Background: Dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) were compared among 3 different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods: Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath-hold (DIBH) position. Three-dimensional conformal RT (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH positions. A 3DCRT plan was also created in the FB position. A dose-volume histogram (DVH) was used to analyze each evaluation index of PTV and OARs. The principal outcomes were PTV dose, heart dose, right breast dose, left anterior descending coronary artery (LADCA) dose, and left lung dose. Results: For 3DCRT plans, significant dose reductions were demonstrated in all evaluation parameters of the heart, LADCA, and left lung doses in the DIBH position compared with those in the FB position ( P < 0.05). In the DIBH position, significant dose reductions were found in the heart and LADCA in VMAT plans compared to those in 3DCRT plans ( P < 0.05). For the right breast, VMAT reduced Dmean significantly (0.32 Gy vs 0.08  Gy, P < 0.01). There were no significant differences between 3DCRT and VMAT plans for the left lung dose in the DIBH position. The indicators of PTV had no significant difference between the 3 plans. Conclusion: DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity.

Breast cancer is the most common malignant disease among older women, and the number of new older patients per year is increasing year by year. Radiotherapy has been confirmed as an important treatment after breast conservation for the reduction of local recurrence and mortality for all patients, including node-positive cases. However, there are fewer clinical trials evaluating the toxicity and benefits of radiotherapy for older patients. Whether radiotherapy can provide substantial benefit for older patients after breast-conserving surgery is controversial. This systematic review will focus on the key aspects of this controversial issue.

Background:We previously reported that magnetic resonance imaging evidence of cranial nerve invasion was an unfavourable prognostic factor in nasopharyngeal carcinoma. However, the prognostic value of this evidence in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy remains unknown.Methods:We retrospectively analysed 749 nasopharyngeal carcinoma patients who underwent intensity-modulated radiotherapy.Results:Cranial nerve invasion was observed in 299 (39.9%) patients with T3–4 disease. In T3–4 nasopharyngeal carcinoma, magnetic resonance imaging-detected cranial nerve invasion was associated with inferior 5-year overall survival, distant metastasis-free survival, and locoregional relapse-free survival (P=0.002, 0.003, and 0.012, respectively). Multivariate analyses confirmed that cranial nerve invasion was an independent prognostic factor for distant metastasis-free survival (hazard ratio, 1.927; P=0.019) and locoregional relapse-free survival (hazard ratio, 2.605; P=0.032). Furthermore, the receiver-operating characteristic curves verified that the predictive validity of T classifications was significantly improved when combined with magnetic resonance imaging-detected cranial nerve invasion in terms of death, distant metastasis, and locoregional recurrence (P=0.015, 0.021 and 0.008, respectively).Conclusions:Magnetic resonance imaging-detected cranial nerve invasion is an independent adverse prognostic factor in nasopharyngeal carcinoma treated with intensity-modulated radiotherapy.

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Background It is still controversial whether intensity-modulated radiotherapy has an obvious advantage over conventional radiotherapy. The purposes of this study were to evaluate prognostic factors in pre-treatment characteristics for nasopharyngeal carcinoma and to compare treatment outcomes in patients who received intensity-modulated radiotherapy and patients who received two-dimensional radiotherapy or three-dimensional radiotherapy. Methods We reviewed patients with nasopharyngeal carcinoma who received chemoradiotherapy in our hospital during the period from 2000 to 2017, and we excluded patients who had a history of surgery for nasopharyngeal carcinoma and those who had distant metastases before treatment. A total of 72 patients who were treated by radiotherapy with concurrent chemotherapy were enrolled. All of the patients were irradiated with a total dose of 58–70 Gy. Overall survival, locoregional control and progression-free survival rates were compared in the groups treated by intensity-modulated radiotherapy and two-dimensional/three-dimensional radiotherapy. Propensity score matching was performed to homogenize the two groups. Results The median follow-up period was 62.5 months. After propensity score matching, in patients treated with intensity-modulated radiotherapy, the 5-year rate of overall survival, locoregional control and progression-free survival were 73.5, 95.2 and 72.7%, respectively. In patients treated with two-dimensional/three-dimensional radiotherapy, the 5-year rate of overall survival, locoregional control and progression-free survival were 69.1, 67.7 and 51.8%, respectively. There was a significant difference between the groups only in locoregional control. Late toxicities of grade 2 or higher were occurred in 38.5 and 24.2% of the patients treated by two-dimensional/three-dimensional radiotherapy and intensity-modulated radiotherapy, respectively. Conclusions Our results suggested that intensity-modulated radiotherapy is more effective than two-dimensional/three-dimensional radiotherapy in patients with nasopharyngeal carcinoma, especially in locoregional control.