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Background: Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, and the median overall survival is approximately 2-3 years among patients with stage III disease. Furthermore, it is one of the deadliest types of cancer globally due to non-specific symptoms and the lack of a biomarker for early detection. The most important decision that clinicians need to make after a lung cancer diagnosis is the selection of a treatment schedule. This decision is based on, among others factors, the risk of developing metastasis. Methods: A cohort of 115 NSCLC patients treated using chemotherapy and radiotherapy with curative intent was retrospectively collated and included patients for whom positron emission tomogra-phy/computed tomography (PET/CT) images, acquired before radiotherapy, were available. The PET/CT images were used to compute radiomic features extracted from a region of interest, the primary tumor. Radiomic and clinical features were then classified to stratify the patients into short and long time to metastasis, and regression analysis was used to predict the risk of metas-tasis. Results: Classification based on binarized metastasis-free survival (MFS) was applied with moderate success. Indeed, an accuracy of 0.73 was obtained for the selection of features based on the Wilcoxon test and logistic regression model. However, the Cox regression model for metastasis risk prediction performed very well, with a concordance index (c-index) score equal to 0.84. Conclusions: It is possible to accurately predict the risk of metastasis in NSCLC patients based on radiomic features. The results demonstrate the potential use of features extracted from cancer imaging in predicting the risk of metastasis.

Objective: To compare the efficacy and tolerance of 7-days-a-week accelerated postoperative radiotherapy (p-CAIR) vs postoperative radio-chemotherapy (p-RTCT) Methods: Between September 2007 and October 2013 111 patients were enrolled and randomly assigned to receive 63 Gy in 1.8 Gy fractions 7-days-a-week (n = 57, p-CAIR) or 63 Gy in 1.8 Gy fractions 5-days-a-week with concurrent cisplatin 80–100 mg per square meter of body-surface area on days 1, 22 and 43 of the radiotherapy course (p-RTCT). It represents approximately 40% of the intended trial size, that was closed prematurely due to slowing accrual. Only high-risk patients with squamous cell cancer of the oropharynx/oral cavity, considered fit for concurrent treatment were enrolled. Results: The rate of locoregional control (LRC) did not differ significantly between treatment arms (p = 0.18, HR = 0.56), 5 year LRC tended, however, to favour p-RTCT (81%) vs p-CAIR (62%). There was no difference in overall survival between treatment arms (p = 0.90, HR = 1.03). The incidence and severity of acute mucosal reactions and late reactions did not differ significantly between treatment arms. Haematological toxicity of p-RTCT was, however, considerably increased compared to p-CAIR Conclusion: Concurrent postoperative RTCT tended to improve locoregional control rate as compared to p-CAIR. This, however, did not transferred into improved overall survival. Postoperative RTCT was associated with a substantial increase in haematological toxicity that negatively affected treatment compliance in this arm. Advances in knowledge: To our knowledge this is the first trial that compares accelerated radiotherapy and radio-chemotherapy in postoperative treatment for oralcavity/oropharyngeal cancer

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radiotherapy (RT) remains only partially understood, though preclinical studies suggest that RT alters tumor immunogenicity to enhance immune response and provide synergism with IT. However, the optimal use and sequencing of IT+RT in metastatic NSCLC has not been established. Here, we performed a retrospective analysis to compare outcomes and identify predictors for improved survival for metastatic NSCLC patients treated with IT+RT at a single institution. Materials/Methods: We retrospectively reviewed 121 patients diagnosed with Stage IV NSCLC from 2015 to 2017 who were treated with IT. Information regarding patient characteristics, PD-L1 expression, use of RT, and sites irradiated were collected. The sequence of IT and RT was determined for patients receiving IT+RT. Neo-adjuvant RT was defined as the completion of RT greater than 4 weeks prior to initiating IT; concurrent IT+RT was defined as the completion of RT up to 4 weeks prior through 4 weeks after initiating IT; adjuvant RT was completed greater than 4 weeks after initiating IT. Overall survival (OS) and progression-free survival (PFS) were compared for patients with different IT+RT sequencing and sites irradiated. Results: Of the 121 Stage IV NSCLC patients receiving IT, there were 77 patients who also received RT as part of their treatment course. No difference was found between patients receiving IT versus IT+RT in terms of OS (median 16.7 months vs 16.2 months, log-rank pZ .87) or PFS (median 9.3 months vs 10.7 months, pZ .40). PD-L1 status was not predictive of OS or PFS among patients receiving IT+RT. Delivery of RT to a nonosseous metastasis, compared to a bone metastasis, was associated with improved PFS (median 11.9 months vs 8.7 months, pZ .047) and a trend towards improved OS (median 22.3 months vs 12.2 months, pZ .058) compared to patients receiving RT to a bone metastasis. Regarding IT+RT sequencing, the use of concurrent IT+RT was associated with worse OS (median 12.0 months, pZ .03) and PFS (median 7.5 months, pZ .048) compared to neo-adjuvant RT or adjuvant RT. Conclusion: The use of RT in addition to IT was not associated with improved OS or PFS in this cohort of metastatic NSCLC patients. Among patients receiving IT+RT, treatment of non-osseous metastases with RT was associated with improved PFS. This possibly suggests an opportunity for increased IT+RT synergism with irradiation of solid organ metastases opposed to bone metastases. The initiation of IT and RT in close temporal sequencing to one another was associated was reduced OS and PFS in this cohort.