BACKGROUND:Intravascular brachytherapy (ICBT) has re-emerged as an effective treatment for in-stent restenosis (ISR). Intravascular ultrasound (IVUS) enables detailed assessment of stent expansion, neointimal proliferation, and other mechanical causes of ISR, potentially allowing more tailored procedural strategies and improved lesion preparation before radiation therapy. OBJECTIVES:The objective of the study was to evaluate the clinical utility of IVUS guidance during ICBT for ISR, with emphasis on long-term clinical outcomes. METHODS:We performed a retrospective analysis of patients undergoing ICBT for ISR between 2016 and 2024. Patients were stratified according IVUS use during the procedure. The primary endpoint was target lesion revascularization at follow-up. Secondary endpoints included all-cause mortality and postprocedural myocardial infarction. RESULTS:A total of 221 patients were included (132/221 [59.7%] IVUS-guided). IVUS use was associated with larger vessel diameter (3.6 ± 0.04 mm vs 3.3 ± 0.05 mm; P < 0.001), advanced lesion preparation (65/132 [49.2%] vs 17/89 [19.1%]; P < 0.001), and longer brachytherapy dwell time (332.2 ± 2.6 s vs 313.4 ± 4.2 s; P < 0.001). At a median follow-up of 717.9 ± 46.1 days, all-cause mortality (11/132 [8.3%] vs 21/89 [23.6%]; P = 0.03) and postprocedural myocardial infarction (15/132 [11.4%] vs 23/89 [25.8%]; P = 0.005) were more frequent in the non-IVUS group. Cox regression analysis showed higher target lesion revascularization in the IVUS group (HR: 1.68; 95% CI: 1.05-2.68; P = 0.03). CONCLUSIONS:IVUS-guided ICBT for ISR was safe but was not independently associated with improved long-term outcomes.

BACKGROUND:In-stent restenosis (ISR) is a common complication following coronary stent implantation. Intracoronary brachytherapy (ICBT) has re-emerged as an effective treatment modality. However, optimal procedural strategies, including the role of radiation source overlap and adequate margin length, remain unclear. AIMS:To evaluate the impact of radiation source overlap and radiation margin adequacy on procedural and clinical outcomes in patients undergoing ICBT for ISR. METHODS:We conducted a retrospective, single-center study of 222 patients treated with ICBT for ISR between June 2016 and December 2024. Patients were stratified using radiation source overlap (single vs. double dwell) and radiation margin length (< 10 vs. ≥ 10 mm). The primary endpoint was 1-year target lesion revascularization (TLR). Secondary endpoints included 1-year and 3-year all-cause mortality and 1-year major adverse cardiovascular events (MACE). RESULTS:Among 222 patients (mean age 65.1 ± 0.7 years; 28.9% female), 42 (19.3%) received overlapping radiation, and 1616 (74.8%) had radiation margins ≥ 10 mm. TLR rates at 1 year were similar between overlap and non-overlap groups (HR = 1.26, 95% CI [0.68-2.31], p = 0.46). There were no significant differences in 1-year mortality (HR = 0.79; 95% CI [0.27-2.29]; p = 0.67) or 1-year MACE (HR = 1.17; 95% CI [0.66-2.10]; p = 0.59). Patients with margins ≥ 10 mm had similar rates of 1-year TLR compared to those with margins < 10 mm (HR = 0.61; 95% CI [0.16-2.30], p = 0.47). Both groups were associated with rates of 1-year mortality (HR = 0.73, 95% CI [0.33-1.60], p = 0.43) and 1-year MACE (HR = 0.98; 95% CI [0.63-1.53], p = 0.94). CONCLUSION:Radiation source overlap and short (< 10 mm) or extended (≥ 10 mm) treatment margins beyond the restenotic lesion do not compromise the safety or efficacy of ICBT. These findings support a more individualized, anatomy-guided approach to ICBT planning, which may enhance procedural feasibility without sacrificing long-term outcomes.

Background In-stent restenosis (ISR) remains a challenging complication following percutaneous coronary intervention, and intravascular brachytherapy (IVBT) has proved to be an important treatment strategy. However, limited data exist on sex-specific outcomes following IVBT. Methods This retrospective, single-center cohort study included 223 patients (61 women, 162 men) treated with IVBT for ISR between 2014 and 2023. The primary end points were all-cause mortality, target lesion revascularization, and major adverse cardiovascular events. Secondary outcomes included technical success, myocardial infarction, cardiac death, and heart failure hospitalization. Multivariable Cox regression was used to adjust for clinical and procedural covariates. Results Baseline characteristics were largely similar between sexes, except for higher body surface area and diabetes prevalence in men. Procedural success rates did not differ between groups. However, female sex was independently associated with a higher risk of target lesion revascularization (adjusted HR, 1.80; 95% CI, 1.07-3.01; P = .026) and major adverse cardiovascular events (adjusted HR, 1.63; 95% CI, 1.09-2.45; P = .017). Women also had a higher risk of myocardial infarction (adjusted HR, 2.58; 95% CI, 1.29-5.19; P = .008), whereas no significant sex-based differences were observed for all-cause mortality or heart failure hospitalization. Conclusions Despite comparable procedural outcomes, women undergoing IVBT for ISR experienced higher rates of adverse cardiovascular events. These findings underscore the need for sex-stratified risk assessment and further prospective research to understand and address sex-based differences in outcomes after IVBT.

Purpose Biochemical recurrence occurs in approximately 30% of men after upfront radical prostatectomy for treatment of their prostate cancer. Salvage treatment options for this patient population are limited, and fossa brachytherapy (BT) offers a promising local treatment option. In this report, we describe the technique of high dose rate (HDR) BT as salvage for nodular prostate fossa recurrences and report initial outcomes. Materials and Methods Patients included had either pathologically confirmed local recurrence or an elevated PSA with a visible lesion on PSMA PET and/or MRI, no evidence of distant metastatic disease, and were suitable candidates for BT implant with trans-rectal ultrasound guidance (TRUS). Patients with prostate fossa recurrences after prior pelvic external beam radiotherapy (EBRT) were treated in two fractions to a total dose of 27 Gy. Patients without a history of prior pelvic EBRT were treated with combination EBRT + BT, BT dose being 15 Gy in a single fraction. Dose constraints utilized were rectal D1cc <75% and urethral D1cc<110% with cumulative D2cc assessed to account for prior radiation. Patients were then followed every 3-4 months for 2 years. Clinical, toxicity and dosimetric data were collected and analyzed. Results At a single institution, 16 patients completed prostate fossa BT salvage with curative intent between June 2020 and January 2024. Five patients had received pelvic EBRT for an initial recurrence after RP, and in this series received HDR BT as definitive treatment of a second local recurrence. The remaining 11 patients were treated with combination EBRT + HDR BT for an initial recurrence after RP. Median age was 68.5 years and the median PSA just prior to BT salvage was 1.8 ng/mL. The median dose of EBRT directed at the pelvis for patients without prior EBRT was 46 Gy prior to HDR BT salvage. Eight patients received androgen directed therapy (ADT) at the time of HDR BT salvage, while the remaining 8 received local therapy only. At the time of reporting, 5 patients remained on ADT while 11 were no longer on active androgen directed therapy. After a median follow up of 8 months, the median PSA after treatment decreased from 1.8 ng/mL to 0.53 ng/mL. All patients had local disease control of the area targeted during HDR BT salvage. There were 3 patients who developed locoregional failures (penile, prostate apex, common iliac node) and 2 patients who developed distant bony metastases. For all patients, the median D1cc to the rectum was 7.37 Gy and to the bladder was 10.3 Gy. The median hot spot (D0.03cc) to the urethra was 10 Gy. There were 13 Grade 1 GU toxicities and a single Grade 2 GU toxicity. There were no grade 3 or higher acute or any late toxicities reported. Conclusions This study found that brachytherapy salvage is a safe and feasible treatment option for patients with prostate fossa recurrences. On preliminary albeit short follow up, PSA control rates also appear to be acceptable in a patient population with limited local treatment options. Future prospective studies are needed.

Background and objective: Renal function preservation is particularly important following nonoperative treatment of localized renal cell carcinoma (RCC) since patients are often older with medical comorbidities. Our objective was to report long-term renal function outcomes after stereotactic ablative radiotherapy (SABR) including patients with a solitary kidney. Methods: Patients with primary RCC treated with SABR with >= 2 yr of follow-up at 12 International Radiosurgery Consortium for Kidney institutions were included. Renal function was measured by estimated glomerular filtration rate (eGFR). Key findings and limitations: In total, 190 patients (56 with a solitary kidney) underwent SABR and were followed for a median of 5.0 yr (interquartile range [IQR]: 3.4- 6.8). In patients with a solitary kidney versus bilateral kidneys, pre-SABR eGFR (mean [standard deviation]) was 61.1 (23.2) versus 58.0 (22.3) ml/min (p = 0.32) and the median tumor size was 3.65 cm (IQR: 2.59-4.50 cm) versus 4.00 cm (IQR: 3.00-5.00 cm; p = 0.026). At 5 yr after SABR, eGFR decreased by -14.5 (7.6) and -13.3 (15.9) ml/min (p = 0.67), respectively, and there were similar rates of post-SABR dialysis (3.6% [n = 2/56] vs 3.7% [n = 5/134]). A multivariable analysis demonstrated that increasing tumor size (odds ratio [OR] per 1 cm: 1.57; 95% confidence interval [CI]: 1.14-2.16, p = 0.0055) and baseline eGFR (OR per 10 ml/min: 1.30; 95% CI: 1.02-1.66, p = 0.034) were associated with an eGFR decline of >= 15 ml/min at 1 yr. Conclusions and clinical implications: With long-term follow-up after SABR, kidney function decline remains moderate, with no observed difference between patients with a solitary kidney and bilateral kidneys. Tumor size and baseline eGFR are dominant factors predictive of long-term renal function decline. Patient summary: With long-term follow-up, stereotactic ablative radiotherapy (SABR) yields moderate long-term renal function decline and low dialysis rates even in patients with a solitary kidney. SABR thus represents a promising noninvasive, nephron-sparing option for patients with localized renal cell carcinoma. (c) 2024 Published by Elsevier B.V. on behalf of European Association of Urology.

Brachytherapy offers a highly conformal and adaptive approach to radiation therapy for various oncologic conditions. This review explores the rationale, applications, technological advances, and future directions of personalized brachytherapy. Integration of advanced imaging techniques, 3D-printed applicators, and artificial intelligence are rapidly enhancing brachytherapy delivery and efficiency, while genomic tests and molecular biomarkers are refining patient and dose selection. Emerging research on combining brachytherapy with immunotherapy offers unique synergistic potential, and technologies such as intensity-modulated and shielded brachytherapy applicators present novel opportunities to further optimize dose distributions. Despite these promising advances, the field faces challenges including a need to train more practitioners and develop new approaches to treating a broader range of malignancies. As personalized medicine evolves, brachytherapy’s ability to deliver highly targeted, individualized treatments positions it as a critical component in future cancer care.

Traditionally, renal cell carcinoma (RCC) was considered a radioresistant tumor, thereby limiting definitive radiation therapy management options. However, several recent studies have demonstrated that stereotactic body radiation therapy (SBRT) can achieve high rates of local control for the treatment of primary RCC. In the setting of expanding use of SBRT for primary RCC, it is crucial to provide guidance on practical considerations such as patient selection, fractionation, target delineation, and response assessment. This is particularly important in challenging scenarios where a paucity of evidence exists, such as in patients with a solitary kidney, bulky tumors, or tumor thrombus. The Radiosurgery Society endorses this case-based guide to provide a practical framework for delivering SBRT to primary RCC, exemplified by 3 cases. This article explores topics of tumor size and dose fractionation, impact on renal function and treatment in the setting of a solitary kidney, and radiation's role in the management of inferior vena cava tumor thrombus. Additionally, we review existing evidence and expert opinion on target delineation, advanced techniques such as magnetic resonance imaging guided SBRT, and SBRT response assessment.

Metastatic renal cell carcinoma (RCC) can present with oligometastatic disease and/or develop oligoprogression following systemic therapy. Cytoreductive and focal metastasis-directed therapy options include resection, stereotactic ablative radiation and thermal ablation. Aggressive focal therapy may allow delay in initiation of or modification to systemic therapy and improve clinical outcomes. In this narrative review we synthesize current practice guidelines and prospective data on focal therapy management options and highlight future research. Patient selection and the choice of focal treatment techniques are controversial due to limited and heterogeneous data and patients may benefit from multidisciplinary evaluation. Prospective comparative trials with clearly defined inclusion criteria and relevant end points are needed to clarify the risks and benefits of different approaches.

Supplementary Table 1 from A Molecular Classification of Papillary Renal Cell Carcinoma

Supplementary Figure 6 from Sunitinib Acts Primarily on Tumor Endothelium rather than Tumor Cells to Inhibit the Growth of Renal Cell Carcinoma

Primary central nervous system lymphoma (PCNSL) is an aggressive subtype of non-Hodgkin lymphoma that carries a poor prognosis in the elderly. The aim of this study is to investigate treatment patterns and survival trends in patients ≥ 65 years with PCNSL through data provided by the Texas Cancer Registry. Adults ≥ 65 years diagnosed with PCNSL and followed between 1995–2017 were identified and separated into three eras: 1995–2003, 2004–2012, and 2013–2017. Baseline covariates compared included patient demographics and treatments administered. Pearson’s chi-squared test and Cox proportional hazard models compared covariates; overall survival (OS) and disease-specific survival (DSS) were assessed via Kaplan–Meier methodology. There were 375 patients; 104 (27.7

Abstract Despite the moderate incidence of papillary renal cell carcinoma (PRCC), there is a disproportionately limited understanding of its underlying genetic programs. There is no effective therapy for metastatic PRCC, and patients are often excluded from kidney cancer trials. A morphologic classification of PRCC into type 1 and 2 tumors has been recently proposed, but its biological relevance remains uncertain. We studied the gene expression profiles of 34 cases of PRCC using Affymetrix HGU133 Plus 2.0 arrays (54,675 probe sets) using both unsupervised and supervised analyses. Comparative genomic microarray analysis was used to infer cytogenetic aberrations, and pathways were ranked with a curated database. Expression of selected genes was validated by immunohistochemistry in 34 samples with 15 independent tumors. We identified two highly distinct molecular PRCC subclasses with morphologic correlation. The first class, with excellent survival, corresponded to three histologic subtypes: type 1, low-grade type 2, and mixed type 1/low-grade type 2 tumors. The second class, with poor survival, corresponded to high-grade type 2 tumors (n = 11). Dysregulation of G1-S and G2-M checkpoint genes were found in class 1 and 2 tumors, respectively, alongside characteristic chromosomal aberrations. We identified a seven-transcript predictor that classified samples on cross-validation with 97% accuracy. Immunohistochemistry confirmed high expression of cytokeratin 7 in class 1 tumors and of topoisomerase IIα in class 2 tumors. We report two molecular subclasses of PRCC, which are biologically and clinically distinct and may be readily distinguished in a clinical setting.

Supplementary Figure 4 from Sunitinib Acts Primarily on Tumor Endothelium rather than Tumor Cells to Inhibit the Growth of Renal Cell Carcinoma

Supplementary Figure Legends 1-7 from Sunitinib Acts Primarily on Tumor Endothelium rather than Tumor Cells to Inhibit the Growth of Renal Cell Carcinoma

Supplementary Figure 5 from Sunitinib Acts Primarily on Tumor Endothelium rather than Tumor Cells to Inhibit the Growth of Renal Cell Carcinoma

Supplementary Table 1 from Tumor Suppressor Activity and Epigenetic Inactivation of Hepatocyte Growth Factor Activator Inhibitor Type 2/SPINT2 in Papillary and Clear Cell Renal Cell Carcinoma

Supplementary Figure 3 from Sunitinib Acts Primarily on Tumor Endothelium rather than Tumor Cells to Inhibit the Growth of Renal Cell Carcinoma

Supplementary Figure 2 from Sunitinib Acts Primarily on Tumor Endothelium rather than Tumor Cells to Inhibit the Growth of Renal Cell Carcinoma