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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]

In "Joint EANM/SNMMI/ESTRO Practice Recommendations for the Use of 2-[18F]FDG-PET/CT External Beam Radiation Treatment Planning in Lung Cancer V1.0" clinical indications for PET-CT in (non-)small cell lung cancer are highlighted and selective nodal irradiation is discussed. Additionally, concepts about target definition, target delineation and treatment evaluation are reviewed. [ABSTRACT FROM AUTHOR]

To describe current practice in the management of rectal cancer, to identify uncertainties that usually arise in the multidisciplinary team (MDT)'s discussions ('grey zones') and propose next generation studies which may provide answers to them. A questionnaire on the areas of controversy in managing T2, T3 and T4 rectal cancer was drawn up and distributed to the Rectal-Assisi Think Tank Meeting (ATTM) Expert European Board. Less than 70% agreement on a treatment option was indicated as uncertainty and selected as a 'grey zone'. Topics with large disagreement were selected by the task force group for discussion at the Rectal-ATTM. The controversial clinical issues that had been identified within cT2–cT3–cT4 needed further investigation. The discussions focused on the role of (1) neoadjuvant therapy and organ preservation on cT2-3a low-middle rectal cancer; (2) neoadjuvant therapy in cT3 low rectal cancer without high risk features; (3) total neoadjuvant therapy, radiotherapy boost and the best chemo-radiotherapy schedule in T4 tumors. A description of each area of investigation and trial proposals are reported. The meeting successfully identified 'grey zones' and, in the light of new evidence, proposed clinical trials for treatment of early, intermediate and advanced stage rectal cancer. [ABSTRACT FROM AUTHOR]

Paediatric malignancies are a challenge for the radiation oncologist due to their rarity, the great variety of histological types, and the complexity of treatment concepts that evolve over time. The Paediatric Radiation Oncology Society (PROS) is the only internationally operating society for paediatric radiation oncology. The objectives of PROS are to set a world-wide standard of excellence with respect to radiation oncology aspects in curing children and adolescents with cancer, to provide a forum for communication between radiation oncologists, and to exchange information with all professionals involved in the management of paediatric and adolescent cancer. Challenges include the need to promote education and support practice in low and middle income countries (LMIC) as well as the cost and availability of modern treatment technologies for all but most especially these countries. Collaborations with other societies that include for example the education programmes provided jointly with ESTRO, and the upgraded technical platform of the PROS web site offer new possibilities to enhance the efficacy of PROS in education and support of paediatric radiation oncology practice world-wide. PROS has made an important contribution to the management of childhood malignancies over the past decade and new and developing collaborations between PROS and other societies or organizations will ultimately lead to a reduction in world-wide health care inequalities. [ABSTRACT FROM AUTHOR]

Teaching Lecture: The ultimate truth on how to get your paper published in an ESTRO journal SP-0002: The ultimate truth on how to get your paper published in an ESTRO journal-ethical considerations. M. Leech. [Extracted from the article]

Approximately 70% of head and neck cancer (HNC) patients present with locoregionally advanced disease. The curative rate for early disease is 80-95%; for advanced tumors, locoregional recurrence rate remains at about 50-60% despite advances in treatment, and 20-30% will have distant metastases. Further, patients will develop a second primary malignancy (SPM) with a rate of 2-4% per year. Follow-up (FU) is important to detect recurrence (REC) and SPM at an early stage, to enable effective salvagetherapy, manage treatment-related sequelae, and provide functional rehabilitation and psychosocial support. In the absence of high-level evidence, there is no clear international consensus in FU regimens. There are only retrospective studies addressing this topic, mostly showing no difference in overall survival between patients with REC detected during routine FU and symptom-driven self-referral visits. The value of imaging is also subject of debate. Moreover, many of the hitherto published studies did not include the logistical, psychological and financial consequences and the relevant cost evaluations in today's healthcare systems facing increasing financial pressure. We propose a large multicenter, randomized prospective trial in HNC patients with complete remission 6 months after curative treatment to compare two FU schemes differing in frequency of scheduled clinical examinations and imaging. We hypothesize that implementing an individualized de-intensified FU with active patient involvement does not differ from a conventional regular FU in terms of death from any cause up to 5 years (=primary endpoint). We also hypothesize that symptom-driven self-referral FU visits have a higher diagnostic yield in detection of REC/SPM than regular scheduled clinical and radiological examinations. Consequently, we assume that fewer scheduled exams in well-instructed patients will not lead to worse outcome. The secondary objectives are the comparison of death from HNC and any cancer, detection of first REC/SPM, health-related quality of life, fear of recurrence, compliance with FU assessments, number of visits and HNC-specific health-care utilization. The objective of the herein presented Pilot 1 study was to assess the feasibility of patients' recruitment, motivation for trial participation and compliance in completing a monthly, paper-based symptoms' monitoring (patient-reported outcome [PRO], symptom tracker). This Pilot is supported by Swiss Cancer Research. The study design is shown in Figure 1 (RMST: restricted mean survival time). [Display omitted] The main study is a randomized-controlled combined non-inferiority and superiority trial with explicit Pilot 1 and 2. After curative treatment, participants are randomized to an individualized de-intensified FU with monthly symptoms' monitoring (Figure 2) (experimental arm) or to standard FU. [Display omitted] Alerting symptoms possibly indicating REC/SPM or non-completion of the PROs will result in an urgent clinical FU appointment in the experimental arm. Minimal FU within Pilot 1 is 12 months (as opposed to 60 months in the main trial). Recruitment was done in three Swiss tertiary referral centers, which committed to enroll at least 20 patients during one year. The primary aim of Pilot 1, evaluating the feasibility of patient recruitment, has been confirmed faster than expected (20 committed patients randomized after 7 and 29 patients randomized after 11 months accrual time, respectively). Six unscheduled visits were triggered by our paper-based PRO. Within Pilot 1, a prescreening survey was conducted to better understand the specific motivation of patients to participate in the trial or not. We surveyed 41 potential participants of which 27 (66%) agreed to participate. The potential reduction in imaging was the main reason for the patients to participate in the trial (52%). Additionally, we collected feedback on the design of the paper-based PRO questionnaire at the 6-month FU visit when participants had already gained some experience. Participants expressed that the PRO questionnaire was easy to understand and comprehensive, thus facilitating them to communicate with their corresponding study center. The completion time for the PRO was between 5-10 minutes in 63% of the participants. In addition, 63% of the patients were in favor of transitioning the paper-based PRO to an electronic version (ePRO), the other 37% felt unsure about using an ePRO. Interim compliance data will be presented. The recruitment and symptoms' monitoring for HNC patients have been proofed as feasible. Pilot 2 is in planning to allow for a smooth continuation of Pilot 1 with following specific goals: 1) to expand the trial to 12 Swiss and 4 European sites; 2) to recruit up to 200 participants; 3) to implement a web-based version of the symptom tracker (ePRO); 4) to develop an enhanced training strategy for HNC patients; 5) to evaluate the usability of the ePRO; and 6) to assess the safety of omitting systematic lung imaging. [ABSTRACT FROM AUTHOR]

Thyroid cancer is the most common endocrine malignancy, accounting for 1 % of all cancers 1. The genetic syndromes associated with differentiated thyroid cancers(DTC) are Cowden syndrome, Familial Adenomatous Polyposis(FAP), Carney's complex, Pendred syndrome and Werner syndrome2. The incidence of synchronous second primary tumors(SSPC) associated with oropharyngeal malignancies was 1 to 10 %3. The incidence of other malignancies other than the above syndromes occurring synchronously with DTC is very rare. Only a few case reports and series are available. The incidence of synchronous second primary cancer(SSPC) with Differentiated Thyroid Cancers(DTC) is a very rare entity. Very few case reports and case series were published in the literature. The current study is aimed to enumerate the clinicopathological data of patients with DTC with SSPC. This is a single-center retrospective study. All the patients diagnosed with DTC and SSPC from January 2016 to July 2023 were included in the study. The demographic, clinicopathological data and survival data were collected from the institute's database. Patients were followed up telephonically and survival status was documented. Synchronous cancers are defined as more than one independent primary malignancy when the second(or third) cancer occurs within six months of diagnosis of the first malignancy4. [Display omitted] A total of 1395 patients were diagnosed with thyroid cancer during the study period. Twelve patients were found to have DTC with SSPC. All the patients had papillary thyroid cancer as primary DTC. Ten patients had head and neck squamous cell carcinoma, one had malignant phyllodes tumor, and another patient with endometrioid adenocarcinoma as the SSPC. Six patients diagnosed during preoperative evaluation, one patient diagnosed 3 months after the oral malignancy diagnosis and five patients were diagnosed to have PTC in cervical nodes after neck dissection. Complete thyroid removal was done in six patients and hemithyroidectomy in two patients. Among the patients who underwent total thyroidectomy, four patients had undergone radioactive iodine scan followed by radioactive iodine ablation for two patients. Three patients had died during follow-up, two patients was lost to follow-up and the rest of the seven patients were alive. Out of those alive one patient had a follow-up of less than six months and was excluded from the survival calculation. The median follow up was 25.55 months. The median overall survival was 40.97 months. DTC constitute 95% of thyroid malignancies. Five to fifteen percent of DTC has familial disease. The genetic syndromes associated with DTC are FAP, PTEN syndromes(Cowden syndrome, Bannayan- Riley-Ruvalcaba syndrome, PTEN hamartoma tumor syndrome), Werner syndrome, Carney complex, DICER1 syndrome, Pendred syndrome, Ataxia telangiectasia, Li Fraumeni syndrome, and Peutz Jeghers syndrome5. But, synchronous occurrence of a second malignancy with DTC is a rare phenomenon. In the present study, the most common SSPC was SCC of the head and neck region(83.3%). 5 patients had incidental detection of thyroid cancer in cervical lymph nodes which were dissected during neck dissection done for other causes. L J Fliegelman et al published a paper on four cases of incidentally detected thyroid malignancy in cervical nodes6. Ansari-Lari et al also published cases of incidentally diagnosed PTC on cervical lymph nodes7. In the present study, one patient had synchronous papillary thyroid carcinoma with a malignant phyllodes tumor of the breast. No such case was found reported in the literature during our literature search. In the present study, we reported a case of synchronous endometrioid adenocarcinoma with PTC. Badan Marius-loan et al reported one case of PTC with endometrioid carcinoma8. Patients with Cowden syndrome can have thyroid carcinoma and endometrial carcinoma9. The overall survival of the study group was 40.97 months. Biopsy-proven SCC recurrence was seen in two patients out of four patients with clinically documented recurrence. In the literature review on case series and case reports, it was concluded that the prognosis of the patient depends on the staging of oral synchronous primary and the treatment of thyroid cancer must be decided based on oral malignancy staging and treatment. In conclusion SSPC with DTC is a very rare phenomenon. SCC of the head and neck region is the most common synchronous second primary malignancy associated with DTC. As there are no published guidelines for this clinical scenario, a multi-disciplinary panel discussion is a must to decide regarding management considering the staging and weighing the treatment benefit for both malignancies. [ABSTRACT FROM AUTHOR]

• 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]

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]

• The purpose of the paper is to update previously published GEC ESTRO guidelines for prostate brachytherapy. • Consensus guidelines are made for Low Dose Rate (LDR) and High Dose Rate (HDR) brachytherapy treatments. • New areas include the use of focal and salvage brachytherapy and the role of androgen deprivation therapy. This is an evidence-based guideline for prostate brachytherapy. Throughout levels of evidence quoted are those from the Oxford Centre for Evidence based Medicine (https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009). Prostate interstitial brachytherapy using either permanent or temporary implantation is an established and evolving treatment technique for non-metastatic prostate cancer. Permanent brachytherapy uses Low Dose Rate (LDR) sources, most commonly I-125, emitting photon radiation over months. Temporary brachytherapy involves first placing catheters within the prostate and, on confirmation of accurate positioning, temporarily introducing the radioactive source, generally High Dose Rate (HDR) radioactive sources of Ir-192 or less commonly Co-60. Pulsed dose rate (PDR) brachytherapy has also been used for prostate cancer [1] but few centres have adopted this approach. Previous GEC ESTRO recommendations have considered LDR and HDR separately [2–4] but as there is considerable overlap, this paper provides updated guidance for both treatment techniques. Prostate brachytherapy allows safe radiation dose escalation beyond that achieved using external beam radiotherapy alone as it has greater conformity around the prostate, sparing surrounding rectum, bladder, and penile bulb. In addition there are fewer issues with changes in prostate position during treatment delivery. Systematic review and randomised trials using both techniques as boost treatments demonstrate improved PSA control when compared to external beam radiotherapy alone [5–7]. [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]

• This is a randomized trial investigating the impact of ePROMs on the patients' perspective on the caregiver. • The use of ePROMs positively influenced the patients' perception of the physician's compassion. • Despite shorter interactions in ePROM based consultations no negative impact was seen in scores for professionalism, empathy and others. Electronic Patient-reported outcome measures (ePROMs) are increasingly used in radiotherapy departments. However, the impact of ePROM integration on patients' perceptions of healthcare providers, particularly in terms of empathy and professionalism, remains unclear. Thus, this study aims to assess the patients' views on healthcare professionals during ePROM-based consultations. In this randomized trial, radiotherapy patients were enrolled and asked to evaluate video vignettes of consultations between a radiation oncologist and a patient. Two scenarios were shown in random order, one vignette portrayed a paper-chart-based clinic visit, and the other a consultation in which ePROMs were implemented. Established questionnaires such as Physician Compassion Questionnaire (PCQ), Jefferson Patient Perception of Physician Empathy (JPP), Physician Professionalism Questionnaire (PPQ) and Global Consultation Rating Scale (GCRS) were used to rate the healthcare professional. The primary endpoint was physician compassion. Between May and August 2022, 152 patients, predominantly with malignancies of the breast, prostate, and brain participated. Patients rated the physician in ePROM-based consultations with higher mean scores for physician compassion compared to paper chart-based ones (36.4 vs. 34.2, p = 0.029). No negative impact of ePROMs was observed in terms of professionalism, global rating or physician empathy. Despite a shorter duration of the visit and reduced eye contact, 63 % of patients ultimately favored ePROM-based consultations. The ePREFERENCE trial shows that the implementation of ePROMs in clinic visits during radiotherapy treatment positively impacts the patients' perception of the physician's compassion. ePROMs can therefore not only be considered a useful tool to improve workflows but are also broadly accepted by patients. [ABSTRACT FROM AUTHOR]

• Treatment planning studies contribute to novel understanding of radiotherapy. • RATING framework helps guide scientists in conducting high-quality research. • The guidelines provide in all aspects of planning studies from setting up the study to the reporting. • The RATING score sheet calculate a weighted normalised sum score, where the scientists evaluate the study according to a series of questions important to planning studies. • The RATING score can help scientists, as well as reviewers and editors, evaluate the quality of the presented research. Radiotherapy treatment planning studies contribute significantly to advances and improvements in radiation treatment of cancer patients. They are a pivotal step to support and facilitate the introduction of novel techniques into clinical practice, or as a first step before clinical trials can be carried out. There have been numerous examples published in the literature that demonstrated the feasibility of such techniques as IMRT, VMAT, IMPT, or that compared different treatment methods (e.g. non-coplanar vs coplanar treatment), or investigated planning approaches (e.g. automated planning). However, for a planning study to generate trustworthy new knowledge and give confidence in applying its findings, then its design, execution and reporting all need to meet high scientific standards. This paper provides a 'quality framework' of recommendations and guidelines that can contribute to the quality of planning studies and resulting publications. Throughout the text, questions are posed and, if applicable to a specific study and if met, they can be answered positively in the provided 'RATING' score sheet. A normalised weighted-sum score can then be calculated from the answers as a quality indicator. The score sheet can also be used to suggest how the quality might be improved, e.g. by focussing on questions with high weight, or by encouraging consideration of aspects given insufficient attention. Whilst the overall aim of this framework and scoring system is to improve the scientific quality of treatment planning studies and papers, it might also be used by reviewers and journal editors to help to evaluate scientific manuscripts reporting planning studies. [ABSTRACT FROM AUTHOR]