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OBJECTIVE: The aim of this study was to report a monoinstitutional multidisciplinary experience about the use of multiparametric imaging to identify the areas with higher risk of relapse in localized prostate cancer, with the purpose of allowing a biologically planned target dose escalation. PATIENTS AND METHODS: We performed a retrospective evaluation of patients diagnosed with prostate cancer who received treatments at our Interventional Oncology Center with interstitial interventional radiotherapy from 2014 to 2022. Inclusion criteria were histologically confirmed localized prostate cancer; and National Comprehensive Cancer Network (NCCN) risk class unfavorable intermediate or high/very high risk. The diagnostic work-up included multiparametric Magnetic resonance imaging (MRI), multiparametric Transrectal ultrasound (TRUS), Positron Emission Tomography Computed Tomography (PET-CT) with choline or PSMA (or alternatively bone scan). All patients were assessed and received one treatment with interstitial high-dose-rate interventional radiotherapy (brachytherapy) delivering external beam radiotherapy (46 Gy). All procedures were performed using transrectal ultrasound guidance under general anesthesia and the prescribed doses were 10 Gy to the whole prostate, 12 Gy to the peripheral zone and 15 Gy to the areas at risk. RESULTS: We report the data of 21 patients who were considered for the statistical analysis with a mean age of 62.5 years. The mean PSA nadir was 0.03 ng/ml (range 0-0.09). So far, no biochemical nor radiological recurrences have been recorded in our series. Regarding acute toxicity, the most commonly reported side effects were G1 urinary in 28.5% of patients and G2 urinary in 9.5%; all recorded acute toxicities resolved spontaneously. CONCLUSIONS: We present a real-life experience of biologically planned local dose escalation by interventional radiotherapy (brachytherapy) boost, followed by external beam radiotherapy in patients with intermediate unfavorableor high/very high risk. The local control and the biochemical control rates are proved to be excellent and the toxicity profile tolerable. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Eccrine porocarcinoma (EPC) is a malignant adnexal tumor accounting for about 0.005% of skin tumors. The standard treatment of EPC is the complete surgical excision of the primary lesion and of the clinically involved lymph nodes. There is limited evidence regarding the role of radiotherapy (RT) in managing EPC after surgery. Therefore, the aim of this multidisciplinary systematic review is to analyze the available evidence about postoperative RT in the curative treatment of EPC. MATERIALS AND METHODS: A systematic search strategy was launched trough the main scientific databases including PubMed, Scopus and Cochrane. An additional manual search and a chain citation were performed about potentially relevant papers. The key words used for the search included "eccrine porocarcinoma", "porocarcinoma", "radiotherapy", "radiation therapy", "adjuvant radiotherapy" and "postoperative radiotherapy". RESULTS: A total of 104 publications were identified and 14 papers were included in the final analysis. The only articles found on adjuvant RT in EPC were case reports published between 1996 and 2019. There was a slight female prevalence (57% female/43% male) with a mean age of 65 years (range 37-85). Head-andneck region was the most frequently involved anatomical site followed by legs. CONCLUSIONS: Adjuvant radiotherapy after surgical removal of EPC could be considered in cases with positive or close margins and in cases with unfavorable histological features. In view of limited literature data and the rarity of EPC the best treatment sequence should always be discussed within the frame of a multidisciplinary setting. Advances in knowledge: adjuvant radiotherapy after surgical removal of EPC could be considered in cases with positive or close margins and in cases with unfavorable histological features. [ABSTRACT FROM AUTHOR]

Objective: The aim of our systematic review was to assess the role of interventional radiotherapy (IRT, brachytherapy) in the management of primary and/or recurrent vulvar carcinoma. Evidence acquisition: A systematic research using PubMed, Scopus and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Only full-text English-language articles related to IRT for treatment of primary or recurrent VC were identified and reviewed. Conference paper, survey, letter, editorial, book chapter and review were excluded. Time restriction (1990–2018) as concerns the years of the publication was considered. Evidence synthesis: Primary disease: the median 5-year LC was 43.5% (range 19–68%); the median 5-year DFS was 44.5% (range 44–81%); the median 5-year OS was 50.5% (range 27–85%). Recurrent disease: the median 5-year DFS was 64% (range 56–72%) and the median 5-year OS was 45% (range 33%-57%). Acute ≥ grade 2 toxicity was reported in three patients (1.6%). The severe late toxicity rates (grade 3–4) ranged from 0% to 14.3% (median 7.7%). Conclusion: IRT as part of primary treatment for primary and/or recurrent vulvar cancer is associated with promising clinical outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: From a clinical point of view, Kimura's disease is typically characterized by a subcutaneous mass occurring predominantly in the head and neck region. It occurs predominantly in young men of Asian descent, with a peak incidence in the second and third decades of life. However, KD has been also reported in other ethnic groups and in children. The most frequently used local treatments are surgical excision, radiotherapy, and surgical excision followed by radiotherapy. The aim of this multicenter systematic review is to highlight the available literature evidence about the outcome of RT in this setting. MATERIALS AND METHODS: A systematic review of any relevant literature in the principal medical databases, such as PubMed, Scopus and Cochrane library, was conducted. The inclusion criteria were original articles specifically reporting about KD and RT, including both prospective and retrospective studies. RESULTS: We were able to identify 11 studies, published from 1989 to 2021, eligible for inclusion in this review. Overall, data on 124 patients were recorded and are presented in this systematic review. The median recurrence rate, considering all patients, was 11% (ranging from 0% to 41.2%). In seven out of 11 studies, the relapse rate was less than 20%. Moreover, the relapse rate was 0% in four studies. CONCLUSIONS: The results of this multicenter systematic literature review show that evidence on RT of KD is limited and derives only from retrospective studies. In this setting RT seems to be well-tolerated and able to produce very high response rates in unresected lesions and reasonable results in terms of local control both as an exclusive and adjuvant treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this paper is to provide an update about the current clinical indications of RT in this poorly explored field outside the traditional oncological setting. MATERIALS AND METHODS: We performed a literature search on the main databases, including PubMed, Scopus and Cochrane from their inception until 31st December 2020. An additional manual check of scientific meeting proceedings and books was conducted in order to identify all the potentially useful sources. Only essays published in English have been considered for the purposes of this analysis. The searched items included: "Radiotherapy or Radiation Therapy" and "Benign disorder or Benign disease". RESULTS: We provided a list of current clinical indications for benign disorders based on the latest international surveys available, including major sites: eye, bone, head and neck, skin, brain, heart and peripheral vascular system. CONCLUSIONS: Radiotherapy for benign diseases is still a feasible therapeutic strategy, which may allow to treat several invalidating conditions, especially after medical therapies have failed thus avoiding potentially invalidating major surgical procedures. A careful evaluation in selecting the indication is essential and all the choices should be thoroughly discussed with the patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This review aimed at examining efficacy of interventional radiotherapy (brachytherapy-IRT) alone or combined with external beam radiotherapy (EBRT) in stage I esophageal cancer as exclusive treatment. MATERIALS AND METHODS: A systematic research using PubMed, Scopus, and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. We analyzed only clinical study as full-text publication, reporting on patients with stage I esophageal cancer treated with IRT alone or in combination with other treatments (e.g., EBRT). Conference paper, survey, letter, editorial, book chapter, and review were excluded. Patients who underwent previous surgery were excluded. Time restriction (1990-2018) was applied for years of the publication. RESULTS: Twelve studies have been selected. The number of evaluated patients was 514; the median age was 69 years. In the IRT group, the median: local control (LC) was 77% (range 63%- 100%), disease-free survival (DFS) was 68.4% (range 49%-86.3%), the overall survival (OS) was 60% (range 31%-84%), the cancer specific survival (CSS) was 80% (range 55-100%), and grade 3-4 toxicity range was 0%-26%. CONCLUSIONS: IRT alone or combined to EBRT is an effective and safe treatment option for patients with stage I esophageal cancer. Definitive radiation therapy could be an alternative to surgery in patients with superficial cancer. [ABSTRACT FROM AUTHOR]

Aim The number of examined lymph nodes (NLN) was associated with survival of stages II and III colorectal cancer (CRC) patients. Guidelines recommend examining at least 12 lymph nodes. This study investigated the influence of surgical specimen length on lymph node harvest and compliance with international guidelines. Materials and methods This population-based study included 4,724 cases of surgically treated CRC that were diagnosed from 2002 to 2008. Multivariate analyses were performed for the main study variables (age, gender, diagnosis at screening or in symptomatic patients, cancer site, staging, grading, number of positive nodes, neo-adjuvant treatment for rectal cancer, hospital were surgery was performed). Fractional polynomial models investigated the relationship between continuous variables and outcomes. Results The NLN increased over time reaching ≥12 NLN in 64% of cases at the end of the study period. More NLN were associated with young age, right colon cancer, pT3–T4 disease, stages II and III and high grade. Fewer NLN were associated with short surgical specimen length and neo-adjuvant treatment in rectal cancer patients. Use of laparoscopy increased sharply over time. Conclusions NLN increased over time in accordance with international guidelines. Surgical specimen length correlated with NLN which may determine therapeutic choices, particularly in stage II colon cancer. When harvested lymph nodes are under 10 in number and all are negative, chemotherapy is always recommended. As specimen lengths <20 cm were associated with a high risk of inadequate NLN counts, patients are at risk of over-treatment. [ABSTRACT FROM AUTHOR]

Poster: Clinical track: Head and Neck PO-0788: Smell protocol:exclusive interventional radiotherapy in the treatment of nasal vestibule carcinomas V. Lancellotta, L. Tagliaferri, E. De Corso, G.C. Passali, G.C. Mattiucci, M.A. Gambacorta, D. Rizzo, B. Fionda, F. Deodato, G. Di Cintio, A. Salvati, G. Paludetti, V. Valentini, J. Galli, F. Bussu. [Extracted from the article]

Abstract Purpose Classical Kaposi's sarcoma (KS) was usually treated with large parallel and opposed photon beam. To spare muscles and bones, a patient with an extended KS (from limbs to fits on both legs) was treated with Helical Tomotherapy (HT). Because of the skin involvement two polyurethane foam cushions (PFC) were applied as immobilization device and as bolus material, in a "shell" configuration. Methods The patient was positioned inside a PFC shell: the inner surface of the shell fitted the skin, in order to act as a bolus material. The CTV extended at least 5 mm inside legs; the PTV was the CTV expanded of 5 mm in all directions. A core structure distant 2 mm from the PTV was created for each leg and completely blocked in order to force HT to deliver only tangential beams to the PTV. The prescription was 60 Gy in 30 fraction; because of the length of target (1 m) the larger field width (5.02 cm), a pitch of 0.430, and a modulation factor of 2.0 were used. The irradiation time resulted in 15 min and the time required for the positioning and the MVCT was about 20 min. The surface doses was measured on the first session by means of EBT3 films: 24 films (2 cm × 2.5 cm) were placed all over the skin of the legs and feet. Results The dosimetric results were reported in Table 1. The density of PFC was measured from the CT and resulted in 0.0066 g/cm3. The measured doses ranged from 83% to 94% with a mean value of 88% (1.75 Gy). Conclusions In KS irradiation, the combination of a core blocked HT and the PSC shell offered an adequate dose coverage on the whole target, including the skin, spearing at the same time the muscles and skeleton. [ABSTRACT FROM AUTHOR]

Abstract Purpose In our centre, an on-going pilot study is testing the feasibility of TMI-TLI delivered with Helical Tomotherapy (HT) instead of TBI. We present our protocol and dosimetric results of first 28 patients treated. Methods Head and shoulders of patient are immobilized with thermoplastic mask. Hips and legs are positioned in polyethylene foam cushion. Two supine CT scans, with feet first and head first orientation, were collected with 1 cm slice thickness. For each CT a treatment plan was optimized with the following parameters: field width 5.0 cm, pitch 0.430 and modulation factor ranging from 2 to 3 for the superior region and 5.0 cm, 0.287 and 2 for the inferior region. The overlapping region was managed with 3 sections to better control the dose accumulation. Others helps structures, like a lung contractions and RVR, were used in order to better optimise the plan. The prescribed dose was 13.5 Gy in 9 fractions to the PTV, 11.5 Gy in 8 fractions to the PTV and 13.5 Gy to the bone PTV and 11.5 Gy to lymph nodes PTV in 9 fractions respectively for 2, 5 and 21 patients. Plans were optimised to ensure 90% PTV volume received at least the 90% of the prescribed dose. Dose limits were D50% < 7.5 Gy for lungs, liver, kidneys, 8 Gy for heart, 9 Gy for small intestine, 6 Gy for eyes. Results All plans satisfied the dose constraints. Mean dosimetric results for the 21 patients treated with two dose level were reported in table in term of D90% for PTV and mean dose for the main OARs. The mean treatment times were 17.8 and 9.8 min respectively for the superior and inferior plan. Conclusions The TMI-TLI with HT showed good dosimetric results. Even though the patient cohort is small, treatments seemed associated with low toxicity and suitable for elderly and unfit young patient. [ABSTRACT FROM AUTHOR]