Radiotherapy for benign diseases in Turkey: a patterns of care survey of the Turkish Society for Radiation Oncology (TROD 05-002).

PURPOSE: We aimed to investigate the patterns of radiotherapy (RT) care in cases of benign diseases in Turkey. METHODS: A questionnaire survey was sent to all radiation oncology (RO) departments in Turkey. The number of patients treated for benign disease between 2015 and 2020 was requested. A list of benign conditions was given, and information on the number of patients per disease, single and total doses prescribed, weekly fractions, radiation type, energy, and device was requested. RESULTS: Of the 138 RO departments, 29 (21%) responded. The data received concerned 15 (52%) university, 10 (34%) public, and four (14%) private hospitals. A total of 130,846 patients were treated with RT in these departments. Of these patients, 6346 (4.85%) were treated for benign conditions. The most common benign diseases treated with RT were meningioma (35%), plantar fasciitis (19%), schwannoma (16%), arteriovenous malformation (11%), and pituitary adenoma (7%). Most centers performed RT for paraganglioma, heterotopic ossification, vertebral hemangioma, and Graves' ophthalmopathy, but none treated arthrosis. Wide variations were observed across the departments. Radiosurgery for intracranial pathologies was performed intensively in four centers. By contrast, RT for plantar fasciitis was predominantly treated in five centers, one of which had more than 1000 patients. CONCLUSION: The ratio of patients who underwent RT for benign diseases in Turkey among all patients who underwent RT was 4.85%. The common pattern of RT in 72% of patients was radiosurgery for intracranial benign diseases, followed by low-dose RT for plantar fasciitis in 19%.

Evaluation of mycosis fungoides management by total skin electron beam therapy with "translational technique".

PURPOSE: The aim of this study was to evaluate the outcomes of total skin electron beam therapy (TSEBT) with "translational technique" in the management of mycosis fungoides (MF). METHODS: Between January 1995 and October 2014, 51 patients with MF were treated using TSEBT with translational technique. The total dose was 2800-3600 cGy, de-livered in 7 to 20 fractions. Out of the total 51 patients, 22 (43.1%) had T2 (generalized patch/plaque) disease, 20 (39.3%) had T3 disease (tumor stage), and 9 (17.6%) had T4 (erythrodermic) disease. Radiation-related late skin injury parameters including atrophy, pigmentation changes, hair loss, telangiectasia and ulceration were assessed according to RTOG/EORTC Late Radiation Morbidity Scoring Schema after at least 3 months from TSEBT. RESULTS: Treatment response was categorized as complete remission (CR), partial remission (PR), or non-responding (NR) lesions. After TSEBT with translational technique, CR rate was 68.6% and PR rate 23.5%, while the NR rate was 7.9%. Overall, the rates of grade 1, grade 2, grade 3, and grade 4 toxicity were 17.6% )9 patients), 39.3% (20 patient), 35.3% (18 patients), and 7.8% (4 patients), respectively. At a median follow-up of 79 months (range 14-142), overall survival (OS) and disease-free survival (DFS) rates were 83% and 46%, respectively. CONCLUSION: For patients with MF refractory to topical chemotherapy and phototherapy, TSEBT with translational technique offers excellent local control (LC: CR+PR) and favorable OS rates along with substantial relief of symptoms.

Role of radiotherapy in the management of heel spur.

AIMS AND BACKGROUND: The purpose of this study is to investigate the use of low-dose radiotherapy (RT) in benign painful heel spur management. METHODS: Between the years of 2009 and 2012, in Gulhane Military Medical Academy Radiation Oncology Department, patients with heel spur undergoing radiotherapy for pain relief were analyzed retrospectively. In the evaluation of treatment response, Verbal Numeric Scale (VNS) scoring method was used to compare the pain status before and after radiotherapy. Age, gender, laterality, VNS score before RT, VNS score after RT, RT doses of the patients and patients undergoing second course of radiotherapy were recorded. All patients received 8 Gy RT in two fractions with Co-60 teletherapy machine. Statistical Package for Social Sciences, version 16.0 was used for data analysis with the level of significance set at p < 0.05. RESULTS: The total number of patients receiving RT for heel spur pain was 450. Median age was 52 years (range 40-85 years). Two hundred and ninety-two (65%) of the patients were women and 158 (35%) were men. Radiologically calcaneal spurs were bilateral in 432 (96%) patients, whereas unilateral left in 8 (1.8%) patients and unilateral right heel location in 10 (2.2%) patients. Ten (2.2%) of the patient group received second course of RT due to refractory pain. Comparative evaluation of VNS scores before and after RT revealed statistically significant pain relief by radiotherapy (p < 0.05). CONCLUSION: Low-dose radiotherapy is an effective and reliable painkilling treatment method that can be used in the treatment of epin calcanei refractory to medical and surgical treatment.

Immunosuppressive effects of multipotent mesenchymal stromal cells on graft-versus-host disease in rats following allogeneic bone marrow transplantation.

OBJECTIVE: Graft-versus-host disease (GVHD) is a major obstacle to successful allogeneic bone marrow transplantation (allo-BMT). While multipotent mesenchymal stromal cells (MSCs) demonstrate alloresponse in vitro and in vivo, they also have clinical applications toward prevention or treatment of GVHD. The aim of this study was to investigate the ability of MSCs to prevent or treat GVHD in a rat BMT model. MATERIALS AND METHODS: The GVHD model was established by transplantation of Sprague Dawley rats' bone marrow and spleen cells into lethally irradiated (950 cGy) SDxWistar rat recipients. A total of 49 rats were randomly assigned to 4 study and 3 control groups administered different GVHD prophylactic regimens including MSCs. After transplantation, clinical GVHD scores and survival status were monitored. RESULTS: All irradiated and untreated control mice with GVHD died. MSCs inhibited lethal GVHD as efficiently as the standard GVHD prophylactic regimen. The gross and histopathological findings of GVHD and the ratio of CD4/CD8 expression decreased. The subgroup given MSCs displayed higher in vivo proportions of CD25+ T cells and plasma interleukin-2 levels as compared to conventional GVHD treatment after allo-BMT. CONCLUSION: Our results suggest that clinical use of MSCs in both prophylaxis against and treatment of established GVHD is effective. This study supports the use of MSCs in the prophylaxis and treatment of GVHD after allo-BMT; however, large scale studies are needed. CONFLICT OF INTEREST: None declared.

Outcomes of hypofractionation for early-stage glottic carcinoma.

BACKGROUND: Our goal is to evaluate hypofractionation in early-stage glottic carcinoma of a single center in line with randomized trials. MATERIALS AND METHODS: Between June 2016 and January 2021, 33 early glottic carcinoma patients treated with IMRT (intensity-modulated radiotherapy) in the Radiation Oncology Department were analyzed. Descriptive statistics and survival analysis were applied. Survival analysis and curves were done via the Kaplan-Meier method. Survival curves were analyzed due to the T stage. Log-rank test was used for the analysis of T stage survival curves. RESULTS: Twenty (60.1%) patients were T1 whereas six (18.2%) and seven (21.2%) were Tis. 56.25 Gy, 63 Gy, and 65.25 Gy were delivered to the patients with Tis, T1, and T2, respectively. All groups were treated with 2.25 Gy per fraction. T2 stage had lesser DFS (disease-free survival) compared to Tis and T1 stage and it was statistically significant (P = 0.035). CONCLUSION: Hypofractionation with 2.25 Gy per fraction may be standard for early glottic carcinoma with similar results compared to microsurgery and conventional fractionation radiotherapy.

Outcomes of Sterotactic Body Radiotherapy (SBRT) for pelvic lymph node recurrences after adjuvant or primary radiotherapy for prostate cancer.

BACKGROUND: There is a paucity of data on the management of recurrent lymph nodes after primary or adjuvant radiotherapy (RT) for prostate cancer (PCa). In this study, we report our tertiary cancer center experience with stereotactic body radiotherapy (SBRT) for the management of pelvic lymph node recurrences after adjuvant or primary RT for PCa. MATERIALS AND METHODS: Patients who underwent SBRT for pelvic lymph node metastases from PCa between 2013 and 2019 were retrospectively assessed for local control (LC), androgen deprivation treatment-free survival (ADT-FS), and toxicity outcomes. The primary endpoint was LC and ADT-FS. The secondary endpoint was late treatment toxicity. RESULTS: Twenty-two lesions of 18 patients receiving SBRT for pelvic lymph node recurrences for PCa between February 2013 and March 2019 were evaluated. At a median follow-up duration of 29.5 months (range: 9-54 months), LC was 95.5% vs. 90.2% at 1 and 2 years, respectively. Ten patients received palliative ADT following SBRT after a median period of 14.5 months (range: 6-31 months). ADT-FS was 72.2% and 54.3% at 1 and 2 years, respectively. Comparative analysis of biologically effective dose (BED) values revealed that higher BED10 values were associated with higher ADT-FS (P = 0.008). ADT-FS was 55.6% and 88.9% for BED10 <50 Gy and for BED10 >50 Gy, respectively (P = 0.008). Assessment of late toxicity outcomes revealed that the most common toxicity was urinary toxicity and fatigue; however, no patient had ≥ grade 3 toxicity. CONCLUSION: Our tertiary cancer center experience confirms the safety and efficacy of SBRT for the management of pelvic lymph node recurrences from PCa.

Potential Utility of Radiopharmaceuticals in the Battle Against SARSCov- 2 and COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) pandemic, which has emerged in December 2019 in the city of Wuhan, China, has significantly affected healthcare systems and economies within a short timeframe. Treatment strategies offer alleviation of symptoms in the absence of commercially available specific antiviral agents. Within this context, the introduction of innovative therapeutic approaches against the SARS-CoV-2 virus is a critical need that should be addressed urgently. The anti-inflammatory effect of low dose irradiation has been proposed as a potential therapeutic strategy for COVID-19 pneumonia. Consideration of external beam irradiation for management of COVID-19 pneumonia has prompted the investigation of alternative methods of irradiation with potentially improved toxicity profiles. Theoretically, targeted radiotherapy may have several advantages over conventional external beam radiotherapy owing to the capability to deliver effective radiation doses without adverse irradiation effects. Since radionuclides are conjugated to targeting vectors, such as antibodies and cell surface receptor binding peptides, irradiation may be focused on targeted cells with optimal sparing of surrounding normal tissues. In the context of COVID-19 management, targeted irradiation is expected to compromise SARS-CoV-2 extracellular virions. Targeted radiotherapy may offer a viable means of combating against SARS-CoV-2 virus. There is room for improvement with the need for efficacy, feasibility, and toxicity studies. Although targeted radiotherapy itself may not achieve absolute eradication of virus or virus-infected cells, it may at least serve as a supplementary therapeutic strategy that could be utilized in combination with other antiviral treatments. Further investigations focusing on nuclear medicine, radiopharmaceuticals, and targeted radiotherapy strategies may pave the way for the development of efficacious antiviral treatments which may be utilized in the battle against the current COVID-19 pandemic.

The effect of cancer diagnosis in first-degree relatives on participation of healthy individuals in cancer screening programs and on their attitudes towards healthy lifestyle changes.

Background: Ensuring that first-degree relatives of patients diagnosed with cancer are included in the cancer screening programs will reduce the negative effects that may arise both for the individuals having the risk of cancer and for the community. In our study, we aimed to investigate the awareness and attitudes of the first-degree relatives of patients, who have received diagnosis of a cancer, toward cancer screening programs and to determine the risk factors for cancer. Methods: A questionnaire prepared by the researchers was conducted over the relatives of 234 cancer patients for determining their awareness about cancer and their attitudes toward participation in cancer screening programs. The data were analyzed using SPSS 22 software package. Results: 72.6% of the participants never heard about Cancer Early Diagnosis, Screening and Training Center, which has been established to carry out cancer screening programs in Turkey. Approximately half of the female participants did not participate in breast cancer and cervical cancer screenings (54.9% and 51.1%, respectively). The rate of those who had screening tests for colon cancer was less than one-fifth of all participants (19.8%). The above data show the low level of awareness of the participants about cancer. Conclusion: It has been observed that diagnosis of cancer in the first-degree relatives of the participants did not create awareness in these people at a level that would enable them to participate in cancer screening programs and make healthy lifestyle changes.

Comparative outcomes of short-term and long-term fractionation with temozolomide in older glioblastoma patients: Single-center experience.

Background: The main goal of our study is to comparatively evaluate outcomes of hypofractionation and long-term fractionation with temozolomide (TMZ) in glioblastoma patients older than 65 years. Methods: Eighty patients with glioblastoma meeting the eligibility criteria of >65 years of age, the Karnofsky performance score (KPS) >60, no previous radiotherapy (RT) to the brain referred to our department between October 2009 and October 2016 for adjuvant chemoradiotherapy after surgery were studied. The first group of patients received a dose of 6000 cGy in 30 fractions and the second group was delivered 4000 cGy in 15 fractions All patients used TMZ concomitantly with RT. We used the paired t-test and the Wilcoxon signed-rank test with Statistical Package for the Social Sciences, version 15.0 (SPSS, Inc., Chicago, IL, USA) software for statistical analysis. Results: Forty-six patients were men (57.5%), and 34 patients (42.5%) were woman. Median age was 68 years (range 66-87). Median KPS was 75 (range 60-100). Median follow-up time was 12 months (range 6-30). Median overall survival was 15.2 months and 14.3 months for patients with hypofractionation and conventional fractionation, respectively, with no statistical significance (P = 0.13). Conclusion: Hypofractionation should be recommended to the elderly glioblastoma patients older than 65 years because of the short treatment time, reduced acute adverse effects of both TMZ and RT compared to long-term fractionation.

Dosimetric evaluation of the effect of dental restorative materials in head and neck radiotherapy.

Background: The aim of our study is to assess the dose enhancement from scattered radiation due to dental restorative materials used for occlusal and mesio-occlusal-distal (MOD) cavity filling during simulated head and neck radiotherapy. Methods: We have studied the dose enhancement ratio (DER) of conventional amalgam, high-copper amalgam, and resin composite dental restorative materials at cadaver mandible teeth using 2 therapeutic photon energies of 1.25 MeV (Co-60 gamma ray) and 6 MV (Linac X-ray) for irradiation. Results: DER values at buccal position for Co-60 and 6 MV X-ray were 1.250 ± 0.013 and 1.151 ± 0.012, respectively. For dental cavity fillings, DER values for 6 MV X-ray were 1.065 ± 0.021, 1.100 ± 0.014, and 1.162 ± 0.016 for resin composite filling, low-copper amalgam filling, and high-copper amalgam filling, respectively. Our results revealed that DER regarding irradiation energy was minimum for 6 MV X-rays. With respect to dental restorative filling material, DER was minimum for resin composite filling. Regarding the cavity type, our results with standard deviation (SD) calculations revealed that DER was slightly but not significantly different for both Co-60 gamma ray (1.25 MeV) and 6 MV X-ray energies for both occlusal and MOD cavities. Conclusion: Our dosimetric results for a single beam geometry suggest that, among the three types of filling, resin composite filling is an ideal restorative filling material with minimal morbidity-inducing radiation dose enhancement that may result in increased osteoradionecrosis and secondary caries risk. There is a need for further dosimetric studies with actual clinical beam arrangements.

Promising Outcome of Radiation Therapy for Chondroblastoma of Temporal Bone in Childhood: A Case Report.

Chondroblastoma is a rare cartilaginous benign bone tumor. Chondroblastoma in the temporal bone is also quite rare. Total excision is the main treatment. Data regarding tumor response to radiation therapy (RT) is insufficient. We describe a case of chondroblastoma that was treated with RT following subtotal tumor resection. In this case, the patient was a 14-year-old male who presented with a three-month history of ear fullness and hearing loss in his right ear. Magnetic resonance imaging revealed a mass partly filling the right external auditory canal and the inferior part of the middle ear. Histopathological findings indicated chondroblastoma. Subtotal tumor resection was performed due to risk of complications. RT was planned upon the growth of the tumor during follow-up. Treatment with subtotal resection and postoperative RT has been successful and the patient had no recurrence in the course of the 12-year follow-up. In chondroblastoma, complete surgical resection is still the gold standard. But the success of subtotal resection followed by adjuvant RT should also be kept in mind for cases where the total excision would pose high morbidity.

Adaptive radiation therapy (art) for patients with limited-stage small cell lung cancer (LS-SCLC): A dosimetric evaluation.

Background: Adaptive radiation therapy (ART) refers to redesigning of radiation therapy (RT) treatment plans with respect to dynamic changes in tumor size and location throughout the treatment course. In this study, we performed a comparative volumetric and dosimetric analysis to investigate the impact of ART for patients with limited-stage small cell lung cancer (LS-SCLC). Methods: Twenty-four patients with LS-SCLC receiving ART and concomitant chemotherapy were included in the study. ART was performed by replanning of patients based on a mid-treatment computed tomography (CT)-simulation which was routinely scheduled for all patients 20-25 days after the initial CT-simulation. While the first 15 RT fractions were planned using the initial CT-simulation images, the latter 15 RT fractions were planned using the mid-treatment CT-simulation images acquired 20-25 days after the initial CT-simulation. In order to document the impact of ART, target and critical organ dose-volume parameters acquired from this adaptive radiation treatment planning (RTP) were compared with the RTP based solely on the initial CT-simulation to deliver the whole RT dose of 60 Gy. Results: Statistically significant reduction was detected in gross tumor volume (GTV) and planning target volume (PTV) during the conventionally fractionated RT course along with statistically significant reduction in critical organ doses with incorporation of ART. Conclusion: One-third of the patients in our study who were otherwise ineligible for curative intent RT due to violation of critical organ dose constraints could be treated with full dose irradiation by use of ART. Our results suggest significant benefit of ART for patients with LS-SCLC.

Optimal timing of thoracic irradiation for limited stage small cell lung cancer: Current evidence and future prospects.

Lung cancer is a global health concern as the leading cause of cancer related mortality worldwide. Small cell lung cancer (SCLC) poses a formidable challenge to the treating physicians with the worst prognosis among all lung cancers. However, limited stage SCLC (LS-SCLC) has a relatively better outcome with multimodality management. Efforts have been focused on optimal integration of treatment modalities to achieve an improved therapeutic ratio for patients with LS-SCLC. While chemotherapy and thoracic radiation therapy (TRT) are primary components of initial management for LS-SCLC, there is no consensus on optimal timing of TRT. Within this context, we herein provide a concise overview of current evidence and future prospects regarding the optimal timing of thoracic irradiation for LS-SCLC in light of the literature.

Concise review of radiosurgery for contemporary management of pilocytic astrocytomas in children and adults.

Pilocytic astrocytoma (PA) may be seen in both adults and children as a distinct histologic and biologic subset of low-grade glioma. Surgery is the principal treatment for the management of PAs; however, selected patients may benefit from irradiation particularly in the setting of inoperability, incomplete resection, or recurrent disease. While conventionally fractionated radiation therapy has been traditionally utilized for radiotherapeutic management, stereotactic irradiation strategies have been introduced more recently to improve the toxicity profile of radiation delivery without compromising tumor control. PAs may be suitable for radiosurgical management due to their typical appearance as well circumscribed lesions. Focused and precise targeting of these well-defined lesions under stereotactic immobilization and image guidance may offer great potential for achieving an improved therapeutic ratio by virtue of radiosurgical techniques. Given the high conformality along with steep dose gradients around the target volume allowing for reduced normal tissue exposure, radiosurgery may be considered a viable modality of radiotherapeutic management. Another advantage of radiosurgery may be the completion of therapy in a usually shorter overall treatment time, which may be particularly well suited for children with requirement of anesthesia during irradiation. Several studies have addressed the utility of radiosurgery particularly as an adjuvant or salvage treatment modality for PA. Nevertheless, despite the growing body of evidence supporting the use of radiosurgery, there is need for a high level of evidence to dictate treatment decisions and establish its optimal role in the management of PA. Herein, we provide a concise review of radiosurgery for PA in light of the literature.

Effect of cobalt-60 (γ radiation) on multidrug-resistant multiple myeloma cell lines.

Emergence of resistance to chemotherapy and radiotherapy is a major obstacle for the successful treatment of MM (multiple myeloma). Prednisone, vincristine and melphalan are commonly used chemotherapeutic agents for the treatment of MM. In the current study, we examined the presence of possible cross-resistance between these drugs and gamma (γ) radiation. Prednisone, vincristine and melphalan resistant RPMI-8226 and U-266 MM cells were generated by stepwise increasing concentrations of the drugs. The sensitive and resistant cells were exposed to 200- and 800 cGy γ radiation, and proliferation was examined by XTT {2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide} assay. The results showed that Prednisone- and melphalan-resistant RPMI-8226 cells were also cross-resistant to 200 and 800 cGy γ radiation application, while vincristine-resistant cells did not show resistance. On the other hand, Prednisone-, vincristine- and melphalan-resistant U-266 cells showed cross-resistance to 200- and 800 cGy γ radiation application. These results demonstrated that MM cells resistant to anticancer agents respond to radiation in different levels. These findings may be important in the clinical applications of radiation therapy in the treatment of vincristine resistant MM.

Single-center outcomes of image-guided radiotherapy in the management of vertebral hemangioma with daily kilovoltage cone-beam computerized tomography.

BACKGROUND: Vertebral hemangiomas are defined as benign proliferation of blood vessels. Vertebral hemangiomas are generally found incidentally by computerized tomography or magnetic resonance imaging; however, they may also cause pain and quality-of-life impairment in some circumstances with reference to their location and association with the spinal cord. In this study, we assessed the utility of image-guided radiation therapy (IGRT) in the management of patients with painful vertebral hemangioma. MATERIALS AND METHODS: Patients receiving IGRT for the management of painful vertebral hemangioma were evaluated. The total dose was 24 Gy delivered in 12 daily fractions. The verbal numeric scale (VNS) was used for the assessment of pain relief. The median follow-up duration was 13 months (range: 6-24 months). RESULTS: Median preradiotherapy VNS score was 8 (range: 6-10) and median postradiotherapy VNS score was 1 (range: 0-2) for the total 135 patients treated with IGRT at our department for painful vertebral hemangioma. Reduction in VNS scores after IGRT was statistically significant (P < 0.05). CONCLUSION: Our single-center study revealed that IGRT resulted in substantial relief of pain from vertebral hemangioma. Randomized prospective multicenter trials are needed to shed light on the optimal management of patients suffering from pain due to vertebral hemangioma.

Evaluation of breathing-adapted radiation therapy for right-sided early stage breast cancer patients.

BACKGROUND: Adverse effects of breast irradiation have been an important concern given the increased survival of early stage breast cancer (ESBC) patients with more effective treatments. However, there is paucity of data on the utility of Active Breathing Control (ABC) technique for right-sided ESBC patients. In this study, we assessed the incorporation of ABC into adjuvant Radiation Therapy (RT) of right-sided ESBC patients and report our dosimetric results. METHODS: Thirty-six patients receiving whole breast irradiation followed by a sequential tumor bed boost were included in the study. All patients received field-in-field intensity modulated radiation therapy with incorporation of active breathing control-moderate deep inspiration breath-hold (ABC-mDIBH) after breast conserving surgery. Dose-volume parameters in both plans with and without ABC-mDIBH were compared using Mann-Whitney U test. RESULTS: Mean lung dose decreased from 7 Gy to 5.2 Gy (26% reduction) for the total lung (p < 0.001) and from 12.6 to 9.4 Gy (25% reduction) for the ipsilateral lung (p < 0.001). Mean dose decreased from 4.6 Gy to 1.7 Gy (58% reduction) for liver (p < 0.001) and 1.7 Gy to 1.4 Gy (16% reduction) for the heart (p < 0.001). CONCLUSION: Our study revealed that incorporation of ABC-mDIBH into adjuvant RT of right-sided ESBC patients results in significantly improved critical organ sparing.

Concise review of stereotactic irradiation for pediatric glial neoplasms: Current concepts and future directions.

Brain tumors, which are among the most common solid tumors in childhood, remain a leading cause of cancer-related mortality in pediatric population. Gliomas, which may be broadly categorized as low grade glioma and high grade glioma, account for the majority of brain tumors in children. Expectant management, surgery, radiation therapy (RT), chemotherapy, targeted therapy or combinations of these modalities may be used for management of pediatric gliomas. Several patient, tumor and treatment-related characteristics including age, lesion size, grade, location, phenotypic and genotypic features, symptomatology, predicted outcomes and toxicity profile of available therapeutic options should be considered in decision making for optimal treatment. Management of pediatric gliomas poses a formidable challenge to the physicians due to concerns about treatment induced toxicity. Adverse effects of therapy may include neurological deficits, hemiparesis, dysphagia, ataxia, spasticity, endocrine sequelae, neurocognitive and communication impairment, deterioration in quality of life, adverse socioeconomic consequences, and secondary cancers. Nevertheless, improved understanding of molecular pathology and technological advancements may pave the way for progress in management of pediatric glial neoplasms. Multidisciplinary management with close collaboration of disciplines including pediatric oncology, surgery, and radiation oncology is warranted to achieve optimal therapeutic outcomes. In the context of RT, stereotactic irradiation is a viable treatment modality for several central nervous system disorders and brain tumors. Considering the importance of minimizing adverse effects of irradiation, radiosurgery has attracted great attention for clinical applications in both adults and children. Radiosurgical applications offer great potential for improving the toxicity profile of radiation delivery by focused and precise targeting of well-defined tumors under stereotactic immobilization and image guidance. Herein, we provide a concise review of stereotactic irradiation for pediatric glial neoplasms in light of the literature.

Meningeal carcinomatosis: an extremely rare involvement of urinary bladder carcinoma.

Meningeal carcinomatosis (MC) is a rare presentation of solid tumors, particularly breast cancer, lung cancer, and malignant melanoma. Recently, the incidence of MC has been reported to be increasing. It has a bad prognosis despite aggressive therapy. The usual clinical presentation is multifocal involvement of the neuraxis, with headache and radicular pain being the most common initial symptoms. The most frequent signs are motor deficits, altered mental status, and cranial nerve involvement. The treatment of MC remains controversial and no straightforward guidelines exist in the literature. MC from urinary bladder tumors is rare. In this case report, we present a 52-year-old male patient with meningeal metastasis from a primary urinary bladder carcinoma along with a review of the related literature. Free full text available at www.tumorionline.it

Comparative Evaluation of Topical Corticosteroid and Moisturizer in the Prevention of Radiodermatitis in Breast Cancer Radiotherapy.

BACKGROUND: Radiodermatitis is a frequent side effect of breast cancer radiotherapy (RT). Treating radiation oncologist should know the prevention and treatment of every grade of radiodermatitis. AIMS: The aim of this study was to compare the topical corticosteroid and moisturizer usage in breast cancer RT. MATERIALS AND METHODS: Fifty patients with early-stage breast cancer undergoing breast-conserving surgery referred to our department for adjuvant RT between October 2009 and October 2016 were compared with regard to topical steroid or moisturizer usage. Patients were followed up weekly after the start of treatment. RESULTS: Mean age was 46 years. Twenty-four patients had stage 1 breast cancer and 26 patients had stage 2 disease. KPS (Karnofsky performance score) was 100 for all patients. Five patients (20.8%) had grade 2 and seven (29.1%) patients had grade 1 acute radiodermatitis in the first group. Eleven (42.3%) patients had grade 2 and 12 (46.1%) patients had grade 1 acute radiodermatitis in the second group. Thirteen (54.1%) patients in the first group had no acute radiodermatitis and three (11.5%) patients in the second group had no acute radiodermatitis. No patient in either group experienced grade 3 radiodermatitis. CONCLUSIONS: Daily use of topical betamethasone for breast cancer RT improves dermal sparing, reduces acute radiodermatitis, and may be recommended for patients receiving RT to the breast.