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Background Radiotherapy (RT) is a standard curative treatment for prostate cancer (PCa) and there is growing evidence of the high efficacy of moderate and ultra-hypofractionated RT. Reducing treatment duration to one week or less is a major advance, but very few studies have explored single-fraction therapy. This study evaluates the feasibility, safety, and efficacy of single-fraction stereotactic body RT (SBRT) while delivering the entire procedure in one day, with a potentially high benefit in terms of patient comfort and therapy cost and logistics. Methods This prospective, non-randomized monocentric trial uses Robotic Radiosurgery (CyberKnife v.7 system) to deliver a single 24 Gy fraction to the prostate (± seminal vesicles) with a “urethral sparing HDR-like” technique, and target tracking. The first phase will enroll 13 PCa patients following Simon’s optimal design. Treatment is to be stopped if ≥ 2 patients develop ≥ G3 toxicity (CTCAE v5.0) within a month from RT end; otherwise, 52 more patients will be added, totaling 65. To account for minimal drop-out, 5 extra patients will be enrolled, reaching 70. All procedures are performed in a single day, including fiducial implantation, imaging acquisition, contouring, planning, dosimetry quality control, and treatment. Apart from treatment feasibility in terms of one-month acute toxicity, secondary endpoints include late toxicity, biochemical and clinical control. Discussion Few others have investigated the 24 Gy single-fraction schedule using different delivery modalities (not including tracking), which has proved to be non-inferior to 5 fraction SBRT. Our approach aims to maintain (and possibly improve) the previously reported acute, subacute and late toxicity as well as disease control, adding evidence in favor of single-fraction delivery. Another significant goal of the study is the demonstration that all the complex treatment procedures can be safely delivered in a single day. This would be especially appealing for patients far from radiotherapy centers and those with work commitments not allowing daily hospital visits. The study of response to RT can also provide useful information about PCa radiobiology. Planned additional analyses may help in better assessing the clinical value of PSMA PET/CT in the selection of high-risk patients with true limited disease, and in identifying radiomic features associated to outcome. Trial registration : The study was prospectively registered at clinicaltrials.gov (NCT 05936736).

Radiotherapy has been increasingly considered as an active treatment to combine with other approaches (i.e., surgery, chemotherapy, and novel target-based drugs) in ovarian cancers to palliate symptoms and/or to prolong chemotherapy-free intervals. This narrative review aimed to summarize the current knowledge of the radiosensitivity/radioresistance of ovarian cancer which remains the most lethal gynecological cancer worldwide. Indeed, considering the high rate of recurrence in and out of the radiotherapy fields, in the era of patient-tailored oncology, elucidating the mechanisms of radiosensitivity and identifying potential radioresistance biomarkers could be crucial in guiding clinical decision-making.

Background Glioblastoma (GBM) is no longer regarded as a single disease, as distinct molecular subgroups exist, with the mesenchymal (MES) having the worst prognosis. As such, there is a critical need for noninvasive methods to determine GBM molecular status. Although conventional magnetic resonance imaging (MRI)-based radiomics showed promise for predicting GBM characteristics, few studies evaluated pipelines that leverage advanced diffusion MRI (dMRI) techniques, such as diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI), enabling characterization and quantification of tumor microstructure. Materials and methods To identify advanced dMRI radiomic features specific to MES GBM, we enrolled 36 GBM patients (4 mesenchymal, 32 non-mesenchymal), who underwent presurgical DTI and NODDI protocols. Post-surgery samples were processed to establish subgroup-specific GBM sphere-forming cell (GSC) lines, generating 21 xenografts (12 non-mesenchymal, 9 mesenchymal) that were subjected to the same dMRI protocols. Results By leveraging a preclinical-to-clinical transfer learning approach, a machine learning classification algorithm was developed to generalize between preclinical and clinical contexts. Models were trained on xenograft-derived data and validated using an independent patient test set. Using bootstrap resampling to estimate confidence intervals, the XGBoost model achieved an area under the receiver operating characteristic curve of 0.93 (95% confidence interval (CI): 0.79–1.00) and a balanced accuracy of 0.86 (0.64–1.00) for MES prediction. A subset of 9 selected features was sufficient to build a model that accurately predicted MES affiliation. Conclusion DTI and NODDI radiomics revealed key features that predict MES GBM and correlate with biological and clinical characteristics. Relevance statement A DTI and NODDI-based model trained on preclinical xenograft-derived data can be validated in a human patient cohort, demonstrating cross-species generalizability of radiomic biomarkers. This approach provides a noninvasive means to molecularly stratify GBM patients, enabling the potential to inform tailored treatment. Key Points We defined a machine learning algorithm that, starting from subgroup-specific glioblastoma xenografts, reliably identifies the mesenchymal affiliation of glioblastoma patients. The specific dMRI features selected from experimental preclinical models of glioblastoma hold a remarkable predictive value. The same features provide insights into subgroup-restricted tumor tissue microstructure and its relationship with the malignant behavior of mesenchymal glioblastomas. Graphical Abstract

Background: Breast cancer (BC) is the most frequently diagnosed cancer in women and the leading cause of cancer-related deaths in women globally. Carriers of P/LP variants in the BRCA1, BRCA2, TP53, PTEN, CDH1, PALB2, and STK11 genes have an increased risk of developing BC, which is why more and more guidelines recommend prophylactic mastectomy in this group of patients. Because traditional genetic testing is expensive and can cause delays in patient management, radiomics based on diagnostic imaging could be an alternative. This study aims to evaluate whether ultrasound-based radiomics features can predict P/LP variant status in BC patients. Methods: This retrospective study included 88 breast tumors in patients tested with multigene panel tests, including all seven above-mentioned genes. Ultrasound images were acquired prior to any treatment, and the tumoral and peritumoral areas were used to extract radiomics data. The study population was divided into P/LP and non-P/LP variant groups. Radiomics features were analyzed using machine learning models, alone or in combination with clinical features, with the aim of predicting the genetic status of BC patients. Results: We observed significant differences in radiomics features between P/LP- and non-P/LP-variant-driven tumors. The developed radiomics model achieved a maximum mean accuracy of 85.7% in identifying P/LP variant carriers. Including features from the peritumoral area yielded the same maximum accuracy. Conclusions: Radiomics models based on ultrasound images of breast tumors may provide a promising alternative for predicting P/LP variant status in BC patients. This approach could reduce dependence on costly genetic testing and expedite the diagnostic process. However, further validation in larger and more diverse populations is needed.

Compliance with government-recommended preventive measures represents a key factor in mitigating the negative consequences of coronavirus disease 2019 (COVID-19). The study investigated the relation between health anxiety, perceived risk and perceived control as predictors of coronavirus disease 2019 (COVID-19)-related anxiety and preventive behaviours (both adaptive and dysfunctional/excessive) during the early pandemic response in Romania. Data were collected in April-May 2020, and the sample comprised 236 participants, 192 women, mean age 31.44 (s.d. = 10.30, age range 16-67). Our results showed that health anxiety and perceived control, but not perceived risk predicted adaptive preventive behaviours, whereas dysfunctional behaviours were predicted by health anxiety alone. COVID-19-related anxiety was predicted by health anxiety and perceived risk, with perceived control emerging as a non-significant predictor. Also, we found that the effect of health anxiety on COVID-19-related anxiety was mediated by perceived risk, and that perceived control acted as a moderator in the relation between health anxiety and dysfunctional (but not adaptive) preventive behaviours. Our results suggest health anxiety is a significant predictor of COVID-19-related anxiety and preventive behaviours. Also, adaptive, but not dysfunctional, preventive behaviours were additionally predicted by perceived control, pointing to the important role of control and self-efficacy in explaining adherence to recommendations.

Ovarian cancer relapses have been traditionally classified according to the platinum-free interval, leading to an arbitrary categorization of possible scenarios and treatment options. Its relevance in assessing treatment strategies has been revised in the last several years, as the panorama is constantly changing in the era of personalized medicine and targeted therapies. Factors to be considered while defining the best management of recurrent disease, and, consequently, the available treatment alternatives are increasing. Platinum remains one of the milestones of ovarian cancer treatment, but for some patients it might not be an ideal choice for several reasons other than limited platinum sensitivity. This review aims to analyze the scenarios in which platinum is not considered suitable in the management of patients with recurrent ovarian cancer, and the currently available alternatives.

This review analyzes the experience and trends in external beam radiotherapy for delivering a boost in locally advanced cervical cancer, identifying whether radiation therapy modalities impact clinical outcomes with the ultimate aim of evaluating alternatives to brachytherapy. Three independent Italian radiation oncologists conducted a literature search on different external beam radiotherapy boost modalities in locally advanced cervical cancer. The search yielded 30 studies. Eight dosimetric studies, evaluating target coverage and dose to organs at risk, and nine clinical investigations, reporting clinical outcomes, were analyzed. Dosimetric studies comparing external beam radiotherapy boost with brachytherapy produced divergent results, while clinical studies were limited by their retrospective nature, heterogeneous doses, radiation schedules, volumes and techniques, diverse follow-up times, and small cohorts of patients. Evidence emerged that high-tech external beam radiotherapy seemed no better than image-guided brachytherapy for delivering a boost in locally advanced cervical cancer. Prospective clinical studies comparing high-tech external beam radiotherapy and image-guided brachytherapy should be encouraged.

Clear cell renal cell carcinoma (ccRCC) is typically managed through surgical resection; however, many patients are not eligible for surgery due to advanced age or comorbidities. Stereotactic body radiotherapy (SBRT) has emerged as a promising noninvasive alternative, providing new opportunities for disease control in selected patients. We report the case of an 80-year-old male with metastatic ccRCC, initially treated with nivolumab plus ipilimumab according to the CheckMate 214 protocol. Due to an oligoprogressive renal lesion, SBRT was administered to a total dose of 40 Gy in five fractions (prescription isodose 80%) without significant toxicity. Immunotherapy was discontinued in June 2022 due to immune-related adverse events. Almost five years after SBRT, the treated lesions remain radiologically and clinically stable, despite the long-term discontinuation of systemic therapy. In this case, SBRT proved to be a valuable treatment option for a patient with RCC who was not a candidate for surgery or further systemic therapy. These findings suggest that integrating SBRT into the multimodal management of mRCC may provide prolonged disease control with minimal toxicity in carefully selected cases.