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.
