PURPOSE: The role of radiotherapy (RT) was largely deserted after the introduction of platinum-based chemotherapy, but still survival rates are disappointingly low. This study focuses on assessing the clinical efficacy of RT in relation to chemotherapy resistance. MATERIALS AND METHODS: From October 2002 to January 2015, 44 patients were diagnosed with epithelial ovarian cancer (EOC) and treated with palliative RT for persistent or recurrent EOC. All patients received initial treatment with optimal debulking surgery and adjuvant platinum-based chemotherapy. The biologically effective dose (BED) was calculated with α/β set at 10. Ninety-four sites were treated with RT with a median BED of 50.7 Gy (range 28.0 to 79.2 Gy). The primary end-point was the in-field local control (LC) interval, defined as the time interval from the date RT was completed to the date any progressive or newly recurring disease within the RT field was detected on radiographic imaging. RESULTS: The median follow-up duration was 52.3 months (range 7.7 to 179.0 months). The 1-year and 2-year in-field LC rates were 66.0% and 55.0%, respectively. Comparisons of percent change of in-field tumor response showed similar distribution of responses among chemoresistant and chemosensitive tumors. On multivariate analysis of predictive factors for in-field LC analyzed by sites treated, BED ≥ 50 Gy (hazard ratio, 0.4; confidence interval, 0.2–0.9; p = 0.025) showed better outcomes. CONCLUSION: Regardless of resistance to platinum-based chemotherapy, RT can be a feasible treatment modality for patients with persistent of recurrent EOC. The specific role of RT using updated approaches needs to be reassessed.
Drug Therapy ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Ovarian Neoplasms* ; Palliative Care ; Radiotherapy ; Survival Rate ; Treatment Outcome

Purpose: This study assessed and compared the dosimetric performance of HyperArc and RapidArc in stereotactic radiosurgery (SRS) for a single brain metastasis. Methods: Twenty patients with intracranial brain metastases, each presenting a distinct target volume, were retrospectively selected. Subsequently, volumetric modulated arc therapy (VMAT) plans were designed using RapidArc (VMATRA ) and HyperArc (VMATHA ) for each patient. For planning comparisons, dose-volumetric histogram (DVH) parameters for planning target volumes (PTVs) and normal brain regions were computed across all VMAT plans. Subsequently, their total monitor units (MUs), total beam-on times, and modulation complexity scores for the VMAT (MCSv ) were compared. A statistical test was used to evaluate the dosimetric disparities in the DVHparameters, total MUs, total beam-on times, and MCSv between the MATHA and VMAT sub>RA plans. Results: For the PTVs, VMATHA presented a higher homogeneity index (HI) than VMAT RA . Moreover, VMATHA presented significantly smaller gradient index (GI) values (P<0.001) than VMATRA . Thus, VMATHA demonstrated better performance in the DVH parameters for the PTV than VMATRA . For normal brain tissues, VMATHA presented lower volume receiving 50% of the prescription dose and V 2Gy to the normal brain tissues than VMATRA (P<0.0001). While the total MUs required for VMATHA was significantly higher than those for VMATRA , the total beam-on time for VMATHA was superior to that for VMATRA . Conclusions Thus, VMATHA exhibited superior performance in achieving rapid dose fall-offs (as indicated by the GI) and a higher HI at the PTV compared to VMATRA in brain SRS. This advancement positions HyperArc as a significant development in the field of radiation therapy, offering optimized treatment outcomes for brain SRS.

Purpose: This study assessed and compared the dosimetric performance of HyperArc and RapidArc in stereotactic radiosurgery (SRS) for a single brain metastasis. Methods: Twenty patients with intracranial brain metastases, each presenting a distinct target volume, were retrospectively selected. Subsequently, volumetric modulated arc therapy (VMAT) plans were designed using RapidArc (VMATRA ) and HyperArc (VMATHA ) for each patient. For planning comparisons, dose-volumetric histogram (DVH) parameters for planning target volumes (PTVs) and normal brain regions were computed across all VMAT plans. Subsequently, their total monitor units (MUs), total beam-on times, and modulation complexity scores for the VMAT (MCSv ) were compared. A statistical test was used to evaluate the dosimetric disparities in the DVHparameters, total MUs, total beam-on times, and MCSv between the MATHA and VMAT sub>RA plans. Results: For the PTVs, VMATHA presented a higher homogeneity index (HI) than VMAT RA . Moreover, VMATHA presented significantly smaller gradient index (GI) values (P<0.001) than VMATRA . Thus, VMATHA demonstrated better performance in the DVH parameters for the PTV than VMATRA . For normal brain tissues, VMATHA presented lower volume receiving 50% of the prescription dose and V 2Gy to the normal brain tissues than VMATRA (P<0.0001). While the total MUs required for VMATHA was significantly higher than those for VMATRA , the total beam-on time for VMATHA was superior to that for VMATRA . Conclusions Thus, VMATHA exhibited superior performance in achieving rapid dose fall-offs (as indicated by the GI) and a higher HI at the PTV compared to VMATRA in brain SRS. This advancement positions HyperArc as a significant development in the field of radiation therapy, offering optimized treatment outcomes for brain SRS.

Purpose: This study assessed and compared the dosimetric performance of HyperArc and RapidArc in stereotactic radiosurgery (SRS) for a single brain metastasis. Methods: Twenty patients with intracranial brain metastases, each presenting a distinct target volume, were retrospectively selected. Subsequently, volumetric modulated arc therapy (VMAT) plans were designed using RapidArc (VMATRA ) and HyperArc (VMATHA ) for each patient. For planning comparisons, dose-volumetric histogram (DVH) parameters for planning target volumes (PTVs) and normal brain regions were computed across all VMAT plans. Subsequently, their total monitor units (MUs), total beam-on times, and modulation complexity scores for the VMAT (MCSv ) were compared. A statistical test was used to evaluate the dosimetric disparities in the DVHparameters, total MUs, total beam-on times, and MCSv between the MATHA and VMAT sub>RA plans. Results: For the PTVs, VMATHA presented a higher homogeneity index (HI) than VMAT RA . Moreover, VMATHA presented significantly smaller gradient index (GI) values (P<0.001) than VMATRA . Thus, VMATHA demonstrated better performance in the DVH parameters for the PTV than VMATRA . For normal brain tissues, VMATHA presented lower volume receiving 50% of the prescription dose and V 2Gy to the normal brain tissues than VMATRA (P<0.0001). While the total MUs required for VMATHA was significantly higher than those for VMATRA , the total beam-on time for VMATHA was superior to that for VMATRA . Conclusions Thus, VMATHA exhibited superior performance in achieving rapid dose fall-offs (as indicated by the GI) and a higher HI at the PTV compared to VMATRA in brain SRS. This advancement positions HyperArc as a significant development in the field of radiation therapy, offering optimized treatment outcomes for brain SRS.

Purpose: This study assessed and compared the dosimetric performance of HyperArc and RapidArc in stereotactic radiosurgery (SRS) for a single brain metastasis. Methods: Twenty patients with intracranial brain metastases, each presenting a distinct target volume, were retrospectively selected. Subsequently, volumetric modulated arc therapy (VMAT) plans were designed using RapidArc (VMATRA ) and HyperArc (VMATHA ) for each patient. For planning comparisons, dose-volumetric histogram (DVH) parameters for planning target volumes (PTVs) and normal brain regions were computed across all VMAT plans. Subsequently, their total monitor units (MUs), total beam-on times, and modulation complexity scores for the VMAT (MCSv ) were compared. A statistical test was used to evaluate the dosimetric disparities in the DVHparameters, total MUs, total beam-on times, and MCSv between the MATHA and VMAT sub>RA plans. Results: For the PTVs, VMATHA presented a higher homogeneity index (HI) than VMAT RA . Moreover, VMATHA presented significantly smaller gradient index (GI) values (P<0.001) than VMATRA . Thus, VMATHA demonstrated better performance in the DVH parameters for the PTV than VMATRA . For normal brain tissues, VMATHA presented lower volume receiving 50% of the prescription dose and V 2Gy to the normal brain tissues than VMATRA (P<0.0001). While the total MUs required for VMATHA was significantly higher than those for VMATRA , the total beam-on time for VMATHA was superior to that for VMATRA . Conclusions Thus, VMATHA exhibited superior performance in achieving rapid dose fall-offs (as indicated by the GI) and a higher HI at the PTV compared to VMATRA in brain SRS. This advancement positions HyperArc as a significant development in the field of radiation therapy, offering optimized treatment outcomes for brain SRS.

Purpose: This study assessed and compared the dosimetric performance of HyperArc and RapidArc in stereotactic radiosurgery (SRS) for a single brain metastasis. Methods: Twenty patients with intracranial brain metastases, each presenting a distinct target volume, were retrospectively selected. Subsequently, volumetric modulated arc therapy (VMAT) plans were designed using RapidArc (VMATRA ) and HyperArc (VMATHA ) for each patient. For planning comparisons, dose-volumetric histogram (DVH) parameters for planning target volumes (PTVs) and normal brain regions were computed across all VMAT plans. Subsequently, their total monitor units (MUs), total beam-on times, and modulation complexity scores for the VMAT (MCSv ) were compared. A statistical test was used to evaluate the dosimetric disparities in the DVHparameters, total MUs, total beam-on times, and MCSv between the MATHA and VMAT sub>RA plans. Results: For the PTVs, VMATHA presented a higher homogeneity index (HI) than VMAT RA . Moreover, VMATHA presented significantly smaller gradient index (GI) values (P<0.001) than VMATRA . Thus, VMATHA demonstrated better performance in the DVH parameters for the PTV than VMATRA . For normal brain tissues, VMATHA presented lower volume receiving 50% of the prescription dose and V 2Gy to the normal brain tissues than VMATRA (P<0.0001). While the total MUs required for VMATHA was significantly higher than those for VMATRA , the total beam-on time for VMATHA was superior to that for VMATRA . Conclusions Thus, VMATHA exhibited superior performance in achieving rapid dose fall-offs (as indicated by the GI) and a higher HI at the PTV compared to VMATRA in brain SRS. This advancement positions HyperArc as a significant development in the field of radiation therapy, offering optimized treatment outcomes for brain SRS.

Hypofractionated whole breast irradiation (HF-WBI) has been proved effective and safe and even better for late or acute radiation toxicity for early breast cancer. Moreover, it improves patient convenience, quality of life and is expected to be advantageous in the medical care system by reducing overall cost. In this review, we examined key randomized trials of HF-WBI, focusing on adequate patient selection as suggested by the American Society of Therapeutic Radiology and Oncology (ASTRO) guideline and the radiobiologic aspects of HF-WBI in relation to its adoption into clinical settings. Further investigation to identify the current practice pattern or cost effectiveness is warranted under the national health insurance service system in Korea.
Breast Neoplasms* ; Breast* ; Cost-Benefit Analysis ; Dose Hypofractionation ; Humans ; Korea ; Mastectomy, Segmental* ; National Health Programs ; Patient Selection ; Quality of Life ; Radiation Oncology ; Radiotherapy

PURPOSE: The purpose of this study is to report on the incidence and the experience in management of radiation-induced sarcoma (RIS) at a large single center in Korea for 15 years. MATERIALS AND METHODS: We retrospectively reviewed the sarcoma registry of a large institution from January 2000 to April 2014. RESULTS: Out of the 3,674 patients listed in the registry, 33 patients (0.9%) diagnosed with RIS were identified. The median latency of RIS was 12.1 years. The number of cases of RIS increased from four cases in the years 2000-2003 to 14 cases in the years 2012-2014. The most common histology was osteosarcoma (36.4%). The median follow-up period was 23.1 months, the median overall survival (OS) of all patients was 2.9 years, and their 5-year survival rate was 44.7%. Univariate and multivariate analyses showed association of the age at diagnosis (p=0.01) and the treatment aim (p=0.001) with the OS. The median OS and the 5-year survival rate of patients treated with curative surgery (n=19) were 9.6 years and 65%, respectively, and of the conservatively treated patients, 0.7 years and 0% (n=14). Re-irradiation was delivered to nine patients, and radiation toxicity was observed in five patients. CONCLUSION: In this study, RIS accounted for 0.9% of the cases of sarcoma, with increasing incidence. Despite the association of curative resection with increased survival, it could be applied to only 58% of the patients. Considering the limited treatment options for RIS, conduct of a genetic study to identify the underlying mechanism of RIS is needed.
Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Multivariate Analysis ; Neoplasms, Radiation-Induced ; Osteosarcoma ; Retrospective Studies ; Sarcoma* ; Survival Rate ; Tertiary Care Centers*

Purpose: It is well known that the majority of the extranodal marginal zone lymphomas of mucosa-associated lymphoid tissues (MALT lymphomas) are associated with microbiota, e.g., gastric MALT lymphoma with Helicobacter pylori. In general, they are very sensitive to low-dose radiotherapy and chemotherapeutic agents. The microbiota profile is not clearly elucidated in bronchus-associated lymphoid tissue (BALT) lymphoma, a rare type of MALT lymphoma in the lung. Thus, this study aimed to clarify the intratumor microbiome in BALT lymphoma using the third-generation next-generation sequencing (NGS) method. Materials and Methods: DNAs were extracted from 12 formalin-fixed paraffin-embedded (FFPE) tumor tissues obtained from BALT lymphoma patients diagnosed between 1990 and 2016. 16S rRNA gene was amplified by polymerase chain reaction. Amplicons were sequenced using a Nanopore platform. Next-generation sequencing analysis was performed to assess microbial profiles. For comparison, FFPE specimens from nine non-cancerous lung tissues were also analyzed. Results: Specific bacterial families including Burkholderiaceae, Bacillaceae, and Microbacteriaceae were associated with BALT lymphoma by a linear discriminant analysis effect size approach. Although the number of specimens was limited, BALT lymphomas exhibited significantly higher microbial abundance and diversity with distinct microbial composition patterns and correlation networks than non-cancerous lung tissues. Conclusion This study provides the first insight into intratumor microbiome in BALT lymphoma using the third-generation NGS method. A distinct microbial composition suggests the presence of a unique tumor microenvironment of BALT lymphoma.

Purpose: It is well known that the majority of the extranodal marginal zone lymphomas of mucosa-associated lymphoid tissues (MALT lymphomas) are associated with microbiota, e.g., gastric MALT lymphoma with Helicobacter pylori. In general, they are very sensitive to low-dose radiotherapy and chemotherapeutic agents. The microbiota profile is not clearly elucidated in bronchus-associated lymphoid tissue (BALT) lymphoma, a rare type of MALT lymphoma in the lung. Thus, this study aimed to clarify the intratumor microbiome in BALT lymphoma using the third-generation next-generation sequencing (NGS) method. Materials and Methods: DNAs were extracted from 12 formalin-fixed paraffin-embedded (FFPE) tumor tissues obtained from BALT lymphoma patients diagnosed between 1990 and 2016. 16S rRNA gene was amplified by polymerase chain reaction. Amplicons were sequenced using a Nanopore platform. Next-generation sequencing analysis was performed to assess microbial profiles. For comparison, FFPE specimens from nine non-cancerous lung tissues were also analyzed. Results: Specific bacterial families including Burkholderiaceae, Bacillaceae, and Microbacteriaceae were associated with BALT lymphoma by a linear discriminant analysis effect size approach. Although the number of specimens was limited, BALT lymphomas exhibited significantly higher microbial abundance and diversity with distinct microbial composition patterns and correlation networks than non-cancerous lung tissues. Conclusion This study provides the first insight into intratumor microbiome in BALT lymphoma using the third-generation NGS method. A distinct microbial composition suggests the presence of a unique tumor microenvironment of BALT lymphoma.