High-Grade Gliomas (HGG) are the most common and aggressive primary brain malignancies in adults. Fractionated Stereotactic Radiotherapy (fSRT) and Stereotactic Radiotherapy (SRS) have emerged as a novel technique to deliver high doses of RT in the recurrent setting with aim for durable local control and potential overall survival benefit. This study evaluated the patterns of recurrence, prognostic indicators as well as the efficacy of treatment in patients with recurrent HGG treated by fSRT or SRS. Favorable outcomes were observed in patients treated with fSRT and SRS as salvage therapy. The predominant mode of failure post salvage SRS and fSRT remains in-field. Prospective trials are required to better define patient selection, tumor recurrence size, and effective dose regimen.

Radiation therapy is used for adjuvant therapy on patients with recurrence or lymphadenectomy in the malignant melanomas. Treatment is used for palliative on metastatic patients. Between 1996 and 2017, 35 patients who received adjuvant radiotherapy and 55 patients who received palliative radiotherapy were retrospectively analyzed. Of the 90 patients included in the study, 56 (62%) were men and 34 (38%) were women. Mean age of patients was 63 years (age range: 22–95 years). For all patients, the overall survival time was 32.23 months (95% CI, 16.8–47.6). As an adjuvant therapy, 48 Gy (hypofractionated) radiotherapy was used in 4 patients and 50-66 Gy radiotherapy was used in 31 patients. Overall survival in these patients was 66.14 (95% CI 36.6-95.6) months. Mean metastases that occur in patients is 37.19 months (range: 2-138 months), which are 37 (41%) patients in the brain, 12 (13%) patients in the bone and 6 (7%) patients in the non-regional lymph node metastasis. 20-30 Gy radiotherapy was used for metastasis treatment. Overall survival in brain metastasis, bone metastasis and lymph nodes metastatic patients were 4.22 (95% CI 2.62-5.82), 7.6 (95% CI 1.14-14.05) and 7.33 (95% CI 0-15.03) months respectively. Although, the regional nodal disease can be favorably controlled with lymphadenectomy and radiotherapy, the risk of distant metastases and the risk of disease-related death are high. In addition, metastasis-related symptoms (particularly pain) can be controlled by radiotherapy.

Purpose: To report the survival benefit of Radiation Therapy (RT) in Leptomeningeal Carcinomatosis (LMC) patients with different primary cancers and to identify the factors of LMC patients that had survival benefit from Whole Brain Radiation Therapy (WBRT).

Methods and Materials: Systematic literature review was performed. Search terms included ‘Leptomeningeal’, ‘prognostic factors’ and ‘lung’ or ‘breast’. Literatures were included if patient profile was reported. Specifically, age, median survival, diagnosis time line, type of cancer, received treatments, performance score, and systemic disease were sought after. Literatures were excluded if they were a) case reports, b) written in language other than English, or c) not including patient profile.

Results: RT treatment has survival benefit for LMC patients with CSF obstruction. For LMC patients with primary breast cancer, 7 studies were found since 1991 that met searching criteria. Factors which would allow breast cancer-caused LMC patients to benefit from WBRT with survival are identified with statistical significance. They include KPS>60, Intrathecal (IT) chemotherapy, systemic therapy, hormonal receptor status and severity of systemic disease. Patients who met aforementioned criteria and received WBRT had longer median survival (17 weeks vs. 11.9weeks, p=0.015). Similarly, 10 studies were found that met searching criteria for Non-Small Cell Lung Cancer (NSCLC) caused LMC. Beneficial factors for NSCLC-caused LMC are identified. They include IT chemotherapy, KPS > 60, and EGFR TKI treatment. Patient who met these criteria had longer median survival when received WBRT (17.6 weeks vs 12.2 weeks, p = 0.0412).

Conclusion: Profiles of LMC patients that can benefit with longer survival by receiving WBRT are identified for breast cancer and NSCLC. Algorithms in identifying such patients are provided.

Background and objectives: Combined chemo radiation is the standard of care for treatment of squamous cell carcinoma of the anal canal. Our objective was to analyze the treatment results of patients with squamous cell carcinoma of the anal canal treated at our institution.

Methods: We identify patients with confirmed diagnoses of anal canal squamous cell carcinoma treated in our institution (KFSHRC), Riyadh between1994-2017. We retrospectively reviewed their pattern of recurrence and survival rate.

Results: 35 males (70%) and 15 females (30%) were identified. Median age at diagnosis was 58 years. 5(10%) patients underwent initial Abdomino Perineal Resection (APR) while 45 patients (90%) received definitive concurrent chemo radiation (30 using 2D/3DCRT and 15 patients using IMRT). All patients completed their planned treatment course except 4 patients (in 2D/3DCRT arm). IMRT resulted in significant decrease in all toxicity grades in comparison to 2D/3DCRT arm (p value 0.035). After median follow up of 13months, two out of the 5 patients (40%) who underwent initial APR had local recurrence; while after 18 months median follow up 8(19.6%) patients who underwent definitive chemo radiation had local recurrence. The 2 and 5 years Disease Free Survival (DFS) were 79.4% and 53% respectively in IMRT group vs 64% and 55% respectively in 2D/3DCRT group (p value 0.79). Regarding Overall survival (OS), the 2 and 5 years OS were 82% and 41% respectively in IMRT vs 66% and 44% respectively in the 2D/3DCRT group(p value 0.36). In Univariate analysis, only number of chemotherapy cycles was statistically correlated with DFS and OS with (p value of 0.02 and <0.0001) respectively.

Conclusion: Combined chemo radiation therapy for anal canal squamous cell carcinoma is effective treatment in term of local control and survival. The recurrence and survival pattern of our patients’ cohort compare favorably to the international results. Radiation therapy using IMRT resulted in significant decrease of all toxicity grades over 2D/3DCRT, with improvement of the 2 years DFS and OS in comparison to the 2D/3DCRT although it was not statistically significant. In Univariate analysis initial Hb level was not significantly correlated with DFS or OS at 5 years, only number of chemotherapy cycles was statistically correlated with survivals at 5 years

A 64-year-old woman who was found to have an abdominal mass on ultrasound was misdiagnosed with a uterine fibroid/uterine sarcoma. Pelvic MRI showed multiple soft tissues mass shadows in the pelvic cavity, and the larger shadows were approximately 14.2 cm × 9.7 cm × 15.6 cm, with clear boundaries dominated by an iso long T1 and slightly longer T2, locally visible nodular long T2 and short T2 signal foci, and obvious high signals on DWI and decreased ADC signals. The enhancement of the densification was obviously non-uniform. The immunohistochemical results were positive for CD20, LCA, PAX-5+, CD43 +, c-myc, bcl2 and bcl6 and negative for SAM, Desmin, Myo D1, MPO, CD99, CD30, CD23, S-100, and CD10. The majority (90%) of tumor cells were positive for Ki-67. The diagnosis was a diffuse large b-cell lymphoma. Preoperative diagnosis of primary lymphoma of the uterus is difficult in clinical situations. Primary Female Genital System Lymphoma (PFGSL) is a rare disease that is mostly associated with non-Hodgkin’s lymphoma, usually Diffuse Large B-Cell Lymphoma (DLBCL). The majority of primary uterine DLBCL originates from endometrial stroma

The objective of this study is to evaluate early side effects, local control and early response rates of adjuvant or definitive radiotherapy and/or chemo radiotherapy in patients diagnosed with cervical cancer and treated in our clinic. Twenty-one patients who were admitted to our clinic with a diagnosis of stage IB-IVA cervical cancer between January 2017 and November 2018 were included in the study. Adjuvant radiotherapy was performed in 1 patient (5%), adjuvant chemo radiotherapy in 3 patients (14%) and definitive chemo radiotherapy in 17 patients (81%). All patients received intracavitary brachytherapy after radiotherapy. Median follow-up period is 13 months (range: 5-23 months). 12 patients (57%) had a complete response, in 7 patients (33%) had the partial response and in 2 patients (10%) had no response to treatment. 1 (5%) patients who did not respond to the treatment had died. One patient (5%) had lung metastasis, 1 (5%) patients had breast cancer as the second primary. Cystitis and diarrhea were the most common early side effects of radiotherapy. 8 patients (38%) had grade II diarrhea and cystitis and 2 patients (10%) had grade III diarrhea. Nine patients (43%) who received concurrent chemotherapy had grade II-III neutropenia as hematological toxicity. None of the cases had grade IV toxicity. In conclusion, concurrent radio chemotherapy or radiotherapy alone is the preferred treatment modalities in patients with adverse risk factors in stage ≥ IB cervical cancers because of high response rates and acceptable toxicity.