title: Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Intratumoral pO2 predicts survival in advanced cancer of the uterine cervix. Time to loco-regional recurrence after resection of Dukes' B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis. Characteristics of response of oral and pharyngeal mucosa in patients receiving chemo-IMRT for head and neck cancer using hypofractionated accelerated radiotherapy. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? A subgroup analysis of the DBCG 82 b&c randomized trials. Multidisciplinary Rectal Cancer Management: 2nd European Rectal Cancer Consensus Conference (EURECA-CC2). Test of association between variant tgβ1 alleles and late adverse effects of breast radiotherapy. Acute toxicity profile of radiotherapy in 690 children and adolescents: RiSK data. Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer. A prospective, randomized, multi-center trial to investigate Actovegin in prevention and treatment of acute oral mucositis caused by chemoradiotherapy for nasopharyngeal carcinoma. Preoperative radiotherapy and local excision of rectal cancer with immediate radical re-operation for poor responders. Image-guided intensity-modulated radiotherapy (IG-IMRT) for biliary adenocarcinomas: Initial clinical results. A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer. Oxygenation predicts radiation response and survival in patients with cervix cancer. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. The potential advantages of (18)FDG PET/CT-based target volume delineation in radiotherapy planning of head and neck cancer. Rectal cancer multidisciplinary management: evidences and future landscape. Accelerated fractionation (AF) compared to conventional fractionation (CF) improves loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomized trial. Diagnostic performance of response assessment FDG-PET/CT in patients with head and neck squamous cell carcinoma treated with high-precision definitive (chemo)radiation. A randomized phase II study of cisplatin/5-FU concurrent chemoradiotherapy for esophageal cancer: Short-term infusion versus protracted infusion chemotherapy (KROSG0101/JROSG021). Target volume shape variation during hypo-fractionated preoperative irradiation of rectal cancer patients.
abstract: EORTC protocol 22791 compared once daily fractionation ( CF ) of 70 Gy in 35 - 40 fractions in 7 - 8 weeks , to pure hyperfractionation ( HF ) of 80.5 Gy in 70 fractions in 7 weeks using 2 fractions of 1.15 Gy per day , in T2-T3 oropharyngeal carcinoma ( excluding base of tongue ) , N0,N1 of less than 3 cm . From 1980 to 1987 , 356 patients were entered . In the final analysis ( June 1990 ) , the local control was significantly higher ( p = 0.02 log-rank ) after HF compared with CF . At 5 years , 59 % of patients are local disease-free in the HF arm compared to 40 % in the CF arm . The superiority of HF was demonstrated in patients staged T3N0,T3N1 but not in T2 . The Cox model confirmed that the treatment regimen was an independent significant prognostic factor for locoregional control ( p = 0.007 log-rank ) . This improvement of locoregional control was responsible for a trend to an improved survival ( p = 0.08 log-rank ) . There was no difference in late normal tissue damage between the two treatment modalities A r and omized trial was conducted at the Institut Gustave-Roussy ( IGR ) between 1972 and 1980 comparing tumorectomy and breast irradiation with modified radical mastectomy . One hundred and seventy-nine patients with an infiltrating breast carcinoma up to 20 mm in diameter at macroscopic examination were included : 88 had conservative management , and 91 a mastectomy .  All patients had a low-axillary dissection  with immediate histological examination . For the patients with positive axillary nodes , a complete axillary dissection was undertaken . Overall survival , distant metastasis , contralateral breast cancer and locoregional recurrence rates were not significantly different between the two treatment groups Experimental evidence suggests that the hypoxic fraction in a solid tumor may increase its malignant potential and reduce its sensitivity towards non-surgical treatment modalities ( e.g. st and ard irradiation , certain anticancer agents ) . However , the clinical importance of tumor hypoxia remains uncertain since valid methods for the routine measurement of intratumoral O2-tensions in patients have so far been lacking . A clinical ly applicable st and ardized procedure has been established which enables the determination of intratumoral oxygen tensions in advanced cervical cancers by use of a computerized polarographic needle electrode histography system . Tumor oxygenation as measured by this method represents a novel tumor feature which can be individually determined for each tumor and which is independent from other known oncological parameters . The results of an interim analysis of an open prospect i ve clinical trial to evaluate the prognostic significance of tumor oxygenation based on the survival data of the first 31 patients are presented . Fifteen patients have been treated by primary radiation , 11 patients received multimodality therapy including irradiation .  After a median follow-up of 19 months ( range 5 - 31 months ) , Kaplan-Meier-life table analysis showed significantly lower survival and recurrence-free survival for patients with a median pO2 of < or = 10 mmHg compared to those with better oxygenated tumors ( median pO2 > 10 mmHg ) . The Cox proportional hazards model revealed that the median pO2 and the clinical stage according to the FIGO are independent , highly significant predictors of survival and recurrence-free survival . We conclude from these preliminary results that tumor oxygenation as determined with this st and ardized procedure appears to be a new independent prognostic factor influencing survival in advanced cancer of the uterine cervix Factors influencing time to loco-regional recurrence were identified in a multivariate regression analysis of data from a series of 468 radically operated patients ( 260 Dukes ' B and 208 Dukes ' C ) with carcinoma of the rectum and the rectosigmoid . A number of clinical and pathological characteristics were prospect ively collected and recorded . In addition , carcinoembryonic antigen ( CEA ) was measured within 1 week before surgery . The endpoint used was recurrence below the level of the umbilicus . All patients were followed for at least 5 years or until time of death . The two Dukes ' stages B and C were analysed in two separate analyses using the Cox proportional hazards model . In patients with Dukes ' B tumours , an increased risk of loco-regional recurrence was associated with perineural invasion , tumour located less than 10 cm from the anal verge , patient aged above 70 years , and small tumour size . In patients with Dukes ' C tumours , the necessity to resect neighbour organs , perineural and venous invasion , tumour located less than 10 cm from the anal verge , and large tumour size were all associated with a poor loco-regional outcome . Postoperative radiotherapy was not a significant prognosticator for loco-regional control . An up date of the 5-year results of the r and omised study of post-operative radiotherapy ( 50 Gy with 2 Gy per fraction in an overall treatment time of 7 weeks ) showed no survival benefit from adjuvant radiotherapy in either Dukes ' category and no statistically significant improvement in the 5-year loco-regional control rate . However , when the comparison was restricted to a group of high-risk patients there was a statistically significant benefit from radiotherapy with respect to loco-regional control ( P = 0.03 ) but not with respect to survival ( P = 0.23 ) . The potential advantage , in terms of the required number of patients , of restricting clinical trials of intensified loco-regional therapies to the high-risk patients , is illustrated PURPOSE This study describes the acute response of oral and pharyngeal mucosa to chemo-IMRT schedules using different doses per fraction . MATERIAL S AND METHODS Patients , treated in prospect i ve trials of concomitant chemo-IMRT with 2.17 Gy , 2.25 Gy and 2.4 Gy per fraction and identical dose of cisplatin , were included in this study .  Acute toxicity was recorded prospect ively using the CTCAE v2.0 . We describe the incidence and prevalence of grade 3 oral mucositis and dysphagia over time and report the influence of overall treatment time ( OTT ) . The association between the lengths of pharyngeal mucosa receiving 50 Gy ( L50 ) and 60 Gy ( L60 ) and grade 3 dysphagia was tested . RESULTS The incidence and the peak prevalence of grade 3 dysphagia were significantly higher in patients receiving 2.4 Gy per fraction . The peak prevalence of grade 3 dysphagia was higher and the recovery was slower in patients with lower OTT ( median 38 days vs. 42 days ) treatment . There was a significant correlation between L50 , L60 and grade 3 dysphagia . A L50 and L60 greater than 8 cm result ed in greater than 60 % and 70 % incidence of grade 3 dysphagia , respectively . CONCLUSION The length of pharyngeal mucosa receiving doses close to the prescription dose correlates with grade 3 dysphagia . It was observed that incidence of grade 3 dysphagia was lower and recovery from it was quicker in patients with greater OTT BACKGROUND AND AIM Numerous consensus reports recommend that postmastectomy radiotherapy ( RT ) in addition to systemic therapy is indicated in high-risk patients with 4 + positive nodes , but not in patients with 1 - 3 positive nodes . A subgroup analysis of the DBCG 82 b&c trials was performed to evaluate the loco-regional recurrence rate and survival in relation to number of positive nodes . MATERIAL S AND METHODS In the DBCG 82 b&c trials 3083 pre- and postmenopausal high-risk women were r and omized to postoperative RT in addition to adjuvant systemic therapy . Since many patients had relatively few lymph nodes removed ( median 7 ) , the present analysis was limited to 1152 node positive patients with 8 or more nodes removed . RESULTS The overall 15-year survival rate in the subgroup was 39 % and 29 % ( p=0.015 ) after RT and no RT , respectively . RT reduced the 15-year loco-regional failure rate from 51 % to 10 % ( p<0.001 ) in 4 + positive node patients and from 27 % to 4 % ( p<0.001 ) in patients with 1 - 3 positive nodes . Similarly , the 15-year survival benefit after RT was significantly improved in both patients with 1 - 3 positive nodes ( 57 % vs 48 % , p=0.03 ) and in patients with 4 + positive nodes ( 21 % vs 12 % , p=0.03 ) . CONCLUSION The survival benefit after postmastectomy RT was substantial and similar in patients with 1 - 3 and 4 + positive lymph nodes . Furthermore , it was not strictly associated with the risk of loco-regional recurrence , which was most pronounced in patients with 4 + positive nodes . The indication for RT seems therefore to be at least equally beneficial in patients with 1 - 3 positive nodes , and future consensus should be modified accordingly BACKGROUND AND PURPOSE During the first decade of the 21st century a number of important European r and omized studies were published . In order to help shape clinical practice based on best scientific evidence from the literature , the International Conference on ' Multidisciplinary Rectal Cancer Treatment : Looking for an European Consensus ' ( EURECA-CC2 ) was organized in Italy under the endorsement of European Society of Medical Oncology ( ESMO ) , European Society of Surgical Oncology ( ESSO ) , and European Society of Therapeutic Radiation Oncology ( ESTRO ) . METHODS Consensus was achieved using the Delphi method . The document was available to all Committee members as a web-based document customized for the consensus process . Eight chapters were identified : epidemiology , diagnostics , pathology , surgery , radiotherapy and chemotherapy , treatment toxicity and quality of life , follow-up , and research questions . Each chapter was subdivided by a topic , and a series of statements were developed . Each member commented and voted , sentence by sentence thrice . Sentences upon which an agreement was not reached after voting round # 2 were openly debated during a Consensus Conference in Perugia ( Italy ) from 11 December to 13 December 2008 . A h and -held televoting system collected the opinions of both the Committee members and the audience after each debate . The Executive Committee scored percentage consensus based on three categories : " large consensus " , " moderate consensus " , and " minimum consensus " . RESULTS The total number of the voted sentences was 207 . Of the 207 , 86 % achieved large consensus , 13 % achieved moderate consensus , and only 3 ( 1 % ) result ed in minimum consensus . No statement was disagreed by more than 50 % of the members . All chapters were voted on by at least 75 % of the members , and the majority was voted on by > 85 % . CONCLUSIONS This Consensus Conference represents an expertise opinion process that may help shape future programs , investigational protocol s , and guidelines for staging and treatment of rectal cancer throughout Europe PURPOSE To test for association between single nucleotide polymorphisms at the TGFβ1 locus and the risk of late normal tissue injury following whole breast radiotherapy . METHODS A retrospective study compared the number of variant alleles at -509 and codons 10 and 25 of the  TGFβ1 locus in women followed up in two prospect i ve clinical trials who developed either marked radiotherapy adverse effects or no adverse effects after matching on fractionation schedule , breast size , surgical deficit , chemotherapy and length of follow up . RESULTS Median follow up in the two trials was 7.4 ( maximum 15 ) years and 5.3 ( maximum 5.3 ) years . 1237/1716 ( 72 % ) women with photographic assessment s of radiotherapy adverse effects  were alive and well , and 147/1237 ( 12 % ) potential cases with the most marked change in photographic change in breast appearance were matched to potential controls recording no change . In an unmatched analysis of 82 cases and 108 controls , no significant difference in the number of genetic variants was observed . CONCLUSIONS No association was detected between sequence variations at the TGFβ1 locus and the risk of late adverse effects of breast radiotherapy BACKGROUND AND PURPOSE The " Registry for the evaluation of side effects after radiation in childhood and adolescence " ( risk ) was introduced to characterize adverse effects of  radiotherapy  in childhood and adolescence prospect ively . The aim of this analysis was to characterize the pattern of acute side effects . MATERIAL S AND METHODS Since 2001 , patients receiving radiotherapy in one of the German pediatric therapy trials have been registered in RiSK with detailed information regarding radiation doses to organs at risk and characterization of acute toxicities . RESULTS From 2001 to May 2009 , 690 patients have been characterized for acute toxicity in primary therapy . Acute toxicity ≥ grade 1 was observed in 506 patients . In patients irradiated in their lung and liver , patients with grade 1 or 2 acute toxicities showed higher organ volumes exposed to radiation doses < 20 Gray ( Gy ) compared to patients without toxicities . For the salivary gl and s , there was a positive correlation between the acute toxicity grade and the maximum radiation dose to the organ ; the lower GI tract showed a similar trend . The impact of different chemotherapy regimens on these acute side effects remains unclear . Age did not have any impact on side effects . CONCLUSION This analysis gives a comprehensive overview of the acute toxicities of radiotherapy in children and adolescents . With prolongation of follow-up , detailed analyses regarding late toxicities will be possible with the characterization of dose-volume-effect relationships BACKGROUND A non-r and omised phase II study suggested a therapeutic effect of hyperbaric oxygen ( HBO ) therapy on arm lymphoedema following adjuvant radiotherapy for early breast cancer , justifying further investigation in a r and omised trial . METHODS Fifty-eight patients with ≥ 15 % increase in arm volume after supraclavicular ± axillary radiotherapy ( axillary surgery in 52/58 patients ) were r and omised in a 2:1 ratio to  HBO ( n=38 ) or to best st and ard care ( n=20 ) . The HBO group breathed 100 % oxygen at 2.4 atmospheres absolute for 100 min on 30 occasions over 6 weeks . Primary endpoint was ipsilateral limb volume expressed as a percentage of contralateral limb volume . Secondary endpoints included fractional removal rate of radioisotopic tracer from the arm , extracellular water content , patient self- assessment s and UK SF-36 Health Survey Question naire . FINDINGS Of 53/58 ( 91.4 % ) patients with baseline assessment s , 46 had 12-month assessment s ( 86.8 % ) . Median volume of ipsilateral limb ( relative to contralateral ) at baseline was 133.5 % ( IQR 126.0 - 152.3 % ) in the control group , and 135.5 % ( IQR 126.5 - 146.0 % ) in the treatment group . Twelve months after baseline the median ( IQR ) volume of the ipsilateral limb was 131.2 % ( IQR 122.7 - 151.5 % ) in the control group and 133.5 % ( IQR 122.3 - 144.9 % ) in the treatment group . Results for the secondary endpoints were similar between r and omised groups . INTERPRETATION No evidence has been found of a beneficial effect of HBO in the treatment of arm lymphoedema following primary surgery and adjuvant radiotherapy for early breast cancer PURPOSE A multi-center prospect i ve r and omized trial was conducted to evaluate the efficacy and safety of Actovegin in the prevention and treatment of chemoradiotherapy-induced acute oral mucositis . METHODS AND MATERIAL S Between February 2006 and May 2007 , 156 evaluable patients with nasopharyngeal carcinoma were r and omized to Group 1 ( n=53 ) for prevention , Group 2 ( n=51 ) for treatment , and Group 3 ( n=52 ) for control . All patients received concomitant chemoradiotherapy ± induction chemotherapy . Radiation technique and dose were similar among 3 groups . Intravenous Actovegin of 30 ml daily ( 5 days/week ) was administrated from day 1 of the radiotherapy for Group 1 and from the onset of grade 2 mucositis for Group 2 , until the end of the radiotherapy . RESULTS The incidence of grade 3 mucositis was lower in Group 1 compared with Group 3 ( 26.4 % vs. 55.8 % , P=0.002 ) . Group 2 had a lower progression rate of mucositis from grade 2 to 3 compared with Group 3 ( 39.2 % vs. 60.4 % , P=0.035 ) . There was no difference in the onset time of grade 3 mucositis among 3 groups . Actovegin was well tolerated and no treatment-related adverse events were observed . CONCLUSIONS Actovegin is effective in the prevention and treatment of chemoradiotherapy-induced oral mucositis BACKGROUND AND PURPOSE To report an early analysis of prospect i ve study exploring preoperative radiotherapy and local excision in rectal cancer . MATERIAL S AND METHODS Mucosa at tumour edges was tattooed . Patients with cT1 - 3N0 tumour < 3 - 4 cm were treated with either 5x5Gy+4Gy boost ( N=31 ) or chemoradiation ( 50.4Gy+5.4Gy boost , 1.8Gy per fraction+5-fluorouracyl and leucovorin ; N=13 ) . Thirteen patients from the short-course group were unfit for chemotherapy .  The interval from radiation to full-thickness local excision was 6 weeks . The protocol called for conversion to a transabdominal surgery in case of ypT2 - 3 disease or positive margin . RESULTS The postoperative complications requiring hospitalization were recorded in 9 % of patients . The rate of pathological complete response was 41 % . The rate of patients requiring conversion was 34 % ; however , 18 % actually underwent conversion and the remaining 16 % refused or were unfit . During the 14 months of median follow-up , local recurrence was detected in 7 % of patients and all underwent salvage surgery . Of 19 patients in whom initially anterior resection was likely , 16 % had abdominoperineal resection performed for a conversion or as a rescue procedure . CONCLUSION Our study suggests that the short-course radiation prior to local excision is a treatment option for high-risk patients PURPOSE Biliary tract lesions are comparatively rare neoplasms , with ambiguous indications for radiotherapy . The specific aim of this study was to report the clinical results of a single-institution biliary tract series treated with modern radiotherapeutic techniques , and detail results using both conventional and image-guided intensity-modulated radiation therapy ( IG-IMRT ) . METHODS AND MATERIAL S From 2001 to 2005 , 24 patients with primary adenocarcinoma of the biliary tract ( gallbladder and extrahepatic bile ducts ) were treated by IG-IMRT .  To compare outcomes , data from a sequential series of 24 patients treated between 1995 and 2005 with conventional radiotherapy ( CRT ) techniques  were collected as a comparator set . Demographic and treatment parameters were collected . Endpoints analyzed included treatment-related acute toxicity and survival . RESULTS Median estimated survival for all patients completing treatment was 13.9 months . A statistically significant higher mean dose was given to patients receiving IG-IMRT compared to CRT , 59 vs. 48Gy . IG-IMRT and CRT cohorts had a median survival of 17.6 and 9.0 months , respectively . Surgical resection was associated with improved survival . Two patients ( 4 % ) experienced an RTOG acute toxicity score>2 . The most commonly reported GI toxicities ( RTOG Grade 2 ) were nausea or diarrhea requiring oral medication , experienced by 46 % of patients . CONCLUSION This series presents the first clinical outcomes of biliary tract cancers treated with IG-IMRT . In comparison to a cohort of patients treated by conventional radiation techniques , IG-IMRT was feasible for biliary tract tumors , warranting further investigation in prospect i ve clinical trials BACKGROUND AND PURPOSE Continuous , hyperfractionated , accelerated radiotherapy ( CHART ) has shown promise of improved tumour control and reduced late morbidity in pilot studies and has now been tested in a multicentre r and omised controlled clinical trial . MATERIAL AND METHODS Patients with squamous cell cancer in the main sites within the head and neck region with the general exception of early T1 N0 tumours were entered into the study by 11 centres . There was a 3:2 r and omisation to either CHART , where a dose of 54 Gy was given in 36 fractions over 12 days , or to conventional therapy where 66 Gy was given in 33 fractions over 6.5 weeks . A total of 918 patients were included over a 5 year period from March 1990 . RESULTS ACUTE MORBIDITY : Acute radiation mucositis was more severe with CHART , occurred earlier but settled sooner and was in nearly all cases healed by 8 weeks in both arms . Skin reactions were less severe and settled more quickly in the CHART treated patients . TUMOUR CONTROL AND SURVIVAL : Life table analyses of loco-regional control , primary tumour control , nodal control , disease-free interval , freedom from metastasis and survival showed no evidence of differences between the two arms . In exploratory subgroup analyses there was evidence of a greater response to  CHART  in younger patients ( P = 0.041 ) and poorly differentiated tumours appeared to fare better with conventional radiotherapy ( P = 0.030 ) . In the larynx there was evidence of a trend towards increasing benefit with more advanced T stage ( P = 0.002 ) . LATE TREATMENT RELATED MORBIDITY : Osteoradionecrosis occurred in 0.4 % of patients after CHART and 1.4 % of patients after conventional radiotherapy . The incidence of chondritis or cartilage necrosis was similar in both arms . Life table analysis showed evidence of reduced severity in a number of late morbidities in favour of CHART . These were most striking for skin telangiectasia , superficial and deep ulceration of the mucosa and laryngeal oedema . CONCLUSION Similar local turnout control was achieved by CHART as compared with conventional radiotherapy despite the reduction in total dose from 66 to 54 Gy supporting the importance of re population as a cause of radiation failure . The effects seen in advanced laryngeal cancer and those related to histological differentiation need further study . Reduced late morbidity is a factor which together with patient preference should be considered in the decision as to the programme of radiotherapy to employ in the curative treatment of head and neck cancer BACKGROUND AND PURPOSE Hypoxia appears to be an important factor in predicting tumor relapse following radiation therapy . This study measured oxygenation prior to treatment in patients with cervix cancer using a polarographic oxygen electrode to determine if oxygenation was an important prognostic factor with regard to tumor control and survival . MATERIAL S AND METHODS Between May 1994 and June 1997 , 74 eligible patients with cervix cancer were entered into an ongoing prospect i ve study of tumor oxygenation prior to primary radiation therapy . All patients were evaluated with an Eppendorf oxygen electrode during examination under anesthesia .  Oxygenation data are presented as the hypoxic proportion , defined as the percentage of pO2 readings of < 5 mm Hg ( abbreviated as HP5 ) . RESULTS The HP5 ranged from 2 to 99 % with a median of 52 % . With a median follow-up of 1.2 years , the disease-free survival ( DFS ) rate was 69 % for patients with HP5 of < or = 50 % compared with 34 % for those with HP5 of > 50 % ( log-rank P = 0.02 ) . Tumor size above and below the median of 5 cm was also significantly related to DFS ( P = 0.0003 ) and patients with bulky hypoxic tumors had a significantly lower DFS ( 12 % at 2 years ) than either bulky oxygenated or non-bulky oxygenated or hypoxic tumors ( 65 % , P = 0.0001 ) . CONCLUSIONS Hypoxia and tumor size are significant adverse prognostic factors in a univariate analysis of disease-free survival in patients with cervix cancer . A high risk group of patients with bulky hypoxic tumors have a significantly higher probability of relapse and death The second part of the GYN GEC ESTRO working group recommendations is focused on 3D dose-volume parameters for brachytherapy of cervical carcinoma . Methods and parameters have been developed and vali date d from dosimetric , imaging and clinical experience from different institutions ( University of Vienna , IGR Paris , University of Leuven ) . Cumulative dose volume histograms ( DVH ) are recommended for evaluation of the complex dose heterogeneity . DVH parameters for GTV , HR CTV and IR CTV are the minimum dose delivered to 90 and 100 % of the respective volume : D90 , D100 . The volume , which is enclosed by 150 or 200 % of the prescribed dose ( V150 , V200 ) , is recommended for overall assessment of high dose volumes . V100 is recommended for quality assessment only within a given treatment schedule . For Organs at Risk ( OAR ) the minimum dose in the most irradiated tissue volume is recommended for reporting : 0.1 , 1 , and 2 cm3 ; optional 5 and 10 cm3 . Underlying assumptions are : full dose of external beam therapy in the volume of interest , identical location during fractionated brachytherapy , contiguous volumes and contouring of organ walls for > 2 cm3 . Dose values are reported as absorbed dose and also taking into account different dose rates . The linear-quadratic radiobiological model-equivalent dose (EQD2)-is applied for brachytherapy and is also used for calculating dose from external beam therapy . This formalism allows systematic assessment within one patient , one centre and comparison between different centres with analysis of dose volume relations for GTV , CTV , and OAR . Recommendations for the transition period from traditional to 3D image-based cervix cancer brachytherapy are formulated . Supplementary data ( available in the electronic version of this paper ) deals with aspects of 3D imaging , radiation physics , radiation biology , dose at reference points and dimensions and volumes for the GTV and CTV ( adding to [ Haie-Meder C , Pötter R , Van Limbergen E et al. Recommendations from Gynaecological ( GYN ) GEC ESTRO Working Group ( I ) : concepts and terms in 3D image-based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV . Radiother Oncol 2005;74:235 - 245 ] ) . It is expected that the therapeutic ratio including target coverage and sparing of organs at risk can be significantly improved , if radiation dose is prescribed to a 3D image-based CTV taking into account dose volume constraints for OAR . However , prospect i ve use of these recommendations in the clinical context is warranted , to further explore and develop the potential of 3D image-based cervix cancer brachytherapy PURPOSE This study investigated two fixed threshold methods to delineate the target volume using (18)FDG PET/CT before and during a course of radical radiotherapy in locally advanced squamous cell carcinoma of the head and neck . MATERIAL S AND METHODS Patients were enrolled into the study between March 2006 and May 2008 .  (18)FDG PET/CT scans were carried out 72h prior to the start of radiotherapy and then at 10 , 44 and 66Gy . Functional volumes were delineated according to the SUV Cut Off ( SUVCO ) ( 2.5 , 3.0 , 3.5 , and 4.0bwg/ml ) and percentage of the SUVmax ( 30 % , 35 % , 40 % , 45 % , and 50 % ) thresholds . The background (18)FDG uptake and the SUVmax within the volumes were also assessed . RESULTS Primary and lymph node volumes for the eight patients significantly reduced with each increase in the delineation threshold ( for example 2.5 - 3.0bwg/ml SUVCO ) compared to the baseline threshold at each imaging point . There was a significant reduction in the volume ( p⩽0.0001 - 0.01 ) after 36Gy compared to the 0Gy by the SUVCO method . There was a negative correlation between the SUVmax within the primary and lymph node volumes and delivered radiation dose ( p⩽0.0001 - 0.011 ) but no difference in the SUV within the background reference region . The volumes delineated by the PTSUVmax method increased with the increase in the delivered radiation dose after 36Gy because the SUVmax within the region of interest used to define the edge of the volume was equal or less than the background (18)FDG uptake and the software was unable to effectively differentiate between tumour and background uptake . CONCLUSIONS The changes in the target volumes delineated by the SUVCO method were less susceptible to background (18)FDG uptake compared to those delineated by the PTSUVmax and may be more helpful in radiotherapy planning . The best method and threshold have still to be determined within institutions , both nationally and internationally In the last two decades we have seen major advances in the way patients with rectal cancer are investigated and treated . Three key components , which have all been led by European investigators , are the well-documented improvements in pre-operative staging , improvements in surgical technique and histopathological assessment of the resected specimen [ 1 ] . Key studies have vali date d the importance of cross-sectional pelvic imaging , particularly phased array MRI and its ability to demonstrate the relationship of the macroscopic tumour to the surrounding well-defined anatomical plane of surgical excision . This development is closely linked with the ability of relatively simple histopathological techniques to assess and measure the distance of microscopic tumour to the circumferential resection margin ( CRM ) of the resected rectal cancer specimen [ 2,3 ] . The third key component is the recognition of the importance of the technique of rectal cancer surgery . The concept of ‘ ‘ mesorectal excision ” where meticulous dissection of the anatomical plane surrounding the mesorectal fat is of crucial importance and has been reported to result in significantly lower rates of local recurrence in specialist centres , population -based audit and within the framework of r and omised controlled trials [ 4 ] . In addition , European investigators have continued to test important questions in the framework of r and omised phase III trials with a specific focus on the role of adjuvant radiotherapy . In the last nine years at least seven European phase III trials evaluating the role of adjuvant radiotherapy in rectal cancer have been published . From these trials , we have an evidence base that demonstrates the efficacy of both short course pre-operative radiotherapy and pre-operative concurrent radiochemotherapy [ 5–11 ] . Despite a major increase in our knowledge we are aware of a wide variation in both opinion and practice within and between European ( and other ) countries . In the United States , the NIH consensus statement was published in 1990 and it had a major influence on North American practice . The EURECA project was proposed to identify the degree of consensus that could be achieved across a wide range of topics relating to the management of rectal cancer and of equal importance to identify areas where future research is a priority . The process anticipated a range of views amongst both experts and the health care professionals who BACKGROUND AND PURPOSE A 5 week-hyperfractionated and accelerated radiotherapy regimen without reduction of the total dose was developed to fight tumour re population during treatment and tumour hypoxia . The purpose of the study was to try to improve loco-regional control in high risk head and neck carcinoma treated with curative radiotherapy .  METHODS AND MATERIAL S From 1985 to 1995 , a r and omised controlled trial of the EORTC Cooperative Group of Radiotherapy ( EORTC 22851 ) compared the experimental regimen ( 72 Gy/45 fractions/5 weeks ) to st and ard fractionation and overall treatment time ( 70 Gy/35 fractions/7 weeks ) in T2 , T3 and T4 head and neck cancers ( hypopharynx excluded ) . The end-point criteria were local and loco-regional control , overall and disease-free survival , and acute and late toxicities .  Five hundred twelve patients were accrued . RESULTS Patients in the AF ( accelerated fractionation ) arm did significantly better with regard to loco-regional control ( P = 0.02 ) result ing at 5 years in a 13 % gain ( 95 % CI 3 - 23 % gain ) in loco-regional control over the CF ( conventional fractionation ) arm . This improvement is of larger magnitude in patients with poorer prognosis ( N2 - 3 any T , T4 any N ) than in patients with more favourable stage . Multivariate analysis confirmed AF as an independent prognostic factor of good prognosis for loco-regional control ( P = 0.03 ) . Specific survival shows a trend ( P = 0.06 ) in favour of the AF arm . ACUTE AND LATE TOXICITIES : Acute and late toxicity were increased in the AF arm . Late severe functional irradiation damage occurred in 14 % of patients of the AF arm versus 4 % in the CF arm . Two cases of radiation-induced myelitis occurred after doses of 42 and 48 Gy to the spinal cord . CONCLUSIONS This trial shows that accelerated radiotherapy improves loco-regional control in head and neck squamous cell carcinomas . A less toxic scheme should , however , be investigated and documented before using accelerated radiotherapy as a st and ard regimen of curative radiotherapy for head and neck cancers PURPOSE To prospect ively assess diagnostic performance of response assessment fluorodeoxyglucose positron emission tomography/computed tomography ( FDG-PET/CT ) in patients with HNSCC treated with high-precision definitive (chemo)radiation . METHODS Fifty-seven patients treated on a prospect i ve clinical trial having post-treatment response assessment FDG-PET/CT scans were included . Clinico-pathologic findings and follow-up information was considered as reference st and ard . RESULTS First response assessment  FDG-PET/CT was done at a median of 9 weeks ( inter-quartile range 8 - 10 weeks ) from completion of treatment . The sensitivity , specificity , positive predictive value ( PPV ) , negative predictive value ( NPV ) , and accuracy of first response assessment FDG-PET/CT  for identifying residual disease at primary site was 50 % , 91.8 % , 50 % , 91.8 % , and 86 % . The corresponding figures for the neck were 62.5 % , 98 % , 83.3 % , 94.1 % , and 93 % . With a median follow-up of 26 months ( range 7 - 45 months ) , the 3-year loco-regional control ( 83.9 % vs 58.3 % , p=0.001 ) and overall survival ( 68.8 % vs 58.3 % , p=0.063 ) was significantly better in patients with negative response assessment scans . CONCLUSION The overall diagnostic accuracy of response assessment FDG-PET/CT is good , but its sensitivity and PPV is somewhat low , particularly for primary site . A negative response assessment FDG-PET/CT scan is highly suggestive of absence of viable disease that could be used to guide decision-making PURPOSE A r and omized phase II study was conducted to compare the toxicity and efficacy of combining short-term chemotherapy ( CT ) or protracted CT with radiotherapy ( RT ) for esophageal cancer . MATERIAL S AND METHODS Eligible patients were < 75 years and with performance status ( PS ) of 0 - 2 , and had stages II-IVA esophageal cancer . Two cycles of cisplatin 70 mg/m(2 ) for 1 day and 5FU 700 mg/m(2 ) for 5 days ( arm A ) or cisplatin 7 mg/m(2 ) for 10 days and 5FU 250 mg/m(2 ) for 14 days ( arm B ) were given with RT of 60Gy/30 fractions/7 weeks ( 1-week split ) . RESULTS Of 91 patients enrolled , 46 were r and omized to arm A and 45 to arm B. Two cycles of CT were given concurrently with RT for 89 % in arm A and for 71 % in arm B with significant difference ( P=.031 ) . The 2- and 5-year overall survival rates for arm A were 46 % and 35 % , while those for arm B were 44 % and 24 % , respectively , without significant difference . The 2- and 5-year progression-free survival rates for arm A were 30 % and 30 % , while those for arm B were 29 % and 12 % , respectively . CONCLUSIONS Protracted infusion CT with RT provides no advantage over st and ard short-term infusion CT with RT for esophageal cancer PURPOSE To quantify the day-to-day target volume shape variation in rectal-cancer patients treated with preoperative 5x5Gy radiotherapy .  MATERIAL S AND METHODS For 27 patients a  prone position plan-CT ( pCT ) and five daily pre-treatment cone-beam-CT ( CBCT ) scans were acquired . A sub-region of the CTV ( MesoRect , anus up to the cranial end of the mesorectal-fascia ) was delineated on all scans . The MesoRect deformation was quantified by the distance between pCT- and CBCT-delineations and was stored in surface-maps . Finally , the influence of bladder and rectum filling on MesoRect deformation was evaluated . Data were analyzed for male and female patients separately . RESULTS A large range of systematic and r and om deformations , 1 - 7 mm ( 1SD ) , on different areas of the MesoRect were found . The maximum deformations were located at the upper-anterior-side of the MesoRect . For females the errors were up to 3 mm larger than for males . Small correlations , r(2)0.4 , were found with changes in bladder volume . Larger correlations , r(2)0.7 , were found for rectal volume in a distinctive area in the upper-half of the MesoRect . CONCLUSIONS Substantial and heterogeneous deformations of the MesoRect were found . Therefore different PTV margins in positions along the cranio-caudal axis , in the anterior-posterior direction . Margins should also be larger for female patients compared to male patients
target: Both journals are anchored in large scientific societies and serve basically the same medical , physical and biological community and at the same scientific level ; the two journals are in the most recent Impact Factor list ranked almost back to back , indicating an equal importance and contribution to science .
  Radiotherapy and Oncology is more than a scientific journal , it also serves other purpose s such as facilitate education through ( educational ) review s and improving the st and ard of care by bringing forward guidelines for conduct of radiotherapy .
  Finally , the journal also tries to maintain a communication platform between the science produced by the membership of ESTRO and therefore it brings papers frommembers in the different European countries , sometimes at the expense of ultimate scientific quality , but with the underst and ing that it is important that the entire ESTRO membership gets access and opportunity to publish in a high ranked journal .
background: ESTRO , the European Society for Therapeutic Radiation Oncology , or with its new name European Society for Radiation Oncology , is a scientific society .
  It means that the prime aim of ESTRO is to bring to bring people together on an individual basis who have a common interest in improving the scientific conduct of radiotherapy and cancer treatment in Europe by ensuring that proper radiotherapy is available in the multidisciplinary treatment of cancer and applied with the right indication and with the most optimal technique .
  One of the main aims of this endeavour was to create a platform for scientific exchange through meetings and through the establishment of a scientific journal [ 1 ] .
  Thus Radiotherapy and Oncology was launched shortly after the foundation of ESTRO and has become the society ’s prime vehicle for scientific communication by serving ESTRO members through almost the entire 30 years of the society ’s existence .
  The aim was to create a peer review ed high quality international journal and that aim has indeed been fulfilled . ‘ ‘