BackgroundEarly-stage oropharyngeal squamous cell carcinoma (OPSCC) can currently be treated by surgical resection or definitive radiotherapy (RT). The aim of this study is to review the outcomes of early-stage OPSCC submitted to surgery or primary RT. Preliminary results have shown similar overall survival (OS) and locoregional recurrence-free survival (LRFS).Material/MethodsRetrospective study of patients with cT1-T2 cN0-N1 OPSCC, diagnosed between January 2009 and December 2014, treated with surgery or primary RT.Results61 patients with cT1-T2 cN0-N1 OPSCC were included. Forty-two (69%) were submitted to surgical resection, of which 37 (88%) had adjuvant treatment (24 received RT and 13 chemoradiotherapy). Nineteen (31%) were treated with primary RT, and 3 of them had concurrent chemotherapy. RT was given with intensity-modulated radiation therapy (IMRT) (71%) or three-dimensional conformal radiation therapy (3D-CRT) (29%). At a median follow-up of 5.4 years, there were 3 tumor persistences, 5 local failures, 2 regional failures and no distant metastasis. The 3-year and 5-year OS were 77% and 71% in the RT group vs. 71% and 59% in the surgery group, respectively (HR 0.60, 95% CI 0.22–1.61; p = 0.30). The 3-year and 5-year LRFS were 71% and 64% in the RT group vs. 66% and 50% in the surgery group, respectively (HR 0.59, 95% CI 0.24–1.45; p = 0.24). Up to 34% had acute grade 3 toxicity and 11% had grade 4 osteoradionecrosis of the jaw.ConclusionsLonger follow-up still does not show a significant difference in OS and LRFS between both treatments. Because most patients submitted to surgery required adjuvant RT and since its side-effects were not negligible, further studies are warranted to better suit the first treatment for each patient and to prevent the need for adjuvant treatment and the risk of toxicity.

Our findings indicate a small deterioration for a global QoL status, and large deterioration for cognitive function after radiation treatments, as well as worsening of brain metastasis related symptom items. Further research is necessary to refine treatment selection for patients with brain metastases, since it may at least contribute to the stabilization of their QoL status.

Background: Stereotactic body radiation therapy (SBRT) is an emerging local treatment for limited liver metastases. We report a single institution experience with liver metastases treated with SBRT. Methods: Twenty-three consecutive patients treated with SBRT for 27 liver metastases: eight women and 15 men, median age 69 years (26 to 87). SBRT was the chosen therapy when the disease was considered life-limiting and unsuitable for resection or radio-frequency ablation. The median radiation dose was 40 Gy (20 to 50 Gy) delivered in one to 10 fractions. Response to treatment was measured according to RECIST criteria on post-treatment CT, MRI and/or PET imaging. Acute and late toxicities were graded according to CTCAE v4.0. Results: Twenty-two patients completed SBRT. One stopped treatment after three fractions due to biliary obstruction from progressive tumor. Treatment was well-tolerated, with three patients (13.6%) presenting with Grade 1 and two (9%) presenting with Grade 2 acute gastrointestinal toxicity. Median follow-up was 15 months (range: 3-43) with one patient lost to follow-up. A single patient had symptomatic colitis that resolved with conservative treatment. Complete response was initially achieved in eight of 25 (32%) lesions, partial response in four (16%), disease stabilization in 12 (48%), and continued progression in one (4%). At last follow-up, six of 21 patients (28.6%) had progression of a treated lesion. Actuarial overall one-year and two-year survival rates were 94% and 60%, respectively (median 30.1 months). Actuarial one and two-year local control rates were 62%. Conclusions: SBRT is a promising well-tolerated treatment for non-resectable liver metastases.

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Liver metastases are common in oncologic patients, causing substantial morbidity and mortality. Systemic therapy is now standard palliative treatment for most patients with liver metastases, often providing transient responses and increased overall survival. In selected oligometastatic patients, local treatment can lead to long disease-free intervals and even permanent disease control. Although surgery remains the gold standard of local treatments, most patients will not be appropriate surgical candidates. For these patients, alternate local treatments have been developed. Among these, stereotactic body radiotherapy (SBRT) presents an attractive non-invasive option for selected patients with limited hepatic involvement. This article reviews the development, indications, methods, and results of SBRT in the management of liver metastases.

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