Radiotherapy Patients Research Articles

Stability of dosiomic features against variations in dose calculation: An analysis based on a cohort of prostate external beam radiotherapy patients.

Interest in using higher order features of the planned 3D dose distributions (i.e., dosiomics) to predict radiotherapy outcomes is growing. This is driving many retrospective studies where historical data are mined to train machine learning models; however, recent decades have seen considerable advances in dose calculation that could have a direct impact on the dosiomic features such studies seek to extract. Is it necessary to recalculate planned dose distributions using a common algorithm if retrospective datasets from different institutions are included? Does a change in dose calculation grid size part way through a retrospective cohort, introduce bias in the extracted dosiomic features? The purpose of this study is to assess the stability of dosiomic features against variations in three factors: the dose calculation algorithm type, version, and dose grid size. Dose distributions for 27 prostate patients who received EBRT were recalculated in the Eclipse Treatment Planning System (Varian Medical Systems, Palo Alto, California, USA) using two algorithms (AAA and Acuros XB), two versions (version 13.6 and 15.6), and three dose grids (2, 2.5s, and 3mm) - 12 dose distributions for each patient. Ninety-three dosiomic features were extracted from each dose distribution and each of the following regions-of-interest: high dose PTV (PTV_High), 1cm rind around PTV_High (PTV_Ring), low dose PTV (PTV_Low), rectum, and bladder using PyRadiomics. The coefficient of variation (CV) was calculated for each dosiomic feature. Hierarchical clustering was used to group features with high and low variability. Three-way repeated measures ANOVA was performed to investigate the effect of the three different factors on dosiomic features that were classified with high variation. Additionally, CVs were calculated for cumulative dose volume histograms (DVHs) to test their ability to detect the variations in dose distributions. For PTV_Ring, PTV_Low, and rectum, all the dosiomic features had low CV (average CV ≤ 0.26) across the varying dose calculation conditions. For PTV_High, six dosiomic features showed CV>0.26, and dose calculation algorithm type and grid size were the major sources of within-patient variation. For bladder, one dosiomic feature had average CV>0.26, but none of the three dose calculation-related factors led to a statistically significant variation. The CVs for all the DVHs were very small (CV<0.05). For all the regions-of-interest examined in this study, the majority of the dosiomic features were stable against variations in dose calculation; however, some of the dosiomic features for PTV_High and bladder had significant variations due to differences in dose calculation details. DVHs were detecting less variation than dosiomic features.

Anatomical variations between sciatic nerve and piriformis muscle on computed tomography images from radiotherapy patients

Anatomical variations between sciatic nerve and piriformis muscle on computed tomography images from radiotherapy patients

PD-L1 expression and prognosis in definitive radiotherapy patients with neuroendocrine cervical carcinoma

PD-L1 expression and prognosis in definitive radiotherapy patients with neuroendocrine cervical carcinoma

Study on the application of 3D printing head film fixation technology in cranial radiotherapy.

Objective: To investigate the use of 3D printing technology to customize individualized precise radiotherapy head masks for cranial radiotherapy patients. Through the comparison with thermoplastic head film, evaluate the effect of this material on deep dose attenuation and body surface dose, and evaluate its positioning accuracy and repeatability for clinical application. Methods: Thirty patients with head and neck radiotherapy were divided into the control group and the experimental group. The control group used the traditional thermoplastic head film fixation technique for body position fixation, and the experimental group used the 3D printing head film fixation technique. The patient setup was verified by kV-CBCT scanning to obtain the translational setup error and rotational setup error in the X, Y, and Z directions. Results: At a depth of 5 cm, both materials have a radiation attenuation rate of <1%. At the surface location, the body surface dose of control group increased by approximately 27%. With a 3D printing head film, the body surface dose increased by approximately 18%. The positioning of two groups of patients was verified by the kV-CBCT, and a total of 232 data sets were obtained. The average translation positioning errors in the X, Y, and Z direction of control group and experimental group were 1.29 mm, 1.42 mm, 1.38 mm and 1.16 mm, 1.24 mm, 1.16 mm, respectively. The average rotation positioning error in the X, Y, and Z direction of control group and experimental group were 1.29°, 1.02°, 1.01° and 1.08°, 0.96°, 1.00°, respectively. The translational setup errors in the Y and Z directions and rotational setup errors in the X direction significantly differed between the control and experimental groups (all p<0.05), but no statistical significance was found in the other directions (all p>0. 05). Conclusion: Compared to the traditional thermoplastic head membranes, 3D printing head membranes has shown a reliable and reproducible interactional positioning accuracy. Of course, further investigations are needed before the new technology can be used on a regular basis.

Classification of IHC Images of NATs With ResNet-FRP-LSTM for Predicting Survival Rates of Rectal Cancer Patients

Over a decade, tissues dissected adjacent to primary tumors have been considered "normal" or healthy samples (NATs). However, NATs have recently been discovered to be distinct from both tumorous and normal tissues. The ability to predict the survival rate of cancer patients using NATs can open a new door to selecting optimal treatments for cancer and discovering biomarkers. This paper introduces an artificial intelligence (AI) approach that uses NATs for predicting the 5-year survival of pre-operative radiotherapy patients with rectal cancer. The new approach combines pre-trained deep learning, nonlinear dynamics, and long short-term memory to classify immunohistochemical images of RhoB protein expression on NATs. Ten-fold cross-validation results show 88% accuracy of prediction obtained from the new approach, which is also higher than those provided from baseline methods. Preliminary results not only add objective evidence to recent findings of NATs' molecular characteristics using state-of-the-art AI methods, but also contribute to the discovery of RhoB expression on NATs in rectal-cancer patients. The ability to predict the survival rate of cancer patients is extremely important for clinical decision-making. The proposed AI tool is promising for assisting oncologists in their treatments of rectal cancer patients.

Nomogram to Predict Long-Term Overall Survival and Cancer-Specific Survival of Radiotherapy Patients with Nasopharyngeal Carcinoma.

To establish and validate a nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) in patients with nasopharyngeal carcinoma (NPC) receiving radiotherapy by integrating multiple independent prognostic factors. Data from 5663 patients with NPC who received definite radiotherapy between 2004 and 2018 were included and divided into training and validation cohorts. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors of patients with NPC after radiotherapy. Thereafter, the predictive accuracy of the nomogram model was evaluated. Age, race, marital status, pathological type, tumor size, T stage, N stage, M stage, American Joint Committee on Cancer stage, and chemotherapy were independent factors affecting the prognosis of patients with NPC receiving radiotherapy. Nomograms with a concordance index of 0.726 (95% confidence interval (CI): 0.675-0.777) and 0.732 (95% CI: 0.680-0.785) were able to predict OS and CSS, respectively. The area under the curve showed excellent predictive performance. Additionally, the calibration curve indicated that the predicted survival rate was consistent with the actual survival rate, and the decision curve indicated its clinical value. The established risk stratification system was able to accurately stratify patients receiving radiotherapy for NPC into three risk subgroups with significant differences in prognosis (P < 0.05). The constructed nomogram had good prognostic performance and could be used as an effective tool to evaluate the prognosis of patients with NPC after radiotherapy. This nomogram could be further used to guide clinical decisions and personalized treatment plans.

Survival and quality of life analysis in glioblastoma multiforme with adjuvant chemoradiotherapy: a retrospective study.

Glioblastoma multiforme (GBM) is the most common and aggressive primary intracranial tumor. Despite modern therapies, it is still fatal with tremendously poor prognosis with a median survival of 14 months. Even though mean survival and progression-free survival (PFS) are considered as primary response measure, it is important to assess the effects of therapies on disease burden and health-related quality of life (HRQoL). Changes in quality of life (QoL) indicates the impact of cytotoxic therapy and may aid in defining response in the absence of quantifiable endpoints like tumor regression. The objective was to assess 2-year survival and quality of life in GBM patients who underwent primary surgery followed by chemo-radiotherapy and 6-month adjuvant chemotherapy with temozolomide. Single-institution retrospective study of 60 patients of GBM from 2015 to 2017. Data regarding patient factors, disease factors, and treatment factors were collected and survival was calculated. 60 patients with GBM were analyzed, male to female ratio was 1.6:1. Patients most commonly presented with headache. Most common tumour site is the frontal lobe. The median overall survival (OS) was 10 months. The 1-year and 2-year survival rates were 30% and 6.7%, respectively. Compared to before surgery patients have showed improved emotional, social and role functioning in Post radiotherapy period. There was a decrease in symptoms like pain, headache and seizures. OS and QoL in GBM patients remains poor despite constant research and studies. Maximum safe resection followed by adjuvant temozolomide has shown improvement in OS. Post-surgery and adjuvant radiotherapy patients have shown a decrease in symptoms and better QoL.

Feasibility and safety of neck level IB-sparing radiotherapy in nasopharyngeal cancer: a long-term single institution analysis.

Nasopharyngeal cancer (NPC) has a higher prevalence of regional nodal metastasis than other head and neck cancers; however, level IB lymph node involvement is rare. We evaluated the safety and feasibility of level IB-sparing radiotherapy (RT) for NPC patients. We retrospectively reviewed 236 patients with NPC who underwent definitive intensity-modulated RT with or without chemotherapy between 2004 and 2018. Of them, 212 received IB-sparing RT, and 24 received non-IB-sparing RT. We conducted a propensity score matching analysis to compare treatment outcomes according to IB-sparing status. In addition, dosimetric analysis of the salivary glands was performed to identify the relationship between xerostomia and the IB-sparing RT. The median follow-up duration was 78 months (range, 7 to 194 months). Local, regional, and distant recurrences were observed in 11.9%, 6.8%, and 16.1% of patients, respectively. Of the 16 patients with regional recurrence, 14 underwent IB-sparing RT. The most common site categorization of regional recurrence was level II (75%), followed by retropharyngeal lymph nodes (43.8%); however, there was no recurrence at level IB. In the matched cohorts, IB-sparing RT was not significantly related to treatment outcomes. However, IB-sparing RT patients received a significantly lower mean ipsilateral and contralateral submandibular glands doses (all, p < 0.001) and had a lower incidence of chronic xerostomia compared with non-IB-sparing RT patients (p = 0.006). Our results demonstrated that IB-sparing RT is sufficiently safe and feasible for treating NPC. To reduce the occurrence of xerostomia, IB-sparing RT should be considered without compromising target coverage.

Lung-Heart Outcomes and Mortality through the 2020 COVID-19 Pandemic in a Prospective Cohort of Breast Cancer Radiotherapy Patients.

We investigated lung-heart toxicity and mortality in 123 women with stage I-II breast cancer enrolled in 2007-2011 in a prospective trial of adjuvant radiotherapy (TomoBreast). We were concerned whether the COVID-19 pandemic affected the outcomes. All patients were analyzed as a single cohort. Lung-heart status was reverse-scored as freedom from adverse-events (fAE) on a 1-5 scale. Left ventricular ejection fraction (LVEF) and pulmonary function tests were untransformed. Statistical analyses applied least-square regression to calendar-year aggregated data. The significance of outliers was determined using the Dixon and the Grubbs corrected tests. At 12.0 years median follow-up, 103 patients remained alive; 10-years overall survival was 87.8%. In 2007-2019, 15 patients died, of whom 11 were cancer-related deaths. In 2020, five patients died, none of whom from cancer. fAE and lung-heart function declined gradually over a decade through 2019, but deteriorated markedly in 2020: fAE dipped significantly from 4.6-4.6 to 4.3-4.2; LVEF dipped to 58.4% versus the expected 60.3% (PDixon = 0.021, PGrubbs = 0.054); forced vital capacity dipped to 2.4 L vs. 2.6 L (PDixon = 0.043, PGrubbs = 0.181); carbon-monoxide diffusing capacity dipped to 12.6 mL/min/mmHg vs. 15.2 (PDixon = 0.008, PGrubbs = 0.006). In conclusion, excess non-cancer mortality was observed in 2020. Deaths in that year totaled one-third of the deaths in the previous decade, and revealed observable lung-heart deterioration.

COVID19-induced immunosuppression and aggressive progression of primary cranial vault lymphoma presenting as a management challenge, a case report, and a literature review

BackgroundWe needs to study Primary Large cell Non-Hodgkin’s Lymphoma of the cranial vault, which is rare, and its association with COVID19 has not been reported, which may have an immunosuppressive effect to aggravate its progression.Patient detailsOur patient, a 53-year-old male, noticed fast growth of posterior cranial vault lesion from 2 to 10 cm size in last 6 months after COVID 19 affliction. MRI brain with contrast revealed lesions suggesting meningioma. The whole-body PET scan was normal. Following Subtotal excision of the mass, histopathology revealed large B-cell Non-Hodgkin’s lymphoma (DLBCL). Immunohistochemistry showed positive results for CD10, CD20, CD45 (LCA), ALK, and BCL-VE with a Ki-67 index of 90–95%. Following radiotherapy and chemotherapy patient is disease-free on imaging and doing well at 5 months of follow-up.ConclusionsEarly intervention with excisional biopsy and timely chemo and radiotherapy in favorable immunostaining may add survival benefits even in malignant features induced by immunosuppressing diseases such as COVID19 in diffuse large B-cell lymphoma (DLBCL) of the scalp.

Inflammatory Cytokines and Radiotherapy in Pancreatic Ductal Adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) remains a therapeutic challenge in clinical oncology. Surgery is the only potentially curative treatment. However, the majority of PDAC patients present with locally advanced/unresectable or metastatic disease, where palliative multiagent chemotherapy is the first-line treatment with the therapeutic intent to delay progression and prolong survival. For locally advanced/unresectable pancreatic cancer patients who are treated with chemotherapy, consolidative radiotherapy in the form concurrent chemoradiation or stereotactic ablative radiotherapy improves locoregional control and pain/symptom control. To improve clinical outcomes of PDAC patients, there is a dire need for discoveries that will shed more light on the pathophysiology of the disease and lead to the development of more efficacious treatment strategies. Inflammatory cytokines are known to play a role in mediating tumor progression, chemoresistance, and radioresistance in PDAC. A PubMed search on published articles related to radiotherapy, inflammatory cytokines, and pancreatic cancer patients in the English language was performed. This article primarily focuses on reviewing the clinical literature that examines the association of inflammatory cytokines with clinical outcomes and the effects of radiotherapy on inflammatory cytokines in PDAC patients.

The Impact of COVID-19 on Radiotherapy Services in Scotland, UK: A Population-based Study

AimsThe effect of the COVID-19 pandemic on cancer radiotherapy services is largely unknown. The aim of the present study was to investigate the impact of the resultant contingency plans on radiotherapy cancer services in Scotland. Materials and methodsDetailed data of radiotherapy activity at our centre were collected from 1 April 2019 to 31 March 2021. Differences in mean weekly radiotherapy courses, dose and fractionation patterns and treatment intent were compared with corresponding pre-pandemic months for all treatment sites. Qualitative data were collected for a subgroup of radical radiotherapy patients. ResultsTotal radiotherapy courses decreased from 6968 to 6240 (–10%) compared with the previous year, prior to the pandemic. Average weekly radiotherapy courses delivered were 134 (standard deviation ±13), decreasing by 10% to 120 (standard deviation 15) (Welch's t-test, P < 0.001). The greatest decrease in new start treatment courses was observed from May to August 2020 (–7.7%, –24.0%, –16.7% and –18.7%) compared with the corresponding months in 2019. A significant reduction was seen for female patients <70 years (–16%) compared with females >70 years (–8%) or their male counterparts (–7% and –6%, respectively). By diagnosis, the largest reductions between pre- and post-pandemic levels were for anal (–26%), breast (–18%) and prostate (–14%) cancer. Contrarily, a significant increase was found for bladder (28%) and oesophageal (11%) cancers. ConclusionsOver the first 12 months of the COVID-19 pandemic, radiotherapy activity significantly decreased compared with the 12 months prior. Due to issued guidance, the use of hypofractionated regimens increased, contributing to the reduction in treatments for some tumour sites. An increase in other tumour sites can probably be attributed to the reduction or cancellation of surgical interventions. These results will inform our understanding of the indirect consequences of the pandemic on radiotherapy services.

Good clinical practice and the use of hypofractionation radiation schedules as weapons to reduce the risk of COVID-19 infections in radiation oncology unit: A mono-institutional experience.

After coronavirus disease outbreak emerged in 2019, radiotherapy departments had to adapt quickly their health system and establish new organizations and priorities. The purpose of this work is to report our experience in dealing with COVID-19 emergency, how we have reorganized our clinical activity, changed our priorities, and stressed the use of hypofractionation in the treatment of oncological diseases. The patients' circuit of first medical examinations and follow-up was reorganized; a more extensive use of hypofractionated schedules was applied; a daily triage of the patients and staff, use of personal protective equipment, hand washing, environment sanitization, social distancing and limitations for the patients' caregivers in the department, unless absolutely essential, were performed; patients with suspected or confirmed COVID-19 were treated at the end of the day. In addition, the total number of radiotherapy treatment courses, patients and sessions, in the period from February 15 to April 30, 2020, comparing the same time period in 2018 were retrospectively investigated. In particular, changes in hypofractionated schedules adopted for the treatment of breast and prostate cancer and palliative bone metastasis were analyzed. Between February 15, and April 30, 2020, an increased number of treatments was carried out: Patients treated were overall 299 compared to 284 of the same period of 2018. Stressing the use of hypofractionation, 2036 RT sessions were performed, with a mean number of fractions per course of 6.8, compared to 3566 and 12.6, respectively, in 2018. For breast cancer, the schedule in 18 fractions has been abandoned and treatment course of 13 fractions has been introduced; a 27% reduction in the use of 40.5 Gy in 15 fractions, (67 treatments in 2018-49 in 2020) was reported. An increase of 13% of stereotactic body radiation therapy for prostate cancer was showed. The use of the 20 Gy in 4 or 5 sessions for the treatment of symptomatic bone metastasis decreased of 17.5% in favor of 8 Gy-single fraction. Three patients results COVID-19 positive swab: 1 during, 2 after treatment. Only one staff member developed an asymptomatic infection. The careful application of triage, anti-contagion and protective measures, a more extensive use of hypofractionation allowed us to maintain an effective and continuous RT service with no delayed/deferred treatment as evidenced by the very low number of patients developing COVID-19 infection during or in the short period after radiotherapy. Our experience has shown how the reorganization of the ward priority, the identification of risk factors with the relative containment measures can guarantee the care of oncological patients, who are potentially at greater risk of contracting the infection.

Clinical application of a template-guided automated planning routine.

Determine the dosimetric quality and the planning time reduction when utilizing a template-based automated planning application. A software application integrated through the treatment planning system application programing interface, QuickPlan, was developed to facilitate automated planning using configurable templates for contouring, knowledge-based planning structure matching, field design, and algorithm settings. Validations are performed at various levels of the planning procedure and assist in the evaluation of readiness of the CT image, structure set, and plan layout for automated planning. QuickPlan is evaluated dosimetrically against 22 hippocampal-avoidance whole brain radiotherapy patients. The required times to treatment plan generation are compared for the validations set as well as 10 prospective patients whose plans have been automated by QuickPlan. The generations of 22 automated treatment plans are compared against a manual replanning using an identical process, resulting in dosimetric differences of minor clinical significance. The target dose to 2% volume and homogeneity index result in significantly decreased values for automated plans, whereas other dose metric evaluations are nonsignificant. The time to generate the treatment plans is reduced for all automated plans with a median difference of 9' 50″±4' 33″. Template-based automated planning allows for reduced treatment planning time with consistent optimization structure creation, treatment field creation, plan optimization, and dose calculation with similar dosimetric quality. This process has potential expansion to numerous disease sites.

Assessment of Dimensional Changes in Submandibular Glands in Head-Neck Radiotherapy Patients by Ultrasonography.

The present study investigated the dimensional changes in the submandibular glands following radiotherapy using ultrasonography. Twenty-three patients planned to receive head-neck radiotherapy were included in this study. The anteroposterior, superoinferior, mediolateral length, and volumes of 46 submandibular glands were measured by ultrasonography at 3 different time periods (before radiotherapy and in the second and sixth months after the radiotherapy onset) and evaluated in terms of dimensional changes and the effect of the radiation dose on these changes. The data were statistically analyzed using repeated measures analysis of variance (ANOVA) and 2-factor repeated measures ANOVA. Before radiotherapy and in the second and sixth months after the radiotherapy onset, mean anteroposterior length of the submandibular glands was 32.39 ± 4.55, 30.38 ± 4.80, and 31.50 ± 3.68 mm, respectively; mean superoinferior length was 9.96 ± 1.54, 8.76 ± 1.26, and 9.08 ± 1.01 mm, respectively; mean mediolateral length was 24.66 ± 3.77, 22.03 ± 3.73, and 21.76 ± 4.01 mm, respectively; and mean volume was 4.21 ± 1.01, 3.08 ± 0.77, and 3.32 ± 0.63 cm3 , respectively. Moreover, there were significant differences in the anteroposterior (P < .01), superoinferior (P < .001), and mediolateral lengths (P < .001), as well as the volumes (P < .001) of the submandibular glands measured at the 3 different time periods. In the second and sixth months after the radiotherapy onset, the sizes of the submandibular glands were markedly reduced, but it partially recovered to normal as more time elapsed after radiotherapy.

Head and neck radiotherapy quality assurance conference for dedicated review of delineated targets and organs at risk: results of a prospective study.

Head and neck (HN) radiotherapy (RT) is complex, involving multiple target and organ at risk (OAR) structures delineated by the radiation oncologist. Site-agnostic peer review after RT plan completion is often inadequate for thorough review of these structures. In-depth review of RT contours is critical to maintain high-quality RT and optimal patient outcomes. In August 2020, the HN RT Quality Assurance Conference, a weekly teleconference that included at least one radiation oncology HN specialist, was activated at our institution. Targets and OARs were reviewed in detail prior to RT plan creation. A parallel implementation study recorded patient factors and outcomes of these reviews. A major change was any modification to the high-dose planning target volume (PTV) or the prescription dose/fractionation; a minor change was modification to the intermediate-dose PTV, low-dose PTV, or any OAR. We analysed the results of consecutive RT contour review in the first 20 months since its initiation. A total of 208 patients treated by 8 providers were reviewed: 86·5% from the primary tertiary care hospital and 13·5% from regional practices. A major change was recommended in 14·4% and implemented in 25 of 30 cases (83·3%). A minor change was recommended in 17·3% and implemented in 32 of 36 cases (88·9%). A survey of participants found that all (n = 11) strongly agreed or agreed that the conference was useful. Dedicated review of RT targets/OARs with a HN subspecialist is associated with substantial rates of suggested and implemented modifications to the contours.

Prediction of Radiation Therapy Dose for Lung Cancer IMRT Technique using Support Vector Regression Model

Optimal dose distribution in the treatment planning system (TPS) is crucial before being applied to radiotherapy patients. However, TPS still uses optimization methods that are time-consuming and user-dependent. This study aimed to evaluate the automatic dose prediction model, support vector regression (SVR), and compare it with the clinically planned dose of lung cancer patients. Sixty patients treated with intensity-modulated radiation therapy (IMRT) were used as the objects in this study. The target dose distribution was evaluated based on the conformity index (CI), and dose homogeneity was evaluated with the homogeneity index (HI). In contrast, the mean and maximum doses were used to evaluate organs at risk (right lung, left lung, heart, and spinal cord). Statistical analysis was performed using the Wilcoxon test. A value of <0.05 indicates a significant difference between the two datasets. The mean CI of the SVR and clinical are 1.154±0.003 and 1.181±0.136. The mean HI for SVR and clinical was 0.075±0.016 and 0.083±0.030. the Wilcoxon test showed no statistically significant difference between the two results. The maximum cardiac dose showed a statistically significant difference (p=0.042), while the mean dose and maximum dose of other OARs did not show a statistically significant difference. The study showed no significant difference between the two strategies, except for the maximum heart dose. The model provides information about dose distribution that can be applied clinically to determine the best technique to use in patients.

Mexican radiationdermatitis management consensus.

Radiotherapy (RT) is an essential element in cancer treatment: 50-70% of cancer patients receive RT at some time of the course of their disease. Of these, almost 95% experience some grade of radiation dermatitis (RD). RD can affect patient's quality of life during and after treatment. Consequently, the management of RD is important. There are few randomized controlled clinical trials on interventions used to prevent and treat RD and no standardized consensus on RD management. A panel of opinion leaders of the Mexican Society of Radiotherapy (SOMERA) took part in a study of oncologic practice in Mexico. The following clinical guide is referenced both by the national practice reality and international evidence. This RD management guide is based on input provided by 25 Mexican radiation oncologists, whose criteria were gathered using the Delphi Method and article review. Twenty-one questions about experience in RD treatment were voted. More than 80% of the panel agreed with: the use of dermocosmetics/medical device in prevention and in treatment of RD grades 1-2. As for grade 3, they recommend individualizing each case and dermatologist evaluation. Topical steroids should be used when there is skin itching or pain. Consider the use of natural soaking elements. Skin care must be continued to avoid or reduce severity of late radiation skin lesions. This consensus was developed as a supportive educational tool that can be adapted to individual clinical needs, useful for professionals involved in the treatment of RT patients.

Results from the AAPM Task Group 324 respiratory motion management in radiation oncology survey.

To quantify the clinical practice of respiratory motion management in radiation oncology. A respiratory motion management survey was designed and conducted based on clinician survey guidelines. The survey was administered to American Association of Physicists in Medicine (AAPM) members on 17 August 2020 and closed on 13 September 2020. A total of 527 respondents completed the entire survey and 651 respondents completed part of the survey, with the partially completed surveys included in the analysis. Overall, 84% of survey respondents used deep inspiration breath hold for left-sided breast cancer. Overall, 83% of respondents perceived respiratory motion management for thoracic and abdominal cancer radiotherapy patients to be either very important or required. Overall, 95% of respondents used respiratory motion management for thoracic and abdominal sites, with 36% of respondents using respiratory motion management for at least 90% of thoracic and abdominal patients. The majority (60%) of respondents used the internal target volume method to treat thoracic and abdominal cancer patients, with 25% using breath hold or abdominal compression and 13% using gating or tracking. A respiratory motion management survey has been completed by AAPM members. Respiratory motion management is generally considered very important or required and is widely used for breast, thoracic, and abdominal cancer treatments.

Comparison of surgery with or without adjuvant radiotherapy in treating central neurocytoma: a single-center retrospective real-world study.

To investigate the efficacy and safety of adjuvant radiotherapy (RT) in patients with central neurocytoma (CN). The study included 68 patients with CN retrospectively, wasfurther divided into surgery + RT group (31 patients) and surgery alone group (37 patients). Progression-free survival (PFS), overall survival (OS), and adverse reactions (AEs) were compared between the two groups. The median follow-up duration was 82.2 (interquartile range, 64.7-104.5) months. Patients in the surgery + RT group tended to have longer PFS than those in the surgery alone group (5-year PFS rate: 92.7% vs. 86.3%; P = 0.074). There was no significant difference in OS between the two groups (5-year OS rate: 96.8% vs. 94.3%; P = 0.639). Subgroup analysis revealed a significant improvement in PFS in patients receiving RT after surgery in patients who underwent subtotal resection (STR) (P = 0.045). In the overall population, univariate multivariate analysis revealed that gross total resection (GTR) (P = 0.002), tumor location in the unilateral ventricle (P = 0.008), and MIB-1 (Ki-67)labeling index (LI) < 5% (P = 0.009) were favorable independent prognostic factors for PFS. Whereas tumor location in the unilateral ventricle (P = 0.043) was a favorable independent prognostic factor for OS. Moreover, RT patients experienced AEs (Grade 1-2, well-tolerated). Adjuvant RT in the treatment of CNs showed satisfactory safety, and postoperative RT could improve PFS in STR patients. Furthermore, GTR, tumor development in the unilateral ventricle, and MIB-1LI < 5% were found to be favorable factors affecting the prognosis of CNs.