There are few comparative outcomes data regarding the therapeutic delivery of proton beam therapy (PBT) versus the more widely used photon-based external-beam radiation (EBRT) and brachytherapy (BT). We evaluated the impact of PBT on overall survival (OS) compared to EBRT or BT on patients with localized prostate cancer.
The National Cancer Data Base (NCDB) was queried for 2004-2015. Men with clinical stage T1-3, N0, M0 prostate cancer treated with radiation, without surgery or chemotherapy, were included. OS, the primary clinical outcome, was fit by Cox proportional hazard model. Propensity score matching was implemented for covariate balance.
There were 276,880 eligible patients with a median follow-up of 80.9 months. A total of 4900 (1.8%) received PBT, while 158,111 (57.1%) received EBRT and 113,869 (41.1%) BT. Compared to EBRT and BT, PBT patients were younger and were less likely to be in the high-risk group. On multivariable analysis, compared to PBT, men had worse OS after EBRT (adjusted hazard ratio [HR] = 1.72; 95% confidence interval [CI], 1.51-1.96) or BT (adjusted HR = 1.38; 95% CI, 1.21-1.58). After propensity score matching, the OS benefit of PBT remained significant compared to EBRT (HR = 1.64; 95% CI, 1.32-2.04) but not BT (adjusted HR = 1.18; 95% CI, 0.93-1.48). The improvement in OS with PBT was most prominent in men ≤ 65 years old with low-risk disease compared to other subgroups (interaction P < .001).
In this national data set, PBT was associated with a significant OS benefit compared to EBRT, and with outcomes similar to BT. These results remain to be validated by ongoing prospective trials.

We report a case of successful salvage radical cystoprostatectomy (RRCP) on a patient with recurrent high-grade T2 transitional cell carcinoma following external-beam radiation and systemic chemotherapy. The effect on tissue planes and the resulting adhesions after external radiation are well-known. While RRCPs have been successfully completed in many academic centers, there have been no reports of using this approach for salvage cystectomy after radiation. The RRCP was performed without complications, and was followed by an extended bilateral pelvic lymph node dissection and creation of an ileal conduit via the midline extraction incision.

Although it is a rare cancer, retinoblastoma has served as an important model in our understanding of genetic cancer syndromes. All patients with a germinal rb1 mutation possess a risk of the development of second malignancies. Approximately 40-50% of all retinoblastoma cases are considered germinal cases and recent work has indicated that nearly all retinoblastoma patients probably demonstrate a degree of mosaicism for the rb1 mutation, and thus are at risk of secondary malignancies. The risk of the development of these cancers continues throughout the patients\' lives due to the loss of a functional RB1 protein and its critical tumor suppressive function in all cells. These cancers can develop in diverse anatomic locations, including the skull and long bones, soft tissues, nasal cavity, skin, orbit, brain, breast and lung. Treatments used for retinoblastoma such as external-beam radiation and chemotherapy can have a significant impact on the risk for and pattern of development of these secondary cancers. Second malignancies are the leading cause of death in germinal retinoblastoma survivors in the USA and thus continue to be an important subject of study in this patient population. Second malignancies following the germinal form of retinoblastoma are the subject of this review.

Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm with a propensity for metastatic spread. When managing MCC, surgical excision is often the initial treatment. As MCC is generally radiosensitive, many institutions include adjuvant radiation therapy (RT) in their standard treatment protocols. In the absence of prospective randomized clinical trials, a number of retrospective reports suggest that adjuvant RT can improve local and regional recurrence rates. Here, we provide an overview of recent studies on the use of RT in MCC treatment and explore the limits of the current knowledge. Ultimately, the benefits and risks associated with using RT in the treatment of MCC remain poorly described and merit more rigorous investigation.