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Several of the cancer immunotherapies under investigation or in clinical use target the programmed death-ligand 1/programmed death-1 (PD-L1/PD-1) signaling axis. PD-L1 expression in tumor samples has been used as a predictive marker for response to these therapeutics, and may also have independent prognostic utility when assessed along with immune cell markers. Our objectives were to assess the expression of PD-L1 in tumor specimens from a uniformly treated patient cohort with locally advanced cervical cancer, and to determine its prognostic significance along with the density of tumor-infiltrating T cells. We identified 120 patients with locally advanced cervical cancer treated with radical chemoradiotherapy, and built tissue microarrays from their formalin-fixed, paraffin-embedded pre-treatment biopsies. We used conventional brightfield and fluorescence immunohistochemistry to detect PD-L1, and quantified protein expression using both manual pathologist scoring and automated software analysis. We also evaluated the effect of PD-L1 expression in tumors, along with the presence and density of intra-tumoral CD8+ T cells, on patient survival outcomes. Approximately 96% of the tumor samples expressed PD-L1, as determined using quantitative software analysis. Neither expression of PD-L1 nor density of CD8+ T cells was associated with progression-free or overall survival. However, there was a trend towards worse progression-free survival in patients whose tumors expressed PD-L1 but lacked CD8+ T cells (hazard ratio=0.43 (0.18-1.01), P=0.053). Nevertheless, the high percentage of cervical cancer tumor samples expressing PD-L1 suggests that anti-PD-L1 or anti-PD-1 therapies are potential treatment options for this patient population.

Adjuvant radiotherapy (RT) is an important part of breast cancer management but the dose and fractionation schedules used are variable. A total of 50 Gy in 25 daily fractions delivered over 5 weeks is often considered the "standard" adjuvant RT prescription. Hypofractionated regimes such as 42.5 Gy in 16 daily fractions or 40 Gy in 15 daily fractions following breast-conserving surgery have proven to be equally effective and achieve similar or better cosmetic and normal tissue outcomes for both invasive and in situ diseases and when treating the regional nodes. Hypofractionation is more convenient for patients and less costly. However, certain patients at higher risk of RT late effects may benefit from a less intense, even more extended fractionation schedule. This review describes the indications for whole breast hypofractionated adjuvant RT for patients with breast cancer following breast-conserving surgery and proposes that hypofractionation should be the new "standard" for adjuvant breast cancer RT.

Purpose To describe the implementation of an MRI-CT–based cervical cancer brachytherapy (BT) program using existing infrastructure. To evaluate its impact on treatment planning. Methods and Materials A step-wise method was used to design and implement three-dimensional–based planning. Prospective risk analysis was used to create a process map and planning protocol. To evaluate the program, charts of cervical cancer patients treated curatively between January 2013 and December 2014, with at least one MRI during BT planning, were reviewed. Dosimetric comparisons were made between prescription point used and that of the traditional Point A and between MRI-planned treatments and CT-planned treatments. They were evaluated for differences between plans as well as adherence to Groupe Europeen de Curietherapie–European Society for Radiotherapy & Oncology (GEC-ESTRO) recommendations for high-risk clinical target volume coverage and organs-at-risk constraints. Results Implementation of the MRI-CT planning program occurred using existing infrastructure. Key to the implementation was communication between departments and the use of a process map to document the workflow. Eighty percent of treatments were prescribed to a point other than Point A, there were no major differences between the MRI-planned and CT-planned (with MRI guidance) treatments, and GEC-ESTRO recommendations were met for target coverage and organs at risk dose constraints. Conclusions It was feasible to implement an MRI-CT–based cervical cancer BT planning program using existing infrastructure and that resulting plans meet GEC-ESTRO recommendations.