Systematic review of economic evaluations on stereotactic ablative radiotherapy (SABR) compared to other radiotherapy techniques or surgical procedures for early-stage non-small cell lung cancer.

BACKGROUND: Stereotactic ablative radiotherapy (SABR) is recommended as first-choice treatment to inoperable early-stage non-small cell lung cancer (NSCLC). However, it is not widely adopted in developing countries, and its cost-effectiveness is unclear. We aimed to perform a systematic review of full economic evaluations (EE) that compared SABR with other radiotherapy or surgical procedures to assess the results and methodological approach. METHODS: The protocol was registered on PROSPERO (CRD42021241640). We included full EE studies with early-stage NSCLC in which one group was submitted to SABR. Studies that were partial EE, included advanced NSCLC or other neoplasm were excluded. We performed the last search on June 2021 in Medline, EMBASE and other databases. The reporting quality were assessed by CHEERS checklist. The main characteristics of each study were tabulated, and the results were presented by a narrative synthesis. RESULTS: We included nine studies. Three compared radiotherapy techniques, in which SABR was found to be dominant or cost-effective. Six compared SABR with surgery, and in this group, there was not a unanimous decision. All included only direct healthcare costs but varied about categories included. The parameters used in the model-based studies were highly heterogeneous using mixed data from various sources. The items properly reported varied from 29 to 67%. CONCLUSIONS: The studies were all from developed countries and lacked in reporting quality. We recommend that developing countries produce their own studies. More strict alignment to reporting guidelines and use of robust evidence as model parameters are also advised.

Results of consolidative radiotherapy for relapsed diffuse B-cell lymphoma.

Background: Recurrent diffuse large B-cell lymphoma (DLBCL) is a disease with high mortality. The standard of care involves autologous stem-cell transplantation (ASCT), which is not always feasible. We investigated the impact of radiotherapy as part of the salvage treatment for patients with relapsed disease. Materials and methods: Retrospective study of patients with recurrent DLBCL after chemotherapy and consolidative radiotherapy at a single institution. All patients were included if radiation was part of the first treatment. Results: Of 359 patients assessed between 2010 and 2017, 65 (18.1%) presented a recurrence, but only 62 received further treatment and were included in the study. Mean overall survival was 18.6 months since diagnosis and progression-free survival after first progression (PFS2) was 7.7 months. Patients were divided into two groups according to whether they did (24.8%) or did not (75.8%) receive radiation as part of their salvage treatment. Patients that did not receive R-CHOP (rituximab plus cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone) in the first line were treated more with radiation in the second line (p = 0.02). Six patients with in-field relapse were re-irradiated. Only 4 patients received ASCT as part of their treatment for relapsed disease. There was no difference in outcomes. Conclusion: There is a place for radiotherapy in the treatment of relapsed DLBCL, particularly when patients do not receive ASCT. Radiotherapy is well-tolerated. More trials to assess the role of radiotherapy for these patients are needed.

Curative treatment for stage IIIC2 cervical cancer: what to expect?

Background: Since the GOG125 study, treating radically patients with positive para-aortic lymph nodes has been a valid approach. Nevertheless, literature lacks data on how to better treat these patients since they are usually excluded from trials. In this study, we aimed to report the outcomes of patients with advanced cervical cancer and positive para-aortic lymph nodes (PAN) treated in a single tertiary/academic institution and try to identify variables that may impact survival. Materials and methods: We retrospectively reviewed patients with positive para-aortic lymph nodes treated in our institution. Demographic variables and treatment options were assessed and their impact on overall survival (OS), locorregional control, distant metastasis free survival, and para-aortic lymph node progression was analyzed. Results: We assessed 65 patients treated from April 2010 to May 2017. Median OS was 38.7 months. Median locorregional and para-aortic progression free survivals were not reached. Median distant metastasis progression-free survival was 64.3 months. Better ECOG performance status (p > 0.001), concurrent chemotherapy (p = 0.031), and brachytherapy (p = 0.02) were independently related to better overall survival. Conclusion: Patients with current stage IIIC2 cervix cancer may present long term survival. Treating positive PAN cervical cancer patients with concurrent chemoradiation including brachytherapy with curative intent should be standard. Poor PS and more advanced pelvic disease may represent a higher risk for worse outcomes. Distant metastases are still a challenge for disease control.

Can we predict who will benefit from the deep inspiration breath hold (DIBH) technique for breast cancer irradiation?

Background: The objective was to explore the clinical use of an "in-house" prototype developed to monitor respiratory motion to implement the deep inspiration breath hold technique (DIBH), compare dosimetric differences, and assess whether simple anatomic metrics measured on free breathing (FB) computed tomography scan (CT) can help in selecting patients that would benefit the most from the technique. Materials and methods: A prospective study was conducted on patients with left breast cancer with an indication of adjuvant radiotherapy for breast only. Treatment simulation consisted of four series of CTs: the first during FB and three in DIBH to assess the reproducibility and stability of apnea. Contouring was based on the RTOG atlas, and planning was done in both FB and DIBH. Dosimetric and geometric parameters were assessed and compared between FB and DIBH. Results: From June 2020 to December 2021, 30 patients with left breast cancer were recruited. Overall, the DIBH technique presented a mean dose reduction of 24% in the heart and 30% in the left anterior descendent coronary artery (LAD) (p < 0.05). The only geometric parameter correlated to a 30% dose reduction in the mean heart dose and LAD doses was the anterolateral distance from the heart to the chest wall of at least 1.5 cm measured on FB (p < 0.0001). Conclusion: The prototype enabled the use of the DIBH technique with dose reductions in the heart and LAD. The benefit of the DIBH technique can be predicted on FB CT by measuring the distance between the heart and chest wall at the treatment isocenter.

Deep inspiration breath hold: dosimetric benefits to decrease cardiac dose during postoperative radiation therapy for breast cancer patients.

Background: Postoperative radiation therapy (RT) is the standard treatment for almost all patients diagnosed with breast cancer. Even with modern RT techniques, parts of the heart may still receive higher doses than those recommended by clinically validated dose limit restrictions, especially when the left breast is irradiated. Deep inspiration breath hold (DIBH) may reduce irradiated cardiac volume compared to free breathing (FB) treatment. This study aimed to evaluate the dosimetric impact on the heart and left anterior descending coronary artery (LAD) in FB and DIBH RT planning in patients with left breast cancer. Materials and methods: A retrospective cohort study of women diagnosed with left-sided breast cancer submitted to breast surgery followed by postoperative RT from 2015 to 2019. All patients were planned with FB and DIBH and hypofractionated dose prescription (40.05 Gy in 15 fractions). Results: 68 patients were included in the study. For the coverage of the planned target volume evaluation [planning target volume (PTV) eval] there was no significant difference between the DIBH versus FB planning. For the heart and LAD parameters, all constraints evaluated favored DIBH planning, with statistical significance. Regarding the heart, median V16.8 Gy was 2.56% in FB vs. 0% in DIBH (p < 0.001); median V8.8 Gy was 3.47% in FB vs. 0% in DIBH (p < 0.001) and the median of mean heart dose was 1.97 Gy in FB vs. 0.92 Gy in DIBH (p < 0.001). For the LAD constraints D2% < 42 Gy, the median dose was 34.87 Gy in FB versus 5.8 Gy in DIBH (p < 0.001); V16.8 Gy < 10%, the median was 15.87% in FB versus 0% in DIBH (p < 0.001) and the median of mean LAD dose was 8.13Gy in FB versus 2.92Gy in DIBH (p < 0.001). Conclusions: The DIBH technique has consistently demonstrated a significant dose reduction in the heart and LAD in all evaluated constraints, while keeping the same dose coverage in the PTV eval.

Moderately hypofractionated post-operative radiation therapy for breast cancer: preferences amongst radiation oncologists from countries in Latin America and the Caribbean.

Background: The safety and effectiveness of moderately hypofractionated post-operative radiation therapy for breast cancer were demonstrated by several trials. This study aimed to evaluate the current patterns of practice and prescription preference about moderately hypofractionated post-operative radiation therapy to assess possible aspects that affect the decision-making process regarding the use of fractionation in breast cancer patients in Latin America and the Caribbean (LAC). We also aimed to identify factors that can restrain the utilization of moderately hypofractionated post-operative radiation therapy for breast cancer. Materials an methods: Radiation oncologists from LAC were invited to contribute to this study. A 38-question survey was used to evaluate their opinions. Results: A total of 173 radiation oncologists from 13 countries answered the questionnaire. The majority of respondents (84.9%) preferred moderately hypofractionated post-operative radiation therapy as their first choice in cases of whole breast irradiation. Whole breast plus regional nodal irradiation, post-mastectomy (chest wall and regional nodal irradiation) without reconstruction, and post-mastectomy (chest wall and regional node irradiation) with reconstruction hypofractionated post-operative radiation therapy was preferred by 72.2% 71.1%, and 53.7% of respondents, respectively. Breast cancer stage, and flap-based breast reconstruction were the factors associated with absolute contraindications for the use of hypofractionated schedules. Conclusion: Even though moderately hypofractionated post-operative radiation therapy for breast cancer is considered a new standard to the vast majority of the patients, its unrestricted application in clinical practice across LAC still faces reluctance.

Quality of Life and Sexual Function of Men Who Have Sex With Men Treated for Anal Cancer: A Prospective Trial of a Neglected Population.

BACKGROUND: Anal cancer is a rare disease, more prevalent in women. Men who have sex with men (MSM) are a high-risk neglected population. AIM: The primary objective was to assess quality of life (QoL) and sexual function (SxF) among MSM treated with radical chemoradiation for anal cancer. Secondary objectives were to assess survivals and to describe the sexual habits of the target population. METHODS: Prospective single institution trial of MSM who were treated for anal cancer with curative intent between 2015 and 2019. QoL and SxF were the primary end-points and were assessed by validated questionnaires and sexual inventory. Overall survival, locoregional relapse-free, distant metastases free, and colostomy-free survivals were evaluated. OUTCOMES: Quality of life and sexual function. RESULTS: Nineteen patients were accrued between November 2015 and August 2019. Median age was 59.3 years. Stage III disease was 53.4% and mean tumor size was 5.4 cm. Fifteen (79.0%) patients were living with HIV (PLHIV). Median follow-up was 21.8 months. Mean overall survival, locoregional relapse-free survival, distant metastases-free survival, and colostomy-free survival were, respectively, 20.8, 17.2, 19.8 and 17.4 months. No median value was reached. QoL followed a trend among questionnaires with significantly worsened values by the end of treatment and a raise to maximum value by three months after treatment, followed by a stabilization reached at 12 months after treatment. IIEF questionnaire showed moderate erectile dysfunction among the population. Intercourse frequency followed QoL measures. CLINICAL IMPLICATIONS: In a MSM population with anal canal cancer, QoL and SxF followed the same pattern up to one year after treatment. Most patients had their SxF compromised during follow-up as shown by IIEF levels and sexual inventory. STRENGTHS AND LIMITATIONS: It is a single institution prospective trial with a limited sample size. Nevertheless, there are no studies addressing this minority population, quality of life or otherwise, making it unique and a special contribution for the literature. CONCLUSION: Anal cancer and its treatment represent a burden to MSM regarding QoL and SxF. Mauro GP, da Conceição Vasconcelos KGM, Carvalho HDA, Quality of Life and Sexual Function of Men Who Have Sex With Men Treated for Anal Cancer: A Prospective Trial of a Neglected Population. J Sex Med 2021;18:1461-1466.

Safety and Feasibility Analysis of a Prospective Trial on Stereotactic Body Radiotherapy for Solitary Bone Plasmacytoma.

BACKGROUND: There have been reports on the use of hypofractionated stereotactic body radiotherapy (SBRT) for bone plasmacytomas, but no prospective data are available. We present the initial analysis of an ongoing prospective protocol on SBRT addressing the feasibility and safety of this treatment for solitary bone plasmacytomas. PATIENTS AND METHODS: A prospective cohort of SBRT for solitary bone plasmacytoma was developed. Patients could receive different doses depending on the index bone, from single fraction for skull base lesions, 24 Gy in 3 fractions for spine lesions, and 30 Gy in 5 fractions for other bones. Overall survival, bone events, local control, and progression to multiple myeloma (MM) were measured and compared to our retrospective cohort of patients treated with conformal standard-dose radiotherapy. Quality of life was assessed via the EORTC QLQ-C30 questionnaire, and toxicities were assessed by the CTCAE v5.0 criteria. After 1 year or the inclusion of 5-10 patients, a feasibility and safety analysis was programmed. RESULTS: Between April 2018 and April 2019, 5 patients were included. All were male, with a median age of 53.1 years. The median follow-up was 21.8 months. No patient had local progression, bone event, or died. Two patients had progressions to MM. The mean survival free of progression to MM was 18.6 months, compared to 19 months in the retrospective cohort; median values were not reached. There were no grade 3 toxicities. CONCLUSION: SBRT for plasmacytoma is safe and feasible. More robust data are awaited.

Hypofractionated radiotherapy in breast cancer: a 10-year single institution experience.

BACKGROUND: Moderately post-operative hypofractionated radiotherapy (HYPO-RT) for breast cancer is a safe and effective strategy as seen in large prospective trials. This study aimed to assess overall and disease-free survivals, local control, and acute and late toxicities in patients treated with HYPO-RT. MATERIALS AND METHODS: Data from patients submitted to post-operative HYPO-RT, with or without boost, were evaluated retrospectively. Demographic, disease, and treatment characteristics were collected. RESULTS: From March 2009 to December 2016, 393 patients were treated. Breast-conserving surgery was performed in 94.7%, immediate reconstruction after mastectomy in 6 (1.5%). Most patients (91.2%) had initial stage (0 to IIA), and chemotherapy was performed in 42.0%, HYPO-RT was mainly performed in 15 or 16 daily fractions of 267 cGy and 265 cGy, respectively. The median follow-up was 5.7 years. There were 25 deaths (6.4%) and 17 (4.3%) local recurrences. At 5 and 10 years, the overall survival, local control, and disease-free survival were, respectively, 96.0% and 79.3%, 99.2% and 94.9%, 96.6%, and 91.9%. Acute grade 3 or 4 dermatitis was observed in 0.9%. Late grade 1 or 2 occurred in less than 3% of the patients. CONCLUSION: HYPO-RT is a safe and effective radiotherapy regimen with excellent disease control and overall survival rates, with low acute and late toxicity rates.

Complications after breast reconstruction with alloplastic material in breast cancer patients submitted or not to post mastectomy radiotherapy.

BACKGROUND AND PURPOSE: Breast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material. MATERIALS AND METHODS: Retrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications. RESULTS: 251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23-9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60-4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97-11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048-0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26-9.99, p = 0.016) were related to late complications. CONCLUSIONS: The overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.

Feasibility of SBRT for hepatocellular carcinoma in Brazil - a prospective pilot study.

BACKGROUND: The aim of the study was to evaluate the feasibility and safety of stereotactic body radiotherapy (SBRT) for the treatment of hepatocellular carcinoma in Brazil. SBRT is an evolving treatment in HCC patients not candidates to other local therapies. Its adoption in clinical practice has been heterogeneous, with lack of data on its generalizability in the Brazilian population. MATERIALS AND METHODS: We conducted a prospective pilot study involving HCC patients after failure or ineligibility for transarterial chemoembolization. Patients received SBRT 30 to 50 Gy in 5 fractions using an isotoxic prescription approach. This study is registered at clinicaltrials.gov NCT02221778. RESULTS: From Nov 2014 through Aug 2019, 26 patients received SBRT with 40 Gy median dose. Underlying liver disease was hepatitis C, hepatitis B and alcohol-related in, respectively, 50%, 23% and 19% of patients. Median lesion size was 3.8 cm (range, 1.5-10 cm), and 46% had multiple lesions. Thirty-two percent had tumor vascular thrombosis; median pretreatment alpha-fetoprotein (AFP) was 171.7 ng/mL (range, 4.2-5,494 ng/mL). 1y-local progression-free survival (PFS) was 86% (95% CI: 61% to 95%), with higher local control in doses ≥ 45Gy (p = 0.037; HR = 0.12). 1y-liver PFS, distant PFS and OS were, respectively, 52%, 77% and 79%. Objective response was seen in 89% of patients, with 3 months post-SBRT median AFP of 12 ng/mL (2.4-637 ng/mL). There were no grade 3 or 4 clinical toxicities. Grade 3 or 4 laboratory toxicities occurred in 27% of patients. CONCLUSION: SBRT is feasible and safe in patients unresponsive or ineligible for TACE in Brazil. Our study suggests doses ≥ 45 Gy yields better local control.

Prospective validation of a core curriculum progress assimilation instrument for radiation oncology residentship.

OBJECTIVES: To develop a tool that could assess residents' knowledge beyond simple information gathering and evaluate its reliability. METHODS: An assessment tool of 40 objective questions and at least one essay-based question was developed to assess residents' comprehension of general radiation oncology accordingly to validated training curricula beyond level 2 in the Bloom scale. With randomized content, questions were developed such as to be classified as at least 2 in the Bloom scale, so that reasoning and not only information gathering could be assessed. Criteria validation was made using the Classical Test Theory to describe difficulty and discrimination of each item. Reliability was tested by internal consistency using the Cronbach alpha test. RESULTS: Between 2016 and 2019, 24 residents were assessed. Six different versions of the test were made with a total of 240 objective questions and 18 essay-based questions. Five of the six versions were deemed valid and reliable. Comparisons between 1st (PGY-1) and 3rd (PGY-3) year residents were made. Consistently, PGY-3 residents had scores 150% higher than PGY-1 residents. Only two different PGY-3 reached the most complex level of answers in the essay-based questions. The results demonstrated that the major part of the acquired knowledge and retention occurs in the first six months of training rather than in all the following period. CONCLUSION: The instrument can be considered valid. This developed instrument also raised the hypothesis that residents may not assess and analyze their acquired knowledge beyond the application level.

Impact of bone events on survival in solitary bone plasmacytoma.

BACKGROUND: Although much studied in multiple myeloma, bone events (BE) can also cause important morbidity in bone plasmacytoma patients. To our knowledge, the effect of BE on overall survival (OS) and progression to multiple myeloma free-survival (MPFS) also has never been studied. PATIENTS AND METHODS: Fifty-nine patients treated from 2008 to 2017 were retrospectively assessed. All patients had histological proof of disease and were treated with radical radiotherapy (RT). Available clinical information for at least 6 months follow-up or until death had to be available. BE were described as one of the following events in the index bone: fractures, osteomyelitis, chronic pain, surgery or loss of limb function after RT. RESULTS: Mean age at diagnosis was 57.3 years (18-80); most male (67.8%). Mean OS, bone event free-survival (BEFS), local progression-free survival (LPFS) and MPFS were 41, 36, 37 and 19 months, respectively. There were 15 deaths. BEFS (p = 0.008) and age>55y (p = 0.044) were associated with MPFS. Only BEFS correlated with OS (p = 0.029). BE was independently associated with both MPFS and OS in multivariate analysis. CONCLUSION: BE and survival end-points were correlated. BE should be investigated in prospective trials.

Patterns of post-operative irradiation in breast cancer patients submitted to neoadjuvant chemotherapy.

BACKGROUND/AIM: Post-operative radiation therapy (PORT) is associated with improvement in loco-regional control and survival rates in early breast cancer. However, the evidence of benefit in patients after treatment with neoadjuvant chemotherapy (NAC) is poor. We aimed to assess the impact of the type of surgery in the PORT plan and the role of the PORT fields in clinical outcomes in breast cancer patients who had undergone NAC followed by surgery. MATERIALS AND METHODS: We performed a retrospective analysis of all non-metastatic breast cancer patients treated between 2008 and 2014 at our institution who had received NAC and PORT. RESULTS: A total of 528 women were included of whom 396 were submitted to mastectomy or nipple-sparing/skin-sparing mastectomy. Most (92.8%) of the patients had locally advanced disease (clinical stage IIB to IIIC). All patients underwent irradiation for breast or chest wall. Most patients received PORT to the supraclavicular and axillary (levels II and III) nodes (87.1% and 86.4% for breast-conserving surgery and 95.1% and 93.8% for mastectomy and nipple-sparing/skin-sparing mastectomy, respectively). Irradiation of level I axillary and internal mammary nodes was uncommon. The disease-free survival and overall survival rates at 3 years were 72% and 85%, respectively. There were no statistically significant differences in clinical outcomes according to the use of nodal irradiation. CONCLUSIONS: After NAC, most patients received irradiation of the breast/chest wall and axillary and supraclavicular nodes. In this setting, PORT to breast/chest wall with or without regional nodal irradiation was safe and effective, with acceptable disease-free and overall survival rates reported in this high-risk population.

Laparoscopic extrafascial hysterectomy (completion surgery) after primary chemoradiation in patients with locally advanced cervical cancer: technical aspects and operative outcomes.

OBJECTIVE: This study aimed to evaluate the feasibility and safety of laparoscopic extrafascial hysterectomy and bilateral salpingo-oophorectomy after primary chemoradiation (CRT) in patients with locally advanced cervical cancer (LACC) without evidence of nodal metastasis. BACKGROUND: Currently, the standard of care for patients with advanced cervical cancer is concurrent CRT. There is an unequivocal correlation between presence of residual disease and risk of local relapse. Nevertheless, the importance of hysterectomy in adjuvant setting remains controversial. METHODS: Prospective study with patients affected by bulky LACC (International Federation of Gynecology and Obstetrics stage IB2 up to IIB) treated initially with radical CRT who underwent laparoscopic surgery 12 weeks after therapy conclusion. Inclusion criteria were absence of signs for extrapelvic or nodal involvement on initial imaging staging, as well as complete clinical and radiologic response. RESULTS: From January 2011 to March 2013, 33 patients were endoscopically operated. The mean age was 44 years (range, 21-77 years). Histologic finding revealed squamous cell carcinoma in 19 (60%) cases and adenocarcinoma in 14 (40%) cases. International Federation of Gynecology and Obstetrics stages distribution were as follow: 1B2, n = 3 (9%); IIA, n = 4 (11%); and IIB, n = 26 (80%). The mean pretherapeutic tumor size was 5.2 cm (range, 4-10.2 cm). Estimated blood loss was 80 mL (range, 40-150 mL), and mean operative time was approximately 104 minutes (range, 75-130 minutes). No casualty or conversion to laparotomy occurred. Hospital stay was in average 1.7 days (range, 1-4 days). Significant complication occurred in 12% of the cases; 2 vaginal vault dehiscence, 1 pelvic infection, and 1 ureterovaginal fistula. Nine (27%) patients had pathologic residual disease, and in 78% of these cases, histologic finding was adenocarcinoma (P = -0.048). All patients had free margins. After median follow-up of 16 months, all women have no signs of local recurrence. CONCLUSIONS: Laparoscopic extrafascial hysterectomy (completion surgery) after primary CRT in patients with apparent node-negative LACC is a feasible and safe strategy to improve tumor local control mainly in cases of adenocarcinoma.

Literature review of clinical results of total skin electron irradiation (TSEBT) of mycosis fungoides in adults.

BACKGROUND: Mycosis fungoides (MF) is an extranodal, indolent non-Hodgkin lymphoma of T cell origin. Even with the establishment of MF staging, the initial treatment strategy often remains unclear. AIM: The aim of this study was to review the clinical results of total skin electron beam therapy (TSEBT) for MF in adults published in English language scientific journals searched in Pubmed/Medline database until December 2012. RESULTS: MF is very sensitive to radiation therapy (RT) delivered either by photons or by electrons. In limited patches and/or plaques local electron beam irradiation results in good outcomes besides the fact of not being superior to other modalities. For extensive patches and/or plaques data suggest that TSEBT shows superior response rates. The cutaneous disease presentation is favorably managed with radiotherapy due to its ability to treat the full thickness of deeply infiltrated skin. For generalized erythroderma presentation, TSEBT seems to be an appropriate initial therapy. For advanced disease, palliation, or recurrence after the first radiotherapy treatment course, TSEBT may still be beneficial, with acceptable toxicity. Recommended dose is 30-36 Gy delivered in 6-10 weeks. CONCLUSION: TSEBT can be used to treat any stage of MF. It also presents good tumor response with symptoms of relief and a palliative effect on MF, either after previous irradiation or failure of other treatment strategies.

Solid epithelioid peritoneal mesothelioma with pulmonary metastasis in feline.

Mesothelioma is a rare malignant neoplasm that affects the mesothelial cells lining the thoracic and abdominal cavities, such as the pleura, peritoneum, and pericardium. It is most prevalent in dogs and cattle, but the causes of this disease in animals are uncertain. In felines, it mainly affects the pleura, with an unfavorable prognosis. This paper explores a rare case of metastatic peritoneal mesothelioma in a 2-year-old female mixed breed cat, emphasizing its uniqueness due to the feline's age. The patient, previously treated at a private clinic, presented moderate abdominal distension as the only clinical sign. Abdominal ultrasound and peritoneal fluid cytology led to the provisional diagnosis of mesothelioma/carcinomatosis. One day after exploratory laparotomy, the animal died and was subsequently sent for necropsy. During macroscopic analysis, nodules were observed in the peritoneum, diaphragm, omentum, stomach serosa, and large intestine, and the diagnosis of solid epithelioid peritoneal mesothelioma with lung metastasis was confirmed after microscopic analysis. The diagnosis of mesothelioma is challenging, and the importance of immunohistochemical panels with specific markers such as cytokeratin AE1/AE3 and calretinin is highlighted. Considering that mesothelioma is a pathology with a poor prognosis, it is essential to include this disease in the list of differential diagnoses within veterinary oncology.

O mesotelioma é uma neoplasia maligna rara que afeta as células mesoteliais que revestem as cavidades torácica e abdominal, como a pleura, o peritônio e o pericárdio. É mais prevalente em cães e bovinos, mas as causas desta doença em animais são incertas. Nos felinos acomete principalmente a pleura, com prognóstico desfavorável. Este artigo explora um caso raro de mesotelioma peritoneal metastático em uma gata sem raça definida de 2 anos de idade, enfatizando sua singularidade devido à idade do felino. O paciente, previamente atendido em clínica particular, apresentava distensão abdominal moderado como único sinal clínico. A ultrassonografia abdominal e a citologia do líquido peritoneal levaram ao diagnóstico provisório de mesotelioma/carcinomatose. Um dia após a laparotomia exploratória, o animal veio a óbito e posteriormente encaminhado para necropsia. Durante a análise macroscópica, foram observados nódulos no peritônio, diafragma, omento, serosa estomacal e intestino grosso e o diagnóstico de mesotelioma peritoneal epitelioide sólido com metástase pulmonar foi confirmado após análise microscópica. O diagnóstico do mesotelioma é desafiador, sendo destacada a importância de painéis imunohistoquímicos com marcadores específicos como citoqueratina AE1/AE3 e calretinina. Considerando que o mesotelioma é uma patologia de prognóstico ruim, é fundamental incluir esta doença na lista de diagnósticos diferenciais dentro da oncologia veterinária.

Use of selected samples to diagnose a tricky feline viral disease in a cat with uveitis and neurological signs.

This case involved a 2-year-old neutered male domestic mixed-breed cat that was rescued from the street eight months earlier. The animal presented with weakness, hyporexia, progressive weight loss, fatigue, uveitis, pale mucous membranes, dehydration (7%), and pelvic limb paresis. Aqueous humor was collected for molecular analysis for the differential diagnosis of potential etiological agents [Feline coronavirus (FCoV), Feline leukemia virus (FeLV), Feline immunodeficiency virus (FIV), Toxoplasma gondii, Cryptococcus spp., Felid herpesvirus-1 (FHV-1) and Bartonella spp.] of feline uveitis. The sample was positive by real-time reverse transcription-polymerase chain reaction (RT-qPCR) for FCoV and RT-qPCR and real-time polymerase chain reaction (qPCR) for FeLV and qPCR FIV. The cat was euthanized due to poor clinical outcomes and prognosis. A cerebrospinal fluid (CSF) sample was collected and tested, and the same pathogens were found in the aqueous humor. Small-cell follicular multicenter lymphoma and multifocal pyogranulomatous meningoencephalitis were observed upon histopathological analysis. In this study, aqueous humor and cerebrospinal fluid samples were efficient for the detection of coinfection with FIV, FeLV, and FCoV.

O caso refere-se a um gato de dois anos de idade, sem raça definida, resgatado da rua há oito meses. O animal apresentava fraqueza, hiporexia, emagrecimento progressivo, cansaço fácil, uveíte, mucosas pálidas, desidratação (7%) e paresia de membros pélvicos. O humor aquoso foi coletado para o diagnóstico molecular diferencial de potenciais agentes etiológicos [coronavírus felino (FCoV), vírus da leucemia felina (FeLV), vírus da imunodeficiência felina (FIV), Toxoplasma gondii, Cryptococcus spp., herpesvírus felino tipo 1 (FHV-1) and Bartonella spp.] causadores de uveíte felina. A amostra foi positiva na reação em cadeia da polimerase precedida por transcrição reversa em tempo real (RT-qPCR) para FCoV, RT-qPCR e reação em cadeia da polimerase em tempo real (qPCR) para FeLV e qPCR para FIV. O animal foi submetido à eutanásia - devido ao quadro clínico e prognóstico desfavorável. Amostra de líquido cefalorraquidiano (LCR) foi coletada e testada, confirmando a identificação dos mesmos patógenos encontrados no humor aquoso. Linfoma multicêntrico folicular de pequenas células e meningoencefalite piogranulomatosa multifocal foram observados na análise histopatológica. Neste relato, as amostras de humor aquoso e líquido cefalorraquidiano foram eficientes para a detecção de coinfecção por FIV, FeLV e FCoV.

Effect of Photobiomodulation With Different Wavelengths on Radiodermatitis Treatment.

Approximately 80% of patients submitted to radiotherapy develop radiodermatitis. Photobiomodulation based on light-emitted diode (LED) is one of the therapeutic strategies for treating inflammation. This study aimed to investigate the effect of the photobiomodulation with two wavelengths, in an acute radiodermatitis animal model. Methods: Twenty rats were submitted to one radiotherapy session. After 15 days, the rats that developed radiodermatitis were divided into control groups, LED-630 nm, LED-850 nm, and LED-630 + 850 nm. The treatment regimen was one session lasting 10 minutes on alternate days for 21 days. We analyzed macroscopy aspects (RTOG scale), vascular density, dermal appendages, VEGF-a, TNF-alpha, MMP-9, and MMP-9 genic expression level. Results: All LED groups revealed a two-point reduction on the radiodermatitis severity grade compared with the baseline classification. Dermal appendage and vascular analysis showed a higher counting in all LED groups compared to control. This study showed dermal appendages twice in the 630/850 nm group compared with the control group. The 630/850 nm group showed six times more arterioles than the control group. Regarding genic expression, this study showed a 10-fold decrease between LED-630 nm versus LED-630 + 850 nm (P = 0.02) interleukin-10 expression and a 12-fold decrease between control versus LED-630 nm (P = 0.006) and LED-850 nm (P = 0.002) in TNF-alpha. Conclusion: LED (630 nm, 850 nm, and 630 nm + 850 nm) showed benefit in the treatment of radiodermatitis, and the association of the 630 nm + 850 nm and 630 nm parameters demonstrated the best macroscopic and microscopic results.

Long-Term Results of Intraoperative Radiation Therapy for Early Breast Cancer Using a Nondedicated Linear Accelerator.

Purpose: To present the long-term results of intraoperative radiation therapy (IORT) for early breast cancer using a nondedicated linear accelerator. Methods and Materials: The eligibility criteria were biopsy-proven invasive carcinoma, age ≥40 years, tumor size ≤3 cm, and N0M0. We excluded multifocal lesions and sentinel lymph node involvement. All patients had previously undergone breast magnetic resonance imaging. Breast-conserving surgery with margins and sentinel lymph node evaluation using frozen sections were performed in all cases. If there were no margins or involved sentinel lymph nodes, the patient was transferred from the operative suite to the linear accelerator room, where IORT was delivered (21 Gy). Results: A total of 209 patients who were followed up for ≥1.5 years from 2004 to 2019 were included. The median age was 60.3 years (range, 40-88.6), and the mean pT was 1.3 cm (range, 0.2-4). There were 90.5% pN0 cases (7.2% of micrometastases and 1.9% of macrometastases). Ninety-seven percent of the cases were margin free. The rate of lymphovascular invasion was 10.6%. Twelve patients were negative for hormonal receptors, and 28 patients were HER2 positive. The median Ki-67 index was 29% (range, 0.1-85). Intrinsic subtype stratification was as follows: luminal A, 62.7% (n = 131); luminal B, 19.1% (n = 40); HER2 enriched 13.4% (n = 28); and triple negative, 4.8% (n = 10). Within the median follow-up of 145 months (range, 12.8-187.1), the 5-year, 10-year, and 15-year overall survival rates were 98%, 94.7%, and 88%, respectively. The 5-year, 10-year, and 15-year disease-free rates were 96.3%, 90%, and 75.6%, respectively. The 15-year local recurrence-free rate was 76%. Fifteen local recurrences (7.2%) occurred throughout the follow-up period. The mean time to local recurrence was 145 months (range, 12.8-187.1). As a first event, 3 cases of lymph node recurrence, 3 cases of distant metastasis, and 2 cancer-related deaths were recorded. Tumor size >1 cm, grade III, and lymphovascular invasion were identified as risk factors. Conclusions: Despite approximately 7% of recurrences, we may infer that IORT may still be a reasonable option for selected cases. However, these patients require a longer follow-up as recurrences may occur after 10 years.