Purpose:Total mesorectal excision (TME) is the standard treatment for early rectal cancer, but radiation therapy (RT) with or without chemotherapy may be considered as an alternative organ-preserving option. This study evaluated the oncologic outcomes, patterns of failure, salvage treatment efficacy, and TME-free survival (TME-FS) following RT without radical surgery after local excision or biopsy in selected patients. Materials and Methods:We retrospectively analyzed 40 patients with cT1-2N0 rectal adenocarcinoma who received RT after local excision or biopsy without subsequent radical surgery between 2007 and 2023. Indications for RT included clinical T1 disease with high-risk features, clinical T2 disease, or tumors located close to the anal verge. The median RT dose was 50.2 Gy, and 29 patients received chemotherapy. Survival outcomes, recurrence patterns, salvage treatments, toxicities, and TME-FS were assessed. Results:The median follow-up was 38 months. The 5-year overall survival rates were 87.5% for the cT1 group and 85.6% for the cT2 group, and the 5-year cancer-specific survival rate was 100% in both groups. The 5-year recurrence-free survival rates were 79.3% and 62.8%, respectively. Overall, nine patients experienced treatment failure, and four patients ultimately underwent salvage TME. The 5-year TME-FS were 87.5% in the cT1 group and 78.6% in the cT2 group. No grade 2 or higher late toxicities were observed. Conclusion:RT without radical surgery may be a feasible treatment option for cT1-2N0 rectal cancer patients who are unsuitable for, or decline, radical surgery. Close surveillance and timely salvage treatment remain essential, particularly for those with cT2 disease.
Purpose:This study aimed to compare left-sided breast volumetric modulated arc therapy plans using heart-only dose constraints with plans that include additional left ventricle (LV) and left anterior descending coronary artery (LAD) dose constraints (heart + LV + LAD). Materials and Methods:Thirty patients treated with whole-breast irradiation with simultaneous integrated boost were replanned using both strategies. The heart + LV + LAD strategy applied dose constraints based on German Society for Radiation Oncology recommendations and Danish Breast Cancer Group HYPO protocol (LV: Dmean [mean dose] <3 Gy, V5Gy [percentage of volume receiving ≥5 Gy] <17%, V23Gy <5%; LAD: Dmean <10 Gy, Dmax [maximum dose] <17 Gy). Target and organ-at-risk (OAR) metrics were compared using Wilcoxon signed-rank tests. For exploratory analyses, LAD-planning target volume (PTV) distance was defined as the minimum distance between LAD and whole-breast PTV, and Spearman's correlations between LAD-PTV distance and LAD or target metrics were evaluated. Results:Compared with heart-only plans, heart + LV + LAD plans reduced LV Dmean, V5Gy, and V23Gy, as well as LAD Dmean and Dmax (all p < 0.001), meeting all prespecified dose constraints except LV Dmean and LAD Dmax (achieved in 70.0% and 63.3%, respectively). Target metrics showed small compromises (e.g., PTV V95% [percentage of volume receiving ≥95% of the prescription dose] 98.391% vs. 99.431%; p < 0.001). Ipsilateral lung Dmean and V5Gy decreased, whereas contralateral breast Dmean and lung V10Gy increased (all p < 0.05). In heart + LV + LAD plans, greater LAD-PTV distance correlated with lower LAD Dmax and Dmean and higher PTV D98%. Conclusion:Applying LV and LAD dose constraints improved cardiac substructure sparing with modest trade-offs in target and contralateral OAR metrics. LAD-PTV distance may influence the feasibility of LAD sparing, but this exploratory association warrants further study.
Extramammary Paget's disease (EMPD) is a rare adenocarcinoma with a poor prognosis when invasive. Here, we report an exceptionally rare case of invasive vulvar EMPD in a 70-year-old woman who presented with extensive lymphadenopathy involving the inguinal, pelvic, para-aortic, and left supraclavicular regions. Histopathology confirmed dermal and lymphovascular invasion. Given the systemic nodal spread, the patient underwent definitive concurrent chemoradiotherapy (CCRT) with weekly cisplatin. Radiotherapy was delivered to the inguinal-to-paraaortic nodes at 57.6 Gy in 32 fractions and to the supraclavicular nodes at 51.0 Gy in 17 fractions. Follow-up imaging 6 months after treatment demonstrated a complete response per Response Evaluation Criteria in Solid Tumor criteria. This case is notable because supraclavicular involvement in EMPD is extremely rare and usually reflects advanced systemic dissemination. Our findings suggest that intensive CCRT may achieve excellent locoregional and systemic disease control, supporting its potential role as an effective primary treatment option for patients with advanced metastatic EMPD.
Purpose:Optimal management of borderline and malignant phyllodes tumors (PT) is not well established, especially regarding margin width and the use of adjuvant radiotherapy (RT). This multicenter study aimed to identify prognostic factors and to assess the effectiveness of adjuvant RT. Materials and Methods:We conducted a retrospective analysis of 183 patients (155 surgery-only, 28 adjuvant RT) diagnosed with borderline or malignant PT from 2009 to 2025. To address selection bias, whereby RT is preferentially given to higher-risk patients, we used overlap weighting based on propensity scores, which estimates the average treatment effect in the overlap population (ATO). Independent prognostic factors were identified through multivariable Cox regression with Firth's penalized likelihood. Results:A resection margin <1 mm was identified as the only independent predictor of local recurrence in multivariable analysis (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.03 to 4.08; p = 0.043). Although conventional analysis did not show a benefit from RT, overlap-weighted analysis suggested an improved local recurrence-free survival with adjuvant RT, though this was not statistically significant (HR, 0.25; 95% CI, 0.05 to 1.19; p = 0.081). Distant metastasis events were rare (n = 3), and no significant difference in DMFS was observed after overlap weighting (HR, 2.27; 95% CI, 0.33 to 15.66; p = 0.404). In an exploratory subgroup analysis, no local recurrence (LR) was observed in the 12 borderline patients who received adjuvant RT (0/12 vs. 27/136 in surgery-only). Conclusion:Margins <1 mm were independently linked to an increased risk of LR. After adjusting for selection bias, adjuvant RT showed a trend toward reduced LR, though it did not achieve statistical significance. Adjuvant RT might be considered for selected high-risk patients.
