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BACKGROUND: We evaluated sociodemographic and clinical predictors of financial toxicity (FT) among patients with breast cancer with higher risk clinical factors warranting regional nodal irradiation (RNI). METHODS: Among 183 participants in a clinical trial of conventional vs. hypofractionated treatment with RNI, 125 (68 %) completed a pilot survey of FT measured using the validated Economic Strain and Resilience in Cancer (ENRICh) instrument, scored from 0 (minimal) to 10 (severe) FT. Associations with predictors were evaluated using Pearson correlation coefficients and Kruskal Wallis, Mann-Whitney U, and Jonckheere-Terpstra tests. Predictors of severe FT (ENRICh≥5) were tested using multivariable logistic regression with odds ratios converted to relative risks (RR). RESULTS: Of the sample, all received RNI, 92 % chemotherapy, 67 % axillary dissection, 26 % mastectomy without reconstruction, and 32 % mastectomy with reconstruction. At a median follow up of 1.48 years, median FT score was 2.13 (IQR 0.93-4.6), with 20.8 % of patients experiencing severe FT. Unadjusted worse FT score was associated with younger age (P = 0.003), Hispanic ethnicity (P = 0.006), lower income (P = 0.02), shorter interval from diagnosis to FT assessment (P = 0.02), and chemotherapy receipt (P = 0.05), but not with breast surgery type (P = 0.42), axillary surgery type (P = 0.33), or pathologic T (P = 0.68) or N stage (P = 0.47). In multivariable analysis, triple negative subtype was the sole clinical factor predicting severe FT (RR = 3.38; 95 % CI 1.48-4.99; P = 0.01). CONCLUSION: Among patients with breast cancer receiving RNI, triple negative subtype was associated with severe FT, suggesting that tumor receptor subtype may help identify a key breast cancer subpopulation for early FT intervention.

Radiation treatment plays a mainstream role in the management of head and necksquamous cell carcinomas (HNSCCs). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathologic fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCCs. Adverse impacts on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCCs exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathologic fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC who had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with the growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dental practitioner may encoun-tersuch patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management. [ABSTRACT FROM AUTHOR]

Chest wall pain syndromes can emerge following local therapies for lung cancer and can adversely affect patients quality-of-life. This can occur after lung surgery, radiation therapy, or percutaneous image-guided thermal ablation. This review describes the multifactorial pathophysiology of chest wall pain syndromes that develop following surgical and non-surgical local therapies for lung cancer and summarizes evidence-based management strategies for inflammatory, neuropathic, myofascial, and osseous pain. It discusses a step-wise approach to treating chest wall pain that begins with non-opioid oral analgesics and includes additional pharmacologic treatments as clinically indicated, such as anticonvulsants, serotonin and norepinephrine reuptake inhibitors, tricyclic antidepressants, and various topical treatments. For myofascial pain, physical medicine techniques, such as acupuncture, trigger point injections, deep tissue massage, and intercostal myofascial release can also offer pain relief. For severe or refractory cases, opioid analgesics, intercostal nerve blocks, or intercostal nerve ablations may be indicated. Fortunately, palliation of treatment-related chest wall pain syndromes can be managed by most clinical providers, regardless of the type of local therapy utilized for a patients lung cancer treatment. In cases where a patients pain fails to respond to initial medical management, clinicians can consider referring to a pain specialist who can tailor a more specific pharmacologic approach or perform a procedural intervention to relieve pain.

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.

BACKGROUND AND OBJECTIVE: Radiation therapy has increasingly been used in the management of pelvic malignancies. However, the use of radiation continues to pose a risk of a secondary malignancy to its recipients. This study investigates the risk of secondary malignancy development following radiation for primary pelvic malignancies. METHODS: A retrospective cohort review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016 was performed. Primary pelvic malignancies were subdivided based on the receipt of radiation, and secondary malignancies were stratified as pelvic or nonpelvic to investigate the local effect of radiation. KEY FINDINGS AND LIMITATIONS: A total of 2 102 192 patients were analyzed (1 189 108 with prostate, 315 026 with bladder, 88 809 with cervical, 249 535 with uterine, and 259 714 with rectal/anal cancer). The incidence rate (defined as cases per 1000 person years) of any secondary malignancies (including but not limited to secondary pelvic malignancies) was higher in radiation patients than in nonradiation patients (incidence rate ratio [IRR] 1.04, confidence interval [CI] 1.03-1.05), with significantly greater rates noted in radiation patients with prostate (IRR 1.22, CI 1.21-1.24), uterine (IRR 1.34), and cervical (IRR 1.80, CI 1.72-1.88) cancer. While the overall incidence rate of any secondary pelvic malignancy was lower in radiation patients (IRR 0.79, CI 0.78-0.81), a greater incidence was still noted in the same cohorts including radiation patients with prostate (IRR 1.42, CI 1.39-1.45), uterine (IRR 1.15, CI 1.08-1.21), and cervical (IRR 1.72, CI 1.59-1.86) cancer. CONCLUSIONS AND CLINICAL IMPLICATIONS: Except for localized cervical cancer, when put in the context of median overall survival, the impact of radiation likely does not carry enough weight to change practice patterns. Radiation for pelvic malignancies increases the risk for several secondary malignancies, and more specifically, secondary pelvic malignancies, but with a relatively low absolute risk of secondary malignancies, the benefits of radiation warrant continued use for most pelvic malignancies. Practice changes should be considered for radiation utilization in malignancies with excellent cancer-specific survival such as cervical cancer. PATIENT SUMMARY: The use of radiation for the management of pelvic malignancies induces a risk of secondary malignancies to its recipients. However, the absolute risk being low, the benefits of radiation warrant its continued use, and a change in practice patterns is unlikely.

PURPOSE: Radiation therapy (RT) plays an important role in the treatment of glioblastoma multiforme (GBM). However, inherent intrinsic resistance of tumors to radiation, coupled with the need to consider the tolerance of normal tissues and the potential effects on neurocognitive function, impose constraints on the amount of RT that can be safely delivered. A strategy for augmenting the effectiveness of RT involves the utilization of radiation sensitizers (RS). Directly implanting RS-loaded fibrin glue (FG) into the tumor resection cavity would by-pass the blood brain barrier, potentially enhancing the impact of RT on tumor recurrence. This study investigated the ability of FG to incorporate and release, in non-degraded form, the radiation sensitizers 5-Fluorouracil (5FU) and Motexafin gadolinium (MGd). METHODS: FG layers were created in a 24-well plate by combining thrombin, fibrinogen, and 5FU or MGd. Supernatants from these layers were collected at various intervals and added to F98 glioma spheroid cultures in 96-well plates. Radiation was applied either before or after RS application as single or fractionated dosages. Spheroid growth was monitored for 14 days. RESULTS: Combined treatment of FG-released 5FU and RT significantly inhibited spheroid growth compared to RS or RT as a single treatment. As a free drug, MGd demonstrated its efficacy in reducing spheroid volume, but had diminished potency as a released RS. Fractionated radiation was more effective than single dose radiation. CONCLUSION: Non-degraded RS was released from the FG for up to 72 h. FG-released 5FU greatly increased the efficacy of radiation therapy.

PURPOSE: Having dedicated MRI scanners within radiation oncology departments may present unexpected challenges since radiation oncologists and radiation therapists are generally not trained in this modality and there are potential patient safety concerns. This study retrospectively reviews the incidental findings and safety events that were observed at a single institution during introduction of MRI sim for head and neck radiotherapy planning. METHODS: Consecutive patients from March 1, 2020, to May 31, 2022, who were scheduled for MRI sim after having completed CT simulation for head and neck radiotherapy were included for analysis. Patients first underwent a CT simulation with a thermoplastic mask and in most cases with an intraoral stent. The same setup was then reproduced in the MRI simulator. Safety events were instances where scheduled MRI sims were not completed due to the MRI technologist identifying MRI-incompatible devices or objects at the time of sim. Incidental findings were identified during weekly quality assurance rounds as a joint enterprise of head and neck radiation oncology and neuroradiology. Categorical variables between completed and not completed MRI sims were compared using the Chi-Square test and continuous variables were compared using the Mann-Whitney U test with a p-value of

INTRODUCTION: Volumetric modulated arc therapy (VMAT) total body irradiation (TBI) allows for greater organ sparing with improved target coverage compared to 2D-TBI. However, there is limited evidence of whether improved organ sparing translates to decreases in toxicities and how its toxicities compare to those of the 2D technique. We aimed to compare differences in toxicities among patients treated with TBI utilizing VMAT and 2D techniques. METHODS/MATERIALS: A matched-pair single-institution retrospective analysis of 200 patients treated with TBI from 2014 to 2023 was performed. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method and compared using log-rank tests. Differences in characteristics and toxicities between the VMAT and 2D cohorts were compared using Fishers exact test. RESULTS: Of the 200 patients analyzed, 100 underwent VMAT-TBI, and 100 underwent 2D-TBI. The median age for VMAT-TBI and 2D-TBI patients was 13.7 years and 16.2 years, respectively (p = 0.25). In each cohort, 53 patients were treated with myeloablative regimens (8-13.76 Gy), and 47 were treated with non-myeloablative regimens (2-4 Gy). For the entire VMAT-TBI cohort, lung Dmean, kidney Dmean, and lens Dmax were spared to 60.6% ± 5.0%, 71.0% ± 8.5%, and 90.1% ± 3.5% of prescription, respectively. For the non-myeloablative VMAT-TBI cohort, testis/ovary Dmax, brain, and thyroid Dmean were spared to 33.4% ± 7.3%, 75.4% ± 7.0%, and 76.1% ± 10.5%, respectively. For 2D-TBI, lungs were spared using partial-transmission lung blocks for myeloablative regimens. The VMAT-TBI cohort experienced significantly lower rates of any grade of pneumonitis (2% vs. 12%), nephrotoxicity (7% vs. 34%), nausea (68% vs. 81%), skin (16% vs. 35%), and graft versus host disease (GVHD) (42% vs. 62%) compared to 2D-TBI patients. For myeloablative regimen patients, rates of pneumonitis (0% vs. 17%) and nephrotoxicity (9% vs. 36%) were significantly lower with VMAT-TBI versus 2D-TBI (p < 0.01). Median follow-up was 14.3 months, and neither median OS nor PFS for the entire cohort was reached. In the VMAT versus 2D-TBI cohort, the 1-year OS was 86.0% versus 83.0% (p = 0.26), and the 1-year PFS was 86.6% and 80.0% (p = 0.36), respectively. CONCLUSION: Normal tissue sparing with VMAT-TBI compared to the 2D-TBI translated to significantly lower rates of pneumonitis, renal toxicity, nausea, skin toxicity, and GVHD in patients, while maintaining excellent disease control.

BACKGROUND: The most common and debilitating side effects of radiation therapy (RT) for prostate cancer (PC) are fatigue, sleep disturbance, anxiety, and depression. Previous research has reported palliative benefits from certain self-management approaches, such as mindfulness meditation. OBJECTIVE: To develop, pre-test, and evaluate the feasibility, acceptability and initial benefit of brief, audio-based mindfulness delivered during daily RT for PC compared to a relaxing music control. METHODS: Following intervention development, participants were randomized to either brief guided mindfulness audio recordings or a relaxing music control during daily RT. A pre-testing phase was first conducted to determine optimal program start time, length, and content most associated with retention. A final program (n = 26) was delivered daily, starting on day one of week 2 of RT and lasting 4 consecutive weeks. Feasibility was defined as ≥70% on enrollment rate, retention, and audio program adherence. Acceptability was measured with a 12-item post-study survey. A secondary focus compared between group changes on patient reported outcomes of fatigue, anxiety, depression, sleep disturbance, and related outcomes at baseline and follow up assessments. Descriptive statistics and general linear models were used. RESULTS: Overall, 76% (n = 38) of approached men enrolled. Pre-testing retention rates were

Natural language processing (NLP), a technology that translates human language into machine-readable data, is revolutionizing numerous sectors, including cancer care. This review outlines the evolution of NLP and its potential for crafting personalized treatment pathways for cancer patients. Leveraging NLPs ability to transform unstructured medical data into structured learnable formats, researchers can tap into the potential of big data for clinical and research applications. Significant advancements in NLP have spurred interest in developing tools that automate information extraction from clinical text, potentially transforming medical research and clinical practices in radiation oncology. Applications discussed include symptom and toxicity monitoring, identification of social determinants of health, improving patient-physician communication, patient education, and predictive modeling. However, several challenges impede the full realization of NLPs benefits, such as privacy and security concerns, biases in NLP models, and the interpretability and generalizability of these models. Overcoming these challenges necessitates a collaborative effort between computer scientists and the radiation oncology community. This paper serves as a comprehensive guide to understanding the intricacies of NLP algorithms, their performance assessment, past research contributions, and the future of NLP in radiation oncology research and clinics.

The electronCT technique is an imaging method based on the multiple Coulomb scattering of relativistic electrons and has potential applications in medical and industrial imaging. It utilizes a pencil beam of electrons in the very high energy electron (VHEE, 50–250 MeV) range and a single detection layer for the determination of the beam profile. The technique constitutes a projectional, two-dimensional imaging method and thus also qualifies for the tomographic reconstruction of samples. Given the simplicity of the technical setup and its location behind the sample, the electronCT technique has potential synergies with VHEE radiotherapy, making use of the same electron source for both treatment and diagnostics and thus being a candidate for in situ imaging and patient localization. At the same time, several technical challenges arise from the measurement technique when applied for the imaging of living beings. Measurements performed at the ARES linear particle accelerator at an electron energy of 155 MeV using a mouse phantom and a Timepix3 silicon pixel detector assembly demonstrate the feasibility of this technique. Both projectional and tomographic reconstructions are presented and the potential and limits of the technology are discussed. [ABSTRACT FROM AUTHOR]

Aim: This article aims to identify risk factors for severe radiation-induced oral mucositis (RIOM) in head and neck cancer (HNC) patients. In addition, we intend to establish a predictive model in patients undergoing intensity-modulated radiotherapy. Patients & methods: In this retrospective study, several HNC patients (n = 179) treated at Zhejiang Provincial People's Hospital from January 2019 to June 2023 were considered. The recruited subjects were divided into modeling and validation groups. The experimental data on clinical characteristics and treatment were collected and analyzed to identify predictive factors for severe RIOM based on the logistic regression approach. Results: The results indicated that severe RIOM occurred in 55.3% of patients. Accordingly, significant predictors included smoking history, diabetes, concurrent chemotherapy, cumulative radiation dose and weight loss of ≥5% in relative to admission weight. A nomogram based on these factors was validated, showing excellent predictive accuracy. Conclusion: In summary, the predictive model could effectively identify high-risk patients for severe RIOM, enabling the design of targeted interventions and improving patient management during radiotherapy. Article highlights Severe radiation-induced oral mucositis (RIOM) is observed in 55.3% of the patients. Key predictive factors for severe RIOM are identified. External validation showed high predictive accuracy. Early identification of high-risk patients allowed for proactive management to mitigate the severity of RIOM. Routine guidance on oral care and mouth rinses improved in early detection and management of mucosal toxicity. [ABSTRACT FROM AUTHOR]

ABSTRACT This multicenter retrospective study evaluated the effects of a time delay and steroids on the volume of peritumoral edema (VPTE) in dogs with extra‐axial brain tumours. The hypothesis is that VPTE will decrease between the diagnostic (MRI‐1) and RT planning (MRI‐2) MRIs following the administration of steroids. Inclusion required paired MRI acquisitions within 3 months, with VPTE contouring for each MRI registered to the RT planning CT. No edema was defined as < 0.2 cm3, increased edema was > 30% VPTE increase and decreased edema was > 30% VPTE decrease. Forty‐four dogs of which 34 (77%) received steroids between MRIs were included. The median time between the MRIs was 22 days (range: 8–74 days). Nine (20%) had no edema on both MRIs. The median MRI‐1/VPTE: 0.83 cm3 (IQR: 0.15–2.06 cm3) and median MRI‐2/VPTE: 0.40 cm3 (IQR: 0.06–1.12 cm3) were significantly different (p = 0.048). Compared to MRI‐1/VPTE: 17 (39%) VPTE decreased, eight were stable and 10 increased. The median VPTE difference was −21%, range: −100 to +6287. With steroids, VPTE decreased in 15/34 (44%) and increasedin 6/34 (18%) (median VPTE diff: −60%) compared to no steroids (median VPTE diff: +25%). Steroids use was associated with change in VPTE (p = 0.009). Two dogs had clinical deterioration and were on steroids with documented VPTE increase (+86% and +1880%) without tumour progression. The change in VPTE is highly variable but reduction is associated with steroids. Notably, subjective improvement of clinical signs can be seen without significant decrease to the VPTE on imaging. [ABSTRACT FROM AUTHOR]

Background: Early evaluation of radiation sensitivity in lung cancer patients can facilitate the transition to personalized treatment strategies. To this end, we assessed the capability of 89Zr-anti-γH2AX-TAT microPET imaging in determining the radiosensitivity of lung cancer xenograft models. We prepared and conducted quality control on 89Zr-anti-γH2AX-TAT. The radiosensitivity of human non-small cell lung cancer cells (H460) and adenocarcinoma cells (A549) was analyzed through clonogenic survival experiments. Additionally, the role of γH2AX as a biomarker for radiosensitivity was validated by quantifying γH2AX foci via fluorescence staining. Subsequently, the H460 and A549 xenograft mouse models were subjected to irradiation, followed by 89Zr-anti-γH2AX-TAT microPET imaging. Concurrently, we performed immunofluorescence staining for γH2AX in tumor tissues to establish a correlation between the uptake of 89Zr-anti-γH2AX-TAT and γH2AX expression. Results: The surviving fraction 2 Gy (SF2) values of H460 and A549 indicating that A549 adenocarcinoma has higher radiosensitivity. The cell immunofluorescence experiment showed that the repair of γH2AX foci in H460 cells after irradiation was significantly higher than that in A549 cells, which also confirmed that A549 has higher radiosensitivity. The microPET imaging results showed the uptake of 89Zr-anti-γH2AX-TAT in the tumor of the A549 models after radiotherapy was higher than H460 models. The immunofluorescence staining of tumor tissue confirmed that the expression level of γH2AX was higher and the correlation with microPET imaging uptake was good. Conclusion: 89Zr-anti-γH2AX-TAT allows PET imaging of radiosensitivity in lung cancer xenograft models, and is expected to become an early evaluation method for lung cancer radiosensitivity. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to better characterize the epidemiology, clinical outcomes, and current treatment patterns of de novo oligometastatic hormone‐sensitive prostate cancer (omHSPC) in the United States Veterans Affairs Health Care System. Methods: In this observational retrospective cohort study, 400 de novo metastatic hormone‐sensitive PC (mHSPC) patients diagnosed from January 2015 to December 2020 (follow‐up through December 2021) were randomly selected. omHSPC was defined as five or less total metastases (excluding liver) by conventional imaging. Kaplan–Meier methods estimated overall survival (OS) and castration‐resistant prostate cancer (CRPC)‐free survival from mHSPC diagnosis date and a log‐rank test compared these outcomes by oligometastatic status. Results: Twenty percent (79 of 400) of de novo mHSPC patients were oligometastatic. Most baseline characteristics were similar by oligometastatic status; however, men with non‐omHSPC had higher median prostate‐specific antigen at diagnosis (151.7) than omHSPC (44.1). First‐line (1L) novel hormonal therapy was similar between groups (20%); 1L chemotherapy was lower in omHSPC (5%) versus non‐omHSPC (14%). More omHSPC patients received metastasis‐directed therapy/prostate radiation therapy (14%) versus non‐omHSPC (2%). Median OS and CRPC‐free survival (in months) were higher in omHSPC versus non‐omHSPC (44.4; 95% confidence interval [CI], 33.9–not estimated vs. 26.2; 95% CI, 20.5–32.5, p =.0089 and 27.6; 95% CI, 22.1–37.2 vs. 15.3; 95% CI, 12.8–17.9, p =.0049), respectively. Conclusions: Approximately 20% of de novo mHSPC were oligometastatic, and OS was significantly longer in omHSPC versus non‐omHSPC. Although potentially "curative" therapy use was higher in omHSPC versus non‐omHSPC, the percentages were still relatively low. Future studies are warranted given potential for prolonged responses with multimodal therapy inclusive of systemic and local therapies. In this observational retrospective Veterans Affairs cohort study, 20% of men had de novo oligometastatic hormone‐sensitive prostate cancer (omHSPC). Although first‐line (1L) novel hormonal therapy was similar between groups, 1L chemotherapy use was lower in omHSPC, more omHSPC patients received metastasis‐directed therapy/prostate radiation therapy, and median overall survival and time to castration resistance was longer in men with omHSPC than non‐omHSPC. [ABSTRACT FROM AUTHOR]

Microbubbles have emerged as versatile carriers used both for cancer diagnosis and therapy. Microbubbles in the presence of ultrasound waves undergo cavitation, generating bioeffects near the cell's vicinity. Studies have shown ultrasound-stimulated microbubbles (USMB) to cause mechanical perturbation of endothelial cells, resulting in acid sphingomyelinase (ASMase)-induced ceramide production. Disruption of endothelial cells further causes vascular deterioration, leading to secondary tumor cell death. These effects are known to be synergistically higher when USMB is combined with radiation. This paper provides insight into the use of USMB as a potential radioenhancer. The possible underlying mechanism and therapeutic effects of combining USMB and radiation therapy are also presented. [ABSTRACT FROM AUTHOR]

Aim: The present investigation aimed to develop niosomes containing gold nanoparticles (Nio-AuNPs) and to evaluate the combinational effect of Nio-AuNPs and x-ray radiation therapy (XRT) on growth inhibition potential and induction of apoptosis in the A549 cell line. Materials & methods: Gold nanoparticles (AuNPs) were synthesized, and niosomes were prepared using the thin-film hydration method. Various techniques were employed to determine their physiochemical characteristics. MTT assay, cell apoptosis analysis and combination index analysis were conducted to evaluate the therapeutic feasibility of Nio-AuNPs combined with XRT. Results: The combination of Nio-AuNPs and XRT resulted in greater cytotoxicity compared with XRT alone or with AuNPs. Conclusion: The AuNPs-loaded niosomal formulation enhances the efficacy of XRT on lung cancer cells in vitro, presenting a promising and effective therapeutic strategy. Article highlights Niosomes containing gold nanoparticles (Nio-AuNPs) were successfully synthesized. The hydrodynamic diameters of gold nanoparticles (AuNPs) and Nio-AuNPs were 38.85 ± 0.85 nm and 127.8 ± 2.92 nm, respectively. TEM and FE-SEM electron micrographs confirm the spherical shape of the synthesized samples. The combination index of Nio-AuNPs + x-ray irradiation (XRT) indicates a synergistic interaction. Nio-AuNPs were not found to be toxic to HFF-2 cells. Apoptosis induction was higher in cells treated with Nio-AuNPs + XRT compared with AuNPs + XRT or XRT alone. [ABSTRACT FROM AUTHOR]

Background: Over the past decade, the adoption of screening programs, digital mammography, and magnetic resonance imaging (MRI) has increased early-stage breast cancer diagnosis rates. Mortality rates have decreased due to early detection and improved treatments, including personalized therapies. Accelerated partial-breast irradiation (APBI) is emerging as a convenient and effective treatment for some patients, with studies exploring its preoperative use. Preoperative APBI, especially with MRI guidance, offers improved tumor targeting and potentially reduced side effects. Magnetic Resonance Imaging-Guided Single-Fraction Pre-Operative Radiotherapy for Early-Stage Breast Cancer (RICE trial) aims to assess the feasibility and efficacy of MRI-guided single-dose radiotherapy (RT) for early-stage breast cancer. Methods: The RICE study is a prospective, single-arm study evaluating single-fraction preoperative, APBI treatment for patients with early-stage breast cancer using a magnetic resonance imaging linear accelerator (MRI linac). Eligible patients enrolled in this study will have a core biopsy to confirm estrogen receptor-positive and HER2-negative sub-type. RT planning will use a planning computed tomography (CT) co-registered with a MRI with the patient in either the supine or prone position. For the diagnostic workup, [18F] fluorodeoxyglucose positron emission tomography/CT ([18F] FDG PET/CT) and [18F] fluoroestradiol positron emission tomography/CT ([18F] FES PET/CT) will be performed prior to treatment. Thirty patients will receive a single ablative RT dose of 21 Gray to the tumor. Pre-treatment and post-treatment MRI scans will be acquired at baseline and 5 weeks post-RT respectively. Breast-conserving surgery will be scheduled for 6 weeks after APBI treatment using the MRI linac. The primary study endpoint is the successful administration of a single fraction of preoperative breast RT under the guidance of an MRI linac. Secondary endpoints include evaluating the utility of MRI, [18F] FDG PET/CT, and [18F] FES PET/CT as a non-invasive method for assessing treatment response in patients undergoing single-fraction preoperative APBI. Conclusion: The RICE trial represents a significant step in breast cancer treatment, offering insights that could lead to treatment protocols with minimized RT appointments and enhanced patient outcomes. Trial registration: This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registered 31st of May 2021. Registration number: ACTRN12621000659808. [ABSTRACT FROM AUTHOR]

Introduction: Penile metastases (PMs) are a rare clinical presentation mainly related to advanced stages of disease. Considering the low incidence, an optimal treatment approach has not yet been defined; surgery, chemotherapy, and radiotherapy (RT) are different options used in the vast majority with palliative intent. The advances in modern RT can represent an innovative tool in PM management and a curative option. This paper aimed to report the case of a PM patient treated with stereotactic body radiotherapy (SBRT) and perform a systematic literature review of current evidence on the RT approach to PM. Case Presentation: We reported the case of an 80-year-old patient with PM from primary bladder cancer. Following the surgical approach for the primary tumor, evidence of PM was shown, and the patient was admitted to SBRT treatment on PM after an adjuvant RT course on the pelvis. A 25 Gy in 5-fraction SBRT treatment was performed, and a complete clinical response was shown at the first follow-up. A PubMed/MEDLINE and Embase systematic review was carried out. The search strategy terms were [("penile metastasis"/exp OR "penile metastasis" OR (penile AND ("metastasis"/exp OR metastasis))) AND ("radiotherapy"/exp OR radiotherapy)] and only original articles up to October 24, 2023 were considered. Conclusion: A total of 174 studies were obtained using the previously mentioned search strategy, and the analysis was performed on 15 papers obtained following the complete selection process. All reported evidence was focused on the palliative approach of PM, showing good results in terms of symptom control. The potential role of modern RT in the management of PM has yet to be defined. The reported case showed the feasibility and the clinical impact of SBRT in PM treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: In this study, we compared two artificial intelligence (AI) tools, OncoStudio and Protégé AI, for their ability to automatically segment organs in Korean cancer patients undergoing radiation therapy. Manual contouring of organs is time-consuming and can vary among clinicians, potentially impacting treatment accuracy. We aimed to evaluate how well the aforementioned AI tools can assist clinicians by speeding up this process and ensuring precision. Our findings showed that OncoStudio, which was specifically developed for Korean patients, performed better in most cases than Protégé AI, a globally developed tool. These results suggest that population-specific AI tools can improve radiation therapy planning, ultimately enhancing patient outcomes and reducing clinician workload. Background: Accurate delineation of tumors and organs at risk (OARs) is crucial for intensity-modulated radiation therapy. This study aimed to evaluate the performance of OncoStudio, an AI-based auto-segmentation tool developed for Korean patients, compared with Protégé AI, a globally developed tool that uses data from Korean cancer patients. Methods: A retrospective analysis of 1200 Korean cancer patients treated with radiotherapy was conducted. Auto-contours generated via OncoStudio and Protégé AI were compared with manual contours across the head and neck and thoracic, abdominal, and pelvic organs. Accuracy was assessed using the Dice similarity coefficient (DSC), mean surface distance (MSD), and 95% Hausdorff distance (HD). Feedback was obtained from 10 participants, including radiation oncologists, residents, and radiation therapists, via an online survey with a Turing test component. Results: OncoStudio outperformed Protégé AI in 85% of the evaluated OARs (p < 0.001). For head and neck organs, OncoStudio achieved a similar DSC (0.70 vs. 0.70, p = 0.637) but significantly lower MSD and 95% HD values (p < 0.001). In thoracic organs, OncoStudio performed excellently in 90% of cases, with a significantly greater DSC (male: 0.87 vs. 0.82, p < 0.001; female: 0.95 vs. 0.87, p < 0.001). OncoStudio also demonstrated superior accuracy in abdominal (DSC 0.88 vs. 0.81, p < 0.001) and pelvic organs (male: DSC 0.95 vs. 0.85, p < 0.001; female: DSC 0.82 vs. 0.73, p < 0.001). Clinicians favored OncoStudio in 70% of cases, with 90% endorsing its clinical suitability for Korean patients. Conclusions: OncoStudio, which is tailored for Korean patients, demonstrated superior segmentation accuracy across multiple anatomical regions, suggesting its suitability for radiotherapy planning in this population. [ABSTRACT FROM AUTHOR]

Simple Summary: Ureteral stricture disease is a rare but fearsome complication after radiation therapy for pelvic malignancies. Several minimally-invasive managements have been proposed: however, the optimal strategy is still a matter of debate, and available literature on this topic is rather heterogeneous. This multi-institutional retrospective analysis showed that an endourological attempt is reliable in case of a short, mid-proximal stricture, while robot-assisted reconstructive surgery seems to best fit with the remaining cases. Up to 15% of recurrences develops within 6 months. Regardless of treatment strategy, a significant improvement in eGFR was found during follow-up. Stricture length and concomitant chemotherapy at the time of radiation therapy were identified as predictors of recurrence. An adequate preoperative strategy is paramount, since stricture's features and oncologic anamnesis could be potential predictors of surgical failure. Objectives. A radiation-induced ureteral stricture (RIUS) is a challenging condition in urologic surgery, and the optimal surgical strategy is still a matter of debate. The aim of this study was to report post-operative outcomes of minimally invasive management of this condition from a multi-institutional cohort. Methods. Data of patients with diagnoses of RIUS at five referral robotic centers between January 2017 and December 2022 were retrospectively analyzed. Pre-, intra- and post-operative variables were collected. Recurrence was defined as the presence of flank pain combined with imaging findings for obstruction, and requiring further management. Univariate and multivariate logistic regression models were built to identify predictors of ureteral stricture recurrence. Results. Fifty-three patients with a diagnosis of an RIUS were included. Primary pelvic malignancy was mostly cervical (42%). In 72% of cases (mostly mid-proximal and short strictures) endourological management was attempted, which was deemed successful in 74% of patients at stent removal. The endourology success rate at a median follow-up of 12 months was 59%. Twenty-five patients (47%) were scheduled for robotic surgery. The reconstructive techniques most often performed were end-to-end anastomosis (44%) and ureteral reimplantation (52%). Three low-grade Clavien-Dindo post-operative complications (12%) occurred. Robotic surgery was successful in all cases except one. Considering the entire cohort, eight patients (15%) developed recurrence at a median follow-up of 5 months. All patients with recurrence were managed by permanent drainage. A statistically significant improvement in eGFR with respect to baseline was found at a median follow-up of 12 months (p = 0.007). The univariate logistic regression model identified ureteral stricture length >2 cm (OR 6.4, 95% C.I. 1.1–36.9, p = 0.04) and concomitant chemotherapy (OR 8.9, 95% C.I. 1.6–49.9, p = 0.01) as predictors of recurrence. At multivariate analysis concomitant chemotherapy was confirmed as an independent predictor of recurrence (OR 7.8, 95% C.I. 1.3–49.0, p = 0.03). Conclusions. Endourological management of an RIUS is reasonable for short and mid-proximal ureteral strictures, while robotics is required in almost all the remaining cases. Up to 15% of recurrence develops within 6 months. Re-do reconstructive surgery is rarely performed, even in referral centers. [ABSTRACT FROM AUTHOR]

Purpose: Oropharyngeal mucositis is a common complication of anticancer therapy. This study aimed to determine the effectiveness and safety of intralesional corticosteroid therapy (ICT) in the management of persistent mucositis. Methods: A retrospective chart review of patients who underwent ICT in the oral cavity to manage oral mucositis managed with basic oral care and preventive modalities and persisting at least 6 weeks after head and neck radiation or chemoradiation therapy completion between November 2017 and September 2023 was performed. Bio-demographic data, cancer and anticancer therapy characteristics, medical history, and mucositis-related variables were extracted from electronic medical records. Results: Among the 34 participants, 22 (64.7%) were male. Twenty (58.8%) participants received radiotherapy; the rest received chemoradiation therapy. Before the ICT, the median mucositis lesion surface area was 225 mm2 (range 9–2025 mm2), and 22 (64.7%) patients had grade III mucositis. Post-intervention, the median size was reduced to 0 mm2 (range 0–1600 mm2). Clinically effective response (≥ 75% size and symptom reduction) was observed in 28 (82.4%) participants over a median of 26 days (7–60 days). Within this cohort, complete healing of the lesion was seen in 18 (64.3%) subjects. Overall, 25 (73.5%) participants experienced a downgradation in the mucositis stage. Local complications from injections were found in two (5.7%) participants. A correlation was found between clinically effective relief and absence of trismus (p =.03) and smaller pre-procedure surface area (p =.009). Conclusion: The ICT represents a viable option in managing non-healing, persistent radiation, and chemoradiation-induced oral mucositis. The modality was well tolerated and had no systemic complications. [ABSTRACT FROM AUTHOR]

Background: Patients may undergo anatomical changes during radiotherapy, leading to an underdosing of the target or overdosing of the organs at risk (OARs). Purpose: This study developed a deep‐learning method to predict the tumor response of patients with nasopharyngeal carcinoma (NPC) during treatment. This method can predict the anatomical changes of a patient. Methods: The participants included 230 patients with NPC. The data included planning computed tomography (pCT) and routine cone‐beam CT (CBCT) images. The CBCT image quality was improved to the CT level using an advanced method. A long short‐term memory network‐generative adversarial network (LSTM‐GAN) is proposed, which can harness the forecasting ability of LSTM and the generation ability of GAN. Four models were trained to predict the anatomical changes that occurred in weeks 3–6 and named LSTM‐GAN‐week 3 to LSTM‐GAN‐week 6. The pCT and CBCT were used as input, and the tumor target volumes (TVs) and OARs were delineated on the predicted and real images (ground truth). Finally, the models were evaluated using contours and dosimetry parameters. Results: The proposed method predicted the anatomical changes, with a dice similarity coefficient above 0.94 and 0.90 for the TVs and surrounding OARs, respectively. The dosimetry parameters were close between the prediction and ground truth. The deviations in the prescription, minimum, and maximum doses of the tumor targets were below 0.5 Gy. For serial organs (brain stem and spinal cord), the deviations in the maximum dose were below 0.6 Gy. For parallel organs (bilateral parotid glands), the deviations in the mean dose were below 0.8 Gy. Conclusion: The proposed method can predict the tumor response to radiotherapy in the future such that adaptation can be scheduled on time. This study provides a proactive mechanism for planning adaptation, which can enable personalized treatment and save clinical time by anticipating and preparing for treatment strategy adjustments. [ABSTRACT FROM AUTHOR]

Currently, in Australia, 1 in 8 women are diagnosed with breast cancer. A common adjuvant treatment for breast cancer is radiation therapy (RT). The amalgamation of side effects caused by RT treatment can ultimately affect a patient’s quality of life (QoL). With increasing breast cancer survival, a greater focus on the non-lethal consequences of this disease and its treatment is warranted. Exercise and nutrition have proven beneficial in promoting and supporting overall health and managing chronic diseases. Furthermore, exercise has demonstrated improvement and sustainment to QoL. The focus of this scoping literature review was to determine the scale of evidence regarding the effectiveness of exercise and/or nutritional interventions for women with breast cancer receiving radiation therapy. An online search of five databases was conducted to identify studies published between 2000 and 2023. The 58 studies included in the scoping review comprised 46 interventions and 4615 women with breast cancer who received radiation therapy participated. Most studies (90%; n = 52) were ‘exercise only’ based, 3% (n = 2) were ‘nutrition only’, and the remaining 7% (n = 4) of studies were combined exercise and nutrition interventions. The findings from this review highlight most studies are dedicated to investigating exercise. Further research is required to fully understand the potential benefits of these interventions and their synergistic impact on the quality of life of women with breast cancer receiving radiation therapy. [ABSTRACT FROM AUTHOR]

L'actualité en oncologie radiothérapie est marquée par les résultats d'essais stratégiques particulièrement pour les cancers de l'œsophage et du rectum. Pour l'adénocarcinome de l'œsophage, en situation préopératoire, les résultats de l'étude ESOPEC ont montré un bénéfice de survie de la chimiothérapie périopératoire par 5-fluoro-uracile, leucovorine oxaliplatine, taxotère en comparaison à la chimioradiothérapie (irradiation de 41,4 Gy avec une chimiothérapie concomitante par carboplatine/paclitaxel). En situation exclusive, l'étude CONCORDE n'a pas montré de bénéfice de l'escalade de dose et la dose standard reste 50 Gy. Pour le cancer du pancréas opérable, l'étude NRG/RTOG0848 qui comparait la chimiothérapie adjuvante avec ou sans chimioradiothérapie complémentaire a retrouvé une augmentation significative de la probabilité de survie sans maladie à 5 ans dans le sous-groupe de patients sans atteinte ganglionnaire. Pour les cancers du rectum, l'actualisation à 7 ans des résultats de l'étude PRODIGE 23 a confirmé le bénéfice non seulement en termes de survie sans récidive mais également de survie globale d'une chimiothérapie néoadjuvante par 5-fluoro-uracile, acide folinique, irinotécan et oxalipalatine avant la chimioradiothérapie, alors que l'actualisation de l'étude RAPIDO a montré un taux de rechute locale inacceptable dans le bras expérimental. L'actualisation de l'étude OPRA a montré un taux de survie avec conservation d'organe à 5 ans significativement supérieur en faveur du bras chimioradiothérapie suivie de la chimiothérapie en comparaison à la chimiothérapie d'induction première suivie de chimioradiothérapie. Une étude de phase 2 incluant 41 patients atteints d'un cancer du rectum localement avancé avec défaillance du système de réparation de l'ADN, a montré qu'un traitement exclusif par immunothérapie anti-PDL1 (dostarlimab) pendant 6 mois permettait une réponse clinique complète sans recours à un traitement complémentaire (ni radiothérapie, ni chirurgie). Pour le carcinome épidermoïde du canal anal, la survie et les profils de toxicité des patients inclus dans la cohorte anabase traités pour une tumeur de petit stade (T1 ou T2) ont été comparés selon qu'ils aient reçu exclusivement de la radiothérapie ou de la chimioradiothérapie. L'ajout d'une chimiothérapie à la radiothérapie ne montrait pas de bénéfice mais augmentait la toxicité et le risque d'allongement du traitement en raison d'interruption. Current events in radiotherapy oncology are marked by the results of strategic trials, particularly for esophageal and rectal cancers. For resectable esophageal adenocarcinoma, results of the ESOPEC study showed a benefit in overall survival from the perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin and docetaxel compared to chemoradiotherapy (41.4 Gy radiotherapy and carboplatin/paclitaxel chemotherapy). In definitive setting, the CONCORDE study did not show any benefit from dose escalation and the standard dose remains 50 Gy. For resectable pancreatic cancer, the NRG/RTOG0848 study that compared adjuvant chemotherapy with or without chemoradiotherapy found a significant increase of the 5-year disease-free survival rate in the subgroup of node-negative patients. For rectal cancers, the 7-year update of PRODIGE 23 study confirmed the benefit in disease-free- and overall survival of neoadjuvant folinic acid, fluorouracil, irinotecan and oxaliplatin chemotherapy before chemoradiotherapy of T3, T4 or N+ adenocarcinoma, while the update of the RAPIDO study revealed an unacceptable local recurrence rate in the experimental arm. The update of the OPRA study shows a significantly higher 5-year organ preservation rate in favor of the chemoradiotherapy arm followed by consolidation chemotherapy compared to induction chemotherapy followed by CRT. A phase 2 study, including 41 patients with mismatch repair deficient, locally advanced rectal cancer reported that exclusive treatment with anti-PDL1 immunotherapy (dostarlimab) for 6 months resulted in complete clinical response without the need of additional treatment (neither radiotherapy nor surgery). For anal carcinoma, the analysis of survival and toxicity profiles of patients treated for a small stage T1 or T2 tumor were compared depending on whether they received exclusive radiotherapy or chemoradiotherapy. The addition of chemotherapy to radiotherapy did not show any survival benefit but significantly increased toxicity and the risk of radiotherapy disruption. [ABSTRACT FROM AUTHOR]

Environ 10 à 15 % des patientes atteintes d'un cancer du sein seront atteintes d'une récidive locale après un traitement conservateur initial ou une mastectomie. La mastectomie totale est historiquement le traitement de référence en cas de récidive locale. Cependant, la réirradiation peut être une option en cas de second traitement conservateur en association à une segmentectomie ou en cas de récidive sur la paroi thoracique afin d'améliorer le taux de contrôle local. Différentes modalités sont disponibles : la curiethérapie, la radiothérapie externe avec ou sans hyperthermie. Bien que les résultats carcinologiques soient encourageants, cette situation complexe nécessite une sélection rigoureuse des patientes et une maîtrise technique afin d'obtenir le meilleur taux de contrôle local et de limiter la toxicité. Cet article présente une revue des données de la littérature sur les indications et différentes techniques de réirradiation des récidives homolatérales des carcinomes mammaires afin d'apporter une aide à la prise de décision en pratique clinique. Approximately 10 to 15% of patients with breast cancer will have a local recurrence after initial conservative treatment or mastectomy. Total mastectomy has historically been the standard treatment for local recurrence. However, the question of reirradiation may arise as part of a second conservative treatment in conjunction with segmentectomy or in the case of chest wall recurrence to improve local control. Different modalities are available: brachytherapy, external beam radiotherapy with or without hyperthermia. Although the carcinologic results are encouraging, this complex situation requires rigorous patient selection and technical requirements to achieve the best local control and limit toxicity events. This article presents a review of the literature on the different indications and techniques for reirradiation of ipsilateral recurrent breast cancer, with the aim of providing decision support in clinical practice. [ABSTRACT FROM AUTHOR]

Nous proposons une sélection non exhaustive des principaux essais cliniques présentés courant 2023–2024 ayant retenu notre attention dans le cadre de l'oncologie-radiothérapie appliquée aux cancers urologiques et incluant la prise en charge du cancer de la prostate (radiothérapie du cancer localisé, radiothérapie après prostatectomie, réirradiation, récidive biochimique après traitement local, radiothérapie du cancer métastatique), du cancer de vessie infiltrant le muscle et du primitif rénal. Herein, we provide a non-exhaustive selection of the main clinical trials presented in 2023–2024 related to radiation-oncology used in the treatment of urological cancers including prostate cancer (radiotherapy of localized prostate cancer, post-prostatectomy irradiation, reirradiation, biochemical recurrence following local treatment, radiotherapy for metastatic cancer), muscle invasive bladder cancer and primary kidney cancer. [ABSTRACT FROM AUTHOR]

In 2022, the radiation therapist committee of the Association française du personnel paramédical d'electroradiologie médicale (AFPPE, French association of paramedical electroradiology technicians), the Société française de radiothérapie oncologique (SFRO, French society of radiation oncology) and the Syndicat national des radiothérapeutes oncologue (SNRO, national syndicate of radiation oncologists) have been committed to working on the development of advanced practice roles. The objective of this article is to report the activities that should be in the scope of radiation therapists advanced practice and describe the competences required for these activities. This work was carried out by six radiation therapists, six radiation oncologists and one medical physicist representatives of the French national societies for each professional group. First, a basic list of activities was established and then competences were identified for groups of activities. In total, the list includes five core competences, nine competences and nine groups of activities that can be divided into the four pillars of advanced practice. The nine groups of activities can be presented in seven different dimensions including patient care and support, treatment planning, treatment imaging and delivery, management and consultancy, quality and risk management, research and innovation, education and training. The French advanced practice competences framework was developed with a multidisciplinary group to move forward the project of a master degree in advanced practice in radiation therapy in France. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the failure patterns based on precision radiation treatment and to determine the predictive factors of treatment failure for sinonasal squamous cell carcinoma (SNSCC) patients. Methods: This was a retrospective study that included 214 cases of treatment failure from 441 consecutive patients. Two experienced radiation oncologists evaluated the tumour volume of cases with local recurrence. The 5-year overall survival (OS), progression-free survival (PFS) rates, and distant-metastasis-free survival (DMFS) were estimated. Investigations were performed on the factors that predicted local failure or distant metastasis. Results: About 140 (31.7%) patients developed local recurrence, 24 (5.4%) experienced regional failure, and 65 (14.7%) underwent distant metastasis. In-field, marginal, and out-of-field failures occurred in 55.7% (78/140), 33.6% (47/140), and 10.7% (15/140) of patients with local recurrence, respectively. In logistic regression analysis, factors statistically significant for total local failure included treatment mode (P < .01), chemotherapy (P < .01), and surgical margins (P < .01). Primary tumours with poor differentiation (P = .018) and R2 resection margin (P = .009) were more prone to develop distant failure. The 5-year OS, PFS, and DMFS rates were 57.8%, 52.0%, and 56.7% for the whole cohort. In univariate and multivariate analysis, the skull base involvement was an independent predictor for poorer OS and PFS; orbital invasion was an independent predictor for poorer OS. Conclusions: Local recurrence and distant metastasis were the most common failure modes. Treatment mode, chemotherapy, and surgical margins were related to local recurrence. Poor differentiation and R2 resection margin were predictors for distant failure. Advances in knowledge: Local recurrence is the most common failure pattern in patients with SNSCC who accepted chemoradiotherapy, and marginal and out-of-field failures occurred in 44.3% of patients with local recurrence. [ABSTRACT FROM AUTHOR]

The paper presents an innovative method for producing high-density ceramics based on bioinert tantalum oxide (Ta 2 O 5) and eye shield products utilizing spark plasma sintering (SPS) technology. Eye shields are in high demand for protecting the cornea and other parts of the eye from ionizing radiation during periorbital eye procedures, such as laser therapy, radiotherapy, and Mohs micrographic surgery (MMS). The dynamics of consolidation of microcrystalline Ta 2 O 5 powder under spark plasma heating conditions in the temperature range of 1000–1400 °C were investigated. The structure, phase, and elemental composition of polycrystalline ceramic samples, including the calculation of crystal structure parameters, were studied using XRD, SEM, and EDS methods. The optimal SPS parameters for achieving maximum relative density (up to 100 %) and Vickers microhardness (up to 510 H V) of the obtained ceramics were determined. The performance properties of the ceramics were examined under conditions of a session of short-focus radiation therapy applied to the periorbital facial area. A dosimetric assessment of the absorbing capacity of the ceramics under X-ray irradiation in modes from 40 to 120 keV was conducted. A prototype of a ceramic eye shield product based on Ta 2 O 5 was developed and manufactured for the first time using SPS technology. [ABSTRACT FROM AUTHOR]

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Radiotherapy (RT) for lung or liver tumors can be challenging due to respiration‐induced organ motion (RIOM). There are some methodological solutions to minimize RIOM. We explored a new approach to evaluate the feasibility and reproducibility of RIOM during RT with five total client‐owned tumor‐bearing animals using a remote‐triggered breath‐hold ventilator under general anesthesia during image acquisition and RT. There was one stereotactic body radiotherapy, one conventionally fractionated definitive intent, and three conventionally fractionated palliative intent RT cases. Based on repeated cone beam CT, there were no treatment table shifts required prior to initiating beam on. No clinically significant complications such as hypotension occurred during anesthesia. This technique appeared to be safe in this group of patients and was easily clinically implemented and highly reproducible. More complete follow‐up data and larger studies are needed to evaluate clinical outcomes with this breath‐hold ventilator technique in veterinary RT. [ABSTRACT FROM AUTHOR]

Introduction: Radiation oncology is a pivotal modality in the treatment of hematologic malignancies. To enable state-of-the-art patient care, structured education during residency is essential. However, given the lack of detailed data, the scope of educational opportunities available to trainees remains elusive. This prompted our group to perform a national survey amongst radiation oncology residents in Germany assessing the status quo of competences in the treatment of lymphoma and leukemia patients. Furthermore, areas of potential improvement were identified to further the goal of competence-based education for residents. Methods: A survey-based analysis was conducted to assess the knowledge and competence of radiation oncology residents in Germany regarding hematological malignancies. A decisive questionnaire covering demographics, self-assessment of competences, and areas for improvement was developed in adaption of a survey by the Association of Residents in Radiation Oncology and distributed amongst 1439 members of the German Society of Radiation Oncology. Responses were collected anonymously via an online survey tool and analyzed using descriptive statistics and chi-square tests. Results: A total of 59 complete and 22 partial responses were collected, yielding a 5.6% response rate. Participants' competence varied, with notable experience gaps in pediatric cases, proton therapy, and large-field techniques like total-skin irradiation or pediatric total body irradiation. While participants felt confident in treatment planning and patient counseling, they showed deficiencies in the definition of the planning target volume for modern involved site radiotherapy. Resources for education included national and international guidelines, scientific reviews, and textbooks. Board-certified radiation oncologists and physicians from specialized lymphoma centers demonstrated higher overall competence levels. Conclusion: This survey highlights the diversity of resident education regarding hematological malignancies in German radiation oncology programs. Knowledge gaps exist in key areas, including pediatric cases and specialized techniques. Competence-based education, interactive teaching formats, and rotations to specialized centers are potential strategies to address these gaps. The study contributes to the understanding of the federal educational landscape, underscoring the need for standardized and comprehensive training to ensure optimal patient care in hematological malignancies within the context of radiation oncology. Further research and collaborations are warranted to enhance training and expertise in this critical domain. [ABSTRACT FROM AUTHOR]

Immunotherapy has become a mainstay treatment for HNSCC, with the FDA (Food and Drug Administration) approval of the anti-PD-1 immune checkpoint inhibitors (ICIs) nivolumab and pembrolizumab in 2016. Five drugs/combinations have received FDA breakthrough designation and are undergoing expedited development in HNSCC. Despite these advances, primary or acquired resistance to ICIs and the FDA-approved EGFR targeting agent cetuximab reduces patient survival, underscoring the need for the development of improved agents and strategies. Areas covered: Here we describe novel agents, their mechanism(s) of action, preclinical results, and ongoing clinical trials in HNSCC. Expert opinion: Established therapeutic targets in HNSCC include EGFR (cetuximab) and PD-1 (pembrolizumab and nivolumab). Despite the detection of many other possible targets in HNSCC cell lines and patient tumors, no other therapies have successfully advanced to date. Identification of predictive biomarkers may guide the use of targeted agents and combination therapies. Clinical trials supported by strong preclinical data in relevant models are more likely to advance treatment options. [ABSTRACT FROM AUTHOR]

Background: The impact of timing of PORT initiation for major salivary gland cancers on survival is unknown. We aim to examine the impact of PORT timeliness on overall survival (OS) of patients with major salivary gland cancers. Methods: This was a cross‐sectional analysis using data from the National Cancer Database (2004–2017) and included patients with major salivary gland cancer treated with surgery and PORT. Results: In total, 5701 patients were included (3133 [55%] male, 4644 [82%] white, mean age 59 ± 16 years). For the overall cohort, PORT >6 weeks was not associated with decreased OS (1.00 aHR, 95% CI 0.89–1.11). When specifically examining patients with mucoepidermoid carcinoma, PORT >6 weeks was associated with a decreased OS (1.27 aHR, 95% CI 1.01–1.58). Conclusions: Overall, this analysis did not demonstrate a survival benefit for initiating PORT within 6 weeks for patients with salivary gland malignancies. Subset analysis did support initiating PORT within 6 weeks after resection for patients with mucoepidermoid carcinomas. This was not demonstrated in other major salivary gland cancer histologies. [ABSTRACT FROM AUTHOR]

Soft tissue sarcomas are a diverse and heterogeneous group of cancers of mesenchymal origin. Each histological type of soft tissue sarcoma has unique clinical particularities, which makes them challenging to diagnose and treat. Multidisciplinary management of these rare diseases is thus key for improved survival. The role of surgery has been well established, and it represents the cornerstone curative treatment for soft tissue sarcomas. To date, local recurrence is the leading cause of death in low-grade sarcomas located at critical sites, and distant metastasis in high-grade sarcomas, regardless of the site of origin. Management must be tailored to each individual histologic type. We describe the most common types of extremity, trunk, abdominal, and retroperitoneal soft tissue sarcoma along with characteristics to consider for optimized management. [ABSTRACT FROM AUTHOR]

Background: Recurrent and locally advanced gynecological malignancies have a poor prognosis. In particularly, pelvic local recurrence after previous radiotherapy and/or positive resection margins during surgical treatment for recurrent disease result in low survival rates. Consequently, locoregional control is of utmost importance in this cohort of patients. The aim of this study was to analyze treatment outcomes and determine prognostic factors for patients treated with surgery and intraoperative radiotherapy (IORT) for recurrent and locally advanced gynecological malignancies. Methods: 40 patients who underwent surgical treatment and IORT between 2010 and 2022 were eligible for inclusion. The median follow-up time was 22 months. The outcomes measured were locoregional control (LRC), overall survival (OS), and survival without distant metastases (DMFS). The Cox proportional hazards model was used for univariate and multivariate analysis to assess the impact of patient variables and treatment factors on the endpoints mentioned. The following variables were analyzed: age at surgical treatment and IORT and initial diagnosis (< 65 vs. ≥65 years, each), disease-free interval (DFI) between initial diagnosis and first recurrence, DFI to surgical treatment and IORT, grading, histology, IORT dose (≤ 13 vs. >13 Gy) and technique (high dose radiotherapy (HDR) vs. IORT using electrons, (IOERT)). Survival curves were generated using the Kaplan-Meier method. Results: The mean IORT dose was 13.8 Gy (range 10–18 Gy). Cervical carcinoma was most frequently found in 27.5% of patients followed by endometrial carcinoma and vulvar carcinoma in 25% respectively. The final histopathologic results after surgery with IORT showed no residual tumour in 24 patients (60%), microscopic residual disease in 5 patients (12.5%), resection status could not be evaluated in three patients (7.5%) and the resection status was unknown in eight patients (20%). Subsequently, 27.5% of patients also received adjuvant radiotherapy of the local recurrence bed. However, after IORT, 65% of the women suffered a recurrence. Of these, the recurrences were localized: in-field 32.5%, out-of-field 22.5% and margin-of-field 12.5%. The 3- and 5-year OS was 69% and 55% respectively. The 3- and 5-year LRC was 56% respectively. The 3- and 5-year DMFS was 66% and 49%. Whereas the comparison between groups by IORT dose level (≤ 13 vs. >13 Gy) showed a non-significant trend in favor of the higher dose only for OS (p = 0.094), but not in LRC and DMFS (p > 0.05). OS and DMFS, but not LRC, differed significantly between the HDR-IORT and IOERT groups (p = 0.06 and p = 0.03,) in favor of the HDR-IORT technique. For HDR-IORT technique a trend towards superior OS and LRC was observed in the univariate analysis: HR 3.76, CI 95%: 0.95–14.881, p = 0.059 and HR 2.165 CI 95%: 0.916–5.114, p = 0.078 Conclusions: The survival rate for pelvic recurrence in gynecological malignancies remains poor and comparable with historical data from the last two decades. Particularly HDR-IORT, appears to provide a long-term oncological benefit in carefully selected patients. [ABSTRACT FROM AUTHOR]

Small cell carcinoma of the bladder (SCCB) is a rare, highly malignant neuroendocrine tumor. This study attempted to analyze tumor characteristics, treatments and clinical outcomes in China. We conducted a retrospective analysis of patients diagnosed with non-metastatic SCCB at multi-institutions between January 2007 and January 2022. The Kaplan-Meier method was used to calculate survival. A total of 20 patients were included. 10 had localized disease (T1-2N0), and 10 had locally advanced disease (≥ T3 or N+). 13 received local treatment (partial cystectomy or transurethral resection of the bladder tumor) and 7 received radical treatment (radical cystectomy or radiotherapy). A total of 18 patients (90%) received chemotherapy (CT), either neoadjuvant CT (n = 5) or adjuvant CT (n = 13). The median OS for the receiving local treatment was 65.3 months (95% CI 0 to 138 months) and the corresponding 1-year, 2-year, and 3-year OS was 77%, 54%, and 54%, respectively. The median OS for the receiving radical treatment was not reached and the corresponding 1-year, 2-year, and 3-year OS was 100%, 100%, and 75%, respectively. The median PFS for receiving local treatment was 13.8 months (95% CI 9.3 to 18.3 months) and the corresponding 1-year, 2-year, and 3-year PFS was 46%, 31%, and 31%, respectively. The median PFS for the receiving radical treatment was not reached and the corresponding 1-year, 2-year, and 3-year PFS was 83%, 56%, and 56%, respectively. This study reported the largest cohort of non-metastatic SCCB among Chinese population. Given its metastatic potential, CT remained an essential part of the treatment. The survival outcomes of radical cystectomy and RT in non-metastatic SCCB were encouraging. [ABSTRACT FROM AUTHOR]

The aim of the present systematic review is to evaluate the effects of different photobiomodulation therapy (PBMT) approaches in oncological treatment practices. The review follows the PRISMA guidelines. Specifically, the review is composed of laser PBMT and LED PBMT. A total of 23 studies were included, 14 investigating laser PBMT and 9 examining LED PBMT. In vitro studies demonstrated laser PBMT's potential to induce apoptosis and cytotoxicity in various cancer cell lines while enhancing sensitivity to chemotherapeutics and natural compounds. However, some studies highlighted divergent effects between in vitro (promoted proliferation) and in vivo xenograft models (slowed tumor growth) for certain laser wavelengths. LED PBMT studies showed blue light inhibited melanoma and pancreatic cancer cell growth, potentially via ROS generation, while red light raised concerns about enhancing oral cancer invasiveness. Both modalities mitigated treatment side effects like oral mucositis, xerostomia, peripheral neuropathy, and improved quality of life. While promising, the outcomes varied based on light parameters, cancer type, and experimental setting, necessitating further optimization of PBMT protocols through well-designed studies to establish long-term safety and efficacy across clinical scenarios. [ABSTRACT FROM AUTHOR]

Our objective was to evaluate the association of adjuvant radiation therapy (RT) to subsequent second primary malignancies (SPMs) in endometrial cancer survivors. Patients with endometrial cancer as their first malignancy were identified from 8 registries of the Surveillance, Epidemiology, and End Results (SEER) database. SPMs were defined as any type of primary malignancy that occurred more than 12 months after the diagnosis of endometrial cancer. Fine-Gray competing risk regression and Poisson regression were used to evaluate the radiotherapy-associated risk (RR) for SPMs. The Kaplan-Meier method was applied to assess the survival outcomes of endometrial cancer patients. Of 62,108 endometrial cancer patients,16,846 patients (27.12%) were in the RT group, and 45,262 patients (72.88%) were in the no-RT group. During the 30-year follow-up period, the cumulative incidence of SPMs was 20.9% and 19.7% in each group, respectively. In both multivariable competing risk regression analysis and Poisson regression analysis, adjuvant RT was found to be associated with a higher risk of developing colon and rectum cancer (adjusted hazard ratio (HR), 1.29; 95% confidence interval (CI), 1.12–1.50; P < 0.001; adjusted RR, 1.29; 95% CI, 1.11–1.49; P < 0.001), lung and bronchus cancer (adjusted HR, 1.27; 95% CI, 1.08–1.50; P = 0.004; adjusted RR, 1.26; 95% CI, 1.07–1.49; P = 0.005), vulva cancer (adjusted HR, 1.72; 95% CI, 1.04–2.85; P = 0.036; adjusted RR, 1.74; 95% CI, 1.03–2.88; P = 0.035), urinary bladder cancer (adjusted HR, 1.86; 95% CI, 1.41–2.46; P < 0.001; adjusted RR, 1.85; 95% CI, 1.40–2.44; P < 0.001), and non-Hodgkin lymphoma (adjusted HR, 1.37; 95% CI, 1.06–1.77; P = 0.016; adjusted RR, 1.37; 95% CI, 1.05–1.76; P = 0.017). However, a slightly decreased risk of breast cancer was observed in patients who underwent adjuvant RT (adjusted HR, 0.89; 95% CI, 0.80–0.98; P = 0.021; adjusted RR, 0.88; 95% CI, 0.80–0.98; P = 0.020). The RR for colon and rectum cancer decreased with age and elevated with increasing latency since endometrial cancer diagnosis, and the RR for urinary bladder cancer showed a similar tendency with latency. SPMs can significantly impair the survival outcomes of primary endometrial cancer survivors. Our findings suggest that adjuvant RT for endometrial cancer patients increases the risk of non-Hodgkin lymphoma and several types of solid cancer. Long-term surveillance of these patients should be recommended for detecting SPMs. [ABSTRACT FROM AUTHOR]

Robotic‐assisted laparoscopic radical prostatectomy and intensity‐modulated radiation therapy are the most common radical treatments for localized prostate cancer, and brachytherapy (BT) also plays a role in this field. Iodine‐125 (I‐125) low–dose rate (LDR) prostate BT is an established treatment. However, it remains controversial. Specifically, there are a variety of issues, such as indications for combined treatment with external beam radiotherapy and androgen deprivation therapy, prostate‐specific antigen follow‐up, the significance of postimplant biopsy, the usefulness of salvage BT and focal therapy, reduction of toxicities, and bladder cancer after BT. In this review, we summarize the recent developments in I‐125 LDR BT. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethods and materialsResultsConclusionsBoron Neutron Capture Therapy (BNCT) is an innovative radiation therapy with significant potential in cancer treatment. This systematic review aimed to comprehensively evaluate the efficacy, safety, and applicability of BNCT across various cancer types.Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic search in PubMed, Scopus, Cochrane CENTRAL, ClinicalTrials.gov, and ICTRP from inception until May 27, 2023. Eligible studies were selected based on predefined criteria, and statistical analyses were performed using IBM SPSS (Statistical Package for the Social Sciences) to assess correlations between histological factors, treatment outcomes, and adverse effects.The initial search identified 925 studies (498 from Scopus, 333 from PubMed, 16 from ClinicalTrials.gov, 41 from ICTRP, and 30 from Cochrane CENTRAL). After removing duplicates and applying selection criteria, 121 full-text articles were assessed, with 39 studies meeting the inclusion criteria. An additional study published in 2024 was included during the peer review process, bringing the total to 40 studies. The analysis revealed that BNCT demonstrates promising efficacy across various cancers, with a manageable safety profile. However, outcome variability and adverse effects were noted among the studies.BNCT shows substantial promise as a treatment modality for multiple cancer types, offering potential benefits with acceptable safety profiles. Nonetheless, further research is essential to refine its clinical application and ensure consistent safety and efficacy. [ABSTRACT FROM AUTHOR]

Radiation therapy (RT) is a pillar of cancer therapy used by more than half of all cancer patients. Clinically, RT is mostly delivered as external beam radiation therapy (EBRT). However, the scope of EBRT is limited in the metastatic setting, where all sites of disease need to be irradiated. Such a limitation is attributed to radiation-induced toxicities, for example on bone marrow and hematologic toxicities, resulting from a large EBRT field. Radiopharmaceutical therapy (RPT) has emerged as an alternative to EBRT for the irradiation of all sites of metastatic disease. While RPT can reduce tumor burden, it can also impact the immune system and anti-tumor immunity. Understanding these effects is crucial for predicting and managing treatment-related hematological toxicities and optimizing their integration with other therapeutic modalities, such as immunotherapies. Here, we review the immunomodulatory effects of α- and β-particle emitter-based RPT on various immune cell lines, such as CD8+and CD4+ T cells, natural killer (NK) cells, and regulatory T (Treg) cells. We briefly discuss Auger electron-emitter (AEE)-based RPT, and finally, we highlight the combination of RPT with immune checkpoint inhibitors, which may offer potential therapeutic synergies for patients with metastatic cancers. [ABSTRACT FROM AUTHOR]

Radiotherapy is a cornerstone in the treatment of solid tumors, with extensive Phase III trials confirming its effectiveness. As advancements in treatment technologies and our understanding of tumor resistance mechanisms continue, the role of radiation oncology is set to become even more pivotal. Addressing the global challenge of lethal cancers demands innovative strategies, particularly in minimizing the side effects associated with traditional chemotherapy and ionizing radiation (IR). Recently, there has been growing interest in natural compounds for radioprotection, aiming to prevent tumor development and metastasis. Piperine, a compound found in black and long pepper, has emerged as a promising chemopreventive agent that works effectively without harming normal cells. Mechanistically, piperine modulates key signaling pathways, inhibits cancer cell migration and invasion, and enhances sensitivity to IR. Combining piperine with radiotherapy offers a compelling approach, boosting treatment efficacy while protecting healthy tissues from radiation damage. Piperine's versatile role goes beyond radiosensitization to include radioprotection by inhibiting NF-κB activation, reducing autophagy, and promoting apoptosis in cancer cells. This dual action makes it a promising candidate for personalized cancer care. As research advances, the therapeutic potential of piperine may drive new frontiers in cancer treatment strategies. [ABSTRACT FROM AUTHOR]

Purpose/Objective(s): Merkel cell carcinoma (MCC) radiation treatment has historically consisted of standard 1.8–2 Gy fractions treated daily over 4–6 weeks. Hypofractionated treatment regimens have demonstrated tumor control and toxicity equivalence to standard fractionation regimens for common cutaneous malignancies such as basal cell and squamous cell carcinomas. Herein we report the outcomes of hypofractionated versus standard fractionation radiotherapy for MCC at our institution. Materials/Methods: The study involved a retrospective review of MCC patients treated with radiotherapy. Treatment characteristics and patient outcomes, including acute toxicities, disease recurrence and survival data were collected. The cumulative incidence of local and distant failures was estimated, with death as a competing risk. Results: A total of 29 treatment courses for 24 patients were included, of which 13 involved standard fractionation with curative intent, 10 involved hypofractionated radiotherapy with curative intent, and 6 involved single fraction (8 Gy) palliative radiation. Half the patients were treated to a head/neck site. A subset of patients treated adjuvantly with curative intent included 8 standard fractionation and 8 hypofractionated radiotherapy patients. No statistically significant differences in local and/or distant failure or overall survival was observed between the patient groups. Conclusion: Hypofractionated radiotherapy for MCC was associated with similar treatment outcomes relative to standard fractionation. In our limited patient sample, hypofractionated radiation treatment achieved similar results with similar toxicity and fewer treatments. Further analysis of a larger patient population with longer follow up is needed to confirm treatment tolerability and efficacy. [ABSTRACT FROM AUTHOR]

Background Objectives Animals Methods Results Conclusion and Clinical Importance Cerebral microbleeds (CMBs) are a possible sequela in human brain tumor patients treated with radiation therapy (RT). No such association is reported in dogs.To investigate whether CMBs occur in dogs after radiotherapy, and if there is an association between number and dose, and an increase over time.Thirty‐four client‐owned dogs irradiated for primary intracranial neoplasia. ≥2 magnetic resonance imaging (MRI) scans including susceptibility‐weighted imaging (SWI) were required.Retrospective, observational, single‐center study. Cerebral microbleeds identified on 3 T SWI were counted within the entire brain, and within low‐ (<20 Gy), intermediate‐ (20‐30 Gy), and high‐ (>30 Gy) dose regions. A generalized linear mixed‐effects model was used to analyze the relationship between the CMBs count and the predictor variables (irradiation dose, time after treatment).Median follow‐up time was 12.6 months (range, 1.8‐37.6 months). Eighty‐three MR scans were performed. In 4/15 dogs (27%, 95% CI, 10%‐52%) CMBs were present at baseline. ≥1 CMBs after RT were identified in 21/34 dogs (62%, 95% CI, 45%‐77%). With each month, the number of CMBs increased by 14% (95% CI, 11%‐16%; P < .001). The odds of developing CMBs in the high‐dose region are 4.7 times (95% CI, 3.9‐5.6; P < .001) greater compared with the low‐dose region.RT is 1 possible cause of CMBs formation in dogs. Cerebral microbleeds are most likely to occur in the peritumoral high‐dose volume, to be chronic, and to increase in number over time. Their clinical relevance remains unknown. [ABSTRACT FROM AUTHOR]

Perineal verrucous carcinoma is a rare variant of squamous cell carcinoma that is mainly treated with surgical excision. In this case report, we present a 58-year-old man with human immunodeficiency virus who presented with an extraordinarily large perineal mass that was ultimately found to be verrucous carcinoma in association with giant condyloma acuminata. He was treated with a wide local excision followed by staged abdominoperineal resection and fasciocutaneous flap reconstruction. In the post-operative course, the patient developed relatively short interval recurrence which was successfully managed with salvage radiotherapy. He is now post-radiation without evidence of recurrence. [ABSTRACT FROM AUTHOR]

Background: Radiation pneumonitis (RP) is not an uncommon complication in lung cancer patients undergoing radiation therapy (RT) and symptomatic RP can affect their quality of life. Purpose: To investigate the CT findings of RP in non–small cell lung cancer (NSCLC) patients and their relationship with clinical outcomes. Materials and methods: We reviewed data from 240 NSCLC patients who underwent RT between 2014 and 2022. CT findings of RP were evaluated for parenchymal abnormalities and distribution, which were then classified into three patterns: localized pneumonia (LP), cryptogenic organizing pneumonia (COP), and acute interstitial pneumonia (AIP). Clinical outcomes of RP were evaluated based on Common Terminology Criteria for Adverse Events (CTCAE) grade. Results: Of the 153 patients, 135 developed RP. The most common pattern was LP (n = 78), followed by COP (n = 30) and AIP (n = 25). Among the three CT patterns, CTCAE grade and days between the start of RT and the onset of RP (RT-RP days) were statistically significantly different (p < 0.05). The patients with AIP patterns exhibited higher CTCAE grade, and fewer RT-RP days compared to those with non-AIP patterns (p < 0.05). In these patients, lung-to-lung metastasis and underlying interstitial lung abnormality were observed more frequently (p < 0.05). Underlying pulmonary fibrosis, the AIP pattern, and higher CT extent scores were more frequently observed in higher CTCAE grade group (p < 0.001). In multiple regression analysis, age, bilateral distribution, RT-RP days, and CT extent score ≥3 were independent predicting factors for higher CTCAE grade. Conclusions: RP in NSCLC patients can be classified into LP, COP, and AIP patterns and they exhibit different severities in clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Anal mucinous adenocarcinoma (AMAC) is an extremely rare form of anal cancer. Our objective was to examine the incidence, management, and prognostic factors of AMAC. Methods: We analyzed age-adjusted incidence (AAI) rates over time and compared the prognosis of AMAC with anal squamous cell carcinoma (ASCC) and adenocarcinoma (AAC) using propensity score matching and Kaplan-Meier analysis. Patients were classified based on summary stage and treatments to determine cancer-specific survival. Results: AAI of AMAC fluctuated within a narrow range (0.082–0.237 per million person-years) from 2000 to 2018. AMAC had a slight non-significant trend of worse prognosis than ASCC (p = 0.348) and a better prognosis than AAC (p < 0.01). Females made up a larger proportion of patients diagnosed with the distant disease (p < 0.05) and unmarried (p < 0.05) and somewhat less probably to need surgical removal (p < 0.01) and radiotherapy (p < 0.01). Elderly patients have lower rates of survival (p < 0.05). Localized stage was associated with better prognosis (p < 0.05). Surgery was associated with a tendency toward better survival (p = 0.095). Conclusions: AMAC exhibits a low incidence yet favorable prognosis compared to typical AAC and slightly worse compared to ASCC. Elderly age is associated with poorer prognosis, while localized stage indicates better prognosis. Surgery demonstrates a trend toward improved survival. [ABSTRACT FROM AUTHOR]

Background/Objectives: The Prostate Cancer Patient Empowerment Program (PC-PEP) is a 6-month, home-based intervention aimed at enhancing mental health in men undergoing curative prostate cancer treatment. This exploratory secondary analysis evaluates PC-PEP's impact on relationship satisfaction, quality of life, and support group attendance among partnered participants. Methods: In a crossover randomized clinical trial ClinicalTrials.gov identifier: NCT03660085) of 128 men aged 50–82 scheduled for curative prostate cancer surgery or radiotherapy, 119 participants in relationships were included. Of these, 59 received the 6-month PC-PEP intervention, while 60 were randomized to a waitlist-control arm, receiving standard care for 6 months before starting PC-PEP. The intervention included daily emails with video instructions on mental and physical health, diet, social support, fitness, stress reduction, and intimacy. Outcomes were assessed using the Dyadic Adjustment Scale (DAS) and the Functional Assessment of Cancer Therapy–Prostate (FACT-P). Results: While relationship satisfaction remained stable, a significant improvement in emotional well-being was observed at 12 months in participants undergoing radiation therapy (p = 0.045). The PC-PEP intervention also led to significantly higher support group attendance at both 6 months (p = 0.001) and 12 months (p = 0.003), emphasizing its role in fostering social support and community engagement. Conclusions: The PC-PEP program effectively maintains relationship satisfaction and enhances emotional well-being, particularly in patients with fewer physical side effects. Its design promotes comprehensive care by integrating physical, psychological, and social support, making it a valuable resource for improving the quality of life in prostate cancer patients and potentially applicable to other cancer types. [ABSTRACT FROM AUTHOR]