Radiation

Purpose: This study aimed to compare QoL outcomes among patients undergoing active breathing control (ABC), voluntary deep inspiration breath hold (vDIBH), and surface-guided radiation therapy (SGRT). Methods: This was a non-randomized, three-arm clinical trial in which 55 patients were sequentially allocated to ABC (n = 19), SGRT (n = 20), or vDIBH (n = 16). QoL was assessed using the European Organization for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30) at baseline, treatment completion, and 6–8 weeks post-treatment. Linear regression was used to compare changed scales in QoL domains across groups. A p-value of <0.05 was considered statistically significant. Results: Baseline QoL scores were high across all groups, with physical functioning being the highest-rated domain and global health status the lowest. Fatigue, pain, and insomnia were the most highly reported symptoms at all time points. At 6–8 weeks, social functioning improved significantly in SGRT compared to vDIBH (16.67 vs. −12.50, p = 0.0053). Patients in the vDIBH group reported significantly increased pain compared to ABC at 6–8 weeks (p = 0.0240). No other significant differences were observed in QoL changes between the groups. Conclusions: The three breath-hold techniques maintained overall QoL with no differences between the groups, except for pain between vDIBH and ABC and social functioning for vDIBH and SGRT both at 6–8 weeks of follow-up. Despite the limitations of this study, each breath-hold technique has demonstrated comparable impact on QoL in patients with left-sided breast cancer and each could be used as a viable option with respect to QoL.

Introduction. This study aims to conduct a cost-effectiveness analysis comparing two primary treatment approaches: radical prostatectomy versus radiotherapy plus androgen deprivation therapy (ADT) in patients with Prostate Imaging Reporting and Data System (PI-RADS) 5 lesions. Patients and Methods. Data were extracted from two published retrospective cohort studies. Using survival data from two retrospective studies, we reconstructed Kaplan–Meier curves, overlaid them for comparative metasurvival analysis, and developed a cost-function model to assess economic implications alongside clinical outcomes. The primary outcomes included biochemical recurrence-free survival (FFBF) at 2 and 5 years; the area under the survival curve; total cost per treatment strategy; and cost per recurrence-free patient at 5 years. Results. At 5 years, the estimated FFBF was 83% for radiotherapy vs. 28% for prostatectomy. Radiotherapy yielded an AUC of 80.7, while prostatectomy showed 41.9. Radiotherapy yielded a cost of 21,211 € per FFBF patient compared to 113,730 € for prostatectomy. Conclusion. Our study demonstrates that radiotherapy combined with ADT, when selected based on mpMRI stratification, may represent a cost-efficient alternative, pending prospective validation. To radical prostatectomy in patients with PI-RADS 5 prostate cancer, with a favourable cost–benefit profile.

Radiation therapy (RT) has been one of the standard treatments for prostate cancer; however, its potential impact on nearby neural structures, such as the lumbosacral plexus (LSP), is often overlooked. The lack of contouring in treatment plans has led to unintended consequences. Radiation-induced lumbosacral plexopathy (RILSP) is a rare but serious complication that presents with progressive lower extremity sensory changes and weakness, mimicking radiculopathy. We report the case of a 66-year-old male who developed bilateral lower extremity neurological deficits post-pelvic radiation for prostate cancer. Radiographically, no compressive lesions were found, and the Electromyography (EMG) revealed involvement of nerves inconsistent with radiculopathy. This led to the diagnosis of RILSP. This case highlights the importance of recognition of RILSP in contrast to radiculopathy in patients with unexplained neurological symptoms after pelvic RT. This highlights the importance of incorporating the LSP as an organ at risk while planning for RT and reviewing retrospectively the dosimetry. It also emphasizes the need for improved contouring of LSP in radiation planning to minimize adverse effects. This sentiment is reflected in the literature, along with the consensus that more research is needed to address the true rate of RILSP.