OBJECTIVE We analyzed the dosimetric performance of Helical Tomotherapy (HT) and Volumetric Modulated Arc Therapy (VMAT) for postmastectomy chest wall irradiation (CWI) in patients with left-sided breast cancer, with a particular focus on target volume coverage, organ-at-risk (OAR) sparing, and low-dose exposure to surrounding normal tissues. METHODS Twenty patients with left-sided breast cancer who received postmastectomy CWI and regional nodal irradiation were retrospectively evaluated. For each patient, HT and VMAT treatment plans were generated. Dosimetric parameters assessed included planning target volume (PTV) coverage, conformity index (CI), homogeneity index (HI), and dose-volume metrics for OARs. Low-dose exposure to normal tissues was quantified using V-10Gy and V-25Gy. Statistical comparisons were performed using the Mann-Whitney U test. RESULTS Both techniques achieved clinically acceptable PTV coverage and comparable HI. VMAT plans demonstrated significantly better CI than HT (CI: 0.79 +/- 0.04 vs. 0.64 +/- 0.03; p<0.001). VMAT was associated with significantly lower high-dose exposure to the ipsilateral lung (V-20Gy and V-30Gy) and heart, and reduced mean dose to the contralateral breast. The VMAT plans also resulted in significantly lower low-dose body volumes (V-10Gy and V-25Gy.) compared to HT. Additionally, VMAT required fewer monitor units and shorter treatment times. CONCLUSION Both HT and VMAT are effective for chest wall irradiation in left-sided breast cancer; however, VMAT provides superior dose conformity, improved OAR sparing, and reduced low-dose exposure. These findings support the preferential use of VMAT in clinical settings where minimization of normal tissue exposure and treatment efficiency are priorities.
OBJECTIVE Ionizing radiation produces reactive oxygen species that may affect biomolecular integrity, but its impact on routine biochemical test accuracy is unclear. This study evaluated the analytical stability of common biochemical parameters in serum control materials following therapeutic photon irradiation. METHODS Commercial multi-analyte serum control solutions were irradiated with 6 MV photons at doses of 1.5-24 Gy using a clinical linear accelerator (LINAC). Thirty routinely tested biochemical parameters were analyzed on the Abbott Alinity c system. Each dose level was tested in 20 technical replicates, and percentage bias (%) from the reference value was calculated. RESULTS Radiation exposure caused no meaningful deviations in 96% of analytes, with all bias values within +/- 6%. Liver enzymes (AST, ALP, GGT, LDH) and other enzymatic markers (CK, amylase, lipase, CK-MB) showed excellent stability. Renal (urea, creatinine, uric acid), lipid (cholesterol, triglycerides, HDL, LDL), and electrolyte parameters (Na+, K+, Cl-, Ca2+, Mg2+, phosphate) remained unaffected. The only dose-dependent change was a similar to 10% decrease in total bilirubin at 24 Gy, consistent with its known light-and radiation-sensitive chromophore. CONCLUSION Serum control materials retained analytical integrity under photon doses up to 24 Gy. Except for bilirubin, all routine assays demonstrated excellent analytical stability, confirming that therapeutic radiation does not compromise biochemical test reliability.
OBJECTIVE Breast cancer incidence increases with age, and elderly patients are frequently underrepresented in clinical trials. This study aimed to show the tumor and treatment characteristics, toxicity and survival differences in the groups under and over 65 years who received adjuvant radiotherapy. METHODS Between 2010-2023, 1265 patients who underwent adjuvant radiotherapy were retrospectively evaluated. Patients were categorized into <65 years and >= 65 years. Demographic characteristics, treatment modalities and treatment outcomes were compared between the groups. RESULTS Of all patients, 14.7% were aged 65 years and older. Median overall survival (OS) was 158.4 months in patients younger than 65 years and 122.7 months in those aged 65 years and older (p<0.001). Age >= 65 years was identified as an independent prognostic factor for both OS and disease-free survival (DFS). Elderly patients received chemotherapy less frequently and were more often treated with hypofractionated radiotherapy. Mortality rates were significantly higher in the >= 65 age group. CONCLUSION Patients aged 65 years and older had worse DFS and OS compared with younger patients. Elderly patients were less likely to receive chemotherapy and more likely to receive hypofractionated radiotherapy. Treatment decisions should be individualized, and chronological age alone should not be the sole determinant in therapeutic planning.
OBJECTIVE This study aimed to investigate the dosimetric evaluation of intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), and HYBRID plans for craniospinal irradiation (CSI) in Halcyon. METHODS VMAT, IMRT, and HYBRID plans were generated for ten pediatric patients. In VMAT plans, triple arcs were utilized for cranial fields. Two full arcs were employed with avoidance sectors for each isocenter of spine fields. In IMRT plans, two opposing lateral fields in the brain and a single posterior field for each isocenter in the spinal region were used. This study obtained HYBRID plans by summing VMAT and IMRT plan. Plans were compared regarding homogeneity, conformity, and organs at risk doses. RESULTS The VMAT plan exhibited a significantly better conformity index than IMRT and HYBRID. The lowest V2 and V5 for body-PTV were obtained in IMRT plans. Compared with IMRT and HYBRID, V10 and V20 of lung, V25 of heart, and Dmean of left eye, thyroid, heart, esophagus, bowel, and liver were lower in VMAT plans. CONCLUSION The HYBRID was superior in terms of PTV dose coverage and homogeneity, and the best protection for many organs was provided in VMAT for CSI.
OBJECTIVE To examine the treatment outcomes and prognostic factors influencing the results in patients treated for pediatric Hodgkin lymphoma. METHODS The study included 115 pediatric patients treated for Hodgkin lymphoma at our clinic between 2007 and 2024. The patients' demographic data, age at diagnosis, disease stage, presenting symptoms, outcome, complete blood count parameters, and positron emission tomography (PET) results were retrospectively reviewed from their medical records. RESULTS The mean age at diagnosis for the 115 patients included in the study was 12.3 +/- 4 years (Range: 2-18 Years). Of the cases, 45.2% (n=52) were female and 54.8% (n=63) were male. Among complete blood count parameters, the mean hemoglobin level was 11.16 +/- 1.6 g/dL (Range: 7-16). Anemia was more frequently observed in patients with advanced-stage disease (p=0.04). The frequency of B symptoms differed significantly in patients with anemia (p=0.03). Although relapse was more frequently observed in this group, no statistically significant difference was found compared to the other group. Examination of PET results at the end of treatment revealed PET negativity in 59.1% (n=68) of patients, progressive/refractory disease in 7% (n=8), and partial PET response in 6.1% (n=7). During follow-up, relapse/refractory disease was observed in 16.5% (n=19) of patients. The mean age of patients with relapse was higher (14 vs. 11.9). In the relapse group, leukocyte counts were higher, hemoglobin levels were lower, and platelet counts were significantly higher compared to the other group. In addition, erythrocyte sedimentation rate was higher (p=0.039), and the frequency of B symptoms was greater (p=0.001) in this group. The mean follow-up period was 90 +/- 52 months (6-200), and 8.7% (n=10) of patients died during follow-up. Six patients died due to infection, pneumonia, or respiratory failure, and four died due to disease progression. The mean survival time for cases was 187.4 +/- 5 months, and the 5-year OS was 91.8 and RFS was 83.5. CONCLUSION Identifying low-risk patients and reducing treatment intensity will protect patients from long-term side effects. Infection and pulmonary toxicity are among the primary causes of decreased survival in Hodgkin lymphoma.
OBJECTIVE Rectal cancer is a leading cause of cancer-related deaths, with total neoadjuvant therapy (TNT) emerging as a key treatment for locally advanced rectal cancer (LARC). However, its clinical application varies due to differing protocols and physician preferences. This study explores physician perspectives on TNT in LARC management. METHODS An online survey was conducted among radiation oncologists, medical oncologists, and colorectal surgeons in T & uuml;rkiye. The questionnaire, consisting of 24 questions, addressed demographics, staging, treatment sequencing, radiotherapy, chemotherapy regimens, and response evaluation. Responses were analyzed using descriptive statistics, with comparisons made between specialties using chi-square or Fisher's exact test. RESULTS A total of 103 participants completed the survey, with 68.9% agreeing on the standardization of TNT as the neoadjuvant treatment for LARC. While no statistically significant differences were observed across specialties, medical oncologists more frequently supported TNT as the standard approach (81.8%) compared to colorectal surgeons (70%) and radiation oncologists (60%). Factors influencing treatment choices included tumor staging, with N stage being the most significant determinant (32%). Opinions on treatment sequencing within TNT were split, with a nearly even distribution between chemotherapy-first and radiotherapy-first approaches. CONCLUSION This nationwide survey indicates that, while many clinicians support TNT as a neoadjuvant treatment for LARC, there remains considerable heterogeneity in clinical approaches, and full consensus among specialties has not yet been achieved. Strengthening evidence-based guidelines and enhancing multidisciplinary collaboration are needed to reduce practice variability and improve patient care.
OBJECTIVE The study aims to evaluate the imaging and positioning accuracy of the BrainLab ExacTrac Dynamic System integrated with the Varian TrueBeam Linear Accelerator for stereotactic radiotherapy. METHODS BrainLab ExacTrac Dynamic System, BrainLab Phantom Pointer, and BrainLab Head Phantom were utilized. Imaging and positioning accuracy were assessed through manual and couch-induced displacement tests. This article does not contain any studies with human participants or animals performed by any of the authors. Ethical approval was not required for this study as it was conducted using phantoms only. RESULTS The study evaluated the accuracy of BrainLab ETD and Varian cone-beam computed tomography (CBCT) systems using a shared reference. Both systems demonstrated sub-millimeter precision, with translational errors ranging between 0.06 mm (ETD Z-axis) and 0.04 mm (ETD X-axis), and rotational errors below 0.12 degrees. Maximum observed errors did not exceed 0.3 mm for translational or 0.2 degrees for rotational movements. For combined errors 3D translational accuracy showed no significant difference (p=0.482) between ETD (0.11 mm) and CBCT (0.09 mm). The 6D error magnitude was slightly lower for ETD (0.14 mm vs. 0.20 mm, p<0.001). Correlation analysis revealed that single-axis correlations between ETD and CBCT were not significant (p>0.05) except for pitch errors (p=0.023), which showed moderate correlation. The mean DIFF 6D vector (0.23 mm), representing the positional offset between ETD and CBCT detections, was significantly larger than both ETD 6D and CBCT 6D errors (p<0.001 and p=0.002, respectively). CONCLUSION Both systems offer high precision in detecting positional shifts. The ETD System's ability to provide continuous, real-time monitoring enhances patient safety by allowing real-time correction of positioning errors, making it a valuable tool for stereotactic radiotherapy applications. Further studies with patient data are needed to validate the clinical application of these findings.
OBJECTIVE Nasopharyngeal cancer (NPC) is highly treatment-sensitive, yet distant metastasis remains a challenge. Data on adjuvan therapy needs in non-metastatic (NM) cases from non-endemic regions (NERs) are limited. This retrospective cohort analysis aimed to evaluate the prognostic impact of PD-L1 and Tumor Proportion Score (TPS) in NM NPC patients from a NER. METHODS We retrospectively analyzed PD-L1 expression in tumor samples of patients with locoregionally confined NPC. TPS, derived from PD-L1 expression, was correlated with clinical outcomes. Data were analyzed using SPSS 26 with t-tests and chi-square tests for group comparisons, Kaplan-Meier, and Cox regression analyses for survival assessment. RESULTS The study included 60 patients with a mean follow-up of 114.5 months. The TPS expression stratified into two groups as <43 (n=24), and >= 43 (n=36). Statistically significant differences were observed in treatment response across the TPS subgroups (p<0.05). TPS >= 43 was associated with significantly longer overall survival compared to lower TPS expression (p<0.05). CONCLUSION TPS expression >= 43 was significantly associated with longer survival and better treatment response in NM NPC. These findings support the use of TPS as a prognostic biomarker, which could guide clinical adjuvant treatment studies that improve survival rates and treatment effectiveness. These results underscore the significance of ongoing research and the development of personalized treatment plans for NM NPC patients.
OBJECTIVE To evaluate the diagnostic performance of eight current large language models (LLMs) in applying the RECIST 1.1 guidelines for oncologic treatment response imaging and to compare their performance with that of board-certified radiologists. This study explores the potential of LLMs as supportive adjuncts in cancer follow-up imaging. METHODS In this observational cross-sectional study, 50 text-based and 30 case-based multiple-choice questions derived from RECIST 1.1 were administered to eight LLMs with three different prompts and two junior radiologists with seven years of experience. Responses were independently scored as correct or incorrect, and non-parametric statistical analyses were performed to compare performance across groups. RESULTS LLMs demonstrated promising performance in text-based interpretation about RECIST, with only minor performance variations. Claude 3.5 Sonnet had the most successful performance, achieving 83.3% accuracy on case-based and 90% on text-based questions. Other models exhibited robust performance, with no significant differences in case-based assessments between LLMs and radiologists. LLMs achieved similar results across the three different prompts with minor variations. CONCLUSION LLMs have great potential for response evaluation in oncological imaging and not only support radiologists but may soon redefine clinical workflows, setting a new benchmark for diagnostic excellence in radiology.
OBJECTIVE The necessity to diagnose breast cancer early and correctly is the need to minimize the diagnostic uncertainty and unwarranted clinical procedures. This paper assesses the reliability of a hybrid deep-ensemble decision-support model in terms of diagnostic reliability, stability of outcome, and translational feasibility of the model via structured clinical data to detect early breast cancer. METHODS The Wisconsin Diagnostic Breast Cancer dataset which consisted of 569 cases of benign and malignant tumors was analyzed retrospectively. The framework proposed combines the deep learning of latent representations with stacked classification, ensemble-based feature selection, and stacked classification. Performance evaluation was performed based on sensitivity, specificity, accuracy, F1-score, and area under the curve (AUC) performed using stratified 10-fold cross-validation. The statistical stability across folds and the comparison with baseline models were determined with the help of non-parametric tests (p<0.05). RESULTS The model had good diagnostic performance with an accuracy of between 91.2-100 (Mean 96), Sensitivity of 76.2-100, good specificity value, and AUC 0.973-1.000. Variability in performance between folds was low, and statistically significant enhancement as compared to baseline classifiers were present. CONCLUSION The hybrid deep-ensemble model is highly diagnostic, has robust discriminative ability, and ultimately remains stable, which demonstrates the methodological robustness and diagnostic reliability of the proposed framework as a proof-of-concept decision-support model for early breast cancer detection, with potential translational relevance subject to further external clinical validation.
OBJECTIVE This study aimed to evaluate fatigue and comfort levels in patients with breast cancer. METHODS This research was conducted between November 2021 and April 2022. The sample consisted of 218 breast cancer patients undergoing chemotherapy treatment in a medical oncology clinic. Data were collected using a questionnaire form, the Fatigue Severity Scale (FSS), and the General Comfort Scale (GCS). RESULTS Patients had a mean age of 53.93 +/- 11.0. Active employment status, income level, smoking, presence of chronic diseases, continuous medication use, metastasis status, ECOG performance score, and sleep duration affected patients' FSS scores (p<0.05). Patients had a mean GCS score of 140.61 +/- 11.42. Active employment status, income, tobacco use, continuous drug use, metastasis status, ECOG performance score, number of chemotherapy cycles and sleep duration affected patients' GCS scores (p<0.05). There was a negative correlation between FSS and GCS scores (p<0.05). Disease status, ECOG performance score, sleep duration, and GCS relief and superiority subscale affected fatigue. Tobacco use, ECOG performance score, number of chemotherapy cycles, sleep duration, and fatigue severity affected comfort (p<0.05). CONCLUSION Patients were generally tired but had high comfort levels. There is a negative correlation between fatigue and comfort. Sociodemographic and disease-related characteristics affect fatigue and comfort.
OBJECTIVE Basal cell carcinoma (BCC) is the most common skin cancer, and dermoscopy significantly enhances its diagnostic accuracy by enabling early, noninvasive recognition. However, dermoscopic patterns may differ according to histologic subtype, tumor size, and anatomical location. This study aimed to compare the dermoscopic features of BCC according to tumor size and anatomical location (H-zone vs. non-Hzone), and to evaluate the association of histologic subtype on these variations. METHODS Dermoscopic images of histopathologically confirmed BCCs from 70 patients were retrospectively analyzed. Dermoscopic features of BCC were evaluated according to tumor size (<= 5 mm vs. >5 mm), anatomical location (H-zone vs. non-H-zone), and histopathologic subtype, and comparisons were performed between these predefined groups. RESULTS Blue-gray ovoid nests were significantly more frequent in smaller tumors (<= 5 mm) (p<0.05). Within the H-zone, blue-gray ovoid nests were observed more frequently in small tumors (<= 5 mm) (p=0.017). Similarly, in nodular BCCs, blue-gray ovoid nests were significantly more common in smaller lesions (p=0.048). In contrast, ulceration was significantly more frequent in larger tumors (>5 mm) (p<0.05). No significant dermoscopic differences were identified between H-zone and non-H-zone lesions, and no correlations were found when tumor size was analyzed as a continuous variable. CONCLUSION Our results show that ulceration was more frequent in larger tumors, whereas blue-gray ovoid nests predominated in smaller lesions, particularly in the nodular subtype. Recognition of these size-and subtype-related variations may aid earlier diagnosis and assist clinical evaluation of BCC.
OBJECTIVE ARID1A has emerged as a pivotal tumour suppressor gene, essential to chromatin remodelling and gene regulation. In colorectal cancer (CRC), dysregulated ARID1A gene expression triggers uncontrolled cellular growth and chemoresistance. This study investigates the spectrum of ARID1A variants in exon-9, its mRNA expression in CRC tissues and potential correlations with clinicopathological parameters. METHODS The present study was a cross-sectional study conducted on 87 histopathologically confirmed CRC and their adjacent normal tissue samples, collected from patients attending SMHS Hospital in Kashmir, India. Sequence elucidation of Exon-9 was done by Di-deoxy Sequencing. mRNA expression of ARID1A gene was carried out using quantitative real-time PCR (qRT-PCR). RESULTS Genomic variants of ARID1A were identified in 19.5% of CRC cases, with a predominant heterozygous condition. In silico analysis of the Pro916His variant indicated a deleterious effect on protein function and stability. The mRNA expression of ARID1A was significantly reduced in 17.2% of CRC tissues compared to their adjacent normal tissue samples (p<0.001), with a 1.43-fold decrease observed. CONCLUSION Our study highlights the prevalence of ARID1A variants in CRC among Kashmiri population. This study proposes that ARID1A under-expression might be relevant in CRC development.
