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Purpose: To compare brachytherapy to external beam radiation therapy (EBRT) with respect to overall survival (OS) and disease-specific survival (DSS) among NSCLC patients undergoing limited surgical resection. Methods: All cases of T1-4 N0 M0 NSCLC undergoing limited resection and either brachytherapy or EBRT diagnosed between 2004 and 2014 were extracted from the Surveillance, Epidemiology, and End Results database. Chi-square test and Fisher's exact analysis were used to analyze categorical variables while Student's t-test was used to analyze continuous variables. Univariate analysis to assess for differences in survival with respect to covariates was performed with the log-rank test. Multivariable analysis was performed with Cox proportional hazards regression models among the entire cohort and after sub-stratification by T stage. Results: Among 543 patients, 471 underwent EBRT and 72 underwent brachytherapy. Brachytherapy demonstrated improved OS and DSS on univariate analysis as compared to EBRT (p < 0.05). Cox regression also demonstrated improved OS and DSS with brachytherapy (HR 0.604; 95% CI [0.380; 0.961] and HR 0.524; 95% CI [0.303; 0.908], respectively). Sub-cohort analysis demonstrated significant improvement in survival only among patients with T1 disease with similar survival between brachytherapy and EBRT among higher stage disease. Conclusions: Patients undergoing brachytherapy for T1-T4, N0, M0 NSCLC demonstrated at least similar survival as compared to those undergoing EBRT among patients undergoing limited resection. Improved survival was demonstrated among patients with T1 disease. [ABSTRACT FROM AUTHOR]

A retrospective analysis of the Surveillance, Epidemiology, and End Results database was performed to evaluate the effect of radiotherapy (RT) on overall survival and disease-specific survival. Patients undergoing RT had improved overall survival and disease-specific survival on multivariate Cox regression and after propensity score matching as compared with patients who did not receive RT. Introduction: The aim of this study was to perform a Surveillance, Epidemiology, and End Results (SEER) analysis on the effect of radiotherapy (RT) on survival among patients with prostate ductal adenocarcinoma (DA), a rare variant of prostate cancer. Patients and Methods: Cases of T1 to 4 N0 M0 prostate DA diagnosed between 2004 and 2013 were extracted from SEER. The association between categorical variables and radiation therapy was assessed for statistical significance using the x² test or Fisher exact test. Difference in continuous variables across the RT groups was assessed for statistical significance using the 2-sample t test or non-parametric test. The distribution of overall survival (OS) and disease-specific survival (DSS) between the RT groups was assessed using the Kaplan-Meier method and the log rank test and after propensity matching. The association between hazards of death (HR) and covariates was examined using Cox proportional hazards model. A 2-sided P-value of .05 was used to determine statistical significance. Results: A total of 205 patients met inclusion criteria. On univariate analysis, RT was associated with significant improvement in OS and DSS. On multivariate Cox regression, RT significantly decreased risk of death for both OS and DSS (HR, 0.516; 95% confidence interval [CI], 0.273-0.978 and HR, 0.232; 95% CI, 0.082-0.658, respectively). After propensity score matching, RT demonstrated a persistent improvement in both OS and DSS. Conclusions: RT decreased risk of death for both OS and DSS in patients with node-negative, nonmetastatic prostate DA on multivariable analysis. RT was also associated with improved OS and DSS after propensity matching. [ABSTRACT FROM AUTHOR]

Down syndrome is the most common chromosomal disorder in humans as well as the most common cause of inherited intellectual disability. A spectrum of physical and functional disability is associated with the syndrome as well as a predisposition to developing particular malignancies, including testicular cancers. These tumours ordinarily have a high cure rate even in widely disseminated disease. However, individuals with Down syndrome may have learning difficulties, behavioural problems, and multiple systemic complications that have the potential to make standard treatment more risky and necessitates individualized approach in order to avoid unacceptable harm. There is also suggestion that tumours may have a different natural history. Further, people with learning disabilities have often experienced poorer healthcare than the general population. In order to address these inequalities, legislation, professional bodies, and charities provide guidance; however, ultimately, consideration of the person in the context of their own psychosocial issues, comorbidities, and possible treatment strategies is vital in delivering optimal care. We aim to present a review of our own experience of delivering individualized care to this group of patients in order to close the existing health inequality gap. [ABSTRACT FROM AUTHOR]

Down syndrome is the most common chromosomal disorder in humans as well as the most common cause of inherited intellectual disability. A spectrum of physical and functional disability is associated with the syndrome as well as a predisposition to developing particular malignancies, including testicular cancers. These tumours ordinarily have a high cure rate even in widely disseminated disease. However, individuals with Down syndrome may have learning difficulties, behavioural problems, and multiple systemic complications that have the potential to make standard treatment more risky and necessitates individualized approach in order to avoid unacceptable harm. There is also suggestion that tumours may have a different natural history. Further, people with learning disabilities have often experienced poorer healthcare than the general population. In order to address these inequalities, legislation, professional bodies, and charities provide guidance; however, ultimately, consideration of the person in the context of their own psychosocial issues, comorbidities, and possible treatment strategies is vital in delivering optimal care. We aim to present a review of our own experience of delivering individualized care to this group of patients in order to close the existing health inequality gap. [ABSTRACT FROM AUTHOR]

Accurate target delineation/contouring is essential for radiation treatment planning and the clinical efficacy of radiation therapy. Clinical trial data has demonstrated the importance of quality contouring and treatment planning for optimal survival outcomes. As a result, improving the quality of target delineation is an important goal in the education of radiation oncology residents. However, there is limited quantitative data on the quality of residents' contours. Therefore, it would be beneficial to track performance and improvement in resident target delineation during residency. The purpose of this study was to determine if it was feasible to track the concordance of radiation oncology residents' contours with faculty physicians' contours. Residents were asked to contour target volumes (GTV, CTV, ITV, PTV, etc.) based on patient history, physical exam, clinical stage and fused diagnostic imaging and were allowed to use any available outside resources, including textbooks, review articles, consensus guidelines, and online atlases. Resident contours were saved as separate structures. Finalized, faculty physician-approved contours were also saved. Saved contour structures and data from October 2019 through June 2020 were reviewed for feasibility. In total, 209 structures had both resident and faculty versions saved within Eclipse and were available for analysis. The Boolean Operations Tool in Eclipse (Varian Medical Systems, Palo Alto, CA, USA) was used to create an intersection volume of the resident/faculty contours. Separately, the Boolean Operations Tool was used to create a union volume of the resident/faculty contours. Based on these two volumes, the Jaccard Concordance Index (JCI) was calculated by dividing the intersection volume (in cubic centimeters [cc]) by the union volume (cc). The JCI could be successfully calculated for 203 (97.1%) of the 209 structures. For 6 structures (2.9%), both the intersection and union volumes could not be calculated because the volumes were too small for Eclipse to determine. All 6 of these structures were small brain metastases. Tracking and comparing the concordance of resident contours and faculty physician contours is feasible using available tools in Eclipse. Additional data collection and assessment is necessary before this technique can be more widely utilized. [ABSTRACT FROM AUTHOR]

• Many head/neck squamous cell cancer patients develop recurrence or second primary. • Re-irradiation is a curative treatment option for these patients. • However, it is associated with significant risk of toxicity. • Pulsed Reduced Dose Rate radiation may reduce re-irradiation toxicity. Pulsed reduced dose rate (PRDR) radiation (RT) is a re-irradiation (Re-RT) technique that potentially overcomes dose/volume constraints in the setting of previous RT. There is minimal data for its use for recurrent or secondary primary head and neck squamous cell carcinoma (HNSCC). In this study, we report preliminary data from our institution of a consecutive cohort of HNSCC patients who received PRDR Re-RT. Nine patients received PRDR Re-RT from August 2020 to January 2023 and had analyzable data. Intensity modulated RT was used for treatment delivery and a wait time between 20 cGy arc/helical deliveries was used to achieve the effective low dose rate. Data collected included patient demographic information, prior interventions, diagnosis, radiation therapy dose and fractionation, progression free survival, overall survival, and toxicity rates. The median time to PRDR-RT from completion of initial RT was 13 months (range, 6–50 months). All but one patient underwent salvage surgery prior to PRDR-RT. The median follow-up after Re-RT was 7 months. The median OS from PRDR-RT was 7 months (range, 1–32 months). Median PFS was 7 months (range, 1–32 months). One patient (11.1 %) had acute grade 3 toxicity, and two patients (22.2 %) had late grade 3 toxicities. There were no grade 4+ toxicities. PRDR Re-RT is a feasible treatment strategy for patients with recurrent or second primary HNSCC. Initial findings from this retrospective review suggest reasonable survival outcomes and potentially improved toxicity; prospective data is needed to establish the safety and efficacy of this technique. [ABSTRACT FROM AUTHOR]