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Low dose radiotherapy (LDRT) is a radiation technique in the treatment of benign conditions to relieve symptoms and improve mobility and pain with minimal overall side effects. There are many reports describing the use of LDRT in the treatment of osteoarthritis (OA), tendinitis and hyperproliferative disorders. The targeted diseases are complex and multifactorial, characterized by inflammation, cellular alterations, and tissue degeneration, affecting millions of people worldwide with increasing prevalence due to aging populations. However, an understanding of the pathophysiological mechanisms as well as the underlying biological and physical mechanisms is important for the clinical-practical application, as a foundation for empirical clinical studies and state-of-the-art patient treatment. In this review, we provide an overview of the broad use of LDRT in the treatment of benign diseases with well-described and illustrated overviews of the pathomechanisms of OA, tendinitis, bursitis, benign fibromatoses and hyperproliferative diseases. The biological, physical, and molecular mechanisms behind it are also described. We further provide a broad overview of studies as well as current discussions of the therapy such as risk assessment, treatment frequency and dosage, along with future perspectives to improve clinical application overall. Taken together, this review illustrates the multifaceted application of (LD)RT, emphasizing that each disease requires a unique treatment approach due to the wide variation in pathology, biological mechanisms, target volumes, and organs at risk, but it also highlights the need for well-designed (placebo)-controlled studies in a range of indications.

The objective of this work is to evaluate dosimetric impact of multilumen balloon applicator rotation in high‐dose‐rate (HDR) brachytherapy for breast cancer. Highly asymmetrical dose distribution was generated for patients A and B, depending upon applicator proximity to skin and rib. Both skin and rib spacing was ≤0.7 cm for A; only rib spacing was ≤0.7 cm for B. Thirty‐five rotation scenarios were simulated for each patient by rotating outer lumens every 10° over ±180∘ range with respect to central lumen using mathematically calculated rotational matrix. Thirty‐five rotated plans were compared with three plans: 1) original multidwell multilumen (MDML) plan, 2) multidwell single‐lumen (MDSL) plan, and 3) singledwell single‐lumen (SDSL) plan. For plan comparison, planning target volume for evaluation (PTV_EVAL) coverage (dose to 95% and 90% volume of PTV_EVAL) (D95 and D90), skin and rib maximal dose (Dmax), and normal breast tissue volume receiving 150% (V150) and 200% (V200) of prescribed dose (PD) were evaluated. Dose variation due to device rotation ranged from −5.6% to 0.8% (A) and −6.5% to 0.2% (B) for PTV_EVAL D95; −5.2% to 0.4% (A) and −4.1% to 0.7% (B) for PTV_EVAL D90; −2.0 to 18.4% (A) and −7.8 to 17.5% (B) for skin Dmax; −11.1 to 22.8% (A) and −4.7 to 55.1% (B) of PD for rib Dmax, respectively. Normal breast tissue V150 and V200 variation was <1.0 cc, except for −0.1 to 2.5 cc (B) of V200. Furthermore, 30° device rotation increased rib Dmax over 145% of PD: 152.9% (A) by clockwise 30° rotation and 152.5% (B) by counterclockwise 30° rotation. For a highly asymmetric dose distribution, device rotation can outweigh the potential benefit of improved dose shaping capability afforded by multilumen and make dosimetric data worse than single‐lumen plans unless it is properly corrected. PACS number: 87.53.Jw

The use of brachytherapy--and to a lesser extent, external-beam radiotherapy--in the management of locally recurrent breast cancer following ipsilateral breast tumor recurrence (IBTR) followed by repeat breast-conservation surgery and irradiation is currently an area of intense study. The current cosmetic scoring system is inadequate to score the outcome resulting from retreatment because it does not account for the cosmetic effect of the initial treatment. We propose a modification of the scale for patients who undergo retreatment--the Allegheny General Modification of the Harvard/NSABP/RTOG scoring scale.

Intraoperative planning with transrectal ultrasound (US) is used for accurate seed placement and optimal dosimetry in prostate brachytherapy. However, prostate magnetic resonance imaging (MRI) has shown superiority in delineation of prostate anatomy. Accordingly, MRI/US fusion may be useful for accurate intraoperative planning. We analyzed planning with MRI/US fusion to compare differences in dosimetry and volume to that derived from the postoperative computed tomography (CT). Twenty patients underwent preoperative prostate MRI, which was fused intraoperatively with US during prostate brachytherapy. Intraoperative I or Pd seed placement was modified by the use of MRI fusion when indicated. Following implantation, dose comparisons were made between data derived from MRI/US and that from post-operative CT scans. Plan parameters analyzed included the D (dose to 90% of the prostate), rectal D , V (volume of the rectum receiving 30 percent of dose), and prostate V . The median number of seeds implanted per patient was seventy-six. The MRI measured prostate volume, which was on average 4.47 cc larger than the CT measured prostate volume. In 9 patients, the apex of the prostate was better identified under MRI with the fusion protocol, and an average of 4 fewer seeds were required to be placed in the apex/urinary sphincter region. Both MRI and US individually showed a reduced intraoperative prostate D in comparison to the postoperative CT, with a larger mean difference for MRI in comparison with US (9.71 vs. 4.31 Gy, = 0.007). This was also true for the prostate V (5.18 vs. 2.73 cc, = 0.009). Post-operative CT underestimated rectal D and V in comparison to both MRI and US with MRI showing a larger mean difference than US for D (40.64 vs. 35.92 Gy, = 0.04) and V (50.20 vs. 44.38 cc, = 0.009). The MRI/US fusion demonstrated greater prostate volume compared to standard CT/US based planning likely due to the better resolution of the prostate apex. Furthermore, rectal dose was underestimated with CT vs. MRI based planning. Additional study is required to assess long-term clinical implications of disease control and effects on long-term toxicity, especially as related to the rectum and urinary sphincter. MRI/US intraoperative fusion may improve prostate dosimetry while sparing the rectum and urethra, potentially impacting disease control and late toxicity.

Acute radiation dermatitis is a frequent adverse effect of radiotherapy, but standardisation of care for acute radiation dermatitis is lacking. Due to the conflicting evidence and variability in current guidelines, a four-round Delphi consensus process was used to compile opinions of 42 international experts on care for people with acute radiation dermatitis on the basis of the evidence in existing medical literature. Interventions for acute radiation dermatitis prevention or management that reached at least 75% consensus were recommended for clinical use. Six interventions could be recommended for the prevention of acute radiation dermatitis: photobiomodulation therapy and Mepitel film in people with breast cancer, Hydrofilm, mometasone, betamethasone, and olive oil. Mepilex Lite dressings were recommended for the management of acute radiation dermatitis. Most interventions were not recommended due to insufficient evidence, conflicting evidence, or lack of consensus to support use, suggesting a need for further research. Clinicians can consider implementing recommended interventions in their practice to prevent and manage acute radiation dermatitis until additional evidence becomes available.

Purpose Radiation dermatitis (RD) is a frequently occurring adverse reaction during radiotherapy in cancer patients. While the use of topical corticosteroids (TCs) is common for the treatment of RD, its role in preventing severe reactions remains unclear. This systematic review and meta-analysis aim to evaluate the evidence on the use of TCs as prophylaxis of RD. Methods A systematic search was conducted using OVID MedLine, Embase, and Cochrane databases (between 1946 and 2023) to identify studies examining TC use in the prevention of severe RD. Statistical analysis was completed using RevMan 5.4 to calculate pooled effect sizes and 95% confidence intervals. Forest plots were then developed using a random effects model. Results Ten RCTs with a total of 1041 patients met the inclusion criteria. Six studies reported on mometasone furoate (MF) and four studies reported on betamethasone. Both TCs were associated with a significant improvement in the prevention of moist desquamation [OR = 0.34, 95% CI [0.25, 0.47], p  < 0.00001], but betamethasone was found to be more effective than MF [OR = 0.29, 95% CI [0.18, 0.46], p  < 0.00001 and OR = 0.39, 95% CI [0.25, 0.61], p  < 0.0001, respectively]. A similar finding was seen in reducing the development of grade 2 or higher RD according to the Radiation Therapy Oncology Group scale. Conclusions The current evidence supports the use of TCs in preventing severe reactions of RD. Both MF and betamethasone were found to be effective; however, betamethasone, a higher potency TC, is more effective despite MF being more commonly reported in literature.

The purpose of this study is to dosimetrically compare two plans generated using single dwell position method (SDPM) and multiple dwell position methods (MDPM) in MammoSite high dose rate (HDR) brachytherapy planning for 19 breast cancer patients. In computed tomography (CT) image‐based HDR planning, a surface optimization technique was used in both methods. Following dosimetric parameters were compared for fraction 1 plans: %PTV_EVAL (planning target volume for plan evaluation) coverage, dose homogeneity index (DHI), dose conformal index (COIN), maximum dose to skin and ipsilateral lung, and breast tissue volume receiving 150% (V150[cc]) and 200% (V200[cc]) of the prescribed dose. In addition, a plan was retrospectively generated for each fraction 2–10 to simulate the clinical situation where the fraction 1 plan was used for fractions 2–10 without modification. In order to create nine derived plans for each method and for each of the 19 patients, the catheter location and contours of target and critical structures were defined on the CT images acquired prior to each fraction 2–10, while using the same dwell‐time distribution as used for fraction 1 (original plan). Interfraction dose variations were evaluated for 19 patients by comparing the derived nine plans (each for fractions 2–10) with the original plan (fraction 1) using the same dosimetric parameters used for fraction 1 plan comparison. For the fraction 1 plan comparison, the MDPM resulted in slightly increased %PTV_EVAL coverage, COIN, V150[cc] and V200[cc] values by an average of 1.2%, 0.025, 0.5 cc and 0.7 cc, respectively, while slightly decreased DHI, maximum skin and ipsilateral lung dose by an average of 0.003, 3.2 cGy and 5.8 cGy, respectively. For the interfraction dose variation comparison, the SDPM resulted in slightly smaller variations in %PTV_EVAL coverage, DHI, maximum skin dose and V150[cc] values by an average of 0.4%, 0.0005, 0.5 cGy and 0.2 cc, respectively, while slightly higher average variations in COIN, maximum ipsilateral lung dose and V200[cc] values by 0.0028, 0.2 cGy and 0.2 cc, respectively. All differences were too small to be clinically significant. Compared to the MDPM, the SDPM combined with a surface optimization technique can generate a clinically comparable fraction 1 treatment plan with a similar interfraction dose variation if a single source is carefully positioned at the center of the balloon catheter. PACS number: 87.53.Jw

Ask most oncologists (especially radiation oncologists), and you may be hard pressed to find one who professes ignorance of Madame Curie and her historic contributions to medicine. Innumerable publications and media over the past century have correctly memorialised Madame Curie as one of the most brilliant minds in world history. However, do any of us really know the woman and the true extent of her sphere of influence? How, as well, does she fit into modern life and contemporary scientific advancement? Let us try to understand and learn from this complex scientist as more than just one of the most brilliant minds in human history.

Skin toxicities are very common in patients undergoing cancer treatment and have been found to occur with all types of cancer therapeutic interventions (cytotoxic chemotherapy, targeted therapies, immunotherapy, and radiotherapy). Further, skin toxicities can lead to interruption or even discontinuation of anticancer treatment in some patients, translating to suboptimal outcomes. Dermocosmetics (or cosmeceuticals)—defined as skincare solutions incorporating dermatologically active ingredients (beyond vehicle effects) that directly improve symptoms of various skin conditions—are increasingly being used in cancer care to prevent and manage skin toxicities. The active ingredients in these products have a measurable biological action in skin; they typically improve skin integrity (barrier function/hydration and other factors) while relieving skin symptoms. The Association Francophone des Soins Oncologiques de Support (AFSOS) and Multinational Association of Supportive Care in Cancer (MASCC) partnered to select a multidisciplinary group of healthcare professionals involved in the management of patients with cancer and skin toxicities. The group reviewed existing literature and created a summary of recommendations for managing these toxicities through online meetings and communication. In this publication, the group (1) reviews new skin toxicities seen with oncology drugs and (2) evaluates the role of dermocosmetics in improving patient outcomes and minimizing cancer treatment interruptions. We provide general recommendations for initiation and selection of skin care in all oncology patients as well as recommendations for what factors should be considered when using dermocosmetics in specific types of skin toxicities.