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Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• Angiosarcoma presents unique challenges in clinical management of localized disease, due to its rarity and aggressiveness. • Dedicated clinical recommendations for angiosarcoma are currently lacking despite the applicability of ESMO guidelines. • The Italian Sarcoma Group, together with patient's advocates from "Sofia nel Cuore Onlus", convened to develop specific recommendations, aiming to standardize and harmonize clinical practices for localized angiosarcoma management. Angiosarcoma (AS) represents a rare and aggressive vascular sarcoma, posing distinct challenges in clinical management compared to other sarcomas. While the current European Society of Medical Oncology (ESMO) clinical practice guidelines for sarcoma treatment are applicable to AS, its unique aggressiveness and diverse tumor presentations necessitate dedicated and detailed clinical recommendations, which are currently lacking. Notably, considerations regarding surgical extent, radiation therapy (RT), and neoadjuvant/adjuvant chemotherapy vary significantly in localized disease, depending on each different site of onset. Indeed, AS are one of the sarcoma types most sensitive to cytotoxic chemotherapy. Despite this, uncertainties persist regarding optimal management across different clinical presentations, highlighting the need for further investigation through clinical trials. The Italian Sarcoma Group (ISG) organized a consensus meeting on April 1st, 2023, in Castel San Pietro, Italy, bringing together Italian sarcoma experts from several disciplines and patient representatives from "Sofia nel Cuore Onlus" and the ISG patient advocacy working group. The objective was to develop specific clinical recommendations for managing localized AS within the existing framework of sarcoma clinical practice guidelines, accounting for potential practice variations among ISG institutions. The aim was to try to standardize and harmonize clinical practices, or at least highlight the open questions in the local management of the disease, to define the best evidence-based practice for the optimal approach of localized AS and generate the recommendations presented herein. [ABSTRACT FROM AUTHOR]

Tubarial glands, Salivary glands, Radiation toxicity, Radiotherapy, Head and neck cancer, PSMA PET/CT The tubarial glands paper: A starting point. A reply to comments. [Extracted from the article]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• Ablative radiotherapy is an effective treatment for oligometastatic prostate cancer. • The lack of randomized phase III trials hampers the generalization of this therapy. • In clinical practice, ablative radiotherapy should be adopted in some cases only. • This position paper explores available literature and proposes some recommendations. Oligometastatic prostate cancer comprises a wide spectrum of conditions, ranging from de novo oligometastatic cancer at diagnosis to oligometastatic castration-resistant disease, which are distinct entities in terms of biology and prognosis. In order to clarify and standardize the clinical role of ablative radiotherapy in oligometastatic prostate cancer, the Italian Association of Radiotherapy and Clinical Oncology (AIRO) formed an expert panel to review the current literature and develop a formal consensus. Oligometastatic prostate cancer was defined as the presence of up to three metastatic lesions involving bones or nodes outside pelvis. Thereafter, four clinical scenarios were explored: metastatic castration-sensitive disease at diagnosis and after primary treatment, and metastatic castration-resistant disease at diagnosis and during treatment, where the role of ablative radiotherapy was defined either in conjunction with systemic therapy or as the only treatment in selected cases. This paper summarizes the current literature about these issues and the proposed recommendations. [ABSTRACT FROM AUTHOR]

Radiotherapy is an effective and complex treatment modality for the ablation of malignant tumors. Despite several technological advances, precise determination of the radiation dose delivered to the tumor and its neighbouring healthy tissues remains a challenge. This work focuses on the synthesis and characterisation of a symmetrically substituted diacetylene which is coated on a paper to function as a radiochromic film. The paper-based film exhibits distinct color change from white to varying shades of blue from the 0.5–20 Gy dose range administered in radiotherapy. The difference in the color intensity of the radiochromic film is used as a quantitative indicator of the radiation dose delivered. A comprehensive evaluation of general optical characteristics, dosimetric properties and stability of the dose response is performed. The prepared film is tissue-equivalent with weak dependence on dosimetric parameters like energy, dose rate and dose accumulation. It can be stored under normal room conditions as the influence of variation in temperature, light intensity and post irradiation time was found to be <2%. The uncertainty in the dose response based on the calibration curve was found to be 2.74%. The therapeutic range of radiation dose detection, facile fabrication and implementation of this radiochromic film can be potentially translated into different radiotherapy clinical applications. • Preparation of paper based radiochromic dosimeter. • Color change from white to blue in 0.5–20 Gy therapeutic dose range. • Analysis of spectral, structural and morphology characteristics. • Evaluation of general dosimetric properties of the prepared radiochromic film. • Water penetration, environmental and post irradiation stability of the fabricated radiochromic dosimeter. [ABSTRACT FROM AUTHOR]

Abstract: The incidence of Cholangiocellular carcinoma (CCA) is increasing, due to a sharp increase of the intra-hepatic form. Evidence-ascertained risk factors for CCA are primary sclerosing cholangitis, Opistorchis viverrini infection, Caroli disease, congenital choledocal cist, Vater ampulla adenoma, bile duct adenoma and intra-hepatic lithiasis. Obesity, diabetes, smoking, abnormal biliary-pancreatic junction, bilio-enteric surgery, and viral cirrhosis are emerging risk factors, but their role still needs to be validated. Patients with primary sclerosing cholangitis should undergo surveillance, even though a survival benefit has not been clearly demonstrated. CCA is most often diagnosed in an advanced stage, when therapeutic options are limited to palliation. Diagnosis of the tumor is often difficult and multiple imaging techniques should be used, particularly for staging. Surgery is the standard of care for resectable CCA, whilst liver transplantation should be considered only in experimental settings. Metal stenting is the standard of care in inoperable patients with an expected survival >4 months. Gemcitabine or platinum analogues are recommended in advanced CCA whilst there are no validated neo-adjuvant treatments or second-line chemotherapies. Even though promising results have been obtained in CCA with radiotherapy, further randomized controlled trials are needed. [ABSTRACT FROM AUTHOR]

Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper. [ABSTRACT FROM AUTHOR]

Abstract Background Vascularized fibular flaps are considered the gold standard for the reconstruction of segmental defects in the mandible. This review compares the complication and success rates of these techniques between primary and secondary reconstruction, as well as between lateral and antero-lateral defects. Type of studies reviewed A systematic review and meta-analysis were conducted according to PRISMA protocol and the Cochrane Handbook for Systematic Reviews of Interventions. The authors performed an independent comprehensive search using PubMed, Ovid MEDLINE, Web of Science, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and COS Conference Papers Index according to established inclusion and exclusion criteria. The methodological index for nonrandomized studies (MINORS) was used to assess the quality of the included studies. Meta-analysis was conducted to compare the type of reconstruction and location of the defect. Results Seventy-eight studies, involving 2461 patients, were eligible. 83.7% of the included patient received primary reconstruction with vascularized fibular flap. The overall flap success rate was 93%. There was improvement in MINORS quality score over time with positive correlation with the publication year (r = 0.5549, P < 0.0001, CI 0.3693 to 0.6979). Meta-analysis indicated no significant association in flap success between primary and secondary reconstruction, or lateral and antero-lateral defects. Conclusion Based on the available studies, this review found no evidence of difference in success or complication rates between primary and secondary reconstruction or between lateral and anterolateral defects. High-quality clinical studies are required to analyze the outcome of these techniques, especially regarding the impact of chemotherapy, radiation therapy, implant-supported dental prostheses, and preoperative planning, on the outcome of reconstruction. [ABSTRACT FROM AUTHOR]

Abstract: Several authors have suggested that low level laser light may have a positive influence on side effects caused by ionizing radiation therapy. We therefore studied indicators of oxidative stress after exposure to gamma radiation with or without pre-exposure to low level laser light. Groups of mice were exposed to light from a laser diode at a wavelength of 830nm, delivering an energy of 20 or 100J to 1cm2 in the abdominal part of the animal with a power density of 300mW/cm2 in continuous regime. Following this treatment (or sham irradiation), mice were irradiated with graded doses of 60Co gamma rays. Levels of superoxide dismutase and malondialdehyde were measured in murine blood cells 30min or 3days after exposure. For both time points, there was a clear increase of superoxide dismutase and malondialdehyde with gamma dose, but laser light (alone or in combination with gamma irradiation) did not seem to have any influence on either parameter. Because the physical parameters in our experiments were similar to those of studies showing a positive effect of laser pre-exposure, we conclude that the lack of an observed effect in our case was due to differences in biological parameters, i.e. to differences between the tissues or cell types studied. It is also possible, of course, that laser effects would be seen mainly in the skin immediately exposed, and not to the same degree in blood cells circulating through that area, which were exposed to considerably smaller laser energies. [Copyright &y& Elsevier]

Patients' understanding of radiation therapy (RT) and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. We aimed to evaluate PE practices of radiation oncologists and interprofessional RT care team members to inform recommendations for delivering inclusive and accessible PE. An anonymous survey was administered to all Radiation Oncology Education Collaborative Study Group members (10/5/22-11/23/22). Respondent demographics, individual practices/preferences, and institutional practices were collected. Qualitative items explored strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. The Fisher exact test compared PE practices by respondent role and PE timing. Thematic analysis was used for qualitative responses. One hundred thirteen Radiation Oncology Education Collaborative Study Group members completed the survey (28.2% response rate); RO attendings comprised 68.1% of respondents. Most practiced in an academic setting (85.8%) in North America (80.5%). Institution-specific materials were the most common PE resource used by radiation oncologists (67.6%). Almost half (40.2%) reported that their PE practices differed based on clinical encounter type, with paper handouts commonly used for in-person and multimedia for telehealth visits. Only 57.7% reported access to non-English PE materials. PE practices among radiation oncologists differed according to RT clinical workflow timing (consultation versus simulation versus first RT, respectively): one-on-one teaching: 88.5% versus 49.4% versus 56.3%, P <.01, and paper handouts: 69.0% versus 28.7% versus 16.1%, P <.01. Identified challenges for PE delivery included limited time, administrative barriers to the development or implementation of new materials or practices, and a lack of customized resources for tailored PE. Effective strategies for PE included utilization of visual diagrams, multimedia, and innovative education techniques to personalize PE delivery/resources for a diverse patient population, as well as fostering interprofessional collaboration to reinforce educational content. Radiation oncologists and interprofessional RO team members engage in PE, with most using institution-specific materials often available only in English. PE practices differ according to clinical encounter type and RT workflow timing. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources are needed to foster high-quality, patient-centered PE delivery. [ABSTRACT FROM AUTHOR]

This review explores the convergence of clinical radiotherapy and space radiation therapeutics, focusing on ionizing radiation (IR)-generated reactive oxygen species (ROS). IR, with high-energy particles, induces precise cellular damage, particularly in cancer treatments. The paper discusses parallels between clinical and space IR, highlighting unique characteristics of high-charge and energy particles in space and potential health risks for astronauts. Emphasizing the parallel occurrence of ROS generation in both clinical and space contexts, the review identifies ROS as a crucial factor with dual roles in cellular responses and potential disease initiation. The analysis covers ROS generation mechanisms, variations, and similarities in terrestrial and extraterrestrial environments leading to innovative ROS-responsive delivery systems adaptable for both clinical and space applications. The paper concludes by discussing applications of personalized ROS-triggered therapeutic approaches and discussing the challenges and prospects of implementing these strategies in clinical radiotherapy and extraterrestrial missions. Overall, it underscores the potential of ROS-targeted delivery for advancing therapeutic strategies in terrestrial clinical settings and space exploration, contributing to human health improvement on Earth and beyond. [Display omitted] • Ionizing radiation within clinical radiotherapy parallels space exposure. • Ionizing radiation causes linear energy transfer-dependent biological effects. • Reactive oxygen species-triggered therapeutics can be applied on Earth and in space. [ABSTRACT FROM AUTHOR]

In this Pediatric Normal Tissue Effects in the Clinic (PENTEC) vision paper, challenges and opportunities in the assessment of subsequent neoplasms (SNs) from radiation therapy (RT) are presented and discussed in the context of technology advancement. The paper discusses the current knowledge of SN risks associated with historic, contemporary, and future RT technologies. Opportunities for research and SN mitigation strategies in pediatric patients with cancer are reviewed. Present experience with radiation carcinogenesis is from populations exposed during widely different scenarios. Knowledge gaps exist within clinical cohorts and follow-up; dose-response and volume effects; dose-rate and fractionation effects; radiation quality and proton/particle therapy; age considerations; susceptibility of specific tissues; and risks related to genetic predisposition. The biological mechanisms associated with local and patient-level risks are largely unknown. Future cancer care is expected to involve several available RT technologies, necessitating evidence and strategies to assess the performance of competing treatments. It is essential to maximize the utilization of existing follow-up while planning for prospective data collection, including standardized registration of individual treatment information with linkage across patient databases. [ABSTRACT FROM AUTHOR]

Although radiotherapy continues to evolve as a mainstay of the oncological armamentarium, research and innovation in radiotherapy in low-income and middle-income countries (LMICs) faces challenges. This third Series paper examines the current state of LMIC radiotherapy research and provides new data from a 2022 survey undertaken by the International Atomic Energy Agency and new data on funding. In the context of LMIC-related challenges and impediments, we explore several developments and advances—such as deep phenotyping, real-time targeting, and artificial intelligence—to flag specific opportunities with applicability and relevance for resource-constrained settings. Given the pressing nature of cancer in LMICs, we also highlight some best practices and address the broader need to develop the research workforce of the future. This Series paper thereby serves as a resource for radiation professionals. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the role of supraomohyoid neck dissection (SOHND) in oral carcinoma patients with clinically negative neck nodes. From July 1993 to June 1998, 140 patients with oral carcinomas and clinically negative lymph nodes in the neck underwent elective SOHND in Chang Gung Memorial Hospital, Taiwan. Thirty-seven patients had postoperative radiotherapy.Thirty-four (24.3%) patients had occult cervical metastases. The overall regional control rates were 93.4% vs. 85.3% for pathologically negative vs positive nodes, respectively, with or without adjuvant radiotherapy. Adjuvant radiotherapy significantly improved ipsilateral regional control (P=0.012) in patients with occult cervical metastases but not in patients with negative neck disease. (P=1.0) SOHND is both a diagnostic and therapeutic procedure in patients with negative neck disease. Its therapeutic role in patients with positive neck disease remains controversial. Postoperative radiotherapy significantly improve ipsilateral neck control in patients with occult cervical metastasis. [ABSTRACT FROM AUTHOR]

In 2021, the Advanced Practice Radiation Therapy Working Group (APRTWG) was established in the United States as a grassroots alliance of multidisciplinary radiation oncology professionals—radiation therapists, physicians, dosimetrists, and administrators—located across the country, interested in studying and establishing the Advanced Practice Radiation Therapist (APRT) level of practice in the United States. The APRT model has shown success in the United Kingdom, Canada, Australia, Singapore, and other countries, documenting the value of the APRT to the quality and advancement of clinical care. In the United States, the APRTWG seeks to coordinate activities, align resources, and drive the national agenda to collectively develop and define novel models of care using APRT in line with the evolving needs of patients and the radiation therapy profession. This environmental scan aims to examine the context of radiation oncology medical practice in the United States to inform pathways ahead for a proposed APRT model through a Political, Economic, Social, Technological, Environmental, and Legal (PESTEL) analysis. A literature search was conducted to understand the chronological timeline of the development of APRT during the past 25 years. Items that included the activities, scope of practice, and implementation of APRT nationally and internationally were identified. Papers describing advanced practitioner roles that are commonly found in the multidisciplinary team in radiation oncology both in the United States and internationally, such as physician assistants and nurse practitioners, were excluded. Despite the environmental scan outcome, it is acknowledged that data collation and analysis was not as robust as that anticipated by undertaking a systematic review. Papers were identified by the lead author that aligned with each of the PESTEL factors. Defined broadly, a new care model can adjust how health services are delivered by incorporating best practices in patient care for a specific population, person, or patient cohort. As patients enter different stages of their disease, the purpose of a new model is to provide individuals with the right care, at the right time, by the right team, in the right place. It is clear that the opportunity for positive change and impact on the current state of practice in radiation oncology exists. The environmental scan findings demonstrate the complexities associated with implementing APRT in the United States, with multifactorial political, environmental, societal, technological, economic, and legal aspects to consider. The APRTWG will continue to lead and participate in such activities to demonstrate and identify APRT role opportunities in the United States and drive the nationwide implementation of the APRT level of practice in this country. [ABSTRACT FROM AUTHOR]

Auto-contouring could revolutionise future planning of radiotherapy treatment. The lack of consensus on how to assess and validate auto-contouring systems currently limits clinical use. This review formally quantifies the assessment metrics used in studies published during one calendar year and assesses the need for standardised practice. A PubMed literature search was undertaken for papers evaluating radiotherapy auto-contouring published during 2021. Papers were assessed for types of metric and the methodology used to generate ground-truth comparators. Our PubMed search identified 212 studies, of which 117 met the criteria for clinical review. Geometric assessment metrics were used in 116 of 117 studies (99.1%). This includes the Dice Similarity Coefficient used in 113 (96.6%) studies. Clinically relevant metrics, such as qualitative, dosimetric and time-saving metrics, were less frequently used in 22 (18.8%), 27 (23.1%) and 18 (15.4%) of 117 studies, respectively. There was heterogeneity within each category of metric. Over 90 different names for geometric measures were used. Methods for qualitative assessment were different in all but two papers. Variation existed in the methods used to generate radiotherapy plans for dosimetric assessment. Consideration of editing time was only given in 11 (9.4%) papers. A single manual contour as a ground-truth comparator was used in 65 (55.6%) studies. Only 31 (26.5%) studies compared auto-contours to usual inter- and/or intra-observer variation. In conclusion, significant variation exists in how research papers currently assess the accuracy of automatically generated contours. Geometric measures are the most popular, however their clinical utility is unknown. There is heterogeneity in the methods used to perform clinical assessment. Considering the different stages of system implementation may provide a framework to decide the most appropriate metrics. This analysis supports the need for a consensus on the clinical implementation of auto-contouring. • A systematic review of auto-contouring assessment publications was performed. • Variation in the metrics used in auto-contouring research is demonstrated. • Geometric metrics are the most popular, but these may not be clinically meaningful. • There is significant heterogeneity in the "clinically relevant" assessment metrics. • There is a need to standardise auto-contouring assessment, to enable clinical use. [ABSTRACT FROM AUTHOR]

Breast cancer and breast cancer-directed radiation therapy (RT) may increase the risk of late effects, such as hypothyroidism. We conducted a systematic review and meta-analysis to investigate the association between breast cancer, RT, and risk of hypothyroidism in breast cancer survivors. Through February 2022, we searched PubMed, EMBASE, and references of relevant articles, to identify papers on breast cancer and breast cancer-directed RT and subsequent risk of hypothyroidism. Articles were screened by title and abstract and reviewed for eligibility. We used a pre-formed data extraction sheet and identified key design elements that could potentially introduce bias. The main outcome was the confounder-adjusted relative risk (RR) of hypothyroidism in breast cancer survivors versus women without breast cancer, and in breast cancer survivors according to the receipt of RT to the supraclavicular lymph nodes. We used a random-effects model to calculate pooled RRs and associated 95% confidence intervals (95% CI). From 951 papers screened by title and abstract, 34 full-text papers were reviewed for eligibility. We included 20 studies published between 1985 and 2021–19 were cohort studies. Compared with women without breast cancer, the pooled RR of hypothyroidism in breast cancer survivors was 1.48 (95% CI: 1.17, 1.87), with highest risk associated with RT to the supraclavicular region (RR = 1.69, 95% CI: 1.16, 2.46). The most important limitations of the studies were small sample size yielding estimates with low precision, and lack of data on potential confounders. Breast cancer and radiation therapy to the supraclavicular lymph nodes is associated with an increased risk of hypothyroidism. • Breast cancer survivors have an increased risk of hypothyroidism. • Radiation therapy to the supraclavicular lymph nodes further increases this risk. • The thyroid gland may be an organ at risk in breast cancer patients. • Using volume-based delineation may spare the thyroid gland from radiation damage. [ABSTRACT FROM AUTHOR]

A series of radiobiological models were developed to study tumor control probability (TCP) for stereotactic body radiation therapy (SBRT) of early-stage non-small cell lung cancer (NSCLC) per the Hypofractionated Treatment Effects in the Clinic (HyTEC) working group. This study was conducted to further validate 3 representative models with the recent clinical TCP data ranging from conventional radiation therapy to SBRT of early-stage NSCLC and to determine systematic optimal fractionation regimens in 1 to 30 fractions for radiation therapy of early-stage NSCLC that were found to be model-independent. Recent clinical 1-, 2-, 3-, and 5-year actuarial or Kaplan-Meier TCP data of 9808 patients from 56 published papers were collected for radiation therapy of 2 to 4 Gy per fraction and SBRT of early-stage NSCLC. This data set nearly triples the original HyTEC sample, which was used to further validate the HyTEC model parameters determined from a fit to the clinical TCP data. TCP data from the expanded data set are well described by the HyTEC models with α/β ratios of about 20 Gy. TCP increases sharply with biologically effective dose and reaches an asymptotic maximal plateau, which allows us to determine optimal fractionation schemes for radiation therapy of early-stage NSCLC. The HyTEC radiobiological models with α/β ratios of about 20 Gy determined from the fits to the clinical TCP data for SBRT of early-stage NSCLC describe the recent TCP data well for both radiation therapy of 2 to 4 Gy per fraction and SBRT dose and fractionation schemes of early-stage NSCLC. A steep dose response exists between TCP and biologically effective dose, and TCP reaches an asymptotic maximum. This feature results in model-independent optimal fractionation regimens determined whenever safe for SBRT and hypofractionated radiation therapy of early-stage NSCLC in 1 to 30 fractions to achieve asymptotic maximal tumor control, and T2 tumors require slightly higher optimal doses than T1 tumors. The proposed optimal fractionation schemes are consistent with clinical practice for SBRT of early-stage NSCLC. [ABSTRACT FROM AUTHOR]

Carbon-ion radiotherapy (CIRT) has unique radiobiological properties that cause increased radiobiological effect and tumour control, especially with hypoxic tissues. This critical review aimed to evaluate clinical response to CIRT across all published tumour sites to establish if there is a clinical need for a CIRT centre in the UK. A critical review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searching was undertaken in November 2022 within the PubMed, Science Direct, SCOPUS and Web of Science databases using the term 'carbon ion radiotherapy' in the title, abstract or author keywords. After critical appraisal, data was extracted from 78 primary study papers. Strong evidence supported use of CIRT for chondrosarcoma, chordoma, nasopharyngeal, non-small cell lung cancer (NSCLC), oral cavity, prostate, rectal and salivary gland tumours. Further research is needed to strengthen the evidence base for some other tumour types. The UK's incidence and mortality rates suggest a clinical need for CIRT for chondrosarcoma, chordoma, NSCLC, oral cavity, prostate, and rectal tumours. There is a need to improve survivorship amongst pancreatic, liver, and oesophageal cancer patients. Data published relating to CIRT for these tumours is promising but of lower quality and more research is needed in these areas. The clinical response to CIRT for certain tumours suggests the need for a carbon-ion centre in the UK. Demand for further research [phase III trials] has been identified, giving the UK opportunity to establish a research centre, with opportunity to treat, contributing to world-renowned research whilst improving patient outcomes. [ABSTRACT FROM AUTHOR]

Patient factors affect the risk of radiotherapy toxicity, but many are poorly defined. Studies have shown that race affects cancer incidence, survival, drug response, molecular pathways and epigenetics. Effects on radiosensitivity and radiotherapy toxicity are not well studied. The aim of the present study was to identify the effects of race and ethnicity on the risk of radiotherapy toxicity. A systematic review was carried out of PubMed, Ovid Medline and Ovid Embase with no year limit. PRISMA 2020 guidelines were followed. Two independent assessors reviewed papers. Of 607 papers screened, 46 fulfilled the inclusion criteria. Papers were published between 1996 and 2021 and involved 30–28,354 individuals (median 433). Most involved patients with prostate (33%), breast (26%) and lung (9%) cancer. Both early and late toxicities were studied. Some studies reported a higher risk of toxicity in White men with prostate cancer compared with other races and ethnicities. For breast cancer patients, some reported an increased risk of toxicity in White women compared with other race and ethnic groups. In general, it was difficult to draw conclusions due to insufficient reporting and analysis of race and ethnicity in published literature. Reporting of race and ethnicity in radiotherapy studies must be harmonised and improved and frameworks are needed to improve the quality of reporting. Further research is needed to understand how ancestral heritage might affect radiosensitivity and risk of radiotherapy toxicity. • Ancestral heritage is likely to affect risk of some radiation toxicities. • Insufficient evidence from reviewing effects of race and ethnicity on toxicity. • Reporting race and ethnicity in radiation studies must be harmonised and improved. • Socioeconomic and comorbidity effects must be addressed. • Radiogenomic research needs diversifying beyond euro-centricity. [ABSTRACT FROM AUTHOR]

Purpose: Taste loss is a major cause of morbidity in patients undergoing head-and-neck irradiation. The relationship between the time course and the degree of taste disorder was studied in both acute and late phases. Methods and Materials: Taste ability was measured by the taste threshold for the four basic tastes using a filter paper disc method in patients before, during, and after radiotherapy. The subjects were divided into two groups. In Group A, the radiation fields included most of the tongue (n = 100), and in Group B the radiation fields did not include the tip of the tongue (n = 18). Results: In Group A, there was a significant impairment of the threshold of all four basic tastes at 3 weeks after starting radiotherapy (RT), and this impairment remained at 8 weeks (p < 0.05). This was not seen in Group B. In Group A, there was no significant difference in the patterns of taste sensitivity change between the high-dose (>20 Gy) and low-dose (≤20 Gy) groups. In the late phase, recovery of taste loss was seen in both groups since 4 months after completing RT. Conclusions: Unless the anterior part of the tongue was irradiated, taste loss was not observed during RT. When the anterior part of the tongue was irradiated, a difference by radiation dose was not observed in the taste loss pattern. Additionally, radiation-induced taste dysfunction appears to be a temporal effect. [Copyright &y& Elsevier]

Adenoid cystic carcinoma (ACC) is a rare malignancy of the salivary glands. The larynx is an uncommon site of disease occurrence. This site and histotype pose a particular challenge for management because of the quality of life implications of radical surgery and the radio- and chemo-resistant nature of the tumor. The aim of this systematic review is to assess the role of modern radiotherapy in the treatment of laryngeal ACC and to suggest practical guidelines for a standardized radiotherapy protocol. A multidisciplinary team consisting of radiation and medical oncologists and otorhinolaryngologists performed a systematic review on MedLine/pubmed using the terms "carcinoma adenoid cystic" and "larynx" and "radiotherapy". The inclusion criteria were: original article, paper concerning laryngeal ACC, paper that reported on radiotherapy for laryngeal ACC. The exclusion criteria were: papers not available, editorials/review, papers not focused on ACC radiotherapy. 233 papers were reviewed, 22 paper were included. All included papers were retrospective studies; 9 papers (40.9%) were 1-patient case reports. Radiotherapy was used as adjuvant therapy in 16 papers (72.7%), as definitive therapy in 2 paper (9.1%), both definitive or adjuvant radiotherapy were used in 3 papers (13.6%) and in one paper (4.5%) patient setting was adjuvant, definitive or neoadjuvant. In 15 paper (68.2%) effect of radiotherapy alone, without any concurrent chemotherapy were described, in 6 paper (27.3%) also concurrent chemotherapy was used, in one study (4.5%) the concurrent chemotherapy was not specified. Based on the scientific literature, which is limited by the lack of strong evidence, a proposal for management in terms of indication and prescription of radiotherapy and chemoradiation treatment in different clinical scenarios was proposed. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

• Radiation therapy underutilisation is contributing to the global burden of cancer. • The most prevalent health professional influence identified was referral. • Misconceptions of the referrer role during a radiotherapy pathway was highlighted. • Gaps in referrer knowledge of radiation oncology can result from limited education. • Limited knowledge can lead to inaccurate perceptions of radiation oncology. The underutilisation of radiation therapy (RT) is contributing to the significant global burden of cancer with studies identifying actual utilisation rates are significantly lower than evidence-based optimal utilisation rates. Attributing factors vary considerably, ranging from patient preference, referrer bias, to geographic variations. The aim of this scoping review is to map and synthesise the current literature reporting on barriers and facilitators influencing utilisation of RT globally. Four online databases; Medline, Embase, Scopus and CINAHL identified articles dated between 1993 and 2023. Study eligibility included reporting on RT services, specifically barriers and influences on utilisation of RT. Title and abstract screening, followed by full text review was performed as per PRISMA guidelines. Variables were extracted and categorised into patient, health professional (HP) and department level influences. In total, 340 studies were included in the scoping review. HP influences (included in this specific review) were reported in 225 (66 %) papers with the most prevalent HP influence being referral (n = 187; 83 %). Of the HP papers, 114 (51 %) identified knowledge and education as an influence on RT utilisation. Subsequently, role interpretation, describing the assumed role adopted by the General Practitioner as the patients advocate, educator, manager or carer was identified in 89 (40 %) studies. This scoping review demonstrates the range of factors impacting RT utilisation. The results suggest referrer knowledge and understanding gaps impact RT utilisation internationally. Future research and intervention into referrer RT education is required to limit the impact of such influences. [ABSTRACT FROM AUTHOR]

Chimeric antigen receptor T (CAR-T) cell therapy, a groundbreaking immunotherapy. However, it faces formidable challenges in treating solid tumors, grappling with issues like poor trafficking, limited penetration, and insufficient persistence within the tumor microenvironment (TME). CAR-T cells are engineered to express receptors that target specific cancer antigens, enhancing their ability to recognize and eliminate cancer cells. This review paper explores the intricate interplay between CAR-T therapy and radiotherapy (RT), investigating their synergistic potential. Radiotherapy, a standard cancer treatment, involves using high doses of radiation to target and damage cancer cells, disrupting their ability to grow and divide. We highlight that RT modulates the TME, augments antigen presentation, and promotes immune cell infiltration, bolstering CAR-T cell-mediated tumor eradication. Molecular insights shed light on RT-induced alterations in tumor stroma, T cell recruitment promotion, and induction of immunogenic cell death. Noteworthy, strategies, such as combining hypofractionated radiotherapy with myeloid-derived suppressor cell blockade, underscore innovative approaches to enhance CAR-T cell therapy in solid tumors. Bridging indications for RT and CAR-T cells in hematological malignancies are discussed, emphasizing scenarios where RT strategically enhances CAR-T cell efficacy. The paper critically evaluates the RT as a bridge compared to traditional chemotherapy, highlighting timing and dosage considerations crucial for optimizing CAR-T therapy outcomes. In summary, the paper provides valuable insights into the intricate molecular mechanisms activated by RT and innovative strategies to improve CAR-T cell therapy, fostering a deeper understanding of their combined potential in cancer treatment. [Display omitted] [ABSTRACT FROM AUTHOR]

Radiation therapy has been described as both precise and personalized. Radiotheranostics is a novel treatment involving the use of radioisotopes for diagnostic and therapeutic purposes to bind to receptors on the tumor cells. Recent examples of radiotheranostics are Lutetium 177 DOTATATE that targets somatostatin receptors on neuroendocrine tumors and Lutetium 177 PSMA which attaches to prostate-specific membrane antigen [PSMA] in prostate cancer. The purpose of this review was to define personalized medicine, precision medicine, and to relate these concepts to radiotherapy and radiotheranostics for cancer treatment. Papers with the title terms precision medicine, personalized medicine and radiation or (Radio)theranostics were searched for in MEDLINE. There were no limitations on years, full-text availability or language. The most relevant papers were read and synthesized. Personalized medicine is defined as the use of an individual's genetic profile to guide decisions made about the prevention, diagnosis and treatment of disease. It is also suggested that shared decision making, patient satisfaction, engagement, compliance and patient centered outcomes reflect the ideals of personalized medicine. Precision medicine is defined as an emerging approach for disease treatment and prevention that accounts for individual variability in genes, but also the environment and lifestyle for each person. Both definitions include the use of genetics in the decisions for treatment. Personalized medicine may also refer to patient centered approaches. External beam radiation therapy is considered precise medicine for several reasons; however, the reasons are unrelated to genetics. In radiation medicine, there are two forms of precision, physical and biological. Biological precision or individual patient genetics are less frequently the dominant factor in the context of external beam radiation therapy, as volume and dose fractionation is guided by prognostic groupings rather than tailored to individual cancer features. Radiation therapy is considered precise from a physical point of view. Patient-specific tumor and normal tissue anatomy are contoured, and treatment plans are designed to maximize the therapeutic ratio. Also, advances in image guidance improve the technical precision of radiation treatment delivery. Radiotheranostics involves radiopharmaceuticals that are designed to bind to receptors on tumour cells to treat cancer after using diagnostic imaging to identify the target receptors. Compared with radiation therapy, radiotheranostics more closely fits the definition of precision medicine. Radiotheranostics adds precision medicine into the armamentarium of Radiation Medicine. One approach to personalization has been to modify dose (escalation or reduction) based on kidney sensitivity. Personalized medicine and precision medicine are often used interchangeably; however, by understanding the definitions of precision medicine and personalized medicine, we can work on focusing our practices on both concepts. In the context of radiotheranostics, as treatment workflows and programs are developed, we seek to understand how the precise treatment of radiotheranostics can be more personalized. Opportunities for personalization lie in dose modification based on patient characteristics and in focusing on the patient experience. [ABSTRACT FROM AUTHOR]

Radiation often plays a part in cancer treatment due to its ability to spare or target organs that surgery might not be able to. This is especially relevant to areas like Head and Neck (h/n) cancers, due to the complex anatomy of this region. However, radiation to the h/n region produces a significant amount of radiation related side effects, including xerostomia, dysphagia, mucositis, and skin reactions (Brook, 2021). These side effects are hard to predict and vary from patient to patient (Brook, 2021). In recent years, the use of Artificial Intelligence (AI) to help make clinical judgments in Radiation Oncology for h/n cancers have started to be explored in research. Specifically, the use of AI has been researched to predict individual levels and risks of side effects. Due to radiation related side effects, up to 57% of h/n patients are reported to miss treatments, leading to a four-time increased risk of worsening locoregional control (Miller et al., 2022). Because of this, the focus on this paper is explore research papers that investigate the potential use AI in predicting radiation related side effects in h/n cancer patients. By accurately predicting individual risk, health care providers can better prepare their patients and help assist with increased quality of life and consistency in treatment. A literature review was conducted. In literature, research has focused on using AI to predict xerostomia, weight loss, dysphagia, and mucositis in h/n patients. Of these four, xerostomia has been the focus of many papers and shows the most potential for clinical use. However, while many papers focused on xerostomia are robust with many algorithms showing high Area Under the Curve (AUC) values (indicating high algorithm performance), larger studies with more external validation are still needed before its application. Importantly, many algorithms studied show potential to not only predict mucositis but also specific dose gradients to avoid, leading to the potential of reducing this side effect all together. Literature remains sparse for dysphagia, weight loss and mucositis. Despite this, many of these side effects have be explored in single institution studies that indicate much promise for further research. While more research is needed globally in this area of cancer treatment, AI shows strong potential, especially in predicting and mitigating xerostomia. It is possible that one day, utilizing AI to predict individual levels of side effects can help with personalized teachings, prophylactic care and better preparation of inter-professional involvement to significantly enhance the care for h/n cancer patients. [ABSTRACT FROM AUTHOR]

Cyberattacks in the healthcare sector have been increasing in frequency and severity over the last decade. Radiation medicine is highly technical healthcare service that relies heavily on computer and network capabilities to drive delivery of care. As a result, it is a highly vulnerable care service to these attacks. In October 2023, our institution experienced a large-scale cyberattack, which brought our local radiation therapy services to a grinding halt. Here we discuss the immediate response strategies and early lessons learnt from a significant Code Grey within our region. The scale and impact of the cyberattack was significant and shut down all systems within our institution. For the radiation therapy department specific, this included the ROIS, EMR, TPS systems, drive access, intra and internet. The immediate first step was to connect with all active treatment patients and notify them of the unexpected downtime with frequent communication maintained while the severity of the Code Grey was understood. Hard copies of the previous days schedules were utilized to make these phone calls. In addition, all future patients were called and notified. These included upcoming new starts and patients for CT simulation. RTT staff were deployed to support and maintain critical services within the oncology program. Activities included support lab services, running faxes between labs and clinics, chemo medication runs from pharmacy and chemo suite, and supporting reception desks with paper document runs. Staff assignments were communicated with team members via group text messages and daily huddles. Broader communication across the entire organization occurred through a text alert system. A master patient list was created for both patients on active treatment and those patients within the treatment planning process. Details included clinical and technical details: disease site, technique, prescription and last fraction treated. Patients were triaged using the OH-CCO framework by Leadership and the Radiation Oncologists to prioritize patients who would remain in house for care delivery and those who would require treatment to be delivered elsewhere within the province. Resuming daily operations and delivering treatment required an approach that diligently protected safety and quality of practices. The use of paper charts for recording treatments, local disc drives for patient data sets and the reintroduction of some ancillary support systems in manual modes meant the pace of day-to-day operations during the code grey was slowed and patient throughput was reduced in order to meet previous standard of safe and effective treatment. To counter this effect and still deliver much needed radiation therapy treatment to all our patients, some more complex cases were transferred to provincial partners, resulting in many patients having to move to other cities to finish treatment. By sharing our experience, we hope to inspire other institutions and leaders to create measures to regularly back-up the current state of their patient data. Recommendations include: ensuring that secondary routes of communication are available for teams, institutional alert systems are in place and tested regularly and a routine of generating and printing backup master lists of patient data daily would all help mitigate the impact of cybercrime like this. [ABSTRACT FROM AUTHOR]

Recently, two new treatment techniques, i.e. proton therapy and MR-linac based radiotherapy (RT), have been introduced in Dutch RT centres with major impact on daily practice. The content and context of these techniques are frequently described in scientific literature while little is reported about the implementation phase. This process is complex due to a variety of aspects, such as the involvement of multiple stakeholders, significant unpredictability in the start-up phase, the impact of the learning curve, standard operating procedures under development, new catchment areas, and extensive training programs. Insight about implementation in daily care is utterly important for clinics that are about to introduce these new technologies in order to prevent that every centre needs to reinvent the wheel. This position paper gives an overview of the implementation of proton therapy and MR-linac based RT in two large academic RT centres in the Netherlands, i.e. Maastro and Radboudumc respectively. With this paper we aim to report our lessons learned, in order to facilitate other RT centres that consider introducing these and other new techniques in their departments. [ABSTRACT FROM AUTHOR]