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Abstract Background This study aimed to establish a consensus on the delineation of target volumes for neoadjuvant radiation therapy (nRT) in esophageal squamous cell carcinoma (ESCC) within China. Methods From February 2020 to June 2021, nine ESCC patients who received nRT were retrospectively selected from Sun Yat-sen University Cancer Center and Shandong Cancer Hospital. A panel from eight cancer radiotherapy centers performed two rounds of nRT target volume delineation for these patients: the first round for cases 1–6 and the second for cases 7–9. Online meetings were held after each delineation round to discuss findings. The consistency of delineations across centers was compared using mean undirected Hausdorff distances (Hmean), dice similarity coefficients (DSC), and total volumes, analyzed with the Mann-Whitney U test. Results The second round of delineations showed improved consistency across centers (total clinical target volume (CTVtotal): mean DSC = 0.76–0.81; mean Hmean = 2.11–3.14 cm) compared to the first round (CTVtotal: mean DSC = 0.63–0.64; mean Hmean = 5.66–7.34 cm; DSC and Hmean: P

Background: This study aimed to establish a consensus on the delineation of target volumes for neoadjuvant radiation therapy (nRT) in esophageal squamous cell carcinoma (ESCC) within China. Methods: From February 2020 to June 2021, nine ESCC patients who received nRT were retrospectively selected from Sun Yat-sen University Cancer Center and Shandong Cancer Hospital. A panel from eight cancer radiotherapy centers performed two rounds of nRT target volume delineation for these patients: the first round for cases 1–6 and the second for cases 7–9. Online meetings were held after each delineation round to discuss findings. The consistency of delineations across centers was compared using mean undirected Hausdorff distances (Hmean), dice similarity coefficients (DSC), and total volumes, analyzed with the Mann-Whitney U test. Results: The second round of delineations showed improved consistency across centers (total clinical target volume (CTVtotal): mean DSC = 0.76–0.81; mean Hmean = 2.11–3.14 cm) compared to the first round (CTVtotal: mean DSC = 0.63–0.64; mean Hmean = 5.66–7.34 cm; DSC and Hmean: P < 0.050 between rounds), leading to the formation of a consensus and an atlas for ESCC nRT target volume delineation. A proposal was reached through evaluating target volume delineations, analyzing questionnaire survey outcomes, and reviewing pertinent literature. Conclusions: We have developed guidelines and an atlas for target volume delineation in nRT therapy for ESCC in China. These resources are designed to facilitate more consistent delineation of target volumes in both clinical practice and clinical trials. [ABSTRACT FROM AUTHOR]

This study aimed to describe the local recurrence (LR) pattern in post-prostatectomy prostate cancer patients using PSMA PET/CT scans. We retrospectively collected 103 PSMA PET/CT scans from patients with suspected LR across nine medical centres. Anonymized scans underwent review by an expert nuclear medicine physician. After review, on 83 PSMA PET/CT scans, 93 lesions were identified as a LR. The predominant LR location (56%) was found within 2 cm cranial to the penile bulb. Additionally, 24 LR (26%) were observed > 2 cm cranial to the penile bulb and caudal to the top of the pubic bone. Only 17 LR (18%) occurred cranial to the symphysis pubis. These findings contribute to the understanding of LR pattern post-prostatectomy, potentially optimizing accurate salvage radiotherapy to the prostate bed. [ABSTRACT FROM AUTHOR]

Introduction: Post-mastectomy radiotherapy (PMRT) improves local control rates and survival in patients with adverse prognostic features. The dose coverage to target volumes is critical to yield maximum benefit to treated patients, increasing local control and reducing risk of toxicity. This study aims to assess patterns of breast cancer relapse in patients treated with mastectomy, breast reconstruction and PMRT. Methods: Breast cancer patients treated with PMRT between 1992 and 2017 were retrospectively reviewed. Clinical and pathological characteristics of patients were collected. Recurrences were defined as "in field," "marginal" or "out of field." Survival analyses were performed in relation to progression-free survival (PFS) and overall survival (OS). Correlation between baseline features was explored. Results: Data of 140 patients are collected. After a median follow-up time of 72 months, median PFS and OS of 63 and 74 months were detected, respectively. Neoadjuvant chemotherapy, lympho-vascular space invasion (LVI) and size of primary tumor were all significantly associated with worst PFS and OS. Ten patients developed local recurrence: 30% "in field," 30% marginal recurrences, 20% "out of field" and 20% both "in field" and "out of field." No recurrence was detected under the expander, 80% above the device and 20% patients relapsed on IMN chain. The mean distant relapse-free survival was 39 months. Overall, 39 of 140 patients developed distant metastases. Conclusions: The onset of local–regional relapses occurred mainly above the expander/prosthesis, underlying the importance of inclusion of the subcutaneous tissues within the target volume. In order to refine new contouring recommendations for PMRT and breast reconstruction, future prospective studies are needed. [ABSTRACT FROM AUTHOR]

Introduction: 18F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) is recommended for staging and defining target volume in limited-stage SCLC, though the impact on outcomes compared with CT staging and elective nodal irradiation (ENI) is not well documented. We analyzed patients receiving 45 Gy/30 fractions in two randomized trials of thoracic radiotherapy (TRT) in limited-stage SCLC (HAST and THORA trials) to evaluate whether PET-CT for staging and radiotherapy planning reduces radiotoxicity and improves survival. Methods: Patients in HAST were staged with CT of the thorax and upper abdomen and brain magnetic resonance imaging of the brain. Patients in THORA were staged with PET-CT in addition. All patients were to receive four courses of platinum/etoposide chemotherapy and concurrent TRT starting three to four weeks after the first chemotherapy course. In HAST, target volumes included pathological lesions on CT plus ENI of lymph node stations 4–7 (bilateral). In THORA, target volumes were limited to PET-CT-positive lesions (selective nodal irradiation [SNI]). Results: A total of 149 patients were included (PET-CT/SNI: n = 76, CT/ENI: n=73); the median age was 64 years, 56% were women, 85% had PS 0 to 1, and 81% had stage III disease. The PET-CT/SNI group experienced less grade 3-4 esophagitis (18% versus 33%, p = 0.043), less grade >=1 pneumonitis (5% versus 16%, p = 0.028), and less dysphagia after TRT (mean scores on European Organisation for Research and Treatment of Cancer 13-item lung cancer module: 45 versus 72). There was no difference in median overall survival (24 versus 25 mo, p = 0.59) or progression-free survival (11 versus 11 mo, p = 0.23). Conclusions: Using PET-CT for staging and target volume definition of TRT reduces acute radiotoxicity but does not improve overall or progression-free survival in limited-stage SCLC.

Abstract Nasopharyngeal carcinoma(NPC) occurs frequently in Southern China, and radiotherapy is the main treatment method. At present, intensity‐modulated radiotherapy is widely used, which has improved efficacy in patients with NPC and reduced toxicity and side effects. Recently, helical tomography radiotherapy, proton radiotherapy, carbon particle radiotherapy, and other radiotherapy techniques have been used for the clinical treatment of NPC. Individualized nasopharyngeal cancer targets have also been explored. This paper reviews the research progress in radiotherapy techniques and target volume for NPC

Abstract Background Supraclavicular nodal (SCL) irradiation is commonly used for patients with high-risk breast cancer after breast surgery. The Radiation Therapy Oncology Group (RTOG) and European Society for Radiotherapy and Oncology (ESTRO) breast contouring atlases delineate the medial part of the SCL region, while excluding the posterolateral part. However, recent studies have found that a substantial proportion of SCL failures are located in the posterolateral SCL region, outside of the RTOG/ESTRO-defined SCL target volumes. Consequently, many radiation oncologists advocate for enlarging the SCL irradiation target volume to include both the medial and posterolateral SCL regions. Nevertheless, it remains uncertain whether adding the posterolateral SCL irradiation improves survival outcomes for high-risk breast cancer patients. Methods The SUCLANODE trial is an open-label, multicenter, randomized, phase 3 trial comparing the efficacy and adverse events of medial SCL irradiation (M-SCLI group) and medial plus posterolateral SCL irradiation (entire SCL irradiation, E-SCLI group) in high-risk breast cancer patients who underwent breast conserving-surgery or mastectomy. Patients with pathological N2-3b disease following initial surgery, or clinical stage III or pathological N1-3b if receiving neoadjuvant systemic therapy, are eligible and randomly assigned (1:1) to M-SCLI group and E-SCLI group. Stratification is by chemotherapy sequence (neoadjuvant vs. adjuvant), T stage (T3-4 vs. T1-2), N stage (N1-2 vs. N3), and ER status (positive vs. negative). Other radiation volumes are identical in the two arms, including breast/chest wall, undissected axillary lymph node, and internal mammary node. Advanced intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), or tomotherapy techniques are recommended. Both hypofractionated and conventional fractionation schedules are permitted. The primary end point is invasive disease-free survival, and secondary end points included overall survival, SCL recurrence, local-regional recurrence, distance recurrence, safety outcome, and patient-reported outcomes. The target sample size is 1650 participants. Discussion The results of the SUCLANODE trial will provide high-level evidence regarding whether adding posterolateral SCL irradiation to medial SCL target volume provides survival benefit in patients with high-risk breast cancer. Trial registration ClinicalTrials.gov Identifier: NCT05059379. Registered 28 September 2021, https://www.clinicaltrials.gov/ct2/show/NCT05059379 .

Multi-criteria optimization (MCO) function has been available on commercial radiotherapy (RT) treatment planning systems to improve plan quality; however, no study has compared Eclipse and RayStation MCO functions for prostate RT planning. The purpose of this study was to compare prostate RT MCO plan qualities in terms of discrepancies between Pareto optimal and final deliverable plans, and dosimetric impact of final deliverable plans. In total, 25 computed tomography datasets of prostate cancer patients were used for Eclipse (version 16.1) and RayStation (version 12A) MCO-based plannings with doses received by 98% of planning target volume having 76 Gy prescription (PTV76D98%) and 50% of rectum (rectum D50%) selected as trade-off criteria. Pareto optimal and final deliverable plan discrepancies were determined based on PTV76D98% and rectum D50% percentage differences. Their final deliverable plans were compared in terms of doses received by PTV76 and other structures including rectum, and PTV76 homogeneity index (HI) and conformity index (CI), using a t-test. Both systems showed discrepancies between Pareto optimal and final deliverable plans (Eclipse: −0.89% (PTV76D98%) and −2.49% (Rectum D50%); RayStation: 3.56% (PTV76D98%) and −1.96% (Rectum D50%)). Statistically significantly different average values of PTV76D98%,HI and CI, and mean dose received by rectum (Eclipse: 76.07 Gy, 0.06, 1.05 and 39.36 Gy; RayStation: 70.43 Gy, 0.11, 0.87 and 51.65 Gy) are noted, respectively (p < 0.001). Eclipse MCO-based prostate RT plan quality appears better than that of RayStation. [ABSTRACT FROM AUTHOR]

Nasopharyngeal carcinoma(NPC) occurs frequently in Southern China, and radiotherapy is the main treatment method. At present, intensity‐modulated radiotherapy is widely used, which has improved efficacy in patients with NPC and reduced toxicity and side effects. Recently, helical tomography radiotherapy, proton radiotherapy, carbon particle radiotherapy, and other radiotherapy techniques have been used for the clinical treatment of NPC. Individualized nasopharyngeal cancer targets have also been explored. This paper reviews the research progress in radiotherapy techniques and target volume for NPC [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the precision of semi-automatic, conventional and automatic volumetry tools for pulmonary nodules in chest CT with phantom N1 LUNGMAN. The phantom is a life-size anatomical chest model with pulmonary nodules representing solid and subsolid metastases. Gross tumor volumes (GTVis) were contoured using various approaches: manually (0); as a means of semi-automated, conventional contouring with (I) adaptive-brush function; (II) flood-fill function; and (III) image-thresholding function. Furthermore, a deep-learning algorithm for automatic contouring was applied (IV). An intermodality comparison of the above-mentioned strategies for contouring GTVis was performed. For the mean GTVref (standard deviation (SD)), the interquartile range (IQR)) was 0.68 mL (0.33; 0.34–1.1). GTV segmentation was distributed as follows: (I) 0.61 mL (0.27; 0.36–0.92); (II) 0.41 mL (0.28; 0.23–0.63); (III) 0.65 mL (0.35; 0.32–0.90); and (IV) 0.61 mL (0.29; 0.33–0.95). GTVref was found to be significantly correlated with GTVis (I) p < 0.001, r = 0.989 (III) p = 0.001, r = 0.916, and (IV) p < 0.001, r = 0.986, but not with (II) p = 0.091, r = 0.595. The Sørensen–Dice indices for the semi-automatic tools were 0.74 (I), 0.57 (II) and 0.71 (III). For the semi-automatic, conventional segmentation tools evaluated, the adaptive-brush function (I) performed closest to the reference standard (0). The automatic deep learning tool (IV) showed high performance for auto-segmentation and was close to the reference standard. For high precision radiation therapy, visual control, and, where necessary, manual correction, are mandatory for all evaluated tools. [ABSTRACT FROM AUTHOR]

Abstract Purpose Radiotherapy is, with surgery, one of the main therapeutic treatment strategies for meningiomas. No prospective study has defined a consensus for the delineation of target volumes for meningioma radiotherapy. Therefore, target volume definition is mainly based on information from retrospective studies that include heterogeneous patient populations. The aim is to describe delineation guidelines for meningioma radiotherapy as an adjuvant or definitive treatment with intensity-modulated radiation therapy and stereotactic radiation therapy techniques. This guideline is based on a consensus endorsed by a multidisciplinary group of brain tumor experts, members of the Association of French-speaking Neuro-oncologists (ANOCEF). Materials and methods A 3-step procedure was used. First, the steering group carried out a comprehensive review to identify divergent issues on meningiomas target volume delineation. Second, an 84-item web-questionnaire has been developed to precisely define meningioma target volume delineation in the most common clinical situations. Third, experts members of the ANOCEF were requested to answer. The first two rounds were completed online. A third round was carried out by videoconference to allow experts to debate and discuss the remaining uncertain questions. All questions remained in a consensus. Results Limits of the target volume were defined using visible landmarks on computed tomography and magnetic resonance imaging, considering the pathways of tumor extension. The purpose was to develop clear and precise recommendations on meningiomas target volumes. Conclusion New recommendations for meningiomas delineation based on simple anatomic boundaries are proposed by the ANOCEF. Improvement in uniformity in target volume definition is expected.

A previous study investigated robustness of manual flash (MF) and robust optimized (RO) volumetric modulated arc therapy plans for breast radiotherapy based on five patients in 2020 and indicated that the RO was more robust than the MF, although the MF is still current standard practice. The purpose of this study was to compare their plan robustness in terms of dose variation to clinical target volume (CTV) and organs at risk (OARs) based on a larger sample size. This was a retrospective study involving 34 female patients. Their plan robustness was evaluated based on measured volume/dose difference between nominal and worst scenarios (ΔV/ΔD) for each CTV and OARs parameter, with a smaller difference representing greater robustness. Paired sample t-test was used to compare their robustness values. All parameters (except CTV ΔD98%) of the RO approach had smaller ΔV/ΔD values than those of the MF. Also, the RO approach had statistically significantly smaller ΔV/ΔD values (p < 0.001–0.012) for all CTV parameters except the CTV ΔV95% and ΔD98% and heart ΔDmean. This study's results confirm that the RO approach was more robust than the MF in general. Although both techniques were able to generate clinically acceptable plans for breast radiotherapy, the RO could potentially improve workflow efficiency due to its simpler planning process. [ABSTRACT FROM AUTHOR]

Background: The target volume for post-mastectomy radiation therapy (PMRT) in breast cancer patients with reconstruction has been a subject of debate. Traditionally, the RT chest wall (CW) volume encompasses the entire implant. For patients with retropectoral implants, the deep lymphatic plexus dorsal part of the implant is no longer considered high risk and can be omitted. This study aimed to assess the radiation dose distribution and treatment outcomes associated with different CW delineation according to ESTRO ACROP guideline for patients who have undergone implant-based reconstruction. Methods: We conducted a retrospective review of breast cancer patients who underwent a mastectomy followed by two-stage implant-based breast reconstruction and adjuvant radiation therapy (RT) between 2007 and 2022. The expanders/implants were positioned retropectorally. The chest wall target volumes were categorized into two groups: the prepectoral group, which excluded the deep lymphatic plexus, and the whole expander group. Results: The study included 26 patients, with 15 in the prepectoral group and 11 in the whole expander group. No significant differences were observed in normal organ exposure between the two groups. There was a trend toward a lower ipsilateral lung mean dose in the prepectoral group (10.2 vs. 11.1 Gy, p = 0.06). Both groups exhibited limited instances of reconstruction failure and local recurrence. Conclusions: For patients undergoing two-stage expander/implant retropectoral breast reconstruction and PMRT, our data provided comparable outcomes and normal organ exposure for those omitting the deep lymphatic plexus. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Radiotherapy is, with surgery, one of the main therapeutic treatment strategies for meningiomas. No prospective study has defined a consensus for the delineation of target volumes for meningioma radiotherapy. Therefore, target volume definition is mainly based on information from retrospective studies that include heterogeneous patient populations. The aim is to describe delineation guidelines for meningioma radiotherapy as an adjuvant or definitive treatment with intensity-modulated radiation therapy and stereotactic radiation therapy techniques. This guideline is based on a consensus endorsed by a multidisciplinary group of brain tumor experts, members of the Association of French-speaking Neuro-oncologists (ANOCEF). Materials and methods: A 3-step procedure was used. First, the steering group carried out a comprehensive review to identify divergent issues on meningiomas target volume delineation. Second, an 84-item web-questionnaire has been developed to precisely define meningioma target volume delineation in the most common clinical situations. Third, experts members of the ANOCEF were requested to answer. The first two rounds were completed online. A third round was carried out by videoconference to allow experts to debate and discuss the remaining uncertain questions. All questions remained in a consensus. Results: Limits of the target volume were defined using visible landmarks on computed tomography and magnetic resonance imaging, considering the pathways of tumor extension. The purpose was to develop clear and precise recommendations on meningiomas target volumes. Conclusion: New recommendations for meningiomas delineation based on simple anatomic boundaries are proposed by the ANOCEF. Improvement in uniformity in target volume definition is expected. [ABSTRACT FROM AUTHOR]

Background and purpose: The standard treatment for patients with locally advanced esophageal cancer is neoadjuvant chemoradiotherapy (NCRT) plus radical resection. However, the technical aspects for implementing this comprehensive treatment strategy differ, especially in the controversial definition of the radiotherapy target area in NCRT. This study aimed to analyze the feasibility of involving field irradiation (IFI) in NCRT for locally advanced esophageal cancer. Methods: Retrospective analysis of locally advanced esophageal squamous cell carcinoma patients receiving NCRT in Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine from July 2016 to May 2017 showed that the radiotherapy target of all patients was our recommended IFI. The radiotherapy plan was redesigned for the enrolled patients according to the two traditional target delineation of elective node irradiation (ENI) and primary subclinical lesion irradiation (SLI). The dosimetric parameters of the three groups and the dose differences of organ at risk (OAR), such as lungs, heart and spinal cord, were compared, and the relationship between IFI Recurrence pattern and radiation target volumes was analyzed. Results: A total of 26 patients were enrolled. The average target volume of IFI was (277±77) cm3, which was significantly lower compared with ENI and SLI (P

Incidence of carcinoma esophagus accounts for approximately 6% of all gastrointestinal malignancies. According to GLOBOCAN 2020 data, 604,100 cases of carcinoma esophagus were detected (3.1% of total cases), and it was the 8th most common cancer in the world. The first choice of treatment for resectable esophageal cancer is surgery. Neoadjuvant radio-chemotherapy improved the overall survival (OS) of patients with advanced carcinomas of the esophagus by about 10% in 5 years, as shown by different studies. In unresectable cases, carcinoma esophagus definitive chemoradiation is the treatment of choice. Determination of the target volume of the esophagus has changed with time due to the advancement of technology. Determining the target volumes accurately is essential to achieve precise dose delivery to the targets. Controversies still exist between different regions and societies regarding target volume determination. However, the choice of the treatment volumes, techniques, and dose for optimal use must be individualized. Patients' disease status, preference, and comorbidities should also be considered while making decisions. This article will review the different target volumes, techniques, and doses used in various large trials used in definitive, neoadjuvant, and adjuvant studies.

Copyright of Journal of Medical Imaging & Radiation Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: High Dose Rate (HDR) brachytherapy plays an important role in the treatment of lung carcinoma. The treatment of lung carcinoma with Endobronchial Brachytherapy Treatment (EBBT) is delivered with three fractions and the effect of EBBT on the Target Volume (TV) after delivering the three fractions in the lung carcinoma needs to be assessed. The TV is covered with the prescribed dose and Organs At Risk (OARs) doses are evaluated. Aim: To assess the doses to OAR nearby the tumour and analyse the effect of the TV, tumour location, and site on the doses to OARs in EBBT in lung carcinoma. Materials and Methods: A cross-sectional study was conducted in the Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University Dehradun, Uttarakhand, India, from January 2018 to December 2020. Thirty patients with lung carcinoma were included in dosimetric and volumetric assessments. A flexible lumencare catheter was inserted into the bronchial lesion. Computed Tomography (CT) scan was acquired and exported to Treatment Planning System (TPS) through Digital Imaging and Communications in Medicine (DICOM) networking system. An optimised treatment plan was generated. The TV and OARs were delineated on the CT scan of the patient. A total of three EBBT sessions were given with a 7 Gy dose per fraction and prescribed the dose at 1.0 cm from the center of the catheter. Doses to OARs and the effects of TV on doses to OARs were evaluated with the help of "Dose Volume Histogram (DVH) tool" in the TPS. Thirty patients, with varying TV and site, were grouped as left lung and right lung tumour lesions and also grouped as TV <22 cc and TV >22 cc for the analysis purpose in this study. The data was entered in Microsoft Office Excel 2007 and analysed in Statistical Package for the Social Sciences (SPSS) version 22.0 statistical analysis software (IBM Corp., Armonk, N.Y., USA) tool. Results: The mean doses to OARs in 1st, 2nd and 3rd EBBT sessions were within their tolerance limit. The mean dose difference between left and right lung tumour site were analysed and found mainly the mean dose to oesophagus and maximum dose to oesophagus, contralateral lung, left coronary artery and descending aorta were significantly higher in left lung compared to right lung with p-value 0.015, 0.027, 0.001, 0.007 and 0.001, respectively. The maximum dose to the contralateral lung and spinal cord were significantly higher in middle-lower bronchial lesion with p-value 0.024 and 0.023, respectively. The mean dose difference between left and right lung tumour volume for TV <22 cc and TV>22 cc was analysed and found mainly for the group TV>22 cc the mean dose to oesophagus and maximum dose to oesophagus, Heart, contralateral lung, left coronary artery and descending aorta were significantly higher in the left lung compared to right lung with p-value 0.002, 0.008, 0.027, 0.003, 0.006 and 0.001, respectively whereas in the TV<22 cc group only the contralateral lung max dose was significantly higher in left lung compared to right lung with p-value 0.046. Conclusion: The OARs doses were increased significantly in left lung compared to right lung carcinoma. The TV was large in the middle-lower bronchial region, therefore, the doses were found higher, and TV in the lower bronchial region is less so the dose was less. [ABSTRACT FROM AUTHOR]

Abstract Background Gallbladder cancer (GBC) is an uncommon malignancy with high recurrent rate and poor prognosis. This study investigates the recurrent patterns of postoperative GBC, with the aim to guide the adjuvant treatments, including the radiotherapy. Methods Retrospectively analyzed the 109 GBC patients who underwent surgery in our institution from January 2013 to 2018. Clinical follow-up revealed 54 recurrent cases, of which 40 had detailed locations of recurrence. The sites of recurrence were recorded and divided into the tumor bed, corresponding lymphatic drainage area, intrahepatic recurrence, and the other distant metastasis. Results The median follow-up time is 34 months (IQR: 11–64). The median disease-free survival (DFS) and overall survival (OS) were 48.8 months and 53.7 months, respectively. Through univariate analysis, risk factors for DFS and OS include tumor markers (CA199 and CEA), hepatic invasion, perineural invasion, lymphovascular invasion, TNM staging and tumor differentiation. Through multivariate analysis, risk factors for DFS include hepatic invasion and TNM staging, and for OS is TNM staging only. Of the 40 cases with specific recurrent sites, 29 patients (29/40, 72.5%) had recurrence in the potential target volume of postoperative radiotherapy (PORT), which include tumor bed and corresponding lymphatic drainage area. The common recurrent lymph node groups included abdominal para-aortic lymph node (No.16, 15/29), hepatoduodenal ligament lymph node (No.12, 8/29), retro-pancreatic head lymph node (No.13, 7/29) and celiac axis lymph node (No.9, 4/29). Twenty cases with recurrences inside the potential PORT target volume were accompanied by distant metastasis. Another 11 cases had distant metastasis alone, so totally 31 cases developed distant metastasis (31/40, 77.5%), including 18 cases with hepatic metastasis. Conclusion The recurrence and metastasis rates are high in GBC and adjuvant therapy is needed. Up to 75% of the recurrent cases occurred in the potential target volume of postoperative radiotherapy, suggesting that postoperative radiotherapy has the possible value of improving local-regional control. The potential target volume of radiotherapy should include the tumor bed, No.8, No.9, No.11, No.12, No.13, No.14, No. 16a2, No. 16b1 lymph node groups.

Introduction: High Dose Rate (HDR) brachytherapy plays an important role in the treatment of lung carcinoma. The treatment of lung carcinoma with Endobronchial Brachytherapy Treatment (EBBT) is delivered with three fractions and the effect of EBBT on the Target Volume (TV) after delivering the three fractions in the lung carcinoma needs to be assessed. The TV is covered with the prescribed dose and Organs At Risk (OARs) doses are evaluated. Aim: To assess the doses to OAR nearby the tumour and analyse the effect of the TV, tumour location, and site on the doses to OARs in EBBT in lung carcinoma. Materials and Methods: A cross-sectional study was conducted in the Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University Dehradun, Uttarakhand, India, from January 2018 to December 2020. Thirty patients with lung carcinoma were included in dosimetric and volumetric assessments. A flexible lumencare catheter was inserted into the bronchial lesion. Computed Tomography (CT) scan was acquired and exported to Treatment Planning System (TPS) through Digital Imaging and Communications in Medicine (DICOM) networking system. An optimised treatment plan was generated. The TV and OARs were delineated on the CT scan of the patient. A total of three EBBT sessions were given with a 7 Gy dose per fraction and prescribed the dose at 1.0 cm from the center of the catheter. Doses to OARs and the effects of TV on doses to OARs were evaluated with the help of “Dose Volume Histogram (DVH) tool” in the TPS. Thirty patients, with varying TV and site, were grouped as left lung and right lung tumour lesions and also grouped as TV 22 cc for the analysis purpose in this study. The data was entered in Microsoft Office Excel 2007 and analysed in Statistical Package for the Social Sciences (SPSS) version 22.0 statistical analysis software (IBM Corp., Armonk, N.Y., USA) tool. Results: The mean doses to OARs in 1st, 2nd and 3rd EBBT sessions were within their tolerance limit. The mean dose difference between left and right lung tumour site were analysed and found mainly the mean dose to oesophagus and maximum dose to oesophagus, contralateral lung, left coronary artery and descending aorta were significantly higher in left lung compared to right lung with p-value 0.015, 0.027, 0.001, 0.007 and 0.001, respectively. The maximum dose to the contralateral lung and spinal cord were significantly higher in middle-lower bronchial lesion with p-value 0.024 and 0.023, respectively. The mean dose difference between left and right lung tumour volume for TV 22 cc was analysed and found mainly for the group TV>22 cc the mean dose to oesophagus and maximum dose to oesophagus, Heart, contralateral lung, left coronary artery and descending aorta were significantly higher in the left lung compared to right lung with p-value 0.002, 0.008, 0.027, 0.003, 0.006 and 0.001, respectively whereas in the TV

Background and purpose: The standard treatment for patients with locally advanced esophageal cancer is neoadjuvant chemoradiotherapy (NCRT) plus radical resection. However, the technical aspects for implementing this comprehensive treatment strategy differ, especially in the controversial definition of the radiotherapy target area in NCRT. This study aimed to analyze the feasibility of involving field irradiation (IFI) in NCRT for locally advanced esophageal cancer. Methods: Retrospective analysis of locally advanced esophageal squamous cell carcinoma patients receiving NCRT in Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine from July 2016 to May 2017 showed that the radiotherapy target of all patients was our recommended IFI. The radiotherapy plan was redesigned for the enrolled patients according to the two traditional target delineation of elective node irradiation (ENI) and primary subclinical lesion irradiation (SLI). The dosimetric parameters of the three groups and the dose differences of organ at risk (OAR), such as lungs, heart and spinal cord, were compared, and the relationship between IFI Recurrence pattern and radiation target volumes was analyzed. Results: A total of 26 patients were enrolled. The average target volume of IFI was (277±77) cm³, which was significantly lower compared with ENI and SLI (P＜0.05). IFI could significantly reduce relative volume fraction of lungs irradiated more than 5 and 20 Gy (V5 and V20), lungs average dose (Dmean), heart V30, heart Dmean and spinal cord maximum dose (Dmax) (P＜0.05), compared with ENI. Lungs V20, lungs Dmean, heart Dmean and spinal cord Dmax decreased by 27.1%, 22.5%, 27.4% and 6.4% compared with ENI, and 24.1%, 22.0%, 24.8% and 5.7% compared with SLI, respectively. After 28 to 69 months of follow-up, 13 patients had recurrence and metastasis, of whom 7 patients had distant metastasis, 4 patients had recurrence in the irradiation field, and 1 patient had local recurrence in the irradiation field. The 3-year overall survival (OS) rate and disease-free survival (DFS) rate were 50.0% and 42.3%, respectively. Conclusion: IFI recommended by our institution is feasible to ensure clinical efficacy while significantly reducing the radiation dose of lungs, heart and spinal cord. [ABSTRACT FROM AUTHOR]

Background: Deep learning-based head and neck lymph node level (HN_LNL) autodelineation is of high relevance to radiotherapy research and clinical treatment planning but still underinvestigated in academic literature. In particular, there is no publicly available open-source solution for large-scale autosegmentation of HN_LNL in the research setting. Methods: An expert-delineated cohort of 35 planning CTs was used for training of an nnU-net 3D-fullres/2D-ensemble model for autosegmentation of 20 different HN_LNL. A second cohort acquired at the same institution later in time served as the test set (n = 20). In a completely blinded evaluation, 3 clinical experts rated the quality of deep learning autosegmentations in a head-to-head comparison with expert-created contours. For a subgroup of 10 cases, intraobserver variability was compared to the average deep learning autosegmentation accuracy on the original and recontoured set of expert segmentations. A postprocessing step to adjust craniocaudal boundaries of level autosegmentations to the CT slice plane was introduced and the effect of autocontour consistency with CT slice plane orientation on geometric accuracy and expert rating was investigated. Results: Blinded expert ratings for deep learning segmentations and expertcreated contours were not significantly different. Deep learning segmentations with slice plane adjustment were rated numerically higher (mean, 81.0 vs. 79.6, p = 0.185) and deep learning segmentations without slice plane adjustment were rated numerically lower (77.2 vs. 79.6, p = 0.167) than manually drawn contours. In a head-to-head comparison, deep learning segmentations with CT slice plane adjustment were rated significantly better than deep learning contours without slice plane adjustment (81.0 vs. 77.2, p = 0.004). Geometric accuracy of deep learning segmentations was not different from intraobserver variability (mean Dice per level, 0.76 vs. 0.77, p = 0.307). Clinical significance of contour consistency with CT slice plane orientation was not represented by geometric accuracy metrics (volumetric Dice, 0.78 vs. 0.78, p = 0.703). Conclusions: We show that a nnU-net 3D-fullres/2D-ensemble model can be used for highly accurate autodelineation of HN_LNL using only a limited training dataset that is ideally suited for large-scale standardized autodelineation of HN_LNL in the research setting. Geometric accuracy metrics are only an imperfect surrogate for blinded expert rating. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the precision of semi-automatic, conventional and automatic volumetry tools for pulmonary nodules in chest CT with phantom N1 LUNGMAN. The phantom is a life-size anatomical chest model with pulmonary nodules representing solid and subsolid metastases. Gross tumor volumes (GTVis) were contoured using various approaches: manually (0); as a means of semi-automated, conventional contouring with (I) adaptive-brush function; (II) flood-fill function; and (III) image-thresholding function. Furthermore, a deep-learning algorithm for automatic contouring was applied (IV). An intermodality comparison of the above-mentioned strategies for contouring GTVis was performed. For the mean GTVref (standard deviation (SD)), the interquartile range (IQR)) was 0.68 mL (0.33; 0.34–1.1). GTV segmentation was distributed as follows: (I) 0.61 mL (0.27; 0.36–0.92); (II) 0.41 mL (0.28; 0.23–0.63); (III) 0.65 mL (0.35; 0.32–0.90); and (IV) 0.61 mL (0.29; 0.33–0.95). GTVref was found to be significantly correlated with GTVis (I) p < 0.001, r = 0.989 (III) p = 0.001, r = 0.916, and (IV) p < 0.001, r = 0.986, but not with (II) p = 0.091, r = 0.595. The Sørensen–Dice indices for the semi-automatic tools were 0.74 (I), 0.57 (II) and 0.71 (III). For the semi-automatic, conventional segmentation tools evaluated, the adaptive-brush function (I) performed closest to the reference standard (0). The automatic deep learning tool (IV) showed high performance for auto-segmentation and was close to the reference standard. For high precision radiation therapy, visual control, and, where necessary, manual correction, are mandatory for all evaluated tools.

Purpose: PET-CT has recently been included in the NCCN staging recommendations for cervical cancer stages II-IV and is already routinely applied to radiotherapy planning for other malignancies, as it is expected to provide higher accuracy for the detection of areas with tumor cell spread. In this study, we report on our first experiences of PET-based radiotherapy planning for cervical cancer.Methods: 19 patients with cervical cancer that underwent pre-therapeutic PET imaging treated at our institution between January 2016 and April 2019 were included in the study. Information on the primary tumor, lymph node involvement, metastatic spread and changes in the radiotherapy procedure based on the PET findings are described.Results: A previously unknown primary tumor extension that was detected by PET imaging in one patient. In patients who underwent a PET before the systematic pelvic and paraaortic lymphonodectomy (n = 2), PET was false negative for pelvic lymph node metastases in 50%. In patients who underwent a PET after the systematic LNE (n = 13), additional lymph node metastases were detected in seven patients (53.80%). Distant metastases were suspected in three patients (15.7%) based on PET imaging. The suspicion was confirmed in one patient (peritoneal spread) and excluded in two patients (supra-diaphragmatic lymph nodes). In 13 patients (68.4%), RT procedures were altered due to findings in PET imaging.Conclusion: PET-based radiochemotherapy planning may improve control rates by identifying areas of tumor cell spread eligible for dose escalation. False positivity, however, should be excluded in patients with findings that lead to major modifications of the therapeutic strategy. [ABSTRACT FROM AUTHOR]

The goal of this study was to investigate the variability of target volume and parotid gland dose distribution for nasopharyngeal carcinoma (NPC), and to explore the shifting patterns of parotid gland centroid and neck radius during radiotherapy. Twenty patients with NPC were enrolled. The target volume dose difference between planning dose and recalculated dose on weekly CT was analyzed. The recalculated doses on every weekly CT were cumulated to assess the difference between delivered dose and planning dose. The relationship of parotid gland centroid deviation with dose was studied, and the shrinking distances of neck radius were calculated for cervical vertebra 1, 2, 3 levels (C1, C2, C3). The ratio of GTVs and CTVs doses on weekly CTs to the doses on planning CT was all above 0.98; the dose of PTVs on weekly CT tended to decrease compared with planning. RMD was defined as the ratio of the mean dose of the left and right parotid glands (L-PG, R-PG) to the planning mean dose. The fitted relationships of RMD and the deviation of centroid (D) for L-PG and R-PG were: RMD=0.37*D+0.98 (R 2  = 0.62, p < 0.001) and RMD = 0.33*D+0.97 (R 2  = 0.72, p < 0.001), respectively. The order of neck radius shrinking distance at different levels was C1>C2=C3. In this study, we quantitatively analyzed the dosimetric variabilities of target volumes, and established linear models of parotid gland dose and its centroid deviation, which provides fractional and full-course dose evaluation during radiotherapy for NPC., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2024 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.)

Purpose: This guideline will discuss radiotherapeutic management of IDH-mutant grade 2 and grade 3 diffuse glioma, using the latest 2021 WHO (5th) classification of brain tumours focusing on: imaging modalities, tumour volume delineation, irradiation dose and fractionation., Methods: The ESTRO Guidelines Committee, CNS subgroup, nominated 15 European experts who identified questions for this guideline. Four working groups were established addressing specific questions concerning imaging, target volume delineation, radiation techniques and fractionation. A literature search was performed, and available literature was discussed. A modified two-step Delphi process was used with majority voting resulted in a decision or highlighting areas of uncertainty., Results: Key issues identified and discussed included imaging needed to define target definition, target delineation and the size of margins, and technical aspects of treatment including different planning techniques such as proton therapy., Conclusions: The GTV should include any residual tumour volume after surgery, as well as the resection cavity. Enhancing lesions on T1 imaging should be included if they are indicative of residual tumour. In grade 2 tumours, T2/FLAIR abnormalities should be included in the GTV. In grade 3 tumours, T2/FLAIR abnormalities should also be included, except areas that are considered to be oedema which should be omitted from the GTV. A GTV to CTV expansion of 10 mm is recommended in grade 2 tumours and 15 mm in grade 3 tumours. A treatment dose of 50.4 Gy in 28 fractions is recommended in grade 2 tumours and 59.4 Gy in 33 fractions in grade 3 tumours. Radiation techniques with IMRT are the preferred approach., Competing Interests: Declaration of competing interest MvdB: Receipt of grant/research support from Boehringer-Ingelheim, and receipt of honoraria or consultation fees from Boehringer-Ingelheim, Servier, Genenta, Nerviano, Incyte, Chimerix, Fore Biotherapeutics. Participated in a company sponsored speaker’s bureau for Servier; NG: Receipt of grant/research support from German Research Council (project number 428090865/SPP 2177), and receipt of honoraria or consultation fees from Blue Earth Diagnostics, Telix Pharmaceuticals; GM: Receipt of grant/research support from Horizon EU-funded LEGATO-Trial, and receipt of honoraria or consultation fees from Servier, AstraZeneca, Novocure; VK: Receipt of grant/research support from Hanarth Stichting, and receipt of honoraria or consultation fees from Eli Lilly (Consultation fees). Bayer stock shareholder; MN: Receipt of grant/research support from Deutsche Krebshilfe (DKH), Brainlab AG, Elekta AB, and participated in a company sponsored speaker’s bureau for AstraZeneca, Brainlab AG; SE: Receipt of honoraria or consultation fees from Servier; UR: Receipt of grant/research support from Institutional research grants from Brainlab, and receipt of honoraria or consultation fees from AstraZeneca, Accuray; RR: Receipt of grant/research support from Institutional research grants from Bayer, and receipt of honoraria or consultation fees from Novocure, Servier, Genenta, CureVac., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: We aimed to examine whether elective inclusion of the posterolateral supraclavicular node (SCL) region to the standard medial SCL target volume improves SCL control and survival outcomes in patients with high-risk node-positive breast cancer undergoing regional nodal irradiation (RNI).Methods and Materials: We retrospectively reviewed 544 consecutive women with high-risk breast cancer treated with postoperative chest wall/breast and RNI in our center from January 2015 to December 2016. High-risk features were defined as clinical or pathologic stage N2-3b disease. Patients were classified into the medial SCL irradiation (M-SCLI) group and the entire SCL irradiation (E-SCLI) group, which included both the medial and the posterolateral SCL region. SCL recurrence (SCLR), disease-free survival (DFS), and overall survival (OS) were estimated and compared. Propensity-score matching (PSM) and multivariate cox regression were used for analysis.Results: The median follow-up time was 64.2 months. Before PSM, there was no significant difference in the cumulative incidence of SCLR between the 2 groups, with 5-year rates of 2.0% in the M-SCLI group and 0.6% in the E-SCLI group (P = .1). After PSM, there was also no significant difference in the cumulative incidence of SCLR (2.1% vs 0.5%; P = .2). Only 2 patients had recurrence in the posterolateral SCL region, with 1 patient in each group. Similarly, there was no significant difference in DFS and OS between the M-SCLI and E-SCLI group both before PSM (5-year rates of 78.5% vs 78.8%, P = .8; 92.2% vs 90.0%, P = .2) and after PSM (76.7% vs 77.2%, P = .8; 91.5% vs 88.4%, P = .1). Multivariate analysis demonstrated that E-SCLI was not independently prognostic for DFS and OS.Conclusions: E-SCLI does not appear to be associated with improved SCL control and survival outcomes in high-risk node-positive breast cancer. These data do not support the routine use of E-SCLI in N2-3b disease. We initiated a multicenter randomized controlled phase 3 study comparing M-SCLI and E-SCLI to further validate these results. [ABSTRACT FROM AUTHOR]

Background: Gallbladder cancer (GBC) is an uncommon malignancy with high recurrent rate and poor prognosis. This study investigates the recurrent patterns of postoperative GBC, with the aim to guide the adjuvant treatments, including the radiotherapy.Methods: Retrospectively analyzed the 109 GBC patients who underwent surgery in our institution from January 2013 to 2018. Clinical follow-up revealed 54 recurrent cases, of which 40 had detailed locations of recurrence. The sites of recurrence were recorded and divided into the tumor bed, corresponding lymphatic drainage area, intrahepatic recurrence, and the other distant metastasis.Results: The median follow-up time is 34 months (IQR: 11-64). The median disease-free survival (DFS) and overall survival (OS) were 48.8 months and 53.7 months, respectively. Through univariate analysis, risk factors for DFS and OS include tumor markers (CA199 and CEA), hepatic invasion, perineural invasion, lymphovascular invasion, TNM staging and tumor differentiation. Through multivariate analysis, risk factors for DFS include hepatic invasion and TNM staging, and for OS is TNM staging only. Of the 40 cases with specific recurrent sites, 29 patients (29/40, 72.5%) had recurrence in the potential target volume of postoperative radiotherapy (PORT), which include tumor bed and corresponding lymphatic drainage area. The common recurrent lymph node groups included abdominal para-aortic lymph node (No.16, 15/29), hepatoduodenal ligament lymph node (No.12, 8/29), retro-pancreatic head lymph node (No.13, 7/29) and celiac axis lymph node (No.9, 4/29). Twenty cases with recurrences inside the potential PORT target volume were accompanied by distant metastasis. Another 11 cases had distant metastasis alone, so totally 31 cases developed distant metastasis (31/40, 77.5%), including 18 cases with hepatic metastasis.Conclusion: The recurrence and metastasis rates are high in GBC and adjuvant therapy is needed. Up to 75% of the recurrent cases occurred in the potential target volume of postoperative radiotherapy, suggesting that postoperative radiotherapy has the possible value of improving local-regional control. The potential target volume of radiotherapy should include the tumor bed, No.8, No.9, No.11, No.12, No.13, No.14, No. 16a2, No. 16b1 lymph node groups. [ABSTRACT FROM AUTHOR]

To analyze the dosimetric effects of shoulder position shift on target volumes and organs at risk (OARs) during radiotherapy for head and neck cancer, 14 patients with different types of head and neck cancer were selected. Based on original positioning CTs (o-CTs), the shoulder position was moved toward the superior inferior (SI) direction, anterior posterior (AP) direction, and the left right (LR) direction by 3 mm, 6 mm, and 15 mm, then 252 new CTs (n-CTs) were produced. After setting the movement, the new adipose tissue density was set to 1 g/cm3, and the movement of the bone tissue was also considered. The original plan (o-plan) on the o-CT was copied to the n-CTs and recalculated to obtain 252 new plans (n-plans). The differences between the o-plan and n-plan target volumes and OARs in field-fixed intensity modulated radiotherapy and the volumetric modulated arc intensity (VMAT) were studied, and the dose changes of the target volume D95% and spinal cord Dmax were compared with the movement of the shoulder position. It was proved that the effects of the shoulder position shift on the target volume and OARs for head and neck cancers are substantial, especially a 15 mm shift toward the superior direction had the greatest influence, reaching 4.16% (VMAT). The closer the target area is to the shoulder, the more serious the impact. The spinal cord dose increased greatly, reaching a maximum of 72.8 cGy, 100 cGy and 212 cGy (VMAT), respectively, for shift of 3 mm, 6 mm, and 15 mm towards the inferior direction. The o-plan and p-plan were analyzed using a 3D γ passing rate (3%/3 mm), that was more than 95% except for the 15 mm shift towards the superior direction. Radiotherapy technicians should pay attention to ensure that the shoulder is lightly touching the thermoplastic mold during radiotherapy positioning for head and neck tumors to prevent patients from shrugging their shoulders. The OAR dose limit should be considered in the planning design, and a sufficient margin should be left to prevent the excessive dose caused by the positioning.

Purpose: The purpose of this study was to evaluate the treatment outcomes and toxicity profile of patients with early glottic cancer who underwent hypofractionated radiation therapy (RT) with 3.5 Gy per fraction. Materials and Methods: A retrospective review was performed of the medical records of 35 patients with early stage (T1-2N0M0) glottic cancer who underwent definitive RT. The dose fractionation scheme was 59.5 Gy in 17 fractions. Posterior commissure was excluded from the clinical target volume (CTV) for 26 patients (74.3%) without glottic lesions close to this region. Results: With a median follow-up of 16.23 months (range, 6.82 to 67.15 months), no local, regional, or distant recurrence was reported. Acute hoarseness (65.7%), mucositis (68.6%), radiation dermatitis (60.0%) was frequent. One patient (2.9%) reported grade 3 acute toxicity (mucositis) and there was no grade 4-5 acute toxicity. There was no grade =3 late toxicities; however, grade 1 late intermittent hoarseness was frequent (45.7%). The receiver operative characteristic analysis revealed that mean hypopharyngeal dose was predictive for acute grade =2 mucositis (area under the curve=0.9314; 95% confidence interval, 0.8524-1). The optimal threshold of mean hypopharyngeal dose for occurrence of acute grade =2 mucositis was 26.31 Gy, with a specificity and sensitivity of 83.3% and 88.2%, respectively. Conclusion: Hypofractionated RT with fraction size of 3.5 Gy for early glottic cancer is effective. The hypopharyngeal mean dose could predict the occurrence of grade =2 acute mucositis. The posterior commissure can be safely excluded from the CTV. [ABSTRACT FROM AUTHOR]

Abstract Purpose To determine which imaging method used during radioembolization (RE) work-up: contrast-enhanced computed tomography (CECT), 99mTc-MAA-SPECT/CT or cone beam-CT (CBCT), more accurately predicts the final target volume (TgV) as well as the influence that each modality has in the dosimetric calculation. Methods TgVs from 99mTc-MAA-SPECT/CT, CECT and CBCT were consecutively obtained in 24 patients treated with RE and compared with 90Y PET/CT TgV. Using the TgVs estimated by each imaging modality and a fictitious activity of 1 GBq, the corresponding absorbed doses by tumor and non-tumoral parenchyma were calculated for each patient. The absorbed doses for each modality were compared with the ones obtained using 90Y PET/CT TgV. Results 99mTc-MAA-SPECT/CT predicted 90Y PET/CT TgV better than CBCT or CECT, even for selective or superselective administrations. Likewise, 99mTc-MAA-SPECT/CT showed dosimetric values more similar to those obtained with 90Y PET/CT. Nevertheless, CBCT provided essential information for RE planning, such as ensuring the total coverage of the tumor and, in cases with more than one feeding artery, splitting the activity according to the volume of tumor perfused by each artery. Conclusion The joint use of 99mTc-MAA-SPECT/CT and CBCT optimizes dosimetric planning for RE procedures, enabling a more accurate personalized approach.

We present the update of the recommendations of the French society of radiotherapy and oncology on the indications and the technical methods of carrying out radiotherapy of sinonasal cancers. Sinonasal cancers (nasal fossae and sinus) account for 3 to 5% of all cancers of the head and neck. They include carcinomas, mucosal melanomas, sarcomas and lymphomas. The management of sinonasal cancers is multidisciplinary but less standardized than that of squamous cell carcinomas of the upper aerodigestive tract. As such, patients with sinonasal tumors can benefit from the expertise of the French expertise network for rare ENT cancers (Refcor). Knowledge of sinonasal tumour characteristics (histology, grade, risk of lymph node involvement, molecular characterization, type of surgery) is critical to the determination of target volumes. An update of multidisciplinary indications and recommendations for radiotherapy in terms of techniques, target volumes and radiotherapy fractionation of the French society of radiotherapy and oncology (SFRO) was reported in this manuscript. [ABSTRACT FROM AUTHOR]