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Cancers
Special Issues
Multimodality Imaging for More Precise Radiotherapy
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Multimodality Imaging for More Precise Radiotherapy

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 20 September 2025 | Viewed by 3346

Special Issue Editors

Dr. Valeria Faccenda

E-Mail Website
Guest Editor
Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
Interests: medical physics; radiotherapy
Dr. Denis Panizza

E-Mail Website
Guest Editor
1. Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
2. School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
Interests: stereotactic ablative radiation therapy; LINAC-based radiosurgery; prostate tumors
Special Issues, Collections and Topics in MDPI journals
Dr. Stefano Arcangeli

E-Mail Website
Guest Editor
1. School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
2. Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
Interests: imaging; radiotherapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thanks to significant technological advancements in recent years, radiotherapy is increasingly evolving towards a more personalized and precise approach. In this context, multimodality imaging plays a crucial role in enhancing visibility, better defining targets and organs at risk (OARs), and detecting macroscopic lesions or recurrences for treatment intensification. Emerging MR-only workflows now allow the avoidance of CT acquisition, using semi-automated algorithms to create synthetic CT images for treatment planning. Alternatively, imaging modalities such as MRI, PET, SPECT, contrast-enhanced CT, and CBCT are typically fused with simulation CT scans, with structures transferred accordingly. This can be conducted manually or with various automated software, particularly when deformable registration is required. In any case, accuracy tests for image fusion and the implementation of multimodality simulation, such as using consistent CT devices and patient positioning, are essential to fully exploit the advantages of multimodality imaging. 

For this Cancers Special Issue, we welcome original research and review articles providing an overview of the most recent advances and future challenges in the use of multimodality imaging for more precise radiotherapy.

Dr. Valeria Faccenda
Dr. Denis Panizza
Dr. Stefano Arcangeli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • multimodality imaging
  • radiotherapy
  • stereotactic radiotherapy

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Published Papers (4 papers)

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Research

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12 pages, 1131 KiB  
Article
Assessing the Potential Usefulness of FDG LAFOV-PET for Oncological Staging: An Evaluation of Lesion Number and Uptake
by Valentino Dragonetti, Sara Peluso, Gastone Castellani and Stefano Fanti
Cancers 2025, 17(12), 1927; https://doi.org/10.3390/cancers17121927 - 10 Jun 2025
Abstract
Background/Objectives: In many cases, the detection of a single lesion could revolutionise patient clinical management; not all localisations, especially those with a low uptake and, consequently, a low Tumour-to-Background Ratio (TBR), are readily detectable using [18F]F-FDG PET/CT. LAFOV-PET offers a [...] Read more.
Background/Objectives: In many cases, the detection of a single lesion could revolutionise patient clinical management; not all localisations, especially those with a low uptake and, consequently, a low Tumour-to-Background Ratio (TBR), are readily detectable using [18F]F-FDG PET/CT. LAFOV-PET offers a potential enhancement in lesion detection, but the proportion of patients who would benefit from its use has yet to be determined. With the present analysis, we aimed to assess which clinical contexts the enhancement in lesion detection could affect the most. Methods: This retrospective study included 764 patients who underwent [18F]F-FDG PET/CT between January and April 2024. Data were obtained through a review of PET/CT reports. Inclusion criteria comprised patients who attended our centre for cancer pathologies or masses of undetermined nature (MUNs) in a staging setting, excluding patients who had undergone a prior [18F]F-FDG PET/CT scan or who had received therapy for any cancer pathology. This analysis focused on the total number of lesions identified, as well as the SUVmax of the lesion with the highest uptake. We analysed the proportion of patients who were within the range of number of lesions between 1 and 2, as well as who had an SUVmax of the lesion with the highest uptake between 2 and 5, either in the whole patient population or in the pathologies with a larger numerosity in the present study. Results: Among the 862 scans analysed, 289 (34%) were found to be negative, while 573 (66%) presented at least one localisation. In total, 4.5% of patients presented both a lesion number of between 1 and 2 and an SUVmax of the lesion with the highest uptake between 2 and 5. Among the malignancies that were the most common in the analysed population, a higher-than-average proportion of patients meeting these criteria were found in melanoma (6.2%), breast cancer (5.9%), and multiple myeloma (4.8%) patients. Conversely, the conditions that presented a lower proportion of patients in this range were suffering from MUNs (4.0%), lung cancer (2.1%), head–neck cancer (2.1%), suspected lymphoma (2.0%), and colon cancer (0.0%). Conclusions: Our analysis shows that almost 1 in 20 patients evaluated at oncological staging with [18F]F-FDG PET/CT could benefit from the increased diagnostic sensitivity offered by LAFOV-PET scanners. These data, although preliminary, support the need for future prospective controlled studies to confirm the actual clinical impact of implementing LAFOV-PET in current practice. Full article
(This article belongs to the Special Issue Multimodality Imaging for More Precise Radiotherapy)
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12 pages, 1965 KiB  
Article
Synchronized Contrast-Enhanced 4DCT Simulation for Target Volume Delineation in Abdominal SBRT
by Valeria Faccenda, Denis Panizza, Rita Marina Niespolo, Riccardo Ray Colciago, Giulia Rossano, Lorenzo De Sanctis, Davide Gandola, Davide Ippolito, Stefano Arcangeli and Elena De Ponti
Cancers 2024, 16(23), 4066; https://doi.org/10.3390/cancers16234066 - 4 Dec 2024
Cited by 2 | Viewed by 1354
Abstract
Background/Objectives: To present the technical aspects of contrast-enhanced 4DCT (ce4DCT) simulation for abdominal SBRT. Methods: Twenty-two patients underwent two sequential 4DCT scans: one baseline and one contrast-enhanced with personalized delay time (tdelay) calculated to capture the tumor in the desired [...] Read more.
Background/Objectives: To present the technical aspects of contrast-enhanced 4DCT (ce4DCT) simulation for abdominal SBRT. Methods: Twenty-two patients underwent two sequential 4DCT scans: one baseline and one contrast-enhanced with personalized delay time (tdelay) calculated to capture the tumor in the desired contrast phase, based on diagnostic triple-phase CT. The internal target volume (ITV) was delineated on ten contrast phases, and a panel of three experts qualitatively evaluated tumor visibility. Aortic HU values were measured to refine the tdelay for subsequent patients. The commonly used approach of combining triple-phase CT with unenhanced 4DCT was simulated, and differences in target delineation were evaluated by volume, centroid shift, Dice and Jaccard indices, and mean distance agreement (MDA). The margins required to account for motion were calculated. Results: The ce4DCT acquisitions substantially improved tumor visibility over the entire breathing cycle in 20 patients, according to the experts’ unanimous evaluation. The median contrast peak time was 54.5 s, and the washout plateau was observed at 70.3 s, with mean peak and plateau HU values of 292 ± 59 and 169 ± 25. The volumes from the commonly used procedure (ITV2) were significantly smaller than the ce4DCT volumes (ITV1) (p = 0.045). The median centroid shift was 4.7 mm. The ITV1-ITV2 overlap was 69% (Dice index), 53% (Jaccard index), and 2.89 mm (MDA), with the liver volumes showing significantly lower indices compared to the pancreatic volumes (p ≤ 0.011). The margins required to better encompass ITV1 were highly variable, with mean values ≥ 4 mm in all directions except for the left–right axis. Conclusions: The ce4DCT simulation was feasible, resulting in optimal tumor enhancement with minimal resource investment, while significantly mitigating uncertainties in SBRT planning by addressing poor visibility and respiratory motion. Triple-phase 3DCT with unenhanced 4DCT led to high variability in target delineation, making the isotropic margins ineffective. Full article
(This article belongs to the Special Issue Multimodality Imaging for More Precise Radiotherapy)
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Review

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24 pages, 2239 KiB  
Review
Impact of PSMA-PET/CT on Radiotherapy Decisions: Is There a Clinical Benefit?
by Elías Gomis-Sellés, Antonio Maldonado, Miren Gaztañaga, Victoria Vera, Odile Ajulia, Gemma Sancho, Shankar Siva, Fernando Lopez-Campos and Felipe Couñago
Cancers 2025, 17(8), 1350; https://doi.org/10.3390/cancers17081350 - 17 Apr 2025
Viewed by 678
Abstract
Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) has emerged as a game-changing imaging modality in prostate cancer, offering superior sensitivity and specificity compared to conventional imaging techniques. Its increasing adoption has significantly influenced radiotherapy decision-making, yet its true clinical impact remains under [...] Read more.
Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA-PET/CT) has emerged as a game-changing imaging modality in prostate cancer, offering superior sensitivity and specificity compared to conventional imaging techniques. Its increasing adoption has significantly influenced radiotherapy decision-making, yet its true clinical impact remains under investigation. This narrative review explores the role of PSMA-PET/CT in guiding radiotherapy decisions across different clinical scenarios, from primary treatment planning to biochemical recurrence and oligometastatic disease. We assess its impact on target delineation, treatment modifications, and overall patient management while addressing existing knowledge gaps. Full article
(This article belongs to the Special Issue Multimodality Imaging for More Precise Radiotherapy)
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Other

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14 pages, 933 KiB  
Systematic Review
Diagnostic Accuracy of Radiomics in the Early Detection of Pancreatic Cancer: A Systematic Review and Qualitative Assessment Using the Methodological Radiomics Score (METRICS)
by María Estefanía Renjifo-Correa, Salvatore Claudio Fanni, Luis A. Bustamante-Cristancho, Maria Emanuela Cuibari, Gayane Aghakhanyan, Lorenzo Faggioni, Emanuele Neri and Dania Cioni
Cancers 2025, 17(5), 803; https://doi.org/10.3390/cancers17050803 - 26 Feb 2025
Viewed by 769
Abstract
Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive and lethal malignancy with increasing incidence and low survival rate, primarily due to the late detection of the disease. Radiomics has demonstrated its utility in recognizing patterns and anomalies not perceptible to the human eye. [...] Read more.
Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive and lethal malignancy with increasing incidence and low survival rate, primarily due to the late detection of the disease. Radiomics has demonstrated its utility in recognizing patterns and anomalies not perceptible to the human eye. This systematic literature review aims to assess the application of radiomics in the analysis of pancreatic parenchyma images to identify early indicators predictive of PDAC. Methods: A systematic search of original research papers was performed on three databases: PubMed, Embase, and Scopus. Two reviewers applied the inclusion and exclusion criteria, and one expert solved conflicts for selecting the articles. After extraction and analysis of the data, there was a quality assessment of these articles using the Methodological Radiomics Score (METRICS) tool. The METRICS assessment was carried out by two raters, and conflicts were solved by a third reviewer. Results: Ten articles for analysis were retrieved. CT scan was the diagnostic imaging used in all the articles. All the studies were retrospective and published between 2019 and 2024. The main objective of the articles was to generate radiomics-based machine learning models able to differentiate pancreatic tumors from healthy tissue. The reported diagnostic performance of the model chosen yielded very high results, with a diagnostic accuracy between 86.5% and 99.2%. Texture and shape features were the most frequently implemented. The METRICS scoring assessment demonstrated that three articles obtained a moderate quality, five a good quality, and, finally, two articles yielded excellent quality. The lack of external validation and available model, code, and data were the major limitations according to the qualitative assessment. Conclusions: There is high heterogeneity in the research question regarding radiomics and pancreatic cancer. The principal limitations of the studies were mainly due to the nature of the trials and the considerable heterogeneity of the radiomic features reported. Nonetheless, the work in this field is promising, and further studies are still required to adopt radiomics in the early detection of PDAC. Full article
(This article belongs to the Special Issue Multimodality Imaging for More Precise Radiotherapy)
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