Solitary fibrous tumors (SFT) are rare unusual ubiquitous soft tissue tumors that are presumed to be of fibroblastic differentiation. At present, the challenge is to establish accurate prognostic ...factors.
A total of 214 consecutive patients with SFT diagnosed in 24 participating cancer centers were entered into the European database (www.conticabase.org) to perform univariate and multivariate analysis for overall survival (OS), local recurrence incidence (LRI) and metastatic recurrence incidence (MRI) by taking competing risks into account. A prognostic model was constructed for LRI and MRI. Internal and external validations of the prognostic models were carried out. An individual risk calculator was carried out to quantify the risk of both local and metastatic recurrence.
We restricted our analysis to 162 patients with local disease. Twenty patients (12.3%) were deceased at the time of analysis and the median OS was not reached. The LRI rates at 10 and 20 years were 19.2% and 38.6%, respectively. The MRI rates at 10 and 20 years were 31.4% and 49.8%, respectively. Multivariate analysis retained age and mitotic count tended to significance for predicting OS. The factors influencing LRI were viscera localization, radiotherapy and age. Mitotic count, tumor localization other than limb and age had independent values for MRI. Three prognostic groups for OS were defined based on the number of unfavorable prognostic factors and calculations were carried out to predict the risk of local and metastatic recurrence for individual patients.
LRI and MRI rates increased between 10 and 20 years so relapses were delayed, suggesting that long-term monitoring is useful. This study also shows that different prognostic SFT sub-groups could benefit from different therapeutic strategies and that use of a survival calculator could become standard practice in SFTs to individualize treatment based on the clinical situation.
To analyze the pattern of failure in relation to pre-treatment
F FDG-PET/CT uptake in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive radio-chemotherapy (RT-CHT).
From ...2012 to 2016, 87 HNSCC patients treated with definitive RT-CHT, with intensity modulated radiation therapy with simultaneous integrated boost, underwent pre-treatment
F FDG-PET/CT (PET
), and MRI/CT for radiotherapy (RT) planning purposes. Patients with local recurrence, received
F FDG-PET/CT, (PET
) at the time of the discovery of recurrence. In these patients, the metabolic target volume (MTV), MTV
and MTV
were segmented on PET images by means of an adaptive thresholding algorithm. The overlapping volume between MTV
and MTV
(MTV
) was generated and the dose coverage of MTV
and MTV
was checked on the planning CT using the D99 and D95 dose metrics. The recurrent volume was defined as: ''In-Field (IF)'', "Marginal recurrence" or ''Out-of-Field (OF)'' if D95 was respectively equal or higher than 95%, D95 was between 95 and 20% or the D95 was less than 20% of prescribed dose.
We found 10/87 patients (11.5%) who had recurrence at primary site. Mean MTV
was 12.2 cc (4.6-28.9 cc), while the mean MTV
was 4.3 cc (1.1-12.7 cc). Two recurrences resulted 100% inside MTV
, 4 recurrences were mostly inside (61-91%) and 4 recurrences were marginal to MTV
(1-33%). At dosimetric analysis, five recurrences (50%) were IF, 4 (40%) marginal and one (10%) OF. The mean D99 of the overlapping volumes MTV
was 68.1 Gy (66.5-69.2 Gy), considering a prescription dose of 70 Gy to the planning target volume (PTV).
Our study shows that the recurrence may originate from the volume with the highest FDG-signal. Tumor relapse in the high-dose volume support the hypothesis that an intensification of the dose on these volumes could be further assessed to prevent local relapse.
The present white paper, referring to the 4th Assisi Think Tank Meeting on breast cancer, reviews state-of-the-art data, on-going studies and research proposals. <70% agreement in an online ...questionnaire identified the following clinical challenges: 1: Nodal RT in patients who have a) 1–2 positive sentinel nodes without ALND (axillary lymph node dissection); b) cN1 disease transformed into ypN0 by primary systemic therapy and c) 1–3 positive nodes after mastectomy and ALND. 2. The optimal combination of RT and immunotherapy (IT), patient selection, IT-RT timing, and RT optimal dose, fractionation and target volume. Most experts agreed that RT- IT combination does not enhance toxicity. 3: Re-irradiation for local relapse converged on the use of partial breast irradiation after second breast conserving surgery. Hyperthermia aroused support but is not widely available. Further studies are required to finetune best practice, especially given the increasing use of re-irradiation.
Display omitted
•Undefined nodal RT indications for non-ALND patients with 1–2 positive SLN.•Undefined nodal RT indications when PST transforms cN1 disease into ypN0.•Undefined nodal RT indications for N + 1–3 mastectomized patients.•Optimal combinations of RT and immunotherapy are as yet unknown.•PBI after second BCS should be proposed for re-irradiation in low-risk patients.•Hyperthermia should be made available for superficial breast cancer recurrencesrecurrences.
Background
Dysphagia is a complication of head and neck cancer patients undergoing radiotherapy (RT). We analysed frequency and severity of swallowing dysfunction and correlated these findings with ...dose–volume histograms (DVHs) of the pharyngeal constrictor muscles.
Methods
A total of 50 patients treated by radical RT were enrolled. DVHs of constrictor muscles were correlated with acute and late dysphagia and with the items of three quality of life questionnaires.
Results
Mean dose to superior and middle constrictor muscles (SCM, MCM), partial volume of SCM and MCM receiving a dose ≥ 50 Gy dose to the whole constrictor muscles ≥ 60 Gy and tumour location were associated to late dysphagia at univariate analysis. Mean dose to the MCM was the only statistically significant predictor of late dysphagia at the multivariable analysis.
Conclusion
The study shows a significant relationship between long-term dysphagia and mean doses to SCM, MCM, whole constrictor muscles, and oropharyngeal tumour. This finding suggests a potential advantage in reducing the RT dose to swallowing structures to avoid severe dysphagia.
A multivariable approach was adopted to study the dependence of the percentage threshold
TH
(
%
)
used to define the boundaries of
F
18
-FDG
positive tissue on emission scan duration (ESD) and ...activity at the start of acquisition
(
A
acq
)
for different target sizes and target-to-background
(
T
/
B
)
ratios. An anthropomorphic model, at least for counting rate characteristics, was used to study this dependence in conditions resembling the ones that can be encountered in the clinical studies. An annular ring of water bags of 3 cm thickness was fitted over an International Electrotechnical Commission (IEC) phantom in order to obtain counting rates similar to those found in average patients. The scatter fraction of the modified IEC phantom was similar to the mean scatter fraction measured on patients, with a similar scanner. A supplemental set of microhollow spheres was positioned inside the phantom. The NEMA NU 2-2001 scatter phantom was positioned at the end of the IEC phantom to approximate the clinical situation of having activity that extends beyond the scanner field of view. The phantoms were filled with a solution of water and
F
18
(12 kBq/mL) and the spheres with various
T
/
B
ratios of 22.5, 10.3, and 3.6. Sequential imaging was performed to acquire PET images with varying background activity concentrations of about 12, 9, 6.4, 5.3, and 3.1 kBq/mL. The ESD was set to 60, 120, 180, and 240 s/bed. Data were fitted using two distinct multiple linear regression models for
sphere
ID
≤
10
mm
and
sphere
ID
>
10
mm
. The fittings of both models were good with an
R
2
of 0.86 in both cases. Neither ESD nor
A
acq
resulted as significant predictors of the
TH
(
%
)
. For
sphere
ID
≤
10
mm
the target size was the most significant predictor of the
TH
(
%
)
, followed by the
T
/
B
ratio, while for
sphere
ID
>
10
mm
the explanatory power of the target size and
T
/
B
ratio were reversed, the
T
/
B
ratio being now the most important predictor of the
TH
(
%
)
. Both the target size and
T
/
B
ratio play a major role in explaining the variance of the
TH
(
%
)
, throughout the whole range of target sizes and
T
/
B
ratios examined. Thus, algorithms aimed at automatic threshold segmentation should incorporate both variables with a relative weight which critically depends on target size.
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