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Background/Objectives: Medulloblastoma is the most common malignant brain tumor in children. In recent decades, the therapeutic landscape has undergone significant changes, with stereotactic radiosurgery (SRS) emerging as a promising treatment for recurrent cases. Our study provides a comprehensive analysis of the long-term efficacy and safety of SRS in recurrent medulloblastomas across both pediatric and adult patients at a single institution. Methods: We retrospectively reviewed the clinical and radiological records of patients who underwent CyberKnife SRS for recurrent cranial medulloblastomas at our institution between 1998 and 2023. Follow-up data were available for 15 medulloblastomas in 10 patients. The cohort comprised eight pediatric patients (ages 3–18) and two adult patients (ages 19–75). The median age at the time of SRS was 13 years, the median tumor volume accounted for 1.9 cc, the median biologically equivalent dose (BED) was 126 Gy, and the single-fraction equivalent dose (SFED) was 18 Gy. The SRS was administered at 75% of the median isodose line. Results: Following a median follow-up of 39 months (range: 6–78), 53.3% of the medulloblastomas progressed, 13.3% regressed, and 33.3% remained stable. The 3-year local tumor control (LTC) rate for all medulloblastomas was 65%, with lower rates observed in the adult cohort (50%) and higher rates in pediatric patients (67%). The 3-year overall survival (OS) rate was 70%, with significantly higher rates in pediatric patients (75%) compared to adult patients (50%). The 3-year progression-free survival (PFS) rate was 58.3%, with higher rates in pediatric patients (60%) compared to adult patients (50%). Two pediatric patients developed radiation-induced edema, while two adult patients experienced radiation necrosis at the latest follow-up, with both adult patients passing away. Conclusions: Our study provides a complex perspective on the efficacy and safety of CyberKnife SRS in treating recurrent cranial medulloblastomas across pediatric and adult populations. The rarity of adverse radiation events (AREs) underscores the safety profile of SRS, reinforcing its role in enhancing treatment outcomes. The intricacies of symptomatic outcomes, intertwined with factors such as age, tumor location, and prior surgeries, emphasize the need for personalized treatment approaches. Our findings underscore the imperative for ongoing research and the development of more refined treatment strategies for recurrent medulloblastomas. Given the observed disparities in treatment outcomes, a more meticulous tailoring of treatment approaches becomes crucial. [ABSTRACT FROM AUTHOR]

Detection and segmentation of brain metastases (BMs) play a pivotal role in diagnosis, treatment planning, and follow-up evaluations for effective BM management. Given the rising prevalence of BM cases and its predominantly multiple onsets, automated segmentation is becoming necessary in stereotactic radiosurgery. It not only alleviates the clinician's manual workload and improves clinical workflow efficiency but also ensures treatment safety, ultimately improving patient care. Recent strides in machine learning, particularly in deep learning (DL), have revolutionized medical image segmentation, achieving state-of-the-art results. This review aims to analyze auto-segmentation strategies, characterize the utilized data, and assess the performance of cutting-edge BM segmentation methodologies. Additionally, we delve into the challenges confronting BM segmentation and share insights gleaned from our algorithmic and clinical implementation experiences. [ABSTRACT FROM AUTHOR]

Iron ion is the common transition metal ion in atmospheric aerosol, which can affect the components and optics of secondary organic aerosol (SOA). In the current study, the atmospheric photooxidation of toluene to produce SOA in the presence of ferric chloride fine particles is simulated in a smog chamber; on-line and off-line mass spectrometry and spectroscopic instruments are used to characterize constituents and optics of SOA. Compare with SOA formed in the absence of fine particles, the laser desorption/ionization mass spectra of toluene SOA generated in the presence of ferric chloride fine particles show ion peaks of m/z = 163 and 178, the UV-Vis spectra of the extracting solution for toluene SOA have peaks near 400 and 700 nm, and the electrospray ionization mass spectra contain peaks at m/z = 248 and 300. Based on this spectral information, it is shown that gaseous methylcatechol formed from photooxidation of toluene may react with iron ion on the surface of fine particles by complexing and oxidation–reduction, resulting in methylbenzoquinone products and metallo-organic complex ions such as [Fe(III)(CH3C6H3OO)]+, [Fe(III)(CH3C6H3 OO)2]− and [Fe(III)(CH3C6H3OO)Cl2]−. These products have strong light absorption ability, resulting in an increase in the averaged mass absorption coefficient () in the 200~1000 nm range and the MAC at 365 nm (MAC365) for toluene SOA, while and MAC365 progressively increase with an increasing concentration of ferric chloride fine particles. These results serve as experimental references for the study of the formation mechanism and optical properties of metallo-organic complexes in atmospheric aerosol particles in regions experiencing high levels of fine particles of metal and automobile exhaust pollution. [ABSTRACT FROM AUTHOR]

Background: Active breathing coordinator (ABC)‐assisted deep inspiration breath hold (DIBH) is an important organ sparing radiation therapy (RT) technique for left‐sided breast cancer patients. Patients with advanced breast cancer undergoing chest wall and regional nodal irradiation often require a field matching technique. While field matching has been demonstrated to be safe and effective in free breathing patients, its safety and accuracy in DIBH/ABC use has not been previously reported. Purpose: To report the accuracy, feasibility, and safety of field matching with ABC/DIBH for patients receiving breast/chest wall irradiation with nodal irradiation using a three‐field technique. Methods: From December 2012 to May 2018, breast cancer patients undergoing ABC/DIBH‐based RT at a single institution were reviewed. For each fraction, the amount of overlap/gap between the supraclavicular and the tangential field were measured and recorded. Patient characteristics, including acute and delayed skin toxicities, were analyzed. Results: A total of 202 patients utilized ABC/DIBH and 4973 fractions had gap/overlap measurements available for analysis. The average gap/overlap measured at junction was 0.28 mm ± 0.99 mm. A total of 72% of fractions had no measurable gap/overlap (0 mm), while 5.6% had an overlap and 22.7% a gap. There was no significant trend for worsening or improvement of gap/overlap measurements with increasing fraction number per patient. OSLD measurements were compared to the planned dose. The median dose 1 cm above the junction was 106% ± 7% of planned dose (range 94%–116%). One centimeter below the junction, the median dose was 114% ± 11% of planned dose (range 95%–131%). At the junction, the median dose was 106% ± 16.3% of planned dose (range 86%–131%). Acute skin toxicity was similar to historically reported values (grade 3, 5.4%, grade 4, 0%). Conclusion: ABC‐assisted DIBH is a safe and technically feasible method of delivering RT in the setting of complex matching field technique for breast and regional nodal treatments. [ABSTRACT FROM AUTHOR]