Proton Beam Therapy for Thymic Carcinoma with Pericardial Involvement.

PURPOSE: Thymic malignancies are the most common anterior mediastinal tumors. Advanced thymic carcinoma treatment relies on chemotherapy and definitive radiation therapy when possible. However, pericardial involvement is problematic for radiation therapy treatment planning owing to significant cardiac radiation exposure. We report the first case of definitive proton beam therapy (PBT) for an advanced thymic carcinoma with pericardial invasion. MATERIALS AND METHODS: We report the case of a 69-year-old patient treated with definitive radiation therapy for a stage IVB thymic carcinoma with pericardial invasion. Mean doses delivered to critical organs at risk were compared between deep inspiration breath-hold (DIBH) volumetric modulated arc therapy (VMAT) and DIBH-PBT. RESULTS: When compared to DIBH-VMAT, DIBH-PBT reduced the mean doses delivered to the heart by 3.72 Gy (19.0% dose reduction), to the right lung by 5.9 Gy (41.7% dose reduction), to the left lung by 3.63 Gy (19.0% dose reduction), and to the esophagus by 3.57 Gy (21.3% dose reduction). Despite an early mediastinal relapse after 3.0 months, our patient is still alive after a 14-month follow-up, without any radiation-induced cardiac adverse events and is undergoing pembrolizumab-based immunotherapy. CONCLUSION: Proton beam therapy is an option for definitive irradiation of thymic malignancies invading the pericardium; in this situation, PBT reduces doses to the heart and may help to reduce cardiotoxicity when compared with photon techniques.

Outcomes of exclusive radiation therapy for older women with breast cancer according to age and comorbidity status: An observational retrospective study.

The management of older patients with breast cancer, a public health issue, remains a highly topical subject. Among this heterogeneous population, only few studies have focused on outcomes of older women treated with exclusive radiation therapy for localized BC. This retrospective study provides data concerning the efficacy and safety of exclusive RT, as well as the impact of comorbidities according to the Charlson Comorbidity Index on survival in this subset of women not suitable for surgery or who have refused it. This analysis demonstrates that this treatment is well-tolerated; however, the prognosis is strongly impacted by age and comorbidities.

Outcomes of postoperative radiation therapy for breast cancer in older women according to age and comorbidity status: An observational retrospective study in 752 patients.

OBJECTIVES: The aim of this study was to assess efficacy, tolerability, and the impact of comorbidities on outcomes in older women treated by radiation therapy (RT) for non-metastatic breast cancer. MATERIALS AND METHODS: Women aged ≥70 years at diagnosis who received postoperative RT for primary non-metastatic BC between 2003 and 2009 were retrieved from the Institut Curie registry. We calculated the Charlson Comorbidity Index (CCI) for each patient. We analyzed overall survival (OS), progression free survival (PFS), and acute and late toxicities according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. RESULTS: A total of 752 patients were included in this study. Median age at diagnosis was 75 years [70-93.3]. With a median follow-up of 7.3 years [0.4-12.9], OS and PFS at 5 years were 87.2% CI95%[84.8-89.8] and 85.7% CI95%[83.1-88.3], respectively. OS at 5 years was statistically different according to the CCI: 90.7% CI95%[87.6-93.9] for a CCI of 0, 85.8% CI95%[81.8-90.1] for a CCI of 1, and 79.1% CI95%[71.1-87.9] for a CCI ≥ 2 (p < 0.01, log-rank test), respectively. Similar results were found for PFS (p < 0.05, log-rank test). Most (23.3%) of the patients had no toxicities; of those who experienced side-effects, the majority were grade I or II (96.9%). CONCLUSION: Postoperative RT for non-metastatic BC in older women is effective and well-tolerated. Outcome is impacted by age and comorbidities, which are clear independent prognostic factors.