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The aim of this work was to evaluate the inter- and intra-observer variation in contouring vestibular schwannoma (VS) and the organs-at-risk (OAR), and its dosimetric impact in Volumetric Modulated Arc Therapy (VMAT). Three VS typical cases were contoured by four clinicians. The Agreement Volume Index (AVI) appeared to be notably higher in VS than in OARs, such that the dose coverage of VS is fairly robust. In OARs, the largest variation was +1.02Gy in dmax for the brainstem, +0.78Gy in dmean for the cochlea and +1.05Gy in dmax of the trigeminal nerve. Accordingly, it was decided that all VS delineations for stereotactic radiosurgery (SRS), and all frame-based SRS contouring in general, should always be reviewed by a second physician. In addition, the retrospective presentation of VS cases at daily peer review meetings has also been adopted to ensure that the consensus is constantly updated, as well as for training purposes., Competing Interests: The authors would like to thank Professor Jose Luis Cruz for his comments. Authors’ disclosure of potential conflicts of interest The authors have nothing to disclose., (© 2024 Old City Publishing, Inc.)

Intracavitary brachytherapy (BT, Interventional Radiotherapy, IRT), plays an essential role in the curative intent of locally advanced cervical cancer, for which the conventional approach involves external beam radiotherapy with concurrent chemotherapy followed by BT. This work aims to review the different methodologies used by commercially available treatment planning systems (TPSs) in exclusive magnetic resonance imaging-based (MRI) cervix BT with interstitial component treatments. Practical aspects and improvements to be implemented into the TPSs are discussed. This review is based on the clinical expertise of a group of radiation oncologists and medical physicists and on interactive demos provided by the software manufacturers. The TPS versions considered include all the new tools currently in development for future commercial releases. The specialists from the supplier companies were asked to propose solutions to some of the challenges often encountered in a clinical environment through a questionnaire. The results include not only such answers but also comments by the authors that, in their opinion, could help solve the challenges covered in these questions. This study summarizes the possibilities offered nowadays by commercial TPSs, highlighting the absence of some useful tools that would notably improve the planning of MR-based interstitial component cervix brachytherapy.

Purpose: The aim of this paper was to assess development of high-dose-rate (HDR) cervix brachytherapy (BT) implants in three Spanish institutions before and after introduction of EMBRACE II protocol., Material and Methods: 392 patients from three different institutions, treated between 2009 and 2019 were analyzed. D 90 of high-risk clinical target volume (HR-CTV) and D 2cc of organs at risk (OARs) of all patients were collected. Statistical distribution was analyzed for two different periods of time: before and after EMBRACE II publication. Index I was applied based on collected dosimetric quantities (D 90 and D 2cc ) to enhance equilibrium between HR-CTV coverage and doses to OARs. Variation in dosimetry and index depending on CTV and technique used (IC vs. IC/IT) were also evaluated., Results: Adaptation of institutions to EMBRACE II protocol resulted in a statistically significant increase of D 90 HR-CTV (Institution 1; p < 0.00001) or decrease of D 2cc OARs (Institution 2; p < 0.04). Increase in the use of interstitial component showed higher coverage of HR-CTV for Institution 3 ( p = 0.03), and lower doses to OARs for the same coverage of HR-CTV at Institution 2 ( p -OARs < 0.03). Even though index I was only significantly different between periods for Institution 1 ( p < 0.0000001), it was able to show a reduction of dose variability related to higher expertise and higher interstitial component., Conclusions: Depending on local protocol before EMBRACE II, the adaptation through increasing interstitial component and physician and physicist training, resulted in a significant increase of HR-CTV doses or reduction of OARs doses. Index I was able to describe an evolution of equilibrium between CTV coverage and OARs' sparing., Competing Interests: The authors report no conflict of interest., (Copyright © 2021 Termedia.)

Antibody-mediated enzyme formation is a phenomenon first described in 1968 and further studied by molecular Immunologists and Biochemists over the following five decades. The present review is made mainly by analyzing the 27 articles concerned with AMEF that appeared over the course of 47 years, commenting 16 original figures selected to be re-printed in AMEF's Legacy. We, the reviewers, started by revisiting our own "insider's" experience of discovery, and followed by considering all results, our own and of members of other AMEF Labs. We had planned to conclude the review by correlating the various AMEF mutants to a detailed knowledge of the consensus betaGal structure. However, we became aware of several "robust" papers, published between 1989 and 2014, by authors outside of AMEF Labs. We familiarly called this surge: "The Second Wave" and adorned it with a doodle in Hokusai style. We were thrilled and happy to take them on board and properly examined their data. A team of this second wave had imagined unique uses for AMEF, and new doors to modern biotechnology. Another one had used AMEF as Tool and Marker to attain high levels of crystallography, solving puzzles of conformation, and ultimate structure. Together, they doubled our motivation to review AMEF. Serendipity gives us back the pleasure of finding, a treat at any age., (© 2021 The Authors. Journal of Molecular Recognition published by John Wiley & Sons Ltd.)