In this article, we report a case of perineal recurrence of prostate cancer occurring 9 years after postoperative radiotherapy following radical prostatectomy for localized prostate cancer. We describe the use of stereotactic body radiotherapy as a potential ablative treatment. Pelvic magnetic resonance imaging identified an 8-mm lesion located below the penile root on the left side, which was distinct from the prostatectomy site. Recurrence was proven by biopsy. Stereotactic body radiotherapy delivered 36Gy in six fractions every other day. The patient showed no recurrence or toxicity by 55 months of follow-up. To the best of our knowledge, this is the first reported case of perineal recurrence successfully treated using stereotactic body radiotherapy.
PURPOSE:Stereotactic radiotherapy is a key treatment for brain metastases, alongside surgery and systemic therapies. A substantial proportion of patients develop radiation necrosis after stereotactic radiotherapy. Differentiating radiation necrosis from tumour progression is critical, as they require distinct therapeutic strategies. While magnetic resonance imaging remains the mainstay of surveillance, its limitations emphasize the need for alternative, non-invasive diagnostic modalities. This narrative review aimed to summarize recent imaging techniques for distinguishing radiation necrosis from tumour progression after stereotactic radiotherapy for brain metastases. MATERIALS AND METHODS:A systematic literature search was conducted in Embase and Medline (using the search engine PubMed) for studies published between January 2012 and February 2025. The terms "radiation necrosis," "brain metastasis," and "diagnosis" were combined. Eligible studies included adult patients with brain metastases treated with stereotactic radiation, with differentiation of radiation necrosis from tumour progression assessed by histopathology or imaging follow-up. Studies exclusively on primary brain tumours or without separate brain metastases analysis were excluded. Both prospective and retrospective designs were considered. RESULTS:Fourty studies met inclusion criteria: magnetic resonance imaging (n=21), nuclear medicine (n=13), and radiomics (n=6). Advanced magnetic resonance imaging (e.g., perfusion, intravoxel incoherent motion, treatment response assessment maps) and aminoacid positron-emission tomography showed the highest diagnostic accuracies. Radiomics, especially multiparametric approaches, improved performance but lacked external validation. CONCLUSION:Combined advanced magnetic resonance imaging, aminoacid positron-emission tomography, and radiomics approaches offer the greatest potential. Prospective studies are needed.
Inflammatory breast cancer represents a rare and aggressive form of locally advanced breast cancer with distinct biological characteristics requiring specialized treatment approaches. Despite its clinical importance, standardized radiotherapy guidelines for inflammatory breast cancer management remain limited, and these patients are often underrepresented in clinical trials. This review aims to provide some practical radiotherapy recommendations for inflammatory breast cancer by integrating data from prospective clinical trials, population studies, and emerging genomic insights. The purpose is to establish clear therapeutic strategies that distinguish between chemosensitive and chemorefractory tumours, optimize dose fractionation and target volume definition, and provide guidance on combination with systemic therapies. These recommendations seek to improve clinical outcomes while avoiding inappropriate therapeutic de-escalation in this high-risk population requiring multidisciplinary expert discussions.
We present the updated recommendations from the Société française de radiothérapie oncologique (SFRO, the French society for radiation oncology) regarding radiation dose constraints for organs at risk in adult patients, with the aim of supporting clinical decision-making in contemporary radiotherapy practice. These guidelines address a wide range of clinical scenarios, including normofractionation, hypofractionation, stereotactic radiotherapy, and reirradiation. Dose constraints are essential to ensure both the safety and efficacy of radiotherapy, especially with the growing use of advanced techniques such as intensity-modulated radiotherapy and stereotactic body radiotherapy. However, given the wide range of existing dose constraints and the lack of harmonization across different practices, this work aims to provide a unified and updated framework adapted to modern radiotherapy techniques. Moreover, many of these constraints are still based on data derived from three-dimensional conformal radiotherapy, which necessitates cautious application when extrapolated to more advanced techniques. Clinical judgment remains crucial, particularly in complex cases such as re-irradiation or treatments using altered fractionation schedules. These updated consensus aim to provide a practical and evidence-based framework to help radiation oncologists and medical physicists minimize the risk of toxicity to normal tissues. By consolidating and adapting current knowledge to modern radiotherapy techniques, they serve as a useful tool in daily clinical practice.
PURPOSE:Oral mucositis is a frequent, dose-limiting toxicity of chemoradiotherapy of head and neck cancer. Clinician-based grading such as the world health organization mucositis scale provides objective assessment of visible lesions, but patient-reported oral mucositis symptom scale capture the subjective functional impact, which may not always correspond with clinical findings. This pilot study examined the association between clinician grading and patient-reported measures and explored differences between benzydamine and bicarbonate rinses. PATIENTS AND METHODS:Twenty patients with head and neck cancer receiving definitive chemoradiotherapy were enrolled; ten received benzydamine and ten bicarbonate rinses. Weekly world health organization mucositis grading and patient-reported oral mucositis symptoms (10-item Visual Analogue Scale assessing pain, speech, eating, swallowing, and taste) were recorded across seven weeks. Spearman's correlation was performed, and descriptive comparisons were made between rinse groups. RESULTS:All patients developed mucositis by week 7. Peak severity ranged from grade 1 to grade 4, with most patients reaching grade 3. Median onset of ulcerative mucositis (grade 2 or worse) was week 3. Patient-reported oral mucositis symptoms correlated with World Health Organization grades (Spearman's ρ=0.72, p<0.01) and increased with ulcerative progression. Taste alteration and difficulty eating solids were most affected domains. Some patients reported symptoms despite absent visible lesions. No significant differences were found between the two rinse groups. CONCLUSIONS:Patient-reported outcome measure symptoms scale strongly complement World Health Organization grading, capturing symptom escalation and functional impairments under-recognized by clinician assessment. Findings support the need for larger multicentre studies integrating clinician and patient assessments.
Purpose The purpose of the study was to give an overview of the radiotherapy dosimetrist workforce in France, to provide quantitative indicators that can support actions or decisions aimed at better recognizing this profession in France. Materials and methods A survey was addressed to dosimetrists working in France (metropolitan France and overseas departments and territories) from April to May 2023. This survey covered four themes: (1) workplaces, staffing levels, and demographic data; (2) tasks performed; (3) training and status; (4) respondents’ expectations. Results A total of 239 people completed all or parts of the survey. Seventy-five percents of respondents were part of a team of at least three dosimetrists. Ninety percents of participants were under 50 years old and 75 % had more than 5 years of experience. A majority (61 %) of respondents reported to only perform treatment planning tasks. Apart from this, image fusion (75 %) and patient quality controls (54 %) were predominant. Before being dosimetrists, 54 % of respondents had been radiation therapy technologists. Fifty-six percents held a dosimetrist diploma. For 36 % of participants, salary grids differed within the same centre. Conclusion This is the first survey to provide an overview of the dosimetrist profession in France. It underlines a wide variety of career paths, profiles, and statuses. This situation highlights the need to raise awareness on this profession in order to guarantee the quality and safety of radiotherapy care. A French version of this article is available as supplementary material.
PURPOSE OF THE STUDY:In France, while radiotherapy is primarily covered by national health insurance, disparities in access may persist. These disparities can be influenced by geographic location, leading to variations in travel time to the nearest radiotherapy unit, the number of accessible radiotherapy units within a reasonable commute, the availability of specific treatments such as brachytherapy, and the resource density within accessible radiotherapy units. This study aimed to assess the accessibility and availability of radiotherapy across France, identifying potential inequities among the population based on home location and regional mean income. MATERIAL AND METHODS:The study covered metropolitan France (including Corsica) and the French overseas departments/territories of Guadeloupe, Martinique, and Réunion, using the commune (municipality) and Paris/Marseille/Lyon arrondissements (city districts; treated as separate communes) as the geographic unit. For each department, annual sex-specific cancer incidence (2007-2014) was applied proportionally to commune populations to estimate the number of patients undergoing radiotherapy, with the scaling coefficient derived from France-wide radiotherapy volumes in 2022. Geographic accessibility was quantified by calculating road and public-transport travel times from each commune's main city to all radiotherapy units, using Haversine-based candidate selection (up to 70km, extended to 100km) and Google Maps/La Poste (French postal service) validation; a radiotherapy unit was considered accessible for external beam radiotherapy, stereotactic body radiotherapy, and brachytherapy if best transportation time was less than 45min, 60min, and 90min, respectively. Availability was summarized using population-weighted efficiency (mean) and equity (dispersion via SD/IQR/D9/D1) across communes, with commune-level availability metrics derived from accessible radiotherapy units (averaged when multiple were accessible; otherwise from the closest), and no statistical testing performed because all French communes were analysed. RESULTS:Ninety percent of the study population had access to at least one radiotherapy unit within 45min of travel (one-way). Forty percent had access by public transportation within 45min. Two-thirds had access to at least two radiotherapy units within 45min. Excluding head and neck brachytherapy, 40 % of the population had access to all treatment modalities (external beam radiotherapy, stereotactic body radiotherapy, and all types of brachytherapy). Residents of mountainous and less densely populated areas faced longer travel times to the nearest radiotherapy unit. The availability of resources within the closest radiotherapy unit was independent of travel time, territorial population density, and mean regional income. In dense territories, accessibility was similar regardless of regional mean income; however, in non-dense territories, accessibility was higher in areas with higher incomes. CONCLUSION:Despite generally good and equitable access in France, disparities persist that may be attributed to factors beyond the control of healthcare authorities, such as territorial density, mountainous terrain, and potentially the real estate market. Densely populated areas offer both the highest and most equitable accessibility to radiotherapy.
Purpose Differentiating between changes after radiotherapy and radionecrosis during the follow-up of brain metastasis remains challenging. Hybrid positron-emission tomography/magnetic resonance imaging is a relatively novel imaging modality that integrates advanced magnetic resonance imaging sequences with metabolic data from positron-emission tomography. This study ailed to evaluate retrospectively the contribution of hybrid (18F)-fluorodeoxyglucose positron-emission tomography/magnetic resonance imaging in distinguishing radionecrosis from recurrent cerebral metastatis, comparing the diagnosis performance of (18F)-fluorodeoxyglucose positron-emission tomography and magnetic resonance imaging independently, without relying clinical or prior imaging data. Patients and methods Over a one-year period, we included 72 patients with brain metastases undergoing evaluation for differential diagnosis between recurrence and radionecrosis. Two senior nuclear medicine physicians and two senior radiologists independently analysed positron-emission tomography and magnetic resonance images. For semi-quantitative positron-emission tomography, analysis maximum standardized uptake value was measured at 30min and 4h postinjection and retention indices were calculated. Reading correlations between physicians was assessed using Cohen's Kappa coefficients. Clinical and imaging follow-up, considered the gold standard, was used to classify the lesion. For discordant cases, a joint interdisciplinary reading was conducted. Results A total of 142 treated brain metastases from 90 hybrid (18F)-fluorodeoxyglucose positron-emission tomography/magnetic resonance imaging scans of 72 patients were analysed. Based on the gold standard for diagnosis, the 142 lesions were categorized into two groups: 47 recurrences and 95 cases of radionecrosis. The sensibility and sensitivity of hybrid (18F)-fluorodeoxyglucose positron-emission tomography/magnetic resonance imaging were 97.9 and 100 %, respectively, outperforming both magnetic resonance imaging and positron-emission tomography alone. Discussion Dual time-point (18F)-fluorodeoxyglucose positron-emission tomography, with retention index calculation, shows significant in differentiating radionecrosis from recurrence. Technological advancements, such as hybrid positron-emission tomography/magnetic resonance imaging, enhance diagnostic accuracy in substantial patients’ cohorts. Further studies incorporating histological confirmation as the gold standard is warranted to validate these findings.
INTRODUCTION:Radiotherapy improves survival of patients who underwent breast-conserving surgery. Tumour bed boost further improves the local control that can be delivered by interstitial brachytherapy, electron beam or X-ray photon beam therapy (external beam radiotherapy). The aim of the study was to compare cosmetic outcome and the factors affecting it after interstitial brachytherapy or external beam radiotherapy. MATERIALS AND METHODS:Sixty patients with infiltrating ductal carcinoma who underwent breast conserving surgery were prospectively enrolled and treated by electron or X-ray photon beams to a total dose of 40Gy delivered in 15 fractions followed by tumour bed boost by interstitial brachytherapy (n=30) or external beam radiotherapy (n=30) to a dose of 14Gy delivered in four fractions. Both the groups were compared in terms of cosmesis, acute toxicity, late toxicity, dosimetry and survival. RESULTS:Median follow up period of the cohort was 56 months (range: 50-63months). There was no significant difference in the two groups in terms of toxicity and cosmetic outcome. Excellent/good cosmesis was seen in 85 % of total patients. Late skin toxicity was significantly lower in the group receiving interstitial brachytherapy. Doses to the normal structures such as heart and skin were significantly lower in patients who had brachytherapy. Using univariate analysis, tumour location (central region), use of neoadjuvant chemotherapy, vertical nipple deviation of more than 2cm and grade 3 skin induration were found to be significantly associated with fair/poor cosmetic outcome. CONCLUSION:Tumour bed boost by external beam radiotherapy or interstitial brachytherapy provide equivalent result in terms of cosmesis. Interstitial brachytherapy has an edge over external beam radiotherapy in reducing skin doses resulting in decreased incidence of higher grade of late skin toxicity.
Radiotherapy is a major component of cancer treatment and contributing to the cure of approximately 220,000 patients annually in France, and to sustained long-term disease control in a substantial proportion of patients. Continuous technological advances - including image-guided radiotherapy, adaptive radiotherapy, and emerging ultra-high dose rate techniques - are transforming clinical practice and improving therapeutic outcomes. However, these innovations also raise important challenges related to equitable access, sustainable financing, workforce capacity, professional training, and the maintenance of high standards of quality and safety. The Société française de radiothérapie oncologique (SFRO; the French society of radiation oncology) conducted a national strategic reflection on the future of radiotherapy in France. Through multidisciplinary consultation involving radiation oncologists, medical physicists, radiation therapists, and healthcare stakeholders, a white paper was developed to assess current challenges and define priorities for the coming years. Four strategic priorities emerged: (i) ensuring equitable access to modern radiotherapy technologies across the national territory; (ii) strengthening patient-centred care and supportive care throughout the treatment pathway; (iii) reinforcing safety and quality frameworks in an increasingly complex technological environment; and (iv) improving workforce planning, training, translational and clinical research, and professional recognition within the radiotherapy field. Ten proposals are outlined to support innovation, strengthen research capacity, modernize financing mechanisms, enhance patient engagement, and address workforce shortages, particularly among radiation therapists and dosimetrists. The recommendations presented in this white paper aim to guide policymakers and healthcare stakeholders in sustaining the development and international competitiveness of radiation oncology in France.
PURPOSE:Modern adjuvant therapies, including systemic treatments and radiotherapy, have significantly improved outcomes for patients with breast cancer. However, isolated nodal recurrences remain rare, comprising less than 1 % of cases, and pose a therapeutic challenge, with historical 5-year overall survival rates below 50 %. This study evaluated the clinical outcomes of patients with isolated nodal recurrences in the modern era using the Surveillance, Epidemiology, and End Results (SEER) database and examined factors associated with survival. MATERIALS AND METHODS:We analysed data from 1479 female patients with cT0N+M0 breast cancer diagnosed between 2000 and 2021 in the SEER database. Patients were categorized as having isolated nodal recurrences if they had prior ipsilateral breast cancer or occult primary breast cancer if presenting with a first cancer diagnosis. Demographics, tumour characteristics, and treatments were recorded. Survival outcomes were assessed using Kaplan-Meier and Cox regression models. RESULTS:Of 1479 patients, 42 (2.8 %) had isolated nodal recurrences, and 1437 (97.2 %) had occult primary breast cancer. Median time to isolated nodal recurrences was 105 months. Most initial tumours were early-stage (T1-T2, 75 %) and node-negative (78.6 %). Five-year overall- and cancer-specific survival rates of patients with isolated nodal recurrences were 72.4 % (95 % confidence interval [CI]: 57.6-91.0 %) and 81.5 % (95 % CI: 67.8-97.9 %), respectively, compared to 80.4 and 86.6 % for patients with occult primary breast cancer. Trends toward improved survival with adjuvant chemotherapy (5-year overall survival rates: 78.0 versus 68.0 %) and radiotherapy (5-year overall survival rates: 83.6 versus 63.2 %) were observed but not statistically significant. No survival benefit was found for total mastectomy in cases of isolated nodal recurrences following breast-conserving surgery. CONCLUSION:This study showed encouraging survival outcomes for patients with isolated nodal recurrences in the modern era, with 5-year overall survival exceeding historical benchmarks. Comparable survival between patients with isolated nodal recurrences and occult primary breast cancer highlights the potential for curative approaches. Further research is required to refine treatment strategies and identify patient subgroups that may benefit from tailored therapies.
PURPOSE:The purpose of this study was to explore the factors affecting the stability of deep inspiration breath-hold for left-sided breast cancer radiotherapy and provide directional suggestions for clinicians to consider whether patients with left-sided breast cancer were fit for this technique. MATERIAL AND METHODS:Using optical body surface monitoring system, 100 patients with left-sided breast cancer were trained for deep inspiration breath-hold before computed tomography positioning. The patients' age, height, weight, vital capacity, type of surgery (modified radical or breast-conserving operation) were recorded. According to the duration and fluctuation of each inspiration, the patients were divided into five categories. The statistical methods of Spearman and Kendall were used to calculate correlation coefficients, and the p values of these factors and breath-holding stability grades were calculated using the Spss software; the correlation heat map was drawn by Origin software, reflecting which of the above factors had significant correlation with breath-holding stability and their correlation strength. RESULTS:Values of p inferior to 0.05 were obtained for vital capacity, body mass index, age and surgical method, and values of p greater than 0.05 were obtained for adjuvant chemotherapy and targeted treatment. According to the value of correlation coefficient and correlation heat map, the order of strength is vital capacity>body mass index>age>surgical method. CONCLUSION:The patient's age, vital capacity, body mass index and operation method significantly affect the stability of breath-holding. For breast cancer radiotherapy, clinicians can select patients by considering these factors related with the stability of holding their breath.
PURPOSE:During radiotherapy of non-small-cell lung cancers, changes in radiomics features extracted from cone-beam computed tomography images can serve as unique predictors. For adapting treatment plans or assessing early treatment responses, there is a pressing need to screen cone-beam computed tomography-derived radiomics features for predicting tumour regression volume. PATIENTS AND METHODS:Our study enrolled 58 patients with non-small cell lung cancer undergoing radiotherapy, comprising dataset1, and an additional 32 patients who underwent an adaptive treatment approach, forming dataset2. For dataset1 patients, radiomics features were extracted from both the planning computed tomography and the first treatment cone-beam computed tomography. For dataset2 patients, features were also extracted from the replanning computed tomography and the corresponding cone-beam computed tomography after 20 fractions of radiotherapy. By employing correlation coefficient and intraclass correlation coefficient analyses on planning computed tomography and first treatment cone-beam computed tomography features, we identified robust and reproducible features in dataset1 patients. Reproducible delta radiomics features were further selected to characterize feature changes and screen delta radiomics features for tumour regression in dataset2 patients. Lastly, predictive delta radiomics features were screened using least absolute shrinkage and selection operator regression. RESULTS:Based on dataset1, we selected 34 radiomics features. From these, 16 delta radiomics features were further screened using dataset2. The changes observed in these features were consistent across both computed tomography and cone-beam computed tomography images. Specifically, nine features exhibited significant differences (p<0.05) while seven features remained relatively unchanged (p>0.05). Ultimately, four delta radiomics features were identified to classify tumour regression volume with a 30 % threshold for cone-beam computed tomography images. CONCLUSION:Our study introduces a novel strategy for selecting computed tomography-based cone-beam computed tomography radiomics features, enabling the identification of reliable features for model development. Preliminary findings firstly demonstrate the feasibility of using cone-beam computed tomography-based delta radiomics features to classify tumour regression volume during radiotherapy of non-small-cell lung cancer.
PURPOSE:Radiation-induced sarcomas are a rare but serious long-term complication of radiotherapy. While radiotherapy is an effective treatment for low-grade non-Hodgkin lymphomas, the incidence and characteristics of radiation-induced sarcomas in this setting have not been previously described. The purpose of this study was to analyse the incidence and outcomes of radiation-induced sarcomas following radiotherapy for low-grade non-Hodgkin lymphomas. PATIENTS AND METHODS:We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database (17 registries, 2024 submission) to identify patients diagnosed with follicular or marginal zone lymphoma between 2000 and 2022 who received radiotherapy. Cases of subsequently histologically-confirmed sarcoma were screened and classified as confirmed or possible radiation-induced sarcomas based on anatomical localization and a minimum latency of 3 years. Clinical characteristics, treatments, latency intervals, and survival outcomes were analysed. RESULTS:Among 18,293 patients with low-grade non-Hodgkin lymphomas treated with radiation, 19 developed sarcomas (0.10 %). Ten cases were excluded (eight due to anatomical mismatch, two due to insufficient latency). Of the nine remaining cases, six met criteria for confirmed radiation-induced sarcomas. The median age at lymphoma diagnosis was at least 70years, and the median latency to radiation-induced sarcoma was 12years (range: 3-20years). All sarcomas were localized and treated surgically; three patients also received radiotherapy. After a median follow-up of 78months, the 5-year overall survival rate was estimated at 83.3 % (95 % confidence interval: 43.6 %-97.0 %). One patient died from lymphoma progression. CONCLUSION:Radiation-induced sarcomas following radiotherapy for low-grade non-Hodgkin lymphomas is extremely rare, with favourable outcomes when it occurs. These results provide reassuring data supporting the long-term safety of modern radiotherapy for low-grade non-Hodgkin lymphomas and underscore the importance of continued surveillance and treatment planning in patients with prolonged life expectancy.
BACKGROUND:Primary pleural indolent non-Hodgkin lymphomas, such as marginal zone lymphoma and follicular lymphoma, are rare and understudied. When truly localized, these entities are theoretically curable with radiotherapy, as is the case for other extranodal indolent lymphomas (e.g., orbit, stomach, lung). However, due to their low incidence and frequent diagnostic delays related to nonspecific clinical and radiologic presentations, no standard therapeutic recommendations currently exist. The role of radiotherapy in this setting remains undefined, even in expert guidelines. METHODS:We performed a narrative literature review and complemented these findings with a descriptive population-based case series extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Based on these findings and institutional expertise, we developed practical radiotherapy recommendations. RESULTS:Published cases show heterogeneous management strategies, with radiotherapy infrequently used but consistently associated with complete responses. In the SEER cohort, seven patients with stage I-II primary pleural indolent B-cell non-Hodgkin lymphoma (three with a marginal zone lymphoma, three with a follicular lymphoma, and one with a lymphoplasmacytic lymphoma) underwent radiotherapy. Median age was 76 years. With a median follow-up of 91 months (range: 47-172 months), the 10-year cause-specific survival rate was 100 %, and overall survival rate was 83.3 % (95 % confidence interval: 0.583-1.0 %). We propose delivering a dose of 24 to 30Gy for curative intent, with reduced-dose strategies (e.g., 2×2Gy with response-adapted completion) in selected patients. Target volumes should encompass the entire pleural mass with 2 to 3cm clinical target volume margins, using advanced planning techniques to minimize cardiac and pulmonary exposure. CONCLUSIONS:This is the first population-based study evaluating radiotherapy outcomes for primary pleural indolent non-Hodgkin lymphomas. Radiotherapy appears to be a relevant curative option for localized disease. In the absence of formal guidelines, these findings and proposed recommendations may help inform clinical management of this rare but potentially curable lymphoma subtype.
This systematic literature review explores the potential clinical benefits of magnetic resonance imaging-guided linear accelerator for radiotherapy of prostate cancer, across multiple indications: primary treatment, salvage therapy following radical prostatectomy, reirradiation, and focal boosting of the dominant intraprostatic lesion. Technical considerations related to magnetic resonance imaging-guided radiotherapy are also addressed. Most of the available studies are single-centre or prospective non-randomized trials, with notable methodological heterogeneity regarding irradiation protocols and outcome measures. To date, the MIRAGE trial remains the only published phase III randomized study comparing magnetic resonance imaging-guided radiotherapy to standard stereotactic body radiotherapy. Significant reduction in both acute and late urinary and gastrointestinal toxicity has been demonstrated, attributed to the enhanced precision of imaging-guidance and the reduction in planning target volume margins. However, long-term oncological efficacy remains to be established. Further phase III trials and health economic evaluations are clearly needed to establish the clinical value of this technology. As of today, the implementation of magnetic resonance imaging-guided linear accelerators in routine clinical practice remains limited by technical, organizational, and financial challenges, with accessibility restricted to a limited number of centres and reimbursement strategies yet to be adequately defined.
PURPOSE:Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare but indolent B-cell lymphoma, most often presenting as localized disease. Radiotherapy is a curative option, but its proximity to the heart raises concerns about long-term cardiac toxicity, which remains poorly documented. The purpose of this work was to evaluate the potential risk of cardiac toxicity following radiotherapy in patients with pulmonary MALT lymphoma. PATIENTS AND METHODS:This retrospective, population-based study used Surveillance, Epidemiology, and End Results (SEER) data (17 registries, 2000-2022; November 2024 submission). We identified patients with primary pulmonary MALT lymphoma treated with radiation. Demographic and clinical characteristics, including age, sex, Ann Arbor stage, tumour laterality, lobe involvement, and treatment modality, were collected. Outcomes included overall survival, cancer-specific survival, cardiac-specific survival, and non-cancer/non-cardiac-specific survival. Survival estimates were generated using Kaplan-Meier methods; univariate and multivariate Cox models assessed factors associated with cardiac-specific mortality. RESULTS:Among 248 patients, the median age was 70 years; 54.0 % were women and 81.9 % Caucasian. Most had early-stage disease (90.3 %) and right-sided tumours (57.3 %). Radiotherapy alone was used in 86.7 %. With a median follow-up of 59 months, median overall survival was 120 months. At 20 years, overall survival rate was 28.9 %, cancer-specific survival rate 85.5 %, and cardiac-specific survival rate 85.0 %. In competing risk multivariate analysis, age greater than 70 years (hazard ratio [HR]: 10.51; 95 % confidence interval [CI]: 1.11-99.8; p=0.040) and stage III-IV (HR: 6.52; 95 % CI: 1.17-36.4; p=0.032) were independently associated with cardiac-specific mortality. CONCLUSION:Radiotherapy for pulmonary MALT lymphoma is associated with excellent long-term outcomes and low cardiac-specific mortality. Tumour location within the lung does not influence cardiac risk, supporting the absence of significant radiation-induced cardiotoxicity.
PURPOSE:Primary involvement of the uveal tract by diffuse large B-cell lymphoma is exceedingly rare and poorly characterized. Most reported ocular lymphomas in this location are indolent mucosa-associated lymphoid tissue lymphomas with favourable outcomes. We aimed to evaluate the epidemiologic and clinical features of primary uveal diffuse large B-cell lymphoma using a large population-based dataset. MATERIAL AND METHODS:We performed a retrospective analysis of cases recorded between 2000 and 2022 in the Surveillance, Epidemiology, and End Results (SEER) database. Eligible patients had histologically confirmed diffuse large B-cell lymphoma with primary localization in the choroid (C69.3) or ciliary body/iris (C69.4). Localized primary uveal diffuse large B-cell lymphoma was defined as Ann Arbor stage I disease without systemic involvement. Survival outcomes were analysed using Kaplan-Meier estimates and Cox univariate models. RESULTS:Among 134,366 diffuse large B-cell lymphoma cases, 51 involved the uveal tract (0.038 %), with 42 (82.4 %) classified as localized primary uveal diffuse large B-cell lymphoma. Median age was 65 years. The 5-year overall survival and cancer-specific survival rates were 45.5 % and 58.4 %, respectively. For patients with localized diseases, 5-year cancer-specific survival rate was 59.4 %, with a survival plateau beyond 6 years. No significant associations were found between overall- or cancer-specific survival and clinical or treatment variables, including radiotherapy or chemotherapy. CONCLUSIONS:Primary uveal diffuse large B-cell lymphoma is an ultra-rare and aggressive malignancy, distinct from uveal mucosa-associated lymphoid tissue lymphoma. While outcomes are poorer, a subset of patients with localized disease may achieve long-term remission. Radiotherapy may be a treatment alternative for selected patients, though optimal management remains undefined. Further prospective studies are warranted.
PURPOSE:This dosimetric study investigated the feasibility and effectiveness of a hybrid stereotactic radiosurgery technique combining dynamic conformal and volumetric modulated arcs for treating multiple small brain metastases in a single fraction, using two treatment planning systems: Elements and Monaco. MATERIALS AND METHODS:A clinical case involving multiple brain metastases was selected. Four treatment plans were generated: three using the Elements treatment planning system - (i) a volumetric modulated arc therapy plan (Cranial SRS); (ii) a dynamic conformal arc therapy plan (Multiple Brain Mets); and (iii) a hybrid dynamic conformal arc with volumetric modulated arc therapy plan - and a fourth using the Monaco treatment planning system with a volumetric modulated arc technique. Plans were assessed using quality indices, including target coverage, conformity, gradient and homogeneity indices, and doses to organs at risk. Quality assurance evaluation was performed with the stereotactic radiosurgery StereoPHAN™ phantom, MapCHECK® detector, and EBT-XD™ film. The gamma passing rates were analysed using 3 %/1mm criteria. All plans were delivered using a 6 MV flattening filter-free photon beam on a Versa HD™ linear accelerator. RESULTS:The hybrid planning technique demonstrated superior plan quality, with a significant reduction in the volumes of normal brain tissue receiving at least 10Gy and 12Gy, as well as lower doses to organs at risk, in accordance with established stereotactic radiosurgery guidelines. Quality assurance evaluation confirmed the dosimetric accuracy of the hybrid plan, showing excellent agreement between measured and calculated dose distributions, with a gamma passing rate exceeding 98 %. CONCLUSION:For single-isocentre, multitarget stereotactic radiosurgery, the hybrid technique could represent a promising approach, offering improved sparing of surrounding normal tissues and consistent plan quality. However, these results need to be validated in larger clinical cases.
