Innovative Radiation Research Articles

La radiothérapie des CBNPC de stade III : nouvelles techniques, nouvelles combinaisons

Defining the optimal treatment approach for patients with stage III non-small cell lung cancer, where the loco-regional disease extension renders a surgical approach obsolete, represents an important clinical challenge. In addition, many of these patients present with several comorbidities, compromising their tolerance to treatment. This article describes how innovative radiotherapy approaches try to enhance loco-regional tumour control as a first step towards improved survival, often by exploring novel avenues to dose-escalation, while at the same time focus on limiting early and long-term radiation-induced toxicity by applying the most advanced radiotherapy techniques. Moreover, the path towards new combinations with systemic agents, particularly immunotherapy building on the actual standard of combined chemo-radiotherapy with durvalumab in consolidation, is reported. This article wants to give a balanced view on the importance to investigate how we can obtain better local and metastatic disease control by intensifying our combined treatment strategies, while bearing in mind that many of our patients in daily clinical practice may not be able tolerate this. This urges us to also explore less disruptive treatment approaches for our more frail and aged patient population and define in a multidisciplinary manner the most optimal treatment strategy for each individual patient in our daily clinical practice.1877-1203/© 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Quantifying societal burden of radiation-induced small bowel toxicity in patients with rectal cancer.

Advancements in rectal cancer (RC) treatment not only led to an increase in lives saved but also improved quality of life (QoL). Notwithstanding these benefits, RC treatment comes at the price of gastrointestinal morbidity in many patients. Health economic modelling poses an opportunity to explore the societal burden of such side-effects. This study aims to quantify radiation-induced late small bowel (SB) toxicity in survivors of RC for Three-Dimensional Conformal Radiation Therapy (3D-CRT), Intensity Modulated Radiation Therapy (IMRT) and Intensity Modulated Radiation Therapy - Image Guided Radiation Therapy (IMRT/IGRT). Materials and A model-based health economic evaluation was performed. The theoretical cohort consists of a case-mix of survivors of RC aged 25-99 years according to Belgian age-specific incidence rates. A societal perspective was adopted. The base case analysis was complemented with one-way deterministic analyses, deterministic scenario analyses and probabilistic sensitivity analysis (1,000 iterations). Results were presented as mean lifetime incremental cost (€) and utility (QALYs) per patient. The analyses showed that the use of innovative radiotherapy (RT) improves lifetime QoL in survivors of RC by 0.11 QALYs and 0.05 QALYs by preferring IMRT/IGRT and IMRT over 3D-CRT, respectively. The use of IMRT/IGRT and IMRT results in an incremental cost-saving of €3,820 and €1,863 per patient, solely by radiation-induced SB toxicity, compared to 3D-CRT. It is important to consider late toxicity effects in decisions regarding investments and reimbursement as our analysis highlighted the potential long-term cost-savings and improved QoL of novel RT techniques in patients with rectal cancer.

Coverage with evidence development program on stereotactic body radiotherapy in Belgium (2013–2019): a nationwide registry-based prospective study

Although stereotactic body radiotherapy (SBRT) was progressively adopted in clinical practice in Belgium, a reimbursement request in 2011 was not granted because of remaining clinical and economic uncertainty. Acoverage with evidence development (CED) program on SBRT started in 2013, with the aim to assess clinical and technical patterns-of-care in Belgium and monitor survival per indication, in view of supporting inclusion in the reimbursement system. The Belgian National Institute for Health and Disability Insurance (NIHDI) initiated this prospective observational registry. Participating departments, using SBRT in clinical practice, signed the 'NIHDI convention'. Eligible patients had a primary tumour (PT) or oligometastatic disease (OMD). Patient, tumour, and treatment characteristics were collected through an online module of the Belgian Cancer Registry, prerequisite for financing. Five-year overall survival (5YOS) and 30- and 90-days mortality were primary outcomes, derived from vital status information. Between 10/2013 and 12/2019, 20 of the 24 accredited radiotherapy departments participated, 6 were academic. Registered cases per department ranged from 21 to 867. Of 5675 registrations analysed, the majority had good performance status and limited number of lesions. Enrolment of PTs remained stable over time, OMDs almost doubled. Peripheral lung lesions dominated in PTs as in OMDs. Other metastases were (para)spinal, 'non-standard' and hepatic. Thirty- and 90-days mortalities remained below 0.5% [95% CI 0.3%-0.8%] respectively 2.1% [95% CI 1.6%-2.7%]. 5YOS varied by indication, primary prostate patients performing best (85%, 95% CI [76%, 96%]), those with liver metastases worst (19%, 95% CI [15%, 24%]). Better OS was observed in academic departments, department size did not significantly impact survival. OMD survival was better in 2018-19. CED can be used to define patterns-of-care and real-life outcome of innovative radiotherapy. As the observed survival for different indications was in line with outcome in emerging literature, SBRT was included in the Belgian reimbursement system as of January2020. NIHDI financed participating departments per registered case.

Pseudoprogression After Adaptive Radiation Therapy For Early-Stage Non-Small Cell Lung Cancer: Case Report

Background: Differentiating local recurrence from pseudoprogression after radiotherapy for early-stage non-small cell lung cancer (NSCLC) can be challenging. Adaptive radiation therapy (ART) is an innovative radiotherapy technique that adjusts the radiation dose and treatment plan to ensure the tumor receives the optimal radiation while minimizing exposure to the surrounding healthy tissue. To our knowledge, there is no report of pseudoprogression in a patient with NSCLC who received ART. Objectives: The purpose of this article is to present the CT and 18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging findings of pseudoprogression after ART and discuss the imaging findings important for diagnosis and management. Case summaries: An 87-year-old woman with early-stage NSCLC underwent ART, receiving a total dose of 74 Gy administered in 37 fractions. The maximum standard uptake value (SUVmax) of 18F-FDG in the tumor increased from 2.5 before ART to 3.7 six months after ART on PET, suggesting local recurrence. However, the SUVmax decreased to 2.2 one year after ART, and on CT, the tumor size decreased consistently after ART. Based on serial CT and PET imaging findings, the temporal uptake of 18F-FDG at 6 months after ART was diagnosed as pseudoprogression. Conclusion: Serial CT and PET imaging findings may help differentiate local recurrence from pseudoprogression when tumor size decreases on CT but 18F-FDG uptake increases on PET. Keywords: Differential Diagnosis; Lung Neoplasms; Adaptive Radiation Therapy, Positron-emission Tomography

Six country vignettes: Strengthening radiotherapy and theranostics

BackgroundFor cancer patient populations worldwide, the synchronous scale-up of diagnostics and treatments yields meaningful gains in survival and quality of life. Among advanced cancer therapies, radiotherapy (RT) and theranostics are key to achieving practical, high-quality, and personalized precision medicine - targeting disease manifestations of individual patients and broad populations, alike. Aiming to learn from one another across different world regions, the six country vignettes presented here depict both challenges and victories in de novo establishment or improvement of RT and theranostics infrastructure. MethodsThe International Atomic Energy Agency (IAEA) convened global RT and theranostics experts from diverse world regions and contexts to identify relevant challenges and report progress in their own six countries: Belgium, Brazil, Costa Rica, Jordan, Mongolia, and South Africa. These accounts are collated, compared, and contrasted herein. ResultsCommon challenges persist which could be more strategically assessed and addressed. A quantifiable discrepancy entails personnel. The estimated radiation oncologists (ROs), nuclear medicine physicians (NMPs), and medical physicists (MPs for RT and nuclear medicine) per million inhabitants in the six collective countries respectively range between 2.69–38.00 ROs, 1.00–26.00 NMPs, and 0.30–3.45 MPs (Table 1), reflecting country-to-country inequities which largely match World Bank country-income stratifications. ConclusionEstablished goals for RT and nuclear medicine advancement worldwide have proven elusive. The pace of progress could be hastened by enhanced approaches such as more sustainably phased implementation; better multinational networking to share lessons learned; routine quality and safety audits; as well as capacity building employing innovative, resource-sparing, cutting-edge technologic approaches.Bodies such as ministries of health, professional societies, and the IAEA shall serve critical roles in convening and coordinating more innovative RT and theranostics translational research, including expanding nuanced global database metrics to inform, reach, and potentiate milestones most meaningfully. Policy SummaryAligned with WHO 25×25 NCDs target; WHA70.12 and WHA76.5 resolutions.

Physics and small-scale dosimetry of -emitters for targeted radionuclide therapy: The case of .

Monte Carlo simulations have been considered for a long time the gold standard for dose calculations in conventional radiotherapy and are currently being applied for the same purpose in innovative radiotherapy techniques such as targeted radionuclide therapy (TRT). We present in this work a benchmarking study of the latest version of the Transport d'Ions Lourds Dans l'Aqua & Vivo (TILDA-V) Monte Carlo track structure code, highlighting its capabilities for describing the full slowing down of -particles in water and the energy deposited in cells by -emitters in the context ofTRT. We performed radiation transport simulations of -particles (10keV -100MeV ) in water with TILDA-Vand the Particle and Heavy Ion Transport code System (PHITS) version 3.33. We compared the predictions of each code in terms of track parameters (stopping power, range and radial dose profiles) and cellular S-values of the promising radionuclide astatine-211 ( ). Additional comparisons were made with available data in theliterature. The stopping power, range and radial dose profiles of -particles computed with TILDA-Vwere in excellent agreement with other calculations and available data. Overall, minor differences with PHITS were ascribed to phase effects, that is, related to the use of interaction cross sectionscomputed for water vapor or liquid water. However, important discrepancies were observed in the radial dose profiles of monoenergetic -particles, for which PHITS results showed a large underestimation of the absorbed dose compared to other codes and experimental data. The cellular S-values of computed with TILDA-V agreed within 4% with the values predicted by PHITS andMIRDcell. The validation of the TILDA-Vcode presented in this work opens the possibility to use it as an accurate simulation tool for investigating the interaction of -particles in biological media down to the nanometer scale in the context of medical research. The code may help nuclear medicine physicians in their choice of -emitters for TRT. Further research will focus on the application of TILDA-Vfor quantifying radioinduced damage on the deoxyribonucleic acid (DNA) molecule.

KRŪTIES VĖŽIO RADIOTERAPIJA TAIKANT INOVATYVŲ GILAUS KVĖPAVIMO KONTROLĖS METODĄ: KLINIKINIAI VAKARŲ LIETUVOJE SUKAUPTOS PATIRTIES ASPEKTAI

Radiation therapy is an important part of breast cancer treatment, reducing local recurrence and improving overall survival. About 1,500 cases of breast cancer are diagnosed in Lithuania every year. About 30% of all newly diagnosed cancers in women are breast cancer, and about 80% of early-stage breast cancers are treated with radiotherapy. New modern radiation techniques have been evaluated with a better understanding of the effects of radiation on the heart. The article reviews the implementation of the deep inhalation breath hold technique in the clinical practice of Klaipėda University Hospital. The purpose of this article is to analyse the results of the first two years after the implementation of the new methods. Assessing the importance of radiotherapy, the author reveals the importance of the innovative deep breathing method in the article, and shares the experience she has gathered. At the same time, scientific and practical assumptions are made that, after the introduction of innovative radiotherapy technologies into practice, new opportunities for optimising the treatment of patients by individualising it open up. The results of the study reveal the need for a prospective cohort study in order to optimise patient education, clarify selection criteria, and increase the availability of modern radiotherapy services. The presentation of this method in an interdisciplinary environment of social and health care specialists allows specialists to familiarise themselves with the achievements of oncological radiotherapy in west Lithuania.

A prospective registry study of stereotactic magnetic resonance guided radiotherapy (MRgRT) for primary liver tumors

Background and PurposeStereotactic body radiation therapy (SBRT) has demonstrated safe and effective results for primary liver tumors. Magnetic Resonance guided Radiotherapy (MRgRT) is an innovative radiotherapy modality for abdominal tumors. The aim of this study is to report on acute and late toxicities and initial oncological results for primary liver tumors treated with MRgRT. Materials and MethodsWe prospectively included in our cohort all patients treated by MRgRT for a primary liver tumor at the Montpellier Cancer Institute. The primary endpoint was acute and late toxicities assessed according to CTCAE v 5.0. The mean prescribed dose was 50 Gy in 5 fractions. ResultsBetween October 2019 and April 2022, MRgRT treated 56 patients for 72 primary liver lesions. No acute or late toxicities of CTCAE grade greater than 2 attributable to radiotherapy were noted during follow-up. No cases of radiation-induced liver disease (RILD), either classical or non-classical, occurred. After a median follow-up of 13.2 months (95% CI [8.8; 15.7]), overall survival was 85.1% (95% CI: [70.8; 92.7]) at 1 year and 74.2% at 18 months (95% CI [52.6; 87.0]). Local control was 98.1% (95% CI: [87.4; 99.7]) and 94.7% (95% CI: [79.5; 98.7]) at 12 and 18 months, respectively. Among the HCC subgroup, no local recurrences were observed. ConclusionMRgRT for primary liver tumors is safe without severe adverse events and reach excellent local control. Numerous studies are underway to better assess the value of MRI guidance and adaptive process in these indications.

Flash Radiotherapy: Innovative Cancer Treatment

Flash radiotherapy (Flash-RT) is an innovative technique used in radiotherapy for cancer treatment because it delivers an extremely high dose of radiation (>40 Gy/s) to the tumour in a very short period of time, typically within a fraction of a second. This ultra-fast delivery of radiation distinguishes Flash-RT from conventional radiotherapy, which typically involves the delivery of radiation over a longer time period, often several minutes. Studies conducted in cell and preclinical models suggested that Flash-RT may spare normal tissues from radiation-related side effects, such as skin toxicity, gastrointestinal complications, and damage to organs-at-risk. This is believed to be due to the unique normal tissue response to the ultra-high dose rate. Nevertheless, while Flash-RT shows promising results in preclinical and early clinical studies, one should note that the technique is still in the early stages of development. This entry provides a comprehensive exploration of the immense potentials of Flash-RT, covering its background, mechanisms, radiation sources, recent experimental findings based on cell and preclinical models, and future prospects. It aims to provide valuable insights into this innovative radiotherapy technology for anyone interested in the subject.

HYpofractionated, dose-redistributed RAdiotherapy with protons and photons to combat radiation-induced immunosuppression in head and neck squamous cell carcinoma: study protocol of the phase I HYDRA trial

BackgroundRadiotherapy (RT) is the standard of care for most advanced head and neck squamous cell carcinoma (HNSCC) and results in an unfavorable 5-year overall survival of 40%. Despite strong biological rationale, combining RT with immune checkpoint inhibitors does not result in a survival benefit. Our hypothesis is that the combination of these individually effective treatments fails because of radiation-induced immunosuppression and lymphodepletion. By integrating modern radiobiology and innovative radiotherapy concepts, the patient’s immune system could be maximally retained by (1) increasing the dose per fraction so that the total dose and number of fractions can be reduced (HYpofractionation), (2) redistributing the radiation dose towards a higher peak dose within the tumor center and a lowered elective lymphatic field dose (Dose-redistribution), and (3) using RAdiotherapy with protons instead of photons (HYDRA).MethodsThe primary aim of this multicenter study is to determine the safety of HYDRA proton- and photon radiotherapy by conducting two parallel phase I trials. Both HYDRA arms are randomized with the standard of care for longitudinal immune profiling. There will be a specific focus on actionable immune targets and their temporal patterns that can be tested in future hypofractionated immunoradiotherapy trials. The HYDRA dose prescriptions (in 20 fractions) are 40 Gy elective dose and 55 Gy simultaneous integrated boost on the clinical target volume with a 59 Gy focal boost on the tumor center. A total of 100 patients (25 per treatment group) will be recruited, and the final analysis will be performed one year after the last patient has been included.DiscussionIn the context of HNSCC, hypofractionation has historically only been reserved for small tumors out of fear for late normal tissue toxicity. To date, hypofractionated radiotherapy may also be safe for larger tumors, as both the radiation dose and volume can be reduced by the combination of advanced imaging for better target definition, novel accelerated repopulation models and high-precision radiation treatment planning and dose delivery. HYDRA’s expected immune-sparing effect may lead to improved outcomes by allowing for future effective combination treatment with immunotherapy.Trial registrationThe trial is registered at ClinicalTrials.gov; NCT05364411 (registered on May 6th, 2022).

The SINTART 2 Study. A phase II non-randomised controlled trial of induction chemotherapy, photon-, proton- and carbon-ion-based radiotherapy integration in patients with locally advanced unresectable sinonasal tumours

PurposeUnresectable, locally advanced sinonasal epithelial tumours are rare diseases with poor prognosis. Multimodal approach is widely used, although no standard therapy has been established in prospective trials. This study assessed activity and safety of an innovative integration of multimodality treatment—induction chemotherapy (ICT), surgery and radiotherapy (RT)—modulated by histology and response to ICT. MethodsPatients with untreated, unresectable sinonasal epithelial tumours with selected histotypes (squamous cell carcinoma, intestinal-type adenocarcinoma, sinonasal undifferentiated and neuroendocrine carcinoma, olfactory neuroblastoma) were enroled in a single-arm, open-label, phase II, multicentre clinical trial. Patients were treated with up to 5 ICT cycles, whose regimen was selected according to histotype. Photon and/or proton/carbon-ion-based RT was employed according to disease site, stage and ICT response. Primary end-point was 5-years progression-free survival (PFS), secondary end-points were overall survival (OS), ICT objective response rate per RECIST 1.1 and safety. ResultsTwenty-five patients were evaluable for primary end-point. Five-year PFS was 26.8% (95% confidence interval [CI]: 12.6–57.1), with a median PFS of 18 months. Five-year OS was 23.8% (95% CI: 9.5–59.3), with a median OS of 27 months. The overall response rate to ICT was 40%. Three-year PFS for patients achieving major volumetric partial response (mPRv) versus non-mPRv was 40% (95% CI: 13.7–100%) versus 23.1% (95% CI: 8.3–64.7%) (P = 0.318) and 3-year OS was 53.3% (95% CI: 21.4–100%) versus 37.7% (95% CI: 20.0–71.0%) (P = 0.114). ConclusionMultimodal combination of ICT and innovative RT did not provide a significant improvement in survival rates with respect to previous experiences. This finding underscores the need for future research in this rare disease, still characterised by a heavy burden and poor prognosis. We observed longer survival in subjects achieving response to ICT. The overall treatment safety is acceptable.

Comparison of the dosimetric response of two Sr salts irradiated with 60Co γ-rays and synchrotron X-rays at ultra-high dose rate

As part of the development of innovative radiotherapy techniques using X-ray synchrotron sources, namely FLASH-radiotherapy and microbeam radiation therapy (MRT), two rod dosimeters based on strontium sulfate (SrSO4) and strontium carbonate (SrCO3) were developed and irradiated at the ESRF-ID17 Biomedical beamline to investigate new solid-state dosimeters.The radiation-induced defect in Sr-based dosimeters was detected by means of an electron paramagnetic resonance (EPR) spectrometer. For the study, the EPR response of the dosimeters irradiated with synchrotron X-rays in the 30–600 keV range and dose rate of 11.6 kGy/s was compared with the response after irradiation with a 60Co γ-ray source with a dose rate of 0.288 Gy/s.Both Sr dosimeters show an increased intensity of the EPR signal in the case of irradiation at the synchrotron with respect to the case of 60Co γ-ray irradiation. The measured enhancement of the delivered dose is explained by the fact that Sr shows an increased photoelectric interaction at orthovoltage X-ray energies, producing an increased number of free radicals.The experimental relative response rESRF of the EPR signals between samples irradiated at the ID17 beamline and the 60Co beam quality was found to be 9.66 for SrSO4 and 11.19 for SrCO3. Meanwhile, the theoritical relative responses rμen/ρESRF calculated as the ratio of mass energy absorption coefficients (μen/ρ) of the dosimeters to that for water at the ID17 with respect to the 60Co beam was found to be 11.85 for SrSO4 and 13.31 for SrCO3.The increased EPR response of Sr salt dosimeters irradiated with photons in the keV range proved that these detectors type could be a good candidate for the development of very sensible detectors for radiotherapy applications.

PO-1434 Innovative radiotherapy technique for the treatment of in-transit or metastatic lower limb melanoma

PO-1434 Innovative radiotherapy technique for the treatment of in-transit or metastatic lower limb melanoma

Neoadjuvant radiotherapy dose escalation for locally advanced rectal cancers in the new era of radiotherapy: A review of literature.

BACKGROUNDThe standard treatment of locally advanced rectal cancers (LARC) consists on neoadjuvant chemoradiotherapy followed by total mesorectal excision. Different data in literature showed a benefit on tumor downstaging and pathological complete response (pCR) rate using radiotherapy dose escalation, however there is shortage of studies regarding dose escalation using the innovative techniques for LARC (T3-4 or N1-2). AIMTo analyze the role of neoadjuvant radiotherapy dose escalation for LARC using innovative radiotherapy techniques. METHODSIn December 2020, we conducted a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus and Cochrane library. The limit period of research included articles published from January 2009 to December 2020. Screening by title and abstract was carried out to identify only studies using radiation doses equivalent dose 2 Gy fraction (EQD2) ≥ 54 Gy and Volumetric Modulated Arc Therapy (VMAT), intensity-modulated radiotherapy or image-guided radiotherapy (IGRT) techniques. The authors’ searches generated a total of 2287 results and, according to PRISMA Group (2009) screening process, 21 publications fulfil selection criteria and were included for the review. RESULTSThe main radiotherapy technique used consisted in VMAT and IGRT modality. The mainly dose prescription was 55 Gy to high risk volume and 45 Gy as prophylactic volume in 25 fractions given with simultaneous integrated boosts technique (42.85%). The mean pCR was 28.2% with no correlation between dose prescribed and response rates (P value ≥ 0.5). The R0 margins and sphincter preservation rates were 98.88% and 76.03%, respectively. After a mean follow-up of 35 months local control was 92.29%. G3 or higher toxicity was 11.06% with no correlation between dose prescription and toxicities. Patients receiving EQD2 dose > 58.9 Gy and BED > 70.7 Gy had higher surgical complications rates compared to other group (P value = 0.047). CONCLUSIONDose escalation neoadjuvant radiotherapy using innovative techniques is safe for LARC achieving higher rates of pCR. EQD2 doses > 58.9 Gy is associated with higher rate of surgical complications.

Innovative Therapeutic Strategies for Primary CNS Lymphoma

Primary central nervous system (CNS) lymphoma (PCNSL) represents 4% of all CNS malignancies and 4–6% of all extranodal lymphomas. Its low incidence is the main reason why it has been difficult to develop guidelines on the treatment and management of PCNSL patients. The lack of consensus around standard therapy and best diagnostic approach, inevitably, affected the outcome of these patients for many years. Current efforts are focusing on: (1) defining the optimal induction and consolidation therapies in fit and frail patients, (2) establishing when and how to use the new non-cytotoxic agents, (3) investigating innovative radiotherapy to mitigate treatment-related neurotoxicity, (4) limiting delays in diagnosis, and (5) improving response assessment with new biological markers and radiological tools. Finally, the complexity of the management of PCNSL patients compels clinicians to provide timely and efficient social, neuropsychological, and physiotherapy support, which is feasible only when there is effective collaboration between the multiple specialists involved in the care of these patients. In the last decade, thanks to multicenter collaborations, important gains have been made, particularly in the front line therapy and in the biological understanding of this disease. The progressive knowledge on molecular profile of PCNSL has justified the recent use of targeted therapy also in these settings of patients. In this review, we discuss important advances in the management of PCNSL and we highlight unresolved questions that should be addressed in the future.

Radiation Dose-Enhancement Is a Potent Radiotherapeutic Effect of Rare-Earth Composite Nanoscintillators in Preclinical Models of Glioblastoma.

To improve the prognosis of glioblastoma, innovative radiotherapy regimens are required to augment the effect of tolerable radiation doses while sparing surrounding tissues. In this context, nanoscintillators are emerging radiotherapeutics that down‐convert X‐rays into photons with energies ranging from UV to near‐infrared. During radiotherapy, these scintillating properties amplify radiation‐induced damage by UV‐C emission or photodynamic effects. Additionally, nanoscintillators that contain high‐Z elements are likely to induce another, currently unexplored effect: radiation dose‐enhancement. This phenomenon stems from a higher photoelectric absorption of orthovoltage X‐rays by high‐Z elements compared to tissues, resulting in increased production of tissue‐damaging photo‐ and Auger electrons. In this study, Geant4 simulations reveal that rare‐earth composite LaF3:Ce nanoscintillators effectively generate photo‐ and Auger‐electrons upon orthovoltage X‐rays. 3D spatially resolved X‐ray fluorescence microtomography shows that LaF3:Ce highly concentrates in microtumors and enhances radiotherapy in an X‐ray energy‐dependent manner. In an aggressive syngeneic model of orthotopic glioblastoma, intracerebral injection of LaF3:Ce is well tolerated and achieves complete tumor remission in 15% of the subjects receiving monochromatic synchrotron radiotherapy. This study provides unequivocal evidence for radiation dose‐enhancement by nanoscintillators, eliciting a prominent radiotherapeutic effect. Altogether, nanoscintillators have invaluable properties for enhancing the focal damage of radiotherapy in glioblastoma and other radioresistant cancers.

The financial impact of SBRT for oligometastatic disease: A population-level analysis in Belgium

IntroductionThere is a steady rise in Stereotactic Body RadioTherapy (SBRT) utilization in oligometastatic disease (OMD). This may generate important financial consequences for radiotherapy budgets. The National Institute for Health and Disability Insurance of Belgium (NIHDI) initiated a coverage with evidence development (CED) project for innovative radiotherapy, including SBRT, in 2011. A cost calculation and budget estimation for SBRT in the OMD setting was carried out. Materials and methodsPredictive growth scenarios for future uptake of SBRT for OMD in Belgium were developed using demographics and CED data. The provider cost of SBRT for OMD in Belgium was calculated using the Time-Driven Activity-Based Costing (TD-ABC) model developed by ESTRO-HERO, alimented with national data on resources, treatments and operational parameters, and compared to the new reimbursement. Combining these, the future financial impact of this novel treatment indication for healthcare providers and payers in Belgium was evaluated. ResultsThe number of 428 OMDs treated with SBRT in Belgium in 2017 is expected to increase between 484 and 2073 courses annually by 2025. A provider cost of €4360 per SBRT was calculated (range: €3488–€5654), whereas the reimbursement covers between €4139 and €4654. Large variations in potential extra provider costs by 2025 ensue from the different scenarios, ranging between €1,765,993 and €9,038,754. Provider costs and reimbursement show good agreement. ConclusionAlthough the financial impact of SBRT for OMD in Belgium is forecasted to remain acceptable, even in extreme scenarios, further clinical trials and real-life clinical and financial monitoring with prospective data gathering are necessary to refine the data.

An unusual case of nasopharyngial adenoid cystic carcinoma with intracranial and orbital extension: a challenge for innovative conformal radiotherapy techniques

An unusual case of nasopharyngial adenoid cystic carcinoma with intracranial and orbital extension: a challenge for innovative conformal radiotherapy techniques

Dosimetric Comparison: Intensity Modulated Radiation Therapy Vs. 3D Conformal Radiotherapy in Prostate Cancer Radical Treatment

Abstract 3D - Conformal Radiotherapy (3DCRT) for decades was a standard technique in the prostate cancer radical radiotherapy treatment. Technological advances and implementation of an innovative radiotherapy technique-Intensity Modulated Radiation Therapy (IMRT), enable even more precise treatment of the prostate cancer patients. Intensity Modulated Radiation Therapy (IMRT) is a technological advancement in Conformal Radiotherapy which allows superior conformity and homogeneity of the absorbed dose in planning target volume with maximal sparing organs of risk. This technique gives us possibility to escalate the radiotherapy dose, prerequisite for the adequate local tumor control. Evaluation of dosimetric parameters 3DCRT vs. IMRT: the homogeneity index, the conformity index, parameters of absorbed dose in planning target volume, dose volume constraints for organs of risk shows that IMRT is an optimal technique in the prostate cancer radical treatment.

National costs and resource requirements of external beam radiotherapy: A time-driven activity-based costing model from the ESTRO-HERO project

BackgroundThe Health Economics in Radiation Oncology (ESTRO-HERO) project aims to provide a knowledge base for health economics in European radiotherapy. A cost-accounting model, providing data on national resource requirements and costs of external beam radiotherapy (EBRT), was developed. Materials and methodsTime-driven activity-based costing (TD-ABC) was applied from the healthcare provider perspective at national level. TD-ABC allocates resource costs to treatment courses through the activities performed, based on time estimates. ResultsThe model is structured in three layers. The central layer, EBRT-Core, accounts for EBRT care-pathway activities and follows TD-ABC allocation principles. Activities supporting radiation oncology (RO) (RO-Support) and multidisciplinary oncology (Beyond-EBRT) follow standard allocation principles.To demonstrate the model’s capabilities, a dataset was constructed for the hypothetical country Europalia, based on published evidence on resources and treatments, whereas time estimates were expert opinions. Applying the TD-ABC model to this example, treatment delivery activities represent 68.4% of the costs; treatment preparation 31.6%. The cost per course shows large variation for different indications, techniques, and fractionation schedules, ranging between €838 and €7193. Resource utilization was estimated to be within the available capacity. Scenario analyses on changes in fractionation and treatment complexity are presented.The ESTRO-HERO TD-ABC tool can model EBRT costs and resource requirements. While the Europalia example illustrates its potential, the results cannot be generalized nor used as a proxy for national evidence. Only real-world data, tailored to the specificities of individual countries, will support National Radiation Oncology Societies with investment planning and access to innovative radiotherapy.