Editorial Board
(Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - July 18, 2019 Category: Radiology Source Type: research

Contents
(Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - July 18, 2019 Category: Radiology Source Type: research

Ultra high dose rate Synchrotron Microbeam Radiation Therapy. Preclinical evidence in view of a clinical transfer
Spatially fractionated radiotherapy was developed and reported in 1909 by Alban K öhler, a German radiologist, to reduce extensive damage to skin and adjacent tissues when he irradiated deep seated tumours with low voltage (60–70 kV) X-rays. To this effect, he held a shielding iron wire grid tightly against the skin before exposure. The heavily irradiated, necrotic spots of the unshielded skin healed in few weeks. Variants of grid therapy were then used successfully in clinical external beam radiotherapy since the 1930s [1]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - July 12, 2019 Category: Radiology Authors: Laura Eling, Audrey Bouchet, Christian Nemoz, Valentin Djonov, Jacques Balosso, Jean Laissue, Elke Br äuer-Krisch, Jean Francois Adam, Raphael Serduc Tags: Original Article Source Type: research

Treatment of a first patient with FLASH-radiotherapy
When compared to conventional radiotherapy (RT) in pre-clinical studies, FLASH-RT was shown to reproducibly spare normal tissues, while preserving the anti-tumor activity. This marked increase of the differential effect between normal tissues and tumors prompted its clinical translation. In this context, we present here the treatment of a first patient with FLASH-RT. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - July 11, 2019 Category: Radiology Authors: Jean Bourhis, Wendy Jeanneret Sozzi, Patrik Gon çalves Jorge, Olivier Gaide, Claude Bailat, Fréderic Duclos, David Patin, Mahmut Ozsahin, François Bochud, Jean-François Germond, Raphaël Moeckli, Marie-Catherine Vozenin Tags: Original Article Source Type: research

Feasibility of proton FLASH effect tested by zebrafish embryo irradiation
During the last decades, radiotherapy dose delivery techniques were notably improved with respect to tumor conformity, e.g., by sophisticated beam delivery techniques like intensity modulated radiation therapy. One disadvantage also of modern photon beam techniques is the exposure of the surrounding normal tissue, which is linked to a risk of severe acute and late effects. Alternatives for reducing the risk are provided by the application of charged particles with their inverse depth dose profile or could be possible by the recently described Flash effect that promises normal tissue protection thanks to dose delivery by be...
Source: Radiotherapy and Oncology - June 29, 2019 Category: Radiology Authors: Elke Beyreuther, Michael Brand, Stefan Hans, Katalin Hidegh éty, Leonhard Karsch, Elisabeth Leßmann, Michael Schürer, Emília Rita Szabó, Jörg Pawelke Tags: Original Article Source Type: research

Clinical translation of FLASH radiotherapy: Why and how?
Radiation therapy (RT) is a major actor in cancer management, with more than half of all cancer patients treated with RT, mostly given with curative potential. RT generally exploits the empirical observation that normal tissues can recover from the harmful effects of ionizing radiation to a higher extent than tumors. This differential effect can be exacerbated by two factors that can independently increase the normal tissue tolerance. The first factor is the fractionation of the total dose with a good protection of normal tissues at 2  Gy per fraction and even more pronounced below 2 Gy/fraction [1]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - June 25, 2019 Category: Radiology Authors: Jean Bourhis, Pierre Montay-Gruel, Patrik Gon çalves Jorge, Claude Bailat, Benoît Petit, Jonathan Ollivier, Wendy Jeanneret-Sozzi, Mahmut Ozsahin, François Bochud, Raphaël Moeckli, Jean-François Germond, Marie-Catherine Vozenin Tags: Original Article Source Type: research

Reduced cognitive deficits after FLASH irradiation of whole mouse brain are associated with less hippocampal dendritic spine loss and neuroinflammation
Radiation therapy is an important treatment modality for a broad range of brain tumors. However, the ability to cure tumors through dose intensity is limited by normal tissue injury, particularly when a large volume of the brain (up to the whole brain) must be included in the treatment volume as is the case for many clinical indications. In the prospective randomized trial RTOG 0614, 64.9% of patients developed a significant decrement in cognitive function by 24  weeks after whole brain radiation therapy [1]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - June 25, 2019 Category: Radiology Authors: Danielle A. Simmons, Frederick M. Lartey, Emil Sch üler, Marjan Rafat, Gregory King, Anna Kim, Ryan Ko, Sarah Semaan, Selena Gonzalez, Melissa Jenkins, Pooja Pradhan, Zion Shih, Jinghui Wang, Rie von Eyben, Edward E. Graves, Peter G. Maxim, Frank M. Long Tags: Original Article Source Type: research

Editorial Board
(Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - June 22, 2019 Category: Radiology Source Type: research

Contents
(Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - June 22, 2019 Category: Radiology Source Type: research

PHASER: A platform for clinical translation of FLASH cancer radiotherapy
Cancer is a leading and epidemically increasing cause of death globally in both the developed and developing world. Because radiation therapy is a pillar of curative cancer therapy, two major challenges must be addressed to reduce cancer mortality substantially: (1) fundamentally increasing the therapeutic index of radiotherapy, maximizing tumor eradication while minimizing toxicity; (2) increasing global access to the highest quality radiotherapy. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - June 6, 2019 Category: Radiology Authors: Peter G. Maxim, Sami G. Tantawi, Billy W. Loo Tags: Original Article Source Type: research

Dosimetric and preparation procedures for irradiating biological models with pulsed electron beam at ultra-high dose-rate
The progress of radiotherapy (RT) over the last few decades was mostly obtained in improving the spatial and dosimetric accuracy of the delivered dose to the patient [1,2]. Lately, a RT technique called FLASH-RT has emerged and questioned some established RT concepts regarding the effects of radiation on healthy tissue. Indeed, preclinical studies in FLASH-RT have shown that irradiations with an ultra-high dose-rate increase the differential response between normal tissues and tumors [3 –6]. In order to reveal differential biological effects, radiobiological studies required a traceable, accurate and repeatable dose ...
Source: Radiotherapy and Oncology - June 4, 2019 Category: Radiology Authors: Patrik Gon çalves Jorge, Maud Jaccard, Kristoffer Petersson, Maude Gondré, Maria Teresa Durán, Laurent Desorgher, Jean-François Germond, Philippe Liger, Marie-Catherine Vozenin, Jean Bourhis, François Bochud, Raphaël Moeckli, Claude Bailat Tags: Original Article Source Type: research

EGCG, a green tea polyphenol, as one more weapon in the arsenal to fight radiation esophagitis?
Radiotherapy (RT) is a mainstay in the treatment of locally advanced non-small cell lung cancer (NSCLC). The addition of chemotherapy (CHT) to RT improves the survival of patients with NSCLC [1]. A concurrent approach is superior to a sequential CHT-RT approach in patients with PS 0 –1 and stage III NSCLC [2]. If, for any reason, CHT cannot be given to such patients, the hyperfractionated acceleration of RT improves the treatment outcome compared with conventional fractionation [3]. However, these more efficacious treatment modalities are also more aggressive, i.e., more toxi c. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 24, 2019 Category: Radiology Authors: Lucyna K ępka, Anna Rychter Tags: Editorial Source Type: research

Imaging of regional ventilation: Is CT ventilation imaging the answer? A systematic review of the validation data
The idea of deriving information about regional pulmonary function from respiratory-correlated computed tomography (CT), especially 4-Dimensional Computed Tomography (4DCT) and inhale/exhale breath-hold CT (BHCT), without exogenous contrast is highly attractive. In the context of radiotherapy treatment planning, respiratory-correlated thoracic CT scans are acquired routinely for lung cancer patients, a population with significant impairment of respiratory function, and breast cancer patients, where radiation-induced lung toxicity remains a major dose-limiting factor. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 23, 2019 Category: Radiology Authors: Fiona Hegi-Johnson, Dirk de Ruysscher, Paul Keall, Lizza Hendriks, Yevgeniy Vinogradskiy, Tokihiro Yamamoto, Bilal Tahir, John Kipritidis Tags: Review Article Source Type: research

Editorial Board
(Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 22, 2019 Category: Radiology Source Type: research

Contents
(Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 22, 2019 Category: Radiology Source Type: research

Big data analysis of associations between patient reported outcomes, observer reported toxicities, and overall quality of life in head and neck cancer patients treated with radiation therapy
Patient reported outcomes (PROs) have become a common component of data collection in clinical trials in oncology in recent years [1 –8]. They can provide information about treatment toxicity that is complementary to the observer-reported Common Terminology Criteria for Adverse Events (CTCAE) rating system that is typically employed in US-based oncology trials [9]. Although the CTCAE system is essential for assessing the safety of treatments being investigated, studies generally show only fair to moderate associations between clinician and patient reported outcomes, with clinicians typically underestimating symptom s...
Source: Radiotherapy and Oncology - May 22, 2019 Category: Radiology Authors: Joel R. Wilkie, Michelle L. Mierzwa, John Yao, Avraham Eisbruch, Mary Feng, Grant Weyburne, Xiaoping Chen, Lynn Holevinski, Charles S. Mayo Tags: Original Article Source Type: research

ESTRO ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer
Breast cancer is the most common non-skin cancer in women worldwide. The vast majority of patients have non-metastatic disease at diagnosis [1]. The rates of mastectomy with an immediate breast reconstruction (IBR), mainly an implant/prosthesis-based reconstruction (IBR-i), as a surgical treatment for early breast cancer patients are increasing [2,3]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 17, 2019 Category: Radiology Authors: Orit Kaidar-Person, Birgitte Vrou Offersen, Sandra Hol, Meritxell Arenas, Cynthia Aristei, Celine Bourgier, Maria Joao Cardoso, Boon Chua, Charlotte E. Coles, Tine Engberg Damsgaard, Dorota Gabrys, Reshma Jagsi, Rachel Jimenez, Anna M. Kirby, Carine Kirko Tags: Original Article Source Type: research

Boron neutron capture therapy for locally recurrent head and neck squamous cell carcinoma: An analysis of dose response and survival
Head and neck squamous cell carcinoma (HNSCC) can be cured with surgery and radiotherapy with or without systemic therapy, but locoregional recurrence is not uncommon. Cancers that recur locally are often considered inoperable, and may pose a therapeutic challenge, because reirradiation is often associated with substantial toxicity, and chemotherapy and immunotherapy have limited efficacy in most patients [1,2]. Intensity modulated radiotherapy (IMRT) and stereotactic radiotherapy (SRT) may allow delivery of relatively high re-treatment radiation doses without excessive adverse effects to the normal tissues and may improve...
Source: Radiotherapy and Oncology - May 17, 2019 Category: Radiology Authors: Hanna Koivunoro, Leena Kankaanranta, Tiina Sepp älä, Aaro Haapaniemi, Antti Mäkitie, Heikki Joensuu Tags: Original Article Source Type: research

Tumor localization accuracy for high-precision radiotherapy during active breath-hold
For thoracoabdominal neoplasms, respiratory motion management techniques may improve target control rates by enhancing the accuracy of target dose delivery, and augmenting normal tissue sparing by accommodating tumor motion during the radiotherapy course [1,2]. Treatment planning that accounts for respiratory motion minimizes errors in target and organs-at-risk (OARs) delineation from motion-induced artifacts, which could consequently contribute to reducing the target margin and decrease the treated volume [3]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 16, 2019 Category: Radiology Authors: Soyoung Lee, Yiran Zheng, Tarun Podder, Tithi Biswas, Vivek Verma, Matthew Goss, Athanasios Colonias, Russell Fuhrer, Yongjun Zhai, David Parda, Jason Sohn Tags: Original Article Source Type: research

Clinical features and survival outcomes between ascending and descending types of nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data intelligence platform-based analysis
Nasopharyngeal carcinoma (NPC) disproportionately burdens southeast Asia, where the highest incidence is in Southern China [1]. Annually, there are 87,000 new NPC diagnosis, and approximately 70% of patients are classified as locoregionally advanced disease [2]. Radiotherapy (RT) is the primary treatment modality for locoregionally advanced NPC [3], which can be categorized by characteristics of natural disease progression as follows: 1) predominantly advanced local disease with early stage cervical lymph node involvement as ascending type (type A, T3-4N0-1); 2) advanced lymph node disease but early stage local invasion as...
Source: Radiotherapy and Oncology - May 15, 2019 Category: Radiology Authors: Ji-Jin Yao, Zhen-Yu Qi, Zhi-Gang Liu, Guan-Min Jiang, Xi-Wei Xu, Shao-Yi Chen, Feng-Ting Zhu, Wang-Jian Zhang, Wayne R. Lawrence, Jun Ma, Guan-Qun Zhou, Ying Sun Tags: Original Article Source Type: research

The first prototype of spot-scanning proton arc treatment delivery
Pencil beam scanning (PBS) technique [1,2] has become a popular treatment modality in proton therapy [3], which offers superior dosimetric properties compared to photon therapy and passive scatter proton beam therapy [4 –7]. In PBS, the narrow beams (spots) deliver the therapeutic radiation dose from several fixed beam directions via spots in an optimized fashion. However, the dosimetric quality of the PBS plan could be limited [8] due to the large lateral penumbra [9], uncertainties from patient’s daily setup and proton range [10–16], and limited angles for delivery given the treatment delivery efficienc...
Source: Radiotherapy and Oncology - May 14, 2019 Category: Radiology Authors: Xiaoqiang Li, Gang Liu, Guillaume Janssens, Olivier De Wilde, Vincent Bossier, Xavier Lerot, Antoine Pouppez, Di Yan, Craig Stevens, Peyman Kabolizadeh, Xuanfeng Ding Tags: Original Article Source Type: research

The impact of sarcopenia on tolerance of radiation and outcome in patients with head and neck cancer receiving chemoradiation
The general treatment paradigm for locally advanced head and neck cancer (HNC) is concurrent chemotherapy and radiation (CRT). The addition of chemotherapy improves survival outcomes [1 –3] and is associated with significant toxicities, including mucositis, dysphagia, and nausea/vomiting. Maintenance of nutrition during treatment presents a challenge. Patients may present with anorexia and malnutrition prior to treatment as a result of their cancer [4]. Most patients then lose si gnificant amounts of weight [5] during treatment. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 11, 2019 Category: Radiology Authors: Rohit G. Ganju, Ryan Morse, Andrew Hoover, Mindi TenNapel, Christopher E. Lominska Tags: Original Article Source Type: research

In vitro biological response of cancer and normal tissue cells to proton irradiation not affected by an added magnetic field
To optimize beam delivery and conformality of proton therapy, MRI integration has been proposed. Therefore, we investigated if proton irradiation in a magnetic field would change biological responses. Our data in cancer cell lines and stem cell-derived organoid models suggest that a magnetic field does not modify the biological response. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 11, 2019 Category: Radiology Authors: Peter W. Nagle, Marc-Jan van Goethem, Marco Kempers, Harry Kiewit, Antje Knopf, Johannes A. Langendijk, Sytze Brandenburg, Peter van Luijk, Rob P. Coppes Tags: Short Communication Source Type: research

An evaluation of the mid-ventilation method for the planning of stereotactic lung plans
Practice varies between radiotherapy departments with respect to the method used to account for breathing motion within the planning target volume (PTV). Where information on breathing motion is available in the form of a 4D-CT, there are two conflicting approaches. One approach is to define an internal target volume (ITV) [1] that covers the clinical target volume (CTV) in all phases of the 4D-CT, and to add margins to this, covering the non-respiratory geometric uncertainties. Although ICRU [1] defines the ITV in relation to the CTV, in cases where no margin for sub-clinical spread is required this is equivalent to cover...
Source: Radiotherapy and Oncology - May 11, 2019 Category: Radiology Authors: Simon J. Thomas, Barry J. Evans, Lakshmi Harihar, Hannah J. Chantler, Alexander G.R. Martin, Susan V. Harden Tags: Original Article Source Type: research

Evaluating radiotherapy treatment delay using Failure Mode and Effects Analysis (FMEA)
The whole process of radiation therapy for cancer treatment is very complex, which is comprised of various advanced technologies such as medical linear accelerator (linac), imaging system, treatment planning system, etc. Additionally, the process of radiation therapy is time-sensitive and contains many discrete coordinated steps that are susceptible to errors and delays that may compel to postpone the start of the treatment. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 10, 2019 Category: Radiology Authors: Zhengzheng Xu, Soyoung Lee, David Albani, Donald Dobbins, Rodney J. Ellis, Tithi Biswas, Mitchell Machtay, Tarun K. Podder Tags: Original Article Source Type: research

Long-term outcomes and late adverse effects of a prospective study on proton radiotherapy for patients with low-grade glioma
Low-grade gliomas account for 20% of all gliomas and typically occur in young patients who survive years with their illness [1 –3]. Choice of treatment must therefore weigh the goals of disease control against late adverse effects [4]. Radiation therapy has been shown to increase PFS in LGG [5], but with risk of late neurocognitive and neuroendocrine toxicity [6–8]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 10, 2019 Category: Radiology Authors: Shervin Tabrizi, Beow Y. Yeap, Janet C. Sherman, Lisa B. Nachtigall, Mary K. Colvin, Michael Dworkin, Barbara C. Fullerton, Juliane Daartz, Trevor J. Royce, Kevin S. Oh, Tracy T. Batchelor, William T. Curry, Jay S. Loeffler, Helen A. Shih Tags: Original Article Source Type: research

Radiation-induced and neurofibromatosis-associated malignant peripheral nerve sheath tumors (MPNST) have worse outcomes than sporadic MPNST
Malignant peripheral nerve sheath tumor (MPNST) is a malignant tumor arising either from a peripheral nerve de novo, a preexisting benign nerve sheath tumor (usually neurofibroma), or in a patient with neurofibromatosis type 1 (NF1). The diagnosis of sporadic MPNST is based on the constellation of light microscopic, immunohistochemical and ultrastructural features suggesting Schwann cell differentiation (WHO 2013 edition page 187) [1]. Approximately 10% of MPNSTs develop as a consequence of prior radiation therapy [2 –5]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 9, 2019 Category: Radiology Authors: Ruoyu Miao, Haotong Wang, Alex Jacobson, Anna P. Lietz, Edwin Choy, Kevin A. Raskin, Joseph H. Schwab, Vikram Deshpande, G. Petur Nielsen, Thomas F. DeLaney, Gregory M. Cote, Francis J. Hornicek, Yen-Lin E. Chen Tags: Original Article Source Type: research

Optimal cumulative cisplatin dose in nasopharyngeal carcinoma patients based on induction chemotherapy response
Nasopharyngeal carcinoma (NPC) is an endemic malignancy in South China [1]. Based on its epidemiology and biological characteristics, NPC is different from other head and neck cancers [2]. Cisplatin-based concurrent chemoradiotherapy (CCRT) has been established as the standard treatment regimen for local advanced NPC patients [3,4]. Recently, the application of induction chemotherapy (IC) before CCRT has received considerable attention. According to previous studies, IC plays an important role in decreasing risk of distant metastasis and improving clinical outcomes [5 –7]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 9, 2019 Category: Radiology Authors: Sai-Lan Liu, Xue-Song Sun, Jin-Jie Yan, Qiu-Yan Chen, Huan-Xin Lin, Yue-Feng Wen, Shan-Shan Guo, Li-Ting Liu, Hao-Jun Xie, Qing-Nan Tang, Yu-Jing Liang, Xiao-Yun Li, Chao Lin, Yu-Yun Du, Zhen-Chong Yang, Bei-Bei Xiao, Jin-Hao Yang, Lin-Quan Tang, Ling Guo Tags: Original Article Source Type: research

Influence of tumour laterality on patient survival in non-small cell lung cancer after radiotherapy
Survival in non-small cell lung cancer (NSCLC) remains poor; in the UK less than 10% of patients survive at five years. This is despite recent advances in radiotherapy technology that have enabled a larger proportion of locally advanced patients to be treated with curative intent, while maintaining the dose received by normal tissues within acceptable safety limits [1,2]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 9, 2019 Category: Radiology Authors: Alan McWilliam, Eliana Vasquez Osorio, Corinne Faivre-Finn, Marcel van Herk Tags: Original Article Source Type: research

Comparison between bone matching and marker matching for evaluation of intra- and inter-fractional changes in accumulated dose of carbon ion radiotherapy for hepatocellular carcinoma
Particle beams, especially carbon ion beams, are characterized by Bragg peak and a steep lateral penumbra that minimize damage to surrounding normal tissues while effectively concentrating damage on the tumor [1 –3]. However, because the sharper borders of the dose distribution are highly position-sensitive, the actual dose may differ from the prescribed dose if either the tumor position shifts or the water equivalent path length (WEL) to the tumor changes. Tumors of mobile organs such as the lung [4,5], liver [6], and pancreas may undergo greater changes [7], so their doses may be more affected by position shift. (S...
Source: Radiotherapy and Oncology - May 8, 2019 Category: Radiology Authors: Yoshiki Kubota, Hiroyuki Katoh, Kei Shibuya, Shintaro Shiba, Satoshi Abe, Makoto Sakai, Daichi Yuasa, Kazuhisa Tsuda, Tatsuya Ohno, Takashi Nakano Tags: Original Article Source Type: research

Challenging the concept that late recurrence and death from tumor are common after fractionated radiotherapy for benign meningioma
Based on national meeting presentations and prominent journal articles, there is major controversy about the curability of benign meningioma and the value of long-term follow-up [1,2]. The view that benign meningioma is a highly curable tumor stems from the many reports of high ( ∼90%) control rates at 5 years after gross total resection or radiotherapy. The contradictory opinion derives from a small number of studies—mainly Scandinavian—that report high recurrence rates with very long-term follow-up. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 6, 2019 Category: Radiology Authors: Lillie O'steen, Robert J. Amdur, Christopher G. Morris, William M. Mendenhall Tags: Original Article Source Type: research

DNA damage accumulation during fractionated low-dose radiation compromises hippocampal neurogenesis
Radiotherapy is an effective treatment modality for patients of all ages with malignant and benign tumors. With intensity-modulated radiotherapy (IMRT) multiple photon-beams from different directions and with adjusted intensities permit close shaping of radiation dose to target volumes, thereby delivering high doses to tumors while sparing specific risk regions. However, with IMRT large volumes of non-targeted brain regions are exposed to daily low-dose radiation (LDR), which may adversely affect neurocognitive functions. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 4, 2019 Category: Radiology Authors: Zo é Schmal, Anna Isermann, Daniela Hladik, Christine von Toerne, Soile Tapio, Claudia E. Rübe Tags: Original Article Source Type: research

Hypoxia and angiogenic biomarkers in prostate cancer after external beam radiotherapy (EBRT) alone or combined with high-dose-rate brachytherapy boost (HDR-BTb)
Prostate cancer is the most common malignancy affecting men in the UK and remains a significant health problem worldwide. Radical treatment in localised prostate cancer comprises external beam radiotherapy, brachytherapy and radical prostatectomy. Traditionally, patient T-stage, Gleason grade and PSA level have been used to stratify patients into risk groups to indicate the risk of recurrence following treatment [1]. Despite advances in radical treatment for localised prostate cancer, a significant proportion will develop local and/or distant relapse [2,3]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - May 3, 2019 Category: Radiology Authors: Indrani S. Bhattacharya, Mansour Taghavi Azar Sharabiani, Roberto Alonzi, Peter J. Hoskin Tags: Original Article Source Type: research

MRI-based tumour control probability in skull-base chordomas treated with carbon-ion therapy
Particle therapy makes use of protons and heavier ions to improve geometrical and biological efficacy in terms of dose distribution, with respect to photons, thus enabling tumour dose escalation whilst sparing the surrounding healthy tissues. Although protons have a biological effectiveness comparable to photons, this is higher for heavy ions [1]. In particular, carbon-ion radiotherapy (CIRT) has been found to perform well with radioresistant tumours close to organs at risk [2], such as chordoma tumours [3]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 30, 2019 Category: Radiology Authors: Giulia Buizza, Silvia Molinelli, Emma D'Ippolito, Giulia Fontana, Andrea Pella, Francesca Valvo, Lorenzo Preda, Roberto Orecchia, Guido Baroni, Chiara Paganelli Tags: Original Article Source Type: research

Interobserver variability in delineation of target volumes in head and neck cancer
Head and neck cancer (HNC) is the seventh most common cancer and cause of cancer-related death worldwide with yearly more than 500  000 new cases and 380 000 deaths [1]. HNC is usually diagnosed in a locally advanced but curable stage for which a multimodal treatment approach is preferred consisting of surgery followed by radio(chemo)therapy or radio(chemo)therapy as definitive treatment. Surgery for locally advanced tumour s can be mutilating whereas radio(chemo)therapy holds the potential for better functional outcomes but can cause treatment-related toxicity. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 29, 2019 Category: Radiology Authors: Julie van der Veen, Akos Gulyban, Sandra Nuyts Tags: Original Article Source Type: research

Residual gammaH2AX foci in head and neck squamous cell carcinomas as predictors for tumour radiosensitivity: Evaluation in pre-clinical xenograft models and clinical specimens
It is estimated that 50% of patients newly diagnosed with cancer will need to undergo radiotherapy [1]. Tumour response to radiotherapy varies between patients [2,3] and influences the success rate of radiotherapy. Treatment individualisation based on patient characteristics should therefore increase cure rates and reduce normal tissue complications [4]. For that matter, predictive biomarkers are of paramount importance to foresee tumour response ahead of treatment and optimise care for the patient [5]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 29, 2019 Category: Radiology Authors: Sarah Meneceur, Steffen L öck, Volker Gudziol, Sandra Hering, Rebecca Bütof, Maximilian Rehm, Michael Baumann, Mechthild Krause, Cläre von Neubeck Tags: Original Article Source Type: research

Comparison between high-dose and low-dose intravenous methylprednisolone therapy in patients with brain necrosis after radiotherapy for nasopharyngeal carcinoma
Nasopharyngeal carcinoma (NPC) is a common malignancy in the southern Chinese population [1]. Radiotherapy is the standard radical treatment for NPC and produces long-term effects. However, therapeutic irradiation increases the risk of neurologic injury, including radiation-induced brain necrosis (RN) [2], which is a common and serious complication among the many radiotherapy-related complications [3]. Furthermore, treatment of RN remains challenging. Treatment strategies such as anticoagulants [4], hyperbaric oxygen [5], and vitamins [6] have been reported in the past two decades, but their use is not widely accepted due ...
Source: Radiotherapy and Oncology - April 29, 2019 Category: Radiology Authors: Xiaohuang Zhuo, Xiaolong Huang, Maosheng Yan, Honghong Li, Yi Li, Xiaoming Rong, Jinpeng Lin, Jinhua Cai, Fukang Xie, Yongteng Xu, Keng Chen, Yamei Tang Tags: Original Article Source Type: research

Impact of deviations in target volume delineation – Time for a new RTQA approach?
Radiation Therapy Quality Assurance (RTQA) is now an integral part of clinical trials involving radiotherapy (RT). The aim is to ensure adherence to RT trial protocols, thereby minimising variations in the planning and delivery of RT between recruiting centres which may subsequently influence trial results [1]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 27, 2019 Category: Radiology Authors: Samantha Cox, Anne Cleves, Enrico Clementel, Elizabeth Miles, John Staffurth, Sarah Gwynne Tags: Review Article Source Type: research

Is breast seroma after tumour resection associated with patient-reported breast appearance change following radiotherapy? Results from the IMPORT HIGH (CRUK/06/003) trial
Seroma formation describes the collection of serous fluid within a cavity and has been reported following breast surgery. Seroma prevalence of 37% and 57% was reported in the Cambridge IMRT [1] and FAST [2] trials respectively. Seroma has been associated with increased rates of post-operative infection and haematoma, and is an independent risk factor for normal tissue effects (NTE) following radiotherapy [1]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 20, 2019 Category: Radiology Authors: Indrani S. Bhattacharya, Joanne S. Haviland, Carola Perotti, David Eaton, Sarah Gulliford, Emma Harris, Charlotte E. Coles, Cliona C. Kirwan, Judith M. Bliss, Anna M. Kirby, on behalf of the IMPORT Trialists Tags: Original Article Source Type: research

Development and internal validation of a multinomial NTCP model for the severity of acute dyspnea after radiotherapy for lung cancer
Radiation-induced pulmonary toxicity remains a major concern in the standard of care radical (chemo)radiotherapy treatment for lung cancer. Approximately 15% of patients suffer from severe symptoms in the first 6  months after treatment, while a larger subgroup present mild symptoms [1]. To manage the toxicity risk in clinical routine, normal tissue complication probability (NTCP) models predicting severe adverse events are applied. These models are based on the correlation of radiation pneumonitis with th e mean lung dose (MLD) or the relative lung volume receiving 20 Gy (V20) [2,3]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 20, 2019 Category: Radiology Authors: Gilles Defraene, Ewoud Schuit, Dirk De Ruysscher Tags: Original Article Source Type: research

Comprehensive 4D robustness evaluation for pencil beam scanned proton plans
Due to anticipated clinical benefits, moving targets are potential future indications for pencil beam scanned proton therapy (PBS-PT). However, currently they are not widely treated at PBS-PT facilities due to dosimetric uncertainties caused by motion. We developed a method, the 4D robustness evaluation method (4DREM), to realistically and efficiently assess all possible events impacting PBS-PT treatments in the thorax. Using the 4DREM in large cohorts of lung and oesophageal cancer patients, it will become possible to illustrate, in clinical practice, how to trigger robustness settings for plan optimisation and to select ...
Source: Radiotherapy and Oncology - April 20, 2019 Category: Radiology Authors: C ássia O. Ribeiro, Arturs Meijers, Erik W. Korevaar, Christina T. Muijs, Stefan Both, Johannes A. Langendijk, Antje Knopf Tags: Technical Note Source Type: research

Differential inflammatory response dynamics in normal lung following stereotactic body radiation therapy with protons versus photons
Proton beam therapy holds promise in several cancer types due to its superior dosimetric properties compared to standard photon radiation therapy (RT) [1]. In the clinic, proton beam therapy has been based on the use of a generic, constant, and spatially invariant relative biological effectiveness (RBE) of 1.1 compared to standard radiation both for cancers and normal tissues [2]. However, the biological effects of protons have been vastly understudied [3]. There is emerging evidence that protons may be associated with enhanced tumor cell kill in defined genotypes, and also unexpected normal tissue reactions or toxicity in...
Source: Radiotherapy and Oncology - April 20, 2019 Category: Radiology Authors: Yanjing Li, Michael Dykstra, Till D. Best, Jennifer Pursley, Nitish Chopra, Florence K. Keane, Melin J. Khandekar, Gregory C. Sharp, Harald Paganetti, Henning Willers, Florian J. Fintelmann, Clemens Grassberger Tags: Original Article Source Type: research

Estimating the cost of radiotherapy for 5-year local control and overall survival benefit
Cancer is one of the leading causes of morbidity and mortality worldwide [1]. Radiotherapy is a major component of cancer management for up to 50% of patients [2]. The recent Lancet Oncology Commission Report [3] concluded that investment in radiotherapy enables the treatment of a large number of cancer cases to save lives and brings positive economic benefits. Since the Baume report in 2002 [4] there has been an increase by the Australian government in radiotherapy investment. Australian government funding for radiation oncology is provided through a range of funding measures including Medicare Benefits Schedule (MBS) fun...
Source: Radiotherapy and Oncology - April 20, 2019 Category: Radiology Authors: Vikneswary Batumalai, Karen Wong, Jesmin Shafiq, Timothy P. Hanna, Gabriel Gabriel, Julia Heberle, Ivan Koprivic, Nasreen Kaadan, Odette King, Thomas Tran, Lynette Cassapi, Dion Forstner, Geoff P. Delaney, Michael Barton Tags: Original Article Source Type: research

Setup strategies and uncertainties in esophageal radiotherapy based on detailed intra- and interfractional tumor motion mapping
Discouraging overall survival rates have been the reality for esophageal cancer patients, although multimodality treatment combining chemo-radiotherapy (RT) with surgery has lately significantly increased the survival rate [1 –4]. Large target volumes are often irradiated due to extensive tumor burden, the risk of subclinical spread along the esophagus and involvement of regional lymph nodes [5–6]. This results in increased risk of severe, potentially lethal normal tissue toxicities for the esophagus, heart and lungs [7–11]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 20, 2019 Category: Radiology Authors: Lone Hoffmann, Per R. Poulsen, Thomas Ravkilde, Jenny Bertholet, Iryna Kruhlikava, Bj ørn L. Helbo, Mai L. Schmidt, Marianne Nordsmark Tags: Original Article Source Type: research

Feasibility of Re-irradiation using carbon ions for recurrent head and neck malignancies after carbon-ion radiotherapy
Carbon-ion radiotherapy (CIRT) is a high linear energy transfer radiotherapy with good dose-localizing properties that is being gradually used across Europe and Asia [1]. It delivers a high dose of radiation to the target tissue, while avoiding the adjacent critical organs-at-risk. Consequently, promising outcomes of CIRT for inoperable radioresistant malignancies such as malignant mucosal melanomas, adenoid cystic carcinomas (ACC), adenocarcinomas, and head and neck sarcomas have been reported [2 –5]. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 19, 2019 Category: Radiology Authors: Kazuhiko Hayashi, Masashi Koto, Hiroaki Ikawa, Yasuhito Hagiwara, Hiroshi Tsuji, Kazuhiko Ogawa, Tadashi Kamada Tags: Original Article Source Type: research

Dosimetric impact of intrafraction rotations in stereotactic prostate radiotherapy: A subset analysis of the TROG 15.01 SPARK trial
The use of ultra-hypofractionated, or SBRT, treatments of the prostate has gained in popularity in recent years [1 –3]. Due to the inherent dose per fraction escalation of these approaches, there is a need for high dose gradients to be employed with tighter than conventional margins. Along with the low number of fractions being used, this results in an increased need for high quality image guidance to be emplo yed to ensure accurate treatment delivery. While commonly used systems such as Cone Beam CT (CBCT) give reasonable image quality and a high level of positioning accuracy when used with implanted fiducial marker...
Source: Radiotherapy and Oncology - April 19, 2019 Category: Radiology Authors: Joshua Wolf, Joshua Nicholls, Perry Hunter, Doan Trang Nguyen, Paul Keall, Jarad Martin Tags: Original Article Source Type: research

An integrated physico-chemical approach for explaining the differential impact of FLASH versus conventional dose rate irradiation on cancer and normal tissue responses
Changes in the methodologies used to deliver radiotherapy may soon be approaching, challenging many of the classical approaches that have been a cornerstone of current clinical practice. At the center of this paradigm shift are the long-standing radiation therapy treatment approaches for multiple cancer types that utilize low doses and low dose rates in a variety of fractionation schedules, all designed to exploit potential differences between normal tissue and tumor radiosensitivity. The underlying premise is that dose fractionation preferentially favors the recovery of normal tissue over tumors from the harmful effects o...
Source: Radiotherapy and Oncology - April 19, 2019 Category: Radiology Authors: Douglas R. Spitz, Garry R. Buettner, Michael S. Petronek, Jo ël J. St-Aubin, Ryan T. Flynn, Timothy J. Waldron, Charles L. Limoli Tags: Original Article Source Type: research

In response to Hsia TC et al. “Addition of chemotherapy improves overall survival in patients with T2N0M0 non-small cell lung cancer undergoing definitive radiation therapy: An analysis of the SEER database”
Prospective clinical trials have been conducted in numerous clinical settings to answer questions that are raised by clinicians. Randomized phase III trials and their meta-analyses have been the gold standard methods to address unanswered questions and define new treatment strategies. Many cooperative trial groups have been performing large clinical trials which contribute to novel treatment modalities in oncology. Clinical trials, however, have many drawbacks for clinicians who practice on a regular basis. (Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 19, 2019 Category: Radiology Authors: Takefumi Komiya, Gerard Chaaya, Emily Powell Tags: Letter to the Editor Source Type: research

Editorial Board
(Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 18, 2019 Category: Radiology Source Type: research

Contents
(Source: Radiotherapy and Oncology)
Source: Radiotherapy and Oncology - April 18, 2019 Category: Radiology Source Type: research