Whole-breast radiotherapy (WBRT) after breast-conserving surgery (BCS) in older patients can be challenging due to the increased presence of comorbidities, comedication, the presence of a pacemaker or difficulties in traveling to treatment every day. Challenging times, such as the pandemic, can also lead to RT not being performed despite the indication. Very short treatment regimens are therefor of special interest in this population reducing overall treatment time and radiation exposure. TARGIT-E is a phase II trial investigating intraoperative radiotherapy (IORT) during BCS in elderly patients. We report long-term follow-up results of TARGIT-E. Patients with BC (≥ 70 years, cT1-2, cN0, M0) were enrolled at 28 European centers. A single dose of IORT (20 Gy) was given during BCS. Additional postoperative WBRT was applied if risk factors were present in final histopathology. Primary outcome was local recurrence-free rate (RFR) using the Kaplan–Meier-method. Late toxicities were assessed by LENT-SOMA criteria, and cosmetic outcomes were graded using BCCT.core software. In 591 patients (median follow-up 5.4 years) RFR was 97.6

Background and Objectives: This study aims to investigate the impact of hemoglobin (Hb) level changes during radiochemotherapy (RCT) on the survival of patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Materials and Methods: A retrospective analysis was conducted on 97 patients with HNSCC, treated with definitive RCT between January 2016 and October 2021. Hb levels were monitored weekly during RCT. Kaplan–Meier and Cox regression analysis were performed. Results: There was a significant association between Hb levels at the end of RCT and overall survival (p < 0.01). Initial Hb levels and Hb level changes were not significantly associated with survival. In multivariate analysis, a lower body mass index (BMI) and Hb levels at week six were identified as significant prognostic factors. Conclusions: At the end of RCT, rather than baseline levels or changes during treatment, Hb levels are a significant prognostic factor for overall survival in patients with HNSCC.

PURPOSE:Coxarthrosis and greater trochanteric pain syndrome (GTPS) are common etiologies of hip pain. In this retrospective study, we analyzed the treatment response within the 3 to 12 months of low-dose external beam radiation therapy (LD-EBRT) for coxarthrosis and GTPS along with potential predictive factors. METHODS AND MATERIALS:We evaluated data from patients who were treated with radiation therapy for GTPS or coxarthrosis at our radiation centers between 2014 and 2024. In addition, all planning computed tomography scans were analyzed according to the Kellgren-Lawrence score. Subsequent univariate and multivariate analyses of the data were performed. RESULTS:The clinical response rate (overall response rate [ORR]) was approximately 64% in GTPS and 58% in coxarthrosis. Approximately 20% of the patients received a second series of LD-EBRT, and approximately 5% a third. In multivariate regression analyses of coxarthrosis, factors negatively correlated with ORR were an initial increase in pain, age ≥ 70 years, and body mass index (BMI) ≥ 25 kg/m2. The outcome was independent of symptom duration, LD-EBRT season, and planning target volume. In GTPS, symptom duration >12 months, initial pain increase, and prior hip prosthesis were negatively correlated with ORR. No dependence on the LD-EBRT season or on the definition of the planning target volume was observed. CONCLUSIONS:LD-EBRT may be an effective treatment option for GTPS and coxarthrosis. Early application of this therapy option appears to alleviate symptoms, regardless of season or planning target volume.

BE following RT after breast-conserving surgery is a common concern, impacting patients’ quality of life. This study introduces a clinically meaningful classification system for BE and retrospectively evaluates its incidence among patients treated with normofractionated (nfRT) and hypofractionated (hfRT) regimens. Data from 1156 patients treated between 2011 and 2021 were analyzed. BE was graded according to the CTC and a so-called “WST classification” (grade 1: lymphatic drainage performed by the patient; grade 2: professional lymphatic drainage; grade 3: surgery). A total of 33%/17% developed BE according to the WST classification/CTC. Grade III BE was not reported. About 70% experienced a remission of BE during follow-up. Risk factors for the development of BE included RT of lymphatic drainage, complete axillary dissection compared to sentinel node dissection, and CTX. CTX was not confirmed in multivariate analysis. The incidence of BE did not differ significantly between the nfRT and hfRT groups, affirming the safety and comparability of hfRT regarding BE risk (HR: 0.833, p = 0.1219). This study emphasizes the importance of precise and standardized BE classification for improved treatment outcomes. Given its comparable risk profile and potential for enhanced therapy adherence, the findings support hfRT as a preferred regimen aligned with the current guidelines.

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G_{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G_{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Breathing instruction and exercises and a time gap between training and planning CT scans (pCT) is recommended as part of deep inspiration breath-hold (DIBH) assisted radiotherapy (RT). However, this is associated with additional time expenditure. In two of the authors’ treatment centers (TC), patient training took place before the planning CT of DIBH-assisted therapy. In TC 1, a further appointment was made with a minimum interval of 2 days to perform the planning CT. At TC 2, the planning CT was performed immediately after the first patient instruction. A retrospective evaluation of the clinical parameters of the therapy was carried out to investigate the relevance of the time gap between DIBH exercises and pCT. A total of 72 patients were included, 35 of whom were treated in TC 1 and 37 in TC 2. In TC 1, an average interval of 4 days was observed between patient training and planning CT, while in TC 2, training and CT were performed immediately after each other. No significant differences in radiation dose exposure of the lung on the treated side, the whole lung, or the heart were found between the two centers. Furthermore, there was no significant difference in the application of the daily RT fraction. The requirement for daily positioning checks was also the same at both treatment centers. This study does not show any advantages for a time gap between instruction/training and pCT. Skipping the time break does not deteriorate any clinically relevant endpoints.

Doch obwohl die RT eine lokal hocheffektive Therapie mit einem sehr

PDF file - 46K, Overall Survival in Prespecified Subgroups

Demographic change will lead to an increase in age-associated cancers. The demand for primary treatment, especially oncologic therapies, is difficult to predict. This work is an attempt to project the demand for radiation therapy (RT) in 2030, taking into account demographic changes using prostate cancer (PC) as an example. Using the GENESIS database of the Federal Statistical Office, we retrieved demographic population projections for 2030 and retrospective demographic surveys from 1999 to 2019. Additionally, we queried incidence rates for PC in the respective age groups of 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, 80–84, and +85 years from 1999–2019 via the Federal Cancer Registry of the Robert Koch Institute. We used a regression method to determine the age-dependent correlation between the incidence of PC and the population size of the respective age group by combining the data from 1999 to 2019. This information was used to calculate the incidence rates in the age groups of the expected population for 2030 and the expected new cases of PC in 2030. Finally, we extrapolated the indications for the demand for RT based on data from the Report on Cancer Incidence in Germany from 2016. Considering a population-dependent incidence rate, an increase in new cases of PC is expected. This increase is particularly evident in the age groups of 70–74 and 80–84 years. With regards to RT, the estimate indicates an overall increase of 27.4

PDF file - 55K, Study Drug Dosing (Safety Population)

Background The dose-limiting effect of CT-assessed low skeletal muscle mass (LSMM) measured at the level of the third cervical vertebra has been found in head and neck cancer patients receiving high-dose cisplatin chemoradiotherapy. The aim of this study was to investigate the predictive factors for dose-limiting toxicities (DLTs) using low-dose weekly chemoradiotherapy. Materials and methods Head and neck cancer patients receiving definite chemoradiotherapy with weekly 40 mg/m2 body surface area (BSA) cisplatin or paclitaxel 45 mg/m2 BSA and carboplatin AUC2 were consecutively included and retrospectively analysed. Skeletal muscle mass was assessed using the muscle surface at the level of the third cervical vertebra in pretherapeutic CT scans. After stratification for LSMM DLT, acute toxicities and feeding status during the treatment were examined. Results Dose-limiting toxicity was significantly higher in patients with LSMM receiving cisplatin weekly chemoradiotherapy. For paclitaxel/carboplatin, no significance regarding DLT and LSMM could be found. Patients with LSMM had significantly more dysphagia before treatment, although feeding tube placement before treatment was equal in patients with and without LSMM. Conclusions LSMM is a predictive factor for DLT in head and neck patients treated with low-dose weekly chemoradiotherapy with cisplatin. For paclitaxel/carboplatin, further research must be carried out.

PDF file - 44K, Sensitivity Analyses of Progression-free Survival

BACKGROUND:In the multimodal breast-conserving curative therapy of some high-risk breast cancer patients, extended external beam radiotherapy (EBRT) not only to the breast but also to the supraclavicular fossa and the internal mammary chain (parasternal region (PSR)) is indicated. We report a dosimetric study on the EBRT of the breast ("B") and the breast including PSR ("B + PSR"), comparing the supine and the laterally tilted prone patient positions in free breathing.METHODS:The planning CT scans of 20 left- and 20 right-sided patients were analyzed. EBRT plans were calculated with 3D conformal EBRT (3D) and with intensity-modulated EBRT (IMRT) for "B" and "B + PSR" in the prone and supine positions. The mean and threshold doses were computed. The quality of EBRT plans was compared with an overall plan assessment factor (OPAF), comprising three subfactors, homogeneity, conformity, and radiogenic exposure of OAR.RESULTS:In the EBRT of "B", prone positioning significantly reduced the exposure of the OARs "heart" and "ipsilateral lung" and "lymphatic regions". The OPAF was significantly better in the prone position, regardless of the planning technique or the treated breast side. In the EBRT of "B + PSR", supine positioning significantly reduced the OAR "heart" exposure but increased the dose to the OARs "ipsilateral lung" and "lymphatic regions". There were no significant differences for the OPAF, independent of the irradiated breast side. Only the IMRT planning technique increased the chance of a comparatively good EBRT plan.CONCLUSION:Free breathing prone positioning significantly improves plan quality in the EBRT of the breast but not in the EBRT of the breast + PSR.

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.