Editor-in-Chief Emeritus Pick of Papers
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For each issue of Radiotherapy and Oncology, the Editor-in-Chief Emeritus Jens Overgaard, picks his favourite papers.
- Compared to paediatric patients, indications for proton therapy (PT) for adult patients are less acknowledged . Although radiation of intra-ocular tumours and chordoma/chondrosarcoma of the skull base are currently regarded as standard indications for adult patients in virtually all countries, there are major differences regarding patient selection for PT across European countries and even between centres in the same country [2–4]. This is especially true for adult patients who would normally be treated with photon therapy but may benefit from PT because of more favourable dose distributions.
- Although progress has been achieved in the treatment of CNS tumours, significant morbidity and mortality are still associated with childhood brain cancers. Current therapeutic strategies include a combination of surgery, chemotherapy and radiotherapy. While all treatment methods impose a certain risk, traditional photon-based treatments carry a high risk of adverse events, especially in very young patients. The more optimal physical and radiobiological properties of protons as compared to photons, have justified their implementation in radiotherapy, with several studies reporting promising results in otherwise difficult-to-treat cancers.
- Several national guidelines consider proton therapy an optimal radiation modality for treating pediatric tumors and reducing treatment toxicities [1–6]. Compared with photons, protons have better physical properties providing clear dosimetric advantages to improve treatment conformality and lower doses to surrounding normal tissues [7–9]. This could have considerable clinical benefits to reduce treatment toxicities while maintaining or improving cure rates, especially when treating young patients with a tumor located close to critical normal tissues, such as the brain stem, eyes and spinal cord.
- Radiotherapy plays an important role in the management of childhood cancer, with the primary aim of achieving the highest likelihood of cure with the lowest risk of radiation-induced morbidity. Proton therapy (PT) provides an undisputable advantage by reducing the radiation ‘bath’ dose delivered to non-target structures/volume while optimally covering the tumor with tumoricidal dose. This treatment modality comes, however, with an additional costs compared to conventional radiotherapy that could put substantial financial pressure to the health care systems with societal implications.
- Dual energy CT (DECT) scanners are nowadays available in many radiology departments. For radiotherapy purposes, new strategies using DECT imaging are investigated to optimize radiation treatment for multiple steps in the radiotherapy chain. This review describes how DECT based methods can be used for electron density estimation, effective atomic number decomposition and contrast material quantification. Clinical radiotherapy related applications for improved dose calculation accuracy of brachytherapy and proton therapy, metal artifact reduction techniques and normal tissue characterization are also summarized together with future perspectives on the use of DECT for radiotherapy purposes.