Radiation

The objective of this study was to evaluate the effectiveness of utilizing radiomic features from radiation planning computed tomography (CT) scans in predicting tumor progression among patients with cervical cancers. A retrospective analysis was conducted on individuals who underwent radiotherapy for cervical cancer between 2015 and 2020, utilizing an institutional database. Radiomic features, encompassing first-order statistical, morphological, Gray-Level Co-Occurrence Matrix (GLCM), Gray-Level Run Length Matrix (GLRLM), and Gray-Level Dependence Matrix (GLDM) features, were extracted from the primary cervical tumor on the CT scans. The study encompassed 112 CT scans from patients with varying stages of cervical cancer ((FIGO Staging of Cervical Cancer 2018): 24% at stage I, 47% at stage II, 21% at stage III, and 10% at stage IV). Of these, 31% (n = 35/112) exhibited tumor progression. Univariate feature analysis identified three morphological features that displayed statistically significant differences (p < 0.05) between patients with and without progression. Combining these features enabled a classification model to be developed with a mean sensitivity, specificity, accuracy, and AUC of 76.1% (CI 1.5%), 70.4% (CI 4.1%), 73.6% (CI 2.1%), and 0.794 (CI 0.029), respectively, employing nested ten-fold cross-validation. This research highlights the potential of CT radiomic models in predicting post-radiotherapy tumor progression, offering a promising approach for tailoring personalized treatment decisions in cervical cancer. Full article

Background: To evaluate p-Cry in 10 years as a feasible and radical approach in patients with small renal masses (<5 cm), we evaluated technical success, side effects, and survival rates. Materials and Methods: We retrospectively evaluated 421 patients with small renal masses (<5 cm) with a median age of 70 years (47–92 C.I.) between June 2014 and July 2024 at our department. We also evaluated side effects, surgical radicality, and therapeutic outcomes of renal functions. Survivals were also evaluated in terms of disease-free, metastasis-free, and cancer-related survival rates. Results: Median follow-up was 90 months (1–120 months C.I.), and median size of the tumor was 3.85 cm (1–4 C.I.). Two cryoprobes were used in median, and two 10-min freeze–thaw cycles were performed. The technical efficacy rate was 100%, whereas only one of 121 lesions required retreatment. No impact on the renal function was registered after p-Cry. Cancer-free survival and metastases-free survival was reached. Conclusions: Compared to surgery, p-Cry is a feasible treatment option in patients with small renal masses, as it does not affect renal function and gives patients good survival rates. Full article

Although radiation therapy is the leading option for effective cancer treatment, a prevalent side effect associated with it is dermatitis. Despite some available literature on this topic, there remain many gaps that need to be addressed. The goal of this study is to determine the incidence of radiation-induced dermatitis (RID) among children receiving proton and photon therapies; a retrospective chart review, at a single institution, was conducted on oncology patients who underwent proton or photon therapy radiation between 2018 and 2023. Significant differences were found between the Radiation Therapy Oncology Group (RTOG) score and the total radiation dose (p = 0.04). The median total dose of radiation received by those with an RTOG score of l was 5040.0 mGy and increased to 7600 mGy for those with a score of 3. A significant association was found between those who received chemotherapy and dermatitis (p = 0.04). No significance was found between the incidence of dermatitis in photon and proton therapy (p = 1.00). The study showed that multiple factors, including total radiation dose and chemotherapy, can affect RID. These relationships can be used to determine the modality, dose, and additional treatment options best suited to treat cancer patients in the pediatric population. Full article

This study investigated the effect of combining radiation with an angiogenesis inhibitor and vascular disrupting agent on tumor response and systemic toxicity. CDF1 mice with 200 mm³ foot implanted C3H mammary carcinomas were treated with TNP-470 (100 mg/kg every second day for 2 weeks; s.c.) and combretastatin A-4 phosphate (CA4P; 1 × 250 mg/kg, i.p.). Radiation (230-kV X-rays) was locally administered to tumors of restrained non-anesthetized mice. Response was tumor growth delay and change in mouse body weight. Radiation induced changes in serum levels of 10 cytokines up to 72-h after irradiation were measured using a Luminex assay. The results showed that TNP-470 (100 mg/kg × 7) or CA4P (250 mg/kg × 1) significantly (Student’s t-test; p < 0.05) inhibited tumor growth; the greatest effect when these two drugs were combined. TNP-470 and CA4P, alone or together, also significantly enhanced tumor response to radiation. No systemic toxicity occurred with drugs administered alone or in combination, but toxicity was observed when TNP-470 was combined with radiation. Serum cytokine levels only showed a significant transient increase in IL-6 1-h after irradiating. In conclusion, combining different acting vascular targeting agents with radiation increased anti-tumor activity. However, this benefit may sometimes be associated with a radiation-induced inflammatory response increasing systemic toxicity. Full article

Radiotherapy remains a cornerstone in cancer treatment, leveraging ionizing radiation to eradicate malignant cells. Its efficacy, however, is frequently challenged by the heterogeneous sensitivity of tumors and surrounding tissues to radiation. Therefore, understanding the molecular mechanisms underlying radiosensitivity is crucial for improving treatment outcomes. Among the myriad of molecular players involved, the tumor suppressor protein p53 stands out as a central regulator with significant implications for radiosensitivity. Known as the “guardian of the genome”, p53 plays a pivotal role in maintaining genomic stability and orchestrating cellular responses such as cell cycle arrest, DNA repair, apoptosis, and senescence in response to various stress signals, including radiation-induced DNA damage. Activation of p53 triggers the transcription of target genes involved in DNA repair pathways, such as p21, MDM2, and GADD45, facilitating the repair of radiation-induced DNA damage or the elimination of irreparably damaged cells. This, in turn, influences the overall radiosensitivity of tissues. Mutations in the TP53 gene, which encodes p53, are among the most frequent genetic alterations in human cancers. Loss or dysfunction of p53 can compromise the cellular response to radiation, leading to increased resistance to therapy and poorer clinical outcomes. Conversely, intact p53 function is associated with enhanced radiosensitivity due to its ability to promote cell cycle arrest and apoptosis in response to radiation-induced DNA damage. In conclusion, elucidating the molecular mechanisms by which p53 influences radiosensitivity is essential for advancing our understanding of the radiation response in cancer cells and developing more effective therapeutic approaches to cancer treatment. This review provides a comprehensive overview of the multifaceted role of p53 in modulating cellular responses to radiation, emphasizing its influence on radiosensitivity. Full article

Vibrational spectroscopic techniques, such as Fourier transform infrared (FTIR) absorption and Raman spectroscopy (RS), offer unique and detailed biochemical fingerprints by detecting specific molecular vibrations within samples. These techniques provide profound insights into the molecular alterations induced by ionising radiation, which are both complex and multifaceted. This paper reviews the application of rapid and label-free vibrational spectroscopic methods for assessing biological radiation responses. These assessments span from early compartmentalised models such as DNA, lipid membranes, and vesicles to comprehensive evaluations in various living biological models, including tissues, cells, and organisms of diverse origins. The review also discusses future perspectives, highlighting how the field is overcoming methodological limitations. RS and FTIR have demonstrated significant potential in detecting radiation-induced biomolecular alternations, which may facilitate the identification of radiation exposure spectral biomarkers/profiles. Full article

X-ray fluoroscopy causes relatively high radiation exposure to physicians, radiation professionals, and patients. Understanding the behavior of scattered radiation is crucial for reducing occupational exposure. We developed a system for estimating radiation exposure during fluoroscopy by monitoring the position of the physician using a depth camera for radiation protection education. The dose distribution of scattered radiation in an X-ray room was simulated using Monte Carlo code. The data were displayed using augmented reality markers, and the dose at each joint point location was estimated using body tracking. Additional functions were created, such as displaying arbitrary two-dimensional cross-sections. The system performance ranged from 9.0 to 11.0 FPS with or without motion and a protective apron. The estimated doses were 0.93 to 1.21 times the measured doses for all joint points, except for the chest and pelvis. The estimated doses for the chest and pelvis were lower than the measured dose, with the minimum values being 0.72 and 0.60 times lower for the chest and pelvis, respectively. The system provides valuable insight into the estimation of radiation dose at joint points based on the physician’s position and movements, the physician’s optimal fluoroscopy location, and warning of dangerous exposure doses. Full article

Nanotechnology has provided considerable advancements in an array of disciplines. Recently, it has been shown that ferumoxytol, a magnetite (Fe₃O₄) nanoparticle, can be oxidized by ionizing radiation. Ferumoxytol nanoparticles have high stability, and thus can be hypothesized that they have dosimetric potential. In this study, it has been observed that xylenol orange, a colorimetric detector of Fe³⁺ used for conventional Fricke dosimetry, was not able to detect radiolytic changes in ferumoxtyol. Electron paramagnetic resonance (EPR) spectroscopy was more readily able to evaluate the oxidation of ferumoxytol. EPR spectroscopy revealed that oxidation of 500 nM ferumoxytol in H₂O was linear up to 20 Gy. This concentration, however, was unable to estimate the delivered dose from a Small Animal Radiation Research Platform system, as a 6 Gy dose was estimated to be 1.37 Gy, which represents a 79.2% underestimation of the dose delivered. Thus, while the high stability of Fe₃O₄ nanoparticles is attractive for use in pre-clinical radiation dosimetry, further radiochemical evaluation may be required before considering them for this application. Full article

Background: Pelvic reirradiation of de novo rectal or anal cancer after prior prostate cancer RT poses a significant risk of urinary and rectal fistula. In this report we describe the use of a rectal spacer to improve dosimetry and reduce this risk. Methods: Patients undergoing anorectal radiotherapy (RT) after prior prostate RT who had a rectal spacer placed prior to RT were identified in a prospective database. Patient, disease, and treatment characteristics were collected for these patients. Survival data were calculated from the end of RT. Radiation was delivered with intensity-modulated radiation therapy (IMRT) or proton beam therapy (PBT) following rectal spacer placement. Results: Rectal spacer placement with hydrogel injected transperineally under transrectal ultrasound guidance was successful in all five patients. MR/CT simulation 1–2 weeks post-spacer placement and IMRT or PBT delivered to a dose of 36–50 Gy in 24–30 fractions once or twice daily were tolerated well by all patients. The V100% of the PTV ranged from 62–100% and mean rectal and bladder dose ranged from 39–46 Gy and 16–40 Gy, respectively. At the last follow-up, three patients were alive and without evidence of disease up to 48 months out from treatment. There were no acute or late grade 3 or higher toxicities observed, but acute grade 2 proctitis was observed in all patients. Conclusions: The use of a rectal spacer placement to improve dosimetry of IMRT and PBT after prior prostate RT is safe and feasible in appropriately selected anorectal cancer patients. Full article

A 98-year-old patient with cognitive impairment and a history of squamous cell carcinoma of the nasal pyramid was referred to the radiation oncology department of our institution’s hospital given that surgery was not recommended. The lesion was sized 6 × 6 cm, ulcerated, and bleeding; was significantly impairing the patient’s health-related quality of life, causing pain; and was not responsive to analgesics, including opioids. The patient experienced deterioration of her general conditions, with a Karnofsky performance status of 40. A single radiotherapy (RT) fraction was delivered on a weekly basis for 3 weeks, up to a total dose of 21 Gy, using a VMAT technique (7 Gy/fraction). The patient was given three fractions of radiotherapy, during which she received continuous assistance due to episodes of mental disorientation and an altered sense of consciousness. One month after the conclusion of the treatment, the patient exhibited a nearly complete clinical response, with full pain relief and an improved health-related quality of life. This favourable clinical outcome was maintained for a period of four months following the conclusion of RT. A brief review was performed on the role of hypofractionated radiation therapy in elderly patients with locally advanced skin cancer of the head and neck region. Full article

Aim: To evaluate patient satisfaction outcomes with respect to pain, discomfort, and quality of life with hematology/oncology referrals undergoing CT-guided bone marrow biopsy and compare these scores with those of patients undergoing in-office biopsy. Methods: A retrospective chart review was performed over 2 years with all patients who underwent CT-guided bone marrow biopsy at our university set-up. Age, gender, BMI, radiation dose (CTDI/DLP), number of in-office biopsies, number of CT-guided biopsies, type/amount of moderate sedation used, technical and pathologic success rates, and complication rates were recorded. All patients who underwent both in-office and CT-guided biopsy were contacted by telephone to answer a brief survey regarding pain, discomfort, quality of life, and future preference with respect to each biopsy. Results: A total of 32 patients underwent CT-guided bone marrow biopsy. Moderate sedation was utilized for all CT patients, and 19 patients underwent both in-office and CT-guided biopsies. Upon surveying the 19 patients who underwent both kinds of biopsies, on a scale of 1–10 (10 = highest discomfort and highest pain), the patients on an average reported 7.8 for in-office vs. 2.1 for CT for the discomfort level (p < 0.001) and 7.9 vs. 1.7 for the pain (p < 0.001). The patients reported an average quality-of-life score of 82 (out of a scale of 100) after CT procedures and 53 for in-office (p < 0.001). All patients reported that they would prefer CT-guided procedures with sedation versus in-office procedures in the future. Conclusion: CT-guided bone marrow biopsy is the preferred and more comfortable procedure, especially in low-pain-tolerant patients, although it involves more cost, conscious sedation, and radiation exposure. Full article

Current radiation dosimeters sometimes face accuracy limitations or provide only cumulative doses over long periods. To contribute to this area, we developed a portable monitor that measures the energy spectrum and dose of gamma rays in real time. To achieve this, we used an improved sequential Bayesian estimation algorithm. The dose rate was then derived from the energy spectrum by applying a flux-to-dose conversion coefficient. The monitor consists mainly of a CsI(Tl) scintillator and a multi-pixel photon counter (MPPC). In developing this device, we focused on striking a balance between measurement accuracy, ease of use, and portability. As an essential aspect of the research, we investigated the influence of the CsI(Tl) crystal size on the performance of the monitor to determine an optimal size. This was accomplished by calculating the detection efficiency and energy resolution through experimental measurements using standard gamma-ray sources and simulations using MCNP5. Within the scope of the research, detector response functions were created for each crystal size for an energy range of 10 keV to 3 MeV. Considering an optimal balance of detection efficiency and energy resolution alongside a compact size suitable for portable applications, the crystal measuring 2.6 × 2.6 × 1.3 cm³ was deemed preferable. Full article

Background: Head and neck cancer treatment does not yield desired outcomes for all patients. This investigation aimed to explore the feasibility of predicting treatment outcomes from routine pre-treatment magnetic resonance images (MRIs). Radiomics features were “mined” and used to train machine learning (ML) classifiers to predict treatment outcomes. Moreover, iterative deep texture analysis (DTA) was explored to boost model performances. Methods: Radiomics features were determined from T1-weighted post-contrast MRIs of pathologically involved lymph node (LN) segmentations for n = 63 patients. SVM, k-NN, and FLD classifier models were trained, selecting for 1–10 features. The model with the top balanced accuracy was chosen for an iteration of DTA. New feature sets were used to retrain and test the ML. Radiomics features were explored for a total of three layers through two iterations of DTA. Results: Models proved useful in predicting treatment outcomes. The best model was a nine-feature multivariable k-NN model with a sensitivity ($\%S_n$) of 93%, specificity ($\%S_p$) of 74%, 86% accuracy ($\%Acc$), and 86% precision ($\%Per$). The best model for two of the three classifiers (k-NN and FLD) was trained using features from three layers. The performance of the average k-NN and FLD models trained with features was boosted significantly with the inclusion of deeper-layer features. Conclusions: Pre-treatment LN MRIs contain quantifiable texture information that can be used to train ML models to predict cancer treatment outcomes. Furthermore, DTA proved useful to boosting predictive models. Full article

Purpose: Uterine carcinosarcomas are highly aggressive tumors of the endometrium and are associated with a poor prognosis. The optimal adjuvant treatment for both early and advanced-stage patients remains unclear. Methods: Cases of uterine carcinosarcoma were identified in our institution’s pathology database between 2000 and 2022. Kaplan–Meier estimates were calculated for the local and distant recurrence-free, disease-free and overall survival; hazard ratios were calculated using Cox proportional hazards modelling for independent prognostic factors including the stage and treatment. Results: A total of 48 patients were identified as having uterine carcinosarcoma, of whom 70.8% were surgically staged. In total, 43 patients had pelvic-confined disease, while five had positive omental or peritoneal biopsies at surgery. There were 10 pelvic (20.8%) and 19 (39.6%) distant recurrences. None of the patients with stage IA disease who received chemotherapy and brachytherapy experienced disease recurrence. The local recurrence-free survival was 54.95%, the distant recurrence-free survival was 44.7%, and the overall survival was 59.6% at 5 years. Local recurrence-free survival and overall survival were inversely associated with advanced-stage OR 1.23 (p = 0.005) and OR 1.28 (p = 0.017), respectively, and no chemotherapy was associated with OR 1.96 (p = 0.06) and OR 2.08 (p = 0.056), respectively. Conclusion: The local and distant recurrence rates were high for advanced=stage patients even when treated with aggressive adjuvant therapy regimens. Chemotherapy may improve recurrence and survival. Early-stage patients may perform well with vaginal vault brachytherapy and chemotherapy. Further prospective comparisons are required between sequential, sandwich, and concurrent approaches to chemotherapy and radiotherapy, to optimize outcomes in this high-risk population. Full article

The combination of an ultra-low-loss optical fiber sensitive to ionizing radiation and an optical time domain reflectometer (OTDR) is investigated to explore the feasibility of a single-ended distributed radiation detector. The peculiarity of the tested fiber resides in its regenerative high radiation-induced attenuation (RIA) response in the infrared spectrum (1310 nm), which returns to a low value once the irradiation has ended, combined to its sensitivity, highly increasing with the dose rate. In this work, only some sections of the fiber line were irradiated with 100 kV X-rays at room temperature, to prove the spatially resolved radiation detection capabilities of the system. The transient RIA response of the fiber was characterized at different pre-irradiation doses. A pre-irradiation treatment was shown to stabilize the optical fiber response, improving its RIA vs. dose rate linearity and repeatability. This improved response, in terms of radiation quantification, comes at the cost of a lower detection threshold. This work lays the bases for a distributed radiation detector, with some capabilities in dose rate evaluation. Full article

The physiological process of iodine uptake in the thyroid is used for ¹³¹I treatment of thyroid diseases. Children are more sensitive to radiation compared to adults and may react differently to ¹³¹I exposure. The aims of this study were to evaluate the effects on thyroid protein expression in young and adult rats one year after ¹³¹I injection and identify potential biomarkers related to ¹³¹I exposure, absorbed dose, and age. Twelve Sprague Dawley rats (young and adults) were i.v. injected with 50 kBq or 500 kBq ¹³¹I and killed twelve months later. Twelve untreated rats were used as age-matched controls. Quantitative proteomics, statistical analysis, and evaluation of biological effects were performed. The effects of irradiation were most prominent in young rats. Protein biomarker candidates were proposed related to age, absorbed dose, thyroid function, and cancer, and a panel was proposed for ¹³¹I exposure. In conclusion, the proteome of rat thyroid was differentially regulated twelve months after low-intermediate dose exposure to ¹³¹I in both young and adult rats. Several biomarker candidates are proposed for ¹³¹I exposure, age, and many of them are known to be related to thyroid function or thyroid cancer. Further research on human samples is needed for validation. Data are avaiable via ProteomeXchange with identifier PXD024786. Full article

PET/CT scans are being used to assess patients who have experienced biochemical failure following surgery or radiation therapy for localized prostate cancer. We aimed to evaluate the language used in report impressions and to determine the level of confidence that radiologists have when reporting on lesions in various anatomic sites. Between 2015 and 2021, 295 F18-fluciclovine PET/CT scan reports were identified. Thirteen phrases commonly used by radiologists in the report impression section to describe a lesion of interest were identified and categorized into three confidence categories: definitive (positive and negative), likely (consistent with, most likely, favors, probable), and unsure (suspicious for, concerning for, non-specific, conspicuous, compatible with, borderline, unknown). The use of definitive language varied depending on the anatomic site, with the highest use in bone (87.1%) and the lowest use in the intact prostate (34.6%). In patients with a PSA < 0.5, there was the highest degree of definitive certainty (89.2%), whereas in patients with a PSA > 1, there was the least definitive certainty (66.2%). The language used in these reports has not been standardized, with definitive, likely, and unsure findings reported in 68.6%, 9.7%, and 21.7% of scans, respectively. Full article

For patients with recurrent brain metastases, there is an urgent need for a more effective and less toxic treatment approach. Accumulating evidence has shown that spatially fractionated radiation therapy (SFRT) is able to provide a significantly higher therapeutic ratio with lower toxicity compared to conventional radiation using a uniform dose. The purpose of this study was to explore the potential low toxicity benefit of mini-beam radiotherapy (MBRT), a form of SFRT, for whole-brain re-irradiation in a healthy mouse model. Animals first received an initial 25 Gy of uniform whole-brain irradiation. Five weeks later, they were randomized into three groups to receive three different re-irradiation treatments as follows: (1) uniform irradiation at 25 Gy; (2) MBRT at a 25 Gy volume-averaged dose (106.1/8.8 Gy for peak/valley dose, 25 Gy-MBRT); and (3) MBRT at a 43 Gy volume-averaged dose (182.5/15.1 Gy for peak/valley dose, 43 Gy-MBRT). Animal survival and changes in body weight were monitored for signs of toxicity. Brains were harvested at 5 weeks after re-irradiation for histologic evaluation and immunostaining. The study showed that 25 Gy-MBRT resulted in significantly less body weight loss than 25 Gy uniform irradiation in whole-brain re-irradiation. Mice in the 25 Gy-MBRT group had a higher level of CD11b-stained microglia but also maintained more Ki67-stained proliferative progenitor cells in the brain compared to mice in the uniform irradiation group. However, the high-dose 43 Gy-MBRT group showed severe radiation toxicity compared to the low-dose 25 Gy-MBRT and uniform irradiation groups, indicating dose-dependent toxicity. Our study demonstrates that MBRT at an appropriate dose level has the potential to provide less toxic whole-brain re-irradiation. Future studies investigating the use of MBRT for brain metastases are warranted. Full article

Background: Stereotactic body radiotherapy (SBRT) targeted at metastatic sites of disease progression is emerging as a potential therapeutic approach for managing oligoprogressive prostate cancer. However, a definitive benefit has yet to be demonstrated. Herein, we present our institution’s experience with this treatment approach. Methods: From April 2018 to March 2023, 11 patients affected by oligoprogressive prostate cancer were treated with SBRT targeting the nodal or bone sites of progression while maintaining the ongoing systemic therapy. Three patients were undergoing single-agent ADT (Androgen Deprivation Therapy), while the remaining eight were receiving a subsequent line of systemic therapy. All patients were evaluated with a pre-treatment 68Ga-PSMA-11 or 18F-fluorocholine PET/CT, which demonstrated between one and five localizations of disease. All the active sites were treated with SBRT in one (15–24 Gy) or three (21–27 Gy) fractions, except for one patient, who was treated in five fractions (35 Gy). PSA serum levels were tested at baseline, one month after RT and at least every three months; all patients underwent a post-treatment 68Ga-PSMA-11 or 18F-fluorocholine PET/CT. The evaluated endpoints were PSA response, defined as a post-treatment decrease >50% from baseline measured within 6 months, time to next-line systemic treatment (NEST), local control (LC), biochemical progression-free survival (bPFS), radiological progression-free survival (rPFS) and freedom from polymetastatic progression (FPP). Results: Nineteen lesions were treated (seven nodal and twelve bone). At a median follow-up of 19 months (7–63), 9 of the 11 patients had a PSA response; all patients had local control of the treated metastases. A total of six patients switched to a next-line systemic treatment, with a median NEST of 13 months. Six patients had polymetastatic progression with an FPP median time of 19 months. No patients died during the follow-up period. The SBRT-related toxicity was negligible. Conclusions: Our data support the use of SBRT targeting the sites of oligoprogressive disease before moving to a subsequent line of systemic treatment in patients with metastatic prostate cancer. Prospective studies to evaluate the potential impact of this approach on overall survival are warranted. Full article