Toxicity Of Radiotherapy Research Articles

Clinical study of radiotherapy combined with tegafur bolus synchronization in the treatment of inoperable elderly middle and advanced esophageal cancer.

460 Background: For patients with inoperable oesophageal cancer, simultaneous radiotherapy is the standard treatment option. However, elderly patients are often unable to tolerate CCRT, so a safe, effective and tolerable treatment option is needed. Tegafur, a derivative of 5-FU, has shown efficacy and safety in the treatment of oesophageal cancer. This clinical study evaluated the efficacy and toxicity of radiotherapy combined with a Tegafur bolus in elderly patients with oesophageal cancer. Methods: In this study, 62 patients with unresectable intermediate and advanced ESCC (stage IIA to IVA) between March 2022 and February 2024 were screened and divided into two groups: 32 in the experimental group (simultaneous radiotherapy and chemotherapy) and 30 in the control group (radiotherapy alone). The total radiotherapy dose was 50.4-64 Gy/5.6-6.4 wGy (1.8-2.0 Gy per fraction) in all cases, and the chemotherapy regimen: tegafur bolus (0.5 g, qd/bid, d1-14,q3w) was given from the first day of radiotherapy. The primary endpoint was near-term efficacy, and secondary endpoints included objective remission rate (ORR), disease control rate (DCR), T-cell subpopulation indices, and safety. Results: The CR, PR, SD and PD of radiotherapy combined with tegafur bolus synchronized treatment were 1 (3.1%), 17 (53.2%), 13 (40.6%) and 1 case (3.1%), respectively. The incidence of CR, PR, SD, and PD in the radiotherapy group was 0 (zero), 8 (26.7%), 19 (63.3%), and 3 (10%), respectively. The ORR of the simultaneous radiotherapy group and the control group were 56.3% and 26.7%(P=0.018), and the DCR of the two groups was 96.9% and 90% of the disease control rate of the patients in both groups (P=0.346). The results of univariate analysis showed that the influencing factor of ORR was the treatment regimen (P=0.018), and multivariate logistic regression analysis of variables with P<0.2 showed that the recent efficacy was correlated with the treatment regimen (P=0.039), and that the patients with radiotherapy synchronized with tigafluoroembolization chemotherapy had a better recent efficacy. After treatment, the levels of CD3 + , CD4 + , CD8 + , CD4 + /CD8 + were higher in the synchronized radiotherapy group than before treatment,CD3 + and CD8 + were higher in the control group than before treatment, and CD4 + and CD4 + /CD8 + were lower than before treatment. In terms of adverse reactions, the incidence of acute hematological toxicity (P=1), nausea and vomiting (P=1), radiation esophagitis (P=0.197), radiation pneumonitis (P=0.238), and esophageal fistula (P=0.613) were slightly increased in the simultaneous radiotherapy group compared with the control group. Conclusions: Radiotherapy synchronized with Tegafur suppositories is effective, with relatively mild side effects, convenient and safe for the treatment of inoperable advanced elderly patients with oesophageal cancer. Clinical trial information: ChiCTR2300073845.

Abstract B019: Mathematical modeling-based optimization of gamma knife surgery after checkpoint blockade in melanoma brain metastases

Abstract Gamma knife radiotherapy (RT) treatment is often used as a salvage therapy after progression of melanoma brain metastasis (MBM) lesions under immune checkpoint inhibitor (ICI) blockade therapy; however, waiting until progression of nonresponsive lesions can result in significant symptomatic progression, and the toxicity of RT is greater for larger lesions as it is directly proportional to lesion volume. Robust and reliable standards for consistently maximizing the benefit of combination ICI + RT therapy remain elusive, likely in part due to the complexity of mechanistic interactions between each therapy. Addressing this clinical need will require optimizing the effects of their reported synergistic interactions such as tumor microenvironment modulation and immune activation while mitigating inhibitory effects such as immunosuppressive radiation effects. The ability to identify lesions unlikely to respond to ICI shortly after start of treatment would offer immediate clinical benefit by enabling earlier RT delivery, reduce the volume-dependent toxicities of RT, and reduce symptoms from lesion progression. To address the unmet clinical need for methods to optimize outcomes of combination ICI and RT therapy, we have developed a mechanistic mathematical model based on the biological and physical underpinnings of these complex therapies, and their interactions, which is able to describe and quantify interactions between ICI and RT and their interactions on the tumor. This builds upon our previous ICI modeling work by expanding the model based on the assumption that therapeutic outcome is not only a result of direct interaction between the treatment and disease, but is also a result of complex interplay between heterogeneous tumor populations that may be sensitive or resistant to treatment and their unique interactions with the immune system that serve to maintain or disrupt the tumor-immune equilibrium. RT further modulates this tumor-immune dynamic both by killing T cells in the tumor interior and by stimulating release of T cell activating antigens which can alter T cell activation exterior to the tumor, thereby affecting T cell recruitment into the tumor. By capturing how the complex time-dependent dynamics of tumor-immune interaction and recruitment influences – and is influenced by – transient shifts in treatment sensitive and resistant populations, our model aims to describe and quantify long-term tumor dynamics after ICI + RT therapy. This platform provides a consistent framework for systematically evaluating various proposed mechanisms underlying treatment interactions and how these may determine treatment failure or success. By applying the model to a retrospective, in-house generated melanoma brain metastasis data set, we are examining and refining our model structure with a goal of capturing a wide range of observed tumor dynamics using only clinically available data. This may lead to robust, quantitative methods to maximize treatment outcomes based on the unique characteristics of individual tumors. Citation Format: Alexander R. J. Silalahi, Caroline Chung, James W. Welsh, Zhihui Wang, Joseph D. Butner. Mathematical modeling-based optimization of gamma knife surgery after checkpoint blockade in melanoma brain metastases. [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr B019.

Radiotherapy toxicities: mechanisms, management, and future directions.

For over a century, radiotherapy has revolutionised cancer treatment. Technological advancements aim to deliver high doses to tumours with increased precision while minimising off-target effects to organs at risk. Despite advancements such as image-guided, high-precision radiotherapy delivery, long-term toxic effects on healthy tissues remain a great clinical challenge. In this Review, we summarise common mechanisms driving acute and long-term side-effects and discuss monitoring strategies for radiotherapy survivors. We explore ways to mitigate toxic effects through novel technologies and proper patient selection and counselling. Additionally, we address policies and management strategies to minimise the severity and impact of toxicity during and after treatment. Finally, we examine the potential advantages of emerging technologies and innovative approaches to improve conformity, accuracy, and minimise off-target effects.

Individual Sensitivity for Radiotherapy-related Adverse Tissue Reactions in Patients Treated Twice for Metachronous Cancers.

The role of genetics in susceptibility to radiotherapy-induced toxicities is unclear. A strong impact of genetics should cause correlated toxicities in patients with metachronous double radiotherapy. We ascertained information about demographics, lifestyle, radiotherapy and early toxicities in irradiated tissues for a retrospective cohort of 98 patients from 2 hospitals who underwent two metachronous radiotherapeutic treatments (2007-2022) of different anatomical regions. European Organisation for Research and Treatment of Cancer/Radiation Therapy Oncology Group (EORTC/RTOG) toxicity scores per organ system were combined to a single mean score. We considered as genetic component the variation of toxicity not explained by radiation dose to the tumor, age at radiotherapy, sex, smoking status, and surgery. Variance components of toxicity were evaluated by ordinal logistic regression with random intercept. Common site combinations were breast/contralateral breast (N = 16), breast/endometrium (N = 6), and cervix/breast (N = 5). Mean toxicity over exposed tissues was 0.70 (range, 0-3). Prescribed radiation dose was significantly associated with mean toxicity, with a 5% (95% CI 3-8) increase of the odds for a higher toxicity level per Gy. Sex, surgery, age and smoking were not. There was no genetic contribution to risk of toxicities after adjustment. Toxicity levels were not more similar within patients than between patients, suggesting a negligible impact of genotype on radiotherapy-related toxicities.

A comparative analysis of toxicity and treatment outcomes of adaptive radiotherapy and intensity-modulated radiotherapy in cervical cancer

Adaptive radiotherapy (ART) provides greater benefits than intensity-modulated radiotherapy (IMRT) regarding dosimetric outcomes in patients with cervical cancer. To investigate the clinical benefits of ART, we have collected data from 115 cervical cancer patients who underwent radical radiotherapy at our institution. Fifty-nine patients received a single course of IMRT. Fifty-six patients underwent offline ART, defined as the reduction of the gross tumor volume (GTV) by at least 30% after 30 Gy of radiotherapy, followed by a modified treatment plan for the second-stage. After treatment, 53 patients of ART group achieved a partial response (PR) or completement response (CR), resulting in an objective response rate (ORR) of 94.6% for the ART group, compared to 93.2% for the IMRT group. Patients in both groups exhibited no significant differences in acute toxicities. However, the incidence of chronic constipation was significantly higher in the IMRT group compared to the ART group (p = 0.021). With a median follow-up time of 27 months, the ART group experienced a higher mortality (10/56) than the IMRT group (6/59). However, the difference between the two groups was not statistically significant. In summary, ART may be advantageous in reducing the incidence of chronic constipation among patients with locally advanced cervical cancer, and both clinical prognosis and near-term survival are satisfactory.

Predicting acute and late toxicity in prostate cancer stereotactic ablative radiotherapy: the role of dosimetric parameters and prostate volume.

Our objective was to identify the dosimetric parameters and prostate volume that most accurately predict the incidence of acute and late gastrointestinal (GI) and genitourinary (GU) toxicity in prostate cancer stereotactic ablative radiotherapy (SABR) treatments. We conducted aretrospective analysis of 122 patients who received SABR for prostate cancer at our clinic between March 2018 and September 2022 using afive-fraction SABR regimen. The existing plans of these patients were re-evaluated according to our institutional protocols (Hacettepe University [HU-1] and HU-2) as well as PACE‑B, RTOG 0938, and NRG GU005 dose-volume constraints. Univariate and multivariate logistic regression analyses were performed using SPSS version 23.0 (IBM, Armonk, NY, USA). The median follow-up was 24.7 months (0.8-94.4 months). For acute GU toxicity, moderate-dose regions were predictive for grade1-2 toxicity, while high-dose regions were more associated with grade3-4 toxicity. For late GU toxicity, moderate-high-dose regions were predictive. For GI toxicity, moderate-dose regions were important for both acute and late toxicity. The HU protocol encompassed all significant dosimetric factors influencing toxicity outcomes. Aprostate volume threshold of 60 cc was predictive of acute grade3-4 GU toxicity. Our study highlighted the critical role of moderate-dose regions for acute and late GI and GU toxicity. Prostate treatment plans should be rigorously evaluated, and moderate doses should be minimized. The HU protocol is an eligible choice for five-fraction SABR plans.

Association of radiation-induced normal tissue toxicity with a high genetic risk for rheumatoid arthritis.

Overlapping genes are involved with rheumatoid arthritis (RA) and DNA repair pathways. Therefore, we hypothesised that patients with a high polygenic risk score (PRS) for RA will have an increased risk of radiotherapy (RT) toxicity given the involvement of DNA repair. Primary analysis was performed on 1494 prostate cancer, 483 lung cancer and 1820 breast cancer patients assessed for development of RT toxicity in the REQUITE study. Validation cohorts were available from the Radiogenomics Consortium. All patients had undergone curative-intent radiotherapy and were assessed prospectively for toxicity. Germline genomic data was available for all patients, allowing a PRS to be calculated using 101 RA risk variants. PRS was analysed as a continuous variable and with >90th percentile cut-off. Associations with acute and late standardised total average toxicity (STAT) scores and individual toxicity end-points were analysed in multivariable models with preselected adjustment variables. Increasing PRS for RA did not increase the risk of acute or late STAT in any cohort. There was an increased risk of late oesophagitis in the lung cancer cohort (coefficient 0.018, p = .01), however this was not validated (p = .79). No individual acute or late toxicity endpoints were significantly associated with PRS for the prostate or breast cohorts. No significant results were found in the validation cohorts in multivariable models. Patients with a high genetic risk for RA do not show increased levels of toxicity after radiotherapy suggesting treatment planning does not need to be modified for such patients.

Investigation of Genetic Polymorphisms Related GSTM1, GSTT1, GSTP1 Genes and their Association with Radiotherapy Toxicity among Head and Neck Cancer Patients.

In this study we explored the association of polymorphisms of glutathione s transferase gene including GSTM1, GSTT1 and GSTP1 with adverse acute normal tissue reactions resulted from radiotherapy in HNC patients. We assessed the association of GSTM1 and GSTT1 null genotypes and Ile105Val of exon-5 and Ala114Val of exon-6 of GSTP1 gene polymorphisms with the risk of acute skin toxicity reactions after therapeutic radiotherapy in HNC patients. Four hundred HNC patients administered with Intensity modulated radiation therapy were enrolled in this study for the evaluation of radiotherapy associated toxicity reactions. The genotyping of GSTM1 and GSTT1 were performed by polymerase chain reaction (PCR). The GSTP1 Ile/Val of exon-5 and Ala/Val of exon-6 polymorphism was determined by PCR followed by restriction fragment length polymorphism (PCR-RFLP). The univariate logistic regression analysis showed that GSTM1 and GSTT1 null genotypes were not associated with either skin reaction or oral mucositis in response to radiotherapy induced after effects. When we studied, A313G polymorphism at exon 5 and C341T polymorphism at exon 6 of GSTP1 gene, majority of genotypes were wild type A/A genotype for exon 5 showed non-significant association with Skin reactions whereas, C/T genotype of exon-6 showed significant negative association with skin reactions. The findings obtained from this study concluded that the null genotypes of GSTM1 and GSTT1 gene polymorphisms showed no association with radiotherapy induced acute toxicities such as dermatitis and oral mucositis. The results indicated negative association of heterozygous C/T genotype of exon-6 of GSTP1 with acute skin reactions.

Machine Learning Models Using Extended Clinical Variables to Predict Real-World Head and Neck Cancer Radiotherapy Toxicity

Machine Learning Models Using Extended Clinical Variables to Predict Real-World Head and Neck Cancer Radiotherapy Toxicity

Dose to cardiac substructures and cardiovascular events in esophageal cancer patients treated with definitive radiotherapy

IntroductionWhile there is a growing amount of data on the cardiac toxicity of radiotherapy (RT) in relation to its impact on cardiac sub-structures (CSS), there are only few studies addressing this issue in patients followed for esophageal cancer (ESOC). We aimed to evaluate the association between independent parameters of dose received by CSS and major cardiac events (MACEs) in this population.Materials and methodsWe retrospectively analyzed 122 patients treated with exclusive RT or chemo-RT for ESOC. Heart and CSS i.e. right atrium, left atrium (LA), right ventricle, left ventricle and myocardium, have been automatically segmented, and dose volume histogram were extracted. Cardiac events were collected focusing on the occurrence of MACEs of grade 3 or higher (G3+) and grade 4 or higher (G4+) according to the CTCAE v5.0.ResultsWith a median follow-up of 21.9 months and in a population of high to very high cardiovascular risk (95.5%), 21 (17.2%) and 9 (7.4%) patients had G3 + and G4 + MACEs with a respective median time to event of 13.05 and 9.8 months. After multivariate analysis and among all heart and CSS-based dosimetric features, only the volume of LA receiving 15 Gy or more (V15LA) remained significantly associated with the G3 + and G4 + MACEs. The use of volumetric modulated arctherapy significantly reduced V15LA compared with 3D conformal RT.ConclusionIn a cohort of ESOC patients treated with exclusive RT, incidence of MACEs was associated with V15LA, underlining the importance of CSS. These high cardiovascular (CV) risk patients should benefit from standard CV assessment and strict control of their risk factors.

Stereotactic ablative radiotherapy for pulmonary metastasis from sarcoma: a retrospective comparison with metastasectomy.

Recent studies report excellent local control (LC) and favorable toxicities of stereotactic ablative radiotherapy (SABR) for pulmonary metastasis (PM) from sarcoma. This study compared the LC and survival of SABR and metastasectomy for sarcoma PM. We analyzed the LC rates of 54 PMs treated with SABR between 2008 and 2022. For survival analysis, we compared 14 patients who received SABR as first-line treatment with 61 patients who underwent metastatectomy. For SABR-treated PMs, a median total dose of 55Gy (range, 48-60) was administered over 3-10 fractions. Median follow-up for LC in SABR-treated PMs was 19.2months (range, 0.8-124.0), and the 2-year LC rate was 92.2%. No patients experienced toxicities of grade 3 or higher. The median age of the patients in the survival analysis was 73years (range, 42-83) in the SABR group and 54years (range, 19-78) in the metastasectomy group (p < 0.001). PMs in the "gray zone" were more common in the SABR group (35.7%) than in the metastasectomy group (8.2%) (p = 0.029). The median follow-up for survival analysis was 44.8months (interquartile range, 21.5-66.4). The 3-year rates of LC and overall survival were 92.3% and 57.3% in the SABR group and 89.2% and 75.9% in the metastasectomy group (p = 0.807, 0.224), respectively. The out-of-field intrapulmonary failure-free survival and extrapulmonary systemic failure-free survival rates at 3years were not significantly different (p = 0.673, 0.386). SABR for sarcoma PM demonstrated excellent LC with acceptable toxicity. Survival rates of SABR were comparable to those of metastasectomy.

Outcome and toxicities of postmastectomy radiotherapy with integral cervicothoracic thermoplastic mask

BackgroundAppropriate immobilization setup for postmastectomy radiotherapy may help to improve tumor control and to reduce radiation-related toxicities. This study aims at retrospectively evaluate the outcome and toxicities of postmastectomy radiotherapy (PMRT) with a novel integral cervicothoracic thermoplastic mask strategy.MethodsBreast cancer patients were treated with modified radical mastectomy and PMRT. Patient immobilization setup was performed with the placement of a 1-cm thickened wax film on the ipsilateral chest wall and an integral cervicothoracic thermoplastic mask. PMRT was delivered according to the institutional protocol. Dose distribution, disease control, patient survival and radiation-induced toxicities were evaluated.ResultsFour-hundred nineteen eligible patients with complete follow-up information were included in the final analysis. The median follow-up was 40.2 (95%CI: 38.9–41.6) months. Two (0.5%) patients had local recurrence and 48 (11.4%) patients had distant metastasis. There were 22 (5.3%) deaths from all causes, of which 19 were caused by breast cancer. The 3-year overall survival (OS) rate was 94.8%. ER status, PR status, triple negative status, and T stages were significantly related to patient survival (p < 0.05). HER2 expression, N stage were not significantly related to patient survival. Most common radiation-induced toxicities included grade I (87.6%) and grade II (10.2%) dermatitis, and grade I pneumonitis (28.9%) found by chest X-ray or CT scans. No clinical detectable cardiovascular event related to radiotherapy was identified.ConclusionPostmastectomy radiotherapy with integral cervicothoracic thermoplastic mask leads to favorable outcome and moderate toxicities compared with results reported in literature and might be of clinical significance in breast cancer patient. However, this approach has not been compared directly with postmastectomy radiotherapy without immobilization, and its applicability in other regions with different treatment protocols requires further investigation.

Artificial Intelligence and Statistical Models for the Prediction of Radiotherapy Toxicity in Prostate Cancer: A Systematic Review

Background: Prostate cancer (PCa) is the second most common cancer in men, and radiotherapy (RT) is one of the main treatment options. Although effective, RT can cause toxic side effects. The accurate prediction of dosimetric parameters, enhanced by advanced technologies and AI-based predictive models, is crucial to optimize treatments and reduce toxicity risks. This study aims to explore current methodologies for predictive dosimetric parameters associated with RT toxicity in PCa patients, analyzing both traditional techniques and recent innovations. Methods: A systematic review was conducted using the PubMed, Scopus, and Medline databases to identify dosimetric predictive parameters for RT in prostate cancer. Studies published from 1987 to April 2024 were included, focusing on predictive models, dosimetric data, and AI techniques. Data extraction covered study details, methodology, predictive models, and results, with an emphasis on identifying trends and gaps in the research. Results: After removing duplicate manuscripts, 354 articles were identified from three databases, with 49 shortlisted for in-depth analysis. Of these, 27 met the inclusion criteria. Most studies utilized logistic regression models to analyze correlations between dosimetric parameters and toxicity, with the accuracy assessed by the area under the curve (AUC). The dosimetric parameter studies included Vdose, Dmax, and Dmean for the rectum, anal canal, bowel, and bladder. The evaluated toxicities were genitourinary, hematological, and gastrointestinal. Conclusions: Understanding dosimetric parameters, such as DVH, Dmax, and Dmean, is crucial for optimizing RT and predicting toxicity. Enhanced predictive accuracy improves treatment effectiveness and reduces side effects, ultimately improving patients’ quality of life. Emerging artificial intelligence and machine learning technologies offer the potential to further refine RT in PCa by analyzing complex data, and enabling more personalized treatment approaches.

Frailty and Overall Survival of Older Patients Undergoing Radiotherapy for Head and Neck Cancer: A Prospective Analysis.

Over 60% of diagnoses of head and neck squamous cell carcinoma (HNSCC) occur in patients aged over 65. The benefits of radiotherapy (RT) combined with chemotherapy remain controversial in geriatric patients. Frailty stratification is underutilized in clinical practice despite evidence suggesting its predictive power. We aimed to assess the impact of pre-treatment frailty stratification on overall survival (OS) and acute radiation-related toxicity in a cohort of older patients with HNSCC. A prospective cohort of 117 patients aged ≥65 years with newly diagnosed HNSCC was enrolled between 2017 and 2022. Patients received RT with or without chemotherapy. Frailty was assessed using the 40-item Frailty Index (FI) as part of a comprehensive geriatric assessment. The primary outcomes were OS and acute RT toxicity, defined as a grade ≥ 3 based on CTCAE 5.0. Cox proportional hazard models and logistic regression models, adjusted for age, tumor stage, and chemotherapy, were used. After a median follow-up of 819 days, FI (HR 1.478, 95% CI 1.182-1.848, p < 0.001) was an independent predictor of OS. Grade ≥ 3 toxicities were observed in 38% of patients, but frailty was not significantly associated with toxicity. A sub-analysis of oropharyngeal carcinoma patients demonstrated improved OS in HPV-positive patients (HR 0.231, 95% CI 0.078-0.686, p = 0.008). the standardized introduction of frailty assessment in the evaluation of older HNSCC patients holds great promise for predicting long-term survival. This approach could be crucial in tailoring treatment protocols that account for the biological heterogeneity of older adults.

The Influence of the Microbiome on the Complications of Radiotherapy and Its Effectiveness in Patients with Laryngeal Cancer.

Radiotherapy is an effective method of treating cancer and affects 50% of patients. Intensity-modulated radiotherapy (IMRT) is a modernized method of classical radiation used in the treatment of laryngeal cancer. Treatment with intent to preserve the larynx is not always safe or complication-free. The microbiome may significantly influence the effectiveness of oncological treatment, especially radiotherapy, and may also be modified by the toxic response to radiation. The aim of the study was to prospectively assess the microbiome and its influence on radiotherapy toxicity in patients with laryngeal cancer. Statistically significant risk factors for complications after radiotherapy were the percentage of Porphyromonas of at least 6.7%, the percentage of Fusobacterium of at least 2.6% and the percentage of Catonella of at least 2.6%. The importance of the microbiome in oncology has been confirmed in many studies. Effective radiotherapy treatment and the prevention of radiation-induced oral mucositis is a challenge in oncology. The microbiome may be an important part of personalized cancer treatment. The assessment of the microbiome of patients diagnosed with cancer may provide the opportunity to predict the response to treatment and its effectiveness. The influence of the microbiome may be important in predicting the risk group for radiotherapy treatment failure. The possibility of modifying the microbiome may become a goal to improve the prognosis of patients with laryngeal cancer. Fusobacterium, Porphyromonas and Catonella are important risk factors for radiation-induced oral mucositis in patients with laryngeal cancer.

Pt loaded CoFe2O4-based nanoparticles for breast cancer treatment with chemodynamic therapy and sonodynamic therapy

Breast cancer is one of the most widespread cancers worldwide in the female population. However, the side effects and toxicity of chemotherapy and radiotherapy are the obstacles to the treatment of breast cancer. Therefore, we developed a Pt loaded CoFe2O4-based nanoparticles (CF@Pt) for breast cancer treatment with chemodynamic therapy (CDT) and sonodynamic therapy (SDT). The Co2+/Co3+ and Fe2+/Fe3+ gave CF@Pt peroxidase-like activity and catalase activity to gain ·OH and O2 in the tumor microenvironment (TME) for CDT. Furthermore, the separation of electron-hole pairs of CF@Pt transferred the O2 into 1O2 in the presence of ultrasound (US) for SDT. The high level of O2 generated by CDT would produce more 1O2 by SDT that promoted the CDT efficiency. Moreover, the addition of Pt limited the recombination of electron-hole pairs and reduced the energy gap to enhance SDT/CDT combination therapy. In addition, CF@Pt could be engulfed by MDA-MB-231 cells and induced the apoptosis while it had good biocompatibility and blood compatibility. This design provided a novel application on the treatment of breast cancer.

Patient Perceptions of Radiation Therapy Prior to Initial Consultation With a Radiation Oncologist

PurposeThere are currently limited data regarding patient perceptions and fears related to radiation therapy (RT). This study sought to identify and quantify patient concerns regarding RT and to determine the potential value of assessing these expectations prior to initial consultation. MethodsPatients with no prior history of RT were invited to complete an investigator-developed anonymous electronic survey prior to consultation. Patients were queried about their perceptions of RT and potential fears/concerns. The content validity index for survey items were scored with adequate construct validity. Survey items were scored descriptively through summary statistics. Relationships between respondent variables and responses to survey questions were analyzed by univariate and multivariate logistic regression. ResultsFrom September 2020 through June 2022, 214 patients completed the survey and were included in the analysis. Fifty percent of respondents reported a complete lack of knowledge regarding RT. Twenty-seven percent of patients reported that RT is their most worrisome cancer treatment, compared to chemotherapy or surgery. The most common self-reported fears of RT included general side effects, skin burns, not knowing what to expect regarding RT, pain, and organ damage. The most frequently reported concerns of physical side effects of RT included pain (67%), memory loss (62%), nausea/vomiting (60%), and skin reactions (58%). Sixty-two percent of respondents reported being either moderately or very concerned about their ability to perform daily activities. Thirty-six percent of respondents reported at least moderate concern over the financial cost of RT. Twenty-six percent of respondents reported at least moderate concern regarding transportation to RT. Forty-eight percent of respondents reported concern about emitting radiation to others. ConclusionsPatient concerns related to RT toxicities and impact on daily life were common, as were misconceptions of RT. Pre-consultation assessment of patient expectations regarding RT is feasible and may be helpful in addressing patients concerns early and in real-time.

Evaluation of the thyroid and hypothyroid function after postoperative radiation therapy among breast cancer patients.

The current advances in radiotherapy (RT) have improved the outcome of breast cancer (BC) patients. Despite its therapeutic benefits, the iatrogenic toxicities of RT and its impact on BC survivors are still debated, and further evaluations should be considered. This study aims to assess the rate of subclinical hypothyroidism and hypoparathyroidism among BC patients who were exposed to therapeutic radiation. Seventy females undergoing RT for BC were enrolled in this cross-sectional study. Laboratory assessment of thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels was obtained to evaluate thyroid function. The parathyroid function was evaluated by measuring serum levels of Calcium (Ca), Phosphorus (P), and parathyroid hormone (PTH) at baseline, six and 12 months after RT. The mean age of patients was 54.3±6.4 years. We found no cases of hypothyroidism before radiotherapy. However, nine patients developed hypothyroidism in the six months after radiotherapy (one clinical and eight subclinical, 13% in total), and six patients were identified with hypothyroidism in the 12 months after radiotherapy (one clinical and five subclinical, 8.7% in total). Significant relationships were observed in the hypothyroidism rate at both six months (p = 0.003) and 12 months (p = 0.028) after RT compared with the baseline. There was no case of hypoparathyroidism before and after RT. In summary, we found that thyroid and parathyroid dysfunction after RT are relatively common findings among women with BC. It is a treatable source of morbidity in patients undergoing RT. Therefore, routine thyroid function monitoring should be recommended to improve the quality of life in BC survivors.

Bridging the care gap: radiation therapy in elderly and frail cancer patients.

This review aims to address the gap in radiation therapy (RT) care for elderly cancer patients. It will discuss the barriers to implementing effective RT in elderly and frail patients with a focus on breast cancer and metastatic settings. Recent studies indicate that SBRT provides better pain control for bone metastases compared to cEBRT, but elderly patients are underrepresented in these trials. Evidence on the effectiveness of geriatric assessment tools in predicting RT tolerance and toxicity is mixed, with some studies showing a correlation while others do not. Comprehensive geriatric assessments, though promising, are often impractical due to time and resource constraints. There is a critical need for more inclusive research to better understand the risks and benefits of RT in elderly patients. Developing streamlined geriatric assessment tools and integrating them into clinical practice can enhance treatment personalization. Future studies should prioritize elderly populations to generate robust data, thereby improving RT outcomes and quality of life for this growing patient group.

Neoadjuvant Radiotherapy and Endocrine Therapy for Oestrogen Receptor Positive Breast Cancers: The Neo-RT Feasibility Study

AimsTo establish the safety and feasibility of delivering neoadjuvant radiotherapy and endocrine therapy for oestrogen receptor-positive breast cancers with palpable size 20mm or greater, for which radiotherapy might facilitate more conservative surgery. Materials and methodsA single-arm feasibility study was conducted. Patients received whole breast radiotherapy with or without radiotherapy to nodal areas. Dose/fractionation was 40Gy in 15 fractions over 3 weeks, with or without either a simultaneous integrated boost to 48Gy or sequential boost to the tumour bed. This was followed by endocrine treatment for 20 weeks, then surgery. The primary endpoint of the study was the proportion of patients successfully completing neoadjuvant radiotherapy and endocrine treatment followed by breast surgery. Response and toxicity endpoints including mastectomy rate, peri/postoperative complications, and pathological response were also evaluated.The primary analysis is descriptive. The study regimen would be considered feasible if more than 70% of patients completed treatment, while it might not be considered feasible if less than 50% did so. With a one-sided 5% significance level and 80% power, a maximum of 43 patients would be required to detect a rate of ≤50% vs ≥70%. Results14 patients were recruited out of the planned 43. Due to slow recruitment, particularly during the COVID-19 pandemic, the decision was made to stop the trial in October 2021. One registered patient was found to be ineligible before starting treatment. 13/13 patients (100%, 90% CI: 75.3%, 100%) who received any trial treatment successfully completed all trial treatments. The lower bound of the Clopper-Pearson (exact) 90% confidence interval was 79%, indicating that the primary endpoint would have been met if the planned recruitment had been achieved. 3/13 patients underwent mastectomy. 7/13 had more conservative surgery than had been planned at baseline. 4/13 patients experienced any peri/postoperative complication. The only acute radiotherapy toxicities reported were grade 1/2 dermatitis and grade 1 fatigue. Long-term breast outcomes were clinician assessed as none/mild at all timepoints in 12/13 patients. All tumours showed evidence of some pathological response to treatment, but none had a pathological complete response. ConclusionThis treatment schedule is likely feasible. It is difficult to draw strong conclusions on safety/toxicity given the small numbers, but these seem in keeping with other recent reports of neoadjuvant breast radiotherapy.