Purpose: To evaluate the long-term oncological outcomes and toxicity profile based on 24 years of follow-up in patients with localized very high-risk prostate cancer (VHR PCa) treated with a combination of high-dose-rate brachytherapy (HDR-BT) and pelvic external beam radiation therapy (EBRT). Methods: A retrospective analysis was conducted on 87 patients with VHR PCa, classified according to National Comprehensive Cancer Network (NCCN) criteria, who received HDR-BT and EBRT. Androgen deprivation therapy (ADT) was administered to 72 patients (82.8%). The primary endpoints were biochemical control and cancer-specific survival (CSS), while the secondary endpoints included local control rates, tumor-free survival (TFS), overall survival (OS), and treatment-related toxicity. Results: The 24-year biochemical control rate was 68% (standard deviation [SD]: ±4%), while CSS and TFS at 24 years were 82% (SD ±4%) and 78% (SD ±4%), respectively. Local control rates remained at 98% at 24 years. Furthermore, the OS rate at 24 years was 30%. Multivariate Cox regression analysis identified the T category in the TNM classification as the only factor significantly associated with biochemical control, with 24-year rates of 69%, 71%, and 50% for patients with T-classifications of ≤T2c, T3a, and T3b-T4, respectively (p = 0.024). Notably, no grade ≥3 late toxicities were observed during the follow-up period. Conclusions: The 24-year outcomes support the viability and therapeutic efficacy of EBRT combined with a conformal HDR-BT boost for patients with VHR PCa.

In the sentence beginning "Q2: Final recommendation: Adjuvant radiotherapy is…" in this article, the text 'Final recommendation: Adjuvant radiotherapy is recommended in the presence of involved or close (≤ 3 mm) margins. Re-excision is not advised in these cases (Fig. 1). Level of recommendation: strong.' should have read 'Final recommendation: Adjuvant radiotherapy is recommended in the presence of involved or close (≤ 3 mm) margins if re-excision is not advised in these cases (Fig. 1). Level of recommendation: strong.'

Objectives: The incidence of endometrial cancer is rising among elderly women due to population aging. However, patients aged ≥ 80 years remain underrepresented in clinical trials, and their management is often influenced by age rather than clinical suitability. This multicenter retrospective study aimed to evaluate treatment patterns, oncologic outcomes, prognostic factors, and the safety of adjuvant radiotherapy (RT) in Spanish women aged ≥ 80 years with surgically treated endometrial cancer. Methods: We analyzed data from 353 patients aged ≥ 80 years treated with curative-intent surgery between 2003 and 2019 across 11 centers. Adjuvant RT included external beam radiotherapy (EBRT), vaginal brachytherapy (VB), or both. Toxicity was graded using CTCAE v5.0. Survival outcomes were assessed using Kaplan–Meier and Cox regression analyses. Results: The median age was 83 years; 83.5% had early-stage disease. Adjuvant RT was administered to 227 patients (64.3%), and chemotherapy to only 13. Grade ≥ 3 toxicity was rare (<1%). Five-year outcomes were as follows: local control (88.9%), cancer-specific survival (68.7%), and overall survival (58.7%). In multivariable analysis, VB alone and combined EBRT + VB were independently associated with improved local control. No RT modality was independently associated with overall survival, although favorable trends were observed for VB alone and EBRT + VB. Higher comorbidity burden (CCI ≥ 5), but not age ≥ 85 years, was independently associated with worse overall survival. Conclusions: Adjuvant RT was associated with favorable oncologic outcomes and a low incidence of severe toxicity in women aged ≥ 80 years with endometrial cancer. These findings support individualized treatment based on tumor characteristics and comorbidity rather than chronological age alone. A multidisciplinary approach incorporating geriatric assessment may further support personalized treatment decision-making in this growing patient population.