Tensor-valued diffusion encoding employs gradient waveforms that enable unique sensitivity to microstructural features of tissue, but the interpretation of signal and parameters may be confounded by diffusion-time dependence. We introduce a framework for restriction-weighted q-space trajectory imaging (ResQ) that incorporates diffusion-time effects via the restriction-weighting tensor, and we evaluate it in a longitudinal study of prostate cancer xenografts treated by external radiotherapy. We proposed a novel gradient waveform design for tensor-valued encoding with controlled restriction weighting and applied a set of four waveforms at a 9.4 T preclinical MRI system. Mice were inoculated with human prostate cancer cells (LNCaP) and assigned to groups that were untreated controls or treated by external beam irradiation. ResQ produced parameters that describe the diffusion process in terms of the mean diffusivity (D), isotropic diffusional variance (VDi), and microscopic diffusion anisotropy (VDa) as well as their diffusion-time dependence (ΔD, ΔVDi, ΔVDa). Analyses were performed to characterize parameters longitudinally and across groups. To highlight the consequences of ignoring restriction effects, we compared ResQ to analogous parameters estimated by q-space trajectory imaging (QTI). ResQ revealed clear diffusion-time dependence across all tumors, with significant longitudinal differences between treated and untreated groups, most prominent in D, ΔD, and VDi. The ResQ signal representation captured the signal dynamics, whereas QTI did not. Neglecting diffusion-time dependence in QTI led to substantial parameter bias, most notably a pronounced overestimation of microscopic diffusion anisotropy. Diffusion-time effects are non-negligible in prostate cancer and must be considered when using tensor-valued diffusion encoding. The ResQ framework enables controlled restriction weighting and improved interpretability of diffusion MRI parameters compared with approaches that ignore the effects of restriction. This provides a more principled approach for tensor-valued diffusion encoding and may enable novel imaging biomarkers that disentangle diffusivity, isotropic diffusional variance, microscopic anisotropy, and their diffusion-time dependence.

Early tumor shrinkage correlates with final EBRT response in cervical cancer patients treated with MRI-guided radiotherapy.

Radiotherapy aims to deliver a uniform dose within±5.0% of the prescription, while minimizing toxicity. Because treatment quality directly influences patient's treatment outcomes, error detection is critical for ensuring accuracy and safety. This study evaluated in-vivo dosimetry (IVD) as a quality assurance (QA) tool to detect treatment errors during the transition from two-dimensional radiotherapy (2DRT) with Cobalt-60 units to three-dimensional conformal radiotherapy (3DCRT) with linear accelerators. IVD was performed for 612 treatment fields across 493 patients treated with either 2DRT or 3DCRT. A calibrated entrance diode was placed on the patient's skin to measure delivered doses, which were compared with prescribed doses at relevant depths. Deviations exceeding±5% were investigated, with findings discussed with oncologists to enable immediate corrective action and subsequently communicated to staff to support continuous learning. Ninety-two errors were identified. The most frequent causes were incorrect calculations (20.7%), procedural changes (15.2%), omission of tray/bolus in treatment time calculations (4.3%), and use of treatment times/monitor units without secondary physics verification (4.3%). Overall, 84.9% of the 612 measurements were within the±5% tolerance. IVD with a calibrated diode provides a simple and effective quality control measure for maintaining treatment accuracy. Systematic error analysis and structured staff feedback enhance awareness, strengthen safety culture, and improve patient care during technological transitions in radiotherapy.

Pre-clinical in vivo characterization is a necessary step in the translation of novel radiotherapeutic interventions to clinical application. In vivo irradiations using a radioactive source like Ir-192 are challenging due to steep dose gradients and absence of universally available applicators that do not require physical contact or interstitial insertion. To develop a novel external beam radiotherapy (EBRT) jig for accurate and reproducible radiotherapy treatments delivered using an Ir-192 source for in vivo studies. An irradiation jig was constructed as a flat treatment bed and upright 6cm diameter semi-circle with eight peripheral catheter positions encompassing the lateral side of a mouse. A CT scan was acquired of the jig along with a silicone phantom of a mouse with flank tumor. The scan was imported into Oncentra® for planning using 500 cGy prescribed to the tumor and calculated using TG43 and collapsed cone. EBT4 film and OSLD measurements verified dose distributions in the axial and coronal directions along with the entrance and exit dose to the tumor. Monte Carlo simulations using TOPAS™ were used to observe the 3D dose distribution within the tumor itself. Five female immunodeficient mice inoculated with HEC-1A cervical cancer tumors were irradiated and monitored for 3weeks for tumor growth, body weight, and signs of toxicity. Dosimetry measurements agreed within 2%-15% of the tumor's entrance and exit dose as reported by Oncentra® using both computational formalisms. Monte Carlo simulations confirmed a uniform dose distribution within the tumor of±10%. Compared to unirradiated mice, a significant reduction in tumor growth post-irradiation was observed in all irradiated mice with no observable signs of toxicity. We have successfully developed an EBRT platform for in vivo irradiations with an Ir-192 source. The platform can be adapted for various tumor and sample sizes and other radioactive sources.

Concurrent chemoradiotherapy (CCRT) consisting of external beam radiotherapy (EBRT) and brachytherapy (BT) combined with cisplatin is a standard treatment for cervical cancer. Acute diarrhea is a common gastrointestinal toxicity associated with CCRT. Although dose-volume histogram (DVH) parameters for radiation of the small bowel have been identified as risk factors for diarrhea, the independent contribution of BT has not been well characterized. This study aimed to investigate the association between BT and the development of acute diarrhea. We analyzed a multicenter retrospective cohort of 688 patients with cervical cancer who underwent CCRT at 14 institutions in Japan between January 2016 and March 2024. Associations between BT administration, the number of BT fractions, and the occurrence of acute diarrhea were assessed using univariate and multivariate logistic regression analyses. The incidence of acute diarrhea was significantly higher in the BT group than in the non-BT group [88.59% vs. 78.26%; adjusted odds ratio=2.15; 95% confidence interval (CI)=1.35-3.43; p=0.001]. When stratified by the estimated number of BT fractions, patients receiving three fractions demonstrated significantly higher rates of diarrhea compared with those who did not receive BT. In patients with cervical cancer undergoing CCRT, BT was significantly associated with the occurrence of acute diarrhea. The inclusion of BT into a treatment plan may serve as a pragmatic surrogate marker for elevated risk of acute diarrhea in clinical practice. Future prospective studies incorporating detailed information on the timing of diarrhea onset and comprehensive radiotherapy schedules are warranted to better define the causal relationship between BT and acute gastrointestinal toxicity.

Dose escalation with intraoperative radiotherapy in newly diagnosed glioblastoma (INTRAGO-II): an open-label, multicentre, randomised, controlled, phase 3 trial.

Cervical cancer (CC) is the fourth-most common and lethal cancer in women worldwide, with ~ 23% of cases in Chinese patients. We sought to characterize real-world treatment patterns and decision drivers for locally advanced CC (LACC) in China. We conducted a cross-sectional, 3-phase survey (quantitative development, cognitive, and quantitative interviews) of 360 physicians across 21 cities in China. Primary outcomes included treatment patterns and decision drivers for Chinese patients with LACC. Cancer stage was reported per International Federation of Gynecology and Obstetrics (FIGO) 2018. Respondents were gynecologists (55.6%), radiation oncologists (36.1%), and medical oncologists (8.3%), who reported 67.7% patients had LACC (stage IB3-IVA). Treatment patterns varied by stage: chemoradiotherapy (CRT) alone was used by 18.1%, 42.2%, and 52.1% of respondents for stages IB3-IIA2, IIB, and III-IVA CC, respectively, with surgery-based treatment used by 67.1%, 42.0%, and 26.6% of respondents. Among patients with LACC receiving concurrent CRT, 57.7% received external-beam radiotherapy (EBRT) plus brachytherapy (BT). The most important LACC treatment decision drivers were treatment efficacy (91.7%), CC stage (89.7%), and safety (88.6%). Only 63.9% reported that both EBRT and BT could be performed at their hospitals. Radiotherapy-related issues were reported as the top unmet medical need by 66.4%. There is a significant LACC burden among female patients in China, and deviations from guideline-concordant concurrent CRT. Addressing implementation gaps in concurrent CRT adoption requires improved radiotherapy access, greater multidisciplinary team use, guideline-aligned quality control, enhanced physician and patient education, and improved affordability. Future research should incorporate patient perspectives to improve patient-centered care and outcomes.

NUT Carcinoma Arising in Stensen's Duct: First Reported Case and Literature Review.

Colorectal large villous adenomas are sometimes associated with McKittrick-Wheelock syndrome, a condition characterized by severe diarrhea leading to dehydration, electrolyte depletion, and acute renal failure, which can be life-threatening in some cases. The efficacy of radiotherapy for colorectal villous adenoma has rarely been reported. We present a rare case of McKittrick-Wheelock syndrome in an older man caused by a large colorectal villous adenoma. This case is notable because palliative external beam radiotherapy of 30 Gy in 10 fractions not only reduced the tumor size but also resulted in significant symptom relief. This report demonstrates the efficacy of palliative radiotherapy for severe colorectal villous adenomas as a valid treatment option, particularly in older patients with complications.

Cavernous sinus metastasis from follicular thyroid carcinoma (FTC) is exceedingly rare and typically indicates advanced, radioiodine-refractory disease. We report a 37-year-old man with minimally invasive FTC who was treated with total thyroidectomy, neck dissection, and cumulative radioiodine therapy totaling 720 mCi for persistent iodine-avid disease. Four years later, he developed progressive left-sided palsies of cranial nerves III, IV, and VI. Imaging revealed a cavernous sinus mass with orbital apex extension and perineural spread. Serum thyroglobulin was markedly elevated (>500 ng/mL), whereas diagnostic radioiodine scintigraphy demonstrated no uptake, a finding consistent with dedifferentiated disease. Biopsy confirmed metastatic FTC. The patient received external beam radiotherapy and systemic therapy with lenvatinib; however, the disease progressed, and he died 16 months after the diagnosis of cavernous sinus metastasis. This case highlights the aggressive potential of FTC, the limitations of radioiodine imaging in dedifferentiated disease, and the poor prognosis associated with skull-base metastases despite multimodal therapy.

This study aimed to evaluate clinical outcomes in patients with vaginal recurrences treated with radiotherapy with or without chemotherapy, followed by image-guided interventional radiotherapy (IG-IRT). We retrospectively analyzed patients with vaginal recurrences treated with external beam radiotherapy (EBRT) ± chemotherapy followed by endovaginal high dose rate IG-IRT. The EBRT total dose was 45Gy. The interventional radiotherapy boost delivered 28Gy in four high-dose-rate fractions, achieving 85-95Gy EQD2 (α/β 10) to the high-risk clinical target volume and 60Gy EQD2 (α/β 10) to the intermediate-risk clinical target volume. The primary endpoint was local control. Secondary endpoints included metastasis-free survival, overall survival, cancer-specific survival, and acute and late toxicities. Thirty-two patients (median age, 54years) were included. Two-year actuarial local control, metastasis-free survival, overall survival, and cancer-specific survival rates were 100%, 77.8%, 93%, and 93%, respectively. At univariate analysis, chemotherapy was significantly associated with a reduced risk of metastasis (p = 0.0038). Among chemotherapy regimens, cisplatin-based therapy showed the lowest metastatic risk, with metastases occurring in 5% of patients (p = 0.019). Age > 59years was significantly associated with increased mortality (p = 0.026). At multivariate analysis, age was the only independent predictor of mortality (p < 0.05). Acute grade 2 gastrointestinal and skin toxicity occurred in two patients, while one patient experienced late grade 3 vaginal stenosis. Image-guided interventional radiotherapy as a boost following EBRT for vaginal cuff recurrences is an effective and safe treatment option, providing excellent local control with a favourable toxicity profile.

The TaiChi radiotherapy platform is an innovative system integrating linear accelerator (LINAC) and Gamma Knife technologies, approved by both NMPA and FDA. This hybrid design enables bimodal (X-ray and γ-ray) radiation delivery, offering enhanced flexibility for treatment planning and dose delivery. This study quantitatively evaluates its dosimetric performance for lattice radiotherapy (LRT) in soft tissue sarcoma (STS), specifically comparing its dose escalation potential and normal tissue sparing to conventional C-arm LINAC. A dosimetric analysis was conducted on 10 STS cases. The treatment combined LRT (15Gy single fraction to spherical vertices within the Gross tumor volume (GTV)) with conventionally fractionated external beam radiotherapy (50Gy/25F to the planning target volume (PTV)). TaiChi utilized its dual-modality capability, employing γ-ray focusing for vertex dose escalation and optimizing the LINAC for conventional coverage. Plans were compared on high-dose vertex coverage, dose fall-off, and organ-at-risk (OAR) sparing. TaiChi demonstrated superior dosimetric performance across all evaluated parameters. For vertex coverage, TaiChi achieved significantly higher D0.5cc (25.15 ± 0.39Gy vs. 18.90 ± 0.44Gy, p < 0.0001) and Dmean (18.87 ± 0.46Gy vs. 16.66 ± 0.85Gy, p < 0.0001). Dose gradient analysis revealed steeper fall-off with TaiChi, evidenced by higher GTV D10/D90 values (5.93 ± 0.84 vs. 3.40 ± 0.92, p < 0.0001) and reduced margin doses (3.95 ± 0.48Gy vs. 4.87 ± 0.41Gy, p < 0.0001). Importantly, these improvements were achieved while maintaining or reducing OAR exposure, with statistically reductions in maximum doses to nerves and bones (p < 0.05). The TaiChi platform's innovative integration of LINAC and Gamma Knife technologies provides distinct dosimetric advantages for STS LRT, enabling superior dose escalation to high-dose vertex regions while maintaining steep dose gradients and effective normal tissue sparing. These capabilities position TaiChi as a promising platform for advancing LRT applications. Not applicable.

Early Economic and Patient-Centered Outcomes Before Spine Metastases Radiation Therapy From an Ongoing Phase II Randomized Controlled Trial.

Study Protocol of OLIGOPELVIS 2-GETUG P12: A Randomized Phase 3 Study Comparing Intermittent Androgen-deprivation Therapy with or Without Salvage High-dose Intensity-modulated Radiotherapy to Oligorecurrent Pelvic and Para-aortic Lymph Nodes in Patients with Biochemically Relapsing Prostate Cancer.

BackgroundSome centres advocate preoperative radiotherapy in patients with pancreatic cancer and arterial involvement despite a lack of Level 1 evidence on survival benefit. Although it has been suggested that preoperative radiotherapy may increase the risk of postpancreatectomy haemorrhage (PPH) and morbidity, evidence is again lacking. This study investigated the association between preoperative radiotherapy and both PPH and major morbidity following arterial divestment/resection during pancreatic adenocarcinoma resection after chemotherapy.MethodsConsecutive patients diagnosed with pancreatic adenocarcinoma and > 180° arterial involvement who were treated with preoperative chemotherapy with or without radiotherapy followed by pancreatic resection with arterial divestment/resection were included in the study. Logistic regression analyses including propensity score-based overlap weighting were performed to investigate associations between radiotherapy and in-hospital PPH grade B/C and major morbidity, expressed as adjusted risk differences (aRDs).ResultsOverall, 246 patients undergoing pancreatic resection with arterial resection (169, 69%) or divestment (77, 31%) were included. Radiotherapy was not associated with PPH (aRD 6%; 95% confidence interval (c.i.) −3 to 14), regardless of arterial divestment (aRD 3%; 95% c.i. −5 to 11) or arterial resection (aRD 12%; 95% c.i. 1 to 23; Pinteraction = 0.189). Radiotherapy was associated with a 14% (95% c.i. 2 to 25) higher risk of major morbidity, especially after arterial resection (aRD 27%; 95% c.i. 11 to 43) compared with arterial divestment (aRD −12%; 95% c.i. −35 to 11; Pinteraction = 0.006) and after external beam radiotherapy (aRD 21%; 95% c.i. 8 to 32) compared with stereotactic body radiotherapy (aRD −12%; 95% c.i. −27 to 6; Pinteraction = 0.0001). Ninety-day mortality was increased, albeit not significantly, after preoperative radiotherapy (10 (8%) versus 3 (3%) deaths with versus without preoperative radiotherapy, respectively; P = 0.067).ConclusionsRadiotherapy before resection of pancreatic cancer with > 180° arterial involvement was associated with an increased risk of postoperative major morbidity when arterial resection, but not arterial divestment, was performed. This risk should be taken into account when considering preoperative radiotherapy in patients who may require arterial resection.

Tri-APBI: Single Institution Phase I/II Prospective Clinical Trial of Three Fraction Accelerated Partial Breast Irradiation for Stage 0-I Breast Cancer.

In patients with endometrial cancer (EC) with metastases at diagnosis, palliative treatment is the only therapy considered and to our knowledge there is no literature on the evolution of these patients following external-beam-irradiation (EBRT) and image-guided brachytherapy (IGBT). We present the clinical outcomes of 11 FIGO 2009 stage-IVB EC patients treated with IGBT ± EBRT. From July 2009 to February 2018, 11 stage IVB patients were treated with IGBT ± EBRT in 4 European centres. The treatments and the outcomes of these patients were analysed. Kaplan-Meier and descriptive analysis were used for analysing overall survival (OS). The median age was 63years (46-79) and the median follow-up was 39months (8-128). The sites of metastases were reported in 8/11 patients: the lung in 4 patients, peritoneal and liver metastasis in one, pleural metastasis in one, bone in one and inguinal lymph nodes in one. Seven patients underwent chemotherapy (5 achieving complete response (CR)). Two patients received IGBT alone and 9 EBRT + IGBT. Three developed uterine relapse, 3 lymph node relapse and all died. Four had distant metastases and only one was alive after treatment. The OS was 69.3% at 2 and 3years and 41.6% at 5 and 10years. In this series, patients with stage IVB EC with CR after chemotherapy and treated with IGBT ± EBRT achieved an OS of 41.6% at 5 and 10years. Local treatment with EBRT ± IGBT should be considered mainly in good responders to chemotherapy and should be validated in prospective trials including biological markers.

Background/Objectives: Surgery is the standard treatment for early-stage endometrial cancer (EC); however, some patients are medically inoperable due to comorbidities or morbid obesity. Definitive image-guided brachytherapy (BT) with or without external beam radiotherapy (EBRT) is a curative alternative, although comparative data with surgery remains limited. This study compared cancer-specific survival (CSS) at 2 and 5 years in high-risk surgical patients with early-stage EC (FIGO 2009 I-II), treated with definitive radiotherapy or surgery. Secondary endpoints included overall survival (OS), recurrence-free survival (RFS), disease-free survival (DFS), and toxicity. Methods: Retrospective comparative study including 72 patients treated between 2011 and 2023: 36 medically inoperable treated with BT +/- EBRT and 36 matched undergoing surgery. Survival outcomes were estimated using Kaplan-Meier methods and compared using log-rank tests. Results: Median age was 74 years and mean BMI was 38.1 kg/m2; 75% were morbidly obese, with endometrioid carcinoma being the predominant histology (88.9%). Five-year CSS was 97.2% in the radiotherapy group versus 91.7% in the surgery group (p = 0.39). Five-year RFS was identical in both groups (86.1%), with recurrence rates of 13.9%. Five-year OS was lower in the radiotherapy group (66.7% vs. 77.8%; p = 0.3), without statistical significance. Grade ≥3 radiotherapy-related toxicity occurred in 19.4%, whereas severe surgical complications occurred in 8.3%. Conclusions: Definitive BT ± EBRT is an effective and well-tolerated curative option for medically inoperable early-stage EC, with survival and recurrence outcomes comparable to surgery, supporting its role as a valid therapeutic alternative in high-risk surgical patients.

The Area Deprivation Index (ADI) ranks neighborhoods by adverse social exposome, considering factors related to income, education, employment, and housing quality. This study evaluates the association between socioeconomic status and outcomes following spine stereotactic body radiation therapy (SBRT). A prospectively maintained database of consecutive patients treated with spine SBRT at a quaternary referral center from 2001 to 2024 was analyzed. Patient addresses were matched to the 2020 ADI to define most advantaged (ADI ≤ 50, 140 patients, 227 metastases) and least advantaged (ADI > 50, 357 patients, 553 metastases) cohorts. The distribution of race and ethnicity differed between cohorts, with a greater proportion of Black or African American patients in the least advantaged cohort (2% vs. 6%, P = 0.008). Public insurance coverage was more common in the least advantaged cohort (42% vs. 54%, P = 0.020). There were no differences with respect to age (P = 0.904), sex (P = 0.495), Karnofsky Performance Status (P = 0.930), radioresistant histologies (P = 0.626), systemic disease burden (P = 0.127), prior or adjuvant chemotherapy (P = 0.146) or immunotherapy (P = 0.537), prior open surgical resection (P = 0.196) or conventional external beam radiation therapy (P = 0.268), Bilsky grade (P = 0.191), Spinal Instability Neoplastic Score (P = 0.076), gross tumor volume (P = 0.731), fractionation regimen (P = 0.437), or biologically effective dose (P = 0.499). There was no difference in 6-month, 1-year, 2-year, and 3-year local control (96%, 88%, 85%, and 79% vs. 91%, 83%, 76%, and 73%; P = 0.062) or overall survival (72%, 56%, 37%, and 28% vs. 70%, 55%, 36%, and 28%; P = 0.890). There was no difference in complete or partial pain response (44% vs. 41%, P = 0.196), radiation toxicity (12% vs. 12%, P = 0.876), or vertebral compression fractures (11% vs. 10%, P = 0.637) following treatment. Multivariable Cox proportional hazards analyses did not identify race or ethnicity, insurance coverage, or the ADI as predictors of local control or overall survival. Race or ethnicity, insurance coverage, and neighborhood deprivation were not associated with any measured outcomes following spine SBRT. These findings suggest equitable SBRT delivery once patients access care at an academic referral center and reinforce the need to improve referral pathways and insurance authorization for socioeconomically disadvantaged patients.

Technical advances and a better understanding of liver tolerance have changed the role of radiotherapy in the treatment of liver cancer. The goal of this retrospective study was to evaluate the outcomes of radiotherapy with curative intent in patients ineligible for surgery and palliative intent in patients with advanced disease. Patients were treated with stereotactic body radiotherapy (SBRT), hypofractionated radiotherapy, or conventionally fractionated radiotherapy. Patients with a solitary liver tumor, no vascular invasion, Child-Pugh class A, and no extrahepatic tumors at the time of radiotherapy were considered for radiotherapy with curative intent, and the remaining patients for radiotherapy with palliative intent. Kaplan-Meier statistics and Cox proportional hazards regression analyses were used to evaluate overall survival. Between 04/2019 and 08/2022, 93 consecutive patients with hepatocellular carcinoma (HCC) were treated external beam radiotherapy in our department. A total of 94.6% of the patients had received prior treatment. The 1-, 2-, and 3-year overall survival rates of patients treated with curative intent (n = 33) were 100%, 76%, and 65%, respectively, and those treated with palliative intent (n = 60) 63%, 31%, and 11%, respectively. No acute radiation reactions of grade ≥ 3 (CTCAE v5.0) were observed. Our data confirm that radiotherapy is an effective treatment option with curative intent for selected patients ineligible for surgery, and with palliative intent for those with advanced disease.