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Background Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) recommendations are commonly used guidelines for adjuvant radiotherapy in glioblastoma. In our institutional protocol, we delineate T2-FLAIR alterations as gross target volume (GTV) with reduced clinical target volume (CTV) margins. We aimed to present our oncologic outcomes and compare the recurrence patterns and planning parameters with EORTC and RTOG delineation strategies. Methods Eighty-one patients who received CRT between 2014 and 2021 were evaluated retrospectively. EORTC and RTOG delineations performed on the simulation computed tomography and recurrence patterns and planning parameters were compared between delineation strategies. Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM, Armonk, NY, USA) was utilized for statistical analyses. Results Median overall survival and progression-free survival were 21 months and 11 months, respectively. At a median 18 month follow-up, of the 48 patients for whom recurrence pattern analysis was performed, recurrence was encompassed by only our institutional protocol's CTV in 13 (27%) of them. For the remaining 35 (73%) patients, recurrence was encompassed by all separate CTVs. In addition to the 100% rate of in-field recurrence, the smallest CTV and lower OAR doses were obtained by our protocol. Conclusions The current study provides promising results for including the T2-FLAIR alterations to the GTV with smaller CTV margins with impressive survival outcomes without any marginal recurrence. The fact that our protocol did not result in larger irradiated brain volume is further encouraging in terms of toxicity. [ABSTRACT FROM AUTHOR]

Reirradiation has been identified as a viable treatment modality for patients with recurrent head and neck cancer (rHNC). Retrospective series demonstrate the superiority of intensity-modulated radiation therapy (IMRT) over stereotactic ablative radiotherapy (SABR) for patients in the Multi-Institution Reirradiation Collaborative (MIRI) class 2 risk group (treatment interval > 2 years without resection or treatment interval ≤ 2 years without organ dysfunction). he objective of this study was to investigate the efficacy and toxicity of SABR in patients classified as "RPA Class 2" rHNC. The data of 85 cases diagnosed with rHNC who underwent reirradiation with the SABR technique between 2007 and 2022 in our department were evaluated retrospectively. We did not incorporate cases of primary nasopharynx cancer due to its comparatively more favorable prognosis in relation to other types of head and neck cancers. The Kaplan-Meier method was used for survival analyzes (IBM SPSS v23). Patient, tumor and treatment characteristics are presented in Table 1. The median age was 59 (range, 19-87). The median follow-up period was 12 months (range,1-178 months). The first assessment following SABR revealed that 30% of the patients achieved a full response, 35% achieved a partial response, 11% had stable disease, and 4% experienced disease progression. During follow-up, local recurrence (LR) developed in 31 patients (36%) and distant metastasis (DM) developed in 24 patients (28%). The local control (LC) rate with SBRT was 64%. The most common sites of DM are the lung, bone, and liver. In 31 patients who developed LR after SABR, the median time to LR development was 8 months (range, 2-55 months). Subsequently, a third course of radiation therapy (RT) was administered to 16 of them (52%). The 1- and 2-year overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) rates were 50% and 30%, 39% and 21%, 46% and 27%, respectively. In univariate analysis, age (≤59 vs. >59 years), gender (male vs. female), interval between treatments (≤2 vs. >2 years), organ dysfunction before SABR (present vs. absent) or surgery (present vs. absent), SABR dose (≤30 vs. >30 Gy), technique (robotic vs. linear accelerator-based), recurrent tumor volume (≤43 vs. >43 cc), and recurrence location (primary vs. neck) parameters did not have prognostic effect on OS, LRFS and DMFS. The rate of grade 3 or 4 late toxicity was 11%, and the rate of grade 5 toxicity was 9%. Eight patients (9%) developed massive hemorrhage secondary to carotid blow out syndrome (CBOS), 6 patients (7%) developed brain parenchymal necrosis, 2 patients (2.5%) required permanent gastrostomy, and 1 patient (1.5%) developed optic neuropathy and vision loss. The administration of SABR in consecutive or alternate day fractions shown comparable effects on toxicity. [Display omitted] The utilization of the SABR as a method of reirradiation in rHNC patients has demonstrated favorable outcomes in terms of achieving effective LC while maintaining acceptable levels of treatment-related toxicity. We provide a study that demonstrates highly favorable survival outcomes with SABR for patients classified as RPA class 2 rHNC. There is a need for prospective randomized studies to be conducted in order to ascertain the ideal approach for reirradiation, specifically comparing SABR and IMRT. These studies would also help identify the patient population that would benefit the most from such reirradiation techniques. [ABSTRACT FROM AUTHOR]

Local recurrence (LR) rates in nasopharyngeal carcinoma (NPC) following definitive radiation (RT) ± chemotherapy (CT) range from 7–15%. A prospective trial comparing endoscopic surgery and reirradiation in recurrent cases found that surgery improved survival in a carefully chosen group of patients with low-volume mucosal recurrence. However, the fact that the recurrent disease is mostly multifocal and infiltrative in nature makes a limited group of patients suitable for surgery. In this study, we aimed to report our stereotactic ablative radiotherapy (SABR) outcomes in cases diagnosed with recurrent NPC. The data of 83 patients who underwent SABR in our department between 2007 and 2022 with the diagnosis of local-regional recurrent NPC, which was unresectable or had surgical margin positivity after resection were evaluated retrospectively. The Kaplan-Meier method was used for survival analyses (IBM SPSS v.23). Patient, tumor, and treatment characteristics are presented in Table 1. The median age was 53 (range, 19-78). The median follow-up was 24 months (range, 3–151 months). The median interval between patients' first and second RT's was 39 months (range, 4–238 months). The initial response evaluation following reirradiation found a complete response in 38%, a partial response in 40%, stable disease in 8%, and progression in 1%. In follow-up, LR developed in 20 patients (24%) and distant metastasis (DM) developed in 14 patients (17%). The most common sites of DM were the lung, bone, and liver. SABR provided 76% local control (LC). The 1- and 2-year overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 67% and 53%, 65% and 46%, and 62% and 49%, respectively. In univariate analysis, LRFS (60% vs. 34%, p=0.002) and DMFS (63% vs. 31%, p=0.007) rates were higher in patients with recurrent tumor volume ≤36 cc compared to patients with tumor volume >36 cc. Age (≤53 vs. >53 years), gender (male vs. female), interval between RTs (≤2 vs. >2 years), surgery before SBRT (yes vs. no), SBRT dose (≤30 vs. >30 Gy) and device (robotic- vs. linear accelerator-based), and site of recurrence (primary vs. neck recurrence) could not be identified for prognostic significance for OS, LRFS, and DMFS parameters. A notable proportion of patients experienced late toxicity, with 20% exhibiting grade 3 or 4 toxicity and 12% experiencing grade 5 toxicity. Fourteen patients (17%) experienced massive hemorrhage as a result of carotid blow-out syndrome (CBOS); two patients (2%) suffered from cerebrovascular disease as a result of carotid artery stenosis; five patients (6%) experienced brain parenchymal necrosis; three patients (3.5%) had permanent gastrostomies; and three patients (3.5%) had hearing loss. There was no observed disparity in toxicity levels between doses administered consecutively or every other day. [Display omitted] Using SABR as a reirradiation method for people with recurrent NPC has shown to be very effective at achieving LC while keeping treatment-related side effects at a level that can be tolerated. There is a positive correlation between a smaller recurring tumor volume and higher levels of local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS). [ABSTRACT FROM AUTHOR]

Background: We routinely delineate the gross tumor volume (GTV) for the lymph nodes (LN) based on post‐induction chemotherapy (IC) MRI in nasopharyngeal carcinoma (NPC). Herein, we investigated the sufficiency of this method, particularly in high‐risk LNs. Methods: Eighty‐one LNs with a high‐risk of clinical extranodal extension and/or ≥3‐cm diameter in 58 patients were evaluated. A new GTV covering the pre‐IC LN volume was delineated for each LN. Results: The median volume reduction was 72.5% for the GTV and 53.1% for the planning target volume. After a median 43 months, the overall LN local control rate was 97.5%. The 2‐ and 5‐year LN recurrence‐free survival, overall survival, and disease‐free survival rate was 88.3% and 84.4%, 92.5% and 85.1%, and 86.8% and 79.2%, respectively. Conclusion: IC yields a significant reduction in nodal target volumes, and post‐IC nodal volume‐based radiotherapy provides excellent LC in NPC, even in high‐risk LNs. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the oncological outcomes and toxicities of indolent ocular adnexal and orbital lymphomas (OOLs) treated with radiotherapy (RT) ± systemic therapy., Methods: A retrospective analysis of 44 patients with indolent OOLs treated with RT was conducted., Results: Most patients (87%) had early-stage disease. Treatment involved RT alone (34%) or RT + systemic therapy (66%). The median RT dose was 30 Gy, with a median follow-up of 45 months. Local and systemic recurrence rates were 4% and 9%, respectively. Five-year overall and disease-free survival (DFS) rates were 96.2% and 83.6%. Early-stage patients showed similar DFS rates regardless of whether they received RT alone or RT plus systemic therapy. No grade 3 RT-related toxicity occurred, but systemic therapy led to grade 3 toxicity in 17% of patients., Conclusions: RT is essential for treating indolent OOLs, and combination with systemic therapies does not enhance outcomes for early-stage patients., (© 2024 Wiley Periodicals LLC.)