Acute radiation dermatitis (ARD) is a common adverse effect experienced by patients undergoing radiation therapy. Effective assessment tools to accurately measure and manage ARD’s impact on patients’ quality of life and treatment outcomes is needed. The aim of this study was to evaluate the diverse tools and outcome measures used in the assessment of ARD. A systematic review of MEDLINE®, Embase, and Cochrane was conducted for records 1946-March 2024. A total of 423 studies, including 227 randomized controlled trials (RCTs), were included in the analysis. The review identified 58 distinct tools utilized in the assessment of ARD including clinician and patient-reported outcomes, quality-of-life instruments, and biophysical measures. The most frequently employed tools were the Radiation Therapy Oncology Group criteria, Common Terminology Criteria for Adverse Events, Skindex-16, Visual Analogue Scale, Dermatology Life Quality Index, European Organization for Research and Treatment of Cancer Quality of Life C30, Radiation-Induced Skin Reaction Assessment Scale, Skin Toxicity Assessment Tool, photography, reflectance spectrophotometry, and the corneometer. This investigation into ARD assessment tools reveals a broad application of instruments but is limited by a pervasive lack of consensus, preventing the endorsement of a standardized toolset. The variability in tool use necessitates further research, particularly high-quality RCTs, to establish validated and reliable measures. Future publications, including Delphi consensus-based recommendations, are anticipated to address these gaps, aiming to standardize ARD assessment methodologies.

INTRODUCTION:Acute radiation dermatitis (ARD) is a common side effect experienced during radiation therapy (RT) for cancer. Published clinical trials for ARD use a myriad of assessment tools and outcomes to measure ARD severity, which limits the comparability of clinical trial results. Our study utilized a modified Delphi consensus survey to gather expert opinions on commonly used tools for ARD severity. MATERIALS AND METHODS:Thirty experts were invited to participate in a two-round Delphi consensus survey. Of these, 80 % (24/30) completed the first round; and 92 % (22/24) completed the second round. The Delphi process was conducted using the REDCap platform to systematically collect expert opinions on 32 assessment tools and 11 key outcomes pertinent to the severity of ARD. Assessment tools and outcomes that achieved a consensus of ≥ 70 % among the experts were subsequently recommended. RESULTS:Expert recommendations included four tools (RTOG, CTCAE, RISRAS, and Skindex-16) and eight relevant outcomes (moist desquamation, pain, QoL, erythema, dry desquamation, pruritus/itching, necrosis/ulceration, and burning) for ARD severity assessment. Due to limited evidence, no biophysical parameters reached consensus. Further, experts suggested modifications to existing tools to improve measurement of ARD severity across all skin types. CONCLUSION:Our study was the first step in standardizing ARD severity assessment with expert consensus recommendation for four tools and eight relevant outcomes. However, modifications to existing tools are necessary to promote validation and accuracy across all skin types. Future efforts should create a new comprehensive ARD severity assessment tool to address deficiencies in existing tools.

Low dose radiotherapy (LDRT) is a radiation technique in the treatment of benign conditions to relieve symptoms and improve mobility and pain with minimal overall side effects. There are many reports describing the use of LDRT in the treatment of osteoarthritis (OA), tendinitis and hyperproliferative disorders. The targeted diseases are complex and multifactorial, characterized by inflammation, cellular alterations, and tissue degeneration, affecting millions of people worldwide with increasing prevalence due to aging populations. However, an understanding of the pathophysiological mechanisms as well as the underlying biological and physical mechanisms is important for the clinical-practical application, as a foundation for empirical clinical studies and state-of-the-art patient treatment. In this review, we provide an overview of the broad use of LDRT in the treatment of benign diseases with well-described and illustrated overviews of the pathomechanisms of OA, tendinitis, bursitis, benign fibromatoses and hyperproliferative diseases. The biological, physical, and molecular mechanisms behind it are also described. We further provide a broad overview of studies as well as current discussions of the therapy such as risk assessment, treatment frequency and dosage, along with future perspectives to improve clinical application overall. Taken together, this review illustrates the multifaceted application of (LD)RT, emphasizing that each disease requires a unique treatment approach due to the wide variation in pathology, biological mechanisms, target volumes, and organs at risk, but it also highlights the need for well-designed (placebo)-controlled studies in a range of indications.

Purpose: Coronary artery disease is the leading cause of death for both men and women in the United States. Percutaneous coronary intervention with drug-eluting stents (DES) has been a major advance in treatment. In-stent restenosis (ISR) occurs in up to 10% of patients, and is often managed with repeat DES placement. However, when DES-ISR occurs, treatment options remain limited. Angioplasty followed by intravascular brachytherapy (IVBT) is one option for such patients. Material and methods: Outcomes of 78 patients (91 vessels) treated with angioplasty followed by strontium-90 IVBT from 2016-2024 were reviewed. Following vessel preparation with angioplasty, an intravascular catheter was introduced into the index lesion. Radiation was prescribed to an area encompassing the angioplasty injury length with a minimum 10 mm margin. Radiation dose delivered was 23 Gy or 18.4 Gy according to protocol standard. Major adverse cardiac events (MACE), including myocardial infarction and stroke as well as all causes of death were analyzed, as was the need for repeat angioplasty or intervention. Results: All patients had at least 2 drug-eluting stents previously deployed in the affected vessel, and were not technically suitable for additional stenting. One patient expired while receiving intervention due to cardiac arrest, with no other intraprocedural toxicities reported. Median follow-up was 22.8 months (range, 0.9-60.6 months), and forty-four percent of patients experienced symptomatic relief. Major cardiac adverse events rates at interval follow-up of IVBT included myocardial infarction (18%) and stroke (5%). Death from any cause occurred in 16% of patients at a median time of 9.3 months post-treatment (range, 0.5-29.5 months). Conclusions: Angioplasty followed by intravascular brachytherapy is a safe and effective therapy for patients with complex coronary artery lesions experiencing stent-in-stent restenosis, who have few other treatment options.

This study assessed the impact of radiotherapy (RT) techniques on chronic skin reactions and health-related quality of life (HRQoL) in breast cancer patients, comparing conventional RT with modern techniques such as intensity-modulated RT (IMRT). A comprehensive search was conducted in Embase, MEDLINE, and Cochrane CENTRAL from inception to April 26, 2024. Conventional RT, which uses 2D or 3D imaging to shape radiation beams without dynamic intensity modulation, was compared with alternate RT techniques for adjuvant breast cancer treatment. Primary outcomes included chronic grade ≥ 2 skin toxicities (hyperpigmentation, breast fibrosis, telangiectasia, edema, and atrophy/retraction) and HRQoL, assessed mainly with EORTC QLQ-C30 and QLQ-BR23 modules. Pooled risk ratios (RR) with 95

Background and purpose Mepitel Film (MF) has been demonstrated to reduce the severity of radiation dermatitis (RD) in patients receiving breast cancer radiotherapy (RT). The objective of this study was to characterize patient-reported experience with MF use, including its impact on daily activities and wellbeing. Materials and methods This single-institution study analyzed anonymized responses to a questionnaire completed by patients who used MF for the prevention of RD during breast cancer RT. Results Of the 254 patients contacted, 192 patients completed the survey. Most patients disagreed or strongly disagreed that MF limited their ability to perform their daily activities, including household chores (88%, n = 169/191), their ability to work (83%, n = 157/189), or their ability to sleep (85%, n = 163/191). Furthermore, patients agreed or strongly agreed MF was comfortable on their skin (67%, n = 126/189) and protected their skin from rubbing against clothing (86%, n = 161/188). Some patients agreed or strongly agreed that MF affected their ability to shower (31%, n = 50/162), wear bras (28%, n = 51/185), and impacted their level of pruritus (35%, n = 67/189). However, most patients agreed or strongly agreed that their overall experience with MF was positive (92%, n = 173/189) and would recommend MF to a friend undergoing breast cancer RT (88%, n = 166/188). Conclusion MF use is associated with positive patient-reported experience during breast RT with minimal impact on daily activities.

Abstract Ask most oncologists (especially radiation oncologists), and you may be hard pressed to find one who professes ignorance of Madame Curie and her historic contributions to medicine. Innumerable publications and media over the past century have correctly memorialised Madame Curie as one of the most brilliant minds in world history. However, do any of us really know the woman and the true extent of her sphere of influence? How, as well, does she fit into modern life and contemporary scientific advancement? Let us try to understand and learn from this complex scientist as more than just one of the most brilliant minds in human history.

Background: Cardiac tumours are rare and treated by surgical resections, which are complex, invasive and carry procedural risks. MRI-guided radiotherapy (MRgRT) noninvasively facilitates conformal dose deliveries using soft-tissue imaging and adaptive radiotherapy techniques. Aim: To assess the application of MRgRT for cardiac tumours, we conducted a patterns-of-care analysis with users of the 1.5T MR-linac. Materials methods: A survey was distributed to users of the 1.5T MR-linac that treated patients with cardiac tumours. The survey included 30 questions concerning the patient cohort, imaging, treatment planning/simulation, radiotherapy treatment and treatment outcome. Results: Users from six international institutes completed the survey reporting twelve cardiac MRgRT treatments between 2021-2024. The median age[range] of the patients was 59[16-81] years with 50 Conclusion: This study provides real-world insights into the feasibility and early outcomes to aid the development of cardiac MRgRT treatment recommendations and protocol harmonization.

Stereotactic arrhythmia radiotherapy (STAR) is a promising therapy for VT refractory to antiarrhythmic medications and ablation. The duration of benefit is unclear, as is the optimal approach for mapping and targeting VT substrate.

Nurses provide information and care on cancer treatment side effects prevention and management. Skin toxicities are common side effects and can be associated with treatment dose reduction or discontinuation. Minimizing skin side effects and using photoprotection improve patient outcomes and quality of life. The Association Francophone des Soins Oncologiques de Support (AFSOS) and Multinational Association of Supportive Care in Cancer (MASCC) teamed to create consensus recommendations about using dermocosmetics in cancer patients. They assembled a group of international experts from nursing and other disciplines who manage cancer patients. After literature review, the group held a consensus meeting to give guidance on the use of dermocosmetics with oncology treatments. Dermocosmetics (or cosmeceuticals) are products with therapeutic value in addition to cosmetic. They contain ingredients that can help repair and support the skin barrier by hydrating the skin, maintaining a healthy microbiome. For general recommendations the group agreed: * Start skin care at the same time as cancer interventions known to be associated with skin toxicities, with a goal of preventing and minimizing problems. * Hydration of the skin relieves symptoms and reduces exacerbations of xerosis. * Use cleansers with pH close to 5 and avoid basic or neutral pH cleansers. * Photoprotection should be part of initial recommendations for all Consensus recommendations for the use of dermocosmetics in specific skin toxicities management were also made. Nurses have an essential role in educating patients about skin care as part of their holistic approach to patient care. This new consensus focuses on the practical and beneficial impact of dermocosmetics to avoid and manage side effects as well as prevent dryness, irritation, and sensitivity. Patient education can help prevent high-grade toxicities and reduce healthcare costs by allowing patients to have an active role in their treatment.

A 1.5T MRI combined with a linear accelerator (Unity®, Elekta; Stockholm, Sweden) is a device that shows promise in MRI-guided stereotactic body radiation treatment (SBRT). Previous studies utilized the manufacturer’s pre-set MRI sequences (i.e., T2 Weighted (T2W)), which limited the visualization of pancreatic and intra-abdominal tumors and organs at risk (OAR). Here, a T1 Weighted (T1W) sequence was utilized to improve the visualization of tumors and OAR for online adapted-to-position (ATP) and adapted-to-shape (ATS) during MRI-guided SBRT. Twenty-six patients, 19 with pancreatic and 7 with intra-abdominal cancers, underwent CT and MRI simulations for SBRT planning before being treated with multi-fractionated MRI-guided SBRT. The boundary of tumors and OAR was more clearly seen on T1W image sets, resulting in fast and accurate contouring during online ATP/ATS planning. Plan quality in 26 patients was dependent on OAR proximity to the target tumor and achieved 96 ± 5% and 92 ± 9% in gross tumor volume D90% and planning target volume D90%. We utilized T1W imaging (about 120 s) to shorten imaging time by 67% compared to T2W imaging (about 360 s) and improve tumor visualization, minimizing target/OAR delineation uncertainty and the treatment margin for sparing OAR. The average time-consumption of MRI-guided SBRT for the first 21 patients was 55 ± 15 min for ATP and 79 ± 20 min for ATS.

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Introduction Randomized clinical trials support Mepitel Film (MF) as a prophylactic treatment for radiation dermatitis (RD) in patients undergoing breast radiotherapy. Although several studies have canvassed the opinion of patients on using MF, no such studies have been done to investigate the perception of healthcare professionals (HCPs). The objective of this study was therefore to investigate the perceptions of HCPs on MF as a treatment option for RD. Methods Anonymized responses to a web-based survey sent to HCPs at a single institution managing patients using MF during breast radiotherapy were analyzed. Results Of the 28 HCPs contacted, 22 completed the survey, including 6 radiation oncologists (ROs), 11 radiation therapists (RTTs), and 5 nurses. Most HCPs reported MF was better at preventing severe RD than the standard of care and improved radiation-induced skin reactions ( n = 20/22, 91%, and n = 19/22, 86%, respectively). MF was recommended for mastectomy patients without reconstruction ( n = 15/21, 71%). The majority of HCPs believed that patients’ families could be trained to apply and remove MF ( n = 19/22, 86%). Many HCPs perceived that implementation of MF would be difficult in terms of maintaining patient flow and wide-scale implementation within their institution ( n = 11/22, 50%, and n = 10/22, 46%, respectively). Most HCPs perceived that fewer than 50% of their patients could afford MF if priced at $100 CAD ( n = 15/20, 75%). Conclusion These findings provide insights into the possibility of MF to be incorporated into standard practice of care for RD. Although most HCPs were satisfied with MF as a prophylactic treatment for RD, there are concerns about its resource-intensive operationalization and financial accessibility to patients. Future research should focus on ways to improve HCP experience with MF and to improve its implementation into clinical settings as standard of care.

Purpose Radiation dermatitis (RD) is a frequently occurring adverse reaction during radiotherapy in cancer patients. While the use of topical corticosteroids (TCs) is common for the treatment of RD, its role in preventing severe reactions remains unclear. This systematic review and meta-analysis aim to evaluate the evidence on the use of TCs as prophylaxis of RD. Methods A systematic search was conducted using OVID MedLine, Embase, and Cochrane databases (between 1946 and 2023) to identify studies examining TC use in the prevention of severe RD. Statistical analysis was completed using RevMan 5.4 to calculate pooled effect sizes and 95% confidence intervals. Forest plots were then developed using a random effects model. Results Ten RCTs with a total of 1041 patients met the inclusion criteria. Six studies reported on mometasone furoate (MF) and four studies reported on betamethasone. Both TCs were associated with a significant improvement in the prevention of moist desquamation [OR = 0.34, 95% CI [0.25, 0.47], p < 0.00001], but betamethasone was found to be more effective than MF [OR = 0.29, 95% CI [0.18, 0.46], p < 0.00001 and OR = 0.39, 95% CI [0.25, 0.61], p < 0.0001, respectively]. A similar finding was seen in reducing the development of grade 2 or higher RD according to the Radiation Therapy Oncology Group scale. Conclusions The current evidence supports the use of TCs in preventing severe reactions of RD. Both MF and betamethasone were found to be effective; however, betamethasone, a higher potency TC, is more effective despite MF being more commonly reported in literature.

Purpose: Identifying the target region is critical for successfully treating ventricular tachycardia (VT) with single fraction stereotactic arrhythmia radioablation (STAR). We report the feasibility of target definition based on direct co-registration of electroanatomic maps (EAM) and radioablation planning images. Materials and methods: The EAM consists of 3D cardiac anatomy representation with electrical activity at endocardium and is acquired by a cardiac electrophysiologist (CEP) during electrophysiology study. The CEP generates an EAM using a 3D cardiac mapping system anticipating radioablation planning. Our in-house software read these non-DICOM EAMs, registered them to a planning image set, and converted them to DICOM structure files. The EAM based target volume was finalized based on a consensus of CEPs, radiation oncologists and medical physicists, then expanded to ITV and PTV. The simulation, planning, and treatment is performed with a standard STAR technique: a single fraction of 25 Gy using volumetric-modulated arc therapy or dynamic conformal arc therapy depending on the target shape. Results: Seven patients with refractory VT were treated by defining the target based on registering EAMs on the planning images. Dice similarity indices between reference map and reference contours after registration were 0.814 +/- 0.053 and 0.575 +/- 0.199 for LV and LA/RV, respectively. Conclusions: The quality of the transferred EAMs on the MR/CT images was sufficient to localize the treatment region. Five of 7 patients demonstrated a dramatic reduction in VT events after 6 weeks. Longer follow-up is required to determine the true safety and efficacy of this therapy using EAM-based direct registration method.

Stereotactic Arrhythmia Radiotherapy (STAR) aided by precise image-guided delivery and respiratory motion management has been used successfully for experimental treatment of refractory VT. However, accurate target selection remains challenging. Current methods often rely on manual delineation and/or visual estimation of predefined cardiac segments.

Skin toxicities are very common in patients undergoing cancer treatment and have been found to occur with all types of cancer therapeutic interventions (cytotoxic chemotherapy, targeted therapies, immunotherapy, and radiotherapy). Further, skin toxicities can lead to interruption or even discontinuation of anticancer treatment in some patients, translating to suboptimal outcomes. Dermocosmetics (or cosmeceuticals)—defined as skincare solutions incorporating dermatologically active ingredients (beyond vehicle effects) that directly improve symptoms of various skin conditions—are increasingly being used in cancer care to prevent and manage skin toxicities. The active ingredients in these products have a measurable biological action in skin; they typically improve skin integrity (barrier function/hydration and other factors) while relieving skin symptoms. The Association Francophone des Soins Oncologiques de Support (AFSOS) and Multinational Association of Supportive Care in Cancer (MASCC) partnered to select a multidisciplinary group of healthcare professionals involved in the management of patients with cancer and skin toxicities. The group reviewed existing literature and created a summary of recommendations for managing these toxicities through online meetings and communication. In this publication, the group (1) reviews new skin toxicities seen with oncology drugs and (2) evaluates the role of dermocosmetics in improving patient outcomes and minimizing cancer treatment interruptions. We provide general recommendations for initiation and selection of skin care in all oncology patients as well as recommendations for what factors should be considered when using dermocosmetics in specific types of skin toxicities.

Stereotactic arrhythmia radioablation (STAR) has been studied for management of refractory ventricular tachycardia (VT) that is not amenable to traditional catheter ablation. We present the case of a patient with recurrent ventricular tachycardia (VT) and left ventricular (LV) thrombus successfully treated with STAR therapy. A 48-year-old man with morbid obesity, paroxysmal atrial fibrillation and infarct related cardiomyopathy was admitted with late presentation of new anterolateral ST elevation myocardial infarction complicated by cardiogenic shock, managed with mechanical circulatory support. He was found to have a 3 x 2.7 cm thrombus in the LV apex (Panel A). He underwent successful percutaneous intervention to an acute left anterior descendinig coronary artery occlusion. During hospitalization, despite aggressive measures, he was noted to have polymorphic ventricular tachycardia (VT), triggered by premature ventricular contractions (PVCs) arising from his LV apical infarct (Panel B). He was treated with multiple antiarrhythmic medications (amiodarone, lidocaine) in addition to electrolyte repletion but unfortunately required repeated external defibrillation for PVC induced VF (Panel C). A dual chamber implantable cardioverter-defibrillator was placed and despite overdrive pacing, he suffered from recurrent life-threatening VT and ventricular fibrillation (VF) requiring additional defibrillation (Panel D). Because he was not a candidate for endocardial ablation, orthotopic heart transplantation, and was deemed too unstable for epicardial ablation, the decision was made to pursue STAR. Surface ECG and 4D computed tomography (Panel E) were used to localize the focus of the VT trigger. A single dose of 25 Gray of radiation was delivered to the LV apex. Our patient has been free of ventricular arrhythmias for 14 months. There has been no clinical evidence of early or late toxicity related to radiotherapy thus far. In challenging cases of PVC induced VT and VF not amenable to traditional therapies, such as our patient, STAR may offer a therapeutic option. Further studies are required.

Key Teaching Points•Stereotactic ablative radiotherapy (STAR) was a treatment option in an otherwise refractory case of life-threatening ventricular tachycardia.•This case highlights a unique utilization of STAR in the novel setting of left ventricular thrombus in a patient not a candidate for catheter ablation.•The long-term safety and efficacy of STAR is still under evaluation in prospective trials. •Stereotactic ablative radiotherapy (STAR) was a treatment option in an otherwise refractory case of life-threatening ventricular tachycardia.•This case highlights a unique utilization of STAR in the novel setting of left ventricular thrombus in a patient not a candidate for catheter ablation.•The long-term safety and efficacy of STAR is still under evaluation in prospective trials.