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Introduction: Chemoradiotherapy in head and neck cancer patients has a curative intent but often deteriorates nutritional status leading to sarcopenia and cachexia. Methods: In this observational and single-centered study, a prospective evaluation of several biochemical and anthropometrical parameters, weight loss, handgrip strength, visual analogue scale of appetite, questionnaires associated with malnutrition & quality of life and body composition (obtained by Bioelectrical Impedance Vector Analysis) was performed before and after high-dose cisplatin chemotherapy combined with radiotherapy in 60 patients affected by head and neck cancer. Oral nutritional supplements were used to reach the correct number of daily calories and proteins. Results and discussion: All patients completed radiotherapy as planned and the 96,4% of them did not interrupt chemotherapy for toxicity, reaching a total dose of at least 200mg/m2. Despite a rapid deterioration of body composition during treatment, nutritional support helped patients to maintain (or in some cases improve) anthropometric parameters from the end of chemoradiotherapy to the following 3 months. Low prealbumin and albumin pre-treatment led to higher risk of toxicities with consequent reduction of cisplatin dose intensity, whereas weight at the end of the treatment seems to be an interesting predicting factor for disease free and overall survival (p=0.007; p=0.015). [ABSTRACT FROM AUTHOR]

Aim: Stereotactic ablative body radiation (SABRT) for lung cancer is a validated treatment’s option for early stage and advanced or oligoprogression disease. Therapeutic strategy in lung cancer for eldery patients is limited by their comorbidities or perfomance status. This is a retrospective analysis to evaluate the safety and efficiency of SBRT for the treatment of lung lesions in elderly patients. Material and methods: Between April 2018 and January 2021, 44 patients (pts) with more than seventy years old affected by lung cancer in early stage or advanced disease (lung metastasis) were treated with SABRT. Only one or two lesions were irradiated in each patients (total lesions: 60) Median age was 83,5 years (range 70-91). Patients were stratified by stage: stage IV (19), stage I (18), local relapse of previous surgery (7). Lesions’ histology distribution was: adenocarcinoma (26), squamous cell carcinoma (7), small cell lung cancer (5) and unknown (22) - biopsy not possible for medical condition. Lesions were treated with four different fractioned regimens depending on location: 50 Gy /5 fr (19), 45 Gy/ 3 fr (23), 54 Gy/3 fr (8) and 60 Gy/ 8 fr (10), prescribed to 80% median isodose curve (71,8-83%). Local control (LC) was defined by RECIST criteria, overall survival (OS) and toxicity according to CTCAE (v.4) were collected and analyzed retrospectively. Results: Median follow-up was 10 months (2,2-38,2 months). Local control (LC) rate was 85,3% and 74% at 12 and 24 months respectively. Twelve and 24 months - OS was 67,2% and 57,1% respectively. Dividing patients by stage, in stage I 12 and 24 months OS was 64,9% and 32,5%, while in stage IV 57% and 48,9%, with a difference not statistically significantly (p-value: 0,17). Significant lung toxicity wasn’t registered. Only two patients had G1 side effects: one, asthenia and the other thoracic wall pain. Conclusion: Based on our experience, SABR for eldery patients affected by lung cancer is efficient, well tolerated with a good patient’s compliance. In our opinion should be a valid option for the therapeutic strategy for this setting of patients. Further patients need to be treated in order to obtain a confirmation of this promising preliminary result. [ABSTRACT FROM AUTHOR]

Objective: To evaluate toxicity and outcomes after salvage robotic stereotactic body radiotherapy-SBRT- (CyberKnife®,Accuray, Sunnyvale, Ca) re-irradiation of patients with intraprostatic/prostatic bed recurrences of pelvic malignancies. Methods: From 11/2018 to 10/2021, 20 patients with intraprostatic/prostatic bed recurrence after radiotherapy, diagnosed on MRI/ PET choline/PSMA and/or biopsyproven, underwent a salvage re-irradiation with SBRT: 9 patients with prostate cancer failure after previous radical radiotherapy, and 11 patients after adjuvant/salvage radiotherapy. Median prior RT dose was 70.7 (38.25- 78) Gy and the median interval to SBRT salvage therapy was 79.3 (11-208) months. Median PSA before robotic SBRT was 2.64 (1.14-26.8) ng/ml. Fiducial markers were implanted into the target in 19 of 20 patients. Median SBRT total dose was 35 (30-35) Gy in 5 fractions (EQD2=85 Gy, for α/β 1.5). Median prescription isodose was 70% (59- 81%). In 12 patients, a “urethral sparing” was used. In 10 cases a precautionary therapy with steroids and alphalytics was prescribed during the salvage treatment. Twelve patients received neoadjuvant or concomitant/adjuvant androgen suppressive therapy during their SBRT course. Toxicity was scored in accordance with CTCAE v 5.0. Results: Median follow-up was 17.4 months (2.35- 38.15) months. Acute genitourinary (GU) toxicity was observed in 40% of patients and was limited to grade (G)1 in 35% of patients and G2 (minimal strangury, urgency and occasional urinary incontinence) in 5%. Ten% of patients reported late GU G3 toxicity (urinary retention requiring catheterization and transurethral resection), and 5% G2 urinary toxicity. No acute and late gastrointestinal toxicity was observed. At the last follow-up 2 patients died due to a non cancer-releated cause. Twenty-four-months Kaplan Meier estimates of biochemical relapse-free survival (bRFS) was 78.2% (see Figure 1), local-relapse-free survival (LRFS) 92.3% and distant-metastases-free survival 85.1%. Conclusions: Prostate SBRT re-irradiation with CK is a feasible treatment option, with good short-term outcomes. Longer follow-up is necessary to assess the long-term benefits and to determine late toxicity. [ABSTRACT FROM AUTHOR]

Purpose: The treatment of relapses of already irradiated primary brain tumors and metastases is difficult, given the limited effectiveness of systemic therapy and the risks of surgery or re-irradiation. Here we present the results of salvage Stereotactic Radiotherapy (SRT) for the treatment of recurrent primary brain tumors and metastases (mts) after previous radiotherapy (RT). Material/methods: From January 2018 to October 2021, 137 intracranial lesions (33 patients) were re-irradiated with robotic SRT. Primary histology was: NSCLC (n=10), breast cancer (n=9), glioblastoma (n=4), meningioma (n=2), oligodendroglioma (n=2), hemangiopericytoma (n=2), pituitary adenoma (n=2), prostate cancer (n=1), and melanoma (1). Previous RT on the same volume were performed with: GammaKnife (n=11), CyberKnife (n=8), Whole-Brain RT (n=8), post-operative IMRT/ Helical IMRT (n=8), VMAT-SRT (n=5), post-operative 3D-CRT (n=3). Eight patients had multiple previous treatments. Median time from the previous radiotherapy was 13 (3-377) months. Gross Tumor Volume (GTV) was delineated on computed tomography and contrast-enhanced T1 magnetic resonance. Median GTV was 5.24 (0.22-78.32) cc. Planning Target Volume (PTV) was obtained adding an expansion to GTV of 1 mm (for brain metastases), or 3 mm (for glioblastoma). Median PTV was 10.19 (0.43-136.9) cc. Median prescribed dose was 30 (24-37.5) Gy in 1-5 fractions (median number of fractions was 5), at a median isodose of 76% (67-80%). The patients were followed up with contrast-enhanced MRI performed every three months. Results: SRT was delivered on a median number of 2 (1-24) lesions; 7 patients were treated on ≥ 5 lesions simultaneously (from 5 to 24 lesions). Acute toxicity was G2 headache in three patients (GTV>1cc or >3 lesions), controlled by increasing the dose of steroids. Median follow-up after re-irradiation in 20 evaluable patients was 9 (1-37) months. Radionecrosis occurred in only one patient (GTV>1cc). He underwent two previous VMAT SRT (prescribed dose 30 Gy in 5 fractions and 21 Gy in 3 fractions) and presented seizures. He was treated with steroids and levetiracetam. Six-, 12-, 18-month overall survival (OS) was 79.2%, 51.7%, 37.7% respectively. Six-, 12-, 18-month local relapse free survival was 70.7%, 64.8%, 48.6% respectively (see Figure 1). Conclusions: SRT for re-irradiation is feasible, with only one case of radionecrosis registered. The treatment is effective with 12-month local control registered in 65% of pts. An accurate patient selection is warranted in order to avoid toxicity and a longer follow-up is needed to confirm the low radionecrosis rate. [ABSTRACT FROM AUTHOR]

Object: Lung metastases from colorectal cancer are more radioresistant, requiring higher dose to obtain a stable local control. Here we evaluate two different techniques of stereotactic body radiotherapy (SBRT) for lung metastases from colorectal cancer in patients treated in our departmed. Material and methods: From 01/2006 to 07/2020, 69 lung metastases (37 patients) from colorectal cancer were treated with SBRT in our department: 48 lesions (27 patients) with 4DCT simulation and helical/VMAT IGIMRT (4DCT) and 21 lesions (10 patients) with real time-tracking robotic radiosurgery (CK). Median ages were 71.9 years (4DCT) vs 64.1 years (CK). Median GTV were 5.16 (0.31-88.6) cc (4DCT) vs 3.98 (0.16-16) cc (CK), while median PTV were 26.3 (6.3-180) (4DCT) cc vs 16.7 (1.9 vs 45.6) cc (CK), respectively. The tighter margins used with the real-time tracking was the main factor that determined a smaller PTV volume. Central lesions were 17.1% in the 4DCT group vs 23.5% in the CK group. Median BED precribed was 102.6 Gy in the 4DCT group vs 112.5 Gy in the CK group. The tighter margins allowed us not only to prescribe a higher median BED, but also to reduce the number of fractions and the overall treatment time from 2 weeks with 6 fractions every other day to 3 consecutive daily fractions. Results: Median follow-ups were 26.4 (3-85.7) months (4DCT group) vs 16.4 (3.4-37.4) months (CK group). The treatment was well tollerated: one patient presented a grade (G) 3 pneumonitis after a treatment on 6 lesions/4 PTV’s in one month with CK. Fully recovered she died one year later for distant metastases. Five patients presented G1/G2 cough and 1 with G1 dyspnea soon after the 4DCT treatment. Four patients had persistent G1 fibrosis, and 7 G1 dyspnea after the 4DCT treatment. Local control was of 69.3% (4DCT) vs 90.5% (CK) at 12 months, 46.5% vs 81.4% at 24 months (p= 0.08) (see Fig. 1). Overall survival at 12 months was 89.5% in the CK group vs 94.7% in the 4DCT group, at 24 months 64.6 % vs 76.5 %, and at 36 months 64.6% vs 51.7%, respectively. Conclusion: SBRT in lung oligometastases from colorectal cancer have a low toxicity profile. Even a small increase of BED from 102 Gy to 112 Gy, and the higher precision allowed by the real-time tracking shows a tendency towards better local control. [ABSTRACT FROM AUTHOR]