Our previous study on breast cancer BRCA carriers disclosed a high local recurrence (LR) rate in patients who underwent skin sparing (SSM) or nipple sparing mastectomy (NSM) without postoperative radiation therapy (RT), compared to breast conservation surgery or mastectomy with RT. The current study compares the LR rates in BRCA versus non BRCA carriers after SSM/NSM in relation the receipt of RT. The study was approved by the institutional ethics committee. Data collected included patient- (e.g., age), tumour- (e.g., subtype, stage), and treatment-related factors and outcomes. LR was defined as ipsilateral chest wall recurrence. P value ≤ 0.05 was considered statistically significant. A total of 255 patients (127 BRCA, 128 non-BRCA) were included. Patients who did not receive RT had an earlier disease stage (most N0). No differences were found for LR rate in non-BRCA versus BRCA groups per involved breast and per patient. Comparing the subgroup of patients who did not receive RT, there were no statistically significant differences in LR between non-BRCA versus BRCA (p-value > 0.05). Similarly, there were no significant differences in LR for the subgroup of patients who did receive RT (p-value > 0.05). Regardless of BRCA status, patients who received RT had significantly lower LR rates. No differences in overall survival were noted between the groups. Our results confirm high LR rates after SSM and NSM in patients who are not treated with RT, independent of BRCA-status. This mandate further investigation, as previous studies did not show a benefit of postmastectomy RT in the early breast cancer stage of those patients.

Introduction: Anaplastic meningiomas, categorized as WHO grade 3 tumors, are rare and highly aggressive, accounting for 1-2% of all meningioma cases. Despite aggressive treatment, including surgery and Radiation, they exhibit a high recurrence rate and poor survival outcomes. The aggressive histopathological features emphasize the urgent need for effective management strategies. Methods: A retrospective multi-institutional analysis was conducted on patients with recurrent anaplastic meningioma who underwent re-irradiation between 2017 and 2023. Clinical, dosimetric, and outcome data were collected and analyzed, focusing on local control, progression free survival and treatment-related adverse events. Results: Thirty-four cases were analyzed, with a median follow-up 11 months after re-irradiation. Progression-free survival at 12 months was 61.9%, with higher doses correlating with better outcomes. Concomitant Bevacizumab improves progression-free survival and reduces the risk of radiation necrosis. CDKN2A homozygote deletion correlated with a higher risk of local failure. Symptomatic radiation necrosis occurred in 20.5% of cases, but its incidence was lower with concomitant Bevacizumab treatment. Conclusion: Re-irradiation presents a viable option for recurrent anaplastic meningioma despite the associated risk of radiation necrosis. Higher doses with concomitant Bevacizumab improve clinical outcomes and reduce toxicity. Individualized treatment approaches are necessary, emphasizing the importance of further research to refine management strategies for this challenging disease.

Whole-brain radiotherapy (WBRT) remains a standard treatment for extensive brain metastases, providing symptom relief and improved progression-free survival (PFS). Re-irradiation is often necessary for recurrent disease, particularly in the cerebellum, which accounts for 10–20% of cases. Cerebellar metastases are associated with distinct symptoms and poorer prognoses compared to supratentorial lesions. This study evaluates the outcomes of cerebellar-only re-irradiation for brain metastases, with or without stereotactic radiosurgery (SRS) for supratentorial lesions. A retrospective analysis of 56 patients treated between 2017 and 2023 was conducted. Patients received cerebellar-only re-irradiation after WBRT. Symptom improvement was assessed three months post-treatment. Statistical analyses included t-tests, Mann-Whitney U tests, and multivariable logistic regression. The cohort’s median age was 53 years, with breast cancer being the most prevalent histology (71%). Symptom improvement occurred in 75% of patients, with relief rates of 84.6% for nausea, 80% for headache, and 58.3% for dizziness. Dexamethasone use decreased in 76.3% of cases. Median PFS was 39.2%, with a six-month overall survival of 50%. Only 1.7% of patients developed symptomatic radiation necrosis. Factors associated with symptom improvement included younger age, extended intervals between WBRT and re-irradiation, and higher equivalent dose in 2 Gy fractions (EQD2). Cerebellar-only re-irradiation is an effective, low-toxicity option for recurrent cerebellar metastases. This approach warrants further validation in prospective studies, particularly in comparison to SRS.