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This study aims to review the current evidence on the utility of stereotactic body radiation therapy (SBRT), with or without transarterial chemoembolization (TACE), for early-stage hepatocellular carcinoma (ESHCC) patients not amenable to standard curative treatment options. MethodsLiterature search was conducted using PubMed, ScienceDirect, and Google Scholar. Comparative studies reporting oncologic outcomes were included in the review. ResultsFour studies (one prospective cohort, three retrospective studies) compared SBRT versus TACE. Pooled analysis showed an overall survival (OS) bene t after three years (OR 1.67, 95% CI 1.17-2.39, p = 0.005) which persisted in the 5-year data (OR 1.53, 95% CI 1.06-2.39, p = 0.02) in favor of SBRT. Recurrence-free survival bene t with SBRT was also seen at three years (OR 2.06, 95% CI 1.03-4.11, p = 0.04) which continued after ve years (OR 2.35, 95% CI 1.47-3.75, p = 0.0004). Two retrospective studies compared TACE followed by SBRT (TACE + SBRT) versus TACE alone. Pooled analysis showed signi cantly improved 3year OS (OR 5.47;, p < 0.0001) and local control (LC) (OR: 21.05; 95% CI 5.01-88.39, p = < 0.0001) in favor of the TACE + SBRT group. A phase III study showed signi cantly improved LC and progression-free survival with SBRT after failed TACE/TAE versus further TACE/TAE.

Purpose This study aims to review the current evidence on the utility of stereotactic body radiation therapy (SBRT), with or without transarterial chemoembolization (TACE), for early-stage hepatocellular carcinoma (ESHCC) patients not amenable to standard curative treatment options. Methods Literature search was conducted using PubMed, ScienceDirect, and Google Scholar. Comparative studies reporting oncologic outcomes were included in the review. Results Four studies (one prospective cohort, three retrospective studies) compared SBRT versus TACE. Pooled analysis showed an overall survival (OS) benefit after three years (OR 1.67, 95% CI 1.17–2.39, p = 0.005) which persisted in the 5-year data (OR 1.53, 95% CI 1.06–2.39, p = 0.02) in favor of SBRT. Recurrence-free survival benefit with SBRT was also seen at three years (OR 2.06, 95% CI 1.03–4.11, p = 0.04) which continued after five years (OR 2.35, 95% CI 1.47–3.75, p = 0.0004). Two retrospective studies compared TACE followed by SBRT (TACE + SBRT) versus TACE alone. Pooled analysis showed significantly improved 3-year OS (OR 5.47; 95% CI 2.47–12.11, p < 0.0001) and local control (LC) (OR: 21.05; 95% CI 5.01–88.39, p = < 0.0001) in favor of the TACE + SBRT group. A phase III study showed significantly improved LC and progression-free survival with SBRT after failed TACE/TAE versus further TACE/TAE. Conclusions In ESHCC patients not amenable to established SOC, SBRT alone or the combination of TACE + SBRT appears to be more effective than TACE alone. SBRT after TACE/TAE failure also appears to be superior to further TACE/TAE based on a phase III trial. Larger prospective studies are warranted to further define the role of SBRT and TACE for ESHCC.

Introduction: Quality-of-life (QOL) is paramount in clinical decision-making in the management of prostate cancer patients. The expanded prostate index composite (EPIC) is a widely used and well-validated QOL tool that allows for the evaluation of bowel, urinary, sexual, and hormonal domains. A Filipino translation was previously lacking. We describe the development and pilot testing of the Filipino translation of the EPIC (EPIC-F). Methodology:The EPIC-32 was translated into Filipino using iterative forward and backward procedures with checks for semantic congruency. The translation was then evaluated by an expert panel consisting of a prostate cancer survivor and pertinent health professionals. A focused group discussion (FGD) was conducted to explore sources of difficulty of use to guide improvement. Results:The linguistically validated translation was evaluated to have cultural relevancy, adequacy, and representativeness by the expert panel, and to have good understandability and answerability by a representative pilot cohort of prostate cancer patients. Seven unsatisfactory items were identified, all pertaining to the sexual domain, and required minimal revision on review during the FGD. Conclusion:The EPIC-F is a linguistically and culturally validated version of the EPIC 32, with good understandability and answerability, permitting clinical use. Its psychometric properties need to be determined to define its utility in clinical research.

PURPOSE The study reports on the current perception of medical and radiation oncologists regarding teleconsultation in the Philippines. Before the COVID-19 pandemic, the adoption of telemedicine was not widespread. With movement restrictions imposed during the pandemic, physicians were compelled to use telemedicine. It is uncertain whether physicians will still adopt its use in practice in the post–COVID-19 era. This study gives insight into the possible adaptation of this mode of consultation in the future, especially in areas with limited health care resources. MATERIALS AND METHODS We conducted a national survey among medical oncologists and radiation oncologists in the Philippines. A 43-item online survey was developed, validated, and administered to the oncologists. The demographics and data from categorical questions were reported as frequencies and percentages. RESULTS A total of 142 responses were gathered from 82 medical oncologists and 60 radiation oncologists. There was agreement among participants that, during the pandemic, teleconsultation could be used for the first visit, diagnostic workup request, treatment explanation, follow-up care, and chronic disease management. There was disagreement whether cancer diagnosis disclosure and cancer prognosis revelation could be performed via teleconsultation, and there was agreement that emergency consultation and physical examination would warrant a face-to-face consultation. After the COVID-19 pandemic, 78.7% intend to continue using teleconsultation except for emergency consultations, first visits, physical examination, diagnosis disclosure, and cancer prognosis revelation. CONCLUSION Teleconsultation was perceived by oncologists as an acceptable method of providing cancer care during and after the COVID-19 pandemic. Oncologists also intend to use teleconsultation in the post–COVID-19 era in certain aspects of patient care.

Objectives The HYACINCT trial will investigate the role of dose-adapted hypofractionated pelvic radiotherapy in patients with locally advanced cervical cancer who are ineligible for cisplatin. This dummy run evaluated the feasibility of the protocol treatment planning objectives using intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT). Material and Methods The HYACINCT protocol defines a set of guidelines for image acquisition, target and organ delineation, and treatment planning objectives. Fifteen dummy cases were prepared, five each for three levels of dose requirements: 40 Gy without boost, and with boost to 45 Gy and to 48 Gy. IMRT and VMAT plans were prepared for each case, evaluated and assigned penalty and compliance scores according to planning objectives, and subjected to quality control. IMRT and VMAT plans were compared in terms of treatment plan quality (target coverage, penalty, and compliance scores), and treatment delivery. Tumor extent (T-stage, T-score), nodal status, and PTV volumes (in cc) were examined as potential determinants of penalty and compliance scores. Results IMRT was able to meet the planning objectives for all but one case; and VMAT, for all cases. All plans passed the quality control check. IMRT and VMAT were equivalent in terms of target coverage and penalty and compliance scores, but the latter was associated with better treatment delivery. T-score was a determinant for the penalty score. Conclusion The HYACINCT radiotherapy protocol is feasible with either IMRT or VMAT. VMAT may be beneficial in more extensive cases, as measured by the T-score. Trial Registration Number NCT05210270

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Purpose To report technical details and 15-month outcomes of a patient with node-positive external auditory canal (EAC) squamous cell carcinoma (SCC) treated with definitive intracavitary high-dose-rate (HDR) brachytherapy to primary tumor, and external beam radiotherapy (EBRT) to draining lymphatics. Material and methods A 21-year-old male was diagnosed with SCC of the right EAC. The patient underwent definitive HDR intracavitary brachytherapy, 340 cGy/fraction for 14 twice-daily fractions, followed by EBRT using intensity-modulated radiation therapy (IMRT) to cover the grossly enlarged pre-auricular node, ipsilateral intra-parotid, and cervical lymph node levels II and III. Results The approved brachytherapy plan had an average high-risk clinical tumor volume (CTV-HR) D 90 of 341 cGy with a total dose of 47.7 Gy (BED, 80.3 Gy, EQD 2 , 66.6 Gy). For the approved IMRT plan, the prescription to the involved right pre-auricular node was 66 Gy in 33 fractions, and more than 95% of the target received at least 62.7 Gy. High-risk nodal regions were simultaneously prescribed: 59.4 Gy in 1.8 Gy fractions, and more than 95% received at least 56.4 Gy. Organs at risk (OARs) were kept below their dose constraints. The patient tolerated both the procedures with no grade ≥ 2 treatment-related adverse events. Grade 1 dermatitis in the right pre-auricular and cervical areas during the course of EBRT was experienced. Fifteen months post-RT, the patient has no evidence of disease, and was noted to have EAC stenosis, which translated to moderate conductive hearing loss of the right ear. Thyroid function was normal at 15 months after EBRT. Conclusions This case report illustrates that the delivered definitive radiotherapy is technically feasible, effective, and well-tolerated in patients with SCC of EAC.