The aim of this study was to identify potential risk factors for acute and late genitourinary toxicities and to determine, using a logistic regression model, which of these factors are also significant and robust predictors of these toxicities.

We conducted a retrospective study by analysing the patient records and their treatment plans from 2013 to 2021. In total, a cohort of 46 patients with clinically staged cT1c-T4N0-1M0 prostate adenocarcinoma was treated with three-dimensional conformal radiotherapy (3D-CRT) with doses ranging from 66 to 80 Gy. Post-radiotherapy genitourinary toxicities were classified and graded according to the Common Terminology Criteria for Adverse Events (CTCAE v4.0).

Median follow-up was 57·5 months (range: 39 – 88 months). In univariable analysis, patient age (p = 0·040), the prostate volume (p = 0·0423), the clinical prostate volume irradiated at the prescribed dose (p = 0·029) and the volume of the bladder receiving doses varying from 60 to 70 Gy were correlated with acute GU toxicities. Arterial hypertension (p = 0·022), some pre-existing urinary symptoms, a history of catheterisation (p = 0·044) and acute genitourinary toxicity (p = 0.009) were linked to late genitourinary toxicities. The logistic regression model found that the prostate volume (p = 0·0423) and the clinical prostate volume irradiated at the prescribed dose (p = 0·029) were predictive of acute GU toxicity. Hypertension (p = 0·039) and acute toxicities were predictive of late GU toxicity.

The results of our study showed that it is essential to identify patients at risk of toxicities from the start of radiotherapy and to offer more proactive monitoring and management.

This study investigated the dose difference (DD) in the surrounding dose area using the real-time motion tracking (RTMT) system in tomotherapy.

Seven stereotactic ablative body radiotherapy treatment plans with a single lesion were used for the investigations. Each treatment plan was evaluated for the Gamma passing rate (GPR) analysis in a static target motion using the ArcCHECK® phantom. Subsequently, each plan was matched with 8 clinical respiratory cycles to simulate moving target motion. The DD was calculated through point-to-point comparison and expressed as the frequency of the DD levels. The DD frequency was analysed for significant correlations with the target travelling distance, target size and respiratory frequency.

The GPR for criteria of 3%/2mm and 3%/3mm revealed values of 97·8 ± 1·9% and 99·5 ± 0·6%, respectively, for static motion. The highest frequency of DD was in the 5 – 10% range. A significant correlation was found between the target travelling distance and the frequency of percent DD at the 2·0 – 3·0% and 10·0 – 15·0% levels, as well as between target size and the frequency of percent DD at the 0·0 – 4·0% and 10·0 – 25·0% levels. Finally, no significant correlation was found between the frequency of percent DD and respiratory frequency.

RTMT introduced the DD in the surrounding treatment area. The DD was found to be up to 15·0% at 119·5 mm (water-equivalent distance) from the phantom centre. The DD was varied depending on the target travelling distance and size, but it did not depend on the respiratory frequency.

Verification of the coincidence between the radiation and mechanical isocentres is an essential quality assurance (QA) procedure for linear accelerators (linacs) in radiotherapy. Ensuring this alignment is critical for accurate beam targeting, especially in conformal and intensity-modulated radiotherapy techniques.

This study aimed to evaluate the feasibility and effectiveness of using computed radiography (CR) with a bare imaging plate (IP) to assess the coincidence between radiation and mechanical isocentres, as a practical QA method, especially applicable in resource-limited settings.

The study was conducted on a Precise linac installed at Bac Ninh General Hospital No2. A Fujifilm IP and an FCR Prima T2 reader were used. Mechanical isocentre marking was performed via 1 monitor unit (MU) open-field exposure. Radiation isocentre verification involved multiple exposures with narrow rectangular fields at various gantry, collimator and couch angles. The latent images were processed using FCR View software to analyse displacement diameters between mechanical and radiation centres.

The CR system demonstrated sufficient sensitivity to detect exposures as low as 1 MU. Deviations (diameters) were 0·44–1·04 mm with expanded uncertainty U up to 0·44 mm (k = 2). All measurements were within the ±2 mm tolerance recommended by American Association of Physicists in Medicine (AAPM) for non-stereotactic systems.

The use of a bare IP in CR offers a reliable and low-cost alternative for verifying the coincidence of radiation and mechanical isocentres. This method is suitable for routine QA procedures in clinical environments lacking access to radiochromic film or electronic portal imaging devices.

This study aimed to determine the optimal Biological Effective Dose (BED)-based compensation strategy for treatment interruptions in left-sided breast cancer radiotherapy, with a focus on evaluating cardiac substructures to address a previously unmet clinical need.

Twenty patients with left-sided breast cancer who had received radiotherapy were retrospectively enrolled.

Simulations assumed treatment interruptions (number of interruption days) occurred after the first week, ranging from 1 to 10 days. Three BED-based compensation strategies were evaluated: (A) maintaining total fractions and days while delivering twice-daily treatments; (B) maintaining total days while increasing the dose per fraction; and (C) keeping the dose per fraction constant while extending the overall treatment course. Original uninterrupted plans served as the baseline. BEDs for the planning target volume (PTV), simultaneous integrated boost (SIB), cardiac substructures and other organs at risk (OARs) were calculated. Physical and BED differences among the schemes were systematically compared.

Compared to the original scheme, physical doses to PTV and SIB were lower in Scheme B but higher in Scheme C. As interruptions increased from 1 to 10 days, PTV and SIB doses in Scheme B decreased to minimum values of 42.71 Gy and 50.58 Gy, respectively, while Scheme C resulted in maximum values of 58.60 Gy and 67.15 Gy. Analysis of BED changes (ΔBED) in OARs revealed that the left anterior descending artery (LAD) was the most affected cardiac substructure, with ΔBED values of 0.41, –1.20 and 0.60 for Schemes A, B and C, respectively, at 10 interruption days. Among other OARs, the left lung showed the highest ΔBED changes (0.39, –0.30 and 0.32, respectively). Most OAR comparisons reached statistical significance (ANOVA, p < 0.05).

Compensation strategies for radiotherapy interruptions significantly influence the BED of OARs, particularly in the LAD and left lung. Scheme B most effectively reduced the BED of OARs but requires replanning. Schemes A and C offer clinical convenience at the cost of a higher BED of OARs. The choice of compensation strategy should be individualised based on clinical priorities and patient-specific anatomy.

Radiotherapy (RT) is a highly effective breast cancer treatment. However, RT can deliver radiation dose to the healthy tissues of the shoulder, increasing the potential for long-term shoulder morbidity. This study compared the dose delivered to key shoulder muscles between common RT techniques and patient positioning.

The treatment plans of 54 patients were analysed, including those treated in the prone and supine positions. Eight shoulder muscles were contoured on each patient’s computer tomography scan. The following breast treatment techniques were analysed: hybrid-intensity-modulated RT (hybrid IMRT), wedged field, two partial arcs volumetric-modulated arc therapy (VMAT), hybrid VMAT, and 3-field supraclavicular technique. Moreover, the effect of patient positioning was also evaluated (supine versus prone). Muscle radiation exposure was compared for the mean dose and the percent muscle volume exposed to V15 Gy and V30 Gy.

The mean dose and exposed volume for the pectoralis major and pectoralis minor were similar between hybrid IMRT, wedged field, VMAT, and hybrid VMAT. VMAT and hybrid VMAT delivered a greater mean dose to most posterior shoulder muscles compared to hybrid IMRT, though overall exposure remained generally low for these muscles. The 3-field supraclavicular technique increased radiation exposure to all shoulder muscles, particularly to the pectoralis major, the pectoralis minor and the supraspinatus. Prone positioning significantly reduced V15 Gy and V30 Gy exposure for both anterior and posterior shoulder muscles.

Shoulder muscle exposure was similar between hybrid IMRT, wedged field, VMAT and hybrid VMAT. The anterior shoulder muscles were consistently exposed to radiation with all RT techniques investigated in this study. In comparison, the 3-field supraclavicular technique substantially increased the radiation exposure to the posterior shoulder muscles. Lastly, delivering radiation in the prone position spared the anterior and posterior shoulder muscles. These findings inform treatment planning decisions aimed at mitigating the risk of long-term shoulder dysfunction.

Radiation oncology (RO) plays a central role in modern cancer treatment. However, in Italy, this specialty remains under-represented in medical education, with limited awareness among students and many residency positions going unfilled. The gap between the importance of the discipline and student interest suggests a need to better integrate RO into medical training.

To assess the impact of early exposure, we conducted a pilot educational intervention involving 54th-year medical students. Participants completed a questionnaire before and after a six-hour clinical rotation in an RO department. The rotation included ward shadowing and introductory sessions on the role of the radiation oncologist.

At baseline, only 50% of students could describe the role of a radiation oncologist, and fewer than 10% were considering the specialty. Post-rotation, all students demonstrated an understanding of the profession. Positive perceptions of workload, safety and career prospects increased significantly (p < 0.01). The proportion of students expressing interest in pursuing RO rose modestly from 8% to 12%, while those definitively excluding it dropped from 40% to 36%. These findings suggest that even brief exposure can correct misconceptions and enhance receptiveness towards the field.

While a single half-day experience can meaningfully improve awareness and perceptions of RO, it is unlikely to drive major changes in career choices on its own. To translate greater understanding into actual recruitment, medical schools should implement more sustained and structured RO experiences throughout the curriculum.