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Purpose/objective(s)Stereotactic body radiation therapy (SBRT) is emerging as a minimally invasive alternative to brachytherapy to deliver highly conformal, dose-­escalated radiation therapy (RT) to the prostate. SBRT alone may not adequately cover the tumor extensions outside the prostate commonly seen in unfavorable prostate cancer. External beam radiation therapy (EBRT) with high dose rate brachytherapy boost is a proven effective therapy for unfavorable prostate cancer. This study reports on early prostate-specific antigen and prostate cancer-specific quality of life (QOL) outcomes in a cohort of unfavorable patients treated with intensity-modulated radiation therapy (IMRT) and SBRT boost.Materials/methodsProstate cancer patients treated with SBRT (19.5 Gy in three fractions) followed by fiducial-guided IMRT (45–50.4 Gy) from March 2008 to September 2012 were included in this retrospective review of prospectively collected data. Biochemical failure was assessed using the Phoenix definition. Patients completed the expanded prostate cancer index composite (EPIC)-26 at baseline, 1 month after the completion of RT, every 3 months for the first year, then every 6 months for a minimum of 2 years.ResultsOne hundred eight patients (4 low-, 45 intermediate-, and 59 high-risk) with median age of 74 years completed treatment, with median follow-up of 4.4 years. Sixty-four percent of the patients received androgen deprivation therapy prior to the initiation of RT. The 3-year actuarial biochemical control rates were 100 and 89.8% for intermediate- and high-risk patients, respectively. At the initiation of RT, 9 and 5% of men felt their urinary and bowel function was a moderate to big problem, respectively. Mean EPIC urinary and bowel function and bother scores exhibited transient declines, with subsequent return to near baseline. At 2 years posttreatment, 13.7 and 5% of men felt their urinary and bowel function was a moderate to big problem, respectively.ConclusionAt 3-year follow-up, biochemical control was favorable. Acute urinary and bowel symptoms were comparable to conventionally fractionated IMRT and brachytherapy. Patients recovered to near their baseline urinary and bowel function by 2 years posttreatment. A combination of IMRT with SBRT boost is well tolerated with minimal impact on prostate cancer-specific QOL.

Background Skull base chordomas and chondrosarcomas are rare tumors traditionally treated by surgical resection and adjuvant radiation therapy (RT). We will discuss data evaluating clinical outcomes of proton therapy in the treatment of skull base chordomas and chondrosarcomas. Methods A literature review was performed using a MEDLINE search from January 1990 to January 2017. Results The published data suggest that the dose intensification allowed by proton therapy has resulted in good clinical outcomes and a tolerable toxicity profile. Conclusion Proton therapy is a modern RT technique that has demonstrated improved preliminary clinical outcomes in the treatment of skull base chordomas and chondrosarcomas compared to conventional radiotherapy, and comparable to other advanced photon‐based RT techniques.

PT achieved superior dose sparing to the heart, lung, and esophagus compared to IMRT for thymic malignancies. Patients treated with PT had few radiation-induced toxicities and similar survival compared to historic proton data.

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Background Cetuximab is a common EGFR monoclonal antibody used with radiotherapy to treat head‐and‐neck cancer. Severe pulmonary toxicity, including interstitial lung disease (ILD), caused by cetuximab is rare. Methods We describe a patient who developed ILD and acute respiratory failure after concurrent chemoradiation with cetuximab for oropharyngeal squamous cell carcinoma, and review the literature. Results A patient developed acute respiratory failure 2 months after starting concurrent chemoradiation with cetuximab and was hospitalized in intensive care after a procedure for progressive respiratory distress. Cultures and serology were negative for infection and radiologic findings were consistent with drug associated pneumonitits. Steroids were administered until the patient was stabilized. The patient fully recovered 1 month after the onset of respiratory distress, although he died of recurrent disease 10 months after completing treatment. Conclusion Although severe pulmonary toxicity caused by EGFR inhibitors has been well described in the literature, ILD caused by cetuximab, an EGFR monoclonal antibody, is rare and not well‐documented. Given its life‐threatening effects, awareness of this potential side effect and early diagnosis is critical.