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The growing interest in complementary interventions for stroke recovery necessitates the need for neural insights to aid in making evidence-based clinical decisions. This systematic review examined the brain activation effects of complementary therapies, including acupuncture (n = 5), motor imagery therapy (MIT) (n = 5), music (n = 3), and virtual reality (VR) interventions (n = 3), on clinical outcomes and neural activity in stroke patients. All therapies engaged motor and sensory networks, frontal regions, parietal regions, and temporal regions, suggesting their potential to improve motor control, attention, memory, and cognitive function. Acupuncture activated motor areas in both hemispheres, while MIT stimulated frontoparietal regions in both sides of the brain, supporting whole-body integration in recovery. In contrast, VR therapy exhibited ipsilesional lateralization, while music therapy showed left-lateralization. The review also found that increased interhemispheric connectivity between motor regions, along with intrahemispheric ipsilesional connectivity between motor, cognitive, and sensory areas, is key to achieving better clinical outcomes. Systematic Review Registration: http://www.crd.york.ac.uk/PROSPERO , identifier (ID: CRD42023455192). [ABSTRACT FROM AUTHOR]

Background: Functional magnetic resonance imaging (fMRI) is a useful tool to evaluate brain inefficiencies secondary to cardiovascular diseases (CVDs); nevertheless, limited fMRI studies have been conducted to investigate the effect of CVDs on brain functional changes and cognitive function. This systematic review aims to explore, synthesise, and report fMRI outcomes (resting state and task-based) and cognitive performance in patients with CVDs. Methods: Two reviewers independently searched published literature until April 2024 on ScienceDirect, PubMed, Web of Science, and ClinicalTrials.gov adhering to the PRISMA protocol. A total of 26 eligible studies were considered for full-text screening, of which 10 were included in this review. The methodological quality was assessed by mixed methods appraisal tool and was reported as empirically fair. Results: Among 336 subjects with CVDs, aged between 49.90  ±  6.10 to 72.20  ±  5.70  years, the majority had coronary artery diseases (n = 177, 52.68%) and hypertension (n = 200, 59.52%), and approximately half of them were females (n = 169, 50.30%). Based on the qualitative synthesis, subjects with CVDs demonstrated an increased cognitive decline (reduced Mini-Mental State Examination/Montreal Cognitive Assessment mean values) and attenuated task performance (lower mean 2-back task scores and slower reaction time). Results also indicated impaired brain activity at the supplementary motor area associated with poor ejection fraction; reduced default mode network suppression linked to high low-density lipoprotein cholesterol; lower regional homogeneity and amplitude of low-frequency fluctuation values; and reduced functional connectivity. In summary, alterations in brain networks connectivity may have contributed to an impaired cognitive performance in patients with cardiovascular diseases. Conclusion: It can be extrapolated that CVDs tend to alter the brain network connectivity and result in cognitive impairment and poorer task performance. However, for future imaging studies, more stringent and homogenous demographic data are highly recommended. [ABSTRACT FROM AUTHOR]

Background: Proton and carbon‐ion therapy may spare normal tissues in regions with many critical structures surrounding the target volume. As toxicity outcome data are emerging, we aimed to synthesize the published data for the toxicity outcomes of proton or carbon‐ion therapy (together known as particle beam therapy [PBT]) for primary nasopharyngeal carcinoma (NPC). Materials and methods: We searched PubMed and Scopus electronic databases to identify original studies reporting toxicity outcomes following PBT of primary NPC. Quality assessment was performed using NIH's Quality Assessment Tool. Reports were extracted for information on demographics, main results, and clinical and dose factors correlates. Meta‐analysis was performed using the random‐effects model. Results: Twelve studies were selected (six using mixed particle‐photon beams, five performed comparisons to photon‐based therapy). The pooled event rates for acute grade ≥2 toxicities mucositis, dermatitis, xerostomia weight loss are 46% (95% confidence interval [95% CI]—29%–64%, I2 = 87%), 47% (95% CI—28%–67%, I2 = 87%), 16% (95% CI—9%–29%, I2 = 76%), and 36% (95% CI—27%–47%, I2 = 45%), respectively. Only one late endpoint (xerostomia grade ≥2) has sufficient data for analysis with pooled event rate of 9% (95% CI—3%–29%, I2 = 77%), lower than intensity‐modulated radiotherapy 27% (95% CI—10%–54%, I2 = 95%). For most endpoints with significant differences between the PBT and photon‐based therapies, PBT resulted in better outcomes. In two studies where dose distribution was studied, doses to the organs at risk were independent risk factors for toxicities. Conclusion: PBT may reduce the risk of acute toxicities for patients treated for primary NPC, likely due to dose reduction to critical structures. The pooled event rate for toxicities derived in this study can be a guide for patient counseling. [ABSTRACT FROM AUTHOR]

Objective: This study examines the impact of volumetric alterations and PTV shifting on the quality of adaptive intensity-modulated radiation (IMRT) plans and their effectiveness in treating head and neck cancer. Methods: The research was carried out at the Sohag Cancer Centre in Egypt, including a sample of 36 individuals diagnosed with head and neck squamous cell carcinoma (HNSCC). Patients were chosen based on the following criteria: locally progressed and node-positive malignancy, oropharyngeal cancer, oral cavity cancer, and unknown primary. The research used dynamic intensity-modulated radiation therapy (D-IMRT) to establish treatment plans and SIEMENS SOMATOM DEFINITION CT scanners to acquire 3D anatomical images. The median dosage per fraction was observed at 1.64 to 2.12 Gy. Using the conformance index (CI) and the homogeneity index (HI), the quality of the plan was assessed. The threshold for statistical significance was set at 0.05. Results: The study analyzed patients with unilateral and bilateral HNSCC tumors, with most having bilateral tumors. The findings demonstrated that the tumor PTV was significantly reduced as a consequence of the suggested adaptive radiation techniques. The homogeneity and conformity indexes were used to evaluate the plan's quality (HI). The maximal homogeneity index (HI) was reached at fractions 14 and 7, respectively. The correlation between the reduction of PTV and CI was initially positive after fraction 7 but became negative after fractions 14 and 21. It was also shown that HI is positively correlated with PTV changes after fractions 7 and 14, while it was negative after 21 fractions. Conclusion: The use of adaptive radiotherapy in intensity-modulated radiation therapy (IMRT) treatment planning improves plan quality and decreases error rates due to tumor margin movement. Following radiation fractions, PTV shifting affects the homogeneity index (HI). [ABSTRACT FROM AUTHOR]

Background: Head and neck cancer (HNC) patients may have considerable anatomical alterations with IMRT and VMAT. Maintaining dosage precision and minimizing tissue damage using adaptive radiotherapy (ART) improves patients' quality of life. However, the optimal time to initiate ART in HNC patients remains undetermined. Objective: This research aimed to identify the optimal time to start ART in HNC patients using a novel method to evaluate anatomical modifications. Materials and Methods: The research included 48 people with HNC who had undergone dynamic IMRT. The size of the patient's PTV was used to divide them into different groups. Both the ER of the original PTV and the ER of the revised PTV were determined. ER differences (dER) were correlated with volume decrease percentage (%dV). Pre-treatment CT images were taken, and then again at fractions 7, 14, and 21 throughout therapy. Results: The PTV volume distributions were verified to be expected. Small, medium, and high ER volumes showed statistically significant variations between the first and second phases (p<0.001). Fraction 14 was the optimum time to administer ART in cases with a PTV of less than <100cc, whereas fractions 7 and 21 were best for cases with a PTV of 100cc to 500cc. Conclusions: The optimal time to begin PTV-based adaptive radiotherapy in HNC patients has been determined. The ER technique improves the clarity of presenting the gap between the reference isodose volume and the PTV, which is valuable information for ART. [ABSTRACT FROM AUTHOR]

Introduction: Delta‐radiomics models are potentially able to improve the treatment assessment than single‐time point features. The purpose of this study is to systematically synthesize the performance of delta‐radiomics‐based models for radiotherapy (RT)‐induced toxicity. Methods: A literature search was performed following the PRISMA guidelines. Systematic searches were performed in PubMed, Scopus, Cochrane and Embase databases in October 2022. Retrospective and prospective studies on the delta‐radiomics model for RT‐induced toxicity were included based on predefined PICOS criteria. A random‐effect meta‐analysis of AUC was performed on the performance of delta‐radiomics models, and a comparison with non‐delta radiomics models was included. Results: Of the 563 articles retrieved, 13 selected studies of RT‐treated patients on different types of cancer (HNC = 571, NPC = 186, NSCLC = 165, oesophagus = 106, prostate = 33, OPC = 21) were eligible for inclusion in the systematic review. Included studies show that morphological and dosimetric features may improve the predictive model performance for the selected toxicity. Four studies that reported both delta and non‐delta radiomics features with AUC were included in the meta‐analysis. The AUC random effects estimate for delta and non‐delta radiomics models were 0.80 and 0.78 with heterogeneity, I2 of 73% and 27% respectively. Conclusion: Delta‐radiomics‐based models were found to be promising predictors of predefined end points. Future studies should consider using standardized methods and radiomics features and external validation to the reviewed delta‐radiomics model. [ABSTRACT FROM AUTHOR]

Simple Summary: Proton therapy is a potentially attractive option to treat oropharyngeal cancers due to better dose distribution. We aimed to synthesize the quality of life (QOL) and patient-reported outcomes (PROs) following treatment. We found that studies frequently demonstrated the advantages of proton therapy compared to photon therapy in terms of QOL and PROs; however, biases due to the non-randomized nature of the studies may require confirmation in phase III randomized controlled trials. Background: Complex anatomy surrounding the oropharynx makes proton therapy (PT), especially intensity-modulated PT (IMPT), a potentially attractive option due to its ability to reduce the volume of irradiated healthy tissues. Dosimetric improvement may not translate to clinically relevant benefits. As outcome data are emerging, we aimed to evaluate the evidence of the quality of life (QOL) and patient-reported outcomes (PROs) following PT for oropharyngeal carcinoma (OC). Materials and Methods: We searched PubMed and Scopus electronic databases (date: 15 February 2023) to identify original studies on QOL and PROs following PT for OC. We employed a fluid strategy in the search strategy by tracking citations of the initially selected studies. Reports were extracted for information on demographics, main results, and clinical and dose factor correlates. Quality assessment was performed using the NIH's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The PRISMA guidelines were followed in the preparation of this report. Results: Seven reports were selected, including one from a recently published paper captured from citation tracking. Five compared PT and photon-based therapy, although none were randomized controlled trials. Most endpoints with significant differences favored PT, including xerostomia, cough, need for nutritional supplements, dysgeusia, food taste, appetite, and general symptoms. However, some endpoints favored photon-based therapy (sexual symptoms) or showed no significant difference (e.g., fatigue, pain, sleep, mouth sores). The PROs and QOL improve following PT but do not appear to return to baseline. Conclusion: Evidence suggests that PT causes less QOL and PRO deterioration than photon-based therapy. Biases due to the non-randomized study design remain obstacles to a firm conclusion. Whether or not PT is cost-effective should be the subject of further investigation. [ABSTRACT FROM AUTHOR]