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Purpose We report our experience of 86 consecutive patients with locally advanced nasopharyngeal carcinoma who were treated with volumetric modulated arc therapy. Materials and methods We retrospectively reviewed the medical records of 86 patients with histologically proven primary nasopharyngeal carcinoma treated with volumetric modulated arctherapy technique radiotherapy. Primary endpoints were local, regional, distant control, and overall survival, second endpoint was late toxicity. Results The median age was 47.5 years (range: 13–79 years) with sex ratio 1.09. At diagnosis, rhinologic symptoms represented the most common clinical presentation, reported by 61 patients (70.9%). Almost 88.4% of patients presented non-keratinizing undifferentiated carcinoma histology (n = 76). Most of the patients presented a locally advanced disease defined by stage III and IVa (95.3%). Therefore, 31 patients were treated by concurrent chemoradiation (36%), 52 patients received induction chemotherapy followed by concurrent chemoradiotherapy (57%), three patients received induction chemotherapy followed by exclusive radiotherapy (3.5%). and three patients treated with exclusive irradiation (3.5%). With a median follow up of 15.7 months (range: 4–33.3 months), nine patients died (10.4%), three presented local or locoregional relapse (3.4%), while nine patients presented distant recurrences (10.4%). The two years overall and disease-free survival rates were 88.7% and 83.1% respectively, locoregional control was 100% at 12 months and 96.2% at 24 months, and the two years distant failure-free survival was 86.7%. Time to relapse was the only prognostic factor in univariate analysis for overall survival in our study. The therapeutic tolerance was good with 61.7% of grade 3 and 2.3% grade 4 hyposialia respectively, 46.5% of otological disorders and no radionecrosis was noted. Conclusion Volumetric modulated arctherapy technique with concurrent chemoradiotherapy is an effective treatment for nasopharyngeal carcinoma with excellent overall and locoregional control without severe toxicity. Distant metastasis is the major site of failure, so induction chemotherapy added to chemoradiotherapy must be discussed in multidisciplinary consultation meeting because it significantly improved recurrence-free survival and overall survival, as compared with chemoradiotherapy alone.

Context: To date, there is no Level 1 evidence comparing the efficacy of radical prostatectomy and radiotherapy for patients with clinically-localized prostate cancer. Objective: to evaluate overall survival (OS) and relapse free survival of high risk prostate cancer (PCa) treated either with external beam radiotherapy (EBRT) associated with androgen deprivation therapy (ADT) or radical prostatectomy (RP) with adjuvant or salvage radiotherapy and ADT. Also, it is very interesting to compare different acute and late toxicity of the both approach. Materials and Methods: During a period of 10 years from April 2009 and December 2018, 149 patients with high-risk prostate cancer were admitted to the radiotherapy department of the Mohammed V military hospital in Rabat (HMIMV). Among these patients, 17 underwent surgery followed by EBRT and ADT: this is the experimental arm (Group I) and 34 patients who had benefited from treatment with EBRT with ADT were selected from the other patients by a 1: 2 matching method who will represent the reference group (Group II) to allow a comparison with the experimental arm with the minimum possible bias. Results: The overall survival (OS) at 5 and 10 years was 100 % in the both arms while relapse free survival at 5 years was 91,7 % and 93,1% respectively in group I and II and at 10 years 91,7% in the group multimodal approach and 88,9 % in the EBRT+ADT group without any significant difference. We note more toxicities in the surgical group with more urinary incontinence (p=0,001) and more erectile dysfunction. Conclusion: RP with adjuvant EBRT and EBRT+ADT provided similar long-term cancer control for patients with high-risk prostate cancer but with different toxicity profiles.

Purpose The aims of this study were: determination of the CTV to PTV margins for prostate and pelvic lymph nodes. Investigation of the impact of registration modality (pelvic bones or prostate) on the CTV to PTV margins of pelvic lymph nodes. Investigation of the variations of bladder and rectum over the treatment course. Investigation of the impact of bladder and rectum variations on prostate position. Patients and methods This study included 15 patients treated for prostate adenocarcinoma. Daily kilo voltage images and weekly CBCT scans were performed to assess prostate displacements and common and external iliac vessels motion. These data was used to calculate the CTV to PTV margins using Van Herk equation in the setting of a daily bone registration. We also compared the CTV to PTV margins of pelvic lymph nodes according to registration method; based on pelvic bone or prostate. We delineated bladder and rectum on all CBCT scans to assess their variations over treatment course at 4 anatomic levels [1.5 cm above pubic bone (PB), superior edge, mid- and inferior edge of PB]. Results Using Van Herk equation, the prostate CTV to PTV margins (bone registration) were 8.03 mm, 5.42 mm and 8.73 mm in AP, ML and SI direction with more than 97% of prostate displacements were less than 5 mm. The CTV to PTV margins ranged from 3.12 mm to 3.25 mm for external iliac vessels and from 3.12 mm to 4.18 mm for common iliac vessels. Compared to registration based on prostate alignment, bone registration resulted in an important reduction of the CTV to PTV margins up to 54.3% for external iliac vessels and up to 39.6% for common iliac vessels. There was no significant variation of the mean bladder volume over the treatment course. There was a significant variation of the mean rectal volume before and after the third week of treatment. After the third week, the mean rectal volume seemed to be stable. The uni- and multivariate analysis identified the anterior wall of rectum as independent factor acting on prostate motion in AP direction at 2 levels (superior edge of, mid PB). The right rectal wall influenced the prostate motion in ML direction at inferior edge of PB. The bladder volume tends toward significance as factor acting on prostate motion in AP direction. Conclusions We recommend CTV to PTV margins of 8 mm, 6 mm and 9 mm in AP, ML and SI directions for prostate. And, we suggest 4 mm and 5 mm for external and common iliac vessels respectively. We also prefer registration based on bony landmarks to minimize bowel irradiation. More CBCT scans should be performed during the first 3 weeks and especially the first week to check rectum volume.

Purpose: The aims of this study were to investigate the clinical feasibility and to report our preliminary treatment outcomes of combined intracavitary/interstitial brachytherapy (IC/IS BT), using a hybrid applicator and magnetic resonance imaging (MRI)based treatment planning in patients with locally advanced cervical cancer. Materials and Methods: Between January 2017 and December 2018, eight patients with locally advanced uterine cervical cancer were treated with primary radiation therapy including hybrid BT. Patients with distant metastasis other than para-aortic lymph node spread were excluded from this study. A hybrid applicator for guidance of parametrial needles was used to perform highdoseratebrachytherapy (HDR BT) with MRIbased treatment pre-planning. Parametrial extent of the disease or large residual disease in these patients was judged to exceed the coverage limit of intracavitary brachytherapy alone. The number of needles, chosen guiding holes through the ovoids, and insertion depths were based on the extent of residual disease. We investigated the dosimetric gain by comparing the clinical IC/IS optimized plan (IC/IS clinical) with an additionally generated optimized plan without needle use (ICstudy). Results: The clinical use of the hybrid applicator system proved to be feasible in all 32 treatment fractions. The applicator Fletcher interstitial 6mm or Utrecht interstitial consists of the IC tandem and two ovoids thatserves as a template for needle insertion. MRI preplanning was performed the week before the implant in 5 cases and the day ofapplication with applicator in place in 3 cases. Four to eight needles were placed per fraction, and overall a total of 152 needles were used. Significant differences in (IC/IS) plan and (IC study) plan were derived for dose application to the target volume D90 high-riskclinical target volume (D90 CTV HR) was 90.1Gy in (IC/ISclinical) plan vs 85.36 Gy in (IC study) plan with an average gain of 4.74 Gy. Likewise, sparing of organs at risk (OAR) differed significantly for bladder D2cc:82,5 Gy(IC/ISclinical) vs95.7 Gy (IC study) and rectum D2cc: 65,5 Gy (IC/ISclinical) vs 67.8 Gy (IC study).With an average follow-up of 27,25 months (range 18–34 months): no patient experienced local relapse, three patients experienced distantmetastasis two of them died, no acute complications such as bleeding or organ penetration occurred due to needle placement, one patient developed recto-vaginal fistula. Conclusions: Our preliminary clinical experience indicates that combined intracavitary and interstitial MRI based brachytherapy in patients with significant residual disease extending up to the distal third of parametriaafter externalbeam therapy is feasible and allows excellent local control and a low rate of morbidity.