Chemoradiotherapy is the standard-of-care treatment of squamous-cell carcinoma of the anus (SCCA), and this has not changed in decades. Radiation doses of 50-60 Gy, as used in many phase III trials, result in substantial late morbidities and fail to control larger and node-positive tumours. Technological advances in radiation therapy are improving patient outcomes and quality of life, and should be applied to patients with SCCA. Modern techniques such as intensity-modulated radiotherapy (IMRT), rotational IMRT, image-guided radiotherapy using cone-beam CT, and stereotactic techniques have enabled smaller margins and highly conformal plans, resulting in decreased radiation doses to the organs at risk and ensuring a shorter overall treatment time. In this Perspectives article, the use of novel approaches to target delineation, optimized radiotherapy techniques, adaptive radiotherapy, dose-escalation with external-beam radiotherapy (EBRT) or brachytherapy, and the potential for modified fractionation are discussed in the context of SCCA.

After publication of this supplement [1, 2], it was brought to our attention that due to an error authors were either missing or incorrectly indicated as contributing author while in fact they didn't contribute in the following abstracts. In addition affiliations were listed where in fact there were no contributing authors affiliated with them in the following abstracts. This has now been included in this correction.

PurposeIn radical radiotherapy for cervical cancer, high-dose-rate (HDR) brachytherapy is commonly used after external beam radiation therapy (EBRT) to deliver a cumulative EQD2 of 80 to 90 Gy to the primary tumor. However, there is less certainty regarding brachytherapy dose contribution to the pelvic lymph nodes. This poses a challenge as to how high a preceding EBRT dose should be prescribed to gross nodal disease, in order to achieve a cumulative tumoricidal effect. Hence, this study aims to quantify brachytherapy dose contribution to individual pelvic nodal groups, using computed tomography (CT) planning with the Manchester system.Material and methodsThis is a single institution retrospective dosimetric study. CT planning datasets from 40 patients who received EBRT followed by intracavitary HDR brachytherapy (5 or 6 Gy fractions) were retrieved. The external iliac (EI), internal iliac (II), and obturator (OB) lymph node groups were contoured on each CT dataset. Applying the initial brachytherapy plan, mean doses to each nodal group were calculated for every patient, and averaged across the respective (5 or 6 Gy) study populations.ResultsWith a brachytherapy dose of 5 Gy to Manchester point A, the mean absolute doses received by the EI, II, and OB groups were 0.79, 1.12, and 1.34 Gy respectively, corresponding to EQD2s (α/β = 10) of 0.71, 1.04, and 1.27 Gy respectively. With a brachytherapy dose of 6 Gy, the mean absolute doses received by the EI, II, and OB groups were 1.16, 1.56, and 1.80 Gy respectively, corresponding to EQD2s of 1.08, 1.49, and 1.77 Gy, respectively.ConclusionsOur study demonstrates that pelvic lymph nodes receive substantial dose contributions from HDR brachytherapy in cervical cancer. This should be taken into account by the radiation oncologist during EBRT planning, and adequate external beam boost doses calculated to achieve cumulative tumoricidal doses to pelvic nodal disease.

Summary Background: In locally advanced pelvic malignancies, there is often involvement of urological organs, necessitating resection and reconstruction, which can be associated with significant complications. Methods: We retrospectively reviewed 20 patients undergoing urological reconstructions during pelvic oncological surgeries from January 2004 to December 2013. All patients had imagingproven involvement of at least one urological organ preoperatively. Primary outcome was urological complication rate. Secondary outcomes were nonurological complication, recurrence rate, and overall survival. Results: Median age of presentation was 51 years. Six and 14 patients underwent resections for primary and secondary tumors, respectively. Colorectal tumors were the most common, followed by gynecological cancers. The ureter was the most common urological organ involved, followed by the bladder, prostate, and seminal vesicles. Reconstructive procedures included ileal and sigmoid conduits, ureteroneocystostomies, Boari flap, transureteroureterostomies (TUUs) and direct ureteroureterostomies. Six patients developed major urological complications, requiring endoscopic and surgical reinterventions. The follow-up time was 34 months. Thirteen patients developed recurrence, associated with higher tumor grade and lymphovascular invasion, and occurred at a median time of 10 months. These patients had an overall survival of 20 months, compared to 45 months in patients without recurrence. Conclusion: Careful patient selection in pelvic oncological surgeries can significantly prolong survival. Recurrent tumors and greater intraoperative blood loss are associated with higher urological complications. A limited pelvic exenteration and lower radiation doses can reduce

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