Results: Among the 501 patients with a median follow-up of 58 months that received CRT, there were 26 (5.2%) events of late SB toxicity ! grade 2, and 21 (4.2%) events ! grade 3. Univariate analysis identified SB volumes exposed to 30 Gy as being significantly associated with grade !3 toxicity (p Z 0.019), while volumes of 25 Gy and 30 Gy were most predictive of grade ! 2 toxicity (p Z 0.023, 0.003). Logistic regression analysis identified volumes of 458 cc receiving 5 Gy (p Z 0.007), 330 cc for 15 Gy (p Z 0.02), 274 cc for 25 Gy (p Z 0.02), and 190 cc for 30 Gy (p Z 0.02) as predictive for grade !2 SB toxicity. Conclusion: This study reports on the late SB toxicity associated with CRT in a large cohort of rectal cancer patients. Dosimetric analysis identified SB volumes that are significantly associated with late SB toxicity of ! grade 2. When planning CRT for rectal cancer patients, restricting V30 to <190cc will be a useful guideline to keep grade !2 late SB toxicity to <5%.

Early-stage breast cancer patients comprise a large proportion of patients treated with radiotherapy in Canada. Proponents have suggested that five-fraction hypofractionated radiotherapy for these patients would result in significant cost savings. An assessment of this argument is thus warranted. The FAST-Forward and UK FAST clinical trials each demonstrated that their respective hypofractionated regimens provided equivalent outcomes compared with standard regimens. Thus, a cost-minimization analysis was performed to quantify the potential savings associated with these regimens, which were designated as FAST-Forward 1 (26 Gy/5 fractions/1 week) and FAST-Forward 2 (27 Gy/5 fractions/1 week), and UK FAST 1 (28.5 Gy/5 fractions/5 weeks) and UK FAST 2 (30 Gy/5 fractions/5 weeks). A standard regimen of 42.5 Gy/16 fractions/5 weeks was also included. A comprehensive model of radiotherapy costs for a Canadian cancer centre was created. Time, labour costs, and capital costs were calculated for each regimen and applied using established measures. The total costs per patient for the FAST-Forward trials were $851.77 for FAST-Forward 1 and $874.77 for FAST-Forward 2, providing a total savings of $487.99 and $464.99, respectively. Similarly, the total costs per patient for the FAST trials were $979.75 for UK FAST 1 and $1017.70 for UK FAST 2, providing savings of $360.01 and $322.06, respectively. Following the FAST-Forward 1 regimen results in the greatest reduction of infrastructure and human resources costs at 36.42% compared with the standard. Sensitivity analysis shows a maximum per-patient costs savings ranging from $474.60 to $508.53 for the FAST-Forward 1 trial, which translates to an annual savings of $174,700/year locally and $2.06 million/year province-wide, based on a moderate-to-large size department workload. Compared with a standard radiotherapy regimen, all FAST-Forward and UK FAST hypofractionated regimens provide cost savings for the treatment of early-stage breast cancer. The cost savings associated with each of these equivalent regimens can be directly calculated; activities in this model can easily be adjusted to account for cost variations, allowing other centres to calculate cost impacts specific to their own centres.

Schwannomas are rare benign tumors that are often asymptomatic and identified incidentally on imaging studies undertaken for another purpose. Schwannomas arising from the vestibular nerve are the most common site of identification; however, schwannomas can arise extracranially in any peripheral nerve tissue. Here, we present a case study of a patient with a localized rectal adenocarcinoma who was found to have a retroperitoneal schwannoma initially felt to be a lymph node metastasis of his rectal cancer. The diagnosis of schwannoma was confirmed via biopsy, which resulted in changes to the patient's overall management including radiotherapy volumes and recommendation against neoadjuvant or adjuvant systemic therapy.

Background and Aims: Stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) is becoming an accepted local therapy in patients who are not candidates for surgical intervention, ablation or transarterial chemo-embolization. In patients with HCC with macrovascular invasion, SBRT is sometimes the treatment of choice, especially when systemic therapies are contraindicated, not available or if the HCC is refractory to systemic therapy. Methods:We present two cases of HCC with tumour macrovascular invasion treated with SBRT. Both tumours appeared to have a complete response to SBRT over the subsequent 5 years.Results: Very late, in-field local recurrences of HCC were diagnosed 73 and 78 months following SBRT. One patient underwent re-irradiation, was started on Levatinib and remains alive at 12 months following his recurrence. The other patient experienced rapid hepatic and extra-hepatic HCC progression shortly after the local recurrence occurred, and they expired 6 months later. Conclusions:We demonstrate that patients treated with SBRT for HCC, with or without vascular invasion, may have prolonged tumour control and overall survival beyond 5 years. As more HCC patients are living longer compared to historical cohorts, it has become apparent that very late local recurrences of HCC may occur highlighting the need for long-term surveillance.