Radiotherapy in Ewing’s Sarcoma Family Tumor — experience from North-East India

Introduction. The multimodality management of Ewing’s Sarcoma Family Tumors (ESFT) consists of neoadjuvant chemotherapy followed by local treatment: surgery, radiotherapy (RT) or a combination of both. The objectives of this study were to analyze disease control and overall survival in patients receiving radiotherapy as local treatment, as part of multimodality management of ESFT at our institute over a period of seven years. Material and methods. This is a retrospective single institutional study. Hospital records were searched for patients with ESFT who received radiotherapy from January, 2012 to December, 2018. Forty-nine patients were found eligible and evaluated with respect to prognostic factors, treatment-related factors and outcomes. Time to event was measured from the date of diagnosis and survival curves were estimated by Kaplan-Meier method and log-rank test for comparison. Results. Median follow up for patients was 18 months (range 3–81 months). Local failure/relapse was associated with worse survival. Five-year local control was 79.1% and overall survival 51.2% in the analyzed cohort. Local control did not differ significantly based on prognostic variables or treatment characteristics. Combined surgery and radiotherapy as local treatment along with good response to neoadjuvant chemotherapy were associated with significant improvement in overall survival (p-value < 0.05). Conclusions. Combined modality local treatment with surgery and radiotherapy along with a favorable response to neoadjuvant chemotherapy are associated with improved survival in ESFT. For unresectable tumors, radiotherapy alone remains the optimum local treatment, albeit with inferior survival outcomes

Navigating Adjuvant Radiotherapy Advancements in Endometrial Cancer within the Molecular Classification Landscape: A Comprehensive Overview

This review’s objective is to consolidate knowledge on key endometrial cancer (EC) biomarkers and their molecular underpinnings within the context of the modern era of molecular classification. The review also encompasses an overview of the molecular subtyping of EC, offers recommendations for treatment approaches, and insights into ongoing radiation trials. By integrating clinical and pathologic features to inform treatment decisions, including concurrent chemoradiation, chemotherapy, targeted therapies, endocrine therapy, and immunotherapy, there is potential to enhance EC management and provide patients with more effective and tailored treatment options. Molecular classification offers the foundation for tailor-made treatment strategies, enabling the development of highly precise and personalized plans. This reduces the utilization of unnecessary treatments, offering the prospect of improved outcomes and ultimately elevating the quality of life for patients with EC

Radiotherapy target volumes in esophageal cancer: The twisting kaleidoscope

Incidence of carcinoma esophagus accounts for approximately 6% of all gastrointestinal malignancies. According to GLOBOCAN 2020 data, 604,100 cases of carcinoma esophagus were detected (3.1% of total cases), and it was the 8th most common cancer in the world. The first choice of treatment for resectable esophageal cancer is surgery. Neoadjuvant radio-chemotherapy improved the overall survival (OS) of patients with advanced carcinomas of the esophagus by about 10% in 5 years, as shown by different studies. In unresectable cases, carcinoma esophagus definitive chemoradiation is the treatment of choice. Determination of the target volume of the esophagus has changed with time due to the advancement of technology. Determining the target volumes accurately is essential to achieve precise dose delivery to the targets. Controversies still exist between different regions and societies regarding target volume determination. However, the choice of the treatment volumes, techniques, and dose for optimal use must be individualized. Patients' disease status, preference, and comorbidities should also be considered while making decisions. This article will review the different target volumes, techniques, and doses used in various large trials used in definitive, neoadjuvant, and adjuvant studies

Synchronous Squamous Cell Carcinoma of the Hypopharynx and Adenocarcinoma of the Lung: A Report of Two Cases Treated with Definitive Radiotherapy

Head and neck squamous cell carcinoma with second primary lung adenocarcinoma is relatively rare. Because of the rarity of such a clinical scenario, there is no standard guideline on the treatment protocol for such patients. Here, we present two cases of synchronous SCC of the hypopharynx and lung adenocarcinoma treated with definitive radiotherapy (RT) to both sites simultaneously. The first case was a 72-year-old male diagnosed synchronously with carcinoma hypopharynx (cT3N3bM0, squamous cell Ca) and carcinoma of the left lung (cT3N0M0, adenocarcinoma). The second case was a 68-year-old male diagnosed synchronously with carcinoma hypopharynx (cT3N3bM0, SCC) and carcinoma of the right lung (cT3N0M, adenocarcinoma). The patients received definitive RT to both primaries using the volumetric modulated arc RT technique. No severe treatment-related toxicities were recorded in any of the patients. The first patient developed local recurrence approximately 5 months after the completion of RT. Definitive RT to both sites, with or without chemotherapy, is a promising treatment modality for such patients. However, careful patient selection is critical when considering this kind of patient for definitive RT

To study the survival outcomes of uncommon recurrences among patients with cervical cancer compared with loco-regional and nodal recurrences at a tertiary care center in North East India – Bridging the knowledge gap in the existing literature.

Background: Recurrence rates of FIGO stage IB-IIA and IIB-IVA cervical cancer 28–64 respectively. There is a scarcity of data on the recurrence recurrence pattern for unusual sites and theirrecurrence pattern for unusual sites and its association with survival and prognosis. Objective: To study overall survival in patients with distant metastasis compared to local and regional nodal metastasis. Methods: A retrospective study was done from 1/1/2017 to 30/12/22. Cervical cancer patients post primary treatments were included. Survival was analyzed with respect to 3 groups local, regional nodalconducted from 1/1/2017 to 30/12/22. Cervical cancer patients who had received primary post-primary treatments were included. Survival was analyzed with respect to three groups: local, regional nodal, and distant metastasis. Results: 225 patients had recurrences post-completion of primary treatment, of which 105 (46.6%)(46.6 %) had local, 46 (20.4%)(20.4 %) had regional nodal, and 74 (33.3%) had distant recurrences. The median time for recurrence in local, regional nodal, and atypical recurrences were 9, 9, and 13 months (p value - <0.05), respectively. Treatment included systemic chemotherapy 122 (54.2%), metronomic therapy 19 (8.4%), palliative radiotherapy 44 (19.5%), palliative surgery 8 (3.5%) and best supportive care 30 (13.3%) patients. Median Time to treatment-death of patients after recurrence in local, nodal and distant recurrences was 17.0 months, 18.0 months and 10.0 months respectively (p value - < 0.05). Overall Survival of patients after primary treatment with local, nodal and distant recurrences was 35.0 months, 47.0 months and 50.0 months respectively (p value <0.05). Conclusion: Local recurrence is most common, followed by regional, nodal, and distant recurrences. Overall survival post recurrence was lowest for distant recurrences and highest for local recurrences however overall survival after primary treatment completion was highest for distant recurrence due to the late presen; however, tation of distant recurrences