Purpose:To evaluate clinical outcomes, patterns of failure, local control (LC), and time to next systemic therapy (TTNT) in patients with bone-only oligometastatic bladder cancer treated with stereotactic body radiotherapy (SBRT). Materials and Methods:We retrospectively analyzed 26 patients with 41 bone metastases treated with SBRT between 2012 and 2020 across four institutions. All patients had ≤3 bone metastases and received metastasis-directed therapy to all lesions. Overall survival (OS), progression-free survival (PFS), TTNT, and LC were estimated using the Kaplan-Meier method. Results:After a median follow-up of 97.8 months, median OS was 8.9 months, with 1- and 2-year OS rates of 38.5% and 22.4%, respectively. Median PFS was 5.8 months, with 1- and 2-year PFS rates of 29.4% and 25.2%, respectively. Median TTNT was 4.4 months, and only 19.8% of patients remained free from systemic therapy at 1 year. Disease progression occurred in 46.2% of patients and was predominantly distant metastasis. In contrast, LC was excellent, with 1- and 2-year rates of 94.7% and 88.0%, respectively. No grade ≥ 3 toxicities were observed. Conclusion:SBRT achieved excellent LC with minimal toxicity. However, systemic progression remained common. These findings suggest that prospective studies are needed to determine the role of SBRT within multimodal treatment strategies for bone-only oligometastatic bladder cancer.

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.

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: 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.

Radiation oncology is a field of medicine that has been rapidly growing with advances in technology, radiobiology, treatment algorithms and quality of life of modern radiotherapy over the last century. In the context of these advances, it is critical to be aware of the role of the young radiation oncologists and enable them to discover new perspectives. For this purpose, "The Young Radiation Oncologists Group" (GROG) has been established by the Turkish Society for Radiation Oncology (TROD), a subgroup which has focused on the professional developments, early career and integrating into the TROD family while supporting education and innovative research of young radiation oncologists. The purpose of this paper was to outline the structure and responsibilities of GROG and its scientific and social activities within TROD and in its own right.

Background: This study aimed to evaluate the safety and efficacy of ultra-hypofractionated stereotactic body radiation therapy (SBRT) to prostate bed. Methods: Sixty-six prostate cancer patients treated with postoperative ultra-hypofractionated SBRT between 2018 and 2020 were retrospectively reviewed. All patients received a total dose of 35 Gy to prostate bed in 5 fractions. Biochemical complete response (BCR), biochemical failure (BF), acute and late toxicities were assessed. Results: After a median follow-up of 24.2 months (range, 6.4- 37.2), seven patients (10.6%) developed BF, and the 2-year freedom from BF (FFBF) rate was 88.4%. BCR was observed in 57 patients (86.4%). The 2-year FFBF in patients with pre-SBRT PSA value of <0.2 ng/mL was higher than those with pre-SBRT PSA of >= 0.2 ng/mL (100% vs. 81.4%; P = 0.04). The 2-year FFBF in patients with BCR was significantly higher than in those without BCR (94.5% vs. 58.3%; P < 0.001). In multivariate analysis, pre-SBRT PSA and post-SBRT PSA values were prognostic factors for FFBF (P = 0.009 and P = 0.01, respectively). Nine patients (13.6 %) developed acute and late grade 2 genitourinary (GU) toxicities. There was no acute or late grade >= 3 GU toxicity. Acute and late grade >= 2 gastrointestinal (GI) toxicity was observed in 9 (13.6%) and 2 (3%) patients, respectively. Conclusion: Postoperative ultra-fractionated SBRT showed no severe acute toxicity and late toxicity rates of about 15%, in addition to excellent biochemical control rates. Pre- and post-SBRT PSA levels may be a predictor of BCR in patients receiving post-operative ultrafractionated SBRT. (c) 2022 Elsevier Inc. All rights reserved.

Few studies have determined the viability of stereotactic body radiotherapy (SBRT) and tyrosine kinase inhibitors (TKIs) in the treatment of metastatic renal cell carcinoma (mRCC). We examined the results of RCC patients who had five or fewer lesions and were treated with TKI and SBRT. The clinical data of 42 patients with 96 metastases treated between 2011 and 2020 were retrospectively evaluated. The prognostic factors predicting overall survival (OS) and progression-free survival (PFS) were assessed in uni- and multivariable analyses. Median follow-up and time between TKI therapy and SBRT were 62.3 and 3.7 months, respectively. The 2‑year OS and PFS rates were 58.0

To clarify the applicability of a liposome immunoblotting assay to microassay systems, the effects of the sample volume blotted on polyvinylidiene fluoride (PVDF) membrane on the sensitivity and signal intensity were studied and compared with those in a conventional immunoblotting assay utilizing enzyme-labeled antibody. In the liposome immunoblotting assay, signal intensities per unit area (signal density) were almost the same or increased slightly with decreasing blotted sample volume (from 20 to 2 μl) at the same concentration of analyte (human IgM) adsorbed on PVDF membrane. A substrate, 4-chloro-1-naphtol, for color development formed colored precipitates inside the liposomes. Thus, the colored signal was detected without loss of intensity. On the other hand, in the conventional immunoblotting assay, signal densities decreased with decreasing sample volume at the same concentration of analyte. This is caused by partial losses of the colored signal into the substrate solution by diffusion, because the fraction of loss increases with decreasing sample volume. These results show that the liposome immunoblotting assay is a promising method for the detection of analytes blotted in small areas, because its sensitivity is higher than that of the conventional blotting assay.

Introduction: The aim of this study was to investigate the clinical outcomes of metastasis-directed therapy (MDT) using stereotactic body radiotherapy (SBRT) in patients with synchronous or metachronous oligometastatic renal cell carcinoma (RCC). Methods: The clinical data of 87 patients with 138 lesions who received MDT between February 2008 and January 2019 were retrospectively analyzed. All patients had ≤5 metastasis at diagnosis (synchronous) or during progression (metachronous) and were treated with SBRT for their metastasis. The primary endpoints were local control (LC) and progression-free survival (PFS). The secondary endpoint was overall survival (OS). Results: Median follow-up was 20.4 months for entire cohort and 27.2 months for survivors. Synchronous oligometastatic disease was observed in 35 patients (40.2%), and 52 patients (59.8%) had metachronous disease. Seventy-two patients (82.8%) received systemic treatment synchronously or after MDT, while 15 patients (17.2%) did not receive any systemic treatment. The 1- and 2-year OS rates were 79.4% and 58.1%, respectively, and the 1- and 2-year PFS rates were 58.6% and 15.1%, respectively. The 1- and 2-year LC rates per lesion were 96.6% and 91.4%, respectively. There were no significant differences in survival between patients with synchronous oligometastasis and those with metachronous oligometastasis. All disease progressions were observed at a median time of 31.6 months (range: 1.9–196.9 months) after the completion of SBRT. Patients with solitary oligometastasis had significantly better OS compared to patients with >1 metastasis (p = 0.04). No patients experienced grade 3 or higher acute or late toxicities. Conclusion: SBRT is a successful treatment for oligometastatic RCC patients due to its excellent LC and minimal toxicity profile. There were no statistically significant survival differences between patients with synchronous and metachronous oligometastasis. Patients with solitary oligometastasis outlived their counterparts.

Targeting oligometastatic lesions with metastasis-directed therapy (MDT) using stereotactic-body radiotherapy (SBRT) may improve treatment outcomes and postpone the need for second-line systemic therapy (NEST). We looked at the results of oligometastatic renal cell carcinoma (RCC) patients who had five or fewer lesions and were treated with SBRT. We examined the treatment outcomes of 70 extracranial metastatic RCC (mRCC) patients treated at two oncology centers between 2011 and 2020. The clinical parameters of patients with and without NEST changes were compared. The prognostic factors for overall survival (OS), progression-free survival (PFS), and NEST-free survival were evaluated. Median age was 67 years (range 31–83 years). Lung and bone metastasis were found in 78.4% and 12.6% of patients, respectively. With a median follow-up of 21.1 months, median OS was 49.1 months and the median PFS was 18.3 months. Histology was a prognostic factor for OS, BED, and treatment switch for PFS in univariate analysis. In multivariate analysis, the significant predictor of poor OS was clear cell histology, and a lower BED for PFS. Following SBRT for oligometastatic lesions, 19 patients (27.2%) had a median NEST change of 15.2 months after MDT completion. There were no significant differences in median OS or PFS between patients who had NEST changes and those who did not. No patient experienced grade ≥ 3 acute and late toxicities. The SBRT to oligometastatic sites is an effective and safe treatment option for ≤ 5 metastases in RCC patients by providing favorable survival and delaying NEST change.

Neoadjuvant chemoradiotherapy (CRT) followed by surgical resection is the standard treatment for locally advanced rectal adenocarcinoma. In this study we evaluate our treatment results in patients treated with neoadjuvant radiotherapy (RT). Medical records of 144 patients treated between January 2009 and February 2019 were retrospectively evaluated. Most of the patients had (76%) MRI as a part of initial staging. Patients received either short course (25 Gy/5 fractions) (8%) or long course RT (92%) (median 50.4 Gy/28 fractions) +/- chemotherapy (ChT). Median age was 56 years (range, 24-90 years) and 131 patients received CRT. Most common concomitant ChT regime was oral capecitabine (48%). 26 patients refused the surgery. For rest of the patients, median time to surgery was 8 weeks. Sphincter was preserved in 19 patients (38%) who underwent surgery for distal tumors. With a median follow-up of 28 months, 19 patients had local recurrence and 30 patients had distant metastases. Two and five year estimated overall survival (OS), locoregional control (LRC) and distant metastases free survival (DMFS) rates were 88-67%, 78-62% and 74-57%, respectively. Presence of surgery significantly affect OS (HR= 0.147, 95% CI: 0.67-0.32, p< 0.001) , LRC (HR= 0.10, 95% CI: 0.05-0.2, p< 0.001) and DMFS (HR= 0.25, 95% CI: 0.13-0.49). Patients tolerated the treatment well with no grade 3 acute or late gastrointestinal and genitourinary system toxicities. Regardless of the schema neoadjuvant RT seems to be an efficient and safe treatment for patients with rectal adenocarcinoma. We found that surgery is the sole prognostic factor for better OS, LC and DMFS.

Background Metastasis-directed therapy (MDT) utilizing stereotactic body radiotherapy (SBRT) for oligoprogressive lesions could provide a delay in next-line systemic treatment (NEST) change while undergoing androgen receptor-targeted agents (ARTA) treatment. We evaluated prognostic factors for prostate cancer-specific survival (PCSS) and progression-free survival (PFS) to characterize patients receiving treatment with ARTA who may benefit from MDT for oligoprogressive lesions. The impact of MDT on delaying NEST and the predictive factors for NEST-free survival (NEST-FS) were also assessed. Materials and Methods The clinical data of 54 metastatic castration-resistant prostate cancer patients with 126 oligoprogressive lesions receiving abiraterone (1 g/day) or enzalutamide (160 mg/day) before or after systemic chemotherapy were analyzed. A median of three lesions (range: 1-5) were treated with MDT. The primary endpoints were PCSS and PFS. The secondary endpoints were time to switch to NEST and NEST-FS. Results The median follow-up time was 19.1 months. Univariate analysis showed that the number of oligoprogressive lesions treated with SBRT and the time between the start of ARTA treatment and oligoprogression were significant prognostic factors for PCSS, and the timing of ARTA treatment (before or after chemotherapy) and the prostate-specific antigen (PSA) response after MDT were significant prognostic factors for PFS. Multivariate analysis showed that early MDT for oligoprogressive lesions delivered less than 6 months after the beginning of ARTA and higher PSA levels after MDT were significant predictors of worse PCSS and PFS. The median total duration of ARTA treatment was 13.8 months. The median time between the start of ARTA treatment and the start of MDT for oligoprogressive lesions was 5.2 months, and MDT extended the ARTA treatment by 8.6 months on average. Thirty-two (59.3%) patients continued ARTA treatment after MDT. ARTA treatment after chemotherapy, early oligoprogression requiring MDT, and lower radiation doses for MDT were independent predictors of NEST-FS in multivariate analysis. Conclusions MDT for oligoprogressive lesions is effective and may provide several benefits compared to switching from ARTA treatment to NEST. Patients with early progression while on ARTAs and inadequate PSA responses after MDT have a greater risk of rapid disease progression and poor survival, which necessitates intensified treatment.

Background Defining the extent of disease spread with imaging modalities is crucial for therapeutic decision-making and definition of treatment. This study aimed to investigate whether clinical parameters and nomograms predict prostate-specific membrane antigen (PSMA)-positive lymph nodes in treatment-naive nonmetastatic prostate cancer (PC) patients. Materials and Methods The clinical data of 443 PC patients (83.3% high-risk and 16.7% intermediate-risk) were retrospectively analyzed. Receiver operating characteristic (ROC) curves with areas under the curve (AUC) were generated to evaluate the accuracy of clinical parameters (prostate-specific antigen [PSA], T stage, Gleason score [GS], International Society of Urological Pathology [ISUP] grade) and nomograms (Roach formula [RF], Yale formula [YF], and a new formula [NF]) in predicting lymph node metastasis. The AUCs of the various parameters and clinical nomograms were compared using ROC and precision-recall (PR) curves. Results A total of 288 lymph node metastases were identified in 121 patients (27.3%) using Ga-68-PSMA-11-positron emission tomography (PET)/computed tomography (CT). Most PSMA-avid lymph node metastases occurred in external or internal iliac lymph nodes (142; 49.3%). Clinical T stage, PSA, GS, and ISUP grade were significantly associated with PSMA-positive lymph nodes according to univariate logistic regression analysis. The PSMA-positive lymph nodes were more frequently detected in patients with PSA >20 ng/ml, GS >= 7 or high risk disease compared to their counterparts. The clinical T stage, serum PSA level, GS, and ISUP grade showed similar accuracy in predicting PSMA-positive metastasis, with AUC values ranging from 0.675 to 0.704. The median risks for PSMA-positive lymph nodes according to the RF, YF, and NF were 31.3% (range: 12.3%-100%), 22.3% (range: 4.7%-100%), and 40.5% (range: 12.3%-100%), respectively. The AUC values generated from ROC and PR curve analyses were similar for all clinical nomograms, although the RF and YF had higher accuracy compared to NF. Conclusion The clinical T stage, PSA, GS, and ISUP grade are independent predictors of PSMA-positive lymph nodes. The RF and YF can be used to identify patients who can benefit from Ga-68-PSMA-11 PET/CT for the detection of lymph node metastasis. Together with nomograms, Ga-68-PSMA-11 PET/CT images help to localize PSMA-positive lymph node metastases and can thus assist in surgery and radiotherapy planning.

We assessed the outcomes of stereotactic body radiotherapy (SBRT) to treat oligoprogressive castration-resistant prostate cancer (CRPC) patients with ≤5 lesions using gallium prostate–specific membrane antigen-positron emission tomography (68Ga-PSMA-PET/CT). The clinical data of 67 CRPC patients with 133 lesions treated with 68Ga-PSMA-PET/CT-based SBRT were retrospectively analyzed. All of the patients had oligoprogressive disease during androgen-deprivation therapy (ADT). The prognostic factors for overall- (OS) and progression-free survival (PFS) and the predictive factors for switching to next-line systemic treatment (NEST) and NEST-free survival (NEST-FS) were analyzed. With a median follow-up of 17.5 months, the 2-year overall survival (OS) and PFS rates were 86.9% and 34.4%, respectively. The PSA response was observed in 49 patients (73.1%). Progression was observed in 37 patients (55.2%) at a median of 11.0 months following SBRT. A total of 45 patients (67.2%) remained on ADT after SBRT, and 22 patients (32.8%) had a NEST change at a median of 16.4 months after metastasis-directed treatment (MDT). Patients with a NEST change had higher post-SBRT PSA values and fewer PSA nadirs after MDT than their counterparts. In multivariate analysis, higher pre-SBRT PSA values were the only significant predictor for worse OS and NEST-FS, and no significant factor was found for PFS. No serious acute or late toxicities were observed. This study demonstrated the feasibility of MDT using SBRT to treat oligoprogressive lesions by 68Ga-PSMA-PET/CT in CRPC patients is efficient and well-tolerated, prolonging the effectiveness of ADT by delaying NEST.

The aim of this study was to evaluate the outcomes of 68Ga prostate-specific membrane antigen (68Ga-PSMA) positron-emission tomography (PET)/CT-based metastasis-directed treatment (MDT) for oligometastatic prostate cancer (PC). In this multi-institutional study, clinical data of 176 PC patients with 353 lesions receiving MDT between 2014 and 2019 were retrospectively evaluated. All patients had biopsy proven PC with ≤5 metastases detected with 68Ga-PSMA-PET/CT. MDT was delivered with conventional fractionation or stereotactic body radiotherapy (SBRT) techniques. CTCAE v4.0 was used for acute and RTOG/EORTC Late Radiation Morbidity Scoring Schema was used for late toxicity evaluation. At the time of MDT, 59 patients (33.5%) had synchronous and 117 patients (66.5%) had metachronous metastases. Median number of metastases was one and the MDT technique was SBRT in 73.3% patients. The 2‑year overall survival (OS) and progression-free survival (PFS) rates were 87.6% and 63.1%, respectively. With a median follow-up of 22.9 months, 9 patients had local recurrence at the irradiated site. The 2‑year local control rate at the treated oligometastatic site per patient was 93.2%. In multivariate analysis, an increased number of oligometastases and untreated primary PC were negative predictors for OS; advanced clinical tumor stage, untreated primary PC, BED3 value of ≤108 Gy, and MDT with conventional fractionation were negative predictors for PFS. No patient experienced grade ≥3 acute toxicity, but one patient had a late grade 3 toxicity of compression fracture after spinal SBRT. 68Ga-PSMA-PET/CT-based MDT is an efficient and safe treatment for oligometastatic PC patients. Proper patient selection might improve treatment outcomes.

We read the article entitled ‘‘Synchronous versus sequential chemo-radiotherapy in patients with early stage breast cancer (SECRAB): A randomised, phase III, trial” by Fernando et al. with great interest [ [1] Fernando I.N. Bowden S.J. Herring K. et al. Synchronous versus sequential chemo-radiotherapy in patients with early stage breast cancer (SECRAB): A randomised, phase III, trial. Radiother Oncol. 2020; 142: 52-61 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar ]. This is a large multicentric randomized phase III trial in which assessed the optimal sequence of adjuvant chemotherapy and radiotherapy (RT) in patients with early stage breast cancer. After a median follow-up of 10.2 years, 10-year local recurrence rates were significantly decreased in synchronous arm compared to sequential arm (4.6% vs. 7.1%, p = 0.012) without a significant difference in overall (OS) or disease-free survival. While, there was a significant increase in moderate or severe acute skin reactions in synchronous arm (24% vs. 14.8%, p < 0.0001), there were no significant differences in late adverse effects except for telangiectasia (3% vs. 1.7%, p = 0.03). Contrary to this study, the role of concomitant chemo-RT in breast cancer patients is controversial in the literature [ 2 Toledano A. Azria D. Garaud P. et al. Phase III trial of concurrent or sequential adjuvant chemoradiotherapy after conservative surgery for early-stage breast cancer: final results of the ARCOSEIN trial. J Clin Oncol. 2007; 25: 405-410 Crossref PubMed Scopus (71) Google Scholar , 3 Rouesse J. de la Lande B. Bertheault-Cvitkovic F. et al. A phase III randomized trial comparing adjuvant concomitant chemoradiotherapy versus standard adjuvant chemotherapy followed by radiotherapy in operable node-positive breast cancer: final results. Int J Radiat Oncol Biol Phys. 2006; 64: 1072-1080 Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar , 4 Pinnaro P. Rambone R. Giordano C. Giannarelli D. Strigari L. Arcangeli G. Long-term results of a randomized trial on the sequencing of radiotherapy and chemotherapy in breast cancer. Am J Clin Oncol. 2011; 34: 238-244 Crossref PubMed Scopus (13) Google Scholar , 5 Pinnaro P. Giordano C. Farneti A. et al. Impact of sequencing radiation therapy and chemotherapy on long-term local toxicity for early breast cancer: results of a randomized study at 15-year follow-up. Int J Radiat Oncol Biol Phys. 2016; 95: 1201-1209 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ]. It results in an increase in both acute and late toxicity without a clear loco-regional benefit.