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To investigate the long-term results of treatment of children and adults with craniopharyngioma and to identify factors related to survival. A retrospective analysis of all consecutive patients (pts) treated due to craniopharyngioma in years 1979–2019 was performed. Event-free survival (EFS) was defined as no tumor progression or pts' death after the end of treatment (radiotherapy – RT or the last surgery in non-irradiated pts). Standard statistical tests were used. The group consisted of 97 pts (41 children, 56 adults) with median age of 26 years (range 2-71) and small predominance of males (56%). The most common symptoms were visual disturbances (54%), headaches (54%), endocrine disorders (20%) and nausea/vomiting (22%). The diagnosis was based on histopathological examination in the majority of pts (84%) with remaining 16 cases diagnosed based on characteristic radiological features. Surgery was the primary treatment in 94% with majority having one (44%) or two (26%) surgeries, while 3, 4 and 5 surgeries were conducted in case of 14%, 6% and 4% of pts, respectively. The most common deficits observed after surgery were visual disturbances (45%) and endocrine disorders (62%). RT was applied in 89% pts with 63% receiving irradiation as part of salvage treatment. Conventional RT (CRT) and stereotactic RT (SRT) was applied in 58 and 28 pts, respectively. Median total dose (TD) in CRT was 54 Gy and 16 Gy in SRT. Ten patients in CRT group had stereotactic boost (median TD 6 Gy). The most common side effects of RT were endocrine disorders (14%), visual disturbances (7%), vasculopathies (6%) and deterioration in general status (8%). Secondary tumors within RT volume were observed in 3 pts (2 high grade gliomas, 1 meningioma). Median follow-up was 13 years from the diagnosis and during that time 29 pts died. Five- & 10-year overall survival (OS) was 90% & 78%, respectively. Univariate analysis showed that adults had worse OS compared to children (p=0.001) with 5- & 10-year OS of 85% & 68% vs 97% & 92% for adult vs children, respectively. Also, pts who did not receive RT had inferior outcome with 5- and 10- year OS of 82% & 34% vs 92% & 84% (p=0.0006). In multivariate analysis, only age was an independent factor affecting OS (p=0.005). Median EFS was 8.4 years. Five- and 10- year EFS for the whole group was 78% and 62%. Univariate analysis showed that adults had worse EFS compared to children (p=0.048). RT was also found in univariate analysis to have positive impact on EFS (p=0.021) which was also confirmed in multivariate Cox regression model (p=0.037). The local effect of RT was evaluated in case of 78 pts with stagnation & regression observed in 35 & 37 pts. The comparison of CRT with SRT showed inferior local control in SRT group (p=0.023). However, in SRT arm, in 5 out of 8 failures TD applied was ≤15 Gy. Adjuvant RT should not be omitted as it is associated with better local control. Meticulous follow up is required to assure effective salvage treatment in case of progression. [ABSTRACT FROM AUTHOR]

A national, anonymous survey evaluating the quality of radiation oncology training in Poland was conducted by young members of Polish Society of Radiation Oncology (yPTRO) in 2018 and more than 70% radiation oncology (RO) trainees participated. We noted that courses included into the specialty program were not sufficient for up to 80% of participants. Thus, we identified several aspects of the training requiring modifications. To address those issues, we introduced a new set of on-line lectures prepared by yPTRO members. Based on the survey and the questionnaire on social media, we started a series of on-line educational lectures hosted on video conference software. Topics were chosen by RO trainees. Sessions were recorded and are publicly available. Pre- and post-surveys of participants which evaluated the quality of the sessions were conducted in half of the cases. Sessions were advertised via social media on dedicated RO groups. Four lectures were held from April to October 2021. We covered the following topics of: consolidation immunotherapy in stage III NSCLC, introduction to biostatistics, radiotherapy in (oligo)metastatic prostate cancer and emergencies in RO. As of now, the lectures had almost 600 views. One woman and three men from four different institutions presented the lectures which lasted from 45 to 200 minutes. Based on the evaluation, the consolidation immunotherapy was considered the most useful. However, the participants reported that more case-based discussion is needed. Biostatistical workshops got 4.8/5.0 points and besides too long time of the lecture (the one which took more than 3 hours) were received as very well prepared. Similar to the immunotherapy lecture, more practical and case based aspects were recognized as necessary in the future lectures. The optimum frequency of the lectures declared by the majority of responders was once a month. Further lectures will cover the topics of brain tumours and various aspects of cranial and extracranial stereotactic radiotherapy. We believe that virtual education on an online platform is a practical and feasible way of collaboration on national level. We expect this effort will result in an improved confidence of RO trainees and will broaden the knowledge of the participants. [ABSTRACT FROM AUTHOR]

Lead, one of the most abundant and hazardous trace metals affecting living organisms, has been commonly detected in plant cell walls including some tolerant plants, mining ecotypes and hyperaccumulators. We have previously shown that in tip growing Funaria sp. protonemata cell wall is remodeled in response to lead by formation of thickenings rich in low-methylesterified pectins (pectin epitope JIM5 - JIM5-P) able to bind metal ions, which accumulate large amounts of Pb. Hence, it leads to the increase of cell wall capacity for Pb compartmentalization. Here we show that diverse plant species belonging to different phyla (Arabidopsis, hybrid aspen, star duckweed), form similar cell wall thickenings in response to Pb. These thickenings are formed in tip growing cells such as the root hairs, and in diffuse growing cells such as meristematic and root cap columella cells of root apices in hybrid aspen and Arabidopsis and in mesophyll cells in star duckweed fronds. Notably, all analyzed cell wall thickenings were abundant in JIM5-P and accumulated high amounts of Pb. In addition, the co-localization of JIM5-P and Pb commonly occurred in these cells. Hence, cell wall thickenings formed the extra compartment for Pb accumulation. In this way plant cells increased cell wall capacity for compartmentalization of this toxic metal, protecting protoplast from its toxicity. As cell wall thickenings occurred in diverse plant species and cell types differing in the type of growth we may conclude that pectinous cell wall thickenings formation is a widespread defense strategy of plants to cope with Pb. Moreover, detection of natural defense strategy, increasing plant cell walls capacity for metal accumulation, reveals a promising direction for enhancing plant efficiency in phytoremediation. [ABSTRACT FROM AUTHOR]

Low-methylesterified homogalacturonans have been suggested to play a role in the binding and immobilization of Pb in CW. Using root apices of hybrid aspen, a plant with a high phytoremediation potential, as a model, we demonstrated that the in situ distribution pattern of low-methylesterified homogalacturonan, pectin epitope (JIM5-P), reflects the pattern of Pb occurrence. The region which indicated high JIM5-P level corresponded with “Pb accumulation zone”. Moreover, JIM5-P was especially abundant in cell junctions, CWs lining the intercellular spaces and the corners of intercellular spaces indicating the highest accumulation of Pb. Furthermore, JIM5-P and Pb commonly co-localized. The observations indicate that low-methylesterified homogalacturonan is the CW polymer that determines the capacity of CW for Pb sequestration. Our results suggest a promising directions for CW modification for enhancing the efficiency of plant roots in Pb accumulation, an important aspect in the phytoremediation of soils contaminated with trace metals. [ABSTRACT FROM AUTHOR]

Purpose/objective(s): The debate of whether radiotherapy (RT) is essential part of primary treatment in patients (pts) with grade 2 ependymoma is still on and this study aims to evaluate its role.Materials/methods: Study inclusion criteria: histopathologically confirmed ependymoma grade II, at least 2 months of follow-up (FU) from the date of diagnosis. A retrospective analysis of all consecutive pts treated in years 1985 - 2019 was performed. In statistical analysis Kaplan - Meier method, log rank test and multivariate Cox regression model were used. A P value of ≤0.05 was regarded as being statistically significant. Inclusion criteria were met by 119 pts with median age of 35 (range 2-82), small predominance of woman (55% vs 45%) and brain location of the tumor (58% vs 42%). All had surgery as primary treatment with 47% R0 resection. RT was applied in 84 pts among whom 81 received radical treatment. In majority of cases (89%) pts received local irradiation. In case of pts with brain lesions total dose ranged from 30 to 60 Gy (median 54) and from 9 to 56 Gy (median 45) in case of spinal tumors. Recurrence of the disease was observed in 34 cases. Among them 18 had surgery combined with RT (7 pts), chemotherapy (2 pts) or both (4 pts). RT as sole treatment of recurrence was applied in 9 pts.Results: Median follow-up was 66.7 months and during that time 17 pts died. Two-, 5- and 10-years overall survival (OS) of the whole group was 96%, 87% and 83%. Radical surgery (R0 vs R1/2) improved OS (P = 0.004), but looking at the location of the tumor the difference was observed only in pts with brain lesions (P = 0.01). RT, applied in case of R1/2 pts, did not improved OS irrespective of primary tumor location. Two-, 5- and 10-years progression free survival (PFS) was 85%, 68% and 51%, respectively. Looking at the treatment of recurrence, those who received RT as part of the treatment of the recurrent tumor had better OS (P = 0.048) - 5- and 10- year OS of 85% and 78% vs 66% and 57%. In multivariate analysis radical surgery (R0 vs R1/2) and the use of radiotherapy in primary treatment improved PFS (P = 0.018 and 0.007). Based on the location of the tumor positive influence of RT on PFS was observed only in case of pts with brain tumors (P = 0.01) with no difference in case of spine lesions (P = 0.2). Also, comparing those who had R1/2 surgery with R0 resection - the benefit of radiotherapy was only observed in R1/2 group (0.02).Conclusion: RT in case of pts with grade 2 ependymoma is valuable treatment of recurrent disease. Patients with brain lesions after non-radical surgery might benefit from local irradiation in terms of progression free survival.Author Disclosure: A.Napieralska: None. L.Miszczyk: None. [ABSTRACT FROM AUTHOR]

About 20% of children with solid tumours (ST) present with distant metastases (DM). Evidence regarding the use of radical radiotherapy of these DM is sparse and open for personal interpretation. The aim of this survey was to review European protocols and to map current practice regarding the irradiation of DM across SIOPE-affiliated countries. Radiotherapy guidelines for metastatic sites (bone, brain, distant lymph nodes, lung and liver) in eight European protocols for rhabdomyosarcoma, non-rhabdomyosarcoma soft-tissue sarcoma, Ewing sarcoma, neuroblastoma and renal tumours were reviewed. SIOPE centres irradiating ≥50 children annually were invited to participate in an online survey. Radiotherapy to at least one metastatic site was recommended in all protocols, except for high-risk neuroblastoma. Per protocol, dose prescription varied per site, and information on delineation and treatment planning/delivery was generally missing. Between July and September 2019, 20/27 centres completed the survey. Around 14% of patients were deemed to have DM from ST at diagnosis, of which half were treated with curative intent. A clear cut-off for a maximum number of DM was not used in half of the centres. Regardless of the tumour type and site, conventional radiotherapy regimens were most commonly used to treat DM. When stereotactic radiotherapy was used, a wide range of fractionation regimens were applied. Current radiotherapy guidelines for DM do not allow a consistent approach in a multicentre setting. Prospective (randomised) trials are needed to define the role of radical irradiation of DM from paediatric ST. • Radical radiotherapy to paediatric solid tumour metastases is mostly unexplored. • In current European protocols, radiotherapy guidelines are inconsistent. • Across 20 major SIOPE centres, a range of radiotherapy approaches were applied. • Trials are needed to define the role of radiotherapy to metastatic sites. [ABSTRACT FROM AUTHOR]

Purpose: Understanding prostate-specific antigen (PSA) kinetics after radiation therapy plays a large role in the management of patients with prostate cancer (PCa). This is particularly true in establishing expectations regarding PSA nadir (nPSA) and PSA bounces, which can be disconcerting. As increasingly more patients are being treated with stereotactic body radiation therapy (SBRT) for low- and intermediate-risk PCa, it is imperative to understand the PSA response to SBRT.Methods and Materials: PSA data from 5 institutions were retrospectively analyzed for patients with localized PCa treated definitively with SBRT alone from 2004 to 2016. Patients received 35 to 40 Gy in 5 fractions, per institutional standards. Patients who had less than 12 months of PSA data or received androgen deprivation therapy were excluded from this study. Linear and logistic multivariable analysis were performed to identify predictors of nPSA, bounce, and biochemical recurrence, and joint latent class models were developed to identify significant predictors of time to biochemical failure.Results: A total of 1062 patients were included in this study. Median follow-up was 66 months (interquartile range [IQR], 36.4-89.9 months). Biochemical failure per the Phoenix criteria occurred in 4% of patients. Median nPSA was 0.2 ng/mL, median time to nPSA was 40 months, 84% of patients had an nPSA ≤0.5 ng/mL, and 54% of patients had an nPSA ≤0.2 ng/mL. On multivariable analysis, nPSA was a significant predictor of biochemical failure. Benign PSA bounce was noted in 26% of patients. The median magnitude of PSA bounce was 0.52 ng/mL (IQR, 0.3-1.0 ng/mL). Median time to PSA bounce was 18.1 months (IQR, 12.0-31.1 months). On multivariable analysis, age and radiation dose were significantly associated with a lower incidence of bounce. Joint latent class models modeling found that nPSA and radiation dose were significantly associated with longer time to biochemical failure.Conclusions: In this multi-institutional cohort of patients with long-term follow-up, we found that SBRT led to low nPSAs. In turn, lower nPSAs are associated with reduced incidence of, and longer time to, biochemical failure. Benign PSA bounces occurred in a quarter of patients, as late as several years after treatment. Further studies are needed to directly compare the PSA response of patients who receive SBRT versus other treatment modalities. [ABSTRACT FROM AUTHOR]