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Financial disengagement of Indigenous Australians stems from external and internal sources. External factors include geographical location, unemployment, lower income, and lower financial literacy. Internal factors relate to Indigenous cultural norms of sharing which influence money management practices. The High Court of Australia’s decision in Australian Securities and Investments Commission v. Kobelt highlights the cultural practice of ‘demand sharing’ and the use of the ‘book-up’ system within remote Indigenous communities. The majority 4:3 decision that Mr. Kobelt did not engage in unconscionable conduct with his practice of the book-up system with Indigenous customers indicates the relevance of cultural lenses in evaluating unconscionable conduct in Indigenous context. Applying an Indigenous Standpoint Theory and using a mixed methodology of statistical and reflective analytical approaches with Indigenous oral testimonies, this article demonstrates that culture matters and that connection to culture and community is key to Indigenous Peoples’ identity and strength. It provides resilience and is foundational to well-being, including financial wellbeing. Thus, effective design and implementation of financial literacy and capabilities programs worked by, or in consultation and collaboration with, Indigenous Peoples will contribute to financial engagement of Indigenous Australians. The lessons learned could also apply broadly to promoting financial engagement of Indigenous Peoples in the CANZUS nations. [ABSTRACT FROM AUTHOR]

[Display omitted] • Complexity index (MCS) and log-files analysis were used for PSQA accuracy assessment. • Prediction accuracy for gamma-pass rate (γ %) was 2.1%. • Precision, recall and F-score performances for γ % was greater than 90%. • An MCS-based traffic light protocol was implemented to "a-priori" flag delivery accuracy. • The optimal MCS threshold values for failed and pass plans were <0.130 and >0.270. We presented different machine learning models based on log files analysis and complexity indexes to predict and classify the dosimetric accuracy of VMAT plans. A total of 1302 VMAT arcs from 651 treatment plans were analyzed using the modulation complexity score (MCS) and the dynamic log-files generated by the linac. Predicted and measured fluences were compared using γ-analysis in terms of mean γ-values (γ mean) and γ-pass rate (γ %). A kernel regression model was developed aiming to predict individual γ % and γ mean values. Multinomial logistic regression (LR), Naïve-Bayes (NB) and support vector machine (SVM) models were developed based on MCS values to classify QA results as "pass" (γ % greater than90 % and γ mean < 0.5), "control" (80 % < γ % < 90 % and 0.50 < γ mean < 0.75) and "fail" (γ % < 80 % and γ mean > 0.75). Training, validation and testing groups were used to evaluate the model reliability. A complexity-based traffic light protocol was implemented to flag pass (green light), control (orange light) and failed plans (red light). Prediction accuracy of residuals for γ % was 2.1 % and 2.2 % in the training and testing cohorts, respectively. For 2 %(local)/2mm, both γ % and γ mean classification performances reported weighted precision, recall and F1-values greater than 90 % for all machine learning models. The optimal MCS threshold value for the identification of failed plans was 0.130, with a sensibility and specificity of 0.994 and 0.952, respectively. The optimal MCS threshold for reliable plans was 0.270, with a sensitivity and specificity of 0.925 and 0.922, respectively. Machine learning can accurately predict the dosimetric accuracy of VMAT treatments, representing an efficient tool to assist patient-specific QA. [ABSTRACT FROM AUTHOR]

The aims of this study were to analyze the pathological response, and survival outcomes of adenocarcinoma/adenosquamous (AC/ASC) versus squamous cell carcinoma (SCC) in patients with locally advanced cervical cancer (LACC) managed by chemoradiotherapy followed by radical surgery. Retrospective, multicenter, observational study, including patients with SCC and AC/ACS LACC patients treated with preoperative CT/RT followed by tailored radical surgery (RS) between 06/2002 and 05/2017. Clinical-pathological characteristics were compared between patients with SCC versus AC/ASC. A 1:3 ratio propensity score (PS) matching was applied to remove the variables imbalance between the two groups. After PS, 320 patients were included, of which 240 (75.0%) in the SCC group, and 80 (25.0%) in the AC/ASC group. Clinico-pathological and surgical baseline characteristics were balanced between the two study groups. Percentage of pathologic complete response was 47.5% in SCC patients versus 22.4% of AC/ASC ones (p < 0.001). With a median follow-up of 51 months (range:1–199), there were 54/240 (22.5%) recurrences in SCC versus 28/80 (35.0%) in AC/ASC patients (p = 0.027). AC/ASC patients experienced worse disease free (DFS), and overall survival (OS) compared to SCC patients (p = 0.019, and p = 0.048, respectively). In multivariate analysis, AC/ACS histotype, and FIGO stage were associated with worse DFS and OS. In LACC patients treated with CT/RT followed by RS, AC/ASC histology was associated with lower pathological complete response to CT/RT, and higher risk of recurrence and death compared with SCC patients. This highlights the need for specific therapeutic strategies based on molecular characterization to identify targets and develop novel treatments. [ABSTRACT FROM AUTHOR]

Objective: Residual disease after surgery is related to an unfavorable prognosis in patients with endometrial cancer (EC). An early diagnosis and treatment of this condition could improve patients' outcome. Aim of this study was to define the role of postoperative 18FFluorodeoxyglucose-Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) in patients with high risk of residual disease after EC surgery. Methods: Patients operated for EC, with one or more risk factors, who underwent 18F-FDG-PET/CT before adjuvant treatment were included in this observational study. The primary endpoint was the rate of patients in whom 18F-FDG-PET/CT changed the treatment strategy and/or the radiotherapy (RT) planning. Results: Our analysis included 58 patients (median age: 67.5 years, range: 48.0-86.0) with the following risk factors: lymphadenectomy not performed (26 patients; 44.8%), inadequate lymphadenectomy (23 patients; 39.7%), and high risk of residual disease due to advanced stage (nine patients; 15.5%). Postoperative 18F-FDG-PET/CT imaging was positive in 18 patients (31%) in the following sites: pelvic extra-nodal disease (one patient), pelvic and/or paraaortic lymph nodes (12 patients), distant metastases (one patient), or combination of previous sites (four patients). Based on these results, the adjuvant therapeutic strategy was changed in five patients, three of whom were referred to chemotherapy alone due to distant metastases and two of whom were referred to nodal-directed treatment due to lymph node metastases (lymphadenectomy and pelvic chemoradiation plus boost, respectively). Furthermore, based on the 18F-FDG-PET/CT results, the RT plan was modified in 13 patients (addition of a boost on residual pelvic/abdominal disease in 12 and target modification in one, respectively). Therefore, based on postoperative 18F-FDGPET/CT findings, the therapeutic strategy and the RT plan were changed in 5 patients (8.6%) and 13 patients (22.4%), respectively. Conclusion: In this analysis, the adjuvant treatment was modified after post-operative 18F-FDG-PET/CT in about one third of patients. Further studies are needed to better define the risk factors (or their combinations) correlated with higher probability of residual disease after radical hysterectomy-adnexectomy for EC. [ABSTRACT FROM AUTHOR]

Background: Single‐cell sequencing has been instrumental in understanding cell‐type specific changes in Alzheimer's disease (AD). While sequencing provides information about changes in individual cells, how these changes impact the interaction between cells is not as well‐defined. Understanding how the transcriptional and epigenetic changes that emerge during disease impact cellular communication will be critical in understanding key pathological changes that contribute to AD. Method: We performed single‐nucleus RNA and ATAC‐seq (10x Multiome) to investigate gene expression and epigenetic regulation of cells in the entorhinal cortex (ENT) of 2‐month and 8‐month‐old 5xFAD and WT mice (n = 2 for each age, condition), and used publicly available single‐nucleus RNA‐seq data from the ENT of patients with and without AD. We used CellChat and the new package NeuronChat to explore how intercellular communication networks change between healthy and AD humans and mice. Based on these results, we then explored relationships between chromatin accessibility and gene expression for genes of interest. Result: We observed changes in cell‐cell communication between AD and healthy samples in both mice and humans, particularly in the later stages of disease. The most prominent change was increased signaling from astrocytes to glutamatergic neurons in AD (Figure 1). This relationship included upregulation of neuroligin and ephrin‐A‐mediated signaling in AD, both previously implicated in synaptic regulation. In inter‐neuronal communications, the pathways most significantly disrupted in both human and mouse neurons were related to glutamatergic signaling. Multiple types of glutamate receptors were upregulated in both AD patients and 5xFAD mice in glutamatergic neurons, while GABAergic signaling did not appear to change. This finding is consistent with the hypothesis that glutamatergic neurons are hyperactive in AD and extends these observations by providing a potential mechanistic explanation of this phenomenon. Conclusion: Our results indicate that in patients with AD and 5xFAD mice, dysfunction of the glutamatergic system is a prominent feature of pathogenesis and includes both inter‐neuronal signaling and communication with astrocytes. These results provide a series of testable hypotheses to explore the consequences of the transcriptional and epigenetic changes on the circuit dysfunction observed in AD. [ABSTRACT FROM AUTHOR]

The questions of whether high-income individuals are more prosocial than low-income individuals and whether income inequality moderates this effect have received extensive attention. We shed new light on this topic by analyzing a large-scale dataset with a representative sample of respondents from 133 countries (N = 948,837). We conduct a multiverse analysis with 30 statistical models: 15 models predicting the likelihood of donating money to charity and 15 models predicting the likelihood of volunteering time to an organization. Across all model specifications, high-income individuals were more likely to donate their money and volunteer their time than low-income individuals. High-income individuals were more likely to engage in prosocial behavior under high (vs. low) income inequality. Avenues for future research and potential mechanisms are discussed. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) has been used as a treatment of last resort for treatment-resistant depression (TRD) for more than a decade. Many DBS targets have been proposed and tested clinically, but the underlying circuit mechanisms remain unclear. Uncovering white matter tracts (WMT) activated by DBS targets may provide crucial information about the circuit substrates mediating DBS efficacy in ameliorating TRD. We performed probabilistic tractography using diffusion magnetic resonance imaging datas from 100 healthy volunteers in Human Connectome Project datasets to analyze the structural connectivity patterns of stimulation targeting currently-used DBS target for TRD. We generated mean and binary fiber distribution maps and calculated the numbers of WMT streamlines in the dataset. Probabilistic tracking results revealed that activation of distinct DBS targets demonstrated modulation of overlapping but considerably distinct pathways. DBS targets were categorized into 4 groups: Cortical, Striatal, Thalamic, and Medial Forebrain Bundle according to their main modulated WMT and brain areas. Our data also revealed that Brodmann area 10 and amygdala are hub structures that are associated with all DBS targets. Our results together suggest that the distinct mechanism of DBS targets implies individualized target selection and formulation in the future of DBS treatment for TRD. The modulation of Brodmann area 10 and amygdala may be critical for the efficacy of DBS-mediated treatment of TRD. • Distinct DBS targets for TRD modulate overlapping but distinct pathways. • The currently used DBS targets can be categorized into 4 distinct groups based on connectomic analysis. • Brodmann Area 10 and amygdala are hub structures in DBS-mediated treatment for TRD. • Individualized DBS target selection is warranted for TRD. [ABSTRACT FROM AUTHOR]

The thyroid is an endocrine gland located in the anterior region of the neck: its main task is to produce thyroid hormones, which are functional to our entire body. Its possible dysfunction can lead to the production of an insufficient or excessive amount of thyroid hormone. Therefore, the thyroid can become inflamed or swollen due to one or more swellings forming inside it. Some of these nodules can be the site of malignant tumors. One of the most used treatments is sodium levothyroxine, also known as LT4, a synthetic thyroid hormone used in the treatment of thyroid disorders and diseases. Predictions about the treatment can be important for supporting endocrinologists' activities and improve the quality of the patients' life. To date, there are numerous studies in the literature that focus on the prediction of thyroid diseases on the trend of the hormonal parameters of people. This work, differently, aims to predict the LT4 treatment trend for patients suffering from hypothyroidism. To this end, a dedicated dataset was built that includes medical information related to patients being treated in the "AOU Federico II" hospital of Naples. For each patient, the clinical history is available over time, and therefore on the basis of the trend of the hormonal parameters and other attributes considered it was possible to predict the course of each patient's treatment in order to understand if this should be increased or decreased. To conduct this study, we used different machine learning algorithms. In particular, we compared the results of 10 different classifiers. The performances of the different algorithms show good results, especially in the case of the Extra-Tree Classifier, where the accuracy reaches 84%. [ABSTRACT FROM AUTHOR]

• Lung metastases are highly heterogeneous in terms of genomic expression and associated stroma and vasculature. • Radiomics can capture intra- and inter-lesion tumor heterogeneity. • DAPC was performed to describe the clusters of "radiomically" related lesions. • DAPC provided an optimal discrimination between different treatment responses after SBRT. Discriminant analysis of principal components (DAPC) was introduced to describe the clusters of genetically related individuals focusing on the variation between the groups of individuals. Borrowing this approach, we evaluated the potential of DAPC for the evaluation of clusters in terms of treatment response to SBRT of lung lesions using radiomics analysis on pre-treatment CT images. 80 pulmonary metastases from 56 patients treated with SBRT were analyzed. Treatment response was stratified as complete, incomplete and null responses. For each lesion, 107 radiomics features were extracted using the PyRadiomics software. The concordance correlation coefficients (CCC) between the radiomics features obtained by two segmentations were calculated. DAPC analysis was performed to infer the structure of "radiomically" related lesions for treatment response assessment. The DAPC was performed using the "adegenet" package for the R software. The overall mean CCC was 0.97 ± 0.14. The analysis yields 14 dimensions in order to explain 95 % of the variance. DAPC was able to group the 80 lesions into the 3 different clusters based on treatment response depending on the radiomics features characteristics. The first Linear Discriminant achieved the best discrimination of individuals into the three pre-defined groups. The greater radiomics loadings who contributed the most to the treatment response differentiation were associated with the "sphericity", "correlation" and "maximal correlation coefficient" features. This study demonstrates that a DAPC analysis based on radiomics features obtained from pretreatment CT is able to provide a reliable stratification of complete, incomplete or null response of lung metastases following SBRT. [ABSTRACT FROM AUTHOR]

We aimed to assess disease-free survival (DFS), overall survival (OS) and treatment-related toxicity of two therapeutic strategies for treating bulky lymph nodes on imaging in patients with locally advanced cervical cancer (LACC): radiotherapy boost versus surgical debulking followed by radiotherapy. We performed a systematic review of studies published up to October 2023. We selected studies including patients with LACC treated by external beam radiotherapy (EBRT) boost or lymph node debulking followed by EBRT (with or without boost). We included two comparative (included in the meta-analysis) and nine non-comparative studies. The estimated 3-year recurrence rate was 28.2% (95%CI:18.3–38.0) in the EBRT group and 39.9% (95%CI:22.1–57.6) in the surgical debulking plus EBRT group. The estimated 3-year DFS was 71.8% and 60.1%, respectively (p = 0.19). The estimated 3-year death rate was 22.2% (95%CI:11.2–33.2) in the EBRT boost group and 31.9% (95%CI:23.3–40.5) in the surgical debulking plus EBRT group. The estimated 3-year OS was 77.8% and 68.1%, respectively (p = 0.04). No difference in lymph node recurrence between the two comparative studies (p = 0.36). The meta-analysis of the two comparative studies showed no DFS difference (p = 0.13) but better OS in the radiotherapy boost group (p = 0.006). The incidence of grade≥3 toxicities (ranging 0–50%) was not different between the two approaches in the two comparative studies (p = 0.31). No DFS and toxicity difference when comparing EBRT boost with surgical debulking of enlarged lymph nodes and EBRT in patients with cervical cancer was evident. Radiotherapy boost had better OS. Further investigation is required to better understand the prognostic role of surgical lymph node debulking in light of radiotherapy developments. [ABSTRACT FROM AUTHOR]

To assess the feasibility and safety of a repeated SHort course Accelerated RadiatiON therapy (SHARON) regimen in the palliative setting of Head and Neck (H&N) cancer in older adults. Patients with histological confirmed H&N cancers, age ≥ 80 years, expected survival >3 months, and Eastern Cooperative Oncology Group (ECOG) performance status of ≤3 were enrolled. Patients were treated in cohorts of six patients: a total dose of 20 Gy was delivered in 2 consecutive days with a twice-daily fractionation (5 Gy per fraction) and at least 8-h interval. If no Grade 3 toxicity was registered, a second enrollment started with another cohort of six patients to whom were administered two cycles (total dose of 40 Gy). The primary endpoint was to evaluate the feasibility of the two cycles of treatment. Secondary endpoints were evaluation of symptoms control rate, symptoms-free survival (SFS), and Quality of Life (QoL) scores. Seventeen consecutive patients (median age: 85 years) were treated. Nine patients were treated with one cycle and 8 patients with two cycles. No G3 toxicity was reported in either cohort. With a median follow-up time of 4 months, 3-month SFS in the first and second cohorts was 83.3%, and 87.5%, respectively. The overall palliative response rate was 88%. Among 13 patients reporting pain, 8 (61.5%) showed an improvement or resolution of their pain. Repeated short course accelerated radiotherapy in a palliative setting of H&N cancers is safe and well-tolerated in older adults. [ABSTRACT FROM AUTHOR]

The EU-supported ATHENA project stems from a previous study suggesting that moderate wine consumption reduced the side-effects of radiotherapy (RT) in breast cancer patients, an effect possibly due to non-alcoholic anthocyanin fractions of wine. To evaluate the role of anthocyanins on RT skin side effects in breast cancer patients. Randomized, controlled, double-blind clinical trial. Patients were assigned to an intensity modulated radiation therapy (IMRT) either for three or five weeks, then randomized to receive three times a day a water-soluble anthocyanin (125 mg)-rich extract of corn cob or a placebo. Supplementation started one week before till the end of RT. Skin characteristics were detected by a standardized, non-invasive Cutometer® dual-MPA580, providing quantitative indices of skin maximal distensibility (R0), elasticity (R2, R5, R7) and viscoelasticity (R6); a Mexameter® MX18 probe evaluated the skin erythema (Er) and melanin (M). Measures were performed before (T0), at the end of RT and of supplementation (T1), and 1, 6 and 12 months after RT (T2-T4). Acute and late skin toxicity were scored according to the RTOG/EORTG scale. Selected biomarkers were measured at T0 and T1. 193 patients previously assigned to 3- or 5-week RT schedules were randomized to either anthocyanin (97) or placebo (96) supplementation. RT induced changes in skin parameters: R0, R2, R5 and R7 decreased, while R6 increased; the changes in R0 and R6 continued in the same direction up to one year, while the others recovered towards basal values; Er and M peaked at T1 and T2, respectively, and returned to basal values at T4. Comparable skin changes were apparent in anthocyanin and placebo groups. A moderate RT-induced increase in total and HDL cholesterol and triglycerides was prevented by anthocyanins. Anthocyanin supplementation did not prevent RT-induced local skin toxicity. The supplementation was well tolerated and safe. [ABSTRACT FROM AUTHOR]

Side-dress N is a management strategy in maize (Zea Mays L.) production that can increase yield, reduce N leaching, and increase the probability that N remains post-flowering. This management adds cost, is time-sensitive, and can be difficult due to field shape and topography. A plantable, polymer-coated urea N bead of two sizes and two coating thicknesses was developed and field tested across multiple locations during 2015-2017 as a replacement to side-dress application. Locations differed in previous crop history and the initial N rates applied prior to treatments. Bead performance varied among locations but averaged 0.3 Mg ha-1 compared to an uncoated control or in-season urea-ammonium-nitrate (UAN) application. Bead application increased yield 0.8 Mg ha-1 when rainfall exceeded 225 mm between planting and R1 (silk appearance) but did not improve yield when rainfall was <125 mm. Nitrogen release from the bead was described by a thermal time function. A common exponential decay function was not adequate to describe the release of N across all locations indicating variation in release of N among locations driven by factors other than soil temperature. Slow-release, polymer-coated fertilizer, placed near the seed at planting, provides the option to apply supplemental N at planting, followed by N release later in the season, eliminating the need for in-season applications. Further research is needed to more closely match coating thickness and N release to crop N demand consistently across locations and development of equipment to enable one-pass seed planting and N application operations. [ABSTRACT FROM AUTHOR]

• Treatment planning for H&N tumors is challenging. • Artificial intelligence has the potential to improve plan quality. • Personalized Planning, a new automated optimization engine, is presented. • Automated plans resulted in significant dosimetric sparing of OARs. • Personalized Planning resulted in clinically favorable H&N cancer plans. To perform a comprehensive dosimetric and clinical evaluation of the new Pinnacle Personalized automated planning system for complex head-and-neck treatments. Fifteen consecutive head-neck patients were enrolled. Radiotherapy was prescribed using VMAT with simultaneous integrated boost strategy. Personalized planning integrates the Feasibility engine able to supply an "a priori" DVH prediction of the achievability of planning goals. Comparison between clinically accepted manually-generated (MP) and automated (AP) plans was performed using dose-volume histograms and a blinded clinical evaluation by two radiation oncologists. Planning time between MP and AP was compared. Dose accuracy was validated using the PTW Octavius-4D phantom together with the 1500 2D-array. For similar targets coverage, AP plans reported less irradiation of healthy tissue, with significant dose reduction for spinal cord, brainstem and parotids. On average, the mean dose to parotids and maximal doses to spinal cord and brainstem were reduced by 13–15% (p < 0.001), 9% (p < 0.001) and 16% (p < 0.001), respectively. The integral dose was reduced by 16% (p < 0.001). The dose conformity for the three PTVs was significantly higher with AP plans (p < 0.001). The two oncologists chose AP plans in more than 80% of cases. Overall planning times were reduced to <30 min for automated optimization. All AP plans passed the 3%/2 mm γ-analysis by more than 95%. Complex head-neck plans created using Personalized automated engine provided an overall increase of plan quality, in terms of dose conformity and sparing of normal tissues. The Feasibility module allowed OARs dose sparing well beyond the clinical objectives. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate a state-wide teen pregnancy dropout prevention program using cost-benefit analysis. Data analyzed from five high schools covering a decade compared three student populations: teens from the general population, teens who were enrolled in the fully online program, and teens who selected out of the full program but made use of daycare services. Graduation outcomes and the cost per student for administering each version of the program were examined. Results revealed that students in the full program (over the 10 years) experienced a graduation rate of 1.6% with a negative rate of return of $-8,989,736; whereas, student continuing their face-to-face courses (but making use of daycare services) experienced a graduation rate of 64.5% and rate of return of $293,370. These findings demonstrate the utility of employing a cost-benefit analysis, encouraging school districts to collect more data regarding educational outcomes of pregnant and parenting teenagers to guide the efficient allocation of resources. This methodology could be adopted to inform future policy decisions aimed at increasing high school graduation rates while judiciously evaluating the investment for those interventions. [ABSTRACT FROM AUTHOR]

Background and Aims: Dietary choices are influenced by several factors including physiological, social, or genetic factors. Among these, flavor is the most important determinant modulating food preferences. The aim of the present study was to assess flavor identification abilities in patients with obesity (Ob) in comparison with matched normal weight (NW) and over-weight (OW) subjects using a specific and validated chemosensory test.Methods and Results: The flavor test was administered to 140 Ob patients recruited in the obesity outpatient Unit at the Federico II University hospital and to the same number of NW and OW subjects matched by sex, age, and smoking habit. Flavor score (FS) inversely correlated with BMI. Median [Q1; Q3] FS was significantly higher in NW (14.5 [12; 16]) than in Ob (13 [10; 15] p < 0.001) and not significantly different from OW (14 [12; 16]) individuals. FS was also higher in OW than in Ob subjects (p < 0.005). When separated according to age quartiles, the BMI-related differences in FS were still significant in younger quartiles, while they were abolished in the older.Conclusions: BMI is a critical factor modulating flavor identification, particularly in young subjects. Further investigations are needed to explore the precise mechanism and the causal relationship between body weight and olfactory dysfunctions.Clinicaltrial Id: NCT03506074. [ABSTRACT FROM AUTHOR]

Introduction Multidisciplinary treatment strategy involving adjuvant radiotherapy for advanced vulvar cancer could be useful in offering the best personalized clinical approach. In 2013, the VULvar CANcer Multi- Disciplinary Team (Vul.Can MDT) was set up in our institution, in order to share knowledge and expertise, high-quality diagnosis, and evidence- based decision making in the context of personalized medicine. The aim of this observational study was to report on our series of vulvar cancer patients managed postoperatively with radiotherapy within the framework of a formal multidisciplinary tumor board. Methods Coupling surgical and oncological international guidelines with "case-by-case" discussions, a multispecialist consensus was progressively reached and internal recommendations were developed and introduced in the daily routine. Data from vulvar cancer patients who underwent primary surgery and adjuvant radiotherapy throughout a 5-year period were retrospectively collected. Actuarial local control was the primary endpoint, while secondary end-points were acute and late toxicities, disease-free survival, and overall survival. Toxicity was evaluated according to the Common Toxicity Criteria Adverse Event v 4.0 scale. results The analysis included 35 patients with squamous vulvar cancer treated with adjuvant radiotherapy±chemotherapy, from April 2013 to September 2017. Median age was 70 years (range 18-87), all patients underwent surgery followed by concomitant chemoradiation (45.7%) or radiotherapy alone (54.3%). The median prophylactic dose on lymphatic drainage was 45 Gy, while positive nodes and perineal area received 51.2 Gy and 52.6 Gy, respectively. Chemotherapy involved the cisplatin- based regimen (45.7%)±5- fluorouracil (37.1%). Median follow- up was 32 months (range 6-72): the 24-months local control, disease-free survival, and actuarial overall survival rates were 88.6%, 82.0%, and 91.0%, respectively. Low rates of severe acute (12%) and late (3%) toxicities occurred. Discussion The outcomes of this series support the benefit of a multidisciplinary personalized approach in the management of vulvar cancer. [ABSTRACT FROM AUTHOR]