Role Of Radiation Oncology Research Articles

Exploring Piperine: Unleashing the multifaceted potential of a phytochemical in cancer therapy.

Radiotherapy is a cornerstone in the treatment of solid tumors, with extensive Phase III trials confirming its effectiveness. As advancements in treatment technologies and our understanding of tumor resistance mechanisms continue, the role of radiation oncology is set to become even more pivotal. Addressing the global challenge of lethal cancers demands innovative strategies, particularly in minimizing the side effects associated with traditional chemotherapy and ionizing radiation (IR). Recently, there has been growing interest in natural compounds for radioprotection, aiming to prevent tumor development and metastasis. Piperine, a compound found in black and long pepper, has emerged as a promising chemopreventive agent that works effectively without harming normal cells. Mechanistically, piperine modulates key signaling pathways, inhibits cancer cell migration and invasion, and enhances sensitivity to IR. Combining piperine with radiotherapy offers a compelling approach, boosting treatment efficacy while protecting healthy tissues from radiation damage. Piperine's versatile role goes beyond radiosensitization to include radioprotection by inhibiting NF-κB activation, reducing autophagy, and promoting apoptosis in cancer cells. This dual action makes it a promising candidate for personalized cancer care. As research advances, the therapeutic potential of piperine may drive new frontiers in cancer treatment strategies.

Hadron therapy in radiation oncology and why BNCT is a paradigm shift

PurposeHadrons, i.e. particles that are heavier than electrons, are playing an increasingly important role in radiation oncology. Due to the high investment costs for the necessary infrastructure, this option is only available in specialized centers.MethodsThis article describes some of the physical properties that make hadrons attractive for external beam radiation therapy (EBRT), but also some of the challenges that need to be considered.ResultsThe importance of linear energy transfer for biological effects is discussed.ConclusionsIn addition to the use of charged particles, the importance of neutrons for radiotherapy is also highlighted, in particular the properties of boron neutron capture therapy (BNCT), which open up completely new possibilities for the further development of EBRT.

How Imaging Advances Are Defining the Future of Precision Radiation Therapy.

Radiation therapy is fundamental in the treatment of cancer. Imaging has always played a central role in radiation oncology. Integrating imaging technology into irradiation devices has increased the precision and accuracy of dose delivery and decreased the toxic effects of the treatment. Although CT has become the standard imaging modality in radiation therapy, the development of recently introduced next-generation imaging techniques has improved diagnostic and therapeutic decision making in radiation oncology. Functional and molecular imaging techniques, as well as other advanced imaging modalities such as SPECT, yield information about the anatomic and biologic characteristics of tumors for the radiation therapy workflow. In clinical practice, they can be useful for characterizing tumor phenotypes, delineating volumes, planning treatment, determining patients' prognoses, predicting toxic effects, assessing responses to therapy, and detecting tumor relapse. Next-generation imaging can enable personalization of radiation therapy based on a greater understanding of tumor biologic factors. It can be used to map tumor characteristics, such as metabolic pathways, vascularity, cellular proliferation, and hypoxia, that are known to define tumor phenotype. It can also be used to consider tumor heterogeneity by highlighting areas at risk for radiation resistance for focused biologic dose escalation, which can impact the radiation planning process and patient outcomes. The authors review the possible contributions of next-generation imaging to the treatment of patients undergoing radiation therapy. In addition, the possible roles of radio(geno)mics in radiation therapy, the limitations of these techniques, and hurdles in introducing them into clinical practice are discussed. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Design and Development of a Low-cost Integrated Dosimeter for External Beam Dosimetry in Radiation Oncology.

Radiation dosimeters play a crucial role in radiation oncology by accurately measuring radiation dose, ensuring precise and safe radiation therapy. This study presents the design and development of a low-cost printed circuit board (PCB) dosimeter and an integrated electrometer with sensitivity optimized for dose rates intended for use in megavoltage radiation therapy. The PCB dosimeter was designed in KiCad, and it uses a low-cost S5MC-13F general-purpose 1 kV 5A power diode as a radiation detector. The dosimeter is calibrated against a known dose derived from an ionization chamber and tested for dose linearity, dose rate dependence, field size dependence, and detector orientation dependence. The observed average dose differences between the delivered and measured doses for most measurements were found to be < 1.1%; the dose rate linearity between 100 MU/min and 1400 MU/min was found to be within 1.3%. This low-cost architecture could successfully be adapted further for a scalable, cost-effective dosimetry solution through firmware or circuit design.

Implementation of Standardized Lecture to Improve Radiation Oncology Knowledge in Multidisciplinary Lung Cancer Care Team: Initial Results of a Multi-Institutional Pilot Study

<h3>Purpose/Objective(s)</h3> Most lung cancer (LC) providers have had no exposure to radiation oncology (RO) in training and may not know when a patient should have RO consultation. Despite this, there is paucity of literature describing RO interdisciplinary educational initiatives in LC. In 2019, ASTRO began developing disease-site specific slide decks, the first of which was designed to teach the specialists about RO in management of LC. The deck has been downloaded over 1000 times since it was made public. The authors examined the feasibility of an introductory lecture using the slide deck and its impact on the providers' knowledge and practice. By understanding treatment modalities outside one's own, it is hoped that the providers can present a full spectrum of options needed for patient-centered decision-making. <h3>Materials/Methods</h3> Between November 2019 and May 2021, a total of 7 radiation oncologists offered lectures to attendings and fellows in pulmonology, thoracic surgery, and medical oncology at 8 academic institutions. Due to the pandemic, lectures were given both in-person as well as virtually. The participants were invited to take an anonymized pre-test online, consisting of demographics and 13 multiple choice questions about RO for LC. After the lectures, the attendees were asked to take a post-test identical to the pre-test, with two additional questions about knowledge gained, and comfort level in making appropriate referrals to RO. <h3>Results</h3> A total of 76 individuals completed the pre-test, and 25 completed the post-test. The vast majority of the participants have never had a RO rotation (86%), lecture (75%), or seen a LINAC (82%). The mean pre-test score was 53.5% (SD 17.6%), and the mean post-test score was 75.1% (SD 3.6%), (p<0.001). On the post-test, 12 participants(48.0%) reported feeling much more knowledgeable about the role of RO in LC treatment and 13 (52.0%) felt a little more knowledgeable. A total of 9 participants (36.0%) felt much more comfortable making appropriate referrals to RO after the lecture, whereas 15 (60.0%) felt a little more comfortable, and 1 (4.0%) felt not any more comfortable. The improvement in score and reported knowledge and comfort levels were similarly observed across all subspecialties and between attendings and fellows. <h3>Conclusion</h3> Introductory lecture on RO for LC given using a standard slide deck resulted in a statistically significant improvement in relevant knowledge of RO. Nearly all participants also reported improved comfort level in making appropriate referrals to RO. The current study demonstrates feasibility of implementing such lectures to multiple providers across various institutions even during a pandemic. An organized effort to provide such lectures at more institutions may result in more appropriate management and RO referral for LC patients, especially in practice settings where tumor board is not readily available.

Applications of artificial intelligence in radiophysics

Artificial intelligence (AI) is playing an important role in radiation oncology. One of the most important applications is in radiotherapy physics. In this field, it has improved the automation of radiotherapy plan design and quality control (QC), thereby promoting and ensuring individualized precision treatment. This article reviews the applications and research on AI in the physics of radiotherapy and projects the prospects of AI in the following aspects: radiotherapy plan design, radiotherapy quality assurance, and QC, organs at risk contouring, dose prediction, etc.

Radiation Oncology Alternative Payment Model and Large Urban Academic Centers: Future Implications for Patients and Providers.

The radiation oncology alternative payment model (RO-APM) was developed by the Center for Medicare and Medicaid Innovation, a part of the Centers for Medicare & Medicaid Services, as a vehicle to optimize value for patients undergoing radiation therapy. By shifting reimbursement away from fee-for-service and toward a prospective bundled payment system, the RO-APM is intended to bend the cost curve in radiation oncology while preserving or even enhancing outcomes. As with prior large-scale policy initiatives, the nature and magnitude of the RO-APM's impact on care delivery will vary substantially depending on a host of local factors, including practice setting. Urban academic centers play a key role in radiation oncology by spearheading innovation, managing the most complicated cases, training the next generation of radiation oncologists, and often caring for vulnerable patient populations. Thus, to protect patients' access to this high-quality cancer care, it will be crucial to characterize the RO-APM's projected impact on large urban academic institutions before its implementation, including possible unintended adverse consequences. Here, we provide an overview of this seismic change in radiation oncology reimbursement and discuss its unique potential implications for large urban academic institutions as a means to facilitate necessary preparations and inform future revisions to the model.

Using the Dosimetric Radiation Plan as a Teaching Tool for Early Trainees to Understand Radiation Toxicity

Radiation therapy (RT) has drastically advanced in the past several decades, leading to highly complex and personalized dosimetric treatment plans. Despite the importance of radiation treatment planning, medical students and residents/fellows in medical or surgical oncology-related fields have limited exposure to radiation therapy management and the role of radiation oncology in cancer care. 1 Saeed S. Undergraduate medical education and radiation oncology: Current concerns and effective initiatives. Appl Rad Oncol. 2018; 7: 21-25 Google Scholar Education literature suggests adult learners comprehend new topics in the context of prior experience. For many medical students and oncology-affiliated trainees, prior experiences with RT have involved clinical care for acute and late-term side effects of RT. Dosimetric RT plans are an accessible visual representation of an individualized treatment and may be a novel method to educate trainees about RT toxicity. We hypothesize that utilizing an RT plan module may improve understanding of acute and late RT toxicity and increased knowledge of radiation oncology decision-making in cancer care among medical students and oncology-affiliated early trainees.

Three-dimensional printing in radiation oncology: A systematic review of the literature.

Purpose/objectivesThree‐dimensional (3D) printing is recognized as an effective clinical and educational tool in procedurally intensive specialties. However, it has a nascent role in radiation oncology. The goal of this investigation is to clarify the extent to which 3D printing applications are currently being used in radiation oncology through a systematic review of the literature.Materials/methodsA search protocol was defined according to preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. Included articles were evaluated using parameters of interest including: year and country of publication, experimental design, sample size for clinical studies, radiation oncology topic, reported outcomes, and implementation barriers or safety concerns.ResultsOne hundred and three publications from 2012 to 2019 met inclusion criteria. The most commonly described 3D printing applications included quality assurance phantoms (26%), brachytherapy applicators (20%), bolus (17%), preclinical animal irradiation (10%), compensators (7%), and immobilization devices (5%). Most studies were preclinical feasibility studies (63%), with few clinical investigations such as case reports or series (13%) or cohort studies (11%). The most common applications evaluated within clinical settings included brachytherapy applicators (44%) and bolus (28%). Sample sizes for clinical investigations were small (median 10, range 1–42). A minority of articles described basic or translational research (11%) and workflow or cost evaluation studies (3%). The number of articles increased over time (P < 0.0001). While outcomes were heterogeneous, most studies reported successful implementation of accurate and cost‐effective 3D printing methods.ConclusionsThree‐dimensional printing is rapidly growing in radiation oncology and has been implemented effectively in a diverse array of applications. Although the number of 3D printing publications has steadily risen, the majority of current reports are preclinical in nature and the few clinical studies that do exist report on small sample sizes. Further dissemination of ongoing investigations describing the clinical application of developed 3D printing technologies in larger cohorts is warranted.

3D Printing in Radiation Oncology: A Systematic Review of the Literature

3D printing is an adaptable technology that is playing an increasing role in medical practice and innovation.Although 3D printing is gaining recognition as an effective clinical and educational tool in procedurally-intensive specialties, it has a nascent role in radiation oncology. The goal of this investigation, therefore, is to clarify the extent to which 3D printing applications are currently being used in radiation oncology through a systematic review of the literature. A search protocol was defined according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using the Population, Intervention, Control, Outcomes (PICO) framework for identification of eligible studies. Two independent reviewers searched PubMed with combinations of predetermined Medical Subject Headings and generic search terms. Any study using 3D printing technology in relation to the delivery or study of radiotherapy was included. In-press articles from radiation oncology and medical physics journals were searched. Article references were examined for identification of any remaining publications. Included articles were evaluated using parameters of interest including: year/country of publication, experimental design, sample size for clinical studies, radiation oncology topic, reported outcomes, and implementation barriers or safety concerns. 103 publications met inclusion criteria. The most commonly described 3D printing applications included quality assurance phantoms (26%), brachytherapy applicators (20%), bolus (17%), preclinical animal irradiation (10%), compensators (7%), and immobilization devices (5%). Most studies were pre-clinical feasibility studies (63%), with few clinical investigations such as case reports or series (13%) or cohort studies (11%). The most common applications evaluated in clinical studies included brachytherapy applicators (42%) and bolus (27%). Furthermore, sample sizes for clinical investigations were small (median 10, range 1-42). A minority of articles described basic or translational research (11%) and workflow or cost evaluation studies (3%). Number of articles increased yearly, as follows (P<0.0001): 2012 (1%), 2013 (0), 2014 (6%), 2015 (14%), 2016 (18%), 2017 (27%), 2018 (31%). While outcomes were varied, the majority of studies reported successful implementation of accurate and cost-effective 3D printing methods. 3D printing is rapidly growing in radiation oncology and has been implemented effectively in a diverse array of applications. Although the number of 3D printing publications has steadily risen, the majority of current reports are pre-clinical in nature and the few clinical studies that do exist report on small sample sizes. Further investigation describing the clinical application and evaluation of developed 3D printing technologies in larger cohorts is warranted.

The Role of Radiation Oncology in Immuno-Oncology.

Despite the promising efficacy of immunotherapy in some patients, many other patients are resistant. The synergistic effect of radiotherapy (RT) in combination with immunotherapy reported in case reports and clinical trials has piqued the interest of radiologists in investigating the underlying mechanisms and efficacy of the combination in preclinical and clinical trials. To date, the reported data are limited to small-sized samples, trials lacking a comparison arm, and trials using diverse immunotherapies, various radiation doses, and fractionations. There are just a few studies comparing the efficacy of immunotherapy and radiotherapy to that of conventional therapies or different combinations. Radiologists should design and conduct clinical trials wisely to confirm the efficacy of the combination, particularly the abscopal effect, identify the best combination of various immunotherapeutic drugs and different radiation models for patients, identify the best sequence of the combination, determine the optimal timing of the combination, select the target site and volume, lower adverse effects, and explore predictive models to identify patients who may benefit from the combination therapy. We expect that these clinical trials performed by radiologists will offer definitive evidence for the wide use of the combination of RT and immunotherapy in clinical practice. IMPLICATIONS FOR PRACTICE: This review will provide an update on the use of a combination of radiotherapy and immunotherapy, a cautious interpretation of preliminary results, and future directions for radiologists to perform well-designed clinical trials.

Prof. Stephen M. Hahn: the important role of radiation oncology in precision oncology

The 10th Shanghai International Conference on Radiation Oncology (SICRO) was held in Shanghai, from 10th to 11st August 2018, attracting many renowned scholars and specialists from all around the world to share new ideas and experience about the hottest issues in radiation oncology.

Comprehensive molecular tumor profiling in radiation oncology: How it could be used for precision medicine

New technologies enabling the analysis of various molecules, including DNA, RNA, proteins and small metabolites, can aid in understanding the complex molecular processes in cancer cells. In particular, for the use of novel targeted therapeutics, elucidation of the mechanisms leading to cell death or survival is crucial to eliminate tumor resistance and optimize therapeutic efficacy. While some techniques, such as genomic analysis for identifying specific gene mutations or epigenetic testing of promoter methylation, are already in clinical use, other “omics-based” assays are still evolving. Here, we provide an overview of the current status of molecular profiling methods, including promising research strategies, as well as possible challenges, and their emerging role in radiation oncology.

Simulation Training in Health Care: A Role in Radiation Oncology?

Simulation Training in Health Care: A Role in Radiation Oncology?

Changes in Radiotherapeutic Management of Head and Neck Cancer: A 30-Year Perspective

I count myself extremely privileged to have spent my professional life in an era of unprecedented growth in medical knowledge and technical capability, during which the practice of medicine has been revolutionized. It is against this backdrop that I reflect on the dramatic changes in the role of radiation oncology in the management of head-and-neck cancer since I first entered the field 30 years ago. Most of these changes have been for the better, although not all.

156 Gynaecologic HDR Interstitial Brachytherapy: The Role of Radiation Oncology Nursing in Multi-disciplinary Care

156 Gynaecologic HDR Interstitial Brachytherapy: The Role of Radiation Oncology Nursing in Multi-disciplinary Care

Why "Radiation Oncology"

Radiotherapy continues to be a major treatment for solid tumours and is a cornerstone of modern oncology. The term 'radiation oncology' describes the integration of radiation therapy into the complexity of multi-modal therapy. Over the last ten years the crucial role of radiation therapy as part of multi-modality protocols in cancer care has been documented in numerous Phase III trials. Advances in treatment technology as well as the underlying biology of tumour resistance mechanisms will further strengthen the role of radiation oncology. The scientific role of radiation oncology is reflected by the increase in the number of papers related to radiation oncology in resources like Medline. In order to reflect the growing scientific importance of radiation oncology, radiation physics and radiation biology, we have initiated Radiation Oncology as the first open access journal in the field. Open access allows for a rapid and transparent publication process together with an unequalled opportunity to reach the widest reader spectrum possible.

The Breast: Comprehensive Management of Benign and Malignant Diseases

The Breast: Comprehensive Management of Benign and Malignant Diseases

The nursing role in radiation oncology

To reflect on the historical evolution of radiation oncology nursing. Published articles and texts, historical archives of professional organizations, and the authors' experience. The radiation oncology nursing role is multifaceted. Role components include patient assessment, patient education, support and counseling, physical care, continuity of care, research, and administrative and leadership activities. There is wide variation in staffing patterns and role implementation throughout the world, and in recent years there has been increasing interest in the development of advanced practice nursing roles in this specialized area of oncology. Changes in the health care environment make it difficult to predict how the role of the nurse in radiation oncology will evolve in the future. Radiation oncology nurses will need to be proactive in developing the knowledge and skills needed to meet the challenges of the future.

The changing role of radiation oncology in cancer management.

Radiation oncologists have contributed greatly to the improved quality of care of the cancer patient; this has been shown repeatedly in various reports. The improvements in quality have been achieved because of a greater understanding of the natural history of cancer and a more critical evaluation of the results of clinical treatment. Increasing numbers of physicians involved in radiation oncology are participating in clinical evaluation and in multimodal programs of treatment. Major areas for future research in radiation oncology have been identified. The radiation oncologist is now a fully integrated member of the multidisciplinary cancer team participating in clinical treatment and in national cooperative clinical trials. The radiation oncologist's active participation in multidisciplinary clinical treatment programs is significantly changing the character of cancer management. Integration of new techniques of treatment, new combined programs, and greater emphasis on the efficacies of single treatment programs offer major opportunities to cure many cancers that were previously considered incurable.