<b><i>Introduction:</i></b> Radiation-induced carotid artery stenosis (RI-CS) is known as one of long-term side effects of radiotherapy for head and neck cancer (HNC). However, the clinical time course after irradiation has been poorly understood. We aimed to investigate the natural history of radiation-induced carotid atherosclerosis, comparing the patients who received radiotherapy for HNC with the patients who were treated without radiotherapy. <b><i>Methods:</i></b> The patients who received treatment of HNC at Department of Otolaryngology, Head and Neck Surgery of Kyoto University Hospital, from November 2012 to July 2015 were enrolled. The patients were assigned into the RT group and the control group, depending on whether radiotherapy was planned or not. Annual carotid ultrasound was performed from the enrollment to 5 years. The increase of mean intima-media thickness (IMT) at common carotid artery from the enrollment (Δmean IMT) was evaluated. <b><i>Results:</i></b> Fifty-six patients in the RT group and 25 patients in the control group were enrolled. From 5-year follow-up data, the significant higher increase of Δmean IMT was consistently observed in the RT group than in the control group after 2 years. The RT group presented a 7.8-fold increase of mean IMT compared to the control group (0.060 mm per year in the RT group and 0.008 mm per year in the control group). Cumulative incidence curves obtained from the analysis of all vessels revealed that the RT group presented higher incidence of Δmean IMT ≥0.25 mm than the control group (<i>p</i> &#x3c; 0.01). In the RT group, the patients with mean IMT ≥1.0 mm at enrollment exhibited significantly higher incidence of Δmean IMT ≥0.25 mm than the patients with mean IMT &#x3c;1.0 mm (<i>p</i> &#x3c; 0.01). <b><i>Discussion:</i></b> Radiotherapy for HNC induces continuous carotid mean IMT progression. The irradiated carotid arteries with mean IMT ≥1.0 mm before radiotherapy presented earlier IMT progression than those with mean IMT &#x3c;1.0 mm.

Background: It is important to understand how elderly patients with locally advanced pancreatic carcinoma (LAPC) should be treated, since the number of elderly patients with cancer has been increasing recently. However, the optimal treatment for elderly patients with LAPC is unclear. The purpose of this study was to evaluate the efficacy and safety of hypofractionated intensity-modulated radiotherapy (IMRT) with concurrent gemcitabine for elderly patients with LAPC. Methods: We retrospectively analyzed data of LAPC patients aged ≥75 years treated with hypofractionated IMRT (48 Gy in 15 fractions), with concurrent weekly gemcitabine at our institution from February 2013 to December 2018. Overall survival (OS), progression free survival (PFS), locoregional progression free survival (LRPFS), distant metastasis free survival (DMFS) and the pattern of recurrence and toxicity were analyzed.Results: Fifteen patients were administered this treatment during the period. The median age was 78 years (range, 75-86 years), and the Eastern Cooperative Oncology Group (ECOG) performance status (PS) of all patients was 0-1. The median survival time (MST) and median PFS were 20.4 (95% confidence interval (CI) 10.3-36.8) and 13.5 (95% CI 6.4-20.3) months, respectively, and the one-year OS and PFS rates were 80.0% (95% CI 50-93.1%) and 66.7% (95% CI, 37.5-84.6%), respectively. The median LRPFS and median DMFS were 15.6 (95% CI 6.4-36.8) and 14.9 (95% CI 7.0-20.5) months, respectively, and the one-year LRPFS and DMFS rates were 73.3% (95% CI, 43.6-89.1%) and 66.7% (95% CI 37.5-84.6%), respectively. Non-hematologic grade 3 toxicity was observed in three cases of which only one was induced by radiotherapy, and grade 4-5 non-hematologic acute or late toxicities were not observed.Conclusions: The OS and PFS of elderly patients with LAPC treated using hypofractionated IMRT using gemcitabine concurrently were favorable without the occurrence of severe toxicity. This treatment strategy is feasible and promising for the elderly LAPC patients with good PS.Trial registrationRetrospectively registered.

Background: It is important to understand how elderly patients with locally advanced pancreatic carcinoma (LAPC) should be treated, since the number of elderly cancer patients will increase. However, the optimal treatment for elderly patients with LAPC remains unclear. The purpose of this study was to evaluate the efficacy and safety of hypofractionated intensity-modulated radiotherapy (IMRT) with concurrent gemcitabine for elderly patients with LAPC. Methods: We retrospectively analysed the data from LAPC patients aged ≥75 years treated with hypofractionated IMRT (48 Gy in 15 fractions) with concurrent weekly gemcitabine at our institution from February 2013 to December 2018. Overall survival (OS), progression-free survival (PFS), locoregional progression-free survival (LRPFS), distant metastasis-free survival (DMFS), and the pattern of recurrence and toxicity were analysed.Results: Fifteen patients received treatment during the study period. The median age was 78 years (range, 75-86 years), and the Eastern Cooperative Oncology Group (ECOG) performance status (PS) of all patients was 0-1. The median survival time (MST) and median PFS were 20.4 (95% confidence interval (CI), 10.3-36.8) and 13.5 (95% CI, 6.4-20.3) months, respectively, and the one-year OS and PFS rates were 80.0% (95% CI, 50-93.1%) and 66.7% (95% CI, 37.5-84.6%), respectively. The median LRPFS and median DMFS were 15.6 (95% CI, 6.4-36.8) and 14.9 (95% CI, 7.0-20.5) months, respectively, and the one-year LRPFS and DMFS rates were 73.3% (95% CI, 43.6-89.1%) and 66.7% (95% CI, 37.5-84.6%), respectively. Non-haematologic grade 3 toxicity was observed in three cases, of which only one was induced by radiotherapy, whereas grade 4-5 non-haematologic acute or late toxicities were not observed.Conclusions: The OS and PFS of elderly patients with LAPC treated using hypofractionated IMRT with concurrent gemcitabine were favourable and without the occurrence of severe toxicity. This treatment strategy is feasible and promising for elderly LAPC patients with good PS.

No abstract

A correction to this paper has been published: https://doi.org/10.1007/s12282-021-01255-8