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The phase 3 PACIFIC trial established consolidation therapy with durvalumab as standard of care for patients with unresectable, stage III NSCLC and no disease progression after definitive chemoradiotherapy (CRT). The observational PACIFIC-R study assesses the real-world effectiveness of durvalumab in patients from an early access program. Here, we report treatment characteristics and a preplanned analysis of real-world progression-free survival (rwPFS).

Advances in therapeutic techniques and multimodal approaches have significantly improved the success rates of treatment for pediatric malignancies, with cure rates now close to 80%. This has led to an increase in long-term survival, with 0.10-0.15% of the general population being survivors of childhood cancer. In Italy, cancer registry data suggest that 75% of treated children become long-term survivors. However, these survivors face significant risks of late adverse events, including chronic diseases and severe conditions, highlighting the need for specialized follow-up care.Radiotherapy, a cornerstone of pediatric cancer treatment, contributes to late toxicities due to the susceptibility of growing tissues. Proton therapy offers advantages in reducing treatment-related toxicity, reducing the risk of secondary cancers, and allowing dose escalation for radioresistant tumors. Comparative studies suggest that proton therapy is superior in sparing healthy tissues and reducing long-term toxicities.Despite these benefits, challenges such as the high cost, limited proton therapy centers, and the need for clinical trials hinder the widespread adoption of proton therapy. Efforts to centralize care in high-ranking centers and ensure equitable access to proton therapy are crucial. In Italy, pediatric solid tumors are now eligible for proton therapy under national health policies, ensuring free access for all children.Dedicated proton therapy centers must provide comprehensive care involving multidisciplinary teams and supportive environments for pediatric patients and their families. Addressing current limitations and enhancing care environments are essential for improving outcomes for pediatric oncology patients.

Stereotactic Ablative Radiotherapy (SABR) has been previously investigated as an alternative to thoracic surgery in patients with a limited number of pulmonary nodules from different primary tumors. We here report the clinical outcomes of a series of consecutive patients homogenously selected and treated with single dose SABR in our Institution. Eligibility criteria were: 1–5 lung metastases, maximum tumor diameter <50 mm, absent or controlled extra-thoracic disease, adequate pulmonary function, no prior radiotherapy, performance status ECOG 0–1. All patients were treated with a single dose of 26 Gy prescribed to the 80% isodose, by 3D-CRT or by IGRT-VMAT. Follow-up consisted of clinical evaluation and periodic CT scans. Primary endpoints were Local Control (LC), toxicity and Progression-Free Survival (PFS). Secondary endpoints were Cancer-Specific Survival (CSS) and Overall Survival (OS). Out of 102 patients treated with SABR between october 2003 and october 2011, we selected 67 patients for a total of 90 lesions. Main primary tumor sites were lung and colon-rectum (37.3% and 43.3% of lesions, respectively). Median follow up time was 24 months. Treated metastasis progression at SABR site was observed in 10 lesions (11.1%), and actuarial LC rates at 1 and 2 years were respectively 93.4% and 88.1%. Systemic failure occurred in 37 patients (55.2%) at a median interval of 8 months after SABR. PFS rates were 72% and 55.4% at 1 and 2 year. Seven patients had grade 1 (10.4%) and 8 grade 2–3 late radiological toxicity (11.9%), while 6 experienced late chest wall toxicity (2 rib fractures, 4 chronic chest pain, 8.9%). CSS rates at 1 and 2 years were 90% and 76%, while OS rates were 85.1% and 70.5%, respectively. Median survival time was 40 months. On multivariate analysis, a disease-free interval longer than 24 months was close to significance for a benefit in CSS (p= 0.07; HR 0.34 [95% CI 0.1–1.12]). The study includes a cohort of patients treated with single fraction 26 Gy SABR followed for a prolonged time interval. Single fraction SABR appears to be an effective treatment option, with little observed acute toxicity and limited late toxicity (<15%); its advantages also include a high patients' compliance, a short overall treatment time and an easy combination with systemic therapies. These results might provide supportive evidence to the use of single fraction SABR as a valid and acceptable alternative to surgery for pulmonary metastases from different primary tumors.

Aims and background The diagnostic and therapeutic approach to prostate cancer has evolved rapidly in last decades. Young professionals need an update about these recent developments in order to improve the care of patients treated in their daily clinical practice.Methods On May 18, 2013, AIRO Giovani (the young section of the Italian Association of Radiation Oncology) organized a multidisciplinary meeting involving, as speakers, several young physicians from many parts of Italy actively involved in the diagnostic and therapeutic approach to prostate cancer. The meeting was specifically addressed to young physicians (radio-oncologists, urologists, medical oncologists) and presented the state-of-the-art of the diagnostic/therapeutic approach based on the latest evidence on the issue. Highlights of the congress are summarized and presented in this report.Results The large participation in the meeting (more than 120 participants were present) confirmed the interest of young radiation oncologists in improving their skills in prostate cancer management. The contributions of the speakers confirmed the need for regular updates, considering the promising results of recently published studies and the many new ongoing trials, on the diagnostic and therapeutic approaches to prostate cancer.Conclusions Multidisciplinary meetings are helpful to improve the skills of young professionals.

ABSTRACTSeveral published studies show a relationship between craniofacial morphology and head posture. The aim of this study was to evaluate the association between cervical lordosis angle and mandibular length from lateral skull radiographs, and to investigate the relationship between mandibular retrusion and cervical lordosis angle decreasing. The sample comprised 70 Caucasian adult women, average 27.4, in skeletal class II and Angle class II. Lateral skull radiographs were obtained in natural head position (mirror position). Ten morphological variables were individuated on tracings. In order to assess errors due to landmark identification, double measurements were made in ten randomly selected radiographs and were compared with Dahlberg's formula. A Sperman's rank correlation test showed a negative correlation (P<0.01) between cervical lordosis and mandibular length (compensatory curvature of the cervical spine) and positive correlation between anterior cranial base and maxillary length (P<0.05). Based upon the cross-sectional method, no conclusion was possible about the mechanism concerning these results. Future longitudinal studies in growing patients should be directed to understanding the extent of environmental and genotype influences on cervical lordosis angle.