SBRT-SG-01: final results of a prospective multicenter study on stereotactic body radiotherapy for liver metastases.

OBJECTIVE: This study aimed to assess the efficacy and tolerability of stereotactic body radiation therapy (SBRT) for the treatment of liver metastases. METHODS: Patients with up to 5 liver metastases were enrolled in this prospective multicenter study and underwent SBRT. Efficacy outcomes included in-field local control (LC), progression-free survival (PFS), and overall survival (OS). Acute and late toxicities were evaluated using CTCAE v.4.0. RESULTS: A total of 52 patients with 105 liver metastases were treated between 2015 and 2018. The most common primary tumor was colorectal cancer (72% of cases). Liver metastases were synchronous with the primary tumor diagnosis in 24 patients (46.2%), and 21 patients (40.4%) presented with other extrahepatic oligometastases. All patients underwent intensity-modulated radiation therapy (IMRT)/volumetric-modulated arc therapy (VMAT) with image-guided radiation therapy (IGRT) and respiratory gating, and a minimum biologically effective dose (BED10Gy) of 100 Gy was delivered to all lesions. With a median follow-up of 23.1 months (range: 13.4-30.9 months) since liver SBRT, the median actuarial local progression-free survival (local-PFS) was not reached. The actuarial in-field LC rates were 84.9% and 78.4% at 24 and 48 months, respectively. The median actuarial liver-PFS and distant-PFS were 11 and 10.8 months, respectively. The actuarial median overall survival (OS) was 27.7 months from SBRT and 52.5 months from metastases diagnosis. Patients with lesion diameter ≤ 5 cm had significantly better median liver-PFS (p = 0.006) and OS (p = 0.018). No acute or late toxicities of grade ≥ 3 were observed. CONCLUSIONS: This prospective multicenter study confirms that liver SBRT is an effective alternative for the treatment of liver metastases, demonstrating high rates of local control and survival while maintaining a low toxicity profile.

Moderate hypofractionated radiation therapy and pathologic response for soft tissue sarcomas (STS) of limbs and trunk: experience from a tertiary cancer center.

BACKGROUND: Preoperative radiation therapy following by limb-sparing or conservative surgery is a standard approach for limb and trunk STS. Data supporting hypofractionated radiotherapy schedules are scarce albeit biological sensitivity of STS to radiation would justify it. We sought to evaluate the impact of moderate hypofractionation on pathologic response and its influence on oncologic outcomes. MATERIAL AND METHODS: From October 2018 to January 2023, 18 patients with limb or trunk STS underwent preoperative radiotherapy at a median dose of 52.5 Gy (range 49.5-60 Gy) in 15 fractions of 3.5 Gy (3.3-4 Gy) with or without neoadjuvant chemotherapy. A favorable pathologic response (fPR) was considered as ≥ 90% tumor necrosis on specimen examination. RESULTS: All patients completed planned preoperative radiotherapy. Eleven patients (61.1%) achieved a fPR, and 7 patients (36.8%) a complete pathologic response with total disappearance of tumor cells. Nine patients (47%) developed grade 1-2 acute skin toxicity, and 7 patients (38.8%) had wound complications on follow-up. With a median follow-up of 14 months (range 1-40), no cases of local relapse were observed, and actuarial 3-year overall survival (OS) and distant metastases-free survival (DMFS) are 87% and 76.4%, respectively. In the univariate analysis, the presence of a favorable pathologic response (fPR) was associated with improved 3-year OS (100% vs. 56.03%, p = 0.058) and 3-year DMFS (86.91% vs. 31.46%, p = 0.002). Moreover, both complete or partial RECIST response and radiological stabilization of the tumor lesion showed a significant association with higher rates of 3-year distant metastasis-free survival (DMFS) (83% vs. 83% vs. 56%, p < 0.001) and 3-year overall survival (OS) (100% vs. 80% vs. 0, p = 0.002). CONCLUSIONS: Preoperative moderate hypofractionated radiation treatment for STS is feasible and well tolerated and associates encouraging rates of pathologic response that could have a favorable impact on final outcomes.

Making Radiation Oncology specialty more attractive to young medical graduates: pulling back the invisibility curtain.

PURPOSE: Radiation Oncology is one of the least-known medical specialties for young graduates at the end of their studies. An in-depth analysis of the strengths and weaknesses of the Radiation Oncology visibility, the training plan, and why it is less attractive for new medical residents during the last years appears as the initial need to turn out this lack of knowledge. MATERIALS AND METHODS: An anonymous pilot survey of 24 questions addressed to specialists in-training in Radiation Oncology in Spain during August and September of 2022. RESULTS: A total of 50 in-training radiation oncologists answered the questionnaire and 90% of them believe that a lack of knowledge, mainly at the School of Medicine, was a major reason why choosing Radiation Oncology was unattractive. All responders were satisfied by choosing Radiation Oncology, and 76% were in favor of extending the residency to 5 years to improve their training. Research activity was considered essential (78%) to complete their training. CONCLUSION: Increasing the presence of Radiation Oncology at the School of Medicine may be one solution to achieve greater attractiveness among future residents. Likewise, extending the training period to five years could help to enhance the learning of all radiotherapy techniques while promoting clinical research.

Stereotactic body radiation therapy (SBRT) for spinal metastases: 12 years of a single center experience.

OBJECTIVE: To assess the clinical outcomes of patients with spine metastases treated with SBRT at our institution. MATERIALS AND METHODS: Patients with spine metastases treated with SBRT (1 fraction/18 Gy or 5 fractions/7 Gy) during the last 12 years have been analyzed. All patients were simulated supine in a vacuum cushion or with a shoulder mask. CT scans and MRI image registration were performed. Contouring was based on International Spine-Radiosurgery-Consortium-Consensus-Guidelines. Highly conformal-techniques (IMRT/VMAT) were used for treatment planning. Intra and interfraction (CBCT or X-Ray-ExacTrac) verification were mandatory. RESULTS: From February 2010 to January 2022, 129 patients with spinal metastases were treated with SBRT [1 fraction/18 Gy (75%) or 5 fractions/7 Gy] (25%). For patients with painful metastases (74/129:57%), 100% experienced an improvement in pain after SBRT. With a median follow-up of 14.2 months (average 22.9; range 0.5-140) 6 patients (4.6%) experienced local relapse. Local progression-free survival was different, considering metastases's location (p < 0.04). The 1, 2 and 3 years overall survival (OS) were 91.2%, 85.1% and 83.2%, respectively. Overall survival was significantly better for patients with spine metastases of breast and prostate cancers compared to other tumors (p < 0.05) and significantly worse when visceral metastases were present (p < 0.05), when patients were metastatic de novo (p < 0.05), and in those patients receiving single fraction SBRT (p: 0.01). CONCLUSIONS: According to our experience, SBRT for patients with spinal metastases was effective in terms of local control and useful to reach pain relief. Regarding the intent of the treatment, an adequate selection of patients is essential to propose this ablative approach.

Cerebellar involvement in Hodgkin's lymphoma: an atypical site of relapse.

The presentation of intracranial metastases from Hodgkin's lymphoma is an infrequent event that worsens clinical outcome. A case of Hodgkin's lymphoma relapse in the cerebellum is described in a 70-year-old woman with a previously treated stage IVA Hodgkin's lymphoma. Diagnostic workup and treatment strategies for central nervous system relapses are reviewed and discussed. A combination of surgery, radiotherapy and occasionally chemotherapy remains the most appropriate approach to intracranial Hodgkin's lymphoma.

High-dose-rate (HDR) plesiotherapy with custom-made moulds for the treatment of non-melanoma skin cancer.

BACKGROUND: Non-melanoma skin tumours (NMSC) are one of the most frequent types of cancer, accounting for nearly one third of newly diagnosed tumours. NMSC are frequently diagnosed in elderly patients and while mortality rates are low, NMSC can be associated with significant morbidity in terms of cosmetic and functional impairment. OBJECTIVE: Surgical excision is nowadays considered the standard treatment for NMSC, although this approach might not be suitable for all the patients. Good rates of local control and cosmetic outcome are achieved by using high-dose-rate (HDR) plesiotherapy. METHODS: Nine consecutive patients with 11 NMSC were treated with custom-made moulds and HDR plesiotherapy reaching a fi nal dose of 44-48 Gy in 11-12 fractions of 4 Gy over 4 weeks. RESULTS: No local or distant relapses have been observed after a mean follow-up of 15 months (range 4-36 months). Acute toxicity was acceptable and cosmetic result was considered as excellent/good in 7 patients. CONCLUSIONS: This modality of treatment offers an alternative for those patients not candidates for surgical procedures because of medical contraindications or risk of disfigurement or functional impairment.

Chylothorax due to metastatic prostate carcinoma: an unusual complication.

Chylothorax, the abnormal accumulation of lymphatic fluid within the pleural space, is an infrequent complication of tumours affecting the mediastinum. The development of chylothorax is extraordinary in association with prostate cancer, although it has been described before. Adequate treatment of malignant chylothorax comprises both a conservative approach, including dietary and hormonal manipulations, and mechanic intercostal drainage that have been demonstrated to be effective in the management of chylothorax of malignant origin. Radiation therapy has been used for the treatment of neoplasic chylothorax but with inconsistent results. We present a new case of chylothorax associated to prostate adenocarcinoma and review the existing evidence for its treatment.