Lower urinary tract sub-structures as predictors of late urinary toxicity in concurrent chemo-radiotherapy for anal cancer.

Background And Purpose: Late toxicity is substantial after chemotherapy for anal cancer. This study aimed to investigate the relationship between radiation dose to lower urinary tract sub-structures and the risk of late urinary toxicities, in patients with anal cancer treated with chemoradiotherapy or radiotherapy.

Materials And Methods: From 2015 to 2021, 314 patients with localized anal cancer were included in a national prospective registration study.

Cognitive impairment in patients with melanoma before adjuvant immune checkpoint inhibitor therapy and associations with brain gray matter, catechol-O-methyltransferase genotype, and psychological factors.

Background: Cancer-related cognitive impairment (CRCI) is a significant concern in patients with cancer but understanding its prevalence and risk factors in patients with malignant melanoma (MMPs) remains limited. This study explores CRCI via a multifaceted approach integrating neurobiological, genetic, and psychological assessments.

Methods: Cognitive functioning across multiple domains was assessed via neuropsychological tests in 47 MMPs before adjuvant immune checkpoint inhibitor therapy, compared with 53 matched healthy controls (HCs).

The current status of brachytherapy in Europe - A GEC-ESTRO Brachy-HERO survey.

A survey regarding utilisation of brachytherapy was distributed to European brachytherapy professionals. Eighty replies from 26 countries were received, two of which were outside Europe. The replies showed that brachytherapy is still widely used.

Measuring healthcare professionals' perceptions of their ability to adopt shared decision making: Translation and psychometric evaluation of the Danish version of the IcanSDM questionnaire.

Background: Shared  decision making in healthcare is a fundamental right for patients. Healthcare professionals' perception of their own abilities to enable shared decision making is crucial for implementing shared decision making within service. IcanSDM (I can shared decision making) is a brief measure to investigate healthcare professionals' perception of shared decision making approaches to their practices.

Proton dose calculation on cone-beam computed tomography using unsupervised 3D deep learning networks.

Background And Purpose: Poor image quality of cone-beam computed tomography (CBCT) images can hinder proton dose calculation to assess the influence of anatomy changes. The aim of this study was to evaluate image quality and proton dose calculation accuracy of synthetic CTs generated from CBCT using unsupervised 3D deep-learning networks.

Materials And Methods: A total of 102 head-and-neck cancer patients were used to train (N=82) and test (N=20) i) a cycle-consistent generative adversarial network, ii) a contrastive unpaired translation, and iii) a fusion of the two (CycleCUT).

Development of a novel 3D-printed dynamic anthropomorphic thorax phantom for evaluation of four-dimensional computed tomography.

Background And Purpose: In radiotherapy, the image quality of four-dimensional computed tomography (4DCT) is often degraded by artifacts resulting from breathing irregularities. Quality assurance mostly employ simplistic phantoms, not fully representing complexities and dynamics in patients. 3D-printing allows for design of highly customized phantoms.

Automated acute skin toxicity scoring in a mouse model through deep learning.

This study presents a novel approach to skin toxicity assessment in preclinical radiotherapy trials through an advanced imaging setup and deep learning. Skin reactions, commonly associated with undesirable side effects in radiotherapy, were meticulously evaluated in 160 mice across four studies. A comprehensive dataset containing 7542 images was derived from proton/electron trials with matched manual scoring of the acute toxicity on the right hind leg, which was the target area irradiated in the trials.

Reirradiation - still navigating uncharted waters?

With the emergence of high-precision radiotherapy technologies such as stereotactic ablative radiotherapy (SABR), MR guided brachytherapy, image guided intensity modulated photon and proton radiotherapy and most recently daily adaptive radiotherapy, reirradiation is increasingly recognized as a viable treatment option for many patients. This includes those with recurrent, metastatic or new malignancies post initial radiotherapy. The primary challenge in reirradiation lies in balancing tumor control against the risk of severe toxicity from cumulative radiation doses to previously irradiated normal tissue.

Six-degrees-of-freedom pelvic bone monitoring on 2D kV intrafraction images to enable multi-target tracking for locally advanced prostate cancer.

Background: Patients with locally advanced prostate cancer require the prostate and pelvic lymph nodes to be irradiated simultaneously during radiation therapy treatment. However, relative motion between treatment targets decreases dosimetric conformity. Current treatment methods mitigate this error by having large treatment margins and often prioritize the prostate at patient setup at the cost of lymph node coverage.

Proton- compared to X-irradiation leads to more acinar atrophy and greater hyposalivation accompanied by a differential cytokine response.

Proton therapy gives less dose to healthy tissue compared to conventional X-ray therapy, but systematic comparisons of normal tissue responses are lacking. The aim of this study was to investigate late tissue responses in the salivary glands following proton- or X-irradiation of the head and neck in mice. Moreover, we aimed at investigating molecular responses by monitoring the cytokine levels in serum and saliva.

Inter-fraction motion robustness in a prospective phase II trial on dose-escalated proton reirradiation for locally recurrent rectal cancer.

Background And Purpose: Intensity modulated proton therapy (IMPT) enables generation of conformal dose plans with organ at risk (OAR) sparing potential. However, pelvic IMPT robustness is challenged by inter-fraction motion caused by constant anatomical variations. In this study, the dosimetric impact of inter-fraction motion on target coverage and dose to OAR was quantified in the prospective phase II study ReRad-II on dose-escalated proton reirradiation for locally recurrent rectal cancer (LRRC).

PTCOG international survey of practice patterns and trends in utilization of proton therapy for breast cancer.

Purpose/objectives: The indications, techniques, and extent to which proton beam therapy (PBT) is employed for breast cancer are unknown. We seek to determine PBT utilization for breast cancer.

Materials/methods: The Particle Therapy Co-Operative Group (PTCOG) Breast Subcommittee developed an IRB-approved 29-question survey and sent it to breast cancer radiation oncologists at all active PBT centers worldwide in June 2023.

Association Between the Regular Use of Vaginal Dilators and/or Sexual Activity and Vaginal Morbidity in Locally Advanced Cervical Cancer Survivors: An EMBRACE-I Study Report.

Purpose: The purpose of this study was to provide risk estimations for vaginal morbidity with regard to vaginal dilation (summarizing the use of dilators and/or sexual activity) in patients with locally advanced cervical cancer treated with definitive radiochemotherapy and image guided adaptive brachytherapy within the prospective, multi-institutional EMBRACE-I study.

Methods And Materials: Physician-assessed vaginal morbidity (National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0), use of vaginal dilators, and patient-reported sexual activity (EORTC-CX24) were prospectively assessed at baseline and during regular follow-ups.

Selection for proton radiotherapy of grade 1-3 glioma patients.

Background: For adult patients with grade 1-3 gliomas, identifying patients with an indication for proton therapy (PT) can be challenging due to sparse evidence supporting its benefits. In this study, we aimed to ensure national consensus and develop a decision support tool to aid clinicians in identifying patients with grade 1-3 gliomas eligible for PT.

Methods: Sixty-one historic patients referred for postoperative radiotherapy for glioma grade 1-3 were included in this study and had new photon therapy and PT plans calculated.

Benefit of range uncertainty reduction in robust optimisation for proton therapy of brain, head-and-neck and breast cancer patients.

Background And Purpose: The primary cause of range uncertainty in proton therapy is inaccuracy in estimating the stopping-power ratio from computed tomography. This study examined the impact on dose-volume metrics by reducing range uncertainty in robust optimisation for a diverse patient cohort and determined the level of range uncertainty that resulted in a relevant reduction in doses to organs-at-risk (OARs).

Materials And Methods: The effect of reducing range uncertainty on OAR doses was evaluated by robustly optimising six proton plans with varying range uncertainty levels (ranging from 3.

Quantifying dose perturbations in high-risk prostate radiotherapy due to translational and rotational motion of prostate and pelvic lymph nodes.

Background: Radiotherapy of the prostate and the pelvic lymph nodes (LN) is a part of the standard of care treatment for high-risk prostate cancer. The independent translational and rotational (i.e.

The effect of editing clinical contours on deep-learning segmentation accuracy of the gross tumor volume in glioblastoma.

Background And Purpose: Deep-learning (DL) models for segmentation of the gross tumor volume (GTV) in radiotherapy are generally based on clinical delineations which suffer from inter-observer variability. The aim of this study was to compare performance of a DL-model based on clinical glioblastoma GTVs to a model based on a single-observer edited version of the same GTVs.

Materials And Methods: The dataset included imaging data (Computed Tomography (CT), T1, contrast-T1 (T1C), and fluid-attenuated-inversion-recovery (FLAIR)) of 259 glioblastoma patients treated with post-operative radiotherapy between 2012 and 2019 at a single institute.

Acute toxicities in proton therapy for head and neck cancer - A matched analysis of the DAHANCA 35 feasibility study.

Background And Purpose: As preparation for a national randomized study comparing proton radiotherapy to photon radiotherapy, DAHANCA 35, we performed a non-randomized pilot study to investigate patient selection, logistics, planning, and treatment delivery. With the present study, as a comprehensive safety analysis, we want to compare toxicity during and up to two months after therapy to a historically matched group of patients treated with photon radiotherapy.

Materials And Methods: 62 patients treated with protons were matched to 124 patients who received photon treatment outside a protocol.

Correlation between local instantaneous dose rate and oxygen pressure reduction during proton pencil beam scanning irradiation.

Background And Purpose: Oxygen dynamics may be important for the tissue-sparing effect observed at ultra-high dose rates (FLASH sparing effect). This study investigated the correlation between local instantaneous dose rate and radiation-induced oxygen pressure reduction during proton pencil beam scanning (PBS) irradiations of a sample and quantified the oxygen consumption g-value.

Materials And Methods: A 0.