Comparison of local recurrence among early breast cancer patients treated with electron intraoperative radiotherapy vs hypofractionated photon radiotherapy: an observational study

Comparison of local recurrence among early breast cancer patients treated with electron intraoperative radiotherapy vs hypofractionated photon radiotherapy: an observational study: PURPOSE: To evaluate local recurrence (LR) in women with early breast cancer (BC) who underwent intraoperative radiation therapy with electrons particles (IORT-E) or adjuvant hypofractionated external radiotherapy (HYPOFX). MATERIALS AND METHODS:We retrospectively analyzed 470 patients with early BC treated at our center from September 2009 to December 2012. 235 women were treated with breast-conserving surgery and immediate IORT-E (21 Gy/1 fraction) while 235 patients underwent wide excision followed by hypofractionated whole breast irradiation. Radiotherapy modality was chosen according an individualized decision based on tumour features, stage, technical feasibility, age, acceptance to be enrolled in the IORT-E group.RESULTS: After a median follow-up of 6 years, we observed 8 (3.4%) and 1 (0.42%) LR in the IORT-E and in the HYPOFX group (p=0.02), respectively. The two groups differed in the prevalence of clinical characteristics (p4 and 1 women in the IORT-E and HYPOFX group died for breast cancer, respectively (p=0.167). OS and DFS hazard ratio [HR] were 2.14 (95% IC, 1.10 to 4.15) and 2.09 (95% IC, 1.17 to 3.73), respectively. CONCLUSIONS:Our comparison showed that IORT-E and HYPOFX are two effective radiotherapy modalities after conservative surgery in early BC. However, at 6 years a significant higher rate of LR occurred in patients submitted to IORT-E with respect to HYPOFX. This finding may be correlated to some subsets of patients who, depending on the biological...

Radiotherapy utilization and fractionation patterns during the first course of cancer treatment in the United States from 2004 to 2014

Radiotherapy utilization and fractionation patterns during the first course of cancer treatment in the United States from 2004 to 2014: The changing use of radiation as a first-line cancer therapy in the United States is poorly characterized. This study aims to report radiotherapy utilization and fractionation patterns during the first course of cancer treatment.

Saving lives with the right dose of radiation

PSAV (prostate specific antigen velocity)

Total PSA (prostate specific antigen) velocity, in ng/mL/year, is the change in total PSA values over time and it is «calculated as the running average of the rate of change during 3 consecutive visits by the equation 0.5{[(PSA2-PSA1)/(elapsed time in years)]+[(PSA3-PSA2)/(elapsed time in years)]}, where PSA1 is the first of the 3 measurements, PSA2 the second and PSA3 the third. Elapsed time refers to time between the 2 measurements [1]».

The rate of change in serum total PSA over time provides useful information and increases the specificity of PSA for cancer detection. Current recommendations for the use of PSAV include a collection of PSA levels over a period of no less than 18 months and the use of multiple values (minimum of 3) to perform the calculation. PSAV «has been best used in younger men who have elected to begin early detection programs before age 50». It «was designed to help avoid unnecessary, costly, and potentially morbid repeat biopsies in these men» [2]. «A rise in PSA of as little as 0.1 ng/ml per year is worrisome as to the long-term chance of being diagnosed with prostate cancer» [2,3]:

PSA Velocity	Prostate Cancer Risk by 10 Years
≤0.1 ng/ml/year	3%
>0.1 ng/ml/year	65%

Source: [2,3].

«Any rapid rise in PSA is worrisome both for the likelihood of developing cancer but of having more serious (high-grade prostate cancer.) A recent study [4] found that men whose PSA jumped more than 2 points in the year prior to being diagnosed had much higher death rate when treated with surgery (radical prostatectomy). Also, patients treated with radiation for prostate cancer whose PSA starts to rise do worse if the PSA doubles in less than 12 months» [2].
In patients with prostate cancer without metastases, those with a rapid PSAV and an otherwise long life expectancy should be encouraged to consider androgen deprivation therapy earlier [5].
A free online calculation can be found here: USRF (Urological Sciences Research Foundation) - PSA Velocity [6], Prostate Cancer Nomograms | Memorial Sloan Kettering Cancer Center [7], and http://www.doubling-time.com/compute-PSA-doubling-time.php [8].

Bibliographic references:

[1] Khan MA, Carter HB, Epstein JI, et al. Can prostate specific antigen derivatives and pathological parameters predict significant change in expectant management criteria for prostate cancer? J Urol. 2003 Dec;170(6 Pt 1):2274-8. Available at: https://doi.org/10.1097/01.ju.0000097124.21878.6b.
[2] PSA Velocity. Aboutcancercom. Available at: http://www.aboutcancer.com/psa_velocity.htm. Accessed June 17, 2018.
[3] Fang J, Metter EJ, Landis P, Carter HB. PSA velocity for assessing prostate cancer risk in men with PSA levels between 2.0 and 4.0 ng/ml. Urology. 2002 Jun;59(6):889-93; discussion 893-4. Available at: https://doi.org/10.1016/S0090-4295(02)01646-1.
[4] D'Amico AV, Chen MH, Roehl KA, Catalona WJ. Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med. 2004 Jul 8;351(2):125-35. Available at: https://doi.org/10.1056/NEJMoa032975.
[5] Mohler J, Lee R, Antonarakis E, et al. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) – Prostate Cancer – Version 2.2018 - March 8, 2018. Nccnorg. 2018. Available at: https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf. Accessed June 17, 2018.
[6] USRF - PSA Velocity. Usrforg. Available at: https://www.usrf.org/questionnaires/PSA_Velocity.html. Accessed June 17, 2018.
[7] Prostate Cancer Nomograms: PSA Doubling Time | Memorial Sloan Kettering Cancer Center. Mskcc.org. https://www.mskcc.org/nomograms/prostate/psa_doubling_time. Accessed October 26, 2018.
[8] PSA Doubling Time Calculator. Doubling-time.com. http://www.doubling-time.com/compute-PSA-doubling-time.php. Accessed October 26, 2018.

Marie Sklodowska Curie’s 150th birthday

Radiation beam to the heart

Source: Hallett M. Radiation beam to the heart - Outlook Magazine. Outlook Magazine. 2018. Available at: https://outlook.wustl.edu/radiation-beam-to-the-heart/. Accessed June 15, 2018.

The winner of the Marie Curie Creative Challenge video contest

The scarcity of funding for radiotherapy trials

Characteristics of radiotherapy trials compared With other oncological clinical trials in the past 10 years.

The limited number of and the scarcity of funding for radiotherapy trials is concerning given the integral role of radiotherapy in the clinical management of patients with cancer worldwide. A multidisciplinary collaboration to promote and fund more radiotherapy research is warranted.

Liu X, Zhang Y, Tang LL, et al. JAMA Oncol. 2018 May 17. Available at: https://doi.org/10.1001/jamaoncol.2018.0887.

Pancoast syndrome or Pancoast's syndrome

«Tumor involving the upper part of the lung, with invasion of the surrounding structures as the plexus brachialis, ribs, and extending in the nodes, possibly causing a Claude-Bernard Horner syndrome. Now currently named superior pulmonary sulcus tumor [1].»

«This is accompanied by the following: severe pain in the shoulder region radiating toward the axilla and scapula, with later extension along the ulnar aspect of the arm to the hand, atrophy of hand and arm muscles, Horner syndrome (...), and compression of the blood vessels with edema [2].»

Bibliographic references:

[1] Debois JM. The Eponyms Of Oncology. Pharmacia & Upjohn; 1996.

[2] D'Silva KJ, May SK. Pancoast Syndrome: Practice Essentials, Pathophysiology, Etiology. Medscape Drugs & Diseases. 2017. Available at: https://emedicine.medscape.com/article/284011-overview. Accessed June 3, 2018.

Horner syndrome, Horner’s syndrome, Claude-Bernard Horner syndrome, or oculosympathetic paresis

Horner syndrome «is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged [1]». It «results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis (ie, constricted pupil [2]», by inactivation of the dilator muscle [1]), partial ptosis [2] (a weak, droopy eyelid, by inactivation of the superior tarsal muscle) [1], «loss of hemifacial sweating (ie, anhidrosis) [2]», «with apparent enophthalmos (inset eyeball) [1]». «The term Horner syndrome is commonly used in English-speaking countries, whereas the term Bernard-Horner syndrome is common in France [2]».

«The nerves of the sympathetic trunk arise from the spinal cord in the chest, and from there ascend to the neck and face. The nerves are part of the sympathetic nervous system, a division of the autonomic (or involuntary) nervous system [1].»

Bibliographic references:

[1] Horner's syndrome. Enwikipediaorg. 2018. Available at: https://en.wikipedia.org/wiki/Horner%27s_syndrome. Accessed June 2, 2018.

[2] Bardorf CM, Stavern GV, Garcia-Valenzuela E. Horner Syndrome: Overview, Anatomy, Pathophysiology. Medscape Drugs & Diseases. 2017. Available at: https://emedicine.medscape.com/article/1220091-overview. Accessed June 2, 2018.