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Purpose: The safety of combined immunotherapy and thoracic radiation therapy (iRT) has been understudied. We evaluated toxicities in patients receiving iRT from 3 single-institutional phase 1/2 trials., Methods and Materials: Clinical/treatment characteristics and toxicities (per the Common Toxicity Criteria for Adverse Events, version 4.0) were extracted. For purposes of this analysis, groupings were made into (1) patients receiving immunotherapy plus stereotactic body radiation therapy (50 Gy/4 fractions or 60 Gy/10 fractions), (2) immunotherapy plus 45 Gy/15 fractions, and (3) twice-daily chemoimmunoradiotherapy (45 Gy in twice-daily fractions)., Results: None of the 60 patients undergoing immunotherapy plus stereotactic body radiation therapy (50 Gy, n = 49; 60 Gy, n = 11) experienced grade ≥4 events. There were 34 instances of any grade 3 event (in 15 total patients), with 9 pulmonary specific grade 3 events (in 4 patients). In the patients receiving 45 Gy/15 fractions (small cell lung cancers, n = 26; non-small cell lung cancers, n = 27), there were 2 grade 4 events (in the same patient), along with 17 grade 3 toxicities experienced by 10 total patients (2 pulmonary specific). Lastly, in the twice-daily cohort (n = 22), there were 5 grade 4 events (3 of which occurred in 1 patient) and 16 grade 3 toxicities occurring in 8 total patients (half of which were hematologic)., Conclusions: Administration of combined iRT is safe in the short term. Toxicities did not appreciably associate with demographics or dosimetry., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We are grateful to the authors of the study by Castagnola et al., which sought to ascertain the prevalence of tooth necrosis in patients undergoing mandibulotomy or mandibulectomy for head and neck cancer. In order to prevent surgical problems, the researchers suggested doing root canal therapy on the teeth next to the surgical site prior to surgery. Although the results offer insightful information about tooth necrosis in patients with head and neck cancer who have had mandibulotomies or mandibulectomy, we would like to voice our concerns about the reported data in order to give a stronger basis for future studies in this field. [ABSTRACT FROM AUTHOR]

Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ is currently less than 5–6% due to advances in dental preventive care programs, RT planning systems, and RT techniques. Although numerous patient-, tumor-, and treatment-related factors may influence the incidence rates of ORNJ, RT modality (equipment), technique, and dose-volume-related factors are three of the most influential factors. This is mainly because different RT equipment and techniques have different levels of success at delivering the prescribed dose to the focal volume of the treatment while keeping the "organ at risk" safe. ORNJ risk is ultimately determined by mandibular dose, despite the RT technique and method being known predictors. Regardless of the photon delivery method, the radiobiological effects will be identical if the total dose, dose per fraction, and dose distribution within the tissue remain constant. Therefore, contemporary RT procedures mitigate this risk by reducing mandibular dosages rather than altering the ionizing radiation behavior in irradiated tissues. In light of the paucity of studies that have examined the impact of RT modality, technique, and dose-volume-related parameters, as well as their radiobiological bases, the present review aims to provide a comprehensive overview of the published literature on these specific issues to establish a common language among related disciplines and provide a more reliable comparison of research results. [ABSTRACT FROM AUTHOR]

The article discusses a study conducted by Katz et al. on the prevalence of acute periapical abscesses (PA) in head and neck cancer patients who received radiation therapy (RT). The study found that patients with a history of oropharyngeal cancer (OPC) had a significantly higher likelihood of developing acute PA, and this risk was further increased if they had received RT. The article suggests that dosimetric data should be included to determine safer RT dosages and stratify patients into PA risk categories. It also highlights the potential development of osteoradionecrosis (ORN) in patients with PA and the need to consider pre-existing PA before RT. The article commends the study for contributing to our understanding of this treatment complication. [Extracted from the article]

Glioblastoma is the most malignant primary brain tumor, and a cornerstone in its treatment is radiotherapy. However, tumor cells surviving after irradiation indicates treatment failure; therefore, better understanding of the mechanisms regulating radiotherapy response is of utmost importance. In this study, we generated clinically relevant irradiation-exposed models by applying fractionated radiotherapy over a long time and selecting irradiation-survivor (IR-Surv) glioblastoma cells. We examined the transcriptomic alterations, cell cycle and growth rate changes and responses to secondary radiotherapy and DNA damage response (DDR) modulators. Accordingly, IR-Surv cells exhibited slower growth and partly retained their ability to resist secondary irradiation. Concomitantly, IR-Surv cells upregulated the expression of DDR-related genes, such as CHK1, ATM, ATR, and MGMT, and had better DNA repair capacity. IR-Surv cells displayed downregulation of hypoxic signature and lower induction of hypoxia target genes, compared to naïve glioblastoma cells. Moreover, Chk1 inhibition alone or in combination with irradiation significantly reduced cell viability in both naïve and IR-Surv cells. However, IR-Surv cells' response to Chk1 inhibition markedly decreased under hypoxic conditions. Taken together, we demonstrate the utility of combining DDR inhibitors and irradiation as a successful approach for both naïve and IR-Surv glioblastoma cells as long as cells are refrained from hypoxic conditions. [ABSTRACT FROM AUTHOR]

28024723 4 Schweyen R, Stang A, Wienke A, Eckert A, Kuhnt T, Hey J. The influence of dental treatment on the development of osteoradionecrosis after radiotherapy by modern irradiation techniques. This exploratory study's primary objective was to assess the clinical outcomes of 311 head and neck squamous cell carcinoma (HNSCC) patients treated with radiotherapy (RT) in a tier-three town. [Extracted from the article]

To illustrate, in a patient with an initial maximum mouth opening (MMO) of 46 mm and potential post-RT MMOs of 32 and 17 mm, the QoL measures would certainly be impacted very differently by these two post-treatment MMOs, with the latter MMO measure reflecting a significantly worse condition and QoL metric.[5] As a result of these concerns, we argue that, besides being simple and easily applicable, QoL questionnaires should be specifically designed to address cancer, treatment, and complication types in an individualised manner to accurately reveal the exact impact of the condition on QoL measures. Patient preference for commonly-used, head and neck cancer-specific quality of life questionnaires in the follow-up setting (Determin): A multi-centre randomised controlled trial and mixed methods study. Although the study's findings provide valuable information in this field by focusing on the QoL of HNC patients, we have two contributions to make to the study's findings. [Extracted from the article]

Objective: We identified factors influencing outcomes in patients with medically inoperable early stage lung cancer (MIESLC) treated with stereotactic ablative radiation therapy (SABR) at 14 centers in Turkey. Materials and Methods: We retrospectively analyzed 431 patients with stage I‐II MIESLC treated with SABR from 2009 through 2017. Age; sex; performance score; imaging technique; tumor histology and size; disease stage radiation dose, fraction and biologically effective dose with an α/β ratio of 10 (BED10); tumor location and treatment center were evaluated for associations with overall survival (OS), local control (LC) and toxicity. Results: Median follow‐up time was 27 months (range 1‐115); median SABR dose was 54 Gy (range 30‐70) given in a median three fractions (range 1‐10); median BED10 was 151 Gy (range 48‐180). Tumors were peripheral in 285 patients (66.1%), central in 69 (16%) and <1 cm from mediastinal structures in 77 (17.9%). Response was evaluated with PET/CT in most cases at a median 3 months after SABR. Response rates were: 48% complete, 36.7% partial, 7.9% stable and 7.4% progression. LC rates were 97.1% at 1 year, 92.6% at 2 years and 91.2% at 3 years; corresponding OS rates were 92.6%, 80.6% and 72.7%. On multivariate analysis, BED10 > 100 Gy (P =.011), adenocarcinoma (P =.025) and complete response on first evaluation (P =.007) predicted favorable LC. BED10 > 120 Gy (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1‐3.2, P =.019) and tumor size (<2 cm HR 1.9, 95% CI 1.3‐3, P =.003) predicted favorable OS. No grade 4‐5 acute side effects were observed; late effects were grade ≤3 pneumonitis (18 [4.2%]), chest wall pain (11 [2.5%]) and rib fracture (1 [0.2%]). Conclusion: SABR produced encouraging results, with satisfactory LC and OS and minimal toxicity. BED10 > 120 Gy was needed for better LC and OS for large, non‐adenocarcinoma tumors. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose 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). Methods We identified 722 patients with stage IIIA/B NSCLC without anemia at baseline [hemoglobin (Hgb) <12 g/dL for women or <13 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. Results 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 Hgb <11.1 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). Conclusion Nadir Hgb <11.1 g/dL levels during C-CRT were associated with significantly poorer survival times in initially non-anemic patients presenting with locally advanced NSCLC. [ABSTRACT FROM AUTHOR]

This study constitutes a feasibility assessment of dynamic conformal arc (DCA) therapy as an alternative to volumetric‐modulated arc therapy (VMAT) for stereotactic body radiation therapy (SBRT) of lung cancer with the free-breathing technique using four-dimensional computed tomography. A total of 25 patients who received 50 Gy in four fractions treated using VMAT technique having two partial coplanar arcs with 6 MV beams for non-small cell lung cancer (NSCLC) were included. Plans were re‐planned using a novel and clinically technique of weight optimized based on dynamic conformal Arcs with two coplanar partial dynamic conformal arcs (WO-DCA). For the two partial arcs, MLC aperture around the 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). The clinical VMAT and WO-DCA plans were compared via the RTOG-0915 protocol for conformity and dose to the organs at risk (OAR). Additionally, delivery efficiency, quality assurance pass rate, monitor unit and beam treatment time were recorded. The mean value of quality assurance (QA) pass rate 98.16 ± 1.27 in WO-DCA and 92.87 ± 1.56 in VMAT. The rate was higher in WO-DCA (p < 0.001 and t = 8.75). The values of beam‐on time (BOT) and monitor units (MU) in the VMAT technique were 4.20 (3.45–4.95) and 3155 (2279–4867) and they were 3.10 (2.85–3.35) and 2167 (1702–2948) in WO-DCA. These values were significantly improved with WO-DCA (p < 0.001 and p < 0.001) As there is, no beam modulation through the target, WO‐DCA plans could potentially minimize small‐field dosimetry error without MLC interplay effects via respiratory motion and provide similar doses to OAR and the tumor while providing faster treatment delivery by significantly reducing MU and BOT in lung cancer for tumors of appropriate localization. Additionally, providing WO‐DCA eliminate patient‐specific VMAT quality assurance; potentially offering cost‐effective, same day SBRT treatments. • Dynamic Conformal Arc technique called WO-DCA (weight optimizations dynamic conformal arc) is a new planning strategy. • WO-DCA provided reduction treatment time. • This technique delivers lower radiation. • WO‐DA could increase efficiency treatment technique compared to VMAT. • It minimizes small‐field dosimetry error without MLC interplay effects via respiratory motion. [ABSTRACT FROM AUTHOR]

We retrospectively evaluated the utility "over D1" or D1 dissections on outcome of gastric cancer patients with subsequent postoperative chemoradiotherapy. Sixty-five patients with gastric adenocarcinoma treated with postoperative concurrent chemoradiotherapy were evaluated. Inclusion criteria were total or subtotal gastrectomy with a cut-point of =10 nodes dissected in the surgery without scheduled splenectomy and pancreatectomy. Nodal dissections grouped according to Japanese Research Society; N1 stations (1-6) as D1, and dissection of additional stations (7-9) as "over D1". The median follow-up was 30 months. Surgery was total gastrectomy in 32 patients and subtotal in 33. Nodal dissection was D1 in 36 (55.4%) patients and over D1 in 29 (44.6%). The 2-year overall, local recurrence free, distant metastasis free, and disease free survivals of the entire group of patients were 83.3%, 89.9%, 68.4%, 62.5% respectively. Two year distant metastasis free survival was %55 for D1 and %88.5 for "over D1" dissected patients (p= 0.06). Overall survival was significantly longer in "over D1" dissected patients (2 year overall survival: 72.3% for D1 and 96% for "over D1", p= 0.05). Moreover, disease specific survival was significantly longer in "over D1" dissected patients (2 year disease specific survival: 72.3% for D1 and 100% for "over D1", p= 0.02). No grade 3-4 acute or late toxicity was observed. In conclusion, our retrospective data showed that over D1 dissected patients treated with concomitant chemoradiotherapy seemed to gain additional survival benefit in comparison to D1 dissected patients in this retrospective cohort with no significant extra toxicity. [ABSTRACT FROM AUTHOR]

We retrospectively assessed the predictive factors for brain metastasis in high-risk breast cancer patients receiving radiotherapy after mastectomy. Between January 1994 and 2002, the medical charts of nonmetastatic breast cancer patients receiving post-mastectomy radiotherapy were evaluated. The clinical and pathologic features of patients who developed brain metastasis as the first site metastatic disease were compared with nonmetastatic patients treated at the same time period. All eligible patients in this study were treated with postoperative radiotherapy ± chemotherapy. Age, stage, percent positive lymph node involvement, number of lymph node metastasis, primary tumor size, grade, surgical margin status, estrogen receptor status, and perinodal fat tissue invasion were analyzed as predictive factors for brain metastasis. Statistical analyses were performed by using Log-rank test and Cox’s regression analysis. Median follow-up-time was 61 months. In this period, 32 out of 957 patients (3.3%) developed brain metastasis. In univariate analysis percent positive axillary lymph node involvement (p < 0.001), primary tumor size (p < 0.001), number of lymph node metastasis (p = 0.01), and American Joint Committee on Cancer 2002 stage (p < 0.001) were found to be predictive for brain metastasis. Multivariate analysis revealed that only the primary tumor size and percent positive lymph node involvement were significant predictive factors for the development of brain metastasis. The primary tumor size and percent positive lymph node involvement increases the risk of brain metastasis in patients with nonmetastatic breast cancer receiving postoperative radiotherapy and chemotherapy. [ABSTRACT FROM AUTHOR]

Purpose. We retrospectively evaluated the impact of percent positive axillary nodal involvement on the therapeutic outcomes in patients with non-metastatic breast cancer receiving postmastectomy radiotherapy and chemotherapy. Materials and methods. Between January 1994 and December 2002, the medical records of 939 eligible non metastatic breast carcinoma patients were analyzed. Chest wall radiotherapy was indicated in case of positive surgical margin, tumor size equal or more than 4 cm, skin-fascia invasion. Lymphatic irradiation was applied for more than three metastatic axillary lymph nodes, incomplete axillary dissection (<10 lymph nodes), extracapsular extension or perinodal fat tissue invasion. A total dose of 50 Gy was given to chest wall and lymph node regions with 2 Gy daily fractions. Statistical analyses were performed by Kaplan-Meier method, Log-rank test and Cox's regression analysis. Results. The median follow-up for all patients alive was 62 months. The 5-year overall survival (OS) and disease-free survival (DFS) for entire cohort were 81%, and 65%, respectively. Univariate analysis for OS revealed significance for tumour size (≤5 cm vs. >5cm, p<0.001), metastatic nodal involvement (0 vs. 1-3 vs. >4 LN, p<0.001), percent positive nodal involvement ([metastatic nodes/total nodes removed]×100; 0 vs.≤25% vs. 26-50% vs. >50%, p<0.001), surgical margin status (negative vs. positive, p=0.05), and hormonal treatment (present vs. absent, p=0.03). DFS had similarly significance for age (≤40 years vs. >40 years, p=0.006), tumour size (0.02), metastatic nodal involvement (p<0.001), percent positive nodal involvement (p<0.001), and perinodal invasion (present vs. absent, p=0.01). Multivariate analysis revealed significance for tumour size, percent positive nodal involvement, hormonal treatment, and surgical margin status for OS. Age and percent positive nodal involvement were found to be significant for DFS. Conclusion. Percent positive nodal involvement was found to be a significant prognostic factor for survival in all end-points. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This Rare Cancer Network (RCN) study was performed in pediatric nasopharyngeal carcinoma (PNPC) patients to evaluate the optimal dose of radiotherapy and to determine prognostic factors. Patients and Methods: The study included 165 patients with the diagnosis of PNPC treated between 1978 and 2003. The median age was 14 years. There were 3 (1.8%) patients with stage I, 1 (0.6%) with IIA, 10 (6.1%) with IIB, 60 (36.4%) with III, 44 (26.7%) with IVA, and 47 (29%) with IVB disease. While 21 (12.7%) patients were treated with radiotherapy (RT) alone, 144 (87.3%) received chemotherapy and RT. The median follow-up time was 48 months. Results: The actuarial 5-year overall survival (OS) was 77.4% (95% CI: 70.06–84.72), whereas the actuarial 5-year disease-free survival (DFS) rate was 68.8% (95% CI: 61.33–76.31). In multivariate analysis, unfavorable factors were age >14 years for LRC (p =0.04); male gender for DMFS (p =0.03); T3/T4 disease for LRFS (p =0.01); and N3 disease for DFS (p =0.002) and OS (p =0.002); EBRT dose of less than 66Gy for LRFS (p =0.02) and LRRFS (p =0.0028); and patients treated with RT alone for LRFS (p =0.0001), LRRFS (p =0.007) and DFS (p =0.02). Conclusion: Our results support the current practice of using combined radiation and chemotherapy for optimal treatment of NPC. However, research should be encouraged in an attempt to reduce the potential for long-term sequelae in pediatric patients given their relatively favorable prognosis and potential for longevity. [Copyright &y& Elsevier]

Summary: Purpose: : To evaluate the outcome of patients ≤30 years old with non-metastatic nasopharyngeal carcinoma and discover adverse prognostic factors. Materials and methods: : We performed a database search maintained by the Department of Radiation Oncology of Hacettepe University School of Medicine for patients with nasopharyngeal cancer who were ≤30 years old at presentation. This search identified 59 (23.7%) patients among 248 patients treated between 1994 and 2001 that met the inclusion criteria for this retrospective study. Patients were staged according to AJCC 1997 classification. There were 1 (2%) patient with stage I, 7 (12%) with stage IIb, 25 (42%) with stage III, 9 (15%) with stage IVA, and 17 (29%) with stage IVB. Thirteen (22%) patients were stage T1, 16 (27%) were T2, 21 (36%) were T3, and 9 (15%) were T4. Nodal staging at presentation was as follows; 7 (12%) N0, 22 (37%) N1, 13 (22%) N2, 13 (22%) N3a, and 4 (7%) N3b. All patients were treated with fractionated external beam radiotherapy (EBRT) to a median dose of 65Gy. While 12 (20.3%) patients were treated with EBRT alone, 47 (79.7%) received chemotherapy beside EBRT. Twenty-five (42.3%) patients older than 17 years of age received brachytherapy boost in addition to EBRT. Results: : The median follow-up time for all patients was 46 months (range, 1–111 months). While only 3 patients (5%) developed local recurrence (1/21 T3 and 2/9 T4 patients), 13 patients (22%) developed distant metastases (6/35 N1 and 2 and 7/17 N3 patients). None of the patients had regional failure. Four patients (6.7%) died due to the treatment related toxicity. The actuarial 5-year local control (LC), regional control (RC), distant metastasis-free survival (DMFS) and disease-free survival (DFS) rates were 96%, 100%, 76.5%, and 74.5%, respectively. The actuarial 5-year disease-specific survival (DSS) was 70.6%. DFS at 5 years is significantly longer in patients aged &#60;16 years than ones >17 (90.5% versus 64.7%; p =0.02). Patients aged &#60;16 years had longer 5 year DMFS (90.5% versus 67.7%; p =0.05) with a borderline significance. DMFS is significantly shorter in patients initially presented with N3 disease compared to N0–2 disease (58.8% versus 84.4%; p =0.04). Conclusions: : We suggest that RT combined with multiagent chemotherapy is effective in achieving satisfactory DFS and comparable OS in young patients with NPC. Results of both previous series and ours are evoking the necessity of early administration of efficient chemotherapeutic agents in addition to radiotherapy, but indistinct is the precise regimen and the intensity along the radiotherapy. All efforts towards decreasing late side effects of treatment should be encouraged in this long life expected group. [Copyright &y& Elsevier]

Purpose: To evaluate the relationship between the dose and volume of radiation to proximal penile structures and the development of erectile dysfunction after external beam radiotherapy (RT) for localized prostate adenocarcinoma.Methods and materials: The study cohort comprised 28 patients who were enrolled our in-house three-dimensional conformal RT dose escalation protocol. The patients were treated to 78 Gy between 1995 and 1998. This protocol included a planned quality-of-life questionnaire to assess sexual function 2 years after completing RT. All the study patients were potent before RT. The median follow-up was 66 months (range 39–95). Penile base contents were outlined retrospectively in restored treatment plans. The dose–volume histograms (DVHs) for the corpus spongiosum (penile bulb), corpora cavernosum and crura, and total penile structure (corpus spongiosum plus corpora cavernosum and crura) were calculated. Statistical significance was defined as p < 0.05. The Bonferroni correction was used to adjust for multiple comparisons. Power calculations showed that our study sample would detect radiation- induced impotence with a very high power. We also estimated that a relatively small difference of 10–15% in the DVHs between the potent and impotent patients could be detected.Results: At 2 years after RT, 10 patients (35.7%) reported new-onset erectile dysfunction and were unable to attain firm enough erections to have intercourse. Only hypertension was observed to affect erectile dysfunction after external beam RT. We found no statistically significant correlation among age, diabetes, or heavy alcohol consumption and post-RT potency. The mean radiation dose ± standard deviation delivered to the corpus spongiosum, corpora cavernosa and crura, and total penile structure was, respectively, 42.2 ± 8.4 Gy, 36.3 ± 8.0 Gy, and 38.2 ± 7.5 Gy. t test comparisons were performed between DVHs of post-RT potent and impotent patients on multiple cutpoints. No dose–volume effect was found. Analysis of the DVHs when the patients were subdivided into normotensive and hypertensive groups also showed no dose–volume response.Conclusion: Our analysis did not show statistically significant correlations between potency preservation and radiation dose to the proximal penis. The entire etiology of radiation- induced erectile dysfunction remains unclear and further research is needed. [Copyright &y& Elsevier]

Purpose: To evaluate the outcomes of radiation therapy treatment of patients with Stage I and II squamous cell carcinoma (SCC) of the oropharynx and discover adverse prognostic factors that may help select a subgroup of patients for a different management approach.Methods and materials: A search of the database maintained by the Department of Radiation Oncology of The University of Texas M. D. Anderson Cancer Center for patients with Stage I or II SCC of the oropharynx was performed. This search identified 175 patients treated between 1970 and 1998 who met the inclusion criteria for this retrospective study. Distribution of primary sites was: tonsillar fossa/pillar, 60 patients; soft palate, 55 patients; base of tongue, 40 patients; and pharyngeal wall, 20 patients. Twenty-five patients were stage T1, 124 were T2, and 26 were Tx. All patients were treated with fractionated radiation to a median dose of 66 Gy. Eighty-five patients were treated with conventionally fractionated radiation, 73 were treated with the concomitant boost fractionation schedule, and the remaining 17 were treated with other altered fractionation schedules or with intraoral or interstitial boosts.Results: The median follow-up for all patients was 76 months (range, 2–302 months). The actuarial 5-year local control (LC), regional control, locoregional control (LRC), and disease-free survival (DFS) rates were 85%, 93%, 81%, and 77%, respectively. Only 7 patients (5%) with LC developed nodal metastases, and 10 patients (7%) with LRC developed distant metastases. Eleven patients (32%) with locoregional recurrence were rendered without evidence of disease after a surgical salvage procedure, resulting in a 5- year ultimate LRC rate of 87%. T-stage classification was statistically significant (p = 0.03) in univariate analysis for actuarial 5-year LRC, 88% for Stage I vs. 72% for Stage II. The 5- and 10-year disease-specific survival rates were 85% and 79%, respectively, while the actuarial 5- and 10-year overall survival rates were 70% and 43%, respectively. Fifty-one patients (29%) developed second primary tumors, 86% of which were cancers of the upper aerodigestive tract (UADT). Heavy alcohol consumption was associated with both an increased risk of disease recurrence and development of a second cancer of the UADT.Conclusions: Patients with early-stage oropharynx cancer have high rates of disease control when treated with radiation. Lymphatic and hematogenous metastases are uncommon. Surgical salvage of disease recurrence is successful in approximately one-third of patients. As the majority of recurrences occur within the first 2 years from treatment, close observation during this time period is important. The development of second primary tumors of the UADT adversely impacts survival in these patients to as great a degree as the index cancer. [Copyright &y& Elsevier]

: PurposeTo determine the utility of the percentage of positive prostate biopsies (PPPB) in predicting prostate-specific antigen (PSA) outcome after external beam radiotherapy alone.: Methods and materialsThe records of 750 clinical Stage T1 and T2 patients treated by external beam radiotherapy alone with a median follow-up of 80 months were reviewed. Of the 750 patients, 345 were eligible for analysis; 255 (74%) had undergone sextant biopsies, 28 (8%) <6 biopsies, and 62 (18%) >6 biopsies. The pretreatment PSA level (<10, 10–20, >20 ng/mL), biopsy Gleason score (2–6, 7, 8–10), and clinical stage (T1-T2a, T2b, T2c), uni- or bilateral positive biopsy, radiation dose, and PPPB were analyzed as potential predictors of PSA outcome. The PPPB data were analyzed as a continuous and as a categorical variable.: ResultsPPPB was a significant predictor of the time to PSA failure on univariate analysis as a continuous (p = 0.0053) and as a categorical (<50% vs. ≥50%, p = 0.0077) variable. In multivariate analysis, a trend was noted for worse 5-year PSA failure-free survival based on PPPB ≥50% vs. <50% (p = 0.082). Sixty-four patients experienced biochemical failure according to the American Society for Therapeutic Radiology Oncology definition. The 5-year PSA failure-free survival rate was 79% vs. 69% (p = 0.02) and the clinical disease-free survival rate was 97% vs. 86% (p = 0.0004) for patients with <50% vs. ≥50% PPPB. PPPB was not a significant predictor for the time to PSA failure within the traditional risk groups (low, intermediate, and high) on multivariate analysis.: ConclusionPPPB was a predictor of post–external beam radiotherapy PSA outcome in clinically localized prostate cancer; but in this cohort it did not provide additional information beyond the traditional risk stratification schema. [Copyright &y& Elsevier]

In this study, we evaluated the efficiency and the toxicity of three dimensional conformal hemithoracic radiotherapy (3DCHRT) after extra pleural pneumonectomy (EPP). The median age of 14 patients were 51 years (range, 33-61 years). Most commonly seen histopathology was epitheliod type (79%). According to American Joint Commission on Cancer (AJCC) 2002 staging system 9 cases (64%) were stage III. A total median dose of 50.4 Gy was applied to hemithoracic cavity. Eleven patients received adjuvant chemotherapy. 3DCHRT was generally well tolerated. The acute toxicities of 3DCHRT were grade I-II. After a median of 16 months follow-up, intrathoracic control was100%. Six patients (43%) developed abdominal relapse and one (7%) developed distant metastasis. Nine cases were dead with two of them being without the evidence of disease. Excellent local control with 3DCHRT after EPP seems to change the relapse patterns of MPM. More effective systemic treatment is needed to prevent the recurrences outside thorax. [ABSTRACT FROM AUTHOR]

Abstract: Objectives:: To assess the factors effecting PSA bounce and to identify any possible relationship with biochemical control after 3-D conformal radiotherapy (3D-CRT) and total androgen deprivation (TAD) for prostate cancer by evaluating four previously described PSA bounce definitions. Methods:: Between January 1998 and January 2001, 83 consecutive patients with clinically localized prostate cancer were treated by 3D-CRT with neoadjuvant 3 months and/or 6 months adjuvant TAD. All patients had a pretreatment PSA level, at least eight post-external beam radiotherapy (EBRT) PSA and testosterone levels and minimum two years of follow-up. Total radiotherapy dose was 73.6Gy at ICRU reference point. Four previous definitions of PSA bounce were used: Critz definition (≥0.1ng/mL), Cavanagh definition (≥0.2ng/mL), Hanlon definition (≥0.4ng/mL) and Rosser definition (≥0.5ng/mL) according to original methodology performed to report PSA bounce. Biochemical failure was defined in accordance with the ASTRO consensus guidelines. Results:: The median follow-up time was 40 months. PSA bounce was recorded as follows: Critz definition, 33 patients (40%); Cavanagh definition, 21 patients (25%); Hanlon definition, 11 patients (13%); and Rosser definition, 7 patients (8%). In multivariate analysis, pre-EBRT PSA level and the duration of TAD for Critz definition; age, pre-EBRT PSA and the duration of TAD for Cavanagh definition; age and duration of TAD for Hanlon definition; age and pre-biopsy PSA for Rosser definition were significant independent prognostic factors determining PSA bounce. A significant increase of mean testosterone level in bouncers was detected at the 6th–9th and 18th–21st months. PSA bounce did not predict for PSA failure in multivariate analysis. Conclusions:: We observed no correlation between biochemical failure and PSA bounce. The longer duration of TAD and older age were found to be inversely proportional with PSA bouncing in this cohort. Notably, recovery of testosterone might cause PSA bouncing. [Copyright &y& Elsevier]

: Background and purposeTo compare the outcome from adjuvant and delayed radiotherapy (RT) after surgery in patients with benign cerebral meningioma.: Patients and methodsBetween March 1953 and January 2001, 92 patients with benign cerebral meningioma (WHO grade I) were treated with surgery. Forty-eight patients underwent gross total resection (GTR), and 44 patients underwent subtotal resection (STR). Treatments were classified as GTR (n=48), STR+adjuvant RT (n=12), STR alone (n=32). The prognostic factors were assessed as, gender, the Karnofsky performance score (KPS) (≥90 vs. <90), the extent of surgery, and adjuvant or delayed RT. The endpoints analyzed were progression-free survival (PFS) and overall survival (OS). Overall survival curve of the study population is compared with the age-adjusted expected survival curve for the US population born in 1970.: ResultsThe median follow-up was 7.7 years. The 5-year PFS and OS rates for all patients were 65 and 93%, respectively. The 5-year PFS rates in patients treated with GTR and STR were 77 and 52%, respectively (P=0.02). Patients treated with STR+adjuvant RT had significantly better PFS (91%) at 5 years than with STR alone (38%) (P=0.0005). Gender showed no statistically significant impact on either PFS or OS (P>0.05). However, multivariate analysis showed the KPS to have a statistically significant effect on OS (P=0.02). The OS rate was the same across all three treatment groups. The age-adjusted expected survival curve for the US population born in 1970 lay within the confidence intervals for the overall survival curve of the study population.: ConclusionsAlthough OS was not affected, adjuvant RT appeared to significantly reduce tumor progression. However, only a prospective randomized trial can adequately determine whether adjuvant or delayed radiotherapy is the better approach in patients with subtotally resected benign meningioma. [Copyright &y& Elsevier]

• Lung cancer is a leading cause of cancer related deaths globally and in MEA. • Surgery remains a gold standard for treatment of resectable NSCLC. • Other treatment modalities include chemotherapy, radiotherapy, targeted therapy and immunotherapy. • We recommend use of MDT with a set composition for management of NSCLC in MEA. The Middle East and Africa (MEA) region, a large geographical area, lies at the confluence of Asian, Caucasian and African races and comprises of a population with several distinct ethnicities. The course of management of non-small cell lung cancer (NSCLC) differs as per patients' performance status as well as stage of disease, requiring personalized therapy decisions. Although management of NSCLC has received a significant impetus in the form of molecularly targeted therapies and immune therapies in last few years, surgery remains gold standard for patients with early-stage disease. In case of unresectable disease, radiotherapy and chemotherapy are the primary management modalities. With newer therapies being approved for treatment of early stage disease, use of multi-disciplinary team (MDT) for comprehensive management of NSCLC is of prime importance. A group of experts with interest in thoracic oncology, deliberated and arrived at a consensus statement for the community oncologists treating patients with NSCLC in the MEA region. The deliberation was based on the review of the published evidence including literature and global and local guidelines, subject expertise of the participating panellists and experience in real-life management of patients with NSCLC. We present the proposed regional adaptations of international guidelines and recommends the MDT approach for management of NSCLC in MEA. [ABSTRACT FROM AUTHOR]

Purpose: 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).Methods and Materials: 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.Results: 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 loss >5% (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 loss >5% (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.Conclusions: 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. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the treatment results of three dimensional conformal radiotherapy (3DCRT) and androgen deprivation therapy (ADT) in patients with clinically localized prostate cancer (CLPC). Between June 1998 and December 2011, 577 patients with the diagnosis of CLPC were treated. ADT was started 3 months prior to radiotherapy (RT). 3DCRT was delivered to prostate and the seminal vesicles (SV) to a total dose of 70Gy. Additionally, patients with lymph node (LN) positivity received 50.4Gy RT to pelvic LN's. Median follow up time was 65 months. Five-ten years overall survival (OS), cause specific survival (CSS), PSA relapse-free survival (PSA-RFS) and distant metastasis-free survival (DMFS) rates were 92-74%, 97-91%, 77-55% and 94-88%, respectively. OS was negatively affected from LN positivity (p< 0.001). In the subgroup of patients with GS= 8, there was no significant difference between < 1 years and = 1 years of ADT in terms of CSS, PSA-RFS and DMFS. OS was better in patients with < 1 years of ADT (p= 0.01). Five year OS (p= 0.02), CSS (p= 0.05), PSA-RFS (p= 0.01) and DMFS (p= 0.07) rates were inferior in the high risk group patients that used ADT = 1 year. Acute and late RTOG grade III/IV gastrointestinal system toxicity rates were 1.7% and 5% and acute and chronic RTOG grade III/IV genitourinary system toxicity rates were 1.4% and 5%, respectively. 3DCRT and ADT combination is an effective treatment modality with acceptable toxicities in patients with clinically localized prostate cancer. [ABSTRACT FROM AUTHOR]