PURPOSE:The Expanded Prostate Cancer Index Composite (EPIC) is a symptom scale that measures health-related quality of life (HRQoL) in prostate cancer (PCa) patients. This scale is translated into different languages and used in daily practice. This study aimed to translate the EPIC scale into Turkish and provide Turkish validation by conducting validity and reliability analyses. METHODS:Patients with biopsy-proven PCa who received definitive or postoperative radiotherapy (RT) at our department were included. All participants were evaluated using the Turkish EPIC, The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ) C30, and EORTC-QLQ PR25 questionnaires at five different time points. First, the original English version of the EPIC was translated into Turkish, and then, two reliability and five validity analyses were performed. RESULTS:One hundred-five patients were included in the study. In the reliability analyses, Cronbach's alpha values of the whole scale were measured at 0.866, and the main scales' Cronbach's alpha values were measured between 0.654 and 0.969. In the test-retest analysis, the correlation values of the main scales were measured between 0.413 and 0.861. The pilot study with 20 patients was completed, thus providing face validity. Sensitivity to change analysis, interscale correlation, criterion validity, and explanatory factor analyses were performed, and results proving the scale's validity were obtained in all analyses. CONCLUSION:The Turkish EPIC scale is applicable for patients in the Turkish population diagnosed with PCa who received either definitive or postoperative RT.

Purpose: For patients with unresectable extrahepatic cholangiocarcinoma, radiotherapy (RT) is the definitive treatment. In this study, we aimed to evaluate the role of two different RT techniques for definitive treatment of unresectable extrahepatic cholangiocarcinoma.Materials and methods: Eighteen patients with unresectable extrahepatic cholangiocarcinoma treated with either conventionally fractionated radiotherapy (CFRT) or stereotactic body radiotherapy (SBRT) were evaluated retrospectively. Patients treated with CFRT also received elective nodal irradiation (ENI) in addition to the primary tumor.Results: Median doses of CFRT and SBRT were 50.4 Gy (range, 45 to 59.4) in 25–33 fractions and 37.5 Gy (range, 27.5 to 50) in 3–5 fractions, respectively. Median follow-up was 22 months (range, 7 to 138). During follow-up, local failure occured in one patient (12.5%) in the SBRT group and six patients (60.0%) in the CFRT group (p = 0.041). On the other hand, regional failure occured in five patients (62.5%) in the SBRT group and in two patients (20.0%) in the CFRT group (p = 0.047). Two-year overall survival (OS), local-regional failure-free survival (LRFFS), and distant metastasis-free survival (DMFS) rates were 35%, 30%, and 24%, respectively. Younger age (≤55 years) was associated with better OS, LRFFS, and DMFS. None of the patients experienced ≥grade 3 acute or late toxicity.Conclusion: While SBRT may provide better local tumor control compared to CFRT, the absence of ENI can result in increased regional recurrences. Hence, conducting prospective studies to examine the safety and efficacy of integrating hypofractionated ENI into SBRT is warranted.

Our objective was to identify the dosimetric parameters and prostate volume that most accurately predict the incidence of acute and late gastrointestinal (GI) and genitourinary (GU) toxicity in prostate cancer stereotactic ablative radiotherapy (SABR) treatments. We conducted a retrospective analysis of 122 patients who received SABR for prostate cancer at our clinic between March 2018 and September 2022 using a five-fraction SABR regimen. The existing plans of these patients were re-evaluated according to our institutional protocols (Hacettepe University [HU-1] and HU-2) as well as PACE‑B, RTOG 0938, and NRG GU005 dose–volume constraints. Univariate and multivariate logistic regression analyses were performed using SPSS version 23.0 (IBM, Armonk, NY, USA). The median follow-up was 24.7 months (0.8–94.4 months). For acute GU toxicity, moderate-dose regions were predictive for grade 1–2 toxicity, while high-dose regions were more associated with grade 3–4 toxicity. For late GU toxicity, moderate–high-dose regions were predictive. For GI toxicity, moderate-dose regions were important for both acute and late toxicity. The HU protocol encompassed all significant dosimetric factors influencing toxicity outcomes. A prostate volume threshold of 60 cc was predictive of acute grade 3–4 GU toxicity. Our study highlighted the critical role of moderate-dose regions for acute and late GI and GU toxicity. Prostate treatment plans should be rigorously evaluated, and moderate doses should be minimized. The HU protocol is an eligible choice for five-fraction SABR plans.

PURPOSE:To evaluate the effect of radiation therapy (RT) boost sequences and doses to internal mammary (IM) lymph nodes (LNs) on oncologic outcomes and toxicity in patients with clinically IMLN-positive breast cancer. METHODS:Twenty-six patients with positive IMLNs at diagnosis who were treated between 2013 and 2022 were retrospectively evaluated. After systemic therapy and surgery, RT was applied to the whole breast or chest wall, including the axillary, supraclavicular, and IM lymphatics. An RT boost to the IMLNs was administered either sequentially or as a simultaneous integrated boost (SIB). Treatment outcomes, prognostic factors, and toxicity profiles were analyzed. RESULTS:A complete response (CR) and partial response (PR) in metastatic IMLNs were observed in 17 patients (65.4%) and 5 patients (19.2%) following systemic therapy, respectively. One patient (3.8%) had stable disease, while two patients (7.7%) experienced disease progression in the IMLNs.After a median follow-up of 67 months, regional recurrence, distant metastasis, or both occurred in 1 (3.8%), 1 (3.8%), and 2 (7.7%) patients, respectively. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 86.7% and 76.4%, respectively. The absence of extracapsular extension in axillary LNs was associated with improved OS and DFS. A CR or PR to systemic treatment in IMLNs was associated with improved DFS only. The boost sequence had no significant effect on survival, organ-at-risk doses, or cardiac toxicity. CONCLUSION:An RT boost to IMLNs without surgical resection provides excellent oncologic outcomes with acceptable toxicity. While the SIB technique reduces the number of treatment fractions, it did not result in superior oncologic outcomes compared to the sequential boost. Further prospective studies are needed to investigate the role of RT boost sequencing to the IMLNs.

Purpose/Objective Reirradiation has been identified as a viable treatment modality for patients with recurrent head and neck cancer (rHNC). Retrospective series demonstrate the superiority of intensity-modulated radiation therapy (IMRT) over stereotactic ablative radiotherapy (SABR) for patients in the Multi-Institution Reirradiation Collaborative (MIRI) class 2 risk group (treatment interval > 2 years without resection or treatment interval ≤ 2 years without organ dysfunction). he objective of this study was to investigate the efficacy and toxicity of SABR in patients classified as “RPA Class 2” rHNC. Material/Methods The data of 85 cases diagnosed with rHNC who underwent reirradiation with the SABR technique between 2007 and 2022 in our department were evaluated retrospectively. We did not incorporate cases of primary nasopharynx cancer due to its comparatively more favorable prognosis in relation to other types of head and neck cancers. The Kaplan-Meier method was used for survival analyzes (IBM SPSS v23). Results Patient, tumor and treatment characteristics are presented in Table 1. The median age was 59 (range, 19-87). The median follow-up period was 12 months (range,1-178 months). The first assessment following SABR revealed that 30% of the patients achieved a full response, 35% achieved a partial response, 11% had stable disease, and 4% experienced disease progression. During follow-up, local recurrence (LR) developed in 31 patients (36%) and distant metastasis (DM) developed in 24 patients (28%). The local control (LC) rate with SBRT was 64%. The most common sites of DM are the lung, bone, and liver. In 31 patients who developed LR after SABR, the median time to LR development was 8 months (range, 2-55 months). Subsequently, a third course of radiation therapy (RT) was administered to 16 of them (52%). The 1- and 2-year overall survival (OS), local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS) rates were 50% and 30%, 39% and 21%, 46% and 27%, respectively. In univariate analysis, age (≤59 vs. >59 years), gender (male vs. female), interval between treatments (≤2 vs. >2 years), organ dysfunction before SABR (present vs. absent) or surgery (present vs. absent), SABR dose (≤30 vs. >30 Gy), technique (robotic vs. linear accelerator-based), recurrent tumor volume (≤43 vs. >43 cc), and recurrence location (primary vs. neck) parameters did not have prognostic effect on OS, LRFS and DMFS. The rate of grade 3 or 4 late toxicity was 11%, and the rate of grade 5 toxicity was 9%. Eight patients (9%) developed massive hemorrhage secondary to carotid blow out syndrome (CBOS), 6 patients (7%) developed brain parenchymal necrosis, 2 patients (2.5%) required permanent gastrostomy, and 1 patient (1.5%) developed optic neuropathy and vision loss. The administration of SABR in consecutive or alternate day fractions shown comparable effects on toxicity. Conclusion The utilization of the SABR as a method of reirradiation in rHNC patients has demonstrated favorable outcomes in terms of achieving effective LC while maintaining acceptable levels of treatment-related toxicity. We provide a study that demonstrates highly favorable survival outcomes with SABR for patients classified as RPA class 2 rHNC. There is a need for prospective randomized studies to be conducted in order to ascertain the ideal approach for reirradiation, specifically comparing SABR and IMRT. These studies would also help identify the patient population that would benefit the most from such reirradiation techniques.

Purpose/Objective Local recurrence (LR) rates in nasopharyngeal carcinoma (NPC) following definitive radiation (RT) ± chemotherapy (CT) range from 7–15%. A prospective trial comparing endoscopic surgery and reirradiation in recurrent cases found that surgery improved survival in a carefully chosen group of patients with low-volume mucosal recurrence. However, the fact that the recurrent disease is mostly multifocal and infiltrative in nature makes a limited group of patients suitable for surgery. In this study, we aimed to report our stereotactic ablative radiotherapy (SABR) outcomes in cases diagnosed with recurrent NPC. Material/Methods The data of 83 patients who underwent SABR in our department between 2007 and 2022 with the diagnosis of local-regional recurrent NPC, which was unresectable or had surgical margin positivity after resection were evaluated retrospectively. The Kaplan-Meier method was used for survival analyses (IBM SPSS v.23). Results Patient, tumor, and treatment characteristics are presented in Table 1. The median age was 53 (range, 19-78). The median follow-up was 24 months (range, 3–151 months). The median interval between patients’ first and second RT's was 39 months (range, 4–238 months). The initial response evaluation following reirradiation found a complete response in 38%, a partial response in 40%, stable disease in 8%, and progression in 1%. In follow-up, LR developed in 20 patients (24%) and distant metastasis (DM) developed in 14 patients (17%). The most common sites of DM were the lung, bone, and liver. SABR provided 76% local control (LC). The 1- and 2-year overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rates were 67% and 53%, 65% and 46%, and 62% and 49%, respectively. In univariate analysis, LRFS (60% vs. 34%, p=0.002) and DMFS (63% vs. 31%, p=0.007) rates were higher in patients with recurrent tumor volume ≤36 cc compared to patients with tumor volume >36 cc. Age (≤53 vs. >53 years), gender (male vs. female), interval between RTs (≤2 vs. >2 years), surgery before SBRT (yes vs. no), SBRT dose (≤30 vs. >30 Gy) and device (robotic- vs. linear accelerator-based), and site of recurrence (primary vs. neck recurrence) could not be identified for prognostic significance for OS, LRFS, and DMFS parameters. A notable proportion of patients experienced late toxicity, with 20% exhibiting grade 3 or 4 toxicity and 12% experiencing grade 5 toxicity. Fourteen patients (17%) experienced massive hemorrhage as a result of carotid blow-out syndrome (CBOS); two patients (2%) suffered from cerebrovascular disease as a result of carotid artery stenosis; five patients (6%) experienced brain parenchymal necrosis; three patients (3.5%) had permanent gastrostomies; and three patients (3.5%) had hearing loss. There was no observed disparity in toxicity levels between doses administered consecutively or every other day. Conclusion Using SABR as a reirradiation method for people with recurrent NPC has shown to be very effective at achieving LC while keeping treatment-related side effects at a level that can be tolerated. There is a positive correlation between a smaller recurring tumor volume and higher levels of local recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS).

While three-dimensional radiotherapy (RT) causes high incidental nodal doses in bladder-only irradiation for muscle-invasive bladder cancer (MIBC), the impact on pelvic lymphatics is unclear in the era of intensity-modulated RT (IMRT). This study evaluates incidental doses to pelvic lymphatics in MIBC patients treated with IMRT. The data of 40 MIBC patients treated with bladder-only IMRT and concurrent chemotherapy were retrospectively evaluated. The pelvic lymphatics were contoured on initial simulation images and incidental nodal doses were evaluated. The Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM, Armonk, NY, USA) was used for statistics. Median RT dose to the bladder was 60 Gy in 30 fractions. In dosimetric analysis, median values of mean dose (Dmean) of the obturator, presacral, external iliac, internal iliac, and distal common iliac lymphatics were 33 Gy (range 4–50 Gy), 3 Gy (range 1–28 Gy), 9.5 Gy (range 3–41 Gy), 7.5 Gy (range 2–14 Gy), and 1 Gy (range 0–15 Gy), respectively. The Dmean of the obturator lymphatics was significantly higher (p < 0.001) and the Dmean of the distal common iliac lymphatics was significantly lower (p < 0.001) than all remaining lymphatic stations. The Dmean of the external iliac lymphatics was significantly higher than that of the presacral lymphatics (p < 0.001), but the difference with the internal iliac lymphatics was not statistically significant (p = 0.563). The incidental nodal doses with bladder-only IMRT are heterogeneous and remain below the generally accepted doses for microscopic disease eradication for bladder cancer.

AIMS:We aimed to evaluate the treatment outcomes and associated prognostic factors in breast cancer (BC) patients who had bone-only oligometastatic disease (OMD) and we tried to determine the subgroup that would benefit most from stereotactic ablative radiotherapy (SABR). MATERIALS AND METHODS:We enrolled 47 patients with a total of 63 lesions with bone-only oligometastatic BC who underwent SABR for all bone lesions between July 2013 and March 2022. Cases with bone-only metastatic disease with up to 5 metastatic lesions that can be safely treated with SABR were included in this study. All statistical analyses were performed using SPSS 23.0 software (SPSS, Chicago, IL). RESULTS:The median follow-up time was 34 months. The 2- and 5-year overall survival (OS) rates were 90% and 66%, and the progression-free survival (PFS) rates were 49% and 29%, respectively. The local control rate in the SABR-treated foci was 85%. In multivariate analysis, OMD state (genuine vs. induced), de-novo OMD state (synchronous vs. metachronous), and histology (luminal vs. HER-2 enriched) were prognostic for OS. Molecular subtype switch was observed in 21 (42%) patients, and 0% PFS was observed in 5 years in patients with phenotypic discordance. SABR was well tolerated and there were no ≥grade 4 acute or late toxicities. CONCLUSION:Our study showed that in patients with bone-only OMD, in HER2-enriched subtypes with genuine & de-novo & synchronous OMD, SABR should be strongly considered for all metastatic foci, especially if there is phenotypic discordance in the primary tumor and metastasis.

Purpose: The Expanded Prostate Cancer Index Composite (EPIC) is a symptom scale that measures health-related quality of life (HRQoL) in prostate cancer (PCa) patients. This scale is translated into different languages and used in daily practice. This study aimed to translate the EPIC scale into Turkish and provide Turkish validation by conducting validity and reliability analyses. Methods: Patients with biopsy-proven PCa who received definitive or postoperative radiotherapy (RT) at our department were included. All participants were evaluated using the Turkish EPIC, The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ) C30, and EORTC-QLQ PR25 questionnaires at five different time intervals. First, the original English version of the EPIC was translated into Turkish, and then, two reliability and five validity analyses were performed. Results: One hundred-five patients were included in the study. In the reliability analyses, Cronbach's alpha values of the whole scale were measured at 0.866, and the main scales' Cronbach's alpha values were measured between 0.654 and 0.969. In the test-retest analysis, the correlation values of the main scales were measured between 0.413 and 0.861. The pilot study with 20 patients was completed, thus providing face validity. Sensitivity to change analysis, interscale correlation, criterion validity, and explanatory factor analyses were performed, and results proving the scale's validity were obtained in all analyses. Conclusion: The Turkish EPIC scale is applicable for patients in the Turkish population diagnosed with PCa who received either definitive or postoperative RT.

Intensity-modulated radiotherapy (IMRT) is the standard treatment approach for nasopharyngeal cancer (NPC). IMRT enables effective sparing of the parotid glands and reduces the risk of xerostomia, a common complication of head and neck irradiation. Nevertheless, it is essential to determine whether the parotid-sparing IMRT (ps-IMRT) technique yields increased intra-/periparotid recurrence rates, which constitutes the main purpose of this study. Patients with a diagnosis of NPC that received definitive chemoradiotherapy/radiotherapy (CRT/RT) between 1991 and 2021 were evaluated retrospectively. Patients with intra-/periparotid recurrence were detected and prognostic factors for recurrence were sought. A total of 746 patients were evaluated. Two-dimensional (2D)-RT was applied to 541, 3D conformal RT (3D-CRT) to 10, and ps-IMRT to 195 patients. After a median 85-month follow-up, one (0.18