Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating multisystem disorder characterized by profound fatigue, post-exertional malaise (PEM), immune dysregulation, and mitochondrial dysfunction. While radiation exposure has been linked to fatigue syndromes with overlapping pathophysiology, no previous reports have described the effects of therapeutic radiation, including proton beam radiotherapy (PBRT), in patients with ME/CFS. We report the case of a 46-year-old woman with a pre-existing, clinically confirmed diagnosis of ME/CFS (Bell score 60, ECOG 1), who underwent postoperative PBRT (50.4 Gy in 28 fractions) for a recurrent left sphenoid wing meningioma (CNS WHO grade 1). The tumor had been surgically resected but showed residual disease with early postoperative progression and close proximity to the left optic nerve, prompting the indication for adjuvant radiotherapy. The patient initially tolerated treatment well, with only mild acute worsening of pre-existing fatigue and transient corticosteroid-responsive symptoms. However, within weeks of completing radiotherapy, she developed progressive and severe worsening of fatigue, myalgia, vertigo, and hypersensitivity to sensory stimuli as well as cognitive decline. Over several months, she became completely bedridden (Bell score 0, ECOG 4) with persistent ME/CFS aggravation unresponsive to supportive measures persisting until the last known contact 20 months after radiation. Follow-up imaging showed stable postoperative findings without tumor progression or new structural brain lesions. This case illustrates a profound and irreversible deterioration of ME/CFS following PBRT, suggesting that radiation-induced mitochondrial dysfunction, oxidative stress, and chronic inflammatory activation may critically worsen pre-existing metabolic fragility. Despite the theoretical advantages of proton radiotherapy in reducing normal tissue exposure, its protective effects may be insufficient in patients with baseline mitochondrial malfunction. This is, to our knowledge, the first reported case of severe and sustained ME/CFS exacerbation after radiotherapy. The case emphasizes the urgent need for risk stratification, tailored consent processes, and research in the field of radiotherapy tolerance in ME/CFS patients, as conventional expectations regarding side effects may not predict outcomes in this vulnerable population.
The irradiation of both breasts poses complex technical challenges. The overlapping treatment fields and large target volumes make dosimetry challenging, while data for hypofractionated regimens in this setting are limited. Bilateral breast cancer patients treated with moderately hypofractionated and conventionally fractionated radiotherapy were identified to evaluate dosimetric parameters, toxicity, and oncologic outcomes. Seventy patients treated with a median dose of 50.4 Gy in 28 fractions or 40.05 Gy in 15 fractions using 3D-CRT, IMRT, VMAT, or tomotherapy were identified. With a median follow-up of 45.3 months, the 1‑ and 5‑year overall survival rates were 96.1
Supraclavicular fossa (SCF) irradiation is integral to adjuvant radiotherapy (RT) for node-positive breast cancer. Due to anatomical proximity, the thyroid gland is frequently exposed, leading to hypothyroidism in approximately 20–40
To investigate the value of cone-beam computed tomography (CBCT)-based delta radiomics for predicting short-term radiotherapy (RT) response in nasopharyngeal carcinoma (NPC). A total of 132 pathologically confirmed NPC patients receiving RT were retrospectively enrolled. Serial CBCT images during weeks 1–4 were collected. Patients were grouped by therapeutic response and randomly divided into training and test sets (7:3). Radiomic features from fractional CBCTs were extracted via Pyradiomics. Temporal delta-radiomic features were derived from interfraction differences. After applying feature normalization and dimensionality reduction, optimal features were selected using analysis of variance (ANOVA), recursive feature elimination, relevant features, and Kruskal–Wallis tests. Ten classifiers, including logistic regression (LR), were trained with 5‑fold cross-validation strategy. Predictive performance was evaluated by receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and the DeLong’s test. The LR model based on the CBCT1st–3rd temporal interval achieved the optimal predictive performance (balanced accuracy 0.73, area under the curve [AUC] 0.74, sensitivity 0.64, specificity 0.81) in the cross-validation set. DeLong’s tests revealed no statistically significant differences (P > 0.05) in AUC values within the cross-validation set between the CBCT1st–3rd model and models based on CBCT1st–4th or CBCT2nd–4th intervals. DCA indicated that the LR model based on CBCT1st–3rd temporal interval provided the highest net clinical benefit within threshold probabilities ranging from 0.2 to 0.4 and exceeding 0.65. The CBCT-based delta radiomics models can dynamically assess short-term RT response in NPC patients. This approach offers potential as an early-warning indicator during the RT course and provides a novel approach to guiding personalized precision radiotherapy for NPC.
NUT carcinoma (NUTc) is a rare, aggressive squamous carcinoma defined by NUTM1 rearrangements. Outcomes in head and neck (H N) disease are poor, and no uniform treatment standard exists; available evidence largely derives from case reports and small series. We performed a structured narrative review of H N NUTc with an emphasis on radiotherapy (RT) dose concepts, chemotherapy regimens, and outcome signals. Published evidence indicates poor overall survival, particularly in metastatic disease. Long-term remissions have been described in selected patients with non-metastatic disease treated with multimodal approaches combining surgery, multi-agent chemotherapy, and early integrated RT. Across reports, use of RT in first-line management and delivery of definitive-dose RT are repeatedly associated with better outcomes. Evidence for immune checkpoint inhibitors is limited to anecdotal single-patient reports. A 19-year-old man with locally advanced supraglottic NUTc and bilateral cervical nodal disease (M0) presented with dysphagia and otalgia. Following laser debulking and temporary tracheostomy, induction cisplatin/doxorubicin/ifosfamide led to a complete metabolic response in positron-emission tomography/computed tomography (PET/CT) after two cycles of chemotherapy. Definitive PET/CT-guided intensity-modulated (IM)RT/image-guided (IG)RT was delivered to 73.2 Gy using an accelerated twice-daily schedule (2.0 Gy to the planning target volume [PTV] in the morning and 1.6 Gy boost to the initial gross target volume [GTV] in the afternoon; ≥ 8-hour interval). Acute toxicity was grade 3 dermatitis and grade 2 mucositis (CTCAE v5.0). After RT, chemotherapy was continued as consolidation and completed with vincristine/doxorubicin/ifosfamide (six cycles) due to acute kidney injury. Complete remission is ongoing at > 7 years, with persistent xerostomia and dysgeusia. In selected non-metastatic H N NUTc, durable control has been reported with timely systemic therapy plus curative-intent RT, often exceeding 50 Gy. This review summarizes dose concepts and case-based systemic regimens and provides a comparative table to support individualized treatment planning.
Postoperative radiotherapy following surgical stabilization in patients with bone metastases is commonly recommended. The aim of the study was to validate existing prognostic scores and parameters for local control and survival in patients with bone metastases treated with surgical resection with or without radiotherapy. This retrospective single-institution study analyzed consecutive patients with bone metastases undergoing resection and/or stabilization mostly due to pathologic or impending fractures (with or without spinal compression). Additive radiotherapy was considered the standard of care. Various fractionated radiotherapy regimens have been applied; equivalent dose in 2 Gy fractions (EQD2) has been calculated to enable comparison between fractionations. Prognostic factors influencing local progression-free survival (LPFS) and overall survival (OS) were evaluated. The median follow-up was 9 months (range 1–121 months). A total of 142 patients were included. Most patients underwent surgery due to pathologic (n = 86, 60.6
Vaginal intraepithelial neoplasia (VaIN) is a rare condition that poses diagnostic and management challenges and carries a significant risk of progression to invasive cancer. Image-guided interventional radiotherapy (IG-IRT, modern brachytherapy) has a high overall success rate, but it is usually reserved for poor surgical candidates and those with multifocal disease or failed prior treatments. This study evaluates the efficacy and safety of IG-IRT in high-grade VaIN by combining a retrospective institutional case series with a systematic review of the available literature. We retrospectively analyzed patients with VaIN3 who received IG-IRT with curative intent between January 2019 and May 2025. The OncentraBrachy treatment planning system and a Flexitron (Elekta, Stockholm, Sweden) afterloading machine with a 192-Ir source were used for IG-IRT. The IG-IRT total dose was 40 Gy over eight high-dose-rate (HDR) fractions to achieve 60 Gy equivalent dose in 2‑Gy fractions (EQD2α/β10) to the clinical target volume (CTV). The exact vaginal target was decided based on the site and the number of lesions. Primary study endpoint was local control (LC); secondary endpoints included the rate and severity of acute and late treatment-related toxicity. A systematic review of the literature was conducted according to the PRISMA guidelines to contextualize institutional outcomes within the existing evidence. A total of 10 patients with high-grade VaIN who were naïve to prior radiotherapy were included in this study. The median follow-up duration was 17 months (7–70 months). The 1‑year actuarial LC and overall survival (OS) rates were 100
