Paolo Muto

Prostate cancer (PCa) is one of the most common malignancies in men and remains a major cause of cancer-related death worldwide. Radiotherapy is a well-established treatment modality for PCa, offering clinical outcomes comparable to surgical approaches. In recent years, stereotactic body radiotherapy (SBRT), characterized by the delivery of high radiation doses in a limited number of fractions, has been increasingly adopted as a standard approach in the treatment of prostate cancer, due to its favorable efficacy and toxicity profile. CyberKnife (CK) is one of the most commonly used hypofractionated radiotherapy techniques. This preliminary study aimed to evaluate and compare the radiation dose delivery and treatment time of CK-based SBRT using two different collimation systems: the multileaf collimator (MLC) and the IRIS variable aperture collimator, a dynamic device that adjusts its opening to simulate different circular field sizes. A total of 19 patients with low-to-intermediate-risk PCa were selected and treated at the Radiation Oncology Department of the National Cancer Institute IRCCS Fondazione G. Pascale in Naples between January 2024 and January 2025. For each patient, two treatment plans were generated—one with the IRIS collimator and one with the MLC. The results demonstrated that the use of the MLC significantly reduced treatment time while maintaining dosimetric quality comparable to IRIS-based plans. These findings support the clinical benefit of MLC implementation in prostate SBRT with the CK system.

The fruits of Solanum lycopersicum L. cultivar “Microtom” are a powerful source of antioxidants. We investigated whether two light-quality regimes, i.e., fluorescent white (FL) and red-blue (RB), influenced the antioxidant composition in such fruits, and assessed the potential radioprotective properties of their extracts on normal human cells exposed to clinical photons as used in cancer radiotherapy (RT). Increasing normal-tissue tolerance to radiation is critical for reducing the risk of RT-associated sequelae. Biochemical characterization showed that RB enhanced the content of antioxidant phytochemicals (i.e., polyphenols, flavonoids, total carotenoids, lycopene), while FL promoted ascorbic acid synthesis. Initially tested at 200 µg/mL, RB-derived extracts decreased radiation-induced DNA damage as measured by the cytokinesis-block micronucleus (CBMN) assay in epidermal HaCaT cells. Both RB and FL regimes were subsequently studied in MCF-10A breast cancer (BC) cells, a model of normal-tissue radioresponse in BC RT, using extracts at 100 and 200 µg/mL and also evaluating oxidative stress by a ROS detection assay. Both FL and RB afforded radioprotection. However, RB suppressed radiation-induced MN formation and oxidative stress to a greater extent compared to FL. Therefore, modulation of light-quality regimes represents an innovative approach for developing radionutraceuticals with potential benefits for RT patients.

The fruits of Solanum lycopersicum L. cultivar “Microtom” are a powerful source of antioxidants. We investigated whether two light-quality regimes, i.e., fluorescent white (FL) and red-blue (RB), influenced the antioxidant composition in such fruits, and assessed the potential radioprotective properties of their extracts on normal human cells exposed to clinical photons as used in cancer radiotherapy (RT). Increasing normal-tissue tolerance to radiation is critical for reducing the risk of RT-associated sequelae. Biochemical characterization showed that RB enhanced the content of antioxidant phytochemicals (i.e., polyphenols, flavonoids, total carotenoids, lycopene) while FL promoted ascorbic acid synthesis. Initially tested at 200 µg ml-1, RB-derived extracts decreased radiation-induced DNA damage as measured by the cytokinesis-block micronucleus (CBMN) assay in epidermal HaCaT cells. Both RB and FL regimes were subsequently studied in MCF-10A breast cancer (BC) cells, a model of normal-tissue radioresponse in BC RT, using extracts at 100 and 200 µg ml-1 also evaluating oxidative stress by a ROS detection assay. Both FL and RB afforded radioprotection. However, RB suppressed radiation-induced MN formation and oxidative stress to a greater extent compared to FL. Therefore, modulation of light-quality regimes represents an innovative approach for developing radionutraceuticals with potential benefits for RT patients.

Main Conclusion: Radiation type and dose distinctly modulate microgreens development, revealing trait-specific thresholds where X-rays induce hormesis, carbon ions delay differentiation, and iron ions enhance biochemical balance with moderate anatomical disruption. As space exploration progresses and controlled-environment agriculture becomes increasingly relevant under extreme conditions, understanding how ionizing radiation affects plant development is crucial. Ionizing radiation poses a major constraint in space cultivation systems, also playing a role in terrestrial stress scenarios. Despite growing interest in radiation biology, few studies have systematically compared plant responses to different radiation types with distinct linear energy transfer (LET). In this study, seeds of Brassica rapa L. were exposed to increasing doses of X-rays (low-LET), carbon ions, and iron ions (high-LET). Seed germination, morpho-anatomical, and biochemical traits of plants were assessed up to the microgreens stage. Plant responses were both dose- and radiation-specific. Specifically, X-rays triggered a hormetic response at low doses (1 Gy), with a decline in several analyzed traits at higher doses. Carbon ions increased leaf expansion but reduced the content of pigments, proteins, and the structural investment, suggesting a delayed tissue differentiation and low-cost acclimation mechanism under stress. Iron ions promoted a coordinated upregulation of biochemical defenses and moderate anatomical changes. Overall, radiation quality induced distinct acclimation strategies in B. rapa , influencing the balance between growth, structural integrity, and defense mechanisms, highlighting its notable radioresistance. Moreover, identifying trait-specific thresholds and response patterns suggests that different radiation types could be selectively applied to modulate specific functions (e.g., biomass or antioxidants promotion, anatomical adjustments) based on desired outcomes. These findings provide valuable insights into how different ionizing radiation types impact plant responses, addressing a critical gap in space-oriented research and guiding strategies to optimize plant growth in extraterrestrial environments.

International Guidelines as well as Cancer Associations recommend a multidisciplinary approach to lung cancer care. A multidisciplinary team (MDT) can significantly improve treatment decision-making and patient coordination by putting different physicians and other health professionals “in the same room”, who collectively decide upon the best possible treatment. However, this is not a panacea for cancer treatment. The impact of multidisciplinary care (MDC) on patient outcomes is not univocal, while the effective functioning of the MDT depends on many factors. This review presents the available MDT literature with an emphasis on the key factors that characterize high-quality patient care in lung cancer. The study was conducted with a bibliographic search using different electronic databases (PubMed Central, Scopus, Google Scholar, and Google) referring to multidisciplinary cancer care settings. Many key elements appear consolidated, while others emerge as prevalent and actual, especially those related to visible barriers which work across geographic, organizational, and disciplinary boundaries. MDTs must be sustained by strategic management, structured within the entity, and cannot be managed as a separate care process. Furthermore, they need to coordinate with other teams (within and outside the organization) and join with the broad range of services delivered by multiple providers at various points of the cancer journey or within the system, with the vision of integrated care.

Metastatic disease in tumors originating from the gastrointestinal tract can exhibit varying degrees of tumor burden at presentation. Some patients follow a less aggressive disease course, characterized by a limited number of metastatic sites, referred to as “oligo-metastatic disease” (OMD). The precise biological characteristics that define the oligometastatic behavior remain uncertain. In this study, we present a protocol designed to prospectively identify OMD, with the aim of proposing novel therapeutic approaches and monitoring strategies. The PREDICTION study is a monocentric, prospective, observational investigation. Enrolled patients will receive standard treatment, while translational activities will involve analysis of the tumor microenvironment and genomic profiling using immunohistochemistry and next-generation sequencing, respectively. The first primary objective (descriptive) is to determine the prevalence of biological characteristics in OMD derived from gastrointestinal tract neoplasms, including high genetic concordance between primary tumors and metastases, a significant infiltration of T lymphocytes, and the absence of clonal evolution favoring specific driver genes (KRAS and PIK3CA). The second co-primary objective (analytic) is to identify a prognostic score for true OMD, with a primary focus on metastatic colorectal cancer. The score will comprise genetic concordance (> 80%), high T-lymphocyte infiltration, and the absence of clonal evolution favoring driver genes. It is hypothesized that patients with true OMD (score 3+) will have a lower rate of progression/recurrence within one year (20%) compared to those with false OMD (80%). The endpoint of the co-primary objective is the rate of recurrence/progression at one year. Considering a reasonable probability (60%) of the three factors occurring simultaneously in true OMD (score 3+), using a significance level of α = 0.05 and a test power of 90%, the study requires a minimum enrollment of 32 patients. Few studies have explored the precise genetic and biological features of OMD thus far. In clinical settings, the diagnosis of OMD is typically made retrospectively, as some patients who undergo intensive treatment for oligometastases develop polymetastatic diseases within a year, while others do not experience disease progression (true OMD). In the coming years, the identification of true OMD will allow us to employ more personalized and comprehensive strategies in cancer treatment. ClinicalTrials.gov ID NCT05806151.

An adequate and balanced diet is fundamental in preserving the health of astronauts from several space-induced diseases. Therefore, the integration of a diet with fresh food, rich in bioactive compounds such as microgreens produced directly onboard, may be useful in space for human nutrition. However, ionizing radiation (IR) in space represents a significant hindrance for organisms, with potential critical outcomes on plant morpho-anatomical, eco-physiological, and biochemical aspects, depending on the plant and IR features (e.g., species, developmental stage, IR dose, and type). In this study, we analyzed the effect of different doses of X-rays (0-control, 0.3, 1, 10, 20, and 30 Gy) on the morpho-anatomical and nutritional traits of microgreens of Brassica rapa L., irradiated at the stage of germinated seeds. After the irradiation, microgreens were cultivated in controlled conditions. At harvest, the morpho-biometric traits were analyzed, along with the leaf functional anatomical traits and the phytochemical content of the aboveground biomass. The results showed that X-ray exposure does not induce detrimental effects on growth, while it stimulates the production of antioxidants, improving plant defense and nutritional value. The overall results support the idea of using this species in space as a supplemental functional food.

Surface brachytherapy (BT) lacks standard quality assurance (QA) protocols. Commercially available treatment planning systems (TPSs) are based on a dose calculation formalism that assumes the patient is made of water, resulting in potential deviations between planned and delivered doses. Here, a method for treatment plan verification for skin surface BT is reported. Chips of thermoluminescent dosimeters (TLDs) were used for dose point measurements. High-dose-rate treatments were simulated and delivered through a custom-flap applicator provided with four fixed catheters to guide the Iridium-192 (Ir-192) source by way of a remote afterloading system. A flat water-equivalent phantom was used to simulate patient skin. Elekta TPS Oncentra Brachy was used for planning. TLDs were calibrated to Ir-192 through an indirect method of linear interpolation between calibration factors (CFs) measured for 250 kV X-rays, Cesium-137, and Cobalt-60. Subsequently, plans were designed and delivered to test the reproducibility of the irradiation set-up and to make comparisons between planned and delivered dose. The obtained CF for Ir-192 was (4.96 ± 0.25) μC/Gy. Deviations between measured and TPS calculated doses for multi-catheter treatment configuration ranged from −8.4% to 13.3% with an average of 0.6%. TLDs could be included in clinical practice for QA in skin BT with a customized flap applicator.

Some cancer patients display a less aggressive form of metastatic disease, characterized by a low tumor burden and involving a smaller number of sites, which is referred to as “oligometastatic disease” (OMD). This review discusses new biomarkers, as well as methodological challenges and perspectives characterizing OMD. Recent studies have revealed that specific microRNA profiles, chromosome patterns, driver gene mutations (ERBB2, PBRM1, SETD2, KRAS, PIK3CA, SMAD4), polymorphisms (TCF7L2), and levels of immune cell infiltration into metastases, depending on the tumor type, are associated with an oligometastatic behavior. This suggests that OMD could be a distinct disease with specific biological and molecular characteristics. Therefore, the heterogeneity of initial tumor burden and inclusion of OMD patients in clinical trials pose a crucial methodological question that requires responses in the near future. Additionally, a solid understanding of the molecular and biological features of OMD will be necessary to support and complete the clinical staging systems, enabling a better distinction of metastatic behavior and tailored treatments.

The objective of the study was to highlight sources of harm that could negatively affect the lung cancer multidisciplinary team (MDT) activities to reduce the level of risk of each factor. A modified Delphi approach was used by a board of multi–health care professionals of the lung cancer MDT to identify the main processes, subprocesses, and risk factors of the multidisciplinary pathway of patients with lung cancer. A semiquantitative matrix was built with a five-point scale for probability of harm (likelihood) and severity of harm (consequences) according to the international risk management standards (ISO 31000-2018). The risk level was calculated by multiplying likelihood × consequences. Mitigation strategies have been identified and applied by the MDT to reduce risks to acceptable levels. Three main processes (outpatient specialist visit, MDT discussion, and MDT program implementation), eight related subprocesses, and 16 risk factors were identified. Four risk factors (25%) were related to outpatient specialist visit, seven (43.75%) to case discussion, and five (31.25%) to program implementation. Overall, two risk factors were assigned a low-risk level (12.5%), 11 a moderate-risk level (68.75%), one (6.25%) a high-risk level, and two (12.5%) a very high-risk level. After the implementation of mitigation measures, the new semiquantitative risk analysis showed a reduction in almost all hazardous situations: two risk factors (12.5%) were given a very low level, six (37.5%) a low level, seven (43.75%) a moderate level, and one (6.25%) a very high level. An interdisciplinary risk assessment analysis is applicable to MDT activities by using an ad hoc risk matrix: if the hazard is identified and monitored, the risk could be reduced and managed in a short time.