Distant progression is the predominant failure pattern after metastasis-directed stereotactic body radiotherapy (SBRT) for oligometastatic disease, but prognostic tools to guide post-progression management are lacking. We aimed to validate the prognostic value of distant metastasis velocity (DMV) for overall survival (OS) and widespread failure-free survival (WFFS) after distant progression. Two independent international cohorts of patients with extracranial oligometastatic disease (≤5 lesions) who developed distant progression after SBRT were analyzed. The primary outcome was OS; secondary outcome was WFFS in the subgroup of patients with repeat oligometastasis at distant progression. DMV was defined as the number of new or progressing metastases per month after initial metastasis-directed SBRT. Among 563 patients (median age 68 years, 56 % male), DMV stratified prognosis in both cohorts. In the prospective cohort (n = 221), median OS was 35.7 months for patients with DMV ≤ 0.5 metastases/month versus 20.6 months for DMV > 0.5 (P = 0.0001). In the retrospective cohort (n = 342), OS was 32.8 vs. 12.1 months (P < 0.0001). Similar trends were observed for WFFS (prospective cohort, n = 91: 6.8 vs. 3.0 months, p = 0.42; retrospective cohort, n = 341: 18.8 vs. 6.1 months, p < 0.0001). Higher DMV was consistently associated with worse outcomes after progression in oligometastatic disease. Its reproducibility across tumor types and independent cohorts supports DMV as a simple, dynamic, and clinically relevant prognostic marker. DMV should be further explored as a component of multimodal prognostic models to refine patient selection and guide post-progression treatment strategies.

To evaluate the factors influencing the outcomes of patients who underwent surgical resection of brain metastasis followed by either surveillance or post-operative stereotactic radiosurgery/fractionated radiotherapy (SRS/SFRT), a retrospective multi-center chart review was performed on all patients who underwent brain metastases resection in British Columbia between 2018 and 2020. Patients with prior whole-brain radiotherapy were excluded from the study. The primary study endpoints included local recurrence, distant intracranial control, radionecrosis (RN), leptomeningeal disease (LMD), and overall survival (OS). The Kaplan–Meier method was used to analyze survival. The Cox proportional hazards model was used to perform univariable (UVA) and multivariable (MVA) analyses to identify predictors of local control. A total of 113 patients met the inclusion criteria. A total of 31 patients received adjuvant SRS/SFRT to the surgical cavity, while 82 went on observation. The 12-month local control was 69% (50–88%) for the SRS/SFRT cohort and 31% (18–45%) for the observation cohort (p < 0.001). The 12-month distant intracranial control was 44% (26–63%) for the SRS/SFRT cohort and 46% (30–62%) for the observation cohort (p = 0.9). Sensitivity analysis did not show a difference in overall survival (p = 0.6). En bloc resection (p < 0.05), resection without residual disease (p < 0.05), and SRS/SFRT (p < 0.001) were predictive of local control on MVA. Three SRS/SFRT patients (10%) and two observation patients (2%) developed LMD. Four SRS/SFRT patients experienced RN (13%), with no grade 3 or higher toxicities observed. Post-operative SRT outcomes based on real-world population data are consistent with the data from clinical trials and support the established guidelines. For patients requiring surgical resection of brain metastasis, en bloc gross total resection should be encouraged when feasible to reduce local recurrence.

People living with HIV (PLWH) have an increased incidence of head and neck cancer (HNC), yet the impact of HIV on radiation therapy (RT) outcomes remains poorly defined. To our knowledge, no prior systematic review has synthesized this evidence. A systematic review was conducted following PRISMA 2020 guidelines and prospectively registered on PROSPERO (CRD420251075908). PubMed was searched from inception to July 2025, with an updated search in May 2026 yielding no additional studies. Eight retrospective studies comprising 185 patients were included, all from the United States. Tumor subsites included the oral cavity, oropharynx, larynx, paranasal sinus, and facial skin, with squamous cell carcinoma and Kaposi sarcoma as the predominant histologies. Treatment techniques ranged from conventional radiotherapy in earlier series to intensity-modulated radiotherapy in more contemporary cohorts. In curative-intent cohorts, 3-year overall survival ranged from 55% to 78% and local control from 69% to 92%. Grade ≥3 acute toxicity, including mucositis, dermatitis, and dysphagia, was common but not clearly disproportionate to HIV-negative populations. Treatment interruption rates appeared elevated, with up to 42% of patients experiencing breaks exceeding 10 cumulative days in one series. Reporting of CD4 count, viral load, and HPV/p16 status was inconsistent. Methodological quality was low to moderate, and clinical heterogeneity precluded meta-analysis. These findings suggest that curative-intent RT for HNC in PLWH is feasible with meaningful disease control. Antiretroviral therapy optimization and multidisciplinary co-management are essential. Prospective, multicenter studies with standardized reporting, matched controls, and inclusion of high HIV-prevalence settings are needed to define optimal treatment strategies.

Objectives: To investigate current Canadian physicians’ practice patterns of treating upper limb post-stroke spasticity (PSS) and hemiplegic shoulder pain (HSP) acutely after a stroke. In addition, by examining Canadian physicians’ diagnostic capabilities, time till treatment, minimum criteria to begin treatment, mechanisms of treatment, targeting of muscles, and benefits and adverse effects of treatment, we aim to learn about areas of improvement to optimize PSS management for Canadians. Design: The present study was a cross-sectional survey, polling practicing Canadian physicians. Results: A total of 17 physicians completed the survey, all PM&R specialists, save one neurologist. Four provinces were represented in the responses. Participants had, on average, over ten years of experience managing post-stroke spasticity in outpatient and inpatient clinics. All 17 perform botulinum neurotoxin A (BoNT-A) injections for HSP associated with PSS. Most participants reported that they will begin BoNT-A treatments 2–3 weeks post-stroke, most commonly targeting the pectoralis major, subscapularis, and latissimus dorsi. Participants reported the mean median dosage they use as onabotulinum toxin A (169.12 units, SD = 73.70), incobotulinum toxin A (178.13 units, SD = 65.75), and abobotulinum toxin A (470.83 units, SD = 171.17). For injection guidance, participants responded that they use ultrasound for the largest percentage of their caseload, followed by electromyography, then electrical stimulation, then palpation. Very seldom did participants use palpation alone. Conclusions: From the limited sample included in analyses, the Canadian physicians respondents seem to be treating HSP and associated PSS with variable strategies. Further research is required to align dosages, targets, and guidance strategies as they vary considerably.