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To evaluate the persistence of symptoms after radiotherapy (RT) for localised prostate cancer (PCa) and the association with quality of life (QOL). Prospective patient-reported outcome (PRO) from a multi-institutional study on PCa treated with radical RT (2010–2014) was analysed. Data was collected at baseline (BL) and follow-ups (FUPs) up to 5 years. Patients with BL and ≥3 late FUPs (≥6 months) were analysed. PRO was scored by means of the IPSS and ICIQ-SF (urinary), LENT-SOMA (gastrointestinal [GI]), and EORTC-C30 (pain, insomnia, fatigue, and QOL) questionnaires. Symptoms were defined 'persistent' if the median score over FUPs was ≥3 (urinary) or ≥2 (GI, pain, insomnia, and fatigue), and worse than BL. Different thresholds were chosen to have enough events for each symptom. QOL was linearly transformed on a continuous scale (0–100). Linear-mixed models were used to identify significant differences between groups with and without persistent symptoms including age, smoking status, previous abdominal surgery, and diabetes as confounders. Mean QOL differences between groups were evaluated longitudinally over FUPs. The analysis included 293 patients. Persistent urinary symptoms ranged from 2% (straining) to 12% (weak stream, and nocturia). Gastrointestinal symptoms ranged from 7% (rectal pain, and incontinence) to 30% (urgency). Proportions of pain, insomnia, and fatigue were 6, 13, and 18%. Significant QOL differences of small-to-medium clinical relevance were found for urinary incontinence, frequency, urgency, and nocturia. Among GI symptoms, rectal pain and incontinence showed small-to-medium differences. Fatigue was associated with the largest differences. The analysis showed that symptoms after RT for PCa occur with different persistence and their association with QOL varies in magnitude. A number of persistent urinary and GI symptoms showed differences in a comparable range. Urinary incontinence and frequency, rectal pain, and faecal incontinence more often had significant associations. Fatigue was also prevalent and associated with largely deteriorated QOL. [ABSTRACT FROM AUTHOR]

Background: Treatment of breast cancer (BC) remains a constant and rapidly evolving issue for multidisciplinary breast cancer teams. Considering the emerging understanding and advances in the biological course of this disease, new trends in radiotherapy fractionation, systemic therapies, and oncoplastic surgical techniques are revolutionizing adjuvant treatment approaches to BC. Novel challenges are questioning the integration of adjuvant radiotherapy (ART) into the real-world clinical setting. Methods: PubMed literature search was conducted in order to extract data supporting the role of new trends in breast cancer adjuvant approach according to rising issues in the multidisciplinary team discussion such as sequencing with chemotherapy (CT) plus whole breast hypofractionated radiotherapy (HF-WBRT); the role of ART after neoadjuvant CT (NACT) followed by breast conservative surgery (BCS) in early BC achieving pathological complete remission (pCR); and the integration of ART in immediate autologous breast oncoplastic reconstruction after mastectomy (a-IBR). Furthermore, there are still several concerns about toxicity with adjuvant trastuzumab emtansine (T-DM1) or breast re-irradiation after BCS relapse in long-term survivors refusing mastectomy. Results: Among 40 hits, only 12 studies answered these issues. Many of them were retrospective studies. Less than 500 patients met the criteria for these issues and several conclusions were found exhaustive. Conclusion: Few issues seem to have a literature solution, while there are still open questions in regard to these new trends. Novel strategies through prospective or randomized studies and new consensus guidelines are required. [ABSTRACT FROM AUTHOR]

Radiotherapy (RT) is an important therapeutic option in patients with localized prostate cancer (PC). Unfortunately, radiation treatment causes a decrease in peripheral lymphocytes and, consequently, influences the patients' immune status. Our aim was to study changes in peripheral blood immune cell subpopulations after RT and during 6 months' follow-up in 2 groups of PC patients irradiated with different techniques and dose fractions with curative intent. We also investigated the presence of correlation between immune cell modulation and genitourinary or gastrointestinal toxicity. We enrolled 44 patients treated with curative RT (RapidArc/hypofractionation regimen or 3D conformal/conventional fractionation) for localized PC. Total white blood cell (WBC), absolute lymphocyte counts (ALCs), and peripheral immune cell subpopulations were analyzed at baseline, at the end of RT, and 3 and 6 months after the end of RT. WBC and ALC greatly decreased at the end of RT with a trend to recover at 6 months' follow-up in the hypofractionation group but not in the conventional one. Furthermore, B, total T, T CD4+, T CD8+, and NK cell values dropped significantly in both groups at the end of RT, with a minor decrease detectable in the hypofractionation group for B, total T, and T CD4+ lymphocytes with respect to the other technique/fractionation group. Double-negative T (DNT), double-positive T (DPT), and NKT cells significantly decreased at the end of RT with a slight tendency to recover values during follow-up, particularly in the hypofractionation group. No correlation with genitourinary or gastrointestinal toxicity was found. In this study, we showed, for the first time, the effects of RapidArc/moderate hypofractionation RT on immune cell subsets in patients treated for localized PC. Due to the growing interest in minority T-cell subpopulations for immunotherapy, we also reported longitudinal monitoring of the effects of RT on DNT, DPT, and NKT, which was never studied before. Our preliminary data highlight the importance of considering the effects of different RT techniques/fractionation regimens on peripheral immune cells, in the era of RT and immunotherapy combination. [ABSTRACT FROM AUTHOR]

Head and neck cancer (HNC) remains a significant health concern worldwide. Approximately 50% of HNC occur in the elderly patients and this rate is destined to increase over time, due to the aging of the population. The treatment of HNC poses unique challenges, as it often requires a combination of surgery, chemotherapy, and radiotherapy (RT). Additionally, age-related comorbidities and frailty may complicate the management of HNC in this setting of patients. RT alone has been one of the treatment options for patients with locally advanced HNC squamous cell carcinoma (SCC) with contraindications to chemotherapy, such as cardiac risk, renal or hepatic impairment, frailty or advanced age, and patient choice. In recent years, hypofractionated RT (HFRT) has emerged as an alternative treatment approach, offering the potential to reduce the overall treatment duration while maintaining or even improving treatment outcomes. Several clinical studies have investigated the efficacy and safety of HFRT in HNC. However, robust data are lacking and mainly concern oropharyngeal and laryngeal carcinoma or palliative treatments. The emergence of the COVID-19 pandemic in late 2019 had a profound impact on healthcare systems worldwide. One significant consequence was the need to adapt cancer treatment protocols to minimize patient exposure to the virus while maintaining treatment efficacy. HFRT, with its potential to shorten treatment duration, became an attractive option during this time. The purpose of this study is to report our preliminary retrospective experience on elderly/frail locally advanced HNC patients treated with HFRT, and to assess how the COVID-19 pandemic influenced treatment duration. We conducted a retrospective analysis of locally advanced HNC patients aged 70 years and older, not candidate to surgery nor chemotherapy and treated with HFRT alone at our Institution from 2021 to 2022. Gross tumor volume (GTV) was determined according to clinical examination, computed-tomography scan (CT), magnetic resonance imaging (MRI), or positron emission tomography scan (PET). Two clinical target volumes (CTV) were identified (high and low risk). HFRT was delivered with a Linear Accelerator (Trilogy, Varian, Palo Alto, CA, USA) with intensity-modulated (IMRT) or volumetric-modulated (VMAT) RT technique and daily image guidance. HFRT regimens included 60 Gy in 25 fractions over 5 weeks (2.4 Gy per fraction) for CTV-high risk and 50 Gy in 25 fractions over 5 weeks (2.0 Gy per fraction) for CTV-low risk. Patients were evaluated by clinical/endoscopic examination and CT or MRI imaging every 3 months after the completion of HFRT. Response to treatment on imaging (complete or partial response, stable disease), overall survival (OS) and Radiation Therapy Oncology Group (RTOG) Toxicity Criteria were assessed. A total of five elderly/frail locally advanced HNC patients were included. The median age was 78 years (range 72-82 years). Patients were staged according to seventh edition of TNM system. Of five patients, three patients had cT3-4 cN2-3 oral cavity SCC, one patient had cT4 parotid gland cancer with cutaneous ulceration and one patient had cT3 cN3b (ipsilateral large lymph node with extracapsular invasion) oropharyngeal SCC. All patients completed the full planned course of HFRT. Acute toxicities according to RTOG scale were grade 2/3 skin toxicity, grade 1/2 dryness of mouth and grade 2 oral mucositis. After a median follow-up of 6.3 months, four patients were alive, one patient with complete response (patient with oropharyngeal SCC), one patient with partial response and two patients with stable disease on imaging. Late toxicities sec. RTOG scale were grade 1/2 skin toxicity and grade 1/2 salivary gland toxicity. In conclusion, HFRT is an evaluable option in the management of elderly/frail HNC patients. With a growing elderly population and the challenges posed by the COVID-19 pandemic, there is a need to explore new treatment strategies that optimize clinical outcomes in this subgroup of patients. This experience has recently been adopted in our daily clinical practice to treat very selected elderly/frail HNC patients not fit to chemo-radiotherapy or access difficulties to our radiation unit center. Future research should focus on HFRT protocols to assess long-term survival and quality of life in elderly/frail HNC patients. [ABSTRACT FROM AUTHOR]