Target Volume (CTV) - Planning Target Volume (PTV) margins by reducing breathing movement can achieve this. Few data were published concerning the effect of a breath-hold technique. This study investigates the potential of Active Breathing Control (ABC) to limit adrenal breathing movement and reduce CTV-PTV margins. We compared adrenal gland movement in free-breathing, making use of the Mid-ventilation (MidV) technique, and with ABC. The coordinates of the adrenal glands obtained on ten phases of a free breathing 4D-CT and on several repeat inspiration ABC CT-scans were measured. Separate coordinates, the random margin component and the margin vector norm were computed and compared between the two techniques. We compared the two techniques in 11 patients (21 adrenal glands) and found the largest movement in the Z-direction, with values of 8.7 ± 4.2 mm for MidV and 2.4 ± 1.5 mm for ABC. In 71% of the cases ABC resulted in a smaller margin component than MidV, although non-significant (p ≥ 0.4). Movement of the adrenal gland is largest in the Z-direction. The mean difference in the margin vector norm between both techniques was small with large variations over the patient group, the clinical effect of these differences is unknown. Applying an individualised motion management strategy could be beneficial. If a peak-to-peak amplitude above 15 mm in the Z-direction is observed in the MidV scan we advise to examine if a breath-hold technique could reduce margins.

The Efficacy of Hypofractionated Radiotherapy for Local Control in Aggressive non-Hodgkin Lymphoma

The Efficacy of Hypofractionated Radiotherapy for Local Control in Aggressive non-Hodgkin Lymphoma

Role of radiotherapy in local control of metastatic rectal cancer: A single-center experience

Role of radiotherapy in local control of metastatic rectal cancer: A single-center experience

Prolonged survival after craniectomy with skull reconstruction and adjuvant definitive radiation therapy in three dogs with multilobular osteochondrosarcoma.

Multilobular osteochondrosarcoma is an uncommon canine tumor but presents a treatment challenge when arising on the skull. This retrospective case series study aimed to describe outcome of a multimodality treatment approach involving aggressive surgical resection and adjuvant definitive radiation therapy in a group of dogs with multilobular osteochondrosarcoma of the calvarium. Clinical, imaging, treatment, and outcome data were collected from retrospective review of medical records. Three dogs met inclusion criteria. The presenting clinical complaint was the presence of a mass effect of the skull in all three dogs and concurrent neurologic abnormalities in one dog. Advanced imaging revealed aggressive lytic and proliferative tumors arising from the calvarium in all three dogs. All dogs were treated surgically with a modified craniectomy, repaired with a titanium mesh-polymethyl methacrylate bone cement implant or a low prolife titanium mesh plate and followed by adjuvant definitive radiation therapy with 2.5Gy per fraction for 22 daily fractions. There were no major immediate surgical complications and radiation was well tolerated overall. Neurologic improvement was seen in the patient that presented with neurologic disease. Survival times from surgery were 387, 422, and 730 days and from the time of radiation were 358, 397, and 677 days. Findings in this sample of three dogs supported the use of aggressive therapy with a combination of surgical craniectomy and cranioplasty utilizing a titanium mesh implant and high dose definitive radiation therapy for local control and prolonged survival times in dogs with multilobular osteochondrosarcoma of the skull.

Stereotactic Body Versus Hypofractionated Radiation Therapy for Local Control of Prostate Cancer Bone Metastases

To compare the rate of radiographic in field failure (IFF) for prostate cancer bone metastases treated with single fraction stereotactic body radiation therapy (SBRT) and hypofractionated radiation therapy (HRT), and secondarily describe the rate of subsequent distant failure (DF). An institutional, retrospective review was conducted of all patients with prostate cancer receiving RT to bone metastases between January 2013 and May 2017. Patients were excluded if less than 6 months of clinical and imaging follow-up was available. IFF was defined as any increase in the size and/or radiotracer avidity of the treated lesion, subsequent use of a secondary local salvage therapy to the treated site, or the appearance of a new lesion within the initial 50% isodose line. DF, defined as new metastatic disease following RT, was a secondary outcome. The cumulative incidence of IFF and DF was determined using the Fine-Gray method with death as a competing risk. Hazard ratios (HR) for single variable associations with outcomes were calculated using the Cox model and a P value of 0.05 was set to determine significance. A total of 201 patients with 249 metastases (191 SBRT, 58 HRT) with a median follow-up of 2.2 (IQR 1.2-3.0) years were analyzed. Patients treated with SBRT more frequently had 1-3 metastases compared to those receiving HRT (85% vs 40%, P<0.0001). The presence of castrate resistant disease was not significantly different between the SBRT and HRT groups (41% vs 35%, P=0.39). The SBRT prescription dose ranged from 16 to 24 Gy in a single fraction, with most receiving 18 (46%) or 20 (47%) Gy. HRT was mainly 8 Gy in 1 fraction (57%) or 20 Gy in 5 fractions (41%). Imaging follow-up was primarily with 11C-choline PET/CT (79%), technetium 99m-MDP bone scan (10%), or CT scan (5%). The one and three-year IFF rates were 34% (95% CI 20-46) and 53% (34-67) for lesions treated with HRT compared to 5% (1.4-7.5) and 13% (7-19) in those treated with SBRT. On single variable regression, the HR for IFF with HRT compared to SBRT was 6.8 (3.7-12.5; P <.0001). No other variables assessed, including Gleason score, castrate resistant disease status, or anatomical location of metastasis were associated with an increased risk of IFF (P >0.05). There was no difference in DF for patients treated with HRT compared with SBRT [3-year cumulative incidence estimate 94% (77-98) vs. 82% (75-88); HR 1.33 (0.97-1.81), P=0.08]. Single fraction SBRT at doses ≥ 16 Gy is an effective means of local therapy and significantly improves radiographic IFF compared to HRT in prostate cancer patients with bone metastases. In this large cohort of patients, local control using SBRT was 95% and 87% at one and three years respectively. The subsequent risk of DF was high. Thus, optimizing patient selection and multidisciplinary management of local and systemic therapies remains essential.

Comparison three-dimensional conformal radiotherapy versus intensity modulated radiation therapy in local control of head and neck cancer.

About 74% of head and neck cancer (HNC) patients need to undergo either definitive or postoperative radiation therapy because of aggressive nature of disease. The transition from two-dimensional conventional radiotherapy to three-dimensional conformal radiotherapy (3D-CRT) and further technological evolutions led to the successful clinical implementation of intensity modulated radiation therapy (IMRT), which constitutes an evolution of 3D-CRT. The IMRT technique gives the ability to create treatment fields with varying beam intensity using inverse planning and optimization algorithms to treat irregularly shaped target volumes with high precision. IMRT is in existence in clinical practice since 1995. Since then, presuming its clinical benefit a significant amount of patients has been treated by this technique. PARSPORT was the first multi-institutional prospective trial comparing IMRT with conventional RT in the treatment of HNC. It has shown a reduction in severe xerostomia but no difference in other toxicity and locoregional control after 24 months' follow or overall survival. Except for early T1, 2 N0 stages, the prognosis for patients with oral cavity cancer (OCC) is dismal than for carcinoma in other sites of the head and neck (HNC). The aim of this study was to assess the outcome of OCC following IMRT. Between January 2013 and January 2015, 40 patients of carcinoma buccal mucosa and carcinoma alveolus were treated by postoperative (19) or definitive (21) radiation therapy by IMRT technique. Of these, 28 patients (70%) presented with locally advanced T3/4 or recurrent tumor. Total radiation doses delivered was between 60 and 70 Gray at 2 Gray/fraction. Of these 31 patients (78%) has received concurrent cisplatin-based chemotherapy. Another group of 42 similar patients treated by 3D-CRT as definitive or postoperative adjuvant treatment over the same period has been selected. Comparisons were performed between these two groups. Data were entered into Excel spreadsheet and expressed as mean and standard deviation for deriving P value, and unpaired t-test was used to calculate 95% confidence interval. Local control (LC) was analyzed using Kaplan-Meier curve. Of all assessed treatment subgroups, LC rate was highest for patients treated with postoperative IMRT (89% LC at 2 years) followed by postoperative 3D-CRT patients (79% LC at 2 years); and finally, poorest LC rates (43% and 32% at 2 years) were seen in definitively irradiated patients with IMRT and 3D-CRT, respectively. LC rate for T1 stage (83%, n = 6) was significantly higher, than that for T2-4 (LC 55%, n = 76) as expected. Postoperative IMRT of carcinoma buccal mucosa and alveolus resulted in the highest LC rate of all the treatment subgroups assessed hence should be generously recommended in such cases especially ones with unfavorable features such as close resection margin, nodal involvement, locally advanced tumor (>T1N0), or recurrent disease, respectively. Despite definitive IMRT, locoregional control in carcinoma buccal mucosa and alveolus remain unsatisfactory, comparable to that following definitive 3D-CRT.

Real-Time Tumor-Tracking Radiotherapy and General Stereotactic Body Radiotherapy for Adrenal Metastasis in Patients With Oligometastasis.

Background:Precise local radiotherapy for adrenal metastasis can prolong the useful life of patients with oligometastasis. The aim of this retrospective, 2-center study was to establish the safety and effectiveness of real-time tumor-tracking radiotherapy and general stereotactic body radiotherapy in treating patients with adrenal metastatic tumors.Materials and Methods:Thirteen lesions in 12 patients were treated with real-time tumor-tracking radiotherapy (48 Gy in 8 fractions over 2 weeks) and 8 lesions in 8 patients were treated with general stereotactic body radiotherapy (40-50 Gy in 5-8 fractions over 2 weeks or 60-70 Gy in 10 fractions over 2 weeks). Overall survival rates, local control rates, and adverse effects were analyzed.Results:The actuarial overall survival rates for all patients at 1 and 2 years were 78.5% and 45.8%, respectively, with a median follow-up of 17.5 months, and the actuarial local control rates for all tumors at 1 and 2 years were 91.7% and 53.0%, respectively, with a median follow-up of 9 months. A complete local tumor response was obtained in 3 tumors treated by real-time tumor-tracking radiotherapy (lung adenocarcinomas with diameters of 35, 40, and 60 mm). There was a statistically significant difference in the local control between the groups treated by real-time tumor-tracking radiotherapy (100% at 1 year) and general stereotactic body radiotherapy (50% at 1 year; P < .001). No late adverse reactions at Grade 2 or higher were reported for either treatment group.Conclusions:This study showed that although both treatments are safe and effective, the real-time tumor-tracking radiotherapy is more effective than general stereotactic body radiotherapy in local control for adrenal metastasis.

A long-surviving patient with advanced esophageal basaloid squamous cell carcinoma treated only with radiotherapy: case report and literature review

BackgroundEsophageal basaloid squamous cell carcinoma (EBSCC) is a rare malignant disease. Advanced EBSCC (AEBSCC) has a poorer prognosis than the more common esophageal squamous cell carcinoma, but no treatment policy has yet been established. This is the first reported case with AEBSCC treated only with radiotherapy. Thus, our long-surviving patient merits consideration. We therefore reviewed cases with the same stage of AEBSCC for further investigation.Case presentationAn 85-year-old man with a chief complaint of difficulty swallowing foods was diagnosed with AEBSCC, cT3N1M0, stage III, by thorough examination. The basaloid carcinoma extended from the upper thoracic esophagus to the middle thoracic esophagus based on imaging studies, endoscopy and biopsy.Morphologically, the tumor was an elevated ulcerative area. We conducted radiotherapy to relieve symptoms, as the patient and his family refused aggressive treatment. He has remained alive without recurrence for 2 years, to date, after completing radiotherapy.ConclusionsBasaloid carcinoma might be highly sensitive to radiotherapy. Thus, radiotherapy for local control might be beneficial for elderly patients with complications and those refusing aggressive treatment.

Benefit of Adjuvant Radiotherapy for Local Control, Distant Metastasis, and Survival Outcomes in Patients with Localized Soft Tissue Sarcoma: Comparative Effectiveness Analysis of an Observational Cohort Study

BackgroundThis study aimed to quantify the benefit of adjuvant radiotherapy (AXRT) for local control, distant metastasis, and long-term survival outcomes in patients with localized soft tissue sarcoma (STS).MethodsThis single-center retrospective observational study enrolled 433 STS patients who underwent surgery with curative intent. An inverse probability of treatment-weighted (IPTW) analysis was implemented to account rigorously for imbalances in prognostic variables between the adjuvant treatment groups.ResultsDuring a median follow-up period of 5.5 years, the study observed 38 local recurrences (9%), 73 occurrences of distant metastasis (17%), 63 STS-related deaths (15%), and 57 deaths from other causes (13%). As expected, patients receiving AXRT (n = 258, 60%) were more likely to have high-grade G3 tumors (p < 0.0001) than patients not receiving AXRT. A crude analysis showed that AXRT was not associated with improved recurrence-free survival [hazard ratio (HR) 1.00; 95% confidence interval (CI) 0.72–1.38; p = 0.98]. However, after IPTW, AXRT was associated with a 38% relative reduction in the risk of recurrence or death (HR 0.62; 95% CI 0.39–1.00; p = 0.05). This benefit was driven by a strong reduction in the risk of local recurrence (HR 0.42; 95% CI 0.19–0.91; p = 0.03), whereas the relative risk of distant metastasis (HR 0.69; 95% CI 0.39–1.25; p = 0.22) and overall survival (HR 0.76; 95% CI 0.44–1.30; p = 0.32) were only nonsignificantly in favor of AXRT. An exploratory analysis showed an overall survival benefit of AXRT for patients with high-grade G3 tumors (HR 0.51; 95% CI 0.33–0.78; p = 0.002). However, this finding may have been attributable to residual confounding.ConclusionIn this observational cohort, AXRT was associated with a 58% reduction in the relative risk of local recurrence. No consistent association between AXRT and lower risks of distant metastasis or death was observed.

The role of revision surgery and adjuvant therapy following subtotal resection of osteosarcoma of the spine: a systematic review with meta-analysis.

OBJECTIVE Primary osteosarcoma of the spine is a rare osseous neoplasm. While previously reported retrospective studies have demonstrated that overall patient survival is impacted mostly by en bloc resection and chemotherapy, the continued management of residual disease remains to be elucidated. This systematic review was designed to address the role of revision surgery and multimodal adjuvant therapy in cases in which en bloc excision is not initially achieved. METHODS A systematic literature search spanning the years 1966 to 2015 was performed on PubMed, Medline, EMBASE, and Web of Science to identify reports describing outcomes of patients who underwent biopsy alone, neurological decompression, or intralesional resection for osteosarcoma of the spine. Studies were reviewed qualitatively, and the clinical course of individual patients was aggregated for quantitative meta-analysis. RESULTS A total of 16 studies were identified for inclusion in the systematic review, of which 8 case reports were summarized qualitatively. These studies strongly support the role of chemotherapy for overall survival and moderately support adjuvant radiation therapy for local control. The meta-analysis revealed a statistically significant benefit in overall survival for performing revision tumor debulking (p = 0.01) and also for chemotherapy at relapse (p < 0.01). Adjuvant radiation therapy was associated with longer survival, although this did not reach statistical significance (p = 0.06). CONCLUSIONS While the initial therapeutic goal in the management of osteosarcoma of the spine is neoadjuvant chemotherapy followed by en bloc marginal resection, this objective is not always achievable given anatomical constraints and other limitations at the time of initial clinical presentation. This systematic review supports the continued aggressive use of revision surgery and multimodal adjuvant therapy when possible to improve outcomes in patients who initially undergo subtotal debulking of osteosarcoma. A limitation of this systematic review is that lesions amenable to subsequent resection or tumors inherently more sensitive to adjuvants would exaggerate a therapeutic effect of these interventions when studied in a retrospective fashion.