Abai S, Danzer MF, Assaf C
… +13 more, Mula-Hussain L, Kirova Y, Kouloulias V, Cowan R, Newmann N, Shi W, Shelan M, Flores DC, Correia D, Campbell BA, Binkley MS, Hoppe RT, Elsayad K
Int J Radiat Oncol Biol Phys
· 2026 May · PMID 42128185
·
Publisher ↗
PURPOSE: Primary cutaneous T-cell lymphomas are a heterogeneous group of T-cell neoplastic entities associated with significant morbidity and high radiosensitivity. Although research on reduced-dose radiation treatment f...PURPOSE: Primary cutaneous T-cell lymphomas are a heterogeneous group of T-cell neoplastic entities associated with significant morbidity and high radiosensitivity. Although research on reduced-dose radiation treatment for mycosis fungoides and Sézary syndrome has significantly increased over the past 2 decades, randomized data are lacking. We aim to summarize the available evidence and analyze the safety and efficacy of reduced-dose total skin electron beam therapy (TSEBT). METHODS AND MATERIALS: A literature search for evidence was conducted, selecting studies with reduced-dose TSEBT in mycosis fungoides and Sézary syndrome that met the inclusion criteria. The studies were critically appraised, and the results were synthesized and interpreted. RESULTS: The analyzed data comprised 11 prospective studies and 11 retrospective studies, with a total of 883 patients. The meta-analysis revealed a pooled overall response rate of 91% (95% CI, 88-93) and complete response rate of 26% (95% CI, 21-31) to reduced-dose TSEBT. The most common toxicities reported were grade 1 and 2 skin reactions. Documented in 7 studies, the time to response ranged from 4 to 8 weeks. Seven studies evaluated the impact of reduced-dose TSEBT on quality of life, and all reported significant improvements in 1 or more subdomains. Fourteen studies indicated that 337 patients (38%) received consolidation/subsequent therapy after TSEBT to maintain remission. Compared with TSEBT monotherapy, the addition of consolidation/subsequent treatments to sustain the response was associated with a progression-free survival or other clinical advantage in 4 of 5 trials. CONCLUSIONS: Reduced-dose TSEBT quickly achieves high overall response rate and improves quality of life with minimal risk of severe adverse events. Knowledge gaps remain on how to optimally prolong these benefits. Investigating maintenance therapy is needed to ensure sustained remission.
Int J Radiat Oncol Biol Phys
· 2026 May · PMID 42126356
·
Publisher ↗
War and armed conflict profoundly disrupt cancer care systems, with radiation therapy services among the most severely affected due to their static geography, reliance on stable infrastructure, specialized equipment, and...War and armed conflict profoundly disrupt cancer care systems, with radiation therapy services among the most severely affected due to their static geography, reliance on stable infrastructure, specialized equipment, and a highly trained multidisciplinary workforce. Drawing on intercontinental narratives shared by clinicians and medical physicists from Sudan, Yemen, Syria, Palestine, and Ukraine, this work synthesizes frontline experiences of delivering radiation therapy amid instability, displacement, and resource collapse. Beyond documenting challenges, the manuscript articulates a collective call to action for the global radiation oncology community, outlining priority areas for intervention, including education, workforce development, technology support, research, and advocacy, and proposing practical, ethically grounded pathways for translating awareness into sustained, collaborative resilience planning. Cancer care in conflict settings is framed not as a peripheral humanitarian concern, but as a central issue of patient safety, equity, and professional responsibility, central to today's new challenges.
Wright JL, Moughan J, Woodward WA
… +24 more, Rahbar H, Shah AB, Comstock C, Jarvis LA, Tjoe JA, Germain I, Badve SS, Strom E, Recht A, Ling DC, Vallow LA, Stephenson JJ, Currey A, Walker EM, Reiter H, Steinberg ML, Pierce LJ, Winter K, Sparano J, Davidson NE, Wolff A, Mamounas EP, White JR, McCormick B
Int J Radiat Oncol Biol Phys
· 2026 May · PMID 42114785
·
Full text
PURPOSE: The NRG Oncology/Radiation Therapy Oncology Group (RTOG) 9804 trial randomized patients with "good-risk" ductal carcinoma in situ (DCIS) to radiation (RT) or no RT following lumpectomy. The Eastern Cooperative O...PURPOSE: The NRG Oncology/Radiation Therapy Oncology Group (RTOG) 9804 trial randomized patients with "good-risk" ductal carcinoma in situ (DCIS) to radiation (RT) or no RT following lumpectomy. The Eastern Cooperative Oncology Group-American College of Radiology Imaging Network E5194 trial had a comparable cohort observed without RT. Tamoxifen use was optional in both trials. This ancillary exploratory analysis combining both data sets assessed the effect of tamoxifen on ipsilateral breast recurrence (IBR) in "good-risk" DCIS treated with lumpectomy alone. METHODS AND MATERIALS: A combined database from the non-RT arm of NRG/RTOG 9804 and the "good-risk" cohort from E5194 (low- or intermediate-grade, ≤2.5 cm, excision margins ≥3 mm) was created, and distributions of patient and DCIS characteristics by tamoxifen use were compared by χ. IBR, invasive IBR, DCIS-IBR, contralateral breast event, and overall survival were estimated, and distributions were compared between tamoxifen use groups. Univariate and multivariable Fine-Gray regression models were used to analyze factors that may be associated with endpoints. RESULTS: Eight hundred and seventy-eight patients were analyzed (317 from NRG/RTOG 9804 and 561 from E5194). The use of tamoxifen overall was 43.1% (65.6% in NRG/RTOG 9804 and 30.3% in E5194). At a median follow-up of 14.85 years, there were 117 IBRs (65 invasive and 52 DCIS). There was a significant association for reduced IBR with tamoxifen use (P = .001); estimated 15-year IBR with tamoxifen is 11.4% (95% CI, 7.9-15.5) and without is 19.0% (15.3-22.9). Tamoxifen use was significantly associated with reduced invasive IBR (P = .0048) but not DCIS-IBR (P = .089). On multivariable analysis, patients who received tamoxifen were 46% less likely to have any IBR (hazard ratio, 0.54; 95% CI, 0.35-0.83; P = .0045), and 57% less likely to have invasive IBR (hazard ratio, 0.43; 95% CI, 0.24-0.77; P = 0.0042). CONCLUSION: For patients with "good-risk" DCIS treated with lumpectomy without RT, tamoxifen use was significantly associated with a reduction in IBR overall and invasive IBR, not DCIS-IBR.
Khan AJ, Koleoso O, White C
… +9 more, Ehrich F, Grabenstetter A, Wen HY, Zhang Z, Choi JI, Braunstein LZ, Xu AJ, Powell SN, Morrow M
Int J Radiat Oncol Biol Phys
· 2026 May · PMID 42114784
·
Publisher ↗
PURPOSE: Tumor size is an established and independent risk factor for locoregional recurrence (LRR) and distant metastasis (DM). More recently, the recurrence score (RS) calculated from a 21-gene expression assay (Oncoty...PURPOSE: Tumor size is an established and independent risk factor for locoregional recurrence (LRR) and distant metastasis (DM). More recently, the recurrence score (RS) calculated from a 21-gene expression assay (Oncotype DX™, Exact Sciences) has been shown to correlate with LRR and DM. This study sought to evaluate the impact of RS on recurrence risks for small tumors (≤1 cm) with RS ≥26 to similar sized tumors with RS <26. METHODS: Between 2008 and 2020, 231 patients with breast cancers ≤1 cm and high RS of ≥26 were retrospectively identified. These were compared to a control cohort of 1,747 breast cancers that were ≤1 cm with RS <26 over the same time interval. Rates of LRR and invasive-recurrence free interval (IR) were estimated using the Kaplan-Meier method, and multivariable Cox regression was conducted. RESULTS: Patients with RS ≥26 had significantly worse time to LRR (p<0.001) and invasive recurrence than patients with RS <26 (p<0.001). The LRR-free probabilities for RS ≥26 and RS<26 patients are 94% vs 99% at 5 years and 88% vs 96% at 10 years. Similarly, the invasive recurrence-free probabilities were 94% vs. 99% at 5 years and 87% vs. 95% at 10 years. In multivariable analyses, RS was independently associated with LRR and IR. CONCLUSIONS: Our findings suggest that patients with small tumors and high RS are at a higher risk for LRR than ≤1 cm breast cancers with low RS, despite the best available standard of care treatment. These findings may have important implications for the tailoring of local-regional treatment strategies as they relate to omission of radiotherapy, and selection of radiotherapy modality.
Okonogi N, Karasawa K, Murata K
… +4 more, Omatsu T, Murata H, Wakatsuki M, Ishikawa H
Int J Radiat Oncol Biol Phys
· 2026 Mar · PMID 42108880
·
Publisher ↗
PURPOSE: To evaluate the long-term efficacy, safety, and cosmetic outcomes of carbon-ion radiation therapy (C-ion RT) as a nonsurgical treatment option for patients with early-stage breast cancer. METHODS AND MATERIALS:...PURPOSE: To evaluate the long-term efficacy, safety, and cosmetic outcomes of carbon-ion radiation therapy (C-ion RT) as a nonsurgical treatment option for patients with early-stage breast cancer. METHODS AND MATERIALS: This single-center, prospective phase 1/2 trial enrolled women aged ≥60 years with stage I (cT1N0M0), estrogen receptor-positive, human epidermal growth factor receptor type 2-negative invasive ductal carcinoma, ≤2 cm in diameter. Patients received C-ion RT at a total dose of 60 Gy (relative biological effectiveness) in 4 fractions, followed by adjuvant aromatase inhibitors. The primary endpoint was 5-year local control. Secondary endpoints included complete response (CR) rate, adverse events (AEs), cosmetic outcomes, disease-free survival, and overall survival. Imaging was used for evaluating tumor response, and follow-up was conducted for a median of 73 months. RESULTS: Twelve patients were treated in the phase 2 component of the trial. The CR rate was 100%, with a median time to CR of 12 months (range, 4-36 months). The 5-year local control and disease-free survival rates were both 92%, and the overall survival rate was 100%. One case of in-field recurrence occurred in a patient with a high Ki-67 index. Acute grade 1 dermatitis was observed in 6 patients. No grade ≥2 acute AEs were reported. Regarding late AEs, grade 1 rib fractures (n = 2) and grade 1 mastitis-related pain (n = 3) were managed conservatively. Magnetic resonance imaging revealed subclinical pectoral muscle inflammation in 7 cases. All patients except one (who underwent mastectomy due to recurrence) maintained excellent cosmetic outcomes. CONCLUSIONS: C-ion RT demonstrated excellent long-term tumor control with minimal toxicity and favorable cosmetic outcomes in selected patients with early-stage breast cancer. These findings support its potential as a nonsurgical alternative for patients who are medically inoperable or decline surgery, warranting further investigation in larger, controlled trials.