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Purpose: To compare patient-reported outcome measures (PROMs) in patients treated either with cone-beam CT (CBCT)-based online adaptive radiotherapy (oART) or with CBCT-guided conventional image guided radiotherapy (IGRT). Materials and methods: In this prospective study with convenience allocation, patients with localized prostate cancer received 62 Gy/20 fractions using either daily CBCT-based oART or CBCT-guided conventional IGRT. PROMs (EPIC, QLQ-PR25, IPSS, NCI-PRO-CTCAE) were collected at baseline and at end of therapy. Changes in scores and clinically meaningful deterioration, based on established minimal clinically important differences (MCID), were analyzed. Results: Seventy-four patients were included (oART: 58.1 %; IGRT: 41.9 %). Groups were demographically similar, although the oART group included more patients with high-risk tumors (40.5 % vs. 9.7 %, p = 0.03). Patients after oART tended to experience smaller, although not statistically significant, declines in health-related quality of life (HRQoL) domains compared to IGRT: EPIC urinary summary (-12.15 vs -20.57, p = 0.07), urinary function (-9.53 vs -17.47, p = 0.05), urinary incontinence (-5.47 vs -13.93, p = 0.07) and PR25 urinary symptom (20.0 vs. 27.5, p = 0.06). EPIC bowel function decline was also less pronounced (-12.64 vs. -19.78, p = 0.10). NCI-PRO-CTCAE scores favored oART for reduced urinary urgency (0.95 vs. 1.57, p = 0.02) and fecal incontinence (0.03 vs. 0.71, p = 0.02). Fewer oART patients reached MCID thresholds for urinary (8-21 %) and bowel (20-23 %) deterioration, but these differences were not statistically significant. Conclusion: Our results suggest a small but consistent trend in PROM scores favoring oART over conventional IGRT. In addition, the results may inform the design of controlled randomized trials in the future.
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Acute radiation dermatitis (ARD) is a frequent adverse effect following postmastectomy radiotherapy. Barrier dressings such as Mepitel Film and StrataXRT are increasingly used to prevent or reduce its severity, yet comparative data remain limited. Recent studies, mostly single-center or intra-patient in design with small sample sizes, have demonstrated the effectiveness of both in protection against skin toxicity, although larger multicenter validation is still needed. Within the current evidence base, StrataXRT showed advantages in tolerability, comfort, and application convenience, whereas Mepitel Film use offered slightly greater efficacy against ARD. This letter reviews emerging evidence comparing these two interventions, emphasizing their practical implications for clinical decision-making and future research priorities in ARD prevention.
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Background and Objective: Spinal metastases occur in 30%-70% of cancer patients, with approximately 10%-20% experiencing symptomatic manifestations including pain, instability, or neurological deficits. Nearly 20% of patients present with malignant spinal cord compression as their initial manifestation of malignancy. Our objectives were to provide a comprehensive review of contemporary management strategies for spinal metastases, focusing on diagnostic approaches, multidisciplinary treatment frameworks, and surgical interventions that optimize patient functional outcomes and quality of life. Methods: SANRA-guided narrative review of PubMed, EMBASE, and Cochrane Library (2000-2025). Clinical trials, meta-analyses, consensus statements, and seminal papers were prioritized; purposive selection ensured broad thematic coverage. The analysis encompasses imaging techniques, surgical interventions, and decision-making frameworks including the NOMS (Neurologic, Oncologic, Mechanical, and Systemic) classification system. Results: Within the spinal column, metastases most commonly affect the thoracic region, followed by lumbar and cervical regions. Common primary tumors with high bone metastasis rates include breast (72%), prostate (84%), thyroid (50%), lung (31%), kidney (37%), and pancreas (33%), collectively accounting for more than 80% of spinal metastases cases. Magnetic resonance imaging demonstrates the advantage of detecting multilevel involvement without radiation exposure. Contemporary management employs a multidisciplinary approach incorporating chemotherapy, radiotherapy, and surgical interventions. Modern surgical approaches have evolved from historical laminectomy-only procedures to comprehensive decompression with stabilization techniques. Conclusions: Early recognition and prompt intervention remain critical for preventing irreversible neurological deficits and optimizing patient outcomes. Future improvements in molecular targeted therapies, imaging precision, and surgical techniques promise continued enhancement of treatment outcomes for patients with spinal metastases.
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Radiotherapy is known to trigger immunogenic cell death and activate local anti-tumor immune responses. However, its systemic immunomodulatory effects remain poorly understood. Here, we discovered that irradiated tumor cell-derived microparticles (RT-MPs) are released into the circulation and subsequently taken up by neutrophils in the spleen. The mitochondrial DNA contained within RT-MPs promotes the hyperactivation of neutrophils, leading to the secretion of interleukin-1beta (IL-1ß) via the STING/NLRP3/GSDMD axis. IL-1ß, in turn, enhances the antigen-presenting capacity of dendritic cells (DCs), which facilitates the formation of cytotoxic T lymphocytes (CTLs) in the spleen. These CTLs then contribute to the destruction of distant, non-irradiated tumors. Our findings provide valuable insights into the mechanisms by which radiotherapy can directly modulate systemic anti-tumor immunity, highlighting the potential for leveraging these effects to improve the efficacy of cancer treatment.
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Most studies on fibroblast activated protein (FAP)-targeted radiopharmaceuticals focus on administered radioactivity, often overlooking the impact of a molar dose on tumor-targeting and off-target accumulation. Here, we investigate the effect of molar dose on biodistribution and pharmacokinetics using [68Ga]Ga-FAPI-04 PET and systematically evaluated two FAP-targeted dimers, DOTAGA.(SA.FAPi)2 and DOTAGA.Glu.(FAPi)2, in a 4T1 syngeneic tumor model. Dynamic PET imaging confirmed a clear molar dose-dependent effect on tumor uptake, tumor-to-organ ratios, and organ pharmacokinetics with lower molar doses prolonging tumor retention. Comparative analyses across multiple molar doses revealed that DOTAGA.Glu.(FAPi)2 achieved comparable tumor uptake to DOTAGA.(SA.FAPi)2 but exhibited significantly reduced liver accumulation. An optimal molar dose range of 8-32 nmol/kg was identified, balancing maximal tumor uptake with reduced off-target exposure. At this optimized dose, [177Lu]Lu-DOTAGA.Glu.(FAPi)2 demonstrated therapeutic efficacy in 4T1 tumor-bearing mice with limited systemic toxicity. These results establish molar dose optimization as a broadly applicable strategy for accurately evaluating and comparing FAP-targeted radiopharmaceuticals and provide a methodological framework to guide future preclinical development and translational studies.
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INTRODUCTION/OBJECTIVE: Radiotherapy (RT) is a standard cancer treatment that may be associated with problems such as ineffectiveness and side effects. This study investigated ginsenosides' radiosensitizing and radioprotective properties and their metabolites during RT. METHODS: This study searched databases including PubMed/MEDLINE, Scopus, Embase, and Cochrane Library for articles before January 28, 2025. After specifying the inclusion and exclusion criteria, relevant articles were imported into EndNote software and screened. Then, the data were recorded in tables and analyzed. RESULTS: After the screening process, 28 articles were included. Ginsenosides exhibited radioprotective effects in normal tissues by reducing oxidative stress, preserving mitochondrial integrity, enhancing DNA repair, modulating inflammatory pathways, and supporting hematopoiesis. Key compounds such as Rg1, Rg3, and Rh2 promoted tissue regeneration and protected against radiation-induced organ damage. In tumour cells, ginsenosides enhance radiosensitivity by increasing reactive oxygen species (ROS), disrupting mitochondrial function, inducing DNA damage and cell cycle arrest, and promoting apoptosis. They also inhibited tumour progression via nuclear factor kappa B (NF-κB) suppression and immune activation, reducing angiogenesis and metastasis. These dual actions suggest their potential to improve radiotherapy outcomes. DISCUSSION: Ginsenosides revealed dual roles as radioprotective and radiosensitizing agents, highlighting their potential in improving RT outcomes. However, the limited clinical data and lack of ginseng extract studies indicate the need for future clinical studies to establish optimal dosing, safety, and relevance for humans. CONCLUSION: The findings of both in vivo and in vitro studies indicated that ginsenosides enhance RT and provide protective effects against the harmful impacts of ionizing radiation.
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Perivascular epithelioid cell tumor (PEComa) is a rare mesenchymal tumor, and primary involvement of the bone is exceptionally uncommon. In this report, a case of malignant PEComa arising from the femur in an elderly patient is described. The patient achieved a favorable therapeutic outcome following surgical resection and adjuvant radiotherapy. This case suggests that this treatment mode may represent a feasible option for elderly patients and provides a valuable reference for clinical management of this rare tumor type.
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Introduction: Radiation dermatitis and oral mucositis are common acute toxicities from carbon-ion radiotherapy (CIRT) for head and neck cancers. These toxicities often impair quality of life (QOL) and can lead to treatment interruption. This study evaluated a dose surface model (DSM) shared by patients and nurses to determine whether it helped patients become more aware of their symptoms and improve their self-care. Methods: This prospective study enrolled 46 patients with head and neck malignancies who underwent CIRT between July 2017 and December 2019. The study program included nurse interviews and administration of the DSM-based patient self-care instructions, which were conducted before treatment, every week during CIRT, and at 1 and 2 months post-treatment. The self-care checklist and daily care frequency data were assessed. QOL was evaluated using the Short Form 8 at baseline, end of CIRT, and 2 months post-CIRT. Results: Radiation dermatitis occurred in 98% of the patients (grades 2-3 in 24%) and oral mucositis in 48% (grades 2-3). The self-care checklist scores improved significantly throughout the latter half of the treatment and post-treatment periods. Self-care frequency did not significantly correlate with adverse event severity, although mouth rinsing frequency tended to increase. Two months after treatment, QOL improved across several domains, particularly mental health. Conclusion: The DSM-based nursing intervention program effectively enhanced patient awareness and confidence in managing radiation-induced skin and mucosal toxicities. This strategy may enhance supportive care and QOL during CIRT for head and neck cancers.
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Esophageal squamous cell carcinoma (ESCC) is a highly aggressive malignancy with poor prognosis, where radiotherapy is a key treatment modality. However, radioresistance significantly limits its efficacy, leading to treatment failure. Septin9 (SEPT9), a cytoskeletal regulatory protein, has been implicated in various cancers, with its methylation status serving as a biomarker for diagnosis and prognosis. While extensively studied in colorectal cancer, the role of SEPT9 and its methylation in ESCC remains unclear. This study aimed to investigate the role of SEPT9 in ESCC and its potential as a predictive biomarker. SEPT9 expression and methylation levels were analyzed in 80 ESCC patients undergoing radiotherapy using qMS-PCR and immunohistochemistry (IHC). Functional experiments using SEPT9-knockout (KO) and overexpressing (Sep) ESCC cell lines were conducted in in vitro and in vivo models. The results demonstrated that SEPT9 overexpression enhances radiosensitivity, while SEPT9-knockout promotes radioresistance. Additionally, higher SEPT9 methylation correlated with radioresistance and poor survival. These findings indicate a potential association between SEPT9 methylation and radiotherapy response in ESCC. While promising, further validation is needed before SEPT9 methylation can be established as a reliable clinical biomarker or therapeutic target.
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Pediatric Hodgkin lymphoma (HL) treatment has increasingly shifted toward response-adapted protocols, aiming to minimize radiotherapy and employ intensive chemotherapy such as OEPA/COPDAC. We retrospectively reviewed treatment outcomes and toxicities in pediatric HL patients treated with OEPA/COPDAC between 2015 and 2019 at a tertiary care center in Pakistan, a resource limited country, following the Euronet PHL-C1 protocol with radiotherapy reserved for inadequate interim responses. Clinical features, treatment-related toxicities, and hospital admissions were documented. The cohort included 20 patients with a median age of 12 years; 13 (65%) achieved complete remission after OEPA induction and avoided radiotherapy. Toxicities were frequent-15 (75%) after OEPA-1 and 13 (68%) after OEPA-2-most commonly gastrointestinal symptoms and febrile neutropenia. Hospitalization was required in 9 (45%) after the first cycle and 11 (58%) after the second, with one treatment-related death from febrile neutropenia. At median follow-up, overall survival was 95% (95% CI: 69.47-99.28%) and event-free survival was 85% (95% CI: 60.38-94.90%). These findings highlight that OEPA/COPDAC achieves high survival rates even in advanced-stage pediatric HL within low-resource settings. However, the substantial toxicity burden and frequent hospitalizations underscore the need for enhanced supportive care and further evaluation in larger, long-term studies.
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BACKGROUND: Prostate cancer (PC) is a common malignancy in older adults. We aimed to construct a nomogram for the overall survival (OS) of elderly patients with locally advanced PC who received radiotherapy and surgery. METHODS: Clinical and pathological information was downloaded from the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015. The selected patients were randomly divided into a training cohort and a validation cohort at a ratio of 7:3. Univariate, multivariate Cox, and stepwise backward regression analyses were used to identify independent risk factors for OS. RESULTS: A total of 2810 elderly patients with locally advanced PC who received radiotherapy and surgery from 2010 to 2015 were included in this study. Age, marital status, Gleason score, tumor stage were identified as independent risk factors for PC patients. Age and marital status primarily reflect background mortality risk. The nomogram demonstrated favorable discrimination and calibration, with AUCs of 0.676-0.774 for 3-, 5-, and 8-year OS, indicating good predictive performance. Decision curve analysis further confirmed its superior clinical net benefit compared with the traditional tumor-node-metastasis staging model. CONCLUSIONS: We developed a new nomogram to predict OS in elderly patients with locally advanced PC treated with radiotherapy and surgery.
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Nomogramas , Neoplasias da Próstata , Humanos , Masculino , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/terapia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Idoso , Programa de SEER , Idoso de 80 Anos ou mais , Prostatectomia , Gradação de Tumores , Estadiamento de Neoplasias , Fatores de RiscoRESUMO
OBJECTIVE: To compare cochlear dose and hearing outcomes between intensity-modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) in patients with nasopharyngeal carcinoma (NPC). STUDY DESIGN: Prospective matched cohorts. SETTING: Tertiary academic center. METHODS: A total of 180 newly diagnosed, treatment-naive NPC patients receiving definitive radiotherapy between 2023 and 2025 were enrolled. Patients were 1:1 matched by sex, age, and disease stage, and assigned to IMPT (n = 90) or VMAT (n = 90). Mean cochlear dose was recorded. Audiological evaluations, including pure-tone audiometry (PTA), air-bone gap, and word recognition score, were performed before and after treatment. RESULTS: IMPT delivered significantly lower mean doses to the ipsilateral (47.51 vs 56.82 Gy, P < .001; 95% CI: -14.27 to -4.35) and contralateral cochlea (30.79 vs 45.71 Gy, P < .001; 95% CI: -18.93 to -10.91). Based on each patient's most recent audiometric assessment (median follow-up, 12.1 months; range, 7.5-19.5 months), IMPT demonstrated better average PTA thresholds than VMAT (33.72 vs 42.00 dB; P = .016; 95% CI, -14.91 to -1.65), superior high-frequency hearing at 2 to 8 kHz (37.94 vs 53.82 dB; P < .001; 95% CI, -23.69 to -8.07), lower air-bone gap (5.67 vs 10.62 dB; P < .001; 95% CI, -6.80 to -3.10), and higher word recognition scores (96.67% vs 94.00%; P = .039; 95% CI, 0.14-5.20), with less bone conduction loss at 1 to 4 kHz. CONCLUSION: IMPT reduces cochlear dose compared to VMAT, resulting in better hearing preservation and suggesting its potential to minimize ototoxicity in NPC patients.
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OBJECTIVE: Incorporating iodine into DNA bases offers a strategy to enhance radiotherapy. The iodine increases the photoabsorption crosssection and can promote DNA disruption and cell death in cancerous tissue. In this study, we investigate the local fragmentation mechanisms of iodinated DNA and the spatial extent of damage propagation following photoactivation. APPROACH: Singlestranded DNA oligonucleotides consisting of 2-5 bases, in which the methyl group of thymine is substituted with an iodine atom, were irradiated with synchrotron Xrays above the iodine L-shell ionisation threshold (4900 eV). Fragmentation patterns were extracted by subtracting background spectra obtained below the threshold (4500 eV), and the results were complemented by Born-Oppenheimer molecular dynamics simulations to resolve bond breaking at the atomic level. MAIN RESULTS: We find that longer oligonucleotide chains predominantly generate larger, highm/z fragments, while shorter sequences produce a wider variety of small fragments. Backbone cleavage is observed in all sequences, with phosphate and sugarbased ions dominating the spectra. Bond scission extends up to five bases from the iodination site, with the heaviest stable fragment containing two bases. SIGNIFICANCE: Suppose this effect is extrapolated to genomic DNA, which includes about 29.5\% thymine. In that case, the amount of thymine replaced by iodinated uracil can help estimate the extent of DNA damage that might occur during radiation therapy using iodine as a radiosensitiser.
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OBJECTIVE: Online adaptive proton therapy could benefit from reoptimization that considers the total dose delivered in previous fractions. However, the accumulated dose is uncertain because of deformable image registration (DIR) uncertainties. This work aims to evaluate the accuracy of a tool predicting the dose accumulation reliability of a treatment plan, allowing consideration of this reliability during treatment planning. Approach: A previously developed deep-learning-based DIR uncertainty model was extended to calculate the expected DIR uncertainty only from the planning CT and the expected dose accumulation uncertainty by including the planned dose distribution. For 5 lung cancer patients, the expected dose accumulation uncertainty was compared to the uncertainty of the accumulated dose of 9 repeated CTs. The model was then applied to several alternative treatment plans for each patient to evaluate its potential for plan selection. Results: The average accumulated dose uncertainty was close to the expected dose uncertainty for a large range of expected uncertainties. For high expected uncertainties, the model slightly overestimated the uncertainty. For individual voxels, errors up to 5% of the prescribed dose were common, mainly due to the daily dose distribution deviating from the plan and not because of inaccuracies in the expected DIR uncertainty. Despite the voxel-wise inaccuracies, the method proved suitable to select and compare treatment plans with respect to their accumulation reliability. Significance: Using our tool to select reliably accumulatable treatment plans can facilitate the use of accumulated doses during online reoptimization.
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BACKGROUND: Retroperitoneal sarcoma (RPS) encompasses a heterogenous group of rare malignancies that develop in the back of the abdomen. For localized primary disease, the mainstay of treatment is surgery. Beyond the primary site, patterns of disease manifestation vary by histologic type and include visceral organ metastasis, as well as intraabdominal multifocal disease. Although cure is extremely rare, some patients may still derive significant benefit from treatment. METHODS: A comprehensive literature search was performed and international, key opinion leaders for RPS met together to discuss principles of practice for multifocal and metastatic disease, summarized in 45 statements, each given a level of evidence and grade of recommendation. RESULTS: Patients should be evaluated in a multidisciplinary sarcoma center with experience in RPS and recognition of histologic type is critical to guide management. After pretreatment assessment that includes imaging and pathology review, the goals of treatment should be clarified upfront and aligned with the anticipated ability for the patient to tolerate treatment. Disease biology (e.g., disease-free interval) should be thoroughly understood. Treatment modalities can include a combination of surgery, non-surgical local therapy (radiation therapy, percutaneous tumor ablation and embolization) and systemic therapy. CONCLUSIONS: This updated consensus document gives comprehensive and practical clinical guidance to providers for the management of multifocal and metastatic RPS. The current document also serves as the foundation for future clinical and translational investigation, as we continue to optimize patient care in these complex and challenging cases.
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OBJECTIVES: Postoperative radiotherapy (RT) for breast cancer (BC) improves survival by preventing local recurrence but can lead to radiation-induced pulmonary fibrosis (RIPF). RIPF typically appears within 6-12 months post-RT and may progress over two years. This study assessed RIPF development in BC patients undergoing hypofractionated RT and evaluated the effects of rehabilitation interventions. METHODS: A total of 209 BC patients were observed: 106 in the study group received rehabilitation, while 103 in the control group followed the standard protocol. Rehabilitation included medications (Aquadetrim, Adenorin, Contimax, Magnesium B6) and topical sodium nucleonate spray. All patients received an average dose of 42.56 Gy over 16 sessions. RESULTS: RIPF developed in 90.3% of patients, with an average onset at 8.7 months post-RT. Rehabilitation delayed RIPF onset-by 8.9 months in the control group vs. 9.8 months in the rehabilitation group-showing a 9.9% improvement (p = 0.034). Body mass index (BMI) was a significant factor: patients with BMI >25 developed RIPF earlier (7.5 months) than those with BMI <25 (11.3 months, p = 0.005). Age and cancer side had no significant effect, though right-sided BC showed slightly earlier onset. Grade 2 skin reactions were linked to higher fibrosis incidence, though not statistically significant. CONCLUSIONS: Rehabilitation may delay RIPF onset, and BMI appears to be a strong predictor of its development. Future research should explore additional risk factors for RIPF in BC patients post-RT. ADVANCES IN KNOWLEDGE: This study is among the first to show that targeted rehabilitation protocols may effectively delay RIPF onset after hypofractionated RT in BC patients.
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BACKGROUND: The conventional method of assessing radiotherapy outcome in brain metastases (BM) is based on monitoring tumor size alterations on serial magnetic resonance imaging (MRI). To accurately determine changes in tumor dimensions, targets require delineations on several volumetric images acquired before treatment and at multiple follow-up scans after radiotherapy. However, manual tumor delineation on serial MRI is labor-intensive, imposes a significant burden on the clinical workflow, and is prone to variability especially for smaller lesions. PURPOSE: This study proposes a novel multi-step transformer-based automated framework with a 3D neighborhood attention mechanism, specifically designed to enhance the segmentation precision for BM of various sizes on standard longitudinal MRI. This framework leverages the hierarchical encoding capabilities of transformer architecture to capture intricate tumor characteristics, with a particular focus on improving the delineation of small metastases (<1 cm), which are often overlooked by existing models. METHODS: The proposed framework was trained on the BraTS and BraTS-METS datasets and evaluated on independent external data acquired from 212 patients (508 BM lesions) treated with stereotactic radiosurgery. The framework's performance was evaluated in segmenting tumors across various size categories, monitoring post-treatment changes in tumor size on serial MRI, and automatically detecting local control/failure (LC/LF) and adverse radiation effect (ARE) following radiosurgery. RESULTS: The framework achieved a dice score of 89.8 ± 3.4%, 92.0 ± 3.0%, and 93.1 ± 2.3% for tumors with a size of less than 1 cm, between 1 and 2 cm, and larger than 2 cm, respectively. It also demonstrated high performance in longitudinal monitoring of tumor size changes and in detecting LC/LF and ARE, achieving accuracies greater than 96% across different tumor size categories compared to the clinical outcome assessment. The results exhibited a substantial improvement over state-of-the-art segmentation models, particularly for smaller lesions. CONCLUSIONS: This study represents a step forward toward deploying AI-driven decision support tools to the neuro-oncology workflow, reducing the assessment burden on oncologists, and improving consistency in routine radiotherapy outcome assessments.
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Inteligência Artificial , Neoplasias Encefálicas , Processamento de Imagem Assistido por Computador , Imageamento por Ressonância Magnética , Radiocirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Humanos , Processamento de Imagem Assistido por Computador/métodos , Estudos Longitudinais , Resultado do Tratamento , AutomaçãoRESUMO
INTRODUCTION: Head and neck cancer (HNC) is the seventh most prevalent cancer globally. Chemoradiotherapy (CRT) and radiotherapy (RT) are the two most common treatment modalities for HNC. However, both treatments are associated with adverse side effects, including hearing loss. This systematic review and meta-analysis aim to evaluate the pooled prevalence of sensorineural hearing loss (SNHL) among HNC patients undergoing CRT versus RT. METHODOLOGY: A comprehensive search of PubMed/MEDLINE, Google Scholar, DOAJ, AJOL, and the Cochrane Library was conducted using predefined key terms to identify original articles reporting the prevalence of SNHL in HNC patients treated with CRT or RT. Additionally, manual Google searches were performed to uncover relevant grey literature. The results were screened and included or excluded according to preset criteria. The Restricted Maximum Likelihood (REML) random-effects model was employed to calculate the overall pooled prevalence and separate prevalences in CRT and RT groups, as well as their respective heterogeneities, using Jamovi 2.3.28 software. Statistical significance was set at p < .05 for all analyses. RESULTS: The overall prevalence of SNHL among HNC patients treated with CRT or RT was 54.5% (95% CI: 44.9% - 64.0%; I² = 90.35%, p < .001). For CRT, the prevalence was 60.4% (95% CI: 50.5% - 70.2%; I² = 88.82%, p < .001). In contrast, the prevalence for RT was 32.9% (95% CI: 21.3% - 44.4%; I² = 60.15%, p = .063). The risk of developing SNHL was nearly twice as high in patients treated with CRT compared to those treated with RT alone, with a prevalence ratio of 1.83. CONCLUSION: Both CRT and RT are associated with SNHL in HNC patients, with a significantly higher prevalence observed in those undergoing CRT compared to RT.
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Pelvic radiotherapy for gynecologic malignancies damages the primary active bone marrow reservoir, inducing hematologic toxicity exacerbated by chemotherapy. Optimizing pelvic bone marrow dose-volume constraints is critical to mitigate myelosuppression and maintain treatment efficacy. The present retrospective cohort study analyzed patients with gynecological cancer (n = 61) undergoing concurrent chemoradiotherapy between August 2021 and August 2024. Associations between pelvic bone marrow (PBM) dose-volume parameters and acute hematologic toxicity (AHT) were systematically evaluated. All patients received intensity-modulated radiotherapy encompassing pelvic lymph node regions, with weekly complete blood count monitoring during and for 2 weeks after treatment. The overall incidence of AHT was 70.5% (43/61), with grade ≥ 2 and ≥ 3 AHT occurring in 63.9% (39/61) and 30.0% (14/61) of patients, respectively. Multivariate analysis identified PBM-V15 as an independent predictor of grade ≥ 2 AHT [odds ratio (OR), 2.653; 95% CI, 1.054-6.682; P = 0.038], with an optimal cutoff threshold of 80.44% [area under the curve (AUC), 0.854]. Notably, a lower PBM (LPBM)-V5 specifically predicted grade ≥ 3 AHT (OR, 1.425; 95% CI, 1.022-1.987; P = 0.037), with a threshold of 91.25% (AUC, 0.695). Implementing bone marrow-sparing strategies by restricting PBM-V15 to <80.44% significantly reduced the grade ≥ 2 AHT risk, while a stringent LPBM-V5 constraint (< 91.25%) was pivotal for preventing severe (grade ≥ 3) AHT. These dose-volume parameters should be incorporated into optimization protocols for pelvic radiotherapy in gynecological malignancies.