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Abstract Background We aimed to assess whether gross tumor volume (GTV) determined by fusion of contrast-enhanced computerized tomography (CT) and 18F-fluoro-deoxy-D-glucose positron emission tomography-CT (FDG-PET-CT) based radiotherapy planning could predict outcomes, namely overall survival (OS), local-regional progression-free survival (LRPFS), and progression-free survival (PFS) in cases with locally advanced pancreas cancer (LAPC) treated with definitive concurrent chemoradiotherapy. Methods A total of 30 patients with histological proof of LAPC underwent 50.4 Gy (1.8 Gy/28 fractions) of radiotherapy concurrent with continuously infused 5-FU followed by 4 to 6 courses of maintenance gemcitabine. Target volume delineations were performed on FDG-PET-CT-based RTP. Patients were stratified into 2 groups: GTV lesser (GTVL) versus greater (GTVG) than cut off value determined by receiver operating characteristic (ROC) analysis, and compared in terms of OS, LRPFS and PFS. Results Median GTV delineated according to the FDG-PET-CT data was 100.0 cm3. Cut off GTV value determined from ROC curves was 91.1 cm3. At a median follow up of 11.2 months, median OS, LRPFS and PFS for the entire population were 10.3, 7.8 and 5.7 months, respectively. Median OS, LRPFS and PFS for GTVL and GTVG cohorts were 16.3 vs. 9.5 (p = 0.005), 11.0 vs. 6.0 (p = 0.013), and 9.0 vs. 4.8 months (p = 0.008), respectively. Conclusions The superior OS, LRPFS and PFS observed in GTVL patients over GTVG ones suggests a potential for FDG-PET-CT-defined GTV size in predicting outcomes of LAPC patients treated with definitive C-CRT, which needs to be validated by further studies with larger cohorts.

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 <51 [N = 49]) revealed that PNI < 51 group had significantly shorter median CSS (P <.001), OS (P <.001), DMFS (P <.001), and PFS (P <.001) times than the PNI ≥ 51 group, and the multivariate results confirmed the PNI < 51 as an independent predictor of poor outcomes for each end point (P <.05 for each). The unfavorable impact of the low PNI was also continued at 10-year time point with survival rates of 77.9% versus 42.4%, 73.6% versus 33.9%, 57.9% versus 27.1%, and 52.6% versus 23.7% for CSS, OS, DMFS, and PFS, respectively. Additionally, we found that PNI < 51 was significantly associated with higher rates of weight loss >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. [ABSTRACT FROM AUTHOR]

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]

Purpose: The aim of this study was to evaluate the outcomes of 68Ga prostate-specific membrane antigen (68Ga-PSMA) positron-emission tomography (PET)/CT-based metastasis-directed treatment (MDT) for oligometastatic prostate cancer (PC). Methods: In this multi-institutional study, clinical data of 176 PC patients with 353 lesions receiving MDT between 2014 and 2019 were retrospectively evaluated. All patients had biopsy proven PC with ≤5 metastases detected with 68Ga-PSMA-PET/CT. MDT was delivered with conventional fractionation or stereotactic body radiotherapy (SBRT) techniques. CTCAE v4.0 was used for acute and RTOG/EORTC Late Radiation Morbidity Scoring Schema was used for late toxicity evaluation. Results: At the time of MDT, 59 patients (33.5%) had synchronous and 117 patients (66.5%) had metachronous metastases. Median number of metastases was one and the MDT technique was SBRT in 73.3% patients. The 2‑year overall survival (OS) and progression-free survival (PFS) rates were 87.6% and 63.1%, respectively. With a median follow-up of 22.9 months, 9 patients had local recurrence at the irradiated site. The 2‑year local control rate at the treated oligometastatic site per patient was 93.2%. In multivariate analysis, an increased number of oligometastases and untreated primary PC were negative predictors for OS; advanced clinical tumor stage, untreated primary PC, BED3 value of ≤108 Gy, and MDT with conventional fractionation were negative predictors for PFS. No patient experienced grade ≥3 acute toxicity, but one patient had a late grade 3 toxicity of compression fracture after spinal SBRT. Conclusion: 68Ga-PSMA-PET/CT-based MDT is an efficient and safe treatment for oligometastatic PC patients. Proper patient selection might improve treatment outcomes. [ABSTRACT FROM AUTHOR]

This article discusses a study on the prevalence and treatment of difficult tracheal intubations (DTI) in patients with nasopharyngeal cancer (NPC) who have undergone radiation therapy. The authors analyzed the airways of 150 patients and found that 28% of the procedures were classified as DTI. The study identified simultaneous cervical mobility restriction and trismus as factors that significantly increased the incidence of DTI. Ethnicity was also found to be a significant predictor, with non-White individuals having a higher likelihood of experiencing DTI. The authors concluded that the incidence of DTI is higher in patients with irradiated NPC compared to the general surgical population, and that standard preoperative airway measures are inadequate for predicting DTI. The article also raises concerns about the lack of information on pre-radiation therapy mouth opening capacity, which could have influenced the incidence of DTI. The authors suggest that assessing mouth opening capacity before treatment could be a useful predictive tool for determining the rates of radiation-induced trismus and the probability of DTI. [Extracted from the article]

The influence of antibiotic administration on the outcomes of head-and-neck squamous cell carcinoma patients undergoing definitive (chemo)radiation. Letter to the Editor regarding "The influence of antibiotic administration on the outcomes of head-and-neck squamous cell carcinoma patients undergoing definitive (chemo)radiation" by Rühle et al Dear Editor, We found Rühle et al.'s analysis of antibiotic use before and during definitive (chemo)radiation for head-and-neck squamous cell carcinoma (HNSCC) and its impact on oncologic outcomes to be fascinating and appreciative [[1]]. [Extracted from the article]

Based on these findings, the authors concluded that their review confirms that patients undergoing PT for oral and/or oropharyngeal cancer had sustained treatment outcomes with a vastly better acute toxicity profile. Second, although the ORNJ has been presented as one of the acute PT toxicities by Sethi et al.,[1] it is typically a late-onset complication of RT since it usually manifests after 6-months of RT in the absence of predisposing risk factors like previous mandibular surgery. First, RT-associated toxicity is classified according to time following treatment: acute toxicity occurs during or within 6 weeks to 3 months of therapy completion; early-delayed (subacute) toxicity appears up to 6 months after treatment completion; and late effects are present at least 6 months after therapy completion. [Extracted from the article]

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 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, 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. [ABSTRACT FROM AUTHOR]

Abstract: Adult survivors of childhood cancers are more prone to developing poor reproductive and obstetrical outcomes than their siblings and the general population as a result of previous exposure to chemotherapy and radiation during childhood. Chemotherapy drugs exert cytotoxic effects systemically and therefore can damage the ovaries, leading to infertility, premature ovarian failure, and, to a lesser extent, spontaneous abortions. They have very limited or no deleterious effects on the uterus that can be recognized clinically. By contrast, radiation is detrimental to both the ovaries and the uterus, thereby causing a greater magnitude of adverse effects on the female reproductive function. These include infertility, premature ovarian failure, miscarriage, fetal growth restrictions, perinatal deaths, preterm births, delivery of small‐for‐gestational‐age infants, preeclampsia, and abnormal placentation. Regrettably, the majority of these adverse outcomes arise from radiation‐induced uterine injury and are reported at higher incidence in the adult survivors of childhood cancers who were exposed to uterine radiation during childhood in the form of pelvic, spinal, or total‐body irradiation. Recent findings of long‐term follow‐up studies evaluating reproductive performance of female survivors provided some reassurance to female cancer survivors by documenting that pregnancy and live birth rates were not significantly compromised in survivors, including those who had been treated with alkylating agents and had not received pelvic, cranial, and total‐body irradiation. We aimed in this narrative review article to provide an update on the impact of chemotherapy and radiation on the ovarian and uterine function in female survivors of childhood cancer. Implications for Practice: Adult survivors of childhood cancers are more prone to developing a number of poor reproductive and obstetrical outcomes than their siblings and the general population as a result of previous exposure to chemotherapy and radiation during childhood. The impact of radiation therapy on the female genital system is greater than chemotherapy regimens because radiation is detrimental to both the uterus and the ovaries, whereas toxic effects of chemotherapy drugs are confined to the ovaries. Therefore, radiation‐induced uterine damage accounts for most poor obstetrical outcomes in the survivors. These include infertility, miscarriages, stillbirths, fetal growth restrictions, preeclampsia, and preterm deliveries. [ABSTRACT FROM AUTHOR]