Predictive significance of intraprostatic volumetric parameters derived from early and standard time 68Ga-PSMA PET/CT images in newly diagnosed prostate cancer patients.

OBJECTIVE: To investigate the relationship between intraprostatic 68Ga-prostate-specific membrane antigen (PSMA) uptake values and volumetric parameters derived from early pelvic and standard-time whole-body 68Ga-PSMA PET/computed tomography (CT) images in untreated prostate cancer (PCa) patients, and to assess the predictive significance of these data in relation to disease prognosis, comparing them with the Gleason score, clinical risk classification and the presence of metastatic disease detected in 68Ga-PSMA PET/CT imaging. METHODS: Eighty-one newly diagnosed PCa patients underwent early phase pelvic imaging at the 5th minute and standard time whole-body imaging at the 60th minute. Various threshold values were used in intraprostatic delineations to compute maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), intraprostatic PSMA tumor volume and intraprostatic total lesion PSMA uptake. Correlations between early and standard time measurements, as well as changes in SUV parameters over time, were examined. The association of these values with Gleason score, clinical risk status (National Comprehensive Cancer Network), and metastatic disease was explored. RESULTS: SUVmax measurements from both early and standard time images distinguished all three groups (clinical risk scores, Gleason score and metastatic group), with standard imaging demonstrating statistical superiority in receiver operating characteristic analyses. Strong correlations were observed between early and standard-time PET parameters. Changes in intraprostatic SUVmax and SUVmean values over time did not exhibit predictive value. CONCLUSION: Although intraprostatic PSMA PET parameters generally aligned at both early and standard times, parameters obtained from standard time images showed more robust correlations with clinical risk scores, Gleason score and metastasis status in newly diagnosed, untreated PCa patients.

Radiotherapy for benign diseases in Turkey: a patterns of care survey of the Turkish Society for Radiation Oncology (TROD 05-002).

PURPOSE: We aimed to investigate the patterns of radiotherapy (RT) care in cases of benign diseases in Turkey. METHODS: A questionnaire survey was sent to all radiation oncology (RO) departments in Turkey. The number of patients treated for benign disease between 2015 and 2020 was requested. A list of benign conditions was given, and information on the number of patients per disease, single and total doses prescribed, weekly fractions, radiation type, energy, and device was requested. RESULTS: Of the 138 RO departments, 29 (21%) responded. The data received concerned 15 (52%) university, 10 (34%) public, and four (14%) private hospitals. A total of 130,846 patients were treated with RT in these departments. Of these patients, 6346 (4.85%) were treated for benign conditions. The most common benign diseases treated with RT were meningioma (35%), plantar fasciitis (19%), schwannoma (16%), arteriovenous malformation (11%), and pituitary adenoma (7%). Most centers performed RT for paraganglioma, heterotopic ossification, vertebral hemangioma, and Graves' ophthalmopathy, but none treated arthrosis. Wide variations were observed across the departments. Radiosurgery for intracranial pathologies was performed intensively in four centers. By contrast, RT for plantar fasciitis was predominantly treated in five centers, one of which had more than 1000 patients. CONCLUSION: The ratio of patients who underwent RT for benign diseases in Turkey among all patients who underwent RT was 4.85%. The common pattern of RT in 72% of patients was radiosurgery for intracranial benign diseases, followed by low-dose RT for plantar fasciitis in 19%.

Impact of Radiotherapy Volumes on Late-Term Cosmetic Outcomes and Quality of Life in Patients With Unifocal and Multifocal/Multicentric Breast Cancer After Breast-Conserving Surgery.

Objective: Breast-conserving surgery (BCS) followed by radiotherapy (RT) is the standard treatment for early-stage breast cancer. The use of an additional RT dose (boost) to the tumour bed improves local control but may worsen quality of life (QOL) and cosmetic results. Multifocal/multicentric tumours (MMTs) pose a challenge as they require larger boost volumes. This study investigated the impact of RT volumes on late-term cosmetic outcomes and QOL in patients with unifocal and MMTs who underwent adjuvant RT after BCS. Materials and Methods: Retrospective data of 367 patients who underwent BCS between 2012 and 2014 were reviewed. A cohort of 121 patients with at least six months of completed RT were prospectively included in the study. Cosmetic results were evaluated using a modified scoring system, and QOL was assessed using The European Cancer Treatment and Organization Committee tools. Results: The results showed that the inclusion of regional lymphatics in the RT treatment field significantly affected QOL, particularly in terms of role functioning and social functioning. Higher boost volume ratios were associated with increased pain-related symptoms. However, the presence of MMTs did not significantly affect cosmetic outcomes compared to unifocal tumours. Conclusion: The size of the boost and inclusion of regional lymphatics in RT significantly impact QOL in patients undergoing BCS. Tumour foci number does not affect cosmetic outcomes. These findings emphasize the need for careful consideration of RT volumes to minimize long-term adverse effects on QOL. Future prospective studies should evaluate early side effects and baseline QOL scores to provide a comprehensive assessment.

Radiation therapy for squamous cell cancer of the skin in a patient with xeroderma pigmentosum.

Xeroderma Pigmentosum is an autosomal recessive disease characterized by increased sensitivity to ultraviolet radiation. Adjuvant radiotherapy (RT) is an important locoregional treatment modality for high-risk skin squamous cell cancers (SCCs). We present a case of an adult with high-risk skin SCC treated with standard adjuvant RT and followed-up for >4 years with acceptable side effects.

Dosimetric comparison of modern radiotherapy techniques for gastric cancer after total gastrectomy.

PURPOSE: The purpose of this study is to investigate the optimal radiotherapy technique for postoperative irradiation of gastric cancer treated with total gastrectomy. MATERIALS AND METHODS: The database of ten patients was used for this study. Three-dimensional (3D) conformal radiotherapy, intensity-modulated therapy (IMRT), volumetric modulated arc therapy (VMAT), and helical tomotherapy (HT) plans were created for each dataset. The prescription dose was 45 Gy in 25 fractions. Comparative analyses of the target volume coverage and the doses of organs at risk were performed. RESULTS: HT was significantly provided more homogeneity. The best conformal plans were achieved with VMAT. Both kidneys were better preserved with HT and VMAT. HT significantly lowered the V13 of the left kidney and VMAT significantly lowered V20. However, the mean left kidney doses were not statistically different. The lowest liver V30 was obtained with VMAT but not with statistically different than IMRT and HT. Mean liver doses were statistically inferior with 3D. The worst spinal cord doses were seen with 3D. The integral dose of the body did not differ among the techniques. CONCLUSION: In comparison of the four techniques, 3D seems to be the most unsuitable method regarding sparing the normal tissues. According to availability, HT and VMAT should be primarily preferred. IMRT can also be used with carefully paying attention to the clinical condition of the patient.

Synchronous Hepatocellular Carcinoma and Cholangiocellular Carcinoma on 18F-FDG PET/CT

A 43-year-old male patient presented with a mass lesion on the right liver lobe, segment 5, in radiological imaging and elevated alpha-fetoprotein levels (323 ng/mL) compatible with hepatocellular carcinoma (HCC). Positron emission tomography/computed tomography (PET/CT) images showed background level 18F-FDG uptake in the mass lesion. In addition, a secondary focus of increased 18F-FDG uptake was detected on the left liver lobe, segment 2, approximately 1,5 cm in diameter. Histopathological examination revealed HCC in the larger mass lesion with a lower 18F-FDG uptake, and cholangiocellular carcinoma in the smaller mass lesion with a higher 18F-FDG uptake. To our knowledge, this is the first case report of two histopathologically different primary malignant liver tumors in two distinct segments of the liver detected by PET/CT.