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Background: Standardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III–IVB). As standardized diagnostics but also increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated. Methods: As MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients treated during 1991-2017 in our hospital were stratified into cohort 1 treated before (n =104) and cohort 2 since 2007 (n =212). Clinical characteristics, diagnostic procedures and treatment modality of patients were compared using Chi-square tests and outcome analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired distant metastasis-free survival (DMFS) in PS-matched patients. Results: Most patient characteristics and treatment modalities applied showed insignificant alteration. Surgical treatment included significantly more often resection of the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and loco-regional control (LRC) were significantly improved but DMFS significantly impaired. Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with increased DM. Conclusions: Despite standardized diagnostic procedures, decision-making considering clear indications and improved therapy algorithms leading to improved LC and LRC, shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental effect on TSS and OS. [ABSTRACT FROM AUTHOR]

BackgroundStandardized staging procedures and presentation of oral squamous cell carcinoma (OSCC) patients in multidisciplinary tumor boards (MDTB) before treatment and utilization of elective neck dissection (ND) are expected to improve the outcome, especially in local advanced LAOSCC (UICC stages III–IVB). As standardized diagnostics but also increased heterogeneity in treatment applied so far have not been demonstrated to improve outcome in LAOSCC, a retrospective study was initiated.MethodsAs MDTB was introduced into clinical routine in 2007, 316 LAOSCC patients treated during 1991-2017 in our hospital were stratified into cohort 1 treated before (n=104) and cohort 2 since 2007 (n=212). Clinical characteristics, diagnostic procedures and treatment modality of patients were compared using Chi-square tests and outcome analyzed applying Kaplan-Meier plots and log-rank tests as well as Cox proportional hazard regression. Propensity scores (PS) were used to elucidate predictors for impaired distant metastasis-free survival (DMFS) in PS-matched patients.ResultsMost patient characteristics and treatment modalities applied showed insignificant alteration. Surgical treatment included significantly more often resection of the primary tumor plus neck dissection, tracheostomy and percutaneous endoscopic gastrostomy tube use. Cisplatin-based chemo-radiotherapy was the most frequent. Only insignificant improved disease- (DFS), progression- (PFS) and event-free (EFS) as well as tumor-specific (TSS) and overall survival (OS) were found after 2006 as local (LC) and loco-regional control (LRC) were significantly improved but DMFS significantly impaired. Cox regression applied to PS-matched patients elucidated N3, belonging to cohort 2 and cisplatin-based chemo-radiotherapy as independent predictors for shortened DMFS. The along chemo-radiotherapy increased dexamethasone use in cohort 2 correlates with increased DM.ConclusionsDespite standardized diagnostic procedures, decision-making considering clear indications and improved therapy algorithms leading to improved LC and LRC, shortened DMFS hypothetically linked to increased dexamethasone use had a detrimental effect on TSS and OS.

The purpose of this retrospective study was to investigate survival outcomes and irradiated tumor control (local control [LC]) and locoregional control (LRC) after stereotactic body radiotherapy (SBRT) for T1 or recurrent T1 (rT1) kidney cancer. Twenty-nine nonconsecutive patients with 30 tumors were included. SBRT doses of 70 Gy, 60 Gy or 50 Gy in 10 fractions were prescribed with a linear accelerator using daily image guidance. The Kaplan-Meier method was used to estimate time-to-event outcomes, and the log-rank test was used to compare survival curves between groups divided by each possible factor. The median follow-up periods for all patients and survivors were 57 months and 69.6 months, respectively. The five-year LC rate, LRC rate, progression-free survival (PFS) rate, disease-specific survival (DSS) rate and overall survival (OS) rate were 94%, 88%, 50%, 96% and 68%, respectively. No significant factor was related to OS and PFS. Three of 24 non-hemodialysis (HD) patients had new-onset-HD because of the progression of underlying kidney disease. Grade 3 or higher toxicities from SBRT did not occur. In conclusion, SBRT for kidney cancer provided a high rate of LC, LRC and DSS with minimal toxicities, but patient selection and indication for SBRT should be done carefully considering the relatively low OS rate., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology.)

Background: To investigate the clinical outcome including efficacy and safety of stereotactic body radiotherapy (SBRT) in management of spinal metastasis., Methods: Between 2010 and 2017, 26 patients with 32 metastatic spine lesions treated with SBRT were retrospectively reviewed. Local control (LC), overall survival (OS), prognostic factors and toxicity were analyzed., Results: There were 15 female and 11 male patients (median age, 62 years; range 27 to 88 years). 32 metastatic spine lesions were treated with SBRT. The most frequent lesions treated were metastatic tumours of the lung (n=19), other primary histologies were prostate (n=4), breast (n=3), sarcoma (n=2), hepatocellular carcinoma (n=1), renal cell carcinoma (n=1), stomach (n=1), nasopharyngeal carcinoma (n=1). Thoracic spine was the most common site treated (n=18), followed by lumbosacral spine (n=12) and cervical spine (n=2). The most common dose fractionation used was 24 Gy in 3Fr. The median EQD2/10 Gy was 36 Gy (range, 34.7-59.7 Gy). The median planning target volume (PTV) was 50 cc (range, 10.4-194 cc). The median follow up was 23.4 months (range, 3-103 months). For the entire cohort, local tumour control (LC) at 1 year and 2 years were 83% and 71% respectively. The median OS was 30.6 months. The OS at 1 year and 2 years were 88% and 59% respectively. On univariate analysis for OS, presence of visceral metastases (HR 11.13, P=0.001), uncontrolled primary disease (HR 4.57, P=0.02) and presence of more than 3 vertebral metastasis (HR 5.50, P=0.04) were corelated with worst outcomes. On multivariate analysis for OS, only presence of visceral metastasis remained significant (HR 23.99, P=0.002). Acute toxicity mainly pain flare occurred in 16% of the treated lesions that can be managed with analgesics and steroid. Other adverse events were rare and no radiation induced myelopathy reported., Conclusions: This study reports SBRT is a safe and effective treatment for spinal metastasis. Prognostic factors were identified to guide patient selection that would benefit from this treatment.

The liver is a common organ of metastases from most solid malignancies, including breast cancer, and breast cancer with liver metastases (BCLM) has a poor prognosis despite advances in systemic therapies. It has become widely recognized that local treatments for oligometastases with curative intent could improve disease control and survival outcomes under certain conditions. Regarding local therapy for BCLM, surgical resection had been the first choice though its indications were quite limited. Recently, an increasing number of prospective trials on stereotactic body radiation therapy (SBRT) for liver metastases (LMs) were published, reporting excellent tumor control with less toxicity. According to these reports, breast cancer origin is a favorable prognostic factor in SBRT for liver metastasis. Further research on patient selection and optimal dose fractionation will establish SBRT as a safe and feasible alternative treatment for resection and ablation in selected patients with BCLM. This review intends to provide evidence on the background and methods of focal radiation therapy for LMs, especially BCLM, and describes the current and future role of SBRT in the treatment of BCLM., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr-20-1833). The series “Loco-regional therapy for metastatic breast cancer” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare., (2020 Translational Cancer Research. All rights reserved.)