Background/Objectives: To analyze the predictive value of the apparent diffusion coefficient (ADC) in patients with prostate cancer (PCa) treated with radiotherapy (RT) and androgen deprivation therapy (ADT). Methods: Retrospective study of patients with high-risk, very high-risk, or unfavorable intermediate-risk PCa who received RT and ADT between 2008 and 2019 and underwent multiparametric magnetic resonance imaging mpMRI) at 6 months post-RT. Differences in ADC values were compared between patients with and without progression and/or local recurrence. Receiver operating characteristic (ROC) curves were used to obtain ADC cutoffs for predicting 10-year progression-free-survival (PFS) and local recurrence-free survival (LRFS). Results: We evaluated 98 patients (73 [74.5%] high-risk). Over a mean ± SD follow-up of 95.36 ± 30.54 months, 19 patients (19.4%) progressed; at 10 years, PFS was 75.6%, LRFS 93.8%, metastasis-free survival 85.5%, and overall survival 89.5%. Post-RT ADC was significantly lower in patients with local recurrence (1.09 ± 0.18 vs. 1.30 ± 0.20 × 10⁻³ mm²/s, p = 0.020) and progression (1.23 ± 0.20 vs. 1.30 ± 0.21 × 10⁻³ mm²/s, p = 0.004). ROC analysis identified a post-RT ADC cutoff of 1.11 × 10⁻³ mm²/s for local recurrence (area under curve [AUC] 0.843, sensitivity 89.4%, positive predictive value [PPV] 98.8%). The cutoff for progression was 1.24 × 10⁻³ mm²/s (AUC0.705, sensitivity 72.2%, PPV87.7%). Patients with a post-RT ADC value below and above 1.11 × 10⁻³ mm²/shad a 10-year LRFS of 66.8% and 97.7%, respectively (HR: 25.04 [2.58–242.92], p < 0.001). The corresponding rates for 10-year PFS were 58.6% and 85.6% in patients with post-RT ADC values below and above 1.24 × 10⁻³ mm²/s (HR: 2.916 [1.113–7.644], p = 0.015). In the multivariate analysis, a post-treatment ADC value ≤ 1.24 × 10⁻³ mm²/s was a significant prognostic factor for a lower PFS (HR: 3823 [1371–10,657], p = 0.010). Conclusions: This is the first study to show that post-RT ADC can be a predictive factor of local recurrence in PCa treated with RT and ADT. Moreover, this long-term study demonstrates its value as a predictive factor of progression in PCa treated with RT and ADT.

Background: Neoadjuvant chemoradiotherapy with CROSS-protocol is the standard of care for locally advanced esophageal cancer. The purpose of this study was to demonstrate an improvement in complete pathological response (ypCR) after a dose-escalation neoadjuvant protocol compared to standard treatment. Secondary endpoints were disease-free survival (DFS) and acute gastrointestinal toxicity. Material and methods: We prospectively evaluated patients with locally advanced esophageal adenocarcinoma who received neoadjuvant chemoradiotherapy. The radiation dose was 41.4 Gy in 23 fractions or 50.4 Gy in 28 fractions with weekly administration of six intravenous cycles of carboplatin AUC 2 mg/mL and intravenous paclitaxel 50 mg/m² followed by surgery. Results: Between December 2015 and July 2020, 21 patients were treated according to the reported radiation schedules. Median age was 61 years (57–67). 20 (95.2%) tumors were located at the esophagogastric junction and 1 (4.8%) in the middle esophagus. Five (23.8%) were stage II and 16 (76.2%) stage III. Twelve (57.1%) patients received 41.4 Gy (standard group) and 9 (42.9%) received 50.4 Gy (intensification group), with 5 (41.67%) and 5 (55.6%) presenting ypCR in the standard and intensification group, respectively (p = 0.67). After a median follow-up of 17 months (8–30), DFS in the standard group was 17.78 months [95% (CI, confidence interval): 12.9–22.6] and 45.5 months (95% CI: 24.4–66.05) in the intensification group (p = 0.299). Grade III acute gastrointestinal toxicity was 16% and 33.33%, respectively (p = 0.552). Postoperative toxicity events ≥ Grade III were 5 (41.7%) and 4 (44.4%), respectively (p = 0.623). Conclusions: In our study we found a trend towards a higher complete pathological response-rate and disease-free survival in the intensification group compared to the standard group, with no differences in gastrointestinal toxicity. Well-designed randomized and controlled trials are needed to obtain conclusive data. Background: Neoadjuvant chemoradiotherapy with CROSS-protocol is the standard of care for locally advanced esophageal cancer. The purpose of this study was to demonstrate an improvement in complete pathological response (ypCR) after a dose-escalation neoadjuvant protocol compared to standard treatment. Secondary endpoints were disease-free survival (DFS) and acute gastrointestinal toxicity. Material and methods: We prospectively evaluated patients with locally advanced esophageal adenocarcinoma who received neoadjuvant chemoradiotherapy. The radiation dose was 41.4 Gy in 23 fractions or 50.4 Gy in 28 fractions with weekly administration of six intravenous cycles of carboplatin AUC 2 mg/mL and intravenous paclitaxel 50 mg/m² followed by surgery. Results: Between December 2015 and July 2020, 21 patients were treated according to the reported radiation schedules. Median age was 61 years (57–67). 20 (95.2%) tumors were located at the esophagogastric junction and 1 (4.8%) in the middle esophagus. Five (23.8%) were stage II and 16 (76.2%) stage III. Twelve (57.1%) patients received 41.4 Gy (standard group) and 9 (42.9%) received 50.4 Gy (intensification group), with 5 (41.67%) and 5 (55.6%) presenting ypCR in the standard and intensification group, respectively (p = 0.67). After a median follow-up of 17 months (8–30), DFS in the standard group was 17.78 months [95% (CI, confidence interval): 12.9–22.6] and 45.5 months (95% CI: 24.4–66.05) in the intensification group (p = 0.299). Grade III acute gastrointestinal toxicity was 16% and 33.33%, respectively (p = 0.552). Postoperative toxicity events ≥ Grade III were 5 (41.7%) and 4 (44.4%), respectively (p = 0.623). Conclusions: In our study we found a trend towards a higher complete pathological response-rate and disease-free survival in the intensification group compared to the standard group, with no differences in gastrointestinal toxicity. Well-designed randomized and controlled trials are needed to obtain conclusive data.

To evaluate the impact of smoking on acute and chronic toxicity in early breast cancer patients treated with hypofractionated intensity-modulated radiation therapy (IMRT) and a brachytherapy boost following breast-conserving surgery. A retrospective study of 638 patients treated between 2009 and 2017, with 566 having recorded smoking status. Acute toxicity was assessed at treatment end and chronic toxicity at least one-year post-treatment, using Common Terminology Criteria for Adverse Events v4.0. Statistical analyses included chi-square tests and relative risk (RR) calculations. A total of 566 patients were included in the study, with 31.3% being smokers. The cohort was followed for a median of 6 years (range: 1–11 years). Acute toxicity was primarily characterized by radiodermatitis, with 87.6% of patients developing grade 1 and 5.5% experiencing grade 2. No cases of grade ≥ 3 were observed, and 6.9% of patients did not experience radiodermatitis. Bleeding was rare (1.1%) and infections occurred in 2.0% of patients. Regarding chronic toxicity, 67.1% of patients had no fibrosis, while 27.4% had grade 1 fibrosis. Grade 2 and grade 3 fibrosis were observed in 4.9% and 0.6% of patients, respectively, with no cases of grade 4 fibrosis. Edema was present in 8.0%, and 4.4% of patients reported chronic pain. When comparing smokers and nonsmokers, acute toxicity incidence, particularly radiodermatitis, was similar between the two groups. Smokers had a significantly higher incidence of chronic fibrosis (35.6% vs. 24.7%, p = 0.013) and chronic pain (7.9% vs. 3.3%, p = 0.024) compared to nonsmokers. However, there were no significant differences in the occurrence of edema between smokers and nonsmokers (7.9% vs. 8.0%, p = 0.879). While advanced radiation techniques such as hypofractionated IMRT improve overall toxicity profiles, smoking significantly exacerbates chronic toxicity in breast cancer patients. This study underscores the urgent need for comprehensive smoking cessation programs as part of cancer care, addressing lifestyle factors to improve patient outcomes and quality of life.

Introduction: Choroidal metastases are the most frequent intraocular secondary tumours, with a prevalence of 2–7% according to the literature. Our aim was to review a clinical case of choroidal metastasis.We present a case of a 63-year-old male patient diagnosed in 2018 with lung adenocarcinoma cT4N0M1. The patient had three metastases in the brain, which were successfully treated with radiosurgery (RS). The patient was treated with chemotherapy with pemetrexed–cisplatin schedule. Five months after diagnosis, the patient presented with decreased vision in the right eye. After ophthalmologic evaluation, he was diagnosed with a right choroidal metastasis, which was treated with external beam radiotherapy with 20 Gy in five fractions, resulting in improved visual acuity and a complete clinical and radiological response.The patient took part in a clinical trial that continued with systemic chemotherapy. Twenty-two months after radiotherapy to the eye, the patient has good visual acuity without any side effects.Conclusions: Choroidal metastasis treated with radiotherapy achieves good local control, with limited side effects, allowing an improvement in visual acuity and consequently, an improvement in the patient´s quality of life.

To determine the prevalence of vascular calcifications on radiotherapy-planning CTs in women with early breast cancer (BC) and their association with subsequent cardiovascular (CV) events. Single-center retrospective study of patients who received adjuvant radiotherapy for early BC after breast conserving surgery (2009–2019). Planning CTs were visually assessed for vascular calcifications and the incidence of CV events during follow-up was determined. Comparative analyses of clinical characteristics were conducted across groups stratified by calcification status. Multivariate logistic regression served to evaluate CV event risk, with adjustment for conventional cardiovascular risk factors (CVRF). The study included 882 patients. The median (IQR) age was 52 (46–62) years. Calcifications were found in 340 patients (38.5 %), 154 (17.5 %) in coronary arteries. Patients with calcifications were significantly older (62 vs. 48 years) and more likely to present CVRF, including hypertension (32.6 % vs. 10.0 %), dyslipidemia (34.7 % vs. 15.3 %), and diabetes (11.5 % vs. 3.1 %). Median follow-up was 8 years (6–10), with 35 patients (4.0 %) experiencing a CV event. Vascular calcification was associated with a significantly higher incidence of CV events (7.1 % vs. 2.0 %; OR = 3.7; 95 % CI: 1.8–7.6). The presence of coronary calcifications, adjusted for age and conventional CVRF, was associated with a 2.86-fold (95 % CI: 1.05–7.78) higher risk of a CV event. This study shows that vascular calcifications detected incidentally on radiotherapy planning CTs for early BC are common and associated with an increased risk of CV events that is independent of conventional CVRF. These findings suggest that planning CTs in these patients should be routinely reviewed to check for vascular calcifications.