Radiotherapy For Cancer Research Articles

Radiotherapy for parotid cancer: 10 years of experience in a single center

<b><br>Introduction:</b> We report our experience in the treatment of parotid cancers by radiotherapy delivered with curative intent over a period of 10 years.</br> <b><br>Aim:</b> The aim of this study was to evaluate the therapeutic results and prognostic factors.</br> <b><br>Materials and methods:</b> This is a retrospective study of patients with parotid cancer treated with radiotherapy between 2008 and 2017 at the National Institute of Oncology in Rabat. Patients who received adjuvant or exclusive radiotherapy were included in this study. We performed a multivariate analysis for the factors related to locoregional control and overall survival.</br> <b><br>Results:</b> Initially, 74 patients (45 men and 29 women), at a median age of 57 years. were identified. At the time of diagnosis, 10 (13.6%), 36 (48.6%), and 28 (37.8%) patients were in stage II, III, and IVab, respectively. Sixty patients received adjuvant radiotherapy after parotidectomy and 14 patients received exclusive radiotherapy for an unresectable tumor. At 5 years, the rate of locoregional control and overall survival were 68.2% and 53.7%, respectively. Surgical resection and negative margins were significantly correlated with locoregional control. Lymph node involvement, unresectable tumors, high-grade histological types, and cystic adenoid carcinoma were significantly correlated with poor overall survival.</br> <b><br>Conclusions:</b> Acceptable long-term results are obtained with surgery combined with radiotherapy. Surgical resection remains essential for parotid cancer, given the disappointing results of treatment with radiotherapy alone.</br>

Proton radiotherapy for rectal cancer

AIM: to assess the effectiveness of proton radiotherapy as part of a combined approach to the treatment of rectal malignancies and to assess acute radiation toxicity, which directly affects patients’ quality of life.PATIENTS AND METHODS: between 2020 and 2023, a study included 74 patients with rectal cancer. The mean age of the patients was 65 ± 9.9 years, 44 (60%) males. Stage I occurred in 8 (10.8%) patients, stage II — in 14 (18.9%) patients, stage III — in 52 (70.3%) patients. At the first stage, all patients completed proton radiation therapy in the classical fractionation mode.RESULTS: of the adverse events, 49 (66%) patients had grade 1–2 radiation reactions in the form of proctitis and cystitis. There were no local radiation reactions of grade 3 or higher. Systemic complications of grade 3 were noted in 2 (2%) patients in the form of hematological toxicity — anemia (1%), afebrile neutropenia (2%). Of the 62 operated patients, 12 (19.3%) people showed complete therapeutic pathomorphosis. With a median follow-up of 23 months (13;35), 1 (1.35%) patient showed continued tumor growth 28 months after completed radiotherapy, 2 (2.7%) patients had local recurrence 3 and 18 months after treatment. Distant metastases to the lungs, liver, or bones were detected in 9 (12.2%) patients, median — 12 months (6;23). Mortality during the entire observation period was 9 (12.2%) patients. Sixty-two (83.8%) patients showed no signs of relapse or progression of the disease, of which 9 (14.5%) patients did not receive any treatment after chemoradiotherapy and are in the process of active follow-up.CONCLUSION: proton radiation therapy in patients with rectal cancer in two-year overall survival (90.5%) and progression-free survival (88.9%) are comparable with the literature data of recent studies, but are superior in overall survival pathological response (19.3%).

Paired conditional generative adversarial network for highly accelerated liver 4D MRI

Purpose. 4D MRI with high spatiotemporal resolution is desired for image-guided liver radiotherapy. Acquiring densely sampling k-space data is time-consuming. Accelerated acquisition with sparse samples is desirable but often causes degraded image quality or long reconstruction time. We propose the Reconstruct Paired Conditional Generative Adversarial Network (Re-Con-GAN) to shorten the 4D MRI reconstruction time while maintaining the reconstruction quality. Methods. Patients who underwent free-breathing liver 4D MRI were included in the study. Fully- and retrospectively under-sampled data at 3, 6 and 10 times (3×, 6× and 10×) were first reconstructed using the nuFFT algorithm. Re-Con-GAN then trained input and output in pairs. Three types of networks, ResNet9, UNet and reconstruction swin transformer (RST), were explored as generators. PatchGAN was selected as the discriminator. Re-Con-GAN processed the data (3D + t) as temporal slices (2D + t). A total of 48 patients with 12 332 temporal slices were split into training (37 patients with 10 721 slices) and test (11 patients with 1611 slices). Compressed sensing (CS) reconstruction with spatiotemporal sparsity constraint was used as a benchmark. Reconstructed image quality was further evaluated with a liver gross tumor volume (GTV) localization task using Mask-RCNN trained from a separate 3D static liver MRI dataset (70 patients; 103 GTV contours). Results. Re-Con-GAN consistently achieved comparable/better PSNR, SSIM, and RMSE scores compared to CS/UNet models. The inference time of Re-Con-GAN, UNet and CS are 0.15, 0.16, and 120 s. The GTV detection task showed that Re-Con-GAN and CS, compared to UNet, better improved the dice score (3× Re-Con-GAN 80.98%; 3× CS 80.74%; 3× UNet 79.88%) of unprocessed under-sampled images (3× 69.61%). Conclusion. A generative network with adversarial training is proposed with promising and efficient reconstruction results demonstrated on an in-house dataset. The rapid and qualitative reconstruction of 4D liver MR has the potential to facilitate online adaptive MR-guided radiotherapy for liver cancer.

Dosimetric risk factors for radiation esophagitis in patients with breast cancer following regional nodal radiation

BACKGROUND Radiation esophagitis (RE) is one of the most common clinical symptoms of regi-onal lymph node radiotherapy for breast cancer. However, there are fewer studies focusing on RE caused by hypofractionated radiotherapy (HFRT). AIM To analyze the clinical and dosimetric factors that contribute to the development of RE in patients with breast cancer treated with HFRT of regional lymph nodes. METHODS Between January and December 2022, we retrospectively analysed 64 patients with breast cancer who met our inclusion criteria underwent regional nodal intensity-modulated radiotherapy at a radiotherapy dose of 43.5 Gy/15F. RESULTS Of the 64 patients in this study, 24 (37.5%) did not develop RE, 29 (45.3%) developed grade 1 RE (G1RE), 11 (17.2%) developed grade 2 RE (G2RE), and none developed grade 3 RE or higher. Our univariable logistic regression analysis found G2RE to be significantly correlated with the maximum dose, mean dose, relative volume 20-40, and absolute volume (AV) 20-40. Our stepwise linear regression analyses found AV30 and AV35 to be significantly associated with G2RE (P < 0.001). The optimal threshold for AV30 was 2.39 mL [area under the curve (AUC): 0.996; sensitivity: 90.9%; specificity: 91.1%]. The optimal threshold for AV35 was 0.71 mL (AUC: 0.932; sensitivity: 90.9%; specificity: 83.9%). CONCLUSION AV30 and AV35 were significantly associated with G2RE. The thresholds for AV30 and AV35 should be limited to 2.39 mL and 0.71 mL, respectively.

Total neoadjuvant treatment with long-course radiotherapy versus concurrent chemoradiotherapy in local advanced rectal cancer with high risk factors (TNTCRT): A multicenter, randomized, open-label, phase 3 trial.

LBA3511 Background: Distant metastases remain a common problem in locally advanced rectal cancer (LARC) patients who received neoadjuvant chemoradiotherapy (NCRT) and surgery. Previous researchers have demonstrated the survival benefits of total neoadjuvant treatment (TNT) using short-course radiotherapy with CAPOX and long-course radiotherapy (LCRT) with mFOLFIRINOX. This study aimed to explore the efficacy of TNT using long-course radiotherapy (LCRT) combined with CAPOX. Methods: In this phase 3, open-label, multicenter, randomized trial, eligible pts were diagnosed as stage II/III and had at least one high risk factor: cT4a-b (resectable), cT3c-d with extramural venous invasion, cN2; involved mesorectal fascia, or enlarged lateral lymph nodes. Pts were randomly assigned to either Arm A to receive TNT (LCRT with six cycles of neoadjuvant CAPOX (one cycle of induction CAPOX, two cycles of concurrent CAPOX, and three cycles of consolidation CAPOX) followed by total mesorectal excision (TME)) or Arm B to receive NCRT (LCRT with concomitant capecitabine, followed by TME and adjuvant CAPOX). Radiotherapy in both groups was administered at 50-50.4 Gy in 25-28 fractions. The primary endpoint was disease free survival (DFS). The secondary endpoints were pathological response complete (pCR) rate, overall survival (OS), metastasis-free survival (MFS) and postoperative 30-day morbidity. Results: (ITT) Between June 6, 2017, and Mar 5, 2024, 458 pts were randomly assigned to two Arms (232 in Arm A, and 226 in Arm B). At a median follow-up of 44 months (IQR, 24-57.25), the 3-yr DFS was significantly increased in Arm A (77.0% vs 67.9% in Arm A/B respectively, HR 0.623, 95% CI 0.435-0.892, p = 0.009). 3-yr MFS was also significantly higher in arm A: 83.0% vs 74.2% in arm B (HR 0.595, 95% CI 0.392-0.903, p= 0.013). A total of 56 OS events was reported, and the 3-yr OS was 90.3% vs 87.9% (HR 0.747, 95% CI 0.441-1.266, p = 0.276) in arm A/B, respectively. TNT and NCRT in both arms were well tolerated. Thrombocytopenia was the most frequent grade 3-4 hematological adverse event in Arm A, occurring in 24 (10.3%) of 232 pts. Until now, 27.5% of pts achieved pCR in Arm A, compared to only 9.9% in Arm B. (OR 3.436, [1.1.941-6.084], p= 0.0001). In Arm A and B, 13 and 2 pts achieved clinical complete response (cCR) and received watch-and-wait strategy, respectively. No significant difference in severe morbidity within 30 days post-operation were found between the two arms. Conclusions: TNT with LCRT combined with CAPOX significantly improve DFS, MFS and pCR compared to standard concurrent neoadjuvant chemoradiotherapy in LARC patients with high risk factors, with acceptable toxicities. Clinical trial information: NCT03177382 .

Ozone enhances the efficacy of radiation therapy in esophageal cancer.

Radioresistance is increasingly developed in esophageal cancer. Increasing radiation sensitivity can reduce the mortality of esophageal cancer. To investigate the effect and mechanism of ozone on the radiotherapy sensitization of esophageal carcinoma. KYSE150 cells were xenografted subcutaneously into nude mice and irradiated with 8Gy radiation according to different subgroups (sham, radiation, ozone and radiation+ozone group (n = 10 per group)). Half of the mice were used to determine the body weight, tumor size and tumor weight. Half of the mice were used to collect peripheral blood. The serum was centrifuged to detect circulating cell-free DNA (cf-DNA), interleukin-6 (IL-6), interferon-γ (IFN-γ), myeloperoxidase (MPO)-DNA complexes, tumor necrosis factor-α (TNF-α), matrix metalloproteinase-9 (MMP-9) and hypoxia-inducible factor-1α (HIF-1α) using commercial kits. The levels of phosphorylation AMP-activated protein kinase (p-AMPK) and scavenger receptor-A (SR-A) were measured by immunocytochemistry and Western blotting in the tumor tissues of mice. Ozone alone or combined with radiation therapy significantly reduced the body weight, tumor volume and tumor weight of esophageal cancer compared to the sham group. The ELISA results showed that the levels of cf-DNA, IFN-γ, MPO-DNA complexes, TNF-α, IL-6, HIF-1α and MMP-9 in the peripheral blood of mice treated with ozone combined with radiation were significantly lower compared with the radiation group. Ozone, synergistically with radiation, significantly increased the protein expression of p-AMPK and SR-A. Ozone may increase the radiosensitivity of esophageal cancer by inhibiting neutrophil extracellular traps.

Knowledge domains and emerging trends in radiotherapy in oesophageal cancer from 2004 to 2023: a bibliometric analysis and visualization study.

Esophageal cancer (EC) is a malignant tumour with high morbidity and mortality rates. Recent studies have shown that much progress has been made in the research of radiotherapy in EC. This study aims to provide a comprehensive overview of the knowledge structure and research hotspots of radiotherapy in EC through bibliometrics. Publications related to radiotherapy in EC from 2014 to 2023 were searched on the web of science core collection database. VOSviewers, CiteSpace and R package 'bibliometrix' were used to conduct this bibliometric analysis. In total, 4258 articles from 76 countries led by China and the USA were included. The Chinese Academy of Medical Sciences-Peking Union Medical College has the highest number of publications. International Journal of Radiation Oncology Biology Physics is the most popular journal and also the most co-cited journal in this field. These publications come from 21 972 authors among which Liao Zhongxing had published the most papers and Cooper JS was co-cited most often. Neoadjuvant chemoradiotherapy and strategies based on it are the main topics in this research field. 'IMRT' and 'immunotherapy' are the primary keywords of emerging research hotspots. This is a bibliometric study that comprehensively summarizes the research trends and developments of radiotherapy in EC. This information identifies recent research frontiers and hot directions, which will provide a reference for scholars studying radiotherapy in EC.

ASO Visual Abstract: Impact of Neoadjuvant Chemoimmunotherapy on Surgical Outcomes and Time to Radiation in Triple-Negative Breast Cancer.

ASO Visual Abstract: Impact of Neoadjuvant Chemoimmunotherapy on Surgical Outcomes and Time to Radiation in Triple-Negative Breast Cancer.

Review of the textbook “Oncology 2.0” edited by D. Sci. (Med.), Professor Sh.Kh. Gantsev

The textbook “Oncology 2.0”, prepared by a team of authors under the guidance of Professor Sh.Kh. Gantsev, is a comprehensive presentation of modern approaches and methods in oncology, aimed at training specialized personnel in this field. The textbook uses an integration approach that combines clinical and morphological aspects of oncology. The textbook material complies with the Federal State Educational Standard of Higher Education. The book is written at a high scientific and methodological level. The integration of the latest achievements in scientific research, the latest diagnostic and treatment methods are presented, which makes it an important tool for the education of residents and graduate students. The textbook stands out for its detailed description of the processes of carcinogenesis and cellular mechanisms of malignant transformation. The textbook is intended for residents and graduate students specializing in the field of oncology, oncological radiotherapy, molecular and cellular aspects of cancer and can be used as the main educational literature in the discipline.

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

Selenium-Doped Nanoheterojunctions for Highly Efficient Cancer Radiosensitization.

Exploring efficient and low-toxicity radiosensitizers to break through the bottleneck of radiation tolerance, immunosuppression and poor prognosis remains one of the critical developmental challenges in radiotherapy. Nanoheterojunctions, due to their unique physicochemical properties, have demonstrated excellent radiosensitization effects in radiation energy deposition and in lifting tumor radiotherapy inhibition. Herein, they doped selenium (Se) into prussian blue (PB) to construct a nano-heterojunction (Se@PB), which could promote the increase of Fe2+/Fe3+ ratio and conversion of Se to a high valence state with Se introduction. The Fe2+-Se-Fe3+ electron transfer chain accelerates the rate of electron transfer on the surface of the nanoparticles, which in turn endows it with efficient X-ray energy transfer and electron transport capability, and enhances radiotherapy physical sensitivity. Furthermore, Se@PB induces glutathione (GSH) depletion and Fe2+ accumulation through pro-Fenton reaction, thereby disturbs the redox balance in tumor cells and enhances biochemical sensitivity of radiotherapy. As an excellent radiosensitizer, Se@PB effectively enhances X-ray induced mitochondrial dysfunction and DNA damage, thereby promotes cell apoptosis and synergistic cervical cancer radiotherapy. This study elucidates the radiosensitization mechanism of Se-doped nanoheterojunction from the perspective of the electron transfer chain and biochemistry reaction, which provides an efficient and low-toxic strategy in radiotherapy.

Development of 225Ac-doped biocompatible nanoparticles for targeted alpha therapy

Targeted alpha therapy (TAT) relies on chemical affinity or active targeting using radioimmunoconjugates as strategies to deliver α-emitting radionuclides to cancerous tissue. These strategies can be affected by transmetalation of the parent radionuclide by competing ions in vivo and the bond-breaking recoil energy of decay daughters. The retention of α-emitting radionuclides and the dose delivered to cancer cells are influenced by these processes. Encapsulating α-emitting radionuclides within nanoparticles can help overcome many of these challenges. Poly(lactic-co-glycolic acid) (PLGA) nanoparticles are a biodegradable and biocompatible delivery platform that has been used for drug delivery. In this study, PLGA nanoparticles are utilized for encapsulation and retention of actinium-225 ([225Ac]Ac3+). Encapsulation of [225Ac]Ac3+ within PLGA nanoparticles (Zave = 155.3 nm) was achieved by adapting a double-emulsion solvent evaporation method. The encapsulation efficiency was affected by both the solvent conditions and the chelation of [225Ac]Ac3+. Chelation of [225Ac]Ac3+ to a lipophilic 2,9-bis-lactam-1,10-phenanthroline ligand ([225Ac]AcBLPhen) significantly decreased its release (< 2%) and that of its decay daughters (< 50%) from PLGA nanoparticles. PLGA nanoparticles encapsulating [225Ac]AcBLPhen significantly increased the delivery of [225Ac]Ac3+ to murine (E0771) and human (MCF-7 and MDA-MB-231) breast cancer cells with a concomitant increase in cell death over free [225Ac]Ac3+ in solution. These results demonstrate that PLGA nanoparticles have potential as radionuclide delivery platforms for TAT to advance precision radiotherapy for cancer. In addition, this technology offers an alternative use for ligands with poor aqueous solubility, low stability, or low affinity, allowing them to be repurposed for TAT by encapsulation within PLGA nanoparticles.Graphical

Risk factors for the long-term persistent genitourinary toxicity after stereotactic body radiation therapy for localized prostate cancer: A single-center, retrospective study of 306 patients.

To identify risk factors for the long-term persistent genitourinary toxicity (GUT) after stereotactic body radiation therapy (SBRT) for localized prostate cancer (PCa). A total of 306 patients who underwent SBRT at our institution between March 2017 and April 2022 were retrospectively evaluated. SBRT was performed at 35 Gy in five fractions over 5 or 10 days. Factors related to the long-term persistence of acute GUT after SBRT were analyzed. During the median follow-up period of 39.1 months, 203 (66%) patients experienced any grade of acute GUT, which remained in 78 (26%) patients 6 months after SBRT. Multivariate analysis revealed that age ≥75 years was consistently a significant independent risk factor for any grade of acute GUT 6, 12, and 24 months after SBRT (hazard ratio [HR] 2.31, p = 0.010; HR 2.84, p = 0001; and HR 3.05, p = 0.009, respectively). Older age was not a significant risk factor for the development of grade ≥2 acute GUT. The duration of acute GUT was significantly longer in the older group than in the nonolder group (median duration = 234 vs. 61 days, p < 0.001), and the incidence of persistent GUT was significantly more frequent in the older group beyond 6 months after SBRT. Older age is a significant independent risk factor for the long-term persistent GUT after SBRT for localized PCa.

Prevalence and clinical outcomes of acute heart failure among patients with mediastinal radiation exposure: A propensity score matched analysis.

e24029 Background: Radiation therapy (RT) for malignancy in mediastinal region is associated with radiation-induced heart disease in subsequent years, including coronary, valvular, myocardial, pericardial and conduction system disease. Although increased risk of diastolic heart failure (DHF) has been established, there is limited data on the prevalence, trends and outcomes of acute DHF admissions in patients with prior mediastinal RT. Methods: We extracted data from the National Inpatient Sample (NIS) Database from 2016 to 2020. We included all admissions ≥18 years old with a principal diagnosis of acute DHF with and without history of RT for mediastinal cancer using International Classification of Diseases Tenth Revision (ICD-10) codes. Propensity score matching was performed to balance hospital characteristics, patient demographics and comorbidities between the two groups. Univariate logistic regression was performed in the balanced cohorts. The primary outcome was inpatient mortality. Analysis was performed using STATA-MP, version 14.2. Results: A total of 2,356,025 admissions for acute DHF were identified between 2016 to 2020, of which 15,435 (0.65%) had prior mediastinal RT. During the study period, we found an increasing trend in the number of admissions for acute DHF (p trend &lt; 0.01) along with an increased proportion of patients with prior mediastinal RT. (0.55% in 2016 to 0.78% in 2020, p trend &lt; 0.01). After propensity score matching, there was no difference in in-hospital mortality (odds ratio [OR] 1.12, 95% CI 0.79-1.58, p = 0.537), or complications such as cardiogenic shock, respiratory failure, stroke, venous thromboembolism, or acute kidney injury between the two cohorts. There was no difference in length of stay, however, cohort with history of mediastinal RT had higher hospital charges ($26,634 vs $31,511, p &lt; 0.01). Conclusions: Exposure to mediastinal RT represents a minority but growing number of hospital admission with DHF. The mortality and complications of RT associated DHF does not differ significantly from those with traditional etiologies of DHF.

Radiopharmaceuticals: A New Vista for Diagnosis and Treatment of Thyroid Cancer.

Radiopharmaceuticals are in the diagnosis and treatment of cancerous and noncancerous diseases, and a hope for optimistic effort in the field of nuclear medicine. They play a crucial role in clinical nuclear medicine by providing a tool to comprehend human disease and create efficient treatments. A detailed analysis is provided regarding the crux of molecular imaging including PET and SPECT overview for the detection of cancers. For a specified understanding of radiation therapy, topics include ranging from the selection of radionuclide to its development and manufacture, and dosage requirements to establishing the importance of I- 131 Radiotherapy in thyroid cancer. In this review, we also discussed the current state of the art of nuclear medicine in thyroid cancer, including the role of radioiodine (RAI) therapeutic scans in the diagnosis of differentiated thyroid cancer. In addition, we established a brief outlook into the current status of the research in thyroid cancer and discussed the future directions in this field.

Lymphovenous Anastomosis for the External and Internal Types of Head and Neck Lymphedema: A Case Series and Preliminary Clinical Results.

Head and neck lymphedema (HNL), including external and internal types, could be a possible consequence for patients who have received neck dissection and radiotherapy for head and neck cancer. Initially, the common presentations are heaviness or tightness, followed by swelling in appearance, or difficulty speaking and swallowing in internal edema cases. Lymphovenous anastomosis (LVA) is an established approach to treat extremity lymphedema. We hereby present our preliminary experience in using LVA to treat HNL. Between March 2021 and January 2024, six patients with HNL were treated with LVA via a preauricular or submandibular incision of the obstructed side. Lymphedema Symptom Intensity and Distress Surveys-Head and Neck (LSIDS-H&N) were used for evaluation. In addition, for the external type, MD Anderson Cancer Center Head and Neck Lymphedema (MDACC HNL) rating scale was used for evaluation. For the internal type, Swallowing Quality of Life was used for evaluation. With an average follow-up period of 15.4 ± 15.9 months, LSIDS-H&N improved from 1.11 ± 0.54 to 0.44 ± 0.66 (P = 0.02). For patients with the external type, within an average follow-up period of 15 ± 16.1 months, the MDACC HNL rating scale improved from level 2 to 0 or 1a (P = 0.008). For patients with the internal type, within an average follow-up period of 21 ± 17.3 months, Swallowing Quality of Life improved from 130.5 ± 9.2 to 151 ± 19.8 (P = 0.5). Based on our preliminary results, LVA could be a potential solution to both external and internal HNL.

Bowel bag sparing in palliative radiotherapy (pRT) of rectal cancer (rCa): Tradeoff between organs at risk (OARs) and use of AI to reduce radiation oncologist (RO) workload.

e15615 Background: We retrospectively studied the potential to reduce bowel toxicity after pRT of rCa using a bowel dose (BD) minimization strategy; also its effect on dose to remaining normal tissues (NT) and pelvic bone marrow (PBM). Finally, we studied the use of AI to reduce the RO workload. Methods: 25 consecutive rCa patients (pts) previously treated with pRT were included. Their treatments were planned without consideration to BD. The following OARs were manually segmented retrospectively: Bowel Bag (BB-M) excluding PTV, PBM (PBM-M), and NT defined as the patient contour excluding PTV and BB-M. The AI-Rad Companion software was used to autosegment: Bowel Loops (BL-AI) and PBM (PBM-AI). For the 25 pts, two Pareto optimal treatment plans (5 Gy x 5) were generated with the Monaco treatment planning system. The first plan (Reference) was optimized aiming to limit dose outside the PTV. The second plan (Opt-BB-M) was optimized aiming firstly to limit BB-M dose and secondly to limit NT dose. A third plan (Opt-BL-AI) was generated for the 10 worst-off pts (in terms of BD) aiming instead to limit BL-AI dose. Two volume-at-dose (VD) metrics (V18Gy, V10Gy) were used as endpoints. Endpoint differences (ΔVD-OAR) were tested using one-sided Wilcoxon signed-rank tests. Spearman (rs) and Pearson (r) correlation coefficients were used to study correlation between variables (ΔVD-BB vs. ΔVD-BM, and ΔVD-BB vs. ΔVD-NT). Dice Similarity Coefficient (DCS) was used to compare PBM-M and PBM-AI. Results: After reoptimization, BB-M VD (V18Gy; V10Gy) was lower (p &lt; 0.001; p &lt; 0.001), PBM-M VD was higher (p = 0.002; p &lt; 0.001), and NT VD was higher (p &lt; 0.001; p &lt; 0.001). For BB-M, ΔV18Gy and ΔV10Gy (median, min, max) were (-4, -46, 0) cm3 and (-33, -254, 0) cm3; for PBM-M: (+2, -4, +56) cm3 and (+33, -6, +189) cm3; for NT: (+10, -43, +194) cm3 and (+146, -18, +614) cm3. Table 1 presents results for the 10 worst-off pts. Medium/strong correlations were found for ΔV18Gy-BB vs. ΔV18Gy-PBM (rs = -0.72, p &lt; 0.001; r = -0.74, p &lt; 0.001), ΔV10Gy-BB vs. ΔV10Gy-PBM (rs = -0.66, p &lt; 0.001; r = -0.32, p = 0.11), ΔV18Gy-BB vs. ΔV18Gy-NT (rs = -0.74, p &lt; 0.001; r = -0.74, p &lt; 0.001), ΔV10Gy-BB vs. ΔV10Gy-NT (rs = -0.74, p &lt; 0.001; r = -0.51, p = 0.009). The DSC (median, min, max) for PBL was (92%, 87%, 94%). Conclusions: Bowel dose in pRT of rCa can be reduced at the expense of increasing dose to PBM and other NT. AI tools can be used effectively to limit RO workload. [Table: see text]

A phase I/II study evaluating the feasibility and safety of delivering adjuvant hypofractionated radiotherapy in resected oral cavity cancers (HYPO-ART study)

Background and purposeTo evaluate the tolerability and efficacy of adjuvant Hypofractionated radiotherapy in resected oral cavity cancer patients. Materials and methodsPost-operative oral cavity cancer patients with indications for adjuvant (chemo) radiotherapy were enrolled. T3/T4 disease, positive lymph nodes(s), lympho-vascular invasion, and/or perineural invasion were considered intermediate risk factors for which a radiation dose of 50Gy over four weeks was delivered. Extra-nodal extension and/or positive margins were considered high-risk factors for which a radiation dose of 62.5Gy over five weeks was delivered. The primary end-point was the incidence of acute radiation-induced toxicities. Secondary endpoints were locoregional control and overall survival. Results38 patients were enrolled in the trial and completed planned radiotherapy treatment. No grade 4 toxicity was observed. Acute grade 3 toxicity included oral mucositis in 60.5 % of patients and dysphagia in 18.3 % of patients. 71 % of patients required nasogastric tube placement and 50 % needed day-care support. At a median follow-up of 20.35 months, 57.9 % were alive with no evidence of disease, and 31.6 % of patients had a loco-regional recurrence. Loco-regional control and overall survival at one year were 68 % and 84 %; at two years, they were 59 % and 59 %, respectively. ConclusionsModerately hypofractionated radiotherapy is well tolerated and can safely be delivered for resected oral cavity tumors with optimal supportive care while maintaining similar oncological outcomes compared to conventional fractionation.

Assessment of treatment outcomes: cytoreductive surgery compared to radiotherapy in oligometastatic prostate cancer - an in-depth quantitative evaluation and retrospective cohort analysis.

The management of oligometastatic prostate cancer, defined by its few metastatic sites, poses distinct clinical dilemmas. Debates persist regarding the most effective treatment approach, with both cytoreductive surgery and radiotherapy being key contenders. The purpose of this research is to thoroughly evaluate and compare the effectiveness of these two treatments in managing patients with oligometastatic prostate cancer. A comprehensive search of the literature was carried out to find pertinent publications that compared the results of radiation and cytoreductive surgery for oligometastatic prostate cancer.A meta-analysis was conducted in order to evaluate both the short- and long-term survival.Furthermore, utilizing institutional patient data, a retrospective cohort research was conducted to offer practical insights into the relative performances of the two treatment regimens. Five relevant studies' worth of data were included for this meta-analysis, which included 1425 patients with oligometastatic prostate cancer.The outcomes showed that, in comparison to radiation, cytoreductive surgery was linked to a substantially better Cancer Specific Survival (CSS) (hazard ratio [HR]: 0.70, 95% [CI]: 0.59-0.81, P<0.001) and Overall Survival (OS)(HR, 0.80; 95% [CI], 0.77-0.82; P < 0.01).The two therapy groups' Progression Free Survival (PFS) and Castration Resistant Prostate Cancer Free Survival(CRPCFS), however, did not differ significantly (HR: 0.56, 95% CI: 0.17-1.06; HR: 0.67, 95% CI: 0.26-1.02, respectively). Out of the 102 patients who were recruited in the retrospective cohort research, 36 had Cytoreductive Surgery(CRP), 36 had radiation therapy (primary lesion), and 30 had radiation therapy (metastatic lesion). The follow-up time was 46.3 months (18.6-60.0) on average. The enhanced OS in the CRP group (OS Interquartile Range (IQR): 45-60 months) in comparison to the radiation group (OS IQR: 39.0-59.0 months and 25.8-55.0 months respectively) was further supported by the cohort research. Furthermore, CRP had a better OS than both radiation (primary region) and radiotherapy (metastatic region), with the latter two therapeutic methods having similar OS. This meta-analysis and retrospective research provide valuable insights into the comparative efficacy of cytoreductive surgery and radiotherapy for oligometastatic prostate cancer. While short term survival(PFS,CRPCFS) were similar between the two groups, cytoreductive surgery exhibited superior CSS and OS.Adverse event rates were manageable in both modalities.These findings contribute to informed treatment decision-making for clinicians managing oligometastatic prostate cancer patients. Further prospective studies and randomized controlled trials are essential to corroborate these results and guide personalized therapeutic approaches for this distinct subset of patients.

Radioprotective Potency of Nanoceria.

Cancer presents a significant medical challenge that requires effective management. Current cancer treatment options, such as chemotherapy, targeted therapy, radiotherapy, and immunotherapy, have limitations in terms of their efficacy and the potential harm they can cause to normal tissues. In response, researchers have been focusing on developing adjuvants that can enhance tumor responses while minimizing damage to healthy tissues. Among the promising options, nanoceria (NC), a type of nanoparticle composed of cerium oxide, has garnered attention for its potential to improve various cancer treatment regimens. Nanoceria has demonstrated its ability to exhibit toxicity towards cancer cells, inhibit invasion, and sensitize cancer cells to both radiation therapy and chemotherapy. The remarkable aspect is that nanoceria show minimal toxicity to normal tissues while protecting against various forms of reactive oxygen species generation. Its capability to enhance the sensitivity of cancer cells to chemotherapy and radiotherapy has also been observed. This paper thoroughly reviews the current literature on nanoceria's applications within different cancer treatment modalities, with a specific focus on radiotherapy. The emphasis is on nanoceria's unique role in enhancing tumor radiosensitization and safeguarding normal tissues from radiation damage.