Sixteen patients were alive at time of analysis. Median follow-up was 4.1 years for all patients and 14 years for living patients. At 15 years, local control rate was 78%, regional control rate was 92%, and localregional control rate was 74%. Cause-specific and disease-free survival rates were 49% at 5 years and 35% at 10 and 15 years. Fifteen percent had a contralateral breast failure. The rate of distant metastases was 59% at 10 years and 61% at 15 years. Overall survival rate was 48% at 5 years, 32% at 10 years, and 23% at 15 years. The 10 patients who received preoperative RT (median dose, 55 Gy) but not surgery fared poorly, with 9 dying of disease; the median time to death was 1.4 years. The 10-year survival rate for the no-surgery group was 20% compared to 25% in the preoperative RT and surgery group and 35% in the postoperative RT group (P Z 0.22). Patients treated once daily (median dose, 50 Gy) had a 10-year local control rate of 78% and regional control rate of 91%. This was comparable to the twice-daily arm (median dose, 51 Gy), which had a local control rate of 76% (P Z 0.69) and regional control rate of 100% (P Z 0.22). Per CTCAE version 4.0, 26 (30.2%) patients experienced lymphedema: 3 with grade 3; 11 with grade 2; 12 with grade 1. In 5 of these patients, lymphedema was permanent. There were 6 grade 3 and 1 grade 4 complications during chemotherapy. No grade 5 toxicity occurred. Conclusion: IBC is an aggressive disease that is routinely self-detected by patients. Once-daily versus twice-daily RT did not affect control rates in this cohort. Patients who did not receive trimodality therapy, especially those who did not proceed to surgery, had a particularly poor prognosis. Nearly a quarter of patients achieve long-term survival.

Evaluation of extrinsic tongue muscle invasion is a subjective finding for all 3 disciplines. For radiology, masslike enhancement of extrinsic tongue muscle invasion most consistently corresponded to concurrent surgery/pathology evaluation positive for extrinsic tongue muscle invasion. Intraoperative surgical and pathologic evaluation should be encouraged to verify radiologic extrinsic tongue muscle invasion to minimize unnecessary upstaging. Because this process is not routine, imaging can add value by identifying those cases most suspicious for extrinsic tongue muscle invasion, thereby prompting this more detailed evaluation by surgeons and pathologists.

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in the remaining patient. The T-stages were as follows: cT1, one patient; cT2, one patient; cT3, 15 patients; and cT4, one patient. According to the Classification of Pancreatic Carcinoma by the Japan Pancreas Society, we selected the lymph node stations around major arteries which were visible on the CE-4DCT images: common hepatic, celiac, splenic, superior mesenteric, and abdominal aortic stations. We delineated the GTV and these arteries on the CE-4DCT images at all respiratory phases. The margins from the arteries to the lymph node stations were decided with reference to the Pancreas Atlas of the Radiation Therapy Oncology Group. The respiratory motion was calculated from the movement of the center of the GTV and the lymph node stations in the craniocaudal direction. The Wilcoxon signed-rank test was used to analyze the differences in the respiratory motion between the GTV and the lymph node stations. The Wilcoxon rank-sum test was used to analyze the relationship between the respiratory motion and clinical factors. Results: The respiratory motion values of the GTV and the lymph node stations are listed in Table 1. The respiratory motion of the celiac (P < 0.001), superior mesenteric (P < 0.001), and abdominal aortic (P < 0.001) stations was significantly smaller than that of the GTV. Patients aged 70 years had significantly larger respiratory motion of the GTV (P Z 0.010) and the common hepatic (P Z 0.038), celiac (P Z 0.012) and superior mesenteric (P Z 0.034) stations. Conclusion: We observed significant differences in the respiratory motion between the GTV and the lymph node stations for pancreatic cancer. The smaller internal margin for the celiac, superior mesenteric, and abdominal aortic stations than that for the GTV may be acceptable.