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Poster Highlights: Poster highlights 19 CL: Breast PH-0596: Whole breast irradiation in comparison to endocrine therapy in early stage breast cancer J. Haussmann, W. Budach, S. Corradini, B. Tamaskovics, E. Boelke, F. Djiepmo-Njanang, K. Kammers, C. Matuschek. [Extracted from the article]

Medulloblastoma is the most common malignant pediatric brain tumor, necessitating normofractionated craniospinal irradiation (CSI) with an additional boost over about 6 weeks in children older than 3 years. This study investigates the sensitivity of pediatric medulloblastoma cell lines to different radiation fractionation schedules. While extensively studied in adult tumors, these ratios remain unknown in pediatric cases due to the rarity of the disease. Five distinct medulloblastoma cell lines (ONS76, UW228-3, DAOY, D283, D425) were exposed to varying radiation doses and fractionation schemes. In addition, ONS76 and UW2283-3 stably overexpressing c-Myc were analyzed. Alpha/beta values, representing fractionation sensitivity, were quantified using the linear-quadratic model of radiation survival. The study unveiled elevated alpha/beta ratios across diverse medulloblastoma cell lines, with a mean alpha/beta value of 25.01 (ranging from 8.42 Gy to 75.09 Gy). Neither TP53 status nor the levels of MYC expression influenced fractionated radiosensitivity. Furthermore, no significant differences in alpha/beta values were observed among various medulloblastoma subgroups. These in vitro findings strongly recommend normofractionated or hyperfractionated radiotherapy for pediatric medulloblastoma cases due to consistently high Alpha/Beta values across subgroups. Conversely, hypofractionated radiotherapy is not advisable. This study highlights the potential for personalized dosage prescriptions, improving patient prognosis and safety. [ABSTRACT FROM AUTHOR]

The article offers clinical practice guidelines from the European Society for Medical Oncology (ESMO) on the diagnosis, treatment, and follow-up for esophageal cancer. It states that esophageal cancer is diagnosed through the identification of small cell carcinomas, which should also be separated from squamous cell carcinomas (SCCs) and adenocarcinomas (ACs). Furthermore, treatment of esophageal cancer involves chemoradiation for unfit patients who are not considered for surgery.

Heel spurs, a common cause of foot pain, pose a challenge in orthopedic management. Traditional treatments often involve physical therapy, orthotics, and medications, with varying degrees of success. This study explores low-dose radiotherapy as a potential treatment option, hypothesizing its efficacy and safety in alleviating heel spur symptoms. The study retrospectively analyzed 100 patients (27 men and 73 women) with an average age of 70.7 years (range = 37-101 years) who underwent low-dose radiotherapy for heel spurs, receiving a total dose of 3 Gy. Parameters assessed included pain levels, mobility, activity limitations, NSAID usage, and skin changes over a 20-year follow-up period. More than 70% of patients reported significant symptom improvement post-treatment. There was minimal reliance on NSAIDs, and no skin changes or tumor induction were observed within the treatment area. Notably, no significant radiogenic side effects were reported, highlighting the treatment's safety profile. While some patients experienced slight impairments in mobility and daily activities, most maintained a normal gait. Low-dose radiotherapy represents a safe and effective treatment modality for heel spurs, evidenced by high success rates and the absence of adverse effects. These findings suggest that low-dose radiotherapy could be a promising addition to orthopedic practice, emphasizing the need for further research on long-term outcomes and the development of optimized treatment protocols. [ABSTRACT FROM AUTHOR]

After vascular reconstructions in the groin area, a persistent lymph fistula regularly threatens the prognosis of the affected extremity. Rapid, effective treatment of the lymph fistula is therefore essential in order to be able to prevent amputation. As part of a pilot study, we wanted to analyze the chances and limitations of radiotherapy in the treatment of lymphatic fistulas. As part of an internal quality control, patients were identified for this study who acquired a lymph fistula in the groin as a result of vascular surgery due to peripheral artery disease stage IV and were irradiated at the University Hospital Düsseldorf. Eight men aged 66 + 12, 4 years underwent vascular surgery for PAD stage IV. Surgery was performed in these patients via the groin and all men subsequently had a persistent lymphatic fistula with a secretion greater than 50 ml/day. Five patients were irradiated with a fractionation of 10 × 0.4 Gy and 3 patients with a fractionation of 10 × 0.3 Gy. In all patients, the lymphatic fistula dried up within the irradiation series. No higher-grade complications occurred. Irradiation of the groin in the case of a persistent lymphatic fistula could be a therapeutic option to avoid amputations due to wound infections after vascular reconstruction in the groin. Prospective randomized studies would be desirable in order to be able to better evaluate the role of radiotherapy in the treatment of lymphatic fistulas. [ABSTRACT FROM AUTHOR]

Background: This open-label, phase III trial compared chemoradiation followed by surgery with or without neoadjuvant and adjuvant cetuximab in patients with resectable esophageal carcinoma. Patients and methods: Patients were randomly assigned (1: 1) to two cycles of chemotherapy (docetaxel 75 mg/m2, cisplatin 75 mg/m2) followed by chemoradiation (45 Gy, docetaxel 20 mg/m2 and cisplatin 25 mg/m2, weekly for 5 weeks) and surgery, with or without neoadjuvant cetuximab 250 mg/m2 weekly and adjuvant cetuximab 500 mg/m2 fortnightly for 3 months. The primary end point was progression-free survival (PFS). Results: In total, 300 patients (median age, 61 years; 88% male; 63% adenocarcinoma; 85% cT3/4a, 90% cNþ) were assigned to cetuximab (n=149) or control (n=151). The R0-resection rate was 95% for cetuximab versus 97% for control. Postoperative treatment-related mortality was 6% in both arms. Median PFS was 2.9 years [95% confidence interval (CI), 2.0 to not reached] with cetuximab and 2.0 years (95% CI, 1.5-2.8) with control [hazard ratio (HR), 0.79; 95% CI, 0.58-1.07; P=0.13]. Median overall survival (OS) time was 5.1 years (95% CI, 3.7 to not reached) versus 3.0 years (95% CI, 2.2-4.2) for cetuximab and control, respectively (HR, 0.73; 95% CI, 0.52-1.01; P=0.055). Time to loco-regional failure after R0-resection was significantly longer for cetuximab (HR 0.53; 95% CI, 0.31-0.90; P=0.017); time to distant failure did not differ between arms (HR, 1.01; 95% CI, 0.64-1.59, P=0.97). Cetuximab did not increase adverse events in neoadjuvant or postoperative settings. Conclusion: Adding cetuximab to multimodal therapy significantly improved loco-regional control, and led to clinically relevant, but not-significant improvements in PFS and OS in resectable esophageal carcinoma. [ABSTRACT FROM AUTHOR]

Background: Radiation dermatitis developing in patients receiving cetuximab concomitantly with radiotherapy for locally advanced squamous cell carcinoma of the head and neck (LA SCCHN) is now recognized to have different pathophysiological and clinical characteristics to the radiation dermatitis associated with radiotherapy or concomitant chemotherapy and radiotherapy. Current grading tools were not designed to grade this type of radiation dermatitis; their use may lead to misclassification of reactions and inappropriate management strategies, potentially compromising cancer treatment.Patients and methods: An advisory board of seven leading European specialists (three medical oncologists, three radiation oncologists and a dermatologist) with extensive experience of the use of cetuximab plus radiotherapy produced consensus guidelines for the grading and management of radiation dermatitis in patients receiving cetuximab plus radiotherapy.Results: Modifications to the current, commonly used National Cancer Institute—Common Terminology Criteria for Adverse Events version 4.3 for grading radiation dermatitis were proposed. Updated management guidelines, building on previously published guidelines from 2008, were also proposed.Conclusions: The proposed revisions to the grading system and updated management guidelines described here represent important developments toward the more appropriate grading and effective management of radiation dermatitis in patients receiving cetuximab plus radiotherapy for LA SCCHN. [ABSTRACT FROM AUTHOR]

Head and neck squamous cell cancer (HNSCC) is the sixth leading cause of cancer-related deaths worldwide. These tumors are commonly diagnosed at advanced stages and mortality rates remain high. Even cured patients suffer the consequences of aggressive treatment that includes surgery, chemotherapy, and radiotherapy. In the past, in clinical trials, HNSCC was considered as a single disease entity. Advances in molecular biology with the development of genomic and proteomic approaches have demonstrated distinct prognostic HNSCC patient subsets beyond those defined by traditional clinical–pathological factors such as tumor subsite and stage [Cho W (ed). An Omics Perspective on Cancer Research. New York/Berlin: Springer 2010]. Validation of these biomarkers in large prospective clinical trials is required before their clinical implementation. To promote this research, the European Organisation for Research and Treatment of Cancer (EORTC) Head and Neck Cancer Program will develop the following strategies—(i) biobanking: prospective tissue collection from uniformly treated patients in the setting of clinical trials; (ii) a group of physicians, physician—scientists, and EORTC Headquarters staff devoted to patient-oriented head and neck cancer research; (iii) a collaboration between the basic scientists of the Translational Research Division interested in head and neck cancer research and the physicians of the Head and Neck Cancer Group; and (iv) funding through the EORTC Grant Program and the Network Core Institutions Consortium. In the present report, we summarize our strategic plans to promote head and neck cancer research within the EORTC framework. [ABSTRACT FROM AUTHOR]

Summary: Purpose: The relevance of 18F-FDG PET for staging non-small cell lung cancer (NSCLC), in particular for the detection of lymph node or distant metastases, has been shown in several studies. The value of FDG-PET for therapy monitoring in NSCLC, in contrast, has not yet been sufficiently analysed. Aim of this study was to evaluate FDG-PET for monitoring treatment response during and after neoadjuvant radiochemotherapy (NARCT) in advanced NSCLC. Methods: Sixty-five patients with histologically proven NSCLC stage III initially underwent three FDG-PET investigations, during NARCT prior to initiating radiation, and post-NARCT. Changes of FDG-uptake in the primary tumour at two time-points during NARCT were analysed concerning their impact on long-term survival. Results: The mean maximum FDG uptake (standardized uptake value, SUVmax) of the whole group decreased significantly during NARCT (SUVmax PET 1: 14.9±4.0, SUVmax PET 3: 5.5±2.4, p =0.004). The difference between initial FDG uptake (PET 1) and uptake after induction chemotherapy (PET 2) was found to be highly predictive for long-term survival patients which had a greater than 60% decreases in their SUV change had a significantly longer survival than those below this threshold (5-year-survival 60% versus 15%, p =0.0007). Patients who had a lower than 25% decrease in their SUV change had a 5-years-survival lower than 5%. Furthermore, the difference between initial FDG uptake (PET 1) and uptake after completion of the whole NARCT (PET 3) was predictive for survival when 75% was applied as cut-off (p =0.02). However, the level of significance was considerably lower. Conclusion: FDG-PET is suitable for therapy monitoring in patients with stage III NSCLC. The decrease of FDG uptake during induction chemotherapy is highly predictive for patient outcome. [Copyright &y& Elsevier]

K. Unger, D.F. Fleischmann, V. Ruf, J. Felsberg, D. Piehlmaier, D. Samaga, J. Heà , M. Mittelbronn, K. Lauber, W. Budach, M. Sabel, C. Rödel, G. Reifenberger, J. Herms, J. Tonn, H. Zitzelsberger, C. Belka, M. Niyazi, Proffered Papers: Proffered papers 15: Radiation response biomarkers OC-0322: 4-miRNA signature and MGMT promoter methylation improve risk stratification in glioblastoma. [Extracted from the article]