Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). DEGRO practical guidelines for radiotherapy of breast cancer V Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. EORTC Lymphoma Cooperative Group studies in clinical stage I-II Hodgkin's disease 1963-1987. [Approval procedures for clinical trials in the field of radiation oncology]. Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. DEGRO practical guidelines: radiotherapy of breast cancer III—radiotherapy of the lymphatic pathways Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. EORTC Radiation Oncology Group quality assurance platform: establishment of a digital central review facility. Net clinical benefit analysis of radiation therapy oncology group 0525: a phase III trial comparing conventional adjuvant temozolomide with dose-intensive temozolomide in patients with newly diagnosed glioblastoma. Adjuvant estrogen following radiation therapy for stage C adenocarcinoma of the prostate: long-term results of a prospective randomized study. Health-related quality of life in patients with high-risk low-grade glioma (EORTC 22033-26033): a randomised, open-label, phase 3 intergroup study. DEGRO Practical Guidelines for Radiotherapy of Breast Cancer II American College of Surgeons Oncology Group Z4099/Radiation Therapy Oncology Group 1021: a randomized study of sublobar resection compared with stereotactic body radiotherapy for high-risk stage I non-small cell lung cancer. Chemoradiation and adjuvant chemotherapy in cervical cancer. Preliminary results of a phase II trial of proton radiotherapy for pediatric rhabdomyosarcoma. A prospective, randomized controlled study on the treatment of stage C and stage D prostatic cancer with estracyt in combination with other chemotherapeutic agents.
BACKGROUND AND PURPOSE During the first decade of the 21st century a number of important European r and omized studies were published . In order to help shape clinical practice based on best scientific evidence from the literature , the International Conference on ' Multidisciplinary Rectal Cancer Treatment : Looking for an European Consensus ' ( EURECA-CC2 ) was organized in Italy under the endorsement of European Society of Medical Oncology ( ESMO ) , European Society of Surgical Oncology ( ESSO ) , and European Society of Therapeutic Radiation Oncology ( ESTRO ) . METHODS Consensus was achieved using the Delphi method . The document was available to all Committee members as a web-based document customized for the consensus process . Eight chapters were identified : epidemiology , diagnostics , pathology , surgery , radiotherapy and chemotherapy , treatment toxicity and quality of life , follow-up , and research questions . Each chapter was subdivided by a topic , and a series of statements were developed . Each member commented and voted , sentence by sentence thrice . Sentences upon which an agreement was not reached after voting round # 2 were openly debated during a Consensus Conference in Perugia ( Italy ) from 11 December to 13 December 2008 . A h and -held televoting system collected the opinions of both the Committee members and the audience after each debate . The Executive Committee scored percentage consensus based on three categories : " large consensus " , " moderate consensus " , and " minimum consensus " . RESULTS The total number of the voted sentences was 207 . Of the 207 , 86 % achieved large consensus , 13 % achieved moderate consensus , and only 3 ( 1 % ) result ed in minimum consensus . No statement was disagreed by more than 50 % of the members . All chapters were voted on by at least 75 % of the members , and the majority was voted on by > 85 % . CONCLUSIONS This Consensus Conference represents an expertise opinion process that may help shape future programs , investigational protocol s , and guidelines for staging and treatment of rectal cancer throughout Europe Aim The purpose of this work is to give practical guidelines for radiotherapy of locally advanced , inflammatory and metastatic breast cancer at first presentation . Methods A comprehensive survey of the literature using the search phrases “ locally advanced breast cancer ” , “ inflammatory breast cancer ” , “ breast cancer and synchronous metastases ” , “ de novo stage IV and breast cancer ” , and “ metastatic breast cancer ” and “ at first presentation ” restricted to “ clinical trials ” , “ r and omized trials ” , “ meta- analysis ” , “ systematic review ” , and “ guideline ” was performed and supplemented by using references of the respective publications . Based on the German interdisciplinary S3 guidelines , up date d in 2012 , this publication addresses indications , sequence to other therapies , target volumes , dose , and fractionation of radiotherapy . Results International and national guidelines are in agreement that locally advanced , at least if regarded primarily unresectable and inflammatory breast cancer should receive neoadjuvant systemic therapy first , followed by surgery and radiotherapy . If surgery is not amenable after systemic therapy , radiotherapy is the treatment of choice followed by surgery , if possible . Surgery and radiotherapy should be administered independent of response to neoadjuvant systemic treatment . In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Conclusion Radiotherapy is an important part in the treatment of locally advanced and inflammatory breast cancer that should be given to all patients regardless to the intensity and effect of neoadjuvant systemic treatment and the extent of surgery . Locoregional radiotherapy in patients with primarily distant metastatic disease should be prescribed on an individual basis . ZusammenfassungZielZiel der Arbeit ist die Entwicklung von Praxis-Leitlinien zur Strahlentherapie des lokal fortgeschrittenen einschließlich des inflammatorischen Mammakarzinoms sowie zur lokalen Therapie bei synchroner Fernmetastasierung . Method enEs erfolgte eine Literaturübersicht basierend auf den Suchbegriffen „ locally advanced breast cancer “ , „ inflammatory breast cancer “ , „ breast cancer and synchronous metastases “ , „ de novo stage IV and breast cancer “ und „ metastatic breast cancer “ sowie „ at first presentation “ . Stratifiziert wurde nach „ clinical trials “ , „ r and omized trials “ , „ meta- analysis “ , „ systematic review “ und „ guideline “ , ergänzt von kürzlich veröffentlichten Abstract s. Ergänzend zu den Stellungnahmen der deutschen interdisziplinären S3-Leitlinie der Deutschen Krebsgesellschaft und der AWMF zum Mammakarzinom von 2012 bezieht diese Publikation Stellung zu den Indikationen , zur zeitlichen Abfolge mit and eren Therapien , zum Zielvolumen sowie zur Dosis und Fraktionierung der Strahlentherapie . ErgebnisseInternationale und nationale Leitlinien stimmen darin überein , dass Patientinnen mit einem lokal fortgeschrittenen , zumindest primär als irresektabel eingestuften , sowie Patientinnen mit einem inflammatorischen Mammakarzinom zunächst eine neoadjuvante Systemtherapie erhalten sollen , gefolgt von einer Operation und einer Strahlentherapie . Falls nach der Systemtherapie eine Operation nicht durchführbar ist , sollte zunächst eine Radiotherapie erfolgen und anschließend noch einmal die Möglichkeit einer Operation bedacht werden . Operation und Bestrahlung erfolgen unabhängig vom Ansprechen auf die neoadjuvante Systemtherapie . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle . Ein Überlebensvorteil besteht wohl nicht , möglicherweise aber doch für einige Subgruppen der Patientinnen . SchlussfolgerungEine Strahlentherapie ist wichtiger Best and teil der Beh and lung lokal fortgeschrittener und inflammatorischer Mammakarzinome für alle betroffenen Patientinnen , unabhängig von der Intensität und dem Ergebnis der neoadjuvanten systemischen Therapie und des Ausmaßes einer eventuellen Chirurgie . Bei Patientinnen mit primärer Fernmetastasierung muss i m Tumorboard die Indikation zur lokoregionären Strahlentherapie individuell gestellt werden The second part of the GYN GEC ESTRO working group recommendations is focused on 3D dose-volume parameters for brachytherapy of cervical carcinoma . Methods and parameters have been developed and vali date d from dosimetric , imaging and clinical experience from different institutions ( University of Vienna , IGR Paris , University of Leuven ) . Cumulative dose volume histograms ( DVH ) are recommended for evaluation of the complex dose heterogeneity . DVH parameters for GTV , HR CTV and IR CTV are the minimum dose delivered to 90 and 100 % of the respective volume : D90 , D100 . The volume , which is enclosed by 150 or 200 % of the prescribed dose ( V150 , V200 ) , is recommended for overall assessment of high dose volumes . V100 is recommended for quality assessment only within a given treatment schedule . For Organs at Risk ( OAR ) the minimum dose in the most irradiated tissue volume is recommended for reporting : 0.1 , 1 , and 2 cm3 ; optional 5 and 10 cm3 . Underlying assumptions are : full dose of external beam therapy in the volume of interest , identical location during fractionated brachytherapy , contiguous volumes and contouring of organ walls for > 2 cm3 . Dose values are reported as absorbed dose and also taking into account different dose rates . The linear-quadratic radiobiological model-equivalent dose (EQD2)-is applied for brachytherapy and is also used for calculating dose from external beam therapy . This formalism allows systematic assessment within one patient , one centre and comparison between different centres with analysis of dose volume relations for GTV , CTV , and OAR . Recommendations for the transition period from traditional to 3D image-based cervix cancer brachytherapy are formulated . Supplementary data ( available in the electronic version of this paper ) deals with aspects of 3D imaging , radiation physics , radiation biology , dose at reference points and dimensions and volumes for the GTV and CTV ( adding to [ Haie-Meder C , Pötter R , Van Limbergen E et al. Recommendations from Gynaecological ( GYN ) GEC ESTRO Working Group ( I ) : concepts and terms in 3D image-based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV . Radiother Oncol 2005;74:235 - 245 ] ) . It is expected that the therapeutic ratio including target coverage and sparing of organs at risk can be significantly improved , if radiation dose is prescribed to a 3D image-based CTV taking into account dose volume constraints for OAR . However , prospect i ve use of these recommendations in the clinical context is warranted , to further explore and develop the potential of 3D image-based cervix cancer brachytherapy The European Organization for Research and Treatment of Cancer ( EORTC ) Lymphoma Cooperative Group was founded in 1963 as the  Radiotherapy-Chemotherapy  Group . It changed its name in 1986 because the main study objects of the group were Hodgkin ’s disease and non-Hodgkin ’s lymphoma . Its aim is to organize multicenter trials between European hospitals , mainly Dutch , French , and Belgian , but recently extended with groups from Switzerl and BACKGROUND AND PURPOSE Application of ionizing radiation for the purpose of medical research in Germany needs to be approved by the national authority for radiation protection ( Bundesamt für Strahlenschutz , BfS ) . For studies in the field of radiation oncology , differentiation between use of radiation for " medical care ( Heilkunde ) " versus " medical research " frequently leads to contradictions . The aim of this article is to provide principle investigators , individuals , and institutions involved in the process , as well as institutional review or ethics committees , with the necessary information for this assessment . Information on the legal frame and the approval procedures are also provided . METHODS A workshop was co-organized by the German Society for Radiation Oncology ( DEGRO ) , the Working Party for Radiation Oncology ( ARO ) of the German Cancer Society ( DKG ) , the German Society for Medical Physics ( DGMP ) , and the German Cancer Consortium ( DKTK ) in October 2013 . This paper summarizes the results of the workshop and the follow-up discussion s between the organizers and the BfS. RESULTS Differentiating between " Heilkunde " which does not need to be approved by the BfS and " medical research " is whether the specific application of radiation ( beam quality , dose , schedule , target volume , etc . ) is a clinical ly established and recognized procedure . This must be answered by the qualified physician(s ) ( " fachkundiger Arzt " according to German radiation protection law ) in charge of the study and the treatments of the patients within the study , taking into consideration of the best available evidence from clinical studies , guidelines and consensus papers . Among the important parameters for assessment are indication , total dose , and fractionation . Radiation treatments applied outside clinical trials do not require approval by the BfS , even if they are applied within a r and omized or nonr and omized clinical trial . The decision-making by the " fachkundigem Arzt " may be supported on request by an opinion given by the DEGRO Expert Committee for clinical trials . CONCLUSION An important aim for promoting clinical research and patient care in radiation oncology is to further professionalize planning and implementation of clinical trials in this field . Correct assessment , at an early stage , whether a trial needs to be approved by the BfS may reduce unnecessary costs and reduce the time needed for the approval procedure for those trials which need to be assessed by the STUDY OBJECTIVES The purpose of this phase III clinical trial was to test whether chemotherapy followed by radiation therapy result ed in superior survival to either hyperfractionated radiation or st and ard radiation in surgically unresectable non-small cell lung cancer . DESIGN Patients were prospect ively r and omized to 2 months of cisplatin , vinblastine chemotherapy followed by 60 Gy of radiation at 2.0 Gy per fraction or 1.2 Gy per fraction radiation delivered twice daily to a total dose of 69.6 Gy , or 2.0 Gy per fraction of radiation once daily to 60 Gy . Patients were enrolled from January 1989 through January 1992 , and followed for a potential minimum period of 5 years . SETTING This trial was an intergroup National Cancer Institute-funded trial within the Radiation Therapy Oncology Group , the Eastern Cooperative Oncology Group , and the Southwest Oncology Group . PATIENTS Patients with surgically unresectable non-small cell lung cancer , clinical stage II , IIIA , and IIIB , were required to have a Karnofsky Performance Status of > or = 70 and a weight loss of < 5 % for 3 months before study entry . Four hundred ninety patients were registered on trial , of which 458 patients were eligible . CONCLUSION Overall survival was statistically superior for the patients receiving chemotherapy and radiation vs the other two arms of the study . The twice-daily radiation therapy arm , although better , was not statistically superior in survival for those patients receiving st and ard radiation .  Median survival for st and ard radiation was 11.4 months ; for chemotherapy and irradiation , 13.2 months ; and for hyperfractionated irradiation , 12 months . The respective 5-year survivals were 5 % for st and ard radiation therapy , 8 % for chemotherapy followed by radiation therapy , and 6 % for hyperfractionated irradiation Aim The purpose of this work is to up date the practical guidelines for adjuvant radiotherapy of the regional lymphatics of breast cancer published in 2008 by the breast cancer expert panel of the German Society of Radiation Oncology ( DEGRO ) . Methods A comprehensive survey of the literature concerning regional nodal irradiation ( RNI ) was performed using the following search terms : “ breast cancer ” , “ radiotherapy ” , “ regional node irradiation ” . Recent r and omized trials were analyzed for outcome as well as for differences in target definition . Field arrangements in the different studies were reproduced and superimposed on CT slices with individually contoured node areas . Moreover , data from recently published meta-analyses and guidelines of international breast cancer societies , yielding new aspects compared to 2008 , provided the basis for defining recommendations according to the criteria of evidence -based medicine . In addition to the more general statements of the German interdisciplinary S3 guidelines up date d in 2012 , this paper addresses indications , targeting , and techniques of radiotherapy of the lymphatic pathways after surgery for breast cancer . Results International guidelines reveal substantial differences regarding indications for RNI .  Patients with 1–3 positive nodes seem to profit from RNI compared to whole breast ( WBI ) or chest wall irradiation alone , both with regard to locoregional control and disease-free survival . Irradiation of the regional lymphatics including axillary , supraclavicular , and internal mammary nodes provided a small but significant survival benefit in recent r and omized trials and one meta- analysis . Lymph node irradiation yields comparable tumor control in comparison to axillary lymph node dissection ( ALND ) , while reducing the rate of lymph edema . Data concerning the impact of 1–2 macroscopically affected sentinel node ( SN ) or microscopic metastases on prognosis are conflicting . Conclusion Recent data suggest that the current restrictive use of RNI should be scrutinized because the risk – benefit relationship appears to shift towards an improvement of outcome .ZusammenfassungZielAktualisierung der DEGRO-Leitlinie von 2008 zur adjuvanten Strahlentherapie des regionalen Lymphabflusses bei Mammakarzinom und Ergänzung der allgemeinen Empfehlungen der interdisziplinären S3-Leitlinie der Deutschen Krebsgesellschaft von 2012 durch spezifisch radioonkologische Leitlinien zur Indikation , Zielvolumendefinition und Technik der postoperativen Radiotherapie . Method enDie DEGRO-Expertengruppe Mammakarzinom führte eine systematische Literaturrecherche nach r and omisierten Studien , Metaanalysen sowie internationalen Leitlinien durch , die nach 2008 publiziert wurden und sich an den Kriterien evidenzbasierter Medizin orientierten . Suchbegriffe waren „ breast cancer “ , „ radiotherapy “ und „ regional node irradiation “ . Die Studien wurden sowohl auf ihre Ergebnisse als auch hinsichtlich der Unterschiede in den Zielvolumina analysiert und auf 3-D-Planungsschnittbilder mit CT-konturierten Lymphabflussgebieten projiziert . ErgebnisseDie Indikation zur regionalen Lymphabflussbestrahlung ( RNI ) wird in internationalen Leitlinien unterschiedlich gestellt . Bei Patientinnen mit 1–3 befallenen axillären Lymphknoten wurden nach RNI i m Vergleich zur alleinigen Bestrahlung der Brust oder Brustw and Verbesserungen der lokoregionalen Kontrolle und des Überlebens beobachtet . Mehrere r and omisierte Studien und eine Metaanalyse zeigten nach RNI ( mit unterschiedlichen Zielvolumina ) eine zwar geringe , jedoch signifikante Verbesserung des Überlebens . Bei positivem Sentinel-Lymphknoten ( SN ) ist die Lymphabflussbestrahlung einer axillären Lymphonodektomie ( ALND ) gleichwertig in der lokalen Tumorkontrolle , geht aber mit einer deutlich geringeren Lymphödemrate einher . Zur Frage , ob ein solch limitierter Lymphknotenbefall und selbst eine Mikrometastasierung langfristig einen Einfluss auf die Prognose haben , ist die Date nlage widersprüchlich . SchlussfolgerungDie restriktive Indikationsstellung zur Lymphabflussbestrahlung muss angesichts neuer Date n aus r and omisierten Studien kritisch überdacht werden PURPOSE To provide evidence -based recommendations to oncologists and others for treatment of patients with locally advanced , unresectable pancreatic cancer . METHODS American Society of Clinical Oncology convened an Expert Panel of medical oncology , radiation oncology , surgical oncology , gastroenterology , palliative care , and advocacy experts and conducted a systematic review of the literature from January 2002 to June 2015 . Outcomes included overall survival , disease-free survival , progression-free survival , and adverse events . RESULTS Twenty-six r and omized controlled trials met the systematic review criteria . RECOMMENDATIONS A multiphase computed tomography scan of the chest , abdomen , and pelvis should be performed . Baseline performance status and comorbidity profile should be evaluated . The goals of care , patient preferences , psychological status , support systems , and symptoms should guide decisions for treatments . A palliative care referral should occur at first visit . Initial systemic chemotherapy ( 6 months ) with a combination regimen is recommended for most patients ( for some patients radiation therapy may be offered up front ) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile . There is no clear evidence to support one regimen over another . The gemcitabine-based combinations and treatments recommended in the metastatic setting ( eg , fluorouracil , leucovorin , irinotecan , and oxaliplatin and gemcitabine plus nanoparticle albumin-bound paclitaxel ) have not been evaluated in r and omized controlled trials involving locally advanced , unresectable pancreatic cancer . If there is local disease progression after induction chemotherapy , without metastasis , then radiation therapy or stereotactic body radiotherapy may be offered also with an Eastern Cooperative Oncology Group performance status ≤ 2 and an adequate comorbidity profile . If there is stable disease after 6 months of induction chemotherapy but unacceptable toxicities , radiation therapy may be offered as an alternative . Patients with disease progression should be offered treatment per the ASCO Metastatic Pancreatic Cancer Treatment Guideline . Follow-up visits every 3 to 4 months are recommended . Additional information is available at www.asco.org/ guidelines /LAPC and www.asco.org/ guidelines /MetPC and www.asco.org/ guidelines wiki OBJECTIVE Quality assurance ( QA ) in clinical trials is essential to ensure treatment is safely and effectively delivered . As QA requirements have increased in complexity in parallel with evolution of radiation therapy ( RT ) delivery , a need to facilitate digital data exchange emerged . Our objective is to present the platform developed for the integration and st and ardization of QART activities across all EORTC trials involving RT . METHODS The following essential requirements were identified : secure and easy access without on-site software installation ; integration within the existing EORTC clinical remote data capture system ; and the ability to both customize the platform to specific studies and adapt to future needs . After retrospective testing within several clinical trials , the platform was introduced in phases to participating sites and QART study review ers . RESULTS The result ing QA platform , integrating RT analysis software installed at EORTC Headquarters , permits timely , secure , and fully digital central DICOM-RT based data review . Participating sites su bmi t data through a st and ard secure upload webpage . Supplemental information is su bmi tted in parallel through web-based forms . An internal quality check by the QART office verifies data consistency , formatting , and anonymization . QART review ers have remote access through a terminal server . Review ers evaluate su bmi ssions for protocol compliance through an online evaluation matrix . Comments are collected by the coordinating centre and institutions are informed of the results . CONCLUSIONS This web-based central review platform facilitates rapid , extensive , and prospect i ve QART review . This reduces the risk that trial outcomes are compromised through inadequate radiotherapy and facilitates correlation of results with clinical outcomes PURPOSE Radiation Therapy Oncology Group trial 0525 tested whether dose-intensifying temozolomide versus st and ard chemoradiotherapy improves overall survival ( OS ) or progression-free survival ( PFS ) in newly diagnosed glioblastoma . Tests of neurocognitive function ( NCF ) and symptoms ( using the MD And erson Symptom Inventory-Brain Tumor module ; MDASI-BT ) and of quality of life ( European Organisation for the Research and Treatment of Cancer Quality of Life Question naire [ EORTC QLQ ] -C30/BN20 ) examined the net clinical benefit ( NCB ) of therapy . PATIENTS AND METHODS  NCF tests ( Hopkins Verbal Learning Test-Revised , Trail Making Test , and Controlled Oral Word Association ) , MDASI-BT , and EORTC QLQ-C30/BN20 were completed in a subset of patients . Multivariate Cox proportional hazard regression modeling determined the prognostic value of baseline and early change from baseline to cycle 1 for OS and PFS . Two- sample proportional test statistic was used to evaluate differences between treatments ( dose-dense v st and ard-dose ) on NCB measures from baseline to cycle 4 in stable patients . RESULTS Overall , 182 patients participated in the study . Baseline NCF tests and the physical functioning quality of life scale were associated with OS and PFS . Baseline to cycle 1 in all NCB components were associated with OS and PFS . There was greater deterioration in the dose-dense arm from baseline to cycle 4 in the Global Health and Motor Function subscales ( EORTC QLQ-C30/BN20 ) as well as in overall symptom burden , overall symptom interference , and activity-related symptom interference subscales ( MDASI-BT ) . There were no between-arm differences in NCF . CONCLUSION Longitudinal collection of NCB measures is feasible in cooperative group studies and provides an added dimension to st and ard outcome measures . Greater adverse symptom burden and functional interference , as well as decreased global health and motor function were observed in patients r and omly assigned to the dose-dense arm . Baseline and early change in NCB measures were associated with decreased rates of survival Seventy-eight patients with clinical Stage C adenocarcinoma of the prostate were prospect ively r and omized to receive either radiation alone or radiation and adjuvant estrogen ( diethylstilbestrol ) . No patient had received any prior definitive treatment for cancer . Forty patients were r and omized to receive radiotherapy only and 38 patients to receive radiotherapy and estrogen .  The median follow-up for all surviving patients was 14.5 years . Whether analyzed according to the original r and omization or according to the treatment actually received , disease-free survival in the adjuvant estrogen group was strikingly and significantly higher than in the radiation-only group . At 5 , 10 , and 15 years patients receiving adjuvant estrogen had respective disease-free survival rates of 71 % , 63 % , and 63 % compared with 49 % , 43 % , and 35 % in patients having radiation only ( p = 0.008 ) . However , because of greater intercurrent disease-related mortality in patients receiving estrogen , there was no improvement in survival . This study suggests that a prospect i ve r and omized evaluation of early and rogen deprivation with orchiectomy or with one of the nonestrogenic agents should be undertaken and that patients receiving early and rogen deprivation should not be included in series reporting on the curative potential of radiation as a single modality BACKGROUND Temozolomide chemotherapy versus radiotherapy in patients with a high-risk low- grade glioma has been shown to have no significant effect on progression-free survival . If these treatments have a different effect on health-related quality of life ( HRQOL ) , it might affect the choice of therapy . We postulated that temozolomide compromises HRQOL and global cognitive functioning to a lesser extent than does radiotherapy . METHODS We did a prospect i ve , phase 3 , r and omised controlled trial at 78 medical centres and large hospitals in 19 countries . We enrolled adult patients ( aged ≥18 years ) with histologically confirmed diffuse ( WHO grade II ) astrocytoma , oligodendroglioma , or mixed oligoastrocytoma , with a WHO performance status of 2 or lower , without previous chemotherapy or radiotherapy , who needed active treatment other than surgery . We r and omly assigned eligible patients ( 1:1 ) using a minimisation technique , stratified by WHO performance status ( 0 - 1 vs 2 ) , age ( < 40 years vs ≥40 years ) , presence of contrast enhancement on MRI , chromosome 1p status ( deleted vs non-deleted vs indeterminate ) , and the treating medical centre , to receive either radiotherapy ( 50·4 Gy in 28 fractions of 1·8 Gy for 5 days per week up to 6·5 weeks ) or temozolomide chemotherapy ( 75 mg/m2 daily , for 21 of 28 days [ one cycle ] for 12 cycles ) . The primary endpoint was progression-free survival ( results published separately ) ; here , we report the results for two key secondary endpoints : HRQOL ( assessed using the European Organisation for Research and Treatment of Cancer 's [ EORTC ] QLQ-C30 [ version 3 ] and the EORTC Brain Cancer Module [ QLQ-BN20 ] ) and global cognitive functioning ( assessed using the Mini-Mental State Examination [ MMSE ] ) . We did analyses on the intention-to-treat population . This study is closed and is registered at EudraCT , number 2004 - 002714 - 11 , and at Clinical Trials.gov , number NCT00182819 . FINDINGS Between Dec 6 , 2005 , and Dec 21 , 2012 , we r and omly assigned 477 eligible patients  to either radiotherapy ( n=240 ) or temozolomide chemotherapy ( n=237 ) . The difference in HRQOL between the two treatment groups was not significant during the 36 months ' follow-up ( mean between group difference [ averaged over all timepoints ] 0·06 , 95 % CI -4·64 to 4·75 , p=0·98 ) . At baseline , 32 ( 13 % ) of 239 patients who received radiotherapy and 32 ( 14 % ) of 236 patients who received temozolomide chemotherapy  had impaired cognitive function , according to the MMSE scores . After r and omisation , five ( 8 % ) of 63 patients who received radiotherapy and three ( 6 % ) of 54 patients who received temozolomide chemotherapy and who could be followed up for 36 months had impaired cognitive function , according to the MMSE scores . No significant difference was recorded between the groups for the change in MMSE scores during the 36 months of follow-up . INTERPRETATION The effect of temozolomide chemotherapy or radiotherapy  on HRQOL or global cognitive functioning did not differ in patients with low- grade glioma . These results do not support the choice of temozolomide alone over radiotherapy alone in patients with high-risk low- grade glioma . FUNDING Merck Sharp & Dohme-Merck & Co , National Cancer Institute , Swiss Cancer League , National Institute for Health Research , Cancer Research UK , Canadian Cancer Society Research Institute , National Health and Medical Research Council , European Organisation for Research and Treatment of Cancer Cancer Research Fund Background and Purpose : The aim of the present paper is to up date the practical guidelines for radiotherapy of breast cancer published in 2006 by the breast cancer expert panel of the German Society for Radiooncology ( DEGRO ) . These recommendations were complementing the S3 guidelines of the German Cancer Society ( DKG ) elaborated in 2004 . The present DEGRO recommendations are based on a revision of the DKG guidelines provided by an interdisciplinary panel and published in February 2008 . Methods : The DEGRO expert panel ( authors of the present manuscript ) performed a comprehensive survey of the literature . Data from lately published meta-analyses , recent r and omized trials and guidelines of international breast cancer societies , yielding new aspects compared to 2006 , provided the basis for defining recommendations referring to the criteria of evidence -based medicine . In addition to the more general statements of the DKG , this paper emphasizes specific radiooncologic issues relating to radiotherapy after mastectomy ( PMRT ) , locally advanced disease , irradiation of the lymphatic pathways , and sequencing of local and systemic treatment . Technique , targeting , and dose are described in detail . Results : PMRT significantly reduces local recurrence rates in patients with T3/T4 tumors and /or positive axillary lymph nodes ( 12.9 % with and 40.6 % without PMRT in patients with four or more positive nodes ) . The more local control is improved , the more substantially it translates into increased survival . In node-positive women the absolute reduction in 15-year breast cancer mortality is 5.4 % . Data referring to the benefit of lymphatic irradiation are conflicting . However , radiotherapy of the supraclavicular area is recommended when four or more nodes are positive and otherwise considered individually . Evidence concerning timing and sequencing of local and systemic treatment is sparse ; therefore , treatment decisions should depend on the dominating risk of recurrence . Conclusion : There is common consensus that PMRT is m and atory for patients with T3/T4 tumors and /or four or more positive axillary nodes and should be considered for patients with one to three involved nodes . Irradiation of the lymphatic pathways and the optimal time point for onset of radiotherapy are still under debate . Hintergrund und Ziel : Ziel der Arbeit ist eine Aktualisierung der 2006 publizierten Leitlinie der „ Expertengruppe Mammakarzinom “ der Deutschen Gesellschaft für Radioonkologie ( DEGRO ) . Diese war seinerzeit in Ergänzung zur interdisziplinären S3-Leitlinie der Deutschen Krebsgesellschaft ( DKG ) von 2004 verfasst worden . Zwischenzeitlich erfolgten eine Überarbeitung und Aktualisierung der S3-Leitlinie der DKG , die i m Februar 2008 publiziert wurde . Method ik : Die Expertengruppe ( identisch mit den Autoren dieses Manuskripts ) führte eine umfassende Literaturrecherche durch . Aktuelle Metaanalysen und r and omisierte Studien , die neue Aspekte gegenüber 2006 ergaben , sowie Empfehlungen internationaler Fachgesellschaften wurden in die Bewertung von Therapieindikationen einbezogen . Diese orientieren sich an den Kriterien evidenzbasierter Medizin . In Ergänzung zu den eher allgemeinen Statements der DKG 2008 werden spezielle radiotherapeutische Fragestellungen beh and elt , die eine Strahlentherapie nach Mastektomie ( PMRT ) und/oder bei fortgeschrittenen Tumoren , die Bestrahlung der Lymphabflusswege und die Sequenz von Radio- und Systemtherapie betreffen . Zielvolumendefinition und Dosierung werden i m Detail beschrieben . Ergebnisse : Die PMRT senkt die Lokalrezidivrate bei Patientinnen mit hohem Rückfallrisiko ( T3/T4-Tumoren und/oder befallene axilläre Lymphknoten ; 12,9 % mit und 40,6 % ohne PMRT ) . Je ausgeprägter die durch die Radiotherapie bewirkte lokale Tumorkontrolle ist , desto stärker wirkt sich dies auf die Überlebenswahrscheinlichkeit aus . Bei lymphonodal positiven Patientinnen ergab sich eine absolute Verminderung der tumorspezifischen Sterblichkeit um 5,4 % nach 15 Jahren . Hinsichtlich des Nutzens einer Strahlentherapie der Lymphabflusswege ist die Date nlage widersprüchlich . Eine Bestrahlung der Supraklavikularregion ist jedoch bei vier oder mehr befallenen axillären Lymphknoten stets indiziert und sollte bei ein bis drei positiven Lymphknoten erwogen werden . Bezüglich der Sequenz von Radio- und Systemtherapie gibt es keine richtungweisenden Evidenzen zugunsten einer Therapiemodalität . Postoperativ sollte die Sequenz vom dominierenden Risiko abhängig gemacht werden . Schlussfolgerung : Nach Mastektomie ist die PMRT bei T3/T4-Tumoren , Resttumor und/oder axillären Lymphknotenmetastasen obligat . Die Bestrahlung der regionalen Lymphabflusswege und die Sequenz von Radio- und Systemtherapie bleiben bei unzureichender Date nlage Gegenst and interdisziplinärer Diskussionen During the past decade , tremendous interest has arisen in the use of nonoperative therapies for patients with non-small cell lung cancer . Of these therapies , stereotactic body radiotherapy has become established as an effective modality for treating peripheral cancer in medically inoperable patients .  Toxicity is low , and the treatment is effective , with excellent local control rates . Several investigators have suggested that stereotactic body radiotherapy could be effective for high-risk operable patients ( usually treated with sublobar resection ) and even perhaps for st and ard-risk operable patients ( usually treated with lobectomy ) ; however , this is less accepted . A direct comparison of stereotactic body radiotherapy and sublobar resection is difficult for a number of reasons . These include different definitions of recurrence , different population s of patients in these studies ( with those undergoing stereotactic body radiotherapy tending to be the medically inoperable group ) , and different methods of classifying morbidity in the surgical and radiation oncology studies . Imaging follow-up has also not been st and ardized among the studies . Thus , a r and omized study is necessary and timely . Investigators from the American College of Surgeons Oncology Group and the Radiation Therapy and Oncology Group have collaborated to develop a phase III r and omized study comparing stereotactic body radiotherapy and sublobar resection ( with or without brachytherapy ) for high-risk operable patients with non-small cell lung cancer . This study ( American College of Surgeons Oncology Group Z4099/Radiation Therapy Oncology Group 1021 ) has recently opened for accrual . It is hoped that this will help to better define the role of these therapies for patients with non-small cell lung cancer PURPOSE Radiotherapy is the st and ard treatment for locally advanced cervical cancer , but treatment results remain disappointing , particularly for women with bulky central disease . We investigated the role of concurrent chemoradiation and adjuvant chemotherapy in a r and omized trial . PATIENTS AND METHODS Two hundred twenty patients with bulky stage I , II , and III cervical cancer were r and omized to receive either st and ard pelvic radiotherapy or chemoradiation ( epirubicin 60 mg/m(2 ) ) followed by adjuvant chemotherapy with epirubicin 90 mg/m(2 ) administered at 4-week intervals for five additional cycles . RESULTS Fifty-nine patients have relapsed , with a median follow-up duration of 77 months . Patients who received epirubicin radiation therapy showed a significantly longer disease-free ( P = .03 ) and cumulative survival ( P = .04 ) . Patients who received radiation alone had significantly more distant metastasis than those who received chemoradiation ( P = .012 ) . There was no difference in long-term local tumor control ( P = .99 ) . CONCLUSION Survival benefit has been demonstrated in patients treated with chemoradiation followed by adjuvant chemotherapy with epirubicin as compared with patients treated with st and ard pelvic radiotherapy alone PURPOSE This prospect i ve phase II study was design ed to assess disease control and to describe acute and late adverse effects of treatment with proton radiotherapy in children with rhabdomyosarcoma ( RMS ) . PATIENTS AND METHODS Fifty-seven patients with localized RMS ( age 21 years or younger ) or metastatic embryonal RMS ( age 2 to 10 years ) were enrolled between February 2005 and August 2012 . All patients were treated with chemotherapy based on either vincristine , actinomycin , and cyclophosphamide or vincristine , actinomycin , and ifosfamide-based chemotherapy and proton radiation . Surgical resection was based on tumor site and accessibility . Common Terminology Criteria for Adverse Events , Version 3.0 , was used to assess and grade adverse effects of treatment . Concurrent enrollment onto Children 's Oncology Group or European Pediatric Sarcoma Study Group protocol s was allowed . All pathology and imaging were review ed at the treating institution . RESULTS Median follow-up was 47 months ( range , 14 to 102 months ) for survivors . Five-year event-free survival ( EFS ) , overall survival ( OS ) , and local control ( LC ) were 69 % , 78 % , and 81 % , respectively , for the entire cohort . The 5-year LC by risk group was 93 % for low-risk and 77 % for intermediate-risk disease . There were 13 patients with grade 3 acute toxicity and three patients with grade 3 late toxicity . There were no acute or late toxicities higher than grade 3 . CONCLUSION Five-year LC , EFS , and OS rates were similar to those observed in comparable trials that used photon radiation .  Acute and late toxicity rates were favorable . Proton radiation appears to represent a safe and effective radiation modality for pediatric RMS The present study was design ed to investigate the efficacy of various combinations of chemotherapeutic agents in the treatment of prostatic cancer in a group refractory to anti and rogenic therapy ( Group 1 ) and in a previous untreated group ( Group 2 ) . Therapeutic combinations of Estracyt ( E ) + Peplomycin ( P ) + Doxorubicin ( Do ) and P + Do + 5 FU ( F ) in Group 1 and E + P , Honvan ( Ds ) + P and E in Group 2 were carried out . The main objectives of this study were estimations of the efficacy of E and P in relation to the refractory cases of Group 1 and the efficacy of the combination E + P , in Group 2 . This is the first such prospect i ve , r and omized , controlled study to be carried out in Japan in relation to prostatic cancer . The results obtained in the present study indicated that chemotherapeutic regimens including E provide some enhanced efficacy , but that the efficacy with regard to refractory cases is poor ( 23.1 - 27.3 % ) , as has been reported of studies conducted in the USA and Europe . With regard to previously untreated cases , the E + P regimen achieved a relatively higher response rate than the other treatments ( 72.7 vs 44.5 or 50.0 % ) . In the comparison of survival times and survival curves , there were no statistically significant differences among the various treatment subgroups . A comparison of survival curves revealed the interesting finding that the PAP-related response showed a clear correlation to the survival curves of Group 2 patients
Both journals are anchored in large scientific societies and serve basically the same medical , physical and biological community and at the same scientific level ; the two journals are in the most recent Impact Factor list ranked almost back to back , indicating an equal importance and contribution to science .
Radiotherapy and Oncology is more than a scientific journal , it also serves other purpose s such as facilitate education through ( educational ) review s and improving the st and ard of care by bringing forward guidelines for conduct of radiotherapy .
Finally , the journal also tries to maintain a communication platform between the science produced by the membership of ESTRO and therefore it brings papers frommembers in the different European countries , sometimes at the expense of ultimate scientific quality , but with the underst and ing that it is important that the entire ESTRO membership gets access and opportunity to publish in a high ranked journal .
ESTRO , the European Society for Therapeutic Radiation Oncology , or with its new name European Society for Radiation Oncology , is a scientific society .
It means that the prime aim of ESTRO is to bring to bring people together on an individual basis who have a common interest in improving the scientific conduct of radiotherapy and cancer treatment in Europe by ensuring that proper radiotherapy is available in the multidisciplinary treatment of cancer and applied with the right indication and with the most optimal technique .
One of the main aims of this endeavour was to create a platform for scientific exchange through meetings and through the establishment of a scientific journal [ 1 ] .
Thus Radiotherapy and Oncology was launched shortly after the foundation of ESTRO and has become the society ’s prime vehicle for scientific communication by serving ESTRO members through almost the entire 30 years of the society ’s existence .
The aim was to create a peer review ed high quality international journal and that aim has indeed been fulfilled . ‘ ‘