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Background: Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is an aggressive lymphoma variant. Anthracycline-based chemotherapy with rituximab is recommended as first-line treatment. Radiotherapy (RT) has been considered as a therapeutic option for local disease control in patients with solitary or localized lesions. Methods: We report the results of a retrospective analysis of PCDLBC, LT patients treated either with RT alone or with physician’s decision as first-line treatment, aiming to assess disease progression and/or first recurrence in these treatment groups. Results: We retrospectively analyzed 20 patients treated either with RT alone (n = 8) or with investigator’s choice treatment (n = 12), which included chemotherapy alone or combined with local therapy (RT and wide local excision). Complete response (CR) was achieved in 8 patients from the first group and 9 patients from the second group, with 1 treatment failure. Six patients treated with RT alone progressed with a median time to progression (TTP) of 12.5 months. In the second group, 5 patients progressed with a median TTP of 5.2 months. RT showed good local disease control in both groups without any skin relapses during the follow-up period. Conclusion: RT as first-line monotherapy followed by watchful waiting did not significantly improve the overall risk of disease progression but resulted in good local disease control. After progression, RT could still easily be combined with systemic treatment. The strength of this analysis needs to be evaluated in a larger patient cohort.

Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors—such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis—influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.

Bone sarcomas (BS) are rare mesenchymal tumors usually located in the extremities and pelvis. While surgical resection is the cornerstone of curative treatment, some locally advanced tumors are deemed unresectable and hence not suitable for curative intent. This is often true for pelvic sarcoma due to anatomic complexity and proximity to vital structures, making treatment options for these tumors generally limited and not unanimous, with decisions being made on an individual basis after multidisciplinary discussion. Several studies have been published in recent years focusing on innovative treatment options for patients with locally advanced sarcoma not amenable to local surgery. The present article reviews the evidence regarding the treatment of patients with locally advanced and unresectable pelvic BS, with the goal of providing an overview of treatment options for the main BS histologic subtypes involving this anatomic area and exploring future therapeutic perspectives. The management of unresectable localized pelvic BS represents a major challenge and is hampered by the lack of comprehensive and standardized guidelines. As such, the optimal treatment needs to be individually tailored, weighing a panoply of patient- and tumor-related factors. Despite the bright prospects raised by novel therapeutic approaches, the role of each treatment option in the therapeutic armamentarium of these patients requires solid clinical evidence before becoming fully established.

Background: Glioblastoma (GBM) is the most common primary CNS tumor in adults. Between 65-70 years of age, treatment involves the best possible surgical removal followed by radiotherapy (RT), with or without temozolomide (TMZ). After assessing whether patients can tolerate TMZ, doubts regarding RT regimens persist in this age group. This study aimed to compare the overall survival (OS) in GBM patients aged 65-70 years, in two RT regimens with TMZ: Stupp (RT 60 Gy/30 fractions (fx)+TMZ) versus mini-Stupp (RT 40.05 Gy/15 fx+TMZ) and 2 regimens of RT without TMZ: 40 Gy/15 fx versus 25 Gy/5 fx.Methods: All GBM patients, 65-70 years, undergoing RT from 1 January 2014 to 31 December 2020 were retrieved and retrospectively evaluated. Patients were divided into 4 groups: group 1 was Stupp; group 2 was mini-Stupp; group 3 was 40,05 Gy/15 fx without TMZ; and group4 was 25 Gy/5 fx without TMZ.Results: Sixty patients were retrieved with median follow up of 12 months. In the analysis of groups 1 and 2, all variables were comparable (0.21

Background: This study evaluates long-term survival outcomes of patients submitted to surgery (with or without neck dissection) and adjuvant radiotherapy for major salivary gland tumors, as well as prognostic factors affecting clinical outcomes.Methods: Retrospective analysis was performed on patients treated for major salivary gland tumors between 2006 and 2018. Kaplan-Meier curves for disease-free survival (DFS) and overall survival (OS) were calculated, Cox regression was used for uni- and multivariate analysis to assess prognostic factors. Log-rank tests were used to compare survival outcomes according to neck dissection status, stratified by stage and by histopathological risk.Results: 38 of 77 pts were eligible for analysis. Median follow-up was 63.1 months and median dose delivered was 66 Gy. The 2- and 5-years DFS rates were 79.2% and 72%, and the 2- and 5-years OS rates were 81.5% and 66.6%, respectively. Lymphovascular invasion and neck dissection were identified as possible prognostic factors for DFS and lymphovascular invasion, positive nodes, high histopathological risk and positive margins, for OS. There were no differences observed in DFS and OS curves for high histopathological risk patients according to neck dissection. A difference was found comparing DFS on stage III-IV patients (p=0.02), OS was not different.Conclusions: DFS and OS improvements were not observed in high-risk histology and III-IV stage disease due to study limitations, regardless of neck dissection status. Some of the results shown, although with no statistically significant differences, could reveal the potential of adjuvant radiotherapy in pts unable to perform neck dissection.

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0, Cervical cancer (CC) is one of the acquired immunodeficiency syndrome (AIDS) defining diseases and the human immunodeficiency virus (HIV) infection is thought to relate with increased acute toxicity of chemoradiotherapy (CRT). We investigated the effect of HIV status in the incidence of neutropenia associated with cisplatin-based CRT for CC and its impact in treatment completion. This is a single-center retrospective cohort study. Data collection was performed for all the consecutive stage Ib-IV CC women treated with cisplatin-based CRT from 2012 to 2016, and with known HIV status. Sixty-one patients were included, 6 were HIV+. HIV+ patients had a higher risk of neutropenia at any cycle during cisplatin CRT [adjusted odds ratio (OR) 7.3, 95% confidence interval (95% CI) 1.02–52.3; P = .05]. Despite the absolute differences, mean neutrophil count was nonsignificantly lower in HIV+ women, both at baseline [4455/μL (interquartile range, IQR: 1830–6689) vs 6340 (IQR: 1720–18,970) for HIV−, P = .98] and at the end of treatment [1752/μL (IQR: 1100–2930) vs 3147/μL (IQR: 920–18,390) in HIV−; P = .06]. Moreover, when considering the effect of time, CRT seems to induce a consistent drop of neutrophils in both groups (P = .229). No febrile neutropenia events occurred. In HIV+ women, there were more CT cycle delays (P = .013), patients were more prone to use granulocyte colony-stimulating factor (G-CSF; HIV+ 40.0% vs HIV− 4.0%; P = .04) and less likely to complete at least 5 cycles of cisplatin (P = .02). All patients received adequate dose of pelvic RT, regardless of HIV status. HIV+ patients have a significantly increased risk of neutropenia during CRT treatment for CC and are less likely to complete chemotherapy with cisplatin.

Hemorrhagic gastritis is a possible late toxicity outcome after radical radiotherapy but it is nowadays a very rare condition and most likely depends on other clinical factors. We report the case of a 77-year-old woman with a symptomatic solitary extramedullary intra-abdominal plasmacytoma and multiple gastric comorbidities, treated with external beam radiotherapy. Despite the good response to radiotherapy, the patient experienced multiple gastric bleeding a few months later, with the need of multiple treatments for its control. In this paper we will discuss in detail all aspects related to the different causes of hemorrhagic gastritis.

PURPOSE: To report the experience and the outcomes of interstitial high-dose-rate (HDR) brachytherapy (BT) of eyelid skin cancer at the Department of Radiotherapy of Hospital de Santa Maria in Lisbon. METHODS AND MATERIALS: Seventeen patients (pts; mean age, 73.75 years) who underwent eyelid interstitial HDR BT with an 192 Ir source between January 2011 and February 2013 were analyzed. Lesions were basal (94%) and squamous (6%) cell carcinomas, on lower (88%) or upper (6%) eyelids, and on inner canthus (6%). T-stage was Tis (6%), T1 (46%), T2 (36%), and T3a (12%). The purpose of BT was radical (12%), adjuvant to surgery (71%), or salvage after surgery (18%). The BT implant and treatment planning were based on the Stepping Source Dosimetry Sys- tem. The median total dose was 42.75 Gy (range, 32e50 Gy), with a median of 10 fractions (range, 9e11 fractions), twice daily, 6 h apart. The median V100 was 2.38 cm 3 (range, 0.83e5.59 cm 3 ), and the median V150 was 1.05 cm 3 (range, 0.24e3.12 cm 3 ). RESULTS: At a median followup of 40 months (range, 7e43 months), the local control was 94.1%. There was one local recurrence and one non-related death. The BT was well tolerated. Ma- darosis was the most common late effect (65% of pts) and was related with higher values of V100 (p 5 0.027). Cosmetic outcomes were good and excellent in 70% of pts. CONCLUSIONS: Interstitial HDR BT is a feasible and safe technique for eyelid skin cancers, with good local control. Recurrent lesions and higher volumes receiving the prescribed dose were associated with worse outcomes. 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Materials and Methods: A retrospective review was made to 17 patients (pts) treated in our department from March 2010 to October 2013 (9 males, 8 females). All pts had squamous cell carcinoma expect for 1 patient with upper lip which was a basal cell carcinoma.Tumor location was reported as: lower lip (n=6), upper lip (n=1), oral tongue(n=8), and oral mucosa (n=2). Tumor staging was report as: I (n=7), II (n=7),III (n=1) and IVA (n=2). Median age was 61.8 ± 14.2 years (range: 40-87). Implantation of Confort® tubes was done on the department’s bunker with local anestehesia (lip, oral mucosa) or at the operating room with general anesthesia (tongue) for optimal procedure. CT acquisition with a section thickness of 3 mm was obtained after implant. All treatment plans were optimized accordingly before after loading with Iridium-192 sources from microSelectron®-HDR treatment unit. BT was employed as follows: monotherapy in 4 pts, boost after external beam in 4pts, salvage in 5 pts and adjuvant after surgery in 4 pts. The mean tota lprescription was 45 ± 10.93 Gy (range: 18-48) with median of 9 fractions (range6-12). Mean values for V100 was 13.22 ± 7.92 cc (range: 4.33-30.22),V150 5.52 ± 2.55 cc (range: 1.98-9.84), V200 3.62 ± 3.10cc (range: 1,01-10).

Purpose/Objective: Radical cystectomy is currently the treatment of choice in muscle-invasive bladder cancer. However, cystectomy is associated with considerable morbidity such as urine leakage, erectile dysfunction, and urinary infection. Bladder sparing treatment consists of transurethral resection of the tumor (with or without partial cystectomy), external beam radiotherapy, and brachytherapy. Patients selected for this procedure have a solitary bladder tumor (T1-T3) of 5 cm or less. The purpose of this study is to compare both treatment modalities by a systematic review.