OBJECTIVES: The purpose of this study was to determine the effect of hospital volume on long-term survival for women with breast cancer. METHODS: Survival analysis and proportional-hazard modeling were used to assess 5-year survival and risk of death, adjusting for clinical and sociodemographic variables. RESULTS: At 5 years, patients from very low-volume hospitals had a 60% greater risk of all-cause mortality than patients from high-volume hospitals. CONCLUSIONS: Hospital volume of breast cancer surgical cases has a strong positive effect on 5-year survival. Research is needed to identify whether processes of care, especially postsurgical adjuvant treatments, contribute to survival differences.

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a b s t r a c tAn extremely large variety of benign and malignant tumours occur at skull base; these tumour lesions are in the proximity to structures deputed to relevant physiologic functions, limiting extensive surgical approaches to this body district. Most recent progresses of surgery and radiotherapy have allowed to improve local control with acceptable rates of side effects. Various photon radiotherapy techniques are employed, including 3-dimensional conformal radiotherapy, intensity modulated radiotherapy (IMRT), stereotactic radiotherapy (SRT) and brachytherapy that is manly limited to the treatment of primary or recurrent nasopharyngeal carcinoma. Proton beam radiotherapy is also extensively used thanks to its physical characteristics. Our review, focusing in particular on meningioma, chordoma, and chondrosarcoma, suggests that proton therapy plays a major role in the treatment of malignant tumours whereas photon therapy still plays a relevant role in the treatment of benign tumour lesions.

Starting from Wuhan, China, SARS-CoV-2 has been a catastrophic epidemic involving many countries worldwide. After China, Italy has been heavily affected, and severe measures to limit the spread of the virus have been taken in the last weeks. Radiation oncology departments must guarantee optimal cancer treatments even in such a challenging scenario of an ongoing aggressive epidemic. Adopted preventive measures and recommendations are highlighted for patients, professionals, and clinical operations to minimize the risk of infection while safely treating patients with cancer.

In COVID-19 pandemic, cancer patients may be vulnerable for their immunological status and need of immunosuppressive anti-neoplastic treatments. Choosing the best treatment option in COVID-19 positive cancer patients is still a challenging issue. We report the case of a 62-year-old woman diagnosed with multiple myeloma and affected by COVID-19. After the diagnosis of multiple myeloma in January 2019, the patient underwent first line therapy followed by bone marrow autologous stem cell transplantation, achieving a complete response in September 2019. In March 2020, the patient showed intrathoracic progression of the disease, resulting in a severe dysphagia and concomitant positivity to SARS-CoV-2 swab test, cough, fever, and dyspnea related to the involvement of the lung parenchyma as shown by CT-scan. After her admittance to a COVID-19 dedicated inward, she was administered oral hydroxychloroquine and darunavir-cobicistat for 7 days with stabilization of her general clinical conditions. For the worsening of dysphagia, after multidisciplinary discussion, it was decided to deliver radiotherapy to the mediastinal and paravertebral mass with 8 Gy single fraction. After 5 days, her clinical conditions improved, with reduction of dysphagia. The CT confirmed a partial response with reduction of the mass of about 50%. Viral clearance was confirmed by triple negative search for SARS-CoV-2 on nasopharyngeal swabs, one month after first documentation of positivity. Unfortunately, the patient died three months later due to a pulmonary mycotic infection causing respiratory failure. To our knowledge, this case report describes the first experience of mediastinal radiotherapy in a COVID-19 patient affected by myeloma reported in the literature. In case of clinical indication, even in presence of SARS-CoV-2 infection, radiotherapy can be safely delivered and might be considered a treatment option as shown by our experience in this challenging case of intrathoracic myeloma.