Special Issue "Radiotherapy and Cancer"

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (30 June 2019).

Special Issue Editor

Dr. Andrew Hartley
Website
Guest Editor
Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
Interests: radiobiological models, oropharyngeal cancer trials, mucositis

Special Issue Information

Dear Colleagues,

Radiotherapy for cancer is rapidly evolving: the use of protons with the aim of sparing acute and late radiation toxicity and reducing second malignancies is becoming more widespread; interest in the potential use of other ions is increasing; stereotactic ablative body radiotherapy is being widely used as an alternative to surgery or to delay the initiation of palliative systemic chemotherapy; combinations of precision surgery and lower dose radiotherapy are being examined in randomized trials; immunotherapy is being tested in combination with radiotherapy; there is a renewed emphasis on both contour peer review and more detailed guidelines for clinical target volume definition. The purpose of this Special Issue is to examine these and other developments in radiotherapy.

Dr. Andrew Hartley
Guest Editor

Manuscript Submission Information

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Keywords

  • Radiation Toxicity
  • Protons
  • Heavy Ions
  • SABR (stereotactic ablative body radiotherapy)
  • Radiotherapy dose de-escalation
  • Immunotherapy
  • Peer review

Published Papers (3 papers)

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Research

Open AccessArticle
Comparison between Conventional IMRT Planning and a Novel Real-Time Adaptive Planning Strategy in Hypofractionated Regimes for Prostate Cancer: A Proof-of-Concept Planning Study
Healthcare 2019, 7(4), 153; https://doi.org/10.3390/healthcare7040153 - 02 Dec 2019
Viewed by 1477
Abstract
In prostate cancer external beam radiation therapy (EBRT), intra-fraction prostate drifts may compromise the treatment efficacy by underdosing the target and/or overdosing the organs at risk. In this study, a recently developed real-time adaptive planning strategy for intensity-modulated radiation therapy (IMRT) for prostate [...] Read more.
In prostate cancer external beam radiation therapy (EBRT), intra-fraction prostate drifts may compromise the treatment efficacy by underdosing the target and/or overdosing the organs at risk. In this study, a recently developed real-time adaptive planning strategy for intensity-modulated radiation therapy (IMRT) for prostate cancer was evaluated in hypofractionated regimes against traditional treatment planning based on a treatment volume margin expansion. The proposed workflow makes use of a “library of plans” corresponding to possible intra-fraction prostate positions. During delivery, at each beam end, the plan prepared for the position of the prostate closest to the current one is selected and the corresponding beam delivered. This adaptive planning strategy was compared with the traditional approach on a clinical prostate cancer case where different prostate shift magnitudes were considered. Five, six and fifteen fraction hypofractionated schemes were considered for each of these scenarios. When shifts larger than the treatment margin were present, using the traditional approach the seminal vesicles were underdosed by 3–4% of the prescribed dose. The adaptive approach instead allowed for correct target dose coverage and lowered the dose on the rectum for each dosimetric endpoint on average by 3–4% in all the fractionation schemes. Standard intensity-modulated radiation therapy planning did not always guarantee a correct dose distribution on the seminal vesicles and the rectum. The adaptive planning strategy proposed resulted insensitive to the intra-fraction prostate drifts, produced a dose distribution in agreement with the dosimetric requirements in every case analysed and significantly lowered the dose on the rectum. Full article
(This article belongs to the Special Issue Radiotherapy and Cancer)
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Open AccessArticle
Radiotherapy for the Palliation of Advanced Sarcomas—The Effectiveness of Radiotherapy in Providing Symptomatic Improvement for Advanced Sarcomas in a Single Centre Cohort
Healthcare 2019, 7(4), 120; https://doi.org/10.3390/healthcare7040120 - 18 Oct 2019
Cited by 2 | Viewed by 1371
Abstract
Background: Sarcomas are rare and heterogeneous tumours with a large proportion of patients requiring palliative intervention. They are regarded as relatively radioresistant and therefore achieving good palliation with radiation may require larger doses than for more common solid tumour types. Limited data is [...] Read more.
Background: Sarcomas are rare and heterogeneous tumours with a large proportion of patients requiring palliative intervention. They are regarded as relatively radioresistant and therefore achieving good palliation with radiation may require larger doses than for more common solid tumour types. Limited data is available regarding appropriate palliative radiotherapy dose fractionation. This case series aims to assess the effectiveness of radiotherapy in providing symptomatic improvement for advanced sarcomas. Method: Data was retrospectively collected for patients treated with palliative radiotherapy between July 2010 and April 2019 at one institution. The primary outcome was documented symptomatic improvement following radiotherapy. Secondary outcome was overall survival. Results: One hundred and five patients had a total of 137 sites treated using 25 different dose fractionation schedules. The median patient age was 54 (range 8–90) years. Treated sites included 114 soft tissue and 23 bone sarcomas. Data on symptomatic improvement was available in 56% and 67% of cases respectively. A total of 70% of soft tissue and 55% of bone sarcoma patients reported symptomatic improvement. Symptomatic response rates appeared to increase to a biological effective dose (BED) of 50Grey4 (Gy4) (alpha beta ratio (α/β) = 4 for tumour) but did not continue to improve with further rises in dose beyond this. Conclusion: Palliative radiotherapy offers symptomatic improvement for sarcoma patients with two-thirds of patients reporting reduction in symptoms. These results are limited by the heterogeneous study population including different sarcoma subtypes each with a probable different radio-sensitivity, treated with different radiotherapy schedules. Further prospective data collection is needed considering sarcoma subtype radio-sensitivity, to determine appropriate palliative dose fractionation schedules. Full article
(This article belongs to the Special Issue Radiotherapy and Cancer)
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Open AccessArticle
Assessment of the Impact of Deformable Registration of Diagnostic MRI to Planning CT on GTV Delineation for Radiotherapy for Oropharyngeal Carcinoma in Routine Clinical Practice
Healthcare 2018, 6(4), 135; https://doi.org/10.3390/healthcare6040135 - 24 Nov 2018
Cited by 2 | Viewed by 2067
Abstract
Background: Aim of study was to assess impact of deformable registration of diagnostic MRI to planning CT upon gross tumour volume (GTV) delineation of oropharyngeal carcinoma in routine practice. Methods: 22 consecutive patients with oropharyngeal squamous cell carcinoma treated with definitive (chemo)radiotherapy between [...] Read more.
Background: Aim of study was to assess impact of deformable registration of diagnostic MRI to planning CT upon gross tumour volume (GTV) delineation of oropharyngeal carcinoma in routine practice. Methods: 22 consecutive patients with oropharyngeal squamous cell carcinoma treated with definitive (chemo)radiotherapy between 2015 and 2016, for whom primary GTV delineation had been performed by a single radiation oncologist using deformable registration of diagnostic MRI to planning CT, were identified. Separate GTVs were delineated as part of routine clinical practice (all diagnostic imaging available side-by-side for each delineation) using: CT (GTVCT), MRI (GTVMR), and CT and MRI (GTVCTMR). Volumetric and positional metric analyses were undertaken using contour comparison metrics (Dice conformity index, centre of gravity distance, mean distance to conformity). Results: Median GTV volumes were 13.7 cm3 (range 3.5–41.7), 15.9 cm3 (range 1.6–38.3), 19.9 cm3 (range 5.5–44.5) for GTVCT, GTVMR and GTVCTMR respectively. There was no significant difference in GTVCT and GTVMR volumes; GTVCTMR was found to be significantly larger than both GTVMR and GTVCT. Based on positional metrics, GTVCT and GTVMR were the least similar (mean Dice similarity coefficient (DSC) 0.71, 0.84, 0.82 for GTVCT–GTVMR, GTVCTMR–GTVCT and GTVCTMR–GTVMR respectively). Conclusions: These data suggest a complementary role of MRI to CT to reduce the risk of geographical misses, although they highlight the potential for larger target volumes and hence toxicity. Full article
(This article belongs to the Special Issue Radiotherapy and Cancer)
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