Receiving Radical Radiotherapy Research Articles

Long-term efficacy analysis of radiotherapy and local management of metastases in patients with newly diagnosed oligometastatic nasopharyngeal carcinoma: A prospective, single-arm, single-center clinical study

PurposeWe conducted a single-center, single-arm study (NCT 03129412) to prospectively analyze the long-term outcomes of newly diagnosed patients with oligometastatic nasopharyngeal carcinoma (NPC) who received radical radiotherapy and local treatment of metastases. Patients and methodsPatients who reached disease controll after platinum-based palliative chemotherapy continued to receive radical radiotherapy for the nasopharyngeal region and neck. Appropriate local treatments were selected to treat the metastatic lesions. The primary endpoint of this study was overall survival (OS) and the secondary endpoint was progression-free survival (PFS). ResultsFifty-one patients were included in the final analysis. During a median follow-up of 60 months, the median OS and PFS were 53.87 and 24.23 months, respectively. The 1-year, 3-year, and 5-year PFS and OS rates were 76.5 %, 38.1 %, and 31.8 % and 98 %, 75.4 %, 45.6 %, respectively. Both single and multivariate analysis indicated that maintenance therapy after radiotherapy could significantly increase PFS (36.43 vs. 16.1 months, P = 0.005). The OS of patients with single organ metastasis was significantly better than that of patients with double organ metastasis (P = 0.001). In addition, the number of metastatic organs also significantly affected PFS in the multifactor analysis. ConclusionPatients with newly diagnosed oligometastatic NPC can achieve long-term survival after receiving radical radiotherapy to the primary site and local treatment for metastases.

157 Establishing a multidisciplinary habilitation clinic for lung cancer patients receiving radical radiotherapy

157 Establishing a multidisciplinary habilitation clinic for lung cancer patients receiving radical radiotherapy

Role of primary tumor volume and metastatic lymph node volume in response to curative effect of definitive radiotherapy for locally advanced head and neck cancer

BackgroundStudies have shown mixed results concerning the role of primary tumor volume (TV) and metastatic lymph node (NV) volume in response to the curative effect of definitive radiotherapy for locally advanced head and neck squamous cell carcinoma (LAHNSCC).ObjectiveWe aimed to evaluate the impact of TV and NV on the efficacy of radical radiotherapy in LAHNSCC patients, with the goal of guiding individualized therapy.Patients and methodsPatients with LAHNSCC who received radical radiation therapy and were reexamined within 6 months post-therapy from January 2012 to December 2021 were selected. The volumes of the primary tumors and metastatic lymph nodes were calculated by software and then were divided into a large TV group vs small TV group and a large NV group vs small NV group according to the relationship with the median. Additionally, patients who received concurrent chemoradiotherapy (CCRT) or not were divided into the CCRT group and the radiotherapy (RT) group. Patients with lymph node metastasis were divided into node concurrent chemotherapy (N-CCRT) group and a node metastatic chemotherapy (N-RT) group according to whether they received concurrent chemotherapy or not. The volume shrinkage rate (VSR), objective response rate (ORR), local control rate (LCR) and overall survival (OS) were recorded and analyzed.Results96 patients were included in the primary tumor volume group, and 73 patients were included in the metastatic lymph node group. Receiver operating characteristic (ROC) curves were constructed for objective remission (OR) endpoints, and a volume threshold was defined for TV and NV patients. The threshold primary tumor volume was 32.45 cm3, and the threshold metastatic lymph node volume was 6.05 cm3.The primary TV shrinkage rates of the small TV and the large TV groups were basically the same, P = 0.801. Similarly, the ORR and LCR were not significantly different between the small TV group and the large TV group (PORR = 0.118, PLCR = 0.315). Additionally, the TV shrinkage rate did not significantly differ between the CCRT group and the RT group, P = 0.133. Additionally, there was no significant difference in ORR or LCR in CCRT group (PORR = 0.057, PLCR = 0.088). However, the metastatic lymph node volume shrinkage rate in the small NV group was significantly greater than that in the large NV group (P = 0.001). The ORR and LCR of the small NV subgroup were significantly greater than those of the large NV subgroup (PORR = 0.002, PLCR = 0.037). Moreover, compared with that of the N-RT group, the NV shrinkage rate of the N-CCRT group was 84.10 ± s3.11%, and the shrinkage rate was 70.76 ± s5.77% (P = 0.047). For the ORR and LCR, the N-CCRT group and N-RT group were significantly different (PORR = 0.030, PLCR = 0.037). The median OS of the whole group was 26 months. However, neither TV/NV nor concurrent chemotherapy seemed to influence OS.ConclusionPrimary tumor volume is not a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Nevertheless, metastatic lymph nodes are a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Patients with smaller lymph nodes have better local control.

Incidental splenic irradiation in patients receiving radical radiotherapy for oesophageal cancer

Incidental splenic irradiation in patients receiving radical radiotherapy for oesophageal cancer

A novel immune-related risk-scoring system associated with the prognosis and response of cervical cancer patients treated with radiation therapy.

Objective: The tumor microenvironment plays a critical role in the radiotherapy and immunotherapy response of cervical squamous cell carcinoma and endocervical adenocarcinoma (CESC). Radioresistance is a key factor in treatment failure among patients who receive radical radiotherapy. Thus, new immune-related biomarkers associated with radiotherapy response in CESC are needed. Methods: In this study, the CIBERSORT and ESTIMATE methods were applied to determine the percentage of tumor-infiltrating cells and the number of immune components in 103 CESCs treated with radiotherapy from The Cancer Genome Atlas (TCGA) database. The main dysregulated genes were subjected to multivariate and univariate analyses. The prognostic value of this system was studied via receiver operating characteristic curve and survival analysis. For further confirmation, the biomarkers' expression levels and predictive value were validated by immunohistochemistry (IHC) and qRT-PCR. The CIBERSORT algorithm was used to calculate the compositional patterns of 22 types of immune cells in cervical cancer patients treated with radiation therapy. Results: Data for 17 radioresistant and 86 radiosensitive tumors were obtained from the The Cancer Genome Atlas database. 53 immune-related DEGs were identified. GO and KEGG analyses revealed that the DEGs were enriched in protein kinase B signaling, growth factors in cytokines, the MAPK pathway and the PI3K-Akt pathway. Then, 14 key immune-related genes built a risk scoring model were deemed prognostic in CESC with radiotherapy. The area under the curve (AUC) of the model was 0.723, and the high-risk group presented worse outcomes than the low-risk group. In addition, the high-risk group tended to have persistent tumors (p = 0.001). The high expression of WT1 and SPOUYT4 were associated with relapse, the high expression of Angiotensinogen and MIEN1 were associated with nonrelapse. Analysis of the immune microenvironment indicated that M0 macrophages, M2 macrophages, activated mast cells and resting memory CD4+ T cells were positively correlated with the risk score (p < 0.05). Conclusion: The novel immune-related risk scoring system has some advantages in predicting the prognosis and treatment response of cervical cancer patients treated with radiotherapy. Moreover, it might provide novel clues for providing targeted immune therapy to these patients.

Clinicoradiological outcomes after radical radiotherapy for lung cancer in patients with interstitial lung disease.

Interstitial lung disease (ILD) is relatively common in patients with lung cancer with an incidence of 7.5%. Historically pre-existing ILD was a contraindication to radical radiotherapy owing to increased radiation pneumonitis rates, worsened fibrosis and poorer survival compared with non-ILD cohorts. Herein, the clinical and radiological toxicity outcomes of a contemporaneous cohort are described. Patients with ILD treated with radical radiotherapy for lung cancer at a regional cancer centre were collected prospectively. Radiotherapy planning, tumour characteristics, and pre- and post-treatment functional and radiological parameters were recorded. Cross-sectional images were independently assessed by two Consultant Thoracic Radiologists. Twenty-seven patients with co-existing ILD received radical radiotherapy from February 2009 to April 2019, with predominance of usual interstitial pneumonia subtype (52%). According to ILD-GAP scores, most patients were Stage I. After radiotherapy, localised (41%) or extensive (41%) progressive interstitial changes were noted for most patients yet dyspnoea scores (n = 15 available) and spirometry (n = 10 available) were stable. One-third of patients with ILD went on to receive long-term oxygen therapy, which was significantly more than the non-ILD cohort. Median survival trended towards being worse compared with non-ILD cases (17.8 vs 24.0 months, p = 0.834). Radiological progression of ILD and reduced survival were observed post-radiotherapy in this small cohort receiving lung cancer radiotherapy, although a matched functional decline was frequently absent. Although there is an excess of early deaths, long-term disease control is achievable. For selected patients with ILD, long-term lung cancer control without severely impacting respiratory function may be possible with radical radiotherapy, albeit with a slightly higher risk of death.

Prognostic value of pretreatment systemic immune-inflammation index in Chinese esophageal squamous cell carcinoma patients receiving radical radiotherapy: A meta-analysis.

The association between pretreatment systemic immune-inflammation index (SII) and long-term survival among Chinese esophageal squamous cell carcinoma (ESCC) patients who received radical radiotherapy remains unclear. The aim of this study was to identify the prognostic role of pretreatment SII in Chinese ESCC patients receiving radical radiotherapy based on current evidence. The PubMed, EMBASE, Web of Science and CNKI databases were searched up to March 18, 2023. Primary and secondary outcomes were overall survival (OS) and progression-free survival (PFS), respectively. The hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were combined to assess the predictive role of pretreatment SII for long-term survival of Chinese ESCC patients receiving radiotherapy. All statistical analyses were conducted by STATA 15.0 software. A total of 8 eligibility studies involving 2101 cases were included in this meta-analysis. The pooled results demonstrated that elevated pretreatment SII was significantly related to worse OS (HR = 1.59, 95% CI: 1.24-2.02, P < .001) and PFS (HR = 1.33, 95% CI: 1.13-1.57, P < .001). Besides, subgroup based on TNM stage showed similar results. Pretreatment SII could serve as a novel prognostic factor in Chinese ESCC patients receiving definitive radiotherapy and patients with an elevated SII may experience poorer survival.

Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer.

Background Prostate cancer holds a substantial presence in the global cancer landscape, and a considerable proportion of diagnoses occur at late stages, particularly in India. Management of locally advanced prostate cancer necessitates a multimodal treatment strategy. A critical part of this strategy is neoadjuvant androgen deprivation therapy, typically administered via luteinizing hormone-releasing hormone (LHRH) analogs. This study explores the potential of an alternative approach: neoadjuvant therapy with degarelix, an LHRH antagonist, and its impact on perioperative and postoperative outcomes in patients undergoing radical prostatectomy for locally advanced or high-risk prostate cancer. Methodology We conducted a retrospective, non-randomized clinical study at Apollo Hospitals in Chennai, India. Patients diagnosed with locally advanced or high-risk prostate cancer who underwent radical prostatectomy were included. Participants were patients treated with neoadjuvant degarelix and subsequent radical prostatectomy between March 2020 and June 2022. We excluded patients receiving radical radiotherapy, those switching from LHRH agonists to antagonists, and those contraindicated for androgen deprivation therapy due to existing comorbidities. For comparison, we selected a group from the institutional database who received conventional treatment (i.e., without neoadjuvant therapy). Results The study compared two groups, each with 32 patients. The groups had no significant difference in total operative duration and console times. The postoperative pathological assessment showed significantly lower margin positivity rates and notable pathological downstaging in the group receiving neoadjuvant degarelix compared to the control group. The incidence of node positivity, prostate-specific antigen levels at three months postoperative, and number of pads used per day at one month did not differ significantly between the two groups. Conclusions Our study suggests that neoadjuvant degarelix could notably enhance patient outcomes in locally advanced prostate cancer management. The benefits include improved symptom control, significant reductions in margin positivity rates, and facilitated surgical procedures. Neoadjuvant degarelix therapy could potentially enhance the feasibility of the surgical intervention in locally advanced prostate cancer management, thus suggesting a promising pathway for improved patient care.

An ehealth intervention during radical radiotherapy: Patient-Reported Outcome Side effects (PROSE) study—An emerging approach from sub-Saharan Africa.

6628 Background: PROSE is an electronic patient-reported outcome tool for real-time, remote monitoring of treatment related side-effects. It enables a two way communication between the patient and clinicians. Remote monitoring of treatment related toxicities can eliminate underreporting of side effects (SE), facilitate timely symptom assessment, and improve management of SE. These will thereby reduce morbidity and hospitalization and improve treatment outcomes and quality of life of affected patients. The overarching goal of the study is to enhance the efficiency of the conventional weekly SE clinic using an emerging technology and thereby create evidence for a personalized digital health interventions for cancer patients in Africa. Methods: A prospective study among adult cancer patients receiving radical radiotherapy for head and neck, pelvic, and breast cancers at NSIA-LUTH Cancer Centre in Nigeria between March and October 2022. Eligible (≥18 years, KPS≥75%) and consenting participants were trained on to report their SE daily and receive remote clinical advice on prosecare.com . The PROSE tool was built as an adapted version of the Patient Reported Outcome version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). The study participants were monitored throughout their radiotherapy sessions and two weeks thereafter. The cancer care team can review the Patients Reported Outcome (PRO) data through a dedicated log-in portal during the SE clinic. Participants scored their SE daily and EORTC QLQ-30 quality of life surveys were administered thrice during the study and 2 weeks thereafter. SE reports were chosen according to the site of disease; 12 items for head and neck tumors, 9 items for breast tumors, 14 items for female pelvic and 18 items for male pelvic tumors. Patient’s PROSE tool application utilization was defined as &gt;50% daily reporting during study period. Results: A total of 137 participants were screened, of which 120 met the eligibility criteria. Of the 120 patients eligible, 23 had technical issues with the use of the PROSE tool application and 1 died during the study; thus, 96 participants data were analyzed. More than 40,000 SE reports were generated during the study. SE with highest symptom burden include urinary frequency in male pelvic cancers (n=17), radiation dermatitis in breast cancer (n=40), diarrhea in female pelvic cancer (n=19) and xerostomia in head/neck cancers (n=20). The app utilization rate was 58%. Conclusions: There was a moderate utilization (58%) of the PROSE tool application. The PROSE pilot study demonstrated the potential utility of the PROSE application as a promising tool and data resource that offers a great opportunity to improve cancer care and the development of predictive clinical algorithms by engaging patients in their own care and increased SE reporting of acute radiation toxicities.

Clinical research of the value of high-risk CTV setting on intensity-modulated radiotherapy for stage IIB-IVA cervical cancer

BackgroundThis study aims to evaluate the clinical efficacy and side effects of setting up a high-risk clinical target volume (CTV-hr) alongside simultaneous integrated boost intensity-modulated radiotherapy (IMRT-SIB) in patients diagnosed with stage IIB-IVA cervical cancer.MethodsThis study retrospectively analysed patients with stage IIB-IVA cervical cancer who received radical radiotherapy at the Affiliated Hospital of Qingdao University between November 2014 and September 2019. The patients were divided into experimental and control groups based on whether CTV-hr was set. All patients received a combined treatment of radiotherapy and chemotherapy. The dosage for paclitaxel was 135 mg/m2, while for cisplatin it was 75 mg/m2 or for carboplatin it was AUC 4–6, given in a cycle of 21 days. Radiotherapy (RT) included external beam radiation therapy (EBRT) and intracavitary brachytherapy (ICBT). In the control group, positive lymph nodes (GTV-n) were treated at a dose of 58–62 Gy/26–28 fractions(f), while clinical target volumes (CTV) were treated with a dose of 46–48 Gy/26-28f. The experimental group received a simultaneous integrated boost (SIB) to CTV-hr at a dose of 54–56 Gy/26-28f, with the same CTV and GTV-n as the control group. Both groups were combined with brachytherapy with a total dose (EQD2, the equivalent dose in 2 Gy/f) of 80-90 Gy. The study measured objective remission rate (ORR), 3-year progression-free survival (PFS) rate, 3-year overall survival (OS) rate, recurrence rate, and side effects as endpoints.ResultsThe study enrolled 217 patients, with 119 in the experimental group and 98 in the control group. Results showed that the experimental group had a higher 3-year OS rate (87.4% vs. 71.4%, p = 0.001) and 3-year PFS rate (72.3% vs. 51.0%, p = 0.000) compared to the control group. Additionally, the experimental group had significantly lower rates of overall recurrence (26.1% vs. 50.0%, p = 0.003), in-field recurrence (15.1% vs. 36.7%, p = 0.000), and out-field recurrence(13.4% vs. 35.7%, p = 0.000) compared to the control group. All observed differences were found to be statistically significant. However, the experimental and control groups had no statistically significant difference in ORR and radiological side effects, such as radiation cystitis and enteritis (p > 0.05).ConclusionsSetting CTV-hr and performing IMRT-SIB on patients with stage IIB-IVA cervical cancer effectively increased the 3-year OS rate, 3-year PFS rate and reduced recurrence rate, with no significant differences in side effects.

Revisiting the Radical Radiotherapy-Radiochemotherapy Results in Anal Canal Cancers: (TROD Gastrointestinal Group Study 02-005)

Background and AimThis study aimed to determine treatment outcomes and factors affecting prognosis in patients diagnosed with anal canal cancer who received radical radiotherapy (RT) or radiotherapy combined with chemotherapy (CT-RT) in radiation oncology centers in Turkey and compare the results with literature. Material and MethodThe study included 193 patients with anal canal cancer reported between 1995 and 2019, of which 162 had complete data. The study was conducted in 11 radiation oncology centers, and a joint database was shared among them. Patients received radiotherapy doses of 45 Gy to 60 Gy. Data analysis was done using SPSS for Windows version 20. ResultsMedian follow-up was 48.51 months (2-214). All patients received radiotherapy, and 140 (86.4%) received concurrent chemotherapy. Radiotherapy doses of 50.4 Gy to 60 Gy were administered to 74 patients (45.7%) using 2-dimensional-3-dimensional (2D-3D) conformal therapy and 70 patients (43.2%) using intensity modulated radiotherapy technique (IMRT). Acute phase hematologic toxicity was observed in 62 patients (38.3%), and nonhematologic toxicity in 123 patients (75.9%). The 5-year overall survival (OS) rate was 75.1% and disease-specific survival (DSS) rate was 76.4%. OS without colostomy was achieved in 79,8 % at 5 years, and complete response in 112 patients (69.1%). OS rate was significantly higher in 142 patients with positive response (P < .000) and 112 with complete response (P < .000). Anemia (P < .002), local progression, and systemic progression (P < .000) resulted in lower OS (P < .002). In univariate analysis, factors affecting OS rate were: gender, age, stage, lymph node status, T stage, RT treatment duration, and treatment planning with PET fusion, which were found to be statistically significant. Completing radiotherapy in less than 45 days, concurrent chemotherapy, and continued administration of mitomycin and 5 FU as chemotherapy had a significant positive effect on overall survival. OS rate was higher in patients receiving RT dose of 58 Gy or less and undergoing IMRT planning in radiotherapy. IMRT was associated with lower acute and late side effects. ConclusionRadiochemotherapy is the primary treatment for anal canal cancer and advanced radiotherapy techniques may increase survival by reducing side effects and improving treatment continuation. Higher treatment doses require further investigation. The efficacy of treatment can be improved by including patients treated with modern radiotherapy techniques in multicenter prospective studies using new and more effective chemotherapy and immunotherapy agents.

Taste changes during radiotherapy for head and neck cancer

IntroductionTaste changes (dysgeusia) during radiotherapy for head and neck cancer are associated with malnutrition, tube feeding and reduced toleration of treatment. MethodThe MD Anderson symptom inventory – head and neck (MDASI-HN) questionnaire was completed by patients in a single department receiving radical radiotherapy or chemo-radiotherapy for head and neck cancer during weeks 1 and 4 of radiotherapy. Participants who developed dysgeusia in week 4 completed supplementary questions exploring what foods they could taste and how they managed taste changes. ResultsAt week 4, 97% of 61 participants reported taste changes, 77% reporting moderate or severe changes. 30% of participants reported taste changes during week 1. Patients with oropharyngeal, oral cavity and parotid gland tumours were most likely to develop dysgeusia. Females were more likely than males to report taste changes. A soft, semi-liquid diet was reportedly easier to tolerate as the more food was chewed the worse the taste became. ConclusionsPatients having radiotherapy for all head and neck cancers should be warned of the very high risk of developing taste changes and the time scale for this. Patients with taste changes should be advised a softer diet requiring less chewing will be better tolerated. The finding that females are more at risk than males of dysgeusia needs further investigation. Implications for practicePatients with head and neck cancer should expect taste changes from the start of radiotherapy. Patients with dysgeusia should be advised that soft, semi-liquid foods that require less chewing before swallowing are easier to tolerate and that taste changes day-to-day.

A RETROSPECTIVE STUDY OF DEMOGRAPHICS AND SURVIVAL ANALYSIS IN CARCINOMA ENDOMETRIUM PATIENTS TREATED AT TERITIARY CARE CENTRE FROM 2014-2019

AIM: To study the demographics, treatment and survival analysis in patients diagnosed with carcinoma endometrium METHODS: All patients diagnosed with endometrial cancer treated between January 2014 and July 2019 were included in the study. The details regarding demographics, treatment, post operative histopathology, and outcomes were taken from the case records.All patients were followed upto August 2022. There were 65 patients with median age RESULTS: was 59 years (Range 36 - 77years), with majority of them (61patients) are postmenopausal. 63 patients underwent surgery and 1 patient received radical radiotherapy and 1 patient received palliative chemotherapy. TAH+BSO was done in all patients and lymphnode dissection was done in 54 patients. 48 patients received adjuvant radiotherapy and 25 patients received adjuvant chemotherapy. Predominant postoperative histology is endometrial adenocarcinoma. The pathological stage distribution was stage IA in 15 patients, stage IB in 19 patients, stage II in 5 patients, stage IIIA in 8 patients, stage IIIB in 3 patients and 8 patients in stage IIIC and stage IV in 5 patients. 23 patients had grade I tumors, 11 patients had grade II tumors, and grade III tumors in 7 patientS. Based on the ESMO risk classication, 14 patients had low risk, 16 patients had intermediate and 6 high intermediate, 23 patients were at high risk, and 6 in the advanced risk category. Median follow up is 3years. 3year DFS is 93% and OS is 95%. Diagnosis CONCLUSION: of carcinoma endometrium have increased all over the world in recent years. We have also found the same trend in our institute. One hypothesis for the increased incidence may be due to increase in risk factors like high and rising rates of obesity, few children and diabetes. It is most common in postmenopausal women. Risk factors includes elderly age, menopause, obesity were signicant in present study. Other risk factors were not statistically signicant. Endometrioid adenocarcinoma is the most common histology with early stage among all surgically treated patients. DFS and OS are good in well differentiated, early stage endometrial cancers and but very poor in and poorly differentiated, stage 3 and stage 4 patients.

Computed tomography and radiation dose images-based deep-learning model for predicting radiation pneumonitis in lung cancer patients after radiation therapy

PurposeTo develop a deep learning model that combines CT and radiation dose (RD) images to predict the occurrence of radiation pneumonitis (RP) in lung cancer patients who received radical (chemo)radiotherapy. MethodsCT, RD images and clinical parameters were obtained from 314 retrospectively-collected patients (training set) and 35 prospectively-collected patients (test-set-1) who were diagnosed with lung cancer and received radical radiotherapy in the dose range of 50 Gy and 70 Gy. Another 194 (60 Gy group, test-set-2) and 158 (74 Gy group, test-set-3) patients from the clinical trial RTOG 0617 were used for external validation. A ResNet architecture was used to develop a prediction model that combines CT and RD features. Thereafter, the CT and RD weights were adjusted by using 40 patients from test-set-2 or 3 to accommodate cohorts with different clinical settings or dose delivery patterns. Visual interpretation was implemented using a gradient-weighted class activation map (grad-CAM) to observe the area of model attention during the prediction process. To improve the usability, ready-to-use online software was developed. ResultsThe discriminative ability of a baseline trained model had an AUC of 0.83 for test-set-1, 0.55 for test-set-2, and 0.63 for test-set-3. After adjusting CT and RD weights of the model using a subset of the RTOG-0617 subjects, the discriminatory power of test-set-2 and 3 improved to AUC 0.65 and AUC 0.70, respectively. Grad-CAM showed the regions of interest to the model that contribute to the prediction of RP. ConclusionA novel deep learning approach combining CT and RD images can effectively and accurately predict the occurrence of RP, and this model can be adjusted easily to fit new cohorts.

Differences in Quality of Life and Toxicity for Male and Female Patients following Chemo(radiotherapy) for Bladder Cancer

AimsBC2001, a randomised trial of treatment for muscle-invasive bladder cancer, demonstrated no difference in health-related quality of life (HRQoL) or late toxicity between patients receiving radical radiotherapy with and without chemotherapy. This secondary analysis explored sex-based differences in HRQoL and toxicity. Materials and methodsParticipants completed the Functional Assessment of Cancer Therapy Bladder (FACT-BL) HRQoL questionnaires at baseline, end of treatment, 6 months and annually until 5 years. Clinicians assessed toxicity with the Radiation Therapy Oncology Group (RTOG) and Late Effects in Normal Tissues Subjective, Objective and Management (LENT/SOM) scoring systems at the same timepoints. The impact of sex on patient-reported HRQoL was evaluated using multivariate analyses of change in FACT-BL subscores from baseline to the timepoints of interest. For clinician-reported toxicity, differences were compared by calculating the proportion of patients with grade 3–4 toxicities occurring over the follow-up period. ResultsFor both males and females, all FACT-BL subscores had a reduction in HRQoL at the end of treatment. For males, the mean bladder cancer subscale (BLCS) score remained stable through to year 5. For females, there was a decline in BLCS from baseline at years 2 and 3 with a return to baseline at year 5. At year 3, females had a statistically significant and clinically meaningful worsening of mean BLCS score (–5.18; 95% confidence interval –8.37 to –1.99), which was not seen in males (0.24; –0.76 to 1.23). RTOG toxicity was more frequent in females than males (27% versus 16%, P = 0.027). ConclusionResults suggest that female patients treated with radiotherapy ± chemotherapy for localised bladder cancer report worse treatment-related toxicity in post-treatment years 2 and 3 than males.

Clinical characteristics and prognostic factors affecting survival after radical radiotherapy for early and late post-treatment metastatic nasopharyngeal carcinoma

ObjectiveWe compared the clinical characteristics and survival outcomes after radical radiotherapy between nasopharyngeal carcinoma (NPC) with early and late metastases based on a relatively large cohort, which provides valuable data for the planning of clinical surveillance strategies.MethodsThis was a single-center retrospective analysis of 10,566 patients who received radical radiotherapy in China from January 2000 to December 2016. Overall survival was the primary endpoint. Kaplan–Meier survival analysis and log-rank tests were applied to investigate the association between early or late metastasis and the endpoints. The prognostic value of clinicopathological features was identified using univariate and multivariate Cox proportional hazards models.ResultsThe cutoff value for time to metastasis was based on ROC analysis. A total of 559 (5.3%) patients developed distant metastases, 297 (53.1%) of which developed early metastatic disease, with the rest (46.9%) developing late metastatic disease. The K-M analysis showed that the patients with late metastatic foci had significantly better post-metastatic OS (P = 0.0056). Multivariate analysis indicated that age, liver metastasis, the number of metastatic foci and time to metastasis (P = 0.013) are independent prognostic factors for OS. After analyzing the impact of different treatment methods, we found that local treatment was an independent protective factor for LM, while local treatment was not associated with a survival benefit for EM disease.ConclusionsThe time to metastasis after radical radiotherapy affected the prognosis of NPC patients and local treatment was an independent protective factor that could improve the survival of late metastatic NPC patients.

Biclonal gammopathy – A single-center experience

BACKGROUND: Biclonal gammopathies are characterized by the production of two distinct monoclonal proteins. It is defined as the presence of two distinct M bands in serum protein electrophoresis. Biclonal myeloma accounted for approximately 1% of newly diagnosed cases of multiple myeloma. OBJECTIVE: The aims was to study the clinical characteristics and treatment outcomes of 13 patients with biclonal gammopathy treated at a tertiary cancer center. MATERIALS AND METHODS: The details of clinical presentation, diagnosis, treatment, and survival were noted from medical records. RESULTS: The median age was 65 years, there were 10 males and 3 females. Eleven patients had multiple myeloma, one had plasmacytoma, and one had monoclonal gammopathy of undetermined significance (MGUS). Twelve patients had biclonal gammopathy at diagnosis and one developed biclonal gammopathy at relapse. Immunofixation showed IgG/IgA in seven cases, IgA/IgG in four, and IgG/IgG in two patients. The patient with MGUS is on follow at 44 months and one with plasmacytoma received radical radiotherapy and alive at 45 months. Ten patients with myeloma received systemic treatment, eight are alive with survival ranging from 44 to 110 months, and four patients are alive more than 5 years. CONCLUSION: Biclonal gammopathies are rare characterized by the presence of two distinct monoclonal proteins. The most frequent combination was IgG/IgA. Treatment of biclonal gammopathy is similar to monoclonal gammopathy with comparable outcomes. During follow-up, both paraproteins have to be addressed.

Treatment Outcomes of Adenoid Cystic Carcinomas of the Head and Neck Region-A Single-Institution Experience.

Malu RafiObjectives  This study was undertaken to evaluate the characteristics and treatment outcomes of patients with adenoid cystic carcinomas of the head and neck region treated at a tertiary cancer center in south India. Materials and Methods  This was a retrospective study done on patients treated at the institute between 2004 and 2011. Clinicopathological details and treatment outcomes were captured from the treatment records to estimate the treatment outcomes and factors affecting them. Results  There were a total of 140 patients with mean age of presentation of 46 years and a median follow-up of 65 months. The most common single site of presentation was the oral cavity. One-hundred eighteen patients (84.3%) underwent primary surgical resection in which 38% had negative surgical margins. Ninety-nine patients were given adjuvant radiotherapy and 18 patients received radical radiotherapy, mostly for surgically inaccessible and inoperable tumors. Median time to recurrence and distant metastasis was 37 and 34 months, respectively. The overall survival and disease-free survival estimate using the Kaplan-Meier method were 92.3 and 71.9%, respectively, at 5 years. Surgical removal of the primary tumor and the nodal stage had the most significant impact on the overall survival outcomes of these patients. Conclusion  Surgery remains the most impactful treatment modality in the management of these rare epithelial tumors. The use of adjuvant radiotherapy may help to tackle the issues of perineural spread and inadequate surgical margins in technically difficult sites. Radical radiotherapy also has impressive response rates.

Effect of Gross Tumor Volume (GTV) after Pelvic External Irradiation on Radiation Dose Selection and Prognosis in Vaginal Stump Cancer

<h3>Purpose/Objective(s)</h3> Radical radiotherapy is safe and effective for patients with vaginal stump cancer after hysterectomy. The tumor volume after external irradiation is important for selecting irradiation dose and local control. For patients with less residual tumor volume after external irradiation, the total irradiation dose < 70Gy does not affect survival. <h3>Materials/Methods</h3> Ninety-nine patients with vaginal stump cancer after hysterectomy between January 2011 and November 2018 were retrospectively analyzed in this study. All patients received radical radiotherapy without prior antitumor therapy. After pelvic irradiation of 45-50Gy, the residual tumor was further irradiated to 60-82Gy (EQD2, a/β=10) by external irradiation or brachytherapy. Cisplatin-based chemotherapy was performed concurrently with radiotherapy. The overall survival (OS), progress-free survival (PFS), local control (LC), and toxicity were analyzed. <h3>Results</h3> Seventy patients (70.7%) had received 70-82Gy (EQD2, a/β=10) for vaginal stump lesions, and external irradiation is responsible for 84.8% of patients. The Median follow-up was 49.9 months (7.4-114.7months). The 4-year actuarial OS, PFS, and LC were 84.4%, 79.2%, and 89.3%, respectively. In multivariable analysis, GTV > 9cc after pelvic radiotherapy an only independent prognostic factor for worse OS, LC (OS: hazard ratio [HR] = 6.87, CI, 1.90 to 24.83, p=0.003; LC: HR = 8.47, CI, 2.18 to 32.82, p = 0.002). In a subgroup analysis, among patients with GTV > 9cc after pelvic radiation, those with an irradiation dose ≥ 70Gy had better LC than those with a dose < 70Gy (86.5% VS. 44.4%, p=0.009). However, the OS or PFS did not show significant differences between the two groups. In patients with GTV ≤9cc, the irradiation dose ≥ 70Gy didn't show a benefit of LC (93.2% VS.100%, p=0.267). 6 patients (6.06%) developed acute grade 3 rectal toxicity, 4 of which occurred at irradiation dose ≥ 70Gy. None of the patients had complications of late G3-4 grade urinary, rectal toxicity, or lymphedema. <h3>Conclusion</h3> Radical radiotherapy is safe and effective for patients with vaginal stump cancer after hysterectomy. The tumor volume after external irradiation is important for selecting irradiation dose and local control. For patients with less residual tumor volume after external irradiation, the total irradiation dose < 70Gy does not affect survival.

The Validation of Predictive Risk Scoring Model of Radiation Pneumonitis (RP) in Lung Cancer Patients

<h3>Purpose/Objective(s)</h3> In our previous research, pulmonary emphysema (PE) was reported as a risk factor of radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC). Subclinical interstitial lung disease (SILD) was associated with severe RP in small cell lung cancer patients. A predictive risk scoring model of RP was developed in stage IIIA or Stage IIIB NSCLC patients receiving radical radiotherapy. The risk score has not been validated using an independent dataset. The aim of this study was to validate the predictive risk score which established in our previous study and evaluate the predictive value of the model. <h3>Materials/Methods</h3> From January 2019 to October 2021,129 lung cancer patients were recruited in study which included in validation group. Those patients were received thoracic radiotherapy with ≥50Gy total radiotherapy dose. The risk scoring model in our previous research as follow: PRS=5 (if subclinical ILD grade≥1) + 3 (if age >68 years) + 3 (if PE grade >1). According to the risk score, the cases in validation group were scored, predictive value of this model were evaluated by receiver operator characteristic curve (ROC) using statistical software. The decision curve analysis was constructed using Stata 17.0 software. <h3>Results</h3> In 129 eligible patients, 13(10.08%, 13/129) developed grade 1 RP, 15(11.62%, 15/129) developed grade 2 RP, grade 3 and grade 4 RP were not observed. 23 (16.60%, 23/129) had PE grade >1. Risk scores of all patients were calculated according to the risk score, 37 had 3 points which incidence of RP ≥2 grade was 13.50%, 2 had 5 points which incidence of RP ≥2 grade was 100.0%, 3 had 6 points which incidence of RP ≥2 grade was 33.33%. ROC curve was plotted according to the risk score of all patients, the area of ROC curve (AUC) was 0.695 (95%CI: 0.541-0.849, P < 0.05). The decision curve indicated that the net benefit of the model was higher in the high-risk threshold of 0.2-0.3. <h3>Conclusion</h3> The previous predictive risk scoring model indicated good discrimination and clinical application value, which can be used in clinical treatment.