Introduction: Standard treatment for early-stage invasive breast cancer (bca) consists of breast-conserving surgery and several weeks of adjuvant radiotherapy (rt). Neoadjuvant single-fraction rt is a novel approach for early-stage bca. We sought to investigate the effect of delaying surgery after neoadjuvant rt with respect to the rate of pathologic response (pr). Methods: Women 65 years of age or older with a new diagnosis of stage i luminal A bca were eligible for inclusion. A single 20 Gy dose to the primary breast tumour was given, followed by breast-conserving surgery 3 months later. The primary endpoint was the pr rate assessed by microscopic evaluation using the Miller–Payne system. Results: To date, 10 patients have been successfully treated. Median age of the patients was 72 years (range: 65–84 years). In 8 patients, neoadjuvant rt resulted in a tumour pr with median residual cellularity of 3%. No immediate rt complications other than mild dermatitis were noted. Conclusions: This study demonstrates a method for delivering single-fraction rt that can lead to a high level of pr in most patients. Continued accrual to this study and subsequent trials are needed to determine the feasibility, safety, and role of this novel technique in the management of early-stage bca.

Recent evidence suggests that cyclin-dependent kinase 4/6 (CDK4/6) inhibitors significantly improve progression-free survival and overall survival among metastatic breast cancer patients. However, given the effects on cell cycle arrest, there is potential for CDK4/6 inhibitors and radiotherapy (RT) to work synergistically, enhancing the effect and toxicities of RT. A comprehensive review of the literature on the combination of RT and CDK4/6 inhibitors was performed with 19 eligible studies included in the final analysis. A total of 373 patients who received radiotherapy combined with CDK4/6 inhibitors were evaluated across 9 retrospective studies, 4 case reports, 3 case series, and 3 letters to the editor. The CDK4/6 inhibitor used, RT target, and RT technique were assessed in terms of toxicities. This literature review demonstrates generally limited toxicities with the combination of CDK4/6 inhibitors and palliative radiotherapy to metastatic breast cancer patients. The current evidence is nonetheless limited, and further results of ongoing prospective clinical trials will help clarify whether these treatments can be safely combined.

To compare cardiac doses of different whole-breast optimization schemes including free-breathing (FB) tangential radiotherapy (TRT), deep-inspiration breath-hold (DIBH) TRT, and FB helical tomotherapy (HT). Early-stage left-sided breast cancer patients who underwent breast-conserving surgery followed by adjuvant radiotherapy were included in the study. Planning images included FB and DIBH CT scans acquired in the same supine treatment position with both arms abducted. A hypofractionated regimen of 42.5 Gy in 16 fractions was used. Clinical target volume delineation was aided through the use of a radio-opaque wire. A 7-mm margin was used in generating the planning target volumes. TRT plans were generated both in FB and DIBH. For the FB tomotherapy technique, a first plan (Tomo 1) was optimized limiting the maximum contralateral breast dose to 3.1 Gy. A second tomotherapy plan (Tomo 2) focused on the reduction of the mean heart dose without controlling the contralateral breast dose. All plans were optimized to obtain an equivalent planning target volume (PTV) coverage of ≥95% of the prescribed dose while minimizing the dose to organs at risk. Twenty-three patients treated between October 2012 and March 2016 were included in this retrospective study. Eleven patients (48%) had at least one major cardiovascular risk factors including one patient (4%) with a history of myocardial infarction. Six patients (26%) had been exposed to cardiotoxic chemotherapy agents. The average mean dose to the heart was 3.1 Gy with FB TRT, 1.1 with DIBH TRT, 2.4 Gy for Tomo 1, and 1.5 Gy for Tomo 2. The mean dose to the left anterior descending artery was 27.0 Gy, 8.0 Gy, 13.7 Gy and 6.6 Gy for FB TRT, DIBH TRT, Tomo 1 and Tomo 2 plans respectively. Different cardiac-sparing optimization schemes are possible when treating left breast cancer. Although DIBH offers clear mean heart dose reductions, tomotherapy can be an interesting alternative treatment modality to spare the heart and coronary vessels, notably in patients who cannot comply with DIBH.

Prostate cancer is a burden on society. Its prevalence can reach up to 80% in males aged 70 years and older. Current screening programs based on prostate-specific antigen testing lead to overdiagnosis and overtreatment with uncertain benefits on survival. Androgenic alopecia is also highly prevalent in elderly males. Observational studies have found that androgenic alopecia is linked to prostate cancer, but studies have been conflictual. Further research should focus on finding the exact mechanism linking these two pathologies. This should help clinicians improve screening programs and guide research into novel molecules to help in the prevention and treatment of both androgenic alopecia and prostate cancer.