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Objective Rectal toxicity is one of the primary dose-limiting side effects of prostate cancer radiotherapy, and consequential impairment on quality of life in these patients with long survival is an important problem. In this study, we aimed to evaluate the possibility of predicting rectal toxicity with artificial intelligence model which was including certain dosimetric parameters. Materials and methods One hundred and thirty-seven patients with a diagnosis of prostate cancer who received curative radiotherapy for prostate +/− pelvic lymphatics were included in the study. The association of the clinical data and dosimetric data between early and late rectal toxicity reported during follow-up was evaluated. The sample size was increased to 274 patients by synthetic data generation method. To determine suitable models, 15 models were studied with machine learning algorithms using Python 2.3, Pycaret library. Random forest classifier was used with to detect active variables. Results The area under the curve and accuracy were found to be 0.89–0.97 and 95%–99%, respectively, with machine learning algorithms. The sensitivity values for acute and toxicity were found to be 0.95 and 0.99, respectively. Conclusion Early or late rectal toxicity can be predicted with a high probability via dosimetric and physical data and machine learning algorithms of patients who underwent prostate +/− pelvic radiotherapy. The fact that rectal toxicity can be predicted before treatment, which may result in limiting the dose and duration of treatment, makes us think that artificial intelligence can enter our daily practice in a short time in this sense. [ABSTRACT FROM AUTHOR]

Background: Curative thoracic radiotherapy (CTRT) with concurrent chemotherapy has been considered as standard treatment approach for stage-III non-small cell lung cancer (NSCLC). The hematological and esophageal toxicities that have been encountered during CTRT would affect the immunonutritional status of the patients. The aim of this study is to evaluate the prognostic value of the change in pre- and post-treatment prognostic nutritional index (PNI) in stage-III NSCLC patients. Methods: Eighty seven consecutive stage III NSCLC patients' data were collected. Pre-radiotherapy (RT) and post-RT PNI values were calculated and the impact of prognostic value of PNI change on overall survival (OS) was evaluated by univariate and multivariate Cox regression analyses. A cutoff value of PNI change was obtained by receiver operator characteristic (ROC) curve analysis. Results: The cutoff value was found to be a 22% decrease in PNI by ROC curve analysis in terms of effect on OS. The median OS of low and high PNI decrease groups were 22.5 and 16.5 months respectively (P = 0,001). In univariate and multivariate analyses PNI decrease of = 22% was found to be an independent poor prognostic factor for OS (P = 0.012) and hazard ratio (95% confidence interval)= 2.05 (1.16-3.62). Conclusion: The PNI change would be a convenient parameter to assess the immunonutritional status of the patient at the end of CTRT. A decrease of more than 22% of PNI value may predict poor prognosis. [ABSTRACT FROM AUTHOR]

Objective: Treatment side effects lead to a negative impact on the quality of life in breast cancer survivors. Exercise is reported to improve the physical and psychological status of these patients. We aimed to investigate the effect of exercise during radiotherapy on physical and psychological status in breast cancer patients. Material and Method: A randomized controlled study was set in outpatient rehabilitation clinic. Histologically proven stage I-III breast cancer patients referred for adjuvant radiotherapy were randomly assigned to a supervised aerobic and strengthening exercise program or usual medical care without exercise training. The primary outcome parameters were Rosenberg Self Esteem Scale (RSES), Short Form-36 (SF_36) Quality of life, Coping Strategies Questionnaire (COPE Inventory), Fatigue Severity Scale (FSS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI). End points were assessed 1 week prior to and 1 week following 6 weeks of exercise training. Results: In the repeated measured analysis, BAI and FSS scores decreased, general health (GH) and energy/fatigue (E) scores of SF-36 increased in the exercise group (p=0.045, Cohen d=0.757 for BAI, p=0.02, Cohen d=0.863, p=0.010, Cohen d =1.02 for GH, p=0.032, Cohen d=0.801 for E), while the use of problem-based coping score decreased in the control group (p=0.049, Cohen d=0.641). No significant differences were found in scores for BDI and RSES (p>0.05). Conclusion: In conclusion, supervised comined exercise training during adjuvant radiotherapy improved anxiety, fatigue, energy, general health perceptions and prevented decreasing in using effective coping strategies. [ABSTRACT FROM AUTHOR]

Breast fibrosis (BF) is one of the most reported late toxicities following whole breast radiotherapy (WBRT). This study aims to find out biomarkers that can be used in individual risk assessment of BF. The correlation of surgical and dosimetric parameters with BF was also analyzed. Two hundred twenty-three invasive breast carcinoma patients who underwent breast conserving surgery and adjuvant WBRT +/- regional nodal irradiation were included in the study. Age, lumpectomy size, microscopic tumor size, systemic treatment status, the time from surgery to WBRT were the clinicopathological features evaluated. The volume of the whole breast and boost volume and their ratio, the maximum and mean dose of the breast, the dose of 95% of breast volume, the percent of the breast volume that had 50Gy and more (V50), V55, and V60 were the parameters evaluated. Neutrophil/lymphocyte, platelet/lymphocyte, lymphocyte/monocyte, systemic immune-inflammation index, hemoglobin, and C-reactive protein (CRP) levels before WBRT, the ratio of hemoglobin and CRP levels before and after WBRT were the biomarkers that investigated for prediction of BF. The median follow-up time was 22.5 (6-85.29) months. Grade 1 fibrosis was observed in 107 (47%), and grade 2 fibrosis in 7 (3.1%) patients. In the grade 1-2 fibrosis group lymphatics irradiation rate was higher (51.8% vs 35.8%, p= 0.016) and the treated breast in this group were mostly left-sided (left side percentages: 38.5% vs 56.1%; p= 0.008). CRP-Ratio was the only parameter that had statistically significant ROC curve (Area under the curve: 0.412, p= 0.024). The CRP-Ratio value of 0.544 was found to have the best sensitivity (35.65%) and specificity (84.25%). [ABSTRACT FROM AUTHOR]

Radiation-induced lung injury (RILI) is one of the most important complications in thoracic tumors. After gastric radiotherapy left lung can be negatively affected in a variable severity depending on several factors due to the close anatomic location. In this study, radiotherapy planning computerized tomography data of 35 gastric cancer patients were evaluated retrospectively in terms of radiationinduced lung injury radiologically. Our aim is to investigate the correlation between the dosimetric data and radiologic changes of the left lung in the treatment field with computerized tomography images in 3-6 months after RT. Median values of treatment volumes, for left lung V25, mean (D mean) and maximum (D max) doses were evaluated via dose-volume histogram. Factors that may contribute to damage such as age, concomitant chemotherapy, radiotherapy technique, surgery and tumor location were also analyzed. RILI was detected in 51.4% of patients. These were parenchymal changes in 71.2%, a decrease in lung volume in 22.8%, pleural changes in 22.7%. RILI development was significantly higher in patients undergoing boost (p< 0.05). [ABSTRACT FROM AUTHOR]

Introduction: Acute esophagitis (AE) is a commonly encountered side effect of curative thoracic radiotherapy (CTRT) for lung cancer patients. Nevertheless, its identification for widely used scoring systems depends on patients' statements. It is aimed to evaluate the correlation between the esophagus doses during CTRT and Grade 1-2 AE, weight change, and change in serum albumin (Alb) levels.Subjects and Methods: The data collected from 124 lung cancer patients treated with ≥60 Gy CTRT were evaluated retrospectively. Weight and serum Alb level difference of each patient, throughout CTRT, were calculated. The percentage of the esophagus volume receiving ≥5 Gy (V5), V10, V35, V50, and V60; the absolute esophagus volume receiving ≥60 Gy (V60(cc)); the length of esophagus receiving ≥60 Gy (L60); the average esophagus dose (Dmean); and the maximum esophagus dose (Dmax) were the dose parameters calculated. The correlations were performed by Spearman's rank correlation coefficient.Results: Grade 1 and Grade 2 AE were reported in 62 and 25 patients, respectively. All of the dose parameters were correlated with Grade 1-2 AE (P < 0.001) and weight loss (P < 0.001 for all, except Dmax P = 0.018). Decrease in serum Alb level was significantly correlated with all the parameters, but V5 and V10. Receiver operating characteristic curve analysis was performed for five parameters with the highest correlation coefficient (V35, V50, V60(%), V60(cc), and Dmean), and the cutoff values were 39.5%, 28.17%, 2.21%, 0.5cc, and 26.04 Gy, respectively.Conclusions: The correlation of the dose parameters that might be effective on Grade 1-2 AE with the weight loss and Alb loss was investigated, and the cutoff values corresponding to the best sensitivity and specificity were identified. [ABSTRACT FROM AUTHOR]

Objectives: We explored the prognostic utility of the unique combination of C-reactive-protein-to-albumin ratio (CAR) and significant weight loss (WL > 5%) over the preceding 6 months, namely, the CARWL score, in stage IIIC non-small-cell lung cancer (NSCLC) patients who underwent concurrent chemoradiotherapy (CCRT)., Methods: For each patient, the CAR was calculated using C-reactive protein and albumin measurements obtained on the first day of CCRT: CAR = C-reactive protein ÷ albumin. The availability of an ideal CAR cutoff that may categorize patients into two distinct progression-free (PFS) and overall survival (OS) outcomes was explored by employing receiver operating characteristic (ROC) curve analysis. Patients were additionally divided into two groups based on their status of significant WL according to the well-recognized Delphi criteria. Then, the CARWL score was created by combining all feasible combinations of the CAR and significant WL groupings. The potential links between pretreatment CARWL groups and the post-CCRT OS and PFS outcomes were determined as the primary and secondary endpoints., Results: This retrospective cohort study comprised a total of 651 stage IIIC NSCLC patients. ROC curve analysis indicated that rounded 3.0 was the ideal CAR cutoff (area under the curve (AUC): 70.1%; sensitivity: 67.8%; specificity: 65.9%), which categorized the patients into CAR < 3.0 ( N  = 324) and CAR ≥ 3.0 ( N  = 327) groups. There were 308 (47.3%) and 343 (52.7%) patients without and with significant WL, respectively. The created CARWL groups were CARWL-0: CAR < 3.0 and WL ≤ 5.0%; CARWL-1: CAR < 3.0 and WL > 5.0%, or CAR ≥ 3.0 and WL ≤ 5.0%; and CARWL-2: CAR > 3.0 and WL > 5.0%. The Kaplan-Meier curves showed that the PFS (14.2 vs. 11.4 vs. 7.5 months; P < 0.001) and OS (37.3 vs. 23.6 vs. 12.8 months; P < 0.001) durations were gradually and significantly lowered from the CARWL-0 to CARWL-2 groups. The CARWL score's significant impacts on PFS and OS outcomes were found to be independent of the other variables in the multivariate analysis ( P < 0.001, for each)., Conclusions: Our findings indicate that the novel CARWL score, which accounts for pretreatment CAR and significant WL during the preceding 6 months, can reliably stratify newly diagnosed stage IIIC NSCLC patients into three groups with significantly different PFS and OS after definitive CCRT., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Erkan Topkan et al.)

Background: Curative thoracic radiotherapy (CTRT) with concurrent chemotherapy has been considered as standard treatment approach for stage-III non-small cell lung cancer (NSCLC). The hematological and esophageal toxicities that have been encountered during CTRT would affect the immunonutritional status of the patients. The aim of this study is to evaluate the prognostic value of the change in pre- and post-treatment prognostic nutritional index (PNI) in stage-III NSCLC patients., Methods: Eighty seven consecutive stage III NSCLC patients' data were collected. Pre-radiotherapy (RT) and post-RT PNI values were calculated and the impact of prognostic value of PNI change on overall survival (OS) was evaluated by univariate and multivariate Cox regression analyses. A cutoff value of PNI change was obtained by receiver operator characteristic (ROC) curve analysis., Results: The cutoff value was found to be a 22% decrease in PNI by ROC curve analysis in terms of effect on OS. The median OS of low and high PNI decrease groups were 22.5 and 16.5 months respectively (P = 0,001). In univariate and multivariate analyses PNI decrease of ≥ 22% was found to be an independent poor prognostic factor for OS (P = 0.012) and hazard ratio (95% confidence interval)= 2.05 (1.16-3.62)., Conclusion: The PNI change would be a convenient parameter to assess the immunonutritional status of the patient at the end of CTRT. A decrease of more than 22% of PNI value may predict poor prognosis., Competing Interests: None

Primary renal synovial sarcomas (SS) are rare tumors of the kidney. Faria et al first described primary renal synovial sarcoma in 1999 (Mod Pathol 12:94A). In this paper we present a primary renal synovial sarcoma case and review the 41 primary renal synovial sarcoma cases reported to date. Primary renal synovial sarcomas can exist in either a monophasic or a biphasic pattern. The monophasic variant of primary renal synovial sarcoma is more common and tends to have a better prognosis than the biphasic variant. We present in this paper, a 68-year-old woman with primary renal synovial sarcoma. She presented with right flank pain and abdominal distention. Postoperative pathology of the 20 cm mass on magnetic resonance imaging showed histologic and immunochemical features of synovial sarcoma with coexisting spindle and epithelial cells. She underwent adjuvant ifosfamide and doxorubicin chemotherapy and was free of disease at 1 year after diagnosis. As a conclusion, physicians should be aware of the possibility of malignancy in cystic renal masses and that synovial sarcoma is one of the possibilities.