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Sara Chierchini,1 Gianluca Ingrosso,1 Simonetta Saldi,1 Fabrizio Stracci,2 Cynthia Aristei1 1Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy; 2Department of Experimental Medicine, Section of Public Health, University of Perugia, Perugia, ItalyCorrespondence: Gianluca IngrossoDepartment of Surgical and Biomedical Sciences, University of Perugia, Piazza Lucio Severi 1, Perugia 06132, ItalyTel +39-075-5783259Fax +39-075-5783614Email ingrosso.gianluca@gmail.comAbstract: Radiotherapy is one of the mainstays of cancer treatment, and about 60% of cancer patients receive this type of treatment during their course of treatment. An evident gap between optimal and actual radiotherapy utilization proportions has recently been reported, which has been ascribed to lack of referral to radiation oncology. There are many factors influencing the radiotherapy referral, including patient anxiety about toxicity, wrong perception of efficacy and side effects by physicians and patients, insufficient knowledge of referral process. These factors, defined as barriers can be categorized in health system barriers, physician and patient barriers. In the present brief narrative review, we discussed barriers to radiotherapy referral focusing on physician and patient barriers.Keywords: radiotherapy, referral, barriers

Aims: This retrospective study reports outcomes after stereotactic body radiation therapy (SBRT) as delivered by helical tomotherapy (HT) for lung lesions. It promotes a dose escalation program., Methods: Histological and/or radiological findings and/or case histories identified 41 primary and 15 metastatic lesions. Thirty patients received 40 Gy in 5 fractions (BED 72 Gy 10Gy ) and 26 50 Gy in 5 fractions (BED 100Gy 10Gy ). Primary end point was lung toxicity. Secondary end points were respiratory function, local control and local progression-free survival., Results: Acute toxicity developed in 18/56 patients and late toxicity in 8/54. Median FEV-1 variations versus baseline were - 0.5% (range - 16 to + 43%) at 6 months and - 4.00% (range - 42 to + 18%) at 24 months. Median DLCO variations versus baseline were - 1% (range - 38 to + 36%) at 6 months and - 12.2% (range - 48 to + 11%) at 24 months. At 6 months, a significant positive correlation emerged between FEV-1 change and KPS (p = 0.047). At 24 months, a significant negative correlation emerged between FEV-1 change and the ipsilateral lung V5 (p = 0.006). A low baseline DLCO correlated with more marked DLCO worsening at 6 months (p = 0.012). At 24 months, DLCO worsening correlated significantly with the median contralateral lung dose (p = 0.003). At the last checkup, 23 patients were in complete remission, 16 were in partial remission, 5 had stable disease, and 7 were in relapse. Median follow-up was 12 months (range 5-56)., Conclusions: In patients with lung disease, SBRT, as delivered by HT, was well tolerated and provided good local control.

Background: SARS-CoV-2 pandemic represents a troubling health emergency but also a main challenge for the clinical governance of the system. Discontinuation of radiation treatments is not desirable and potentially life-threatening. On the other hand, accesses to hospital expose cancer patients to an increased risk of COVID-19 infection. We report our extended protocol, draft to manage clinical activities in our radiotherapy department, by minimizing contagion risks., Methods: We used telephonic screening to assess the need for patient admission. A telephonic triage was performed to identify the presence of COVID-19 infection risk factors or symptoms. New treatments were stratified according to priority codes. A reserved entrance to radiotherapy department was assured for patients and staff. Surgical disposable mask was required for patients and caregivers. The activities were distributed during the whole workday, avoiding overlap to reduce aggregation., Results: From 1st February 2020 to 31 March 2020, we reported an increase in the number of first medical examinations and treatments, compared to the same period of the previous year. Outpatients first medical examinations have been spread over the 12 working hours. No COVID-19 cases were detected., Conclusion: During COVID-19 pandemic, we introduced procedures that allowed us to ensure the continuity in oncological cares, with limited risks of infection for patients and staff.

This clinical report describes the use of a 3-dimensional (3D) printer to create an individual mold for delivering high-dose-rate interventional radiotherapy for hard palate cancer. The maxillary teeth and palate were scanned with an intraoral scanner (3Shape TRIOS 3). The scan was transformed into a mesh using the standard tessellation language (STL) format and aligned with Digital Imaging and Communications in Medicine (DICOM) computed tomography (CT) images using free Blue Sky Plan 4 planning software. A mold was generated by tracing a guideline around the gingival margins of the maxillary teeth and palate on the scan mesh in accordance with established parameters. All data were imported into computer-aided design (CAD) software. For this patient, 3 parallel 2.2-mm-diameter ducts were placed 10 mm from each other in the mold mesh. A CT scan of the patient's mouth with the mold in place was used for treatment planning. Treatment was delivered by means of microSelectron digital afterloading., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Aim: The difficulty in conducting meaningful clinical research is a multifactorial issue, involving political, financial and cultural problems, which can lead to unexpected negative long-term consequences, in terms of knowledge advancement and impact on patient care. The aims of the present review were to evaluate the publications of Italian radiotherapy (RT) groups during a 20-year period and to verify whether research is still appealing to young radiation oncologists (ROs) in Italy., Methods: PubMed database was searched for English-language articles published by Italian groups from January 1985 to December 2005. Analyzed variables were: publication/year, kind of study, geographical area and age of the first author., Results: The systematic review identified 3291 articles: 1207 papers fulfilled the inclusion criteria. The number of Italian published papers increased during the examined period. Retrospective analyses, prospective phase I-II trials and literature reviews were 44, 20 and 14.5% of all published manuscripts, respectively. Randomized trials showed a mild increase from 2000 to 2005, but their absolute number remained low respect to other types of studies (4%). Northern Italy produced the very most of Italian research papers (58.7%). The age of the first/second author was evaluated on 716 papers: In more than 50% of cases, the first author was younger than 40., Conclusion: Despite a general gradual improvement, RT clinical research suffers in Italy (as elsewhere) from insufficient funding, with a negative impact on evidence production. It is worth noting that clinical research is still appealing and accessible to junior Italian RO.

Purpose: High-dose-rate, multicatheter interstitial brachytherapy is technically complex and operator-dependent, requiring lengthy training and specialized skills. Furthermore, until the advent of contouring on computerized tomography (CT) images, difficulties existed in locating the target volume precisely. The present article reports the results of a study that aimed at producing and validating a 3D-printed template to aid in target volume localization for multicatheter interstitial brachytherapy in patients with breast cancer., Methods and Materials: Thirteen patients, candidates for accelerated partial breast irradiation or boost, were enrolled in the study. The target volume was defined on CT slices, and a template with empty spaces corresponding to the target volume projection on the patient's skin was produced by a 3D printer. The procedure was compared with the standard method followed in our center (1) visually, by assessing overlap between the target volume projections on the patient's skin, (2) by X-ray findings, and (3) by intraclass correlation coefficient., Results: Visual assessment and X-ray findings showed the 3D-printed target volume always fell within the standard volume in all 13 patients. The intraclass correlation coefficient indicated moderate agreement for both the medial and the lateral skin projections., Conclusions: The 3-D printed templates constitute a quick, easy, and reliable method to localize the target volume for high-dose-rate interstitial multicathether brachytherapy in patients with breast cancer and can safely be used in clinical practice., (Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)

Introduction: To evaluate the incidence of toxicity in breast cancer with helical tomotherapy (HT)., Materials and Methods: 51 patients with breast cancer were assigned to postoperative radiotherapy by means of HT to the chest wall/breast plus draining nodes. During HT treatment, toxicity was monitored and were assessed using the Common Terminology Criteria for Adverse Events 4.0 scale., Results: Acute skin G3 toxicity observed in 1.9% cases. No acute or late G4 toxicity was observed. At a median follow-up of 21 months 2 patients have late G1 toxicity., Conclusions: HT was associated with a low incidence of low-grade skin toxicity.