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We aimed to investigate the appropriate postoperative radiotherapy dose and selective volume in T3-4 N0 laryngeal cancer patients treated with either total or partial laryngectomy.Patients who received radiotherapy for locally advanced (T3-T4) and pathologic node-negative (N0) squamous cell laryngeal cancer were retrospectively evaluated. Radiotherapy was applied to median 60 Gy (range 54-60 Gy) as selective local radiotherapy (±stoma). The local treatment areas included postoperative bed + laryngeal area for patients with a partial laryngectomy, and the postoperative bed only for patients with total laryngectomy.The median follow-up time was 59 months and 52 patients were included. The 2‑year, 5‑year, and 8‑year locoregional recurrence controls (LRC) were 95.6%. The 2‑year and 5‑year OS rates were 93.8% and 78.9%, respectively. The 5‑year OS for age lt; 60 years was 95.8%, for above 60 years 56.5%.Our data suggest that local selective irradiation to the postoperative bed + stoma is enough in patients with T3-4 N0 laryngeal cancer without applying elective nodal irradiation.

Background and Objectives: Quality assurance is an integral part of brachytherapy. Traditionally, radiographic films have been used for source position verification, however, in many clinics, computerized tomography simulators have replaced conventional simulators, and computerized radiography systems have replaced radiographic film processing units. With these advances, the problem of controlling source position verification without traditional radiographic films and conventional simulators has appeared. Materials and Methods: In this study, we investigated an alternative method for source position verification for brachytherapy applications. Source positions were evaluated using Gafchromic™ RTQA2 and EBT3 film and visually compared to exposed RTQA radiochromic film when using a Nucletron Oldelft Simulix HP conventional simulator and a Gammamed 12-i brachytherapy device for performance evaluation. Gafchromic film autoradiography was performed with a linear accelerator (LINAC) on-board imager (OBI). Radiochromic films are very suitable for evaluation by visual inspection with a LINAC OBI. Results: The results showed that this type of low-cost, easy-to-find material can be used for verification purposes under clinical conditions. Conclusions: It can be concluded that source-position quality assurance may be performed through a LINAC OBI device.

The aim of this study was to investigate the recurrence patterns in pancreatic cancer patients treated with adjuvant intensity modulated radiotherapy (IMRT) and to correlate the sites of locoregional recurrence with radiotherapy target volumes.Thirty-eight patients who had undergone resection and adjuvant chemoradiation for pancreatic cancer were evaluated. Radiotherapy (RT) was started after 1-3 cycles of adjuvant chemotherapy (CHT). Clinical target volume (CTV) was contoured according to the RTOG guideline. All patients were treated with IMRT with a dose of 45-50.4 Gy. Computerized tomography (CT) images at the time of recurrence were correlated with radiotherapy plans. Locoregional recurrences were classified as in-field, out-field and marginal.Median overall survival (OS) was 19 months. One- and 2-year OS rates were 73.6% and 37.1%, respectively. Locoregional recurrence and distant metastases were observed in 11 (28.9%) and 23 (60.5%) patients, respectively. For the 11 locoregional recurrences, 7 were in-field, 1 was marginal, and 3 were out-of-field. One patient had isolated local, 2 patients had isolated regional and 15 (57.6%) patients had only distant failures. The first presentations of failures were mostly distant (58%). On multivariate analysis, tumor size ≥ 3 cm (p = 0.011) and positive vascular invasion (p = 0.014) predicted for worse OS rate.The majority of locoregional recurrences were in the radiation field among pancreatic cancer patients treated with postoperative IMRT. However, failures were predominantly distant, and improvement of systemic control may be of particular interest.

Objective: Diabetes mellitus (DM) is a common comorbidity in patients with prostate cancer. Radiotherapy was reported to induce acute and late side effects in patients with DM due to vascular damage. Moreover, some studies have shown that metformin, an oral antidiabetic drug, can reduce biochemical and disease recurrence in patients with prostate cancer. This study aimed to evaluate retrospectively the effect of metformin on biochemical disease control and to observe the acute and late side effects of prostate cancer treated with radiotherapy. Materials and Methods: This study enrolled 94 patients who received radical radiotherapy between 2010 and 2017. However, out of 22 patients with DM, 17 received metformin and five received metformin plus insulin treatment. Biochemical recurrence-free survival (bRFS), overall survival, and side effects were assessed between patients with and without DM. Results: The median follow-up time was 57 (15-128) months. The 5-year bRFS rate in patients with and without DM were 100% and 89.2%, respectively (p=0.10). Acute grade 1-2 side effects were observed in all patients with DM, while 56 (78%) patients without DM had acute side effects, and the difference is significant (p=0.02). Acute grade 3 genitourinary and gastrointestinal toxicity was found in one patient without DM, whereas late grade 3 gastrointestinal toxicity was observed in one patient with DM. Conclusion: Although patients with DM were found to have better bRFS than patients without DM, we could not show the benefit of metformin, and the difference was not significant. By contrast, acute side effects were significantly higher in patients with DM.