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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).

Purpose: To validate and compare the deformable image registration and parotid contour propagation process for head and neck magnetic resonance imaging in patients treated with radiotherapy using 3 different approaches—the commercial MIM, the open-source Elastix software, and an optimized version of it. Materials and Methods: Twelve patients with head and neck cancer previously treated with radiotherapy were considered. Deformable image registration and parotid contour propagation were evaluated by considering the magnetic resonance images acquired before and after the end of the treatment. Deformable image registration, based on free-form deformation method, and contour propagation available on MIM were compared to Elastix. Two different contour propagation approaches were implemented for Elastix software, a conventional one (DIR_Trx) and an optimized homemade version, based on mesh deformation (DIR_Mesh). The accuracy of these 3 approaches was estimated by comparing propagated to manual contours in terms of average symmetric distance, maximum symmetric distance, Dice similarity coefficient, sensitivity, and inclusiveness. Results: A good agreement was generally found between the manual contours and the propagated ones, without differences among the 3 methods; in few critical cases with complex deformations, DIR_Mesh proved to be more accurate, having the lowest values of average symmetric distance and maximum symmetric distance and the highest value of Dice similarity coefficient, although nonsignificant. The average propagation errors with respect to the reference contours are lower than the voxel diagonal (2 mm), and Dice similarity coefficient is around 0.8 for all 3 methods. Conclusion: The 3 free-form deformation approaches were not significantly different in terms of deformable image registration accuracy and can be safely adopted for the registration and parotid contour propagation during radiotherapy on magnetic resonance imaging. More optimized approaches (as DIR_Mesh) could be preferable for critical deformations.

Objectives Congenital thoracic masses (CTMs) are suspected in presence of solid or cystic thoracic lesions at ultrasound. The common typical fetal CTMs encompass: hyperechogenic lung lesions such as congenital pulmonary airway malformation (CPAM), broncopulmonary sequestration (PS) and congenital high airway obstruction syndrome (CHAOS); less common solid thoracic masses are mediastinal/pericardial tumors as rhabdomyoma and teratoma. The aim of our study is to gather the available evidence on cases of atypical CTMs of difficult classification, for which the diagnosis remains often uncertain. Methods A review of the literature on the prenatal diagnosis of CTMs was performed, focusing on ultrasound features, postnatal manifestation, treatment and neonatal outcome. Inclusion criterion was prenatal diagnosis of CTM cases with difficult classification in six typical categories. A summary of results was carried out. Results The literature review included six studies in the analysis. Two cases experienced intrauterine fetal death, one with hydrops in rhabdomyoma and another one for a rapid growth of the mass, with autopsies precising the diagnoses. In two other instances, surgery after birth provided also different histologic diagnoses. All surviving children were asymptomatic at follow-up. One case with rhabdomyoma and another one with atypical pericardial teratoma showed spontaneous regression. Moreover we are presenting our unpublished case of an atypical mass diagnosed as rhabdomyoma or broncopulmonary sequestration. Conclusions Some masses may present atypical presentation of a known disease or we may face rare diagnosis for which there is lack of information in the literature. The definitive diagnosis still relies on histologic analysis.

Anaplastic thyroid carcinoma (ATC) is a very rare, highly aggressive malignant thyroid tumor with an overall survival from 3 to 5 months in most of the cases. Even the modern and intensive treatments seem not to be enough to provide a cure, also for the resectable ones, and the role of chemotherapy is still unclear but does not seem to prolong survival. Nevertheless, some patients survive longer and have a better outcome, even in the presence of metastasis, than what the literature reports. We present the case of a 64-year-old female affected by ATC, treated on February 2018 with surgery followed by chemoradiation. One year after surgery, the patient developed a subcutaneous recurrence that was radically resected and is still alive 29 months after the diagnosis. We propose a systematic review of the literature to deepen the knowledge of the prognostic factors of ATC with the aim to recognize and select the patients with a better outcome, even if metastatic, and to describe a very uncommon site of metastatization.

Chronic infections such as Helicobacter pylori (Hp), Hepatitis C virus (HCV), and Human Papillomavirus (HPV) significantly contribute to the global cancer burden, necessitating targeted and cost-effective prevention strategies. The Cancer Prevention at Work (CPW) project pioneers an innovative approach by integrating primary prevention interventions into occupational health surveillance (OHS) programs, thus leveraging existing workplace infrastructure for a large-scale impact. CPW aims to screen and treat Hp and HCV infections, and promote HPV vaccination, targeting not only workers but also their household members. CPW aims to support accessibility, facilitate earlier detection, and strengthen cancer prevention at a population level. The project employs a micro-elimination strategy for HCV, supports data-driven risk assessment for Hp and HPV, and promotes evidence-based communication to reduce HPV vaccine hesitancy. A comprehensive data management framework ensures harmonized data collection, integration, and cost-effectiveness analysis, aiming at providing robust evidence for policy recommendations. Through pilot studies conducted across four European countries, CPW assesses the feasibility, cost-effectiveness, and economic sustainability, with the potential to inform future occupational cancer prevention initiatives across Europe. This work summarizes the CPW project's research framework designed to integrate infection-related cancer prevention into workplace health programs across Europe. It details the project's goals, methods, and discusses the impact on occupational cancer prevention.