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Postmenopausal patients with breast cancer have two options for adjuvant endocrine therapy, tamoxifen and aromatase inhibitors (AIs) as well as radiotherapy (RT) and chemotherapy. However, there is limited data regarding the optimal sequencing of RT and tamoxifen/AIs. Thus, we aimed to evaluate the effects of tamoxifen and AIs on radiation-induced cardiotoxicity. Eighty ovariectomized rats were divided into eight groups (G). G1 was defined as a control group; G2, G3, G4, and G5 were RT, tamoxifen, anastrozle, and letrozole groups, respectively; G6, G7, and G8 were RT plus tamoxifen, anastrozle, and letrozole groups, respectively. Drugs were started 1 week before RT and continued until the animals were killed 16 weeks after RT. The heart tissues were then dissected and examined with light microscopy to determine endocardial thickness and cardiac fibrosis. The endocardial thickness scores of both RT alone and the tamoxifen groups as well as the cardiac fibrosis score of RT alone were higher than that the control group (p < 0.05 for all). There was no difference in the endocardial thickness and cardiac fibrosis scores of the RT-only group and the RT plus hormonotherapy groups (p > 0.05 for all). Concurrent administration of RT and hormonal therapy with either tamoxifen or AIs did not further amplify radiation-induced cardiac toxicity. This issue warrants further study. [ABSTRACT FROM AUTHOR]

To evaluate effects of halofuginone (H) on radiation-induced lung injury (RILI), 60 rats were divided into six groups: Group (G) 1 control, G2 radiotherapy (RT) only, G3 and G4 2. 5 and 5 μg H and G5 and G6 RT + 2.5 and 5 μg H groups, respectively. A single dose of 12 Gy RT was given to both lungs. H was applied intraperitoneally with daily doses, until animals were killed at 6 and 16 weeks after RT. At 6th and 16th weeks of RT, five rats from each group were killed. Lung tissues were dissected for light and electron microscopy. Chronic inflammation, fibrosis and transforming growth factor-beta (TGF)-β scores of all study groups were significantly different at 6th and 16th week (p < 0.001). Chronic inflammation, fibrosis and TGF-β scores of G2 were higher than G5 and G6 at 6th and 16th weeks of RT. At 16th week, fibrosis and TGF-β scores of G5 were higher than G6 (p = 0.040 and 0.028, respectively). Electron microscopical findings also supported these results. Therefore, H may ameliorate RILI. The effect of the H was more prominent at higher dose and after long-term follow-up. These findings should be clarified with further studies. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to evaluate the effects of β-hydroxy-β-methylbutyrate, L-glutamine, and L-arginine (HMB/Glu/Arg) on radiation-induced acute inflammation and mucosal atrophy in the oral mucosa.Methods: Twenty-eight rats were divided into four groups. group (G) 1 was defined as control group, and G2 was the radiation therapy (RT) group. G3 and G4 were HMB/Glu/Arg control and 17 Gy RT plus HMB/Glu/Arg groups, respectively. A single dose of 17 Gy RT was given to the head and neck area, and the active supplement consisting of 5.2 g of HMB, 29.6 g arginine, and 29.6 g of glutamine which was equivalent to 60 kg adult dose was calculated for each rat and administrated orally. HMB/Glu/Arg started from the day of RT and continued until the animals were sacrificed 7 days after the RT. The extent of acute inflammation and mucosal atrophy for each rat was quantified with image analysis of histological sections of the oral mucosa.Results: There were significant differences in terms of epithelial thickness, subepithelial edema, inflammation, and congestion between all groups (p values were <0.001, 0.003, <0.001, and 0.001 for each parameter, respectively). Using HMB/Glu/Arg alone led to hypertrophic changes in the epithelial layer. Moreover, when used with RT, HMB/Glu/Arg reversed radiation-induced epithelial atrophy (p, 0.006) and decreased radiation-induced inflammation at a significant level (p, 0.007).Conclusion: Concomitant use of HMB/Glu/Arg appears to ameliorate the radiation-induced acute inflammation and mucosal atrophy which represent the early phase of acute oral mucositis; however, this finding should be clarified with further clinical studies. [ABSTRACT FROM AUTHOR]

Purpose: The assessment of Health-Related Quality of Life (HRQoL) in cancer patients has become increasingly important during the past decades. The aim of this study was to evaluate the HRQoL in patients treated for low-grade glioma (LGG).Methods and Materials: Forty-three adult patients with LGG were evaluated prospectively between September 2006 and December 2010. We assessed HRQoL at baseline (after surgery before radiotherapy), at the end of radiotherapy and during follow-up (every 3 months for the first 2 years and every 6 months between 2 and 5 years), using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire 30 (EORTC-C30), Brain Cancer Module-20 (BN-20), Mini Mental State Examination (MMSE) and Hospital Anxiety and Depression Scale (HADS).Results: We demonstrated changes in global score (p = 0.004), and future uncertainty (p < 0.001), communication deficit (p = 0.007), headache (p < 0.001), drowsiness (p = 0.002) and hair loss (p < 0.001), and recall score (p = 0.0029) during follow-up. All complaints of LGG patients showed improvement, except for the hair loss. Although the baseline cognitive function scores was not significantly different, the third-year cognitive function scores of patients who used antiepileptic drugs had lower when compared to patients who did not use (p < 0.001). The baseline and follow-up anxiety and depression scores did not differ significantly.Conclusion: Our results suggested that there were improvement in HRQoL in LGG patients during follow-up and antiepileptic drugs had negative effect on cognitive functions. [ABSTRACT FROM AUTHOR]

Background: 5-hydroxytryptamine receptor type-3 (5-HT3) antagonists are widely used for prophylaxis of chemotherapy-induced nausea and vomiting (CINV) and regarded to have a high safety profile. However, several electrocardiographic changes and cardiac arrhythmias have been reported due to administration of 5-HT3 antagonists. Only prolongation of QT interval has been investigated as an index of potential for life-threatening arrhythmias in adult patients using 5-HT3 antagonists. Recently, increase in transmural dispersion of repolarization (TDR) has been proposed as a more reliable determinant of arrhythmogenic potential. Aim: To assess the effects of palonosetron, a second-generation 5-HT3 antagonist, on the T-wave peak to T-wave end (TpTe) interval which has been proposed as a reliable index of spatial TDR. Patients and Methods: A total of 50 consecutive cancer patients (aged: 57 ± 12 years) who were scheduled to receive emetogenic chemotherapy were included to the study. Baseline12-lead electrocardiography (ECG) recordings were obtained. Then, all patients received 8 mg intravenous dexamethasone followed by a single dose of 0.25 mg intravenous palonosetron administered over 30 seconds. A second ECG was performed 30 minutes after the administration of palonosetron. Indices of cardiac repolarization and TDR before and after the administration of palonosetron were compared. Results: In comparison with baseline there was no statistically significant change in any of the heart rate-corrected parameters, including QTc (lead V5), QTmaxc, QTminc, QTcd, TpTe (V5), TpTemax, TpTemin, TpTed and TpTe/QT (V5). Conclusions: Palonosetron does not have any significant effect on QTc and TpTe intervals. It might be the drug of choice for prophylaxis of CINV in cancer patients receiving chemotherapy with known cardiotoxic potential or who have pre-existing cardiac disease that predispose them to drug-induced arrhythmias. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the changes in accommodation amplitude in cases with pseudoexfoliation.Materials and methodsTwenty-nine eyes having pseudoexfoliation and 37 normal eyes aged between 40–60 years were included in the study. After ophthalmic examination, accommodation amplitude was measured using Powerrefractor II. Besides, axial length, anterior chamber depth, and lens thickness was measured by A-scan ultrasonography. The results obtained were evaluated by independent samples' t-test.ResultsThere was no difference in mean age between cases with pseudoexfoliation and normal cases (P=0.131). Mean accommodation amplitude was significantly lower in cases with pseudoexfoliation (P=0.002). Axial length, anterior chamber depth, and lens thickness measurements did not show significant change between groups (P=0.55, P=0.66, P=0.36, respectively).ConclusionIn the presence of pseudoexfoliation, ciliary apparatus can be affected and accommodation amplitude can be decreased in earlier ages.Eye (2009) 23, 822–826; doi:10.1038/eye.2008.143; published online 23 May 2008 [ABSTRACT FROM AUTHOR]

Previous studies had shown a dose-response relationship in prostate cancer during radiotherapy (RT). The clinical outcomes of prostate cancer patients treated with definitive RT using the simultaneous-integrated boost (SIB) technique were investigated in this study. The clinical data of 556 prostate cancer patients who underwent RT using the SIB technique between September 2012 and September 2021 were retrospectively analyzed. In 39 fractions, patients received 78 Gy to the entire prostate±seminal vesicles and 86 Gy to the intraprostatic lesion (IPL). In addition, high-risk patients received 54 Gy pelvic field irradiation. Diffusion-weighted magnetic resonance imaging was used to define the IPL. Failure from biochemical failure (FFBF) and prostate-cancer specific survival (PCSS) were the primary endpoints. Secondary endpoints were progression free survival (PFS) and toxicity. The median age of the population was 69 years (range: 47–89 years). According to D'Amico risk categories, there were 175 patients (31.5%) classified as low risk, 186 patients (33.4%) classified as intermediate risk, and 195 patients (35.1%) classified as high risk. 253 patients (54.5%) received androgen deprivation therapy. The median duration of follow-up was 58.2 months (range, 4.7–126.8 months) for the entire cohort. The 5-year FFBF, PCSS, and PFS rates were respectively 93.3%, 98.5%, and 84.1%. In 40 patients (7.2%), progression was observed as biochemical failure in 16 patients, distant metastasis in 2 patients, and both biochemical failure and distant metastasis in 22 patients. Only four patients (0.7%) had a local recurrence. Univariate analysis revealed that the pretreatment PSA value, T and N stages, ISUP score, and D'Amico risk groups were all significant prognostic factors for FFBF and PCSS. PSA levels higher than 20 ng/mL [HR=3.39 (95% CI, 1.28–8.94); p=0.01], nodal metastasis [HR=4.03 (95% CI, 1.61–10.03); p=0.003], high risk disease [HR=6.66 (95% CI, 1.72–25.77); p=0.001], and higher ISUP scores [HR=2.31 (95% CI, 1.53–3.49); p<0.001] were all independent predictors of worse FFBF. In multivariable analysis, the significant predictors of worse PCSS were high risk disease [HR=8.96 (95% CI: 2.13–19.71; p=0.01] and a higher ISUP score [HR=12.21 (95% CI: 1.70–87.74; p=0.004]. Acute gastrointestinal (GI) and genitourinary (GU) system toxicities of grade 2 or greater were observed in 7.4% and 14.0% of patients, respectively. Late GI and GU toxicities of grade 2 or greater were observed in 5.3% and 6.9% of patients, respectively. The treatment strategy of 78 Gy delivered to the entire prostate with a boost dose of 86 Gy to IPL was effective and safe, with excellent biochemical control and PCSS, and very low toxicity rates. Longer follow-up and randomized trials are needed to validate our findings. [ABSTRACT FROM AUTHOR]

To investigate the clinical outcomes of cervical esophageal carcinoma patients treated with definitive chemoradiotherapy (CRT). The clinical data of 180 patients received concurrent CRT between April 2005 and September 2021 at 17 institutions were retrospectively analyzed. All patients were treated with curative intent CRT. Only patients treated with definitive intent, and squamous histology were analyzed. Patients who were treated with adjuvant or neoadjuvant setting or adenocarcinoma histology were excluded. The primary endpoint was LC, and the secondary endpoints were PFS and OS. Median age was 56 years (range; 26-87 years). Mean tumor size was 4.9 ± 2.1 cm. Majority of patients (60.6%) are female, had extensive T stage (78.9%), and regional lymph node metastasis (60.6%). Median fraction and total radiation doses were 2 Gy (range, 1.8-2.3 Gy) and 60 Gy (45-72 Gy), respectively delivered in median 30 fractions (range, 23-38 fr). Thirty-six patients (20%) were treated with 3-D conformal radiotherapy (RT) and 144 patients (80%) received intensity modulated RT (IMRT). Majority of the patients (49.4%) received concurrent cisplatin-based chemotherapy with a median 5 cycles (range, 1-8). Median follow-up was 20.7 months (range, 2.4-155.2 months). The 2-year OS and PFS rates were 58.7% and 47%, respectively. The 2-year LC was 69.5%. In univariate analysis ECOG performance score (p:0.01) and treatment response (p<0.001) were significant prognostic factors for OS and PFS. In multivariate analysis ECOG score 2 (HR=1.94, 95%CI, 1.18-3.18, p=0.009) and incomplete treatment response (HR=4.42, 95%CI, 2.80-6.99, p<0.001) were independent predictors for worse OS. In multivariate analysis ECOG score 2 (HR=1.73, 95%CI, 1.0.7-3.79, p=0.003) and incomplete treatment response (HR=4.42, 95%CI, 2.88-6.74, p<0.001) were independent predictors for worse PFS. We found that CRT is a safe and effective treatment modality in patients with cervical esophageal carcinoma. The treatment response and patient performance status were predictive for survival. Further prospective studies with larger cohorts are warranted to confirm our findings. [ABSTRACT FROM AUTHOR]

By providing more objective measurements, quantitative magnetic resonance imaging (MRI) has the potential to further improve prediction of treatment outcomes for prostate cancer patients. The purpose of this study was to determine whether quantitative multiparametric MRI performed prior to treatment can accurately predict the biochemical outcome of prostate cancer patients receiving definitive radiotherapy (RT). The clinical data of 503 prostate cancer patients who received definitive radiation therapy (RT) between June 2008 and September 2021 were analyzed retrospectively. Prior to RT, all patients had a prostate multiparametric MRI on a 3T MRI scanner. A radiologist outlined the index lesion and measured the quantitative apparent diffusion coefficient (ADC). The Phoenix criteria were used to define biochemical failure. The primary endpoints were failure from biochemical failure (FFBF) and progression free survival (PFS). The median age of the population was 69 years (range: 47–87 years). According to D'Amico risk categories, there were 183 patients (36.4%) classified as low risk, 156 patients (31%) classified as intermediate risk, and 164 patients (32.6%) classified as high risk. The mean ADC values for tumor and normal prostate tissue were 0.712±0.158 µm²/ms and 1.365±0.227 µm²/ms, respectively (p<0.001). The ADC values were significantly lower in patients with higher PSA (≥20 ng/mL), advanced T stage (≥T3a), nodal metastasis, higher ISUP score (≥3) and high-risk group compared to their counterparts. The median duration of follow-up was 72.9 months (range, 4.3–170.6 months) for the entire cohort. The 5-year FFBF and PFS rates were 93.2% and 86.2%, respectively. Biochemical failure was observed in 42 patients (9.3%). After 'Receiver Operating Characteristics' (ROC) curve analysis, the cut-off point of ADC for predicting high-risk progression was 0.653 µm²/ms with area under curve of 0.656 (95%CI 0.581 – 0.736; p<0.001). In univariate analysis, PSA, T stage, ISUP score, risk group were significant prognostic factors for FFBF and PFS. Additional prognostic factor for OS was N stage, and age was for PFS. The 5-year FFBF for lower and higher ADC values were 89.1% and 95.6%, respectively (p<0.001). The 5-year PFS was significantly less for patients with lower ADC compared to those with higher ADC (82.2% vs. 88.5%; p = 0.002). In multivariate analysis higher ISUP score and lower ADC values were independent predictors for worse FFBF and PFS rates. Additional predictive factor for dismal PFS was older age. Our findings suggest that quantitative ADC values of the index lesion may be used to predict biochemical failure and disease progression in patients with prostate cancer following definitive RT. Inferior biochemical control was associated with lower ADC values and higher ISUP scores. [ABSTRACT FROM AUTHOR]

Previous studies demonstrated the efficacy of stereotactic-body radiotherapy (SBRT) for oligometastatic renal cell carcinoma (RCC) patients. However, it has not been well-studied in patients with bone-only metastatic RCC. This study aimed to analyze the prognostic factors associated with overall survival (OS) and progression-free survival (PFS) in patients with bone-only metastatic RCC who have five or fewer lesions treated with SBRT. The clinical data of 54 patients with 70 bone metastases undergoing SBRT treated between 2013 and 2020 with a fraction dose of at least 6 Gy per fraction, and a biologically effective dose (BED) of at least 90 Gy was retrospectively evaluated. The prognostic factors associated with OS and PFS were assessed. The majority of lesions were located in the spine (57.4%), and had only one metastasis (64.8%). The median SBRT fraction and total doses were 10 Gy (range: 6–18 Gy) and 20 Gy (range: 12–40 Gy), and SBRT was administered with a median fraction of 3 (range, 1–5). The median BED of SBRT was 108.4 Gy (range: 90.0–202.2 Gy). After a median follow-up of 22.4 months, the 1- and 2-year OS rates were 84.6% and 67.3%, respectively, and median OS was 43.1 months. The 1- and 2-year PFS rate, and median PFS were 63.0%, 38.9%, and 15.3 months, respectively. After completion of metastasis-directed treatment (MDT), disease progression occurred in 26 patients (48.1%) at a median of 12.7 months (IQR 7.1–29.9 months). There were 22 (84.6%) with distant metastasis, one (3.8%) with in-field local recurrence, and three (11.6%) with both distant metastasis and local recurrence. In SBRT-treated lesions, only 4 patients (7.4%) experienced local recurrence, and the 1- and 2-year LC rates per lesion were 94.9% and 92.0% per lesion. Age, metastasis localization, and number of fractions for SBRT were significant prognostic factors for OS in univariate analysis. In multivariate analysis, patients with spine metastasis had a better OS [HR=3.1 (95% CI, 1.3–7.7; p = 0.001)] compared to their counterparts, and patients who received single fraction SBRT [HR=2.2 (95%, 1.2–4.2; p = 0.01)] had a better PFS than those who did not. No patient experienced acute or late toxicities of grade 3 or greater. To the best of our knowledge, this is the first multicenter study of bone-only oligometastatic RCC patients treated with SBRT. Despite excellent LC at the oligometastatic site treated with SBRT, disease progression was observed in nearly half of patients 13 months after MDT, particularly as distant disease progression other than treated lesion, necessitating an effective systemic treatment to improve treatment outcomes. Prospective trials of SBRT for oligometastatic bone sites are warranted because they may shed light on disease control, survival, and quality of life after such therapy. [ABSTRACT FROM AUTHOR]

Stereotactic body radiotherapy (SBRT) is increasingly being used to treat oligometastatic cancers, but high-level evidence to support policy decisions is lacking in patients with colorectal carcinoma (CRC). The purpose of this study was to determine the prognostic factors for survival in oligometastatic colorectal cancer patients treated with SBRT in a multicentric setting. The clinical data of 437 oligometastatic CRC patients who received metastasis directed treatment (MDT) via SBRT at 18 institutions between February 2007 and February 2021 were reviewed retrospectively. Patients either had de novo oligometastasis (≤5 metastases) at the time of diagnosis or had oligometastatic recurrences during follow-up. All patients were treated with the goal of curing their metastasis, and 839 lesions were irradiated. The average age was 61 years (range; 27-92 years). The majority of patients (58.8%) had colon carcinoma with a single organ metastasis (88.8 %). The average number of metastatic lesions was 2 (range, 1-5). There were 103 patients with liver metastasis, 222 patients with lung metastasis, 58 patients with lymph node metastasis, 60 patients with bone metastasis, 32 patients with brain metastasis, and 6 patients with other organ metastasis. Before RT, the median CEA and Ca-19-9 levels were 5.16 ng/mL (range: 0-8181.1 ng/mL) and 19.4 (range: 0.60 - 3693), respectively. After RT, the median CEA and Ca-19-9 were 5.00 ng/mL (range, 0.4-5693v ng/mL) and 18 (range, 0 - 6577), respectively. The average period of follow-up was 15.2 months (range, 0.3-91.5 months). The rates of OS and PFS after two years were 76.3 % and 28.1 %, respectively. Age (p<0.001), pre-RT CEA (p=0.006), pre-RT Ca19-9 (p=0.02), post-RT CEA (p=0.01), and post-RT Ca19-9 (p=0.02) were all significant prognostic factors for OS in univariate analysis. Age (HR=1.03, 95 % CI, 1.01-1.04, p=0.004) and pre-RT CEA (HR=1.01, 95 % CI, 1.00-1.02, p=0.04) were independent predictors of OS in multivariate analysis, while post-RT CEA (HR=1.93, 95 % CI, 1.28-2.90, p=0.002) was an independent predictor of PFS. SBRT to oligometastatic lesions was found to be a safe and effective treatment modality for patients with colorectal cancer. Survival was predicted by age, baseline CEA, and the Ca19-9 response to MDT. Additional prospective studies with larger cohorts are necessary to validate our findings. [ABSTRACT FROM AUTHOR]

The standard of care for high grade glioma (HGG) treatment consists of postoperative radiotherapy and temozolamide (TMZ). The effect of time between TMZ administration and RT on treatment outcomes is not well defined. The purpose of this study was to examine the interval between oral administration of TMZ and RT, and its effect on treatment outcomes in patients with HGG. The clinical data of 277 patients with HGG treated between 2009 – 2021 at four centers were retrospectively analyzed. The following are the inclusion criteria: Pathologically proven grade ≥3 glial tumors, ≥18 years old, and completion of curative RT with concurrent oral 75 mg/m2/day TMZ. Patients who were unable to take oral TMZ, or had previously been treated with TMZ and/or RT were excluded. The TMZ to RT interval (TRI) was calculated from the time of oral TMZ administration to the time of RT fraction. In relation to the TMZ half-life, the interval time was divided into <2 h and ≥2 h groups. Progression free survival (PFS) is calculated as the time between the end of RT and clinical or radiological progression. Overall survival (OS) is calculated from the time of diagnosis to the last follow-up. The median age was 58 years (range: 19–81). 159 patients (57.4%) were male, while 118 (42.6%) were female. 75.4% of patients had an ECOG performance score (ECOG PS) of 0–1, and 54.5% had gross total resection (GTR). The median fraction and total RT doses were 2 Gy (1.8–3) and 60 Gy (40–60), respectively. The median follow-up was 15.2 months (range: 1.9–75.1) for the entire cohort. Two-year OS and PFS rates were 35% and 15%, respectively. After completion of RT, disease progression occurred in 255 patients (92.1%) at a median of 6.4 months (range, 0.2–64.9). The 2-year OS was 42.8% for patients with a TRI >2 hours and 32% for patients with a time interval of ≤2 hours (p = 0.18). Similarly, there was no statistically significant difference in 2-year PFS between the two groups (12.8% vs. 9%; p = 0.95). Age, ECOG PS, and type of surgery were all significant prognostic factors for OS and PFS in univariate analysis. In multivariate analysis, advanced age [HR = 1.03 (95% CI, 1.01 – 1.04); p<0.001], poor ECOG PS [HR = 2.14 (95% CI, 1.56 – 2.94); p<0.001], and incomplete surgical resection [HR = 1.39 (95% CI, 1.06–1.84); p = 0.02] were independent predictors of poorer OS. Similarly, age [HR = 1.02 (95% CI, 1.01 – 1.03); p = 0.002], ECOG PS [HR = 1.57 (95% CI, 1.17 – 2.09); p = 0.002], and type of surgery [HR = 1.41 (95% CI, 1.10 – 1.80); p = 0.006] were all significant prognostic factors for PFS in multivariate analysis. We found that advanced age, poor performance status, and incomplete surgical resection were all predictive of poor OS and PFS in this current study. However, we were unable to detect a statistically significant effect of the time interval between oral administration of TMZ and RT. Validation of our findings will require a longer follow-up period and randomized trials. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this retrospective multicenter study was to evaluate the prognostic significance of low muscle mass, and inflammatory markers in patients with stage III nonsmall cell lung cancer (NSCLC) who received definitive chemoradiotherapy (CRT). Furthermore, the study aimed to determine the threshold value of disease-specific low muscle mass., Methods: A total of 461 patients with stage III NSCLC were evaluated. Low muscle mass, prognostic nutritional index (PNI), and biochemical inflammatory markers were assessed. The Kaplan-Meier method and Cox regression analysis were used to analyze overall survival (OS) and progression-free survival (PFS)., Results: This study found a disease-specific low muscle mass threshold of LSMI <38.7 cm²/m² for women and <45.1 cm²/m² for men, with 25.2% of patients having disease-specific low muscle mass. Multivariate cox regression analysis revealed that low PNI was found to be an independent unfavorable prognostic factor for both PFS (HR=0.67; 95% CI: 0.48-0.92, P= 0.015) and OS (HR=0.67; 95% CI: 0.50-0.91, P=0.008). Other factors including ECOG PS 3 (HR=7.76; 95% CI: 1.73-34.76, P=0.007), induction CT (HR=0.66; 95% CI: 0.49-0.88, P= 0.004), and disease-specific low muscle mass (HR=1.40; 95% CI: 1.02-1.92, P= 0.038) also had independent effects on prognosis., Conclusions: The present study provides evidence that the presence of low muscle mass and low PNI significantly impacts the prognosis of patients with stage III NSCLC who undergo definitive CRT. Furthermore, our study is notable for being the first multicenter investigation to identify a disease-specific low muscle mass threshold., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: We analyzed a dose escalation of 36.25 Gy to the entire prostate and a dose increment up to 40 Gy with 1.25 Gy increments to intraprostatic lesion (IPL) using simultaneous integrated boost (SIB) in five fractions., Materials and Methods: Eighteen low- and intermediate-risk prostate cancer patients treated with 1.5T MR-Linac were retrospectively evaluated. The same planning computed tomography (CT) images generated four plans: no SIB, 37.5 Gy SIB, 38.75 Gy SIB, and 40 Gy SIB. In four plans, planning target volume (PTV) doses, organ at risk (OAR) doses, and PTV-SIB homogeneity index (HI), gradient index (GI) and conformity index (CI) were compared., Results: All plans met the criteria for PTV and PTV-SIB coverage. PTV 40 Gy plan has higher maximum PTV and PTV-SIB doses than other plans. The PTV HI was significantly higher in the SIB 40 Gy plan (0.135 ± 0.007) compared to SIB 38.75 Gy plan (0.099 ± 0.007; p = 0.001), SIB 37.5 Gy (0.067 ± 0.008; p < 0.001), and no SIB plan (0.049 ± 0.010; p < 0.001), while there were no significant differences in HI, GI and CI for PTV-SIB between three plans. Four rectum and bladder plans had similar dosimetric parameters. The urethra D5 was significantly higher in SIB 40 Gy plan compared to no SIB plan (37.7 ± 1.1 Gy vs . 37.0 ± 0.7 Gy; p = 0.009) and SIB 37.5 Gy plan (36.9 ± 0.8 Gy; p = 0.008). There was no significant difference in monitor units between the four consecutive plans., Conclusions: Ultra-hypofractionated dose escalation to IPL up to 40 Gy in 5 fractions with a 1.5-T MR-linac is dosimetrically feasible, potentially paving the way for clinical trials., Competing Interests: Conflict of interest: The authors declare no conflicts of interest., (© 2024 Greater Poland Cancer Centre.)

Background: We examined the effects of reducing the planning target volume (PTV) margin in MR-guided radiotherapy (MRgRT) on the distribution of radiation dose to target volumes and organs-at-risk (OARs). Thus, we compared MR-Linac (MRL) plans with and without reduced margin and intensity-modulated radiotherapy (IMRT) plan with conventional linac for low-risk prostate cancer patients receiving 36.25 Gy in five fractions of ultra-hypofractionated radiation therapy., Materials and Methods: Twenty low-risk prostate cancer patients treated with 1.5 T MR-Linac were evaluated. The same planning CT images were used for four plans: the MRL-R plan with reduced margin planning target volume (PTV-R) and the MRL-N plan with normal margin PTV (PTV-N), which is also used for IMRT plan. In four plans, PTV doses, organs-at-risk (OARs) doses, the homogeneity index (HI), and monitor units were compared., Results: All plans met the criteria for PTV coverage and OARs dose constraints. The maximum and mean PTV doses were significantly higher in the MRL-R and MRL-N plans compared to the IMRT plan. The HI was lowest in the IMRT plan (0.040 ± 0.013) and highest in the MRL-N plan (0.055 ± 0.012; p < 0.001). There was no significant difference in the PTV dosimetric parameters between the MRL-R and the MRL-N plans. The high doses in the rectum was significantly lower in the MRL-R compared to other plans. The bladder V36.25 Gy was significantly lower in the MRL-R plan (2.43 ± 1.87 Gy) compared to MRL-N (4.50 ± 2.42 Gy; p < 0.001), and IMRT plans (4.76 ± 2.77 Gy; p < 0.001). There was no significant difference in the low-dose volumes of the body, maximum femur doses, or monitor units across each plan., Conclusions: Ultra-hypofractionated MR-guided RT with 1.5 T MRL is dosimetrically feasible for patients with prostate cancer. The improved soft tissue contrast and the online adaptive plan for 1.5 T MR-Linac allows for PTV margin reduction resulted in a significant dose reduction in OARs., (© 2023 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals LLC on behalf of American Association of Physicists in Medicine.)

Objective: The objective of this study was to assess the intraoperative accuracy and feasibility of 3D-printed marker-based mixed-reality neurosurgical navigation for spinal intradural pathologies., Methods: The authors produced 3D segmentations of spinal intradural tumors with neighboring structures by using combined CT and MRI, and preoperative registration of pathology and markers was successfully performed. A patient-specific, surgeon-facilitated application for mobile devices was built, and a mixed-reality light detection and ranging (LIDAR) camera on a mobile device was employed for cost-effective, high-accuracy spinal neuronavigation., Results: Mobile device LIDAR cameras can successfully overlay images of virtual tumor segmentations according to the position of a 3D-printed marker. The surgeon can visualize and manipulate 3D segmentations of the pathology intraoperatively in 3D., Conclusions: A 3D-printed marker-based mixed-reality spinal neuronavigation technique was performed in spinal intradural pathology procedures and has potential to be clinically feasible and easy to use for surgeons, as well as being time saving, cost-effective, and highly precise for spinal surgical procedures.

Background: Encapsulated papillary carcinoma (EPC) is a rare malignant papillary breast cancer accounting for approximately .5%-2% of all breast tumors. The aim of this multicenter study was to evaluate clinicopathologic features of EPC in addition to oncological outcomes and radiotherapy (RT) details., Methods: From 10 different academic hospitals in Turkey, we obtained pathology reports of 80 patients with histologically confirmed EPC between 2005 and 2022. Demographic, diagnostic, and treatment data were collected from medical records, retrospectively. Local failure, distant progression, toxicity-adverse effects, overall survival (OS), and disease-free survival were evaluated, and survival analyzes were performed using the Kaplan-Meier method., Results: Eighty patients with the diagnosis of misspelled sorry (ECP) were retrospectively evaluated. The median age of the patients was 63 (range, 35-85). After a median follow-up of 48 (range; 6-206) months, local recurrence was observed in three patients (4%). Local recurrence was less common in the patients who received whole breast RT with a tumour bed boost (p = .025). There were not any distant metastasis or disease-related death. RT was applied to 61% of the cases, and no treatment-related grade 3 or higher toxicity was reported in any of the patients. Five year OS, cancer-specific survival (CSS), and  were observed as 85%, 100%, and 96%, respectively., Conclusions: ECP is a rare, slow-progressing breast carcinoma associated with good prognosis, it is a disease of elderly patient, and usually occurs in postmenopausal women. It responds extremely well to optimal local treatments and appropriate adjuvant treatments on a patient basis, and has excellent OS and CSS ratios., (© 2022 John Wiley & Sons Australia, Ltd.)