The purpose of this study is to compare three commonly used radiotherapy fractionation schedules for bone metastasis in terms of clinical and radiological effectiveness. A total of 93 patients with osteolytic bone metastasis were randomized to receive 8 Gyin a single fraction (group A), 20 Gy in 5 fractions (group B) and 30 Gy in 10 fractions (group C). Changes in bone density were measured using the Relative Electron Density (RED) type corrected by Thomas (pe = HU/1.950 + 1.0), where HU is Hounsfield Units. Pain response was assessed according to the Brief Pain Inventory tool. Quality of life was estimated using the EORTC QLQ-C30 and the MD Anderson Symptom (MDAS) tools.After RT, RED, together with the parameters of EORTC QLQ-C30, MDAS and SAT, significantly increased in all groups (p < 0.001).Specifically, the increase of RED was higher in group C compared to group Athree months post-RT (p = 0.014). Group C was also superior to group A in terms of QoL and BPI three months post-treatment. Multifractionated radiotherapy for osteolytic bone metastasis is superior to single fraction radiotherapy in terms of improvement in quality of life and bone remineralization three months post-RT.

Background/Objectives: Surgery is the primary treatment for early-stage lung cancer. Patients with medically inoperable lung carcinomas and patients who refuse to undergo surgery are treated with definite radiotherapy. Stereotactic ablative radiotherapy (SABR) is a compelling non-invasive therapeutic modality for this group of patients that confers promising results. Methods: We report an interim analysis of an ongoing trial. Eighty-one patients with medically inoperable early-stage (T1,2N0) lung cancer underwent SABR in our institution. SABR was delivered via the CyberKnife M6 robotic radiosurgery system. The endpoints of the analysis were treatment efficacy and tolerance. Results: There were no acute or late toxicities from the skin or the connective tissue of the thorax. A grade 2/3 lung injury of non-clinical significance was noted in 6% of patients, which was directly related to a higher biologically effective dose (BED_{α/β = 3}) and larger irradiation lung volumes in both univariate and multivariate analyses. A local control (LC) was achieved in 100% of the patients at the first follow-up, and the projected 24-month local progression-free survival (LPFS) rate was 95%. The projected 24-month disease-specific overall survival (OS) was 94%. Conclusions: High LC and OS rates can be achieved with SABR for early-stage lung cancer, with minimal toxicity. This study continues to recruit patients.

Background/Objectives: The lung is the most common site of metastases, regardless of the cancer subtype. Treating oligometastatic disease with surgery or stereotactic ablative radiotherapy (SABR) may improve patient survival. Methods: We retrospectively analyzed 41 patients with limited (one or two lesions, max dimension <3 cm) lung-only metastatic disease that were treated with the CK M6 robotic radiosurgery system in our Department, in terms of treatment efficacy and toxicity. Results: Acute and late toxicity was negligible (4 out of 41 patients developed grade 2 or 3 lung fibrosis). Six months post-SABR, complete response was achieved in 18 out of 41 patients (43.9%), while the rest of the cases exhibited major responses. A biological effective dose (BED_α/β=10) in the range of 100 Gy appears to be equally effective with higher doses. Within a median follow-up of 34 months, only three patients (7.3%) progressed locally, while three patients progressed to distal sites. Two-year local progression-free survival (LPFS) rates were 92.6% (95% CI 78.5–97%). Conclusions: SABR for low-burden lung oligometastases is an effective treatment modality that yields high local control and survival rates. Toxicity is negligible, regardless of the performance status of patients. Early referral of such patients to radiation oncology departments may be critical for patient survival and quality of life.

Background/Objectives: The use of stereotactic body radiotherapy (SBRT) for centrally and ultra-centrally located early-stage non-small cell lung cancer (NSCLC) remains clinically challenging due to the proximity of critical mediastinal organs at risk and the limited prospective evidence, particularly for ultra-central disease. Real-world data are needed to better define the safety and efficacy of SBRT when delivered according to contemporary protocol-based planning principles. Methods: This retrospective cohort study included patients treated at two radiotherapy centers, with centralized follow-up and outcome adjudication at a single academic institution. We evaluated patients with centrally or ultra-centrally located, early-stage NSCLC treated with SBRT according to dose-fractionation and planning principles derived from the NRG Oncology/RTOG 0813 protocol. Tumors were classified as central or ultra-central according to the International Association for the Study of Lung Cancer and HILUS definitions, respectively. The prescribed dose was 50 Gy in five fractions. Primary endpoints were treatment-related toxicity and local progression-free survival (LPFS). Secondary endpoints included overall survival (OS), progression-free survival (PFS), and dosimetric outcomes. Survival endpoints were analyzed using the Kaplan–Meier method. Results: Seventy-eight patients were included, of whom 52 had centrally located and 26 ultra-centrally located tumors. Median follow-up was 57 months. The overall objective response rate was 92.3%. The estimated 4-year LPFS was 97.4% for the entire cohort, with rates of 100% for central and 91.6% for ultra-central tumors (p < 0.001). Four-year OS was 98.7%, with no treatment-related deaths observed. Treatment-related toxicity was minimal, with grade ≥ 2 events occurring in only one patient (1.3%) and no grade ≥ 3 toxicity. All treatment plans met predefined organ-at-risk dose constraints. Conclusions: In this real-world cohort, SBRT delivered according to RTOG 0813 planning principles achieved excellent local control with minimal clinically relevant toxicity in patients with centrally and ultra-centrally located early-stage NSCLC. These findings support the safe implementation of SBRT in carefully selected patients when stringent organ-at-risk constraints and conservative treatment planning are employed.