The risk for developing a secondary cancer after breast radiation therapy: Comparison of photon and proton techniques
The use of a specific treatment technique in radiation therapy is mainly motivated by the achievable dose conformity to the target and the overall integral dose. Proton therapy offers a highly conformal and comprehensive treatment option with a lower integral dose (reduced low-dose bath) to organs at risk (OARs). Consequently, given the proximity of cardiopulmonary structures, proton therapy has been discussed as a treatment alternative for breast cancer patients [1 –3]. Treatment planning studies, comparing 3DCRT, IMRT, and proton therapy when irradiating the breast and regional nodes showed advantages of using prot...
Source: Radiotherapy and Oncology - May 24, 2020 Category: Radiology Authors: Harald Paganetti, Nicolas Depauw, Andrew Johnson, Rachel Beth Forman, Jackson Lau, Rachel Jimenez Tags: Original Article Source Type: research

Percussion assisted radiation therapy in Hodgkin lymphoma allows a marked reduction in heart dose
Early-stage Hodgkin lymphoma (HL) is a largely curable disease with 10-year overall survival rates of over 90% [1 –3] with most patients achieving long-term complete remission. However, HL survivors are at risk of developing therapy-related complications years after treatment responsible for increased morbidity and mortality [4]. Therefore, significant efforts have been made to balance the cure with the toxic effects by using less toxic chemotherapy regimens and decreasing radiation dose and field size [2]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 21, 2020 Category: Radiology Authors: Andr é-Dante Durham, Alban Lovis, Julien Simons, Olivier Long, Flore Buela, Adam Ogna, Raphaël Jumeau, Anne Cairoli, Susana Rocha Do Carmo Leal, Michele Zeverino, David Patin, Véronique Vallet, Raphaël Moeckli, Jean Bourhis, Mahmut Ozsahin Tags: Original Article Source Type: research

Once daily versus twice-daily radiotherapy in the management of limited disease small cell lung cancer - Decision criteria in routine practice
Lung cancer is the leading cause of cancer death worldwide. Small cell lung cancer (SCLC) accounts for approximately 15% of all lung cancers. About one third of patients will present with limited TNM stage I-III at the time of diagnosis (1). Standard of care for those patients is concurrent thoracic chemo-radiotherapy and prophylactic cranial irradiation (PCI)(2, 3). (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 21, 2020 Category: Radiology Authors: Markus Glatzer, Corinne Faivre-Finn, Dirk De Ruysscher, Joachim Widder, Paul Van Houtte, Esther G.C. Troost, MR Dahele, Ben J. Slotman, Sara Ramella, Christoph P öttgen, Stephanie T.H. Peeters, Ursula Nestle, Fiona McDonald, Cecile Le Pechoux, Rafal Dzia Tags: Original Article Source Type: research

Letter to the editor regarding Lee J, Shin IS, Yoon WS, Koom WS, Rim CH. Comparisons between radiofrequency ablation and stereotactic body radiotherapy for liver malignancies: Meta-analyses and a systematic review. Radiother Oncol 2020;145:63 –70
Dear Sir, (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 21, 2020 Category: Radiology Authors: Edward W Johnston, Nicos Fotiadis Tags: Letter to the Editor Source Type: research

The simulation-CT: Radiotherapy ’s useful tool in the race against COVID-19 pandemic. A serendipity approach
Since the Italian “Patient Zero” was identified, an enormous effort was made by the entire Radiotherapy (RT) centers, included the “Fondazione IRCCS-Istituto Nazionale dei Tumori di Milano” (INT) [1], to pursue the Care Mission during the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-COVID 19 p andemic [2,3]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 21, 2020 Category: Radiology Authors: Angelo Vitullo, Maria Carmen De Santis, Alfonso Marchian ò, Riccardo Valdagni, Laura Lozza Tags: COVID-19 Rapid Letter Source Type: research

Tumor-targeted dose escalation for localized prostate cancer using MR-guided HDR brachytherapy (HDR) or integrated VMAT (IB-VMAT) boost: Dosimetry, toxicity and health related quality of life
Radiation treatment (RT) is an effective option for men with localized prostate cancer (PCa).[1] However, local recurrences (LR) remain common in patients treated with external beam radiotherapy (EBRT) alone.[2] Dose-escalated RT to the whole gland (WG) has demonstrated increased locoregional and biochemical control in localized PCa.[3-5] A meta-analysis concluded that each 1-Gray (Gy) increased in dose delivered reduces 1.8% the risk of biochemical failure.[6] Nevertheless, concerns have been raised with regards to increased toxicity and subsequently worsening the quality of life (QoL) of patients treated with dose escala...
Source: Radiotherapy and Oncology - May 21, 2020 Category: Radiology Authors: Noelia Sanmamed, Jenny Lee, Alejandro Berlin, Tim Craig, Bernadeth Lao, Alexandra Rink, Andrew Bayley, Charles Catton, Aravindhan Sundaramurthy, WarrenFoltz, Andrew McPartlin, Sangeet Ghai, Mary Gospodarowicz, Padraig Warde, Cynthia M énard, Peter Chung Tags: Original Article Source Type: research

Response to Letter to the Editor by Johnston and Fotiadis regarding “Comparisons between radiofrequency ablation and stereotactic body radiotherapy for liver malignancies: Meta-analyses and a systematic review.”
First, we appreciate the authors interest in our research. We completely agree that radiofrequency ablation (RFA) has a higher level of evidence than stereotactic body radiotherapy (SBRT). Because of the difference in evidence level, RFA or surgery is considered the standard treatment for liver malignancies, whereas radiotherapy is indicated for patients who are not candidates to these treatments [1 –3]. Most studies included in our meta-analysis [4] were conducted by radiation oncologists who treated patients with SBRT and compared with statistically and/or propensity matched cohorts. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 20, 2020 Category: Radiology Authors: Chai Hong Rim Source Type: research

Response to SAFFRON spinal radiosurgery comments
We read with great interest the Letter to the Editor by Dr. Isabel Bravo, which raises valid questions regarding our selection criteria and potential methodological issues that potentially could have compromised the results of our findings. We certainly agree that systematic reviews and meta-analyses must make all attempts to mitigate potential sources of bias to provide reliable information for practitioners to make informed clinical decisions. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 20, 2020 Category: Radiology Authors: Raj Singh, Eric J. Lehrer, Daniel M. Trifiletti Tags: Letter to the Editor Source Type: research

Comment on a systematic review and meta-analysis on single fraction radiosurgery, fractionated radiosurgery, and conventional radiotherapy for spinal oligometastasis
We have read with great interest the recent article by Singh et al, recently reported in this journal [1]. The authors performed a systematic review and meta-analysis of outcomes for 3237 patients with spinal metastases treated with sterotactic body radiation therapy (SBRT), either single-fraction (SF) or multiple fraction (MF) or conventional radiotherapy (RT) and we commend the authors for their effort. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 20, 2020 Category: Radiology Authors: Isabel Bravo Tags: Letter to the Editor Source Type: research

Can we safely reduce the radiation dose to the heart while compromising the dose to the lungs in oesophageal cancer patients?
Over the last decade, increasing numbers of oesophageal cancer patients have been treated with radiotherapy, either in the neo-adjuvant setting followed by surgery or as definitive treatment. Due to neo-adjuvant CRT, cure rates have improved [1,2]. As a consequence, the number of oesophageal cancer survivors at risk of developing late toxicity is has risen correspondingly. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 20, 2020 Category: Radiology Authors: Jannet C. Beukema, Yoshifumi Kawaguchi, Nanna M. Sijtsema, Tian-Tian Zhai, Johannes A. Langendijk, Lisanne V. van Dijk, Peter van Luijk, Teruki Teshima, Christina T. Muijs Tags: Original Article Source Type: research

Μulti-institutional dosimetric delivery assessment of intracranial stereotactic radiosurgery on different treatment platforms
Stereotactic radiosurgery (SRS), was first developed in the 1950s [1] and has since evolved substantially. There are now several manufacturers that offer commercial solutions for delivering SRS and such treatments may be delivered by a Gamma Knife (GK) unit, a CyberKnife (CK) or a gantry-based linear accelerator (linac) system with stereotactic capabilities. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 20, 2020 Category: Radiology Authors: Alexis Dimitriadis, Yatman Tsang, Russell A.S. Thomas, Antony L. Palmer, David Eaton, Jonathan Lee, Rushil Patel, Ileana Silvestre Patallo, Clare Gouldstone, Julia A.D. Snaith, Karen J. Kirkby, Andrew Nisbet, Catharine H. Clark Tags: Original Article Source Type: research

The impact of the effective dose to immune cells on lymphopenia and survival of esophageal cancer after chemoradiotherapy: Asian perspectives in the immunotherapy era
To the Editor: We read the work by Xu, et al [1] with great interest and congratulate them for the publication of this large-scale retrospective study. Radiation-induced lymphopenia is an important prognostic factor for esophageal cancers [2,3] and many other solid tumours [4]. The estimation of dose to circulating lymphocytes by adopting the effective dose to immune cells (EDIC) formula is gaining external validity in different types of cancers. In stage III non-small cell lung cancer, Ladbury, et al [5] have recently published the correlation of EDIC and lymphopenia with consistent findings. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 18, 2020 Category: Radiology Authors: Tsz-Him So, Ka-On Lam Tags: Letter to the Editor Source Type: research

Precision toxicity correlates of tumor spatial proximity to organs at risk in cancer patients receiving intensity-modulated radiotherapy
Radiation-associated dysphagia (RAD) is one of the severe sequelae of treatment in head and neck (HNC) cancer patients undergoing radiation therapy (RT), with chronic toxicity arising even after acute symptoms have ceased [1]. Chronic RAD is even more relevant in the era of Human Papillomavirus associated (HPV) HNC, where the majority of patients have curable disease with prolonged survival, and thereby endure later toxicities which are otherwise not encountered in patients with aggressive HPV negative disease and relatively shorter survival duration. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 15, 2020 Category: Radiology Authors: Andrew Wentzel, Peter Hanula, Lisanne V. van Dijk, Baher Elgohari, Abdallah S. R. Mohamed, Carlos E. Cardenas, Clifton D. Fuller, David M. Vock, Guadalupe Canahuate, G. Elisabeta Marai Tags: Original Article Source Type: research

Efficacy and safety of stenting and additional oncological treatment versus stenting alone in unresectable esophageal cancer: a meta-analysis and systematic review
Esophageal cancer is the eighth most common cancer worldwide with an estimated annual incidence and mortality above 572,000 and 508,000, respectively [1]. This makes it the sixth leading cause for cancer-related mortality [2]. Its five-year survival rate is estimated to be as low as 14% [3] and patients with metastatic disease have a median survival of less than one year if treated with chemotherapy [4]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 15, 2020 Category: Radiology Authors: Benedek Tinusz, Alexandra So ós, Péter Hegyi, Patrícia Sarlós, László Szapáry, Adrienn Erős, Donáta Feczák, Zsolt Szakács, Katalin Márta, Viktória Venglovecz, Bálint Erőss Tags: Systematic Review Source Type: research

Patient-Reported Outcomes, Physician-Reported Toxicities, and Treatment Outcomes in a Modern Cohort of Patients with Sinonasal Cancer Treated Using Proton Beam Therapy
Sinonasal malignancies are an uncommon subgroup of head and neck cancers that are difficult to treat due to disease heterogeneity, intricate anatomy, and lack of randomized evidence to guide treatment decisions.1,2 As locally advanced disease is common at time of presentation, patients require multidisciplinary evaluation and management using a combination of surgery, chemotherapy, and radiotherapy.3 Historically, sinonasal cancer outcomes have demonstrated minimal improvement over treatment eras, from the 1970s to the 2000s, with approximate three-year local control (LC), disease-free survival (DFS), and overall survival ...
Source: Radiotherapy and Oncology - May 14, 2020 Category: Radiology Authors: Dario Pasalic, Ethan B. Ludmir, Pamela K. Allen, Nikhil G. Thaker, Bhavana V. Chapman, Ehab Y. Hanna, Shirley Y. Su, Renata Ferrarotto, Bonnie S. Glisson, Jay P. Reddy, G. Brandon Gunn, Clifton D. Fuller, Jack Phan, David I. Rosenthal, William H. Morrison Tags: Original Article Source Type: research

Acute organ toxicity correlates with better clinical outcome after chemoradiotherapy in patients with anal carcinoma
Anal squamous cell carcinoma (ASCC) is mainly caused by infection with the human papillomavirus (HPV) and epidemiologic data indicate an increasing incidence [1,2]. Standard treatment for non-metastatic disease is primary chemoradiotherapy (CRT) [3]. In general, treatment outcomes are favorable, but disease recurrence occurs in up to 40% of patients with advanced stages (cT3-4 and/or cN+) [3,4]. Pelvic radiotherapy (RT) and CRT are associated with acute organ toxicities such as proctitis, diarrhea, cystitis and dermatitis that may, in addition to hematologic side effects, challenge compliance with CRT and, thus, tumor resp...
Source: Radiotherapy and Oncology - May 14, 2020 Category: Radiology Authors: Daniel Martin, Franz R ödel, Jens von der Grün, Claus Rödel, Emmanouil Fokas Tags: Original Article Source Type: research

Professional quality of life and burnout amongst radiation oncologists: the impact of alexythymia and empathy
Radiation oncology is a clinical discipline based on the use of ionizing radiation to treat cancer [1,2]. On a daily basis, oncologists exploit articulated diagnosis, deliver multimodality personalized cancer treatments, supportive care and pain control. They take care of the comunicational needs of both patients and caregivers and are confronted with death and suffering [3]. They also need to face demanding productivity requirements, coping with limited autonomy and increasing regulatory which can lead to ‘administrative fatigue’ [4]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 14, 2020 Category: Radiology Authors: Pierfrancesco Franco, Valentina Tesio, Jenny Bertholet, Anne Gasnier, Elisabet Gonzalez del Portillo, Mateusz Spalek, Jean-Emmanuel Bibault, Gerben Borst, Wouter Van Elmpt, Daniela Thorwarth, Laura Mullaney, Kathrine R øe Redalen, Ludwig Dubois, Cyrus Ch Tags: Original Article Source Type: research

Patterns of Inguinal Lymph Node Metastases in Anal Canal Cancer and Recommendations for Elective Clinical Target Volume (CTV) Delineation
For local-regionally confined squamous cell carcinoma of the anal canal, standard treatment is definitive external beam radiotherapy with concurrent chemotherapy. Malignancies of the anus metastasize to the inguinal and femoral lymph node region [1]. Multiple consensus guidelines recommend routine elective coverage of the inguinal lymph node basin in the definitive treatment of anal cancer [2 –4]. Omission of the inguinal lymph node basin has been associated with an unacceptably high risk of inguinal failure, with the possible exception of very early stage primary tumors [5–7]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 14, 2020 Category: Radiology Authors: Allison E. Garda, Patrick J. Navin, Kenneth W. Merrell, James A. Martenson, Michelle A. Neben Wittich, Michael G. Haddock, Terence T. Sio, William G. Rule, Jonathan B. Ashman, Shannon P. Sheedy, Christopher L. Hallemeier Tags: Original Article Source Type: research

Predicting pathological response after radio-chemotherapy for rectal cancer: impact of late oxaliplatin administration
Pathological complete response (pCR) at surgery after neo-adjuvant radio-chemotherapy (RCT) of locally advanced rectal cancer is known to be a robust predictor of outcome [1,2]. On the other hand, the early identification of patients with a high probability of experiencing pCR is of extremely high interest due to the great consequent potential in individualizing therapy [3], including the choice of treatment intensification for non-responding patients and omission of surgery for patients with a high probability of experiencing pCR. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 14, 2020 Category: Radiology Authors: Sara Broggi, Paolo Passoni, Calogero Gumina, Anna Palmisano, Andrea Bresolin, Valentina Burgio, Alessandra Di Chiara, Ugo Elmore, Martina Mori, Najla Slim, Monica Ronzoni, Riccardo Rosati, Francesco De Cobelli, Nadia G. Di Muzio, Claudio Fiorino Tags: Original Article Source Type: research

Randomized controlled trial to identify the optimal radiotherapy scheme for palliative treatment of incurable head and neck squamous cell carcinoma
A substantial proportion of patients with advanced-stage head and neck squamous cell carcinoma (HNSCC) are unsuitable for radical treatment with surgery or (chemo)radiotherapy [1 –2] because of very advanced loco‐regional disease, significant comorbidities, poor performance status, distant metastatic disease or any combination of these factors. Patients with untreated advanced HNSCC have a median survival of approximately 100 days [3]. However, this group of patients sti ll requires some form of treatment to control their loco‐regional disease and to alleviate their troublesome symptoms. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 14, 2020 Category: Radiology Authors: Abrahim Al-Mamgani, Rob Kessels, Cornelia G. Verhoef, Arash Navran, Olga Hamming-Vrieze, Johannes H.A.M. Kaanders, Roel J.H.M. Steenbakkers, Lisa Tans, Frank Hoebers, Francisca Ong, Erik van Werkhoven, Johannes A. Langendijk Tags: Original Article Source Type: research

Concurrent cisplatin and Dose escalation with Intensity-modulated radiotherapy (IMRT) versus conventional radiotherapy for locally advanced head and neck squamous cell carcinomas (HNSCC): GORTEC 2004-01 randomized phase III trial
Concurrent chemoradiotherapy (CRT) is a well-established standard-of-care (SoC) in locally advanced (LA) head and neck squamous cell carcinomas (HNSCC) as shown in the update of MACH-NC database (8% survival benefit at 5 years) [1 2 3]. The most commonly adopted standard CRT regimen is combination of conventional fractionated radiotherapy (70 Gy/7 weeks) with high-dose cisplatin (100 mg /m2 every 3 weeks). (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 14, 2020 Category: Radiology Authors: Yungan Tao, Anne Auperin, Pierre Blanchard, Marc Alfonsi, Xu-Shan Sun, Michel Rives, Yoann Pointreau, Jo ël Castelli, Pierre Graff, Stéphanie Wong Hee Kam, Juliette Thariat, Ovidiu Veresezan, Steve Heymann, Sophie Renard-Oldrini, Cédrik Lafond, Alexand Tags: Original Article Source Type: research

Individual patient data meta-analysis of FMISO and FAZA hypoxia PET scans from head and neck cancer patients undergoing definitive radio-chemotherapy
Tumor hypoxia is a well-known adverse prognostic factor in various solid cancers and also showed predictive value in two a posteriori analyses of trials testing the addition of the hypoxia activated prodrug Tirapazamine to standard radiochemotherapy [1 –3]. Since hypoxia-activated prodrugs failed to demonstrate their superiority compared to standard treatment in three large phase III studies on various tumors including HNSCC without pre-selection on the basis of tumor hypoxia, the inclusion of a hypoxia-specific biomarker seems imperative [4–6 ]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 14, 2020 Category: Radiology Authors: Sebastian Zschaeck, Steffen L öck, Frank Hofheinz, Daniel Zips, Lise Saksø Mortensen, Klaus Zöphel, Esther GC Troost, Simon Boeke, Mette Saksø, David Mönnich, Annekatrin Seidlitz, Jørgen Johansen, Tomas Skripcak, Vincent Gregoire, Jens Overgaard, Mi Tags: Original Article Source Type: research

Dose prediction using a deep neural network for accelerated planning of rectal cancer radiotherapy
Colorectal cancer is the third most common cancer in men and the second most common in women, [1]. Radiation therapy is an indispensable part of adjuvant therapy for rectal cancer, because it improves local control, overall survival, and the opportunity for good quality of life [2]. Intensity-modulated radiation therapy (IMRT) is the most commonly used technique [3,4], with the advantages of high target dose coverage and organs-at-risk (OAR) dose sparing because IMRT has strong dose modulation ability with multiple segments at fixed gantry angles by inverse optimization process. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 13, 2020 Category: Radiology Authors: Ying Song, Junjie Hu, Yang Liu, Haiyun Hu, Yang Huang, Sen Bai, Zhang Yi Tags: Original Article Source Type: research

Prospective assessment of mask versus frame fixation during Gamma Knife treatment for brain metastases
Stereotactic radiosurgery (SRS) has become a standard-of-care option for patients with limited numbers of brain metastases as SRS alone results in similar overall survival outcomes but better neurocognitive outcomes than whole-brain radiotherapy (WBRT) or WBRT plus SRS boost [1,2]. Especially with improved systemic options and prolonged OS, SRS provides the possibility for repeated treatments of sequentially diagnosed brain metastases [3].Table 1.Table 2. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 13, 2020 Category: Radiology Authors: Mario A. Grimm, Ulrich K öppen, Florian Stieler, Grit Welzel, Arne Mathias Ruder, Martin Polednik, Frederik Wenz, Sabine K. Mai, Frank A. Giordano Tags: Original Article Source Type: research

Carbon ion radiotherapy in pancreatic cancer: A review of clinical data
Pancreatic cancer is one of the most lethal cancer entities with estimated 45.750 deaths in the United States in 2019[1]. Despite decades of research, the overall survival rate at five years is still at 5-10%[2]. The only curative therapy option is tumor resection, but only 20% of all patients present with resectable disease at time of diagnosis[3]. Even after resection the postoperative 5-year overall survival rate remains poor[4] since metachronous metastasis and local recurrence occur commonly. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 13, 2020 Category: Radiology Authors: Jakob Liermann, Makoto Shinoto, Mustafa Syed, J ürgen Debus, Klaus Herfarth, Patrick Naumann Tags: Review Article Source Type: research

Estimating dose delivery accuracy in stereotactic body radiation therapy: a review of in-vivo measurement methods
Stereotactic body radiation therapy (SBRT) has been recognized as an appropriate treatment option for both primary and metastatic tumors in different anatomical sites such as the lungs [1], liver [2], prostate [3] and spine [4]. Furthermore, international recommendations on SBRT delivery are being cited in literature [3,5,6]. An important feature of SBRT is that it delivers high radiation doses to small lesions with short fractionation schemes [7]. Single or few fractions (up to 8) with dose for fraction greater than 6 Gy are commonly used. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 13, 2020 Category: Radiology Authors: Marco Esposito, Elena Villaggi, Sara Bresciani, Savino Cilla, Maria Daniela Falco, Cristina Garibaldi, Serenella Russo, Cinzia Talamonti, Michele Stasi, Pietro Mancosu Tags: Review Article Source Type: research

ESTRO IORT Task Force/ACROP recommendations for intraoperative radiation therapy with electrons (IOERT) in breast cancer
In breast conserving treatment (BCT), radiation therapy following breast-conserving surgery (BCS) is performed as whole breast irradiation (WBI) or, increasingly, as accelerated partial breast irradiation (APBI), targeting the tissue surrounding the original tumour site (tumour bed) in selected patients with low local recurrence risks [1]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 12, 2020 Category: Radiology Authors: Gerd Fastner, Christoph Gaisberger, Julia Kaiser, Philipp Scherer, Antonella Ciabattoni, Anna Petoukhova, Elena Sperk, Philip Poortmans, Felipe A. Calvo, Felix Sedlmayer, Maria Cristina Leonardi Tags: Original Article Source Type: research

Lack of supporting data make the risks of a clinical trial of radiation therapy as a treatment for COVID-19 pneumonia unacceptable
Conflict of Interest: DGK is on the scientific advisory board and owns stock in Lumicell, Inc which is developing intraoperative imaging technology. DGK is a co-founder of X-RAD Therapeutics, which is developing radiosensitizers. DGK reports research support from Merck, Bristol Myers Squibb, and X-RAD Therapeutics. MD reports research funding from Varian Medical Systems and Illumina, ownership interest in CiberMed, patent filings related to cancer biomarkers, paid consultancy from Roche, AstraZeneca, Illumina, RefleXion, and BioNTech. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 12, 2020 Category: Radiology Authors: David G. Kirsch, Maximilian Diehn, Francis A. Cucinoata, Ralph Weichselbaum Tags: COVID-19 Rapid Letter Source Type: research

COVID-19 outbreak and cancer radiotherapy disruption in italy: Survey endorsed by the italian association of radiotherapy and clinical oncology (AIRO)
Italy experienced one of the world ’s deadliest COVID-19 outbreaks and healthcare systems had to instantly reorganise activity. The Italian Radiation Oncology Departments adapted numerous solutions to minimize the disruptions. Information technologies, treatment prioritization and implementation of hypofractionation and protection procedures allowed balancing between cancer patient care and patient/healthcare workers safety. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 12, 2020 Category: Radiology Authors: Barbara Alicja Jereczek-Fossa, Matteo Pepa, Giulia Marvaso, Alessio Bruni, Michela Buglione di Monale e Bastia, Gianpiero Catalano, Andrea Riccardo Filippi, Pierfrancesco Franco, Maria Antonietta Gambacorta, Domenico Genovesi, Giuseppe Iat ì, Alessandro Tags: COVID-19 Rapid Communication Source Type: research

Cranberry capsules are not superior to placebo capsules in managing acute non-haemorrhagic radiation cystitis in prostate cancer patients: a phase III double blinded randomised placebo controlled clinical trial
Radiation-cystitis is an unavoidable side effect of external beam radiation therapy to the pelvis, even when delivered using normal tissue sparing delivery methods such as image guided radiation therapy (IGRT) and volumetric modulated arc therapy (VMAT). Cystitis symptoms include dysuria, urinary frequency, urgency, nocturia, the sensation of incomplete bladder voiding, haematuria and an increased risk of urinary tract infections. Acute radiation-cystitis develops during radiation therapy and generally resolves within weeks of completing radiation treatment. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 12, 2020 Category: Radiology Authors: Patries M Herst, Andre Aumata, Vanessa Sword, Rowan Jones, Gordon Purdie, Shaun Costello Tags: Original Article Source Type: research

Clinical and radiographic adverse events after Gamma Knife radiosurgery for brainstem lesions: a dosimetric analysis
The brainstem is composed of several densely packed neural tracts that are critical for neurological function and survival. Progressing lesions near or on the brainstem often lead to rapid neurological decline and even death.[1-6] A 2017 study by Emery et al. found that brainstem metastases are associated with more than a three-fold risk of death when compared to supratentorial lesions.[7] Resection is typically avoided as a treatment option due to operative risk and poor outcomes, and instead, stereotactic radiosurgery (SRS), whole brain radiation therapy (WBRT), or both are performed. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 12, 2020 Category: Radiology Authors: Eric J. Lehrer, M. Harrison Snyder, Bhargav D. Desai, Chelsea E. Li, Aditya Narayan, Daniel M. Trifiletti, David Schlesinger, Jason P. Sheehan Tags: Original Article Source Type: research

Epithelial-to-mesenchymal transition is a prognostic marker for patient outcome in advanced stage HNSCC patients treated with chemoradiotherapy
About half of head and neck squamous cell carcinoma (HNSCC) patients present with advanced stage disease. In the case of hypopharyngeal, laryngeal and HPV-negative oropharyngeal carcinomas, chemoradiotherapy is the current treatment of choice for these patients[1]. Disease progression occurs in around 40%, stressing the need for additional treatment options for poor prognosis patients. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 12, 2020 Category: Radiology Authors: Martijn van der Heijden, Paul B.M. Essers, Caroline V.M. Verhagen, Stefan M. Willems, Joyce Sanders, Reinout H. de Roest, David M. Vossen, C. Ren é Leemans, Marcel Verheij, Ruud H. Brakenhoff, Michiel W.M. van den Brekel, Conchita Vens Tags: Original Article Source Type: research

Reduced increase of calcium scores using breath-hold in left-sided whole breast irradiation
Radiotherapy for left-sided breast cancer is associated with an increased risk of Coronary Artery Disease (CAD) which is proportional to the mean dose to the heart [1,2]. This counts for younger breast cancers survivors as well [3]. When patients also received anthracycline-containing chemotherapy an even higher increased risk of heart disease was observed [4]. Apart from that, cardiovascular disease (CVD) is the most important cause of death in women [5]. Finally, it appears that the death rate due to breast cancer decreases around time of menopause whereas the age-specific CVD death rate increases steadily across the lif...
Source: Radiotherapy and Oncology - May 11, 2020 Category: Radiology Authors: M.E. Mast, J.F. Pekelharing, M.W. Heijenbrok, D. van Klaveren, M.L. van Kempen-Harteveld, A.L. Petoukhova, A. Verbeek-de Kanter, J.H.M. Schreur, H. Struikmans Tags: Original Article Source Type: research

Low dose radiation therapy as a potential life saving treatment for COVID-19-induced acute respiratory distress syndrome (ARDS)
The recent outbreak of the new corona virus (SARS-CoV-2/COVID-19) has spread throughout the globe at an alarming rate, with many countries being scientifically, medically, economically, socially, and/or politically unprepared to meet and respond to the pandemic threat. The clinical spectrum of COVID-19 ranges from an asymptomatic form to mild respiratory symptoms such as dry cough, fever, and moderate dyspnea, to more severe presentations, such as neurologic manifestations (e.g.- cerebrovascular accident consequential to cytokine-induced changes in blood clotting; direct encephalitic effects), viral pneumonia, acute respir...
Source: Radiotherapy and Oncology - May 10, 2020 Category: Radiology Authors: Gaurav Dhawan, Rachna Kapoor, Rajiv Dhawan, Ravinder Singh, Bharat Monga, James Giordano, Edward J. Calabrese Tags: COVID-19 Rapid Communication Source Type: research

Radiation therapy for COVID-19 pneumopathy
The COVID-19 pandemic has a dramatic impact on global healthcare. In lack of effective SARS-CoV-2 directed therapeutics, several treatment approaches are currently being re-purposed. In this regard, Kirkby and Mackenzie drew the radiotherapy community ’s attention to the historical use of low-dose lung radiotherapy for bacterial and viral pneumonia in the pre-penicillin-era [1]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 10, 2020 Category: Radiology Authors: Klaus R üdiger Trott, Sebastian Zschaeck, Marcus Beck Tags: COVID-19 Rapid Letter Source Type: research

Response letter: Handling of COVID-19 positive lung cancer patients during the pandemic
We would like to thank Troost et al. [1] and Magrini et al. [2] for opening a broader discussion about radiotherapy treatment of COVID-19 positive lung cancer patients during the time of the pandemic [3]. We propose differentiating two separate aspects and risk categories which need to be considered in this situation. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 7, 2020 Category: Radiology Authors: Matthias Guckenberger, David A. Palma Tags: COVID-19 Rapid Letter Source Type: research

What is our threshold? Departmental planning for radiation oncology ’s future in the time of COVID-19
The outbreak of novel coronavirus disease 2019 (COVID-2019) is of significant concern. As of this writing, the slope of the upward portion of the logarithmic curve of cases and deaths in the US is unclear and much is unknown about the virology and epidemiology of the disease. Furthermore, the short- and long-term impact of this pandemic on the medical community and society, at-large, is yet to be understood. Nevertheless, it is becoming clearer, however, that we are settling into a new and dynamic reality as a medical specialty. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 7, 2020 Category: Radiology Authors: Ravi A. Chandra, Charles R. Thomas Source Type: research

COVID-19 outbreak and cancer patient management: viewpoint from radio-oncologists
COVID-19 has emerged as a major global health threat since December, 2019. By April 1st, 2020, there were more than 800,000 patients with confirmed COVID-19 infection worldwide.Radiotherapy is continuous in treatment schedule. Interruption of the treatment or delay of the treatment may jeopardise therapeutic efficacy.Liang et al.[1]demonstrated that due to receipt of immunotherapy, cancer patients are at higher risk to be infected with COVID-19. Recently, Xie[2] et al. revealed cancer patients older than 60 years old have an excess risk of COVID-19 infection, which deserves special attention. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 7, 2020 Category: Radiology Authors: Hongnan Zhen, Fuquan Zhang, Hui Guan, Zhikai Liu, Jie Shen, Xiaorong Hou, Xin lian, Ke Hu Tags: COVID-19 Rapid Letter Source Type: research

RILI model and the Covid-19 pneumonia: the radiation oncologist point of view
With regard to the letter written by Kirkby C, investigating a hypothetical benefit of the whole lung low dose radiotherapy (LDRT) to treat COVID-19 pneumonia, several considerations should be examined in light of the recent advances in the pathophysiology of COVID-19 pneumonia provided by autopsies. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 7, 2020 Category: Radiology Authors: Grazia Lazzari, Giovanni Silvano Source Type: research

Advocacy to provide good quality oncology services during the COVID-19 pandemic – Actions at 3-Levels
The COVID-19 pandemic is a devastating catastrophe to the whole world, China is the first country seriously affected. This review shows that it is possible to stop wide-spread infection in the country and to provide good quality oncology services even during this challenging period, through concerted efforts with well-organized actions at all levels (National/Municipal, Hospital and Department). The key strategies leading to successful impacts are summarized for sharing. In addition to making practice changes to cope with the adverse realities, oncologists should also work together to raise pragmatic suggestions to policy ...
Source: Radiotherapy and Oncology - May 7, 2020 Category: Radiology Authors: Anne W.M. Lee, Zhi-Yuan Xu, Lily Lin, Joy Xu, Jin Yang, Eric Lee, Tim Hui, Jacob Cheung Tags: COVID-19 Rapid Communication Source Type: research

Practical indications for management of patients candidate to Interventional and Intraoperative Radiotherapy (Brachytherapy, IORT) during COVID-19 pandemic – A document endorsed by AIRO (Italian Association of Radiotherapy and Clinical Oncology) Interventional Radiotherapy Working Group
In the contest of COVID-19 rapid spread in Italy, the Italian Government in March 2020 released an official recommendation statement indicating .1 (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 7, 2020 Category: Radiology Authors: Andrea Vavassori, Luca Tagliaferri, Lisa Vicenzi, Andrea D'Aviero, Antonella Ciabattoni, Sergio Gribaudo, Loredana Lapadula, Gian Carlo Mattiucci, Lorenzo Vinante, Vitaliana De Sanctis, Cristiana Vidali, Rita Murri, Maria Antonietta Gambacorta, Marcello M Tags: COVID-19 Rapid Letter Source Type: research

Response letter: handling of COVID-19 positive patients during the pandemic
We would like to thank Troost et al. [1] and Magrini et al. [2] for their feedback and for opening a broader discussion about radiotherapy treatment of COVID-19 positive lung cancer patients during the time of the pandemic [3]. We propose differentiating two separate aspects and risk categories which need to be considered in this situation. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 7, 2020 Category: Radiology Authors: Matthias Guckenberger, David A. Palma Source Type: research

Response to: low dose radiation therapy for COVID-19 pneumonia a double-edged sword
We thank the authors for their response and welcome critical discussion on the potential of LDRT as a treatment for COVID-19 pneumonia. Kefayat and Ghahremani raise several valid points in their letter. Certainly further study on the matter is warranted. Based on historical evidence in the literature and the current pandemic status, the radiation therapy community would be justified in designing both pre-clinical and clinical trials to modern standards to investigate the effectiveness of LDRT against COVID-19 pneumonia using end points such as progression to the need for ventilator support, duration of hospitalisation, len...
Source: Radiotherapy and Oncology - May 6, 2020 Category: Radiology Authors: Charles Kirkby, Marc Mackenzie Source Type: research

Improving 3D ultrasound prostate localisation in radiotherapy through increased automation of interfraction matching
Accurate image guidance is essential to minimise setup errors and facilitate reduced margins in prostate radiotherapy. This is especially the case for ultrahypofractionation which may become standard within a few years. However, streamlined workflows are required to reduce interobserver variability in matching and to improve departmental efficiency.Fig 1. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 6, 2020 Category: Radiology Authors: Alexander Grimwood, Hassan Rivaz, Hang Zhou, Helen A. McNair, Klaudiusz Yakubowski, Jeffrey C. Bamber, Alison C. Tree, Emma J. Harris Tags: Original Article Source Type: research

Response to: RILI model and the Covid-19 pneumonia: the radiation oncologist point of view
We thank the author for this letter and welcome the critical discussion on the potential of LDRT as a treatment for COVID-19 pneumonia. While indeed models for RILI may provide useful insight into COVID-19 disease progression, and successful treatments for radiation-induced lung injury may also be applicable to COVID-19-induced lung injury, this does not invalidate the hypothesis that low doses ( (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 6, 2020 Category: Radiology Authors: Charles Kirkby, Marc Mackenzie Source Type: research

Radiotherapy and COVID-19: Practical recommendations from iran
Following the announcement of the COVID-19 pandemic by the World Health Organization in March 2020, the outbreak of new coronavirus in Iran and most of the world has posed severe challenges in the treatment of cancer patients. This group of patients is more prone to this new virus due to immune-compromised status following active treatment and frequent visits to hospitals [1]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 6, 2020 Category: Radiology Authors: Mahdi Aghili, Reza Ghalehtaki, Nima Mousavi Darzikolaee, Fatemeh Jafari, Mahsa Moshtaghian Source Type: research

Pencil beam scanning proton therapy for the treatment of craniopharyngioma complicated with radiation-induced cerebral vasculopathies: a dosimetric and linear energy transfer (LET) evaluation
Radiation-induced cerebral vasculopathy (RICV) has been described in paediatric patients after radiation therapy (RT) for tumours of optic tracts, hypothalamus, and suprasellar region [1,2]. Delayed RICV mainly results from an accelerated arteriosclerosis process of small and medium sized vessels within the radiation field [3,4]. This complication can present as moyamoya syndrome, which results from stenosis or occlusion of large and intermediate cerebral arteries [5]. The real incidence of RT-induced stenosis of carotid arteries and intracerebral arteries is however not well established. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 5, 2020 Category: Radiology Authors: Alessandra Bolsi, Lorenzo Placidi, Alessia Pica, Frank Ahllhelm, Marc Walser, Tony Lomax, Damien C. Weber Tags: Original Article Source Type: research

Dose-volume correlates of the prevalence of patient-reported trismus in long-term survivorship after oropharyngeal IMRT: a cross-sectional dosimetric analysis
Survivors of oropharyngeal carcinoma (OPC) treated with radiotherapy (RT) risk a host of substantial, lifelong functional impairments. Functional toxicity is of particular interest in OPC survivorship as the rise in biologically favorable HPV-associated disease in younger patients has led to unprecedented numbers of long-term survivors facing late effects of RT at relatively young ages (commonly in their 60s). Thus, it is more imperative than ever to develop and implement proactive risk reduction strategies in these patients to minimize or prevent loss of function and improve quality of life (QOL) after RT [1]. (Source: Ra...
Source: Radiotherapy and Oncology - May 5, 2020 Category: Radiology Authors: Mona Kamal, Crosby Rock, Stephen Grant, Jhankruti Zaveri, Robin Claire Granberry, Barrett O'Donnell, Amy Dursteler, Benjamin W. Warren, Stefania Volpe, Karine Al Feghali, Carlos E. Cardenas, Richard Cardoso, Stephen Lai, Abdallah Sherif Radwan, Clifton D. Tags: Original Article Source Type: research

Ultra-High Dose Rate Effect on Circulating Immune Cells: A Potential Mechanism for FLASH Effect?
FLASH radiotherapy (RT) delivers ultra-fast radiation treatment with a dose rate several orders of magnitude higher than conventional dose rates [1 –7]. It has been reported that FLASH-RT can significantly spare normal tissues in comparison to RT at conventional dose rates, whereas tumor responses are the same as or better than those resulting from conventional dose rate RT [1–7]. This FLASH effect has been demonstrated in various experimen tal animal models (mice, zebrafish, pigs, cats), various organs (lung, gut, brain, skin) and by various research groups [1–7]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 5, 2020 Category: Radiology Authors: Jian-Yue Jin, Anxin Gu, Weili Wang, Nancy L. Oleinick, Mitchell Machtay, Feng-Ming (Spring) Kong Tags: Original Article Source Type: research

Immunogenetic markers in IL17F predict the risk of metastases spread and overall survival in rectal cancer patients treated with neoadjuvant chemoradiotherapy
It is recognized that the anti-tumor effect of radiotherapy is linked to a direct damaging effect on tumor cells DNA and to the generation of free oxygen radicals, but recently it was also related to its priming action on the immune system [1,2]. The radiation-induced immune activation was shown to elicit a systemic antitumor response, reducing the risk of distant failures by the so-called abscopal effect. Recent studies demonstrated that in the context of the pre-operative chemoradiotherapy (poCRT) in locally advanced rectal cancer (LARC), radiotherapy can significantly modify the tumor tissue immune-profile by inducing a...
Source: Radiotherapy and Oncology - May 5, 2020 Category: Radiology Authors: Cecchin Erika, Elena De Mattia, Eva Dreussi, Marcella Montico, Elisa Palazzari, Federico Navarria, Francesca Bergamo, Claudio Belluco, Luca Quartuccio, Salvatore De Vita, Vincenzo Canzonieri, Sara Gagno, Chiara Zanusso, Angela Buonadonna, Salvatore Puccia Tags: Original Article Source Type: research