Exercise-induced left bundle branch block is rare and can be demonstrated with exercise testing. When the heart rate reaches a certain threshold, the QRS widens into left bundle branch block. This paper describes a patient with exercise-induced left bundle branch block related angina and dyspnea, who responded to cardiac resynchronization therapy. We documented the potential benefits of cardiac resynchronization therapy with a left ventricular rapid pacing study prior to its implantation. Although exercise-induced left bundle branch block is not a current indication for cardiac resynchronization therapy in patients such as ours, it could be considered when conventional drug therapy fails.

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Objective:To review the outcomes of postoperative radiotherapy (PORT) using three-dimensional conformal techniques in patients with resected pathological N2 (pN2) non-small-cell lung cancer (NSCLC). Methods: Consecutive patients who underwent PORT for resected pN2 NSCLC were retrospectively reviewed. Adjuvant chemotherapy was given before PORT. Locoregional and systemic recurrences, disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Factors associated with DFS and OS were determined using the log-rank test. Results: Eight men and seven women aged 38 to 76 (median, 65) years were included. All had stage IIIA cancer and underwent lobectomy. 12 and three patients had single and multiple mediastinal lymph node station involvement, respectively. The median numbers of resected lymph nodes and lymph node stations were 6 and 4, respectively. Only five patients underwent systematic nodal dissection or sampling. 13 patients underwent adjuvant chemotherapy. The median follow-up period was 31.9 months. Actuarial locoregional control was 100% at 1 year, 92.4% at 2 years, and 82.0% at 3 years. Ten patients had recurrence; all had distant metastases as the first failure event. The median time to recurrence was 12.6 months. DFS was 66.5% at 1 year, 46.5% at 2 years, and 40.0% at 3 years; the median DFS was 14.9 months. OS was 93.5% at 1 year, 66.5% at 2 years, and 51.5% at 3 years; the median OS was 42.4 months. There were nine deaths; eight were cancer-related and one was of unknown cause. Multiple pN2 lymph node station involvement was the only variable that was significant for both DFS and OS. Compared with patients with single pN2 lymph node station involvement, patients with multiple pN2 lymph node station involvement had shorter median DFS (10.9 months vs. 29.2 months, p = 0.008) and median OS (12.1 months vs. 54.1 months, p = 0.003). No patient had grade 3 or above toxicities. Conclusion: PORT using modern techniques and dose fractionation for patients with resected pN2 NSCLC was well tolerated and resulted in a high locoregional control rate, but the rate of distant metastasis remained high. Patients with multiple pN2 lymph node station involvement had worse survival.

Introduction: Choroidal metastasis is the most common intraocular malignancy, which causes visual loss and hence adversely affects patient's quality of life. External beam radiotherapy (RT) remains the treatment of choice. This retrospective study aimed to look at the treatment outcomes and clinical features in patients with choroidal metastases. Methods: It is a retrospective single-centre study. Patients with choroidal metastases diagnosed between 2006 and 2016 were identified from RT treatment database. Treatment outcomes after RT in terms of visual and objective response, median time to response were analysed. Clinical features regarding patients' demographics, cancer and ocular disease characteristics and survival were evaluated. Results: 21 patients with 28 involved eyes were identified. The median age at diagnosis of choroidal metastases was 55 years. The female-to-male ratio was 4:3. Bilateral choroidal metastases were found in seven (33%) patients. Concurrent or subsequent brain metastases were developed in eight (38%) patients. The most common symptom was blurring of vision (95%). The most common primary tumour type was lung carcinoma (n=9, 43%). The median survival was 5 months. The median prescribed biological effective dose was 39 Gy 10 (range, 28-39 Gy 10). Visual improvement was observed in 70% of irradiated eyes. Median time to visual improvement was 3.5 months (range, 2-5 months). Complete and partial remissions were achieved in nine (70%) eyes and two (15%) eyes, respectively. Conclusion: RT can effectively improve vision of patients with choroidal metastases. Prognosis in this group of patient remains poor.

Objectives: Radical radiotherapy or chemoirradiation is the standard of care for International Federation of Gynecology and Obstetrics (FIGO) stage Ib-IVa cervical cancer. However, patients with pelvic or para-aortic nodal metastases have increased chance of recurrence and poor survival compared with those patients with no lymph node involvement. Their optimal management remains unclear. This study aimed at retrospectively evaluating the treatment outcomes of these patients in our unit to identify potential ways of improvement. Methods: From May 2007 to December 2012, 137 consecutive patients with FIGO stage Ib-IVa cervical cancers were treated with radical radiotherapy or chemoirradiation. Radical radiotherapy consisted of whole-pelvic external radiotherapy (ERT) with a median dose of 50 Gy in 2 Gy per fraction (median shield after 40 Gy), highdose-rate intracavitary brachytherapy (6.5 Gy/application for four or 7.7 Gy/application for three at Manchester point A, 2 applications/week) followed by additional external beam parametrial boost of 6 to 8 Gy, if indicated. Involved pelvic lymph nodes were boosted with a total dose of 60 to 64 Gy. Para-aortic nodal metastases were treated upfront by extended anteroposterior-posteroanterior field ERT covering both the para-aortic regions and the whole pelvis with a dose of 30 Gy in 2 Gy per fraction, followed by split-field 3-dimensional conformal boost of 20 Gy. Routine intracavitary brachytherapy, parametrial boost, and pelvic nodal boost were then given, when appropriate. Concurrent chemotherapy, when given, consisted of weekly cisplatin (40 mg/m 2). Treatment outcome parameters including overall survival (OS), cancer-specific survival (CSS), relapse-free survival (RFS), and patterns of failure were evaluated in all patients. Survival data were compared with the log-rank test and prognostic factors were analysed with the Cox proportional hazards regression model. Results: Of the 137 patients, 99 (72%) received chemoirradiation; 37 (27%) had either pelvic and / or paraaortic nodal metastases on radiological or pathological examination. After a median follow-up of 31 (range, 2-72) months, a significantly higher proportion of patients in group A (those with lymph node metastasis, 35%) had disease recurrence than in group B (those without lymph node metastasis, 19%; p = 0.047). Patients in group A had poorer 3-year OS (60%) and CSS (64%) compared with those in group B (OS, 75%, p = 0.08; CSS, 81%, p = 0.051) but the difference did not reach statistical significance. Patients in group A had significantly poorer 3-year RFS (50%) compared with those in group B (RFS, 73%; p = 0.009). FIGO stage III-IVa, presence of nodal metastases, and overall treatment time of more than 56 days were significant poor prognostic factors for both OS and RFS in multivariate analysis. Among patients with relapse, the majority (77% in group A and 84% in group B) developed first recurrence at distant sites with or without local relapse at a median time of 9.6 (range, 1.3-39.6) months. Only four (11...

Introduction:We reviewed the efficacy, toxicities, and prognostic factors of two 3-week cycles of paclitaxelcarboplatin administered concurrently with radiotherapy for treatment of unresectable stage III non-small cell lung cancer (NSCLC). Methods: Cases of unresectable stage III NSCLC treated with chemoradiotherapy using paclitaxel 175 mg/m 2 and carboplatin area under the curve=5 on day 1 of a 21-day cycle concurrently with 6 weeks of radiotherapy (60-66 Gy) from 2007 to 2017 were retrieved. Results: A total of 65 patients (median age=63 years) were included. At a 29.5-month median follow-up, the median overall survival was 35.0 months (95% confidence interval [CI]=17.5-52.5 months). Multivariable Cox regression analyses showed that gross tumour volume (p = 0.001), mean heart dose ≥5 Gy (p = 0.007), and more than four cycles of chemotherapy administered (p = 0.006) were independent negative prognostic factors. The maximum grade toxicity was Grade 2 in 27 patients (41.5%), grade 3 in 13 patients (20.0%) and grade 4 in five patients (7.7%). No grade 5 events were observed. The most common grade 3 or 4 toxicity was neutropenia, which occurred in nine (13.8%) and five (7.7%) patients, respectively. Three patients (4.6%) had neutropenic fever. Grade ≥2 pneumonitis and oesophagitis were seen in five (7.7%) and nine (13.8%) patients, respectively. Conclusion: Two 3-week cycles of paclitaxel-carboplatin given concurrently with radiotherapy for unresectable stage III NSCLC was well-tolerated, with outcomes comparable to historical data, and fewer hospital visits.

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Objective : We performed a systematic review to quantify the cardiovascular risk of adjuvant radiotherapy (RT) for breast cancer. Methods: A literature search was conducted using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception to July 2020. Results: The literature search produced 7363 reports, of which 76 met our inclusion criteria. In studies comparing left-sided RT with right-sided RT, 7 of 35 (20%) studies found increased cardiovascular mortality, and 8 of 28 (29%) studies found increased cardiovascular events. In studies comparing patients who received RT with those who did not, 7 of 26 (27%) studies found increased cardiovascular mortality, and 5 of 22 (23%) studies found increased cardiovascular events. Conclusion:Most of the studies that found significant associations between laterality and cardiovascular risks included treatment periods that started prior to 1985, suggesting that modern RT techniques have minimised the cardiac exposure in breast cancer patients receiving RT. However, more focused studies must be conducted to investigate the long-term cardiovascular risk associated with modern RT techniques.