Practice pointsr Locoregional breast recurrences still occur in more or less 5-20% of patients despite receiving adjuvant radiotherapy. r Resection alone provides limited local control with approximately 33% at 5-years compared to 42% with resection plus other oncologic treatments necessitating curative intent multidisciplinary approach. r Hyperthermia (HT) is the use of elevated temperature to the degrees of 40-44 • C for 30-60 min. The addition of HT to ionizing radiation results in a synergistic effect called radiosensitization. r Toxicity related to HT includes generally second-and third-degree skin and subcutaneous burns, which are usually self-limited making this combination a favorable easy to use modality. r Data addressing the use of HT in locoregional breast recurrences (LRBR) is well-validated and includes randomized trials and meta-analysis. r Thermoradiotherapy enhances local control rates in LRBR with minimal acute, late morbidity and is even more effective in previously irradiated group. r Two trials conducted by European Society for Hyperthermic Oncology will further clarify the multimodal treatment with chemotherapy in R1/R2 resection and neoadjuvant use of thermoradiotherapy.Breast cancer is a second common form of malignancy and is one of the leading causes of mortality among cancer patients across the world. Locoregional recurrence occurs in 5-20% of patients despite upfront treatment. Local therapy (surgery plus minus re-irradiation) with or without systemic therapy is generally recommended for management. Local control rates vary; months to years, but a significant percentage lives 5 years. Therefore, treatment strategies to increase response rates are significant. Hyperthermia is one of the most potent radiosensitizers and data from meta-analysis and randomized trials support its use with radiotherapy. This study reviews the biologic rationale and clinical evidence about concomitant use of hyperthermia and radiotherapy in locally-recurrent breast cancer patients. Chest wall or whole breast irradiation with or without regional nodal sites is indicated after modified radical mastectomy and breast conserving surgery (BCS), respectively. Although adjuvant radiotherapy (RT) effectively reduces locoregional recurrences, data from randomized trials have demonstrated that this type of recurrences still occur in more or less 5-20% of patients despite receiving adjuvant RT after surgery (mastectomy or BCS) [1][2][3][4][5][6].Although locally-recurrent breast cancer (LRBC) is usually accompanied by concurrent or subsequent distant metastases [3,7,8], a significant percentage, more than 50% live 5 years [9]. In a retrospective study of 145 patients with isolated locoregional recurrence of breast cancer following modified radical mastectomy without evidence of distant metastases, 5-year survival rates were 42% overall but it was 100% for a highly favorable subgroup [10].

Background Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients’ procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT’s efficacy as well as the value of using a blanking period following a SBRT session. Methods Eight patients (mean age 58 ± 14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area. Results During a median follow-up of 8 months, all patients demonstrated VT recurrences; however, implantable cardioverter-defibrillator (ICD) and anti-tachycardia pacing therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p = 0.047; 18.50 to 3.29/per month, p = 0.036, respectively). While analyzing the temporal SBRT outcomes, the 2 weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes. Conclusions Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT does not seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm.

In patients with mechanical aortic and mitral valves and left ventricular (LV) tachycardia (VT), catheter ablation is technically challenging due to the limited access to the LV. Promising new alternatives to radiofrequency ablation include pulsed-field electroporation, percutaneous or surgical sympathetic neuromodulation, and noninvasive stereotactic radioablation therapy (SBRT). We herein describe the effect of SBRT as a bailout therapy on the management of a challenging VT case in the presence of double left-sided mechanical valves.

Background: This study aimed to evaluate acute toxicity and oncological outcomes of breast cancer patients who underwent adjuvant radiotherapy (RT) with tomotherapy. Materials and methods:The results of 114 patients who underwent adjuvant RT with Tomotherapy device between 17.08.10-12.06.2021 in XXX Hospital were evaluated retrospectively. The primary endpoint of the study was acute adverse events, and the secondary endpoints were overall survival (OS) and disease-free survival (DFS). Results:The results of 103 patients who met the inclusion criteria were analyzed. The median follow-up was 21 (range 1-125.8) months. Grade +3 esophagitis was not observed in any patient; no esophagitis was observed in 60 (58.3%) patients. Grade 3 dermatitis was observed in 3 (2.9%) patients. In addition, dermatitis was not observed in 47 (45.6%) patients. The relationship between chest wall volume and esophagitis development was statistically significant (p = 0.006; Z score: -2769). The median OS was 24.1 (range 1-128.5) and median disease-free survival was 21.1 (range 1-125.8) months. Five patients (4.9%) died and 9 patients (8.7%) relapsed. Local recurrence was observed in only 1 (1%) patient. There was a statistically significant correlation between OS and contralateral lung V20 dose [p < 0.001; Spearman Correlation Coefficient (SCC) -406) and heart mean dose (p < 0.001; SCC -370)]. There was a statically significant correlation between DFS and cN (p < 0.001); pN (p < 0.001); heart mean dose (p < 0.001; SCC -351); contralateral lung V5 dose (p = 0.041; SCC -213); contralateral lung V20 dose (p < 0.001; SCC -434). Conclusion:Acute toxicity results show improvement in breast cancer adjuvant radiotherapy with helical tomotherapy.

Background: Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients' procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT's efficacy as well as the value of using a blanking period following a SBRT session.Methods: Eight patients (mean age 58 ±14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area.Results: During a median follow-up of 8 months, all patients demonstrated VT recurrences, however, implantable cardioverter-defibrillator (ICD) therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p=0.047; 18.50 to 3.29/per month, p=0.036, respectively). While analyzing the temporal SBRT outcomes, the two weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes. Conclusions: Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT doesn’t seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm.

The study aimed to evaluate the efficacy of targeted therapies used as the third-line treatment after first-line cytokine and second-line tyrosine kinase inhibitor (TKI) therapies in metastatic renal cell carcinoma (mRCC) patients and assess the quality of life (QoL) of patients. Material and Methods: This national, multicenter, non-interventional study included patients aged ≥18 years with histologically confirmed mRCC, receiving targeted therapies as the third-line treatment for the last one month. Overall survival (OS), progression-free survival (PFS), adverse events (AEs), and QoL were evaluated. Results: The study included 102 mRCC patients (74 males) (median age of 61 years). The median disease duration since diagnosis was 27.5 months (ranging 4-201 months). Of all the patients, 75.5% and 24.5% were receiving Axitinib and Everolimus, respectively, as third-line therapy. In all patients, the one-year PFS and OS rates were 62.9% and 79.9%, respectively. Seventy-one AEs (mostly mild) developed in 29 (28.4%) patients, fatigue being the most common (9.8%) AE. As compared to the baseline, no significant change was observed in the QoL scores of patients in the 12 th month. The Axitinib and Everolimus groups did not differ significantly as regards to PFS and OS. Of the 11 patients with grade III-IV AEs, four were from the Everolimus group, and seven belonged to the Axitinib group. The QoL scores did not show a significant difference between the two groups except for that in the 12 th month. Conclusion: Third-line therapy in mRCC patients was found to be effective and tolerable. Prolonged survival in mRCC patients receiving an increasing number of therapy lines requires further evaluation of QoL, considering it to be a part of treatment assessment.

Purpose: This study aimed to report the adjuvant radiotherapy results of pediatric patients with Ewing sarcoma who received multimodal treatment for this rare disease using modern radiotherapy (RT) techniques. Materials and Methods: Pediatric patients with Ewing Sarcoma (ES) who received adjuvant radiotherapy were evaluated retrospectively. The study's primary endpoint was Overall Survival (OS) and disease-free survival (DFS). The secondary endpoint was local relapse-free survival after RT (LRFS- RT) and overall survival after RT (OS-RT). Results: The results of 18 pediatric patients diagnosed with Ewing Sarcoma in our clinic between 09.12.2013- 04.04.2021 and underwent RT for adjuvant were evaluated retrospectively. The three patients were excluded since they did not meet the inclusion criteria. The median age of the patients at the time of diagnosis was 10.5 (range 3-17). All the patients received pre-RT chemotherapy according to EURO-EWING 99. All the patients were operated and 7 (46.7 %) patients were R0; 4 (26.7%) patients were R1, and 4 (26.7%) patients were R2. RT was administered to patients for adjuvant purposes. The time from diagnosis to the onset of RT was 8.6 (range 2-20) months. The median fraction dose was 180 cGy, and the median total RT dose was 50.4 (range 45-55.80) Gy. The three patients (20%) received less than a total of 50 Gy, and 12 (80%) patients received a total of 50 Gy or more. The median follow-up period of the study was 27 (range 11-86) months. The 12 (80%) patients survived, and 3 (20%) died. The median OS diagnosis of the patients was 27.3 (range 11 to 86.5) months. The overall survival of the patients after RT was median 17.3 (range 4.4-83.9) months. Recurrence (local + distant) was observed in 7 patients (46.7%); 2 (13.3%) local, 3 (20 %) distant and 2 (13.3%) both. The median DFS was 24 months (range 1-86.5). Median LRFS-RT is 14.2 (range 1-83.9). The relationship between LRFS-RT and age (< 10 vs. over ≥ years old) (p0.050; HR:2.30; %95 CI 0.70-3.17) was significant. Significantly higher LRFS-RT was observed in the older age. No significant relationship was found between OS diagnosis, OSRT, and DFS and the following variables: gender (female vs. male), age at diagnosis (< 10 vs. over ≥ years old), tumor size (

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