Purpose/Objective(s): To characterize patterns of failure and clinical-and treatment-related predictors of survival in adult medulloblastoma. Materials/Methods: The clinical records of 57 adult patients (age 18 years) with histologically proven medulloblastoma treated at our institutions between 1986 and 2015 were retrospectively analyzed. All patients had disease confined to the craniospinal axis at presentation, and 7 patients had M+ Chang stage. Lesions were midline in 23 cases and lateral in 34. Histological subtypes were as follows: 31 classic, 20 desmoplastic and 6 anaplastic. Gross total resection was achieved in 37 patients, and the remaining 20 patients underwent subtotal resection. All patients received post-operative radiotherapy, with median craniospinal dose of 36 Gy and posterior fossa dose of 54 Gy. Thirty-eight patients received chemotherapy (14 pre-radiation, 24 post-radiation). Results: With a median follow-up period of 5.2 years, 18 patients experienced recurrences. At 5 years, overall survival rate was 87%, and eventfree survival rate was 70%. The 5-year posterior fossa control rate was 81%. Twenty-two percent of all relapses occurred more than 5 years postradiotherapy. The posterior fossa was the most common site of relapse. In univariate analysis, radiotherapy duration of 7 weeks or less was associated with improved overall survival (PZ0.02). Extent of resection (PZ0.001), standard-risk grouping (PZ0.006) and radiotherapy duration of 7 weeks or less (PZ0.007) were statistically significant predictors of improved posterior fossa control. In multivariate analysis, completion of radiotherapy in 7 weeks or less was predictive of improved posterior fossa control (PZ 0.04) and overall survival (PZ 0.05). Conclusion: Patients with adult medulloblastoma have survival rates similar to their pediatric counterparts, but late and distant relapses are common. The delivery of radiation therapy over a shorter interval is associated with improved local control and survival.

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To evaluate the prognostic value of magnetic resonance imaging (MRI)-determined lymph nodal necrosis (LNN) in patients with nasopharyngeal carcinoma (NPC) and further explored the feasibility of an N-classification system based on the 8th edition of the American Joint Committee on Cancer (AJCC) system. Materials/Methods: The MRI scans of 616 patients with newly diagnosed stage T1, 4N1, 3M0 NPC treated with definitive intensity-modulated radiotherapy (IMRT) were reviewed retrospectively. Results: The incidence of LNN was 38.1% (235 of 616). Multivariate analysis showed that LNN was an independent prognostic predictor of distant metastasis free survival and overall survival. The survival outcomes for patients with classification N2 disease and LNN were similar to patients with classification N3 disease. Patients with classification N1 disease and LNN had similar survival outcomes as those with stage N2 disease without LNN. Patients of classification N1 disease with LNN were reclassified as classification N2, and classification N2 disease with LNN as classification N3 in the proposed N-classification system. Correlation with death and distant failure was significant, and the total difference between N1 and N3 was wider with the proposed system. The overall distribution pattern of the proposed N-classification was more equitable than that of the 8th AJCC N-classification. Conclusion: MRI-determined LNN is an independent prognostic factor for NPC treated by IMRT. The proposed N classification system with MRIdetermined LNN based on the 8th AJCC system is powerfully predictive.

Purpose/Objective(s): Stereotactic ablative radiotherapy (SABR) for the treatment of oligometastases is being investigated in ongoing prospective studies, with available phase II data suggesting favorable outcomes. However, there is little data regarding the use of SABR for oligometastatic lymph nodes (LNs). The objectives of the study are to report the demographics, toxicity and outcomes of all patients treated provincially with SABR to oligometastatic LNs. Materials/Methods: We conducted an analysis of all patients who underwent SABR to oligometastatic LNs in our provincial program, from 2013 to 2017. Some of the patients were treated on clinical trials, and data was prospectively collected. For the remaining majority of the patients, baseline patient, tumor, treatment and clinical outcome data were collected through retrospective review. Local control (LC), progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier method. Cox regression analysis was used to identify predictors of outcomes. Results: Twenty-four patients underwent SABR to 35 LNs (median 1 and mean 1.5 LNs per patient). The primary sites were colorectal 8 (22.9%), kidney 6 (17.1%), esophagus 4 (11.4%), gallbladder 4 (11.4%), stomach 3 (8.6%), lung 3 (8.6%), skin 2 (5.7%), pancreas 2 (5.7%), liver 1 (2.9%), duodenum 1 (2.9%), and unknown origin 1 (2.9%). Four (11.4%) LNs were in the neck / supraclavicular regions, 14 (40.0%) in the hilum / mediastinum and 17 (48.6%) in the abdomen / pelvis. All patients had treated and controlled primary sites at the time of SABR. The median follow-up post-SABR was 31.7 months. The SABR dose fractionation ranged between 30-60 Gy in 5-10 fractions, with median BED 10 of 72 Gy (range 41.3-105 Gy). All patients were treated with VMAT technique, with 4DCT and respiratory gating used for motion management in 19 (54.3%) cases. The 1-and 3-year LC were 85.4% and 62.7%. The median PFS was 7.6 months, with 1-year PFS at 25.7% and 3-year at 18.4%. The median OS was 45.0 months, with 1-year OS at 91.3% and 3-year at 55.7%. Thirteen (54.2%) patients initiated systemic therapy after SABR, at a median time for these patients of 10.0 months following completion of SABR. The median systemic therapy-free survival (STFS) for all patients after SABR was 17.8 months. There was no grade 3-5 toxicity as per CTCAE V5 criteria. On multivariate analysis, younger age (pZ0.019) and female gender (pZ0.046) were found to be factors predictive of improved OS. Conclusion: SABR to oligometastatic LNs achieves meaningful STFS, without significant toxicity. While the treatment yields moderate rates of long-term LC, the PFS was limited in this cohort. Further evaluation of patient and tumor selection is warranted.