Purpose: Brachytherapy is a critical component of cervical cancer treatment, but unfavourable anatomy or poor tumour response to external beam radiotherapy can make brachytherapy technically difficult or suboptimal, resulting in inadequate target coverage or unacceptable organ-at-risk doses. This study evaluated the dosimetric feasibility of spatially fractionated radiotherapy as an alternative boost option when brachytherapy cannot be optimally delivered. Materials and methods: An in-silico study was performed using volumetric-modulated arc therapy-based spa tially fractionated radiotherapy on imaging data from ten patients who received brachytherapy between 2018 and 2021. These patients had suboptimal brachytherapy dosimetry due to unfavourable anatomy and/or large residual disease, or required advanced intracavitary-interstitial techniques. Before brachytherapy, magnetic re sonance imaging was used to delineate the high-risk clinical target volume, and organs-at-risk were contoured on contrast-enhanced computed tomography. Two spatially fractionated radiotherapy plans were developed: (i) using straight virtual "rods" and (ii) using bending "rods". These virtual rods represented intentionally pla ced high-dose regions to recreate the heterogenous dose distribution characteristic of brachytherapy. Spatially fractionated radiotherapy plans were compared with clinically delivered brachytherapy plans. Results: Both spatially fractionated radiotherapy approaches achieved high-risk clinical target D90 matching or exceeding brachytherapy across all patients. In cases with large residual tumours or unfavourable anatomy (n = 7), spatially fractionated radiotherapy produced higher target coverage than brachytherapy. In patients with favourable intracavitary-interstitial brachytherapy dosimetry (n = 3), spatially fractionated radiotherapy achieved comparable target doses. Bladder and rectum doses exceeded recommended constraints in seven of ten brachytherapy plans, whereas all spatially fractionated radiotherapy plans maintained organ-at-risk doses within recommended hard constraints. Conclusion: Spatially fractionated radiotherapy may offer a feasible alternative boost strategy for patients in whom brachytherapy is technically limited or yields suboptimal dosimetry. While not intended to replace bra chytherapy, it may help bridge treatment gaps in challenging clinical scenarios.
The process of reirradiation in oncology presents a distinctive set of challenges, wherein clinical decision-making relies on a delicate balance between the efficacy of the treatment and the risk of severe toxicity. Despite the paucity of randomized data, there is an increasing number of data encouraging its consideration for patients with local or metastatic recurrence. While awaiting dedicated guidance from supranational scientific societies, the following publication is based on the "Recommendations Commission" of the Societe francaise de radiotherapie oncologique (the French society for radiation oncology). It addresses key questions related to reirradiation, with a particular focus on brain tumours and head and neck cancers.
Purpose The purpose of this study was to evaluate survival outcomes of multimodal treatment, including chemotherapy, surgery, and radiotherapy, of patients with stage IVB endometrial carcinoma treated at a single institution. Materials and methods We retrospectively identified 56 patients with stage IVB according to the International Federation of Gynaecology and Obstetrics endometrial carcinoma treated between 2004 and 2017. All patients received chemotherapy. Survival outcomes were analysed in the overall cohort and according to treatment strategies. Results With a median follow-up of 7.5 years, overall survival rates at 2, 3, and 5 years were 57.1 %, 46.4 %, and 32.1 %, respectively. Progression-free survival rates at 2, 3, and 5 years were 35.7 %, 28.6 %, and 23.2 %, respectively. Patients with a single metastatic site had significantly better outcomes compared with those with multiple metastatic sites. Among patients undergoing trimodal therapy, survival outcomes were more favourable, particularly in those with limited metastatic burden. Conclusion Multimodal treatment including surgery and radiotherapy was associated with improved survival outcomes in selected patients with stage IVB endometrial cancer. These findings support a personalized treatment strategy based on metastatic burden and response to systemic therapy.
Introduction: Breast adenoid cystic carcinoma is a rare triple-negative breast cancer subtype with a favourable prognosis. While hypofractionated and ultra-hypofractionated radiotherapy are increasingly used for breast cancer, no dedicated data exist for breast adenoid cystic carcinoma. This study reports contemporary oncological outcomes, radiotherapy parameters, and toxicity in a uniformly treated single-institution cohort. Patients and methods: We retrospectively reviewed files of all patients with non-metastatic breast adenoid cystic carcinoma treated with surgery and adjuvant radiation between 2006 and 2023. Clinical, pathological, treatment, and follow-up data were analysed. Survival was estimated using Kaplan-Meier methods. Results: The data from 13 women (median age 69 years, range 47-79 years) were included; 92.3 % underwent breast-conserving surgery, and all were node-negative. Hypofractionation was used in 69.2 %, including three ultra-hypofractionated regimens (32.5 Gy delivered in five fractions). At a median follow-up of 60 months, there were no regional or distant recurrences and one local recurrence salvaged surgically. Five- and 10-year cancer-specific survival rates were 100 %, overall survival rates were 90.0 % and 67.5 %, respectively, and local recurrence-free survival rate was 90.0 % at both time points. Eight patients developed grade 1 acute radiodermatitis; no other acute or late toxicity events were observed. Conclusion: Modern adjuvant radiotherapy for breast adenoid cystic carcinoma provides excellent long-term local control with minimal toxicity. Hypofractionated and ultra-hypofractionated schedules appear safe and efficient. Prospective collaborative studies are needed to define the role of boost and optimal fractionation strategies in this rare histology.
Purpose: Hypofractionated radiotherapy is a standard treatment for localized prostate cancer, supported by phase III trials showing non-inferiority versus conventional fractionation. However, most trials excluded elective pelvic lymph node irradiation, so evidence remains limited when pelvic nodes are treated. The primary objective of this study was to compare clinical outcomes and toxicity profiles between normofractionated radiotherapy and moderately hypofractionated radiotherapy. Material and methods: We performed a narrative review of phase III trials evaluating moderate or ultra-hypofractionated radiotherapy, then conducted a retrospective single-institution analysis comparing conventional fractionation (delivering 80 Gy in 40 fractions) with moderate hypofractionation (delivering 72.5 Gy in 29 fractions), with or without elective pelvic lymph node irradiation. The primary endpoint was disease-free survival. Secondary endpoints were overall survival and acute and late genitourinary and gastroin testinal toxicity. Results: Eleven phase III trials were identified, confirming non-inferiority of moderate hypofractionation for prostate-only irradiation. In our cohort of 156 patients (76 treated with conventional fractionation and 80 with moderate hypofractionation), half received elective pelvic lymph node irradiation, and three quarters recei ved androgen deprivation therapy. After a median follow-up of 69 months, 5-year disease-free survival was 85 % with conventional fractionation and 84 % with moderate hypofractionation, with similar five-year overall survival (88 % and 84 %). Grade 2 or higher acute genitourinary toxicity was more frequent with moderate hypofractionation, whereas late genitourinary and gastrointestinal toxicities were comparable. Conclusions: Moderate hypofractionation achieved disease control similar to conventional fractionation with acceptable toxicity, including in patients receiving elective pelvic lymph node irradiation. These findings support extension of moderate hypofractionation to patients requiring pelvic treatment and the need for prospective validation and integration with androgen deprivation therapy and stereotactic radiotherapy.
