Carlo Greco

Background: This exploratory study assessed whether qualitative dynamic contrast-enhanced MRI (DCE-MRI) time–intensity curves (TICs) differentiate non-progressive treatment-related changes (NPTRC) from tumor progression after stereotactic radiotherapy for brain metastases. Methods: Thirty-two patients with 51 treated lesions underwent DCE-MRI. Five neuroradiologists independently delineated a volume of interest and classified the resulting TIC as Type A–D. Longitudinal clinical and MRI follow-up provided the reference outcome, which was recorded before the TIC framework was finalized. An A/B versus C/D grouping was evaluated as a secondary exploratory analysis. Results: Thirty-five lesions were classified as NPTRC and 16 as tumor progression. All 17 Type A lesions were NPTRC, whereas all 13 Type C/D lesions showed progression. Type B was observed in 21 of 51 lesions (41.2%), including 18 NPTRC and 3 progressive lesions, representing a substantial indeterminate subgroup. The exploratory A/B versus C/D grouping yielded 81.3% sensitivity and 100% specificity. The ordinal TIC analysis yielded an AUC of 0.952. Interobserver agreement was high within the present reader group (Fleiss’ κ = 0.889). Conclusions: Type A was associated with NPTRC, Types C/D were associated with progression, and Type B represented an indeterminate pattern. These descriptive findings require independent validation before clinical use.

Background: This exploratory study assessed whether qualitative dynamic contrast-enhanced MRI (DCE-MRI) time–intensity curves (TICs) differentiate non-progressive treatment-related changes (NPTRC) from tumor recurrence after stereotactic radiotherapy for brain metastases. Methods: Thirty-two patients with 51 treated lesions underwent DCE-MRI. Five neuroradiologists inde-pendently delineated a volume of interest and classified the resulting TIC as Type A–D. Longitudinal clinical and MRI follow-up provided the reference outcome, which was recorded before the TIC framework was finalized. An A/B versus C/D grouping was evaluated as a secondary exploratory analysis. Results: Thirty-five lesions were classified as NPTRC and 16 as tumor recurrence. All 17 Type A lesions were NPTRC, and all 13 Type C/D lesions showed recurrence. Type B occurred in both groups (18 NPTRC; 3 recurrences). The A/B versus C/D grouping yielded 81.3% sensitivity and 100% specificity. The ordinal TIC analysis yielded an area under the curve of 0.952. Interobserver agree-ment was high for the four TIC categories (Fleiss’ κ = 0.889). Conclusions: Type A was associated with NPTRC, Types C/D with recurrence, and Type B represented an indeterminate pattern. These descriptive findings require independent validation before clinical use.

Accurate prognosis of Non-Small Cell Lung Cancer (NSCLC) is crucial for enhancing patient care and treatment outcomes. Despite the advancements in deep learning, the task of overall survival prediction in NSCLC has not fully leveraged these techniques, yet. This study introduces a novel methodology for predicting 2-year overall survival (OS) in NSCLC patients using CT scans. Our approach integrates CT scan representations produced by EfficientNetB0 with a soft attention mechanism to identify the most relevant slices for survival risk prediction, which are then analyzed by a risk-assessment network. To validate our method and ensure reproducibility, we employed the public LUNG1 dataset and a smaller private dataset. Our approach was compared to a benchmark 3D network and two variants of our methodology: on the LUNG1 it outperformed the competitors achieving a mean Ctd-index of 0.584 over 10-fold cross-validation. On the LUNG1 we also demonstrated the adaptability of our method with 4 other 2D backbones replacing the EfficientNetB0, confirming that our mechanism of combining 2D slice representations to construct a 3D volume representation is more effective for OS prediction compared to a traditional 3D approach. Finally, we used transfer learning on the private dataset, showing that it can significantly enhance performance in limited data scenarios, increasing the Ctd-index by 0.076 compared to model without transfer learning.

In breast cancer volumetric-modulated arc therapy (VMAT) planning, the rotation of the gantry around the target implies a greater dose spreading to the whole heart, compared to tangential-field standard treatment. A consecutive cohort of 121 breast cancer patients treated with the VMAT technique was investigated. The correlation of breast volume, heart volume and lung volume with mean heart dose (mHD) and mean and maximum LAD dose (mLAD dose, MLAD dose) was tested, and a subsequent a linear regression analysis was carried out. VMAT treatment plans from 56 left breast cancer and 65 right breast cancer patients were analyzed. For right-sided patients, breast volume was significantly correlated with mHD, mLAD and MLAD dose, while for left-sided patients, breast volume was significantly correlated with mHD and mLAD, while heart volume and lung volume were correlated with mHD, mLAD and MLAD dose. Breast volume was the only predictor of increased heart and LAD dose (p ≤ 0.001) for right-sided patients. In left-sided patients, heart and lung were also predictors of increased mHD (p = 0.005, p ≤ 0.001) and mean LAD dose (p = 0.009, p ≤ 0.001). In this study, we observed an increase in heart and LAD doses in larger-breasted patients treated with VMAT planning. In right-sided patients, breast volume was shown to be the only predictor of increased heart dose and LAD dose.

Aim: The aim was to investigate the use of comprehensive pretreatment staging with multiple diagnostic modalities, including functional imaging and minimally invasive surgical procedures, in locally advanced pancreatic cancer (LAPC) patients. The primary objective was to detect occult metastatic disease using staging laparoscopy and 18F-FDG-positron emission tomography (PET)/computed tomography (CT) scan. The study also evaluated treatment efficacy and outcomes in LAPC patients treated with combined therapies. Materials and methods: This study was a secondary analysis of three prospective studies of chemoradiotherapy (CRT) with or without induction chemotherapy (IC). The inclusion period was from December 2009 until February 2023. An intensified pretreatment staging was conducted for all LAPC patients. Patients without distant disease at initial staging, with borderline resectable or unresectable LAPC, were enrolled in CRT combination protocols (CRT with or without IC). IC regimens included GemOx or FOLFIRINOX for four cycles, followed by concurrent CRT with gemcitabine. The primary endpoint was the detection of occult metastatic disease, and secondary objectives included resection rate, treatment toxicity, overall survival (OS), progression-free survival (PFS), local control, and metastasis-free survival. Results: Out of the 134 LAPC patients, 33.5% were identified with metastatic disease. Of these, 23.1% had a positive exploratory laparoscopy. Additionally, 13.4% were identified as having distant metastases by 18-FDG PET/CT. The median PFS for all patients who completed CRT was 14.3 months, and the median OS was 17.2 months. Resected patients after the combined therapies demonstrated significantly improved outcomes compared tonon-resected patients (median PFS, 22.5 months vs. 9.5 months, PPPPP=0.05), and this data was confirmed at multivariate analysis (95% CI: 0.09–0.98, P=0.04). Hematological and gastrointestinal toxicities were observed during treatment, with manageable adverse events. Conclusions: The use of comprehensive pretreatment staging, including laparoscopy and 18F-FDG-PET/CT scan, is an effective approach in identifying occult metastatic disease in LAPC patients. Our findings offer valuable insights into accurate staging and treatment efficacy, providing evidence-based support for optimal management strategies in LAPC patients.

Despite being usually delivered in oncological patients, radiotherapy can be used as a successful treatment for several non-malignant disorders. Even though this use of radiotherapy has been scarcely investigated since the 1950s, more recent interest has actually shed the light on this approach. Thus, the aim of this narrative review is to analyze the applications of non-oncological radiotherapy in different disorders. Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. This review contains a narrative report and a critical discussion of non-oncological radiotherapy approaches. In conclusion, non-oncological radiotherapy is a safe and efficacious approach to treat several disorders that needs to be further investigated and used in clinical practice.

Brain metastases (BMs) are common among patients affected by HER2+ metastatic breast cancer (>30%). The management of BMs is usually multimodal, including surgery, radiotherapy, systemic therapy and palliative care. Standard brain radiotherapy (RT) includes the use of stereotactic radiotherapy (SRT) for limited disease and whole brain radiotherapy (WBRT) for extensive disease. The latter is an effective palliative treatment but has a reduced effect on brain local control and BM overall survival, as it is also associated with severe neurocognitive sequelae. Recent advances both in radiation therapy and systemic treatment may change the paradigm in this subset of patients who can experience long survival notwithstanding BMs. In fact, in recent studies, SRT for multiple BM sites (>4) has shown similar efficacy when compared to irradiation of a limited number of lesions (one to three) without increasing toxicity. These findings, in addition to the introduction of new drugs with recognized intracranial activity, may further limit the use of WBRT in favor of SRT, which should be employed for treatment of both multiple-site BMs and for oligo-progressive brain disease. This review summarizes the supporting literature and highlights the need for optimizing combinations of the available treatments in this setting, with a particular focus on radiation therapy.