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In literature data, an uncertainty exists whether occurrence of bilateral breast cancer decreases the survival probability of affected patients. Therefore, we analyzed the medical records of 498 postoperatively irradiated (1977-1982) female breast cancer patients (T1-4,N0-3,M0). In the follow-up time, in 36 patients a bilateral breast carcinoma treated by surgery with or without radiotherapy was found. The 10-year overall survival rates were 54% in patients who had unilateral disease, compared with 56% in bilateral carcinoma patients, respectively. The incidence of metastasis did not differ between both groups: 24.2% versus 38.8%. Eleven percent of unilateral cancers recurred; in the other group, local failure of the first and second tumor was observed in 19.4% and 11.1%, respectively. We conclude that the occurrence of bilateral breast cancer has no significant impact on survival, although the development of local failures and metastases seems to be more frequent. The therapeutic strategy in bilateral carcinoma should resemble the treatment procedure in unilaterally affected patients.

Therapeutic application of immunoglobulin is reported to be successful in radiation-induced oral and oropharyngeal mucositis. In this study the efficacy of prophylactic application of immunoglobulin was investigated. In 42 patients with head and neck cancer, postoperative radiation treatment or radiation combined with chemotherapy was performed. In 20 consecutive patients, prophylactic mucositis treatment consisted of panthenol (4 x 10 ml/day) and nystatin (4 x 1 ml/day). The 22 following patients received, supplementary to panthenol and nystatin, 800 mg (5 ml) human immunoglobulin intramuscularly once weekly. During the treatment time, the degree of mucositis was examined 3 times a week. The distribution of maximal mucositis degree revealed slightly more severe mucous membrane reaction in the control group compared with the immunoglobulin group (n.s.). The analysis of mean mucositis degrees in both groups demonstrated statistically significant differences (t test, p = 0.031) related to the entire group (n = 42) and to those 16 patients receiving radiation combined with chemotherapy. There was no significant immunoglobulin-induced effect on mucositis in patients treated by radiation alone. The time from the beginning of therapy to the first interruption could be prolonged 5 days in the immunoglobulin group (n.s.). In conclusion, it is demonstrated that the prophylactic application of immunoglobulin seems to lower the degree of radiation-induced mucositis. In comparison to the published data about therapeutically given immunoglobulin, the clinical efficacy of the prophylactic application of immunoglobulin as it is performed in this study is less evident.

The Addition of Bevacizumab (BEV) to Temozolomide (TMZ) and Radiation Therapy (RT) in Newly Diagnosed Glioblastoma (GBM) Improves Progression-Free Survival (PFS) Without Adding to RT Toxicity

WCN 2013 No: 1207 Topic: 36 — Other topic Efficacy and biomarker findings from AVaglio, a phase III trial of bevacizumab plus temozolomide and radiotherapy in newly diagnosed glioblastoma W. Wick, T. Cloughesy, W. Mason, R. Henriksson, F. Saran, R. Nishikawa, M. Hilton, J. Garcia, C. Pallaud, O. Chinot. University Medical Centre, Heidelberg, Germany; University of California, Los Angeles, CA, USA; Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada; Regional Cancer Center Stockholm, Stockholm, Sweden; Umea University, Umea, Sweden; The Royal Marsden NHS Foundation Trust, Surrey, UK; International Medical Center, Saitama Medical University, Saitama, Japan; F. Hoffmann-La Roche, Basel, Switzerland; Aix-Marseille University, AP-HM, Service de Neuro-Oncologie, CHU Timone, Marseille, France Background: Glioblastoma has a high disease burden and poor prognosis. AVAgliowas the first double-blind, placebo-controlled phase III study evaluating bevacizumab in newly diagnosed glioblastoma. Objectives: To evaluate efficacy, safety and potential biomarkers (plasma VEGF-A/VEGFR-2 prioritised). Patients and methods: Patients received single-agent bevacizumab or placebo plus standard-of-care treatment (radiotherapy plus temozolomide) until progression/unacceptable toxicity. Co-primary endpoints were investigator-assessed PFS and OS. Secondary endpoints included health-related quality of life (HRQoL). Exploratory endpoints included correlative biomarker analysis, KPS, corticosteroid use. Results: Baseline characteristics were balanced for intent-to-treat (n = 921) and biomarker-evaluable (n = 571) populations. Bevacizumab significantly prolonged PFS (HR = 0.64, 95% CI 0.55– 0.74, p b 0.0001; median 10.6 vs 6.2 months) and delayed HRQoL time to definitive deterioration (p b 0.0001). Interim OS did not cross the threshold for significance (HR = 0.89, 95% CI 0.75–1.07, p = 0.2135). Functional independence (KPS ≥ 70%) was maintained during PFS in both arms (median bevacizumab vs placebo: 9 vs 6 months). Patients treated with bevacizumab had a diminished corticosteroid requirement. Patients with low and high baseline plasma VEGF-A concentrations derived similar PFS benefit with bevacizumab (p = 0.610): low VEGF-A (HR = 0.64, 95% CI 0.48– 0.84) versus high (HR = 0.59, 95% CI 0.45–0.78). Similarly, PFS benefit in patients with low and high baseline VEGFR-2 levels was comparable (p = 0.736): low VEGFR-2 (HR = 0.54, 95% CI 0.41– 0.71) versus high (HR = 0.66, 95% CI 0.50–0.87). Conclusion: Addition of bevacizumab to standard-of-care therapy provided a significant clinically meaningful PFS improvement with stable/improved HRQoL/KPS and reduced corticosteroid requirement. NoVEGF-A/VEGFR-2 predictive/prognostic effectwas observed. Interim OS analysis did not cross the threshold for significance. doi:10.1016/j.jns.2013.07.2268 Abstract — WCN 2013 No: 2103 Topic: 36 — Other topic Flow cytometric analysis of cerebrospinal fluid is low diagnostic yield without atypical morphology or prior history of hematologic malignancy WCN 2013 No: 2103 Topic: 36 — Other topic Flow cytometric analysis of cerebrospinal fluid is low diagnostic yield without atypical morphology or prior history of hematologic malignancy G.H.J. Stevens, A.M.B. Collie, B.T. Hill, K. Fenner, E. Gazdick, L.A. Rybicki, E.H. Hsi. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA; Pathology, Cleveland Clinic, Cleveland, OH, USA; Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA; Quality Health Science, Cleveland Clinic, Cleveland, OH, USA Background: Flow cytometric analysis (FCA) of cerebrospinal fluid (CSF) has utility in detecting central nervous system (CNS) involvement by hematologic malignancies. Yet, the majority of samples are negative by FCA. Objective: Identify pre-test characteristics of CSF specimens that will allow the rational use of FCA in the diagnosis of hematologic malignancy in CSF. Design: Retrospective data was collected from the medical record and flow cytometric reports for all CSF samples submitted for FCA between 2007 and 2009. Patients: 423 patients for whom 501 CSF samples were submitted for FCA. Results: A positive diagnosis of a hematologic malignancy was made in 41 specimens (8.2%). The FCA-positive specimens showed atypical morphology, either blasts or atypical lymphocytes, in 98% of Abstracts / Journal of the Neurological Sciences e629 (2013) e629–e678 e654

Purpose: To assess the utility of SEMAC MRI metal artifact reduction technique for radiotherapy (RT) planning using CT/MRI fusion in patients with spine stabilisation devices. Methods: Conventional MRI spin‐echo (SE) sequences used for spinal cord delineation and radiotherapy planning in the spine were compared with a prototype implementation of Slice Encoding for Metal Artifact Correction (SEMAC) (WARP works‐in‐progress software package, Siemens Healthcare, Erlangen, Germany). Sequences were first optimised at 1.5T (Siemens MAGNETOM Aera) using a phantom constructed of a spine stabilisation device suspended in gelatin and then applied in patient studies (n=2). Both patient and phantom MRI series were co‐registered with spine CT data to assess artifact extent and geometrical image distortion. Registered data sets were assessed in terms of artifact size, distortions, image quality, visualisation of the spinal cord, spinal fluid, disease site and soft tissues adjacent to metal implants. Results: The optimal parameters were found as a compromise between artifact reduction and MRI acquisition time, while maintaining image quality comparable to conventional sequences: TR/TE 560/15ms, res: 0.8×0.8×4mm, GRAPPA=3, BW=587Hz/Px, 30 slices, TA=3:57min, SEMAC parameters: Slice encoding steps=4, Excitation & Refocusing RF duration=1500us, slice correction factor=1.2. The metal artifact volumes (signal voids and pile‐ups) were reduced using 2D SEMAC sequence on average by 43±16 % from 15.6±2.5 cm3 to 8.9±1.4 cm3. The difference in spinal cord, fluid and lesion volumes outlined using conventional and SEMAC sequences were 7±0.15, 2±0.42 and 35±3.11% respectively in the 6cm long spine sections affected by metallic artifacts. Conclusion: The work shows the importance of MRI metal artifact reduction techniques for reliable RT planning in the vicinity of metallic implants. The use of SEMAC sequence improves geometrical accuracy of outlined volumes in the presence of spine stabilization devices which degrade geometrical information from both CT and conventional SE MRI.

2005^ Background: GBM has a high disease burden and poor prognosis, and impacts negatively on HRQoL. Symptomatic therapies for GBM, such as corticosteroids (CS), may impact patient status negatively Methods: AVAglio, a randomized, double-blind, placebo (P)-controlled trial in patients (pts) ≥18 yrs with newly diagnosed GBM, evaluated the addition of Bv or P (10mg/kg, q2w) to 6 wks of T (75mg/m2/d) + RT (2Gy, 5d/wk) followed by 28 treatment-free days, then 6 cycles of T (150–200 mg/m2/d, 5d q4w) with Bv or P (10 mg/kg, q2w), and then single-agent Bv or P (15 mg/kg, q3w) until disease progression (PD)/unacceptable toxicity. Co-primary endpoints were investigator-assessed PFS and overall survival. Secondary endpoints included HRQoL (EORTC QLQ-C30 and BN20, with 5 prespecified domains based on relevance in GBM). HRQoL time to definitive deterioration (TDD) was defined as time from randomization to ≥10 point deterioration from baseline with no subsequent improvement, PD, or death. Exploratory endpoints included KPS and CS use. Results: Baseline characteristics were well balanced. Bv significantly prolonged PFS (HR 0.64, 95% CI 0.55–0.74, p

2002^ Background: Until recently the primary criteria for assessing response to GBM therapy were those by Macdonald et al. (JCO 1990;8:1277–80). Advances in imaging technology/targeted therapies exposed limitations, addressed in 2010 by Response Assessment in Neuro-Oncology Working Group. Prior to this, the AVAglio study similarly adapted Macdonald criteria to address anti-angiogenic therapy/corticosteroid use by incorporating non-contrast-enhancing components and integrating a strict algorithm to standardize assessment of possible PsPD. Methods: Randomisedpts (n=921) received: T/RT + Bv or placebo (P), 6 wks; 28-d break; maintenance T + Bv or P (6 cycles); monotherapy Bv or P until PD/unacceptable toxicity. Tumor response was investigator (inv)-assessed by MRI (adapted Macdonald criteria) at baseline (BL), end of break, every 2nd maintenance cycle, every 9 wks during monotherapy, at PD and 9 wks post-PD. PsPD was inv-assessed at the end of the break. A ≥25% increase in index lesions and/or unequivocal progression of existing non-index lesions relative to BL and in the absence of clinical deterioration was assessed as PsPD. Confirmatory PsPD assessment: end of the 2nd maintenance cycle. If progression was confirmed, PsPD was retrospectively designated as PD. If PsPD was confirmed, pts remained on treatment and the 1st post-RT MRI was used as a new BL. Best ORR was evaluated in pts with lesions at BL, excluding pts with confirmed PsPD. Results: Co-primary endpoint of inv-assessed PFS was longer for pts receiving Bv+RT/T compared with P+RT/T (HR 0.64, 95% CI 0.55–0.74; p

2023^ Background: Bv plus 1st-line standard of care (SoC; T+RT) achieved a PFS benefit in the AVAglio phase III, randomized, double-blind, placebo [P]-controlled trial in patients (pts) with newly diagnosed GBM. AVAglio includes BM evaluation to identify pts benefiting most from Bv. Analysis of plasma VEGF-A and VEGFR-2 was prioritized based on encouraging findings in Bv trials in several tumor types. Methods: AVAglio includes an optional, exploratory correlative BM analysis; participating pts provided informed consent for BMs. Baseline (BL) plasma samples were analyzed using the Roche IMPACT platform, based on multiplex ELISA technology. Pts were dichotomized according to BM levels using either Q1, median or Q3 cut-offs. Potential interactions between BL BM levels and PFS were tested using Cox regression analyses. Results: Of 921 patients enrolled, 571 (62%) were evaluable in the BM study. Baseline characteristics and PFS outcome were comparable in the ITT and BM-evaluable populations. Median BL VEGF-A and VEGFR-2 levels were 77.0 pg/mL and 12.6 ng/mL, respectively. No significant interaction for PFS was seen at α=0.025. Conclusions: The potential predictive (VEGF-A, VEGFR-2) and prognostic (VEGF-A) value seen in breast, pancreatic and gastric cancers was not apparent in BL BM samples from AVAglio using a median, Q1 or Q3 cut-off. Additional plasma and tumor BM analyses are ongoing. Clinical trial information: NCT00943826. [Table: see text]

TPS9596 Background: Despite therapeutic advances, outcomes in pediatric HGG remain poor. The phase I study (Glade-Bender et al., J Clin Oncol. 2008) indicated that Bv is well tolerated in children with refractory solid tumors and yielded pharmacokinetic (PK) data that support further studies of Bv in childhood cancer. Reports of Bv used in children with solid tumors showed safety profiles consistent with data from adults. Methods: 120 evaluable patients aged 3-18 years with newly diagnosed histologically confirmed WHO grade 3or 4 HGG are randomized to receive standard combined modality therapy as currently adopted worldwide by the pediatric neuro-oncology community with or without Bv. Treatment consists of 6 weeks of concomitant TMZ and local radiotherapy, followed by a 4-week TMZ treatment break and 48 weeks of adjuvant TMZ with or without Bv every other week. Primary endpoint is event-free survival (EFS). Progression is based on RANO criteria. Secondary endpoints are overall survival (OS), safety, feasibility, and tolerability. PK sampling is performed during cycles 1-4 of the adjuvant TMZ phase on all patients randomized to receive Bv. Health-related quality of life, neurocognitive functions, MGMT methylation status, functional changes in tumor based on magnetic resonance diffusion & perfusion imaging and spectroscopy are explored as well as the correlation of biomarkers with clinical activity and adverse events. All randomized patients will be followed for at least 3 years. Analysis of EFS and secondary endpoints will be performed after the 120 patients evaluable for EFS have been followed for 1 year. Multimodal imaging will provide a platform to develop new imaging criteria for pediatric neuro-oncological treatment response. An updated OS and safety analysis will be performed 3 years after the last patient has been randomized. The first patient was randomized in October 2011; completion of the study is expected in 2016.

10060 Background: Sarcoma of the mediastinum and great vessels remain a rare subgroup of soft tissue sarcoma and prognosis remains poor with patients (pts) often presenting with advanced disease. There is no standard treatment due to paucity of data hence its management relies on case series. To date this is the largest series of pts reported. Methods: Retrospective analysis of pts identified anonymously from a prospectively maintained database of the sarcoma unit. Results: 46 pts were included in the analysis. The median age at diagnosis was 45.9 with a male: female ratio of 1.2: 1. 60% of pts presented with localised disease. The most common histological subtype was spindle cell sarcoma followed by angiosarcoma. The heart (n=21), majority in the atria, was the commonest primary site. 28 pts presented with localised disease of which 21 had surgery and 16 received chemotherapy (CT). 4 pts received multi-modality treatment. 83% of pts with metastases had CT. 6 of them attained stable disease, 1 had partial response and 4 (Ewing’s, rhabdomyosarcoma and angiosarcoma) had complete response. 31 pts developed disease recurrence of which 58% had initial localised disease. 6 pts had metastectomy, 19 received palliative CT and 11 had palliative radiotherapy (RT). RT of 50-60Gy to the heart or mediastinum was delivered to 61% of pts with initial localized disease and 33% of pts with metastases. 2 pts had documented post-treatment cardiac complication. After a median follow up of 2.16 years, the median event-free survival was 0.97 years (95%CI 0.65-1.30), median overall survival (OS) was 1.7 years (95% CI 0.70-2.71) and 5 year OS was 17.9%. Conclusions: The optimal management in this disease is unclear. In this study, surgery was frequently implemented in both localised and metastatic settings but challenges remain in achieving clear margins. Chemotherapy has a role and it is key to identify chemosensitive subtypes. RT is offered as an adjunct following suboptimal resection. Despite aggressive treatments, this group of young pts had high recurrence rate and poor prognosis. Multi-modality treatment may have a role in selected pts but its efficacy and long-term cardiac sequelae need to be evaluated prospectively.

Between March 1973 and August 2003, 747 patients (M: 430, F:317; median age: 29yr, range:1–65) who survived for at least 1 yr. post stem cell transplant and were 15 to 65 years of age (median: 38, range:15–71) at the time of last follow-up (LFU) were analysed to study the incidence and outcome of pregnancies. At the time of transplantation, 138 patients were pre-pubertal (M: 79, F: 59, p=0.8). Transplants were allogeneic (n=429, median age: 28yr), autologous (n=304, median age: 32) or syngeneic (n=14, median age: 37) and were performed for Ac. Leukaemia (n=583), Chr. Leukaemia (n=82) or other diseases (n=82). Patients with Myeloma who received Autograft were not included. Conditioning included TBI in 561 patients using either single fraction (n=478) or a fractionated schedule (n=83) and 168 patients also received cranial radiation. Stem cell source was marrow (n=573), PBSC (n=166) or both (n=8). GVHD prophylaxis was CyA alone (n=188), CyA with another agent (n=227) or other measures (n=14). 79 patients received more than one transplant. The probability of overall survival in this group of patients was 65% at 10yr. Median follow-up was 7 yr. (range: 1–33). Twenty seven patients (10 females and 17 partners of male patients) had 41 pregnancies and sired 45 children, including 4 twin pregnancies. The probability of conception was 4% at 10yr. Pregnancies occurred in 17/429 allografts (3.96%; 6/186 females; 11/243 males), 8/304 autograft patients (2.63%; 4/123 females, 4/181 males) and 2/14 syngeneic transplants (14.3%; 0/8 females, 2/6 males). Amongst 10 female patients 3 had assisted conception and 7 had natural pregnancy. Amongst 17 partners of male patients, 5 had assisted conception, 11 had natural conception and 1 had assisted conception followed by natural pregnancy. In uni-variate analysis chances of becoming pregnant were higher with age> 15yr. at transplant (5% vs. 1% at 10 yr., p15 yr. (RR: 11.6, 95% CI: 1.6–86.3, p=0.02) and age of 20–45 at LFU (RR: 5.53, 95% CI: 1.9–16.1, p=0.002) were independently associated with higher chances of conception. Two pregnancies resulted in miscarriages leading to 3 foetal deaths (2/42, 5%; 3/45, 7%). Four babies were born prematurely and required admission to neonatal unit and 2 died after 6 weeks. None had congenital malformations. Currently, 40 children are alive and well; 26 after natural conception and 14 after assisted fertilization. In conclusion, even though the chances of conception are lower in patients undergoing transplant, especially after TBI conditioning, pregnancy outcomes following natural and assisted conception are likely to be similar in terms of chances of successful outcome.

From August 1973 to December 2003, 1651 patients (median age: 28yr., range: 1–74 yr.; M: 982, F: 669) received stem cell transplants for haematological malignancies (Ac. Leuk: 1246, Chr. Leuk: 182, other: 223). Donor was allogeneic (n=1088), autologous (n=537) or syngeneic (n=26) and conditioning was with (n=1243) or without TBI (n=408). Primary disease was classed as high risk in 714 and low risk in 937 patients. Dose of TBI was ≤9.5 Gy (n=342), 10.5 Gy (n=613) or ≥ 10.5 Gy (n=282) delivered in single fraction (n=1015) or multiple fractions (n=222). Donor was sibling (n=900), matched unrelated (n=135) or mismatched family member (n=53). Cranial top-up radiation was used in 357 patients. Source of stem cell was marrow (n=1312), PBSC (n=320) or both (n=19). GVH prophylaxis was CyA alone (n=527), CyA with other agent (n=516) or other measures (n=45). Of all the patients 1515 received single transplant but 136 received more than one transplant. Data was analysed as of 01/07/2006. Of all the patients 897 (54.3%) survived for at least 1 yr. post transplant and the median follow-up in this group was 27yr. Second cancers developed in 50 cases with the incidence of 2.6% at 5yr (95% CI: 1.3–3.9), 7.5% at 10 yr (95% CI: 4.9–10.1) and 11.5% at 15yr (95%CI: 7.6–15.4). Site of second malignancy was brain (n=10), breast (n=6), cervix (n=3), GIT (n=2), lung (n=1), skin (n=9), sarcoma (n=3), thyroid (n=1), oral cavity (n=4), MDS (n=6), CML (n=1), ovary (n=1) and non EBV related lymphoma (n=3). In univariate analysis 10 yr. probability of developing SMN was significantly higher with chronic GVHD (5% vs. 10%, p=0.008, high risk disease (5% vs. 11%, p=0.0007), cranial RT (4% vs. 18%, p=0.015) and ALL as primary diagnosis (4% vs. 10%, p=0.06). In multi-variate analysis advanced stage disease (RR: 2.4, 95% CI: 1.3–4.2, p=0.004), Chr. GVHD (RR: 2.5, 95% CI: 1.4–4.4, p=0.003) and cranial RT (RR: 2.3, 95% CI: 1.2–4.4, p=0.01) were independently associated with increased risk of SMN. There was strong interdependence between cranial RT and ALL as primary diagnosis. It was noted that the multi-variate risk factors were different for site specific SMNs. For brain tumours cranial RT (RR: 12.8, 95% CI:2–75.5, p=0.006) and age

Diffuse intrinsic pontine glioma (DIPG) has a dismal prognosis with no chemotherapy regimen so far resulting in any significant improvement over standard radiotherapy. In this trial, a prolonged regimen (21/28 d) of temozolomide was studied with the aim of overcoming O6-methylguanine methyltransferase (MGMT) mediated resistance. Forty-three patients with a defined clinico-radiological diagnosis of DIPG received radiotherapy and concomitant temozolomide (75 mg/m2) after which up to 12 courses of 21 d of adjuvant temozolomide (75–100 mg/m2) were given 4 weekly. The trial used a 2-stage design and passed interim analysis. At diagnosis median age was 8 years (2–20 years), 81% had cranial nerve abnormalities, 76% ataxia and 57% long tract signs. Median Karnofsky/Lansky score was 80 (10–100). Patients received a median of three courses of adjuvant temozolomide, five received all 12 courses and seven did not start adjuvant treatment. Three patients were withdrawn from study treatment due to haematological toxicity and 10 had a dose reduction. No other significant toxicity related to temozolomide was noted. Overall survival (OS) (95% confidence interval (CI)) was 56% (40%, 69%) at 9 months, 35% (21%, 49%) at 1 year and 17% (7%, 30%) at 2 years. Median survival was 9.5 months (range 7.5–11.4 months). There were five 2-year survivors with a median age of 13.6 years at diagnosis. This trial demonstrated no survival benefit of the addition of dose dense temozolomide, to standard radiotherapy in children with classical DIPG. However, a subgroup of adolescent DIPG patients did have a prolonged survival, which needs further exploration.

AimsCancer remains a leading cause of death in children and adolescents in the developed world. Despite advances in oncological management, rates of primary treatment failure remain significant. Radiation of recurrent or metastatic disease improves survival in adults but there is little data to support clinical decision making in the paediatric/teenage and young adult population.Materials and methodsWe present a retrospective case series of 14 patients treated with stereotactic ablative body radiotherapy or stereotactic radiosurgery at The Royal Marsden Hospital from September 2011 to December 2015. Eligible patients were aged ResultsData for 14 patients with 18 treated lesions were included. The median patient age was 15 years (range 5–20 years). Nine patients were treated for local recurrence and five for metastatic lesions. All patients had already undergone multiple previous treatments. Eleven patients had undergone previous radiotherapy. The median interval between the completion of initial radiotherapy and reirradiation was 29.0 months (range 0.2–49.5 months). The median follow-up was 3.4 years (range 0.28–6.4 years). The 1-year local control rate was 78.6% and the 2-year local control rate was 57.1%. Overall median survival was 58.4 months (95% confidence interval 33.8–82.9 months). Cumulative biologically effective doses (BED) over 200 Gy were associated with late toxicity (P = 0.04).ConclusionRadical doses of short-course hypofractionated radiotherapy can achieve excellent local control and may contribute to the prolongation of overall survival. There is a need for prospective trials exploring the use of ablative radiotherapy in metastatic disease in paediatric/teenage and young adult patients in order to establish safe and effective treatment schedules.