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Background/aim Primary gastrointestinal mucosal melanoma (PGIM) is an aggressive and rare disease, commonly with poor prognosis. We aimed to determine the clinical risk and prognosis of this rare entity. Patients and methods Patients (n=962) with PGIM documented in the Surveillance, Epidemiology, and End Results database between 1975-2016 were included. Prognostic factors on overall survival (OS) and cancer-specific survival (CSS) were identified. A nomogram was constructed to predict the OS of PGIM patients. Results Primary site, summary stage, and therapeutic method were all independent predictors of OS and CSS, and age was the only factor significantly associated with OS. Independent prognostic factors of OS were selected to develop a predictive nomogram. The Harrell's C-index of the nomogram was 0.712, the area under the curve (AUC) was 0.746, 0.758, 0.810 for the 1-, 3-, and 5-year OS, respectively, and calibration plots were in good agreement. Conclusion Several prognostic factors of PGIM were demonstrated and a practical nomogram model was created in this study.

BACKGROUND/AIM This study analyzed the impact of concomitant boost on long-term clinical outcomes in locally advanced rectal cancer. PATIENTS AND METHODS A total of 141 patients (median age=61 years) were treated with neoadjuvant chemoradiotherapy. Median total dose was 50.4 Gy. Forty-three patients received a concomitant boost. Concurrent chemotherapy consisted of 5-fluorouracil (5-FU), given as a 24-h continuous infusion. Mean follow-up was 83.7 months. RESULTS The 3, 5-, and 10-year overall survival (OS) rates were 91.9%, 84.6%, and 52.9%, respectively. Recurrence-free survival (RFS) rates at 3, 5, and 10 years were 91.4%, 88.9%, and 79.3%, respectively. Metastasis-free survival (MFS) rates at 3, 5, and 10 years were 84.6%, 75.4%, and 49.9%, respectively. Overall, 9.9% of all patients achieved pathological complete response. Down-staging of T- or N-stage was achieved in 55.1% and 41.5% of patients. Multivariate analysis revealed that female sex (p=0.011), concomitant boost-radiotherapy (p=0.014), and the presence of fewer than five positive lymph nodes (p

The aim of the present study was to compare simultaneous integrated boost (SIB) plans using volumetric modulated arc therapy (RapidArc®; RA) or tomotherapy (TT) for bilateral (BL) and unilateral (UL) treatment in head-and-neck cancer (HNC) patients.Seventeen computed tomography scans (CTs) of 16 patients with SIB were replanned using TT and RA. We defined three groups: All, UL and BL, compared the dose distributions, homogeneity, conformity to planning target volume (PTV), organs at risk (OAR) and healthy tissue (HT) sparing. We evaluated a therapeutic-width index (TWI) based on PTV coverage and parotid gland (PG) sparing.PTV coverage for RA and TT was equivalent for all groups. UL irradiation resulted in similar doses to the HT for both techniques but TT achieved better sparing of spinal cord, larynx and contralateral PGs. TT provided better homogeneity. RA gave better conformity.Both methods achieved clinically acceptable results for UL and BL treatment, RA with better dose conformity to elective PTV, TT with better OAR sparing and homogeneity.

Brain metastases due to endometrial cancer are rare and usually occur in the context of widespread disease. We present a rare case of a 74-year-old woman with recurrent endometrial cancer in terms of a solitary brain lesion two years after initial diagnosis. She was treated with local resection of the brain metastasis and subsequent whole-brain radiotherapy. She then experienced relapse twice, presenting two solitary metastases at two different time points at the same location as at initial diagnosis, but never showed any signs of extracranial widespread disease. The patient has been alive for 13 months after detection of her initial brain metastasis. Despite the identification of some risk factors, there is still very limited knowledge why some patients develop brain metastases as the only sign of distant spread. Our review of the literature revealed that the combination of two treatment modalities yields higher survival rates than single treatment-alone, as was the case in the presented patient. Further case reports, as well as large and prospective studies, may contribute to a better understanding of the etiology and dynamics of this disease and allow better evaluation of treatment options.

We investigated patient positioning during radiosurgery of cranial lesions, and calculated clinical target volume (CTV) to planning target volume (PTV) margins using a modified common margin recipe. We simulated CTV-to-PTV margins for reduced image guidance, and repositioning for the first table angle only.Patients were immobilized with a thermoplastic mask. Positioning was verified and corrected using the ExacTrac/Novalis Body. Each patient was repositioned before each beam. A common margin recipe was adapted for estimation of CTV-to-PTV margins. Necessary margins were estimated to correct positioning for the initial table angle only in comparison.In total, 269 radiosurgery treatments with 967 different-angle setups (mean 3.6 different angles) were performed on 190 patients. Residual translational errors were (one standard deviation) 0.3 mm in left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions, with a mean three-dimensional vector of 0.5 mm. Margins for residual errors after correction were calculated in LR, SI, and AP directions as 0.8 mm. For simulated reduced frequency setup correction, we calculated CTV-to-PTV margins as 1.9, 1.9, and 1.6 mm, respectively.The ExacTrac/Novalis Body system allows for accurate positioning of the patient with a residual error comparable to invasive mask fixation. If verification is only performed after initial positioning, adaption of CTV-to-PTV margins should be considered.

Concurrent radiochemotherapy (cRCT) is the standard-of-care for patients with locally advanced anal cancer. There is a subgroup of patients however, vastly with small tumors, which undergo local excision before combined modality treatment. It was suggested that local excision prior to cRCT might improve the local control in comparison with cRCT. We evaluated local excision in comparison to incisional biopsy in this setting.Between 2000 and 2005, 84 patients were included in the study. In the majority of patients, only incisional biopsy (INC) was performed for the histopathological verification. Other patients underwent surgery prior to the RCT course as excisional biopsy (EXC). The chemotherapy consisted of 5-fluorouracil (800/1000 mg/m(2)/d, 4 consecutive days, w 1, five) and mitomycin C (2 times 10 mg/m(2)). Radiotherapy was prescribed 45 at Gy.All patients (T1-2) were available for analysis. 14% of patients had node-positive disease. For the entire series, at five years and eight years, the actuarial OAS rates were 71% and 54%, respectively; the DSS rates were 74% and 68%, respectively; and the DFS rates were 54% and 54%, respectively. The actuarial control rate achieved by the EXC group was 80% after five years, better than the one for the INC group at 64%. Univariate analysis showed that tumor stage T3-T4 (p=0.04), tumor size ≥6 cm (p0.001), nodal stage N1-3 (p0.00) and OTT40 days (p=0.05) are significantly correlated with poorer local disease control. Local excision in comparison with INC did not prove to be significant for local disease control (p=0.45). No significance was found for pre-therapeutic prognostic factors age, gender, histological type and grading. Multivariate analysis showed that tumor size as continuous variable (p=0.02) and OTT (p=0.04) remained significant when adjusted for T-stage and nodal stage.According to this highly qualitative trial, surgical excision prior to cRCT, did not improve results. cRCT was confirmed as the standard-of-care.

To assess intrafractional prostate and patient movement using intra-prostatic fiducials and stereoscopic kilovoltage (kV) X-ray imaging in a 6-dimensional (6D) position correction protocol. To evaluate potential gains of intra-treatment repositioning with respect to treatment margins.In intensity-modulated radiotherapy of prostate cancer patients were positioned according to internal fiducials in six dimensions by the use of ExacTrac/Novalis Body™ (ET/NB) System and a robotic couch. Intrafractional displacement of both, prostate and patient were analyzed in 427 treatment fractions of 13 patients. Systematic and random components were specified and used for intra-treatment margin calculation. The potential reduction of treatment margins, and intrafractional repositioning by use of the ET Snap Verification presumed, was simulated.The mean treatment duration was 14.2±2.6 min. Standard deviations (SDs) of the effective intrafractional target displacement in superior-inferior (SI) and anterior-posterior (AP) axes were 2.4 mm and 2.1 mm, respectively. Systematic errors for patient were 1.8 and 1.7 mm, and for prostate movement were 2.1 and 2.0 mm in SI and AP, respectively. The SDs of intrafractional rotation errors of the prostate around SI and left right (LR) were on average 2.2 and 3.6 degrees, respectively. Margins covering intrafractional motion were 4.5 and 4.3 mm in SI and AP without intrafractional correction and were estimated to 2.9 mm and 2.8 mm in SI and AP, respectively for simulated intra-treatment intervention.After positioning according to fiducials, intrafractional motion is significant for treatment margins. Despite correcting rotational deviations by couch angulation, the systematic error for the component of prostate motion was somewhat larger than that of patient displacement. Intrafractional correction could be useful in reducing treatment margins.