HighlightsTreatment de-escalation in HPV+ oropharynx cancer is an active area of research.A Bayesian phase II trial of MR-guided radiotherapy dose adaptation is proposed.High dose volume will be adapted on weekly MRI based on tumor response.The non-inferiority of dose adaptation compared to standard IMRT will be assessed.

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Background. Failure of chemoradiotherapy (CRT) for anal squamous cell carcinoma (SCC) results in persistent or recurrent anal SCC. Treatment with salvage abdominoperineal resection (APR) can potentially achieve cure. The aims of this study are to analyze oncological and surgical outcomes of our 30-year experience with salvage APR for anal SCC after failed CRT and identify prognostic factors for overall survival (OS). Methods. All consecutive patients who underwent salvage APR between 1990 and 2016 for histologically confirmed persistent or recurrent anal SCC after failed CRT were retrospectively analyzed. Results. Forty-seven patients underwent salvage APR for either persistent (n = 24) or recurrent SCC (n = 23). Median OS was 47 months [95% confidence interval (CI) 10.0-84.0 months] and 5-year survival was 41.6%, which did not differ significantly between persistent or recurrent disease (p = 0.551). Increased pathological tumor size (p \ 0.001) and lymph node involvement (p = 0.014) were associated with impaired hazard for OS on multivariable analysis, and irradical resection only (p = 0.001) on univariable analysis. Twenty-one patients developed local recurrence after salvage APR, of whom 8 underwent repeat salvage surgery and 13 received palliative treatment. Median OS was 9 months (95% CI 7.2-10.8 months) after

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BackgroundFailure of chemoradiotherapy (CRT) for anal squamous cell carcinoma (SCC) results in persistent or recurrent anal SCC. Treatment with salvage abdominoperineal resection (APR) can potentially achieve cure. The aims of this study are to analyze oncological and surgical outcomes of our 30-year experience with salvage APR for anal SCC after failed CRT and identify prognostic factors for overall survival (OS).MethodsAll consecutive patients who underwent salvage APR between 1990 and 2016 for histologically confirmed persistent or recurrent anal SCC after failed CRT were retrospectively analyzed.ResultsForty-seven patients underwent salvage APR for either persistent (n = 24) or recurrent SCC (n = 23). Median OS was 47 months [95% confidence interval (CI) 10.0–84.0 months] and 5-year survival was 41.6%, which did not differ significantly between persistent or recurrent disease (p = 0.551). Increased pathological tumor size (p < 0.001) and lymph node involvement (p = 0.014) were associated with impaired hazard for OS on multivariable analysis, and irradical resection only (p = 0.001) on univariable analysis. Twenty-one patients developed local recurrence after salvage APR, of whom 8 underwent repeat salvage surgery and 13 received palliative treatment. Median OS was 9 months (95% CI 7.2–10.8 months) after repeat salvage surgery and 4 months (95% CI 2.8–5.1 months) following palliative treatment (p = 0.055).ConclusionsSalvage APR for anal SCC after failed CRT resulted in adequate survival, with 5-year survival of 41.6%. Negative prognostic factors for survival were increased tumor size, lymph node involvement, and irradical resection. Patients with recurrent anal SCC after salvage APR had poor prognosis, irrespective of performance of repeat salvage surgery, which never resulted in cure.

Elective irradiation of the groin should be considered for local control in patients (N0-N1) with T2 tumors ≥4 cm in size and/or located in the perianal skin, and in all patients with T3 and T4 tumors.

Purpose/Objective(s): Nowadays, a (contrast-enhanced) CT is used for delineation of oropharyngeal carcinomas (OPCs). MRI, however, has better soft tissue contrast. MR-guided radiation therapy has just started, but will be standard in the near future. Therefore, we want to determine the variation in target delineation for oropharyngeal cancer (OPC) by international experts using MR as a single delineation modality and determine the variation in target delineation for OPC after adding PET and CT to MRI. Materials/Methods: Twenty-four radiation oncologists from 7 centers affiliated with the MRI linear accelerator (MRL) Consortium were asked to delineate the gross tumor volume (GTV) and the clinical target volume (CTV) of the primary tumor of 4 OPC cases. In the first phase, observers were given a brief clinical history, physical examination, and the T1, T1 plus Gadolinium and T2 weighted MRI sequences. Target contours were delineated according to experts' institutional guidelines. The absolute and encompassing volumes, the generalized conformity index and median surface distances were then calculated from the voxel count maps of each case. The data were also analyzed with the Simultaneous Truth and Performance Level Estimation (STAPLE) algorithm. In the second phase, PET and CT data were sent to the observers and they were asked to contour the same cases again using MRI, PET, and CT. Then, the data were analyzed as in phase 1. Results: Median years of experience for the participating radiation oncologists was 5 years (range 0-15 years). The mean absolute volumes of the GTV'

Purpose: Tumor and target volume manual delineation remains a challenging task in head and neck cancer radiotherapy. The purpose of this study is to conduct a multi-institutional evaluation of manual delineations of gross tumor volume (GTV), high-risk clinical target volume (CTV), parotids, and submandibular glands on treatment simulation MR scans of oropharyngeal cancer (OPC) patients. Methods: Pre-treatment T1-weighted (T1w), T1-weighted with Gadolinium contrast (T1w+C) and T2-weighted (T2w) MRI scans were retrospectively collected for 4 OPC patients under an IRB-approved protocol. The scans were provided to twenty-six radiation oncologists from seven international cancer centers who participated in this delineation study. In addition, clinical history and physical examination findings along with a medical photographic image and radiological results were provided. The contours were compared using overlap and distance metrics using both STAPLE and pair-wise comparisons. Lastly, participants completed a brief questionnaire to assess personal experience and CTV delineation institutional practices. Results: Large variability was measured between observer delineations for both GTVs and CTVs. The mean Dice Similarity Coefficient values across all case delineations for GTVp, GTVn, CTVp, and CTVn where 0.77, 0.67, 0.77, and 0.69, respectively, for STAPLE comparison and 0.67, 0.60, 0.67, and 0.58, respectively, for pair-wise analysis. Normal tissue contours were defined more consistently when considering overlap and distance metrics. The median radiation oncology clinical experience was 7 years and the median experience delineating on MRI was 3.5 years. The GTV-to-CTV margin used was 10 mm for six of seven participant institutions. One institution used 8 mm and three delineators (from three different institutions) used a margin of 5 mm. Conclusion: The data from this study suggests that appropriate guidelines, contouring quality assurance sessions, and training are still needed for the adoption of MR-based treatment planning for head and neck cancers. Such efforts should play a critical role in reducing inter-observer delineation variation and ensure standardization of target design across clinical practices.