Implications of all the available evidenceThis evaluation study strengthens the available evidence in the literature supporting the use of SABR in appropriately selected patients with metachronous extracranial oligometastases and resulted in routine commissioning of SABR for treating patients with oligometastatic disease by NHS England in 2019 (4).

Adding Bcl2 to the panel of markers used in current clinical practice could provide both prognostic and predictive information in TNBC. TNBC/Bcl2- patients appear to benefit from ATC-CT, whereas Bcl2+ TNBC seems to be resistant to ATC-CT and may benefit from a trial of different type of chemotherapy with/without novel-targeted agents.

No abstract

For previously irradiated patients with recurrent pelvic disease, SABR re-irradiation could be a feasible intervention for those who otherwise have limited options. Evidence to support this technique is limited but shows initial promise. Based on the available literature, suggestions for a more formal SABR re-irradiation pathway are proposed. Prospective studies and a multidisciplinary approach are required to optimise future treatment.

No abstract

The choice of DIR algorithm was limited to those available in the RayStation 9B Treatment Planning System. However, these algorithms are representative of the range of approaches available commercially, encompassing grey-scale driven (correlation and mutual information), biomechanical and contour-driven methods. The Anaconda algorithm is capable of combining greyscale and contour registration and, herein, we have additionally combined biomechanical registration with Anaconda.Whilst many other DIR software platforms and algorithms exist, these do not fundamentally differ from the algorithms used here. Our focus was to explore the potential for combinations of existing DIR methods to overcome challenges in the case of extreme pelvic anatomical changes, so we have not attempted an algorithmic comparison. However, we would expect our findings to apply to any combination of similar grey-scale and biomechanical DIR algorithms in other contexts and systems, given an appropriate workflow as outlined below. 2 and Figure 3 and 4): DIR results (see also Supplementary Table Jacobian analysis:Clinical significance for reRT was assessed by overlaying the negative element mask onto the reRT CT image and combined dose distribution. In two cases the folding was <1 grid voxel (2.5 mm) and clinically insignificant. In one case, folding ~20 mm was observed, along the bladder-rectal interface. This case fell >3 s.d. from the mean for bladder DSC (0.

No abstract

High-dose Methotrexate (MTX) is the most useful cytotoxic drug used in the treatment of primary central nervous system lymphoma (PCNSL). Dose reduction should be made in patients with reduced renal function. We evaluated the age of patients over a period of 22 years and estimated their glomerular filtration rate. One hundred and two patients were treated in Nottingham University Hospitals (a regional centre for neurosurgery) during the period 1986-2008. Patients were treated either with the BVAM regimen (carmustine, vincristine, cytarabine, MTX) or with CHOD (cyclophosphamide, doxorubicin, vincristine and dexamethasone) given for one cycle prior to BVAM. The age at which patients were diagnosed with PCNSL increased during the period of the study. During the first half of the study period (1986-1997) the median age was 60.5 years, compared to a median age of 65 years during the second half of the study period (1998-2008) (P = 0.001). The estimated glomerular filtration rate decreased with age over 40 years in a similar way to the general population. The increasing age of patients with PCNSL and decreasing renal function limit the intensity of chemotherapy with MTX containing regimens.