December 1, 2022

Clues to address barriers for access to proton therapy in the Netherlands

  • Salina V. Thijssen,
  • Liesbeth J. Boersma,
  • Luca Heising,
  • ...
  • Carol X. J. Ou,
  • Cheryl Roumen,
  • Maria J. G. Jacobs
Published online: December 01, 2022
Open Access
Due to the physical properties of protons, proton therapy (PT) offers the potential to reduce dose to organs at risk, and thereby side effects of radiation treatment (e.g. heart damage, swallowing problems, cognition loss). A reduction in side-effects is expected to improve quality of life [1] and possibly even survival, since survival has been shown to be related to the dose to the heart [1–3]. However, as the costs of PT are almost two-and-a-half times higher than conventional therapy, it is essential to select patients that would benefit the most [4,5].

Radiotherapy-specific quality indicators at national level: how to make it happen

  • Aude Vaandering,
  • Nicolas Jansen,
  • Caroline Weltens,
  • ...
  • Pierre Scalliet,
  • Vincent Remouchamps,
  • Yolande Lievens
Published online: December 01, 2022
There has been a growing interest in defining and collecting quality indicators (QI) that can guide healthcare programs, institutions and departments in monitoring and improving the quality of care provided to patients. A clear definition and continuous collection of QIs allows for the monitoring of performance over time. Even more, centres or countries can compare their results with others through the process of benchmarking if QIs are collected on a multicentric or multi-national basis [1-4]. Through this process, it is possible to identify gaps in practice and to put into place improvement actions that favour the delivery of best-quality care.

The role of radiologic extranodal extension in predicting prognosis and chemotherapy benefit for T1-2N1 nasopharyngeal carcinoma: a multicenter retrospective study

  • Yu-Jun Hu,
  • Tian-Zhu Lu,
  • Qiao-Juan Guo,
  • ...
  • Jin-Gao Li,
  • Jian-Ji Pan,
  • Yun-Fei Xia
Published online: December 01, 2022
The value of chemotherapy for stage II nasopharyngeal carcinoma (NPC) remains debatable in the intensity-modulated radiation therapy (IMRT) era. The National Comprehensive Cancer Network (NCCN) guidelines recommends concurrent chemoradiotherapy (CCRT) for stages II-IVA [1]. The inclusion of stage II NPC for chemotherapy was based on a single phase-III randomized trial by Li et al. [2] demonstrating that patients treated with CCRT had a significantly better outcomes than those received radiotherapy (RT) alone in the conventional two-dimensional radiotherapy (2DRT) era.

External validation of a CT-based radiomics signature in oropharyngeal cancer: assessing sources of variation

  • Philipp Guevorguian,
  • Tricia Chinnery,
  • Pencilla Lang,
  • Anthony Nichols,
  • Sarah A. Mattonen
Published online: December 01, 2022
To make appropriate treatment planning decisions, clinicians rely primarily on pathological findings, smoking habits, and alcohol consumption to risk stratify head and neck cancer patients. In oropharyngeal cancer (OPC), the tumor, node, metastasis (TNM), American Joint Committee on Cancer (AJCC) 8th edition staging system has been shown to effectively prognose patients and has recently incorporated stratification by tumor human papilloma virus (HPV) status, which is a newly recognized prognostic marker[1,2].

November 28, 2022

Prospective Imaging Comparison of Anatomic Delineation with Rapid kV Cone Beam CT on a Novel Ring Gantry Radiotherapy Device

  • Lauren E. Henke,
  • Benjamin W. Fischer-Valuck,
  • Soumon Rudra,
  • ...
  • Geoffrey D. Hugo,
  • Bin Cai,
  • Hyun Kim
Published online: November 28, 2022
Image-guided radiotherapy (IGRT) has substantially improved clinical outcomes in definitive radiotherapeutic treatment of cancer by improving the therapeutic index of radiation delivery [1–3]. Current standard-of-care IGRT comprises onboard volumetric imaging with cone beam computed tomography (CBCT). The current primary use of CT-based image guidance is limited to patient setup verification due to poor soft tissue visualization and delineation of the daily target and adjacent organ-at-risk (OAR) anatomy [4].

Excellent treatment outcomes from low dose radiation therapy for primary cutaneous CD4+ small/ medium T-Cell lymphoproliferative disorder

  • Jennifer Ward,
  • H. Miles Prince,
  • Chris McCormack,
  • ...
  • Carrie van der Weyden,
  • Friyana Bhabha,
  • Belinda A. Campbell
Published online: November 28, 2022
Primary cutaneous CD4+ small/ medium T cell lymphoproliferative disorder (PCSMLPD) is a rare cutaneous disease, and has only relatively recently been recognised by the World Health Organisation (WHO) as a distinct disease entity. (1) PCSMLPD is reported to have an indolent clinical course and an excellent response to local therapies. (2-7) Although not considered malignant, local and distant relapses have been reported. (8, 9) PCSMLPD typically presents as a protruding, erythematous nodule on the face or neck, and, therefore, frequently represents a cosmetic concern for patients.

In response to Topkan E. et al. letter (Radiother Oncol. 2022;174:132. doi:

  • Nicola Dinapoli,
  • Mariangela Massaccesi,
  • Francesco Miccichè
Published online: November 28, 2022
On behalf of authors of the article by Massaccesi et al.[1] we are grateful to Topkan E et al.[2], to whom we respond, for defining our nomogram “unarguably [...] useful in routine radiation oncology”, and we add, even though it has not been externally validated yet. Indeed, we believe that the lack of external validation is not completely detrimental to the overall value of the work, simply because, usually, most of the articles referring to dosimetric and clinical results for toxicity assessment, written to a good quality standard, have an approach like ours: prospective collection of data and mostly carried out in single-center settings.

November 25, 2022

Comparing symptom reporting by prostate cancer patients and healthcare professionals in the international multicentre REQUITE study

  • Philipp Heumann,
  • Miguel E. Aguado-Barrera,
  • Barbara Avuzzi,
  • ...
  • Jenny Chang-Claude,
  • Petra Seibold
  • on behalf of the REQUITE Consortium
Published online: November 25, 2022
Open Access
The assessment of treatment-related symptoms and severity is subject to the perception and interpretation of healthcare professionals such as physicians and study nurses [1]. Patient-reported outcomes (PROs) have been suggested to improve communication between patients and healthcare professionals and to facilitate early detection of adverse events [1,2]. Thus, inclusion of the patient perspective has received increased attention in recent years [3]. Treatment-related symptoms have been shown to affect patients' physical and psychosocial domains of quality of life [4].

November 11, 2022

Cost-effectiveness of proton radiotherapy versus photon radiotherapy for non-small cell lung cancer patients: Exploring the model-based approach

  • L. Aldenhoven,
  • B. Ramaekers,
  • J. Degens,
  • ...
  • A.C. Dingemans,
  • D. De Ruysscher,
  • M. Joore
Published online: November 11, 2022
Open Access
Proton radiotherapy (PT) is a potentially beneficial (e.g. reduced toxicities) but significantly more expensive treatment strategy for patients with stage I-III non-small cell lung cancer (NSCLC) compared to photon-based radiotherapy (XRT).1,2 Furthermore, treatment capacity is limited.3 Considering the limited treatment capacity, costs and the substantial number of patients with NSCLC, great attention should be paid to optimal patient selection, since not all patients will benefit from PT. Hence, using PT instead of XRT without optimal patient selection would lead to unnecessary high costs, inefficient and unfair healthcare provision.

November 2, 2022

Postoperative radiotherapy for ypN2 non-small cell lung cancer after neoadjuvant chemotherapy and surgery warrants further evaluation

  • Yongxing Bao,
  • Zhouguang Hui
Published online: November 02, 2022
Komiya and colleagues’ study showed the survival benefit of postoperative radiotherapy (PORT) in patients with ypN2 non-small cell lung cancer after neoadjuvant chemotherapy and surgery through the National Cancer Database (NCDB) [1]. The results are of great significance for exploring the indication of PORT for N2 non-small cell lung cancer. Compared with pN2, patients with ypN2 might face more regional tumour burden and higher risk of systematic therapy resistance, which may theoretically benefit more from PORT.

Response to Bao et al

  • Takefumi Komiya,
  • Shinkichi Takamori,
  • Gregory Wilding
Published online: November 02, 2022
We appreciate Bao et al. for their interest on our recently reported retrospective study regarding the use of postoperative radiotherapy (PORT) in patients with persistent N2 non-small cell lung cancer after neoadjuvant chemotherapy [1,2]. The role of PORT has been one of the controversial subjects in thoracic oncology for decades. Although the recent prospective phase III trials demonstrated lack of survival benefit in overall N2 population, the subgroup analysis of patients who have undergone neoadjuvant chemotherapy had a significantly longer disease-free survival in those with PORT [3,4].

Response to Gargi S Sarode, Sachin C Sarode, and Rahul Anand’s Letter to the Editor of Radiotherapy and Oncology regarding the paper titled “Impact on xerostomia for nasopharyngeal carcinoma patients treated with superficial parotid lobe-sparing intensity-modulated radiation therapy (SPLS-IMRT): A prospective phase II randomized controlled study.” by Huang et al.

  • Huageng Huang,
  • Jingjing Miao,
  • Chong Zhao,
  • Lin Wang
Published online: November 02, 2022
We are very grateful for these great comments made by Prof. Sachin C Sarode and his teams [1] about our recent article [2]. We agree that chronic betel quid (BQ) and alcohol consumption habits and Type 2 diabetes will have a negative influence on patients’ salivary functions and probably aggravate the severity of xerostomia, just as previous studies reported [3–5]. Hereby, we want to provide more information on these aspects.

Not only volumes matter for breast radiation therapy

  • Orit Kaidar-Person,
  • Oreste Gentilini,
  • Philip Poortmans
Published online: November 02, 2022
In contrast to most other indications in radiation oncology, many adhere to field-based techniques based on bony landmarks for breast cancer radiation therapy (RT), representing approximately 25% of the department’s workload [1]. Similarly, the boost volume often is considered erroneously as the “surgical bed” including visible surgical changes, without full understanding of the “tumour bed” concept, often leading to excessively large boost volumes. Therefore, the analysis by Thomsen et al., of the relation between breast induration grade 2–3 at 3 years after RT and the irradiated breast volume, using the data from the Danish Breast Cancer Group (DBCG) phase III prospective trial comparing whole breast irradiation (WBI) with partial breast irradiation (PBI) [2] [cite as additional reference: Thomsen et al, Radiother Oncol 2022] is extremely relevant.

Letter to the editor of radiotherapy and oncology regarding the paper titled “Impact on xerostomia for nasopharyngeal carcinoma patients treated with superficial parotid lobe-sparing intensity-modulated radiation therapy (SPLS-IMRT): A prospective phase II randomized controlled study.” by Huang et al.

  • Gargi S. Sarode,
  • Sachin C. Sarode,
  • Rahul Anand
Published online: November 02, 2022
In a recently published paper, Huang et al. [1] implicitly demonstrated the significance of superficial parotid lobe-sparing intensity-modulated radiation therapy (SPLS-IMRT) in reducing the incidence of xerostomia at 12 months without compromising survival. We appreciate the voluminous work done by the authors and take this opportunity to discuss some of the perspectives on the study.

October 20, 2022

Dose-escalated re-irradiation improves outcome in locally recurrent head and neck cancer – Results of a large multicenter analysis

  • Johannes Roesch,
  • Michael Oertel,
  • Simone Wegen,
  • ...
  • Maria Vinsensia,
  • Markus Hecht
  • on behalf of Young DEGRO Group
Published online: October 20, 2022
Malignancies of the head and neck region arise from mucosal epithelium of the oral cavity, pharynx or larynx and are known collectively as head and neck squamous cell carcinoma (HNSCC). Worldwide estimates suggest almost 880,000 cases accounting for more than 440,000 deaths per year and numbers seem to grow steadily [11]. In primary, locally advanced HNSCC current standard of care is surgery followed by adjuvant radiotherapy or radiochemotherapy (RCT), or definitive RCT. Due to advances in multimodal treatment, radiation techniques and adverse event management, overall survival (OS) in this patient cohort improved over the last decades [30].

October 17, 2022

Adjuvant chemotherapy and hypofractionated whole breast cancer radiotherapy: Is it time to rethink the sequencing?

  • Grazia Lazzari,
  • Luciana Rago,
  • Angela P. Solazzo,
  • ...
  • Antonietta Montagna,
  • Giovanni Castaldo,
  • Giovanni Silvano
Published online: October 17, 2022
In regard to the article on DBCG 82bc trial [1], an important milestone has been reached, because it has definitely demonstrated the benefits of PMRT at 30-year long-term. Looking ahead, several considerations should be done in light of the advantages of the new breast radiation schedules.

Breast cancer radiotherapy: Is it time to rethink the indication?

  • Birgitte Vrou Offersen,
  • Marie Overgaard,
  • Jens Overgaard
Published online: October 17, 2022
Based on our recent published paper [1] Lazzari et al. [2] raise the general question of whether we should rethink the sequencing of radiotherapy and systemic treatment in early breast cancer (BC), as recently discussed elsewhere [3]. The complexity in treating patients with BC has increased considerably since the accrual of patients in the DBCG 82b&c trial. There are several important results from the trial, that are still valid today, but also pivotal differences making extrapolation of the DBCG 82b&c results up to 2020’s difficult.

Volume matters: Breast induration is associated with irradiated breast volume in the Danish Breast Cancer Group phase III randomized Partial Breast Irradiation trial

  • Mette S. Thomsen,
  • Jan Alsner,
  • Hanne M. Nielsen,
  • ...
  • Jens Overgaard,
  • Birgitte V. Offersen
  • on behalf of the DBCG RT Committee
Published online: October 17, 2022
Open Access
Radiation therapy (RT) of the whole breast used to be the standard care after breast-conserving surgery and was shown to significantly lower the risk of local, regional and distant failure and improve overall survival [1]. However, for patients with a relatively low-risk breast cancer partial breast irradiation (PBI) has gained more interest to reduce adverse events by irradiating smaller volumes [2] without a higher risk of local recurrence.

In reply to Li et al. Letter to the editor. “Once daily (OD) versus twice-daily (BID) chemoradiation for limited stage small cell lung cancer (LS-SCLC): A meta-analysis of randomized clinical trials.”

  • Gustavo A. Viani,
  • Andre G. Gouveia,
  • Fabio Y. Moraes
Published online: October 17, 2022
We appreciate the interest by Li Zheng et al in our paper [1]. In their accompanying letter, several points are raised about our work, and here we are addressing all of those points. First, Li Zheng et al mentioned that “the fixed-effect was used to calculate the heterogeneity between the outcomes, and when necessary, the random effect was employed to evaluate it.” According to our and the available knowledge, this strategy is totally acceptable. Other meta-analyses, including the Cochrane or not meta-analysis, used the same approach to solve this question (i.e.

October 3, 2022

Letter regarding “Once daily (OD) versus twice-daily (BID) chemoradiation for limited stage small cell lung cancer (LS-SCLC): A meta-analysis of randomized clinical trials”

  • Zheng Li,
  • Yue Hu,
  • Qiang Li
Published online: October 03, 2022
With great interest, we read the article by Viani et al. [1] recently published in the Green Journal in August 2022. The authors conducted a meta-analysis to synthesize the randomized controlled trials (RCTs) for assessing once-daily versus twice-daily chemoradiation for limited-stage small-cell lung cancer. It is necessary for corresponding clinical decision-makings because meta-analysis could provide more determinate evidence. However, some issues should be addressed to reduce the risk of potential biases and obtain more convincing results.

July 26, 2022

Pre-operative Stereotactic Radiosurgery for Cerebral Metastatic Disease: A Retrospective Dose-Volume Study

  • Alejandro Bugarini,
  • Evan Meekins,
  • Joshua Salazar,
  • ...
  • Edward A. Monaco III,
  • Andrew R. Conger,
  • Anand Mahadevan
Published online: July 26, 2022
Cerebral metastatic disease is a significant cause of mortality and morbidity and occurs in up to 40% of adult patients with solid malignancies.[1] Stereotactic radiosurgery (SRS) after maximal safe resection has become a common treatment strategy due to its avoidance of whole brain radiation therapy, excellent local control and improved overall survival rate.[2-4] Despite its high conformality profile, the incidence of radionecrosis (RN) with this approach is estimated to be 5%-25%.[3,5,6] Patients RN-induced deterioration often require further intervention, such as steroid administration, bevacizumab, resection, and laser interstitial thermocoagulation in select cases, which augments their morbidity.

June 14, 2022

Response to “Letter to the editor of radiotherapy and oncology regarding of the article “Dosimetric parameters related to occurrence of distant metastases and regional nodal relapse after SBRT for early-stage non-small cell lung cancer” by Lalonde et al.”

  • Ronald Lalonde,
  • Mohamed Abdelhakiem,
  • Andrew Keller,
  • M. Saiful Huq
Published online: June 14, 2022
We thank the authors of this letter [1] for their interest in our work [2]. They discuss several concerns about the work, which we will be happy to address.

Letter to the editor of radiotherapy and oncology regarding of the article “Dosimetric parameters related to occurrence of distant metastases and regional nodal relapse after SBRT for early-stage non-small cell lung cancer” by Lalonde et al.

  • Kaixuan Yang,
  • Chuntang Sun,
  • Rutie Yin
Published online: June 14, 2022
The goal of this letter is not to underestimate the work done by Lalonde and colleagues [1], “Dosimetric parameters related to occurrence of distant metastases and regional nodal relapse after SBRT for early-stage non-small cell lung cancer” published on Radiotherapy and Oncology in 2022. Instead, this letter intends to draw attention to certain incorrect conclusions concerning four-dimensional CT (4D-CT), which appear to be based on different respiratory motion management strategies in lung cancer radiotherapy [1–2].