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Cancers
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Advances in Modern Radiation Oncology
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Advances in Modern Radiation Oncology

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 27296

Special Issue Editor

Prof. Dr. Anca-Ligia Grosu

E-Mail Website
Guest Editor
University of Freiburg Medical Center, German Cancer Consortium DKTK, Partner Site Freiburg, Freiburg, Germany
Interests: imaging for radiation oncology; neuro-oncology; prostate cancer; stereotactic radiotherapy

Special Issue Information

Dear Colleagues,

The Special Issue “Advances in Modern Radiation Oncology” aims at presenting important developments in this field in recent years and discussing perspectives and possible future developments.

Like other areas of oncology, radiation oncology follows three important goals: precision, personalization, and individualization of the treatment.

Precision: Significant technological developments have made it possible to apply increasing radiation doses with high precision, resulting in maximum sparing of healthy tissue and allowing escalation of the radiation dose to tumor sites. In this respect, increasing precision aims at improving local tumor control while reducing side effects. Treatment techniques such as image-guided (IGRT) and intensity-modulated radiotherapy (IMRT), radiosurgery/stereotactic radiotherapy, and brachytherapy have become established worldwide. In addition, the number of centers offering particle therapy such as proton or heavier ion treatment is increasing. The main advantages of these therapeutic strategies are discussed in detail in this issue, and the worldwide availability of precision radiation oncology, including the development of radiation therapy in the Third World, is also covered.

Personalization: In the second part of this issue, we will discuss the role of imaging and biomarkers for a personalized radiation oncology. We will show, in different tumor entities, the importance of imaging for radiotherapy planning in order to make treatment not only precise but also personalized. The correlation between biomarkers and bio-imaging markers for a personalized radiation treatment will be an important topic of this Special Issue, and novel strategies to improve biological patient stratification based on artificial intelligence (AI), convolutional neuronal networks (CNN), and deep learning technologies will be covered.

The combination of radiotherapy with chemotherapy and especially with immunotherapy and targeted therapy is another important aspect of radiation oncology personalization. Multiple studies have demonstrated synergistic effects between radiation and immunotherapy and the underlying mechanisms. This synergy reveals an enormous potential in the further development of new interdisciplinary oncologic treatment concepts. Radiation biology has been proven to be a highly innovative field of research, and a deeper understanding of the complex radiobiology of tumors and normal tissues will ultimately result in improvements in radiation therapy. In this respect, recent advances regarding FLASH radiation, the radiobiology of normal tissue and tumor stem cells, the interaction between tumor, stroma, and the immune system or the biology of high-LET radiation have a high potential for translation into clinical application.

Individualization: In addition to base radiation treatment decisions on available biological or bio-imaging markers, treatment individualization also takes into account patient-specific features including individual anatomies, co-morbidities, patient performance, and patient preferences. In this respect, the individualization of radiation treatments allows shared decision-making processes and an increasing empowerment of patients. Currently available technologies such as patient- and disease-specific apps or the structured and longitudinal electronic collection of patient-reported outcomes (ePROMs) will massively boost the development of individualization strategies in radiation oncology.

Therefore, this issue will provide an overview of recent technological, biological, and clinical developments and advances in radiation oncology and also allow a perspective for the future of this area.

Prof. Dr. Anca-Ligia Grosu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Published Papers (11 papers)

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Research

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14 pages, 1669 KiB  
Article
A Prospective Study on Deep Inspiration Breath Hold Thoracic Radiation Therapy Guided by Bronchoscopically Implanted Electromagnetic Transponders
by Yuzhong Jeff Meng, Nikhil P. Mankuzhy, Mohit Chawla, Robert P. Lee, Ellen D. Yorke, Zhigang Zhang, Emily Gelb, Seng Boh Lim, John J. Cuaron, Abraham J. Wu, Charles B. Simone II, Daphna Y. Gelblum, Dale Michael Lovelock, Wendy Harris and Andreas Rimner
Cancers 2024, 16(8), 1534; https://doi.org/10.3390/cancers16081534 - 17 Apr 2024
Viewed by 1281
Abstract
Background: Electromagnetic transponders bronchoscopically implanted near the tumor can be used to monitor deep inspiration breath hold (DIBH) for thoracic radiation therapy (RT). The feasibility and safety of this approach require further study. Methods: We enrolled patients with primary lung cancer or lung [...] Read more.
Background: Electromagnetic transponders bronchoscopically implanted near the tumor can be used to monitor deep inspiration breath hold (DIBH) for thoracic radiation therapy (RT). The feasibility and safety of this approach require further study. Methods: We enrolled patients with primary lung cancer or lung metastases. Three transponders were implanted near the tumor, followed by simulation with DIBH, free breathing, and 4D-CT as backup. The initial gating window for treatment was ±5 mm; in a second cohort, the window was incrementally reduced to determine the smallest feasible gating window. The primary endpoint was feasibility, defined as completion of RT using transponder-guided DIBH. Patients were followed for assessment of transponder- and RT-related toxicity. Results: We enrolled 48 patients (35 with primary lung cancer and 13 with lung metastases). The median distance of transponders to tumor was 1.6 cm (IQR 0.6–2.8 cm). RT delivery ranged from 3 to 35 fractions. Transponder-guided DIBH was feasible in all but two patients (96% feasible), where it failed because the distance between the transponders and the antenna was >19 cm. Among the remaining 46 patients, 6 were treated prone to keep the transponders within 19 cm of the antenna, and 40 were treated supine. The smallest feasible gating window was identified as ±3 mm. Thirty-nine (85%) patients completed one year of follow-up. Toxicities at least possibly related to transponders or the implantation procedure were grade 2 in six patients (six incidences, cough and hemoptysis), grade 3 in three patients (five incidences, cough, dyspnea, pneumonia, and supraventricular tachycardia), and grade 4 pneumonia in one patient (occurring a few days after implantation but recovered fully and completed RT). Toxicities at least possibly related to RT were grade 2 in 18 patients (41 incidences, most commonly cough, fatigue, and pneumonitis) and grade 3 in four patients (seven incidences, most commonly pneumonia), and no patients had grade 4 or higher toxicity. Conclusions: Bronchoscopically implanted electromagnetic transponder–guided DIBH lung RT is feasible and safe, allowing for precise tumor targeting and reduced normal tissue exposure. Transponder–antenna distance was the most common challenge due to a limited antenna range, which could sometimes be circumvented by prone positioning. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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12 pages, 1336 KiB  
Article
Radiotherapy for Metastatic Epidural Spinal Cord Compression with Increased Doses: Final Results of the RAMSES-01 Trial
by Dirk Rades, Darejan Lomidze, Natalia Jankarashvili, Fernando Lopez Campos, Arturo Navarro-Martin, Barbara Segedin, Blaz Groselj, Christian Staackmann, Charlotte Kristiansen, Kristopher Dennis, Steven E. Schild and Jon Cacicedo
Cancers 2024, 16(6), 1149; https://doi.org/10.3390/cancers16061149 - 14 Mar 2024
Cited by 2 | Viewed by 1743
Abstract
Patients with metastatic epidural spinal cord compression (MESCC) and favorable survival prognoses may benefit from radiation doses exceeding 10 × 3.0 Gy. In a multi-center phase 2 trial, patients receiving 15 × 2.633 Gy (41.6 Gy10) or 18 × 2.333 Gy [...] Read more.
Patients with metastatic epidural spinal cord compression (MESCC) and favorable survival prognoses may benefit from radiation doses exceeding 10 × 3.0 Gy. In a multi-center phase 2 trial, patients receiving 15 × 2.633 Gy (41.6 Gy10) or 18 × 2.333 Gy (43.2 Gy10) were evaluated for local progression-free survival (LPFS), motor/sensory functions, ambulatory status, pain, distress, toxicity, and overall survival (OS). They were compared (propensity score-adjusted Cox regression) to a historical control group (n = 266) receiving 10 × 3.0 Gy (32.5 Gy10). In the phase 2 cohort, 50 (of 62 planned) patients were evaluated for LPFS. Twelve-month rates of LPFS and OS were 96.8% and 69.9%, respectively. Motor and sensory functions improved in 56% and 57.1% of patients, and 94.0% were ambulatory following radiotherapy. Pain and distress decreased in 84.4% and 78.0% of patients. Ten and two patients experienced grade 2 and 3 toxicities, respectively. Phase 2 patients showed significantly better LPFS than the control group (p = 0.039) and a trend for improved motor function (p = 0.057). Ambulatory and OS rates were not significantly different. Radiotherapy with 15 × 2.633 Gy or 18 × 2.333 Gy was well tolerated and appeared superior to 10 × 3.0 Gy. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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15 pages, 1766 KiB  
Article
Diabetes Mellitus Is a Strong Independent Negative Prognostic Factor in Patients with Brain Metastases Treated with Radiotherapy
by Seong Jeong, Soniya Poudyal, Sabine Klagges, Thomas Kuhnt, Kirsten Papsdorf, Peter Hambsch, Johannes Wach, Erdem Güresir, Franziska Nägler, Alexander Rühle, Nils H. Nicolay and Clemens Seidel
Cancers 2023, 15(19), 4845; https://doi.org/10.3390/cancers15194845 - 4 Oct 2023
Cited by 2 | Viewed by 1959
Abstract
Background: Brain metastases (BM) cause relevant morbidity and mortality in cancer patients. The presence of cerebrovascular diseases can alter the tumor microenvironment, cellular proliferation and treatment resistance. However, it is largely unknown if the presence of distinct cerebrovascular risk factors may alter the [...] Read more.
Background: Brain metastases (BM) cause relevant morbidity and mortality in cancer patients. The presence of cerebrovascular diseases can alter the tumor microenvironment, cellular proliferation and treatment resistance. However, it is largely unknown if the presence of distinct cerebrovascular risk factors may alter the prognosis of patients with BM. Methods: Patients admitted for the radiotherapy of BM at a large tertiary cancer center were included. Patient and survival data, including cerebrovascular risk factors (diabetes mellitus (DM), smoking, arterial hypertension, peripheral arterial occlusive disease, hypercholesterolemia and smoking) were recorded. Results: 203 patients were included. Patients with DM (n = 39) had significantly shorter overall survival (OS) (HR 1.75 (1.20–2.56), p = 0.003, log-rank). Other vascular comorbidities were not associated with differences in OS. DM remained prognostically significant in the multivariate Cox regression including established prognostic factors (HR 1.92 (1.20–3.06), p = 0.006). Furthermore, subgroup analyses revealed a prognostic role of DM in patients with non-small cell lung cancer, both in univariate (HR 1.68 (0.97–2.93), p = 0.066) and multivariate analysis (HR 2.73 (1.33–5.63), p = 0.006), and a trend in melanoma patients. Conclusion: DM is associated with reduced survival in patients with BM. Further research is necessary to better understand the molecular mechanisms and therapeutic implications of this important interaction. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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11 pages, 3603 KiB  
Article
Immune Checkpoint Inhibitors after Radiation Therapy Improve Overall Survival Rates in Patients with Stage IV Lung Cancer
by Hidekazu Tanaka, Kazushi Ueda, Masako Karita, Taiki Ono, Yuki Manabe, Miki Kajima, Koya Fujimoto, Yuki Yuasa and Takehiro Shiinoki
Cancers 2023, 15(17), 4260; https://doi.org/10.3390/cancers15174260 - 25 Aug 2023
Cited by 3 | Viewed by 1458
Abstract
This exploratory and retrospective study aimed to evaluate whether there is a difference in the overall survival (OS) rates of patients with stage IV lung cancer who underwent radiation therapy (RT) depending on the presence or absence of immune checkpoint inhibitors (ICIs) and [...] Read more.
This exploratory and retrospective study aimed to evaluate whether there is a difference in the overall survival (OS) rates of patients with stage IV lung cancer who underwent radiation therapy (RT) depending on the presence or absence of immune checkpoint inhibitors (ICIs) and the timing of their use. Eighty patients with histologically confirmed stage IV lung cancer were enrolled, and ICIs were administered to thirty (37.5%). ICIs were administered before RT and after RT in 11 and 20 patients, respectively. The median follow-up period was 6 (range: 1–37) months. Patients treated with ICIs had significantly better OS rates than those not treated with ICIs (p < 0.001). The 6-month OS rates in patients treated with and without ICIs were 76.3% and 34.5%, respectively. The group that received ICI therapy after RT had a significantly better OS rate than the group that received ICI therapy prior to RT (6-month OS: 94.7% vs. 40.0%, p < 0.001). In the multivariate analysis, performance status (0–1 vs. 2–4) and ICI use after RT were significant factors for OS (p = 0.032 and p < 0.001, respectively). Our results suggest that ICI administration after RT may prolong the OS of patients with stage IV lung cancer. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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12 pages, 1819 KiB  
Article
ASSET: Auto-Segmentation of the Seventeen SEgments for Ventricular Tachycardia Ablation in Radiation Therapy
by Eric Morris, Robert Chin, Trudy Wu, Clayton Smith, Siamak Nejad-Davarani and Minsong Cao
Cancers 2023, 15(16), 4062; https://doi.org/10.3390/cancers15164062 - 11 Aug 2023
Cited by 2 | Viewed by 1832
Abstract
There has been a recent effort to treat high-risk ventricular tachycardia (VT) patients through radio-ablation. However, manual segmentation of the VT target is complex and time-consuming. This work introduces ASSET, or Auto-segmentation of the Seventeen SEgments for Tachycardia ablation, to aid in radiation [...] Read more.
There has been a recent effort to treat high-risk ventricular tachycardia (VT) patients through radio-ablation. However, manual segmentation of the VT target is complex and time-consuming. This work introduces ASSET, or Auto-segmentation of the Seventeen SEgments for Tachycardia ablation, to aid in radiation therapy (RT) planning. ASSET was retrospectively applied to CTs for 26 thoracic RT patients (13 undergoing VT ablation). The physician-defined parasternal long-axis of the left ventricle (LV) and the axes generated from principal component analysis (PCA) were compared using mean distance to agreement (MDA) and angle of separation. The manually selected right ventricle insertion point and LVs were used to apply the ASSET model to automatically generate the 17 segments of the LV myocardium (LVM). Physician-defined parasternal long-axis differed from PCA by 1.2 ± 0.3 mm MDA and 6.9 ± 0.7 degrees. Segments differed by 0.69 ± 0.29 mm MDA and 0.89 ± 0.03 Dice similarity coefficient. Running ASSET takes <5 min where manual segmentation took >2 h/patient. Agreement between ASSET and expert contours was comparable to inter-observer variability. Qualitative scoring conducted by three experts revealed automatically generated segmentations were clinically useable as-is. ASSET offers efficient and reliable automatic segmentations for the 17 segments of the LVM for target generation in RT planning. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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17 pages, 1554 KiB  
Article
Dose Reduction to Motor Structures in Adjuvant Fractionated Stereotactic Radiotherapy of Brain Metastases: nTMS-Derived DTI-Based Motor Fiber Tracking in Treatment Planning
by Christian D. Diehl, Enrike Rosenkranz, Maximilian Schwendner, Martin Mißlbeck, Nico Sollmann, Sebastian Ille, Bernhard Meyer, Stephanie E. Combs and Sandro M. Krieg
Cancers 2023, 15(1), 282; https://doi.org/10.3390/cancers15010282 - 31 Dec 2022
Cited by 1 | Viewed by 3008
Abstract
Background: Resection of brain metastases (BM) close to motor structures is challenging for treatment. Navigated transcranial magnetic stimulation (nTMS) motor mapping, combined with diffusion tensor imaging (DTI)-based fiber tracking (DTI-FTmot.TMS), is a valuable tool in neurosurgery to preserve motor function. This [...] Read more.
Background: Resection of brain metastases (BM) close to motor structures is challenging for treatment. Navigated transcranial magnetic stimulation (nTMS) motor mapping, combined with diffusion tensor imaging (DTI)-based fiber tracking (DTI-FTmot.TMS), is a valuable tool in neurosurgery to preserve motor function. This study aimed to assess the practicability of DTI-FTmot.TMS for local adjuvant radiotherapy (RT) planning of BM. Methods: Presurgically generated DTI-FTmot.TMS-based corticospinal tract (CST) reconstructions (FTmot.TMS) of 24 patients with 25 BM resected during later surgery were incorporated into the RT planning system. Completed fractionated stereotactic intensity-modulated RT (IMRT) plans were retrospectively analyzed and adapted to preserve FTmot.TMS. Results: In regular plans, mean dose (Dmean) of complete FTmot.TMS was 5.2 ± 2.4 Gy. Regarding planning risk volume (PRV-FTTMS) portions outside of the planning target volume (PTV) within the 17.5 Gy (50%) isodose line, the DTI-FTmot.TMS Dmean was significantly reduced by 33.0% (range, 5.9–57.6%) from 23.4 ± 3.3 Gy to 15.9 ± 4.7 Gy (p < 0.001). There was no significant decline in the effective treatment dose, with PTV Dmean 35.6 ± 0.9 Gy vs. 36.0 ± 1.2 Gy (p = 0.063) after adaption. Conclusions: The DTI-FTmot.TMS-based CST reconstructions could be implemented in adjuvant IMRT planning of BM. A significant dose reduction regarding motor structures within critical dose levels seems possible. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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12 pages, 1091 KiB  
Article
Low-Energy X-Ray Intraoperative Radiation Therapy (Lex-IORT) for Resected Brain Metastases: A Single-Institution Experience
by Christian D. Diehl, Steffi U. Pigorsch, Jens Gempt, Sandro M. Krieg, Silvia Reitz, Maria Waltenberger, Melanie Barz, Hanno S. Meyer, Arthur Wagner, Jan Wilkens, Benedikt Wiestler, Claus Zimmer, Bernhard Meyer and Stephanie E. Combs
Cancers 2023, 15(1), 14; https://doi.org/10.3390/cancers15010014 - 20 Dec 2022
Cited by 17 | Viewed by 2384
Abstract
Background: Resection followed by local radiation therapy (RT) is the standard of care for symptomatic brain metastases. However, the optimal technique, fractionation scheme and dose are still being debated. Lately, low-energy X-ray intraoperative RT (lex-IORT) has been of increasing interest. Method: Eighteen consecutive [...] Read more.
Background: Resection followed by local radiation therapy (RT) is the standard of care for symptomatic brain metastases. However, the optimal technique, fractionation scheme and dose are still being debated. Lately, low-energy X-ray intraoperative RT (lex-IORT) has been of increasing interest. Method: Eighteen consecutive patients undergoing BM resection followed by immediate lex-IORT with 16–30 Gy applied to the spherical applicator were retrospectively analyzed. Demographic, RT-specific, radiographic and clinical data were reviewed to evaluate the effectiveness and safety of IORT for BM. Descriptive statistics and Kaplan–Meyer analysis were applied. Results: The mean follow-up time was 10.8 months (range, 0–39 months). The estimated local control (LC), distant brain control (DBC) and overall survival (OS) at 12 months post IORT were 92.9% (95%-CI 79.3–100%), 71.4% (95%-CI 50.2–92.6%) and 58.0% (95%-CI 34.1–81.9%), respectively. Two patients developed radiation necrosis (11.1%) and wound infection (CTCAE grade III); both had additional adjuvant treatment after IORT. For five patients (27.8%), the time to the start or continuation of systemic treatment was ≤15 days and hence shorter than wound healing and adjuvant RT would have required. Conclusion: In accordance with previous series, this study demonstrates the effectiveness and safety of IORT in the management of brain metastases despite the small cohort and the retrospective characteristic of this analysis. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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12 pages, 1804 KiB  
Article
Stereotactic Body Radiotherapy for Renal Cell Carcinoma in Patients with Von Hippel–Lindau Disease—Results of a Prospective Trial
by Simon Kirste, Alexander Rühle, Stefan Zschiedrich, Wolfgang Schultze-Seemann, Cordula A. Jilg, Elke Neumann-Haefelin, Simon S. Lo, Anca-Ligia Grosu and Emily Kim
Cancers 2022, 14(20), 5069; https://doi.org/10.3390/cancers14205069 - 17 Oct 2022
Cited by 14 | Viewed by 2789
Abstract
Von Hippel–Lindau disease (VHL) is a hereditary disorder associated with malignant tumors including clear cell renal cell carcinoma (ccRCC). Partial nephrectomy is complicated by multilocular tumor occurrence and a high recurrence rate. The aim of this study was to evaluate the potential of [...] Read more.
Von Hippel–Lindau disease (VHL) is a hereditary disorder associated with malignant tumors including clear cell renal cell carcinoma (ccRCC). Partial nephrectomy is complicated by multilocular tumor occurrence and a high recurrence rate. The aim of this study was to evaluate the potential of stereotactic body radiotherapy (SBRT) as an alternative treatment approach in VHL patients with multiple ccRCC. Patients with VHL and a diagnosis of ccRCC were enrolled. SBRT was conducted using five fractions of 10 Gy or eight fractions of 7.5 Gy. The primary endpoint was local control (LC). Secondary endpoints included alteration of renal function and adverse events. Seven patients with a total of eight treated lesions were enrolled. Median age was 44 years. Five patients exhibited multiple bilateral kidney cysts in addition to ccRCC. Three patients underwent at least one partial nephrectomy in the past. After a median follow-up of 43 months, 2-year LC was 100%, while 2-year CSS, 2-year PFS and 2-year OS was 100%, 85.7% and 85.7%, respectively. SBRT was very well tolerated with no acute or chronic toxicities grade ≥ 2. Mean estimated glomerular filtration rate (eGFR) at baseline was 83.7 ± 13.0 mL/min/1.73 m2, which decreased to 76.6 ± 8.0 mL/min/1.73 m2 after 1 year. Although the sample size was small, SBRT resulted in an excellent LC rate and was very well tolerated with preservation of kidney function in patients with multiple renal lesions and cysts. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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Review

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13 pages, 710 KiB  
Review
Stereotactic Radiosurgery of Multiple Brain Metastases: A Review of Treatment Techniques
by Raphael Bodensohn, Sebastian H. Maier, Claus Belka, Giuseppe Minniti and Maximilian Niyazi
Cancers 2023, 15(22), 5404; https://doi.org/10.3390/cancers15225404 - 14 Nov 2023
Cited by 7 | Viewed by 2891
Abstract
The advancement of systemic targeted treatments has led to improvements in the management of metastatic disease, particularly in terms of survival outcomes. However, brain metastases remain less responsive to systemic therapies, underscoring the significance of local interventions for comprehensive disease control. Over the [...] Read more.
The advancement of systemic targeted treatments has led to improvements in the management of metastatic disease, particularly in terms of survival outcomes. However, brain metastases remain less responsive to systemic therapies, underscoring the significance of local interventions for comprehensive disease control. Over the past years, the threshold for treating brain metastases through stereotactic radiosurgery has risen. Yet, as the number of treated metastases increases, treatment complexity and duration also escalate. This trend has made multi-isocenter radiosurgery treatments, such as those with the Gamma Knife, challenging to plan and lengthy for patients. In contrast, single-isocenter approaches employing linear accelerators offer an efficient and expeditious treatment option. This review delves into the literature, comparing different linear-accelerator-based techniques with each other and in relation to dedicated systems, focusing on dosimetric considerations and feasibility. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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26 pages, 1907 KiB  
Review
Opportunities and Alternatives of Modern Radiation Oncology and Surgery for the Management of Resectable Brain Metastases
by Christian D. Diehl, Frank A. Giordano, Anca-L. Grosu, Sebastian Ille, Klaus-Henning Kahl, Julia Onken, Stefan Rieken, Gustavo R. Sarria, Ehab Shiban, Arthur Wagner, Jürgen Beck, Stefanie Brehmer, Oliver Ganslandt, Motaz Hamed, Bernhard Meyer, Marc Münter, Andreas Raabe, Veit Rohde, Karl Schaller, Daniela Schilling, Matthias Schneider, Elena Sperk, Claudius Thomé, Peter Vajkoczy, Hartmut Vatter and Stephanie E. Combsadd Show full author list remove Hide full author list
Cancers 2023, 15(14), 3670; https://doi.org/10.3390/cancers15143670 - 19 Jul 2023
Cited by 5 | Viewed by 3097
Abstract
Postsurgical radiotherapy (RT) has been early proven to prevent local tumor recurrence, initially performed with whole brain RT (WBRT). Subsequent to disadvantageous cognitive sequalae for the patient and the broad distribution of modern linear accelerators, focal irradiation of the tumor has omitted WBRT [...] Read more.
Postsurgical radiotherapy (RT) has been early proven to prevent local tumor recurrence, initially performed with whole brain RT (WBRT). Subsequent to disadvantageous cognitive sequalae for the patient and the broad distribution of modern linear accelerators, focal irradiation of the tumor has omitted WBRT in most cases. In many studies, the effectiveness of local RT of the resection cavity, either as single-fraction stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic RT (hFSRT), has been demonstrated to be effective and safe. However, whereas prospective high-level incidence is still lacking on which dose and fractionation scheme is the best choice for the patient, further ablative techniques have come into play. Neoadjuvant SRS (N-SRS) prior to resection combines straightforward target delineation with an accelerated post-surgical phase, allowing an earlier start of systemic treatment or rehabilitation as indicated. In addition, low-energy intraoperative RT (IORT) on the surgical bed has been introduced as another alternative to external beam RT, offering sterilization of the cavity surface with steep dose gradients towards the healthy brain. This consensus paper summarizes current local treatment strategies for resectable brain metastases regarding available data and patient-centered decision-making. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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Other

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16 pages, 310 KiB  
Guidelines
An International Consensus on the Design of Prospective Clinical–Translational Trials in Spatially Fractionated Radiation Therapy for Advanced Gynecologic Cancer
by Beatriz E. Amendola, Anand Mahadevan, Jesus Manuel Blanco Suarez, Robert J. Griffin, Xiaodong Wu, Naipy C. Perez, Daniel S. Hippe, Charles B. Simone II, Majid Mohiuddin, Mohammed Mohiuddin, James W. Snider, Hualin Zhang, Quynh-Thu Le and Nina A. Mayr
Cancers 2022, 14(17), 4267; https://doi.org/10.3390/cancers14174267 - 31 Aug 2022
Cited by 12 | Viewed by 2546
Abstract
Despite the unexpectedly high tumor responses and limited treatment-related toxicities observed with SFRT, prospective multi-institutional clinical trials of SFRT are still lacking. High variability of SFRT technologies and methods, unfamiliar complex dose and prescription concepts for heterogeneous dose and uncertainty regarding systemic therapies [...] Read more.
Despite the unexpectedly high tumor responses and limited treatment-related toxicities observed with SFRT, prospective multi-institutional clinical trials of SFRT are still lacking. High variability of SFRT technologies and methods, unfamiliar complex dose and prescription concepts for heterogeneous dose and uncertainty regarding systemic therapies present major obstacles towards clinical trial development. To address these challenges, the consensus guideline reported here aimed at facilitating trial development and feasibility through a priori harmonization of treatment approach and the full range of clinical trial design parameters for SFRT trials in gynecologic cancer. Gynecologic cancers were evaluated for the status of SFRT pilot experience. A multi-disciplinary SFRT expert panel for gynecologic cancer was established to develop the consensus through formal panel review/discussions, appropriateness rank voting and public comment solicitation/review. The trial design parameters included eligibility/exclusions, endpoints, SFRT technology/technique, dose/dosimetric parameters, systemic therapies, patient evaluations, and embedded translational science. Cervical cancer was determined as the most suitable gynecologic tumor for an SFRT trial. Consensus emphasized standardization of SFRT dosimetry/physics parameters, biologic dose modeling, and specimen collection for translational/biological endpoints, which may be uniquely feasible in cervical cancer. Incorporation of brachytherapy into the SFRT regimen requires additional pre-trial pilot investigations. Specific consensus recommendations are presented and discussed. Full article
(This article belongs to the Special Issue Advances in Modern Radiation Oncology)
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