Effect of dose constraint on the thyroid gland during locoregional intensity-modulated radiotherapy in breast cancer patients.

The aim of the present study was to compare radiation dose received by thyroid gland using different radiotherapy (RT) techniques with or without thyroid dose constraint (DC) for breast cancer patients. Computerized tomography (CT) image sets for 10 patients with breast cancer were selected. All patients were treated originally with opposite tangential field-in field (FinF) for the chest wall and anteroposterior fields for the ipsilateral supraclavicular field. The thyroid gland was not contoured on the CT images at the time of the original scheduled treatment. Four new treatment plans were created for each patient, including intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) plans with thyroid DC exclusion and inclusion (IMRTDC(-) , IMRTDC(+) , HTDC(-) , and HTDC(+) , respectively). Thyroid DCs were used to create acceptable dose limits to avoid hypothyroidism as follows: percentage of thyroid volume exceeding 30 Gy less than 50% (V30  < 50%) and mean dose of thyroid (TDmean ) ≤ 21 Gy. Dose-volume histograms (DVHs) for TDmean and percentages of thyroid volume exceeding 10, 20, 30, 40, and 50 Gy (V10 , V20 , V30 , V40 , and V50 , respectively) were also analyzed. The Dmean of the FinF, IMRTDC(-) , HTDC(-) , IMRTDC(+) and HTDC(+) plans were 30.56 ± 5.38 Gy, 25.56 ± 6.66 Gy, 27.48 ± 4.16 Gy, 18.57 ± 2.14 Gy, and 17.34 ± 2.70 Gy, respectively. Median V30 values were 55%, 33%, 36%, 18%, and 17%, for FinF, IMRTDC(-) , HTDC(-) , IMRTDC(+) , and HTDC(+) , respectively. Differences between treatment plans with or without DC with respect to Dmean and V30 values were statistically significant (P < 0.05). When thyroid DC during breast cancer RT was applied to IMRT and HT, the TDmean and V30 values significantly decreased. Therefore, recognition of the thyroid as an organ at risk (OAR) and the use of DCs during IMRT and HT planning to minimize radiation dose and thyroid volume exposure are recommended.

Radiotherapy in the management of classic Kaposi's sarcoma: A single institution experience from Northeast Turkey.

Kaposi sarcoma is a rare adult neoplasm and there has been no certain consensus on standard treatment, either local or systemic. Radiotherapy is an effective, suitable treatment modality. Between 1996 and 2016, patients who were diagnosed with Kaposi sarcoma and referred to our clinic for radiotherapy were included in this retrospective study. Ninety-two patients were examined in total and it was diagnosed that all the patients had non-HIV associated Kaposi's sarcoma. There were 36 (39%) females and 56 (61%) males and female to male ratio was 2/3. Median age at presentation was 72 (30-93) years. Sixty-eight patients (77%) were treated with 8 Gy (1 fraction), 15 patients (16%) were treated with 20 Gy (2 Gy/fraction), four patients (4%) were treated 25 Gy (2.5 Gy/fraction), and five patients (6%) were treated 30 Gy (3 Gy/fraction). The median follow-up time was 72 (5-192) months. The complete response at 5 years was 91.6% with >20 Gy and 89.6% with 8 Gy. Radiotherapy is an effective, suitable treatment modality of Classic Kaposi sarcoma and usually, radiotherapy is well tolerated with minimal side effects.

Evaluation of outcome and prognostic factors in 739 patients with uterine cervix carcinoma: a single institution experience.

AIM OF THE STUDY: The aim of this retrospective chart review was to determine the long-term outcomes and identify prognostic factors that impact the survival of patients with cervical cancer. MATERIAL AND METHODS: A retrospective chart review of 739 patients with International Federation of Gynaecology and Obstetrics (FIGO) stage I-IV cervical cancer treated with surgery, radiation or chemoradiation was performed. Patient charts were evaluated in terms of demographics, clinical outcomes, and survival. Disease-free survival (DFS) and overall survival (OS) were calculated with the Kaplan-Meier method, and differences in survival were compared with the log-rank test. Multivariate analysis was performed with a Cox proportional hazards model to determine the estimated hazard ratios (HR) with 95% confidence intervals (CI) for each prognostic factor. RESULTS: The Cox proportional hazards model demonstrated that pelvic nodal metastasis (p = 0.018), parametrial invasion (p = 0.015), and presence of disease in the surgical margin (p = 0.011) were all independent prognostic factors for OS. The 5-year OS rate of patients with negative pelvic lymph nodes was 67.1%, which was higher than the rate for those with positive nodes at 49.0% (p < 0.05). The 5-year OS rate was 54.3% for patients with metastasis to the parametrium, 79.2% with a cancer-free parametrium, 60.9% with a cancer-positive surgical margin, 85.4% with a cancer-negative surgical margin, and 64.3% with a 1-3 mm close surgical margin (p < 0.05). CONCLUSIONS: Assessing pelvic lymph nodes, the parametrium, and surgical margins is important for survival and may aid in better identifying patients who would derive greater benefits from receiving adjuvant therapies and more aggressive treatments.

Radiosurgery effects and adverse effects in symptomatic eloquent brain-located Cavernomas.

In this study, the dose schedule efficacy, safety and late adverse effects of stereotactic radiosurgery (SRS) were evaluated for patients with symptomatic cavernomas who were not eligible for surgery and treated with SRS. Between January 2013 and December 2018, 53 patients with cavernomas were treated using SRS with the CyberKnife® system. Patients' diseases were deeply located or were in subcortical functional brain regions. In addition to bleeding, 23 (43.4%) patients had epilepsy, 12 (22.6%) had neurologic symptoms and 16 patients (30.2%) had severe headaches. The median volume was 741 (range, 421-1351) mm3, and the median dose was 15 (range, 14-16) Gy in one fraction. After treatment, six (50%) of 12 patients with neurologic deficits still had deficits. Rebleeding after treatment developed in only two (3.8%) patients. The drug was completely stopped in 14 (60.9%) out of 23 patients who received epilepsy treatment, and the dose of levetiracetam decreased from 2000 mg to 1000 mg in four (17.3%) of nine patients. Radiologically, complete response (CR) was observed in 13 (24.5%) patients, and partial responses (PR) were observed in 32 (60.2%) patients. Clinical response of CR was observed in 30 (56.6%) patients, PR was observed in 16 (30.2%), stable disease (SD) was observed in three (5.7%) and four (7.5%) patients progressed. In conclusion, SRS applied in the appropriate dose schedule may be an effective and reliable method in terms of symptom control and prevention of rebleeding, especially in patients with inoperable cavernomas.

Prognostic factors and clinical course of extremity soft-tissue sarcomas.

PURPOSE: Although soft tissue constitutes half of the body weight, soft-tissue sarcomas (STSs) are less common than any other types of tumors. MATERIALS AND METHODS: In this retrospective study, the prognostic factors and clinical courses of 64 patients with extremity STSs treated at our clinic between 1996 and 2012 were investigated. RESULTS: Of the 64 patients included in this study, 35 (55%) were male and 29 (45%) were female. By the end of follow-up, 29 (45%) of the patients remained alive while 35 (55%) deceased. The overall survival (OS) time of the patients was 89.1 months, and their 1-, 3-, 5-, and 10-year survival rates were 82.8%, 69.3%, 51.6%, and 39.4%, respectively. Univariate analysis revealed the following variables as prognostic factors: tumor stage (P < 0.001), surgical method applied (P = 0.009), radiotherapy (RT) application (P = 0.018), RT dose (P < 0.001), and development of metastasis during follow-up (P < 0.001). Multivariate analysis revealed only type of surgery to be a prognostic factor (P = 0.016). CONCLUSION: Besides surgery, RT plays a crucial role in the multimodal treatment of STSs and increases local control rates and OS. In our study, stage, surgery, and adjuvant RT were found to be effective factors indicating OS. However, more prospective work in this area is necessary.

Comparison of Radiation-Induced Secondary Malignancy Risk Between Sequential and Simultaneous Integrated Boost for the Treatment of Nasopharyngeal Carcinoma: Intensity-Modulated Radiotherapy versus Volumetric-Modulated Arc Therapy.

PURPOSE: This study aimed to compare the secondary cancer risk (SCR) between the sequential boost (SEQ) technique and simultaneous integrated boost (SIB) technique in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with nasopharyngeal carcinoma (NPC) using the concepts of organ equivalent dose (OED) and excess absolute risk (EAR). PATIENTS AND METHODS: IMRT-SEQ, VMAT-SEQ, IMRT-SIB, and VMAT-SIB plans were created with identical objective functions for five patients with early-stage NPC. Three different planning tumor volumes (PTVs; PTV1, PTV2, and PTV3) were delineated for each patient, and the prescribed doses were 50 Gy, 60 Gy, and 70 Gy (2 Gy/fraction), respectively, for the SEQ technique and 52.8 Gy, 59.4 Gy, and 69.3 Gy (33 fractions), respectively, for the SIB technique. RESULTS: All plans were clinically acceptable. There was no difference in most OED-based SCRs between IMRT and VMAT when the same fractionation scheme was used. Compared with the SEQ technique, the SIB technique in IMRT and VMAT was associated with the lowest OEDs for the oral cavity, pharynx, parotids, and submandibular glands, resulting in SCR reduction. SCR for the parotids was much lower than that for the other assessed organs when the SIB technique was used. CONCLUSION: Our findings suggest that OED-based SCRs are lower with the SIB technique than with the SEQ technique in IMRT and VMAT in most organs for which SCR was calculated; furthermore, SCR for the parotids is much lower than that for other organs when the SIB technique is used in patients with NPC.

A case of surgically treated bilateral metachronous malignant pleural mesothelioma.

In this article, we present a 59-year-old male patient who was admitted to our hospital with right pleural effusion and right-sided chest pain and diagnosed as malignant pleural mesothelioma with thoracentesis and pleural biopsy. After the patient was determined to be operable, right parietal pleurectomy + pericardial resection + diaphragmatic resection were performed and four cycles of cisplatin and pemetrexed combination as adjuvant treatment were added. The patient was followed-up without any problem for three and a half years. At this time, left-sided chest pain and leftsided effusion were noticed. Tumor was negative in thoracentesis and pleural biopsy. Then, video-assisted thoracoscopic surgery was applied, which resulted in Stage 1a malignant pleural mesothelioma. Thoracoscopic parietal pleurectomy was performed with success. Four cycles of pemetrexed single-agent therapy was performed as an adjuvant treatment. The patient died of chronic obstructive pulmonary disease and heart failure in 57th month of the first and 21st month of the second operation while he was tumor free. To the best of our knowledge, this case is the first operated bilateral metachronous primary malignant pleural mesothelioma in the literature.

Secondary cancer risk after whole-breast radiation therapy: field-in-field versus intensity modulated radiation therapy versus volumetric modulated arc therapy.

OBJECTIVE: In this study, we used the concept of organ-equivalent dose (OED) to evaluate the excess absolute risk (EAR) for secondary cancer in various organs after radiation treatment for breast cancer. METHODS: Using CT data set of 12 patients, we generated three different whole-breast radiation treatment plans using 50 Gy in 2 Gy fractions: three-dimensional conformal radiotherapy with a field-in-field (FinF) technique, intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). The OEDs were calculated from differential dose-volume histograms on the basis of the "linear-exponential," "plateau," and "full mechanistic" dose-response models. Secondary cancer risks of the contralateral breast (CB), contralateral lung (CL), and ipsilateral lung (IL) were estimated and compared. RESULTS: The lowest EARs for the CB, CL, and IL were achieved with FinF, which reduced the EARs by 77%, 88%, and 56% relative to those with IMRT, and by 77%, 84%, and 58% relative to those with VMAT, respectively. The secondary cancer risk for FinF was significantly lower than those of IMRT and VMAT. OED-based secondary cancer risks for CB and IL were similar when IMRT and VMAT were used, but the risk for CL was statistically lower when VMAT was used. CONCLUSION: The overall estimation of EAR indicated that the radiation-induced cancer risk of breast radiation therapy was lower with FinF than with IMRT and VMAT. Therefore, when secondary cancer risk is a major concern, FinF is considered to be the preferred treatment option in irradiation of whole-breast. ADVANCES IN KNOWLEDGE: Secondary malignancy estimation after breast radiotherapy is becoming an important subject for comparative treatment planning.When secondary cancer risk a major concern, FinF technique is considered the preferred treatment option in whole breast patients.

Whole Brain Radiotherapy Plus Conventional Boost in Non-Small Cell Lung Cancer Patients with Brain Metastasis: A Retrospective Analysis of Overall Survival.

AIM: To evaluate the clinical characteristics and treatment outcomes of non-small cell lung cancer (NSCLC) patients with brain metastasis, who were treated by whole brain radiotherapy with a conventional boost at a single institution. MATERIAL AND METHODS: A total of 296 patients diagnosed with NSCLC with brain metastasis and referred to our clinic for radiotherapy between 2000 and 2017 were included in this retrospective study. RESULTS: The median age was 60.8 ± 12.1 years, with a range of 21-85 years. The estimated median survival time for all patients was 7.81 ± 0.66 months (95% CI: 6.52-9.11). The one-year survival, two-year survival and three-year survival rates were 18.8%, 5.8% and 2.9%, respectively. The median survival of patients with solitary brain metastasis who received 45 Gy radiotherapy was 14.70 ± 2.80 months (95% CI: 9.20-20.20). These patients had 6 and 12 months survival rates of 65.4% and 42.6%, respectively. The median survival time of patients with solitary brain metastasis who received > 45 Gy radiotherapywas 13.86 ± 2.56 months (95% CI: 8.08-18.02). These patients had 6 and 12 months survival rates of 66.2% and 27.2%, respectively. There was no significant difference between the two groups (p=0.321). The median survival duration of patients under 65 years was 9.65 ± 1.02 months. The median survival time of patients aged 65 years and overwas 5.15 ± 0.51 months. There was a statistically significant difference in the median survival rates between the groups (p < 0.001). CONCLUSION: Patients with solitary metastasis or single metastases tolerated whole brain radiotherapy with a conventional boost. Although the overall survival rates were numerically better in the high dose RT group, the difference was not statistically significant. Prospective studies with a larger sample size are needed to consolidate our results.

Hyperfractionated accelerated radiotherapy in locally advanced head and neck cancers.

PURPOSE: Head and neck cancers are rapidly proliferating and relatively radiosensitive tumors. The increase in the number of daily fractions and the decrease in total treatment time give promising results in clinical practice. PATIENTS AND METHODS: 20 patients diagnosed with head and neck cancer between August 2000 and July 2001 participated in this study. Median age was 63 years (range: 42-78). The tumors were mainly located in the larynx (40%), and in the hypopharynx (25%). Daily doses of 1.5 Gy thrice a day in 6-h intervals were given on each of 12 consecutive days with the exception of weekends. RESULTS: Median follow-up was 22 months (range: 1-62). The overall response rate was 90%, and grade IIII early toxicity was 24%. No grade IV early toxicity was observed. Grade IV late toxicity was observed just in 1 case. 5-year rates for locoregional recurrence, distant metastasis, progression-free survival, and overall survival were 45, 20, 20, and 25%, respectively. CONCLUSION: Our schedule was acceptable regarding the toxicity. However, the high incidence of locoregional failures urges us to modify the treatment modality.

Prognostic Factors and Clinical Outcome in Parotid Gland Tumors: a Single Institution Experience from the Eastern Black Sea Region of Turkey.

PURPOSE: To review clinical characteristics, treatment outcomes and prognostic factors in patients with parotid gland tumors treated with surgery and postoperative radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed 69 patients with parotid gland tumors, with a median follow-up of 52 months (range, 2-228 months). and a median radiotherapy dose of 60Gy (range, 30-69 Gy). RESULTS: There were 24 (35%) females and 45 (65%) males, at a ratio of 1/1.9. Median age at presentation was 58.9±17.2 (range 13-88) years. The most common histology was adenoid cystic carcinoma (33%) and mucoepidermoid carcinoma (28%). The mean overall survival (OS) was 65.3±8 (95% confidence interval [CI], 49.6-81.1) months and the median overall survival was 40.0 ± 7 (95% CI, 26.2-53.7) months. The -1, -3, -5 and -10 year OS rates were 78%, 52.4%, 35.3% and 19.6% respectively. The mean disease free survival (DFS) was 79.2±10 (95% CI, 59.3-97.1) months and the median disease free survival was 38±13 (95% CI, 7.05-88.7) months. The -1,-3,-5 and -10 year DFS rates were 71.9%, 50.1%, 43.7% and 30.1% respectively. On univariate analysis, the OS was significantly better with female sex (p<0.005), < 50 age (p<0.021), T stage (p<0.0001), absence of lymph node involvement (p<0.0001), lower tumor grade (p<0.0001), absence of lymphovascular invasion (p<0.002), absence of perineural invasion (p<0.0001), absence of extracapsuler extension (p<0.0001), surgical margin negativity (p<0.006), ≤60 Gy radiotherapy dose (p<0.0001) and absence of distant metastasis (p<0.027). CONCLUSIONS: Employing existing standards of postoperative radiotherapy is a possible treatment that was found to be mainly effective in patients with parotid gland carcinomas.

Survival and prognostic factors in limited stage small cell lung cancer: A retrospective study from northeast Turkey.

AIM OF THE STUDY: The purposes of this retrospective study were to identify survival rates for limited stage small cell lung cancer (LD-SCLC) and analyze treatment outcomes and influencing factors on survival. MATERIALS AND METHODS: We conducted data from patients diagnosed with LD.SCLC between January 1998 and December 2012 at our institution. Dermographic information, treatment modalities, pretreatment clinical asessment, were recorded. Most of the patients. (88.4%) were treated with curative intent. The survival probabilties were asessed by Kaplan.Meier analysis. Cox regression was used to assess prognostic factors on overall survival and disease.free survival. RESULTS: A total of 129 patients were examined as a LD-SCLC. The median age was 60 (range; 31-86). Median follow-up time was 9.4 (SE ± 20.5) months and the median overall survival was 13.9 months [95% cumulative incidence (CI): 10.1-17.6]. On multivariate analysis, concurrent chemotherapy [HZ: 2.7 (95% CI: (1.0-7.2)] (P = 0.037) and doses of radiation therapy (<50, ≥50) [HZ: 1.4 (95% CI: (1.0-2.2)] (P = 0.046) were statistically significant on overall survival. With regard to multivariate anlaysis age (<60, ≥60) [HZ: 2.2 (95% CI: (0.6-3.7)] (P = 0.011), doses of radiation therapy (<50, ≥50) [HZ: 2.7 (95% CI: (1.0-7.2)] (P = 0.046), precense of surgery [HZ: 15.3 (95% CI: (1.5-152)] (P = 0.020), prophilactic cranial radiation therapy (PCI) [HZ: 2.3 (95% CI: (1.1-4.5)] (P = 0.014), and presence of concurrent chemoradiotherapy [HZ: 3.0 (95% CI: (1.3-6.8)] (P = 0.008) were important variable affecting disease-free survival. CONCLUSION: For LD-SCLC patients concurrent chemoradiation therapy and 50. Gy and over doses radiation therapy provided improvement on overall and disease.free survival.

Comparison of the effects of melatonin and genistein on radiation-induced nephrotoxicity: Results of an experimental study.

The aim of the present study was to compare the effects of melatonin and genistein on radiation-induced nephrotoxicity (RIN). A total of 70 Swiss Albino mice were divided into 7 groups. Five control groups were defined, which were sham irradiation (C, G1), radiation therapy only (RT, G2), melatonin (M, G3), genistein (G, G4) and polyethylene glycol-400 (G5), respectively. The co-treatment groups were the RT plus melatonin (RT+M, G6) and RT plus genistein (RT+G, G7) groups. Irradiation was applied using a cobalt-60 teletherapy machine (80-cm fixed source-to-surface distance, 2.5-cm depth). Melatonin was administered (100 mg/kg, intraperitoneal injection) 30 min before the single dose of irradiation, whereas genistein was administered (200 mg/kg, subcutaneous injection) 1 day before the single dose of irradiation. All the mice were sacrificed 6 months after irradiation. As an end point, the extent of renal tubular atrophy for each mouse was quantified with image analysis of histological sections of the kidney. Tissue malondialdehyde (MDA) levels were also measured in each animal. In the histopathological examination of the mouse kidneys, there was a statistically significant reduction (P<0.05) in the presence of tubular atrophy between the RT+M and RT+G groups and the RT group. There was a statistically significant increase in MDA levels in the irradiated versus sham groups (RT vs. C; P<0.05); however, MDA levels were significantly decreased by co-treatment with melatonin or genistein vs. RT alone (RT+M and RT+G vs. RT; P<0.05). In conclusion, the present experimental study showed that melatonin and genistein supplementation prior to irradiation-protected mice against RIN, which may have therapeutic implications for radiation-induced injuries.

The choice of multi-beam IMRT for whole breast radiotherapy in early-stage right breast cancer.

The aim of this study was to identify a rational strategy for the selection of multi-beam IMRT in patients with right breast cancer through the comparison of dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) using five different radiotherapy modalities. This was a retrospective study using computed tomography scans from ten patients with early-stage right breast cancer who had been treated previously. Three dimensional conformal radiotherapy (3DCRT), forward-planned IMRT (for-IMRT), inverse-planned IMRT (inv-IMRT), helical tomotherapy (HT), and volumetric-modulated arc therapy (VMAT) were planned for each patient. The plans were compared according to dose-volume histogram analysis. The most significant impact of inverse-planned multi-beam modalities for right breast cancer was the reduction of Dmax, Dmean, V53.5 and prescribed dose volume (cc) outside of the PTV (breast) (OB-V50) of the PTV. HT decreased the ipsilateral OAR volumes receiving higher doses. In exchange, HT also increased the volumes receiving low doses, which is known to lead to an increased rate of radiation-induced secondary malignancies. The heart, LAD, and contralateral doses for 3DCRT and for-IMRT were significantly lower than those for inv-IMRT, HT, and VMAT. In addition, inv-IMRT demonstrated an increase in exposed volume of heart, LAD, ipsilateral lung, and contralateral lung compared with those parameters for HT or VMAT. Although it is known to reduce cardiac toxicity with breath hold technique in left sided breast cancer, similarly it is possible for 3DCRT and for-IMRT techniques in right sided breast cancer even in free breathing.

Prognostic factors and clinical course of extremity soft-tissue sarcomas

Purpose: Although soft tissue constitutes half of the body weight, soft-tissue sarcomas (STSs) are less common than any other types of tumors. Materials and Methods: In this retrospective study, the prognostic factors and clinical courses of 64 patients with extremity STSs treated at our clinic between 1996 and 2012 were investigated. Results: Of the 64 patients included in this study, 35 (55%) were male and 29 (45%) were female. By the end of follow-up, 29 (45%) of the patients remained alive while 35 (55%) deceased. The overall survival (OS) time of the patients was 89.1 months, and their 1-, 3-, 5-, and 10-year survival rates were 82.8%, 69.3%, 51.6%, and 39.4%, respectively. Univariate analysis revealed the following variables as prognostic factors: tumor stage (P < 0.001), surgical method applied (P = 0.009), radiotherapy (RT) application (P = 0.018), RT dose (P < 0.001), and development of metastasis during follow-up (P < 0.001). Multivariate analysis revealed only type of surgery to be a prognostic factor (P = 0.016). Conclusion: Besides surgery, RT plays a crucial role in the multimodal treatment of STSs and increases local control rates and OS. In our study, stage, surgery, and adjuvant RT were found to be effective factors indicating OS. However, more prospective work in this area is necessary

Long-term results of a concomitant boost radiotherapy technique for elderly patients with muscle-invasive bladder cancer.

OBJECTIVES: To evaluate the long-term clinical efficacy and toxicity of concomitant boost radiotherapy (CBRT) in elderly patients with invasive bladder cancer. METHODS AND MATERIALS: Elderly patients (n=188; mean 75-year-old, range 70-91 years; 88.3% male/11.7% female) with T1-T4a bladder carcinoma were irradiated with CBRT. A total of 24 (12.8%) patients were diagnosed at stage T1, 117 (62.2%) were at stage T2, 28 (14.9%) at were stage T3a, 14 (7.4%) were stage T3b, and 5 (2.7%) were stage T4a. A dose of 45Gy in 1.8Gy fractions was administered to the whole pelvis 5 days/week over 5 weeks. A concomitant boost limited to the bladder tumor area plus margin or whole bladder of 22.5Gy in 1.5Gy fractions was administered from weeks 3×5. Thus, irradiation totalled 67.5Gy over 5 weeks. The interfraction interval was ≥6h/treatment day. We assessed prognostic factors for overall survival (OS), cause-specific survival (CSS) and relapse-free survival (RFS). RESULTS: Median follow-up was 46.2 months (range 4.7-155.7 months). Median overall survival was 27 months (95% CI:21-33 months). In this study, 146 (77.7%) patients had complete response, 39 (20.7%) had residual disease and 4 (1.6%) had progressive disease. The mean 3-, 5- and 10-year OS rates were respectively 41.2% (S.E.±0.036), 29% (S.E.±0.034), and 13.8% (S.E.±0.031). Significant prognostic factors for OS and CSS, by multivariate analysis, were tumor T-stage and urothelial obstruction. CONCLUSION: This CBRT protocol provided excellent results with a high complete response rate and good tolerance. This approach may therefore be particularly appropriate for elderly patients with invasive bladder cancer.

Olfactory neuroblastoma: A case report.

Olfactory neuroblastoma (ON) is a rare type of malignant neoplasm originating from the olfactory neuroepithelial cells of the nasal cavity. ON is also known as esthesioneuroblastoma or neuroendocrine carcinoma. The malignancy accounts for <3% of tumors originating in the nasal cavity. Through the nasal cavity, ON may infiltrate the sinuses, the orbit and the cranium. The tumor is characterized by a pattern of slow growth and local recurrences. Treatment options are surgical excision or surgery combined with a radiotherapy (RT) and/or chemotherapy combination treatment. The present study reports the case of a 69-year-old patient with a mass in the nasal cavity who was treated by combined surgical excision and RT. The literature for ON and the treatment of the tumor are also discussed.

Comparison of dose distributions hippocampus in high grade gliomas irradiation with linac-based imrt and volumetric arc therapy: a dosimetric study.

The aim of this study was to assess the feasibility of sparing contralateral hippocampus during partial brain radiotherapy in high grade gliomas. 20 previously treated patients were replanned to 60 Gy in 30 fractions with sparing intensity-modulated radiotherapy (IMRT) and volumetric modulated arctherapy (VMAT) using the following planning objectives: 100 % of PTV covered by 95% isodose without violating organs at risk (OAR) and hot spot dose constraints. For each, standard intensity-modulated radiotherapy (IMRT) plans were generated, as well as sparing IMRT and VMAT plans which spared contralateral (hemispheric cases) hippocampus. When the three plans were compared, there was equivalent PTV coverage, homogeneity, and conformality. Sparing IMRT significantly reduced maximum, mean, V20, V30 and V40 hippocampus doses compared with standart IMRT and VMAT (p < 0.05). VMAT significantly reduced maximum left lens and mean eye doses compared with standart IMRT and sparing IMRT (p < 0.05). Brainstem, chiasm, left and right optic nerves, right eyes and lens doses were similar. VMAT significantly reduced monitor units compared with standart IMRT and sparing IMRT (p < 0.05). It is possible to spare contralateral hippocampus during PBRT for high grade gliomas using IMRT. This approach may reduce late cognitive sequelae of cranial radiotherapy.

Adjuvant radiotherapy in stage 1 seminoma: Evaluation of prognostic factors and results of survival.

PURPOSE: The purpose of this study was to evaluate the prognostic factors affecting overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS), and survival among patients undergoing adjuvant radiotherapy (RT) for stage-1 seminoma. MATERIALS AND METHODS: Between August 1997 and May 2013, 68 patients diagnosed with stage-1 seminoma were retrospectively evaluated. The median age was 39 (24-74) years. All patients received adjuvant RT after inguinal orchiectomy. Fifty-eight (85.3%) patients received paraaortic RT; 10 (14.7%) received dog-leg field RT. The median RT dose was 23.4 (23.4-30.6) Gy. RESULTS: The median follow-up period was 77.5 (6.7-198.5) months. During the follow-up period, two patients developed distant metastasis, and none developed local recurrence. Two patients died from seminoma, and three died for other reasons. The 5, 10, and 15-year OS rates were 94.7%, 89.6%, and 89.6%, respectively. The 5, 10, and 15-year CSS rates were 98.5%, 96%, and 96%, respectively. The 5, 10, and 15-year PFS rate was 96.1%. The univariate analysis showed that only histological subtype was significant for OS. The 10-year survival rate was 100% among patients with seminoma histology, 90.8% among patients with a classic seminoma histology, and 50% among patients with an anaplastic seminoma histology (P < 0.001). A multivariate analysis showed that the anaplastic seminoma was a negative prognostic indicator for OS (P = 0.042). CONCLUSION: Adjuvant RT resulted in excellent long-term survival and local control in patients with stage-1 seminoma after orchiectomy. During a short follow-up, secondary malignancy (SM) and late cardiovascular morbidity were not observed. Despite those results, concern of SM and late cardiovascular morbidity remains.