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Background: to evaluate the utility of pretreatment systemic immune-inflammation index (SII) in predicting the teeth caries and need for tooth extraction after concurrent chemoradiotherapy (C-CRT) for locally advanced squamous-cell head and neck cancer (LASCHNC) patients. Methods: the records of LA-SCHNC patients who underwent formal dental evaluations at pre and post-C-CRT periods were retrospectively analyzed. The pretreatment SII values were calculated using the platelet, neutrophil, and lymphocyte measures acquired on the first day of C-CRT: SII=Plateletsxneutrophils/lymphocytes. Receiver operating characteristic (ROC) curve analysis was employed to identify the ideal pre-C-CRT SII cutoff that may predict the teeth caries and the need for tooth extraction after the C-CRT. The primary endpoint was the link between the pre-C-CRT SII and the need for tooth extraction during the follow-up period. Results: a sum of 126 patients were included. Median follow-up was 4.9 years (range: 2.7-7.8). Nasopharyngeal and laryngeal cancers comprised the majority (75.4%) study cohort. Posttreatment teeth extractions were reported in 62.7% patients. The optimal cutoff was 558 [Area under the curve (AUC): %76.8 sensitivity: 72.3%; and specificity: 70.9%] that grouped the patients into two subgroups with significantly different post-C-CRT tooth extraction rates: Group 1: SII558 (n = 56), respectively. Correlation analysis revealed a significant relationship between the pretreatment SII and the tooth extraction rates after the C-CRT (rs:0.89: P = 0.001). The comparative analysis displayed that the teeth extractions rates were significantly higher in the SII>558 group (77.1% versus 51.4% for SII558 was the unique factor associated with meaningfully higher necessities for post-C-CRT teeth extractions. Conclusion: the present outcomes intimated that high pretreatment SII levels were linked to significantly increased post-treatment teeth extractions in LA-SCHNC patients undergoing definitive C-CRT., NA

Veysel Haksoyler,1 Erkan Topkan2 1Medline Hospital, Department of Medical Oncology, Adana, Turkey; 2Baskent University Medical Faculty, Department of Radiation Oncology, Adana, TurkeyCorrespondence: Erkan TopkanBaskent University Medical Faculty, Department of Radiation Oncology, Adana, 01120, TurkeyTel +90-533-7381069Fax +90-322-3444452Email docdretopkan@gmail.comPurpose: In a lack of similar research, we assessed the prognostic utility of pretreatment platelet-to-albumin ratio (PAR) in locally advanced nasopharyngeal carcinoma (LANPC) patients managed with concurrent chemoradiotherapy (CCRT).Patients and Methods: Present retrospective analysis included a sum of 128 consecutively treated LANPC patients who underwent cisplatinum-based radical CCRT. Availability of an ideal pretreatment PAR cutoff that may stratify the study population into two cohorts with significantly distinct survival outcomes was sought by utilizing the receiver operating characteristic (ROC) curve analysis. The primary and secondary endpoints were overall survival (OS) and progression-free survival (PFS), respectively.Results: A rounded 5.2 [area under the curve (AUC): 68.9%; sensitivity: 67.4%; and specificity: 65.2%] value was identified as the ideal PAR cutoff that grouped patients into two gatherings [PAR≥ 5.2 (N=60) versus < 5.2 (N=68)]. The median follow-up duration was 86.4 months (range: 9– 147). Kaplan–Meier comparisons between the two PAR groups revealed significantly diminished median PFS (69.4 versus 106.8 months for PAR< 5.2; P< 0.012) and OS (88.3 versus not reached yet for PAR< 5.2; P= 0.023) for the PAR ≥ 5.2 group. The results of multivariate analyses affirmed the pretreatment PAR≥ 5.2 as an independent prognostic factor that indicates diminished PFS (P= 0.016) and OS (P= 0.019) together with the respective N2-3 nodal stage (versus N0-1; P< 0.05 for PFS and OS, respectively) and weight loss > 5% at past six months (≤ 5%; P< 0.05 for PFS and OS, respectively).Conclusion: The results of the current retrospective analysis provided a robust and independent adverse prognostic value for pretreatment PAR ≥ 5.2 in terms of median and long-term PFS and OS outcomes in LA-NPC patients this patient group treated with conclusive CCRT.Keywords: concurrent chemoradiotherapy nasopharyngeal cancer, platelet-to-albumin ratio, prognostic worth, survival results

Perpetual advances in the diagnostic tools, local plus systemic cancer treatments, and ensued lengthened survival times led to striking increments in the incidence rates of brain metastases (BMs), with a collective incidence range of 20-40% for all solid cancers. Stereotactic radiosurgery (SRS) and innovative molecularly targeted therapies are continuously gaining growing significance in the triumphant management of BMs, as the brain represents a sanctuary site for the vast majority of the conventional cytotoxic chemotherapies. In this scenario, the molecularly targeted agents appear to be an attractive alternative to traditional chemotherapeutics as they can modulate cancer metabolism and progression and exert synergism with radiation therapy. Therefore, the present paper intends to sum up the accessible proof on the consolidated utilization of SRS and molecularly targeted agents in the precise management of BMs from certain solid cancers, specifically the non-small-cell lung, breast, and renal-cell carcinomas, and malignant melanomas.

Objectives: we endeavored to retrospectively assess the prognostic merit of pretreatment systemic immune response index (SIRI) in glioblastoma multiforme (GBM) patients who underwent postoperative partial brain radiotherapy (RT) and concurrent plus adjuvant temozolomide (TMZ), namely, the Stupp protocol. Methods: the records of 181 newly diagnosed GBM patients who received the postoperative Stupp protocol were retrospectively analyzed. The SIRI value for each eligible patient was calculated by utilizing the platelet, neutrophil, and lymphocyte measures obtained on the first day of treatment: SIRI=NeutrophilsxMonocytes/Lymphocytes. The ideal cutoff values for SIRI connected with the progression-free- (PFS) and overall survival (OS) results were methodically searched through using the receiver operating characteristic (ROC) curve analysis. Primary and secondary end-points constituted the potential OS and PFS distinctions among the SIRI groups, respectively. Results: the ROC curve analysis labeled the ideal SIRI cutoffs at 1.74 (Area under the curve (AUC): 74.9%; sensitivity: 74.2%; specificity: 71.4%) and 1.78 (AUC: 73.6%; sensitivity: 73.1%; specificity: 70.8%) for PFS and OS status, individually. The SIRI cutoff of 1.78 of the OS status was chosen as the common cutoff for the stratification of the study population (Group 1: SIRI 1.78 (N=85)) and further comparative PFS and OS analyses. Comparisons between the two SIRI cohorts manifested that the SIRI 1.78 counterparts. The results of multivariate Cox regression analyses ratified the independent and significant alliance between a low SIRI and longer PFS (P, NA

Objectives: to investigate the influence of pretreatment primary tumor or nodal photopenia (PP) on F-18-fluorodeoxyglu- case positron emission tomography-computed tomography (FDG PET-CT), an indicator of tumor ischemia, on survival results of nasopharyngeal cancers (NPCs) treated with concurrent chemoradiotherapy (C-CRT). Methods: the pre-C-CRT FDG PET-CT scans of 104 patients with NPC (cT1-4 N0-3 M0) were retrospectively examined to determine the presence of PP (PP+). Our primary endpoint was the influence of PP+ on overall survival (OS), while the progression-free survival (PFS) and locoregional PFS (LRPFS) constituted the secondary endpoints. Results: the PP+ was detected in 29 (27.9%): nine (8.7%), seven (6.7%), and 13 (12.5%) in the primary tumor alone, primary tumor plus neck nodes, and neck nodes alone, respectively. Because the PP+ cases were small by count per location, all comparative analyses were performed according to overall PP+/PP- status instead of per detected site. At a median follow-up of 67.8 months (range, 9 to 130 months), the median survival times were not reached (NR) for the entire population. while 5-year OS, LRPFS, and PFS rates were 73.3%, 68.2%, and 63.4%, respectively. Comparatively the PP patients exhibited significantly poorer median OS (49.8 months vs. NR, P, NA

Stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) have settled down in the center of modern palliative and recently curative intent treatments in the last two decades. Being special, technology-driven, direct knowledge and experience based clinical procedures, both SRS and SBRT require high precision, accuracy and reproducibility to be safely and effectively delivered, which delineates the importance of quality assurance (QA) procedures from head to toe. In this review, we focused on summary of the comprehensive QA program covering clinical, technical and patient-specific treatment aspects, which need to be individualized per department based on several current recommendation guidelines.

Stereotactic radiosurgery (SRS) has been utilized broadly for brain metastases not only for intact ones but as well as of late for the postoperative cavity of metastases after surgery, due to the advantages of SRS to preserve neurocognitive functions, maintain local control and prescribe the treatment in a short time frame. Randomized trials have proven the safety and efficacy of cavity SRS compared to observation. As WBRT offers no survival advantage in comparison to SRS and frequent monitorization with brain MRIs for early salvage upon failure, there has been a revolution in clinical approach for patients with limited intact brain metastases to treat with SRS only and omit WBRT. Likewise, the postoperative cavity SRS for brain metastases has gained a growing reputation. In this review, we summarize the proof for evidence-based optimization in the postoperative setting of the surgically removed brain metastases.

As a notable cause of cancer-related morbidity and mortality, brain metastases (BMs) represent the most prevalent intracranial tumors arising in up to 40% of all adult solid tumors during the course of treatment. Intracranial stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) gained wide appreciation by the radiation oncology communities for the treatment of BM with regards to the grim prognosis of such patients after alternative therapies, including the whole brain radiotherapy (WBRT). Additional concerns on the neurocognitive deterioration and comparably low tumor control rates offered by the conventional WBRT further quickened the implementation of SRS to the daily practice of radiation oncology clinics. However, the striking diversities among the treatment algorithms and the treatment planning systems of the gamma knife-, linear accelerator- (LINAC), tomotherapy-, robotic Cyberknife-, or the proton therapy-based SRS render the administration of SRS/FSRT challenging. Acknowledging these difficulties, the present review intended to offer a thorough outline of the main principals of the SRS/FSRT technique from the initial patient fixation to the final machine and dose delivery quality assurance treads.

Brain metastases (BMs), the most frequent intracranial tumors, are diagnosed in approximately 30% of all adult patients over the span of planned treatment against a broad spectrum of solid cancers. The prognosis of patients presenting with BM is bleak with an expected median OS of only 4-7 months. However, some particular patients’ groups may enjoy longer survival durations with effective systemic and local therapies. At present, the feasible alternatives for active management of BMs typically include the whole-brain radiotherapy (WBRT), surgery, definitive SRS, postoperative SRS, systemic chemotherapy, targeted therapies, and their combination variants. Considering the local treatment, the severe neurotoxic effects of WBRT, and the increased risk for radionecrosis and leptomeningeal dissemination after postoperative SRS and together with the ineligibility of certain patients during the postoperative period prompted the energetic quest of alternative treatment strategies for such patients. In this respect, the novel preoperative SRS (PO-SRS) was proposed to provide at least equivalent local control rates with lesser radionecrosis and leptomeningeal dissemination risk. Respecting the scarcity of related literature, the present review aimed to meticulously detail theplausible rationale and accessible evidence for the novel PO-SRS in the management of patients presenting with BMs.

Brain metastases (BM) of various primaries merely remain the most prevalent type of intracranial tumors, and approximately 25% of all cancer patients are diagnosed with this poor prognostic disease condition somewhere during their treatment course. Contingent upon the general wellbeing status of the potential patient, currently available major treatment options typically include palliative radiotherapy, chemotherapy, and best supportive care. Various published studies have convincingly shown the likelihood to stratify BM patients into particular prognostic gatherings according to the conceivable combinations of multiple patients- and tumor-related characteristics; namely the prognostic scoring systems, which might be useful in the accurate prediction of survival, and thusly, the appropriate choice of the best-fit treatment alternative. In this present article, we meant to review the pros and cons of the as of now accessible and broadly acknowledged prognostic scoring systems for BMs and their clinical values.

Purpose: to evaluate the feasibility of shortening the duration of liver stereotactic radiotherapy (SBRT) without jeopardizing dosimetry or conformity by utilizing weight-optimized dynamic conformal arcs (WO-DCA) as opposed to volumetric modulated arc therapy (VMAT) for tumors away from critical structures. Methods: nineteen patients with liver metastasis were included, previously treated with 50 Gy in 4 fractions with VMAT technique using two partial coplanar arcs of 6 MV beams delivered in high-definition multi-leaf collimator (HD-MLC). Two coplanar partial WODCA were generated on Pinnacle treatment planning system (TPS) for each patient; and MLC aperture around the planning target volume (PTV) was automatically generated at different margins for both arcs and maintained dynamically around the target during arc rotation. Weight of the two arcs using optimization method was adjusted between the arcs to maximize tumor coverage and protect organs at risk (OAR) based on the RTOG-0438 protocol. Results: the WO-DCA plans successfully ""agreed"" with the standard VMAT for OAR (liver, spinal cord, stomach, duodenum, small bowel, and heart) and PTV (D-mean, D-98%, D-2%, CI, and GI), with superior mean quality assurance (QA) pass rate (97.06 vs 93.00 for VMAT; P < 0.001 and t = 8.87). Similarly, the WO-DCA technique additionally reduced the beam-on time (3.26 vs 4.43; P < 0.001) and monitor unit (1860 vs 2705 for VMAT; P < 0.001) values significantly. Conclusion: the WO-DCA plans might minimize small-field dosimetry errors and defeat patient-specific VMAT QA requirements due to the omission of MLC beam modulation through the target volume. The WO-DCA plans may additionally enable faster treatment delivery times and lower OAR without sacrificing target doses in SBRT of liver tumors away from critical structures., NA

Brain metastases (BMs) represent the most common intracranial tumors, and nearly 25% of all cancer patients are diagnosed with this poor prognostic disease condition somewhere during their treatment course. Depending on the potential patient's general well-being status, the main prevailing treatment options typically incorporate palliative radiotherapy, chemotherapy, targeted agents, immunotherapy, best supportive care, and less frequently surgery in select patients. Past investigations demonstrated the probability to stratify BM patients into particular prognostic gatherings according to the credible combinations of multiple patients- and tumor-related features: the prognostic scoring systems. Such frameworks may serve usefully in the accurate prediction of survival outcomes and the appropriate selection of the best-fit treatment elective. In this present review, we intended to survey the advantages and disadvantages of the broadly recognized on-the-spot prognostic scoring systems for BMs and their clinical merits.

Purpose: we evaluated the prognostic quality of the novel pancreas cancer prognostic index (PCPI), a combination of CA 19-9 and systemic inflammation response index (SIRI), on the outcomes of locally advanced pancreas adenocarcinoma (LAPAC) patients who received concurrent chemoradiotherapy (C-CRT). Methods: this retrospective analysis covered 152 unresectable LAPAC patients treated from 2007 to 2019. Receiver operating characteristic (ROC) curve analysis was used to define ideal cutoff thresholds for the pretreatment CA 19-9 and SIRI measurements, indivi-dually. The associations between the PCPI groups and progression -free-(PFS) and overall survival (OS) comprised the respective primary and secondary endpoints. Results: the ROC curve analysis distinguished the respective rounded optimal cutoffs at 91 U/m/ L (< versus >= 90) and 1.8 (< versus >= 1.8) for CA 19-9 and SIRI, arranging the study cohort into two significantly different survival groups for each, with resultant four likely groups: Group-1: CA 19-9= 1.8, Group-3: CA 19-9 >= 90 U/ m/L but SIRI= 90 U/m/L and SIRI >= 1.8. Since the PFS (P=0.79) and OS (P=0.86) estimates of the groups 2 and 3 were statistically indistinct, we merged them as one group and created the novel three-tiered PCPI: PCPI-1: CA 19-9= 1.8 or CA 19-9 >= 90 U/m/L but SIRI= 90 U/m/L and SIRI >= 1.8, respectively. Comparative analyses unveiled that the PCPI-1 and PCPI-3 groups had the respective best and worst PFS (17.0 versus 7.5 versus 4.4 months; P, NA

Aim: We intended to survey the prognostic utility of pretreatment neutrophil-to-lymphocyte ratio (NLR) as a novel prognostic index in recurrent glioblastoma multiforme (R-GBMs) treated with bevacizumab plus irinotecan (BEVIRI). Patients & methods: The present retrospective investigation incorporated the R-GBMs patients who underwent BEVIRI. The pre-BEVIRI NLR was calculated for each patient by utilizing the complete blood count tests obtained on the first day of BEVIRI. Results: The data of a total of 103 patients were analyzed. The ideal cutoff was identified at 3.04 (area under the curve: 60%; sensitivity: 60.3%; specificity 60%) for the pre-BEVIRI NLR. Low-NLR group had significantly longer overall survival times than the high-NLR group (15.8 vs 9.3 months; p = 0.015). Conclusion: NLR might be utilized as a novel biomarker in the prognostic stratification of the R-GBMs treated with BEVIRI.

To investigate the prognostic significance of pre-treatment Glasgow prognostic score (GPS) in stage IIIB non-small-cell lung cancer (NSCLC) older patients treated with radical concurrent chemoradiotherapy (C-CRT).We included 83 stage IIIB NSCLC older patients (age 70 years) treated with C-CRT consisting of 60-66 Gy (2 Gy/fx) thoracic radiotherapy and at least 1 cycle of platinum-based chemotherapy. Patients were grouped into three: GPS-0: c-reactive protein (CRP) ≤ 10 mg/L and albumin35 g/L, GPS-1: CRP ≤ 10 mg/L and albumin ≤35 g/L or CRP 10 mg/L and albumin35 g/L, GPS-2: CRP 10 mg/L and albumin ≤35 g/L according to the definition. The relationship between GPS groups and overall survival (OS) was the primary objective, while locoregional- (LRPFS) and progression-free survival (PFS) were secondary objectives.For the whole cohort, the median OS, LRPFS, and OS were 19.7 (95% confidence interval [CI]: 16.8-22.6), 13.2 (95% CI: 8.7-17.7), and 8.3 months (95% CI: 6.6-10.0), respectively. Comparisons between the GPS-0, GPS-1, and GPS -2 groups revealed that the lower GPS was associated with significantly superior median OS (25.8 versus 16.3 versus 9.4 months; p .001) which retained its independent significance in multivariate analysis (p .001), as well. Similarly, the respective median LRPFS (20.0 versus 10.4 versus 6.3 months; p .001), and PFS (11.3 versus 7.3 versus 4.1 months; p .001) durations were also significantly longer in the earlier GPS groups.The present results suggested that the GPS was useful in three layered stratification of older stage IIIB NSCLC patients undergoing C-CRT in terms of OS, LRPS, and PFS times.

Background: to retrospectively assess the impact of prognostic nutritional index (PNI) on survival outcomes of patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) treated with concurrent chemoradiotherapy (CCRT). Methods: this study incorporated 154 patients with LA-NPC who received exclusive cisplatinum-based CCRT. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of pretreatment PNI cutoffs influencing survival results. The primary end point was the interaction between the overall survival (OS) and PNI values, while cancer-specific survival (CSS) locoregional progression-free survival (LR-PFS), distant metastasis–free survival (DMFS), and PFS were the secondary end points. Results: a rounded PNI cutoff value of 51 was identified in ROC curve analyses to exhibit significant link with CSS, OS, DMFS, and PFS outcomes, but not LR-PFS. Patients grouping per PNI value (≥51 [N = 95] vs 5% over past 6 months (49.2% versus 11.6%; P =.002) compared to PNI < 51 group. Conclusion: low pre-CCRT PNI levels were independently associated with significantly reduced CSS, OS, DMFS, and PFS outcomes in patients with LA-NPC treated with definitive CCRT., NA

Representing the most common intracranial tumors brain metastases (BMs) are diagnosed in nearly 30% to 54% of all patients during or after their treatment courses against solid cancers. Although the prognosis of BM patients is extremely poor with an estimated median OS of usually less than 7 months. Nevertheless, nowadays some patients’ groups may experience significantly longer survival durations after the implementation of effective systemic and local therapies, such as surgery and radiotherapy (RT). Currently, the noteworthy alternatives for the management of BMs include the neurosurgery, whole-brain RT (WBRT), definitive SRS, postoperative SRS, systemic chemotherapy, targeted therapies, immunotherapy and their various blends. Regarding the local treatment maneuvers, the well-recognized severe neurotoxicity of WBRT and the augmented risk for radionecrosis and leptomeningeal dissemination after postoperative SRS and the ineligibility of certain patients during the postoperative period mandated the search for safer and potentially more effective treatment alternatives for such patients’ group. In this regard, the novel preoperative SRS (PO-SRS) was proposed to provide at least comparable local control rates with lesser radionecrosis and leptomeningeal dissemination risk. The present chapter details the conceivable rationale and available proof for the novel PO-SRS in the management armamentarium of the cancer patients presenting with BMs.

Stereotactic radiosurgery (SRS) has been utilized broadly for brain metastases not only for intact ones but as well as of late for the postoperative cavity of metastases after surgery, due to the advantages of SRS to preserve neurocognitive functions, maintain local control and prescribe the treatment in a short time frame. Randomized trials have proven the safety and efficacy of cavity SRS compared to observation. As WBRT offers no survival advantage in comparison to SRS and frequent monitorization with brain MRIs for early salvage upon failure, there has been a revolution in clinical approach for patients with limited intact brain metastases to treat with SRS only and omit WBRT. The recent implementation of the PO-SRS applications to the treatment algorithm of resected BMs has reputably enhanced the local control at the surgical resection bed in comparison to observation or WBRT Likewise, the postoperative cavity SRS for brain metastases has gained a growing reputation. In this review, we summarize the proof for evidence-based optimization in the postoperative setting of the surgically removed brain metastases.

Objective:we surveyed the anxiety, depression, and secondary trauma levels of Turkish Radiation Oncologists related with COVID pandemics. Methods: an anonymous online questionnaire survey was created to evaluate levels of depression, anxiety, and secondary trauma among Turkish Radiation Oncologists. The survey included demographics and occupational status, Secondary Traumatic Stress Scale (STSSS), The Beck Depression Inventory (BDI), The Beck Anxiety Inventory (BAI), and State-Trait Anxiety Inventory (STAI). Results: seventy-two respondents provided the power of about 91.4% for the significance level of 0.05. The variance homogeneity was checked by the Levene test, the effect of COVID-19 on psychology is higher in the group of >19 (9.02 +/- 0.820), as well as the effect of social isolation (8.02 +/- 1.622), the STSS scores (34.28 +/- 9.062), the STAIS scores (60.46 +/- 5.296), the STAIT scores (82.21 +/- 9.298), the BDI scores (22.68 +/- 2.788), and the BAI scores (21.04 +/- 9.321). The multiple regressions to estimate BDI revealed statistically significant effects in STAIS, BAI, and STAIT. There is a significant correlation between STSS, STAIS, STAIT, BDI, BAI, the effect of COVID-19 on psychology, and the effect of social isolation. Conclusion: we have established one of the first studies demonstrating the effects of COVID-19 pandemic on depression, anxiety levels, and secondary trauma on a special physician population, the Radiation Oncologists, who specifically do not directly take part in COVID19 management., NA

Purpose: we explored the prognostic influence of the systemic inflammation response index (SIRI) on the survival outcomes of stage IIIB/C non-small-cell lung cancer (NSCLC) patients who underwent concurrent chemoradiotherapy. Methods: present propensity score-matching (PSM) analysis comprised 876 stage IIIB/C NSCLC patients who received 1-3 cycles of platinum-based doublets concurrent with thoracic radiotherapy from 2007 to 2017. The primary and secondary objectives were the relationships between the SIRI values and overall (OS) and progression-free survival, respectively. Propensity scores were calculated for SIRI groups to adjust for confounders and to facilitate well-balanced comparability between the SIRI groups by creating 1 : 1 matched study groups. Results: the receiver operating characteristic curve analysis identified an optimal SIRI cutoff at 1.9 for OS (AUC: 78.8%; sensitivity: 73.7%; specificity: 70.7%) and PFS (AUC: 80.5%; sensitivity: 75.8%; specificity: 72.9%) and we grouped the patients into two PSM cohorts: SIRI < 1.9 (N = 304) and SIRI >= 1.9 (N = 304), respectively. The SIRI >= 1.9 cohort had significantly worse median OS (P= 1.9) cohorts had the best and worst outcomes, respectively, with SIRI-2 cohort (IIIB and SIRI >= 1.9 or IIIC and SIRI < 1.9) being remained in between (P= 1.9 independently prognosticated significantly worse OS and PFS results and plated the stage IIIB/C patients into three fundamentally distinct prognostic groups., NA

Background. We investigated the prognostic usefulness of prechemoradiotherapy (CRT) albumin-to-alkaline phosphatase ratio (AAPR) in unresectable locally advanced pancreatic adenocarcinoma (LAPAC) patients managed with definitive concurrent CRT (CCRT). Methods. A sum of 136 LAPAC patients who consecutively underwent definitive CCRT was retrospectively analyzed. The AAPR (serum albumin (g/dL)/serum alkaline phosphatase (IU/L)) was calculated by using the parameters obtained from the routine biochemistry tests on the first day of the CCRT. Ideal AAPR cutoff was sought by utilizing receiver operating characteristic (ROC) curve analysis. The primary and secondary endpoints were the impact of the AAPR on the overall survival (OS) and progression-free survival (PFS) results, respectively. Results. At a median follow-up of 14.8 months (range: 3.2-85.7), the median PFS and OS times were 7.5 (95% confidence interval (CI): 6.0-9.0) and 14.9 months (95% CI: 11.9-17.9), respectively. The ideal common AAPR cutoff was identified at the rounded 0.46 (area under the curve: 72.3%; sensitivity: 71.2%; specificity: 70.3%) point that dichotomized the patients into two groups: low AAPR (L-AAPR; N = 71 ) and high AAPR (H-AAPR; N = 65 ) groups, respectively. Comparative survival analyses showed that the L-AAPR cohort had significantly shorter median PFS (6.8 (95% CI: 5.7-7.9) versus 11.3 (95% CI: 9.9-12.7) months; P = 0.005 ) and OS (12.8 (95% CI: 10.6-15.0) versus 19.2 (95% CI: 16.9-21.5) months; P = 0.001 ) durations than their H-AAPR counterparts, separately. Albeit the N1-2 ( P = 0.004 ) and CA 19 ‐ 9 > 90 U / mL ( P = 0.008 ) were also found to be associated with inferior outcomes, yet the results of the multivariate analyses ascertained the L-AAPR as an independent indicator of diminished PFS ( P = 0.003 ) and OS ( P = 0.002 ) results. Conclusion. The present results proposed that the pretreatment AAPR < 0.46 was a novel independent indicator of adverse PFS and OS in unresectable LAPAC patients undergoing definitive CCRT.

Background: this preliminary simulation study aimed to compare the dosimetric outcomes of carotid arteries (CAs) and pharyngeal constrictor muscle (PCM) in patients with T1N0M0 glottic carcinoma undergoing helical tomotherapy-intensity modulated radiotherapy (HT-IMRT) and 3-dimensional conformal radiotherapy (3D-CRT) plans. Methods: in addition to the clinical target volume (CTV) which was defined as the entire larynx, the CAs and PCM of 11 glottic carcinoma patients were delineated. The CTV was uniformly expanded 5 mm to create a planning target volume (PTV) relative to the PCM and at a distance of 2 mm from the CA. The dosimetric characteristics in HT-IMRT and lateral opposed fields-based 3D-CRT plans were analyzed. Results: median D(95%)and V(100%)of PTV were significantly higher in HT-IMRT (p < 0.001) compared to 3D-CRT. The right/left CA dosimetric outcomes, including the mean doses (20.7/21.5 Gy versus 48.7/50.5 Gy), D-max(53.6/52.0 Gy versus 67.4/67.7 Gy), V-30(25.0/27.1% versus 77.6/80.3%), V-40(8.0/7.9% versus 74.6/71.9%), and V-50(2.0/1.2% versus 70.0/71.6%) were also significantly lower in HT-IMRT (p < 0.05), similar to the mean PCM doses (49.6 Gy versus 62.6 Gy for 3D-CRT;p < 0.001), respectively. Conclusions: our present results demonstrated the feasibility of simultaneous sparing of the CAs and PCM in HT-IMRT- compared to 3D-CRT plans in glottic carcinoma patients undergoing definitive radiotherapy., NA

Background: recent studies have indicated that the systemic inflammation response index (SIRI) can efficiently predict survival outcomes in various tumor types. Thusly, in absence of comparable investigations in limited-stage small-cell lung cancers (LS-SCLCs), we aimed to retrospectively evaluate the prognostic utility of SIRI in LS-SCLC patients treated with concurrent chemoradiotherapy (CRT). Patients and methods: present multi-institutional retrospective analysis incorporated LS-SCLC patients treated with CRT at three academic radiation oncology centers between January 2007 and December 2018. The SIRI was calculated by using the peripheral blood neutrophil (N), monocyte (M), and lymphocyte (L) counts acquired in the last = 1.93 (N = 110), respectively. At a median follow-up of 17.9 (95% CI: 13.2-22.6) months, 47 (26.0%) patients were still alive (47.9% for SIRI p= 1.93 cohort. Similarly, the 3- (54% versus 12.6%) and 5-year (33% versus 9.9%) OS rates were also numerically superior in the SIRI Conclusions: the results of this retrospective multi-institutional cohort analysis suggested that a pre-CRT SIRI was a strong and independent prognostic biomarker that reliably stratified LS-SCLC patients into two cohorts with significantly different OS outcomes., NA

Objectives. To evaluate the potential prognostic utility of pretreatment systemic immune-inflammation index (SII) in newly diagnosed glioblastoma multiforme (GBM) patients who underwent postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide. Methods. The retrospective data of GBM patients who underwent postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide were analyzed. For each patient, SII was calculated using the platelet, neutrophil, and lymphocyte measures obtained on the first day of treatment: SII=platelets×neutrophils/lymphocytes. The receiver operating characteristic (ROC) curve analysis was utilized for the evaluation of optimal cut-off values for SII those linked with the outcomes. Primary and secondary endpoints constituted the overall (OS) and progression-free survival (PFS) per conveyance SII group. Results. A total of 167 patients were included. The ROC curve analysis identified the optimum SII cut-off at a rounded 565 value that significantly interacted with the PFS and OS and stratified patients into two groups: low-SII (SII<565; n=71) and high-SII (SII≥565; n=96), respectively. Comparative survival analyses exhibited that the high-SII cohort had significantly shorter median PFS (6.0 versus 16.6 months; P<0.001) and OS (11.1 versus 22.9 months; P<0.001) than the low-SII cohort. The relationship between the high-SII and poorer PFS (P<0.001) and OS (P<0.001) further retained its independent significance in multivariate analysis, as well. Conclusions. The outcomes displayed here qualified the pretreatment SII as a novel independent prognostic index for predicting survival outcomes of newly diagnosed GBM patients undergoing postneurosurgical radiotherapy and concurrent plus adjuvant temozolomide.

Objective. We investigated the prognostic impact of C-reactive protein to albumin ratio (CRP/Alb) on the survival outcomes of newly diagnosed glioblastoma multiforme (GBM) patients treated with radiotherapy (RT) and concurrent plus adjuvant temozolomide (TMZ). Methods. The pretreatment CRP and Alb records of GBM patients who underwent RT and concurrent plus adjuvant TMZ were retrospectively analyzed. The CRP/Alb was calculated by dividing serum CRP level by serum Alb level obtained prior to RT. The availability of significant cutoff value for CRP/Alb that interacts with survival was assessed with the receiver-operating characteristic (ROC) curve analysis. The primary endpoint was the association between the CRP/Alb and the overall survival (OS). Results. A total of 153 patients were analyzed. At a median follow-up of 14.7 months, median and 5-year OS rates were 16.2 months (95% CI: 12.5–19.7) and 9.5%, respectively, for the entire cohort. The ROC curve analysis identified a significant cutoff value at 0.75 point (area under the curve: 74.9%; sensitivity: 70.9%; specificity: 67.7%; P<0.001) for CRP/Alb that interacts with OS and grouped the patients into two: CRP/Alb n = 61) and ≥0.75 (n = 92), respectively. Survival comparisons revealed that the CRP/Alb P<0.001) and 5-year (20% versus 0%) rates than the CRP/Alb ≥0.75, which retained its independent significance in multivariate analysis (P<0.001). Conclusion. Present results suggested the pretreatment CRP/Alb as a significant and independent inflammation-based index which can be utilized for further prognostic lamination of GBM patients.

Background: we investigated the prognostic significance of pretreatment systemic inflammation response index (SIRI) in locally advanced pancreatic carcinoma (LAPC) patients treated with concurrent chemoradiotherapy (CRT). Methods: present retrospective cohort analysis investigated consecutive 154 LAPC patients who received radical CRT. The SIRI was defined as:SIRI=neutrophilxmonocyte/lymphocyte counts. Ideal SIRI cutoff(s) influencing overall survival (OS) and progression-free survival (PFS) results were sought by using receiver operating characteristic (ROC) curve analysis. The primary endpoint was the interaction between the SIRI and OS results. Results: the median follow-up, PFS, and OS durations were 14.3 (range: 2.9-74.6), 7.9 [%95 confidence interval (CI): 5.7-10.1), and 14.7 months (%95 CI: 11.4-18.0) for the entire cohort, respectively. ROC curve analyses determined the ideal SIRI cutoff that exhibiting a significant link with OS and PFS outcomes at the rounded 1.6 point (AUC: 74.3%; sensitivity: 73.8%; specificity: 70.1%).The SIRI = 1.6 patients (N=96), respectively. Although the N0 (versus N1; P90 U/mL) appeared as the other significant associates of better OS and PFS in univariate analyses, yet the results of multivariate analyses confirmed the SIRI, NA

Purpose: we aimed to retrospectively investigate the prognostic worth of pretreatment advanced lung cancer inflammation index (ALI) in locally advanced nasopharyngeal carcinoma (LA-NPC) patients treated with concurrent chemoradiotherapy (C-CRT). Patients and methods: A total of 164 LA-NPC patients treated with cisplatinum-based definitive C-CRT were included in this retrospective cohort analysis. The convenience of ideal pre-C-CRT ALI cut-offs affecting survival results was searched by employing the receiver operating characteristic (ROC) curve analyses. The primary endpoint was the link between the ALI groups and overall survival (OS), while cancer-specific survival (CSS), locoregional progression-free survival [LR(PFS)], distant metastasis-free survival (DMFS), and PFS comprised the secondary endpoints. Results: the ROC curve analyses distinguished a rounded ALI cut-off score of 24.2 that arranged the patients into two cohorts [ALI ≥ 24.2 (N = 94) versus, NA

Background: we retrospectively compared the incidence of isolated elective nodal failure (IENF) and toxicity rates and survival outcomes after elective nodal irradiation (ENI) versus involved-field RT (IFRT) by employing the propensity score matching (PSM) methodology in stage IIIB/C inoperable non-small-cell lung cancer (NSCLC) patients treated with definitive concurrent chemoradiotherapy (C-CRT). Methods: our PSM examination included 1048 stage IIIB/C NSCLC patients treated with C-CRT from January 2007 to December 2016: a total dose of 66 Gy (2 Gy/fraction) radiotherapy and 1-3 cycles of platinum-based doublet chemotherapy concurrently. The primary and secondary endpoints were the IENF and toxicity rates and survival outcomes after ENI versus IFRT, respectively. Propensity scores were calculated for each group to adjust for confounding variables and facilitate well-balanced comparability by creating 1: 1 matched study groups. Results: the median follow-up was 26.4 months for the whole study accomplice. The PSM analysis unveiled 1: 1 matched 646 patients for the ENI (N = 323) and IFRT (N = 323) cohorts. Intergroup comparisons discovered that the 5-year isolated ENF incidence rates (3.4% versus 4.3%; P=0.52) and median overall survival (25.2 versus 24.6 months; P=0.69), locoregional progression-free survival (15.3 versus 15.1 months; P=0.52), and progression-free survival (11.7 versus 11.2 months; P=0.57) durations were similar between the ENI and IFRT cohorts, separately. However, acute grade 3-4 leukopenia (P=0.0012), grade 3 nausea-vomiting (P=0.006), esophagitis (P=0.003), pneumonitis (P=0.002), late grade 3-4 esophageal toxicity (P=0.038), and the need for hospitalization (P, NA

We aimed to assess the efficacy of external beam radiotherapy (EBRT) in central airway obstruction (CAO) and associated factors for metastatic lung cancer (MLC) patients. Records of 72 MLC patients presenting with CAO were retrospectively analyzed. The serial chests X-rays prior and after the EBRT were compared for response assessment. The primary end-point was radiologic response, while overall-(OS) and CAO-free survival, and predictors of better outcomes constituted secondary endpoints. The EBRT doses ranged between 8 to 40 Gy (1-13 fractions). Median follow-up and OS were 5.6 (range: 1.3-17.8) and 7.6 months (95% CI: 6.5-8.7), respectively. Objective CAO resolution was achieved in 58 patients (80.6%) on serial chest X-rays with a median time to maximum CAO response of 23 days (range: 3-86). In responders the response was durable (8.1 months) almost nearly for all their remaining life spans (8.3 months) with only 19.0% CAO recurrences. Median OS was also significantly longer in responders (8.3 vs. 2.4 months; p= 39 Gy (p= 39 Gy (p=0.008) were the factors to relate with better OS on multivariate analyses. The EBRT proves effective and durable CAO palliation with only 19.0% re-CAO rate in MLC patients. Better CAO responses may be achieved in patients treated with smaller tumor size, small-cell histology, and higher BED10 values.

e21167 Background: The role of thoracic radiotherapy in the treatment of metastatic EGFR mutant non-small cell lung cancer patients in literature datas are insufficient.The aim of this study was to examine the effectiveness of upfront thoracic radiotherapy in metastatic EGFR mutant NSCLC patients treated with chemotherapy or TKI. Methods: This study was designed as a hospital-based retrospective observational case-series study. A total of 141 patients with metastatic EGFR mutant non-small cell lung cancer who has followed in two different oncology centers at Turkey between 2014 and 2020. have been included to this study. Results: The median age of the patients was 63 (range 35-91) years. EGFR mutation results of exon 19 deletion, exon 21 mutation and exon 18 mutation were found in 82 (58.2%), 56 (39.7%) and 3 (2.1%) patients, respectively. The median follow-up time was 22 months and 94 (33.3%) patients died during follow-up. Median overall survival (OS) was 26 months and progression free survival (for first line treatment) (PFS) was 10 months for whole patients, respectively. Radiotherapy was given to the primary tumor site in 32 (22,6%) patients. Patients receiving radiotherapy to primary tumor site had better overall survival than those not (31 versus 23 months respectively and p = 0,02) The survival advantage was also seen for patients group taking TKI at upfront setting (33 versus 23 months respectively and p = 0.05). Conclusions: In this study, we have showed that upfront thoracic radiotherapy to primary lession as combination with EGFR-TKI treatment may improve the outcome in advanced stage IV NSCLC patients harboring EGFR mutations.

Intensity Modulated Radiotherapy (IMRT, step and shoot) is emerging as the standard of care in non-small cell lung cancer (NSCLC) patient treatments. Volumetric Arc Therapy (VMAT) delivered with two arcs offers fast and homogeneous dose delivery with known limitations of increased volumes of low dose. The aim of this study is to define whether Hybrid volumetric arc IMRT (HA-IMRT: IMRT and VMAT combination) offers a superior dose distribution over IMRT without the limitations found in VMAT delivery alone. Ten (previously 4DCT planned) locally advanced NSCLC patients treated by IMRT to 70 Gy in 35 fractions were retrospectively re-planned using the HA-IMRT technique. Respiratory correlated imaging (3 mm slice thickness) were generated utilizing the Philips Large Bore 16 slice CT Scanner (Phillips, Inc.). Treatment planning was performed using The Philips Pinnacle Treatment Planning System v. 9.0 (Philips Medical, Cleveland, OH). The PTV was defined as the Integrated Tumor Volume (ITV=internal GTV contoured on all respiratory data sets plus 8 mm margin for all histologies) with a 4 mm margin added. Lung parenchyme was defined and contoured using the 50% phase. Conventional IMRT plans used 6:8 non coplanar or coplanar fields and VMAT plans were generated using two 180 degrees arcs. HA-IMRT plans were generated using a combination of 60% conventional IMRT with 40% VMAT. The maximum dose (Gy) to the spinal cord, V5, V10, V20 for total lung, V20 and V30 for the ipsilateral lung, V30 for heart, V50 and V70 for esophagus, and the V77 for the Clinical Treat Volume (CTV) were compared for all techniques utilizing the Dose Volume Histograms. In addition, total monitor units (MU), total treatment time (I I) and the conformality index (CI) were compared.. Conventional IMRT delivers less low dose to the lung compared to VMAT alone. (V5 VMAT (V5: 55.0% vs 63.0%, p=0.005; V10: 41.4% vs 43.9%, p=0.018). However, VMAT is superior in total lung V20 (V20:30.6% vs 29.3% p=0.010), ipsilateral lung doses (V20:55.5% vs 52.8% p=0.008; V30: 46.1% vs 42.9% p= 0.012), and in heart sparing. (V30: 21.09% vs 17.78% p=0.015; MHD: 15.92% vs 14.81% p=0.021). It is also superior in conformality (CI 1.51 vs 1.26 p=0.005) and treatment delivery is faster ( 293 min vs 108 min p=0.005) with lower MUs (24805 vs 19141 p=0.005). HA-IMRT was found to be superior to VMAT in terms of total lung low dose volumes (V5:58.1% vs 63.0%, p=0.005; V10:42.2% vs 44.9%, p=0.027), superior to IMRT for ipsilateral lung doses (V20: 53.6% vs 55.5%, p=0.007; V30: 43.4% vs 46.1%, p=0.018), and superior in treatment time (199 min vs 293 min, p=0.005) with lower MU's (22155 vs 24805, p=.005). Overall, HA-IMRT provides a more homogenous dose distribution (CTV: V77: 0.55% vs 2.1% vs 1.7%, p=0.000) compared to IMRT and VMAT alone. All three plans provided comparable esophagus and spinal cord Organ at Risk (OAR) doses. HA-IMRT seems to combine the benefits of both conventional IMRT and VMAT; such as to deliver a faster, more conformal, homogeneous treatment in comparison to ssIMRT, and to deliver lower dose to lung in comparison to VMAT. Screen reader support enabled., NA

Radiation-induced sensorineural hearing loss (RI-SNHL) is a progressive and irreversible complication of radiotherapy (RT) or chemoradiotherapy (CRT) of brain or head and neck tumors. Onset and progression times of RI-SNHL may broadly vary depending on the RT technique, dose, and concurrent or adjuvant usage of ototoxic medications, such as cisplatin. Characteristically the high frequencies (≥4 kHz) form the first affected range on a typical audiogram, which may be trailed by impairements in the lower hearing frequencies. RI-SNHL may adversely impact both the academic and social advancement in pediatric age and may deteriorate quality of life measures in all affected patients regardless of their age. Even if not eliminate all, in absence of a unequivocally proven medical treatment to avoid or alleviate the RI-SNHL, utilization of more advanced RT techniques, such as the intensity-modulated RT, and limiting the cochlea doses to ≤40-45 Gy for RT alone

Background/Aims: previously advanced lung cancer inflammation index (ALI) has been demonstrated to have prognostic utility in the stratification of patients into distinctive survival groups, but the prognostic value of ALI has never been explored in the setting of locally advanced pancreatic carcinomas (LAPC) treated with concurrent chemoradiotherapy (CCRT). Hence, we aimed to investigate the prognostic value of pre-treatment ALI in LAPC patients who underwent radical CCRT. Methods: present retrospective cohort analysis incorporated 141 LAPC patients who received radical CCRT. Accessibility of baseline ALI cutoff(s) impacting survival outcomes was sought by receiver operating characteristic (ROC) curve analysis. Interaction between the ALI and overall- (OS) and progression-free survival (PFS) comprised our primary and secondary endpoints, respectively. Results: at a median follow-up of 14.4 months (range: 3.2-74.2), the median PFS and OS were 7.5 (%95 CI: 5.9-9.1) and 14.6 months (%95 CI: 11.6-17.6), respectively. ROC curve analyses set the ideal ALI cutoff value at 25.3 (AUC: 75.6%; sensitivity: 72.7%; specificity: 70.3%) that exhibited significant associations with both the OS and PFS results. Patient stratification into two groups per ALI [25.3 (N=66)] showed that the ALI>25.3 group had significantly superior median OS (25.8 versus 11.4 months; P90 U/mL; P, NA

BACKGROUND: To compare the efficacies of standard dose-(SDRT) and escalated dose radiotherapy (EDRT) in newly diagnosed glioblastoma (GBM) with concurrent and adjuvant temozolomide (TMZ). MATERIALS AND METHODS: Outcomes of 126 newly diagnosed GBM patients who received SDRT (60 Gy, 30 fractions) or EDRT (70 Gy, 30 fractions) with concurrent plus adjuvant TMZ were retrospectively analyzed. Both groups received concurrent TMZ (75 mg/m2) during the course of RT and at least one course of adjuvant TMZ (150–200 mg/m2), thereafter. Overall survival (OS) and local progression free survival (LPFS) constituted the primary and secondary endpoints, respectively. RESULTS: At median 14.2 months follow-up, 26 (20.6%) patients were alive. Median LPFS and OS were 9.2 [95% confidence interval (CI); 8.4–10.0] and 15.4 months (95% CI; 12.1–18.8), respectively, for the entire cohort. Although the median OS was numerically superior in the EDRT this difference could not reach statistical significance (22.0 vs. 14.9 months; P = 0.45), Likewise, LPFS was also (9.9 vs. 8.9 months; P = 0.89) not different between the two treatment groups. In multivariate analysis, better recursive partitioning analysis class (3–4 vs. 5; P = 0.044) and extensive surgery (gross total resection vs. subtotal resection/biopsy only; P= 0.021) were identified to associate significantly with superior OS times, irrespective of the RT protocol. CONCLUSIONS: Although the current median OS of 22 months of the EDRT group is promising, no statistically significant survival advantage for EDRT was observed even in the presence of TMZ. Randomized studies with larger population sizes and available genetic markers are warranted to conclude more reliably on the fate of EDRT plus TMZ.

Background: to investigate the detrimental effects of prolonged overall radiotherapy duration (ORTD) on survival outcomes of stage IIIB/C NSCLC patients treated with concurrent chemoradiotherapy (C-CRT) Methods: the study cohort consisted of 956 patients who underwent C-CRT for stage IIIB/C NSCLC. Primary endpoint was the association between the ORTD and overall survival (OS) with locoregional progression-free survival (LRPFS) and PFS comprising the secondary endpoints. Receiver operating characteristic (ROC) curve analysis was utilized for accessibility of the cut-off that interacts with survival outcomes. Multivariate Cox model was utilized to identify the independent associates of survival outcomes. Results: the ROC curve analysis exhibited significance at 49 days of ORTD cut-off that dichotomized patients into ORTD, NA

Background: to retrospectively investigate the influence of pretreatment anemia and hemoglobin levels on the survival of nasopharyngeal carcinoma patients treated with concurrent chemoradiotherapy (C-CRT). Methods: a total of 149 nasopharyngeal carcinoma patients who received C-CRT were included. All patients had received 70 Gy to the primary tumor plus the involved lymph nodes, and 59.4 Gy and 54 Gy to the intermediate- and low-risk neck regions concurrent with 1-3 cycles of cisplatin. Patients were dichotomized into non-anemic and anemic (hemoglobin, NA

Purpose To assess the survival outcomes and prognostic factors of young (≤45 years) Stage IIIB nonsmall cell lung cancer (NSCLC) patients treated with definitive concurrent chemoradiotherapy (C-CRT). Materials and Methods Medical records of 145 Stage IIIB NSCLC patients (≤45 years) who received 60-66 Gy thoracic radiotherapy and concurrent 1-3 cycles of cisplatin-based doublet chemotherapy were retrospectively evaluated. The primary endpoint was overall survival (OS), while locoregional progression-free survival (LRPFS), progression-free survival (PFS), and evaluation of potential prognostic factors constituted the secondary endpoints. Results At median 21.6 months (range: 7.3-62.5) of follow-up, the median and 4-year survival estimates were 24.8 months and 24.2% for OS, 15.7 months and 18.9%, for LRPFS and 12.0 months and 11.2% for PFS, respectively. On univariate analyses, among all factors, the smaller tumor size (≤7.0 cm; P = 0.03), lower T-stage (T1-T2; P = 0.02), lower N-stage (N2; P = 0.01), absence of anemia before C-CRT (hemoglobin [Hb] ≥12 g/dL; P < 0.001), and lower/no pretreatment weight loss (WL ≤5%; P < 0.001) were found to be associated significantly with longer median OS durations, which also retained their independent significance on multivariate analyses, except for tumor size category. Conclusions The encouraging median 24.8 months OS duration observed here in young NSCLC patients accords well with the results of recent landmark locally advanced NSCLC series without age stratification. Other than the well-established T and N stages, extra exhibit of superior OS in patients with initial Hb ≥12 g/dL and ≤5% WL levels suggests a noteworthy prognostic role for these two latter variables in the stratification of such patients.

Background We retrospectively investigated the prognostic value of pre-treatment advanced lung cancer inflammation index (ALI) in locally advanced pancreatic carcinoma (LAPC) patients who underwent concurrent chemoradiotherapy (CCRT). Methods Present retrospective cohort analysis incorporated consecutive 141 LAPC patients who received radical CCRT. Accessibility of baseline ALI cutoff(s) impacting survival outcomes was sought by receiver operating characteristic (ROC) curve analysis. Interaction between the ALI and overall- (OS) and while progression-free survival (PFS) constituted our primary and secondary end points, respectively. Results At a median follow-up of 14.4 months (range: 3.2-74.2), the median PFS and OS were 7.5 (%95 CI: 5.9-9.1) and 14.6 months (%95 CI: 11.6-17.6), respectively. ROC curve analyses set the ideal ALI cutoff value at 25.3 (AUC: 75.6; sensitivity: 72.7%; specificity: 70.3%) that exhibited a significant association with both the OS and PFS results. Patient stratification into two groups per ALI [≤25.3 (N = 75) versus >25.3 (N = 66)] showed that the ALI>25.3 group had a significantly superior median OS (25.8 versus 11.4 months; P 90 U/mL), respectively (P Conclusions Results of this hypothesis-generating research proposed the pre-CCRT ALI as a novel robust associate of OS and PFS outcomes for LAPC patients undergoing CCRT. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

To investigate the incidence and influence of tumor cavitation (TC) on survival outcomes of locally advanced squamous cell lung cancer (LA-SqCLC) patients treated with concurrent chemoradiation therapy (C-CRT).Records of 789 stages IIIA/B squamous cell lung cancer (SqCLC) patients treated with C-CRT who received 1 to 3 cycles of platinum-based doublet chemotherapy during 60 to 66 Gy radiation therapy (RT) were analyzed retrospectively. Primary endpoint was the association between overall survival (OS) and pretreatment TC status. Secondary endpoints included locoregional progression-free survival (LRPFS), progression-free survival (PFS), and incidence of TC and correlated factors.Pretreatment TC occurred in 95 patients (12%), being significantly more common in those patients with ever-smoking history (12.6% vs 3.9%; P .001), weight loss5% (20.9% vs 7.1%; P .001), and hemoptysis (27.1% vs 6.4%; P .001). Rates of acute and late toxicities were similar in patients who presented with and without TC (P .05 for each). For the whole cohort, at a median follow-up of 22.9 months (range: 2.4-71.1), the respective median OS, LRPFS, and PFS estimates were 23.7, 14.7, and 10.7 months. In multivariate analysis, stage IIIB disease (P .001; hazard ratio [HR]: 1.33; 95% CI: 1.21-1.45), weight loss5% (P .001; HR: 2.10; 95% CI: 1.85-2.35), anemia (P .001; HR: 1.82; 95% CI: 1.67-1.97), and presence of TC (P .001; HR: 1.54; 95% CI: 1.37-1.71) appeared to be independently associated with poorer OS durations, likewise the LRPFS (P .001 for each of these covariates), and PFS (P .001 for each of these covariates), respectively.Present results showed that the TC occurred in 12% of LA-SqCLC patients, which was strongly associated with poorer PFS, LRPFS, and OS outcomes after definitive C-CRT.

To evaluate the prognostic value of the Glasgow Prognostic Score (GPS), the combination of C-reactive protein (CRP) and albumin, in glioblastoma multiforme (GBM) patients treated with radiotherapy (RT) and concurrent plus adjuvant temozolomide (GPS).Data of newly diagnosed GBM patients treated with partial brain RT and concurrent and adjuvant TMZ were retrospectively analyzed. The patients were grouped into three according to the GPS criteria: GPS-0: CRP 10 mg/L and albumin 35 g/L; GPS-1: CRP 10 mg/L and albumin 35 g/L or CRP 10 mg/L and albumin 35 g/L; and GPS-2: CRP 10 mg/L and albumin 35 g/L. Primary end-point was the association between the GPS groups and the overall survival (OS) outcomes.A total of 142 patients were analyzed (median age: 58 years, 66.2% male). There were 64 (45.1%), 40 (28.2%), and 38 (26.7%) patients in GPS-0, GPS-1, and GPS-2 groups, respectively. At median 15.7 months follow-up, the respective median and 5-year OS rates for the whole cohort were 16.2 months (95% CI 12.7-19.7) and 9.5%. In multivariate analyses GPS grouping emerged independently associated with the median OS (P 0.001) in addition to the extent of surgery (P = 0.032), Karnofsky performance status (P = 0.009), and the Radiation Therapy Oncology Group recursive partitioning analysis (RTOG RPA) classification (P 0.001). The GPS grouping and the RTOG RPA classification were found to be strongly correlated in prognostic stratification of GBM patients (correlation coefficient: 0.42; P 0.001).The GPS appeared to be useful in prognostic stratification of GBM patients into three groups with significantly different survival durations resembling the RTOG RPA classification.

We investigated the influence of change in hemoglobin (Hgb) levels during concurrent chemoradiotherapy (C-CRT) on outcomes of non-anemic patients with stage IIIA/B non-small cell lung cancer (NSCLC).We identified 722 patients with stage IIIA/B NSCLC without anemia at baseline [hemoglobin (Hgb) 12 g/dL for women or13 g/dL for men], either nonsmokers or ex-smokers, who received C-CRT between 2007 and 2012. All patients had received 1-3 cycles of platinum-based doublet chemotherapy during radiotherapy to 60-66 Gy and had documented Hgb measurements before treatment and at weekly intervals for 6 weeks during the C-CRT. Potential associations were assessed between baseline, nadir, extent of change in Hgb level, and anemia and overall survival (OS), locoregional progression-free survival (LRPFS), and PFS.The median baseline Hgb level was 13.9 g/dL (range 12.0-16.8) and declined to a median 12.4 g/dL (range 7.9-16.1) during treatment. Anemia appeared in 237 patients (32.8%) and was more common among women (44.8% vs. 26.5%, P 0.001). Neither baseline Hgb level nor change during treatment nor anemia emergence influenced any survival endpoint. Receiver operating curve analysis revealed an Hgb nadir of 11.1 g/dL to be associated with outcomes, in that a nadir Hgb11.1 g/dL (in 156 patients) was linked with shorter median OS time (P 0.001), LRPFS time (P 0.001), and PFS time (P 0.001); retained significance for all three endpoints in multivariate analyses; and was more strongly associated with OS in squamous cell carcinoma (P 0.001) than in adenocarcinoma (P = 0.009).Nadir Hgb11.1 g/dL levels during C-CRT were associated with significantly poorer survival times in initially non-anemic patients presenting with locally advanced NSCLC.

In a limited prospective data environment of skull base tumors including olfactory neuroblastoma, chordoma, chondrosarcoma, and jugulotympanic paraganglioma, this chapter tries to summarize the worldwide experience from initial admission to follow-up covering the up-to-date multimodality management options of adjuvant, definitive, or palliative intent radiotherapy along with the best possible applicable modality of IMRT, VMAT, SRS, FSRT, and proton-beam therapy.

We aimed to identify the fatal pulmonary hemorrhage- (FPH-) related risk factors in stage 3B/C squamous-cell lung carcinoma (SqCLC) patients treated with definitive concurrent chemoradiotherapy (C-CRT). Medical records of 505 stage 3B/C SqCLC patients who underwent 66 Gy radiotherapy plus 1-3 cycles of concurrent chemotherapy with available pretreatment thoracic computerized tomography scans were retrospectively analyzed. Primary end-point was the identification of FPH-related risk factors. Examined factors included the basal patient and tumor characteristics with specific emphasis on the tumor cavitation (TC) status, tumor size (TS) and cavitation size (CS), tumor volume and cavitation volume (TV and CV), relative cavitation size (RCS = CS/Ts), and relative cavitation volume (RCV=CV/TV). FPH emerged in 13 (2.6%) patients, with 12 (92.3%) of them being diagnosed 0.14 (37.5% versus 11.1% for RCV 0.14. Diagnosis of >90% FPHs, NA

PURPOSE To evaluate the radioprotective efficacy of amifostine on irradiated mature rat retina. METHODS A total of 108 Wistar albino rats were categorized into 3 groups, namely, apoptosis (n = 48), acute effects (n = 40), and late changes in retinal cell layers (n = 20). Each group was further subcategorized into 4 arms: control, amifostine (A), radiotherapy + placebo (RT), and RT + A arms, respectively. Intraperitoneal amifostine (260 mg/kg) was administrated to A and RT + A arms 30 minutes before irradiation. Control and A groups were sham-irradiated, whereas a single dose of 20 Gy whole-cranium irradiation was delivered to RT and RT + A arms. Apoptosis was assessed in 8, 12, and 18 hours after irradiation. Electron microscope was used 2 weeks after irradiation for evaluation and scoring of early morphologic changes in retina. Late effects were assessed and scored accordingly by using both the electron and the light microscope on Week 10. RESULTS At acute phase, although no notable change was seen in 8 hours, significant increase in apoptosis was detected in 12 hours in RT arm (P = 0.029). Comparative analyses between the groups in 3 different time points displayed a higher apoptotic rate in RT group than the RT + A group (P = 0.008). Similarly, comparisons between groups for late effects on the basis of electron microscopic findings revealed lower scores in the RT + A than the RT arm (P < 0.001). CONCLUSION This study suggested a potential radioprotective role for amifostine on mature rat retina by reducing radiation-induced apoptosis in retinal cells. These results form a basis for such preclinical investigations and call for future clinical studies.

Chemoradiotherapy is the current standard of care in patients with advanced inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC). Three-dimensional radiotherapy (3DCRT) has been a trusted method for a long time and has well-known drawbacks, most of which could be improved by Intensity Modulated Radiotherapy (IMRT). IMRT is not currently the standard treatment of locally advanced NSCLC, but almost all patients could benefit to a degree in organ at risk sparing, dose coverage conformality, or dose escalation. The most critical step for a radiation oncology department is to strictly evaluate its own technical and physical capabilities to determine the ability of IMRT to deliver an optimal treatment plan. This includes calculating the internal tumor motion (ideally 4DCT or equivalent techniques), treatment planning software with an up-to-date heterogeneity correction algorithm, and daily image guidance. It is crucial to optimise and individualise the therapeutic ratio for each patient during the decision of 3DCRT versus IMRT. The current literature rationalises the increasing use of IMRT, including 4D imaging plus PET/CT, and encourages the applicable knowledge-based and individualised dose escalation using advanced daily image-guided radiotherapy.

Purpose: The aim of this retrospective cohort study was to evaluate the prognostic effect extended temozolamide on survival outcomes of glioblastoma multiforme patients who were underwent surgery/biopsy followed treated with definitive chemo-radiotherapy.Materials and Methods: We retrospectively analyzed the datas of 225 patients with gliablastoma multiforme whom admitted to our clinic All patients were completed concomitant chemoradiotherapy with temozolamide and adjuvant temozolamide therapy at least for six months or more. Patients were divided into two groups as standart and extended temozolamid therapy group as using temozolamide therapy for at least 6 months or more. Results: The median follow-up of the whole patients18 (range 2-125) months, 65 patients (56%) were alive. Extended temozolamide (>6) was associated with longer survival, but was not significantly with survival outcomes in the univariate analysis (49.0 vs 68.33 months;p=0.082). However, progression free survival analysis demonstrated that the patient in extended temozolamide group had paramount extended progression free survival (14 vs 9 months) than other group in standart cycle temozolamide. Conclusion: Our study show that extended temozolamide is well tolerated and leads to a significantly increase in progression free survival and overall survival in newly diagnosed patients with glioblastoma multiforme., Amaç: Retrospektif bu çalışmanın amacı cerrahi/biyopsi ile glioblastoma multiforme tanısı almış, kemoradyoterapi uygulanmış hastalarda uzatılmış temozolamid kullanımının genel ve progresyonsuz sağkalım etkisini araştırmak olarak belirlendi.Gereç ve Yöntem: Kliniğimize başvuran cerrahi/biyopsi ile glioblastoma multiforme tanısı almış 225 hastadan, temozolamid ile birlikte radyoterapi tedavisi uygulandıktan sonra, ≤6 ay ve >6 ay süreyle adjuvan temozolamid kemoterapisi uygulanmış 116 hastatedavi toleransı, genel ve progresyonsuz sağkalımları arasındaki farklar retrospektif olarak incelendi.Bulgular: Hastaların ortalama takip süresi 18 ay (2-125 ay) olarak belirlenirken, 65(%56) hasta halen hayattadır. Uzatılmış temozolamid (>6 ay) olan grupta genel sağkalım daha uzun tespit edilirken istatistiksel bir fark tek değişkenli analizde tespit edilememiştir sırasıyla 49.0 (≤6)vs 68.33 ay(>6). Ancak progresyonsuz sağkalım süresi uzatılmış temozolamid grubunda standart temozolamid alan gruba göre istatistiksel olarak anlamlı oranda uzun saptanmıştır 14 (>6)vs 9 ay(≤6). Gruplar arasında anlamlı bir yan etki farklılığı görülmemiştir.Sonuç: Çalışmamızda glioblastoma multiforme tanısı almış hastalarda uzatılmış temozolamid kullanımı hastaların progresyonsuz sağkalım ve genel sağkalımlarının belirgin oranda artmasına neden olur.

This study is aimed to evaluate the effects of setup errors on dose distribution for target volume and healthy tissue within the irradiated volume and also critical surrounding organs for breast radiotherapy (RT) using both the tangential field and the field-in-field (FIF) technique. Ten patients with breast cancer were enrolled. For each patients two plans were generated; tangential field plan and FIF-plan. The setup errors were simulated for a series of displacements of +/- 5 mm and +/- 10 mm in superior-inferior (x-axis), medial-lateral (y-axis), and anterior-posterior (z-axis) directions and dose volume comparisons were made both between and within groups. The most prominent changes were observed in setup errors at z-axis. In wedge plan, 10-mm setup error at the +z axis caused a significant decrease in tumor coverage compared with the plan with no setup error (96.5% vs. 99.2%; p= 0.01). The 5 and 10 mm setup errors at the +z-axis resulted in significantly higher healthy tissue doses in wedge plans compared with FIF plans. The setup errors along z-axis had a significant effect on the dose distribution for target volume and also to the lungs. The setup error in the isocenter should be kept strictly below 5 mm.