CRT-related immunosuppression is associated with delayed durvalumab initiation and worse DCR. Larger PTV and higher lung and heart doses are associated with TRL. Median real-world OS and PFS are similar to those in the PACIFIC trial.

PET-PSMA is a powerful diagnostic tool that conditions significant changes in the therapeutic approach in those patients with occult biochemical recurrence with low PSA, changing the treatment in 75% of the cases when the study is positive.

PET-PSMA shows excellent diagnostic capability even in strictly selected patients with PSA values < 2ng/ml. Its indication with values < 0.5ng/mL should be assessed according to individual risk. In 56.9% of the patients in the study the positive result could influence changes in therapeutic strategy.

The limited current literature on the use of IORT in brain metastases appears to show efficacy and safety, but the most effective dose is unknown as well as whether it is as effective as other radiotherapy alternatives. Our study is ongoing and needs to be completed and evaluated with more follow-up in order to reach definitive conclusions.

BACKGROUND:Radiotherapy (RT) combined with breast reconstruction can reduce the risk of cancer recurrence and increase the survival rate. However, this approach seems to worsen aesthetic outcomes and increase complication rates. The impact of breast reconstruction timing and techniques on clinical outcomes, however, remains unclear. For this reason, we aimed to perform a more comprehensive analysis of a series of patients undergoing RT and breast reconstruction.METHODS:Patients were divided into 4 groups according to the timing of reconstruction (before RT and after RT) and surgical technique (heterologous reconstruction and autologous reconstruction (AR)). The median time between RT and reconstruction, number of revision surgeries, incidence of complications, toxicity, aesthetics and associated clinical risk factors were used to assess the clinical outcomes. An objective system of skin toxicity evaluation was performed.RESULTS:Ninety-five patients were included in this study. No significant differences in the median time between RT and reconstruction, incidence of complications, toxicity or aesthetics were noted between different timings or techniques of reconstruction. Patients undergoing AR needed more revision surgeries to complete reconstruction. However, the total number of surgical procedures was similar between the groups. In a comparison between the treated and untreated breasts by an objective system, RT produced an increase in erythema and pigmentation and a decrease in elasticity in the treated breast (p<0.05 for all parameters). On multivariate analysis, smoking was a significant predictor associated with complications.CONCLUSIONS:Combined breast reconstruction and RT seem to be successful regardless of the order of treatment or the type of reconstruction.

Purpose To report long-term results of a randomized trial comparing accelerated partial breast irradiation (APBI) to whole-breast irradiation (WBI) in terms of efficacy, toxicity, and cosmesis. Methods and materials WBI group was treated with 3D conformal external irradiation, 2 Gy daily/fraction, 5 fractions/week, to a total dose of 50 Gy. APBI group was treated with 3D conformal external irradiation 3.75 Gy/fraction, twice a day, 5 fractions/week, to a total dose of 37.5 Gy in the APBI group. Patients were followed up every 6 months up to 5 years and yearly thereafter. During follow-up visits, the clinician evaluated chronic toxicity and scored cosmetic results with a four-scale system. Results After a median follow-up of 10.3 years, 43 patients in each group (84%) are alive without disease. One patient died after disease progression in the APBI arm, and there was no death in the WBI arm. The rest of the patients died from another disease different than breast cancer, similarly between groups. There was greater fibrosis in the APBI group (9 patients grade 1 and one grade 2) compared to WBI (3 patients grade 1 and one grade 2); p = 0.18. Regarding cosmesis, in APBI group, 19 and 21 (43.2 and 47%) patients had excellent or good results, similar to the WBI group with 18 patients (40.9%) in each cosmesis outcome. The WBI group did not have any patient with poor cosmesis but the APBI had 3 (6.8%; p = 0.24). Conclusion After a follow-up of 10 years, there were no differences in efficacy between the 2 treatment arms. Despite slight greater toxicity in the APBI group, the cosmesis was similar and satisfactory in both groups.

Purpose Radiation-induced toxicity (RIT) is usually assessed by inspection and palpation. Due to their subjective and unquantitative nature, objective methods are required. This study aimed to determine whether a quantitative tool is able to assess RIT and establish an underlying BED-response relationship in breast cancer. Methods Patients following seven different breast radiation protocols were recruited to this study for RIT assessment with qualitative and quantitative examination. The biologically equivalent dose (BED) was used to directly compare different radiation regimens. RIT was subjectively evaluated by physicians using the Radiation Therapy Oncology Group (RTOG) late toxicity scores. Simultaneously an objective multiprobe device was also used to quantitatively assess late RIT in terms of erythema, hyperpigmentation, elasticity and skin hydration. Results In 194 patients, in terms of the objective measurements, treated breasts showed higher erythema and hyperpigmentation and lower elasticity and hydration than untreated breasts ( p < 0.001, p < 0.001, p < 0.001, p = 0.019, respectively). As the BED increased, Δerythema and Δpigmentation gradually increased as well ( p = 0.006 and p = 0.002, respectively). Regarding the clinical assessment, the increase in BED resulted in a higher RTOG toxicity grade ( p < 0.001). Quantitative assessments were consistent with RTOG scores. As the RTOG toxicity grade increased, the erythema and pigmentation values increased, and the elasticity index decreased ( p < 0.001, p = 0.016, p = 0.005, respectively). Conclusions The multiprobe device can be a sensitive and simple tool for research purpose and quantitatively assessing RIT in patients undergoing radiotherapy for breast cancer. Physician-assessed toxicity scores and objective measurements revealed that the BED was positively associated with the severity of RIT.

Background Perineural invasion (PNI) is a feature of poor prognosis in cutaneous squamous cell carcinoma (CSCC). The benefit of postoperative radiotherapy (PORT) in the management of CSCC with PNI is still not well established. Objectives We aimed to evaluate the usefulness of PORT in the treatment of CSCC with PNI so as to determine which patients would best benefit from this type of treatment. Methods A retrospective multicenter cohort of 110 CSCCs with PNI was evaluated. Eighteen recurrent cases were excluded for subsequent analysis. We searched for the types of PNI associated with poor outcome and analysed the effectiveness of PORT on different groups of CSCC with PNI. We also assessed for the usefulness of PORT depending on the surgical margin status (either clear or positive). Results Postoperative radiotherapy showed clear benefit over observation in CSCC with PNI and positive margins after surgery, where the management by observation increased the risk of poor outcome events 2.43 times (P = 0.025), and especially in those with positive margins and PNI >= 0.1 mm, where the risk of poor prognosis is eight times greater following a management by observation (P = 0.0065). Multivariate competing risk analysis preserved statistical significance. Conclusions The use of PORT on patients with CSCC with PNI and positive margins after surgery, especially in PNI >= 0.1 mm, significantly improves long-term outcome. The benefit of PORT in cases with clear margins is not as evident, especially in those with PNI of small-calibre nerves. Clinical trials are imperative.

The weekly irradiation in breast cancer patients of advanced age is an option of treatment which tolerance can be influenced by the fractionation utilized. We analyze the long-term results of two weekly schedules. Between 1992 and 2016, we included 486 elderly patients presenting concomitant pathology or socio-familial problems in which it was not feasible to propose conventional treatment. They were treated with conservative surgery (or mastectomy in some cases) and then adjuvant hypofractionated irradiation, administering 5 Gy or 6.25 Gy in 6 fractions, once a week (total dose 30–37.5Gy) over 6 weeks. Both long-term fractionations have been compared in a cohort of 46 patients. Long term efficacy is evaluated as well as the chronic toxicity by means of scales of the CTCAE version 5.0 as for dermatitis, telangiectasia, fibrosis, and pain. Objective parameters of skin quality have been evaluated by means a multiprobe system, MultiSkin Test Center, measuring erythema, pigmentation, elasticity, and hydration. Median follow-up was 6 years. Overall survival according to the Kaplan-Meier method at 5 years was 74.2%±2.3%; breast cancer disease-free survival was 90%±1.6%; local relapse-free survival was 96.5%±1% showing that patients die more from other causes and not from their neoplasia. Acute dermatitis was mild (75.6% of the patients, grades I–III) and 30.6% had moderate chronic fibrosis. In the cohort of longer survivors, patients received doses of 6.25 Gy in 21 cases and 5 Gy in 25 cases. Patients treated with smaller dose presented lower incidence of dermatitis, telangiectasias fibrosis, or local pain. Diminish in elasticity measured by multiprobe system was also less marked in patients receiving doses of 5 Gy. There were no differences in the other parameters of skin quality at long term. Once-weekly hypofractionated radiotherapy is feasible and convenient option for elderly patients with breast cancer. It is a safe treatment modality with similar survival and local control results compared to standard fractionation, while the side effects are acceptable. Weekly irradiation at a 5 Gy per dose is equal in terms of efficacy but better tolerated compared to a superior dose schedule.

ConclusionPatients with choking when drinking before treatment have a higher risk of penetration/aspiration after (CH)RT.The risk increases significantly in case of bilateral neck irradiation and/or T3-T4 tumors.Therefore patients at risk should be referred for baseline (and follow up) VF examination, giving better insight into mechanisms and severity of penetration/aspiration and supporting an optimal treatment choice.

To determine if there is an association between the incidental radiation dose to the subventricular zone and survival in patients with glioblastoma multiforme treated with surgery, radiotherapy and temozolomide.

Introduction Neoadjuvant radiochemotherapy followed by radical surgery is the standard approach in advanced rectal carcinoma. Tumor response is determined in histological specimen. Objective To assess predictive factors for survival in 115 patients. Patients and Method 115 patients treated with neoadjuvant radiochemotherapy followed by radical surgery with total mesorectal excision, in our hospital from January 2007 to December 2014. All patients received pelvic radiotherapy with concomitant chemotherapy, followed by radical surgery and in some adjuvant chemotherapy. Results In univariate analysis, distance to anal verge, radial margin, perineural invasion, and good grade regression are predictive factors for both, specific and disease free survival; and in multivariant, only radial margin and perineural invasion were predictive factors for survival. We found distance to anal verge (<5 cm) as the only clinical factor to predict a positive margin in the histologic specimen. Conclusions Perineural invasion and positive radial margin are predictive factors for both specific and disease free survival.

Purpose To evaluate the impact of hypofractionated boost after hypofractionated whole breast irradiation in breast carcinoma. Methods and materials Patients after breast conservative surgery were treated all time with hypofractionation of 2.67 Gy/day. Whole breast dose was 40.05 Gy followed in case of risk of local relapse by a boost of 16.02 Gy or 8.01 Gy. Acute and chronic toxicity results were evaluated including cosmetic software-assisted assessment and objective evaluation of fibrosis parameters (elasticity and hydration) by means of a skin tester. Results A total of 362 patients were evaluated. Acute toxicities comprised grade 1 dermatitis in 48.1 %, grade 2 in 44.5 % and grade 3 in 17 patients 4.7 %, respectively. After a median follow-up of 4.5 years, in 308 cases (86.6 %) there was no chronic skin or subcutaneous changes. In the first consecutive 50 patients, measures with skin tester showed no statistical differences in parameters for skin and subcutaneous fibrosis. Cosmetic results were considered excellent and good in 26 and 62 %, respectively. Conclusions Boost to tumour bed with hypofractionated doses is well tolerated and acute and chronic toxicities are mild with good cosmetic results. Objective systems are encouraging methods to assess skin quality and cosmesis.

To report interim results from a single-institution study conducted to assess accelerated hypofractionated radiotherapy (AHRT) delivered with 3D conformal radiotherapy in two groups of patients with non-small cell lung cancer: (1) patients with early stage disease unable to tolerate surgery and ineligible for stereotactic body radiation therapy, and (2) patients with locally advanced disease unsuitable for concurrent chemoradiotherapy.

The aim of this study is to correlate chronic toxicity and multidimensional subjective/objective cosmetic evaluations in early stage breast cancer patients treated with conservative surgery, whole breast hypofractionated irradiation, and hypofractionated sequential boost. From a series of 586 patients treated with hypofractionated whole breast irradiation, 50 patients with high dose hypofractionated boost were selected for exhaustive result evaluation. Patients were treated at a dose of 2.67 Gy/fr, 5 fractions at week, as far as 40 Gy and a sequential boost at the same hypofractionated doses, up to 56 Gy according to risk factors for local relapse. Patients were evaluated at minimum follow-up of 2 years for: a) chronic toxicity by means RTOG scale, b) subjective cosmetic assessment by Harvard scale, c) self-cosmetic assessment by means a 11 item questionnaire, that was considered gold standard for all comparisons, d) objective evaluation of skin pigmentation and fibrosis parameters (elasticity and hydration) by means a skin tester (Multi-Skin-Center® MC-750-B2) and e) computer assisted photograph cosmetic and morphologic evaluations by BCCT-Core 2.0 software (UNESC, Porto University). Median follow-up was 3.2 years (range: 2-4.4 years). There were no local relapses. All patients presented mild acute skin toxicity (22 patients grade I, 24 patients grade II). Chronic toxicity was present in 20 patients (17 patients grade I, 3 patients grade II). Elasticity and erythema measured by skin tester showed differences between patients with or without chronic toxicity (P = 0.047 and P = 0.035 respectively). Patient cosmetic assessment resulted excellent in 26%, good in 64%, fair in 8% and bad in 2%. Overall score by photographic software correlated better to patient satisfaction than subjective physician evaluation (CC 0.36 vs 0.26; P = 0,016). The morphologic values on software assessment that best correlate with asymmetry perceived by patient were the BCE (Breast Compliance Evaluation) (P = 0,018), pBRA (proportion Breast Retraction Assessment) (P = 0,021) i pUNR (proportion Upward Nipple Retraction) (P = 0,023). There was also a correlation between RTOG toxicity score and overall software cosmetic values (P = 0,041). Hypofractionated boost is feasible with good results in terms of chronic toxicity and cosmesis. Outcomes seem best evaluated by objective tests.

survival as well as acute and late toxicities were retrospectively analyzed.

Results:The main result was the reduction in primary and nodal volumes due to better definition of lung mass and nearby lung Collapse , the latter could be easily defined in 14 cases on the DW-MRI vs. 7 cases only by CT scans (P=0.016).Median GTV total (sum of 1ry and nodal GTV), on MRI Diffusion compared to that on the CT scan was 354 and 386 cm3 respectively (P= 0.009).In 15 cases, a mean decrease in the GTV total of 34% ±56% (median, 9%; range, 0.2-32.5%)by using DW-MRI.only in three other cases a mean increase in the GTV total of 12.7% ±14.9% (median, 9.7%; range, 0.4-221%).was found.The median PTVs on the CT scans vs. the MRI Diffusion were 1623 (range, 493-2965 cm3) & 1419 (range, 542-3158 cm3) respectively which was statistically non significant (P= 0.391). Conclusion:This pilot prospective study concluded that DW-MRI as a functional image can aid in proper definition and delineation of the target volumes after fusion of DWI and the CT images .GTV Total decreased in most cases due to exclusion of collapse, consolidation, reactionary and inflammatory LN, however GTV total was increased in 3/20 patients due to better nodal detection and better visualization of borders adjacent to the mediastinum and chest wall.DW MRI could be a future good tool for proper staging and guidance of radiotherapy in NSCLC cases indicated for chemo/radiation.

Tumor response to neoadjuvant radiochemotherapy is determined at the time of surgical resection with histologic examination and is quantified on a spectrum ranging from no response to complete response. Good responder patients (Mandard classification I/II, compared to bad responders III/IV/V) achieve low level of local and distant relapses, with good survival. Other factors, as perineural, venous, vascular invasion, and positive radial margin also worsen prognosis. To assess the predictive factors for survival in our series of 115 patients. Between January 2006 and December 2013, patients diagnosed of rectal adenocarcinoma received neoadjuvant radiochemotherapy. There were 77 men and 38 women. A pelvic CT and MRI were done to all patients. Patients received pelvic radiation therapy to a total dose of 45-50.4 Gy with concomitant chemotherapy. An anterior resection was performed to 101 patients and an abdomino perineal resection to 14. Mandard classification was used to evaluate grade of pathologic response (TRG1-5). Log Rank test were used for univariate analysis and Cox regression for multivariate. There were 11 local and 24 distant relapses. Specific survival at 5 years was 75.1 ± 0.1%. Pathologic specimen showed: 16 TRG1, 43 TRG2, 39 TRG3, 17 TRG4. 11/115 patients had positive radial margin; 23/115 perineural invasion, 10/115 venous or arterial invasion and 14/115 patients small vessels invasion. In univariate analysis, distance to anal verge p< 0.04, radial margin p< 0.01, perineural invasion p< 0.000, venous invasion p< 0.001 and good grade regression p< 0.009 are predictive factors for survival. In multivariate analysis only radial margin p < 0.03 and perineural invasion p< 0.000 were predictive factors for survival. Good responders, compared to bad responders, showed decrease distant relapses p < 0.04, less perineural invasion p < 0.000, venous or vascular invasion p< 0.000, and small vessels invasion p < 0.000. None of the 16 patients who achieved a complete pathologic response (TRGI) had perineural, venous or vascular invasion in the histologic specimen and radial margin were negative. In univariate analysis we could also find distance to anal verge ≤ 5 cm as the only predictive factor to find positive margin in the histologic specimen. Tumors located ≤5 cm from anal verge, predict to have positive margins in histologic specimen. Positive margin and perineural invasion are predictive factors for survival. Good responders have less perineural, vascular or venous invasion than bad responders with decrease distant relapses.