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K. Haustermans, Symposium: How to combine different treatment modalities in rectal cancer SP-0502: Organ preservation: where are we and where do we go?. [Extracted from the article]

• The guideline covers diagnosis, staging, risk assessment, treatment, disease monitoring and follow-up. • The multidisciplinary expert author group is from different institutions and countries in Europe, Asia and the USA. • Recommendations are based on available scientific data and the authors' collective expert opinion. • ESMO-MCBS and ESCAT scores provide levels of evidence for treatment choices, including targeted therapies. • In clinical practice, all recommendations provided need to be discussed with patients in a shared decision-making approach. [ABSTRACT FROM AUTHOR]

Background: The primary objective of this study was to determine the maximum tolerated dose (MTD) of escalating doses of radiotherapy (RT) concomitantly with a fixed dose of gemcitabine (300 mg/m²/week) within the same overall treatment time. Methods: Thirteen patients were included. Gemcitabine 300 mg/m²/week was administered prior to RT. The initial dose of RT was 45 Gy in 1.8 Gy fractions, escalated by adding 5 fractions of 1.8 Gy (one/week) to a dose of 54 Gy with a total duration kept at 5 weeks. All patients received a dynamic MRI to assess the pancreatic respiratory related movements. Toxicity was scored using the RTOG-EORTC toxicity criteria. Results: Three of six patients experienced an acute dose limiting toxicity (DLT) at the 54 Gy dose level. For these patients a grade III gastro-intestinal toxicity (GI) was noted. Patients treated at the 45 Gy dose level tolerated therapy without DLT. The 54 Gy dose level was designated as the MTD and was deemed not suitable for further investigation. Between both dose levels, there was a significant difference in percentage weight loss (p = 0.006) and also in cumulative GI toxicity (p = 0.027). There was no grade 3 toxicity in the 45 Gy cohort versus 4 grade 3 toxicity events in the 54 Gy cohort. The mean dose to the duodenum was significantly higher in the 54 Gy cohort (38.45 Gy vs. 51.82 Gy; p = 0.001). Conclusion: Accelerated dose escalation to a total dose of 54 Gy with 300 mg/m²/week gemcitabine was not feasible. GI toxicity was the DLT. Retrospectively, the dose escalation of 9 Gy by accelerated radiotherapy might have been to large. A dose of 45 Gy is recommended. Considering the good patient outcomes, there might be a role for the investigation of a fixed dose of gemcitabine and concurrent RT with small fractions (1.8 Gy/day) in borderline resectable or unresectable non-metastatic locally advanced pancreatic cancer. [ABSTRACT FROM AUTHOR]

• This ESMO Clinical Practice Guideline provides key recommendations for managing gastric cancer. • The guideline covers clinical and pathological diagnosis, staging and risk assessment, treatment and follow-up. • Treatment and management algorithms for localised and advanced/metastatic disease are provided. • The author group encompasses a multidisciplinary group of experts from different institutions and countries in Europe. • Recommendations are based on available scientific evidence and the authors' collective expert opinion. [ABSTRACT FROM AUTHOR]

The article focuses on clinical practice guidelines offered by the European Society for Medical Oncology, for treatment and diagnosis of oesophageal cancer. Topics discussed include diagnosis of squamous cell carcinoma (SCCs) and adenocarcinoma, risk factors for SCCs are alcohol consumption and smoking and impact of preoperative chemotherapy and post-operative chemotherapy on cancer treatment. It also mentions that the American Joint Cancer Committee (AJCC) discusses several stages of tumour.

Aim: The aim of the study was to evaluate the usefulness of a decision aid regarding treatment options for patients with early-stage localized prostate cancer. Methods: 50 patients with newly diagnosed localized prostate cancer received the decision aid and were interviewed twice: before the decision-making consultation with the physicians and before treatment or, in case of watchful waiting, before the follow-up consultation. The physicians (radiation oncologists and urologists) were interviewed after the consultation. Results: The patients became more active partners in the decision-making process: They were better prepared for the consultation, asked more direct information, and were able to make a more deliberative choice. Generally, the use of the decision aid improved the quality of the consultation and resulted in a treatment decision agreed upon by both parties. Sometimes the consultation turned out to be more time-consuming. The decision aid did not only improve the patient-physician interaction but also helped patients to discuss the disease with their partner and family members. Conclusion: The use of the decision aid has a positive impact on the consultation and the decision-making process. The policy of involving patients more actively in the decision process should be further implemented in daily practice. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: The surgical treatment of locally advanced prostate cancer has often been discouraged and in many cases a combined treatment with radiotherapy and hormone-therapy is proposed. Nevertheless, radical prostatectomy is efficient in mono-therapy in the majority of patients with a PSA lower than 20 μg/l, a unilateral stage T3a and a Gleason score lower than 8. Patients with a more advanced local stage or with a less well differentiated tumour should not be excluded from a surgical treatment as an initial option. The majority of them will benefit from a multimodal treatment. This can consist of adjuvant radiotherapy in case of obvious margin positive disease, a salvage radiotherapy in case of PSA relapse during follow-up, or a hormonal treatment in case of PSA persistence after surgery or in cases of advanced lymph node invasion. The urologist must utilise the results of the definitive pathology and of the post-operative PSA levels in order to find the indications where and when additional treatment can be applied. The results obtained after 10–15 years with a radical prostatectomy, eventually combined with radiation or hormonal treatment are excellent concerning the cancer specific survival at long term. Therefore radiotherapy and hormones is not the treatment of choice for all clinical T3 prostate cancers. [Copyright &y& Elsevier]

OC-0209: "SBRT and the Boost", a love story: primary endpoint analysis of the phase II hypo-FLAME trial Proffered Papers: Proffered papers 10: Prostate OC-0209: "SBRT and the Boost", a love story: primary endpoint analysis of the phase II hypo-FLAME trial C. Draulans, U.A. Van der Heide, K. Haustermans, F.J. Pos, J. Van der Voort van Zyp, H. De Boer, V. Groen, E.M. Monninkhof, R.J. Smeenk, M. Kunze-Busch, T. Depuydt, R. De Roover, S. Isebaert, L.G.W. Kerkmeijer. [Extracted from the article]

Abstract: Objective:: To assess the efficacy and tolerability of localised radiotherapy for the treatment of bicalutamide (‘Casodex’ 1 [1] ‘Casodex’ is a trademark of the AstraZeneca group of companies. )-induced gynaecomastia and/or breast pain. Methods:: This open-label, non-comparative, multicentre study included 51 patients receiving bicalutamide 150mg for the treatment of non-metastatic prostate cancer (T1b–T4, Nx, M0). Patients who developed symptomatic gynaecomastia and/or breast pain received two 6-Gy fractions of external-beam radiation to the breasts and were then assessed at two 3-monthly follow-up visits. Results:: 37/51 (72.5%) patients experienced gynaecomastia and 41/51 (80.4%) experienced breast pain, typically within the first 6 months. Twenty seven and 38 patients, respectively, went on to receive breast irradiation. Following radiotherapy, gynaecomastia improved or resolved in 7/27 (25.9%) and 2/27 (7.4%) cases, respectively, and breast pain improved or resolved in 12/38 (31.6%) and 3/38 (7.9%) cases, respectively. No change was observed in 7 patients (25.9%) with gynaecomastia and 12 patients (31.6%) with breast pain, while 9 patients (33.3%) and 8 patients (21.1%), respectively, worsened. Radiotherapy-related adverse events, reported by 18/41 (43.9%) patients, were generally mild and short lived (median duration approximately 5 weeks). Conclusions:: Therapeutic radiotherapy, using two fractions of 6 Gy external-beam radiation to the male breast, improves the intensity of bicalutamide-induced gynaecomastia and/or breast pain in approximately one-third of patients. Adverse events were often mild and short lived. [Copyright &y& Elsevier]

This study aimed to evaluate tumour hypoxia by comparing [(18)F]Fluoromisonidazole uptake measured using positron emission tomography ([(18)F]FMISO-PET) with immunohistochemical (IHC) staining techniques. Syngeneic rhabdomyosarcoma (R1) tumour pieces were transplanted subcutaneously in the flanks of WAG/Rij rats. Tumours were analysed at volumes between 0.9 and 7.3 cm(3). Hypoxic volumes were defined using a 3D region of interest on 2 h postinjection [(18)F]FMISO-PET images, applying different thresholds (1.2-3.0). Monoclonal antibodies to pimonidazole (PIMO) and carbonic anhydrase IX (CA IX), exogenous and endogenous markers of hypoxia, respectively, were used for IHC staining. Marker-positive fractions were microscopically measured for each tumour, and hypoxic volumes were calculated. A heterogeneous distribution of hypoxia was observed both with histology and [(18)F]FMISO autoradiography. A statistically significant correlation (P<0.05) was obtained between the hypoxic volumes defined with [(18)F]FMISO-PET and the volumes derived from the PIMO-stained tumour sections (r=0.9066; P=0.0001), regardless of the selected threshold between 1.4 and 2.2. A similar observation was made with the CA IX staining (r=0.8636; P=0.0006). The relationship found between [(18)F]FMISO-PET and PIMO- and additionally CA IX-derived hypoxic volumes in rat rhabdomyosarcomas indicates the value of the noninvasive imaging method to measure hypoxia in whole tumours. [ABSTRACT FROM AUTHOR]

• A variety of PROMs are used in the setting of palliative radiotherapy (RT). • PROMs are primarily used as a benchmarking tool after palliative treatment. • Patient feedback on the use of PROMs in the palliative RT setting is limited. • Given the benefits of symptom monitoring interventions in patients with advanced cancer, PROMs in routine clinical care after palliative RT should be studied. Radiotherapy (RT) can be used to palliate cancer-related symptoms and improve quality of life (QoL). Patient Reported Outcome Measures (PROMs) could be a reliable, minimally invasive method to monitor patients after palliative radiotherapy. This review was performed to provide an overview of the way PROMs are currently used in follow-up after palliative RT, regarding the goal of the PROM, the type of PROMs, PROM selection, PROM completion as well as the follow-up schemes and patient adherence and attrition. Pubmed, EMBASE and the Cochrane Library were systematically searched for articles published between 2008 and 2020. Titles and abstracts were reviewed to find relevant studies, which were advanced to full-text review. The reference lists of review articles were screened for correctness of the search and additional studies. No meta-analysis was performed. This search strategy identified 5733 studies, with 94 ultimately selected for inclusion in this topical review. We discovered a great variety of studies that used PROMs after palliative RT. We found no articles describing PROMs in routine clinical care. PROMs were exclusively used as a benchmarking tool and never to improve symptom control or QoL for individual patients. The selection process for the questionnaires, completion method and/or follow-up scheme was seldom described. We did not find any studies referencing patients' experience on PROMs. Although clear guidelines on the use of PROMs in palliative RT may be difficult to establish, more attention should be paid to the PROM aspect when writing study protocols. Furthermore, efforts should be made to introduce PROMs in routine clinical care in the context of palliative RT. [ABSTRACT FROM AUTHOR]

La radiothérapie externe avec chimiothérapie concomitante (5-fluoro-uracile–mitomycine C) est le traitement de référence du cancer de canal anal. Une analyse des données de sept essais a été faite pour quantifier l'effet des paramètres relié avec la radiothérapie externe sur les résultats thérapeutiques. Après fusion des jeux de données l'impact des paramètres de radiothérapie (étalement, durée de l'intervalle de temps, dose totale) sur les résultats thérapeutiques (récidive locorégionale, taux de survie sans progression à 5 ans et toxicité) ont été évalués. Les données ont été reçues de dix essais publiés sur 13, réalisés entre 1987 et 2008 (n = 3031). Une régression de Cox a été utilisée. Seuls les dossiers de 1343 patients des sept essais plus récents et homogènes ont été analysés (durée médiane de suivi :4,1 ans). Un taux supérieur de récidive locorégionale à 5 ans avait une corrélation significative avec un étalement plus long (22,8 %, intervalle de confiance à 95 % [IC 95 %] : 22,3–27,3 %, p = 0,030), une taille tumorale supérieure (p < 0,001) et avec les sexe masculin (p = 0,045). Les analyses par sous-groupe de la récidive locorégionale(intervalle de dose : 50,4–59 Gy) semblaient en faveur des doses plus basses (p = 0,412). La comparaison avec un intervalle de temps de deux semaines (dose : 59,4 Gy) suggérait que trois semaines pouvaient être désavantageux (p = 0,245), et ne montrait pas de différence (p = 0,89) avec aucun intervalle de temps (intervalle de dose : 55–59,4 Gy). La probabilité de survie sans progression à 5 ans était 65,7 % (IC 95 % : 62,8–68,5 %). Des taux de survie sans progression plus élevés ont été observés chez les femmes (p < 0,001), les tailles tumorales plus petites (p < 0,001) et les étalements plus courts (p = 0,025). La survie globale à 5 ans était en relation avec les femmes (76,7 % ; IC 95 % : 73,9 % > 79,3 % ; p < 0,001), tailles tumorales plus petites (p = 0,027) et étalements plus courts (p = 0,026). Les données descriptives de la toxicité seront présentées. Pour des patients pris en charge par chimioradiothérapie concomitante par deux agents et une radiothérapie externe, un étalement plus long semble désavantageux. De futurs essais avec des techniques modernes pourraient mieux définir l'étalement optimal et le rôle de l'escalade de dose. [ABSTRACT FROM AUTHOR]