Purpose:Palliative radiotherapy for patients with head and neck cancer can be used to alleviate symptoms. Only a few studies have investigated its impact on patient-reported outcomes (PRO). Therefore, we conducted a prospective multicenter observational study. The primary objective was to assess changes in health-related quality of life (HrQoL) per PRO. Methods:Eligibility criteria included i.) head and neck cancer and ii.) palliative radiotherapy indicated (EQD2Gy < 60 Gy). The primary follow-up date was eight weeks after radiotherapy (t8w). PRO measures included the EORTC QLQ-C30 and EORTC QLQ-H&N43 and pain per Numeric Rating Scale (NRS). Per protocol, five PRO domains were to be reported in detail as well as PRO domains corresponding to a primary and secondary symptom as determined by the individual patient. We defined a minimal important difference (MID) of 10 points. Results:From 06/2020 to 06/2022, 61 patients were screened and 21 patients were included. Due to death or decline in health-status, HrQoL data was available for 18 patients at the first fraction and for eight patients at t8w. The MID was not met for the predefined domains in terms of mean values as compared from first fraction to t8w. Individually in those patients with available HrQoL data at t8w, 71% (5/7) improved in their primary and 40% (2/5) in their secondary symptom domain reaching the MID from first fraction to t8w, respectively. There was a significant improvement in pain per NRS in those patients with available data at t8w per Wilcoxon signed rank test (p = 0.041). Acute mucositis of grade ≥3 per CTCAE v5.0 occurred in 44% (8/18) of the patients. The median overall survival was 11 months. Conclusion:Despite low patient numbers and risk of selection bias, our study shows some evidence of a benefit from palliative radiotherapy for head and neck cancer as measured by PRO.German Clinical Trial Registry identifier: DRKS00021197.

INTRODUCTION:Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines.MATERIALS AND METHODS:To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses.RESULTS:A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate.CONCLUSION:While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.

Background: International guidelines recommend the use of high-dose platinum chemoradiotherapy (CRT) (3 x 100 mg/m², q3w) for the treatment of LA SCCHN. The clinical benefit of CRT decreases with lower cumulative dosage. Dose reductions to ≤ 200 mg/m² lead to a significantly lowered OS. Predictive factors would help to select patients who are suitable for an optimal cumulative dose of cisplatin. Methods: The COMPLY trial included patients with LA SCCHN from Germany and Switzerland. Eligible patients were treated in 2013/2014. The planned target dose of cisplatin had to be > 200 mg/m². Compliance was defined as an administration of > 200 mg/m² cisplatin. R/M SCCHN, nasopharyngeal carcinomas, adjuvant treatment or participation in other clinical trials were excluded. The exploratory objective was to identify a predictive score for therapy compliance with platinum-based CRT. A multiple logistic regression analysis was performed to identify independent explanatory variables associated with compliance with cisplatin. Only independent variables with a p-value <0.15 in the univariate analysis were considered for multiple logistic regression analysis. Results: 184 patients in 9 sites were included. Median age was 61.0 years, 82.6% were male, 167 patients (90.8%) were ECOG 0-1. A significant difference in treatment compliance with cisplatin was shown for patients with concomitant musculoskeletal/connective tissue disorders (odds ratio for absence of disease vs. presence: 9.43; 95% CI: 1.20, 74.02; p = 0.03) and respiratory, thoracic and mediastinal disorders (odds ratio for absence of disease vs. presence: 6.59; 95% CI: 1.47, 29.48; p = 0.01) by system organ class. The probability of treatment compliance with cisplatin, being an estimate from a scoring system developed for the study, was 43.4% in subjects with absence of both disorders while the treatment compliance was 8.9% in subjects who presented with either one of the disorders and 1.2% in subjects with both disorders. Conclusions: These exploratory results indicate that subjects without musculoskeletal/connective tissue and respiratory, thoracic and mediastinal disorders as concomitant diseases were more likely to have received cisplatin >200 mg/m². Editorial acknowledgement: The Medical Affairs Oncology Department of Merck Serono GmbH, Darmstadt, Germany assisted in the writing of this abstract. Legal entity responsible for the study: Merck Serono GmbH, Darmstadt, Germany. Funding: Merck Serono GmbH, Darmstadt, Germany. Disclosure: J. Dunst: Honoraria: Merck KGaA. D. Vordermark: Advisor: Boehringer Ingelheim, Bristol-Myers Squibb, Chugai, Merck KGaA; Honoraria as speaker: Roche, AstraZeneca, Merck KGaA, Lilly, Ferring. M. Pless: Advisory boards honoraria: Merck, D. Hofmann: Employee and stock ownership: Merck Serono GmbH. V. Bühler: Employee: Merck (Schweiz) AG. S.I. Rothschild: Advisory boards honoraria (to Institution): Merck; Research funding: Merck. All other authors have declared no conflicts of interest.

Weichgewebstumore sind häufige Befunde in der hausärztlichen Praxis. Der Hausarzt ist häufig erste Anlaufstelle. Er stellt die Weichen für die weitere Diagnostik und Therapie. Pubmed (Soft tissue sarcoma) Der überwiegende Anteil von Weichgewebstumoren ist gutartig. Weichgewebstumore mit schnellem Wachstum, einer Größe von > 4 cm und einer subfaszialen Lage sollten an ein Weichgewebssarkom denken lassen. Die Behandlung der Weichgewebssarkome muss interdisziplinär in einem Zentrum mit Erfahrung erfolgen. Eine zielgerichtete, frühe Zuweisung ist zu fordern. Der weiten Resektion kommt entscheidende Bedeutung zu. Zur Prognoseverbesserung existieren heute (neo-)adjuvante Therapiekonzepte, die für den individuellen Fall in einer speziellen Konferenz festgelegt werden. Der Hausarzt sollte bei Weichgewebstumoren an die Möglichkeit eines Sarkoms denken und an die Notwendigkeit der Behandlung in einer spezialisierten, interdisziplinären Einrichtung.

Aim: To determine the influence of IGRT in terms of toxicities compared to non-IGRT patients undergoing definitive RT.Background: Image-guided radiotherapy (IGRT) enables immediate correction of target movement by online imaging. For prostate cancer patients undergoing radiation therapy (RT), a geographical miss of the prostate may result in increased dose-volume effects in the rectum and bladder.Methods: A total of 198 prostate cancer patients treated between 2003 and 2013 were recruited randomly for this evaluation. The rates of genitourinary (GU) and gastrointestinal (GI) toxicity for 96 non-IGRT patients (total dose: 72/73.8 Gy) were compared to those for 102 IGRT patients (total dose: 77.4 Gy) according to the Common Toxicity Criteria Version 3.0 (CTCAEv3.0). Follow-up information included treatment-related symptoms and PSA relapse.Results: After a median follow-up of 55.4 months, a statistically significant difference was noted for acute GI toxicities >= 1 in favour of IGRT. Significantly more patients treated by IGRT were free of acute GI symptoms (43% vs. 19%, p = 0.0012). In the non-IGRT group, more patients experienced acute GU side effects (89% vs. 80%, p = 0.07). Late toxicity scores were comparable for both cohorts.Conclusions: Based on the data, we demonstrated that despite dose escalation, IGRT enabled us to reduce the GI side effects of radiation. IGRT can therefore be considered to be the standard of care for dose-escalated RT of localized prostate cancer. (C) 2016 Greater Poland Cancer Centre. Published by Elsevier Sp. z o.o. All rights reserved.

With extensive use of systemic treatment, the issue of cardiac mortality after breast cancer radiation (RT) is still important. The aim of our analysis was to clarify whether the dose to one surrogate parameter (e. g., mean heart dose, as used in most studies) reflects the dose to the other cardiovascular structures especially the left anterior descending artery depending on breathing-adapted RT.

Aim: Up to now, the incidence of HPV-associated oropharyngeal cancer is rising, indicating the increased impact of the viral etiology, but prognostic significance of HPV/p16 in other pharyngeal sites remains unclear. In addition, hypoxia might be important for carcinogenesis of head and neck cancer (HNSCC) and treatment response as well. This evaluation was carried out to explore, whether there is any correlation between pretreatment factors like pre-RT anemia and p16 expression and to determine the prognostic value of these factors in advanced HNSCC pts. Methods: A total of 79 locally advanced HNSCC patients (pts.) who underwent definitive RCTor RT-antibody-therapy were retrospectively analysed. p16 (INK4A) expression was detected by immunohistochemical analysis. Factors predisposing for treatment response were examined and survival curves were compared. Results: The follow-up period ranged from 16 to 48 months, with a median of 25.3 months. Pretreatment anemia was apparent in one third of pts..P16 overexpression was detected in 32 cases. A significant correlation was found between p16 expression and pretreatment hemoglobin level. Only 3 pts. were characterized by both pre-RT anemia and p16 overexpression. Two-year locoregional control, progression-free survival (PFS) and overall survival (OS) were 75%, 62% and 70%, respectively. The prognostic value of p16 in the entire HNSCC patient cohort was confirmed; Kaplan-Meier analysis proved significant differences in progression-free survival (PFS) depending on p16 overexpression and PFS was significantly improved in the non-anemic patient group (p=0.023). In conclusion, this study demonstrated that p16 expression and pretreatment anemia are related to HNSCC subgroups. The prognostic value of this variables was confirmed for a patient cohort consisting of advanced naso-/oro-and hypopharyngeal carcinomas undergoing definitive RCT.