Current Issue 1 June 2012, Vol. 83, No. 2

A regular feature where senior members of the Red Journal editorial team highlight recent articles related to the scientific literature that they feel are "must reads" for the radiation oncology community. Major articles are summarized and editorial comments are provided. This issue, Senior Editor Robert L. Foote, MD, FASTRO, reviews the best head-and-neck literature. He also explains recent changes to the head-and-neck cancers editorial section.

This critical review took as its objective the identification of a cohort of women treated with neoadjuvant chemotherapy and mastectomy for whom postmastectomy radiation may be safely omitted based on a low risk of local-regional failure (LRF). The authors used published data, hypothetical clinical scenarios, and an appropriateness criteria methodology to find such a cohort that will form the basis for prospective study.

This study analyzed cosmetic outcomes for the 1440 patients in the American Society of Breast Surgeons MammoSite Registry with 6 years of median follow-up. At 36 and 72 months, the rate of excellent/good cosmesis was 93.3% and 90.4% respectively. The best outcomes were associated with larger skin spacing and smaller tumors (less than 2cm).

This prospective study reports on patients undergoing elective pelvic nodal irradiation with a hypofractionated concomitant boost to the prostate (67.5Gy at 2.7Gy per fraction) together with androgen deprivation. There were only modest declines in urinary and bowel quality of life at 24 months following this regimen. Although more time will be required, this study bolsters the growing sense that creatively designed hypofractionated treatments are a tolerable and patient-friendly approach in the management of this disease.

Image guided radiation therapy is increasingly used for a variety of tumor sites. This study reports the correlation between daily shifts, margin requirements, and body mass index (BMI) in women receiving post operative adjuvant pelvic radiation therapy for endometrial cancer. Daily shifts, systematic errors, and margin requirements were highest in patients who were obese. The use of image guided IMRT in women with a high BMI receiving pelvic radiation therapy is appropriate but the margins may have to be tailored to BMI.

This important analysis from the Children's Oncology Group D9602 study supports the use of reduced radiation therapy doses for local control of rhabdomyosarcoma (RMS) in lymph node-negative, low-risk patients with either orbital primary tumors or microscopic tumor after resection. Cyclophosphamide- containing regimens are associated with lower rates of local failure for these patients. The current COG RMS protocols continue the use of these reduced RT doses, with the addition of a moderate cumulative dose of cyclophosphamide.