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The use of RT for primary or recurrent ovarian cancer is well tolerated, with durable rates of FFP. RT with palliative intent achieved high rates of symptom palliation without much additional toxicity. RT should be considered for patients with advanced ovarian cancer.
With respect to local control and toxicity, SBRT may be a reasonable method of boosting patients who cannot safely undergo brachytherapy boosts for locally advanced gynecologic malignancies.
Cetuximab may be considered as an alternative to cisplatin with concurrent RT, particularly for patients with locally advanced head and neck squamous cell carcinoma who are not candidates for platinum therapy. These results indicate no difference in patterns of local or distant failure between cetuximab, low-dose weekly cisplatin, or q3 weekly high-dose cisplatin in this patient population.
Excellent 5-year oncologic and functional outcomes were achieved for patients presented in the study. The use of altered fractionation, concurrent chemotherapy, and different radiation techniques did not show any significant differences in outcomes. However, the reduced radiation dose delivered to the carotid arteries using IMRT suggests that it is potentially advantageous for reduction of long-term vascular toxicity and is therefore recommended as the treatment of choice.
Pelvic radiation reduces the risk of pelvic relapse in patients with MMMT and may be indicated with patients at high risk for pelvic recurrence, including patients with cervical involvement, heterologous elements, and stage III disease.
We confirm that analysis of routine CT scans for sarcopenia can predict outcomes for HNSCC patients. Pre-RT sarcopenia is associated with more poor outcomes for nonoperated patients and post-RT sarcopenia for all HNSCC patients. Post-RT sarcopenia, as measured by routine CT, outperformed simple weight loss and BMI-derived cachexia metrics, because loss of lean muscle mass can occur independently of BMI status. These findings suggest the potential benefit for investigating intervention with aggressive nutritional and physiatric methods to prevent sarcopenia during RT and to study how these interventions might affect outcomes in nonoperated, pre-RT sarcopenia patients.
OGCC can exhibit aggressive progression, warranting investigation into multimodal therapy. Given that adjuvant chemoradiation and immunotherapy are associated with improved outcomes in primary head and neck cancer, a similar application in OGCC may help guide optimal treatment. This approach was well tolerated in our pediatric patient, and he remains disease-free at 14 months.
ENB is a rare malignancy, with optimal management remaining uncertain. Our experience suggests that aggressive management seems successful in providing sustained LRC with acceptable long-term toxicity. The role of elective nodal irradiation to the upper neck remains unclear.
A multimodality approach to SGTs with PNI provides excellent LRC. Further studies are warranted to identify the patients at higher risk of LRF and DMs to optimize their management.
This report of adjuvant RT for pediatric salivary gland tumors is one of the largest to date and the only one to document outcomes following proton therapy. Compared with conventional photon/electron-based therapy, proton therapy significantly reduced doses to multiple normal tissues. Moreover, clinically, no grade 3 toxicities were observed in the proton group vs 45% in the photon/electron cohort. Continued follow-up is required to determine long-term outcomes.
Proton therapy for parotid cancers results in very low rates of GI toxicity. Nutritional status and weight were preserved throughout therapy. These results should be validated with patient-reported outcomes.
NCCN guidelines were not followed in 9.4% of patients with early-stage LSCC in 2011, because chemotherapy was added to their RT-based regimen. In these patients, the addition of chemotherapy reduced patient survival by 18%. These results indicate the importance of adherence to NCCN guidelines when prescribing RT-based regimens in the early-stage LSCC setting.
Our results suggest that p16 overexpression can act as a marker for PFS and LRC in EBV-positive nasopharyngeal carcinoma patients. This interesting finding raises the possibility of further stratifying more aggressive phenotypes within EBV-positive tumors. Therefore, molecular testing of p16 expression may complement EBV status to provide more detailed and comprehensive guidance in determining the prognosis and predicting treatment outcomes for patients diagnosed with nasopharyngeal carcinoma.
Definitive CRT or RT is feasible for unresectable, very locally advanced, or medically inoperable PNS/NC cancer with minimal late toxicity. Local disease control is encouraging, with acceptable treatment-related complications, when treating with the described two-phase IMRT treatment technique.
In the HPV+ population, ECE remains a significant risk factor for LRR without adjuvant therapy after MIS. Patients with intermediate-risk disease after MIS have moderate rates of LRR.
With proper preparation and antibiotics, placement of the rectal spacer into the anterior perirectal fat is extremely safe, without any risk of infection, in our series. Also, infections were not found in patients who had rectal wall penetration with the rectal spacer applicator needle.
The data support that SBRT improves local control over standard fractionation schemes. Higher dose per fraction, with a BED in the range of 48 Gy10, is a safe and effective local treatment modality for RCC.
