UNASSIGNED: Although both intensity-modulated radiation therapy (IMRT) and proton beam therapy (PBT) offer effective long-term disease control for localized prostate cancer (PCa), there are limited data directly comparing the 2 modalities.
UNASSIGNED: The data from 334 patients treated with conventionally fractionated (79.2 GyRBE in 44 fractions) PBT or IMRT were retrospectively analyzed. Propensity score matching was used to balance factors associated with biochemical failure-free survival (BFFS). Age, race, and comorbidities (not BFFS associates) remained imbalanced after matching. Univariable and covariate-adjusted multivariable (MVA) Cox regression models were used to determine if modality affected BFFS.
UNASSIGNED: Of 334 patients, 176 (52.7%) were included in the matched cohort with exact matching to National Comprehensive Cancer Network (NCCN) risk group. With a median follow-up time of 9.0 years (interquartile range [IQR]: 7.8-10.2 years), long-term BFFS was similar between the IMRT and PBT matched arms with 8-year estimates of 85% (95% CI: 76%-91%) and 91% (95% CI: 82%-96%, P = .39), respectively. On MVA, modality was not significantly associated with BFFS in both the unmatched (hazard ratio [HR] = 0.75, 95% CI: 0.35-1.63, P = .47) and matched (HR = 0.87, 95% CI: 0.33-2.33, P = .78) cohorts. Prostate cancer-specific survival (PCSS) and overall survival (OS) were also similar (P > .05). However, in an unmatched analysis, the PBT arm had significantly fewer incidences of secondary cancers within the irradiated field (0.6%, 95% CI: 0.0%-3.1% versus 4.5%, 95% CI: 1.8%-9.0%, P = .028).
UNASSIGNED: Both PBT and IMRT offer excellent long-term disease control for PCa, with no significant differences between the 2 modalities in BFFS, PCSS, and OS in matched patients. In the unmatched cohort, fewer incidences of secondary malignancy were noted in the PBT group; however, owing to overall low incidence of secondary cancer and imbalanced patient characteristics between the 2 groups, these data are strictly hypothesis generating and require further investigation.

UNASSIGNED: To report technical details and 15-month outcomes of a patient with node-positive external auditory canal (EAC) squamous cell carcinoma (SCC) treated with definitive intracavitary high-dose-rate (HDR) brachytherapy to primary tumor, and external beam radiotherapy (EBRT) to draining lymphatics.
UNASSIGNED: A 21-year-old male was diagnosed with SCC of the right EAC. The patient underwent definitive HDR intracavitary brachytherapy, 340 cGy/fraction for 14 twice-daily fractions, followed by EBRT using intensity-modulated radiation therapy (IMRT) to cover the grossly enlarged pre-auricular node, ipsilateral intra-parotid, and cervical lymph node levels II and III.
UNASSIGNED: The approved brachytherapy plan had an average high-risk clinical tumor volume (CTV-HR) D90 of 341 cGy with a total dose of 47.7 Gy (BED, 80.3 Gy, EQD2, 66.6 Gy). For the approved IMRT plan, the prescription to the involved right pre-auricular node was 66 Gy in 33 fractions, and more than 95% of the target received at least 62.7 Gy. High-risk nodal regions were simultaneously prescribed: 59.4 Gy in 1.8 Gy fractions, and more than 95% received at least 56.4 Gy. Organs at risk (OARs) were kept below their dose constraints.The patient tolerated both the procedures with no grade ≥ 2 treatment-related adverse events. Grade 1 dermatitis in the right pre-auricular and cervical areas during the course of EBRT was experienced. Fifteen months post-RT, the patient has no evidence of disease, and was noted to have EAC stenosis, which translated to moderate conductive hearing loss of the right ear. Thyroid function was normal at 15 months after EBRT.
UNASSIGNED: This case report illustrates that the delivered definitive radiotherapy is technically feasible, effective, and well-tolerated in patients with SCC of EAC.

Brain metastases of a chondrosarcoma are extremely rare, and treatment remains controversial. A 54-year-old woman had undergone surgical treatment for a femoral chondrosarcoma and its lung metastases. She presented with visual disturbance and dizziness 22 months after the initial surgery; imaging studies of the brain revealed a metastatic tumor in the left parieto-occipital lobe. Surgical tumor resection was performed; however, only 2 months after gross total resection of the tumor, rapid tumor recurrence was observed. Surgical resection was performed again, followed by intensity-modulated radiation therapy. Three months later, another small brain lesion was detected in the right parietal lobe and was treated with gamma knife stereotactic radiosurgery. No recurrence has been reported 20 months after this radiosurgery for brain metastasis. Thus, surgical treatment combined with several adequate radiation therapy sessions may be a viable treatment strategy for brain metastases of chondrosarcomas.

Adenoid cystic carcinoma of the submandibular gland is a relatively rare malignancy of the oral and maxillofacial region. It is an insidious disease characterized by regional spread, perineural invasion, and potential distant metastases. Because of the aggressive nature of this lesion, it is often impossible to completely excise the tumor, necessitating combination therapy of surgery and radiation. The consequences of surgical ablation coupled with radiation treatment can result in complex considerations in the dental care of these patients. This case report outlines a patient who has recovered from multiple surgeries and radiation therapy, requiring mandibular dental implant reconstruction for a return to normal comfort and function.

OBJECTIVE: We evaluated local control and toxicity in patients receiving radiotherapy associated with immune check point inhibitors and analyzed which oligometastatic disease setting benefits the most from local ablation in terms of advantage in overall survival.
METHODS: We retrospectively identified 60 oligoprogressive patients treated with a PD-1 inhibitor in association with radiotherapy on the site of progression (119 lesions).
RESULTS: After a median follow-up of 11.7 months (range=1-39 months), we observed complete response (CR) in 45/119, partial response (RP) in 42/119, and stable disease (SD) in 30/119 patients. Nine radionecrotic events occurred. Two patients experienced grade 3 toxicities and 32 patients reported grade 2 toxicities. The number of radiologically evident metastatic organs in patients who received concomitant PD-1 inhibitors and radiotherapy showed a significant increase in survival (respectively, 73% after 12 months and 47% after 24 months) in patients with 0-3 metastatic organs compared to those with more than 3 organ sites involved (p<0.0001).
CONCLUSIONS: Radiotherapy associated with PD-1 inhibitors is overall safe and efficacious. Patients eligible for intensification of local treatments should have less or equal to 3 metastatic organ sites.

To compare the treatment outcomes between young and adult patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).
We conducted a retrospective case-matched analysis of all patients with non-metastatic NPC ≤20 years treated in our institution between January 2010 and July 2016. Adult patients ≥35 years treated over the same time period were included and matched at a ratio of 1:1 according to N classification, T classification, treatment modality, year of diagnosis, and gender. Survival outcomes and late toxicities were compared between the two groups.
Overall 112 young patients with NPC were included, and 112 out of 3105 consecutive patients with NPC aged ≥35 years were matched. The 5-year overall survival (OS), progression-free survival, locoregional control and distant control of young and control cohorts were 89.1% vs. 79.3% (p = 0.03), 80.3% vs. 67.0% (p = 0.02), 96.4% vs. 84.3% (p < 0.01), and 82.9% vs. 82.8% (p = 0.94), respectively. Multi-variate analysis showed that age ≤20 years was the only significant factor predicting for better OS (HR = 0.5, CI 0.3-0.97, p = 0.04). A trend of higher rate of hypothyroidism (grade 1-2) was observed in the young cohort (67.9% vs. 46.2%, p = 0.08).
Young patients with NPC treated with modern multimodality therapy have better survival outcomes. Age was an independent favorable prognostic factor for NPC in the IMRT era. Further prospective studies are needed to establish optimal management for the young population to minimize and manage long-term side-effects without compromising survival.

OBJECTIVE: To report a case of radiation-induced brachial plexopathy (RIBP) with significant radiographic and clinical improvement after a course of hyperbaric oxygen (HBO).
BACKGROUND: RIBP is a rare complication after radiotherapy to the neck and axilla. There are no standard treatment options, with empirical use pharmacotherapy being predominately used, which has had mixed results.HBO is efficacious for the treatment of other severe radiation-induced side effects, however, its benefit in RIBP has conflicting reports.
METHODS: A 45-year-old male, with a 33 pack-year smoking history, presented with a 6-month history of a progressive left neck mass. The final diagnosis was unknown primary squamous cell carcinoma of the head and neck. He received intensity-modulated radiation therapy (IMRT) with 70 Gy prescribed to the gross tumor volume (PTV HR) and 56 Gy to the oropharynx, nasopharynx, and bilateral lymphatics (PTV SR) in 35 daily fractions with three cycles of concurrent cisplatin at 100 mg/m2.Fifteen months following therapy completion, the patient began to endorse symptoms of left brachial plexopathy. Decadron was prescribed for 2 weeks, trental and vitamin E for 6 months, and HBO. The patient returned for follow-up 2 months after completing 30 dives of HBO at 2.4 atmospheres for 2 hours per session. He reported pain resolution and full range of motion of his left arm.
CONCLUSIONS: The best management strategy of RIBP is prevention by reducing total RT doses and close follow-up. However, when RIBP occurs, we recommend treatment with HBO therapy, steroids, trental, and vitamin E as tolerable.

BACKGROUND: Sinonasal teratocarcinosarcoma is a rare and aggressive malignancy with histological features of both carcinosarcoma and teratoma. The optimal management of this malignancy is unclear, with most patients being managed by a combination of surgery and radiotherapy.
METHODS: We describe an 83-year-old white woman with sinonasal teratocarcinosarcoma of her left nasal cavity treated with surgical debulking initially with radiological evidence of residual disease which was treated with radiotherapy (60 Gy in 30 fractions). A follow-up examination at 2 years showed no evidence of recurrence.
CONCLUSIONS: In cases of sinonasal teratocarcinosarcoma with residual disease post-surgery, radiotherapy alone can be an effective option.

BACKGROUND: Capecitabine has been commonly used in recurrent or metastatic nasopharyngeal carcinoma. However, radiation recall after capecitabine for nasopharyngeal carcinoma has not been reported.
METHODS: We report the case of a 64-year-old Chinese woman with locoregionally advanced nasopharyngeal carcinoma previously treated with induction chemotherapy followed by concurrent chemoradiation 6 years ago. She developed cervical, mediastinal, and abdominal nodal relapses 14 months later. She then received capecitabine with initial excellent tumor response for 1 year but disease recurrence was noticed at the peripancreatic nodal region, which was successfully treated with concurrent chemoradiation with capecitabine. Unfortunately, she developed progressive erythema of the face and neck region at exactly the previous irradiation site for her initial nasopharyngeal carcinoma, 2 months after taking capecitabine. She initially ignored it, but it became more confluent and serious. Eventually, a facial skin biopsy was performed showing nonspecific chronic inflammation only. The diagnosis was most likely radiation recall phenomenon since capecitabine was the only drug she received before development of this dermatological manifestation on her previously irradiated face and neck. Treatment was conservative and supportive albeit with no significant clinical improvement.
CONCLUSIONS: Radiation oncologists should be aware of this potential risk of capecitabine, especially when it is administered for a long period of time.

Craniopharyngiomas (CPs) are rare benign suprasellar tumors. The standard treatment for CP is complete surgical resection or partial resection followed by adjuvant radiotherapy (RT). Adjuvant RT is typically administered at a total dose of 54 Gy with 1.8 Gy/fraction. The current study reported the case of a young patient affected by recurrent craniopharyngioma, who was treated with irradiation subsequent to several surgical resections. Image fusion and intensity-modulated radiation therapy techniques were employed to deliver a high total dose (63 Gy with 2.1 Gy/fraction) with no severe acute toxicities recorded. At the 6-year follow-up, no radiological or clinical signs of disease progression or late sequelae were observed.