2025-12-21
Marija Živković Radojević, Katarina Janković, Marko Folić, Marko Spasić, Vladan Marković, Dragan Lončar, Pavle Petković, Radiša Vojinović, Neda Milosavljević
Background : The 2018 International Federation of Gynecology and Obstetrics (FIGO) classification redefined stage III of locally advanced cervical cancer into substages IIIC1 pelvic and IIIC2 para-aortic lymphadenopathy, ignoring the number and size of lymph nodes. The aim was to analyse of the volume burden influence of the primary tumor and pathological lymph nodes, on the three-year overall survival (OS) and progression free survival (PFS), in cervical cancer patients FIGO stages IIIC1 and IIIC2 treated with definitive chemoradiation. Materials and methods : A retrospective clinical study based on the analysis of three-year OS, PFS and factors that may influence the time to disease progression in cervical cancer patients in FIGO IIIC1 and IIIC2 stages treated from January 2020 to January 2024 with external beam radiotherapy (EBRT) with simultaneous integrated or sequential boost doses, brachytherapy and chemopotentiation at the Radiation Oncology Center of the UCC Kragujevac. Results: The study included 92 patients whose three-year OS was 68.5%, while PFS was 57.6%. The influence of age, comorbidity, belonging to stage IIIC1 or IIIC2, pathohistological tumor characteristics, number, total volume (GTVn) or the presence of a conglomerate of lymph nodes, tumor volume (GTVt), treatment duration over 56 days and radiotherapy technique on the length of PFS was examined. The length of PFS is influenced by treatment duration over 56 days, GTVn, number and conglomeration of lymph nodes, and EBRT dose (p < 0.05). Conclusions: The number and total volume of lymph nodes have a statistically significant effect on the length of PFS in FIGO stage IIIC1 and IIIC2 cervical cancer patients treated with definitive chemoradiation.
2025-12-20
Koji Kosaka, Yoshihiro Ueda, Yuji Kuroki, Hikari Minami, Shoki Inui, Masahiro Morimoto, Ryohei Sasaki
Background: This study evaluated the usefulness of a diagnostic imaging workstation in streamlining procedures and improving the accuracy of contouring pelvic bones with characteristic shapes. Materials and methods: The study included 18 patients with computed tomography (CT) images of the pelvic bone undergoing radiation therapy planning. Four pelvic bone structures (ST) were created: ST_EZ1, ST_EZ3, ST_Zio, and ST_MN. ST_EZ1 and ST_EZ3 using the automatic contouring function of EZ Sketch in Monaco (Elekta Inc.), a treatment planning system (TPS). ST_EZ3 was then duplicated and manually modified to create ST_MN. The CT data were reconstructed using Ziostation2 to create pelvic bone-only data, which were then imported into the TPS to create the structure using EZ Sketch. A 2-mm inner margin was added to create ST_Zio. Each structure was compared with ST_MN and evaluated using the Hausdorff distance (HD), mean distance to agreement (MDA), Dice similarity coefficient (DSC), and Jaccard similarity coefficient (JSC). Results: A comparison of ST_EZ1, ST_EZ3, and ST_Zio with ST_MN revealed the following: average HD, 53.87, 33.14, and 16.64, respectively; average MDA, 3.70, 2.03, and 0.99, respectively; average DSC, 0.80, 0.85, and 0.91, respectively; and average JSC, 0.68, 0.74, and 0.83, respectively. The average structure creation times were 1 min 7 s for ST_EZ1, 3 min 45 s for ST_EZ3, 1 min 50 s for ST_Zio, and 33 min 5 s for ST_MN. Conclusion: Diagnostic imaging workstations are effective for pelvic bone contouring, improving both efficiency and accuracy.
2025-12-20
Kae Okuma, Tairo Kashihara, Yuko Nakayama, Koji Inaba, Tomoya Kaneda, Kana Takahashi, Madoka Sakuramachi, Ayaka Nagao, Akane Yoshiba, Hiroshi Igaki
Background: Concurrent chemoradiotherapy followed by durvalumab is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). However, uniform radiation dose escalation has failed to improve outcomes due to increased toxicity. The intentional internal high dose policy (IIHDP) selectively escalates radiation dose within the tumor while sparing organs at risk (OARs). This study assesses the feasibility and clinical outcomes of IIHDP using volumetric modulated arc therapy (VMAT). Materials and methods: We retrospectively analyzed 280 patients treated with definitive VMAT from 2017 to 2024, divided into IIHDP (n = 112) and homogeneous dose distribution policy (HDDP; n = 168) groups. The primary endpoint was local recurrence control (LRC); secondary endpoints included overall survival (OS), progression-free survival (PFS), and toxicity. Receiver operating characteristic (ROC) analysis was used to evaluate planning target volume (PTV) volume as a predictor of LRC. Results: Median follow-up was 20.5 months. The 2-year LRC was 75% (IIHDP) and 72% (HDDP) (p = 0.296). In patients with large PTVs (≥ 373 cc), IIHDP showed a trend toward improved LRC, though not statistically significant. The 2-year OS was 75% in both groups. Durvalumab ≥ 6 months was a strong independent predictor of OS [p < 0.001; hazard ratio (HR) = 0.274]. Rates of grade ≥ 3 pneumonitis (2.7% vs. 3.6%, p = 0.490) and esophagitis (0% vs. 1.2%, p = 0.212) were similar across groups. Conclusions: IIHDP with VMAT appears feasible and safe in selected patients with stage III NSCLC, achieving favorable tumor control without added toxicity or interruption of durvalumab. Further prospective studies are warranted to validate its benefit and define optimal patient selection.
2025-12-20
Geovanne Pedro Mauro, Vinicius de Carvalho Gico, Gabriel Faria Najas, Evandro César de Souza, Eduardo Weltman, Eberval Gadelha Figueiredo, Heloisa de Andrade Carvalho, Silvia Radwanski Stuart, Leila Maria Da Róz
Background: Stereotactic radiosurgery (SRS) has a fundamental role in the treatment of breast cancer brain metastases (BCBM). Current data on the matter comes from trials with brain metastases from any histology or with limited description on survival, focusing mostly on response rate. This retrospective study will assess the impact of SRS on survival and its interaction with systemic treatment (ST). Materials and methods: Charts from January 2011 to July 2022 were retrospectively assessed to investigate the relation between SRS and concurrent ST for BCBM. Since different protocols for ST can be offered, we divided our cohort and assessed the impact of different concurrent ST, in each subtype, on oncological survival outcomes. Results: There were 208 patients, 138 met inclusion criteria. Median follow-up was 10.7 months. Median overall survival (OS), progression-free survival (PFS), survival-free from central nervous system (CNS) progression and survival-free from new neurological deficits were 12.5, 14.1, 16.2, and 16.3 months, respectively. For the whole cohort, any concurrent ST did not impact OS (p = 0.68). For hormone-positive patients, concurrent hormone therapy (HT) did not impact OS (p = 0.75). For those receiving anti-human epidermal growth factor receptor-type 2 (anti-HER-2) therapy there was no impact on OS (p = 0.47). Propensity score match analysis found that ST during SRS would reduce the chance of death by 19.4%. ST did not impact toxicities, chances of radionecrosis nor survival free of neurological symptoms. Conclusions: There has been an increase in research on the synergy between SRS and ST. In our study, this synergy was not sensible for oncological outcomes. New prospective research should focus more on survival outcomes than response rate.
2025-12-16
Martin Palička, Marian Rybar, Jana Jackaninová, Lukáš Knybel, Stefan Reguli, Tomáš Blazek, Silvia Tomoszkova, Jakub Cvek
Background: Meningiomas are the most common primary brain tumors in adults, typically managed with surgery, stereotactic radiosurgery (SRS), or hypofractionated stereotactic radiotherapy (hFSRT). While local control rates are high, volumetric regression dynamics and radiobiological parameters remain underexplored. This study evaluates meningioma regression after SRS and hFSRT and estimates the α/β ratio to refine radiotherapy strategies. Materials and methods: A retrospective analysis included 150 patients with intracranial meningiomas treated between 2010–2021. Volumetric assessment was performed for 62 lesions (1–10 cm³) treated with SRS (1 × 14 Gy) or hFSRT (3 × 7 Gy, 5 × 5 Gy, 5 × 6 Gy). Tumor volumes were measured pre-treatment and during follow-up using 3D MRI reconstruction. Radiobiological modeling and α/β calculation employed linear-quadratic (LQ) and linear-quadratic-linear (LQ-L) models. Results: SRS achieved significantly faster regression, with tumors shrinking by 32.7% at 2 years and 67.4% at 4 years, compared with 15.3% and 31.7% for hFSRT (p = 0.003). The α/β ratio was calculated at 3.15 Gy [95% confidence interval (CI): 3.07–3.23], refining understanding of meningioma radiobiology. Local control reached 91.3%, with comparable outcomes for SRS (91.4%) and hFSRT (91.3%). Symptomatic complications included brain edema (7.9%) and radiation necrosis (2.6%). Conclusion: CyberKnife SRS and hFSRT are effective and safe for meningiomas, though SRS induces faster volumetric regression (19% vs. 9% annual reduction for hFSRT). The α/β ratio of 3.15 Gy provides novel radiobiological insight, supporting more personalized treatment strategies.
2025-12-15
Prashant Gupta, Varun Kumar Agarwal, Anoop Kumar Varshney
Background: Sentinel lymph node biopsy (SLNB) is important in the treatment and staging of early-stage breast carcinoma. Traditional methods, including blue dyes and radiocolloids, are limited by high cost, radiation safety concerns, and reliance on nuclear medicine centers. Low-cost fluorescent dye, fluorescein, has been suggested as a potential alternative due to its safety, ease of visualization, and low cost. This study aimed to find the sensitivity of fluorescein as an alternative to radiocolloid in SLNB for breast carcinoma. Materials and methods: A prospective observational study was done at a tertiary care teaching hospital in 50 female patients of early-stage breast carcinoma. Intraoperative injection of fluorescein and visualization with ultraviolet (UV) light were done. Sentinel nodes were detected with a hand-held UV light source. Results: Fluorescein detected sentinel nodes in 96% of patients. Fluorescein had a sensitivity of 96%, specificity of 98%, and 4.2% false-negative rate (FNR). Negative predictive value (NPV) was 98.5%. No significant adverse effects were noted. Conclusion: Fluorescein is a safe, cost-effective, and efficient replacement for radiocolloid in SLNB in breast cancer. It provides outstanding identification rates, sensitivity, and specificity and can be utilized to the best in low-resource settings. Multicenter trials are required to confirm these findings and promote more widespread adoption of fluorescein-based SLNB in clinical care.
2025-10-07
Divyesh Kumar, Jayanta Samanta, Harshal Mandavdhare, Santosh Irrinki, Pankaj Gupta, Parikshaa Gupta, Shikha Goyal, Divya Khosla, Rakesh Kapoor
Background: Extrahepatic biliary tract cancer (BTC) group of cancers are considered as highly lethal. Patients who are unfit for definitive treatment (surgery/chemotherapy) are usually kept on best supportive care (BSC) only. Literature regarding the role of palliative radiation therapy (RT) in this patient population is limited. Thus, this study aimed to evaluate the role of palliative RT in patients with advanced-stage BTC. Materials and methods: After obtaining institutional ethics committee approval, patients who fulfilled the inclusion or exclusion criteria were included in this study. Patients were treated by palliative RT (30 Gy/10#) by 3DCRT post-PTBD insertion, if jaundice was present. Patients were assessed for response, pain, and quality of life (QoL). Results were statistically analyzed using SPSS version 22. Results: Fifteen patients were selected for analysis. The mean age of the patients was 52 years (range 41–67 years). The female-to-male ratio was 4:1. Jaundice was the primary presenting symptom in 5/15 (33.33%) of patients, whereas pain alone and in combination with jaundice was observed in 3/15 (20%) and 7/15 (46.66%), respectively. Among all assessed, 53.33% showed a partial response, 26.66% showed stable disease, and 20% showed progressive disease, while no patients had a complete response. Grade 2 toxicities were observed mainly. Statistically significant changes were seen in visual analogue scores (VAS), and QoL showed improvement post RT. Conclusions: Palliative RT seems effective in patients with advanced-stage BTC who otherwise are kept on BSC only, with minimal and manageable toxicities. Studies with a larger sample size are warranted.
2025-10-03
Alexander Bennassi, Kamel Debbi, Lahcène Belaïdi, Fatima Zahra Bellefkih, Taoufik El Gnaoui, Karim Belhadj, Narjess Daikhi, Gabriele Coraggio, Yazid Belkacemi
Not required for Clinical Vignette.
2025-09-12
Wiktoria Maria Suchorska, Witold Cholewinski, Jolanta Kunikowska, Dariusz Pawlak, Maciej Paweł Jankowski, Agata Karolina Pietrzak
Background: The purpose of the study was to discuss the role of molecular imaging in stem cells (SCs) therapy and SC tracking with the special focus on nuclear medicine (NM) applications. Materials and methods: A comprehensive analysis of studies published between 2010 and 2025 focusing on the application of molecular imaging in SCs research with the special focus on NM applications. Results: Molecular imaging provides the possibility of tracking SCs in vivo , enabling insights into their biodistribution, viability, and therapeutic efficacy. We observed that the most of the studies discussed the use of the mesenchymal SC, neural SC and cancer SC, presenting the magnetic resonance imaging (MRI) and positron emission tomography (PET) methods as the most useful imaging tools for SCs-based therapy monitoring. However, the SCs tracking in itself is a complex issue and, more frequently than not, more than one method is required for the diagnostic protocol to be successful. Depending on the properties of the imaging technique, the different aspect — transplanted SCs biology or the treated tissue’s damage and repair process — might be examined. Conclusions: Molecular imaging plays a central role in SC research, offering non-invasive and dynamic visualization of SC in vivo that ensures the possibility to provide the regenerative and cancer treatment with PET-CT and MRI being the most frequently mentioned in the literature and presenting different advantages in SCs-based therapy monitoring.