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Life
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Cancer Radiotherapy: Recent Advances and Challenges
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Cancer Radiotherapy: Recent Advances and Challenges

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Radiobiology and Nuclear Medicine".

Deadline for manuscript submissions: closed (25 November 2022) | Viewed by 19614

Special Issue Editor

Prof. Dr. Beata Biesaga

E-Mail Website
Guest Editor
Maria Skłodowska-Curie National Research Institute of Oncology, Cracow Branch, Cracow, Poland
Interests: intensity modulated radiation therapy; image guided radiotherapy; proton therapy; low doses; radiobiology

Special Issue Information

Dear Colleagues,

Radiation therapy remains an important component of cancer treatment with approximately 50% of all cancer patients receiving radiation therapy during their course of illness; it contributes toward 40% of curative treatment for cancer. Radiotherapy is frequently used to treat the most common types, such as breast, cervical, colorectal, and lung cancer. Radiation therapy is still rapidly evolving. New radiotherapy techniques have been implemented in the past few decades, including three-dimensional conformal therapy, stereotactic radiotherapy, intensity modulated radiation therapy, image guided and stereotactic body radiation therapy, tomotherapy, new brachytherapy techniques, and proton or heavy ion therapy. New perspectives before radiotherapy also focus on attempts to use low doses to sensitize to some cystostatics or to support the treatment of patients with COVID-19. Although ionizing radiation remains one of the most effective components in the therapy of cancer cure, answers to a number of questions remain unsolved, such as (1) ways to optimize the effectiveness of radiation therapy in combination with other modalities of treatment, (2) on what basis cells trigger a certain type of death after ionizing radiation treatment, and (3) the possibility of less toxic effects to normal tissues. Answers to these and other questions together with ongoing advancements in radiation therapy technology and techniques will ultimately lead to continued improvement in cancer treatment. In the light of these questions, we are proposing this Special Issue of Life dedicated to modern radiotherapy.

Prof. Dr. Beata Biesaga
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • intensity modulated radiation therapy
  • image guided radiotherapy
  • proton therapy
  • low doses
  • radiobiology

Published Papers (8 papers)

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Research

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8 pages, 909 KiB  
Communication
Clinical Application of a Customized 3D-Printed Bolus in Radiation Therapy for Distal Extremities
by Suah Yu, So Hyun Ahn, Sang Hyoun Choi, Woo Sang Ahn and In-hye Jung
Life 2023, 13(2), 362; https://doi.org/10.3390/life13020362 - 28 Jan 2023
Cited by 2 | Viewed by 2169
Abstract
In radiation therapy (RT) for skin cancer, tissue-equivalent substances called boluses are widely used to ensure the delivery of an adequate dose to the skin surface and to provide a radioprotective effect for normal tissue. The aim of this study was to develop [...] Read more.
In radiation therapy (RT) for skin cancer, tissue-equivalent substances called boluses are widely used to ensure the delivery of an adequate dose to the skin surface and to provide a radioprotective effect for normal tissue. The aim of this study was to develop a new type of three-dimensional (3D) bolus for RT involving body parts with irregular geometries and to evaluate its clinical feasibility. Two 3D-printed boluses were designed for two patients with squamous cell carcinoma (SCC) of their distal extremities based on computed tomography (CT) images and printed with polylactic acid (PLA). The clinical feasibility of the boluses was evaluated by measuring the in vivo skin dose at the tumor site with optically stimulated luminescence detectors (OSLDs) and comparing the results with the prescribed and calculated doses from the Eclipse treatment planning system (TPS). The average measured dose distribution for the two patients was 94.75% of the prescribed dose and 98.8% of the calculated dose. In addition, the average measured dose during repeated treatments was 189.5 ± 3.7 cGy, thus demonstrating the excellent reproducibility of the proposed approach. Overall, the customized 3D-printed boluses for the RT of distal extremities accurately delivered doses to skin tumors with improved reproducibility. Full article
(This article belongs to the Special Issue Cancer Radiotherapy: Recent Advances and Challenges)
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10 pages, 1614 KiB  
Article
Nontarget and Out-of-Field Doses from Electron Beam Radiotherapy
by Natalia Matuszak, Marta Kruszyna-Mochalska, Agnieszka Skrobala, Adam Ryczkowski, Piotr Romanski, Igor Piotrowski, Katarzyna Kulcenty, Wiktoria Maria Suchorska and Julian Malicki
Life 2022, 12(6), 858; https://doi.org/10.3390/life12060858 - 08 Jun 2022
Cited by 3 | Viewed by 1861
Abstract
In clinical radiotherapy, the most important aspects are the dose distribution in the target volume and healthy organs, including out-of-field doses in the body. Compared to photon beam radiation, dose distribution in electron beam radiotherapy has received much less attention, mainly due to [...] Read more.
In clinical radiotherapy, the most important aspects are the dose distribution in the target volume and healthy organs, including out-of-field doses in the body. Compared to photon beam radiation, dose distribution in electron beam radiotherapy has received much less attention, mainly due to the limited range of electrons in tissues. However, given the growing use of electron intraoperative radiotherapy and FLASH, further study is needed. Therefore, in this study, we determined out-of-field doses from an electron beam in a phantom model using two dosimetric detectors (diode E and cylindrical Farmer-type ionizing chamber) for electron energies of 6 MeV, 9 MeV and 12 MeV. We found a clear decrease in out-of-field doses as the distance from the field edge and depth increased. The out-of-field doses measured with the diode E were lower than those measured with the Farmer-type ionization chamber at each depth and for each electron energy level. The out-of-field doses increased when higher energy megavoltage electron beams were used (except for 9 MeV). The out-of-field doses at shallow depths (1 or 2 cm) declined rapidly up to a distance of 3 cm from the field edge. This study provides valuable data on the deposition of radiation energy from electron beams outside the irradiation field. Full article
(This article belongs to the Special Issue Cancer Radiotherapy: Recent Advances and Challenges)
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14 pages, 3953 KiB  
Article
Criteria for Verification and Replanning Based on the Adaptive Radiotherapy Protocol “Best for Adaptive Radiotherapy” in Head and Neck Cancer
by Bartosz Bak, Agnieszka Skrobala, Anna Adamska, Joanna Kazmierska, Natalia Jozefacka, Tomasz Piotrowski and Julian Malicki
Life 2022, 12(5), 722; https://doi.org/10.3390/life12050722 - 12 May 2022
Cited by 3 | Viewed by 4444
Abstract
No clear criteria have yet been established to guide decision-making for patient selection and the optimal timing of adaptive radiotherapy (ART) based on image-guided radiotherapy (IGRT). We have developed a novel protocol—the Best for Adaptive Radiotherapy (B-ART) protocol—to guide patient selection for ART. [...] Read more.
No clear criteria have yet been established to guide decision-making for patient selection and the optimal timing of adaptive radiotherapy (ART) based on image-guided radiotherapy (IGRT). We have developed a novel protocol—the Best for Adaptive Radiotherapy (B-ART) protocol—to guide patient selection for ART. The aim of the present study is to describe this protocol, to evaluate its validity in patients with head and neck (HN) cancer, and to identify the anatomical and clinical predictors of the need for replanning. We retrospectively evaluated 82 patients with HN cancer who underwent helical tomotherapy (HT) and subsequently required replanning due to soft tissue changes upon daily MVCT. Under the proposed criteria, patients with anatomical changes >3 mm on three to four consecutive scans are candidates for ART. We compared the volumes on the initial CT scan (iCT) and the replanning CT (rCT) scan for the clinical target volumes (CTV1, referring to primary tumor or tumor bed and CTV2, metastatic lymph nodes) and for the parotid glands (PG) and body contour (B-body). The patients were stratified by primary tumor localization, clinical stage, and treatment scheme. The main reasons for replanning were: (1) a planning target volume (PTV) outside the body contour (n = 70; 85.4%), (2) PG shrinkage (n = 69; 84.1%), (3) B-body deviations (n = 69; 84.1%), and (4) setup deviations (n = 40; 48.8%). The replanning decision was made, on average, during the fourth week of treatment (n = 47; 57.3%). The mean reductions in the size of the right and left PG volumes were 6.31 cc (20.9%) and 5.98 cc (20.5%), respectively (p < 0.001). The reduction in PG volume was ≥30% in 30 patients (36.6%). The volume reduction in all of the anatomical structures was statistically significant. Four variables—advanced stage disease (T3–T4), chemoradiation, increased weight loss, and oropharyngeal localization—were significantly associated with the need for ART. The B-ART protocol provides clear criteria to eliminate random errors, and to allow for an early response to relevant changes in target volumes. Full article
(This article belongs to the Special Issue Cancer Radiotherapy: Recent Advances and Challenges)
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14 pages, 1218 KiB  
Article
Influence of Specific Treatment Parameters on Nontarget and Out-of-Field Doses in a Phantom Model of Prostate SBRT with CyberKnife and TrueBeam
by Marta Kruszyna-Mochalska, Agnieszka Skrobala, Piotr Romanski, Adam Ryczkowski, Wiktoria Suchorska, Katarzyna Kulcenty, Igor Piotrowski, Dorota Borowicz, Kinga Graczyk, Natalia Matuszak and Julian Malicki
Life 2022, 12(5), 628; https://doi.org/10.3390/life12050628 - 23 Apr 2022
Cited by 2 | Viewed by 1756
Abstract
The aim of the study was to determine the influence of a key treatment plan and beam parameters on overall dose distribution and on doses in organs laying in further distance from the target during prostate SBRT. Multiple representative treatment plans (n = [...] Read more.
The aim of the study was to determine the influence of a key treatment plan and beam parameters on overall dose distribution and on doses in organs laying in further distance from the target during prostate SBRT. Multiple representative treatment plans (n = 12) for TrueBeam and CyberKnife were prepared and evaluated. Nontarget doses were measured with anionization chamber, in a quasi-humanoid phantom at four sites corresponding to the intestines, right lung, thyroid, and head. The following parameters were modified: radiotherapy technique, presence or not of a flattening filter, degree of modulation, and use or not of jaw tracking function for TrueBeam and beam orientation set-up, optimization techniques, and number of MUs for CyberKnife. After usual optimization doses in intestines (near the target) were 0.73% and 0.76%, in head (farthest from target) 0.05% and 0.19% for TrueBeam and CyberKnife, respectively. For TrueBeam the highest peripheral (head, thyroid, lung) doses occurred for the VMAT with the flattening filter while the lowest for 3DCRT. For CyberKnife the highest doses were for gantry with caudal direction beams blocked (gantry close to OARs) while the lowest was the low modulated VOLO optimization technique. The easiest method to reduce peripheral doses was to combine FFF with jaw tracking and reducing monitor units at TrueBeam and to avoid gantry position close to OARs together with reduction of monitor units at CyberKnife, respectively. The presented strategies allowed to significantly reduce out-of-field and nontarget doses during prostate radiotherapy delivered with TrueBeam and CyberKnife. A different approach was required to reduce peripheral doses because of the difference in dose delivery techniques: non-coplanar using CyberKnife and coplanar using TrueBeam, respectively. Full article
(This article belongs to the Special Issue Cancer Radiotherapy: Recent Advances and Challenges)
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14 pages, 4333 KiB  
Article
Thermal Boost to Breast Tumor Bed—New Technique Description, Treatment Application and Example Clinical Results
by Adam Chicheł, Wojciech Burchardt, Artur J. Chyrek, Grzegorz Bielęda, Grzegorz Zwierzchowski, Patrycja Stefaniak and Julian Malicki
Life 2022, 12(4), 512; https://doi.org/10.3390/life12040512 - 30 Mar 2022
Cited by 2 | Viewed by 1739
Abstract
(1) Current breast-conserving therapy for breast cancer consists of a combination of many consecutive treatment modalities. The most crucial goal of postoperative treatment is to eradicate potentially relapse-forming residual cancerous cells within the tumor bed. To achieve this, the HDR brachytherapy boost standardly [...] Read more.
(1) Current breast-conserving therapy for breast cancer consists of a combination of many consecutive treatment modalities. The most crucial goal of postoperative treatment is to eradicate potentially relapse-forming residual cancerous cells within the tumor bed. To achieve this, the HDR brachytherapy boost standardly added to external beam radiotherapy was enhanced with an initial thermal boost. This study presents an original thermal boost technique developed in the clinic. (2) A detailed point-by-point description of thermal boost application is presented. Data on proper patient selection, microwave thermal boost planning, and interstitial hyperthermia treatment delivery are supported by relevant figures and schemes. (3) Out of 1134 breast cancer patients who were administered HDR brachytherapy boost in the tumor bed, 262 were also pre-heated interstitially without unexpected complications. The results are supported by two example cases of hyperthermia planning and delivery. (4) Additional breast cancer interstitial thermal boost preceding HDR brachytherapy boost as a part of combined treatment in a unique postoperative setting was feasible, well-tolerated, completed in a reasonable amount of time, and reproducible. A commercially available interstitial hyperthermia system fit and worked well with standard interstitial brachytherapy equipment. Full article
(This article belongs to the Special Issue Cancer Radiotherapy: Recent Advances and Challenges)
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12 pages, 1512 KiB  
Article
Dosimetric Comparison of Ultra-Hypofractionated and Conventionally Fractionated Radiation Therapy Boosts for Patients with High-Risk Prostate Cancer
by Tomasz Piotrowski, Slav Yartsev, Jaroslaw Krawczyk, Marta Adamczyk, Agata Jodda, Julian Malicki and Piotr Milecki
Life 2022, 12(3), 394; https://doi.org/10.3390/life12030394 - 09 Mar 2022
Cited by 1 | Viewed by 2028
Abstract
Recent comparison of an ultra-hypofractionated radiotherapy (UF-RT) boost to a conventionally fractionated (CF-RT) option showed similar toxicity and disease control outcomes. An analysis of the treatment plans for these patients is needed for evaluating calculated doses for different organs, treatment beam-on time, and [...] Read more.
Recent comparison of an ultra-hypofractionated radiotherapy (UF-RT) boost to a conventionally fractionated (CF-RT) option showed similar toxicity and disease control outcomes. An analysis of the treatment plans for these patients is needed for evaluating calculated doses for different organs, treatment beam-on time, and requirements for human and financial resources. Eighty-six plans for UF-RT and 93 plans for CF-RT schemes were evaluated. The biologically equivalent dose, EQD2, summed for the first phase and the boost, was calculated for dose-volume parameters for organs at risk (OARs), as well as for the PTV1. ArcCHECK measurements for the boost plans were used for a comparison of planned and delivered doses. Monitor units and beam-on times were recorded by the Eclipse treatment planning system. Statistical analysis was performed with a significance level of 0.05. Dosimetric parameter values for OARs were well within tolerance for both groups. EQD2 for the PTV1 was on average 84 Gy for UF-RT patients and 76 Gy for CF-RT patients. Gamma passing rate for planned/delivered doses comparison was above 98% for both groups with 3 mm/3% distance to agreement/dose difference criteria. Total monitor units per fraction were 647 ± 94 and 2034 ± 570 for CF-RT and UF-RT, respectively. The total delivery time for boost radiation for the patients in the UF-RT arm was, on average, four times less than the total time for a conventional regimen with statistically equal clinical outcomes for the two arms in this study. Full article
(This article belongs to the Special Issue Cancer Radiotherapy: Recent Advances and Challenges)
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20 pages, 4558 KiB  
Article
Multi-Planar VMAT Plans for High-Grade Glioma and Glioblastoma Targeting the Hypothalamic-Pituitary Axis Sparing
by Eva Y. W. Cheung, Shirley S. H. Ng, Sapphire H. Y. Yung, Dominic Y. T. Cheng, Fandy Y. C. Chan and Janice K. Y. Cheng
Life 2022, 12(2), 195; https://doi.org/10.3390/life12020195 - 28 Jan 2022
Cited by 4 | Viewed by 2841
Abstract
Background: This study aimed to identify the better arc configuration of volumetric modulated arc therapy (VMAT) for high-grade glioma and glioblastoma, focusing on a dose reduction to the hypothalamic–pituitary axis through an analysis of dose-volumetric parameters, as well as a correlation analysis between [...] Read more.
Background: This study aimed to identify the better arc configuration of volumetric modulated arc therapy (VMAT) for high-grade glioma and glioblastoma, focusing on a dose reduction to the hypothalamic–pituitary axis through an analysis of dose-volumetric parameters, as well as a correlation analysis between the planned target volume (PTV) to organs at risk (OAR) distance and the radiation dose. Method: Twenty-four patients with 9 high-grade glioma and 15 glioblastomas were included in this study. Identical CT, MRI and structure sets of each patient were used for coplanar VMAT (CO-VMAT), dual planar VMAT (DP-VMAT) and multi-planar VMAT (MP-VMAT) planning. The dose constraints adhered to the RTOG0825 and RTOG9006 protocols. The dose-volumetric parameters of each plan were collected for statistical analysis. Correlation analyses were performed between radiation dose and PTV-OARs distance. Results: The DP-VMAT and MP-VMAT achieved a significant dose reduction to most nearby OARs when compared to CO-VMAT, without compromising the dose to PTV, plan homogeneity and conformity. For centrally located OARs, including the hypothalamus, pituitary, brain stem and optic chiasm, the dose reductions ranged from 2.65 Gy to 3.91 Gy (p < 0.001) in DP-VMAT and from 2.57 Gy to 4 Gy (p < 0.001) in MP-VMAT. Similar dose reduction effects were achieved for contralaterally located OARs, including the hippocampus, optic nerve, lens and retina, ranging from 1.06 Gy to 4.37 Gy in DP-VMAT and from 0.54 Gy to 3.39 Gy in MP-VMAT. For ipsilaterally located OARs, DP-VMAT achieved a significant dose reduction of 1.75 Gy to Dmax for the optic nerve. In the correlation analysis, DP-VMAT and MP-VMAT showed significant dose reductions to centrally located OARs when the PTV-OAR distance was less than 4 cm. In particular, DP-VMAT offered better sparing to the optic chiasm when it was located less than 2 cm from the PTV than that of MP-VMAT and CO-VMAT. DP-VMAT and MP-VMAT also showed better sparing to the contralateral hippocampus and retina when they were located 3–8 cm from the PTV. Conclusion: The proposed DP-VMAT and MP-VMAT demonstrated significant dose reductions to centrally located and contralateral OARs and maintained the high plan qualities to PTV with good homogeneity and conformity when compared to CO-VMAT for high-grade glioma and glioblastoma. The benefit in choosing DP-VMAT and MP-VMAT over CO-VMAT was substantial when the PTV was located near the hypothalamus, pituitary, optic chiasm, contralateral hippocampus and contralateral retina. Full article
(This article belongs to the Special Issue Cancer Radiotherapy: Recent Advances and Challenges)
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Review

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16 pages, 11683 KiB  
Review
Photon- and Proton-Mediated Biological Effects: What Has Been Learned?
by Enar Jumaniyazova, Daniil Smyk, Polina Vishnyakova, Timur Fatkhudinov and Konstantin Gordon
Life 2023, 13(1), 30; https://doi.org/10.3390/life13010030 - 22 Dec 2022
Cited by 3 | Viewed by 1438
Abstract
The current understanding of the effects of radiation is gradually becoming broader. However, it still remains unclear why some patients respond to radiation with a pronounced positive response, while in some cases the disease progresses. This is the motivation for studying the effects [...] Read more.
The current understanding of the effects of radiation is gradually becoming broader. However, it still remains unclear why some patients respond to radiation with a pronounced positive response, while in some cases the disease progresses. This is the motivation for studying the effects of radiation therapy not only on tumor cells, but also on the tumor microenvironment, as well as studying the systemic effects of radiation. In this framework, we review the biological effects of two types of radiotherapy: photon and proton irradiations. Photon therapy is a commonly used type of radiation therapy due to its wide availability and long-term history, with understandable and predictable outcomes. Proton therapy is an emerging technology, already regarded as the method of choice for many cancers in adults and children, both dosimetrically and biologically. This review, written after the analysis of more than 100 relevant literary sources, describes the local effects of photon and proton therapy and shows the mechanisms of tumor cell damage, interaction with tumor microenvironment cells and effects on angiogenesis. After systematic analysis of the literature, we can conclude that proton therapy has potentially favorable toxicological profiles compared to photon irradiation, explained mainly by physical but also biological properties of protons. Despite the fact that radiobiological effects of protons and photons are generally similar, protons inflict reduced damage to healthy tissues surrounding the tumor and hence promote fewer adverse events, not only local, but also systemic. Full article
(This article belongs to the Special Issue Cancer Radiotherapy: Recent Advances and Challenges)
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