Author: QuadShot News

Top Line: Conventional wisdom is to avoid radiating gross disease for localized breast cancer if at all possible. The Study: This phase 2 trial was designed to upend this decades-long thinking. It enrolled 20 patients with cT1N0 ER+ breast cancer per MRI to receive preoperative ablative radiation of 28.5 Gy in 3 fractions to intact breast tumor. We know, we know, this may seem like a bad idea on its face, as we’ve seen what treating blind to surgical pathology can do. But there were also some reasons this may be beneficial: the thought was treating a small intact tumor…

Read More

This meta-analysis reveals over one-third of women treated for breast cancer in high-income countries experience financial toxicity. Citation(s) Ehsan, JAMA Netw Open 2023

Read More

Modern series have revealed that rates of lymphedema are quite low after de-escalated modern treatments for breast cancer. Here is an interesting, if somewhat complicated, normal tissue complication probability model for lymphedema following breast radiation. Per usual, the two biggest culprits were the number of nodes dissected and the volume of axilla—specifically the ALTJ—receiving at least 35 Gy. An online tool is needed to plug and play numbers to best individualize risk, but in general there were three risk groups based on two risk factors: >10 dissected nodes and ALTJ V35 ≥40%. Rate of lymphedema for the high-risk group (both…

Read More

Top Line: Does a hyaluronic acid rectal spacer reduce GI toxicity from hypofractionated prostate radiation? The Study: SpaceOAR is a polyethylene glycol hydrogel commonly used to displace the anterior rectal wall away from the target volume during prostate radiation. In a randomized trial of 222 patients receiving conventionally fractionated radiation (79.2 Gy in 44 fractions), SpaceOAR reduced late GI toxicity. Hypofractionated RT is increasingly used for intact prostate cancer, but there is a slightly higher rate of GI toxicity than with conventional fractionation. Might a rectal spacer help even more during hypofractionation? In this multicenter, randomized phase 3 trial performed by…

Read More

Here are some helpful tips in overcoming some common pitfalls when performing gynecologic brachytherapy such as obstructing fibroids, retroverted uterus, uterine perforation, and advanced tumors obstructing the cervical os. Citation(s) Bell, Pract Radiat Onol 2023

Read More

Basic science explorations have demonstrated a fascinating synergism whereby the Hepatitis B surface antigen (HBsAg) invigorates the metastatic potential of EBV+ nasopharyngeal cancer cells by promoting them to become more invasive and migratory. This retrospective look at 792 patients with localized nasopharyngeal carcinoma demonstrating a glaring relationship between EBV-DNA levels and subsequent development of mets, but only among the 18% of patients with HBsAg. In fact, those with HBsAg and EBV-DNA levels surpassing ​​6 × 1000 copies/mL had a nearly 10-fold risk of developing mets, more than those with any other clinical risk factor. Citation(s) Li, JAMA Netw Open 2023

Read More

Top Line: At what point are we going to feel comfortable treating unilaterally for localized tonsil cancer The Study: This meta-analysis of 17 studies (mostly retrospective) including 1487 patients receiving unilateral radiation reports a pooled rate of contralateral neck failure of only 1.9%. This is because most patients, as expected, had small tumors. Contralateral neck failure was strongly associated with T stage and was much higher for those who had more advanced tumors (making it difficult to imagine how they were truly well lateralized): 1.3% for T1, 3% for T2, 11% for T3, and 16% for T4. This did not…

Read More

Prophylactic cranial irradiation (PCI) is still the standard for limited stage small cell lung cancer (LS-SCLC), at least until MAVERICK reports at the end of the decade, although there is now a “consider MRI brain surveillance” caveat in the NCCN algorithm. In the meantime, here’s a small series from Henry Ford looking at the last 14 patients treated with SBRT or surgery typically followed by chemo for T1-2N0 LS-SCLC. The point is that none of them got PCI and none have evidence of brain mets on close interval surveillance MRI at a median of 14 months (range 2.4 months to…

Read More

This editorial argues, without reservation, that 36 Gy craniospinal irradiation (CSI) for so-called “high-risk” medulloblastoma should be retired—without further study—given the lack of proven interval benefit over lower dose CSI and the unacceptable long term sequelae with an accompanying article demonstrating “perhaps up to a quarter, and possibly less, of those children originally diagnosed with medulloblastoma were 15-year survivors and not disabled, yet still subject to hypertension, stroke, hearing loss, mental health disorders, or infertility.” Citation(s) Fisher, J Clin Oncol 2023

Read More

Top Line: Do age and comorbidity influence the benefit of short course ADT for prostate cancer? The Study: Prostate cancer treated with radiation almost always benefits from ADT. The problem is that the absolute benefit depends on the relative risk of developing distant metastatic disease or prostate cancer mortality. At ASTRO 2021, the results of RTOG 0815 showed that the addition of 6 months of ADT to dose-escalated prostate radiation for intermediate risk disease reduced biochemical recurrence risk (10% v 21%) but not overall survival (~90%) at 5 years. But we’ve also seen studies that show prostate cancer of any…

Read More