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Aims: To report the findings of an audit for radiotherapy errors from a low-middle-income country (LMICs) centre. This would serve as baseline data for radiotherapy error rates, their severity and causes, in such centres where modern error reporting and learning processes still do not exist., Materials and Methods: A planned cross-sectional weekly audit of electronic radiotherapy charts at the radiotherapy planning and delivery step for all patients treated with curative intent was conducted. Detailed analysis was carried out to determine the step of origin of error, time and contributing factors. They were graded as per indigenous institutional (TMC) radiotherapy error grading (TREG) system and the contributing factors identified were prioritised using the product of frequency, severity and ease of detection., Results: In total, 1005 consecutive radically treated patients' charts were audited, 67 radiotherapy errors affecting 60 patients, including 42 incidents and 25 near-misses were identified. Transcriptional errors (29%) were the most common type. Most errors occurred at the time of treatment planning (59.7%), with "plan information transfer to the radiation oncology information system" being the most frequently affected sub-step of the radiotherapy process (47.8%). More errors were noted at cobalt units (52/67; 77.6%) than at linear accelerators. Trend analysis showed an increased number of radiotherapy incidents on Fridays and near-misses on Mondays. Trend for increased radiotherapy errors noted in the evening over other shifts. On severity grading, most of the errors (54/60; 90%) were clinically insignificant (grade I/II). Inadequacies and non-adherence towards standard operating procedures, poor documentation and lack of continuing education were the three most prominent causes., Conclusion: Preliminary data suggest a vulnerability of LMIC set-up to radiotherapy errors and emphasises the need for the development of longitudinal prospective processes, such as voluntary reporting and a continued education system, to ensure robust and comprehensive safe practises on par with centres in developed countries., (Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Total Neoadjuvant treatment (TNT) comprising short-course radiotherapy (SCRT) and neoadjuvant chemotherapy is one of the standard treatment options for locally advanced rectal cancer patients. Adding brachytherapy boost dose, can improve local tumor control and organ preservation rates in select patients. Overall, the increased risk of acute treatment-related toxicity rates with TNT approaches and dose escalation can be a deterrent to compliance, treatment completion and overall outcomes. We aim to evaluate the utility of adding chlorophyllin to SCRT-based TNT interdigitated with brachytherapy in reducing the incidence of >/ = grade 2 acute Gastrointestinal (GI)/Genito-urinary (GU)/ hematological toxicity along with improving the rates of complete clinical responses (pathological + clinical). The study is a 2-arm, phase II, prospective, randomized, double-blind, placebo-controlled superiority study evaluating the clinical outcome – local tumor response, the feasibility of non-operative management (NOM) with hypofractionated dose-escalated radiotherapy and brachytherapy in TNT setting, and the benefit of Chlorophyllin in reducing toxicity during this treatment approach for select locally advanced rectal cancer patients suitable for wait and watch approach. NOM or standard surgery will be followed based on response to TNT as standard treatment in both arms. After accrual and informed consent of eligible LARC patients, there will be: Arm 1 to receive chlorophyllin, and Arm 2 will receive a matching placebo, blinded centrally for both the investigators and patients. Permuted block randomization with a variable block size will be used to randomize 76 (38 in each arm), providing 80% power and a two-sided alpha of 10% to test an absolute reduction in > grade 2 GU/GI/Hematological toxicity rates by 30% (from 70% to 40%) with an anticipated dropout of 10%. It will also provide an estimate for NOM and organ preservation success rates. The current sample size is adequate for the estimated overall response rate at two years to be 50% compared to pCR of 28% (est. 95% CI = 24% - 32%) as reported in the RAPIDO study. We will also be estimating organ preservation rates, TME-free survival, Disease-free survival, Distant metastasis-free survival, Loco-regional failure-free survival, and Overall survival, along with toxicities and Quality of Life outcomes as secondary objectives. The study started accrual on 04th July 2023 and is currently ongoing. We anticipate that with improved logistics of SCRT, better compliance to TNT and improved NOM rates with endorectal brachytherapy boost could be achieved with Chylorophyllin by ameliorating acute treatment-related GI/GU /Hematological toxicity rates. Improved NOM rates and lesser toxicity would result in superior QoL and an improved therapeutic ratio and patient satisfaction for these deserving patients. [ABSTRACT FROM AUTHOR]

Due to the lack of high-quality evidence and consensus on adjuvant treatment for locoregionally advanced penile cancer, we reviewed the outcomes of pN3 patients to determine the suitable adjuvant treatment options. All consecutive pN3 penile cancer patients treated at our institution between January 2010 and December 2018 were reviewed to assess the impact of demographical, pathological and treatment factors on disease-free survival (DFS) and overall survival. The DFS and overall survival were estimated using the Kaplan–Meier method and association was tested using the Cox regression model (two-sided test with P < 0.05 considered significant). Of 128 patients, 31 (24%) had pelvic nodal involvement. Twenty-six patients (20.3%) received no adjuvant treatment, 40 (31.3%) received single modality adjuvant treatment and 62 (48.4%) received multimodality adjuvant treatment (a combination of chemotherapy and radiotherapy). At a median follow-up of 22 months, the DFS and overall survival were 55.4 and 62%, respectively. The best DFS and overall survival was noted with chemotherapy followed by concurrent chemoradiation (C-CTRT; 93% each). On multivariate analysis, both DFS and overall survival were worse with pelvic node involvement (2.2 [1.3–4], P = 0.027 and 2.2 [1.3–4], P = 0.027, respectively) and better with any adjuvant treatment (single modality: 3 [1.5–5.5], P < 0.001; multimodality: 3.1 [1.6–6], P < 0.001). C-CTRT was associated with improved DFS over chemotherapy alone (0.17 [0.4–0.78], P = 0.02) but not over radiotherapy alone (0.35 [0.07–1.6], P = 0.19). In patients with no pelvic nodes involved, chemotherapy and radiotherapy as single modalities were associated with similar DFS and overall survival. In patients with pelvic nodes, multimodality treatment was associated with better DFS than single modality treatment (0.3 [0.1–1], P = 0.05). Conclusion: pN3 penile cancer is a diverse prognostic group with poorer outcomes associated with pelvic nodes. Single modality adjuvant treatment may be adequate in inguinal nodes with extranodal extension, but multimodality treatment should be given in patients with pelvic nodal involvement. • Pelvic nodal involvement has poorer outcomes among pN3 penile cancer. • Combined modality adjuvant treatment improves disease-free survival when there is pelvic nodal involvement. • Single modality adjuvant treatment (CT or RT) is adequate if there is involvement of inguinal lymph node alone. [ABSTRACT FROM AUTHOR]

Abstract: Stereotactic conformal radiotherapy is an established technique in treating cranial lesions and has made significant inroads in the treatment of extracranial sites as well. Early stage non-small cell lung cancer is one such site. This overview assesses the results that have been achieved with stereotactic conformal radiotherapy in non-small cell lung cancer so far and compares its efficacy with surgical and other non-surgical modalities. [Copyright &y& Elsevier]

There is a lack of consensus regarding the management of post-chemotherapy residual mass in classical seminoma. The use of fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) may aid the detection of residual masses harbouring viable disease and help to tailor therapy. The aim of this study was to evaluate if PET-CT could identify patients who will benefit from locoregional radiotherapy. This ethics-approved study included patients with advanced classical seminoma primarily treated with standard platinum-based first-line chemotherapy. Patients were either observed or given adjuvant radiotherapy based on the clinician's preference and followed up. For this study, patients were stratified into two groups based on FDG PET-CT residual nodal maximum standardised uptake value (SUVmax): low risk (SUVmax <3) and high risk (SUVmax ≥3). Further subgroup analysis was carried out for patients with residual nodal size ≥3 cm and SUVmax ≥3, and this was considered as the very high risk group. The diagnostic accuracy of FDG PET-CT was assessed and survival was compared between the different groups. Sixty-nine patients were included in the study: 48 patients were observed and 21 received radiotherapy. The low and high risk groups contained 50.7% and 49.3% of the patients, respectively. The very high risk subgroup had 24 patients. At a median follow-up of 44 months, locoregional failures in the radiotherapy and observation cohorts were 0% and 30% (P = 0.059) in the very high risk subgroup and 5.8% and 29.4% (P = 0.078) in the high risk group. The positive predictive value for the very high risk and high risk groups was 30% and 17.1%, respectively. The benefit of locoregional control failed to translate into overall survival benefit. A tailored, FDG PET-based risk-adapted treatment approach can refine the management of post-chemotherapy residual masses in seminoma. In this study, with the largest cohort of advanced seminoma patients treated with radiotherapy reported to date, radiotherapy seems to benefit patients with post-chemotherapy residual mass SUVmax ≥3. • FDG PET-CT can help to optimise the management of post-chemotherapy residual mass in advanced seminoma. • Risk grouping can be carried out based on uptake in residual mass in PET-CT scan. • Residual mass with SUVmax ≥3 seems to benefit from locoregional radiotherapy. [ABSTRACT FROM AUTHOR]

To report long-term outcomes with dose-escalated, image-guided adaptive radiotherapy (ART) for bladder preservation in muscle-invasive bladder cancer (MIBC). All MIBC patients receiving bladder-preserving ART at our institute from 2009 to 2018 were analysed. For ART, three anisotropic planning target volumes (PTV) were concentrically grown around the simulation bladder volume. A library of intensity-modulated radiotherapy plans was created for each patient. A total dose of 64 Gy in 32 fractions to the entire bladder and 55 Gy to pelvic nodes was planned, with 68 Gy to the tumour bed (2 Gy equivalent dose = 68.7 Gy, α/β = 10) as simultaneous integrated boost for solitary tumours. The most appropriate PTV encompassing the bladder ('plan-of-the-day') was chosen daily using on-board megavoltage imaging. Neoadjuvant and concurrent chemotherapy was prescribed for medically fit patients. Of a total of 106 patients, most had T2 (68%) or T3 (19%) disease. Ninety-two patients (87%) completed 64 Gy to the whole bladder. Sixty-three patients (59%) received 68 Gy as tumour bed boost. Seventy-six per cent received concurrent weekly chemotherapy. At a median follow-up of 26 months, 3-year locoregional control, disease-free survival and overall survival were 74.3, 62.9 and 67.7%, respectively. Eighty-two per cent of patients retained disease-free bladder. Radiation Therapy Oncology Group grade III/IV acute genitourinary and gastrointestinal toxicities were 7.5% and 0%, respectively, and late genitourinary/gastrointestinal toxicities were 6.5% and 3.8%, respectively. Overall survival, disease-free survival, locoregional control and grade III/IV genitourinary/gastrointestinal toxicities did not differ significantly with dose escalation. Plan-of-the-day ART is clinically safe and effective for bladder preservation and can be implemented in routine clinical practice. A high bladder preservation rate is achievable without compromising on survival or toxicities. Dose escalation does not seem to affect outcomes. • Long-term outcomes in invasive bladder cancer with bladder-preserving adaptive radiotherapy. • 82% of patients retained disease-free bladder at 3 years after treatment. • No difference with dose escalation in survival, local control, bladder preservation and acute/late toxicities. • Plan-of-the-day adaptive radiotherapy is clinically safe and effective for bladder preservation. [ABSTRACT FROM AUTHOR]

Aims Stereotactic body radiotherapy (SBRT) in low- and intermediate-risk prostate cancer has shown encouraging results. However, its use in high-risk patients is limited due to lack of data regarding adequate radiotherapy dose, need for pelvic nodal treatment and androgen deprivation therapy. Herein we report our experience of SBRT in this subgroup. Materials and methods Analysis of a prospectively maintained database of 68 consecutive patients of the National Comprehensive Cancer Network (NCCN) high-risk, very high-risk and node-positive adenocarcinoma prostate treated with SBRT was undertaken. All patients were treated with rotational intensity-modulated radiotherapy with daily image guidance. The dose delivered to the prostate and gross node was 35–37.5 Gy in 5 alternate day fractions. Node-positive patients received 25 Gy to pelvic nodal regions until the common iliac nodes. Treatment was delivered in 7–10 days. All patients received long-term androgen deprivation therapy (79% medical and 21% surgical). Results Most patients (65%) had a Gleason score ≥ 8. The median prostate-specific antigen was 42. Twenty patients were high risk (30%), 11 (16%) very high risk and 37 (54%) node positive. No acute Radiation Therapy Oncology Group grade ≥ 3 genitourinary or gastrointestinal toxicity was noted. Acute grade 2 genitourinary and gastrointestinal toxicity were 12% and 3%, respectively. Late grade 3 genitourinary and gastrointestinal toxicity was 3% and 0%, respectively. There was no increase in acute or late gastrointestinal toxicity with prophylactic pelvic nodal radiotherapy. Prior transurethral resection of prostate ( n = 11) did not increase toxicity. At a median follow-up of 18 months, 97% patients were alive and 94% were biochemically controlled. Conclusion SBRT is safe in the treatment of high-risk, very high-risk and node-positive prostate cancer, even with prophylactic pelvic radiotherapy or prior transurethral resection of prostate. Longer follow-up is required to determine efficacy. [ABSTRACT FROM AUTHOR]

Plenary Session: Highlights of Proffered papers (latebreaking abstracts) OC-0613: Prostate Only or Pelvic Radiotherapy in High Risk Prostate Cancer: Outcomes of a Randomised Trial V. Murthy, P. Maitre, G. Panigrahi, D. Chaurasia, R. Krishnatry, R. Phurailatpam, G. Prakash, G. Bakshi, M. Pal, S. Menon, U. Mahantshetty. [Extracted from the article]