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- Radiotherapy & Oncology

Radiotherapy and Oncology
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  • A prospective, three-arm, randomized trial of EGCG for preventing radiation-induced esophagitis in lung cancer patients receiving radiotherapy
    Lung cancer (LC), as one of the most common malignant tumors, is the leading cause of cancer-related deaths worldwide [1]. Most patients are diagnosed with locally advanced disease and require sequential or concurrent chemoradiotherapy (CRT) [2]. However, a combination therapy often causes severe adverse events leading to prolonged treatment, unplanned treatment interruptions or ineffective doses. Acute radiation-induced esophagitis (ARIE) is a major non-hematologic toxicity of chemoradiotherapy in patients with stage III non-small cell lung cancer (NSCLC) or limited stage small cell lung cancer (LD-SCLC).

  • Biological effects in normal cells exposed to FLASH dose rate protons
    It is estimated that each year in the United States almost 500,000 cancer patients receive radiation alone or in combination with chemotherapy [1]. In radiotherapy, the dose delivered to the tumor is limited by the toxicity to the surrounding healthy tissue. As the number of cancer survivors increases each year, there is a need to develop novel treatment modalities that eradicate the tumor while preventing or mitigating radiation-induced normal tissue injury.

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  • Editorial Board
  • Corrigendum to “Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer” [Radiother. Oncol. 118 (2016) 510–514]
    The authors regret that in the abovementioned article, an error was found. The study evaluated inter- and intra-fractional uncertainties in the position of the peripheral tumour, mediastinal lymph nodes and the differential motion between the tumour and the nodes in deep inspiration breath hold (DIBH) for radiotherapy of patients with locally advanced non-small cell lung cancer.

  • Modifying a clinical linear accelerator for delivery of ultra-high dose rate irradiation
    FLASH radiotherapy (FLASH-RT) involves radiation treatment at ultra-high dose rates (30 to >106 Gy/s), at least a few hundred times higher than what is conventionally used in radiotherapy. Mainly in mice, it has been shown that there exists a larger differential effect between normal tissue and tumors when exposed to radiation of this intensity compared to radiation delivered with conventional dose rates [1–4]. Thus, there appears to be a pure radiobiological advantage of increasing the radiotherapy dose rate.

  • Are hypothyroidism and hypogonadism clinically relevant in patients with malignant gliomas? A longitudinal trial in patients with glioma
    Handisurya and colleagues undertook longitudinal analysis of thyroid hormone, sex steroid and prolactin serum concentrations in large sample of high-grade glioma patients [1]. Their findings suggested that hormonal deficiencies are common in high-grade glioma patients and hormone concentrations fluctuate throughout the disease course.

  • Response to Golden DW et al “A global call for increased interdisciplinary oncologic education”
    We appreciate the comments of colleagues Akthar and Golden [1] supporting interdisciplinary training for clinical cancer specialists. Although the lack of such training is widely recognised, the potential consequences of this deficiency have been acknowledged only recently.

  • A global call for increased interdisciplinary oncologic education
    We thank you for the opportunity to comment on the article titled “Interdisciplinary training for cancer specialists: The time has come” by O’Higgins et al. [1]. We commend the authors on bringing to the forefront a deficiency in interdisciplinary education among current oncology trainees. Previous work by our group has revealed similar deficiencies in the curricula of United States oncology trainees. In 2013, we distributed a web-based survey to oncology trainees across the country with the amount of formal education received by trainees outside their oncologic discipline shown in Fig.

  • Modeling radiation pneumonitis of pulmonary stereotactic body radiotherapy: The impact of a local dose–effect relationship for lung perfusion loss
    Stereotactic body radiotherapy (SBRT) is now considered as the standard of care for early-stage medically inoperable non-small-cell lung cancer (NSCLC) patients [1,2]. Toxicity is low in most prospective and retrospective studies, but radiation pneumonitis (RP) has serious clinical implications. In order to optimize radiation therapy and counsel patients, it is important to determine the normal-tissue complication probability (NTCP) of RP before treatment [3]. However, in contrast to conventionally fractionated (CF) radiotherapy (RT), data to derive accurate NTCP models for SBRT are scarce and hampered by the relatively low incidence of toxicity observed in SBRT [4].

  • Phase I trial of alisertib with concurrent fractionated stereotactic re-irradiation for recurrent high grade gliomas
    Recurrence is an inevitable process for most patients with high grade glioma (HGG) despite standard of care treatment. The median progression free survival for glioblastoma (GBM) was 10.3 months in MGMT-methylated patients, and just 5.3 months for MGMT-unmethylated patients, with a median survival after progression of 6.2 months [1–3]. There is no consensus for optimal treatment for recurrent HGG. Salvage treatment options include surgery, re-irradiation, chemotherapy/systemic therapy, supportive care only, and more recently, tumor treatment fields (TTFields) [1,4–8].

  • Patient specific outcomes of charged particle therapy for hepatocellular carcinoma – A systematic review and quantitative analysis
    Hepatocellular carcinoma (HCC) is a raising condition both world-wide and in Europe, already being one of the leading causes of cancer-specific deaths. Particular characteristics of the disease associated with its location in the liver and mixed etiology remain a challenge. Surgery, both liver resection and liver transplant, is the recommended curative treatment for the eligible patients. However, presence of cirrhosis, localization and extent of the tumor, performance status and comorbidities limit the number of qualifying patients.

  • Incidence and evolution of imaging changes on cone-beam CT during and after radical radiotherapy for non-small cell lung cancer
    High dose fractionated external beam radiotherapy with or without chemotherapy remains the mainstay of radical treatment of localised and locally advanced non-small cell lung cancer (NSCLC) not amenable to surgical excision [1].

  • MRI commissioning of 1.5T MR-linac systems – a multi-institutional study
    MR-guided radiotherapy systems provide high and versatile soft-tissue contrast imaging during irradiation. This increases the targeting precision particularly in parts of the body where CT provides insufficient contrast and where intra-fractional motion is considerable [1,2]. To date, two hybrid MR-linac systems for MR-guided radiotherapy are commercially available. Both are currently being introduced into the clinic. For these systems, which rely critically on adequate image guidance, a rigorous commissioning of the MRI system is essential.

  • MRI visibility of gold fiducial markers for image-guided radiotherapy of rectal cancer
    Neoadjuvant radiotherapy plays an important role in the treatment of patients with rectal cancer since it reduces the rate of local recurrence [1–4]. After standard neoadjuvant chemoradiation, pathological complete response is observed in approximately 15–25% of patients [5,6]. In selected centers with a watch and wait approach, clinical complete response is observed in up to 50% of patients, probably due to better patient selection [7,8]. Dose response analyses suggest that higher tumor doses result in higher complete response rates in rectal cancer patients, which is attractive in the light of increased interest for organ preservation [6,9–11].

  • Occurrence and mechanism of visual phosphenes in external photon beam radiation therapy and how to influence them
    The first visual phosphene due to radiation has been discovered in 1896 by Brandes and Dorn who treated a blindfolded aphakic person with X-rays [1]. Giesel was the first who was able to isolate a large amount of fairly pure radium [2]. He discovered that a very clear glow was perceived when radium was attached to the eye, even with the eyelid closed. In the early years after the discovery of X-rays by Röntgen, many experiments were performed with test persons on visual phosphenes. Experiments ended after the harmful effects of radiation became clear.

  • Radiotherapy quality assurance of SBRT for patients with centrally located lung tumours within the multicentre phase II EORTC Lungtech trial: Benchmark case results
    Radiotherapy Quality assurance (RTQA) has become a necessary and valuable intrinsic tool for conducting clinical trials and poor protocol compliance has been shown to have a critical impact on the trial outcome [1–3]. The EORTC has defined various RTQA levels which can be adopted in specific trials depending on e.g. trial complexity and trial end-points. Within the EORTC 22113-08113 prospective phase II Lungtech trial on stereotactic radiotherapy for centrally located non-small cell lung cancer (NSCLC), an RTQA programme was initiated that entailed not only all the standard RTQA levels but also included new quality assurance measurements and procedures not previously used within the EORTC [4,5].

  • A nomogram for the prediction of cerebrovascular disease among patients with brain necrosis after radiotherapy for nasopharyngeal carcinoma
    In various cancer populations, radiotherapy is associated with the development of vascular disease [1–4]. Previous studies have established an increased incidence of carotid stenosis (CAS) and ischemic stroke in patients with head and neck cancer treated with radiotherapy [4,5]. A study of 6862 patients (age >65 years) showed that five-year incidence of cerebrovascular events was 19% in patients treated with radiotherapy alone compared with 14% in patients treated with surgery plus radiotherapy; the corresponding ten-year incidence were 34% and 25%, respectively [4].

  • Auto-planning for VMAT accelerated partial breast irradiation
    Plan optimization as performed in IMRT (Intensity Modulated Radiation Therapy) and VMAT (Volumetric Modulated Arc Therapy) treatment planning is a highly complex and time-consuming process, involving many manual steps. The choice of the planning objectives and constraints depends on the specific clinical situation, patient anatomy and target location and the final result is considerably influenced by planner experience.

  • Quantitative analysis of diffusion weighted imaging to predict pathological good response to neoadjuvant chemoradiation for locally advanced rectal cancer
    Neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) is the standard treatment procedure for locally advanced rectal cancer (LARC) patients [1–4]. Nevertheless, the application of TME will cause considerable perioperative morbidities and possible permanent stoma due to sphincter resection, which greatly affects the life quality of patients [5,6]. In recent years, the organ-preserving strategies including local excision [7–9] or “wait and see” policy [10,11] are proposed as alternatives to TME for the patients showing pathological good response (pGR) of down-staging to ypT0-1N0 after nCRT.

  • Impact of radiotherapy on anorectal function in patients with rectal cancer following a watch and wait programme
    The standard of care for patients with locally advanced or distal rectal cancer is neoadjuvant chemoradiation therapy (CRT) followed by total mesorectal excision (TME). CRT leads to downsizing and downstaging of the tumour in most patients, it may increase the opportunity for sphincter-saving surgery and CRT decreases the risk for local recurrence [1]. However, treatment with neoadjuvant CRT and TME can adversely affect bladder, sexual, and anorectal function in the long term [2]. In patients who achieve a complete response to neoadjuvant CRT, a watch-and-wait policy can be considered to avoid the related morbidity and mortality of TME [3–5].

  • Linac-based radiosurgery for multiple brain metastases: Comparison between two mono-isocenter techniques with multiple non-coplanar arcs
    Brain metastases BM are the most common intracranial tumors in adults: about 20–40% of cancer patients will develop BM in their oncological history [1]. In the past, patients with multiple BM were typically treated by whole-brain radiotherapy (WBRT). Radiosurgery, both as single-fraction (SRS) and as 3–5 fractions (FSRT) stereotactic radiotherapy, has also gained importance in this treatment setting [2], given the increased risk of detriment in neurocognitive functions for patients undergoing WBRT [3,4], without any improvement in overall survival (OS) as compared to SRS/FSRT [5,6].

  • Stereotactic body radiotherapy dose and its impact on local control and overall survival of patients for locally advanced intrahepatic and extrahepatic cholangiocarcinoma
    Cholangiocarcinoma (CCC) is a cancer of the epithelial cells of bile ducts that can occur anywhere along the biliary tree between the ducts in the liver and the papilla of Vater which itself is excluded as a separate entity. Accordingly, the classification comprises intrahepatic cholangiocarcinoma (IHCCC), perihilar cholangiocarcinoma (PHCCC) and extrahepatic cholangiocarcinoma (EHCCC). IHCCC only accounts for about 10% of the cholangiocarcinomas with a rising incidence in Europe whereas PHCCC is responsible for up to two thirds of all tumors and about one quarter of the tumors are EHCCC [3].

  • Postmastectomy radiation therapy for triple negative, node-negative breast cancer
    The National Comprehensive Cancer Network (NCCN) currently recommends post-mastectomy radiation therapy (PMRT) for invasive breast cancer with ≥4 positive axillary nodes, with strong consideration for 1–3 positive nodes, and a consideration for negative axillary nodes but >5 cm primary tumor [1]. This recommendation is based on three randomized trials that have shown an overall survival (OS) benefit with the use of PMRT in patients with breast cancer with positive surgical margins, tumor size >5 cm, or positive axillary lymph nodes, as well as a meta-analysis demonstrating higher OS with PMRT in women with breast cancer and positive axillary nodal disease [2–5].

  • Identifying early diffusion imaging biomarkers of regional white matter injury as indicators of executive function decline following brain radiotherapy: A prospective clinical trial in primary brain tumor patients
    Radiation therapy (RT) is fundamental for brain tumor management, yet most brain tumor patients will live long enough to experience some capacity of RT-induced neurocognitive decline [1]. The majority of research in this area has focused on effects of RT on hippocampal networks and subsequent memory decline [2,3]. However, it is increasingly recognized that RT-induced brain injury is not limited to the hippocampus and memory. Damage to prefrontal white matter may have important consequences, notably a decline in executive functioning (EF), abilities including multi-tasking, planning, fluency, and flexibility in thinking (i.e., cognitive flexibility) [4].

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