The COVID-19 pandemic has opened several new disease scenarios, yielding novel syndromes that have never been seen before and resurrecting old inflammatory phenomena that are no longer recorded, such ...as radiation recall (RR) syndromes. Radiation recall syndrome is a limited field inflammatory reaction that occurs in a volume that was irradiated several months or years previously before being induced by a triggering factor. The most frequently reported phenomena are skin reactions; however, other organs could be involved, such as the lungs in radiation recall pneumonitis (RRP). It is a well-described inflammatory reaction that occurs within a pulmonary volume that was irradiated several months or years previously via radiotherapy (RT), triggered by factors such as drugs, including chemotherapy agents, immunotherapy, or vaccination. Indeed, during the COVID-19 pandemic, RRP following anti-COVID -19 vaccination or SARS-CoV2 infection was recently reported. ACE receptor-rich tissues such as lung or skin tissues were mainly involved. Herein, we present a case of RRP triggered by COVID-19 pulmonary infection in a woman who previously underwent adjuvant breast cancer radiotherapy. Although symptoms were typical, pulmonary CT findings depicted a unique distribution of ground-glass opacities (GGOs) throughout the previous radiation portals and mirror-like the radiation fields. Anamnesis and radiation plan evaluation were crucial in the diagnosis of RRP. Keywords: recall syndromes, adjuvant radiotherapy, immune memory, ACE receptors
•24 centres performed an autoplanning validation for whole breast radiotherapy.•Centers had large variations in case complexity and clinical practices.•A single autoplanning configuration was used ...for all patients and all centres.•Autoplanning was favorable compared to manual, but with large inter-centre variations.•Autoplanning configuration adaptation in some centres may enhance clinician satisfaction.
To present the results of the first multi-centre real-world validation of autoplanning for whole breast irradiation after breast-sparing surgery, encompassing high complexity cases (e.g. with a boost or regional lymph nodes) and a wide range of clinical practices.
The 24 participating centers each included 10 IMRT/VMAT/Tomotherapy patients, previously treated with a manually generated plan (‘manplan’). There were no restrictions regarding case complexity, planning aims, plan evaluation parameters and criteria, fractionation, treatment planning system or treatment machine/technique. In addition to dosimetric comparisons of autoplans with manplans, blinded plan scoring/ranking was conducted by a clinician from the treating center. Autoplanning was performed using a single configuration for all patients in all centres. Deliverability was verified through measurements at delivery units.
Target dosimetry showed comparability, while reductions in OAR dose parameters were 21.4 % for heart Dmean, 16.7 % for ipsilateral lung Dmean, and 101.9 %, 45.5 %, and 35.7 % for contralateral breast D0.03cc, D5% and Dmean, respectively (all p < 0.001). Among the 240 patients included, the clinicians preferred the autoplan for 119 patients, with manplans preferred for 96 cases (p = 0.01). Per centre there were on average 5.0 ± 2.9 (1SD) patients with a preferred autoplan (range 0–10), compared to 4.0 ± 2.7 with a preferred manplan (0,9). No differences were observed regarding deliverability.
The automation significantly reduced the hands-on planning workload compared to manual planning, while also achieving an overall superiority. However, fine-tuning of the autoplanning configuration prior to clinical implementation may be necessary in some centres to enhance clinicians’ satisfaction with the generated autoplans.
Dosimetric treatment optimization is recommended for radioiodine therapy of hyperthyroidism. However, many clinicians still claim that fixed activity administrations yield analogous effectiveness, ...sparing time-consuming pretherapeutic studies. The possibility to establish a dose-response correlation was here investigated, highlighting the added value of patient-specific dosimetry.
374 patients affected by autonomous thyroid nodule, or multinodular goitre – presenting abnormal blood tests (TSH, and/or FT3, FT4) – were treated. Post-therapy follow-up lasted for at least 1 year. 187 patients were treated with an empiric methodology (not basing on a pre-treatment dosimetric study). 187 patients underwent dosimetry-based treatments (collecting just three biokinetics points), including also 67 treatments based on a biologically effective dose (BED) prescription. The normality of blood tests at 1 year from the therapy, after the first treatment, was evaluated. The BED was also used in the result analysis for all dosimetry-based treatments. Statistical analysis was performed by Mann-Withney and Chi-squared test, univariate receiver operating characteristics (ROC) analysis, and interpolation of dose-response data by a logistic model.
Dosimetric differences between the unhealed and the healed group (p = 0.0067) resulted from the 120 treatments based on absorbed dose prescriptions, also after conversion of the absorbed dose values in BED (p = 0.0049): the Area-under-curve (AUC) was 0.758 and 0.770, respectively. No significant differences were observed for the healing probability between the BED- or absorbed dose-based treatments (p = 0.423). Considering the total 187 dosimetry-based treatments, the absorbed dose/BED-response curves showed regular trends with r-value of 0.979 and 0.977, respectively. The absorbed dose associated to a healing probability of 50% and 95%, was 42.6 Gy and 242.3 Gy, respectively. The probability of recurrence was 9.6%, exactly half of that associated to the empiric treatment group (19.3%, p = 0.0081).
Patient-specific dosimetry has proven to increase therapeutic effectiveness, reducing the recurrence frequency and the need of repeated treatments.
