Cost-minimization analysis of the GORTEC 2014-04 randomized phase II study of stereotactic ablative radiotherapy (SABR) or chemotherapy-SABR in oligometastatic head and neck cancer.

Purpose: The randomized phase II GORTEC 2014-04 and French Head and Neck Intergroup study showed deeper deterioration of the quality of life (HRQoL) and dramatically higher severe toxicity rates with similar overall survival rates using chemo-SABR compared to SABR alone in oligometastatic head and neck cancer (HNSCC) patients. We evaluated the costs associated with SABR-alone versus chemo-SABR and their associated costs (transportation, hospitalizations, etc).

Materials And Methods: 69 HNSCC patients with 1-3 oligometastases and a controlled primary were randomized from September 2015 to October 2022.

International Expert-Based Consensus Definition, Classification Criteria, and Minimum Data Elements for Osteoradionecrosis of the Jaw: An Inter-Disciplinary Modified Delphi Study.

Purpose: Osteoradionecrosis of the jaw (ORNJ) is a severe iatrogenic disease characterized by bone death after radiation therapy (RT) to the head and neck. With over 9 published definitions and at least 16 classification systems, the true incidence and severity of ORNJ are obscured by lack of a standard for disease definition and severity assessment, leading to inaccurate estimation of incidence, reporting ambiguity, and likely under-diagnosis worldwide. This study aimed to achieve consensus on an explicit definition and phenotype of ORNJ and related precursor states through data standardization to facilitate effective diagnosis, monitoring, and multidisciplinary management of ORNJ.

Brain radiotherapy and dorsal vagal complex irradiation: A new organ at risk to decrease radiation-induced nausea and vomiting?

Purpose: Nausea is a common symptom in patients irradiated for benign brain tumors. The dorsal vagal complex (DVC) located in the brainstem (BS) has been identified as the center of nausea and vomiting. The objective of our study was to determine an association between mean dose to the DVC and nausea.

Prospective Study of Corneal Sensitivity in Patients Treated With Proton Therapy for Extraocular Tumors.

Introduction: Several cases of radio-induced neurotrophic keratitis had been observed after proton therapy delivering a mean corneal dose of ≥50 GyRBE. We conducted a prospective exploratory study to assess corneal sensitivity in subsequent patients undergoing proton therapy for cephalic extraocular tumors.

Material And Methods: Forty-three patients (85 eyes) treated with high-energy proton therapy were included in this prospective, single-center, observational cohort study.

Survival Without Quality of Life Deterioration in the GORTEC 2014-04 "OMET" Randomized Phase 2 Trial in Patients with Head and Neck Cancer with Oligometastases using Stereotactic Ablative Radiation Therapy (SABR) alone or Chemotherapy and SABR.

Purpose: Patients with oligometastasis may have prolonged survival with multisite stereotactic ablative radiation therapy (SABR). Evidence to support this paradigm is scarce in squamous cell carcinoma of the head and neck (HNSCC). The multicenter open-label randomized GORTEC 2014-04 (NCT03070366) phase 2 study assesses survival without definitive quality of life (QoL) deterioration of omitting upfront chemotherapy in oligometastatic patients with HNSCC using SABR alone, in the French Head and Neck Intergroup.

Neuroendocrine neoplasms of head and neck, genitourinary and gynaecological systems, unknown primaries, parathyroid carcinomas and intrathyroid thymic neoplasms: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.

• This Clinical Practice Guideline provides key recommendations for managing rare endocrine tumours. • Neuroendocrine neoplasms of different origins, parathyroid carcinoma and intrathyroid thymic neoplasms are included. • The guideline covers clinical imaging and pathological diagnosis, staging and risk assessment, treatment and follow-up.

Radiomics-driven personalized radiotherapy for primary and recurrent tumors: A general review with a focus on reirradiation.

Purpose: This review systematically investigates the role of radiomics in radiotherapy, with a particular emphasis on the use of quantitative imaging biomarkers for predicting clinical outcomes, assessing toxicity, and optimizing treatment planning. While the review encompasses various applications of radiomics in radiotherapy, it particularly highlights its potential for guiding reirradiation of recurrent cancers.

Methods: A systematic review was conducted based on a Medline search with the search engine PubMed using the keywords "radiomics or radiomic" and "radiotherapy or reirradiation".

[Update of guidelines of the AFSOS, SFRO, SFH, SFNCM, SFCE, GFRP for the management of radio-induced nausea and vomiting].

Background: Radiation-induced nausea and vomiting have mutiple clinical consequences: delay or refusal of irradiation (decreased antineoplastic efficacy of irradiation), altered quality of life, dehydration, malnutrition, interruption of treatment, decompensation of comorbidities and aspiration. These guidelines aim at defining good clinical practices for management of radiation-induced nausea and vomiting (RINV).

Methods: AFSOS, SFRO, SFH, SFNEP, SFCE and GFRP applied an expert consensus methodology to propose updated guidelines.

CYRAD: a translational study assessing immune response to radiotherapy by photons or protons in postoperative head and neck cancer patients through circulating leukocyte subpopulations and cytokine levels.

Background: Radiotherapy has both immunostimulant and immunosuppressive effects, particularly in radiation-induced lymphopenia. Proton therapy has demonstrated potential in mitigating this lymphopenia, yet the mechanisms by which different types of radiation affect the immune system function are not fully characterized. The Circulating Immunes Cells, Cytokines and Brain Radiotherapy (CYRAD) trial aims to compare the effects of postoperative X-ray and proton radiotherapy on circulating leukocyte subpopulations and cytokine levels in patients with head and neck (CNS and ear nose throat) cancer.

Differential plasma cytokine variation following X-ray or proton brain irradiation using machine-learning approaches.

Purpose: X-ray and proton irradiation have been reported to induce distinct modifications in cytokine expression in vitro and in vivo, suggesting a dissimilar inflammatory response between X-rays and protons. We aimed to investigate the differences in cytokine profiles early following fractionated brain irradiation with X-rays or protons and their relationship with leukocyte subpopulations in rodents.

Materials And Methods: Our study utilized data from 80 tumor-free mice subjected to X-ray or proton brain irradiation in four fractions of 2.

Particle Beam Radiobiology Status and Challenges: A PTCOG Radiobiology Subcommittee Report.

Particle therapy (PT) represents a significant advancement in cancer treatment, precisely targeting tumor cells while sparing surrounding healthy tissues thanks to the unique depth-dose profiles of the charged particles. Furthermore, their linear energy transfer and relative biological effectiveness enhance their capability to treat radioresistant tumors, including hypoxic ones. Over the years, extensive research has paved the way for PT's clinical application, and current efforts aim to refine its efficacy and precision, minimizing the toxicities.

Development of a three-dimensional scintillation detector for pencil beam verification in proton therapy patient-specific quality assurance.

Background: Pencil Beam Scanning proton therapy has many advantages from a therapeutic point of view, but raises technical constraints in terms of treatment verification. The treatment relies on a large number of planned pencil beams (PB) (up to thousands), whose delivery is divided in several low-intensity pulses delivered a high frequency (1 kHz in this study).

Purpose: The purpose of this study was to develop a three-dimensional quality assurance system allowing to verify all the PBs' characteristics (position, energy, intensity in terms of delivered monitor unit-MU) of patient treatment plans on a pulse-by-pulse or a PB-by-PB basis.

Interpretability of operative and pathological reports for radiotherapy planning of sinonasal carcinomas: An ancillary study of the GORTEC 2016-02 SANTAL trial.

Interpretation of surgical mapping is essential for postoperative radiotherapy planning. Operative and pathological reports lack comprehensive information on margins quality and tissue block mapping. Standardizing reports is essential to reduce uncertainties, aiming for less morbid poRT.

Intraoperative surgical navigation as a precision medicine tool in sinonasal and craniofacial oncologic surgery.

Introduction: Recent evidence supports the efficacy of surgical navigation (SN) in improving outcomes of sinonasal and craniofacial oncologic surgery. This study aims to demonstrate the utility of SN as a tool for integrating surgical, radiologic, and pathologic information. Additionally, a system for recording and mapping biopsy samples has been devised to facilitate sharing of spatial information.

Prospective assessment of peripapillary microvasculature using optical coherence tomography angiography in para-optic intracranial and sinonasal tumors treated with proton therapy.

Purpose: Radiation-induced optic neuropathy (RION) is rare but may lead to blindness. The mechanisms by which this occurs include endothelial and neuronal damage, but RION has been assessed very little in the case of extraocular tumors treated with high-energy proton therapy, the use of which is expanding worldwide. We assessed peripapillary microvascular changes by optical coherence tomography angiography (OCT-A) in patients undergoing high-energy proton therapy for para-optic intracranial or head and neck tumors.

Revealing the effect of X-ray or proton brain irradiation on systemic inflammation and leukocyte subpopulation interplay in rodents.

The absolute lymphocyte count (ALC), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-lymphocyte ratio (NLR) offer convenient means to assess systemic inflammation post-cancer treatment, which influences treatment outcomes. Understanding these biomarker variations and leukocyte subpopulation interplay is crucial for optimizing radiotherapy. Herein, leukocyte subpopulations (T-CD4+, T-CD8+, B cells, NK cells, neutrophils, monocytes) during and after brain irradiation (using X-rays or protons) in tumor-free mice were used to compute ALC, LMR, and NLR, on which radiation parameter influence was assessed by principal component analysis (PCA).

Lymphocyte radiosensitivity: An extension to the linear-quadratic model?

Background And Purpose: The linear-quadratic (LQ) model has been pivotal for evaluating the effects of radiation on cells, but it is primarily characterized by linear responses, which has exhibited limitations when applied to lymphocyte data. The present research aims to address these limitations and to explore an alternative model extended from the conventional LQ model.

Materials And Methods: Literature providing lymphocyte counts from assays investigating apoptosis and survival after in vitro irradiation was selected.

Patterns of practice of image guided particle therapy for cranio-spinal irradiation: A site specific multi-institutional survey of European Particle Therapy Network.

Purpose: To investigate the current practice patterns in image-guided particle therapy (IGPT) for cranio-spinal irradiation (CSI).

Methods: A multi-institutional survey was distributed to European particle therapy centres to analyse all aspects of IGPT. Based on the survey results, a Delphi consensus analysis was developed to define minimum requirements and optimal workflow for clinical practice.

Artificial intelligence solution to accelerate the acquisition of MRI images: Impact on the therapeutic care in oncology in radiology and radiotherapy departments.

Purpose: MRI is essential in the management of brain tumours. However, long waiting times reduce patient accessibility. Reducing acquisition time could improve access but at the cost of spatial resolution and diagnostic quality.

Assessment of gaze direction during head and neck irradiation and dosimetric impact on the retina, macula and papilla in a cohort of 240 patients with paraoptic tumors.

In a prospective cohort of 240 paraoptic tumors patients treated with protons, there was 10° inter-individual gaze angle variability (up to 30°). In a random 21-patient subset with initial CTs versus and adaptive CTs, 6 (28.57 %) patients had at least twice a 10°-difference in their gaze angle, with > 5 Gy difference on the retina/macula or papilla in 2/21 (9.

Prognostic Factors of Mandibular Osteoradionecrosis Including Accurate Colocalization of Avulsions and Dosimetric Dental Mapping Software, a Case-control Study.

Purpose: Osteoradionecrosis (ORN) of the mandible remains a significant complication in the intensity modulated radiation therapy (IMRT) era. Dental dose cannot be predicted from heterogeneous IMRT dose distributions; mandibular dose metrics cannot guide dentist avulsion decisions in high-risk ORN situations. Using a mapping tool to report dental root dose, avulsions, and ORN sites, we re-examined ORN risk factors in a case-control study.

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy.

Background: Major advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging.

Towards a European prospective data registry for particle therapy.

The evidence for the value of particle therapy (PT) is still sparse. While randomized trials remain a cornerstone for robust comparisons with photon-based radiotherapy, data registries collecting real-world data can play a crucial role in building evidence for new developments. This Perspective describes how the European Particle Therapy Network (EPTN) is actively working on establishing a prospective data registry encompassing all patients undergoing PT in European centers.