Vaginal toxicity management in patients with locally advanced cervical cancer following exclusive chemoradiation—a nationwide survey on knowledge and attitudes by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gynecology Study Group

Background and Objective: Exclusive radiotherapy, including external beam radiotherapy (EBRT) and interventional radiotherapy/brachytherapy (IRT/BT), with concurrent cisplatin-based chemotherapy, represents the standard of care in patients with locally advanced cervical cancer (LACC). The emerging topic of vaginal toxicity has become a key endpoint in LACC management, although different approaches and non-standardized procedures were available. Our aim was to analyze a nationwide study of the attitudes of Italian gynecological radiation oncology teams in the management of LACC patients' vaginal toxicities. Methods: A nationwide survey of radiation oncologists specializing in the treatment of gynecological malignancies was performed, using the free SurveyMonkey platform, consisting of 26 items. The questionnaire was proposed by the Italian Association of Radiation Oncologists (AIRO) gynecological working group to all 183 Italian radiation oncology institutions, as per AIRO's website. Results: Fifty-eight questionnaires (31%) were completed and returned. The assessment of acute and late vaginal toxicities was systematic in 32 (55.2%) and 26 (44.8%) centers, respectively. In the case of EBRT, 70.7% of centers, according to the contouring and treatment plan data, did not contour the vagina as an organ at risk (OAR). Vaginal dose constraints were heterogeneous for both EBRT and IRT/BT. Local treatment to prevent vaginal toxicity was prescribed by 60.3% of radiation oncologists, mostly vaginal hyaluronic acid cream, and one center recommended vaginal estrogen preparations. During follow-up visits, vaginal toxicity was considered an issue to be investigated always (n = 31) or in sexually active women only (n = 11). Conclusions: This survey showed that wide variation exists with regard to recording and treating vaginal toxicity after exclusive chemoradiation for cervical cancer, underscoring the need to develop more comprehensive guidelines for contouring e-dose reporting of the vagina, so as to implement clinical approaches for vaginal toxicity

Contouring of emerging organs-at-risk (OARS) of the female pelvis and interobserver variability. A study by the Italian association of radiotherapy and clinical oncology (AIRO)

Purpose: To provide straightforward instructions for daily practice in delineating emerging organs-at-risk (OARs) of the female pelvis and to discuss the interobserver variability in a two-step multicenter study.Methods and materials: A contouring atlas with anatomical boundaries for each emerging OAR was realized by radiation oncologists and radiologists who are experts in pelvic imaging, as per their knowledge and clinical practice. These contours were identified as quality benchmarks for the analysis subsequently carried out. Radiation oncologists not involved in setting the custom-built contouring atlas and interested in the treatment of gynecological cancer were invited to participate in this 2-step trial. In the first step all participants were supplied with a selected clinical case of locally advanced cervical cancer and had to identify emerging OARs (Levator ani muscle; Puborectalis muscle; Internal anal sphincter; External anal sphincter; Bladder base and trigone; Bladder neck; Iliac Bone Marrow; Lower Pelvis Bone Marrow; Lumbosacral Bone Marrow) based on their own personal knowledge of pelvic anatomy and experience. The suggested OARs and the contouring process were then presented at a subsequent webinar meeting with a contouring laboratory. Finally, in the second step, after the webinar meeting, each participant who had joined the study but was not involved in setting the benchmark received the custom-built contouring atlas with anatomical boundaries and was requested to delineate again the OARs using the tool provided. The Dice Similarity Coefficient (DSC) and the Jaccard Similarity Coefficient (JSC) were used to evaluate the spatial overlap accuracy of the different volume delineations and compared with the benchmark; the Hausdorff distance (HD) and the mean distance to agreement (MDA) to explore the distance between contours. All the results were reported as sample mean and standard deviation (SD). Results: Fifteen radiation oncologists from different Institutions joined the study. The participants had a high agreement degree for pelvic bones sub-structures delineation according to DICE (IBM: 0.9 +/- 0.02; LPBM: 0.91 +/- 0.01). A moderate degree according to DICE was showed for ovaries (Right: 0.61 +/- 0.16, Left: 0.72 +/- 0.05), vagina (0.575 +/- 0.13), bladder sub-structures (0.515 +/- 0.08) and EAS (0.605 +/- 0.05), whereas a low degree for the other sub-structures of the anal-rectal sphincter complex (LAM: 0.345 +/- 0.07, PRM: 0.41 +/- 0.10, and IAS: 0.4 +/- 0.07).Conclusion: This study found a moderate to low level of agreement in the delineation of the female pelvis emerging OARs, with a high degree of variability among observers. The development of delineation tools should be encouraged to improve the routine contouring of these OARs and increase the quality and consistency of radiotherapy planning

Aerosol Assisted Solvent Treatment: A Universal Method for Performance and Stability Enhancements in Perovskite Solar Cells

Abstract: Metal‐halide perovskite solar cells (PSCs) have had a transformative impact on the renewable energy landscape since they were first demonstrated just over a decade ago. Outstanding improvements in performance have been demonstrated through structural, compositional, and morphological control of devices, with commercialization now being a reality. Here the authors present an aerosol assisted solvent treatment as a universal method to obtain performance and stability enhancements in PSCs, demonstrating their methodology as a convenient, scalable, and reproducible post‐deposition treatment for PSCs. Their results identify improvements in crystallinity and grain size, accompanied by a narrowing in grain size distribution as the underlying physical changes that drive reductions of electronic and ionic defects. These changes lead to prolonged charge‐carrier lifetimes and ultimately increased device efficiencies. The versatility of the process is demonstrated for PSCs with thick (>1 µm) active layers, large‐areas (>1 cm2) and a variety of device architectures and active layer compositions. This simple post‐deposition process is widely transferable across the field of perovskites, thereby improving the future design principles of these materials to develop large‐area, stable, and efficient PSCs

Image-guided moderately hypofractionated radiotherapy for localized prostate cancer: a multicentric retrospective study (IPOPROMISE)

Background: Moderate hypofractionated radiotherapy is a treatment option for the cure of localized prostate cancer (PCa) patients based on the results of randomized prospective trials, but there is a clinical concern about the relatively short length of follow-up, and real-world results on outcome and toxicity based on cutting-edge techniques are lacking. The objective of this study is to present the long-term results of a large multicentric series. Materials and methods: We retrospectively evaluated 1325 PCa patients treated with daily volumetric image-guided hypofractionated radiotherapy between 2007 and 2020 in 16 Centers. For survival endpoints, we used Kaplan–Meier survival curves and fitted univariate and multivariable Cox’s proportional hazards regression models to study the association between the clinical variables and each survival type. Results: At the end of the follow-up, 11 patients died from PCa. The 15-year values of cancer-specific survival (CSS) and biochemical relapse-free survival (b-RFS) were 98.5% (95%CI 97.3–99.6%) and 85.5% (95%CI 81.9–89.4%), respectively. The multivariate analysis showed that baseline PSA, Gleason score, and the use of androgen deprivation therapy were significant variables for all the outcomes. Acute gastrointestinal (GI) and genitourinary (GU) toxicities of grade ≥ 2 were 7.0% and 16.98%, respectively. The 15-year late grade ≥ 2 GI and GU toxicities were 5% (95%CI 4–6%) and 6% (95%CI 4–8%), respectively. Conclusion: Real-world long-term results of this multicentric study on cutting-edge techniques for the cure of localized PCa demonstrated an excellent biochemical-free survival rate of 85.5% at 15 years, and very low rates of ≥ G3 late GU and GI toxicity (1.6% and 0.9% respectively), strengthening the results of the available published trials

Ferroelectric-photocatalyst nanocomposite thin films for enhanced photocatalytic activity

Photoelectrochemical (PEC) water splitting has recently gained particular attention as promising method to produce hydrogen through the conversion of solar light into chemical energy. A key challenge for this application is to reduce the high level of electron-hole recombination, which can significantly affect the efficiency of a PEC system. Ferroelectric polarization has emerged as new strategy to facilitate the separation of electron-hole pairs, driving them towards the opposite direction and consequently enhancing the water splitting performance. In this thesis, the influence of ferroelectric polarization on the photoelectrochemical properties of bare nanostructured BaTiO3 as well as nanostructured BaTiO3 combined with Fe2O3 photocatalyst is explored. Nanostructured BaTiO3 thin films are synthesized and employed as photoanodes for photocatalytic studies. Porous barium titanate (pBTO) thin films show a controllable porosity by tuning organic/inorganic ratios. Importantly, the switching of ferroelectric domains in pBTO thin films is still observed in the porous structures. The presence of porosity in pBTO thin films leads to a clear improvement of the PEC response. By electrochemical (EC) poling, the tuning of PEC performance of pBTO thin films via ferroelectric polarization is also demonstrated. In addition, the influence of oxygen vacancies on EC poling of pBTO thin films, prepared in different annealing conditions (O2, air, N2) is investigated, revealing that higher concentrations of oxygen vacancies limit the ability of these films to be controlled via poling. Lastly, Fe2O3/pBTO thin films are developed and studied. The composite film shows higher photocurrent density than pBTO and Fe2O3 and this is ascribed to the improved charge injection and separation in Fe2O3/pBTO. The possibility of achieving PEC performance enhancements in Fe2O3/pBTO by controlling ferroelectric polarisation is also demonstrated. This research reveals the role of ferroelectricity on the photocatalytic activity enhancements in nanostructured BaTiO3 and Fe2O3-BaTiO3 films, which could benefit future work on ferroelectric photocatalysts