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Cancers
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New Approaches in Radiotherapy for Cancer
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New Approaches in Radiotherapy for Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 15376

Special Issue Editors

Dr. Dandan Zheng

E-Mail Website
Guest Editor
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14626, USA
Interests: SRS/SRT/SBRT; radiomics; artificial intelligence; adaptive radiotherapy; imaging in radiotherapy; HDR
Dr. Alexander Podgorsak

E-Mail Website
Guest Editor
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14626, USA
Interests: artificial intelligence; deep learning; image processing; radiomics; CT reconstruction
Dr. Olga Maria Dona Lemus

E-Mail Website
Guest Editor
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY 14626, USA
Interests: artificial intelligence; adaptive radiotherapy; image processing; image analysis

Special Issue Information

Dear Colleagues,

In the dynamic field of radiotherapy, recent years have witnessed groundbreaking advancements that have significantly reshaped cancer treatment strategies. We have seen remarkable progress boosted by advanced imaging techniques, the integration of artificial intelligence, the development of new radiation treatment machines and online adaptive platforms, novel treatment and monitoring modalities, and a deeper understanding of radiobiology. These advances include adaptive therapy, spatially fractionated radiotherapy, FLASH, immuno-radiotherapy, proton and particle therapy, SRS for multiple brain metastases and functional diseases, radiogenomics, HDR brachytherapy, optimized beam geometry and automated treatment planning, advanced dose calculation, 3D printing, etc. Collectively, they contribute to more precise, effective and personalized radiotherapy, offering new hope and improved outcomes for patients. Therefore, this Special Issue aims to highlight and explore these innovations.

We cordially invite you to submit your cutting-edge research and review articles to this Special Issue. Your contributions will help in disseminating knowledge about these remarkable advances, fostering further research and collaboration in the field of radiotherapy. We look forward to receiving your submissions and the vibrant discussions they will undoubtedly inspire.

Dr. Dandan Zheng
Dr. Alexander Podgorsak
Dr. Olga Maria Dona Lemus
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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. Cancers is an international peer-reviewed open access semimonthly 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 2900 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

  • adaptive radiotherapy
  • FLASH
  • artificial intelligence
  • SFRT
  • particle therapy
  • proton therapy
  • SRS
  • SBRT
  • HDR
  • 3D printing
  • immuno-radiotherapy
  • radiogenmics

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Published Papers (11 papers)

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Research

Jump to: Review, Other

25 pages, 12113 KiB  
Article
Melanoma Cells from Different Patients Differ in Their Sensitivity to Alpha Radiation-Mediated Killing, Sensitivity Which Correlates with Cell Nuclei Area and Double Strand Breaks
by Or I. Levy, Anat Altaras, Lior Binyamini, Orit Sagi-Assif, Sivan Izraely, Tomer Cooks, Oren Kobiler, Motti Gerlic, Itzhak Kelson, Isaac P. Witz and Yona Keisari
Cancers 2024, 16(22), 3804; https://doi.org/10.3390/cancers16223804 - 12 Nov 2024
Viewed by 508
Abstract
Background/Objective: In this study, for the first time, we examined and compared the sensitivity of four patient-derived cutaneous melanoma cell lines to alpha radiation in vitro and analyzed it in view of cell nucleus area and the formation of double-strand breaks (DSB). [...] Read more.
Background/Objective: In this study, for the first time, we examined and compared the sensitivity of four patient-derived cutaneous melanoma cell lines to alpha radiation in vitro and analyzed it in view of cell nucleus area and the formation of double-strand breaks (DSB). Melanoma cells sensitivity to alpha radiation was compared to photon radiation effects. Furthermore, we compared the sensitivity of the melanoma cells to squamous cell carcinoma. Methods: Human melanoma cell lines YDFR.C, DP.C, M12.C, and M16.C, and the squamous cell carcinoma cell line, CAL 27, were irradiated in vitro using Americium-241 as alpha-particle source. Cells were irradiated with doses of 0 to 2.8 gray (Gy). Cell viability, DNA DSB, and nuclear size were measured. Results: 1. Alpha radiation caused death and proliferation arrest of all four melanoma cell lines, but inter-tumor heterogeneity was observed. 2. The most sensitive cell line (DP.C) had a significantly larger nucleus area (408 µm2) and the highest mean number of DSB per cell (9.61) compared to more resistant cells. 3. The most resistant cell, M16.C, had a much lower nucleus area (236.99 µm2) and DSB per cell (6.9). 4. Alpha radiation was more lethal than photon radiation for all melanoma cells. 5. The SCC cell, CAL 27, was more sensitive to alpha radiation than all melanoma cells but had a similar number of DSB (6.67) and nucleus size (175.49 µm2) as the more resistant cells. 6. The cytotoxic effect of alpha radiation was not affected by proliferation arrest after serum starvation. 7. Killing of cells by alpha radiation was marginally elevated by ATR or topoisomerase 1 inhibition. Conclusions: This study demonstrates that various human melanoma cells can be killed by alpha radiation but exhibit variance in sensitivity to alpha radiation. Alpha radiation applied using the Intra-tumoral Diffusing alpha-emitters Radiation Therapy (Alpha DaRT) methodology may serve as an efficient treatment for human melanoma. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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11 pages, 2417 KiB  
Article
Use of Radioguided Surgery for Small and Difficult-to-Locate Relapsed MIBG (+) High-Risk Neuroblastoma Lesions
by Lucas Krauel, Albert Pasten, Maite Gorostegui, Salvador Mañé, Marta Pilar Martin Giménez, Maria Coronas, Rosalia Carrasco Torrents and Jaume Mora
Cancers 2024, 16(19), 3348; https://doi.org/10.3390/cancers16193348 - 30 Sep 2024
Viewed by 641
Abstract
Introduction: High-risk neuroblastoma, particularly in the relapse/refractory (R/R) setting, poses unique challenges to obtaining the representative-quality tissue that is mostly required for molecular analysis. This study explores the use of 123I-MIBG radioguided surgery to access complex locations of MIBG-positive neuroblastoma as a tool [...] Read more.
Introduction: High-risk neuroblastoma, particularly in the relapse/refractory (R/R) setting, poses unique challenges to obtaining the representative-quality tissue that is mostly required for molecular analysis. This study explores the use of 123I-MIBG radioguided surgery to access complex locations of MIBG-positive neuroblastoma as a tool to overcome the difficulties associated with repeated surgeries in these patients. Methods: This study is a retrospective review of all patients with R/R neuroblastoma and MIBG-uptaking lesions who underwent radioguided surgery between February 2020 and 2023 at SJD Barcelona Children’s Hospital. The Europrobe 3.2 gamma probe was used to identify neuroblastoma tissue in the operating room. Results: Ten patients were identified. Radioguided surgery was useful in all patients. One patient with previous multiple operations developed an entero-cutaneous fistula with posterior full recovery. Mean surgical time was 111.7 min. The gamma probe identified 100% of neuroblastoma lesions which were all completely removed (123I-MIBG-SPECT/CT negative post-surgery). Pathology and molecular studies could be successfully performed in all samples. Conclusions: 123I-MIBG radioguided surgery proved effective in obtaining viable tissue from difficult-to-access sites in high-risk relapsed neuroblastoma. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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14 pages, 906 KiB  
Article
Radiation Dose-Induced Carotid Artery Stenosis and Brain Necrosis in Head and Neck Cancer—A Real World Cohort Study
by Henry W. C. Leung, Shyh-Yau Wang, Cheng-Li Lin and Agnes L. F. Chan
Cancers 2024, 16(17), 2982; https://doi.org/10.3390/cancers16172982 - 27 Aug 2024
Viewed by 707
Abstract
Objective: This study aims to examine whether radiation therapy doses are related to incidences of carotid artery stenosis and brain necrosis in a large-scale real-world database. Methods: We identified a cohort of HNC patients from the catastrophic illness patient dataset using ICD-9 or [...] Read more.
Objective: This study aims to examine whether radiation therapy doses are related to incidences of carotid artery stenosis and brain necrosis in a large-scale real-world database. Methods: We identified a cohort of HNC patients from the catastrophic illness patient dataset using ICD-9 or ICD-10 to compare the incidence and risks of carotid artery stenosis (CAS) and brain necrosis (RIBN) in patients who received a radiation therapy dose of ≥5400 cGy/30 fractions (group A) with those who received a radiation therapy dose of <5400 cGy/30 fractions (group B). The incidence and hazard ratios were quantified using Cox proportional hazards models. Results: A total of 19,964 patients were identified in group A and group B. Among them, 965 and 863 cases of CAS and 435 and 359 cases of RIBN were identified in group A and group B, respectively. There was no statistically significant association between the two groups for CAS risk, whereas there was a statistically significant association between the two groups for RIBN risk. The most common primary site of head and neck cancers was the nasopharynx (1144 of 19,964, 5.73%). Conclusions: Our study suggests that RT may increase the risk of carotid stenosis and brain necrosis in patients with NPC. To ensure patient safety during treatment, the optimal balance between tumor control and toxicity prevention in individual patients through minimization of the radiation dose to all relevant OARs must be properly understood. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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11 pages, 1250 KiB  
Article
Clinical Outcomes of Online Adaptive Magnetic Resonance-Guided Stereotactic Body Radiotherapy of Adrenal Metastases from a Single Institution
by Philipp Hoegen-Saßmannshausen, Inga Jessen, Carolin Buchele, Fabian Schlüter, Carolin Rippke, Claudia Katharina Renkamp, Fabian Weykamp, Sebastian Regnery, Jakob Liermann, Eva Meixner, Line Hoeltgen, Tanja Eichkorn, Laila König, Jürgen Debus, Sebastian Klüter and Juliane Hörner-Rieber
Cancers 2024, 16(12), 2273; https://doi.org/10.3390/cancers16122273 - 19 Jun 2024
Viewed by 861
Abstract
(1) Background: Recent publications foster stereotactic body radiotherapy (SBRT) in patients with adrenal oligometastases or oligoprogression. However, local control (LC) after non-adaptive SBRT shows the potential for improvement. Online adaptive MR-guided SBRT (MRgSBRT) improves tumor coverage and organ-at-risk (OAR) sparing. Long-term results of [...] Read more.
(1) Background: Recent publications foster stereotactic body radiotherapy (SBRT) in patients with adrenal oligometastases or oligoprogression. However, local control (LC) after non-adaptive SBRT shows the potential for improvement. Online adaptive MR-guided SBRT (MRgSBRT) improves tumor coverage and organ-at-risk (OAR) sparing. Long-term results of adaptive MRgSBRT are still sparse. (2) Methods: Adaptive MRgSBRT was performed on a 0.35 T MR-Linac. LC, overall survival (OS), progression-free survival (PFS), overall response rate (ORR), and toxicity were assessed. (3) Results: 35 patients with 40 adrenal metastases were analyzed. The median gross tumor volume was 30.6 cc. The most common regimen was 10 fractions at 5 Gy. The median biologically effective dose (BED10) was 75.0 Gy. Plan adaptation was performed in 98% of all fractions. The median follow-up was 7.9 months. One local failure occurred after 16.6 months, resulting in estimated LC rates of 100% at one year and 90% at two years. ORR was 67.5%. The median OS was 22.4 months, and the median PFS was 5.1 months. No toxicity > CTCAE grade 2 occurred. (4) Conclusions: LC and ORR after adrenal adaptive MRgSBRT were excellent, even in a cohort with comparably large metastases. A BED10 of 75 Gy seems sufficient for improved LC in comparison to non-adaptive SBRT. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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14 pages, 2752 KiB  
Article
Clinical Workflow of Cone Beam Computer Tomography-Based Daily Online Adaptive Radiotherapy with Offline Magnetic Resonance Guidance: The Modular Adaptive Radiotherapy System (MARS)
by Ji-Young Kim, Bouchra Tawk, Maximilian Knoll, Philipp Hoegen-Saßmannshausen, Jakob Liermann, Peter E. Huber, Mona Lifferth, Clemens Lang, Peter Häring, Regula Gnirs, Oliver Jäkel, Heinz-Peter Schlemmer, Jürgen Debus, Juliane Hörner-Rieber and Fabian Weykamp
Cancers 2024, 16(6), 1210; https://doi.org/10.3390/cancers16061210 - 19 Mar 2024
Cited by 1 | Viewed by 1962
Abstract
Purpose: The Ethos (Varian Medical Systems) radiotherapy device combines semi-automated anatomy detection and plan generation for cone beam computer tomography (CBCT)-based daily online adaptive radiotherapy (oART). However, CBCT offers less soft tissue contrast than magnetic resonance imaging (MRI). This work aims to present [...] Read more.
Purpose: The Ethos (Varian Medical Systems) radiotherapy device combines semi-automated anatomy detection and plan generation for cone beam computer tomography (CBCT)-based daily online adaptive radiotherapy (oART). However, CBCT offers less soft tissue contrast than magnetic resonance imaging (MRI). This work aims to present the clinical workflow of CBCT-based oART with shuttle-based offline MR guidance. Methods: From February to November 2023, 31 patients underwent radiotherapy on the Ethos (Varian, Palo Alto, CA, USA) system with machine learning (ML)-supported daily oART. Moreover, patients received weekly MRI in treatment position, which was utilized for daily plan adaptation, via a shuttle-based system. Initial and adapted treatment plans were generated using the Ethos treatment planning system. Patient clinical data, fractional session times (MRI + shuttle transport + positioning, adaptation, QA, RT delivery) and plan selection were assessed for all fractions in all patients. Results: In total, 737 oART fractions were applied and 118 MRIs for offline MR guidance were acquired. Primary sites of tumors were prostate (n = 16), lung (n = 7), cervix (n = 5), bladder (n = 1) and endometrium (n = 2). The treatment was completed in all patients. The median MRI acquisition time including shuttle transport and positioning to initiation of the Ethos adaptive session was 53.6 min (IQR 46.5–63.4). The median total treatment time without MRI was 30.7 min (IQR 24.7–39.2). Separately, median adaptation, plan QA and RT times were 24.3 min (IQR 18.6–32.2), 0.4 min (IQR 0.3–1,0) and 5.3 min (IQR 4.5–6.7), respectively. The adapted plan was chosen over the scheduled plan in 97.7% of cases. Conclusion: This study describes the first workflow to date of a CBCT-based oART combined with a shuttle-based offline approach for MR guidance. The oART duration times reported resemble the range shown by previous publications for first clinical experiences with the Ethos system. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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Review

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22 pages, 523 KiB  
Review
New Frontiers in the Treatment of Patients with HER2+ Cancer and Brain Metastases: Is Radiotherapy Always Useful?
by Giuseppa Scandurra, Valentina Lombardo, Giuseppe Scibilia, Daniela Sambataro, Vittorio Gebbia, Paolo Scollo, Basilio Pecorino and Maria Rosaria Valerio
Cancers 2024, 16(13), 2466; https://doi.org/10.3390/cancers16132466 - 5 Jul 2024
Viewed by 1254
Abstract
Brain metastases (BM) pose a significant challenge in the management of HER2+ breast cancer since almost 50% of patients with HER2+ breast cancer develop brain tumors. The complex process of brain metastases involves genetic mutations, adaptations and mechanisms to overcome the blood–brain barrier. [...] Read more.
Brain metastases (BM) pose a significant challenge in the management of HER2+ breast cancer since almost 50% of patients with HER2+ breast cancer develop brain tumors. The complex process of brain metastases involves genetic mutations, adaptations and mechanisms to overcome the blood–brain barrier. While radiotherapy is still fundamental in local therapy, its use is associated with cognitive adverse effects and limited long-term control, necessitating the exploration of alternative treatments. Targeted therapies, including tyrosine kinase inhibitors, monoclonal antibodies, and antibody–drug conjugates, offer promising options for HER2+ breast cancer patients with BM. Clinical trials have demonstrated the efficacy of these agents in controlling tumor growth and improving patient outcomes, posing the question of whether radiotherapy is always the unique choice in treating this cancer. Ongoing research into novel anti-HER2 antibodies and innovative combination therapies holds promise for advancing treatment outcomes and enhancing patient care in this clinical scenario. This narrative review provides a comprehensive overview of traditional medical treatments, molecularly targeted therapy and investigational agents in the management of HER2+ breast cancer with BM, highlighting the evolving landscape and potential future directions in treatment strategies to improve patient survival and quality of life. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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33 pages, 6872 KiB  
Review
The Role of MRI in Breast Cancer and Breast Conservation Therapy
by Iman Washington, Russell F. Palm, Julia White, Stephen A. Rosenberg and Dana Ataya
Cancers 2024, 16(11), 2122; https://doi.org/10.3390/cancers16112122 - 1 Jun 2024
Viewed by 1754
Abstract
Contrast-enhanced breast MRI has an established role in aiding in the detection, evaluation, and management of breast cancer. This article discusses MRI sequences, the clinical utility of MRI, and how MRI has been evaluated for use in breast radiotherapy treatment planning. We highlight [...] Read more.
Contrast-enhanced breast MRI has an established role in aiding in the detection, evaluation, and management of breast cancer. This article discusses MRI sequences, the clinical utility of MRI, and how MRI has been evaluated for use in breast radiotherapy treatment planning. We highlight the contribution of MRI in the decision-making regarding selecting appropriate candidates for breast conservation therapy and review the emerging role of MRI-guided breast radiotherapy. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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14 pages, 782 KiB  
Review
Impact of Relative Biologic Effectiveness for Proton Therapy for Head and Neck and Skull-Base Tumors: A Technical and Clinical Review
by Adam L. Holtzman, Homan Mohammadi, Keith M. Furutani, Daniel M. Koffler, Lisa A. McGee, Scott C. Lester, Mauricio E. Gamez, David M. Routman, Chris J. Beltran and Xiaoying Liang
Cancers 2024, 16(11), 1947; https://doi.org/10.3390/cancers16111947 - 21 May 2024
Viewed by 1168
Abstract
Proton therapy has emerged as a crucial tool in the treatment of head and neck and skull-base cancers, offering advantages over photon therapy in terms of decreasing integral dose and reducing acute and late toxicities, such as dysgeusia, feeding tube dependence, xerostomia, secondary [...] Read more.
Proton therapy has emerged as a crucial tool in the treatment of head and neck and skull-base cancers, offering advantages over photon therapy in terms of decreasing integral dose and reducing acute and late toxicities, such as dysgeusia, feeding tube dependence, xerostomia, secondary malignancies, and neurocognitive dysfunction. Despite its benefits in dose distribution and biological effectiveness, the application of proton therapy is challenged by uncertainties in its relative biological effectiveness (RBE). Overcoming the challenges related to RBE is key to fully realizing proton therapy’s potential, which extends beyond its physical dosimetric properties when compared with photon-based therapies. In this paper, we discuss the clinical significance of RBE within treatment volumes and adjacent serial organs at risk in the management of head and neck and skull-base tumors. We review proton RBE uncertainties and its modeling and explore clinical outcomes. Additionally, we highlight technological advancements and innovations in plan optimization and treatment delivery, including linear energy transfer/RBE optimizations and the development of spot-scanning proton arc therapy. These advancements show promise in harnessing the full capabilities of proton therapy from an academic standpoint, further technological innovations and clinical outcome studies, however, are needed for their integration into routine clinical practice. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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25 pages, 4297 KiB  
Review
Adaptive Radiotherapy: Next-Generation Radiotherapy
by Olga Maria Dona Lemus, Minsong Cao, Bin Cai, Michael Cummings and Dandan Zheng
Cancers 2024, 16(6), 1206; https://doi.org/10.3390/cancers16061206 - 19 Mar 2024
Cited by 9 | Viewed by 4292
Abstract
Radiotherapy, a crucial technique in cancer therapy, has traditionally relied on the premise of largely unchanging patient anatomy during the treatment course and encompassing uncertainties by target margins. This review introduces adaptive radiotherapy (ART), a notable innovation that addresses anatomy changes and optimizes [...] Read more.
Radiotherapy, a crucial technique in cancer therapy, has traditionally relied on the premise of largely unchanging patient anatomy during the treatment course and encompassing uncertainties by target margins. This review introduces adaptive radiotherapy (ART), a notable innovation that addresses anatomy changes and optimizes the therapeutic ratio. ART utilizes advanced imaging techniques such as CT, MRI, and PET to modify the treatment plan based on observed anatomical changes and even biological changes during the course of treatment. The narrative review provides a comprehensive guide on ART for healthcare professionals and trainees in radiation oncology and anyone else interested in the topic. The incorporation of artificial intelligence in ART has played a crucial role in improving effectiveness, particularly in contour segmentation, treatment planning, and quality assurance. This has expedited the process to render online ART feasible, lowered the burden for radiation oncology practitioners, and enhanced the precision of dynamically personalized treatment. Current technical and clinical progress on ART is discussed in this review, highlighting the ongoing development of imaging technologies and AI and emphasizing their contribution to enhancing the applicability and effectiveness of ART. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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Other

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14 pages, 2192 KiB  
Systematic Review
Prostate-Specific Membrane Antigen (PSMA) PET/CT in the Detection and Diagnosis of Hepatocellular Carcinoma (HCC): A Systematic Review and Meta-Analysis
by Nicholas Hannah, Catherine Yu, Leya Nedumannil, James Haridy, Grace Kong, Alex Boussioutas and Siddharth Sood
Cancers 2024, 16(22), 3865; https://doi.org/10.3390/cancers16223865 - 19 Nov 2024
Viewed by 309
Abstract
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is widely used in prostate cancer. Recent studies indicate hepatocellular carcinoma (HCC) demonstrates PSMA PET uptake. The diagnostic accuracy of PSMA PET for HCC is not known. We conducted a systematic review and meta-analysis of [...] Read more.
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is widely used in prostate cancer. Recent studies indicate hepatocellular carcinoma (HCC) demonstrates PSMA PET uptake. The diagnostic accuracy of PSMA PET for HCC is not known. We conducted a systematic review and meta-analysis of studies assessing 68Ga-PSMA-11 in HCC. Nine studies were included, with 196 patients and a total of 491 HCC lesions. Per-patient analysis yielded a pooled sensitivity of 89.8% (95% CI 78.5–95.5). Specificity was poorly reported, with insufficient data. When per-lesion level analysis was performed on seven studies, the pooled sensitivity was 94.5% (95% CI 82.9–98.4), and specificity was again poorly reported with insufficient data. Among the three studies with adequate data for full per-lesion meta-analysis, 115 lesions in 41 patients demonstrated sensitivity of 97.1% (95% CI 87.8–99.4), while specificity was 42.2% (95% CI 0.3–99.4). Two studies provided sufficient data for meta-analysis on a per-patient level (n = 50 patients), demonstrating a sensitivity of 92.5% (95% CI 64.0–98.9) and specificity of 72.4% (95% CI 1.3–99.8). PSMA PET demonstrates a high sensitivity for HCC and shows promise as an imaging modality for diagnosis and staging of HCC. However, the existing literature does not provide enough data to confidently evaluate its specificity and, therefore, accuracy. Further prospective studies are necessary, with a focus on the accurate reporting of benign lesions and inclusion of patients with an intermediate probability of HCC. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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19 pages, 2938 KiB  
Systematic Review
The Current Position of Postoperative Radiotherapy for Salivary Gland Cancer: A Systematic Review and Meta-Analysis
by Jingbo Wang, Ji Eun Moon, Xin Guo, Jiaqi Yu, Junlin Yi and Sun Hyun Bae
Cancers 2024, 16(13), 2375; https://doi.org/10.3390/cancers16132375 - 28 Jun 2024
Viewed by 1103
Abstract
Background: Because of the rarity, heterogeneous histology, and diverse anatomical sites of salivary gland cancer (SGC), there are a limited number of clinical studies on its management. This study reports the cumulative evidence of postoperative radiotherapy (PORT) for SGC of the head and [...] Read more.
Background: Because of the rarity, heterogeneous histology, and diverse anatomical sites of salivary gland cancer (SGC), there are a limited number of clinical studies on its management. This study reports the cumulative evidence of postoperative radiotherapy (PORT) for SGC of the head and neck. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases between 7th and 10th November 2023. Results: A total of 2962 patients from 26 studies between 2007 and 2023 were included in this meta-analysis. The median RT dose was 64 Gy (range: 56–66 Gy). The median proportions of high-grade, pathological tumor stage 3 or 4 and pathological lymph node involvement were 42% (0–100%), 40% (0–77%), and 31% (0–75%). The pooled locoregional control rates at 3, 5, and 10 years were 92% (95% confidence interval [CI], 89–94%), 89% (95% CI, 86–93%), and 84% (95% CI, 73–92%), respectively. The pooled disease-free survival (DFS) rates at 3, 5, and 10 years were 77% (95% CI, 70–83%), 67% (95% CI, 60–74%), and 61% (95% CI, 55–67%), respectively. The pooled overall survival rates at 3, 5, and 10 years were 84% (95% CI, 79–88%), 75% (95% CI, 72–79%), and 68% (95% CI, 62–74%), respectively. Severe late toxicity ≥ grade 3 occurred in 7% (95% CI, 3–14%). Conclusion: PORT showed favorable long-term efficacy and safety in SGC, especially for patients with high-grade histology. Considering that DFS continued to decrease, further clinical trials exploring treatment intensification are warranted. Full article
(This article belongs to the Special Issue New Approaches in Radiotherapy for Cancer)
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