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Introduction: Chordoma is a malignant neoplasm that arises from notochord remnants. Its incidence is highest above the age of 50 and behaves as a locally aggressive tumor with a slow growth rate. In most cases, complete surgical resection followed by radiotherapy offers the best chance of control. Developing metachronous tumors or distant metastasis is uncommon. Case Report: A 56-year-old male patient of sacral chordoma was treated by surgery and radiotherapy. He developed later bilateral inguinal lymph node metastasis and metachronous clivus chordoma. Conclusion: Chordomas are rare. Multiplicity of primary disease and distant metastasis could happen, so regular follow-up is warranted and more effective therapeutic modalities are needed. Keywords: Chordoma, sacrococcygeal tumors, notochord tumors, lymph node metastasis, clivus tumors.

Background: Hypofractionated whole breast radiotherapy (HFWBRT) showed comparable efficacy and safety to conventional fractionated radiotherapy. Dose and fractionation of the tumor bed boost to be integrated during HF-WBRT schedules is still to be determined. Aim: to investigate the clinical feasibility of HF-WBRT with simultaneous integrated boost (SIB), in early breast cancer patients who underwent breast conserving surgery (BCS). Methods: This single arm prospective study included 40 female patients with pathologically proven stage I-II breast cancer following BCS with high risk factors. Patients received 3D conformal radiotherapy (3DCRT) with field in field (FIF) technique. The whole breast received a dose of 40 gray (Gy) over 15 fractions for 3 weeks with an additional SIB dose of 8 Gy over 15 fractions to be give daily during WBRT. Radiation toxicities were graded using the common terminology criteria for adverse events (NCI-CTCAE) scale version 4.03. Cosmetic outcome was assessed using Harvard cosmetic score. Kaplan Meier method was used to estimate the 3- year disease free (DFS) and overall survival (OS). Results: The median age at presentation was 48 years (range 33-68). No reported grade 3 or 4 toxicities. Grade 1 and 2 radiation dermatitis affected 80% of the patients, breast pain was observed in 62.5% of the patients while 25% had radiation pneumonitis. Most of the patients (95%) had excellent and good cosmetic outcomes. At 3 years the estimated DFS was 95% and OS was 97.5 %. Conclusion: WBRT-SIB using 3DCRT with FIF technique is clinically feasible for early stage breast cancer patients.

Highlights • 40 dose plans from the Skagen Trial 1 collected from Denmark, Belgium and Norway. • Atlas-based automated segmentation of each CT scan was obtained using MIM Maestro™. • DSC and difference in volume with manual segmentation were collected. • HI, V95 and V90% measured on the two different segmentations were compared. • Inter-observer variability was low and dose parameters were comparable., The effect of Atlas-based automated segmentation (ABAS) on dose volume histogram (DVH) parameters compared to manual segmentation (MS) in loco-regional radiotherapy (RT) of early breast cancer was investigated in patients included in the Skagen Trial 1. This analysis supports implementation of ABAS in clinical practice and multi-institutional trials.

Item does not contain fulltext BACKGROUND AND PURPOSE: To internally and externally validate an atlas based automated segmentation (ABAS) in loco-regional radiation therapy of breast cancer. MATERIALS AND METHODS: Structures of 60 patients delineated according to the ESTRO consensus guideline were included in four categorized multi-atlas libraries using MIM Maestro software. These libraries were used for auto-segmentation in two different patient groups (50 patients from the local institution and 40 patients from other institutions). Dice Similarity Coefficient, Average Hausdorff Distance, difference in volume and time were computed to compare ABAS before and after correction against a gold standard manual segmentation (MS). RESULTS: ABAS reduced the time of MS before and after correction by 93% and 32%, respectively. ABAS showed high agreement for lung, heart, breast and humeral head, moderate agreement for chest wall and axillary nodal levels and poor agreement for interpectoral, internal mammary nodal regions and LADCA. Correcting ABAS significantly improved all the results. External validation of ABAS showed comparable results. CONCLUSIONS: ABAS is a clinically useful tool for segmenting structures in breast cancer loco-regional radiation therapy in a multi-institutional setting. However, manual correction of some structures is important before clinical use. The ABAS is now available for routine clinical use in Danish patients.