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International Journal of Molecular... Mar 2023Radiotherapy may be used alone or in combination with chemotherapy for cancer treatment. There are many mechanisms of radiation treatment exposure to toxicities. Our aim... (Review)
Review
Radiotherapy may be used alone or in combination with chemotherapy for cancer treatment. There are many mechanisms of radiation treatment exposure to toxicities. Our aim was to summarize the literature about known mechanisms of radiation-induced cardiac toxicities. We performed a systematic review of the literature on the PubMed database until October 2022 about cardiovascular toxicities and radiation therapy exposure. Only systematic reviews, meta-analyses, and reviews were selected. Out of 1429 publications screened, 43 papers met inclusion criteria and were selected for the umbrella review process. Microvascular and macrovascular complications could lead to adverse cardiac effects. Many radiotherapy-associated risk factors were responsible, such as the site of radiation treatment, beam proximity to heart tissues, total dosage, the number of radiotherapy sessions, adjuvant chemotherapeutic agents used, and patient traditional cardiovascular risk factors, patient age, and gender. Moreover, important dosage cutoff values could increase the incidence of cardiac toxicities. Finally, the time from radiation exposure to cardiac side effects was assessed. Our report highlighted mechanisms, radiation dosage values, and the timeline of cardiovascular toxicities after radiation therapy. All of the above may be used for the assessment of cardiovascular risk factors and the development of screening programs for cancer patients.
Topics: Humans; Cardiotoxicity; Heart; Neoplasms; Risk Factors; Radiation Dosage
PubMed: 37047245
DOI: 10.3390/ijms24076272 -
Brachytherapy 2023To provide a systematic review of the applications of 3D printing in gynecological brachytherapy. (Review)
Review
PURPOSE
To provide a systematic review of the applications of 3D printing in gynecological brachytherapy.
METHODS
Peer-reviewed articles relating to additive manufacturing (3D printing) from the 34 million plus biomedical citations in National Center for Biotechnology Information (NCBI/PubMed), and 53 million records in Web of Science (Clarivate) were queried for 3D printing applications. The results were narrowed sequentially to, (1) all literature in 3D printing with final publications prior to July 2022 (in English, and excluding books, proceedings, and reviews), and then to applications in, (2) radiotherapy, (3) brachytherapy, (4) gynecological brachytherapy. Brachytherapy applications were reviewed and grouped by disease site, with gynecological applications additionally grouped by study type, methodology, delivery modality, and device type.
RESULTS
From 47,541 3D printing citations, 96 publications met the inclusion criteria for brachytherapy, with gynecological clinical applications compromising the highest percentage (32%), followed by skin and surface (19%), and head and neck (9%). The distribution of delivery modalities was 58% for HDR (Ir-192), 35% for LDR (I-125), and 7% for other modalities. In gynecological brachytherapy, studies included design of patient specific applicators and templates, novel applicator designs, applicator additions, quality assurance and dosimetry devices, anthropomorphic gynecological applicators, and in-human clinical trials. Plots of year-to-year growth demonstrate a rapid nonlinear trend since 2014 due to the improving accessibility of low-cost 3D printers. Based on these publications, considerations for clinical use are provided.
CONCLUSIONS
3D printing has emerged as an important clinical technology enabling customized applicator and template designs, representing a major advancement in the methodology for implantation and delivery in gynecological brachytherapy.
Topics: Humans; Radiotherapy Dosage; Iodine Radioisotopes; Brachytherapy; Printing, Three-Dimensional
PubMed: 37024350
DOI: 10.1016/j.brachy.2023.02.002 -
Biomedicines Feb 2023(1) Background: Epilepsy is a frequent comorbidity in patients with brain tumors, in whom seizures are often drug-resistant. Current evidence suggests that excess of... (Review)
Review
(1) Background: Epilepsy is a frequent comorbidity in patients with brain tumors, in whom seizures are often drug-resistant. Current evidence suggests that excess of glutamatergic activity in the tumor microenvironment may favor epileptogenesis, but also tumor growth and invasiveness. The selective non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor antagonist perampanel (PER) was demonstrated to be efficacious and well-tolerated in patients with focal seizures. Moreover, preclinical in vitro studies suggested a potential anti-tumor activity of this drug. In this systematic review, the clinical evidence on the efficacy and tolerability of PER in brain tumor-related epilepsy (BTRE) is summarized. (2) Methods: Five databases and two clinical trial registries were searched from inception to December 2022. (3) Results: Seven studies and six clinical trials were included. Sample size ranged from 8 to 36 patients, who received add-on PER (mean dosage from 4 to 7 mg/day) for BTRE. After a 6-12 month follow-up, the responder rate (% of patients achieving seizure freedom or reduction ≥ 50% of seizure frequency) ranged from 75% to 95%, with a seizure freedom rate of up to 94%. Regarding tolerability, 11-52% of patients experienced non-severe adverse effects (most frequent: dizziness, vertigo, anxiety, irritability). The retention rate ranged from 56% to 83%. However, only up to 12.5% of patients discontinued the drug because of the adverse events. (4) Conclusions: PER seems to be efficacious, safe, and well-tolerated in patients with BTRE. Further randomized studies should be conducted in more homogeneous and larger populations, also evaluating the effect of PER on tumor progression, overall survival, and progression-free survival.
PubMed: 36979629
DOI: 10.3390/biomedicines11030651 -
Radiation Oncology (London, England) Mar 2023Recent years have seen both a fresh knowledge of cancer and impressive advancements in its treatment. However, the clinical treatment paradigm of cancer is still... (Review)
Review
Recent years have seen both a fresh knowledge of cancer and impressive advancements in its treatment. However, the clinical treatment paradigm of cancer is still difficult to implement in the twenty-first century due to the rise in its prevalence. Radiotherapy (RT) is a crucial component of cancer treatment that is helpful for almost all cancer types. The accuracy of RT dosage delivery is increasing as a result of the quick development of computer and imaging technology. The use of image-guided radiation (IGRT) has improved cancer outcomes and decreased toxicity. Online adaptive radiotherapy will be made possible by magnetic resonance imaging-guided radiotherapy (MRgRT) using a magnetic resonance linear accelerator (MR-Linac), which will enhance the visibility of malignancies. This review's objectives are to examine the benefits of MR-Linac as a treatment approach from the perspective of various cancer patients' prognoses and to suggest prospective development areas for additional study.
Topics: Humans; Prospective Studies; Radiotherapy Planning, Computer-Assisted; Neoplasms; Particle Accelerators; Radiotherapy, Image-Guided; Radiotherapy Dosage; Magnetic Resonance Imaging
PubMed: 36918884
DOI: 10.1186/s13014-023-02221-8 -
Clinical Neuroradiology Sep 2023In 1971, the first computed tomography (CT) scan was performed on a patient's brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New... (Review)
Review
In 1971, the first computed tomography (CT) scan was performed on a patient's brain. Clinical CT systems were introduced in 1974 and dedicated to head imaging only. New technological developments, broader availability, and the clinical success of CT led to a steady growth in examination numbers. Most frequent indications for non-contrast CT (NCCT) of the head include the assessment of ischemia and stroke, intracranial hemorrhage and trauma, while CT angiography (CTA) has become the standard for first-line cerebrovascular evaluation; however, resulting improvements in patient management and clinical outcomes come at the cost of radiation exposure, increasing the risk for secondary morbidity. Therefore, radiation dose optimization should always be part of technical advancements in CT imaging but how can the dose be optimized? What dose reduction can be achieved without compromising diagnostic value, and what is the potential of the upcoming technologies artificial intelligence and photon counting CT? In this article, we look for answers to these questions by reviewing dose reduction techniques with respect to the major clinical indications of NCCT and CTA of the head, including a brief perspective on what to expect from current and future developments in CT technology with respect to radiation dose optimization.
Topics: Humans; Artificial Intelligence; Radiation Dosage; Tomography, X-Ray Computed; Computed Tomography Angiography; Angiography; Radiographic Image Interpretation, Computer-Assisted
PubMed: 36862232
DOI: 10.1007/s00062-023-01271-5 -
Cancer Radiotherapie : Journal de La... Apr 2023Hadrontherapy is a form of radiation therapy (RT) that relies on heavy particles, such as proton, heavy ions, or neutrons, to enhance anti-tumoral efficacy based on... (Review)
Review
Hadrontherapy is a form of radiation therapy (RT) that relies on heavy particles, such as proton, heavy ions, or neutrons, to enhance anti-tumoral efficacy based on their specific dosimetric and radio-biological properties. Neutrons are characterized by specific radiobiological properties that might deserve greater consideration, including the high linear energy transfer and the low oxygen enhancement ratio. Neutron brachytherapy, relying on interstitial or intracavitary neutron sources, has been developed since the 1950s using Californium-252 (252Cf) as a mixed emitter of fission fast neutrons and γ-photos. However, the place of NBT in the era of modern radiation therapy is yet to be precisely defined. In this systematic review, we aim to provide an up-to-date analysis of current experience and clinical evidence of NBT in the XXI century, by answering the following clinical questions: How is NBT currently delivered? What are the current efficacy data and tolerance profiles of NBT?
Topics: Humans; Brachytherapy; Neutrons; Neoplasms; Radiometry; Radiotherapy Dosage
PubMed: 36759242
DOI: 10.1016/j.canrad.2022.08.010 -
Radiotherapy and Oncology : Journal of... Mar 2023Compare the efficacy and safety of high vs standard radiation dose of definitive concurrent chemoradiotherapy (dCCRT) for esophageal cancer (EC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Compare the efficacy and safety of high vs standard radiation dose of definitive concurrent chemoradiotherapy (dCCRT) for esophageal cancer (EC).
METHODS AND MATERIALS
This meta-analysis is registered in PROSPERO, and it was followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Eligible randomized clinical trials (RCTs) comparing high dose (HD;≥59.4 Gy/1.8 Gy) and standard doses (SD; 50 Gy/2Gy or 50.4 Gy/1.8 Gy) were identified on electronic databases. STATA16.0 was used for statistical analysis. A meta-analysis was performed to compare treatment effect and toxicity.
RESULTS
Four articles with a total of 1014 patients were finally included. The results showed that the two groups had similar 1-, 2-, and 3-year OS rates (RR = 1.08, 95 % CI = 0.90-1.30, P = 0.395; RR = 1.07, 95 % CI = 0.95-1.20, P = 0.272; RR = 1.06, 95 % CI = 0.97-1.17, P = 0.184; respectively) and 2-, and 3-year locoregional progression-free survival (LRPFS) (RR = 0.95, 95 % CI = 0.81-1.10, P = 0.478; RR = 0.97, 95 % CI = 0.85-1.11, P = 0.674; respectively). The HD-RT group had higher grade ≥ 3 treatment-related toxicities (OR = 1.35, 95 % CI = 1.03-1.77, P = 0.029) and treatment-related deaths rates (OR = 1.85, 95 % CI = 1.04-3.28, P = 0.036) compared with the SD-RT group. Results of subgroup analysis also indicated that HD could not bring benefit compared to SD, even with modern radiotherapy techniques.
CONCLUSION
SD-RT had similar treatment effect but lower Grade ≥ 3 treatment-related toxicities rates compared with the HD-RT. Therefore, SD (50 Gy/2Gy or 50.4 Gy/1.8 Gy) should be considered as the recommended dose in dCCRT for EC. Further RCTs are needed to verify our conclusions.
Topics: Humans; Randomized Controlled Trials as Topic; Esophageal Neoplasms; Chemoradiotherapy; Radiotherapy Dosage; Radiation Dosage
PubMed: 36642387
DOI: 10.1016/j.radonc.2023.109463 -
Journal of Cancer Research and... Jan 2023A key challenge in radiation therapy is to maximize the radiation dose to cancer cells while minimizing damage to healthy tissues. In recent years, the introduction of...
A key challenge in radiation therapy is to maximize the radiation dose to cancer cells while minimizing damage to healthy tissues. In recent years, the introduction of remote after-loading technology such as high-dose-rate (HDR) brachytherapy becomes the safest and more precise way of radiation delivery compared to classical low-dose-rate (LDR) brachytherapy. However, the axially symmetric dose distribution of HDR with single channel cylindrical applicator, the physical "dead-space" with multichannel applicators, and shielding material heterogeneities are the main challenges of HDR brachytherapy. Thus, this review aimed to quantitatively evaluate the dose enhancement factor (DEF) produced by high atomic number nanoparticles (NPs) which increases the interaction probability of photons mainly through the photoelectric effect induced in the great number of atoms contained in each nanoparticle. The NPs loaded to the target volume create a local intensification effect on the target tissue that allows imparting the prescribed therapeutic dose using lower fluxes of irradiation and spare the surrounding healthy tissues. An electronic database such as PubMed/Medline, Embase, Scopus, and Google Scholar was searched to retrieve the required articles. Unpublished articles were also reached by hand from available sources. The dose is increased using the high atomic number of nanoparticle elements under the high dose iridium radionuclide whereas the cobalt-60 radionuclide source did not. However, much work is required to determine the dose distribution outside the target organ or tumor to spare the surrounding healthy tissues for the iridium source and make compressive work to have more data for the cobalt source.
Topics: Humans; Iridium; Radioisotopes; Iridium Radioisotopes; Brachytherapy; Neoplasms; Nanoparticles; Radiotherapy Dosage; Cobalt Radioisotopes
PubMed: 38384008
DOI: 10.4103/jcrt.jcrt_1353_22 -
European Journal of Medical Research Dec 2022Charged particle beams from protons to carbon ions provide many significant physical benefits in radiation therapy. However, preclinical studies of charged particle... (Review)
Review
BACKGROUND
Charged particle beams from protons to carbon ions provide many significant physical benefits in radiation therapy. However, preclinical studies of charged particle therapy for prostate cancer are extremely limited. The aim of this study was to comprehensively investigate the biological effects of charged particles on prostate cancer from the perspective of in vitro studies.
METHODS
We conducted a systematic review by searching EMBASE (OVID), Medline (OVID), and Web of Science databases to identify the publications assessing the radiobiological effects of charged particle irradiation on prostate cancer cells. The data of relative biological effectiveness (RBE), surviving fraction (SF), standard enhancement ratio (SER) and oxygen enhancement ratio (OER) were extracted.
RESULTS
We found 12 studies met the eligible criteria. The relative biological effectiveness values of proton and carbon ion irradiation ranged from 0.94 to 1.52, and 1.67 to 3.7, respectively. Surviving fraction of 2 Gy were 0.17 ± 0.12, 0.55 ± 0.20 and 0.53 ± 0.16 in carbon ion, proton, and photon irradiation, respectively. PNKP inhibitor and gold nanoparticles were favorable sensitizing agents, while it was presented poorer performance in GANT61. The oxygen enhancement ratio values of photon and carbon ion irradiation were 2.32 ± 0.04, and 1.77 ± 0.13, respectively. Charged particle irradiation induced more G0-/G1- or G2-/M-phase arrest, more expression of γ-H2AX, more apoptosis, and lower motility and/or migration ability than photon irradiation.
CONCLUSIONS
Both carbon ion and proton irradiation have advantages over photon irradiation in radiobiological effects on prostate cancer cell lines. Carbon ion irradiation seems to have further advantages over proton irradiation.
Topics: Male; Humans; Protons; Gold; Dose-Response Relationship, Radiation; Metal Nanoparticles; Prostatic Neoplasms; Carbon; Oxygen; Phosphotransferases (Alcohol Group Acceptor); DNA Repair Enzymes
PubMed: 36572945
DOI: 10.1186/s40001-022-00942-2 -
Technology in Cancer Research &... 2022The development of new techniques in radiotherapy (RT) provides a better planned target volume (PTV) dose distribution while further improving the protection of organs... (Review)
Review
The development of new techniques in radiotherapy (RT) provides a better planned target volume (PTV) dose distribution while further improving the protection of organs at risk (OARs). The study aims to present the dosimetric results of studies using hybrid techniques in whole-breast radiotherapy (WBRT). This systematic literature review was conducted by scanning the relevant literature in PubMed, Scopus, and Web of Science following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Among the parameters are dose values for PTV and OARs beam contribute ratios, the value of monitors, and treatment times for different RT techniques. Initially, 586 articles were identified; 196 duplicate articles were removed leaving 391 articles for screening. Three-hundred and thirty-seven irrelevant articles were excluded, leaving 54 studies assessed for eligibility. A total of 22 articles met the search criteria to evaluate dosimetric results of hybrid and other RT techniques in WBRT. According to the dosimetric data of the studies, hybrid intensity-modulated RT (H-IMRT) and hybrid volumetric-modulated arc therapy (H-VMAT) techniques give dosimetrically advantageous results in WBRT compared to other RT techniques. Hybrid techniques using appropriate beams contribute value and show great promise in improving dosimetric results in WBRT. However, there is a need for new studies showing the long-term clinical results of hybrid RT.
Topics: Humans; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Breast; Organs at Risk
PubMed: 36537067
DOI: 10.1177/15330338221143937