Explore the vast range of titles available.

Aims This review aims to synthesize the existing literature on palliative radiotherapy (RT) delivered in two daily fractions for patients with advanced cancer, focusing on its impact on symptom alleviation, treatment tolerance, and the implications for clinical practice and future research. Methods An international team conducted this narrative review, adhering to SANRA guidelines. Studies published in English on palliative RT delivered in two daily fractions were selected without date restrictions. The literature search, using a combination of specific key terms, led to a comprehensive examination of relevant studies. Data on study objectives, treatment approaches, palliative effectiveness, and toxicity were extracted and qualitatively analyzed. Results The review included 29 publications, showing consistent efficacy in symptom reduction (63.0%–100% palliative response rate) and general tolerability across various cancer types. These studies highlighted the potential radiobiological advantages and practicality of accelerated multi-fractionated regimens, which provide rapid tumor response with reduced late toxicity risks. Furthermore, the logistical benefits of such treatments, including shorter hospital stays and minimized travel requirements, were noted as particularly valuable during challenging times such as recent pandemics. Conclusions The evidence supports the integration of evidence-based, accelerated-hypofractionated RT into palliative care strategies, ensuring effective symptom management with minimal patient burden. Future research should focus on comparative studies on single versus multiple-cycle treatments, optimal intervals between treatment cycles, and the integration of advanced RT techniques.

Purpose To evaluate the impact of patient setup errors on the dosimetry and radiobiological models of intensity-modulated radiotherapy (IMRT) for esophageal cancer. Methods and materials This retrospective study with 56 patients in thermoplastic mask (TM) and vacuum bag (VB) groups utilized real setup-error (RSE) data from cone-beam CT scans to generate simulated setup-error (SSE) data following a normal distribution. The SSE data were applied to simulate all treatment fractions per patient by shifting the plan isocenter and recalculating the dose. A simulated plan sum (SPS) was created by accumulating all simulated fraction plans. Comparisons of target dose, improved homogeneity index (iHI), conformity index (CI), tumor control probability (TCP) and normal tissue complication probability (NTCP) were conducted between SPSs and original treatment plans (OTPs). Correlations between RSE and TCP/NTCP were analyzed. Results Compared to OTPs in the TM group, the planning target volume (PTV) of SPSs showed reductions in D95%, D98%, iHI, CI and TCP by 1.2%, 2.2%, 2.3%, 7.3% and 1.2%, while D2% increased by 0.3%; D2% of clinical target volume (CTV) increased by 0.2% (P < .05). In the VB group, D95%, D98%, iHI, CI and TCP of PTV decreased by 2.5%, 4.5%, 4.2%, 15.6% and 2.0%, with D2% increasing by 0.5%; D2% of CTV increased by 0.5% while D98% decreased by 0.2% (P < .05). The dose of organs at risk (OARs) changed slightly in both groups. The mean and standard deviation of absolute RSE negatively correlated with the TCP of PTV, while the mean RSE positively correlated with the NTCP of lung and spinal cord. Conclusions Setup errors may reduce dose homogeneity and conformity, potentially reducing TCP of PTV and increasing NTCP, especially when mean RSE shifts the isocenter towards OARs. VB immobilization may result in relatively larger impacts of setup errors, but this needs future validation.

Objective: In external radiotherapy, dose boluses and compensators are used for treatment of irregular facial topography surfaces. In such cases, skewed isodose curves need to be addressed using a bolus that gives the deep dose distribution a shape adapted to the anatomical structures to be protected or irradiated. The combination of 3D modeling and printing technologies is a promising alternative to the conventional inaccurate and uncomfortable bolus fabrication technique. In this work, the proposed technologies will be used in the design and fabrication of high-performance and high-accuracy boluses that respond to the main constraints on metrology, adhesion to the patient's surface, comfort, and dose delivery. Methods: As a first phase in the implementation of the proposed solution, 3D printing materials, to be used in the fabrication of radiotherapy boluses, were selected and characterized to check how they respond to the required criteria on functionality, safety, and quality. Results: The obtained results show that among the studied materials, thermoplastic polyurethane (TPU) was found to be slightly more suitable than polylactic acid (PLA) for the fabrication of 3D printing boluses but for some kinds of treatments, PLA may be preferred despite its relative rigidity. Conclusion: In this work, procedures for dose bolus fabrication were proposed, and necessary data were obtained for some available 3D printing materials (TPU and PLA) that can be used for targeted applications. This achievement is a major step toward the final implementation of 3D modeling and printing technologies for the efficient fabrication of radiotherapy dose boluses.

Purpose To evaluate the accuracy of two bladder scanners (BS) in measuring bladder volume (BV) during radiotherapy (RT), and explore the influence of two bladder filling methods and patients’ subjective urinary sensation on the consistency of BV. Methods Forty-two patients with pelvic tumors were divided into two groups: Group A (20 patients) and Group B (22 patients). Before the planning CT and each treatment session, all patients drank 500 mL of water after emptying their bladder and rectum. Group A waited for patients to provide feedback on urination, while Group B waited for 1 h. Subsequently, three consecutive measurements using two BSs were performed. The average volumes measured by the BS Padscan HD5 and Padscan HDW1 were recorded as BSHD5-v and BSHDW1-v, respectively. The differences between BSHD5-v, BSHDW1-v, and the BV obtained from planning CT (CT-v) or cone beam CT (CBCT) (CBCT-v) were assessed. The consistency between CBCT-v and CT-v in two patient groups was calculated. Urinary sensation score BV (VSC) was determined by the patient's urge to urinate score and CT-v. Results The average CT-v or CBCT-v was 280 mL (range 78-710 mL, SD = 119 mL). BSHD5-v had an average of 271 mL (range 61-611 mL, SD = 115 mL), with a significant correlation with CT-v or CBCT-v (R = 0.89, p < 0.001). BSHDW1-v averaged 267 mL (range 92-634 mL, SD = 77 mL), positively correlated with CT-v or CBCT-v (R = 0.70, p < 0.001). Group A's CBCT-v proportions within ±20%, ± 30%, and ±50% of CT-v were 51.20%, 66.90%, and 91.90%, respectively, contrasting with Group B's 26.2%, 41.1%, and 67.7%. VSC exhibited a positive association with CBCT-v (R = 0.59, p < 0.001). Conclusions Consistent and reproducible bladder volume was obtained by using Padscan HD5 and Padscan HDW1. The Padscan HD5 demonstrated greater consistency and accuracy. Furthermore, the urinary feedback method has a more consistent bladder volume than the fixed-time method.

Hepatoblastoma, a common extracranial malignant solid tumor in childhood, is often detected at an advanced stage and is difficult to treat surgically. Despite the availability of multiple comprehensive treatments that can be combined with surgery, hepatoblastoma treatment outcomes remain poor. Surgery is the main treatment strategy for hepatoblastoma, but it faces many challenges, including tumor attachment to surrounding tissues, tumor wrapping or invading of vital organs and tissues, the presence of giant or multiple tumors, distant metastasis, the formation of a tumor thrombus, and significant surgical trauma. In this review, we discuss recent research advances and propose potential strategies for overcoming these challenges. Such strategies may improve the rate of hepatoblastoma resection and local control in children, as well as reduce complications and trauma.