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ZusammenfassungDie 2020 veröffentlichten Ergebnisse der PET-Plan-Studie haben zum ersten Mal randomisiert kontrolliert eine Nichtunterlegenheit einer FDG-PET basierten involved-field-Bestrahlung beim lokal fortgeschrittenen nicht-kleinzelligen Lungenkarzinom im Vergleich zur elektiven Lymphabflussbestrahlung gezeigt. In Kombination mit einer isotoxischen Dosiseskalation resultieren daraus eindrucksvoll geringe Lokalrezidivraten. Die aus der Studie abgeleiteten technischen Voraussetzungen der Bestrahlungsplanung erfordern ein Qualitätsniveau, dessen Umsetzung beim Lungenkarzinom angestrebt werden sollte und in Zukunft ein Vorbild für die Therapie bei anderen soliden Tumoren sein kann.

Introduction: Tumours with chest wall invasion form a distinct sub-entity in the heterogeneuous group of locally advanced NSCLC. Despite some available evidence, the best sequence of recommended multimodal therapeutic approaches continues to be subjet of clinical research in view of the improved possibilities of radiation and systemic therapies. Material and Methods: In our mono-centric, retrospective observational study, all NSCLC pts. with chest wall infiltration or pancoast tumour (N0-2, M0), diagnosed between 01/2009 and 12/2013, were analyzed using our hospital information system and cancer registry. Clinical, radiological, tumour biological, therapeutic and follow-up data were recorded for this study. Results: In the 5 year period, 81 pts. were detected with chest wall invasion and pancoast in 72 and 9 pts., respectively. Mean age was 66.4 yrs. (45.7-84,7 yrs.). Histology was dominated by squamous cell (53.1%) and adenocarcinoma (32.1%), followed by large cell carc. (6.2%). Theraputic regimes were: 1. neoadjuvant Tx.+resection (22 pts., 27.2%), 2. planned neoadj. Tx. with change to definite chemoradiotherapy due to progression (13. pts., 16.0%), 3. resection+adjuv. Tx (25 pts., 30.8%), 4. primary definite chemoradiotherapy (19 pts., 23.5%) and 5. best-supportive care only (2 pts., 2.5%). Best median 5-year overall survival was seen in the cohort with neoadjuvant Tx.+resection (11.6-153.4 months) (fig. 1). Discussion: Our retrospective data underline the prognostic significance of neoadjuvant tx followed by resection as treatment regimen in NSCLC with chest wall invasion. However, patient and tumour characteristics havinfluence the choice of treatment.

Chemoradiation is one of the therapeutic options in palliative treatment of locally advanced pancreatic adenocarcinoma, with a well-known safety profile. In this case report, we describe the treatment-related occurrence of an intrasplenic pancreatic pseudocyst which was successfully removed by gastrocystic drainage. This rare complication should be considered in the follow-up and clinical management of patients, particularly if left-sided complaints occur.

Background Treatment modalities in iris melanoma include excision, plaque radiotherapy, photon or proton beam therapy and enucleation. In extensive tumours and diffuse seeding, radiotherapy remains as an alternative to enucleation. Methods This study is a retrospective, consecutive, interventional, single-institutional case series. 54 patients with a diffuse and non-resectable iris melanoma diagnosed from September 1998 to June 2012 were included. A 68-megaelectron volt proton beam was used to treat the anterior segment with a total dose of 4×12.5 cobalt grey equivalent. The cases were evaluated for local tumour control, eye retention, functional outcome and local complications after treatment. Results During a mean follow-up of 62.7 months (median 54.8 months, range 5.5–159.6 months), local tumour control was achieved in 96.3% of the patients. Cataract and glaucoma were the main complications developing after irradiation in 42.6% and 55.6%, respectively. In 34 of 44 patients (77.3%) who underwent cataract removal, a visual acuity of 20/40 or better following surgery was preserved. Enucleation was performed in three patients. The reason was suspected tumour recurrence in one and glaucoma in two. Hepatic metastasis occurred in one patient. Conclusions As an alternative to enucleation, whole anterior segment fractionated proton beam radiotherapy offered excellent local tumour control in diffuse iris melanoma. Given the limited alternatives, the rate of complications appears acceptable and visual function could be preserved in the majority of the patients during follow-up.

A biochemical recurrence following prostatectomy is often diagnosed in relatively young and healthy men, and hence deemed very relevant concerning life, given the generally high life expectancy of these patients. Therefore, there is a need for a therapy that offers a long-term chance of cure. Following salvage radiotherapy in large multicenter series, about 45% of the patients treated are in biochemical complete remission 4 years after radiotherapy. The best chances of response are in those patients in whom none of the established risk factors, that will be discussed, are present. Given the established curative potential of salvage radiotherapy and the fact that there are no therapeutic alternatives with a realistic chance of cure, the rather moderate rates of side effects seem acceptable.

Prostate cancer progression is commonly manifested by obstructive uropathy, regional lymphatic metastases and hematogenous metastases to the axial skeleton. Radiotherapy is a mainstay in the palliation of symptomatic metastatic prostate cancer and is most often used for the palliation of painful metastatic bone lesions, resulting in a relief of pain in about 80-90% of patients and a reduction of analgesics. In metastatic disease compromising the integrity of the spinal cord or a nerve root, radiotherapy can be used as an urgent intervention to minimize neurological dysfunction and local progression or as an adjunct to surgical decompression. Local progression is often associated with hematuria, ureteric obstruction and perineal discomfort. Symptoms of metastatic lymphadenopathy like leg edema and back discomfort caused by pelvic or paraaortic metastases are related to the immediate anatomic structures affected. Radiotherapy for localized hormone-refractory prostate cancer has an excellent local control rate; nevertheless, the prognosis is poor, the majority of patients failing with distant metastasis within few years. The role of radiotherapy in hormone-refractory and metastatic prostate cancer, considering the patient's individual situation, are presented and discussed.

A biochemical recurrence following prostatectomy is often diagnosed in relatively young and healthy men, and hence deemed very relevant concerning life, given the generally high life expectancy of the

153 Background: Biochemical recurrence (BCR) after radical prostatectomy (RP) is usually defined at a PSA >0.2 ng/ml. BCR may precede clinical progression by years. Though salvage radiotherapy (SRT) is recommend to be initiated at PSA 0.2 ng/ml) within a median time of 7 months. Subsequent PSA rise to >0.3, >0.4, and >0.6 ng/ml was recorded in 174 (58%), 123 (41%), and 24 (8%) men, respectively. Twenty-four (8%) men developed metastases. In cohort 2, 112 men received SRT at PSA between 0.03 and 0.2 ng/ml, and 86 at 0.2-0.499 ng/ml. The latter group, had a poorer 10-years BCR-free Kaplan-Meier rate, 43% vs. 66% (p=0.051). Together with pT0.1 ng/ml after RP will subsequently progress to PSA >0.2 ng/ml. Improved progression free survival can be achieved, if SRT is administered at a PSA