Prognostic Value of Pre-Chemoradiotherapy Pan-Immune-Inflammation Value (PIV) in Locally Advanced Nasopharyngeal Cancers.

BACKGROUND: To examine the prognostic relevance of pan-immune-inflammation value (PIV) in locally advanced nasopharyngeal carcinomas (LA-NPC) patients treated with concurrent chemoradiotherapy (CCRT) definitively. METHODS: We used receiver operating characteristic (ROC) curve analysis to determine an optimal PIV cutoff that could effectively divide the patient cohort into two distinct groups based on distant metastasis-free (DMFS) and overall survival (OS) results. For this purpose, receiver operating characteristic (ROC) curve analysis was employed. Our primary and secondary endpoints were to investigate the potential correlations between pre-CCRT PIV measurements and post-CCRT OS and DMFS outcomes, respectively. RESULTS: This retrospective cohort study included 179 LA-NPC patients. The optimal PIV cutoff was 512 (area under the curve: 74.0%; sensitivity: 70.8%, specificity: 68.6%; J-index: 0.394) in ROC curve analysis, creating two patient groups: Group-1: PIV < 512 (N = 108); vs Group-2: PIV ≥ 512 (N = 71). In the comparative analysis, although there were no significant differences between the two groups regarding the patient, disease, and treatment characteristics, the PIV ≥ 512 group had significantly poorer median OS [74.0 months vs not reached yet (NR); HR: 2.81; P < 0.001] and DMFS (27.0 months vs NR; HR: 3.23; P < 0.001) than the PIV < 512 group. Apart from PIV ≥ 512, the N2-3 nodal stage and ≥ 5% weight loss within the preceding 6 months were significant predictors of unfavorable outcomes for DMFS (P < 0.05 for each) and OS (P < 0.05 for each) in univariate analyses. The results of the multivariate analysis showed that each of the three variables had independent negative impacts on both DMFS and OS outcomes (P < 0.05 for each). CONCLUSIONS: The present findings indicate that PIV, which classifies these patients into two groups with significantly different DMFS and OS, might be a potent prognostic biological marker for LA-NPC patients.

Topkan's CARWL Index Efficiently Predicts the Radiation-Induced Tooth Loss Rates in Radically Treated Locally Advanced Nasopharyngeal Cancer Patients.

PURPOSE: To assess the usefulness of the novel CARWL index in predicting radiation-induced tooth loss (RITL) rates in locally advanced nasopharyngeal cancer (LA-NPC) patients undergoing concurrent chemoradiotherapy (C-CRT). METHODS: The study retrospectively examined data from 323 LA-NPC patients. The patients were divided into two groups based on cutoff values for CAR and weight loss (WL). The ideal cutoff for RITL was 3.0 g/dL [AUC: 83.0%, sensitivity: 83.6%, specificity: 81.4%, J-index: 0.650]. CARWL index was created by combining pretreatment CAR and WL status (WL ≤ 5.0% vs > 5.0%, resulting in four groups: Group 1: CAR < 3.0 and WL ≤ 5.0%, Group 2: CAR < 3.0 and WL > 5.0%, Group 3: CAR ≥ 3.0 and WL ≤ 5.0%, and Group 4: CAR > 3.0 and WL > 5.0%. RESULTS: RITL was diagnosed in 67.2% of patients. Since the RITL rates of Groups 2 and 3 were statistically indistinguishable, we combined them and created the three-tiered CARWL score groups: CARWL-0: CAR < 3.0 and WL ≤ 5.0%; CARWL-1: CAR < 3.0 and WL > 5.0%, or CAR ≥ 3.0 and WL ≤ 5.0%; and CARWL-2: CAR > 3.0 and WL > 5.0%. Comparative analysis revealed that the RITL rates gradually and significantly increased from CARWL-0 to CARWL-2 score groups (49.4% vs 64.7% vs 83.0%; P <0.001) despite similar baseline disease and patient characteristics. Results of the multivariate analysis showed that higher CARWL score groups were independent and significant predictors of increased RITL rates (p < 0.001). CONCLUSION: Present results suggest that the novel CARWL index is a reliable biomarker for predicting RITL incidence in LA-NPC patients.

The unique CARWL score stratifies locally advanced nasopharyngeal cancer patients receiving concurrent chemoradiotherapy into risk groups for radiation-induced trismus.

PURPOSE: To determine the utility of the novel CARWL score, which integrates C-reactive protein-to-albumin ratio (CAR) and significant weight loss (SWL), in stratifying the locally advanced nasopharyngeal carcinoma (LA-NPC) patients into significantly different radiation-induced trismus (RIT) risk groups following definitive C-CRT. PATIENTS AND METHODS: This retrospective study analyzed the medical records of 286 LA-NPC patients who received C-CRT between January 2010 and December 2022. The maximum mouth opening (MMO) was measured before the C-CRT, at 1, 3, 6, 9, and 12 months, and every 6 months after that during the follow-up. Additionally, the CAR value just before the commencement of C-CRT and SWL defined as a weight loss > 5% in the preceding six months were documented for each patient. RIT was defined as a MMO ≤ 35 mm. RESULTS: The optimal CAR cut-off was 3.03 (area under the curve: 87.3%; sensitivity: 82.6%; specificity: 80.9%, J-index: 0.635), using receiver operating characteristic (ROC) curve analysis, with RIT incidence being the event. We stratified the patients into three CARWL score groups. CARWL-0: CAR < 3.0 and WL ≤ 5.0% (N = 92), CARWL-1: CAR < 3.0 and WL > 5.0% or CAR ≥ 3.0 (N = 99), and WL ≤ 5.0% and CARWL-2: CAR > 3.0 and WL > 5.0% (N = 95). The incidence of RIT increased significantly across CARWL score groups (8.7% for CARWL-0, 23.2% for CARWL-1, and 44.2% for CARWL-2; P < 0.001). CONCLUSION: The current study indicated that the novel CARWL scoring system is efficient in precisely stratifying LA-NPC patients into distinct RIT risk groups after C-CRT.

The Systemic Inflammation Response Index Efficiently Discriminates between the Failure Patterns of Patients with Isocitrate Dehydrogenase Wild-Type Glioblastoma Following Radiochemotherapy with FLAIR-Based Gross Tumor Volume Delineation.

BACKGROUND/OBJECTIVES: The objective of this study was to assess the connection between the systemic inflammation response index (SIRI) values and failure patterns of patients with IDH wild-type glioblastoma (GB) who underwent radiotherapy (RT) with FLAIR-based gross tumor volume (GTV) delineation. METHODS: Seventy-one patients who received RT at a dose of 60 Gy to the GTV and 50 Gy to the clinical target volume (CTV) and had documented recurrence were retrospectively analyzed. Each patient's maximum distance of recurrence (MDR) from the GTV was documented in whichever plane it extended the farthest. The failure patterns were described as intra-GTV, in-CTV/out-GTV, distant, and intra-GTV and distant. For analytical purposes, the failure pattern was categorized into two groups, namely Group 1, intra-GTV or in-CTV/out-GTV, and Group 2, distant or intra-GTV and distant. The SIRI was calculated before surgery and corticosteroid administration. A receiver operating characteristic (ROC) curve analysis was used to determine the optimal SIRI cut-off that distinguishes between the different failure patterns. RESULTS: Failure occurred as follows: intra-GTV in 40 (56.3%), in-CTV/out-GTV in 4 (5.6%), distant in 18 (25.4%), and intra-GTV + distant in 9 (12.7%) patients. The mean MDR was 13.5 mm, and recurrent lesions extended beyond 15 mm in only seven patients. Patients with an SIRI score ≥ 3 demonstrated a significantly higher incidence of Group 1 failure patterns than their counterparts with an SIRI score < 3 (74.3% vs. 50.0%; p = 0.035). CONCLUSIONS: The present results show that using the SIRI with a cut-off value of ≥3 significantly predicts failure patterns. Additionally, the margin for the GTV can be safely reduced to 15 mm when using FLAIR-based target delineation in patients with GB.

The global immune-nutrition-inflammation index (GINI) as a robust prognostic factor in glioblastoma patients treated with the standard stupp protocol.

BACKGROUND: Systemic inflammation can significantly impact gliomas' onset, progression, and prognosis. Glioblastoma multiforme (GBM) represents the glioma subtype characterized by the most profound inflammatory and immunosuppressive states. Consequently, various blood-borne biomarkers have been scrutinized concerning their prognostic value in GBM patients. OBJECTIVE: We sought to investigate whether the recently introduced Global Immune-Nutrition-Inflammation Index (GINI) holds prognostic significance for GBM patients treated with the standard Stupp protocol. METHODS: We retrospectively analyzed the data from a cohort of newly diagnosed GBM patients receiving the standard Stupp regimen using the propensity score-matching methodology. The GINI was computed using the original formula: GINI = [(C-reactive protein × Monocytes × Platelets × Neutrophils) ÷ (Albumin × Lymphocytes)]. We employed receiver operating characteristic (ROC) curve analysis to identify the optimal cutoff values for GINI, which could help distinguish between different survival outcomes. The primary and secondary objectives were the differences in overall survival (OS) and progression-free survival (PFS) between the GINI groups. RESULTS: The optimal GINI cutoff value was 1350. Out of 294 eligible patients, 211 were PSM-matched: GINI<1350 (N = 95) and GINI≥1350 (N = 116). Comparative Kaplan-Meier estimates indicated that the GINI≥1350 patients had substantially worse median PFS (8.0 vs 16.8 months; p < .001) and OS (14.3 vs 22.9 months; p < .001) durations than their GINI<1350 counterparts. CONCLUSION: High pretreatment GINI values are robustly and independently associated with inferior PFS and OS outcomes in selected GBM patients who receive standard Stupp protocol. These findings suggest that if further confirmed, the novel GINI could serve as a valuable biological marker for the prognostic stratification of GBM patients.

Predicting osteoradionecrosis risk in patients with locoregionally advanced nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy: The value of the CARWL index.

Osteoradionecrosis (ORN) is a severe complication that can arise in patients with nasopharyngeal carcinoma due to the aggressive nature of chemoradiotherapy treatment. The purpose of our study was to assess the utility of the recently introduced CARWL index, which integrates the C-reactive protein-to-albumin ratio (CAR) and significant weight loss (SWL), in predicting the risk of ORN in patients with locoregionally advanced nasopharyngeal cancer (LA-NPC) undergoing concurrent chemoradiotherapy (CCRT). We conducted a retrospective cohort analysis on 304 patients with LA-NPC treated with CCRT. Patients were categorized into CARWL index groups based on CAR (cut-off: 3.0) and SWL (weight loss > 5% over the past six months): CARWL-0 (CAR < 3.0, SWL ≤ 5%), CARWL-1 (CAR < 3.0 with SWL > 5% or CAR ≥ 3.0 with SWL ≤ 5%), and CARWL-2 (CAR ≥ 3.0 and SWL > 5%). The primary endpoint was the incidence of ORN in each CARWL index group. At a median follow-up of 67.2 months, 28 patients (9.2%) developed ORN. The incidence of ORN was 2.1%, 9.4%, and 16.3% in the CARWL-0, CARWL-1, and CARWL-2 groups, respectively (P < 0.001). Multivariate analysis identified smoking status (HR: 2.58, P = 0.034), N-stage (HR: 1.96, P = 0.008), T-stage (HR: 1.84, P = 0.017), pre-CCRT tooth extraction status (HR: 5.81, P < 0.001), post-CCRT tooth extraction status (HR: 6.82, P < 0.001), mandibular V55.8 Gy (HR: 6.12, P < 0.001), and CARWL score (HR: 5.67, P = 0.002) as significant predictors of ORN. The CARWL index is a reliable predictive tool for evaluating the risk of ORN in LA-NPC patients undergoing CCRT. If further validated, its use in clinical settings could aid in the early identification of high-risk patients and enable the implementation of personalized preventive strategies.

Novel Somay's GLUCAR Index Efficiently Predicts Survival Outcomes in Locally Advanced Pancreas Cancer Patients Receiving Definitive Chemoradiotherapy: A Propensity-Score-Matched Cohort Analysis.

BACKGROUND: Propensity score matching (PSM) was used to investigate the prognostic value of a novel GLUCAR index [Glucose × (C-reactive protein ÷ albumin)] in unresectable locally advanced pancreatic cancer (LA-NPC) patients who received definitive concurrent chemoradiotherapy (CCRT). METHODS: The PSM analysis comprised 142 LA-PAC patients subjected to definitive CCRT. Receiver operating characteristic (ROC) curve analysis was utilized to identify relevant pre-CCRT cutoffs that could effectively stratify survival results. The primary and secondary objectives were the correlations between the pre-CCRT GLUCAR measures and overall survival (OS) and progression-free survival (PFS). RESULTS: The ROC analysis revealed significance at 43.3 for PFS [area under the curve (AUC): 85.1%; sensitivity: 76.8%; specificity: 74.2%; J-index: 0.510)] and 42.8 for OS (AUC: 81.8%; sensitivity: 74.2%; specificity: 71.7%; J-index: 0.459). Given that these cutoff points were close, the standard cutoff point, 42.8, was selected for further analysis. Comparative survival analyses showed that pre-CCRT GLUCAR ≥ 42.8 (n = 71) measures were associated with significantly shorter median PFS (4.7 vs. 15.8 months; p < 0.001) and OS (10.1 vs. 25.4 months; p < 0.001) durations compared to GLUCAR < 42.8 measures (n = 71). The multivariate analysis results confirmed the independent significance of the GLUCAR index on PFS (p < 0.001) and OS (p < 0.001) outcomes. CONCLUSIONS: Elevated pre-CCRT GLUCAR levels are robustly and independently linked to significantly poorer PFS and OS outcomes in unresectable LA-PAC patients treated with definitive CCRT.

Gamma Knife radiosurgery for multiple sclerosis-associated trigeminal neuralgia.

BACKGROUND: Gamma Knife radiosurgery (GKRS) has well-known efficacy in the treatment of idiopathic trigeminal neuralgia (TN). However, few studies have evaluated the effects of GKRS in the treatment of multiple sclerosis (MS)-related TN. This study analyzed the efficacy and complications of GKRS for MS-related TN. METHODS: This retrospective study included 28 MS-related TN patients who underwent GKRS with a median follow-up of 27 (range, 12-181) months. The cisternal segment of the trigeminal nerve was targeted with a median radiation dose of 80 (80-90) Gy. Pain intensity was assessed using Barrow Neurological Institute (BNI)-Pain Intensity Scores (BNI-PIS). Before GKRS, all patients suffered from BNI pain levels of 4 or 5. A reduction in pain to BNI 3b or below was deemed as adequate pain relief. RESULTS: The initial proportion of patients who experienced adequate pain relief was 71.4%, with a median interval of 21 (1-45) days. At the final follow-up, 50% of patients had achieved adequate pain relief. Ten patients (35.7%) suffered from complications, including four with facial sensorial dysfunctions, four with a decline in their corneal reflexes, and two with jaw weakness. Among the 20 initial responders, six (30%) patients suffered pain recurrence after a median interval of 35 (12-180) months. CONCLUSIONS: GKRS is an effective means of pain relief in MS-related TN, but has side effects that are relevant to other ablative treatments. The benefits and risks of GKRS should be discussed with patients who wish to avoid surgery or when previous treatments fail.

Global Immune-Nutrition-Inflammation Index as a novel comprehensive biomarker in predicting the radiation-induced trismus rates in locally advanced nasopharyngeal carcinoma patients.

In this study, we aimed to evaluate whether the novel pretreatment Global Immune-Nutrition-Inflammation Index (GINI) can predict radiation-induced trismus (RIT) in locally advanced nasopharyngeal carcinoma (LA-NPC) patients undergoing concurrent chemoradiotherapy (CCRT). Data of LA-NPC patients presenting without RIT were reviewed retrospectively. Any post-CCRT maximum mouth openings (MMO) ≤ 35 mm were considered RIT. The GINI index was calculated using the formula: GINI = (CRP x Monocytes x Platelets x Neutrophils) ÷ (Albumin x Lymphocytes). We used receiver operating characteristic (ROC) curve analysis to examine the potential correlation between pretreatment GINI measures and post-CCRT RIT status. Logistic regression analysis examined the independence of the association between confounding factors and RIT rates. The study comprised 230 participants, and 52 (22.6%) received an RIT diagnosis. The optimal pre-CCRT GINI cutoff that dichotomizes RIT rates was determined to be 1,424 (area under the curve [AUC]: 76%; sensitivity: 75.0%; specificity: 71.7%; J-index: 0.463). RIT incidence was significantly higher in the GINI ≥ 1424 group than in its GINI < 1424 counterpart (43.3% vs. 9.3%; hazard ratio: 4.76; P < 0.001). Multivariate logistic regression analysis revealed that a pre-CCRT GINI ≥ 1424 was an independent predictor of increased RIT rates after definitive CCRT in this patient group (P < 0.001). In conclusion, the present results revealed that elevated pre-CCRT GINI measures (≥ 1424) can efficiently and independently predict elevated RIT rates in LA-NPC patients after CCRT.

Neoadjuvant intermediate-course versus long-course chemoradiotherapy in T3-4/N0+ rectal cancer: Istanbul R-02 phase II randomized study.

Radiation therapy (RT) is typically applied using one of two standard approaches for preoperative treatment of resectable locally advanced rectal cancer (LARC): short-course RT (SC-RT) alone or long-course RT (LC-RT) with concurrent fluorouracil (5-FU) chemotherapy. The Phase II single-arm KROG 11-02 study using intermediate-course (IC) (33 Gy (Gray)/10 fr (fraction) with concurrent capecitabine) preoperative chemoradiotherapy (CRT) demonstrated a pathologically complete response rate and a sphincter-sparing rate that were close to those of LC-CRT. The current trial aim to compare the pathological/oncological outcomes, toxicity, and quality of life results of LC-CRT and IC-CRT in cases of LARC. The prescribed dose was 33 Gy/10 fr for the IC-CRT group and 50.4 Gy/28 fr for the LC-CRT group. Concurrent chronomodulated capecitabine (Brunch regimen) 1650 mg/m2/daily chemotherapy treatment was applied in both groups. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal Cancer Module (EORTC QLQ-CR29) was administered at baseline and at three and six months after CRT. A total of 60 patients with LARC randomized to receive IC-CRT (n = 30) or LC-CRT (n = 30) were included in this phase II randomized trial. No significant difference was noted between groups in terms of pathological outcomes, including pathological response rates (ypT0N0-complete response: 23.3% vs. 16.7%, respectively, and ypT0-2N0-downstaging: 50% for each; p = 0.809) and Dworak score-based pathological tumor regression grade (Grade 4-complete response: 23.3 vs. 16.7%, p = 0.839). The 5-year overall survival (73.3 vs. 86.7%, p = 0.173) rate was also similar. The acute radiation dermatitis (p < 0.001) and any hematological toxicity (p = 0.004) rates were significantly higher in the LC-CRT group, while no significant difference was noted between treatment groups in terms of baseline, third month, and sixth month EORTC QLQ-CR29 scores.

Utilization of radiation therapy and predictors of noncompliance among Syrian refugees in Turkey.

BACKGROUND: Access to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT. METHODS: In this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined. RESULTS: We identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06-2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43-5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance. CONCLUSIONS: Noncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.

Double isocenter optimization with HD-MLC linear accelerator to treat extended fields in patients with head and neck cancers.

PURPOSE: For departments with a congested patient burden or with a limited number of eligible LINACs, we investigated whether LINACS dedicated for SRS-SBRT with limited field high-definition (HD) multi-leaf collimator (MLC) could help to carry this load, and utilized a double-isocenter (DI) optimization with a limited field size of HD-MLC to defeat the craniocaudal field size restriction to match treated plans in a wide-field MLC LINAC for head and neck cancer patients. METHODS: Fourteen patients with locally advanced head and neck cancers were included, previously treated with simultaneous integrated boost volumetric modulated arc treatment (VMAT) in 33 fractions of clinical target volumes (CTV) of 70Gy, 63Gy, and 57Gy, via single isocenter (SI) plans in Millennium MLC-120 of Varian Trilogy. The DI plans were generated on Pinnacle TPS to be delivered in HD 120 leaves MLC on Varian Truebeam. The organs at risk (OAR) doses and the prescription volume parameters were compared. RESULTS: The DI plans in HD-MLC LINACs were successfully matching the previously treated plans for OAR and CTV constraints. The CI (1.18 versus 1.26; p=0.004) and HI (0.23 versus 0.29; p<0.001) were significantly improved with DI, while the MUs (1321.5 versus 800.3; p<0.001) and the treatment delivery times (6.1 versus 3.7 min; p<0.001) per fraction increased modestly with DI compared to SI, respectively. CONCLUSIONS: We revealed that DI optimization plans prepared for HD-MLC could effectively accomplish our goal dosimetrically in locoregionally advanced head and neck cases, despite a modest increase in the MU and treatment delivery times per fraction. This technique may provide an alternative in case of downtimes of standard MLC systems or a standalone treatment machine in case of high volumes requiring extended-field IMRT procedures, or possibly shorten the lengthy waiting times in facilities with limited SRS or SBRT patients.

Vaginal cuff brachytherapy practice in endometrial cancer patients: a report from the Turkish Oncology Group.

PURPOSE: The American Brachytherapy Association is attempting to develop standards for delivering brachytherapy, although differences in practice have been reported in the literature. This study evaluated vaginal cuff brachytherapy (VBT) practice and quality of life-related recommendations among Turkish radiation oncologists. MATERIAL AND METHODS: A nationwide web-based 17-item survey was distributed to the members of the Turkish Society for Radiation Oncology. These members received e-mail notifications, and a link was posted on the Turkish Society for Radiation Oncology internet site to solicit voluntary responses The survey addressed the simulation processes, target volume, prescribed dose, delivery schedules, and recommendations related to vaginal side effects. RESULTS: Fifty-seven radiation oncologists responded to the survey. The most used dose fraction schemes for adjuvant VBT were 7 Gy × 3 fractions (30%), 5.5 Gy × 5 fractions (26%), and 6 Gy × 5 fractions (28%). The preferred VBT scheme was 5 Gy × 3 fractions (50%) when the external beam radiotherapy (EBRT) dose was 45 Gy external radiotherapy, while the preferred schemes were 6 Gy × 3 fractions (30%) or 5 Gy × 3 fractions (32%) when the external radiotherapy dose was increased to 50.4 Gy. One-half of the respondents delivered VBT twice a week, and the dose was prescribed to 0.5 cm from vaginal mucosa by 86% of the respondents. There was no common definition for the dose prescription length, which was defined as 3 cm from the vaginal cuff in 33% of responses and as 4 cm in 35% of responses. For serous and clear cell histological types, 38% of the respondents targeted "full cylinder length". To prevent vaginal side effects, 78% of the respondents recommended using a vaginal dilator and/or sexual intercourse after VBT. CONCLUSIONS: This survey revealed variations in the clinical practice of VBT among Turkish radiation oncologists, which suggests that standardization is necessary.

Single-fraction versus hypofractionated gamma knife radiosurgery for small metastatic brain tumors.

Stereotactic radiosurgery (SRS) has become a standard of care for the treatment of metastatic brain tumors (METs). Although a better balance of tumor control and toxicity of hypofractionated SRS (hfSRS) compared with single-fraction SRS (sfSRS) was demonstrated in large METs, there is no data comparing two approaches for small METs (< 4 cm3). It was aimed to compare clinical outcomes between sfSRS versus hfSRS Gamma Knife radiosurgery (GKRS) in a series of patients with unresected, small METs. Patients (n = 208) treated with sfGKRS or hfGKRS between June 2017 and May 2020 were retrospectively examined in a single center. The co-primary endpoints of local control (LC) and toxicity were estimated by applying the Kaplan-Meier method. Multivariate analysis using Cox proportional hazards (HR) modeling was used to assess the effect of independent variables on the outcomes. The actuarial LC rate was 99.7% at six months and 98.8% at 18 months in the sfGKRS group, and 99.4% and 94.3% in the hfGKRS group (p = 0.089), respectively. In multivariate analysis, MET volume (p = 0.023, HR 2.064) and biologically effective dose (BED10) (p < 0.0001, HR 0.753) was associated with LC. In total, treatment-related toxicity was observed in 13 (8.7%) patients during a median period of 10 weeks (range 1-31). Radiation necrosis was observed in four patients (1.9%), and all patients were in the sfGKRS group (p = 0.042). Only the maximum dose was associated with toxicity (p = 0.032, HR 1.047). Our current results suggest that hfGKRS is advantageous and beneficial also in patients with unresected, small METs.

Low Advanced Lung Cancer Inflammation Index Predicts Poor Prognosis in Locally Advanced Nasopharyngeal Carcinoma Patients Treated with Definitive Concurrent Chemoradiotherapy.

PURPOSE: We aimed to retrospectively investigate the prognostic worth of pretreatment advanced lung cancer inflammation index (ALI) in locally advanced nasopharyngeal carcinoma (LA-NPC) patients treated with concurrent chemoradiotherapy (C-CRT). Patients and Methods. A total of 164 LA-NPC patients treated with cisplatinum-based definitive C-CRT were included in this retrospective cohort analysis. The convenience of ideal pre-C-CRT ALI cut-offs affecting survival results was searched by employing the receiver operating characteristic (ROC) curve analyses. The primary endpoint was the link between the ALI groups and overall survival (OS), while cancer-specific survival (CSS), locoregional progression-free survival [LR(PFS)], distant metastasis-free survival (DMFS), and PFS comprised the secondary endpoints. RESULTS: The ROC curve analyses distinguished a rounded ALI cut-off score of 24.2 that arranged the patients into two cohorts [ALI ≥ 24.2 (N = 94) versus < 24.2 (N = 70)] with significantly distinct CSS, OS, DMFS, and PFS outcomes, except for the LRPFS. At a median follow-up time of 79.2 months (range: 6-141), the comparative analyses showed that ALI < 24.2 cohort had significantly shorter median CSS, OS, DMFS, and PFS time than the ALI ≥ 24.2 cohort (P < 0.001for each), which retained significance at 5- (P < 0.001) and 10-year (P < 0.001) time points. In multivariate analyses, ALI < 24.2 was asserted to be an independent predictor of the worse prognosis for each endpoint (P < 0.001for each) in addition to the tumor stage (T-stage) (P < 0.05 for all endpoints) and nodal stage (N-stage) (P < 0.05 for all endpoints). CONCLUSION: As a novel prognostic index, the pretreatment ALI < 24.2 appeared to be strongly associated with significantly diminished survival outcomes in LA-NPC patients treated with C-CRT independent of the universally recognized T- and N-stages.

Current treatment strategies in malignant pleural mesothelioma with a treatment algorithm.

Malignant pleural mesothelioma (MPM) is arare disease with apoor prognosis. The main therapeutic options for MPM include surgery, chemotherapy, and radiation therapy (RT). Although multimodality therapy has been reported to improve survival, not every medically operable patient is able to undergo all recommended therapy. With improvements in surgical techniques and systemic therapies, as well as advancements in RT, there has been apotential new paradigm in the management of this disease. In this review, we discuss the current literature on MPM management and propose afunctional treatment algorithm.