Patients Undergoing Radiation Therapy Research Articles

Can Oral Traditional Chinese Medicine Be a New Option for Improving Acute Radiation Dermatitis? A Case Report of a Breast Cancer Patient

Abstract Over 90% of cancer patients undergoing radiation therapy suffer from the distressing effects of acute radiation dermatitis (ARD), with breast cancer patients being particularly affected. Although there are conventional preventive, care, and treatment plans for ARD, there is still a need for improvement. The efficacy of oral application of traditional Chinese medicine (TCM) in treating ARD is rarely discussed in existing medical literature. Here, we report the case of an 86-year-old female with invasive ductal carcinoma of the left breast, who developed ARD 2 weeks after undergoing radiation therapy following surgery. Despite the use of conventional medications orally and topically, symptoms showed no significant improvement. After 2 months of oral TCM, the symptoms improved from Grade II to normal. This clinical case provides a new perspective that oral TCM can also improve ARD.

Efficacy and Safety of Hyperbaric Oxygen Therapy for Radiation-Induced Hemorrhagic Cystitis: A Systematic Review and Meta-Analysis.

Background: Radiation-induced hemorrhagic cystitis (RHC) is a chronic inflammatory disease in patients undergoing radiation therapy that causes a cluster of symptoms which may have a latent period of months to years. The current non-invasive treatments include drug treatment and hyperbaric oxygen therapy (HBOT), which has been widely applied for RHC so far but with limited evidence. Thus, we conducted a systematic review and meta-analysis to clarify the effects and safety of HBOT for RHC. Methods: A systematic review and meta-analysis were utilized, searching in the databases of Embase, Pubmed, and Web of Science. The primary endpoint of the present study was complete remission of hematuria. The meta-analysis was conducted using a random effects model, and a pooled odds ratio with 95% CI was calculated. Results: A total of 317 studies were searched and fourteen articles with 556 patients were collected. The results showed that a total of 500 patients (89.9%) had symptom improvement, and the pooled results demonstrated that 55% of patients with HBOT had complete remission of hematuria (95% CI 51-59%). Conclusions: A significant improvement of symptoms when treated with HBOT was shown in this meta-analysis for patients with RHC.

Therapy-Associated Saliva and Taste change Evaluation (TASTE) in head & neck cancer patients undergoing radiotherapy: a study protocol

BackgroundOne of the main side effects of radiation therapy to the head and neck region is altered taste sensation. This causes significant morbidity and has profound effects on the quality of life (QoL) of patients. While radiation-associated toxicities like xerostomia and dysphagia are part of large investigations, data on taste impairment is sparse. Small cohort sizes in the majority of studies and a variety of analysis methods limit our current understanding of the underlying processes. None of the studies published to date used a taste-specific QoL questionnaire with differentiation of the different taste qualities (e.g. sour, bitter). Furthermore, data regarding the correlation of taste impairment with radiation-associated change in saliva composition is currently not available. The aim of the TASTE study is to fill this gap. Based on the acquired data, a normal tissue complication probability (NTCP) model for late radiation-associated taste impairment will be developed.MethodsIn this prospective, observational multicenter study 150 head and neck cancer patients undergoing radiation therapy will be recruited and undergo repetitive (semi-) objective and subjective assessment of their taste, smell and salivary function (questionnaires, taste and smell assessment, saliva analysis). Primary endpoint will be patient-reported taste impairment 12 months post radiation therapy using a standardized questionnaire. Secondary endpoints will include taste impairment measured using taste strips at 12 months and 2 years post radiation therapy. Differences between subgroups (radiation side, chemotherapy, etc.) and changes over time will be assessed while adjusting for confounding factors (e.g. age, sex, smoking history).DiscussionThis study sets out to further our understanding of taste impairment in patients undergoing radiation therapy to the head and neck region with the goal to prevent this common side effect in future patients. The results of the study may be used to evaluate taste-preserving radiotherapy for patients with head and neck cancer, which may significantly reduce the long-term burden in this patient cohort.

Treatment Terminations During Radiation Therapy: A 10-Year Experience

Patients undergoing radiation therapy may terminate treatment for any number of reasons. The incidence of treatment termination (TT) during radiation therapy has not been studied. Herein we present a cohort of TT at a large multi-center radiation oncology department over 10 years. TTs between 1/2013 and 1/2023 were prospectively analyzed as part of an ongoing departmental quality and safety program. TT was defined as any premature discontinuation of therapy after initiating radiation planning. The rate of TT was calculated as a percentage of all patients starting radiation planning. All cases were presented at monthly morbidity and mortality (MM) conferences with a root cause reviewed (RCA). A total of 1,448 TTs were identified out of 31,199 planned courses of care (4.6%). Six hundred eighty-six (47.4%) involved patients treated with curative intent, while 753 (52.0%) with palliative intent, and 9 (0.6%) for benign disease. The rate of TT decreased from 8.49% in 2013 to 3.02% in 2022 with rates decreasing yearly. The most common disease sites for TT were CNS (21.7%), H&N (19.3%), Thorax (17.5%), and Bone (14.2%). The most common causes of TT were hospice and/or patient expiration (35.9%), patient choice unrelated to toxicity (35.2%), and clinician choice unrelated to toxicity (11.5%). This 10-year prospective review of TTs identified a year-over-year decrease in TTs as a percentage of planned patients. This decrease may be associated with the addition of RCA for TTs and discussion monthly at MM rounds, coupled with departmental upstream quality initiatives implemented over time. Understanding the reasons behind TTs may help to decrease preventable TTs. While some TTs may be unavoidable, open discourse and quality improvement changes effectively reduce TT incidents over time.

Short-Term Statin Treatment Reduces, and Long-Term Statin Treatment Abolishes, Chronic Vascular Injury by Radiation Therapy.

The incidental use of statins during radiation therapy has been associated with a reduced long-term risk of developing atherosclerotic cardiovascular disease. We examined whether irradiation causes chronic vascular injury and whether short-term administration of statins during and after irradiation is sufficient to prevent chronic injury compared with long-term administration. C57Bl/6 mice were pretreated with pravastatin for 72 hours and then exposed to 12 Gy X-ray head-and-neck irradiation. Pravastatin was then administered either for an additional 24 hours or for 1 year. Carotid arteries were tested for vascular reactivity, altered gene expression, and collagen deposition 1 year after irradiation. Treatment with pravastatin for 24 hours after irradiation reduced the loss of endothelium-dependent vasorelaxation and protected against enhanced vasoconstriction. Expression of markers associated with inflammation (NFκB p65 [phospho-nuclear factor kappa B p65] and TNF-α [tumor necrosis factor alpha]) and with oxidative stress (NADPH oxidases 2 and 4) were lowered and subunits of the voltage and Ca2+ activated K+ BK channel (potassium calcium-activated channel subfamily M alpha 1 and potassium calcium-activated channel subfamily M regulatory beta subunit 1) in the carotid artery were modulated. Treatment with pravastatin for 1 year after irradiation completely reversed irradiation-induced changes. Short-term administration of pravastatin is sufficient to reduce chronic vascular injury at 1 year after irradiation. Long-term administration eliminates the effects of irradiation. These findings suggest that a prospective treatment strategy involving statins could be effective in patients undergoing radiation therapy. The optimal duration of treatment in humans has yet to be determined.

Evaluating psychological anxiety in patients receiving radiation therapy using smartwatch.

Patients undergoing radiation therapy (RT) often experience psychological anxiety that manifests as muscle contraction. Our study explored psychological anxiety in these patients by using biological signals recorded using a smartwatch. Informed consent was obtained from participating patients prior to the initiation of RT. The patients wore a smartwatch from the waiting room until the conclusion of the treatment. The smartwatch acquired data related to heart rate features (average, minimum, and maximum) and stress score features (average, minimum, and maximum). On the first day of treatment, we analyzed the participants' heart rates and stress scores before and during the treatment. The acquired data were categorized according to sex and age. For patients with more than three days of data, we observed trends in heart rate during treatment relative to heart rate before treatment (HRtb) over the course of treatment. Statistical analyses were performed using the Wilcoxon signed-rank test and paired t-test. Twenty-nine individuals participated in the study, of which 17 had more than 3 days of data. During treatment, all patients exhibited elevated heart rates and stress scores, particularly those in the younger groups. The HRtb levels decreased as treatment progresses. Patients undergoing RT experience notable psychological anxiety, which tends to diminish as the treatment progresses. Early stage interventions are crucial to alleviate patient anxiety during RT.

Remineralization Rate of Lytic Lesions of the Spine in Multiple Myeloma Patients Undergoing Radiation Therapy

Study Design Retrospective cohort study. Objective In general, Multiple Myeloma (MM) patients are treated with systemic therapy including chemotherapy. Radiation therapy can have an important supportive role in the palliative management of MM-related osteolytic lesions. Our study aims to investigate the degree of radiation-induced remineralization in MM patients to gain a better understanding of its potential impact on bone mineral density and, consequently, fracture prevention. Our primary outcome measure was percent change in bone mineral density measured in Hounsfield Units (Δ% HU) between pre- and post-radiation measurements, compared to non-targeted vertebrae. Methods We included 119 patients with MM who underwent radiotherapy of the spine between January 2010 and June 2021 and who had a CT scan of the spine at baseline and between 3-24 months after radiation. A linear mixed effect model tested any differences in remineralization rate per month (βdifference) between targeted and non-targeted vertebrae. Results Analyses of CT scans yielded 565 unique vertebrae (366 targeted and 199 non-targeted vertebrae). In both targeted and non-targeted vertebrae, there was an increase in bone density per month (βoverall = .04; P = .002) with the largest effect being between 9-18 months post-radiation. Radiation did not cause a greater increase in bone density per month compared to non-targeted vertebrae (βdifference = .67; P = .118). Conclusion Our results demonstrate that following radiation, bone density increased over time for both targeted and non-targeted vertebrae. However, no conclusive evidence was found that targeted vertebrae have a higher remineralization rate than non-targeted vertebrae in patients with MM.

Trait Mindfulness and Social Support Predict Lower Perceived Stress Burden in Patients Undergoing Radiation Therapy

Purpose/ObjectivesCancer diagnosis and treatment, including radiation therapy (RT), cause significant patient stress. Mindfulness and social support have been shown to help manage the psychological effects of cancer treatment. The objective of our study was to determine the sociodemographic and clinical factors associated with stress burden in patients undergoing RT. Materials/MethodsPatients undergoing RT for cancer at a single institution were given 3 surveys to complete at the beginning of on-treatment visit. The surveys included the Perceived Stress Scale (PSS), Medical Outcomes Study Social Support Survey (MOS), and Mindfulness Attention Awareness Scale (MAAS), which were used to measure stress, social support, and trait mindfulness, respectively. Linear regression analysis was performed to determine associations between perceived stress and age, patient sex, race and ethnicity, treatment intent, disease site, trait mindfulness, and social support. Factors significant on univariable analysis were analyzed with a multivariable analysis. ResultsA total of 93 patients completed 279 surveys during treatment at a tertiary care academic institution from July to September 2019. Median scores for PSS, MOS, and MAAS were 14.6 (range: 0-31, SD: 6.9), 4.2 (range: 0-5, SD: 1.0), and 5.1 (range: 3.1-6.0, SD: 0.8), respectively. On univariable analysis, mindfulness and social support were associated with decreased stress burden, and female sex and palliative intent were associated with increased stress burden. These factors all maintained significance on multivariable analysis. ConclusionThese results suggest measures to improve mindfulness and perceived social support, such as mindfulness meditation and psychoeducational approaches, may lessen the stress burden and improve quality of life for patients undergoing RT. Future studies should analyze the longitudinal impact of individual patient characteristics, including patient sex and treatment intent, to better understand their effects on psychological maladjustment during cancer care

Prognostic factors for patients with sarcoma with brain metastases.

e23542 Background: Sarcomas arise in mesenchymal tissue occurring anywhere in the body with a propensity to metastasize often to the lung, liver, and bones. The brain is a rare site of metastasis with increasing incidences found in those relapsing after prolonged disease control with treatment. Brain metastases development has been associated with dismal prognoses, and more data is necessary to assess factors for improved outcomes of patients. Methods: The retrospective cohort includes 81 patients diagnosed with sarcomas metastasizing to the brain treated at five sarcoma centers between 1/1998 and 12/2021. Demographic data, characteristics and presentation of brain metastases, and treatment modalities for malignancy were identified and analyzed. Results: In total, there were 45 men and 36 women with the mean age of diagnosis being 43 years. Upon presentation, 89% of patients were symptomatic with the most common presenting symptom being focal neurological deficits (37.9%) and headaches (22.1%). At the time of analysis, 58 patients (71.6%) had died of metastatic sarcoma, 16 patients (19.8%) were alive with disease, and 3 patients (3.7%) were alive without evidence of disease. The most frequent histologies were leiomyosarcoma (12.3%) and undifferentiated pleomorphic sarcoma (12.3%). In 70.4% of patients, the tumor also had metastasized to the lung. Median time from sarcoma diagnosis to brain metastases was 1.9 years (range: 0-34.6 yrs). Median time from diagnosis of brain metastases until death was 6 months (range: 0.5-330 mo). Treatment modalities of brain metastasis varied widely with 18 patients (22.2%) undergoing whole brain radiation therapy (WBRT), 11 (13.6%) undergoing systemic chemotherapy and WBRT, and 10 (12.3%) undergoing combined surgery, systemic chemotherapy, and stereotactic radiosurgery. In multivariate analysis, the variables identified as statistically significant for predicting improved survival outcomes included surgery (HR 0.30) and chemotherapy (HR 0.24), but not radiation therapy. In patients undergoing surgery or chemotherapy, the median survival time after brain metastasis diagnosis was markedly improved, with 13.9 months and 12 months respectively versus the overall patient median of 6 months. In patients undergoing radiation therapy, there was significantly improved survival with stereotactic radiosurgery (SRS, mOS 11.6mo) as opposed to whole brain radiation therapy (WBRT, mOS 8.3mo) probably due to decreased mean number of brain metastases found in those necessitating SRS (3.2) compared to WBRT (5.7). Conclusions: Together, our findings identify that patients with metastatic sarcoma to the brain have poor prognoses, often have concurrent metastasis, and have median survival of only 6 months. However, there were significantly improved outcomes with interventions such as surgery, chemotherapy, or SRS, suggesting that aggressive treatments are warranted despite the overall poor prognosis.

Hemoglobin Concentration as an Indicator of Skin Radiation Damage During Radiation Therapy Treatments

Acute radiation dermatitis (ARD) is the most common side effect reported by patients undergoing radiation therapy (RT). Currently, the assessment of the severity of the reaction is based on the visual assessment of the skin, which is a subjective method, depending on many factors. The main aim of this study was to investigate the usefulness of hyperspectral imaging (HSI) in the assessment of ARD and find physiological factors that could be correlated with ARD. In this clinical pilot trial, weekly acquisitions of hyperspectral camera images of irradiated skin were performed for 5 weeks of RT and at the posttreatment follow-up visit which took place 30 to 40 days after the last fraction of RT. At the same time, the severity of radiodermatitis was assessed based on the criteria of the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). The content and concentration of chromophores in irradiated skin were quantitatively determined using a hyperspectral camera. The use of HSI supported by image analysis and processing methods allowed for the determination of the content and distribution of hemoglobin and melanin in the irradiated skin. It was found that the hemoglobin concentration is correlated with the subjective assessment made according to the CTCAE protocol. HSI is a sensitive and specific method of analyzing the concentration of chromophores in the skin, including hemoglobin. A clear correlation was found between hemoglobin concentration and CTCAE v.5 scale because of which HSI can be considered as an objective method of skin assessment during RT.

The Prediction of Stress in Radiation Therapy: Integrating Artificial Intelligence with Biological Signals.

This study aimed to predict stress in patients using artificial intelligence (AI) from biological signals and verify the effect of stress on respiratory irregularity. We measured 123 cases in 41 patients and calculated stress scores with seven stress-related features derived from heart-rate variability. The distribution and trends of stress scores across the treatment period were analyzed. Before-treatment information was used to predict the stress features during treatment. AI models included both non-pretrained (decision tree, random forest, support vector machine, long short-term memory (LSTM), and transformer) and pretrained (ChatGPT) models. Performance was evaluated using 10-fold cross-validation, exact match ratio, accuracy, recall, precision, and F1 score. Respiratory irregularities were calculated in phase and amplitude and analyzed for correlation with stress score. Over 90% of the patients experienced stress during radiation therapy. LSTM and prompt engineering GPT4.0 had the highest accuracy (feature classification, LSTM: 0.703, GPT4.0: 0.659; stress classification, LSTM: 0.846, GPT4.0: 0.769). A 10% increase in stress score was associated with a 0.286 higher phase irregularity (p < 0.025). Our research pioneers the use of AI and biological signals for stress prediction in patients undergoing radiation therapy, potentially identifying those needing psychological support and suggesting methods to improve radiotherapy effectiveness through stress management.

Personalized Composite Dosimetric Score–Based Machine Learning Model of Severe Radiation-Induced Lymphopenia Among Patients With Esophageal Cancer

Radiation-induced lymphopenia (RIL) is common among patients undergoing radiation therapy (RT)' Severe RIL has been linked to adverse outcomes. The severity and risk of RIL can be predicted from baseline clinical characteristics and dosimetric parameters. However, dosimetric parameters, e.g. dose-volume (DV) indices, are highly correlated with one another and are only weakly associated with RIL. Here we introduce the novel concept of "composite dosimetric score" (CDS) as the index that condenses the dose distribution in immune tissues of interest to study the dosimetric dependence of RIL. We derived an improved multivariate classification scheme for risk of grade 4 RIL (G4RIL), based on this novel RT dosimetric feature, for patients receiving chemo RT for esophageal cancer. DV indices were extracted for 734 patients who received chemo RT for biopsy-proven esophageal cancer. Nonnegative matrix factorization was used to project the DV indices of lung, heart, and spleen into a single CDS; XGBoost was employed to explore significant interactions among predictors; and logistic regression was applied to combine the resultant CDS with baseline clinical factors and interaction terms to facilitate individualized prediction of immunotoxicity. Five-fold cross-validation was applied to evaluate the model performance. The CDS for selected immune organs at risk (ie, heart, lung, and spleen) (OR 1.791; 95 CI [1.350, 2.377]) was a statistically significant risk determinant for G4RIL. Pearson correlation coefficients for CDS versus G4RIL risk for individual immune organs at risk were greater than any single DV indicx. Personalized prediction of G4RIL based on CDS and 4 clinical risk factors yielded an area under the curve value of 0.78. Interaction between age and CDS revealed that G4RIL risk increased more sharply with increasing CDS for patients aged ≥65 years. Risk of immunotoxicity for patients undergoing chemo RT for esophageal cancer can be predicted by CDS. The CDS concept can be extended to immunotoxicity in other cancer types and in dose-response models currently based on DV indices. Personalized treatment planning should leverage composite dosimetric scoring methods rather than using individual or subsets of DV indices.

Impact of gamma rays on DNA quality and genetic traits in human blood samples

This research investigates the effects of gamma rays on DNA quality and genetic traits in eight participants from Saudi Arabia (4 males and 4 females). The study aims to understand changes in genetic fingerprint sites resulting from varying levels of radiation exposure. It addresses three key research questions related to DNA quantity, obtaining complete genetic fingerprint sites, and the reliability of genetic trait results from cancer patients undergoing radiation therapy. The study's significance lies in its potential applications in forensics, medical diagnostics, and public safety, providing insights into identifying victims and perpetrators in radiation-related incidents and enhancing treatment planning for cancer patients exposed to radiation therapies. The research contributes to a broader understanding of radiation's impact on genetic material, promotes scientific knowledge, and safeguards public health. This research investigated the impact of gamma radiation on DNA quality and genetic traits in human blood samples from Saudi Arabian volunteers. Exposure to gamma radiation at doses similar to therapeutic levels used in cancer treatment was found to cause DNA fragmentation, resulting in decreased concentrations of detectable genetic loci. The study revealed that higher radiation doses had a more pronounced effect on DNA content in blood cells.

Exploring the Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Genitourinary Toxicities in Prostate Cancer Patients Undergoing Radiation Therapy: A Case Study and Discussion

Radiation therapy is a common treatment modality offered to patients with localized prostate cancer. It can be associated with early radiation-induced toxicities including dysuria, nocturia, frequency, urgency, spasm, and, rarely, hematuria. Early toxicities usually resolve once the treatment period has ended. Chronic toxicities are less common, and rarely, patients may experience radiation-induced hemorrhagic cystitis and hematuria months or years after radiation. We herein describe the case of a 65-year-old man with a past medical history of type-2 diabetes mellitus who experienced hemorrhagic cystitis for months following his radiation therapy. The patient was on sodium-glucose cotransporter-2 inhibitor therapy (empagliflozin), which we highlight as a potential risk factor for hemorrhagic cystitis. After cessation of Jardiance and initiation of semaglutide (GLP-1 agonist), his urinary symptoms significantly improved. To the best of our knowledge, this is the first such case reported.

Interdisciplinary Collaboration in Head and Neck Cancer Care: Optimizing Oral Health Management for Patients Undergoing Radiation Therapy.

Radiation therapy (RT) plays a crucial role in the treatment of head and neck cancers (HNCs). This paper emphasizes the importance of effective communication and collaboration between radiation oncologists and dental specialists in the HNC care pathway. It also provides an overview of the role of RT in HNC treatment and illustrates the interdisciplinary collaboration between these teams to optimize patient care, expedite treatment, and prevent post-treatment oral complications. The methods utilized include a thorough analysis of existing research articles, case reports, and clinical guidelines, with terms such as 'dental management', 'oral oncology', 'head and neck cancer', and 'radiotherapy' included for this review. The findings underscore the significance of the early involvement of dental specialists in the treatment planning phase to assess and prepare patients for RT, including strategies such as prophylactic tooth extraction to mitigate potential oral complications. Furthermore, post-treatment oral health follow-up and management by dental specialists are crucial in minimizing the incidence and severity of RT-induced oral sequelae. In conclusion, these proactive measures help minimize dental and oral complications before, during, and after treatment.

Association of Insomnia and Obstructive Sleep Apnea with Worse Oral Mucositis and Quality of Life in Head and Neck Cancer Patients Undergoing Radiation Therapy.

Patients with head and neck cancer (HNC) undergoing radiation therapy (RT) often experience sleep disturbances that may contribute to oral mucositis (OM) and quality of life (QOL). Patients with HNC treated with RT at a single institution were examined. Sleep questionnaires were given on the first day of RT to assess for insomnia and obstructive sleep apnea (OSA). Patient-reported QOL and oral mucositis were assessed during RT. Associations between insomnia and OSA with QOL were assessed using the Mann-Whitney U test. Linear mixed models assessed associations with OM. Among 87 patients, 34 patients (39%) had subthreshold or greater insomnia and 47 patients (54%) screened positive for OSA. Upon RT completion, patients with subthreshold or greater insomnia had worse physical function (p = 0.005), fatigue (p = 0.01), insomnia (p < 0.001), and sticky saliva (p = 0.002). Patients screening positive for OSA had worse physical function (p = 0.01), sticky saliva (p = 0.02), fatigue (p = 0.007), insomnia (p = 0.009), and pain (p = 0.005). Upon linear mixed model evaluation, subthreshold or greater insomnia (p = 0.01) and positive OSA screen (p = 0.002) were associated with worse OM. Insomnia and OSA are highly prevalent in patients with HNC undergoing RT. These sleep disturbances are associated with worse QOL and OM during treatment.

Profile of Rectal Cancer Patients Undergoing Radiation Therapy in Dr. Hasan Sadikin General Hospital From 2016 Until 2021

Background: Rectal cancer is a type of malignancy that occurs in the rectum. One of the many options of therapy for rectal cancer includes radiotherapy. This research was done to learn about the profile of rectal cancer patients undergoing radiation therapy at Dr. Hasan Sadikin General Hospital from 2016 until 2021. Methods: A retrospective descriptive study that uses data obtained from patient’s medical records from Dr. Hasan Sadikin General Hospital from 2016 until 2021. The sampling technique used is total sampling from 109 data of rectal cancer patients who underwent radiation therapy in Dr. Hasan Sadikin from 2016 until 2021 Results: : From all 109 rectal cancer patients undergoing radiotherapy, the most often patients found have the age group of 40-49 years old (28.4%), females (50.5%), are mostly found from Priangan area (65.1%), have the chief complaint of a problem with defecating (51.3%), at stage III (36.7%), and have previously received operative management from their previous institutions (42.2%). The patients are mostly undergoing radiotherapy for curative indications (68.8%) and most have a waiting time of more than six weeks before obtaining radiotherapy (61.4%). Conclusions: Cases of rectal cancer in radiotherapy patients in Dr. Hasan Sadikin General Hospital from the year 2016 to 2021 are seldom compared to other types of cancer and mostly occur in patients aged 40 to 49 years old. Most of the patients come for a curative reason and must wait for more than six weeks before obtaining radiation therapy. Further research may be performed to find the most effective method of giving curative radiotherapy as well as the time given in the hope of making radiotherapy planning more effective in the future.

Abstract 6035: Fluoride effects on thermal properties of irradiated dentin and enamel

Abstract Aim: Radiation therapy to treat oral cancer introduces various harms, including decreased hardness of dentin and enamel. Fluoride treatments, including silver diamine fluoride (SDF), have been used as a tool to combat these harms, but its influences on the thermal properties of dentin and enamel prior to and after radiation therapy are not well understood. Thus, this study analyzed how SDF influences the thermal stability of dentin and enamel that has been exposed to radiation therapy intended for head and neck cancer patients. Methods: Forty human posterior teeth were collected, cleaned of debris and soft tissue, and then mounted into acrylic resin molds. The teeth were divided into two equal groups, with one group being the control (no treatment) and the other group receiving SDF treatment. Using an X-Rad 320ix biological irradiator, all teeth were subjected to two grays of radiation therapy every day for six weeks. Afterwards, the dentin and enamel were pulverized a SPEX freezer mill. Samples were heated in a NETZSCH Thermal Analysis instrument, and the amount of carbon dioxide and water released was determined. All teeth were heated to 1429 °C from room temperature. Results: The SDF-treated dentin released the most carbon dioxide (49,611.82 ppm/mg), followed by irradiated dentin (47,672.76 ppm/mg) and untreated dentin (45,249.66 ppm/mg). In contrast, the SDF-treated enamel released less carbon dioxide (7,367.62 ppm/mg) than the control enamel (8,172.01 ppm/mg). The pattern of release of water was different from that of carbon dioxide. The control dentin group released the most water (45.56 ppt/mg), followed by the SDF-treated (39.72 ppt/mg) and irradiated dentin (23.51 ppt/mg). Similarly, the control enamel also released the highest amount of water (0.83 ppt/mg), as well as the highest amount of carbon dioxide. The SDF-treated enamel released around 65% of the water compared to the control enamel group (0.54 ppt/mg). Furthermore, the irradiated dentin had the largest heat reversal temperatures for carbon dioxide (85.19 °C) and water (86.57 °C). Conclusions: The impacts of SDF treatment and radiation vary between dentin and enamel. Comparatively, dentin has a higher content of combustible material than enamel. Radiation treatment reduces the water content of both enamel and dentin, which may make teeth more susceptible to fracture. Therefore, regular dental check-ups and frequent fluoride treatment to increase the strength of the teeth are recommended for patients undergoing radiation therapy. Citation Format: Rachel J. Kulchar, Yusuke Kakiuchi, Vania Sanchez-Gamarra, Jie Deng, Francis Mante. Fluoride effects on thermal properties of irradiated dentin and enamel [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6035.

A Randomized, Double-blinded Pivotal Study of the Safety and Efficacy of a Novel Intraoral Photobiomodulation Device in Head and Neck Cancer Patients Undergoing Radiation Therapy With or Without Vhemotherapy

A Randomized, Double-blinded Pivotal Study of the Safety and Efficacy of a Novel Intraoral Photobiomodulation Device in Head and Neck Cancer Patients Undergoing Radiation Therapy With or Without Vhemotherapy

An Innovative Inducer of Platelet Production, Isochlorogenic Acid A, Is Uncovered through the Application of Deep Neural Networks.

(1) Background: Radiation-induced thrombocytopenia (RIT) often occurs in cancer patients undergoing radiation therapy, which can result in morbidity and even death. However, a notable deficiency exists in the availability of specific drugs designed for the treatment of RIT. (2) Methods: In our pursuit of new drugs for RIT treatment, we employed three deep learning (DL) algorithms: convolutional neural network (CNN), deep neural network (DNN), and a hybrid neural network that combines the computational characteristics of the two. These algorithms construct computational models that can screen compounds for drug activity by utilizing the distinct physicochemical properties of the molecules. The best model underwent testing using a set of 10 drugs endorsed by the US Food and Drug Administration (FDA) specifically for the treatment of thrombocytopenia. (3) Results: The Hybrid CNN+DNN (HCD) model demonstrated the most effective predictive performance on the test dataset, achieving an accuracy of 98.3% and a precision of 97.0%. Both metrics surpassed the performance of the other models, and the model predicted that seven FDA drugs would exhibit activity. Isochlorogenic acid A, identified through screening the Chinese Pharmacopoeia Natural Product Library, was subsequently subjected to experimental verification. The results indicated a substantial enhancement in the differentiation and maturation of megakaryocytes (MKs), along with a notable increase in platelet production. (4) Conclusions: This underscores the potential therapeutic efficacy of isochlorogenic acid A in addressing RIT.