PURPOSE:To report the rapid recovery of treatment-related dysgeusia after tongue-out radiation therapy (TORT) for head and neck cancer (HNC). METHODS AND MATERIALS:We retrospectively reviewed 14 patients with HNC who completed TORT with 70 Gy for definitive or salvage and 60 to 66 Gy for adjuvant treatment with or without concurrent chemotherapy. Patient-reported quality of taste was evaluated before, at the end of TORT therapy, and periodically 1, 3, and 6 months after TORT therapy using the University of Washington Quality of Life questionnaire version 4, question 9, including options for no-, mild-, and severe dysgeusia and ageusia. Oral cavity (OC) and oral tongue (OT) were contoured following guidelines. A portion of the anteriorly displaced OT outside the mouth was separately contoured as OTOUT. Statistical analysis was conducted with the χ2 and t test. A probability level of P < .05 was considered significant. RESULTS:In 14 TORT plans, the average volume of OC and OT was 105.8 ± 25.3 and 67.6 ± 20.7 cm3, respectively. OTOUT comprised 20% (13.4 ± 9.1 cm3) of the entire OT volume. Average mean dose (DMEAN) to OC, OT, and OTOUT was 25.2 ± 6.9, 26.4 ± 6.8, and 13.3 ± 2.9 Gy, respectively. Before TORT, no-to-mild versus equal or higher than severe dysgeusia (≥ severe dysgeusia) was 86% (n = 12) versus 14% (n = 2) of patients, respectively; 14% (n = 2) versus 86% (n =12) at the end of TORT (P < .01); 57% (n = 8) versus 43% (n = 6) at 1-month post-TORT (P < .01); 79% (n = 11) versus 21% (n = 3) at 3-month post-TORT (P = .23) and 93% (n = 13) versus 7% (n = 1) at 6-month post-TORT (P = .18). CONCLUSION:TORT displaced OT anteriorly, lowered DMEAN to OT, especially to OTOUT, and facilitated rapid regaining of sense of taste at 1-month post-TORT. Patient-reported quality of taste returned to the baseline at 3-month and 6-month post-TORT. Further randomized study to verify clinical advantages with TORT for HNC is warranted.

This report details a pharyngeal constrictor muscle (PCM)-sparing stereotactic body radiation therapy (SBRT) using our institutional technique of " tongue-out" radiation therapy (TORT) for treating a local recurrent cancer in the uvula (GTVuvula) in a patient with history of a definitive chemotherapy with radiation therapy (70 Gy with weekly cisplatin) for a locally advanced laryngeal cancer 4 years ago. TORT includes optimizing the patients' reproducible tongue-out position using readily available medicine cup (30 cc) followed by sculping the thermoplastic mask with tongue-out, and real-time visual monitoring of the tongue position during the computed tomography simulation scan, cone beam computed tomography acquisition, and treatment. Between arcs during volumetric modulated arc therapy, time for tongue relaxation and saliva swallowing can be given to the patient. Without TORT, the patient's GTVuvulaabutted the medial aspect of superior PCM (medial-sPCM) and a substantial volume of the previously irradiated superior PCM (sPCM) would have received high radiation dose from this salvage SBRT (32.5 Gy in 5 fractions). Comparing without TORT, the shortest distance between medial-sPCM-toGTVuvulawas increased by 13 mm with TORT, which reduced radiation dose to sPCM in the salvage SBRT plan. The mean dose to sPCM was decreased from 20.5 Gy without TORT to 12.7 Gy with TORT. With TORT, minimal sPCM volumes fell within higher isodose line: volume receiving >= 60% prescription dose (V 60%Rx ), V 80%Rx , and V 100%Rx to sPCM was, 4.8 versus 0.7 cc (without vs with TORT, respectively), 2.9 versus 0.19 cc, and 1.6 versus 0.04 cc, respectively. Maximum dose (Dmax) to medial-sPCM was 34.6 Gy without TORT versus 22.7 Gy with TORT. These high doses to the sPCM and intrafractional swallowing-related geographic misses of GTV uvula were avoided through the application of TORT in this salvage reirradiation setting. The patient successfully fi nished salvage SBRT with TORT resulting in no dysphagia or mucositis and maintained complete response at 12 months after treatment. (c) 2024 American Society for Radiation Oncology. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

For breast cancer patients with ipsilateral diaphragm paralysis hindering follow through deep-inspiration breath hold (DIBH), continuously positive airway pressure-assisted breathing (CPAP) provided thoracic anatomical changes like successful DIBH by increasing ipsilateral lung volume by 46-51% than free-breathing (FB); reducing the liver volume within right supine tangential fields by 93% (FB:163 vs CPAP:12 cc); displacing the heart and intestine completely out of left supine tangential field. CPAP reduced radiation dose to OARs in ipsilateral supine tangential breast RT: mean dose to right lung by 21% (FB:6.9 vs CPAP:5.4 Gy), liver volume receiving ≥30 Gy by 94% (FB:140 vs CPAP:8 cc) in right diaphragm paralysis; mean dose to left lung by 12% (FB:8.2 vs CPAP:7.2 Gy), mean dose to the heart by 67% (FB:2.7 vs CPAP:0.9 Gy) and maximum dose to intestine by 90% (FB:40.6 vs CPAP:4.4 Gy) in left diaphragm paralysis.

Purpose:To describe organs at risk (OARs)-sparing breast cancer (BC) radiotherapy (RT) for patients with ipsilateral (Ipsi-diaphragm) paralysis using continuously positive airway pressure (CPAP) and supine tangential RT-field. Material and method:Breast RT plans with free-breathing (FB) for a patient with right-sided BC (patient1) and another patient with left-sided BC (patient2) showed an elevated Ipsi-diaphragm and displaced portions of liver (patient1) and the heart and intestine (patient2) into supine tangential RT-field. Although both patients denied cardiopulmonary symptoms, their elevated diaphragm, liver, intestine and the heart were unchanged with deep-inspiration breath hold (DIBH) while contralateral diaphragm moved caudally suggesting clinical diagnosis of Ipsi-diaphragm paralysis. Subsequently, patients underwent CT-sim under CPAP to create supine tangential breast RT plan. Result:Compared with FB, CPAP inflated lungs and moved both patients paralyzed diaphragm, liver, heart, and intestine caudally and displaced these OARs away from breast RT-field. The liver volume within right supine tangential RT-fields in patient1 was 163 cc with FB versus 12 cc with CPAP (93 % reduction). The heart and intestine were completely outside the left supine tangential RT-field with CPAP in patient2. For dosimetric comparison, supine tangential RT-fields for breast-only RT were used with prescription of 40 Gy in 15 fractions on each patients' CT-sim with FB and CPAP, respectively. Compared with FB, CPAP reduced liver volume receiving ≥ 30 Gy by 94 % (FB:140 vs CPAP:8 cc) in patient1 and mean dose to the heart by 67 % (FB:2.7 vs CPAP:0.9 Gy) and left anterior descending artery by 84 % (FB:25 vs CPAP:3.9 Gy), maximum dose to the intestine by 90 % (FB:40.6 vs CPAP:4.4 Gy). Conclusion:BC patients with Ipsi-diaphragm paralysis, CPAP provided an effective and practical technique for OARs-sparing breast RT.

Authors report oral tongue (OT)-sparing radiotherapy (RT) with tongue-out (TORT) for various virtual primary head and neck cancer (HNC). TORT lowered Dmean to OT by 25 % than non-TORT (22.4 vs 29.4 Gy, p < 0.05); V30 by 65 % (15.2 % vs 43.3 %, p < 0.05) suggesting clinical implications for minimizing post-RT dysgeusia in HNC patients.

Purpose:To report continuous positive airway pressure (CPAP)-assisted breathing with supine tangential left breast radiation therapy (CPAP-RT) when deep inspiration breath-hold RT (DIBH-RT) was ineffective or unsuitable. Methods and Materials:Ten patients with left breast cancer underwent computed tomography simulation scan (CT-sim) under DIBH followed by CPAP-assisted breathing (15 cm H2O) to create CPAP-RT plans in authors' institute. Reasons for CPAP-RT include inability to reproduce DIBH (n = 5), DIBH-RT plan exceeded dose limits to the heart (n = 2), and unable to proceed with planned DIBH-RT due to mechanical issues (n = 3). Radiation target volumes and organs at risk were contoured according to published atlas data. For dosimetric comparison, supine tangential fields for breast only RT (Breast-RT) and wide-tangential fields for breast + internal mammary nodal RT (Breast + IMN-RT) were used with prescription of 40 Gy in 15 fractions on each patients' CT-sim with free-breathing (FB), DIBH, and CPAP-assisted breathing, respectively. Results:Planning target volume (PTV) coverage was acceptable and comparable in all RT plans. Compared with FB, both DIBH and CPAP-assisted breathing inflated the thorax and increased left lung volume on average by 46% and 51%, respectively (FB: 1230 vs DIBH: 1802 vs CPAP-assisted breathing:1860 cc, P < .01), and increased the shortest distance between PTVeval-Breast to the heart by 5.6 ± 3.0 and 11.9 ± 3.6 mm (P < .01) and to LAD by 4.9 ± 2.9 and 10.8 ± 4.3 mm, respectively (P < .01). Compared with FB, both DIBH and CPAP significantly reduced radiation dose to the heart and LAD. A mean dose to the heart (HeartDmean) was FB: 2.3 ± 0.9, DIBH: 1.2 ± 0.7, and CPAP: 0.9 ± 0.4 Gy in Breast-RT (P < .01); FB: 3.2 ± 1.7, DIBH: 1.7 ± 0.8, and CPAP: 1.3 ± 0.5 Gy in Breast + IMN-RT (P < .01). LADDmean was FB: 11 ± 4.5, DIBH: 5.4 ± 3.2, and CPAP: 2.4 ± 0.9 Gy in Breast-RT (P < .01); FB: 15.5 ± 7.8, DIBH: 7.4 ± 4.1, and CPAP: 3.5 ± 1.4 Gy in Breast + IMN-RT (P < .01). A maximum dose to LAD (LADDmax) was FB: 35.8 ± 8.7, DIBH: 22.4 ± 15.4, and CPAP: 7.8 ± 5.3 Gy in Breast-RT (P < .01); FB: 38.7 ± 5.0, DIBH: 25.3 ± 15.2, and CPAP: 10.2 ± 6.8 Gy in Breast + IMN-RT (P < .01). All patients successfully completed CPAP-RT. Conclusions:CPAP-RT provides efficient and practical heart and LAD sparing RT using simple supine tangential fields for Breast-RT or wide-tangential fields for Breast + IMN-RT when DIBH-RT was ineffective or unsuitable. With its easy accessibility and low infrastructural requirement, CPAP-RT can provide affordable heart-sparing left breast RT to reduce the health care disparities in low-resource settings.

Purpose To report continuously positive airway pressure (CPAP)-assisted breathing with supine tangential left breast radiotherapy (CPAP-RT) when deep inspiration breath-hold RT (DIBH-RT) was ineffective or unsuitable. Methods Ten patients with left breast cancer underwent CT-simulation scan (CT-sim) under DIBH followed by CPAP-assisted breathing (15 cm H20) to create CPAP-RT plans in authors’ institute. Reasons for CPAP-RT include inability to reproduce DIBH (n=5), DIBH-RT plan exceeded dose limits to the heart (n=2), and unable to proceed with planned DIBH-RT due to mechanical issues (n=3). Radiation target volumes and organs at risk were contoured according to published atlas data. For dosimetric comparison, supine tangential fields for breast only RT (Breast-RT) and wide-tangential fields for breast+internal mammary nodal RT (Breast+IMN-RT) were used with prescription of 40 Gy in 15 fractions on each patients’ CT-sim with free-breathing (FB), DIBH, and CPAP-assisted breathing, respectively. Results Planning target volume (PTV) coverage was acceptable and comparable in all RT plans. Compared to FB, both DIBH and CPAP-assisted breathing inflated the thorax and increased left lung volume on average by 46% and 51%, respectively (FB:1230 vs. DIBH:1802 vs. CPAP-assisted breathing:1860 cc, p<0.01), and increased the shortest distance between PTVeval-Breast to the heart by 5.6±3.0 and 11.9±3.6 mm (p<0.01) and to LAD by 4.9±2.9 and 10.8±4.3 mm, respectively (p<0.01). Compared to FB, both DIBH and CPAP significantly reduced radiation dose to the heart and LAD. A mean dose to the heart (HeartDmean) was FB:2.3±0.9, DIBH:1.2±0.7, and CPAP:0.9±0.4 Gy in Breast-RT (p<0.01); FB:3.2±1.7, DIBH:1.7±0.8, and CPAP:1.3±0.5 Gy in Breast+IMN-RT (p<0.01). LADDmean was FB:11±4.5, DIBH:5.4±3.2, and CPAP:2.4±0.9 Gy in Breast-RT (p<0.01); FB:15.5±7.8, DIBH:7.4±4.1, and CPAP:3.5±1.4 Gy in Breast+IMN-RT (p<0.01). A maximum dose to LAD (LADDmax) was FB:35.8±8.7, DIBH:22.4±15.4, and CPAP:7.8±5.3 Gy in Breast-RT (p<0.01); FB:38.7±5.0, DIBH:25.3±15.2, and CPAP:10.2±6.8 Gy in Breast+IMN-RT (p<0.01). All patients successfully completed CPAP-RT. Conclusions CPAP-RT provides efficient and practical heart and LAD sparing RT using simple supine tangential fields for Breast-RT or wide-tangential fields for Breast+IMN-RT when DIBH-RT was ineffective or unsuitable. With its easy accessibility and low infrastructural requirement, CPAP-RT can provide affordable heart-sparing left breast RT to reduce the healthcare disparities in low-resource settings.

We thank Wada et al1 for their comments on our article, "Breast-directed quad shot radiation therapy (RT) for effective breast symptoms palliation without interrupting or delaying systemic cancer therapy schedule in patients with neglected breast cancer."2 The authors note important points that we will respond to in this letter. First, regarding the number of breast-directed quad shot (QS), we would like to clarify that only 1 of 3 patients (including a case presented in Fig. E1) received 3 cycles of QS.2 All patients reported significant subjective and objective symptom relief immediately after the first QS (QS1). The reason for receiving a subsequent with rapid tumor regression after QS1 (Fig. 1D in the

More than half of patients with cancer receiving radiation therapy (RT) are treated in a palliative setting. Elderly or frail patients with metastatic/recurrent cancer require palliative RT that can provide a rapid cancer-related symptom response with low toxicity and short overall treatment time. Cyclical hypofractionated RT (quad shot: 14-14.8 Gy/4 fractions, twice-daily treatments with 6-hour intervals on 2 consecutive days monthly to a total of 42-44.4 Gy) can be a practical palliative RT regimen for patients with poor performance status. In this report, we present palliative symptom response and objective tumor response after quad shot for elderly or frail patients with nonosseous metastatic/recurrent cancers in various sites with varying histology.

Abstract AZD0530, a potent small-molecule inhibitor of the Src kinase family, is an anticancer drug used in the treatment of various cancers. In the case of glioblastoma (GBM), where resistance to radiotherapy frequently occurs, Src kinase is known as one of the molecules responsible for imparting radioresistance to GBM. Thus, we evaluated the effect of AZD0530 on the radiosensitivity of human GBM cells and human glioblastoma stem-like cells (GSCs). We show that Src activity of GBM and GSC is increased by radiation and inhibited by AZD0530, and using clonogenic assays, AZD0530 enhances the radiosensitivity of GBM and GSCs. Also, AZD0530 induced a prolongation of radiation-induced γH2AX without specific cell cycle and mitotic index changes, suggesting that AZD0530-induced radiosensitization in GBM cells and GSCs results from the inhibition of DNA repair. In addition, AZD0530 was shown to inhibit the radiation-induced EGFR/PI3K/AKT pathway, which is known to promote and regulate radioresistance and survival of GBM cells by radiation. Finally, mice bearing orthotopic xenografts initiated from GBM cells were then used to evaluate the in vivo response to AZD0530 and radiation. The combination of AZD0530 and radiation showed the longest median survival compared with any single modality. Thus, these results show that AZD0530 enhances the radiosensitivity of GBM cells and GSCs and suggest the possibility of AZD0530 as a clinical radiosensitizer for treatment of GBM.