Delay In Radiotherapy Research Articles

Seroma in breast surgery: all the surgeons fault?

Despite a trend for less radical surgical approaches in breast cancer due to better understanding of tumour biology and new treatment options such as neoadjuvant chemotherapy (NAC) and intra-operative radiotherapy (IORT), seroma production remains one of the main surgical side effects that can result in prolonged recovery, delay of radiotherapy and patient discomfort. The aim of this study is to provide an update on risk factors for seroma production after breast cancer surgery considering the latest treatment options. A retrospective analysis of seroma production in primary breast cancer patients treated between 01.01.2010 and 31.12.2014 at the Breast Cancer Centre, University Hospital Ulm, was performed. Patients with previous breast/axillary surgery or more than one intervention were excluded. Seroma formation was measured using wound drains placed in breast and axilla. In total, 581 patients met the inclusion criteria. Median age at diagnosis was 60years, and median BMI 25.6kg/m2. 60 (10.3%) patients had a mastectomy, 175 (30.1%) patients received IORT, and 72 (12.4%) patients received NAC. Median amount of seroma production was 82.5ml (range 0-3012.5ml). Multivariate analysis revealed that most of the observed variation in seroma production was due to type of surgery (mastectomy vs. breast conserving), length of surgery and number of removed lymph nodes. Both NAC and IORT explained a significant but very small amount of the observed variation in seroma production. The most important factors for seroma production are extent and duration of breast surgery.

Survival Impact of Delaying Postoperative Radiotherapy in Patients with Esophageal Cancer

The purpose of the current study was to retrospectively assess the effect of postoperative radiotherapy (RT) delay on survival for patients with esophageal cancer. From 2008 to 2011, patients with esophageal cancer who had undergone postoperative RT in five different hospitals in China were reviewed. Clinical data, including time interval between surgery to RT, were prospectively collected. Kaplan-Meier method was conducted to estimate the effect of each variable on progression-free survival (PFS) and overall survival (OS), with differences assessed by log-rank test. Univariate Cox proportional-hazards models were performed for both PFS and OS for all assumed predictor variables. Statistically significant predictor variables (P < .05) on univariate analysis were then included in multivariate Cox proportional-hazards models, which were performed to compare the effects of RT delay on PFS and OS. A total of 316 patients were finally enrolled in this prospectively multicentric study. Time to RT after surgery varied from 12 days to over 60 days (median, 26 days). Multivariate analysis showed that delay to RT longer than the median does not appear to be a survival cost. There was also no statistically difference in PFS (P = .513) or OS (P = .236) between patients stratified by quartiles (≤21 days vs ≧35 days). However, patients with particularly long delays (≧42 days) demonstrated a detrimental impact on OS (P = .021) but not PFS (P = .580). Delaying postoperative RT of esophageal cancer does not impact PFS, but results in a significant reduction on OS if delaying longer than 6 weeks.

Effect of Delayed Adjuvant Radiotherapy in Early Breast Cancer on Local Control, Distant Metastasis and Overall Survival: an Evidence-Based Case Report

Breast cancer is the second most common cancer in the world and, by far, the most frequent cancer among women with an estimated 1,67 million new cancer diagnosed in 2012 (25% of all cancers). In principle, radiation therapy is indicated in early breast cancer after breast conserving surgery or after radical mastectomy-with-positive-or-near-margin. Unfortunately, not all aforementioned indicated patients could receive immediate treatment, often due to limited radiation therapy facility. We constructed this report to investigate comprehensively, whether delayed radiation therapy for indicated-post-surgical-early breast cancer case has a significant effect to survival (either locoregional or distant metastasis-free survival). Searching was conducted on PubMed ® , Cochrane ® , and Scopus ® . After screening for titles and abstracts, we found 25 articles, 15 of which we finally included for performing full reading. From this systematic searching, we found that time to radiation is inconsistently related to locoregional survival, overall survival, and distant metastasis-free survival.

Moderately Hypofractionated Helical IMRT, FDG–PET/CT-guided, for Progressive Malignant Pleural Mesothelioma in Patients With Intact Lungs

IntroductionThe objective of this study was to present the outcomes of moderately hypofractionated helical intensity-modulated radiation therapy (HT) with/without simultaneous integrated boost (SIB) on fluorodeoxyglucose-positron emission tomography (FDG-PET) positive areas (gross tumor volume [GTV]-PET) for patients with progressive malignant pleural mesothelioma (MPM) after previous treatments. Methods and MaterialsFrom May 2006 to April 2014, 51 patients with a median age of 68.8 years (range, 38.6-82 years) were treated. There were 41 men and 10 women; 43 epithelioid MPM and 8 sarcomatoid, involving the left pleura in 25 patients and the right pleura in 26 patients. The initial stage was: I, 11 patients; II, 14 patients; III, 17 patients; and IV, 9 patients. Chemotherapy was prescribed for 46 patients, for 6 cycles (range, 0-18 cycles). Eighteen patients had pleurectomy/decortication, and 33 had talc pleurodesis. FDG-PET was used for target identification. A median dose of 56 Gy/25 fractions was prescribed to the involved pleura, and SIB to 62.5 Gy to GTV-PET was added in 38 patients. ResultsThe median survival from diagnosis was 25.8 months (range, 8.4-99.0 months). One patient, treated with SIB, was alive at the October 2017 follow-up. Two cases of grade 5 radiation pneumonitis were registered. A GTV-PET ≤ 205 cc was predictive of late ≥ grade 2 lung toxicity, but also of better survival in stage III and IV disease: 5.9 versus 11.7 months (P = .04). A GTV-PET ≥ 473 cc was predictive of early death (P = .001). ConclusionsModerately hypofractionated, FDG-PET guided salvage HT in patients with progressive MPM after previous treatments showed acceptable toxicity and outcome results similar to adjuvant radiotherapy after pleurectomy/decortication, suggesting that the delay of radiotherapy is not detrimental to survival, and has the associated benefit of postponing inherent toxicity.

Treatment Approach and Outcomes in Infants With Localized Rhabdomyosarcoma: A Report From the Soft Tissue Sarcoma Committee of the Children's Oncology Group

For infants with localized rhabdomyosarcoma who were enrolled on Children's Oncology Group ARST0331 and ARST0531, local therapy guidelines were provided, but adherence was not mandated because of toxicity concerns. We examined adherence to protocol for local therapy guidelines, treatment variations, and outcomes for these patients. Children aged ≤24months who were enrolled on ARST0331 and ARST0531 were evaluated. Data were verified through radiologic, surgical, pathologic, and clinical records. Local therapy was assessed for adherence to protocol guidelines, with variations termed "individualized local therapy." The subdistribution hazards model assessed local failure, the Kaplan-Meier product limit method assessed event-free survival (EFS) and overall survival, and the log-rank test was used to evaluate prognostic impact. The median age of the patients was 14months, and 124 patients were eligible. Common primary sites were genitourinary (40%), parameningeal (14%), and the extremities (11%). Most patients had unresected disease (group 3, 64%) and embryonal histology (73%). Fifty-eight percent of patients received radiation therapy at a median of week 12 (weeks 1-45). The median radiation dose was 48.6Gy (30.6-54Gy). Forty-three percent of patients received individualized local therapy (outside protocol guidelines), typically omission or delay of radiation therapy. Delayed primary excision was performed in 28% at a median of week 14 (weeks 7-34). With a median follow-up of 5.6years, the 5-year local failure, EFS, and overall survival rates were 24%, 68%, and 82%, respectively. Local failure was significantly higher (35%) in patients receiving individualized local therapy than in patients who received protocol-specified local therapy (16%; P=.02). The site of failure was local in 64% of patients, local and distant in 5%, and distant only in 23%. EFS was significantly higher among patients who were aged 12 to 24months, had tumors ≤5cm, had group 1/2 disease, and underwent protocol-specified therapy. Local recurrence was the predominant pattern of failure and was more common in those receiving individualized local therapy. De-escalation of effective therapies because of concerns about treatment toxicity should be considered cautiously.

Impact of Delayed Adjuvant Radiotherapy in the Survival of Women with Breast Cancer.

ObjectiveOur objective was to determine whether a delay in adjuvant radiotherapy is related to a decrease in relapse-free survival and disease-specific survival of women with operable breast cancer.MethodsData on 1000 patients diagnosed with breast cancer were recorded. The cohort was divided into five groups according to the timing of radiotherapy: ≤30 days, 31 to 60 days, 61 to 90 days, 91 to 120 days, and >120 days. The relapse-free survival and disease-specific survival were also calculated in relation to the number of patients.ResultsThis study found no statistical difference for delays in adjuvant radiotherapy in patients with early breast cancer, but we noted a statistical decrease in disease-specific survival in patients with locally advanced breast cancer receiving radiotherapy after a delay of at least 60 days.ConclusionWaiting times for radiotherapy should be as short as reasonably achievable, given the specific risk factors in the individual patient.

(OA11) Timing of Radiotherapy for Pediatric Patients With Parameningeal Rhabdomyosarcoma With Intracranial Extension

This study was designed to assess clinical outcomes and patterns of failure, particularly as regards the timing of radiotherapy (RT), for pediatric patients with parameningeal rhabdomyosarcoma with intracranial extension (ICE-PM-RMS). Patients with ICE-PM-RMS have high rates of local and central nervous system (CNS) relapse, and historically have been treated with RT at week 0 of chemotherapy to improve disease-related outcomes. The recently-completed Children’s Oncology Group (COG) ARST0531 trial delayed RT for these patients to week 4, and the ongoing COG protocol ARST1431 is further deferring RT until week 13 of chemotherapy. With limited data available on the effect of such a delay in RT for ICE-PM-RMS patients, we sought to characterize our own experience treating ICE-PM-RMS, and determine the effect of RT timing on outcomes. Between 2006 and 2015, 15 consecutive patients with ICE-PM-RMS were treated at a single institution with RT as part of combined modality therapy using RT and chemotherapy. All patients had radiographic evidence of intracranial extension by MRI; patients with leptomeningeal disease (LMD) at diagnosis were excluded. RT was delivered using proton-beam therapy (11/15 patients, 73%) or photon-based RT (4/15 patients, 27%), to a median dose of 50.4Gy(RBE) to the primary tumor site. RT was initiated at or before week 4 of chemotherapy in 5 patients (33%), and after week 4 in 10 patients (67%). The primary reason for RT initiation after week 4 was referral delay. Five-year overall survival and progression-free survival for the entire cohort were 51.4% and 40.0%, respectively. Nine patients (60%) experienced disease recurrence, all of whom had a combination of LMD and/or in-field local relapse with intracranial component. No patient who initiated RT by week 4 experienced relapse (0/5 patients, 0%), whereas 9 patients who initiated RT after week 4 experienced failure (9/10 patients, 90%, Fisher’s exact test p=0.002). RT timing was a significant predictor of both progression-free survival (PFS, hazard ratio [HR] 7.79, 95% confidence interval [CI] 2.02 – 29.98, log-rank test p=0.003) and overall survival (HR 6.92, CI 1.49 – 32.08, p=0.01). Other disease and treatment characteristics such as tumor size, choice of chemotherapy regimen, and response to induction chemotherapy did not predict PFS. Early initiation of local therapy (by week 4) for ICE-PM-RMS patients appears to be critical for both disease control and survival. These data raise concerns regarding the current COG trial ARST1431, in which non-metastatic ICE-PM-RMS patients will be treated with RT at week 13 after chemotherapy initiation. Our findings suggest ICE-PM-RMS patients on this protocol may be at risk for poorer outcomes as a result of this change in RT timing compared with prior cooperative group studies.

Delay of adjuvant radiotherapy due to postoperative complications after oncoplastic breast conserving surgery

BackgroundIn the past a mastectomy was the first approach of treating breast cancer. Oncoplastic techniques combined with breast conserving surgery (BCS) and radiotherapy has become an alternative to mastectomy in patients with non-metastasized breast cancer. The aim of this study was to analyse the amount and types of complications occurring after oncoplastic BCS before and after adjuvant radiotherapy and the delay of adjuvant therapy due to the complications. MethodA retrospective study based on all patients who received immediate oncoplastic BCS by a plastic surgeon at two medical hospitals in The Netherlands between 2013 and 2015. (n = 150). The performed oncoplastic BCS techniques were the primary outcome measures. In particular major complications with the need for antibiotics or surgical intervention. A one-year follow-up was achieved for all patients. Results52% of the 150 included patients received an oncoplastic BCS through the reduction pattern, 35% with a LICAP and 10% with an AICAP. Complications occurred in 37.5% of the patients, 10% of the patients needed treatment with antibiotics and in 6.6% of the patients a revision operation was indicated. 79.6% of all postoperative complications occurred before the start of adjuvant radiotherapy. In 8.2% of the patients the adjuvant radiotherapy had to be delayed due to a complication. ConclusionThis study provides a detailed overview of the used techniques of oncoplastic BCS and their postoperative complications. Most complications occurred before the start of the adjuvant radiotherapy. Just a small amount caused a delay for the radiotherapy to start.

EP-1124: Delay of postoperative radiotherapy affected treatment outcomes of head and neck cancer

EP-1124: Delay of postoperative radiotherapy affected treatment outcomes of head and neck cancer

Safety Evaluation of Nivolumab Concomitant With Platinum-Based Chemoradiation therapy for Intermediate and High-Risk Local-Regionally Advanced Head and Neck Squamous Cell Carcinoma: RTOG Foundation 3504

Nivolumab (Nivo), which inhibits the programmed death-1 (PD-1) receptor, improved survival for patients (pts) with platinum-refractory recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) compared with standard therapy. A clinical trial was designed to evaluate the safety of adding nivo to four standard radiation therapy (RT) regimens for pts with newly diagnosed intermediate (IR) and high-risk (HR) HNSCC (Table 1). Early safety data for cohort 1 (weekly cisplatin) and accrual for cohort 2 (high-dose cisplatin) are reported. Eligibility includes IR (p16+, oropharynx T1-2N2b-N3/T3-4N0-3, >10 pack-years (pys) or T4N0-N3, T1-3N3 ≤10 pys) and HR HNSCC (oral cavity, larynx, hypopharynx, or p16(-) oropharynx, stage T1-2N2a-N3 or T3-4N0-3). Ten pts are enrolled to obtain 8 evaluable pts in each cohort. The feasibility of adjuvant nivo at 3-12 months post-RT is also evaluated. Primary endpoints are safety and feasibility, with dose-limiting toxicity (DLT) defined as nivo-related: ≥grade 3 adverse event unresolved to ≤grade 1 in ≤28 days; RT delay >2 wks; incomplete RT; or inability to receive ≥70% of prescribed systemic therapy due to nivo-related toxicity. DLT window was from first nivo dose (day -14) to 28 days post RT. Characteristics of 10 enrolled pts for cohort 1(weekly cisplatin): median age 56, 80% male, 90% caucasian, 40% PS 0, 80% >10 pys, 50% larynx and 50% p16(+) oropharynx cancer, 80% T3-4 and 80% N2-3 disease. Two of 10 pts were unevaluable due to withdrawal of consent. All 8 evaluable pts completed RT. 3 of 8 pts received 10 doses of concurrent nivo: 1 pt received 9 doses, 3 pts are ongoing after 8 doses, and nivo was discontinued due to blurred vision in 1 pt after 8 doses. Seven of 8 pts received >70% of prescribed cisplatin, which was discontinued early in 3 pts due to AEs unrelated to nivo. No DLT was observed. SAEs included anaphylaxis to cisplatin (cis) (n=1), cholecystitis (1), but none attributable to nivo. Grade ≥3 toxicities attributable to nivo included fatigue (n=1), anorexia (1), WBC decrease (2), neutrophil count decrease (1), mucositis (1), lipase (1) elevation. Seven of 8 pts continued on to maintenance nivo. Toxicity data for cohort 2 (high-dose cisplatin), 10 patients accrued, will also be available at the time of the meeting. Nivo is safe and feasible to administer concurrently with a weekly cisplatin-RT regimen for patients with newly diagnosed IR/HR HNSCC (NCT02764593).

Clinical impact of adjuvant radiation therapy delay after neoadjuvant chemotherapy in locally advanced breast cancer

Backgroundand Purpose: Post-operative radiation therapy (PORT) is usually indicated for patients with breast cancer (BC) after neoadjuvant chemotherapy (NAC) and surgery. However, the optimal timing to initiation of PORT is currently unknown. Material and methodsWe retrospectively evaluated data from patients with BC who received PORT after NAC and surgery at our institution from 2008 to 2014. Patients were categorized into three groups according to the time between surgery and PORT: <8 weeks, 8–16 weeks and >16 weeks. ResultsA total of 581 patients were included; 74% had clinical stage III. Forty-three patients started PORT within 8 weeks, 354 between 8 and 16 weeks and 184 beyond 16 weeks from surgery. With a median follow-up of 32 months, initiation of PORT up to 8 weeks after surgery was associated with better disease-free survival (DFS) (<8 weeks versus 8–16 weeks: HR 0.33; 95% CI 0.13–0.81; p = 0.02; <8 weeks versus >16 weeks: HR 0.38; 95% CI 0.15–0.96; p = 0.04) and better overall survival (OS) (<8 weeks versus 8–16 weeks: HR 0.22; 95% CI 0.05–0.90; p = 0.036; <8 weeks versus >16 weeks: HR 0.28; 95% CI 0.07–1.15; p = 0.08). ConclusionPORT started up to 8 weeks after surgery was associated with better DFS and OS in locally-advanced BC patients submitted to NAC. Our findings suggest that early initiation of PORT is critically important for these patients. However, the low numbers of patients and events in this study prevent us from drawing firm conclusions.

Computed tomography based evaluation of prostatic fiducial marker migration between the periods of insertion and simulation.

The aim of this study was to determine whether significant fiducial marker migration occurs between the periods of prostatic marker insertion and computed tomography (CT) performed for radiotherapy planning and if a waiting period is necessary. Thirty-nine patients with prostate adenocarcinoma underwent fiducial marker insertion before radiotherapy between June 2013 and December 2015. Three markers were inserted by one radiologist under the guidance of transrectal ultrasonography. All patients underwent CT three hours after insertion to confirm the number and position of fiducial markers. Radiotherapy planning CT was performed on an average of 11 days (range 7-20) after insertion. CT images were imported into treatment planning system to analyze the position of fiducial markers. Point- based marker match algorithm was used to find the distance of marker migration. The mean and maximum distances between each fiducial markers were calculated. The mean distance of migration was 1.029±0.42 mm (range 0.23-1.93 mm) and the maximum distance was 1.361±0.59 mm (range 0.25-2.74 mm). The distance of marker migration was not statistically significant for the groups organized according to the timing of marker insertion, prostate volume, patient age, prostate specific antigen level and Gleason score. According to our results significant fiducial marker migration did not occur during the interval between insertion and treatment planning CT. It should be taken into consideration that performing simulation on the same day as marker insertion might prevent increased cost and delayed radiation therapy by saving the patients from extra visits to the clinic.

Delay in radiotherapy is associated with an increased risk of disease recurrence in women with ductal carcinoma in situ.

The current study was conducted to examine the association between ipsilateral breast tumor recurrence (IBTR) and the timing of radiotherapy (RT) in women with ductal carcinoma in situ (DCIS) undergoing breast-conserving surgery (BCS). Women with DCIS who were treated with BCS and RT from 1980 through 2010 were identified from a prospectively maintained database. IBTR rates, measured from the time of RT completion, were compared between those who initiated RT ≤8 weeks, >8 to 12 weeks, and >12 weeks after the completion of surgery. The association between RT timing and IBTR was evaluated by Kaplan-Meier and log-rank analyses; Cox modeling was used for multivariable analysis. A total of 1323 women met the inclusion criteria. The median follow-up was 6.6 years, with 311 patients followed for ≥10 years. A total of 126 IBTR events occurred. Patients were categorized by RT timing: 806 patients (61%) with timing of ≤8 weeks, 386 patients (29%) with timing of >8 to 12 weeks, and 131 patients (10%) with timing >12 weeks. The 5-year and 10-year IBTR rates were 5.8% and 13.0%, respectively, for RT starting ≤8 weeks after surgery; 3.8% and 7.6%, respectively, for RT starting >8 to 12 weeks after surgery; and 8.8% and 23.0%, respectively, for an RT delay >12 weeks after surgery (P = .004). On multivariable analysis, menopause (hazard ratio [HR], 0.54; P = .0009) and endocrine therapy (HR, 0.45; P = .002) were found to be protective against IBTR, whereas a delay in RT >12 weeks compared with ≤8 weeks was associated with a higher risk of IBTR (HR, 1.92; P = .014). There was no difference in IBTR noted between RT initiation at ≤8 weeks and initiation at >8 to 12 weeks after BCS (P = .3). A delay in RT >12 weeks is associated with a significantly higher risk of IBTR in women undergoing BCS for DCIS. Efforts should be made to avoid delays in starting RT to minimize the risk of disease recurrence. Cancer 2018;124:46-54. © 2017 American Cancer Society.

Prospective evaluation of concurrent paclitaxel and radiation therapy after adjuvant doxorubicin and cyclophosphamide chemotherapy for stage II or III breast cancer

Radiation therapy after breast conserving surgery is a standard part of treatment forinvasive breast cancer [12].. The authors found that delay in radiotherapy after surgery translated to increase inlocal recurrence.

Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients With Esophageal Cancer.

Rationale: It has been shown that early nutrition intervention improves nutrition status (NS) and treatment tolerance in patients with esophageal cancer. However, it remains unknown whether pretreatment parameters of NS are associated with treatment modifications (TMs) during neoadjuvant chemoradiation (CR) in patients who are intensively nutritionally supervised during treatment. Methods:All outpatients with esophageal cancer who were scheduled for CR in the VU medical center from 2006–2015 were included. NS was assessed by body mass index (BMI), weight loss in the past 6 months (WL), fat mass index (FMI) and fat-free mass index (FFMI), handgrip strength (HGS), and energy/protein intake. Logistic regression analyses, adjusted for age, sex, previous tumor, tumor stage, and physical status, were applied. TMs were defined as delay, dose reduction or discontinuation of chemotherapy and/or radiotherapy, hospitalization, or mortality (yes/no). Results: In total, 162 patients were included (73% male; mean age 65 ± 9 years). Mean BMI was 25.1 ± 4.5 kg/m2, and WL was 4.8 ± 5.1 kg. HGS and FFMI were below the 10th percentile of reference values in 21 and 37 patients, respectively. Thirty-five (22%) patients experienced at least 1 TM during CR; unplanned hospitalization (n = 18, 11%) was the most prevalent. After adjustments for confounders, only HGS was statistically significantly associated with TMs (odds ratio, 0.93; 95% confidence interval, 0.88–1.00). Conclusion: In this group of intensively supervised patients with esophageal cancer, pretreatment parameters of NS had little influence on TMs during CR. Only a lower HGS was associated with TMs.

PV-0236: Impact of radiation therapy delay in patients underwent neoadjuvant chemotherapy and breast surgery

PV-0236: Impact of radiation therapy delay in patients underwent neoadjuvant chemotherapy and breast surgery

Feasibility of Concurrent Radiotherapy and Paclitaxel-Based Chemotherapy after Conservative Surgery for Breast Cancer

Purpose: Our prospective phase II trial aims to show the feasibility of adjuvant paclitaxel-based concurrent chemoradiotherapy (CCRT) following doxorubicin and cyclophosphamide (AC) to get the survival benefit of taxanes addition and avoid delay of radiotherapy. Patients and Methods: A total of 63 patients with pT1-2, and pN1-3, M0 breast cancer underwent conservative surgery followed by adjuvant 4 cycles AC followed by 4 cycles Paclitaxel 175 mg/m2 every 3 weeks. Adjuvant radiotherapy started during the first and second cycle of paclitaxel (CCRT). Toxicities evaluated at the base time, weekly during radiation therapy and every 3 months for 24 months for skin, pulmonary, cardiac, lymphedema, subcutaneous fibrosis and cosmoses. Survival reported at 2-year median follow-up. Results: At median follow up time of 24 months (6 - 30), we did not report any toxicity postpone or stop treatment and only two patients had grade III acute dermatitis. Fifty-two patients (82.5%) had satisfactory cosmoses and none of the patients developed local recurrence. Conclusion: Three-weekly paclitaxel during radiotherapy is considered safe without significant complications and acceptable cosmoses with excellent local control and could be considered to avoid radiotherapy delay.

State of the art of chemotherapy for the treatment of central nervous system metastases from non-small cell lung cancer.

Chemotherapy is the mainstay of treatment of advanced non-small cell lung cancer (NSCLC) without molecular drivers. Despite a low penetration of central nervous system (CNS), chemotherapy drugs demonstrated encouraging activity against CNS metastases from NSCLC. Based on the available data, chemotherapy should be considered as an important part of the multidisciplinary treatment of CNS metastases. Particularly, platinum-based regimens represent the most active combinations and pemetrexed is associated with a meaningful clinical benefit for patients with non-squamous histology. How to integrate chemotherapy and radiotherapy for newly diagnosed brain metastases (BMs) is still debated. Although flawed by some limitations, the available evidence suggests a role for upfront chemotherapy for the treatment of NSCLC patients with synchronous, asymptomatic BMs, thus allowing a delay of radiotherapy. Despite the introduction of modern and more effective chemotherapy, however, the prognosis of NSCLC patients with CNS metastases remains poor, especially for those with progressive BMs or leptomeningeal carcinomatosis (LC).

216P - The impact of delay in adjuvant radiotherapy in the combined modality treatment of early stage breast cancer: single institutional experience

216P - The impact of delay in adjuvant radiotherapy in the combined modality treatment of early stage breast cancer: single institutional experience

Patterns of Care and Survival for Early Versus Delayed Radiation Therapy (RT) in Limited-Stage Small Cell Lung Cancer (LS-SCLC): A Review of the National Cancer Data Base

Patterns of Care and Survival for Early Versus Delayed Radiation Therapy (RT) in Limited-Stage Small Cell Lung Cancer (LS-SCLC): A Review of the National Cancer Data Base