Radiation oncology is a field of medicine that has been rapidly growing with advances in technology, radiobiology, treatment algorithms and quality of life of modern radiotherapy over the last ...century. In the context of these advances, it is critical to be aware of the role of the young radiation oncologists and enable them to discover new perspectives. For this purpose, "The Young Radiation Oncologists Group" (GROG) has been established by the Turkish Society for Radiation Oncology (TROD), a subgroup which has focused on the professional developments, early career and integrating into the TROD family while supporting education and innovative research of young radiation oncologists. The purpose of this paper was to outline the structure and responsibilities of GROG and its scientific and social activities within TROD and in its own right.
Stereotactic radiosurgery (SRS) is a treatment option in the initial management of patients with brain metastases. While its efficacy has been demonstrated in several prior studies, treatment-related ...complications, particularly symptomatic radiation necrosis (RN), remains as an obstacle for wider implementation of this treatment modality. We thus examined risk factors associated with the development of symptomatic RN in patients treated with SRS for brain metastases.
We performed a retrospective review of our institutional database to identify patients with brain metastases treated with SRS. Diagnosis of symptomatic RN was determined by appearance on serial MRIs, MR spectroscopy, requirement of therapy, and the development of new neurological complaints without evidence of disease progression.
We identified 323 brain metastases treated with SRS in 170 patients from 2009 to 2018. Thirteen patients (4%) experienced symptomatic RN after treatment of 23 (7%) lesions. After SRS, the median time to symptomatic RN was 8.3 months. Patients with symptomatic RN had a larger mean target volume (p<0.0001), and thus larger V100% (p<0.0001), V50% (p<0.0001), V12Gy (p<0.0001), and V10Gy (p=0.0002), compared to the rest of the cohort. Single-fraction treatment (p=0.0025) and diabetes (p=0.019) were also significantly associated with symptomatic RN.
SRS is an effective treatment option for patients with brain metastases; however, a subset of patients may develop symptomatic RN. We found that patients with larger tumor size, larger plan V100%, V50%, V12Gy, or V10Gy, who received single-fraction SRS, or who had diabetes were all at higher risk of symptomatic RN.
BACKGROUND:Robotic surgery is thought to be a solution to overcome the limitations of laparoscopy in sphincter-saving resections. In this study, we present our results on patients undergoing robotic ...and laparoscopic low anterior resection (LAR) consecutively for rectal adenocarcinoma.
MATERIALS AND METHODS:Between February 2008 and June 2011, consecutive patients who underwent laparoscopic or robotic LAR by a single surgical team for rectal cancer were evaluated. The patients’ demographic, operative, postoperative short-term follow-up, and histopathologic data were analyzed.
RESULTS:Twenty-seven patients underwent robotic LAR, whereas 37 patients underwent laparoscopic LAR. The operation time of the laparoscopy group was significantly shorter than that of the robotic group (P=0.02). The complete total mesorectal excision rate was significantly higher in the robotic group (P=0.02). The overall complication rates were 11.11% and 21.62% in the robotic and laparoscopy groups, respectively (P=0.45).
CONCLUSIONS:Good quality of resected specimens could be achieved with robotic LAR. Further prospective studies including long-term oncologic outcomes and costs with higher patient number are definitely needed to assess the benefits of robotic resection in rectal cancer treatment.
In this study, 683 patients with endometrial cancer (EC) after comprehensive surgical staging were classified into four risk groups as low (LR), intermediate (IR), high-intermediate (HIR) and ...high-risk (HR), according to the recent consensus risk grouping. Patients with disease confined to the uterus, ≥50% myometrial invasion (MI) and/or grade 3 histology were treated with vaginal brachytherapy (VBT). Patients with stage II disease, positive/close surgical margins or extra-uterine extension were treated with external beam radiotherapy (EBRT)±VBT. The median follow-up was 56 months. The overall survival (OS) was significantly different between LR and HR groups, and there was a trend between LR and HIR groups. Relapse-free survival (RFS) was significantly different between LR and HIR, LR and HR and IR and HR groups. There was no significant difference in OS and RFS rates between the HIR and HR groups. In HR patients, the OS and RFS rates were significantly higher in stage IB - grade 3 and stage II compared to stage III and non-endometrioid histology without any difference between the two uterine-confined stages and between stage III and non-endometrioid histology. The current risk grouping does not clearly discriminate the HIR and IR groups. In patients with comprehensive surgical staging, a further risk grouping is needed to distinguish the real HR group.
Impact statement
What is already known on this subject? The standard treatment for endometrial cancer (EC) is surgery and adjuvant radiotherapy (RT) and/or chemotherapy is recommended according to risk factors. The recent European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guideline have introduced a new risk group. However, the risk grouping is still quite heterogeneous.
What do the results of this study add? This study demonstrated that the current risk grouping recommended by ESMO-ESGO-ESTRO does not clearly discriminate the intermediate risk (IR) and high-intermediate risk (HIR) groups.
What are the implications of these findings for clinical practice and/or further research? Based on the results of this study, a new risk grouping can be made to discriminate HIR and IR groups clearly in patients with comprehensive surgical staging.
PurposeTo validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8–10 disease treated with external beam radiotherapy (EBRT) + androgen ...deprivation therapy (ADT) in the modern era.MethodsInstitutional databases of biopsy proven 641 patients with GS 8–10 PCa treated between 2000 and 2015 were collected from 11 institutions. In this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. The inclusion criteria were, T1–T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70 Gy total irradiation dose to prostate ± seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT.ResultsThe median follow-up time was 5.9 years (range 0.4–18.2 years); 5‑year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (≥78 Gy) and longer ADT duration (≥2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9–10.ConclusionsOur results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9–10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving ‘non-optimal treatment’ (RT doses <78 Gy and ADT period <2 years) had the worst treatment outcomes.
Purpose
To validate the clinical outcomes and prognostic factors in prostate cancer (PCa) patients with Gleason score (GS) 8–10 disease treated with external beam radiotherapy (EBRT) + androgen ...deprivation therapy (ADT) in the modern era.
Methods
Institutional databases of biopsy proven 641 patients with GS 8–10 PCa treated between 2000 and 2015 were collected from 11 institutions. In this multi-institutional Turkish Radiation Oncology Group study, a standard database sheet was sent to each institution for patient enrollment. The inclusion criteria were, T1–T3N0M0 disease according to AJCC (American Joint Committee on Cancer) 2010 Staging System, no prior diagnosis of malignancy, at least 70 Gy total irradiation dose to prostate ± seminal vesicles delivered with either three-dimensional conformal RT or intensity-modulated RT and patients receiving ADT.
Results
The median follow-up time was 5.9 years (range 0.4–18.2 years); 5‑year overall survival (OS), biochemical relapse-free survival (BRFS) and distant metastases-free survival (DMFS) rates were 88%, 78%, and 79%, respectively. Higher RT doses (≥78 Gy) and longer ADT duration (≥2 years) were significant predictors for improved DMFS, whereas advanced stage was a negative prognosticator for DMFS in patients with GS 9–10.
Conclusions
Our results validated the fact that oncologic outcomes after radical EBRT significantly differ in men with GS 8 versus those with GS 9–10 prostate cancer. We found that EBRT dose was important predictive factor regardless of ADT period. Patients receiving ‘non-optimal treatment’ (RT doses <78 Gy and ADT period <2 years) had the worst treatment outcomes.
BACKGROUND:This study primarily aimed to assess the impact of prolonged neoadjuvant treatment–surgery interval (PNSI) on histopathologic and postoperative outcomes. Impacts of the mode of neoadjuvant ...treatment (NT) and surgery on the outcomes were also evaluated in the same patient population.
PATIENTS AND METHODS:Between February 2011 and December 2017, patients who underwent NT and total mesorectal excision for locally advanced rectal cancer were included. PNSI was defined as >4 and >8 weeks after short-course and long-course NT modalities, respectively.
RESULTS:A total of 44 (27%) patients received short-course NT (standard intervaln=28; PNSIn=16) and 122 (73%) patients received long-course NT (standard intervaln=39; PNSIn=83). Postoperative morbidity was similar between the standard interval and PNSI in patients undergoing short-course n=3 (11%) vs. n=3 (19%), P=0.455 and long-course n=6 (15%) vs. n=16 (19%), P=0.602 NT. PNSI was associated with increased complete pathologic response in patients receiving short-course NT 0 vs. n=5 (31%), P=0.002. Compared with short-course NT, long-course NT was superior in terms of tumor response based on the Mandard Mandard 1 to 2n=6 (21%) vs. 6 (38%), P=0.012 and the College of American Pathologists (CAP) CAP 0 to 1n=13 (46%) vs. n=8 (50%), P=0.009 scores. Postoperative morbidity was similar after open, laparoscopic, and robotic total mesorectal excision n=1 (14.2%) vs. n=21 (21%) vs. n=6 (12.5%), P=0.455 irrespective of the interval time to surgery and the type of NT.
CONCLUSIONS:PNSI can be considered in patients undergoing short-course NT due to its potential oncological benefits. The mode of surgery performed at tertiary centers has no impact on postoperative morbidity after both NT modalities.
Purpose
Stereotactic body radiotherapy (SBRT) is an established treatment technique in the management of medically inoperable early stage non–small cell lung cancer (NSCLC). Different techniques such ...as volumetric modulated arc (VMAT) and three‐dimensional conformal arc (DCA) can be used in SBRT. Previously, it has been shown that VMAT is superior to DCA technique in terms of plan evaluation parameters. However, DCA technique has several advantages such as ease of use and considerable shortening of the treatment time. DCA technique usually results in worse conformity which is not possible to ameliorate by inverse optimization. In this study, we aimed to analyze whether a simple method – deformable margin delineation (DMD) – improves the quality of the DCA technique, reaching similar results to VMAT in terms of plan evaluation parameters.
Methods
Twenty stage I–II (T1‐2, N0, M0) NSCLC patients were included in this retrospective dosimetric study. Noncoplanar VMAT and conventional DCA plans were generated using 6 MV and 10 MV with flattening filter free (FFF) photon energies. The DCA plan with 6FFF was calculated and 95% of the PTV was covered by the prescription isodose line. Hot dose regions (receiving dose over 100% of prescription dose) outside PTV and cold dose regions (receiving dose under 100% of prescription dose) inside PTV were identified. A new PTV (PTV‐DMD) was delineated by deforming PTV margin with respect to hot and cold spot regions obtained from conventional DCA plans. Dynamic multileaf collimators (MLC) were set to PTV‐DMD beam eye view (BEV) positions and the new DCA plans (DCA‐DMD) with 6FFF were generated. Three‐dimensional (3D) dose calculations were computed for PTV‐DMD volume. However, the prescription isodose was specified and normalized to cover 95% volume of original PTV. Several conformity indices and lung doses were compared for different treatment techniques.
Results
DCA‐DMD method significantly achieved a superior conformity index (CI), conformity number (CIPaddick), gradient index (R50%), isodose at 2 cm (D2 cm) and external index (CΔ) with respect to VMAT and conventional DCA plans (P < 0.05 for all comparisons). CI ranged between 1.00–1.07 (Mean: 1.02); 1.00–1.18 (Mean: 1.06); 1.01–1.23 (Mean 1.08); 1.03–1.29 (Mean: 1.15); 1.04–1.29 (Mean: 1.18) for DCA‐DMD‐6FFF, VMAT‐6FFF, VMAT‐10FFF DCA‐6FFF and DCA‐10FFF respectively. DCA‐DMD‐6FFF technique resulted significantly better CI compared to others (P = 0.002; < 0.001; < 0.001; < 0.001). R50% ranged between 3.22–4.74 (Mean: 3.99); 3.24–5.92 (Mean: 4.15) for DCA‐DMD‐6FFF, VMAT‐6FFF, respectively. DCA‐DMD‐6FFF technique resulted lower intermediate dose spillage compared to VMAT‐6FFF, though the difference was statistically insignificant (P = 0.32). D2 cm ranged between 35.7% and 67.0% (Mean: 53.2%); 42.1%–79.2% (Mean: 57.8%) for DCA‐DMD‐6FFF, VMAT‐6FFF respectively. DCA‐DMD‐6FFF have significantly better and sharp falloff gradient 2 cm away from PTV compared to VMAT‐6FFF (P = 0.009). CΔ ranged between 0.052 and 0.140 (Mean: 0.085); 0,056–0,311 (Mean: 0.120) for DCA‐DMD, VMAT‐6FFF, respectively. DCA‐DMD‐6FFF have significantly improved CΔ (P = 0.002). VMAT‐ V20 Gy, V2.5 Gy and mean lung dose (MLD) indices are calculated to be 4.03%, 23.83%, 3.42 Gy and 4.19%, 27.88%,3.72 Gy, for DCA‐DMD‐6FFF and DCA techniques, respectively. DCA‐DMD‐6FFF achieved superior lung sparing compared to DCA technique. DCA‐DMD‐6FFF method reduced MUs 44% and 33% with respect to VMAT‐6FFF and 10FFF, respectively, without sacrificing dose conformity (P < 0.001; P < 0.001).
Conclusions
Our results demonstrated that DCA plan evaluation parameters can be ameliorated by using the DMD method. This new method improves DCA plan quality and reaches similar results with VMAT in terms of dosimetric parameters. We believe that DCA‐DMD is a simple and effective technique for SBRT and can be preferred due to shorter treatment and planning time.
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