Search

BackgroundStandard treatment for patients with newly diagnosed glioblastoma includes surgery, radiotherapy (RT), and temozolomide (TMZ) chemotherapy (TMZ/RT→TMZ). The proteasome has long been considered a promising therapeutic target because of its role as a central biological hub in tumor cells. Marizomib is a novel pan-proteasome inhibitor that crosses the blood-brain barrier.MethodsEuropean Organisation for Research and Treatment of Cancer 1709/Canadian Cancer Trials Group CE.8 was a multicenter, randomized, controlled, open-label phase 3 superiority trial. Key eligibility criteria included newly diagnosed glioblastoma, age > 18 years and Karnofsky performance status > 70. Patients were randomized in a 1:1 ratio. The primary objective was to compare overall survival (OS) in patients receiving marizomib in addition to TMZ/RT→TMZ with patients receiving the only standard treatment in the whole population and in the subgroup of patients with MGMT promoter-unmethylated tumors.ResultsThe trial was opened at 82 institutions in Europe, Canada, and the U.S. A total of 749 patients (99.9% of the planned 750) were randomized. OS was not different between the standard and the marizomib arm (median 17 vs. 16.5 months; HR = 1.04; P = .64). PFS was not statistically different either (median 6.0 vs. 6.3 months; HR = 0.97; P = .67). In patients with MGMT promoter-unmethylated tumors, OS was also not different between standard therapy and marizomib (median 14.5 vs. 15.1 months, HR = 1.13; P = .27). More CTCAE grade 3/4 treatment-emergent adverse events were observed in the marizomib arm than in the standard arm.ConclusionsAdding marizomib to standard temozolomide-based radiochemotherapy resulted in more toxicity, but did not improve OS or PFS in patients with newly diagnosed glioblastoma.

PURPOSE: This practice parameter for the performance of proton beam radiation therapy was revised collaboratively by the American College of Radiology (ACR) and the American Radium Society (ARS). This practice parameter was developed to serve as a tool in the appropriate application of proton therapy in the care of cancer patients or other patients with conditions in which radiation therapy is indicated. It addresses clinical implementation of proton radiation therapy, including personnel qualifications, quality assurance (QA) standards, indications, and suggested documentation. MATERIALS AND METHODS: This practice parameter for the performance of proton beam radiation therapy was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters - Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the ARS. RESULTS: The qualifications and responsibilities of personnel, such as the proton center Chief Medical Officer or Medical Director, Radiation Oncologist, Radiation Physicist, Dosimetrist and Therapist, are outlined, including the necessity for continuing medical education. Proton therapy standard clinical indications and methodologies of treatment management are outlined by disease site and treatment group (e.g. pediatrics) including documentation and the process of proton therapy workflow and equipment specifications. Additionally, this proton therapy practice parameter updates policies and procedures related to a quality assurance and performance improvement program (QAPI), patient education, infection control, and safety. CONCLUSION: As proton therapy becomes more accessible to cancer patients, policies and procedures as outlined in this practice parameter will help ensure quality and safety programs are effectively implemented to optimize clinical care.

BackgroundApplying ultra-high dose rates to radiation therapy, otherwise known as FLASH, has been shown to be just as effective while sparing more normal tissue compared to conventional radiation therapy. However, there is a need for a dosimeter that is able to detect such high instantaneous dose, particularly in vivo. To fulfill this need, protoacoustics is introduced, which is an in vivo range verification method with submillimeter accuracy.PurposeThe purpose of this work is to demonstrate the feasibility of using protoacoustics as a method of in vivo real-time monitoring during FLASH proton therapy and investigating the resulting protoacoustic signal when dose per pulse and pulsewidth are varied through multiple simulation studies.MethodsThe dose distribution of a proton pencil beam was calculated through a Monte Carlo toolbox, TOPAS. Next, the k-Wave toolbox in MATLAB was used for performing protoacoustic simulations, where the initial proton dose deposition was inputted to model acoustic propagations, which were also used for reconstructions. Simulations involving the manipulation of the dose per pulse and pulsewidth were performed, and the temporal and spatial resolution for protoacoustic reconstructions were investigated as well. A 3D reconstruction was performed with a multiple beam spot profile to investigate the spatial resolution as well as determine the feasibility of 3D imaging with protoacoustics.ResultsOur results showed consistent linearity in the increasing dose-per-pulse, even up to rates considered for FLASH. The simulations and reconstructions were performed for a range of pulsewidths from 0.1 to 10 μs. The results show the characteristics of the proton beam after convolving the protoacoustic signal with the varying pulsewidths. 3D reconstruction was successfully performed with each beam being distinguishable using an 8 cm × 8 cm planar array. These simulation results show that measurements using protoacoustics has the potential for in vivo dosimetry in FLASH therapy during patient treatments in real time.ConclusionThrough this simulation study, the use of protoacoustics in FLASH therapy was verified and explored through observations of varying parameters, such as the dose per pulse and pulsewidth. 2D and 3D reconstructions were also completed. This study shows the significance of using protoacoustics and provides necessary information, which can further be explored in clinical settings.

Introduction: Financial toxicity has negative implications for patient well-being and health outcomes. There is a gap in understanding financial toxicity for patients undergoing palliative radiotherapy (RT). Methods: A review of patients treated with palliative RT was conducted from January 2021 to December 2022. The FACIT-COST (COST) was measured (higher scores implying better financial well-being). Financial toxicity was graded according to previously suggested cutoffs: Grade 0 (score ≥26), Grade 1 (14-25), Grade 2 (1-13), and Grade 3 (0). FACIT-TS-G was used for treatment satisfaction, and EORTC QLQ-C30 was assessed for global health status and functional scales. Results: 53 patients were identified. Median COST was 25 (range 0-44), 49% had Grade 0 financial toxicity, 32% Grade 1, 15% Grade 2, and 4% Grade 3. Overall, cancer caused financial hardship among 45%. Higher COST was weakly associated with higher global health status/Quality of Life (QoL), physical functioning, role functioning, and cognitive functioning; moderately associated with higher social functioning; and strongly associated with improved emotional functioning. Higher income or Medicare or private coverage (rather than Medicaid) was associated with less financial toxicity, whereas an underrepresented minority background or a non-English language preference was associated with greater financial toxicity. A multivariate model found that higher area income (HR .80, P = .007) and higher cognitive functioning (HR .96, P = .01) were significantly associated with financial toxicity. Conclusions: Financial toxicity was seen in approximately half of patients receiving palliative RT. The highest risk groups were those with lower income and lower cognitive functioning. This study supports the measurement of financial toxicity by clinicians.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.To assess long-term risk of local tumor regrowth, we report updated organ preservation rate and oncologic outcomes of the OPRA trial (ClinicalTrials.gov identifier: NCT02008656). Patients with stage II/III rectal cancer were randomly assigned to receive induction chemotherapy followed by chemoradiation (INCT-CRT) or chemoradiation followed by consolidation chemotherapy (CRT-CNCT). Patients who achieved a complete or near-complete response after finishing treatment were offered watch-and-wait (WW). Total mesorectal excision (TME) was recommended for those who achieved an incomplete response. The primary end point was disease-free survival (DFS). The secondary end point was TME-free survival. In total, 324 patients were randomly assigned (INCT-CRT, n = 158; CRT-CNCT, n = 166). Median follow-up was 5.1 years. The 5-year DFS rates were 71% (95% CI, 64 to 79) and 69% (95% CI, 62 to 77) for INCT-CRT and CRT-CNCT, respectively (P = .68). TME-free survival was 39% (95% CI, 32 to 48) in the INCT-CRT group and 54% (95% CI, 46 to 62) in the CRT-CNCT group (P = .012). Of 81 patients with regrowth, 94% occurred within 2 years and 99% occurred within 3 years. DFS was similar for patients who underwent TME after restaging (64% [95% CI, 53 to 78]) and patients in WW who underwent TME after regrowth (64% [95% CI, 53 to 78]; P = .94). Updated analysis continues to show long-term organ preservation in half of the patients with rectal cancer treated with total neoadjuvant therapy. In patients who enter WW, most cases of tumor regrowth occur in the first 2 years.

In the original publication [...].

IntroductionCancer combination treatments involving immunotherapies with targeted radiation therapy are at the forefront of treating cancers. However, dosing and scheduling of these therapies pose a challenge. Mathematical models provide a unique way of optimizing these therapies.MethodsUsing a preclinical model of multiple myeloma as an example, we demonstrate the capability of a mathematical model to combine these therapies to achieve maximum response, defined as delay in tumor growth. Data from mice studies with targeted radionuclide therapy (TRT) and chimeric antigen receptor (CAR)-T cell monotherapies and combinations with different intervals between them was used to calibrate mathematical model parameters. The dependence of progression-free survival (PFS), overall survival (OS), and the time to minimum tumor burden on dosing and scheduling was evaluated. Different dosing and scheduling schemes were evaluated to maximize the PFS and optimize timings of TRT and CAR-T cell therapies.ResultsTherapy intervals that were too close or too far apart are shown to be detrimental to the therapeutic efficacy, as TRT too close to CAR-T cell therapy results in radiation related CAR-T cell killing while the therapies being too far apart result in tumor regrowth, negatively impacting tumor control and survival. We show that splitting a dose of TRT or CAR-T cells when administered in combination is advantageous only if the first therapy delivered can produce a significant benefit as a monotherapy.DiscussionMathematical models are crucial tools for optimizing the delivery of cancer combination therapy regimens with application along the lines of achieving cure, maximizing survival or minimizing toxicity.

BackgroundNeuroblastoma is the most common extra-cranial pediatric solid tumor. 131I-metaiodobenzylguanidine (MIBG) is a targeted radiopharmaceutical highly specific for neuroblastoma tumors, providing potent radiotherapy to widely metastatic disease. Aurora kinase A (AURKA) plays a role in mitosis and stabilization of the MYCN protein in neuroblastoma. We aimed to study the impact of AURKA inhibitors on DNA damage and tumor cell death in combination with 131I-MIBG therapy in a pre-clinical model of high-risk neuroblastoma.ResultsUsing an in vivo model of high-risk neuroblastoma, we demonstrated a marked combinatorial effect of 131I-MIBG and alisertib on tumor growth. In MYCN amplified cell lines, the combination of radiation and an AURKA A inhibitor increased DNA damage and apoptosis and decreased MYCN protein levels.ConclusionThe combination of AURKA inhibition with 131I-MIBG treatment is active in resistant neuroblastoma models.

Targeted alpha particle therapy (TAT) has emerged as a promising strategy for the treatment of prostate cancer (PCa). Actinium-225 (225Ac), a potent alpha-emitting radionuclide, may be incorporated into targeting vectors, causing robust and in some cases sustained antitumor responses. The development of radiolabeling techniques involving EDTA, DOTA, DOTPA, and Macropa chelators has laid the groundwork for advancements in this field. At the forefront of clinical trials with 225Ac in PCa are PSMA-targeted TAT agents, notably [225Ac]Ac-PSMA-617, [225Ac]Ac-PSMA-I&T and [225Ac]Ac-J591. Ongoing investigations spotlight [225Ac]Ac-hu11B6, [225Ac]Ac-YS5, and [225Ac]Ac-SibuDAB, targeting hK2, CD46, and PSMA, respectively. Despite these efforts, hurdles in 225Ac production, daughter redistribution, and a lack of suitable imaging techniques hinder the development of TAT. To address these challenges and additional advantages, researchers are exploring alpha-emitting isotopes including 227Th, 223Ra, 211At, 213Bi, 212Pb or 149Tb, providing viable alternatives for TAT.

ObjectivesImmunotherapy with immune checkpoint inhibitors has shown only limited success in the management of metastatic soft tissue sarcoma. Overall response rates (ORR) with single agent pembrolizumab were 18% and median PFS was 18 weeks on the clinical trial SARC028. One strategy to improve the responses to immunotherapy is with stereotactic body radiation therapy (SBRT), which can enhance the antitumor CD8 T cell response through the release of tumor-specific antigens, potentially priming a more diverse class of T cell receptors.MethodsThis is a phase 0, pilot prospective study taking place at a single center with 2 arms. In Arm A, patients are treated with pembrolizumab 400 mg IV infusion on day 1 of a 42-day cycle. Stereotactic body radiation therapy (SBRT) is delivered in 1-5 fractions starting on C1D15-28 and given every other day. In Arm B, patients who have started an immune checkpoint inhibitor within 60 days are treated with SBRT in addition to the current therapy.ResultsIn this study we outline testing the feasibility of adding SBRT to pembrolizumab.ConclusionThe ultimate goal of combination therapy is improved overall response, including tumors not treated with SBRT. This trial can be found registered online: NCT05488366.

PurposeThe objectives of this study were to identify key dosimetric parameters associated with postradiation therapy lymphopenia and uncover any effect on clinical outcomes.Methods and materialsThis was a retrospective review of 69 patients (between April 2010 and January 2023) who underwent radiation therapy (RT) as a part of curative intent for soft tissue sarcoma (STS) at a single academic institution. All patients with treatment plans available to review and measurable absolute lymphocyte count (ALC) nadir within a year after completion of RT were included.ResultsMedian follow-up was 22 months after the start of RT. A decrease in lymphocyte count was noted as early as during treatment and persisted at least 3 months after the completion of RT. On multivariable linear regression, the strongest correlations with ALC nadir were mean body dose, body V10 Gy, mean bone dose, bone V10 Gy, and bone V20 Gy. Five-year overall survival was 60% and 5-year disease-free survival was 44%. Advanced T-stage, chemotherapy use, use of intensity-modulated RT, lower ALC nadir, and the development of grade ≥2 lymphopenia at nadir were associated with worse overall survival and disease-free survival.ConclusionsPost-RT lymphopenia was associated with worse outcomes in STS. There were associations between higher body V10 Gy and bone V10 Gy and lower post-RT ALC nadir, despite the varying sites of STS presentation, which aligns with the well-known radiosensitivity of lymphocyte cell lines. These findings support efforts to reduce treatment-related hematopoietic toxicity as a way to improve oncologic outcomes. Additionally, this study supports the idea that the effect of radiation on lymphocyte progenitors in the bone marrow is more significant than that on circulating lymphocytes in treatments with limited involvement of the heart and lung.

Radiation-induced acoustics (RIA) shows promise in advancing radiological imaging and radiotherapy dosimetry methods. However, RIA signals often require extensive averaging to achieve reasonable signal-to-noise ratios, which increases patient radiation exposure and limits real-time applications. Therefore, this paper proposes a discrete wavelet transform (DWT) based filtering approach to denoise the RIA signals and avoid extensive averaging. The algorithm was benchmarked against low-pass filters and tested on various types of RIA sources, including low-energy X-rays, high-energy X-rays, and protons. The proposed method significantly reduced the required averages (1000 times less averaging for low-energy X-ray RIA, 32 times less averaging for high-energy X-ray RIA, and 4 times less averaging for proton RIA) and demonstrated robustness in filtering signals from different sources of radiation. The coif5 wavelet in conjunction with the sqtwolog threshold selection algorithm yielded the best results. The proposed DWT filtering method enables high-quality, automated, and robust filtering of RIA signals, with a performance similar to low-pass filtering, aiding in the clinical translation of radiation-based acoustic imaging for radiology and radiation oncology.

Among most tailored approaches in radiation oncology, the development of brachytherapy for the treatment of cervical cancer patients has benefited from various technological innovations. The development of 3D image-guided treatments was the first step for treatment personalization. This breakthrough preceded practice homogenization and validation of predictive dose and volume parameters and prognostic factors. We review some of the most significant strategies that emerged from the ongoing research in order to increase personalization in uterovaginal brachytherapy. A better stratification based on patients and tumors characteristics may lead to better discriminate candidates for intensification or de-escalation strategies, in order to still improve patient outcome while minimizing the risk of treatment-related side effects. [ABSTRACT FROM AUTHOR]

The integration of artificial intelligence, particularly deep learning algorithms, into radiotherapy represents a transformative shift in the field, enhancing accuracy, efficiency, and personalized care. This paper explores the multifaceted impact of artificial intelligence on radiotherapy, the evolution of the roles of radiation oncologists and medical physicists, and the associated practical challenges. The adoption of artificial intelligence promises to revolutionize the profession by automating repetitive tasks, improving diagnostic precision, and enabling adaptive radiotherapy. However, it also introduces significant risks, such as automation bias, verification failures, and the potential erosion of clinical skills. Ethical considerations, such as maintaining patient autonomy and addressing biases in artificial intelligence systems, are critical to ensuring the responsible use of artificial intelligence. Continuous training and development of robust quality assurance programs are required to mitigate these risks and maximize the benefits of artificial intelligence in radiotherapy. [ABSTRACT FROM AUTHOR]

Le terme d'évènement recouvre un large éventail de situations concrètes en oncologie radiothérapie, de l'effet secondaire particulièrement intense en lien avec l'irradiation à la possibilité d'une erreur technique ou humaine. Si les démarches qualité font désormais partie intégrante du fonctionnement des services d'oncologie radiothérapie pour l'analyse et la prévention de ces évènements, leur survenue au cours d'une irradiation conserve un impact significatif sur les personnes soignées et leur vécu du parcours de soin, mais aussi sur les professionnels de santé. Ces impacts pratiques, émotionnels et symboliques sont d'autant plus importants quand l'évènement survient dans les suites d'une erreur. La démarche éthique comprend alors trois temps essentiels : reconnaître l'évènement en tant que tel, informer les personnes impliquées de l'évènement et enfin créer les conditions favorables au maintien du soin. Chacune de ses étapes est marquée d'enjeux et de questionnements spécifiques nécessitant une approche éthique complexe amenant à considérer constamment la conciliation de perceptives parfois divergentes entre personnes soignées et professionnels de santé. La survenue d'un évènement peut aussi déboucher sur une authentique crise de confiance aux multiples dimensions que les professionnels de santé auront aussi à accompagner. Enfin, la survenue d'un évènement interroge notre responsabilité vis-à-vis des personnes que nous prenons en soin, mais aussi notre idéal de maîtrise. Critiquer notre culture de la performance, repenser profondément notre approche de l'évènement et de l'erreur pour y voir aussi une opportunité d'évolution positive sont autant de pistes à déployer au sein de nos unités de soin. The term "event" covers a wide range of concrete situations in radiation oncology, from particularly intense radiation-related side effects to the possibility of technical or human error. Although quality procedures are an integral part of radiotherapy oncology department operations ensuring the analysis and prevention of such events, their occurrence during radiation treatment still has a significant impact on patients and their experience of the treatment process, as well as on health professionals. These practical, emotional and symbolic impacts are all the greater when the event occurs in the aftermath of an error. The ethical approach therefore comprises three essential stages: recognizing the event as such, informing those involved of the event and, finally, creating conditions for the continuation of care. Each of these stages is marked by specific issues and questions, requiring a complex ethical approach that constantly involves reconciling the possible divergent perceptions of patients and health professionals. The occurrence of an event can also lead to a genuine crisis of confidence with multiple dimensions, which health professionals will also have to face and to support. Finally, the occurrence of an event calls into question not only our responsibility towards patients, but also our ideal of control. We need to criticize our culture of performance, rethink our approach to events and errors, and see them also as opportunities for positive change. [ABSTRACT FROM AUTHOR]

There are longstanding concerns relating to clinical academic training pipelines, with evidence for multiple barriers and enablers to clinical academic career progression. We sought to assess the extent to which these and other factors apply to academic training in clinical oncology in the United Kingdom. A cross-sectional survey was undertaken using a bespoke, pre-piloted online electronic questionnaire that was distributed to clinical oncology specialty trainees and consultants who had at any point between January 2013–January 2024 commenced an academic post whilst in training. Collated information included demographic data, location and stage of training, research experience and ambitions, research skill confidence and academic career progression. Seventy eligible responses were included, representing 84% (n = 16/19) of UK training deaneries. Thirty-seven (53%) of the respondents had obtained their certificate of completion of training (CCT) whilst 11% (n = 8/70) and 40% (n = 28/70) were at specialty trainee level and respectively pre- or within-/post-doctoral studies. Of 34 post-CCT respondents, 58% (n = 20) had ongoing research commitments but this reached 30% of their overall activity for just 30% (n = 10). Barriers to academic progression included clinical training requirements, post availability and limited mentorship. Most (60%; n = 35/58) undertook doctoral studies in their final two training years. A majority of respondents lacked confidence in radiation oncology (RO) skills relevant to their career ambitions, with 60%, 40% and 30%, respectively, confident in RO clinical research outcome evaluation, in vitro radiation analyses and using RO animal models. These data provide a granular, long-term analysis of academic clinical oncology training at a national level; identifying poor progression to research independence underlined by limited confidence in RO research skills and multiple barriers to academic career progression. These data provide areas in which policy makers, research funders and training programmes can focus to improve academic training in clinical oncology. • Clinician scientists are vital to the continued development of radiation oncology. • This work explores viewpoints on clinical oncology clinical academic training. • There is poor progression to senior clinician scientist roles. • Clinical training, postgraduate exams and limited funding impact progression. • Even senior clinical academics lack confidence in key research skills. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Paediatric cancers are rare, and most children requiring radiation therapy receive external beam radiation (EBRT). Although EBRT may offer organ preservation compared to surgery, it can be associated with significant late effects. Image‐guided brachytherapy is a highly specialised technique offering both organ preservation and dose conformity to minimise late toxicity.This is a retrospective mono‐institutional review of paediatric brachytherapy in one of the largest paediatric centres in Australia. Outcomes and toxicities are presented as well as brachytherapy versus proton plan comparison in four patients.A total of 14 patients were treated with adjuvant brachytherapy between 2012 and 2022. The predominant histology was rhabdomyosarcoma, and all patients had pelvic tumours. High‐dose rate (HDR) brachytherapy was given for 13 patients with one patient receiving low‐dose rate (LDR) brachytherapy. Only one grade three late toxicity was reported and two patients developed metastatic disease within one year of completion of treatment. The brachytherapy plan was superior to protons in two of four patients and equivocal in one patient.This is the first Australian publication of a paediatric brachytherapy series from a single institution. This retrospective series demonstrates the feasibility and safety of brachytherapy in paediatric pelvic tumours. The initial work presented here demonstrates the value of a comprehensive radiation plan review in selecting the optimal modality for an individual paediatric patient. [ABSTRACT FROM AUTHOR]

Introduction: Stereotactic ablative radiotherapy (SABR) is a standard of care treatment for medically inoperable early‐stage non‐small‐cell lung cancer (NSCLC). The CHISEL trial was a phase 3 randomised controlled trial that compared SABR to conventional radiation therapy (CRT). Using patient‐level data, we compared the cost‐effectiveness of SABR and CRT for early‐stage NSCLC. Methods: Data on treatment exposure, outcomes (recurrence, survival) and quality of life (QoL; EORTC QLQ‐C30) were sourced from the trial. Quality‐adjusted life years (QALYs) were estimated for the trial period using Australian utility weights for the EORTC QLQ‐C30‐derived QLU‐C10D. Costs related to simulation, planning, delivery, verification and post‐treatment monitoring were estimated by applying Australian Medicare Benefits Schedule fees. The costs of post‐progression therapy and grade ≥3 toxicity were estimated using trial data and relevant literature sources. Cost‐effectiveness was investigated as the incremental cost per QALY gained for SABR compared to CRT. Results: Complete QoL data were available for 21 patients: 14 in the SABR arm and 7 in the CRT arm. Mean QALYs discounted at 5% per annum were similar between arms: 12.68 months for SABR and 12.12 months for CRT. The mean costs of delivering SABR and CRT were $4763 and $6817, respectively. The costs of monitoring were similar in both arms, $4856 and $4853 for SABR and CRT. The mean costs of post‐progression therapy were $24,572 for SABR and $42,801 for CRT. The mean costs of grade ≥3 toxicity were $809 in the SABR arm and $132 in the CRT arm. Therefore, the total mean cost for SABR over the period of interest was lower for SABR than CRT. Given lower mean costs and numerically higher QALYs for SABR compared with CRT, an incremental cost‐effectiveness ratio was not calculated. Conclusion: Compared to CRT, SABR is a cost‐effective treatment for early‐stage NSCLC as the estimated upfront treatment cost and the cost of subsequent care are lower for SABR for comparable mean QALYs. Assessment of the lifetime QALYs and projections of cost estimation will provide a better indication of the long‐term cost‐effectiveness of SABR. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to describe the research productivity among RANZCR Radiation Oncology (RO) trainees. Methods: Publicly available data on RO fellows, who were awarded the RANZCR fellowship between July 2014 and June 2023, was extracted from the RANZCR Annual Reports. Fellows who had qualified overseas and did not undertake full RANZCR training were excluded. A PubMed search was performed for publications by each fellow in the 5 years prior, and 6 months, after the estimated completion of training. Research productivity was defined as the number of first‐author and any‐author publications per trainee. Results: In total, 168 eligible RO fellows were included in this study. 104 (62%) and 118 (70%) fellows had first‐author and any‐author publications during training, respectively. A total of 203 first‐author and 308 unique any‐author publications were identified, with mean first‐author and any‐author publications per trainee of 1.21 (SD = 2.37) and 2.02 (SD = 3.71), respectively. Trainee research was most commonly published in JMIRO (34% of first‐author and 27% of any‐author publications). There were significant differences in the number of first‐author publications by gender (P = 0.04) and training jurisdictions (P = 0.03). There were also differences in the number of any‐author publications by gender (P = 0.002) and training jurisdictions (P = 0.03). There was a significant increase in any‐author publications over the 9‐year study period (P = 0.005). Conclusion: This is the first study evaluating research productivity among RO fellows during training. We identified disparities in research productivity by gender and training jurisdictions. This offers opportunities to tailor efforts to better support a vibrant and productive research culture across the RO training program. [ABSTRACT FROM AUTHOR]

Introduction: This study compared the predictive ability of radiation‐induced cataract between maximum point dose of the lens (Lens Dmax) ≥7 Gy, mean lens dose (Lens Dmean) ≥7 Gy, Lens Dmax ≥10 Gy, and Lens Dmean ≥10 Gy. Methods: Patients aged 3–18 years received cranial irradiation or radiation therapy at head and neck area between January 2010 and December 2019 at our institute were included. Patients without baseline and/or follow‐up eye examination were excluded. Receiver operating characteristic (ROC) curves identified potential predictors and Cox regression analysed correlations between potential factors and cataract occurrence. Results: Sixty‐three patients (122 eyes) were analysed. Cataracts were detected in 14 eyes (11.5%). Median follow‐up time was 4 years (range 0.5–10 years), with cataract developing in a median of 2.5 years (range 0.3–7 years). Three patients (21.4%) developed grade ≥3 cataract. Lens Dmean ≥10 Gy was associated with cataract formation. Conclusion: Lens Dmean ≥10 Gy showed the highest ability for predicting radiation‐induced cataract in paediatric patients. Net reclassification improvement (NRI) suggested that changing lens dose constraint from Dmax <7 Gy to Dmean <10 Gy would miss 7% of cataract cases but avoid 28% of unnecessary restrictions. Adopting a mean lens dose <10 Gy was suggested as a constraint for lens dose. [ABSTRACT FROM AUTHOR]

Introduction: Radiotherapy plays a key role in the multidisciplinary management of oesophageal cancers across neoadjuvant, definitive and palliative settings. Improved precision in radiotherapy planning and delivery techniques have allowed treating disease with tighter margins reducing toxicity. In this study, we examine the appropriateness of current practice in defining the planning target volume (PTV). Methods: This is a single institutional retrospective study of patients who received radiotherapy for oesophageal cancers using volumetric modulated arc therapy (VMAT) during 2020. All cone‐beam computerised tomography (CBCT) scans were reviewed to assess whether PTV expansions appropriately accounted for tumour motion and interfractional variation. Results: Of the 27 patients, 2 (7%), 5 (19%) and 20 (74%) had cervical, thoracic and distal/gastro‐oesophageal junction (GOJ) disease, respectively. 16 (59%) had adenocarcinoma and 9 (33%) had squamous cell carcinoma. 9 of 20 distal/GOJ patients were planned and treated according to the institutional stomach filling protocol. 521/528 (98.7%) CBCTs demonstrated adequate target coverage. Cervical, thoracic and GOJ regions demonstrated adequate target coverage in 57/58, 96/97 and 368/373 CBCTs with median PTV expansions of 5, 7 and 7 mm, respectively. In four patients with GOJ disease, CBCT review identified five episodes where the target volume was insufficiently covered during the treatment course. Conclusion: In this single institutional retrospective study, for the vast majority of patients, our institutional practice of defining PTV margins achieved satisfactory target treatment. The interfractional variations observed in patients with GOJ tumours due to target motion and variable gastric volume, highlights the role of further refinements to motion management techniques in this cohort. [ABSTRACT FROM AUTHOR]

Trismus commonly arises after surgery for head and neck cancer (HNC) and its severity is potentiated by postoperative radiotherapy. While the benefit of trismus rehabilitation after surgery and radiotherapy is well established, the evidence during radiotherapy is less clear. This may be due to poor adherence to trismus exercises secondary to acute mucositis. This study assessed the feasibility of using a novel trismus device during adjuvant radiotherapy for HNC in patients with acute postoperative trismus. Prospective single-arm cohort feasibility study. Eligible patients had undergone surgery with curative intent for HNC, planned for adjuvant radiotherapy, and were suitable for trismus rehabilitation. Participants completed a 10-week exercise program using a novel jaw stretching device. Study outcomes were adherence, maximal incisal opening (MIO), and trismus-related function and quality of life scores, assessed at baseline, 10 weeks, and 6 months after commencing exercises. Nine patients diagnosed with trismus after primary surgery were recruited. The mean increase in MIO at 10 weeks was 7.8 mm (range −4 to 15 mm, p = 0.03), and at 6 months was 10.6 mm (range 1–26 mm, p = 0.03). Significant improvements were observed in trismus-related quality of life (Gothenburg Trismus Questionnaire; p = 0.04). Adherence to the exercises was 100% in week 1–2, 67% in weeks 3–6, and 100% at 10 weeks (1 month post radiation). This study demonstrates the feasibility of using a novel jaw stretching device during adjuvant radiotherapy. Further evaluation is warranted to assess the effectiveness of early intervention and prevention of trismus during HNC radiotherapy. Level of Evidence: IV [ABSTRACT FROM AUTHOR]

Normal tissue tolerance dose limits to the heart have been established to reduce the risk of radiation‐induced cardiac disease (RICD). Dose constraints have been developed based on either the mean dose delivered to the whole heart (MHD) or the dose delivered to a specific volume, for example, volume of heart receiving equal to or greater than 30 Gy (V30). There is increasing evidence that the impact of thoracic radiation on cardiac morbidity and mortality has been underestimated. Consequently, there is a need to reduce the dose delivered to the heart in radical radiotherapy treatment planning. The pathophysiology of RICD may relate to dose to specific cardiac substructures (CS) rather than the traditionally observed MHD for common toxicities. The MHD or V30 Gy threshold dose rarely represents the true dose delivered to individual CS. Studies have shown the dose to specific areas may be more strongly correlated with overall survival (OS). With advances in modern radiotherapy techniques, it is vital that we develop robust, evidence‐based dose limits for CS, to fully understand and reduce the risk of RICD, particularly in high‐risk populations with cardiac risk factors. The following review will summarise the existing evidence of dose limits to CS, explain how dose limits may vary according to different disease sites or radiation techniques and propose how radiotherapy plans can be optimised to reduce the dose to these CS in clinical practice. [ABSTRACT FROM AUTHOR]

Background: The suspension of breast cancer screening during the COVID‐19 pandemic altered patient diagnosis and management. This study investigates the impact of the COVID‐19 lockdowns, screening delays and reduced healthcare attendance on changes in tumour and treatment characteristics, particularly for biologically more aggressive breast cancers. Methods: This retrospective single‐hospital analysis utilized data from a prospective cancer database between July 2019 and June 2022. Patient, tumour and treatment factors were compared across pre‐pandemic, pandemic and post‐pandemic groups. Results: Symptomatic breast cancer increased from 42.3% in the pre‐, 53.1% in the pandemic and 57% in the post‐ respectively (P ≤ 0.05). Compared to the pre‐pandemic group (4.6%), an increase in stages 3 or 4 breast cancers in the pandemic (8.5%) and post‐pandemic (7.1%) was found. Increased node‐positivity in Ki67 > 20%, grade 3 or ER‐ tumours post‐pandemic (+5.4%, +14.8%, +33.4%, respectively) was identified. More neoadjuvant chemotherapy was found in both the pandemic (+4.3%) and post‐pandemic (+11.3%, P = 0.0261) groups. An increase in hypofractionated radiotherapy in the post‐pandemic group (+9.4%) was also identified. Conclusion: Our study identified a decrease in early‐stage cancers and an increase in node positivity, particularly for biologically more aggressive tumours. An increase in the number of patients receiving neoadjuvant chemotherapy or hypofractionated radiotherapy during the pandemic and post‐pandemic periods was also identified. [ABSTRACT FROM AUTHOR]

Background: This case study discusses a 37-year-old man who presented with stage IV (cT3N1M1a) sigmoid colon cancer that had metastasized to the liver. The patient underwent stereotactic body radiation therapy using real-time, fiducial-based, triggered-imaging guidance and amplitude-based respiratory gating at exhalation. In addition to the cancer diagnosis, the patient was deaf and had a substantial medical and surgical history for other comorbidities. Discussion: Although deaf patients account for a small percentage of those undergoing radiation therapy, this treatment has the potential to be more inclusive to this group, which the authors accomplished using a novel approach. Providing instructions to enable the patient to breathe in a consistent, periodic, and reproducible manner via sign-language interpretation and visual setup was key to providing equitable care. Conclusion: The multidisciplinary team must work to ensure that deaf patients are not excluded from gating treatment protocols typically achieved through verbal coaching. With appropriate visual setup, sign-language interpretation, and coaching through translation, culturally competent care can be provided successfully and seamlessly. [ABSTRACT FROM AUTHOR]

Background/Aim: To evaluate the safety and efficacy of lattice radiotherapy (LRT) for large, inoperable breast cancers. Patients and Methods: In this prospective study, patients who underwent LRT for breast tumors that were ulcerating/fungating/extensively eroding the chest wall, and were ineligible/unwilling for surgery, were enrolled from May 2021 to Nov 2023. Baseline Eastern Cooperative Oncology Group (ECOG) status, pre- and post-LRT numerical rating scale (NRS), and post-LRT changes in quality of life (QoL) were recorded. Survival outcomes were reported at 6 months and 1-year. Median rates of survival and dosimetric parameters were calculated. Kaplan–Meier curves for overall survival (OS), cancer-specific survival (CSS), and failure of local control (LC) were constructed. Results: Ten patients (8 females) underwent LRT. The median age was 76 years (range=57-99 years) and the median ECOG performance status was 2.5 (range=1-4). The planned schedule was completed by 9/10 patients, accounting for a 90% compliance rate. Among patients with pain (n=7), NRS rapidly reduced from 7 (range=5-10) to 3 (range=1-6). The median equivalent uniform dose was 0.71 Gy (0.09-1.59 Gy). The actuarial rates of 6-month LC, CSS, and OS were 75%, 89%, and 61%, respectively, with only LC rate changing to 50% at 1 year. Two patients had local relapse at the six-month and 1-year follow-up, respectively, after having achieved a complete response at three months, and two others died of COVID-19 infection and ischemic stroke. Conclusion: LRT was found to be effective and safe in palliating symptoms among patients with large inoperable breast tumors. [ABSTRACT FROM AUTHOR]

Purpose and objective: To develop expert consensus statements on multiparametric dose prescriptions for stereotactic body radiotherapy (SBRT) aligning with ICRU report 91. These statements serve as a foundational step towards harmonizing current SBRT practices and refining dose prescription and documentation requirements for clinical trial designs. Materials and methods: Based on the results of a literature review by the working group, a two-tier Delphi consensus process was conducted among 24 physicians and physics experts from three European countries. The degree of consensus was predefined for overarching (OA) and organ-specific (OS) statements (≥ 80%, 60–79%, < 60% for high, intermediate, and poor consensus, respectively). Post-first round statements were refined in a live discussion for the second round of the Delphi process. Results: Experts consented on a total of 14 OA and 17 OS statements regarding SBRT of primary and secondary lung, liver, pancreatic, adrenal, and kidney tumors regarding dose prescription, target coverage, and organ at risk dose limitations. Degree of consent was ≥ 80% in 79% and 41% of OA and OS statements, respectively, with higher consensus for lung compared to the upper abdomen. In round 2, the degree of consent was ≥ 80 to 100% for OA and 88% in OS statements. No consensus was reached for dose escalation to liver metastases after chemotherapy (47%) or single-fraction SBRT for kidney primaries (13%). In round 2, no statement had 60–79% consensus. Conclusion: In 29 of 31 statements a high consensus was achieved after a two-tier Delphi process and one statement (kidney) was clearly refused. The Delphi process was able to achieve a high degree of consensus for SBRT dose prescription. In summary, clear recommendations for both OA and OS could be defined. This contributes significantly to harmonization of SBRT practice and facilitates dose prescription and reporting in clinical trials investigating SBRT. [ABSTRACT FROM AUTHOR]

Workforce modelling for Radiation Oncology Medical Physicists (ROMPs) is evolving and challenging, prompting the development of the 2021 Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) ROMP Workforce (ARW) Model. In the exploration of this model at Sir Charles Gairdner Hospital, a comprehensive productivity exercise was conducted to obtain a detailed breakdown of ROMP time at a granular level. The results provide valuable insights into ROMP activities and enabled an evaluation of ARW Model calculations. The findings also capture the changing ROMP role as evidenced by an increasing involvement in consultation and advisory tasks with other professionals in the field. They also suggest that CyberKnife QA time requirements in the data utilised by the model may need to be revised. This study emphasises features inherent in the model, that need to be understood if the model is to be applied correctly. [ABSTRACT FROM AUTHOR]

Abstract Over the last few years, radiation therapy (RT) techniques have evolved very rapidly, with the aim of conforming high-dose volume tightly to a target. Although to date CT is still considered the imaging modality for target delineation, it has some known limited capabilities in properly identifying pathologic processes occurring, for instance, in soft tissues. This limitation, along with other advantages such as dose reduction, can be overcome using magnetic resonance imaging (MRI), which is increasingly being recognized as a useful tool in RT clinical practice. This review has a two-fold aim of providing a basic introduction to the physics of MRI in a narrative way and illustrating the current knowledge on its application “from head to toe” (i.e., different body sites), in order to highlight the numerous advantages in using MRI to ensure the best therapeutic response. We provided a basic introduction for residents and non-radiologist on the physics of MR and reported evidence of the advantages and future improvements of MRI in planning a tailored radiotherapy treatment “from head to toe”. Critical relevance statement This review aims to help understand how MRI has become indispensable, not only to better characterize and evaluate lesions, but also to predict the evolution of the disease and, consequently, to ensure the best therapeutic response. Key Points MRI is increasingly gaining interest and applications in RT planning. MRI provides high soft tissue contrast resolution and accurate delineation of the target volume. MRI will increasingly become indispensable for characterizing and evaluating lesions, and to predict the evolution of disease. Graphical Abstract

Haitham Alahmad,1 Abdulrhman M Alshahrani,2 Khaled Alenazi,1 Mohammad Alarifi,1 Ahmad Abanomy,1 Ahmad A Alhulail,3 Raed A Albathi,4 Saleh Alzughaibi,5 Mansour Almanaa1 1Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, 4545, Saudi Arabia; 2Radiology Technology Department, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia; 3Department of Radiology and Medical Imaging, Prince Sattam Bin Abdulaziz University, Al-Kharj, 16278, Saudi Arabia; 4Radiology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; 5Health Informatics Department, College of Health Science, Saudi Electronic University, Riyadh, Saudi ArabiaCorrespondence: Haitham Alahmad, Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh, 4545, Saudi Arabia, Tel +966114693567, Email hnalahmad@ksu.edu.saBackground: Radiation therapy utilizes complex technologies to target tumors. Radiation therapy is not immune to human errors. Reporting medical errors and near misses is crucial to improving patient outcomes and ensuring the safety of future patients.Objective: This study aimed to measure the attitudes of radiotherapy staff members in Saudi Arabia regarding reporting errors and near misses in radiation therapy practice. It also examined the participants’ reporting patterns and behaviors and explored the potential barriers to reporting errors and near misses as perceived by the participants.Methods: A cross-sectional study utilizing an online questionnaire was implemented. A sample of 70 health professionals working in radiation oncology departments in Saudi Arabia, including radiation oncologists, medical physicists, and radiotherapists, were recruited to participate in this study from January to June 2023. The data was analyzed using chi-squared testing to compare different groups, and the Kruskal–Wallis was used to find any statistically significant differences between different groups.Results: The study included 70 radiotherapy staff members. Professional roles did not significantly impact participants’ decisions to report minor or major errors, with most consistently reporting errors to their supervisors regardless of role. The study revealed that fear of professional sanctions and the potential negative impact on a department’s reputation are significant barriers to reporting errors or near misses. However, Only 17% of radiation oncologists did consider departmental sanctions as a barrier. Participants identified communication failure as the most significant source of errors in radiation oncology departments. The study also found a high level of agreement among the participants regarding the responsibility of reporting errors and near misses.Conclusion: The study investigated reporting errors and near misses in radiotherapy and considered the factors influencing them. The findings highlight the importance of effective communication and the implementation of an electronic reporting system.Keywords: radiotherapy, radiation oncology, medical errors, near misses

Backgrounds/Aims This study explored the initial institutional experience of using gold fiducial markers for stereotactic body radiotherapy (SBRT) in treating malignant hepatic tumors using real-time ultrasound-computed tomography (CT)/magnetic resonance (MR) imaging fusion-guided percutaneous placement. Methods From May 2021 to August 2023, 19 patients with 25 liver tumors that were invisible on pre-contrast CT received fiducial markers following these guidelines. Postprocedural scans were used to confirm their placement. We assessed technical and clinical success rates and monitored complications. The implantation of fiducial markers facilitating adequate treatment prior to SBRT, which was achieved in 96% of the cases (24 of 25 tumors), was considered technical success. Clinical success was the successful completion of SBRT without evidence of marker displacement and was achieved in 88% of cases (22 of 25 tumors). Complications included one major subcapsular hematoma and marker migration into the right atrium in two cases, which prevented SBRT. Results Among the treated tumors, 20 of 24 (83.3%) showed a complete response, three of 24 (12.5%) remained stable, and one of 24 (4.2%) progressed during an average 11.7-month follow-up (range, 2-32 months). Conclusions This study confirms that percutaneous gold fiducial marker placement using real-time CT/MR guidance is effective and safe for SBRT in hepatic tumors, but warns of marker migration risks, especially near the hepatic veins and in subcapsular locations. Using fewer markers than traditionally recommended-typically two per patient, the outcomes were still satisfactory, particularly given the increased risk of migration when markers were placed near major hepatic veins.

BackgroundResistance to existing therapies is a significant challenge in improving outcomes for glioblastoma (GBM) patients. Metabolic plasticity has emerged as an important contributor to therapy resistance, including radiation therapy (RT). Here, we investigated how GBM cells reprogram their glucose metabolism in response to RT to promote radiation resistance.MethodsEffects of radiation on glucose metabolism of human GBM specimens were examined in vitro and in vivo with the use of metabolic and enzymatic assays, targeted metabolomics, and FDG-PET. Radiosensitization potential of interfering with M2 isoform of pyruvate kinase (PKM2) activity was tested via gliomasphere formation assays and in vivo human GBM models.ResultsHere, we show that RT induces increased glucose utilization by GBM cells, and this is accompanied with translocation of GLUT3 transporters to the cell membrane. Irradiated GBM cells route glucose carbons through the pentose phosphate pathway (PPP) to harness the antioxidant power of the PPP and support survival after radiation. This response is regulated in part by the PKM2. Activators of PKM2 can antagonize the radiation-induced rewiring of glucose metabolism and radiosensitize GBM cells in vitro and in vivo.ConclusionsThese findings open the possibility that interventions designed to target cancer-specific regulators of metabolic plasticity, such as PKM2, rather than specific metabolic pathways, have the potential to improve the radiotherapeutic outcomes in GBM patients.

BackgroundTo report objective long-term complications and health related quality of life (HRQOL) outcomes after radical prostatectomy (RP) with and without radiation therapy (RT) for prostate cancer (CaP).MethodsWe analyzed patients diagnosed with CaP who underwent RP from the UCSF Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry between 1995 and 2020. Cox proportional hazards were used to assess risk of postoperative complications which included cystitis, gastrointestinal (GI) toxicity, incontinence requiring a surgical procedure, ureteral injury and urinary stricture. Repeated measures mixed models were used to assess the effects of radiation and complications on patient-reported urinary, bowel, and sexual function after surgery.ResultsOf 6,258 men who underwent RP, cumulative incidence of EBRT was 9.1% at 5 years after surgery. Patients who received postoperative radiation were at increased risk for onset of cystitis (HR 5.60, 95% CI 3.40-9.22, P < 0.01). Receipt of RT was not associated with other complications. In repeated measures analysis, postoperative RT was associated with worsening general health scores, adjusting for complications of incontinence, urinary stricture, GI toxicity or ureteral injury, independent of whether patients had those complications.ConclusionsRT after RP was associated with an increase in the risk of cystitis and worse general health in the long term. Other complications and HRQOL outcomes did not demonstrate differences by whether patients had RT or not. While post-operative RT is the only curative option for CaP after RP, patients and providers should be aware of the increased risks when making treatment decisions.

Technological advances in MRI-guided radiation therapy (MRIgRT) have improved real-time visualization of the prostate and its surrounding structures over CT-guided radiation therapy. Seminal studies have demonstrated safe dose escalation achieved through ultrahypofractionation with MRIgRT due to planning target volume (PTV) margin reduction and treatment gating. On-table adaptation with MRI-based technologies can also incorporate real-time changes in target shape and volume and can reduce high doses of radiation to sensitive surrounding structures that may move into the treatment field. Ongoing clinical trials seek to refine ultrahypofractionated radiotherapy treatments for prostate cancer using MRIgRT. Though these studies have the potential to demonstrate improved biochemical control and reduced side effects, limitations concerning patient treatment times and operational workflows may preclude wide adoption of this technology outside of centers of excellence. In this review, we discuss the advantages and limitations of MRIgRT for prostate cancer, as well as clinical trials testing the efficacy and toxicity of ultrafractionation in patients with localized or post-prostatectomy recurrent prostate cancer.

Objective. To propose a mathematical model for applying ionization detail (ID), the detailed spatial distribution of ionization along a particle track, to proton and ion beam radiotherapy treatment planning (RTP).Approach. Our model provides for selection of preferred ID parameters (Ip) for RTP, that associate closest to biological effects. Cluster dose is proposed to bridge the large gap between nanoscopicIpand macroscopic RTP. Selection ofIpis demonstrated using published cell survival measurements for protons through argon, comparing results for nineteenIp:Nk,k= 2, 3, …, 10, the number of ionizations in clusters ofkor more per particle, andFk,k= 1, 2, …, 10, the number of clusters ofkor more per particle. We then describe application of the model to ID-based RTP and propose a path to clinical translation.Main results. The preferredIpwereN4andF5for aerobic cells,N5andF7for hypoxic cells. Significant differences were found in cell survival for beams having the same LET or the preferredNk. Conversely, there was no significant difference forF5for aerobic cells andF7for hypoxic cells, regardless of ion beam atomic number or energy. Further, cells irradiated with the same cluster dose for theseIphad the same cell survival. Based on these preliminary results and other compelling results in nanodosimetry, it is reasonable to assert thatIpexist that are more closely associated with biological effects than current LET-based approaches and microdosimetric RBE-based models used in particle RTP. However, more biological variables such as cell line and cycle phase, as well as ion beam pulse structure and rate still need investigation.Significance. Our model provides a practical means to select preferredIpfrom radiobiological data, and to convertIpto the macroscopic cluster dose for particle RTP.

Background: Cystic, sporadic hemangioblastomas (HBLs) represent a unique, therapeutically challenging subset of central nervous system tumors, mainly due to their unpredictable growth patterns and potential for symptomatic progression. This study aims to explore the complexities surrounding the diagnosis, treatment, and long-term management of these lesions. Methods: A comprehensive literature review was performed, and a detailed case study of a 56-year-old patient with a cystic, sporadic cerebellar HBL was produced. Results: The case highlights the multiphasic growth pattern typical of cystic, sporadic HBLs, characterized by periods of dormancy and subsequent rapid expansion. An initial surgical intervention offered temporary control. Tumor recurrence, mainly through cystic enlargement, was treated by SRS. A subsequent recurrence, again caused by cystic growth, eventually led to the patient’s death. The intricacies of treatment modalities, focusing on the transition from surgical resection to stereotactic radiosurgery (SRS) upon recurrence, are discussed. Parameters indicating impending tumor growth, coupled with symptomatic advances, are also explored. Conclusions: The management of cystic, sporadic cerebellar HBLs requires a strategic approach that can be informed by radiological characteristics and tumoral behavior. This study underscores the importance of a proactive, individualized management plan and suggests guidelines that could inform clinical decision making.

This work aimed to characterize a dedicated phantom for assessing the dose near metal implants for radiotherapy with photons and protons. A dosimetry audit phantom was redesigned to position a Gafchromic EBT-3 film within a bisected titanium pedicle screw (6.5 mm diameter). The mass density and the water equivalent thickness (WET) of the phantom material were determined. The phantom was irradiated using a photon arc and a horizontal proton beam in combination with a couch rotation of 20°, with three repeated measurements each. Treatment plans utilizing a single field covering the screw and the EBT-3 film were optimized to deliver a physical dose of 2 Gy using a collapsed cone and Monte Carlo dose engine for photons and protons, respectively. The mass density and the WET of the phantom were determined as (1.033 ± 0.010) gcm-3 and (1.022 ± 0.013), respectively. Ionisation chamber measurements agreed within 1% (photons) and 0.5% (protons) with the calculated dose values. Relative photon dosimetry measurements using EBT-3 films revealed an agreement between measured and calculated horizontal profiles within the confidence interval for areas beyond 5 mm from the center. For photon plans, significant deviations of more than 10% were found at the interfaces between phantom material and screw. The proton measurements showed a gradual decrease of 3% across both profiles. In contrast to photon plans, no dose increase was measured within the screw, but significant dose fluctuations (>5%) in the beam's exit region. This study showed that the behavior of dose engine is affected by metal implants and thus dosimetric measurements are highly recommended. The presented phantom can serve as foundation for dedicated end-2-end phantoms. [ABSTRACT FROM AUTHOR]

Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment; yet their efficacy remains variable across patients. This review delves into the intricate interplay of tumour characteristics contributing to resistance against ICI therapy and suggests that combining with radiotherapy holds promise. Radiation, known for its ability to trigger immunogenic cell death and foster an in situ vaccination effect, may counteract these resistance mechanisms, enhancing ICI response and patient outcomes. However, particularly when delivered at high-dose, it may trigger immunosuppressive mechanism and consequent side-effects. Notably, low-dose radiotherapy (LDRT), with its capacity for tumour reprogramming and reduced side effects, offers the potential for widespread application. Preclinical and clinical studies have shown encouraging results in this regard. [ABSTRACT FROM AUTHOR]

A 71-year-old male with type 2 diabetes and hypertension was diagnosed with carcinoma of the pyriform fossa in 2019. The biopsy was reported as a moderately differentiated squamous cell carcinoma, and positron emission tomography-computed tomography (PET-CT) scan showed an fluorodeoxyglucose (FDG)-avid lesion in the pyriform fossa and the aryepiglottic fold with few nodes in level II and level III. The paitent was treated with radical chemoradiotherapy. A follow-up PET-CT scan done in 2022 revealed an FDG-avid soft tissue thickening in the left palatine tonsillar region and an uptake in the thyroid that was reported as not significant. A punch biopsy from the tonsillar fossa lesion revealed squamous cell carcinoma. The lesion was treated as a second primary and treated with radiotherapy with curative intent. The patient was complaining of dysphagia, difficulty in breathing, and weight loss around 6 months after treatment that were addressed medically. There was a significant reduction in size and FDG activity of the ill-defined thickening in the left tonsillar region which was seen in the response-assessment PET done 6 months after RT. A heterogeneously enhancing nodules were seen in both lobes of the thyroid in which the largest one measured 3.5 × 3.1 cm seen in the right lobe. The patient underwent a biopsy from the thyroid that revealed a benign thyroid gland infiltrated by clusters and nests of poorly differentiated malignant cells. The histomorphology was suggestive of a poorly differentiated carcinoma, likely anaplastic carcinoma thyroid, or metastasis of the squamous cell carcinoma. Curative treatment was ruled out in this case due to his comorbidities, pulmonary symptoms, and radiation delivered to the neck. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia. Methods: A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021. Results: Out of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training. Conclusion: These findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians. What is known about the topic? During the coronavirus disease 2019 (COVID-19) pandemic there were significant adaptations required to the delivery of clinical care. What does this paper add? There is a strong preference for ongoing work from home arrangements, especially for administrative and non-clinical work. Most radiation oncologists feel more confident using telehealth and favour its ongoing use post-pandemic. Burnout and stress remain prevalent within the workforce. What are the implications for practitioners? There is a high demand among the radiation oncology workforce for adoption of technological advances to improve work satisfaction including remote access to enable flexible work arrangements. [ABSTRACT FROM AUTHOR]

The article explores AI and ML's transformative potential in reshaping the radiation therapy landscape. The article navigates through the evolving field of radiation oncology, highlighting the constant influx of information facilitated by advanced imaging techniques. The technical scrutiny of AI's potential within radiation oncology is explored, contrasting definitions by Russell and Norvig with Goel's more insightful perspective. A detailed overview of the radiation therapy process, from diagnosis to follow-up, sets the stage for discussing the role of AI and ML. The utilities of AI in radiation oncology are dissected, emphasizing the reduction of clinical load through decision support systems, streamlined treatment planning, and the automated enhancement of radiation therapy. The article showcases various AI algorithms deployed in the workflow, their applications, and the promising results they offer. While acknowledging the challenges, including the opaque nature of AI and the critical need for clinical adoption, the article outlines criteria for evaluating AI tools in clinical settings. It stresses the importance of trust-building, transparency and overcoming challenges to harness AI's full potential in radiation oncology. In conclusion, the article advocates for a proactive integration of AI and ML, envisioning a future where these technologies empower radiation oncologists to enhance patient care, optimize workflows, and advance the field. [ABSTRACT FROM AUTHOR]

Radiomics is a promising tool for the development of quantitative biomarkers to support clinical decision-making. It has been shown to improve the prediction of response to treatment and outcome in different settings, particularly in the field of radiation oncology by optimising the dose delivery solutions and reducing the rate of radiation-induced side effects, leading to a fully personalised approach. Despite the promising results offered by radiomics at each of these stages, standardised methodologies, reproducibility and interpretability of results are still lacking, limiting the potential clinical impact of these tools. In this review, we briefly describe the principles of radiomics and the most relevant applications of radiomics at each stage of cancer management in the framework of radiation oncology. Furthermore, the integration of radiomics into clinical decision support systems is analysed, defining the challenges and offering possible solutions for translating radiomics into a clinically applicable tool. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Cranio‐spinal radiotherapy (CSI) is used to treat central nervous system malignancies in paediatric, adolescent/young adult (AYA), and adult patients. Its delivery in the paediatric/AYA population is particularly challenging across different age groups. This study aims to assess the setup variations and dosimetric impact of CSI in paediatric and AYA patients.This retrospective analysis included, 10 paediatric and AYA patients (aged 4–25) who underwent volumetric modulated arc therapy (VMAT) CSI between 2016 and 2022. Patient characteristics, diagnoses, prescribed CSI doses, and fractionation details were assessed. CT simulation and treatment planning followed standard protocols with setup errors were quantified by comparing daily treatment setup images with the planned position. The study evaluated the dosimetric impact on target volumes and organs at risk (OARs).The setup errors were identified, ranging from 0.5 to 6.2 mm in different directions, especially in the cranio‐caudal direction. Despite these variations, there was minimal impact observed on the coverage of clinical target volumes (CTV) and doses to OARs (<1% relative change).Ensuring precise setup in paediatric and AYA patients undergoing CSI is essential to maintain adequate CTV coverage. Although occasional substantial setup variations occurred during treatment, they had a limited impact on CTV coverage and OAR doses when infrequent. Appropriate planning target volume (PTV) margins can effectively compensate for occasional shifts. However, systematic errors could compromise treatment quality if undetected. Regular off‐line review of patient set‐up trends is recommended. [ABSTRACT FROM AUTHOR]

Cardiac risk mitigation is a major priority in improving outcomes for cancer survivors as advances in cancer screening and treatments continue to decrease cancer mortality. More than half of adult cancer patients will be treated with radiotherapy (RT); therefore it is crucial to develop a framework for how to assess and predict radiation‐induced cardiac disease (RICD). Historically, RICD was modelled solely using whole heart metrics such as mean heart dose. However, data over the past decade has identified cardiac substructures which outperform whole heart metrics in predicting for significant cardiac events. Additionally, non‐RT factors such as pre‐existing cardiovascular risk factors and toxicity from other therapies contribute to risk of future cardiac events. In this review, we aim to discuss the current evidence and knowledge gaps in predicting RICD and provide a roadmap for the development of comprehensive models based on three interrelated components, (1) baseline CV risk assessment, (2) cardiac substructure radiation dosimetry linked with cardiac‐specific outcomes and (3) novel biomarker development. [ABSTRACT FROM AUTHOR]

Background: Cystic, sporadic hemangioblastomas (HBLs) represent a unique, therapeutically challenging subset of central nervous system tumors, mainly due to their unpredictable growth patterns and potential for symptomatic progression. This study aims to explore the complexities surrounding the diagnosis, treatment, and long-term management of these lesions. Methods: A comprehensive literature review was performed, and a detailed case study of a 56-year-old patient with a cystic, sporadic cerebellar HBL was produced. Results: The case highlights the multiphasic growth pattern typical of cystic, sporadic HBLs, characterized by periods of dormancy and subsequent rapid expansion. An initial surgical intervention offered temporary control. Tumor recurrence, mainly through cystic enlargement, was treated by SRS. A subsequent recurrence, again caused by cystic growth, eventually led to the patient's death. The intricacies of treatment modalities, focusing on the transition from surgical resection to stereotactic radiosurgery (SRS) upon recurrence, are discussed. Parameters indicating impending tumor growth, coupled with symptomatic advances, are also explored. Conclusions: The management of cystic, sporadic cerebellar HBLs requires a strategic approach that can be informed by radiological characteristics and tumoral behavior. This study underscores the importance of a proactive, individualized management plan and suggests guidelines that could inform clinical decision making. [ABSTRACT FROM AUTHOR]

Nurses have a minimal introduction to the oncology specialty, and their exposure to radiation therapy is further limited to a superficial understanding of the patient experience. Radiation is a primary mode of oncologic treatment; thus, a comprehensive cancer center developed a 13-week training program to enhance education and clinical skills for nurses transitioning to the radiation subspecialty. Nursing retention rates were analyzed at 3, 6, 12, 18, and 24 months. Two-year postanalysis results show a 92.3% retention rate. With the cost of onboarding a single registered nurse (RN) ranging from $52,100 to $52,350, nursing leadership must develop innovative, evidence-based methods to support RN transition to practice. [ABSTRACT FROM AUTHOR]

The objective of this study was to develop a two-year overall survival model for inoperable stage I-III non–small cell lung cancer (NSCLC) patients using routine radiation oncology data over a federated (distributed) learning network and evaluate the potential of decision support for curative versus palliative radiotherapy. A federated infrastructure of data extraction, de-identification, standardisation, image analysis, and modelling was installed for seven clinics to obtain clinical and imaging features and survival information for patients treated in 2011–2019. A logistic regression model was trained for the 2011–2016 curative patient cohort and validated for the 2017–2019 cohort. Features were selected with univariate and model-based analysis and optimised using bootstrapping. System performance was assessed by the receiver operating characteristic (ROC) and corresponding area under curve (AUC), C-index, calibration metrics and Kaplan–Meier survival curves, with risk groups defined by model probability quartiles. Decision support was evaluated using a case-control analysis using propensity matching between treatment groups. 1655 patient datasets were included. The overall model AUC was 0.68. Fifty-eight percent of patients treated with palliative radiotherapy had a low-to-moderate risk prediction according to the model, with survival times not significantly different (p = 0.87 and 0.061) from patients treated with curative radiotherapy classified as high-risk by the model. When survival was simulated by risk group and model-indicated treatment, there was an estimated 11% increase in survival rate at two years (p < 0.01). Federated learning over multiple institution data can be used to develop and validate decision support systems for lung cancer while quantifying the potential impact of their use in practice. This paves the way for personalised medicine, where decisions can be based more closely on individual patient details from routine care. • Survival model for inoperable stage I-III nonsmall cell lung cancer. • Federated learning connects seven radiation oncology institutes. • Case-control propensity matched decision support simulation indicates a potential 11% increase in overall survival. [ABSTRACT FROM AUTHOR]