Fabio Marazzi

Purpose Recent studies indicate that gender plays a role in influencing the side effects and outcomes of radiotherapy (RT), thus highlighting the importance of gender-specific clinical approaches. However, there remains a knowledge gap regarding potential gender differences in the domain of psychosocial profiles during RT. This retrospective analysis examines the psychosocial impact of RT on a cohort of adult and paediatric patients in Italy who received psycho-oncological support during RT from January 2020 to April 2024. Methods Medical charts of a total of 750 adult (418 females and 332 males) and 145 paediatric patients (78 male and 67 females) were reviewed. In our radiation oncology department, two psycho-oncological pathways are available for adults: 1) dedicated pathways for patients with head and neck, brain, or rectal and anal cancers, where psychological support is provided automatically; and 2) support for other patients upon request or clinical recommendation. For paediatric patients, psychoeducational/psychotherapeutic interventions tailored to the needs of patients/caregivers are initiated at the start of RT to ensure compliance and promote psychological wellbeing. Results Female adult patients reported higher levels of distress, anxiety, and depression than males, with significant predictors including gender and previous psychological disturbances. Notably, patients undergoing RT with palliative or local-control intent exhibited increased anxiety and depression. In contrast, no significant gender differences in psychosocial distress were observed among paediatric patients. Both genders received consistent psychological support, and familial trauma and RT intent did not significantly affect their scores. Conclusion In this retrospective analysis, gender is a crucial predictor of psychosocial outcomes in adults undergoing RT, with females experiencing higher distress levels. Prior mental health stability appears protective against anxiety and depression. In paediatric patients, interventions remain effective across genders. Early psychological assessments are essential for both groups to identify patients at risk and enhance coping strategies.

Purpose Breast cancer is the most frequently diagnosed tumour, representing nearly 30% of all new cases in women. Radiotherapy (RT) plays a crucial role in the management of breast cancer. The objective of this study is to assess modesty in patients undergoing RT for breast cancer and take their suggestions and ideas into consideration to enhance the quality of treatment in this regard. Methods The study enrolled 555 breast cancer patients undergoing adjuvant RT in three Italian centres. Patients completed a self-test questionnaire assessing their comfort level concerning modesty during therapy and their relationship with strangers and healthcare professionals. The impact of religious views and potential changes in sexuality were also examined. Results Results showed that modesty was a common concern across the overall cohort of patients, with discomfort in being undressed during RT correlating with discomfort experienced in other daily life situations. Most patients felt more at ease with same sex healthcare workers. Age was also a major factor with younger patients generally feeling more comfortable with healthcare workers of the same age group. Interestingly, the surgical technique used (mastectomy vs. quadrantectomy) did not significantly influence modesty perceptions. Patients provided valuable suggestions to improve privacy and modesty during RT. Conclusion This study demonstrates that modesty is an important issue for women undergoing RT, which can be influenced by personal characteristics and hospital-related factors. A reflection about the need to address modesty concerns and to incorporate dedicated interventions for protecting patients’ physical and emotional well-being is warranted. Initiatives to improve communication, involvement, and body image support should also be integrated into the care path of patients to better their overall therapeutic experience. This study paves the way for broader research and interventions in daily cancer care.

Introduction: The aim of this study was to create a radiomic model able to calculate the probability of 5-year disease-free survival (5yDFS) when oxaliplatin (OXA) is or not administered in patients with locally advanced rectal cancer (LARC) and treated with neoadjuvant chemoradiotherapy (nCRT), allowing physicians to choose the best chemotherapy (CT) regimen.Methods: LARC patients with cT3–4 cN0 or cT1–4 cN1–2 were treated according to an nCRT protocol that included concomitant CT schedules with or without OXA and radiotherapy dose of 55 Gy in 25 fractions. Radiomic analysis was performed on the T2-weighted (T2-w) MR images acquired during the initial tumor staging. Statistical analysis was performed separately for the cohort of patients treated with and without OXA. The ability of every single radiomic feature in predicting 5yDFS as a univariate analysis was assessed using the Wilcoxon–Mann–Whitney (WMW) test or t-test. Two logistic models (one for each cohort) were calculated, and their performance was assessed using the area under the receiver operating characteristic (ROC) curve (AUC).Results: A total of 176 image features belonging to four families (morphological, statistical, textural, and fractal) were calculated for each patient. At the univariate analysis, the only feature showing significance in predicting 5yDFS was the maximum fractal dimension of the subpopulation identified considering 30% and 50% as threshold levels (maxFD_30–50). Once the models were developed using this feature, an AUC of 0.67 (0.57–0.77) and 0.75 (0.56–0.95) was obtained for patients treated with and without OXA, respectively. A maxFD_30–50 >1.6 was correlated to a higher 5yDFS probability in patients treated with OXA.Conclusion: This study suggests that radiomic analysis of MR T2-w images can be used to define the optimal concomitant CT regimen for stage III LARC cancer patients. In particular, by providing an indication of the gross tumor volume (GTV) spatial heterogeneity at initial staging, maxFD_30–50 seems to be able to predict the probability of 5yDFS. New studies including a larger cohort of patients and external validation sets are recommended to verify the results of this hypothesis-generating study.

Oncologists continue to prefer traditional low molecular weight heparins over direct oral anticoagulants (DOAC) for the treatment of venous thromboembolism (VTE) cancer-related. Recently published studies supporting the use DOACs in this patient setting confirm the safety and efficacy of the treatment, but this still does not seem to be enough. The major obstacles to their use are interaction with chemotherapeutic agents, fear of haemorrhage, poor habit of using DOACs for VTE prophylaxis. But what if the haemostasis and thrombosis laboratory reassured oncologists? In this short report we talk about this topic in order to stimulate a fruitful discussion between expert.

Purpose: To evaluate the performance of eleven Knowledge-Based (KB) models for planning optimization (RapidPlan^tm (RP), Varian) of Volumetric Modulated Arc Therapy (VMAT) applied to whole breast comprehensive of nodal stations, internal mammary and/or supraclavicular regions. Methods and materials: Six RP models have been generated and trained based on 120 VMAT plans data set with different criteria. Two extra-structures were delineated: a PTV for the optimization and a ring structure. Five more models, twins of the previous models, have been created without the need of these structures. Results: All models were successfully validated on an independent cohort of 40 patients, 30 from the same institute that provided the training patients and 10 from an additional institute, with the resulting plans being of equal or better quality compared with the clinical plans. The internal validation shows that the models reduce the heart maximum dose of about 2 Gy, the mean dose of about 1 Gy and the V_20Gy of 1.5 Gy on average. Model R and L together with model B without optimization structures ensured the best outcomes in the 20% of the values compared to other models. The external validation observed an average improvement of at least 16% for the V_5Gy of lungs in RP plans. The mean heart dose and for the V_20Gy for lung IPSI were almost halved. The models reduce the maximum dose for the spinal canal of more than 2 Gy on average Conclusions: All KB models allow a homogeneous plan quality and some dosimetric gains, as we saw in both internal and external validation. Sub-KB models, developed by splitting right and left breast cases or including only whole breast with locoregional lymph nodes, have shown good performances, comparable but slightly worse than the general model. Finally, models generated without the optimization structures, performed better than the original ones.

Background: Pain and functional impairment of the ipsilateral shoulder girdle in patients who underwent surgery and radiotherapy for breast cancer (BC) is a late complication reported in the literature. We analyze a correlation with dosimetric parameters and propose an algorithm for sparing strategies. Methods: A total of 111 patients treated for BC were included in this observational analysis during follow-up protocol visits. Exclusion criteria were the presence of moderate or severe arthrosis history and/or rheumatologic diseases. All the patients had complete physical and multidimensional examinations during joint (physiatrist and radiotherapy oncology) follow-up visits. A scapula–humeral articulation (SHA) standardized contouring was performed retrospectively on Eclipse® treatment plans. A possible correlation between patients’ characteristics, radiotherapy, and dosimetry analysis and functional impairment was investigated at statistical analysis. Results of analysis were summarized into a proposal of algorithm for sparing SHA. Results: A total of 111 patients were selected during follow-up visits. Mean age of patients was 60 years (range 41–85 years). A total of 103 patients (93%) underwent conservative surgery, with 110 patients (99%) undergoing axilla surgery as well. Fifty-two patients (46.8%) presented a reduction of range of motion (ROM) abduction on the treated side at the observational analysis. Mean ROM abduction reduction was 13°06’ (range 0°–100°). Disability of the Arm, Shoulder and Hand questionnaire (DASH) score results were excellent in 79 patients (71.2%), discrete in 15 patients (13.5%), good in 15 patients (13.5%), and sufficient in 2 patients (1.8%). Median EQD₂ D_max at SHA was 18 Gy (range 0.22–51.9 Gy) and median EQD₂ mean dose at SHA was 2 Gy (range 0.04–24.32 Gy). Univariate analysis showed a linear correlation between DASH score and ROM of abduction of treated side (ρ=−0.7), ROM of abduction and ROM of flexion in ipsilateral arm (ρ=0.8), or ROM of abduction and ROM of flexion in contralateral arm (ρ=0.8). A statistically significant difference in ROM abduction between the 2 arms was found at χ² test ( P2 confidence interval = 95%). Cox linear regression analysis showed ROM abduction on treated arm as a predictive factor of DASH score ( P<0.0001). Age ( P<0.05), DASH score ( P=0.006), and ROM abduction on treated arm ( P=0.005) were found as independent predictive factors of mean dose at multivariate analysis. A mean dose higher than 7 Gy and ROM abduction reduction more than 30° were related to DASH score level reduction. Conclusions: This hypothesis-generating study introduces an algorithm to be validated for management of sparing SHA and improving quality of survivorship. ROM evaluation after surgery, early physiotherapy, standard contouring, and planning adaptation represent possible indications to preserve shoulder impairment. Further prospective studies are needed to discriminate impairment of surgery and radiotherapy in order to personalized therapeutic plan programs.