COVID-19 and information and communication technology in radiation oncology:A new paradigm

Due to coronavirus disease 2019 pandemic caused by severe acute respiratory syndrome coronavirus 2,there has been a major reallocation of resources that has impacted the treatment of many diseases,including cancer.The growing use of information and communication technologies(ICT),together with a new approach to work aimed at ensuring the safety of health care professionals and patients alike,has allowed us to maintain the quality of care while ensuring biosecurity.The application of ICT to health care(eHealth)aims to significantly improve the quality,access to,and effectiveness of medical care.In fact,the expanded use of ICT has been recognized as a key,cost-effective priority for health care by the World Health Organisation.The medical speciality of radiation oncology is closely linked to technology and as a consequence of coronavirus disease 2019,ICT has been widely employed by radiation oncologists worldwide,providing new opportunities for interaction among professionals,including telemedicine and e-learning,while also minimizing treatment interruptions.Future research should concentrate on this emerging paradigm,which offers new opportunities,including faster and more diverse exchange of scientific knowledge,organizational improvements,and more efficient workflows.Moreover,these efficiencies will allow professionals to dedicate more time to patient care,with a better work-life balance.In the present editorial,we discuss the opportunities provided by these digital tools,as well as barriers to theirimplementation,and a vision of the future.

Report of China's innovation increase and research growth in radiation oncology

Aims： To investigate the research status of radiation oncology in China through survey of literature in international radiation oncology journals and retrospectively compare the outputs of radiation oncology articles of the three major regions of China--Mainland （ML）, Taiwan （TW） and Hong Kong （HK）. Methods： Radiation oncology journals were selected from ＂oncology＂ and ＂radiology, nuclear ＆ medical image＂ category from Science Citation Index Expand （SCIE）. Articles from the ML, TW and HK were retrieved from MEDLINE. The number of total articles, clinical trials, case reports, impact factors （IF）, institutions and articles published in each journals were conducted for quantity and quality comparisons. Results： A total 818 articles from 13 radiation oncology journals were searched, of which 427 are from ML, 259 from TW, and 132 from HK. Ninety-seven clinical trials and 5 case reports are reported in China. Accumulated IF of articles from ML （1,417.11） was much higher than that of TW （1,003.093） and HK （544.711）, while the average IF of articles from ML is the lowest. Conclusions： The total number of articles from China especially ML increased significantly in the last decade. The number of articles published from the ML has exceeded those from TW and HK. However, the quality of articles from TW and HK is better than that from ML.

Radiation Oncology and Medical Devices(Part 2)

Radiation oncology is one of the three major treatment modalities to manage cancer patient cares,and is a discipline mainly driven by technology and medical devices.Modern radiation treatments have become fairly complex and involve in utilizing a variety of medical devices to achieve the goal of providing conformal radiation dose coverage to the tumor target(s)while maximizing the sparing of normal organ structures.Recently,different forms of linear accelerators/radioactive source based machines have been invented and developed with the aim of providing improved treatments and more treatment options.Besides linear accelerators(Linac)that have been undergoing constant improvement and advancement and can deliver fairly complicated dose distribution patterns,imaging systems,computer information and calculation systems have been more and more integrated into radiotherapy processes.To bring radiotherapy to a potentially higher level,many institutions have either acquired or started to consider particle therapy,especially proton therapy.The complexity of modern radiotherapy demands in-depth understanding of radiation physics and machine engineering as well as computer information systems.This paper is intended to provide an introductory description of radiation oncology and related procedures,and to provide an overview of the current status of medical devices in radiotherapy in the United States of America.This paper covers the radiation delivery systems,imaging systems,treatment planning systems,record and verify systems,and QA systems.

Radiation Oncology and Medical Devices( Part 1)

Modern radiation treatments have become fairly complex and involve in utilizing a variety of medical devices to achieve the goal of providing conformal radiation dose coverage to the tumor target(s)while maximizing the sparing of normal organ structures.Recently,different forms of linear accelerators/radioactive source based machines have been invented and developed with the aim of providing improved treatments and more treatment options.Besides linear accelerators(Linac)that have been undergoing constant improvement and advancement and can deliver fairly complicated dose distribution patterns,imaging systems,computer information and calculation systems have been more and more integrated into radiotherapy processes.To bring radiotherapy to a potentially higher level,many institutions have either acquired or started to consider particle therapy,especially proton therapy.The complexity of modern radiotherapy demands in-depth understanding of radiation physics and machine engineering as well as computer information systems.This paper is intended to provide an introductory description of radiation oncology and related procedures,and to provide an overview of the current status of medical devices in radiotherapy in the United States of America.This paper covers the radiation delivery systems,imaging systems,treatment planning systems,record and verify systems,and QA systems.

Artificial intelligence in radiation oncology

Artificial intelligence(AI)is a computer science that tries to mimic human-like intelligence in machines that use computer software and algorithms to perform specific tasks without direct human input.Machine learning(ML)is a subunit of AI that uses data-driven algorithms that learn to imitate human behavior based on a previous example or experience.Deep learning is an ML technique that uses deep neural networks to create a model.The growth and sharing of data,increasing computing power,and developments in AI have initiated a transformation in healthcare.Advances in radiation oncology have produced a significant amount of data that must be integrated with computed tomography imaging,dosimetry,and imaging performed before each fraction.Of the many algorithms used in radiation oncology,has advantages and limitations with different computational power requirements.The aim of this review is to summarize the radiotherapy(RT)process in workflow order by identifying specific areas in which quality and efficiency can be improved by ML.The RT stage is divided into seven stages:patient evaluation,simulation,contouring,planning,quality control,treatment application,and patient follow-up.A systematic evaluation of the applicability,limitations,and advantages of AI algorithms has been done for each stage.

Radiation oncology practice during COVID-19 pandemic in developing countries

Radiation therapy(RT)is considered one of the cornerstone modalities of treatment for different cancer types.The preparation and delivery of RT requires a number of staff members from different disciplines within the radiation oncology department.Since the emergence of the corona virus disease 2019(COVID-19)pandemic,RT,similar to other cancer care modalities,has been adapted to minimize patient and staff exposure without compromising the oncological outcomes.This was reflected in the dramatic practice changes that occurred in the past year to address the lockdown restrictions and fulfill the infection control requirements.RT practices differ across regions based on financial and training levels,and developing countries with limited resources have struggled to maintain radiation treatment services at a level equivalent to that in developed countries while following pandemic control guidelines.The response during the COVID-19 pandemic varied between developing countries according to the infection rate and RT technological capabilities.In this editorial,we review recently published articles addressing radiotherapy practice reports during the COVID-19 pandemic in developing countries.

Survey of Stereotactic Body Radiation Oncology for Early Staged Non-Small Cell Lung Cancer in China

Purpose: To evaluate the current status of stereotactic body radiotherapy (SBRT) for early staged non-small cell lung cancer (NSCLC) at main cancer hospitals in China. Methods and Materials: The questionnaire was sent by mail and email to 21 hospitals, which include the patient enrollment, treatment technique, dose and fractionation, quality control, disease control and side effects. Results: Nineteen hospitals responded. It was found that SBRT has been used for early staged NSCLC in most of the hospitals participating in the survey. The patient characteristics and techniques were relatively consistent, but there were many controversies regarding dose fractionation and quality control. Conclusions: SBRT for early staged NSCLC has been applied at main cancer hospitals in China. However, considerable variation exists. The establishment of clinical guidelines and standardized quality control are crucial for further improvement.

Erratum to “Novel Wavelet-Based Segmentation of Prostate CBCT Images with Implanted Calypso Transponders” [International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 6 (2017) 336-343]

The original online version of this article (Liu, Y.X., Saleh, Z., Song, Y.L., Chan, M., Li, X., Shi, C.Y., Qian, X. and Tang, X.L (2017) Novel Wavelet-Based Segmentation of Prostate CBCT Images with Implanted Calypso Transponders. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 6, 336-343. doi: 10.4236/ijmpcero.2017.63030) was published without acknowledging our support. The authors wish to add the acknowledgments.

An overview of artificial intelligence in medical physics and radiation oncology

Artificial intelligence(AI)is developing rapidly and has found widespread applications in medicine,especially radiotherapy.This paper provides a brief overview of AI applications in radiotherapy,and highlights the research directions of AI that can potentially make significant impacts and relevant ongoing research works in these directions.Challenging issues related to the clinical applications of AI,such as robustness and interpretability of AI models,are also discussed.The future research directions of AI in the field of medical physics and radiotherapy are highlighted.

Advances of radiation oncology in China

Radiation therapy is one of the main treatment .modalities used in cancer management. It is the primary curative modality for about 30% of patients with cancer, and more than half of all cancer patients received radiation therapy sometime during the course of their disease. It is estimated that 70% of the patients with cancer required radiation therapy in China.1 Radiation oncology is based on the development of radiological physics, radiological biology and clinical oncology.

Progress of radiation oncology： known and unknown

Objective To elaborate known and unknown aspects of radiation oncology.Data sources Data cited in this review were obtained mainly from PubMed and Medline in English from 1999 to 2013,with keywords ＂individualized medicine＂,＂personalized medicine＂,＂radiation dose＂,＂radiation target＂,＂molecular targeted therapy＂,＂molecular imaging＂ and ＂functional imaging＂.Study selection Articles regarding radiation target delineation,radiation doses,new technology and equipment,combination of radiotherapy and molecular targeted therapy as well as other aspects were identified,retrieved and reviewed.Results A larger radiation field and a higher radiation dose are not always better.New equipment and technology are also not always better than conventional equipment and technologies.Effectiveness of radiotherapy combined with molecular targeted therapy needs more data to verify.Conclusion Personalized radiotherapy is the direction for the future.

Evolving role of biomaterials in diagnostic and therapeutic radiation oncology

Radiation therapy to treat cancer has evolved significantly since the discovery of x-rays.Yet,radiation therapy still has room for improvement in reducing side effects and improving control of cancer.Safer and more effective delivery of radiation has led us to novel techniques and use of biomaterials.Biomaterials in combination with radiation and chemotherapy have started to appear in pre-clinical explorations and clinical applications,with many more on the horizon.Biomaterials have revolutionized the field of diagnostic imaging,and now are being cultivated into the field of theranostics,combination therapy,and tissue protection.This review summarizes recent development of biomaterials in radiation therapy in several application areas.

Use of a dedicated day care unit in a modern radiation oncology facility -- a short audit

Our radiotherapy department specializes in all types of conformal therapy including stereotactic body radiotherapy,stereotactic radiosurgery and brachytherapy including interstitial and prostate seed implant.The department also includes a dedicated four-bed day care unit attached to the integrated brachytherapy suite.It is managed by a resident doctor,along with four staff nurses under the supervision of a radiation oncologist.We performed an audit of our day care unit to gain insight into its utilization and needs.

Re-evaluating the role of pelvic radiation in the age of modern precision medicine and systemic therapy

The efficacy of pelvic radiation in the management of locally advanced stage rectal cancer has come under scrutiny in the context of modern precision medicine and systemic therapy as evidenced by recent clinical trials such as FOWARC(J Clin Oncol 2019;37:3223-3233),NCT04165772(N Engl J Med 2022;386:2363-2376),and PROSPECT(N Engl J Med 2023;389:322-334).In this review,we comprehensively assess these pivotal trials and offer additional insights into the evolving role of pelvic radiation in contemporary oncology.

Potential of non-Western medicines in chemoradiotherapy for cervical cancer

This editorial explores the potential integration of non-Western medicine into radiotherapy for cervical cancer.While radiotherapy remains a radical treatment for cervical cancer,its associated toxicity and decline in quality of life can significantly impact patients’lives.Currently,most treatments are supportive,with no specific treatment options available in Western medicine.Non-Western medicine,often less toxic and easier to administer,has shown promising results when used alongside radiotherapy for cervical cancer.Despite these potential benefits,challenges such as limited evidence and restricted application areas persist.While non-Western medicines may offer potential improvements in chemoradiotherapy outcomes for cervical cancer,further research is necessary to substantiate these benefits.

Precision radiation oncology in head and neck cancer: beyond physical precision - a narrative review

Radiotherapy is an integral part of the management of head and neck cancers,both in radical and adjuvant settings.Traditionally,similar radiation dose and fractionation schedules have been used based on tumor stage with variable outcomes indicating“one size does not fit all”.In the era of precision medicine,though we have achieved physical precision with technological advancements,we have yet to attain biologic precision.In the current review,we have highlighted the different aspects of precision oncology such as hypoxia targeting,radiomics and radiogenomics,radiobiologic targeting,and big data.The review also discusses various potential therapeutic targets and approaches in head and neck cancer management that might help to increase radiosensitization,which in turn increase survival,and quality of life.This can be incorporated into the armamentarium of radiation oncology in all the phases of radiation planning,from diagnosis to treatment to the prognosis and management of long-term side effects.Biologic precision can be applied in the clinic to provide individualized,personalized treatment in the future.

Prognostic impact of inflammatory and nutritional biomarkers in pancreatic cancer

Pancreatic cancer is usually associated with a poor prognosis.Surgery is the main curative treatment but pancreatic operations are aggressive and new tools that help clinicians to predict surgical and prognostic outcomes are necessary.Lu et al recently published a retrospective,single centre cohort study evaluating the impact of seven nutritional and inflammatory markers in pancreatic cancer surgical patients:The albumin-to-globulin ratio,prognostic nutritional index(PNI),systemic immune-inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),nutritional risk index,and the geriatric nutritional risk index.A significant correlation was found between the PNI,SII,NLR,and PLR and a hospital discharge of less than 15 days.In a univariable analysis,PNI,SII,NLR and PLR were significantly related to recurrence-free survival and,in a multivariable analysis PNI was associated with overall survival.Various meta-analyses corroborate the results in terms of prognosis but individual studies are discordant on their usefulness.Besides,the cut-off values for these markers vary significantly between studies and there are no clinical trials comparing them to identify the most relevant ones.These are limitations when implementing nutritional and inflammatory biomarkers into clinical practice and further studies are needed in order to answer these questions.

Role of radiation therapy in gastric adenocarcinoma

Outcomes in patients with gastric cancer in the United States remain disappointing, with a five-year overall survival rate of approximately 23%. Given high rates of local-regional control following surgery, a strong rationale exists for the use of adjuvant radiation therapy. Randomized trials have shown superior local control with adjuvant radiotherapy and improved overall survival with adjuvant chemoradiation. The benefit of adjuvant chemoradiation in patients who have undergone D2 lymph node dissection by an experienced surgeon is not known, and the benefit of adjuvant radiation therapy in addition to adjuvant chemotherapy continues to be defined. In unresectable disease, chemoradiation allows long-term survival in a small number of patients and provides effective palliation. Most trials show a benefit to combined modality therapy compared to chemotherapy or radiation therapy alone. The use of pre-operative, intra-operative, 3D conformal, and intensity modulated radiation therapy in gastric cancer is promising but requires further study. The current article reviews the role of radiation therapy in the treatment of resectable and unresectable gastric carcinoma, focusing on current recommendations in the United States.

Gastrointestinal radiation injury:Symptoms,risk factors and mechanisms

Ionising radiation therapy is a common treatment modality for different types of cancer and its use is expected to increase with advances in screening and early detection of cancer.Radiation injury to the gastrointestinal tract is important factor working against better utility of this important therapeutic modality.Cancer survivors can suffer a wide variety of acute and chronic symptoms following radiotherapy,which significantly reduces their quality of life as well as adding an extra burden to the cost of health care.The accurate diagnosis and treatment of intestinal radiation injury often represents a clinical challenge to practicing physicians in both gastroenterology and oncology.Despite the growing recognition of the problem and some advances in understanding the cellular and molecular mechanisms of radiation injury,relatively little is known about the pathophysiology of gastrointestinal radiation injury or any possible susceptibility factors that could aggravate its severity.The aims of this review are to examine the various clinical manifestations of post-radiation gastrointestinal symptoms,to discuss possible patient and treatment factors implicated in normal gastrointestinal tissue radiosensitivity and to outline different mechanisms of intestinal tissue injury.

Gastrointestinal radiation injury:Prevention and treatment

With the recent advances in detection and treatment of cancer,there is an increasing emphasis on the efficacy and safety aspects of cancer therapy.Radiation therapy is a common treatment for a wide variety of cancers,either alone or in combination with other treatments.Ionising radiation injury to the gastrointestinal tract is a frequent side effect of radiation therapy and a considerable proportion of patients suffer acute or chronic gastrointestinal symptoms as a result.These side effects often cause morbidity and may in some cases lower the efficacy of radiotherapy treatment.Radiation injury to the gastrointestinal tract can be minimised by either of two strategies:technical strategies which aim to physically shift radiation dose away from the normal intestinal tissues,and biological strategies which aim to modulate the normal tissue response to ionising radiation or to increase its resistance to it.Although considerable improvement in the safety of radiotherapy treatment has been achieved through the use of modern optimised planning and delivery techniques,biological techniques may offer additional further promise.Different agents have been used to prevent or minimize the severity of gastrointestinal injury induced by ionising radiation exposure,including biological,chemical and pharmacological agents.In this review we aim to discuss various technical strategies to prevent gastrointestinal injury during cancer radiotherapy,examine the different therapeutic options for acute and chronic gastrointestinal radiation injury and outline some examples of research directions and considerations for prevention at a pre-clinical level.