Exploring the Evolving Landscape of Stereotactic Body Radiation Therapy in Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) carries significant morbidity and mortality. Management of the HCC requires a multidisciplinary approach. Surgical resection and liver transplantation are the gold standard options for the appropriate settings. Stereotactic body radiation therapy (SBRT) has emerged as a promising treatment modality in managing HCC; its use is more studied and well-established in advanced HCC (aHCC). Current clinical guidelines universally endorse SBRT as a viable alternative to radiofrequency ablation (RFA), transarterial chemoembolisation (TACE), and transarterial radioembolisation (TARE), a recommendation substantiated by literature demonstrating comparable efficacy among these modalities. In early-stage HCC, SBRT primarily manages unresectable tumours unsuitable for ablative procedures such as microwave ablation and RFA. SBRT has been incorporated as a modality to downstage tumours or as a bridge to transplant. In the case of intermediate or advanced HCC, SBRT offers excellent results either as a single modality or adjunct to other locoregional modalities such as TACE/TARE. Recent data from late-stage HCC patients illustrate the effectiveness of SBRT in achieving local tumour control while minimising damage to surrounding healthy liver tissue. It has promising local control of approximately 80-90% in managing HCC. Additional prospective data comparing the efficacy of SBRT with the first-line recommended therapies such as RFA, TACE, and surgery are essential. The standard of care for patients with advanced/metastatic disease is systemic therapy (immunotherapy/tyrosine kinase inhibitors). SBRT, in combination with immune-checkpoint inhibitors, has an immune-modulatory effect that results in a synergistic effect. Recent findings indicate that the combination of immunotherapy and SBRT in HCC is well-tolerated and exhibits synergistic effects. Further exploration of diverse immunotherapy and radiotherapy strategies is essential to identify the appropriate time for combination treatments and to optimise dose and fraction regimens. Prospective, randomised studies are imperative to establish SBRT as the primary treatment for HCC.

Estimation of the absorbed dose in simultaneous digital breast tomosynthesis and mechanical imaging.

Purpose: Use of mechanical imaging (MI) as complementary to digital mammography (DM), or in simultaneous digital breast tomosynthesis (DBT) and MI - DBTMI, has demonstrated the potential to increase the specificity of breast cancer screening and reduce unnecessary biopsies compared with DM. The aim of this study is to investigate the increase in the radiation dose due to the presence of an MI sensor during simultaneous image acquisition when automatic exposure control is used. Approach: A radiation dose study was conducted on clinically available breast imaging systems with and without an MI sensor present. Our estimations were based on three approaches. In the first approach, exposure values were compared in paired clinical DBT and DBTMI acquisitions in 97 women. In the second approach polymethyl methacrylate (PMMA) phantoms of various thicknesses were used, and the average glandular dose (AGD) values were compared. Finally, a rectangular PMMA phantom with a 45 mm thickness was used, and the AGD values were estimated based on air kerma measurements with an electronic dosemeter. Results: The relative increase in exposure estimated from digital imaging and communications in medicine headers when using an MI sensor in clinical DBTMI was 11.9 % ± 10.4 . For the phantom measurements of various thicknesses of PMMA, the relative increases in the AGD for DM and DBT measurements were, on average, 10.7 % ± 3.1 and 11.4 % ± 3.0 , respectively. The relative increase in the AGD using the electronic dosemeter was 11.2 % ± < 0.001 in DM and 12.2 % ± < 0.001 in DBT. The average difference in dose between the methods was 11.5 % ± 3.3 . Conclusions: Our measurements suggest that the use of simultaneous breast radiography and MI increases the AGD by an average of 11.5 % ± 3.3 . The increase in dose is within the acceptable values for mammography screening recommended by European guidelines.

Trojan-horse inspired nanoblaster: X-ray triggered spot attack on radio-resistant cancer through radiodynamic therapy.

Radiotherapy as a mainstay of in-depth cervical cancer (CC) treatment suffers from its radioresistance. Radiodynamic therapy (RDT) effectively reverses radio-resistance by generating reactive oxygen species (ROS) with deep tissue penetration. However, the photosensitizers stimulated by X-ray have high toxicity and energy attenuation. Therefore, X-ray responsive diselenide-bridged mesoporous silica nanoparticles (DMSNs) are designed, loading X-ray-activated photosensitizer acridine orange (AO) for spot blasting RDT like Trojan-horse against radio-resistance cervical cancer (R-CC). DMSNs can encapsulate a large amount of AO, in the tumor microenvironment (TME), which has a high concentration of hydrogen peroxide, X-ray radiation triggers the cleavage of diselenide bonds, leading to the degradation of DMSNs and the consequent release of AO directly at the tumor site. On the one hand, it solves the problems of rapid drug clearance, adverse distribution, and side effects caused by simple AO treatment. On the other hand, it fully utilizes the advantages of highly penetrating X-ray responsive RDT to enhance radiotherapy sensitivity. This approach results in ROS-induced mitochondria damage, inhibition of DNA damage repair, cell cycle arrest and promotion of cancer cell apoptosis in R-CC. The X-ray responsive DMSNs@AO hold considerable potential in overcoming obstacles for advanced RDT in the treatment of R-CC.

Head and Neck Paragangliomas: 16-year Single-center Experience and Mini Review on Diagnosis, Treatment, and Follow-up.

Objective: To investigate head and neck paraganglioma cases treated at a tertiary center from 2007 to 2023. The research includes a thorough examination of published studies that have focused on long-term outcomes. The additional goal is to contribute to the existing knowledge on head and neck paraganglioma, with a particular emphasis on refining diagnostic algorithms, treatment selection, and follow-up procedures. Methods: A total of 44 patients were retrospectively analyzed, and 39 were included. Demographic information, symptoms, radiological examination results, types, stages, and postoperative complications were recorded. A review was conducted to select articles that reported single-center experiences with large cohorts, long follow-ups, and different treatment modalities since 2010. Results: The mean age of the patients was 54 years, and the female/male ratio was 3.55:1. Among the 39 cases examined, 18 and 19 were identified as cervical paraganglioma and 19 as temporal bone paraganglioma. All patients initially underwent surgical resection. The mean follow-up duration was 5.42 years. Four residual cases and two recurrences were identified postoperatively, and a Gamma Knife was used as additional treatment. Subsequently, 17 articles were selected and summarized, and then a flowchart was prepared showing the possible options for diagnosis, treatment, and follow-up. Conclusions: Preoperative staging is essential for surgical planning and predicting potential intraoperative complications. Based on our findings and review of the articles, we have prepared a flowchart that includes all possibilities depending on the tumor stage to help in the diagnosis, treatment, and follow-up of head and neck paragangliomas.

[Analysis of the results of personal monitoring to ionizing radiation at workplaces]. / Analiza wyników rutynowego monitoringu narazenia personelu na promieniowanie jonizujace w miejscach pracy.

BACKGROUND: The paper presents the results of dosimetric measurements routinely performed by the Radiation Protection Department of the Nofer Institute of Occupational Medicine (NIOM) in Lódz in 2022 for people occupationally exposed to X and γ radiation. MATERIAL AND METHODS: The evaluation of the effective dose as part of individual dosimetry was provided using the film or thermoluminescent dosimetry (TLD). Additionally, based exclusively on the TLD method, measurements of the ambient dose equivalent H*(10) and personal dose equivalents Hp(0.07) and Hp(3) were performed. In 2022, the dosimetric service of the Radiological Protection Department of the NIOM covered >30 000 workers employed in >4500 laboratories (mainly health care departments). All measurements were performed in accordance with accredited research procedures (number AB 327). RESULTS: In 2022, the average annual dose of Hp(10) was equal to 0.26 mSv, whereas Hp(0.07) measured using ring and wrist dosimetry was equal to 0.63 mSv and 0.78 mSv, respectively. In turn, the average Hp(3) value was 0.21 mSv. In 2022, there was not a single case of exceeding the annual dose limit among people measured by the NIOM. CONCLUSIONS: The data collected in the "Dosimetry" database of the NIOM and a detailed analysis of annual doses received by people occupationally exposed to ionizing radiation indicate a well-functioning radiological protection system in Poland. Med Pr Work Health Saf. 2024;75(5).

Celebrating JSR's 30th anniversary: reminiscences of a Main Editor.

Reminiscences of one of the founding Main Editors of JSR on its 30th anniversary.

Long-term trends in total administered radiation dose from brain [18F]FDG-PET in children with drug-resistant epilepsy.

PURPOSE: To assess the trends in administered 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) doses, computed tomography (CT) radiation doses, and image quality over the last 15 years in children with drug-resistant epilepsy (DRE) undergoing hybrid positron emission tomography (PET) brain scans. METHODS: We retrospectively analyzed data from children with DRE who had [18F]FDG-PET/CT or magnetic resonance scans for presurgical evaluation between 2005 and 2021. We evaluated changes in injected [18F]FDG doses, administered activity per body weight, CT dose index volume (CTDIvol), and dose length product (DLP). PET image quality was assessed visually by four trained raters. Conversely, CT image quality was measured using region-of-interest analysis, normalized by signal-to-noise (SNR) and contrast-to-noise ratio (CNR). RESULTS: We included 55 children (30 male, mean age: 9 ± 6 years) who underwent 61 [18F]FDG-PET scans (71% as PET/CT). Annually, the injected [18F]FDG dose decreased by ~ 1% (95% CI: 0.92%-0.98%, p < 0.001), with no significant changes in administered activity per body weight (p = 0.51). CTDIvol and DLP decreased annually by 16% (95% CI: 9%-23%) and 15% (95% CI: 8%-21%, both p < 0.001), respectively. PET image quality improved by 9% year-over-year (95% CI: 6%-13%, p < 0.001), while CT-associated SNR and CNR decreased annually by 7% (95% CI: 3%-11%, p = 0.001) and 6% (95% CI: 2%-10%, p = 0.008), respectively. CONCLUSION: Our findings indicate stability in [18F]FDG administered activity per body weight alongside improvements in PET image quality. Conversely, CT-associated radiation doses reduced. These results reaffirm [18F]FDG-PET as an increasingly safer and higher-resolution auxiliary imaging modality for children with DRE. These improvements, driven by technological advancements, may enhance the diagnostic precision and patient outcomes in pediatric epilepsy surgery.

Postoperative irradiation in stage II thymomas: is it worth it?-shedding some light in the guidelines' gray zone.

Thymomas are rare, indolent tumors. Early stages (I-II) benefit from surgical treatment, while locally advanced diseases (stages III-IV) usually require a multidisciplinary approach. The role of postoperative radiotherapy (PORT) on anterior mediastinum for radically resected Masaoka-Koga stage II thymomas remains controversial. This study aims to determine the impact of PORT on the disease-free survival (DFS) of stage II thymomas. We retrospectively collected the clinical and oncologic data [age, sex, myasthenia gravis (MG) prevalence, Masaoka-Koga stage, World Health Organization (WHO) histologic subtype] of those patients who underwent radical exeresis in our Unit between January 2000 and December 2020. Kaplan-Meier estimates of DFS were then performed. Our study included 195 patients (M/F = 98/97). Almost all patients were affected by MG (90.7%) and most of them were operated by median sternotomy (93.3%). Thymoma stage was IIa in 87 cases (44.6%) and IIb in 108 cases (55.4%). The most represented histologic subtype was AB (27.7%), followed by B2 (24.6%), A (19%), B1 (14.9%) and B3 (13.8%). PORT was performed in 113 patients (58%, 39 stage IIa and 74 stage IIb). During the surveillance, 8 patients (4.1%) presented pleural recurrences and no local relapses. DFS was comparable in stage IIa and IIb patients, independently from PORT administration (p = .395 and p = .858, respectively). Moreover, PORT did not affect DFS considering the histologic subtypes (p = .304 for A and AB thymomas, p = .608 for B1, B2 and B3 thymomas). In our wide series, PORT administration didn't show any additional benefit on DFS. Therefore, based on our experience, patients with stage II thymoma who underwent radical surgery should not undergo any local adjuvant treatment.

Return to work in younger patients with brain metastases who survived for 2 years or more.

PURPOSE: The study's purpose was to analyze return to work and other long-term outcomes in younger patients with newly diagnosed brain metastases, treated before they reached legal retirement age, i.e. younger than 65 years. METHODS: We included patients who survived greater than 2 years after their first treatment, regardless of approach (systemic therapy, neurosurgical resection, whole-brain or stereotactic radiotherapy). The primary endpoint was the proportion of patients who worked 2 years after their initial treatment for brain metastases. Outcomes beyond the 2-year cut-off were also abstracted from comprehensive electronic health records, throughout the follow-up period. RESULTS: Of 455 patients who received active therapy for brain metastases, 62 (14%) survived for > 2 years. Twenty-eight were younger than 65 years. The actuarial median survival was 81 months and the 5-year survival rate 53%. For patients alive after 5 years, the 10-year survival rate was 54%. At diagnosis, 25% of patients (7 of 28) were permanently incapacitated for work/retired. Of the remaining 21 patients, 33% did work 2 years later. However, several of these patients went on to receive disability pension afterwards. Eventually, 19% continued working in the longer run. Younger age, absence of extracranial metastases, presence of a single brain metastasis, and Karnofsky performance status 90-100 were common features of patients who worked after 2 years. CONCLUSION: Long-term survival was achieved after vastly different therapeutic approaches, regarding both upfront and sequential management. Many patients required three or more lines of brain-directed treatment. Few patients continued working in the longer run.

Probiotics in the management of radiation-induced oral mucositis.

Oral mucositis is a common and debilitating oral complication in head and neck cancer patients undergoing radiotherapy, resulting in diminished quality of life and potential treatment disruptions. Oral microbiota has long been recognized as a contributing factor in the initiation and progression of radiation-induced oral mucositis (RIOM). Numerous studies have indicated that the radiation-induced oral microbial dysbiosis promotes the occurrence and severity of oral mucositis. Therefore, approaches that modulate oral microbial ecology are promising for the management of RIOM. Probiotics as a relatively predicable and safe measure that modulates microecology have garnered significant interest. In this review, we discussed the correlation between RIOM and oral microbiota, with a particular focus on the efficacy of probiotics in the control of RIOM, in order to provide novel paradigm for the management of this disease.

A Review of Neoadjuvant Therapy and the Watch-and-Wait Protocol in Rectal Cancer: Current Evidence and Future Directions.

The treatment of rectal cancer underwent a significant change with the introduction of total mesorectal excision (TME), which substantially improved recurrence rates. However, TME is associated with complications such as fecal incontinence and poor bladder control, especially in tumors located near the anal verge. The watch-and-wait (WW) protocol has emerged as an alternative for patients achieving a clinical complete response (cCR) following neoadjuvant radiochemotherapy. This narrative review, developed according to the Scale for the Assessment of Narrative Review Articles guidelines, evaluates neoadjuvant treatments and the WW protocol for rectal cancer. Literature was sourced from the PubMed database using specific search terms related to neoadjuvant therapy and the WW protocol, resulting in 63 articles selected for discussion. Neoadjuvant treatment, including chemoradiation and short-course radiotherapy, is indicated for T3 and T4 rectal adenocarcinomas. Studies like the German Rectal Cancer Study Group and the PRODIGE 23 trial have shown the benefits of preoperative treatment, including improved disease-free survival and reduced local recurrence rates. However, challenges in adopting the WW protocol include the risk of local regrowth and distant metastasis. Immune checkpoint inhibitors have shown promise in mismatch repair-deficient patients, yet the data are insufficient to fully endorse WW for these cases. The WW protocol is viable for selected rectal cancer patients, with ongoing debates regarding criteria for inclusion. Key challenges include accurately identifying cCR and managing patients with near-complete responses. MRI and endoscopic evaluation are crucial for assessing treatment response, although achieving a pathological complete response remains uncertain. The WW strategy offers a potential organ-preserving approach in rectal cancer management but requires careful patient selection and comprehensive risk-benefit discussions. Further research is needed to refine criteria for inclusion and optimize treatment protocols, enhancing outcomes while minimizing invasive interventions.

Assessing the biochemical and genotoxic effects of low intensity 2.45GHz microwave exposure on Arabidopsis thaliana plants.

The electromagnetic waves of 2.45 GHz microwave frequency have become abundant in environments worldwide. This study assessed the short-term impact of low-intensity 2.45 GHz exposure on young Arabidopsis thaliana plants. The plants underwent a 48-hour exposure to continuous wave 2.45 GHz microwaves at a power density of 1.0 ± 0.1 W m-2. Experiments were conducted inside anechoic chambers. After the microwave exposure samples were subjected to morphological, genotoxicity, pigmentation, and physiochemical analysis. Microwave exposure elevated the levels of photosynthetic pigments, oxidative stress, guaiacol peroxidase activity, and ascorbic peroxidase activity in plants. Conversely, catalase activity decreased. Photosystem efficiency remained unchanged, while non-photochemical quenching increased. Leaf morphological parameters exhibited no significant alterations during this brief exposure period. Notably, despite shifts in physiological parameters and pigmentations, genomic template stability remained unaffected. The findings suggest that the non-thermal effects of microwave exposure influence the photosystem and plant physiology. Research confirmed the existence of non-thermal effects of microwave exposure; however, these effects are within tolerable limits for Arabidopsis thaliana plants.

Microwaves are a category of radio waves with wavelengths ranging from approximately 30 centimeters to one millimeter. The most utilized microwave frequency these days is 2.45GHz, which is used in everyday devices such as microwaves and WiFi signals. This investigation explored the impact of low-intensity 2.45GHz microwaves on young thale cress (Arabidopsis thaliana) plants for 48hours. In other words, research is comparable to scientific assessing how plants respond to the proximity of a 2G WiFi signal. The exposure resulted in increased pigment production in plants and displayed indications of stress, influencing specific plant activities. However, these alterations did not compromise the stability of the genetic materials of the plants. This suggests that although low-intensity microwaves can affect plant systems, the effects appear to be manageable during brief exposures.

Development of a method to use standard hospital gamma cameras as triage whole body monitors in UK emergencies.

This paper outlines the process by which a medical gamma camera can be utilised to support assessment of internal radionuclides for the public. While hospital based gamma cameras are able to detect photopeaks, they are often limited to an energy range of 40-540 keV. However, radionuclides with photopeak energies above 540 keV can still be detected as the partial collection of photon energy increases the count rate at lower energies. By combining extensive mathematical modelling with empirical calibration of multiple gamma cameras it is possible to develop a linear correlation between the efficiency of counting point sources and the overall counting efficiency for the camera. Once established, a simple protocol can be used to characterise any gamma camera, using optimal system settings, and hence generate a system efficiency with sufficient accuracy to allow the camera to be used in a triage process to committed effective doses of 2 mSv. .

Is the IROC H&N credentialing phantom an effective surrogate for different anatomical sites?: Using IROC's H&N phantom for various sites.

PURPOSE: The IROC head and neck phantom is used to credential institutions for IMRT delivery for all anatomical sites where delivery of modulated therapy is a primary challenge. This study evaluated how appropriate the use of this phantom is for varied clinical anatomy by evaluating how closely the IROC head and neck phantom described clinical dose errors from beam modeling compared to various anatomical sites. METHODS: The MLC offset, transmission, PDD and seven additional beam modeling parameters for a Varian accelerator were modified in RayStation to match community data at the 2.5, 25, 50, 75 and 97.5 percentile levels. Modifications were evaluated on 25 H&N phantom cases and 25 clinical cases (H&N, prostate, lung, mesothelioma, and brain), generating 2,000 plan perturbations. Differences in mean dose delivered to clinical target volumes (CTV) and organs at risk (OAR) were compared between phantom and clinical plans to assess the relationship between dose deviations in phantom versus clinical CTVs, and as a function of 18 different complexity metrics. RESULTS: Perturbations to MLC offset and transmission parameters demonstrated the greatest impact on dose accuracy for phantom and clinical plans (for all anatomic sites). The phantom demonstrated equivalent or greater sensitivity to these parameter perturbations when compared to clinical sites, largely aligning with treatment complexity. The mean MLC Gap best described the impact of errors in TPS beam modeling parameters in phantoms plan and clinical plans from various anatomical sites. CONCLUSION: When compared across various anatomical sites, the IROC H&N credentialing phantom exhibited similar or greater sensitivity to errors in the treatment planning system. As such, it is a suitable surrogate device for assessing institutional performance across various anatomical sites. If an institution successfully irradiates the phantom, that result confers confidence that IMRT to a wide range of anatomical sites can be successfully delivered by the institution.

More is Less: Image Enhancement Technology Reduces Radiation Exposure During Anterior Lumber Interbody Fusion.

BACKGROUND CONTEXT: Fluoroscopy and radiation exposure occur during anterior lumbar interbody fusion (ALIF). Image enhancement technology is available that can potentially reduce radiation exposure. PURPOSE: The purpose of this study is to evaluate radiation exposure and fluoroscopy times comparing standard fluoroscopy (FL) with a low dose image enhancement platform (LD). STUDY DESIGN: Retrospective review of prospectively maintained database PATIENT SAMPLE: Consecutive patients undergoing ALIF with either standard fluoroscopy or low dose image enhancement technology OUTCOME MEASURES: Radiation dispersion and fluoroscopy times in ALIF patients with standard fluoroscopy and low dose image enhancement technology METHODS: A retrospective review of a prospective database on consecutive patients who have undergone ALIF, stratified into two groups: subjects with standard fluoroscopy (FL), and low dose fluoroscopy with image enhancement technology (LD). RESULTS: A total of 487 ALIF patients were included (FL: 372 vs LD: 115). LD patients were significantly older (66 vs 60 years), with more deformity cases (28% vs 12%), and less degenerative cases (71% vs 87%), all p<0.05; no differences in sex, BMI, or the number of levels operated on between groups. Fluoroscopy time (sec) was significantly higher in LD (51.4 vs 45.5), with a statistically significant reduction in radiation (mGy) compared to FL (23.3 vs 48.2), both p<0.05. Furthermore, the results showed that radiation dispersion is increasingly reduced as fluoroscopy time increases in LD compared to FL (12%, 56%, and 65% reduction in radiation dispersion for fluoroscopy time < 30 sec, between 30 to 60 sec, and > 60 sec, respectively). CONCLUSIONS: The use of low dose fluoroscopy with image enhancement technology significantly reduces the cumulative dose of radiation during ALIF compared to standard dose fluoroscopy. Also, radiation dispersion increasingly decreases as fluoroscopy time increases using low dose image enhancement technology. Low dose image enhancement technology improves the safety profile of ALIF for patients and operating room staff.

National Council on Radiation Protection (NCRP) 2024 annual meeting:advanced and small modular nuclear power reactors.

On 25-26 March 2023, the U.S. National Council on Radiation Protection and Measurements (NCRP) held its 2024 annual meeting in Bethesda, Maryland, USA. The NCRP dates from 1929, and this meeting celebrated the 60th anniversary of receiving a U.S. Congressional Charter. For this annual meeting the NCRP felt it was essential to provide a briefing about advanced and small modular nuclear reactors (SMRs). The Journal of Radiological Protection is delighted to publish the following synopsis of material presented at the U.S. NCRP meeting. This synopsis is divided into five sections. The first section provides an overview of the whole meeting together with summaries of two context setting overview papers. The following four sessions of this synopsis are specific to advanced and small modular nuclear power reactors. The meeting also included keynote presentations by three of NCRP annual award recipients. The meeting topical areas were Technology Overview and Critical Issues. The individual papers laid the groundwork to understanding reactor technologies, terminology, and the fundamental concepts and processes for electrical generation. The perspectives of the U.S. Environmental Protection Agency and states, through the Conference of Radiation Control Program Directors were provided. The papers included a discussion of diverse topics including potential emergency preparedness considerations, radiological survey requirements, an evaluation of the future of nuclear power, the economics of reactors (both large and small), and the critical issues identified by the recent National Academies of Sciences' study on advanced reactors. The summary papers were developed to briefly document the major points and concepts presented during the oral papers presented at the 2024 NCRP Annual Meeting. The meeting heralded the dawn of a new era for commercial nuclear power.

Overall survival and prognostic factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy combined with intraoperative radiation therapy in patients with advanced abdominopelvic malignancies: A single center retrospective analysis of 159 patients.

BACKGROUND AND OBJECTIVES: The aim of this study was to look at the overall survival (OS), progression-free survival (PFS), and prognostic factors associated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) combined with intraoperative radiation therapy (IORT). METHODS: This study is a single center retrospective study performed on 159 patients who underwent treatment with CRS and HIPEC combined with IORT for abdominopelvic malignancies. OS and PFS were used to evaluate the efficacy of this treatment strategy amongst patients with abdominopelvic malignancies. RESULTS: The cohort's median age was 53 years, with a male predominance (58.5%). The median OS was not reached, but the mean OS was 76.87 months. In univariate analysis, several factors, including synchronous organ metastasis, Pathologic Peritoneal Carcinomatosis Index (pPCI) ≥10, increased estimated blood loss, and severe postoperative complications, were associated with worse OS. However, multivariate analysis identified pPCI ≥ 10 as the sole independent predictor of worse OS. The 1- and 3-year survival rates were 83% and 70.4%, respectively. pPCI ≥ 10 and severe postoperative complications were significant predictors of worse survival outcomes. CONCLUSIONS: Radical surgery alone is not enough, and CRS combined with HIPEC and IORT, when indicated, was proven to be safe and effective with no added morbidity or mortality.

Cardiac Radiation Exposure and Incident Cancer: challenges and opportunities.

Use of radiological procedures has enormously advanced cardiology. People with heart disease are exposed to ionizing radiation. Exposure to ionizing radiation increases lifetime cancer risk with a dose-proportional hazard according to the linear no-threshold model adopted for radioprotection purposes. In the United States, the average citizen accumulates a median annual medical radiation exposure of 2.29 millisievert (mSv) per year per capita as of the radiologic year 2016, corresponding to the dose exposure of 115 chest X-rays. Cardiology studies often involve high exposures per procedure accounting for approximately 30% to 50% of cumulative medical radiation exposures. Malignancy is more incident in the most radiosensitive organs receiving the largest organ dose from cardiac interventions and cardiovascular imaging testing, such as the lung, bone marrow, and female breast. The latency period between radiation exposure and cancer is thought to be at least 2 years for leukemia and 5 years for all solid cancers, and differences are more likely to emerge in cardiology studies with longer follow-up and inclusion of non-cardiovascular endpoints such as cancer incidence. In cardiological studies, excess cancers are observed 3 to 12 years following exposure, with longer follow-up times showing greater differences in cancer incidence. The presumed associated excess cancer risk needs greater study. These exposures provide a unique opportunity to expand our knowledge of the relationship between exposure to ionizing radiation and cancer risk. Future trials comparing interventional fluoroscopy versus optimal medical therapy or open surgery should include a cancer incidence endpoint.

Spinal chordoma and chondrosarcoma treatment experiences - a 20-year retrospective study from databases of two medical centers.

The research retrospectively analyzed cases of spinal chordoma and chondrosarcoma involving patients who received treatment at the two hospitals between 2001 and 2023. Among the 48 patients studied (39 chordoma and 9 chondrosarcoma cases), the average age was 53.9 ± 15.8 years, with a range of 17 to 86 years. Out of these patients, 43 underwent excision surgery and were categorized based on tumor margin into negative (R0) or microscopically positive (R1) margin (n = 14) and macroscopically positive (R2) margin (n = 29) groups. The mean overall survival (OS) for R0/R1 and R2 groups was 156.5 ± 19.3 and 79.2 ± 11.9 months, respectively (p value = 0.012). The mean progression-free survival (PFS) for R0/R1 and R2 was 112.9 ± 24.4 and 25.5 ± 5.5 months (p value < 0.001). The study showed that regardless of whether patients in the R0/R1 or R2 groups received radiation therapy (RT) or not, there was no significant improvement in OS or PFS. Specifically, the OS and PFS for the RT only group were 75.9 ± 16.6 and 73.3 ± 18.0 months. In conclusion, the recommended treatment approach for spinal chordoma and chondrosarcoma remains en bloc resection surgery with an appropriate margin. Patients who are unsuitable for or decline surgery may find a beneficial disease control rate with traditional external beam photon/proton therapy.