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Nature Reviews. Clinical Oncology Jan 2013With the emergence of individualized medicine and the increasing amount and complexity of available medical data, a growing need exists for the development of clinical... (Review)
Review
With the emergence of individualized medicine and the increasing amount and complexity of available medical data, a growing need exists for the development of clinical decision-support systems based on prediction models of treatment outcome. In radiation oncology, these models combine both predictive and prognostic data factors from clinical, imaging, molecular and other sources to achieve the highest accuracy to predict tumour response and follow-up event rates. In this Review, we provide an overview of the factors that are correlated with outcome-including survival, recurrence patterns and toxicity-in radiation oncology and discuss the methodology behind the development of prediction models, which is a multistage process. Even after initial development and clinical introduction, a truly useful predictive model will be continuously re-evaluated on different patient datasets from different regions to ensure its population-specific strength. In the future, validated decision-support systems will be fully integrated in the clinic, with data and knowledge being shared in a standardized, instant and global manner.
Topics: Decision Support Systems, Clinical; Humans; Models, Theoretical; Neoplasms; Precision Medicine; Radiation Oncology; Treatment Outcome
PubMed: 23165123
DOI: 10.1038/nrclinonc.2012.196 -
Digestive Diseases (Basel, Switzerland) 2022Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths, and radiological imaging and locoregional therapies are essential for the... (Review)
Review
BACKGROUND
Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths, and radiological imaging and locoregional therapies are essential for the management of patients with HCC.
SUMMARY
In cirrhotic patients, a characteristic imaging pattern establishes the noninvasive diagnosis of HCC with acceptable sensitivity and high specificity. In addition to diagnosis, imaging is used in the staging of patients and treatment allocation. Multiparametric MRI with hepatospecific contrast agents improves lesion detection, characterization, and treatment allocation; recently described imaging criteria allow identification of precursor lesions. Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) have been established in the treatment of patients with HCC at the early and intermediate stages, respectively. Microwave ablation has been described as an alternative to RFA in selected cases. Imaging-guided brachytherapy, a catheter-based radiotherapy technique, offers advantages to overcome some limitations of the aforementioned therapies, including the tumor location and size. Currently, no adjuvant therapy is recommended after RFA or TACE, but several new drugs are under evaluation. Furthermore, although the exact role of selective internal radiation therapy (SIRT) in HCC still needs to be defined, it is an alternative to systemic agents in patients with intolerance, and additional benefit has been shown in selected subgroups. Additionally, SIRT offers an alternate to TACE with higher objective response rates in patients who needs bridging before transplantation.
KEY MESSAGES
New imaging criteria improved lesion detection in patients at a risk for HCC, and advances in interventional therapies expanded the range of patients eligible for locoregional treatments.
Topics: Humans; Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Combined Modality Therapy; Liver Neoplasms; Radiology, Interventional; Retrospective Studies; Treatment Outcome
PubMed: 34348282
DOI: 10.1159/000518101 -
Annals of Nuclear Medicine Nov 2018Written by associate editors of the Annals of Nuclear Medicine, this invited review article is intended to offer our readers a condensed global view on the high-quality... (Review)
Review
Written by associate editors of the Annals of Nuclear Medicine, this invited review article is intended to offer our readers a condensed global view on the high-quality research work that has been published in Europe last year. We have divided this article into five sections. The first three sections from the oncology category include "[F]fluorodeoxyglucose (FDG) positron-emission tomography (PET) for therapy monitoring in malignant lymphoma", "[F]fluoromisonidazole (FMISO) PET for hypoxia", and "lymphoscintigraphy update". It is followed by a section on "amyloid PET for Alzheimer's disease" using [C]Pittsburgh Compound B (PiB) and [F]florbetapir from the neurology category. The final section reviews three original articles in the field of "basic and translational molecular imaging" regardless of the category, which investigated new PET tracers such as L-4-borono-2-[F]fluoro-phenylalanine (FBPA), O-(2-[F]fluoroethyl)-L-tyrosine (FET) and Cu-NOTA-pertuzumab in small animals. We hope that this review article will arouse greater interest in our readers in recent European research trends in the field of nuclear medicine.
Topics: Alzheimer Disease; Animals; Biomedical Research; Europe; Humans; Neoplasms; Nuclear Medicine; Translational Research, Biomedical
PubMed: 30242670
DOI: 10.1007/s12149-018-1303-7 -
European Journal of Cancer (Oxford,... Nov 2019Radiation therapy (RT) is an essential component of effective cancer care and is used across nearly all cancer types. The delivery of RT is becoming more precise through... (Review)
Review
Radiation therapy (RT) is an essential component of effective cancer care and is used across nearly all cancer types. The delivery of RT is becoming more precise through rapid advances in both computing and imaging. The direct integration of magnetic resonance imaging (MRI) with linear accelerators represents an exciting development with the potential to dramatically impact cancer research and treatment. These impacts extend beyond improved imaging and dose deposition. Real-time MRI-guided RT is actively transforming the work flows and capabilities of virtually every aspect of RT. It has the opportunity to change entirely the delivery methods and response assessments of numerous malignancies. This review intends to approach the topic of MRI-based RT guidance from a vendor neutral and international perspective. It also aims to provide an introduction to this topic targeted towards oncologists without a speciality focus in RT. Speciality implications, areas for physician education and research opportunities are identified as they are associated with MRI-guided RT. The uniquely disruptive implications of MRI-guided RT are discussed and placed in context. We further aim to describe and outline important future changes to the speciality of radiation oncology that will occur with MRI-guided RT. The impacts on RT caused by MRI guidance include target identification, RT planning, quality assurance, treatment delivery, training, clinical workflow, tumour response assessment and treatment scheduling. In addition, entirely novel research areas that may be enabled by MRI guidance are identified for future investigation.
Topics: Humans; Magnetic Resonance Imaging; Quality Assurance, Health Care; Radiation Oncology; Radiotherapy, Image-Guided
PubMed: 31614288
DOI: 10.1016/j.ejca.2019.07.021 -
Radiation Oncology (London, England) Jan 2017Literature was reviewed to assess the physical aspects governing the present and emerging technologies used in intraoperative radiation therapy (IORT). Three major... (Review)
Review
Literature was reviewed to assess the physical aspects governing the present and emerging technologies used in intraoperative radiation therapy (IORT). Three major technologies were identified: treatment with electrons, treatment with external generators of kV X-rays and electronic brachytherapy. Although also used in IORT, literature on brachytherapy with radioactive sources is not systematically reviewed since an extensive own body of specialized literature and reviews exists in this field. A comparison with radioactive sources is made in the use of balloon catheters for partial breast irradiation where these are applied in almost an identical applicator technique as used with kV X-ray sources. The physical constraints of adaption of the dose distribution to the extended target in breast IORT are compared. Concerning further physical issues, the literature on radiation protection, commissioning, calibration, quality assurance (QA) and in-vivo dosimetry of the three technologies was reviewed. Several issues were found in the calibration and the use of dosimetry detectors and phantoms for low energy X-rays which require further investigation. The uncertainties in the different steps of dose determination were estimated, leading to an estimated total uncertainty of around 10-15% for IORT procedures. The dose inhomogeneity caused by the prescription of electrons at 90% and by the steep dose gradient of kV X-rays causes additional deviations from prescription dose which must be considered in the assessment of dose response in IORT.
Topics: Humans; Intraoperative Period; Radiation Oncology; Radiotherapy; Radiotherapy Dosage
PubMed: 28193241
DOI: 10.1186/s13014-016-0754-z -
Radiation Research Dec 2010Epidemiological studies of medical radiation workers have found excess risks of leukemia, skin and female breast cancer in those employed before 1950 but little... (Review)
Review
Epidemiological studies of medical radiation workers have found excess risks of leukemia, skin and female breast cancer in those employed before 1950 but little consistent evidence of cancer risk increases subsequently. Occupational radiation-related dose-response data and recent and lifetime cancer risk data are limited for radiologists and radiologic technologists and lacking for physicians and technologists performing fluoroscopically guided procedures. Survey data demonstrate that occupational doses to radiologists and radiologic technologists have declined over time. Eighty mostly small studies of cardiologists and fewer studies of other physicians reveal that effective doses to physicians per interventional procedure vary by more than an order of magnitude. For medical radiation workers, there is an urgent need to expand the limited information on average annual, time-trend and organ doses from occupational radiation exposures and to assess lifetime cancer risks of these workers. For physicians and technologists performing interventional procedures, more information about occupational doses should be collected and long-term follow-up studies of cancer and other serious disease risks should be initiated. Such studies will help optimize standardized protocols for radiologic procedures, determine whether current radiation protection measures for medical radiation workers are adequate, provide guidance on cancer screening needs, and yield valuable insights on cancer risks associated with chronic radiation exposure.
Topics: Fluoroscopy; Health Personnel; Humans; Neoplasms, Radiation-Induced; Occupational Exposure; Radiation Protection; Radiology; Radiometry; Risk; Technology, Radiologic
PubMed: 21128805
DOI: 10.1667/RR2014.1 -
Cancer Letters Feb 2016Ionizing radiations interact with molecules at the cellular and molecular levels leading to several biochemical modifications that may be responsible for biological... (Review)
Review
Ionizing radiations interact with molecules at the cellular and molecular levels leading to several biochemical modifications that may be responsible for biological effects on tissue or whole organisms. The study of these changes is difficult because of the complexity of the biological response(s) to radiations and the lack of reliable models able to mimic the whole molecular phenomenon and different communications between the various cell networks, from the cell activation to the macroscopic effect at the tissue or organismal level. Microfluidics, the science and technology of systems that can handle small amounts of fluids in confined and controlled environment, has been an emerging field for several years. Some microfluidic devices, even at early stages of development, may already help radiobiological research by proposing new approaches to study cellular, tissue and total-body behavior upon irradiation. These devices may also be used in clinical biodosimetry since microfluidic technology is frequently developed for integrating complex bioassay chemistries into automated user-friendly, reproducible and sensitive analyses. In this review, we discuss the use, numerous advantages, and possible future of microfluidic technology in the field of radiobiology. We will also examine the disadvantages and required improvements for microfluidics to be fully practical in radiation research and to become an enabling tool for radiobiologists and radiation oncologists.
Topics: Animals; Automation, Laboratory; Biomarkers, Tumor; Equipment Design; Humans; Lab-On-A-Chip Devices; Microfluidics; Neoplasms; Radiation Dosage; Radiation Oncology; Radiobiology
PubMed: 26704304
DOI: 10.1016/j.canlet.2015.11.033 -
Genes Oct 2022Osteopetrosis (from the Greek "osteo": bone; "petrosis": stone) is a clinically and genetically heterogeneous group of rare diseases of the skeleton, sharing the same... (Review)
Review
Osteopetrosis (from the Greek "osteo": bone; "petrosis": stone) is a clinically and genetically heterogeneous group of rare diseases of the skeleton, sharing the same main characteristic of an abnormally increased bone density. Dense bones in radiological studies are considered the hallmark of these diseases, and the reason for the common term used: "Marble bone disease". Interestingly, a radiologist, Dr. Albers-Schonberg, described this disease for the first time in Germany in 1904. Indeed, radiology has a key role in the clinical diagnosis of osteopetrosis and is fundamental in assessing the disease severity and complications, as well as in follow-up controls and the evaluation of the response to treatment. Osteopetrosis includes a broad spectrum of genetic mutations with very different clinical symptoms, age onset, and prognosis (from mild to severe). This diversity translates into different imaging patterns related to specific mutations, and different disease severity. The main recognized types of osteopetrosis are the infantile malignant forms with autosomal recessive transmission (ARO-including the rarer X-linked recessive form); the intermediate autosomal recessive form (IAO); and the autosomal dominant ones ADO, type I, and type II, the latter being called 'Albers-Schonberg' disease. Imaging features may change among those distinct types with different patterns, severities, skeletal segment involvement, and speeds of progression. There are several classical and well-recognized radiological features related to osteopetrosis: increased bone density (all types with different degrees of severity assuming a 'Marble Bone Appearance' especially in the ARO type), different metaphyseal alterations/enlargement including the so-called 'Erlenmeyer flask deformity' (particularly of femoral bones, more frequent in ADO type 2, and less frequent in ARO and IAO), 'bone in bone' appearance (more frequent in ADO type 2, less frequent in ARO and IAO), and 'rugger-jersey spine' appearance (typical of ADO type 2). After conducting an overview of the epidemiological and clinical characteristic of the disease, this review article aims at summarizing the main radiological features found in different forms of osteopetrosis together with their inheritance pattern.
Topics: Humans; Osteopetrosis; Genes, Dominant; Inheritance Patterns; Radiology; Calcium Carbonate
PubMed: 36360203
DOI: 10.3390/genes13111965 -
Theranostics 2017Theranostics is the integration of diagnostic information with pharmaceuticals to increase effectiveness and safety of cancer treatments. Nuclear medicine provides a... (Review)
Review
Theranostics is the integration of diagnostic information with pharmaceuticals to increase effectiveness and safety of cancer treatments. Nuclear medicine provides a non-invasive means to visualize drug target expression across primary and metastatic sites, and assess pharmacokinetics and efficacy of companion therapeutic agents. This is significant given the increasing recognition of the importance of clonal heterogeneity in treatment response and resistance. Carbonic anhydrase IX (CA-IX) has been advocated as an attractive diagnostic and therapeutic biomarker for targeting hypoxia in solid malignancies. CA-IX confers cancer cell survival under low oxygen tension, and is associated with increased propensity for metastasis. As such, CA-IX is overexpressed in a broad spectrum of cancers. Different classes of antigen recognition molecules targeting CA-IX including monoclonal antibodies, peptides, small molecule inhibitors, and antibody mimetics have been radiolabeled for imaging and therapeutic applications. cG250, a chimeric monoclonal antibody, has been labeled with an assortment of radionuclides (I, In, Zr, I, Y, and Lu) and is the most extensively investigated CA-IX radiopharmaceutical. In recent years, there have been tremendous advancements made by the research community in developing alternatives to cG250. Although still in preclinical settings, several small molecule inhibitors and antibody mimetics hold great promise in improving the management of aggressive and resistant cancers.
Topics: Carbonic Anhydrase IX; Humans; Hypoxia; Neoplasms; Nuclear Medicine
PubMed: 29158829
DOI: 10.7150/thno.21848 -
Journal of Nuclear Medicine Technology Jun 2021Workplace bullying (WPB) in the medical field is a significant occupational hazard and health-care safety concern, though many cases go unreported. Often regarded as a... (Review)
Review
Workplace bullying (WPB) in the medical field is a significant occupational hazard and health-care safety concern, though many cases go unreported. Often regarded as a rite of passage to desensitize and toughen new employees and students, WPB causes psychologic harm and creates an unsafe working environment resulting in health complications, anxiety, depression, low self-esteem, difficulty concentrating, and self-harm. Decreased productivity, increased absenteeism, high turnover rates, and inappropriate patient care are linked to WPB, perpetrating organizational dysfunction. This research study evaluated WPB (prevalence, frequency, and behaviors; associated characteristics; effects on patient care; and awareness and enforcement of antibullying protocols) in nuclear medicine (NM) departments and clinical education. A quantitative single-group correlational analysis was used to survey certified NM technologists and students in the Nuclear Medicine Technology Certification Board e-mail database ( = 20,389). The highest response rate for any individual question was 836. Data were collected using the short version of the negative-acts questionnaire along with a researcher-created survey and analyzed using χ testing and central tendencies. WPB existed in varying degrees (46.8%) within the previous 6 mo, predominantly in the form of being ignored, excluded, and subjected to repeated reminders of errors and having information affecting performance withheld. NM professionals are more likely to witness and experience WPB than students and are more likely to be bullied by a fellow technologist. Some characteristics, such as sex, age, and occupation, were statistically significant, whereas others, such as race, height, body type, experience, and education, showed no significant correlation. Attention to patient care decreased (39.6%) when WPB was present. An 8% variation exists between enforcement and nonenforcement of antibullying policies, with 26% of professionals being unaware of whether antibullying policies exist at their workplace. Explanations for underreported WPB include fear of retaliation, nonenforcement and lack of awareness of antibullying policies, organizational complacency, and perceived hierarchic power. Recommendations to minimize WPB include adopting and publicizing a descriptive definition, implementing antibullying policies, using mediation procedures, and imposing noncompliance penalties. A decrease in the incidence of WPB correlates with an increase in employee satisfaction and retention, patient safety, and student success.
Topics: Bullying; Humans; Nuclear Medicine; Patient Safety; Surveys and Questionnaires; Workplace
PubMed: 33361177
DOI: 10.2967/jnmt.120.257204