Special Issue "Advances and Perspectives in Radiotherapy Treatments"

A special issue of Medicines (ISSN 2305-6320).

Deadline for manuscript submissions: closed (30 November 2018).

Special Issue Editor

Guest Editor
Assoc. Prof. Dr. Spyros Manolopoulos

1. School of Physics, University of Warwick, Coventry, CV4 7AL, UK
2. University Hospitals Coventry and Warwickshire, Arden Cancer Centre, Clifford Bridge Road, Coventry CV2 2DX, UK
† Now at GenesisCare, 69 Alma Road, Windsor SL4 3ES, UK
Website | E-Mail
Phone: +44 2476 967258
Interests: radiotherapy; treatment planning; clinical radiotherapy trials; IMRT; IGRT; VMAT; SBRT; SRT; protontherapy; particle therapy; proton CT; theragnostics; dose escalation

Special Issue Information

Dear Colleagues,

Radiotherapy (RT) is an effective and efficient cancer treatment, with around 4 in 10 patients whose cancer is cured having received radiotherapy as part of their treatment (“Achieving world-class cancer outcomes; a strategy for England 2015-2020, CRUK, 2015). It is suggested that RT should be offered to ca. 50% of cancer patients (“The role of radiotherapy in cancer treatment”, Delaney et al., Cancer, 104 (2005) pp. 1129-1137). RT is a highly-technical treatment modality, in which effectiveness relies greatly on technological advances. This has manifested itself in recent years, with cutting-edge imaging that allows for more accurate treatments, computing technology that sped up and increased the accuracy of treatment planning and dose calculation, and radiation beam delivery techniques that have helped to target the dose more optimally. As a result, there is well founded optimism that the outcome of radiotherapy treatments will continue to improve, both in disease control and quality of life for patients.

This prompted national governments to invest in radiotherapy and for example in the UK NHS England is implementing the largest radiotherapy upgrade programme in 15 years, aiming for all patients to have access to high-quality, modern radiotherapy treatments. As a result, over 50 radiotherapy treatment machines (linacs) in at least 34 hospitals nationwide are being replaced or upgraded, with a final aim to replace all linacs that are more than 10 years old, with modern ones that offer real time IG-VMAT as minimum specification (“Next steps on the NHS five year forward view”, NHS England, 2017).

Research should also be an integral part of the radiotherapy service, as it helps developing new treatment techniques to improve outcomes. Clinical trials are the best way to evaluate new ideas and implement them safely in the clinic. For clinical research to be conducted effectively it is imperative that further steps are taken apart from modernising the treatment machines, such as earlier diagnosis, new treatment strategies aiming for personalised radiotherapy and robust and comprehensive collection of treatment outcome data (“Principles for supporting radiotherapy clinical research in England”, CRUK, 2016).

The purpose of this Special Issue is to publish or review research related to contemporary radiotherapy and future advances.

Assoc. Prof. Dr. Spyros Manolopoulos
Guest Editor

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 papers will be 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 short 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. Medicines is an international peer-reviewed open access quarterly 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 1000 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

  • radiotherapy
  • imaging
  • treatment planning
  • dosimetry
  • dosimeters
  • radiotherapy treatment techniques
  • IMRT
  • IGRT
  • VMAT
  • SABR
  • SRS
  • SRT
  • proton therapy
  • particle therapy
  • radiosensitisation
  • targeted therapy

Published Papers (7 papers)

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Research

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Open AccessFeature PaperArticle
The Association between Age, Comorbidities and Use of Radiotherapy in Women with Breast Cancer: Implications for Survival
Received: 29 May 2018 / Revised: 18 June 2018 / Accepted: 23 June 2018 / Published: 25 June 2018
Cited by 2 | PDF Full-text (278 KB) | HTML Full-text | XML Full-text
Abstract
Background: Radiotherapy (RT) plays an important role in the management and survival of patients with breast cancer. The aim of this study was to examine the association between age, comorbidities and use of RT in this population. Methods: Patients diagnosed with breast cancer [...] Read more.
Background: Radiotherapy (RT) plays an important role in the management and survival of patients with breast cancer. The aim of this study was to examine the association between age, comorbidities and use of RT in this population. Methods: Patients diagnosed with breast cancer from 2004–2013 were identified from the American College of Surgeons National Cancer Database (NCDB). Follow-up time was measured from the date of diagnosis (baseline) to the date of death or censoring. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were used as the measure of association. Results: Independently of comorbidities and other important outcome-related factors, patients >65 years of age who received RT survived significantly longer than those who did not receive RT (aHR = 0.53, 95% CI = 0.52–0.54). However, as women aged, those with comorbidities were less likely to receive RT (adjusted p-trend by age < 0.0001). Conclusions: The development of decision-making tools to assist clinicians, and older women with breast cancer and comorbidities, are needed to facilitate personalized treatment plans regarding RT. This is particularly relevant as the population ages and the number of women with breast cancer is expected to increase in the near future. Full article
(This article belongs to the Special Issue Advances and Perspectives in Radiotherapy Treatments)
Open AccessFeature PaperArticle
Revised Modelling of the Addition of Synchronous Chemotherapy to Radiotherapy in Squamous Cell Carcinoma of the Head and Neck—A Low α/β?
Received: 24 May 2018 / Revised: 9 June 2018 / Accepted: 11 June 2018 / Published: 13 June 2018
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Abstract
Background: The effect of synchronous chemotherapy in squamous cell carcinoma of the head and neck (SCCHN) has been modelled as additional Biologically Effective Dose (BED) or as a prolonged tumour cell turnover time during accelerated repopulation. Such models may not accurately predict the [...] Read more.
Background: The effect of synchronous chemotherapy in squamous cell carcinoma of the head and neck (SCCHN) has been modelled as additional Biologically Effective Dose (BED) or as a prolonged tumour cell turnover time during accelerated repopulation. Such models may not accurately predict the local control seen when hypofractionated accelerated radiotherapy is used with synchronous chemotherapy. Methods: For the purposes of this study three isoeffect relationships were assumed: Firstly, from the RTOG 0129 trial, synchronous cisplatin chemotherapy with 70 Gy in 35 fractions over 46 days results in equivalent local control to synchronous cisplatin chemotherapy with 36 Gy in 18# followed by 36 Gy in 24# (2# per day) over a total of 39 days. Secondly, in line with primary local control outcomes from the PET-Neck study, synchronous cisplatin chemotherapy with 70 Gy in 35# over 46 days results in equivalent local control to synchronous cisplatin chemotherapy delivered with 65 Gy in 30# over 39 days. Thirdly, from meta-analysis data, 70 Gy in 35# over 46 days with synchronous cisplatin results in equivalent local control to 84 Gy in 70# over 46 days delivered without synchronous chemotherapy. Using the linear quadratic equation the above isoeffect relationships were expressed algebraically to determine values of α, α/β, and k for SCCHN when treated with synchronous cisplatin using standard parameters for the radiotherapy alone schedule (α = 0.3 Gy−1, α/β = 10 Gy, and k = 0.42 Gy10day−1). Results: The values derived for α/β, α and k were 2 Gy, 0.20 and 0.21 Gy−1, and 0.65 and 0.71 Gy2day−1. Conclusions: Within the limitations of the assumptions made, this model suggests that accelerated repopulation may remain a significant factor when synchronous chemotherapy is delivered with radiotherapy in SCCHN. The finding of a low α/β for SCCHN treated with cisplatin suggests a greater tumour susceptibility to increasing dose per fraction and underlines the importance of the completion of randomized trials examining the role of hypofractionated acceleration in SCCHN. Full article
(This article belongs to the Special Issue Advances and Perspectives in Radiotherapy Treatments)
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Open AccessFeature PaperArticle
Dosimetric Implications of Computerised Tomography-Only versus Magnetic Resonance-Fusion Contouring in Stereotactic Body Radiotherapy for Prostate Cancer
Received: 31 March 2018 / Revised: 2 April 2018 / Accepted: 3 April 2018 / Published: 5 April 2018
Cited by 1 | PDF Full-text (7406 KB) | HTML Full-text | XML Full-text | Supplementary Files
Abstract
Background: Magnetic resonance (MR)-fusion contouring is the standard of care in prostate stereotactic body radiotherapy (SBRT) for target volume localisation. However, the planning computerised tomography (CT) scan continues to be used for dose calculation and treatment planning and verification. Discrepancies between the planning [...] Read more.
Background: Magnetic resonance (MR)-fusion contouring is the standard of care in prostate stereotactic body radiotherapy (SBRT) for target volume localisation. However, the planning computerised tomography (CT) scan continues to be used for dose calculation and treatment planning and verification. Discrepancies between the planning MR and CT scans may negate the benefits of MR-fusion contouring and it adds a significant resource burden. We aimed to determine whether CT-only contouring resulted in a dosimetric detriment compared with MR-fusion contouring in prostate SBRT planning. Methods: We retrospectively compared target volumes and SBRT plans for 20 patients treated clinically with MR-fusion contouring (standard of care) with those produced by re-contouring using CT data only. Dose was 36.25 Gy in 5 fractions. CT-only contouring was done on two occasions blind to MR data and reviewed by a separate observer. Primary outcome was the difference in rectal volume receiving 36 Gy or above. Results: Absolute target volumes were similar: 63.5 cc (SD ± 27.9) versus 63.2 (SD ± 26.5), Dice coefficient 0.86 (SD ± 0.04). Mean difference in apex superior-inferior position was 1.1 (SD ± 3.5; CI: −0.4–2.6). Small dosimetric differences in favour of CT-only contours were seen, with the mean rectal V36 Gy 0.3 cc (95% CI: 0.1–0.5) lower for CT-only contouring. Conclusions: Prostate SBRT can be successfully planned without MR-fusion contouring. Consideration can be given to omitting MR-fusion from the prostate SBRT workflow, provided reference to diagnostic MR imaging is available. Development of MR-only work flow is a key research priority to gain access to the anatomical fidelity of MR imaging. Full article
(This article belongs to the Special Issue Advances and Perspectives in Radiotherapy Treatments)
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Review

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Open AccessReview
Assessing the Role of Artificial Intelligence (AI) in Clinical Oncology: Utility of Machine Learning in Radiotherapy Target Volume Delineation
Medicines 2018, 5(4), 131; https://doi.org/10.3390/medicines5040131
Received: 30 November 2018 / Revised: 4 December 2018 / Accepted: 7 December 2018 / Published: 11 December 2018
Cited by 4 | PDF Full-text (368 KB) | HTML Full-text | XML Full-text
Abstract
The fields of radiotherapy and clinical oncology have been rapidly changed by the advances of technology. Improvement in computer processing power and imaging quality heralded precision radiotherapy allowing radiotherapy to be delivered efficiently, safely and effectively for patient benefit. Artificial intelligence (AI) is [...] Read more.
The fields of radiotherapy and clinical oncology have been rapidly changed by the advances of technology. Improvement in computer processing power and imaging quality heralded precision radiotherapy allowing radiotherapy to be delivered efficiently, safely and effectively for patient benefit. Artificial intelligence (AI) is an emerging field of computer science which uses computer models and algorithms to replicate human-like intelligence and perform specific tasks which offers a huge potential to healthcare. We reviewed and presented the history, evolution and advancement in the fields of radiotherapy, clinical oncology and machine learning. Radiotherapy target delineation is a complex task of outlining tumour and organ at risks volumes to allow accurate delivery of radiotherapy. We discussed the radiotherapy planning, treatment delivery and reviewed how technology can help with this challenging process. We explored the evidence and clinical application of machine learning to radiotherapy. We concluded on the challenges, possible future directions and potential collaborations to achieve better outcome for cancer patients. Full article
(This article belongs to the Special Issue Advances and Perspectives in Radiotherapy Treatments)
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Open AccessFeature PaperReview
The Expanding Role of Radiosurgery for Brain Metastases
Received: 23 July 2018 / Revised: 3 August 2018 / Accepted: 7 August 2018 / Published: 14 August 2018
Cited by 1 | PDF Full-text (1186 KB) | HTML Full-text | XML Full-text
Abstract
Stereotactic radiosurgery (SRS) has become increasingly important in the management of brain metastases due to improving systemic disease control and rising incidence. Initial trials demonstrated SRS with whole-brain radiotherapy (WBRT) improved local control rates compared with WBRT alone. Concerns with WBRT associated neurocognitive [...] Read more.
Stereotactic radiosurgery (SRS) has become increasingly important in the management of brain metastases due to improving systemic disease control and rising incidence. Initial trials demonstrated SRS with whole-brain radiotherapy (WBRT) improved local control rates compared with WBRT alone. Concerns with WBRT associated neurocognitive toxicity have contributed to a greater use of SRS alone, including for patients with multiple metastases and following surgical resection. Molecular information, targeted agents, and immunotherapy have also altered the landscape for the management of brain metastases. This review summarises current and emerging data on the role of SRS in the management of brain metastases. Full article
(This article belongs to the Special Issue Advances and Perspectives in Radiotherapy Treatments)
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Open AccessReview
Evolution of Stereotactic Ablative Radiotherapy in Lung Cancer and Birmingham’s (UK) Experience
Received: 26 June 2018 / Revised: 20 July 2018 / Accepted: 21 July 2018 / Published: 23 July 2018
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Abstract
Stereotactic ablative radiotherapy (SABR) has taken a pivotal role in early lung cancer management particularly in the medically inoperable patients. Retrospective studies have shown this to be well tolerated with comparable results to surgery and no significant increase in toxicity. Paucity of randomized [...] Read more.
Stereotactic ablative radiotherapy (SABR) has taken a pivotal role in early lung cancer management particularly in the medically inoperable patients. Retrospective studies have shown this to be well tolerated with comparable results to surgery and no significant increase in toxicity. Paucity of randomized evidence has dictated initiation of several trials to provide good quality evidence to steer future practice. This review summaries salient developments in lung SABR, comparisons to surgery and other platforms and our local experience at University Hospitals Birmingham, UK of lung SABR since its initiation in June 2013. Full article
(This article belongs to the Special Issue Advances and Perspectives in Radiotherapy Treatments)
Open AccessFeature PaperReview
Assessing Novel Drugs and Radiation Technology in the Chemoradiation of Oropharyngeal Cancer
Received: 2 June 2018 / Revised: 21 June 2018 / Accepted: 25 June 2018 / Published: 27 June 2018
Cited by 1 | PDF Full-text (274 KB) | HTML Full-text | XML Full-text
Abstract
Integrating immunotherapy, proton therapy and biological dose escalation into the definitive chemoradiation of oropharyngeal cancer poses several challenges. Reliable and reproducible data must be obtained in a timely fashion. However, despite recent international radiotherapy contouring guidelines, controversy persists as to the applicability of [...] Read more.
Integrating immunotherapy, proton therapy and biological dose escalation into the definitive chemoradiation of oropharyngeal cancer poses several challenges. Reliable and reproducible data must be obtained in a timely fashion. However, despite recent international radiotherapy contouring guidelines, controversy persists as to the applicability of such guidelines to all cases. Similarly, a lack of consensus exists concerning both the definition of the organ at risk for oral mucositis and the most appropriate endpoint to measure for this critical toxicity. Finally, the correlation between early markers of efficacy such as complete response on PET CT following treatment and subsequent survival needs elucidation for biological subsets of oropharyngeal cancer. Full article
(This article belongs to the Special Issue Advances and Perspectives in Radiotherapy Treatments)
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