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.

ZusammenfassungEine Strahlenösophagitis im Rahmen einer therapeutischen Radiotherapie ist weiterhin eine relativ häufige Komplikation. In diesem Fallbericht beschreiben wir eine Patientin, bei der unter einer Therapie mit orodispersiblem Budesonid eine Strahlenösophagitis ohne erkennbare Residuen abheilen konnte.

Radiation esophagitis is a common side effect of therapeutic radiotherapy. In this case report, we describe a patient with a complete remission of the esophagitis after therapy with an oro-dispersible budesonide formulation.

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.

Für die Mehrzahl der Patienten mit fortgeschrittenem nichtkleinzelligem Lungenkarzinom (NSCLC) besteht ein großer Bedarf an effektiven, gut verträglichen Behandlungsoptionen die das Gesamtüberleben und die Lebensqualität verbessern. Insbesondere dann, wenn keine EGFRoder ALK-Mutationen vorliegen, wie es bei 80–85% aller Adenokarzinompatienten der Fall ist. Nach der erfolgreichen Einführung von Zytostatika der 3. Generation wie Docetaxel wurde ein Plateau der Wirksamkeit in der Behandlung des fortgeschrittenen NSCLC erreicht – das erst nach fast 10 Jahren durch die Zulassung des 3-fach zielgerichteten Angiokinase-Hemmers Nintedanib übertroffen wurde. Darüber hinaus gibt es weitere zielgerichtete Substanzen, die sich noch in der Erprobung befinden.

BACKGROUND:Human papilloma virus (HPV) infection, p16 expression and hypoxia may play important roles in the carcinogenesis, treatment response and toxicities of head and neck squamous cell carcinoma (HNSCC). The aim of this analysis was to assess whether there is any correlation between pre-radiotherapy (RT) anemia, p16 expression and toxicities and local control for patients undergoing definitive therapy.METHODS:79 HNSCC patients who had undergone radiochemotherapy (RCT) or RT-antibody therapy were retrospectively analyzed. p16 (INK4A) expression was detected by immunohistochemical analysis. Factors predisposing for acute side effects were examined by uni- and multivariate analysis.RESULTS:p16 overexpression was detected in 32 cases. Pretreatment anemia was present in one third of patients. Only 5% of patients were characterized by both pre-RT anemia and p16 overexpression. p16 expression was significantly associated with acute grade 3 toxicity. 47% of p16-positive patients developed grade ≥ 3 radiodermatitis compared to 26% of p16-negative patients (p = 0.04). A reduced risk of severe skin toxicities was noted for patients with hypoxic blood values before RT. p16 expression was significantly correlated with local control (p = 0.002).CONCLUSIONS:p16 expression is associated with better response to definitive combined treatment (RCT, RT + cetuximab), but also significantly related to acute high-grade toxicity.

BACKGROUND:Reporting the experiences and satisfaction of patients, as well as their quality of care scores is an emerging recommendation in health care systems. Many aspects of patients' experience determine their overall satisfaction. The aim of this evaluation was to define the main factors contributing to the satisfaction of patients undergoing radiotherapy in an outpatient setting.PATIENTS AND METHODS:A total of 1,710 patients with a histologically proven cancer, who were treated in our department between 2012 and 2014, were recruited for this prospective evaluation. At the end of therapy, each patient was asked to grade the skills and the care provided by radiation therapists, physicians, and physician's assistants, as well as the overall satisfaction during therapy. Statistical analysis was performed to determine which parameters had the greatest influence on overall satisfaction.RESULTS:Overall satisfaction with the provided care was high with a mean satisfaction score of 1.4. Significant correlations were found between overall satisfaction and each of the following survey items: courtesy, protection of privacy, professional skills and care provided by the radiation therapists and physicians, accuracy of provided information, and cleanliness. Linear regression analysis demonstrated that courteous behavior and the protection of privacy were the strongest predictors for overall satisfaction (P<0.001), followed by care and skills of physicians and radiation therapists. Patients suffering from head and neck cancer expressed lower overall satisfaction.CONCLUSION:Based on our prospectively acquired data, we were able to identify and confirm key factors for patient satisfaction in an outpatient radiooncological cancer center. From these results, we conclude that patients want most importantly to be treated with courtesy, protection of privacy and care.

Management of anal cancer shifted from radical surgical procedures to sphincter-preserving approaches by combined radio-chemotherapy (RCT). Several randomized trials investigated the most appropriate chemotherapy schedule, radiation doses, and treatment techniques. RCT employing 5-fluorouracil (5-FU)/mitomycin C (MMC) remains the standard treatment. Cisplatin was proposed as an alternative drug but failed to improve outcome when given instead of MMC or during maintenance chemotherapy. Currently, studies are ongoing that investigate staging procedures like PET-CT and diagnostic workup processes in treatment follow-up.This review focuses on treatment results of definitive RCT and factors related to treatment failure. Subsequent follow-up recommendations and the timing of invasive follow-up biopsies are discussed.

Hintergrund: Die Behandlung der Peritonealkarzinose ist eine interdisziplinäre medizinische Herausforderung. Betreffend der medikamentösen Therapie fehlt bislang eine Standardisierung. Methode: Relevante Artikel zum Thema Peritonealkarzinose aus den Datenbanken der U.S. National Library of Medicine (PubMed) sowie der Kongressregister der American Society of Clinical Oncology und der European Society of Medical Oncology wurden durchsucht. Die Bedeutung der Berichte für die klinische Praxis wurde zwischen den Autoren diskutiert und interdisziplinär abgestimmt. Es wurden praxisnahe Folgerungen und Empfehlungen abgeleitet. Ergebnisse: PubMed weist eine ansteigende Zahl an Publikationen zum Thema Peritonealkarzinose auf. In 2012 wurden 563 Arbeiten unter dem Stichwort abgelegt. Die medikamentöse Therapie der Peritonealkarzinose ist ein Teil der multimodalen Behandlung, zu der die lokalen chirurgischen und physikalischen Therapiemaßnahmen zählen. Die Auswahl der Chemotherapeutika richtet sich nach der entsprechenden malignen Grunderkrankung. Aktuelle zielgerichtete Ansätze wie die anti-angiogene Therapie und die gegen das epitheliale Zelladhäsionsmolekül (EpCAM) gerichtete Immuntherapie ergänzen neuerdings das Behandlungsspektrum bei Peritonealkarzinose und malignem Aszites. Schlussfolgerungen: Die medikamentöse Behandlung der Peritonealkarzinose bleibt eine medizinische Herausforderung. Die zunehmende Zahl an Publikationen und Studien auf dem Gebiet lässt aber mittlerweile mehr evidenzbasierte Entscheidungen zu. Die interdisziplinäre Abstimmung eines individuellen Behandlungskonzepts bleibt bis auf Weiteres der Goldstandard auch für die medikamentöse Therapie der Peritonealkarzinose.

Bronchus-associated Lymphoid Tissue (BALT) lymphoma is a rare type of extranodal marginal zone lymphoma. It is defined as subgroup of B-cell non-Hodgkin’s lymphoma typically with an indolent clinical course. Often the clinical symptoms of pulmonary mucosa-associated lymphoid tissue (MALT) lymphomas are highly heterogeneous with more than half of the patients initially suffering from multiple manifestations. Due to the rarity of this tumour and lack of randomized data, the optimal therapeutical pathway remains controversial. We report a case of this rare tumour with characteristic histological features. The patient complained about severe hemoptysis caused by an isolated tracheobronchial manifestation. According to treatment recommendations of extranodal MALT lymphomas, curative radiotherapy was administered, resulting in a complete and sustaining tumour remission and relief of symptoms.