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Abstract: Background and purpose: Identify the incidence of early pulmonary toxicity in a cohort of patients treated with lung stereotactic body radiation therapy (SBRT) on consecutive treatment days. Material and methods: A total of 88 lesions in 84 patients were treated with SBRT in consecutive daily fractions (Fx) for medically inoperable non-small cell lung cancer or metastasis. The incidence of pneumonitis was evaluated and graded according to the NCI CTCAE v3.0. Results: With a median follow-up of 15.8months (range 2.5–28.6), the median age at SBRT was 71.8years (range 23.8–87.8). 47 lesions were centrally located and 41 were peripheral. Most central lesions were treated with 48Gy in 4 Fx, and most peripheral lesions with 54Gy in 3 Fx. The incidence of grade ⩾2 pneumonitis was 12.5% in all patients treated, and 14.3% among the subset of patients treated with 54Gy in 3 Fx. A total of two grade 3 toxicities were seen as one grade 5 toxicity in a patient treated for recurrence after pneumonectomy. Conclusions: Treating both central and peripheral lung lesions with SBRT in consecutive daily fractions in this cohort was well tolerated and did not cause excessive early pulmonary toxicity. [Copyright &y& Elsevier]

Primary and metastatic spinal tumors as a group represent a heterogeneous mixture of benign and malignant processes. In general, primary tumors of the spine remain relatively uncommon, and the majority of spinal tumors that are treated annually represent systemic spread of extraosseous primary malignancy. The management of spinal tumors requires meticulous yet expedient attention as the consequences of failed or inappropriate treatment can be devastating. Radiotherapy has proven beneficial in many tumors of the spine, particularly metastatic lesions, Ewing''s sarcoma, and myeloid malignancies. A review of the use of radiotherapy for the more common primary spinal malignancies and metastasis is presented. [Copyright &y& Elsevier]

The article discusses a study on descriptive nomograms of adjuvant radiotherapy (RT) use and patterns of care analysis for stage I and II of endometrial adenocarcinoma. It found that higher tumor grade and stage led to greater use of RT. It notes that geographic location had a significant effect on overall RT use and therapy choice. It also mentions the absence of a national consensus on adjuvant treatment for early-stage disease.

Objectives: To analyze an observational database of prostate cancer, assessing for patterns of use and predictors of prostate-specific antigen (PSA) recurrence after adjuvant radiotherapy (RT). Methods: From the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), 5336 men underwent prostatectomy from 1989 to 2004. Of these 5336 men, 96 men (1.8%) underwent adjuvant RT. These 96 men were classified as having low (Stage T1c-T2a and PSA level of 10 ng/mL or less and Gleason score of 6 or less), intermediate (Stage T2b or PSA level greater than 10 ng/mL and 20 ng/mL or less or Gleason score 7), or high (Stage T2c or higher or PSA level greater 20 ng/mL or Gleason score of 8 or greater) risk of PSA recurrence. PSA recurrence was defined as two consecutive PSA levels greater than 0.2 ng/mL. Differences between patients who experienced failure were assessed by chi-square tests or analysis of variance. Univariate and multivariate analyses were performed using a Cox proportional hazard regression model. Results: Of the 96 men, 27 (28%) experienced PSA failure and 20 (21%) received additional treatment, with a median of 60 months of follow-up. The clinical risk group (P <0.01), PSA level at diagnosis (P <0.01), Gleason score (P <0.01), and seminal vesicle invasion (P <0.01) all significantly associated with PSA recurrence. The clinical risk group was the sole predictor of PSA recurrence-free survival on multivariate analysis (hazard ratio 2.4, 95% confidence interval 1.7 to 8.3, P = 0.007). Conclusions: Adjuvant RT was not frequently used in men enrolled in CaPSURE. PSA recurrence was observed more frequently in men with high-risk disease, suggesting that adjuvant RT is not adequate therapy and that these men might benefit from the combined use of hormonal therapy and RT. [Copyright &y& Elsevier]

Objectives: To analyze the prostate-specific antigen (PSA) outcome after low-dose adjuvant RT at a single institution, because the role and optimal dose of external beam radiotherapy (RT) after radical prostatectomy for prostate cancer remain controversial. Methods: We retrospectively identified 65 men who had received low-dose adjuvant RT (median 50 Gy) for microscopically positive margins with an undetectable postoperative PSA from 1990 to 2004. Biochemical failure-free survival was the primary endpoint. Biochemical failure was defined as two consecutive PSA increases to greater than 0.2 ng/mL. Results: At a median follow-up of 5 years, 2 men had developed distant metastasis, 2 had local recurrence, and 2 had died (neither attributable to prostate cancer). Biochemical failure had occurred in 7 men (11%). The 5 and 8-year rate of biochemical failure-free survival was 87%. A greater Gleason score (P = 0.04) and seminal vesicle invasion (P = 0.04) predicted significantly for increased biochemical failure on univariate analysis. No single factor was significant on multivariate analysis. Men with a Gleason score of 7 or less had a 5-year biochemical failure-free survival rate of more than 90%. In contrast, those with a Gleason score of 8 or more had a 50% risk of biochemical failure at 5 years. Acute bowel or bladder toxicity (all grade 2 or less) developed in 25%. Two men developed chronic urethral stricture requiring dilation, and 34 (51%) developed surgery-related toxicity that persisted throughout and after RT. Conclusions: Low-dose RT is well tolerated and can potentially provide PSA control in men with Gleason score 7 or less disease with positive surgical margins after radical prostatectomy. [Copyright &y& Elsevier]

Purpose: This study was performed to evaluate the results and prognostic factors associated with radiotherapy for a detectable serum prostate specific antigen level after radical prostatectomy. Materials and Methods: From July 1987 through July 2003, 368 patients received radiotherapy for a detectable prostate specific antigen level (biochemical relapse) as the sole evidence of recurrence after radical prostatectomy for node negative prostate cancer. Estimated survival and relapse-free probabilities were obtained via Kaplan-Meier estimation. Associations of patient factors with survival and biochemical relapse were investigated using Cox proportional hazards models. Results: With a median followup of 5 years the 5 and 8-year freedom from biochemical relapse were an estimated 46% (95% CI 41%–53%) and 35% (95% CI 29%–43%) while survival was 92% (95% CI 89%–95%) and 80% (95% CI 74%–87%), respectively. Patient and treatment variables showing evidence of association with biochemical relapse on multivariate analysis included pathological stage T3a or less vs T3b (seminal vesicle involvement, p = 0.029), pathological Gleason score 7 or less vs 8 or greater (p <0.001) and pre-radiotherapy prostate specific antigen (p <0.001). Four biochemical failure risk groups were created by assigning seminal vesicle involvement, Gleason score and pre-radiotherapy prostate specific antigen each a score of 0 to 2. These individual scores were summed. The freedom from biochemical failure at 5 years for each risk group was 0 to 1—69%, 2—53%, 3—26% and 4 to 5—6%. Conclusions: The presence of seminal vesicle involvement and high Gleason score in the radical prostatectomy specimen are inherent predictors of adverse outcome. Early referral for salvage radiotherapy can decrease subsequent biochemical relapse. [Copyright &y& Elsevier]

The article presents a medical study to evaluate the frequency and effect of adjuvant radiation therapy among women with stage one endometrial adenocarcinoma. Endometrial cancer is the most common gynecological malignancy in the United States. The benefit of adjuvant radiation therapy in stage one endometrial adenocarcinoma remains controversial despite clinical trials. This medical study reveals a statistically significant association between improved survival and adjuvant radiation therapy.

: PurposeA retrospective study to evaluate the outcome of salvage radiotherapy (RT) for clinically apparent, palpable prostate cancer recurrence after radical prostatectomy (RP).: Methods and materialsForty-two patients underwent RT for clinically apparent recurrent prostate cancer after RP between 1993 and 1999. The end points and treatment variables of biochemical disease-free survival were evaluated statistically.: ResultsThe median follow-up was 4.3 years. All 42 patients experienced resolution of clinically detectable recurrence within 1 year after RT. The 5-year biochemical disease-free survival, local control, freedom from distant metastases, and overall survival rate was 27%, 94%, 82%, and 78%, respectively. The initial pathologic stage (T3 or T4; p = 0.04) and interval (<2 years from RP to RT; p = 0.01) were independent predictors of biochemical failure, and RT simulation without contrast (p = 0.05) was nearly significant on multivariate analysis. Three patients (7%) experienced chronic Grade 3 or 4 RT-related toxicity.: ConclusionSalvage prostate bed RT for clinically apparent locally recurrent prostate cancer after RP provides effective local tumor control with modest durable biochemical control. Patients irradiated with a better simulation technique were found to have a more favorable outcome. A consensus on a definition of biochemical disease-free survival after salvage RT is critical for meaningful comparison of the available data and to future progress in treating this disease process. [Copyright &y& Elsevier]

Abstract: Purpose: To quantify the dosimetric deviations that would arise from delivering subsequent prostate high-dose-rate fractions with only needle readjustment and no replanning after the first fraction. Methods and Materials: Patients were treated with either two implant sessions (two 9.5-Gy fractions per session) separated by 2–4 weeks or with one implant session and external beam radiotherapy. After needle placement, needle positions were adjusted under CT guidance, after which dosimetric planning was performed before each fraction. To evaluate the consequence of not replanning before the second fraction, we analyzed the dosimetric parameters of 45 consecutive implants (26 patients). Needles with optimized dwell positions from the first fraction were transferred to the needle positions in the second fraction. Needle displacement between fractions was assessed as well as changes in plan metrics. Results: After adjustment, the mean interfractional needle displacement was 3.5mm. If replanned, the probability of planning target volume D 90% ≥95% is 100%, prostate V 100% ≥95% is 87%, and urethra V 115% ≤10% is 78%. If treated without replanning, the probability of planning target volume D 90% ≥95% is 82%, prostate V 100% ≥95% is 53%, and urethra V 115% ≤10% is 69%. Even for implants with minimal needle displacement (<3mm) and minimal prostate volume change (<3cc), the dosimetric consequence of not replanning the second fraction would result in 46% of cases with a prostate V 100% <95%. Conclusion: The dosimetric consequences of not replanning the second fraction for prostate high-dose-rate implants results in significantly inferior plan metrics. [Copyright &y& Elsevier]

Purpose: The benefit of adjuvant radiotherapy (RT) after surgical resection for extrahepatic cholangiocarcinoma has not been clearly established. We analyzed survival outcomes of patients with resected extrahepatic cholangiocarcinoma and examined the effect of adjuvant RT. Methods and Materials: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2003. The primary endpoint was the overall survival time. Cox regression analysis was used to perform univariate and multivariate analyses of the following clinical variables: age, year of diagnosis, histologic grade, localized (Stage T1-T2) vs. regional (Stage T3 or greater and/or node positive) stage, gender, race, and the use of adjuvant RT after surgical resection. Results: The records for 2,332 patients were obtained. Patients with previous malignancy, distant disease, incomplete or conflicting records, atypical histologic features, and those treated with preoperative/intraoperative RT were excluded. Of the remaining 1,491 patients eligible for analysis, 473 (32%) had undergone adjuvant RT. After a median follow-up of 27 months (among surviving patients), the median overall survival time for the entire cohort was 20 months. Patients with localized and regional disease had a median survival time of 33 and 18 months, respectively (p < .001). The addition of adjuvant RT was not associated with an improvement in overall or cause-specific survival for patients with local or regional disease. Conclusion: Patients with localized disease had significantly better overall survival than those with regional disease. Adjuvant RT was not associated with an improvement in long-term overall survival in patients with resected extrahepatic bile duct cancer. Key data, including margin status and the use of combined chemotherapy, was not available through the SEER database. [ABSTRACT FROM AUTHOR]

High-dose-rate brachytherapy is a relatively new radiotherapeutic intervention that is used as a curative treatment for patients with many types of cancer. Advances in mechanical systems and computer applications result in a sophisticated treatment technique that reliably delivers a high-quality radiation dose distribution to the intended target. Patients with localized prostate cancer may benefit from high-dose-rate brachytherapy, which may be used alone in certain circumstances or in combination with external-beam radiotherapy in other settings. The authors comprehensively searched the MEDLINE database for clinical studies published from January 1, 2002, through December 31, 2007, using the key terms brachytherapy, high-dose-rate, and prostatic neoplasms. Criteria for study review were study design, English language, relevance to clinicians, and validity based on design and appropriateness of conclusions. The abstract proceedings of meetings sponsored by the American Brachytherapy Society and the American Society for Therapeutic Radiology and Oncology were reviewed to identify additional relevant material. These sources provided the basis for a concise review of the rationale and advantages of high-dose-rate brachytherapy in the management of localized prostate cancer, as well as the details of the clinical use and therapeutic outcomes of this treatment as observed in a contemporaneous time frame. [ABSTRACT FROM AUTHOR]