Radiobiology of stereotactic radiotherapy

This paper focuses on the radiobiological mechanisms underlying the effects of stereotactic radiotherapy (SRT) which, despite SRT expansion, have not yet been fully elucidated. Some authors postulated that radiobiology principles, as applied to conventional fractionations (5R: reoxygenation, repair, repopulation, redistribution, radioresistence), suffice in themselves to account for the excellent clinical results of SRT; others argued that the role of the 5R was limited. Recent preclinical data showed that hypofractionated ablative treatments altered the microenvironment, thus determining cell death either directly or indirectly. Furthermore, dead tumor cells released quantities of antigens, which stimulated antitumor immunity, thus reducing the risk of relapse and metastasis. Better understanding of the radiobiological mechanisms underlying response to high-dose radiation treatment is essential for predicting its short- and long-term effects on the tumor and surrounding healthy tissues and, consequently, for improving its related therapeutic index

Partial breast irradiation for ductal carcinoma in situ: The Goldilocks principle?

BACKGROUND In many women with early-stage breast cancer, breast-conserving surgery (BCS) with partial breast irradiation (PBI) has similar overall survival and local recurrence rates compared to BCS with whole-breast irradiation (WBI). A better understanding of the quality of life (QOL) outcomes during and following BCS with PBI versus BCS with WBI is needed. OBJECTIVES This study was conducted to examine symptoms, symptom distress, cosmesis, QOL, and perceived body image in women during and after BCS with PBI. METHODS A convenience sample of 31 women completed self-reports pre- and post-PBI over six months. Descriptive statistics and repeated- measures analysis were performed at baseline and three times post-PBI. FINDINGS Most women reported satisfaction with body image and good QOL, despite a small decline in social well-being. Fatigue and mild to moderate symptom distress persisted over time

LA RADIOTERAPIA STEREOTASSICA NELLE NEOPLASIE POLMONARI IN STADIO INIZIALE NON OPERABILI

Il tumore del polmone è la causa principale di mortalità per cancro nel mondo, con oltre un milione di morti ogni anno; la variante non a piccole cellule rappresenta la percentuale maggiore di casi (85%). Il gold standard per il trattamento di questo tipo di tumori è la resezione chirurgica, tuttavia circa un quarto dei pazienti affetti da NSCLC in stadio I si presenta alla diagnosi in età avanzata con multiple comorbitidà associate, rientrando così nella categoria dei pazienti clinicamente inoperabili.Per questi pazienti esistono varie possibilità alternative di trattamento che includono la radioterapia stereotassica(SBRT). Alcuni studi hanno suggerito che l'uso di RT ad intensità modulata (IMRT) nelle procedure di radiochirurgia o SBRT potrebbe migliorare la copertura del tumore ed il risparmio dei tessuti sani;la volumetric modulated arc therapy (VMAT) è una nuova estensione della IMRT che riduce i tempi di trattamento. In questo lavoro vogliamo analizzare l'esperienza della Unità Operativa di Radioterapia dell'Università di Pisa nell'utilizzo della SBRT, con una valutazione comparata dei risultati ottenuti attraverso piani terapeutici diversi che vanno dalla singola frazione alle 3 frazioni consecutive, in una popolazione di pazienti omogenea con tumore del polmone non a piccole cellule in stadio iniziale

Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment

Introduction: Neoadjuvant radiotherapy is currently used mainly in locally advanced rectal cancer and sarcoma and in a subset of non-small cell lung cancer and esophageal cancer, whereas in other diseases it is under investigation. The evaluation of the efficacy of the induction strategy is made possible by performing imaging investigations before and after the neoadjuvant therapy and is usually challenging. In the last decade, texture analysis (TA) has been developed to help the radiologist to quantify and identify the parameters related to tumor heterogeneity, which cannot be appreciated by the naked eye. The aim of this narrative is to review the impact of TA on the prediction of response to neoadjuvant radiotherapy and or chemoradiotherapy. Materials and Methods: Key references were derived from a PubMed query. Hand searching and ClinicalTrials.gov were also used. Results: This paper contains a narrative report and a critical discussion of radiomics approaches in different fields of neoadjuvant radiotherapy, including esophageal cancer, lung cancer, sarcoma, and rectal cancer. Conclusions: Radiomics can shed a light on the setting of neoadjuvant therapies that can be used to tailor subsequent approaches or even to avoid surgery in the future. At the same, these results need to be validated in prospective and multicenter trials

The Italian Association for Radiotherapy and Clinical Oncology (AIRO) position statements for postoperative breast cancer radiation therapy volume, dose, and fractionation

Recent advances in non-metastatic breast cancer radiation therapy significantly reshaped our views on modern dose and fractionation schedules. Especially the advent of hypofractionation and partial breast irradiation defined a new concept of treatment optimization, that should strongly include both patient and tumour characteristics in the physician’s decision-making process. Unfortunately, hypofractionation for breast cancer radiation therapy needed long time to enter the routine practice during the last decades despite the level-1 evidence published over time. Hereby we present the Italian Association for Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group position statements for postoperative breast cancer radiation therapy volume, dose, and fractionation to harmonically boost routine clinical practice implementation following evidence-based data

Radiotherapy for papillary tumor of the pineal region: A systematic review of the literature

Papillary tumor of the pineal region (PTPR) is a rare neuroepithelial brain tumor, characterized by a high risk of local recurrence (greater than 70 % at 6 years). The aim of our study was to review the available literature on radiotherapy for PTPR in order to evaluate timings, schedules, outcomes and toxicities of this treatment modality. In our review, 72.4 % (84) of the patients diagnosed with PTPR received radiation therapy. There is heterogeneity in the dose prescription, ranging from 45 Gy (25 x 1.8 Gy) to 60 Gy (30 x 2 Gy) for 3D Conformal Radiation Therapy and from 12 Gy to 36 Gy for Stereotactic Radiosurgery. Being considered as a grade II or III tumor, PTPR should receive higher total radiation dose in the adjuvant setting. Our analysis showed a very limited treatment-related toxicity with an expected 10-y OS of 72.5 %. At 5-years from the diagnosis, about 60 % of the patients experienced a local recurrence, whereas at 10 years the rate is higher than 80 %. In the literature, conflicting data about radiotherapy for PTPR are reported, in particular regarding disease progression. Although radiotherapy represents a fundamental treatment in the management of PTPR, prospective studies are required to better define its impact on overall survival and progression-free survival

Radiomic Analysis for Human Papillomavirus Assessment in Oropharyngeal Carcinoma: Lessons and Pitfalls for the Next Future

Background: Oropharyngeal Squamous Cell Carcinoma (OPSCC) is rapidly increasing due to the spread of Human Papillomavirus (HPV) infection. HPV-positive disease has unique characteristics, with better response to treatment and consequent better prognosis. HPV status is routinely assessed via p16 immunohistochemistry or HPV DNA Polymerase Chain Reaction. Radiomics is a quantitative approach to medical imaging which can overcome limitations due to its subjective interpretation and correlation with clinical data. The aim of this narrative review is to evaluate the impact of radiomic features on assessing HPV status in OPSCC patients. Methods: A narrative review was performed by synthesizing literature results from PUBMED. In the search strategy, Medical Subject Headings (MeSH) terms were used. Retrospective mono- or multicentric works assessing the correlation between radiomic features and HPV status prediction in OPSCC were included. Selected papers were in English and included studies on humans. The range of publication date was July 2015–April 2023. Results: Our research returned 23 published papers; the accuracy of radiomic models was evaluated by ROC curves and AUC values. MRI- and CT-based radiomic models proved of comparable efficacy. Also, metabolic imaging showed crucial importance in the determination of HPV status, albeit with lower AUC values. Conclusions: Radiomic features from conventional imaging can play a complementary role in the assessment of HPV status in OPSCC. Both primary tumor- and nodal-related features and multisequencing-based models demonstrated higher accuracy