Lower fluorodeoxyglucose positron emission tomography maximum standardized uptake value may show a better response to stereotactic body radiotherapy of adrenals in oligometastatic disease.

Introduction: Stereotactic body radiotherapy (SBRT) is well established for oligometastatic disease, and it is increasingly used to treat adrenal metastases. Material and methods: In this retrospective study we performed an analysis of 75 metastatic adrenal lesions in 64 patients with oligometastatic disease. According to the fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) maximum standardized uptake value (SUVmax) of adrenal metastases, patients were categorized into three groups: low, intermediate, and high SUVmax. Results: For all clinicopathological characteristics we found significant relationships for levels of SUVmax and objective response rate (Kendall Tau-c = 0.290; p = 0.017). Patients who responded to SBRT had a significantly lower SUVmax value than those who did not respond (7.6 ±2.4 vs. 9.7 ±3.8; p = 0.015). At the appropriate SUVmax cut-off values, the biomarker distinguished between patients with and without a response significantly and moderately (area under the curve = 0.670, 95% confidence intervals: 0.540-0.790; p = 0.015). Conclusions: Lower SUVmax is associated with a better response to SBRT in patients whose disease progressed mainly in the adrenal glands.

COVID-19 Vaccinations: Summary Guidance for Cancer Patients in 28 Languages: Breaking Barriers to Cancer Patient Information.

BACKGROUND: Covid-19 vaccination has started in the majority of the countries at the global level. Cancer patients are at high risk for infection, serious illness, and death from COVID-19 and need vaccination guidance and support. Guidance availability in the English language only is a major limit for recommendations' delivery and their application in the world's population and generates information inequalities across the different populations. METHODS: Most of the available COVID-19 vaccination guidance for cancer patients was screened and scrutinized by the European Cancer Patients Coalition (ECPC) and an international oncology panel of 52 physicians from 33 countries. RESULTS: A summary guidance was developed and provided in 28 languages in order to reach more than 70 percent of the global population. CONCLUSION: Language barrier and e-guidance availability in the native language are the most important barriers when communicating with patients. E-guidance availability in various native languages should be considered a major priority by international medical and health organizations that are communicating with patients at the global level.

Ipsilateral in-breast tumor recurrence after breast conserving therapy: true recurrence versus new primary tumor.

PURPOSE: To classify ipsilateral in-breast cancer recurrences (IBCR) in patients treated with conservative surgery and radiation therapy, either as new primary tumor (NP) or true recurrence (TR) and to assess the prognostic and therapeutic importance of this classification. METHODS: The records of 107 patients treated for local tu- mor recurrence after breast-conserving therapy (BCT) at the National Cancer Center, Sofia, between March 1999 and May 2011 were retrospectively analysed. The patients'primary tumors were up to 2 cm in size. For their primary tumors all patients underwent quadrantectomy, axillary lymph node dissection and postoperative radiotherapy (RT) up to 50 Gy. In cases with nodal metastasis additional RT has been used. Adjuvant chemotherapy and hormonotherapy have been used according to the clinical indications and depending of the patient's condition. Every attempt was made to define a tumor as a TR or NP, based on the changes in location and histology. (99m)Tc-MIBI SPECT-CT was used to localize the site of recurrence. RESULTS: Forty-four (41.1%) of the relapses were TR and 63 (58.9%) NPs. Out of 63 relapses defined as NPs, 54 (85.7%) changed the location and 49 (68.3%) had a different histology. The age of patients with TR and with NP did not differ significantly at the time of diagnosis of the primary tumor (TR 48.8±10.45 years vs NP 50.8±10.56; p<0.330), but those who developed TR were significantly younger than those with NP at the time of recurrence (TR 53 years, 66±11.1 vs NP 58.15+10.6; p<0.05). Recurrences defined as NPs, developed after a significantly longer period of time in comparison to the TRs (7.4±2.6 years vs 4.8±2.2 years; p<0.0001). Five-year overall survival of patients with TR was significantly lower compared to patients with NP (31.8% vs 96.7% p=0.0001). CONCLUSIONS: Recurrences developing after BCT represent different clinical events, having different origin, prognosis and, therefore, requiring different type of treatment. It seems that a significant part of the recurrences that develop in the residual parenchyma, following BCT, are new carcinomas.

SPECT-CT in Radiotherapy Planning, with Main Reference to Patients with Breast Cancer.

The aim of modern intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) is to define the target areas including the smallest non-invaded margins, thus reducing the radiation dose to radiosensitive organs. To reach this goal, these methods require a more precise target delineation by imaging to better define the viable part of the tumor. Image-guided selection and demarcation of Gross Tumor Volume (GTV), Clinical Target Volume (CTV) and Organs at Risk (OAR) are the main steps to reach a satisfactory radiation treatment plan. Hybrid machines, such as PET-CT, SPECT-CT and, more recently, PET-MRI, may significantly increase diagnostic accuracy improving either sensitivity and specificity achievable alone by the single constituents of the hybrid tools. While the implementation contribution of PET-CT in radiotherapy, with respect to CT stand alone, has been extensively and successfully investigated, few papers have been at present written on the possible role of SPECT-CT for the same purpose. With an identical contribution to CT, SPECT may give similar information with respect to PET, when suitable radiopharmaceuticals are available. In particular, SPECT may provide additional information to CT, better defining the viable tumor mass; as a consequence, a more effective delineation of the GTV, saving the maximum normal tissue as possible, may be allowed. In this paper, we review some of the most important applications of SPECT-CT in oncology, as a premise to its possible utilization in tumor target definition in radiotherapy. In particular, we discuss sentinel lymph node (SLN) detection, tumor imaging with cationic lipophilic radiotracers, as (99m)Tc-methoxyisobutylisonitrile (MIBI) and (99m)Tc-tetrofosmin (TF) in breast cancer, thymoma, and lung cancer, (99m)Tcmethylene diphosphonate (MDP) for bone scan, (131)Iodine and (123)Iodine in differentiated thyroid cancer (DTC), as useful methods to optimize GTV and CTV definition. A reflection on the possible role in radiotherapy of other radiotracers labeled with gamma emitters, such as In-111 pentreotide has also been included.

Radiation-induced breast cancer in women with Hodgkin's disease.

AIM AND BACKGROUND: The aim of this study is to analyze the main clinical and pathologic characteristics of radiation-induced breast carcinomas (BC) following treatment for Hodgkin's disease (HD) and to identify the risk factors for their induction. To create a mathematical model for the prediction of expected age at which a BC might develop based on the age at treatment for HD. MATERIALS AND METHODS: Thirty-nine cases of women with BC that developed after treatment for HD in puberty or adolescence were analyzed retrospectively. The median age at initiation of treatment for HD was 12.9 years (9-21). The median age at diagnosis of the second malignancy - breast carcinoma was 32.4 years (22.9-39). RESULTS: THE DISTRIBUTION OF PATIENTS ACCORDING TO THE CLINICAL T STAGE OF BREAST CANCER WAS AS FOLLOWS: 11 patients with T1 stage BC (28%), 22 with T2 stage (56%) and 6 with stage T3 (16%). Prevalent were tumors localized in the lateral breast quadrants. The observed 5 year survival was 95%. CONCLUSION: The risk of solid tumors, especially breast cancer, is high among women with HD disease who were treated with radiotherapy in their childhood. In this article, we propose a specific mathematical age formula which could be used as predictive equation when the age of the treatment for HD is in the range between 9 and 21 years. Systematic screening for breast cancer in these patients would be significantly important for their health and could improve their survival.

Primary angiosarcoma of the breast complicated by the syndrome of disseminated intravascular coagulation (DIC): Case report and literature review.

Primary angiosarcoma of the breast (PAB) accounts for 0.04% of all breast malignant tumors. It affects young women usually at third or fourth decades of life. PAB clinically manifests as a painless, movable mass with sharp limits. A bluish red discoloration of the overlying skin is often observed. Enlargement of axillary lymph nodes generally does not occur. Angiosarcoma of the breast has a very poor prognosis due to the tendency to metastasize haematogenously and high frequency of local recurrence. Mastectomy and chemotherapy are preferable treatment choices. This paper presents a case of primary angiosarcoma of the breast with a syndrome of disseminated intravascular coagulation (DIC).

Degree of tumor regression after preoperative chemo-radiotherapy in locally advanced rectal cancer-Preliminary results.

AIM: The aim of this investigation is to determine the degree of tumor regression by histopathological evaluation of surgical specimen after neoadjuvant chemo-radiotherapy for patients with stage IIIB rectal cancer. BACKGROUND: The standard therapy for rectal carcinoma is surgical, however, preoperative radiochemotherapy will play an increasing role especially in locally advanced disease. To estimate the prognosis and the effect of radiochemotherapy the postradiochemotherapeutical pathological features are important to assess. MATERIALS AND METHODS: Ten patients with cT3-4, cN1 stage rectal cancer received preoperative chemo-radiotherapy. A total tumor dose of 50 Gy was applied to all patients, with a daily fraction of 2 Gy, 5 times a week, with concomitant Capecitabine 1650 mg/m(2). A pathomorphologic assessment of the therapeutic response of the residual tumor volumes and estimation of tumor control were performed using Dworak's system of tumor regression grading (TRD) from no regression (0) to a complete tumor control (4). RESULTS: Dworak's TRD for the examined patients is as follows: in 20% of the patients no tumor regression was observed - Grade 0, in 30% - Grade 1, in 20% - Grade 2 and in 30% a complete tumor regression was achieved - Grade 4. Four of the patients (40%) presented with borderline resectable tumors before the neoadjuvant chemo-radiotherapy. Nine of the patients (90%) underwent radical surgery. In one case (10%) a radical surgery was not possible. One patient (10%) developed severe radiation enteritis in both the early and late postoperative period, with her tumor regression evaluated as Grade 4. CONCLUSION: Accurate evaluation of local tumor control using Dworak's tumor regression grading scale after preoperative chemo-radiotherapy gives the basis for a larger investigation and search for a correlation with the prognosis of the disease and individual choice of adjuvant treatment.