Radiation Oncologists' Approach to Internal Mammary Lymph Node Radiotherapy in Breast Cancer: The Turkish Society for Radiation Oncology Breast Cancer Study Group (TROD 06-005 Survey Study).

BACKGROUND: This study aimed to examine the practice patterns of radiation oncologists in Turkey regarding radiotherapy to the regional lymph nodes, including internal mammary lymph nodes (IMNs), and identify the factors influencing their clinical decisions in breast cancer patients. METHODS: A nationwide, 19-point questionnaire was sent to the physician members of the Turkish Society for Radiation Oncology (TROD). RESULTS: In total, 165 radiation oncologists completed the survey, corresponding to a 27% response rate. Regional radiotherapy was used in 64.2% of the patients with 1-3 axillary lymphatic involvement and unfavorable prognostic factors. In contrast, 61.2% of the respondents indicated that IMN should be included in the target volume for regional radiotherapy when the patient had one positive node after axillary lymph node dissection (ALND) in the inner quadrant and central region tumors. However, 71.5% of the respondents chose to include the IMN in the non-inner quadrant and non-central region tumors for patients with four or more positive nodes after ALND. The decision to offer internal mammary lymph node radiotherapy (IMNRT) varied widely and significantly among respondents, years in practice, and the rates of dedicating their clinical time to patients with breast cancer. CONCLUSION: The results of this survey revealed significant national variation in attitudes regarding the treatment of IMN. Thus, this study may also help document the impact of future studies on clinical practice.

The Effect of Thoracic Radiotherapy on the Quality of Life in Lung Cancer Patients.

Introduction This study aimed to investigate changes in respiratory symptoms and quality of life (QoL) in patients with locally advanced and metastatic lung cancer receiving thoracic radiotherapy (RT). We investigated the correlation between the level of symptom relief and tumor response. Methods Thirty-two patients were included in this study. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QoL) Questionnaire (QLQ)-C30 and EORTC QLQ-LC13 were used to investigate QoL changes. Assessments were performed on the first day of RT, on the last day of RT, routinely monthly follow-ups, and three months after RT. Results The median age of the patients was 62; 88% of the patients were male. For the symptom scale, fatigue and dyspnea provided significant improvement at the end of RT (p=0.000, p=0.047). No significant improvement was observed at the end of RT in pain and insomnia. While coughing showed substantial improvement at the end of RT (p=0.004), the maximum improvement was achieved during the third-month follow-up (p<0.001). No significant improvement was observed at the end of RT in hemoptysis, but a considerable improvement was observed during the third-month follow-up (p=0.008). Conclusion This study confirms that RT offered palliation of respiratory symptoms and improved QoL in a substantial proportion of patients with lung cancer.

Comparison of kV Orthogonal Radiographs and kV-Cone-Beam Computed Tomography Image-Guided Radiotherapy Methods With and Without Implanted Fiducials in Prostate Cancer.

Introduction The aim of this study is to investigate the performance of kilovoltage (kV) cone-beam computed tomography (CBCT)-based adjustments with respect to kV-orthogonal fiducial marker-based matching in a group of patients with prostate cancer.  Methods Twenty prostate cancer patients were evaluated retrospectively: 10 with implanted fiducial markers and 10 without. Daily orthogonal kV imaging was recorded prior to radiation delivery. Images were evaluated in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions by matching either the implanted fiducials or going off bony anatomy, depending on the presence or absence of markers, respectively. Cone-beam computed tomography (CBCT) imaging was also subsequently acquired and images were aligned with the planning CT. The couch shifts were calculated and the patient's position was adjusted accordingly. Standard deviations and random errors were also computed. Pearson correlation and Bland-Altman analysis were performed to evaluate relationships between the datasets. Results A total of 240 images were evaluated. The Pearson correlation coefficient for shifts applied to patients with markers using kV and CBCT was 88.3%, 87.8%, and 94.5% for the LR, AP, and SI directions, respectively. For those without markers, the respective values for the LR, AP, and SI directions were: 39.3%, 22.4%, and 3.7%. A Bland-Altman analysis comparing kV and CBCT in patients with markers, revealed R2 values of 0.152, 0.282, and 0.097 in the LR, AP, and SI directions, respectively. The R2 values for patients without markers were 0.008, 0.01, and 0.057, in the LR, AP, and SI directions, respectively. Conclusions Our data suggest that CBCT can be a viable option for image-guidance in clinical settings where fiducial markers are unavailable such as situations of inaccessibility or medical contraindications.

The Impact of Everolimus and Radiation Therapy on Pulmonary Fibrosis.

Background and objectives: Everolimus (EVE) is a mammalian target of the rapamycin (mTOR) inhibitor that is widely used in cancer patients. Pulmonary toxicity, usually manifesting as interstitial pneumonitis, is a serious adverse effect of this drug. Radiation therapy, which is often administered in conjunction with chemotherapy for synergistic effects, also causes pulmonary fibrosis. In view of pulmonary damage development in these two forms of cancer treatment, we have examined the effect of EVE administration individually, in combination with radiation given in varying sequences, and its relation to the extent of pulmonary damage. Materials and Methods: We performed an experimental study in albino rats, which were randomized into five groups: (1) control group, (2) EVE alone, (3) EVE 22 h after radiation, (4) EVE 2 h after irradiation, and (5) only radiation. Sixteen weeks after thoracic irradiation, rat lung tissue samples were examined under light microscopy, and the extent of pulmonary damage was estimated. After this, we calculated median fibrosis scores in each group. Results: The highest fibrosis score was noted in Group 4. Among the five groups, the control group had a significantly lower median fibrosis score compared to the others. When the median fibrosis score of the group that received concurrent EVE with radiation therapy (RT) (Group 4) was compared with that of the control group, the difference was statistically significant (p = 0.0022). However, no significant differences were achieved among the study groups that received EVE only or RT only, whether concurrently or sequentially (p > 0.05). Conclusion: EVE is an effective treatment option for the management of several malignancies and is often combined with other therapies, such as radiation, for a more efficient response. However, an increased risk of pulmonary fibrosis should also be anticipated when these two modalities are combined, as they both can cause pulmonary damage, especially when administered concurrently.