Local Tumor Control Research Articles

Long term effectiveness of intraoperative radiotherapy given as a boost in adjuvant treatment for oral cavity cancers

The oral cancer treatment of choice is surgical excision with an organ preservation, if it is possible. Radiation therapy is commonly used as a postoperative treatment. Delivering radiation dose during surgery, defined as intraoperative radiotherapy (IORT), can be very useful especially in case of high risk of recurrence or where gross or macroscopic residual disease are present. The aim of this retrospective study is to evaluate the effectiveness of IORT combined with postoperative fractionated irradiation (EBRT) of patients with squamous cell carcinoma of the oral cavity. The study included 23 patients: IORT dose of 5–7.5 Gy was delivered using 50 kV X-rays generated by INTRABEAM™, combined with EBRT of 50–60 Gy in 25–30 fractions depending on presence of extracapsular invasion and narrow or positive surgical margins. Standard statistical tests were used. Median follow up was 64 months (range 8–222 months). The 5-year local tumour control was 92% and 82.5% in the 10-year follow-up. The 5-year overall survival (OS) was 56% and decreased to 45% during the next 5 years. There were no differences in the LTC, DFS and OS regarding sex, T-stage, grade and tumour localization, although a small group of analysed cases may raise some uncertainties. Acute side effects of combined IORT and EBRT were mild and no late complications occurred. The present study indicated that low-energy X-rays IORT combined with postoperative EBRT is a feasible and safe therapeutic modality which likely reduces a risk of locoregional recurrences.

Microwave ablation versus liver resection for patients with hepatocellular carcinomas.

Microwave ablation (MWA) is an emerging ablative therapy that surpasses previous methods by achieving higher temperatures and creating larger ablation zones within shorter periods. This study compared the therapeutic outcomes of MWA with those of liver resection in real-world clinical practice. A total of 178 patients with 259 nodules who underwent MWA or liver resection between January 2015 and July 2023 were enrolled. Local tumor progression-free survival (LTP), overall progression-free survival (OP), and overall survival (OS) were assessed based on the treatment modality for the index nodule. Of the 178 patients, 134 with 214 nodules underwent MWA, and 44 with 45 nodules underwent liver resection. The median follow-up period was 2.0 ± 1.5 years. The annual incidence of LTP was 3.7% for MWA and 1.4% for liver resection. Treatment modality did not significantly affect LTP-free survival (hazard ratio: 0.61, 95% confidence interval: 0.14-2.69, P = 0.511). For nodules larger than 3 cm, LTP-free survival was not affected by the treatment modality. Similarly, OP-free survival and OS were not influenced by treatment modality. MWA and liver resection demonstrated comparable treatment outcomes in terms of local tumor control, overall recurrence, and survival. MWA may be an alternative treatment option for select patients; however, further studies are necessary to generalize these findings.

Long-term local control and cosmesis of perioperative interstitial brachytherapy for partial breast irradiation following breast-conserving surgery.

Multicatheter interstitial brachytherapy (MIB) is an established technique of partial breast irradiation (PBI). However, postoperative catheter implant is an invasive, inconvenient, and skillful procedure. In this study, local control and cosmesis of perioperative interstitial brachytherapy (PIB) by intraoperative catheter implant were evaluated by comparing with those of whole breast irradiation (WBI) following breast-conserving surgery (BCS). Between October 2007 and August 2019, consequent patients who underwent either PIB or WBI following BCS were included. In general, additional indications for PIB to WBI included age ≥ 40years, tumor ≤ 3cm, and pN0 or pNmi. WBI was initiated with a total dose of 50Gy in 25 fractions, whereas PBI was delivered immediately following BCS at 32Gy in eight fractions. Local recurrence (LR) was the primary endpoint, and subjective and objective cosmetic outcomes at 5years using the Harvard Cosmesis Scale and BCCT.core software, respectively, were the secondary endpoints. During the 10-year follow-up, the crude rate of LR was 3.8% (95% confidence interval [CI] 2.3-5.4) in 577 patients receiving PIB and 3.3% (95% CI 1.1-5.6) in 241 patients receiving WBI (P = 0.73). The 5- and 10-year LR-free survival rates in the PBI and WBI cohorts were 97.9% versus 97.9% and 95.4% versus 96.8%, respectively (P = 0.64). Multivariate analysis selected age < 50years as an independent risk factor for LR. Excellent or good cosmesis in the PBI and WBI cohorts assessed by subjective and objective measures was 89.5% versus 84.5% (P = 0.26) and 83.7% versus 68.1% (P < 0.005), respectively. Although this study was based on a retrospective chart review in a single institution, the largest series of data with a long follow-up suggested that acceptable local tumor control and cosmesis were achieved following PIB compared with WBI.

Electrochemotherapy in metastatic epidural spinal cord compression: a review and technical update.

This review aims to analyse the safety and clinical efficacy in terms of pain relief and local tumour control, in patients with metastatic epidural spinal cord compression undergoing electrochemotherapy (ECT). Moreover, a recommendation detailing optimal electrodes insertion is proposed with the intent of improving treatment planning. Clinical studies published between 2015 and 2023 were included since this time window is consistent with recent developments in the field of ECT of spinal metastases. In the whole, three articles were included. Results showed that percutaneous image-guided ECT provides effective pain relief with limited procedure-related morbidity, along with local tumour control (complete response 28.5%, 38% partial response, 24% stable disease) at 3- month follow-up in the largest published series so far. In conclusion, ECT should integrate the armamentarium of therapies that are currently being proposed to patients with painful metastatic epidural disease.

Pandemic driven preoperative moderate hypofractionated radiotherapy for soft tissue sarcomas.

Moderate hypofractionation was adopted to reduce hospital visits during the COVID-19 pandemic aiming to maintain treatment efficacy for soft tissue sarcoma (STS) patients, shifting preoperative schedules from 25 fractions of 2 Gy to 14-15 fractions of 3 Gy. This study evaluates the clinical implications and outcomes of this schedule, focusing on wound complications, radiation toxicity, local tumour control, and distant metastases. Data was collected from patients treated between 01 and 01-2020 and 31-12-2023. Outcomes included wound complications within 120 days post-surgery, local-recurrence, distant metastases and radiation toxicity. Logistic regression was performed to identify factors associated with wound complications. The cumulative incidence of local recurrence and distant metastases were estimated with a competing risk model. Sixty-six patients were analysed, with a mean age of 74 years (standard deviation (SD)± 11). Tumours were mainly localized in the lower extremities (64 %), mean size 103 mm (SD±58). Median follow-up was 29 months (range 2-50). A R0 resection margin was achieved in 77 % of the operated patients. The wound complication rate was 33 %, with moderate complications in 13 patients and severe in 6. The cumulative incidences of local recurrence and distant metastases at 2 years were 7.6 % (standard error (SE) 3.7 %) and 29 % (SE 6 %, Fig. 1) respectively. Acute grade 3 dermatitis occurred in one patient (1.5 %)and two patients experienced late grade 3 toxicity (fractures, 3.0 %). Twenty patients developed distant metastases, two diagnosed before start of the treatment. Eighteen patients died, with six deaths from distant metastases and one from the primary tumour. Preoperative moderate hypofractionation for STS during COVID-19 showed promising results, with no increase in postoperative wound complications and favourable local failure rates.

Lymphatic vessel network injury reduces local tumor control despite preservation of the tumor-draining lymph node

The lymphatic system plays complex, often contradictory, roles in many cancers, including melanoma; these roles include contributions to tumor cell metastasis and immunosuppression in the tumor microenvironment as well as generation of antitumor immunity. Advancing our understanding of lymphatic vessel involvement in regulating tumor growth and immune response may provide new therapeutic targets or treatment plans to enhance the efficacy of existing therapies. We utilized a syngeneic murine melanoma model in which we surgically disrupted the lymphatic vessel network draining from the tumor to the tumor-draining lymph node (TDLN) while leaving the TDLN intact. Although transport of lymphatic-specific molecular weight tracers to the TDLN remains present after surgery, disruption of the tumor-draining lymphatic vessels results in decreased local tumor control, as reflected in an increase in the rate of tumor growth and reduction in effector-like T cell infiltration into the tumor. Our findings suggest that preservation of the functional tumor-draining lymphatic network may be essential in promoting a robust antitumor immune response.

Abstract B006: Targeting REV-ERB/RORα/IRF3 axis to enhance radiation-induced immune response in cancer radiotherapy

Abstract Radiotherapy is an important component of the therapeutics for cancer. Although the primary objective of RT is the local control of tumors, RT-mediated antitumor adaptive immunity is emerging as a promising tool in cancer treatment. Increasing evidence indicates that RT enhances adaptive anti-tumor immunity by augmenting the innate immune sensing of tumors in a type I IFN-dependent matter. Both retinoic acid-related orphan receptor α (RORα) and nuclear heme receptor Rev-erbα, are core components of the circadian rhythm, all have critical roles in inflammation and immune process. Our preliminary data showed that both RORα inverse agonist (antagonist) SR1001 and Rev-erbα agonist GSK4112 significantly enhanced radiation-induced type I IFN activation. We also found that both RORα and Rev-erbα could associate with IRF3 and regulate IRF3 phosphorylation, which enhance radiation-induced type I IFN activation. Furthermore, our data indicated that radiation induced Type I IFN production may depend on circadian cycle, and SR1001 treatment contribute to antitumor immunity of radiation. These results usher the hypothesis that RORα/Rev-erbα work together to regulate radiation-induced type I IFN response, and contribute to antitumor immunity of RT. Specifically, our data shown the critical role of RORα/Rev-erbα/IRF3 axis in regulating radiation-induced type I IFN activation and targeting RORα/Rev-erbα will synergize with radiotherapy. Altogether, the preliminary data generated from this proposal opens additional avenues of research, both preclinically and clinically, to help better understand the relationship of the circadian rhythm proteins on the RT-immune response. Citation Format: Nan LI, Chen Bruan, Steven Hsesheng Lin. Targeting REV-ERB/RORα/IRF3 axis to enhance radiation-induced immune response in cancer radiotherapy. [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr B006.

Abstract IA01: Moving forward translation of targeted therapy with external beam radiation

Radiotherapy is an anatomically highly targeted treatment modality capable of eradicating cancer cells, including cancer stem cells (CSC). This precision makes radiotherapy an ideal partner for synergistic treatment with targeted drugs, combining local effects on the tumor with systemic molecular interventions. To evaluate the efficacy of such combined treatments on inactivation of CSC in translational research, it is essential to select the appropriate clinical endpoints for preclinical experiments, most importantly inactivation of CSC in vitro or local tumor control in vivo. This ensures that preclinical findings are better translatable to the clinical setting, bridging the gap between experimental models and patient outcomes. A critical factor in this translational pipeline is the use of appropriate in vitro and animal or explant models that as accurate as possible mimic the clinical tumor microenvironment and response dynamics. To account for inter-tumor heterogeneity, it is necessary to apply a panel of models that are well characterized on a molecular biological level. With the right preclinical systems in place, combination strategies can be refined to optimize timing, dosing and sequencing of therapies to maximize tumor control while minimizing damage to normal tissues. Biomarker-driven approaches and molecular pathway analysis are increasingly guiding patient selection and therapeutic personalization, thereby improving the likelihood of clinical success. Examples include biomarker-based studies such as the DELPHI trial for dose de-escalation in post-op HPV-positive head and neck cancer (HNSCC) and the INDIRA Miso study on escalation of PET hypoxic HNSCC. Promising examples of novel combinations with radiotherapy include not only small molecule or Immunotherapeutics, but also the use of radiotherapy integration with novel theranostic radiopharmaceuticals, genomic and radiomic data for adaptive treatment planning. By aligning preclinical and clinical strategies, these efforts are advancing the integration of targeted therapies with radiotherapy and improve loco-regional control, overall survival and quality of life for patients. Citation Format: Michael Baumann. Moving forward translation of targeted therapy with external beam radiation. [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr IA01

A Systematic Review of Indications and Clinical Outcomes of Electrochemotherapy in Pancreatic Ductal Adenocarcinoma

Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the most difficult cancers to treat, with a dismal 5-year survival rate of only 8–10%. This challenging prognosis highlights the urgent need for innovative therapeutic approaches to improve outcomes for patients with PDAC. Electrochemotherapy (ECT), which enhances intracellular chemotherapeutic uptake via electric pulses, has been explored for resectable, borderline resectable (BR), locally advanced (LA), recurrent, and metastatic PDAC, either as a complement to conventional treatments or as an alternative when these are not feasible or effective, offering possible benefits in symptomatic palliation and local tumor control. Methods: A systematic review was performed in accordance with PRISMA guidelines for studies assessing the efficacy of ECT in PDAC. After searching Embase, PubMed/MEDLINE, Scopus, and Web of Science, five studies with a combined total of 43 patients in various disease stages were identified. Results: ECT showed promise in improving tumor control, alleviating cancer-related pain, and improving quality of life. One study noted a trend towards tumor size reduction of 8.3% at one-month and 16.1% at six-months follow-up (p = 0.211 and p = 0.315), although these findings were derived from studies conducted without specific comparative control groups. Severity of complication was mainly mild (Clavien–Dindo I-II), while severe complications occurred in only 2.3% of patients. Median overall survival was reported in two studies as 8 months (range 2–19) and 11.5 months (range 1–74). ECT showed efficacy for symptom management, with 60% of patients reporting reduced pain/discomfort and 40% showing enhanced quality of life in one study, while another reported pain scores as decreasing from 6 to 3 at one month and to 2 at six months. Conclusions: ECT appears to be a new promising and safe adjunct treatment modality in PDAC management across different disease stages, with potential benefits in tumor control, cancer-related pain reduction, and quality of life. Further studies are warranted to validate these findings and identify patients who could benefit most.

Abstract B032: Concurrent mutant KRAS inhibition and Stereotactic Body Radiation Therapy (SBRT) for preclinical KRASG12D-Driven Pancreatic Ductal Adenocarcinoma (PDAC) treatment

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is known for its extensive intrinsic and acquired resistance to standard of care therapies. With the KRASG12D mutation being a key driver, MRTX1133, a selective small molecule KRASG12D inhibitor, has demonstrated superior anti-tumor efficacy in preclinical PDAC models. However, tumor resistance to MRTX1133 is expected to occur inevitably. We hypothesize that combining MRTX1133 with stereotactic body radiation therapy (SBRT) can enhance local tumor control and minimize tumor recurrence after treatment. Methods: C57Bl/6J mice orthotopically transplanted with luciferase-tagged mouse KPC PDAC cells (KrasG12D; Trp53R172H; Pdx1-Cre) were assigned to 4 treatment groups: (1) vehicle, (2) SBRT (8 Gy x 5), (3) MRTX1133 (30 mg/kg I.P. BID), and (4) SBRT + MRTX1133. Tumor progression was monitored with IVIS luciferase imaging, and survival data were collected and analyzed using a Log-rank test. At the study endpoint, tumors as well as normal tissues were collected for histological analysis to evaluate immune cell infiltration, tumor proliferation and differentiation, and normal tissue toxicity. Results: SBRT + MRTX1133 combination therapy significantly enhanced local tumor control and prolonged mouse survival when compared to either MRTX1133 or SBRT alone. The median survival in the combination group exceeded 120 days, with significantly reduced tumor burden, suggesting a synergistic effect between SBRT and MRTX1133 in suppressing KPC tumor progress in vivo. Conclusion: Our findings demonstrate that MRTX1133 combined with SBRT improves tumor control and overall survival in a preclinical KRASG12D-driven PDAC tumor model. This combination strategy has the potential for clinical translation, offering a promising therapeutic approach to overcome resistance and improve outcomes in PDAC patients. Citation Format: Tianyu Wang, Jasper R Chen, Vincent Bernard Pagan, Liang Wang, Youming Guo, Ling Xia, Pankaj K. Singh, Dadi Jiang, Albert Koong. Concurrent mutant KRAS inhibition and Stereotactic Body Radiation Therapy (SBRT) for preclinical KRASG12D-Driven Pancreatic Ductal Adenocarcinoma (PDAC) treatment [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr B032.

Neuroendoscopic surgery for acute presentation of cystic craniopharyngiomas.

Acute presentation of cystic craniopharyngioma is a potentially life-threatening condition, characterized by disability and increased mortality risk, often caused by large cysts with or without hydrocephalus. This study evaluated the applicability of minimally invasive neuroendoscopic surgery (NES) for rapid intracranial pressure relief and tumor control as an alternative to emergent microsurgical resection. A retrospective review of the electronic medical record database of patients with craniopharyngiomas treated at our institution between June 2007 and October 2024 identified 13 non-consecutive cases of acute presentation of cystic craniopharyngioma managed with NES. Interventions included pellucid septostomy (n = 2), ventriculoperitoneal shunt surgery (n = 2), and Ommaya reservoir placement (n = 6). Clinical and radiological data were analyzed to assess treatment outcomes. The most common acute symptoms were severe headache (69.2%), frequent vomiting (53.8%), sudden onset of consciousness disturbance (38.5%), visual impairment (46.2%), gait instability (23.1%), and cognitive dysfunction (15.4%). Ten patients had hydrocephalus at admission. All patients experienced symptom relief following NES, with no procedure-related mortality or complications. Hydrocephalus resolved in all cases, and subjective visual function improved in 83.3% of patients postoperatively. Endocrine function remained stable. At a median follow-up of 62 months (range, 38-130), local tumor control was achieved in 8 patients (61.5%) without requiring adjuvant therapy. NES is a safe, effective approach for managing acute presentation of cystic craniopharyngioma, particularly in patients with hydrocephalus. It offers rapid symptom relief and tumor control and is a potential staging treatment in selected cases.

Enhancing patient engagement: the influence of an in-consult patient decision aid on shared decision-making for lung tumour radiation – protocol for the randomised trial ‘SDM Lung SBRT’

IntroductionPatient engagement is continuously being promoted by patients as well as politicians and healthcare professionals. One way of increasing patient engagement is by using shared decision-making (SDM), which is a...

Efficacy and safety of robotic Cyberknife radiotherapy in uveal melanoma: a systematic review and meta-analysis.

This systematic review is aimed to evaluate the efficacy and safety of robotic Cyberknife radiotherapy (CKRT) in the treatment of uveal melanoma (UM). Clinical studies published in English that assessed the efficacy and safety of robotic CKRT in UM were systematically searched in PubMed, Web of Science, Cochrane and Embase from inception to July 2023. Studies reporting extraocular tumours or other radiosurgery approaches were excluded. Outcomes measured were tumour size, reflectivity, local tumour control rate, eye retention rate, survival rate, complication rate, recurrence rate, and metastasis rate. Ten eligible articles involving 2370 patients with 2372 UMs were included in evidence synthesis. Meta-analysis showed 811 of 912 patients (0.89, 95% Cl: 0.86, 0.92) maintained local control for three years, and 1448 of 1724 patients (0.84, 95% Cl: 0.81, 0.88) preserved the eye in three years. During follow-up, 91% (0.91, 95% Cl: 0.85, 0.97) patients survived and 351 of 1720 patients (0.23, 95% Cl: 0.09, 0.37) involving 1722 eyes had tumour recurrence. In addition, 1376 patients (0.79, 95% Cl: 0.77, 0.82) preserved the eyeball in five years. Following treatment, approximately 20% of patients had radiation retinopathy (95% Cl: 0.13, 0.28), 19% developed glaucoma (95% Cl: 0.11, 0.28), and 22% experienced retinal detachment (95% Cl: 0.07, 0.36). CKRT is a viable, noninvasive RT for UM. The rate of local tumour control following treatment is comparable to that of other RT approaches, providing additional options based on the patient's condition.

Induction of macrophage efferocytosis in pancreatic cancer via PI3Kγ inhibition and radiotherapy promotes tumour control

BackgroundThe immune suppression mechanisms in pancreatic ductal adenocarcinoma (PDAC) remain unknown, but preclinical studies have implicated macrophage-mediated immune tolerance. Hence, pathways that regulate macrophage phenotype are of strategic interest, with...

Defining the Optimal Dose for 3-Dimensional Conformal Accelerated Partial Breast Irradiation: 15-Year Follow-Up of a Dose-Escalation Trial.

Randomized trials have demonstrated similar local tumor control in patients treated with accelerated partial-breast irradiation (APBI) compared with whole-breast irradiation. However, the optimal APBI dose for maximizing tumor control and minimizing toxicity is uncertain. We enrolled patients ≥18 years of age with grade 1 or 2 ductal carcinoma in situ or stage I invasive breast cancer and resection margins ≥2 mm between 2003 and 2011 to a sequential dose-escalation trial using 3-dimensional conformal external beam APBI giving twice daily 4 Gy fractions with total doses of 32 Gy, 36 Gy, and 40 Gy. Most were irradiated using mini-tangents plus en-face electrons or 3 to 4 coplanar photon beams; 19 patients in the 32 Gy dose cohort were treated with protons. The trial accrued 324 patients (99, 101, and 124 in 32 Gy, 36 Gy, and 40 Gy cohorts, respectively). The median follow-up was 15.2 years. The 15-year cumulative incidence of local failure in each dose cohort was 6.9%, 5%, and 3.9% in the 32 Gy, 36 Gy, and 40 Gy cohorts, respectively (log-rank P = .21) The 10-year cumulative incidence of local failure in each dose cohort was 5.2%, 5.2%, and 2.2%, respectively (log-rank P = .2). Ten-year rates of moderate or severe fibrosis by physician assessment in each cohort were 40%, 58%, and 67%, respectively (log-rank P < .01). The 10-year rates of fair or poor cosmesis by patient self-assessment were 25%, 30%, and 49% in each cohort, respectively (log-rank P < .01); physician assessment yielded similar 10-year rates of 21%, 39%, and 61%, respectively (log-rank P < .01). There were no significant differences in local failure rates between 32 Gy, 36 Gy, or 40 Gy delivered in twice daily 4 Gy fractions, but fibrosis and cosmetic outcomes were worse for patients treated to the 2 higher doses. Hence, our study did not show the benefit of administering more than 32 Gy using this fractionation scheme.

Comparison of the effect of early versus late surgical strategies on outcomes in patients with hand enchondromas complicated with pathological fractures.

This study aimed to evaluate the advantages and disadvantages of early versus delayed single-stage surgery in patients with hand enchondromas who developed pathological fractures, focusing on local tumor control and hand function, to determine the optimal timing for surgery. Delayed surgical curettage may offer advantages regarding both local tumor control and hand function outcomes.Thirty-five patients who developed pathological fractures due to solitary hand enchondromas and underwent surgical treatment between 2015 and 2021 were analysed. Patients were divided into two groups based on the timing of surgery. Patients who underwent surgical treatment immediately after a pathological fracture were assigned to the early-surgery group, and those who underwent surgical treatment after waiting for fracture union were assigned to the late-surgery group. Demographic data, lesion characteristics, and fixation methods were analysed. Parameters affecting outcome measurements were analysed, including visual pain scale, fracture healing time, recurrence, ROM, time to return to daily activities, and secondary surgical procedures.The study included 35 patients, of whom 24 were female, with a median age of 33 years. Fifteen patients were included in the early-surgery group and 20 in the late-surgery group, with a follow-up period of 36.3 and 38.9 months, respectively. The duration of surgery, time to fracture union, and total physical therapy duration during treatment were lower in the late-surgery group (p<0.05). At the final follow-up, the mean loss of ROM was 17.6˚ in the early-surgery group and 3.3˚ in the late-surgery group (p=0.00). The rate of secondary surgery was higher in the early-surgery group (p=0.040).In patients with hand enchondromas presenting with pathological fractures, early surgery resulted in higher complication rates, poorer functional outcomes, and an increased need for secondary surgeries.

Silicone Fiducial Markers Improve Precision in Uveal Melanoma Radiation Therapy.

Objectives: Accurate target definition, treatment planning and delivery increases local tumor control for radiotherapy by minimizing collateral damage. To achieve this goal for uveal melanoma (UM), tantalum fiducial markers (TFMs) were previously introduced in proton and photon beam radiotherapy. However, TFMs cause pronounced scattering effects in imaging that make the delineation of small tumors difficult. The aim of this study was to evaluate silicone fiducial markers (SFMs) for the guiding of stereotactic radiosurgery (SRS) for UM. Methods: In this retrospective interventional pilot case series, three patients with small UMs 3 mm or less in tumor thickness and ≤10 mm in largest basal diameter received silicone fiducial markers. The fiducial markers were punched out (3 mm) from conventional silicone encircling bands for buckle surgery. The markers were sutured onto the sclera at the tumor margins according to the use of TFMs. MRI and CT images were used for the localization of the tumor and the markers before robotic-guided SRS. Results: The silicone fiducial markers were punched out easily from the original band, better to handle than TFMs and easy to suture onto the sclera. They could be visualized in both MRI and CT, but were more visible in CT. In the absence of scattering effects, both the markers and thus the tumor boundaries could be clearly delineated. Conclusions: This is the first report that introduces fiducial markers intraoperatively shaped from conventional silicone encircling bands usually used for retinal detachment surgery. The SFMs allow more accurate tumor delineation, resulting in the more precise planning and administration of SRS when compared to TFMs. This simple modification has a major impact on a well-known treatment approach.

Longitudinal Evaluation of Vestibular Symptoms in Patients with Vestibular Schwannoma After Robotic-Guided Stereotactic Radiosurgery Using the Dizziness Handicap Inventory (DHI).

Background: Vestibular symptoms can severely affect patients with vestibular schwannomas (VSs). Studies assessing vestibular symptoms beyond clinical routine assessment in patients with VS treated by stereotactic radiosurgery (SRS) are scarce. Therefore, we employed the standardized questionnaire Dizziness Handicap Inventory (DHI) to systematically evaluate vestibular symptoms prior to and after SRS. Methods: For this retrospective single center study, we included patients who received Cyberknife® SRS for newly diagnosed unilateral VS between 2012 and 2022, and who had a minimum of two follow-up (FU) visits. Besides clinical assessment, the presence and severeness of vestibular symptoms before and after treatment was recorded by using the DHI. Overall DHI symptom scores (1-100) were classified into four grades (0 = "none", 1 = "mild", 2 = "moderate" and 3 = "severe"). The results were correlated with tumor-, patient-, and treatment-related characteristics. Results: We analyzed 128 patients with a median age of 60 years (range: 20-82) and a median FU of 36 months (range: 11-106 months). The median tumor volume was 0.99 cm3 (range: 0.04-7.1 cm3). A median marginal dose of 13 Gy (range: 12-14 Gy) was administered. The crude rate of local tumor control was 99.2%. The mean DHI total score at last follow-up (LFU, 25.5 ± 24.7; range 0-92) was significantly lower than before SRS (29.4 ± 25.3; range:0-92, p = 0.026), which was reflected in a higher proportion of patients with DHI grade "none" and a lower proportion of patients with DHI grade "severe" at LFU. Chi-square tests showed a significant correlation of the DHI grades (DHI 0-1 vs. DHI 2-3) with the absence or presence of vestibular symptoms both before SRS (p < 0.001, CI 95%) and at LFU (p = 0.038). Conclusions: The DHI is a feasible and valid instrument for measuring vestibular symptoms after SRS. In addition, the DHI enables the quantification of symptoms and can therefore serve as an important tool for outcome assessment after SRS of VS. In the present cohort, DHI scores improved significantly during FU.

Combined treatment of small cell lung cancer using radiotherapy and immunotherapy: Challenges and updates.

Currently, chemotherapy remains the standard first- and second-line treatment for small cell lung cancer (SCLC). Research concerning immunotherapy has brought about a remarkable development in the treatment pattern of SCLC. Atirizumab, duvalizumab, atezolizumab, and serplulimab can significantly improve the clinical outcomes of SCLC. Given the rapidly evolving concept that combining immunotherapy with radiotherapy can increase therapeutic effectiveness, clinicians are devoted to further improving local tumor control by integrating immunotherapy with radiotherapy. This paper reviews the research progress in this field to date and explores ways to further enhance the efficacy of this combination therapy. We first discussed that immunotherapy combined with radiotherapy can improve the abscopal effect, progression-free survival, and overall survival rates of SCLC patients. Then, the biomarkers related to the radiation immune microenvironment, such as programmed death ligand-1 (PD-L1), tumor mutational burden (TMB), and the immune function of patients were discussed. Next, we explored the occurrence and underlying mechanisms of immune resistance during radiotherapy implementation. Finally, we clarified that the emerging trend of low-dose radiotherapy help overcome the inhibitory signals that limit T-cell infiltration in the tumor matrix. In summary, considering the rapid development of this field, these combined therapy strategies may have unlimited potential to further improve the efficacy of radiotherapy combined with immunotherapy for patients.

Uveal metastasis: clinical characteristics, treatment, and prognostic factors in a cohort of 161 patients in China.

To investigate the clinical and prognostic features of uveal metastasis in a Chinese population and compare these features across different primary cancers. Retrospective cross-sectional study. 161 patients with uveal metastasis at Beijing Tongren Hospital. Clinical characteristics of the primary tumour and uveal metastasis, treatments and outcomes were reviewed. Tumor regression was assessed using B-scan ultrasonography to measure changes in tumor height. Among 161 patients, 185 eyes had uveal metastasis. Lung cancer was the most common primary tumour (49.4%), followed by breast cancer (22.4%), kidney cancer (4.3%). Uveal metastasis was the initial cancer manifestation in 39 patients (24.2%). Unilateral involvement was predominant (86.3%), with the choroid being the most common site (91%). Compared with lung cancer and other cancers, breast carcinoma patients developed uveal metastasis at a younger age (p < 0.001), had a longer interval to uveal metastasis diagnosis (0.67, 4.19, and 6.27 years, p < 0.0001), were prone to be bilateral (11.1%, 9.1%, and 27.8%; p < 0.05) and exhibited lower tumour height (4.47 ± 2.49 mm and 4.88 ± 3.01 mm, 3.09 ± 2.46 mm; p < 0.01). Local treatments (133 eyes) included plaque radiotherapy (PRT, brachytherapy), transpupillary thermotherapy (TTT), anti-VEGF and enucleation. The tumour regression correlated with increased tumor height (r = 0.5699; p < 0.05) in eyes treated with PRT (n = 15). Despite effective local tumour control, the 1-year, 3-year, and 5-year survival rates were 72.61%, 31.82%, and 19.84%, respectively (n = 103). Among the 54 deceased patients, 27 (50%) died within one year following the diagnosis of uveal metastasis. The mean survival was 18.84 months. Extraocular metastasis correlated with shorter survival (p < 0.05). This study provides a comprehensive analysis of uveal metastasis in Chinese patients, highlighting the distinct characteristics from various primaries. Although survival rates remain uncertain, local therapies were effective at achieving ocular tumor control, which aligns with the expectations for patients battling metastatic cancers.