Radiotherapy remains one of the most prevalent forms of cancer treatment, with approximately 50% of all cancer patients receiving some form of radiation treatment throughout the course of their illness [1]. In short, radiotherapy aims to deprive cancerous cells of their multiplicative ability through the initiation of DNA double-stranded breaks (DSB). Yet, cells have mechanisms to repair such DSB — non-homologous end-joining (NHEJ) [2] and homologous recombination (HR) [3] — allowing the continued proliferation of cancer even after intense radio treatment. Nearly 60% of all patients remain uncured after radio treatment [1]. Notably, histone deacetylase inhibitors (HDACi), when used in combination with traditional radiotherapy, have shown promising anticancer effects. Although the underlying mechanism is not fully uncovered, studies have shown that HDACi prevent DSB repair which in turn mediates, at least in some significant part, the radio sensitization of cancerous cell lines.

Purpose: To determine the analgesic response to a low-dose radiation therapy (RT) in trochanteric bursitis in elderly patient’s refractory to conventional therapies. Methods: We evaluated sixty consecutive patients diagnosed with trochanteric bursitis receiving RT in our institution from July 2010 to August 2014. All patients were treated with a total dose of 10 Gy in 10 daily fractions. The median age was 68.0 years (mean 68.5 years, range 40-89 years). All patients were evaluated for the pain assessment using a visual analogue scale (VAS) before the radiotherapy, at 1 and 4 months after radiotherapy and then yearly thereafter. Results: Patient’s population analyzed according to patients’ age: patients at diagnosis: patients aged (= 70 years old and patients <70 years old. Basic characteristics in the group of elderly patients (= 70 years old) and the rate of response to radiotherapy were similar in both groups. No complications were observed after radiotherapy. The decrease of pain according to subjective evaluation with VAS scale was significant in the total of patients (VAS mean pre-RT 7.48, standard deviation (SD) 1.27, range 3-10 vs. VAS mean post-RT 3.81, SD 2.54, range 0-8), and for each group separately (p=0.000). In the group <70 years: VAS mean pre-RT was of 7.57 (SD 1.12, range 3-10) and VAS mean post-RT was of 4.00 (SD 2.64, range 0-8). In the group = 70 years VAS mean pre-RT was of 7.24 (SD 1.45, range 4-10), and VAS mean post-RT was of 3.46 (SD 2.43, range 0-8). Conclusion: The percentage of response was similar in patients with = 70 years at diagnosis and the group <70 years. A low-dose radiation therapy is an effective treatment of trochanteric bursitis in elderly patients.

The various production routes of the prospective medical radioisotopes 43Sc, 44gSc, 44mSc, 47Sc, 4Ti/44gSc, 99mTc, 72Se/72As and 211At were investigated by a team from the Heavy Ion Laboratory, University of Warsaw (HIL-UW), the University of Silesia (US) and the National Centre for Nuclear Research (NCNR). Three cyclotrons were employed: the K=160 heavy-ion cyclotron with an internal 32 MeV alpha particle beam and the p/d PETtrace medical cyclotron at HIL and the C30 proton cyclotron at NCNR in Swierk, near Warsaw. The Thick Target Yields, activity at the End of Bombardment (EOB) and the impurities produced in addition to the main isotope are reported. The possible medical applications of these radioisotopes are briefly discussed

Primary orbital lymphoma is a rare malignancy that accounts for only 1% of all lymphomas, and more than half of orbital lymphomas present histology of marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT). MALT lymphoma is an indolent and slow growing disease that is very radiosensitive. Radiation therapy is thus the first choice of curative treatment for MALT lymphoma. The total dose of approximately 30 Gy in conventional fractions has been most frequently used for the treatment of MALT lymphoma, and has achieved an excellent local control rate of = 95%. Recently, the total dose has been reduced to 24 Gy to 25 Gy in some institutions. Furthermore, low dose irradiation with 4 Gy in 2 fractions is also given, but the long-term efficacy is still unclear even though the initial response is good. In contrast, higher dose irradiation with >30 Gy is not recommendable, because there is no evidence that such higher doses enhance the efficacy of local control, and because higher doses can cause unacceptable toxicities, such as severe retinopathy.

Histiocytic sarcoma (HS) is an extremely rare neoplasia, of hematopoietic origin that accounts for less than 1% of hematologic malignancies. HS can be localized or disseminated and the majority of lesions are reported presenting at extra-nodal sites, most frequently in the soft tissues and skin. Most patients presenting HS are being treated on an individual basis and the outcomes are still poor, especially in those with advanced or disseminated disease. There is no standard treatment recommended for HS. The treatment protocols available in the literature are diverse, with most patients being treated on an individual basis. Surgery and/or chemotherapy are the most commonly employed treatments, but radiotherapy seems to be an effective option in patients with localized disease.

Parathyroid cancer is an uncommon endocrine malignancy representing 0.005% of all cancers with the less than 1% frequency in all primary hyperparathyroid patients. The treatment of choice is radical surgical resection – parathyroidectomy and en bloc resection of surrounding tissues. Radiofrequency ablation, radiotherapy and chemotherapy are therapeutic palliative options without evidence of effectiveness. In parathyroid carcinoma hypercalcaemia rather than local infiltration or metastases presence is the main cause of death. At this work we introduce a 10 years case history of a patient with hormonally active disseminated parathyroid cancer in whom the use of radiotherapy allowed for long lasting hypercalcaemia control. The case we present and data reported by others though covering a small number of patients may indicate potential positive role of radiotherapy in parathyroid carcinoma both in case of residual local or metastatic disease.

Cellular senescence is a complex process of irreversible growth arrest which contributes to several physiological and pathological conditions. A variety of intrinsic or extrinsic stress signals, including those induced by Radiation Therapy (RT) also in combination with chemotherapeutic drugs, are able to cause stress-induced premature senescence in cancer cells (known as Therapy-Induced Senescence, TIS). Although TIS may inhibit tumor growth following RT, a number of outstanding issues about long-term tumor control and recurrence still remain unclear. The aim of this review is to describe the principal aspects of radiation induced senescence, the molecular pathways involved and the Senescence-Associated Secretory Phenotype (SASP). Finally, we report some therapeutic applications with the use of targeted molecules in TIS approaches.

Patients with locally advanced Non-Small Cell Lung Cancer (NSCLC) often show significant tumor regression and anatomical changes during the course of radiation treatment. As reaction to these changes, planned treatment parameter will be modified multiple times so that the overall treatment can be optimized. This is termed as Adaptive Radiotherapy (ART). While significant progress has been made in the past few years for development of different ART techniques, challenges still exist in implementation of this treatment modality in clinic. In this topical review, techniques used in different ART components will be briefly reviewed, and strategies to maximize the efficacy of adaptive treatment will also be discussed.

Goal: The overall goal of this study is to present data assisting the implementation of the principle based dose calculation algorithm Acuros XB for Stereotactic Body Radiation Treatments (SBRT) of lung tumors. In particular, the goal is to investigate differences in target dose distributions calculated by the clinical algorithms AAA and Acuros XB as well as by the Monte Carlo method. Materials and Methods: Twenty conventional 3D conformal plans for SBRT of lung cancer were investigated. The prescribed dose was 3 Gy × 22 Gy at the center and 3 Gy × 15 Gy at the periphery of PTV. The plans were originally designed with AAA based on the requirement PTV-V100% (percentage of PTV receiving a dose larger than 100%=45 Gy), to be 100%. Recalculations were performed by utilizing Acuros XB as well as by full Monte Carlo method. Dose variations were evaluated in terms of DVH parameters D5%, D50%, D98% for GTV and PTV as well as PTV-V100%. Five plans showing large algorithm sensitivity in terms of PTV-V100% were re-planned by Acuros XB using the same treatment planning criteria. Results: AAA systematically overestimated the PTV dose compared to Acuros XB and Monte Carlo. Differences between AAA and Acuros XB of up to 8%, 10% and 5% were observed for PTV-D50%, PTV-D98% and PTV-V100%, correspondingly. The values obtained by the Monte Carlo method were up to 7% lower than these for Acuros XB. The variations in the PTV dose estimation could not be related to patient/plan characteristics like target volume, lung tissue volume included in the target or tumor proximity to the lung wall. The variations in the GTV parameters were smaller and the agreement between AAA and AXB as well as between Acuros XB and Monte Carlo was within 3%. Planning with Acuros XB increased the volume of the lung tissue close to the tumor receiving full dose by more than 20%. Conclusion: PTV dose coverage was overestimated in plans calculated by AAA. Transition to Acuros XB without changing the treatment planning criteria increased the dose to the lung tissue close to the tumor. The GTV dose coverage was more robust with respect to the algorithm changes.

Expression of cyclooxygenase-2 (COX-2) and subsequent higher availability of eicosanoids are important modulators of tumor radioresistance. Additionally, elevated COX-2 protein is closely associated with hypoxia, which itself is a key promoter of tumor radioresistance. In this regard, selective COX-2 inhibitors (coxibs) containing a nitric oxide (NO)-releasing moiety (NO-coxibs) are hypothesized to act as bi-functional radiosensitizers. Therefore, novel NO-coxibs with a (pyrazolyl) benzenesulfonamide lead were investigated in vitro. As model, two human melanoma cell lines were exposed to several doses of X-ray in presence or absence of the novel NO-coxibs or the corresponding coxib during irradiation. Cells were examined in clonogenic cell survival assays to determine radiosensitizing effects under both normoxic and hypoxic conditions. COX-2 protein expression of two melanoma cell lines with a dissimilar baseline COX-2 synthesis was increased by irradiation and, furthermore, by experimental hypoxia. Radiosensitivity of both cell lines was significantly enhanced by the novel NO-coxibs and, to a lesser extent, also by the corresponding coxib. Moreover, the most potent NO-coxib 5 significantly increased the radiosensitivity of both cell lines also under hypoxic conditions. By administration of 5 the required radiation dose for 10% survival could be reduced from 6.6 Gy (DMSO control) to 5.2 Gy (p<0.01) for the ‘COX-2-positive’ A2058 cells and from 4.2 Gy (DMSO control) to 3.2 Gy for the ‘COX-2-negative’ Mel-Juso cells. The results confirm the auspicious bifunctional approach of the novel NO-coxibs as potential adjuvant radiosensitizers under normoxic and hypoxic conditions in vitro. Further studies are necessary to confirm the promising findings in vivo.

Purpose: Review of our experience in treating thymic carcinoma patients using a combination of surgery, chemotherapy and radiation therapy. Methods: An institutional review of thymic carcinoma patients treated between 2007 and 2014 was performed analyzing clinical characteristics, treatment intent, surgical margin status, and radiation treatment dose. Survival curves were generated using the Kaplan-Meier method. Results: Nine individuals were treated for newly diagnosed thymic carcinoma. Three patients had unresectable disease at presentation; two of these were treated with definitive chemo-radiation therapy while another received neoadjuvant chemotherapy. Seven subjects underwent surgical resection (one after neoadjuvant chemotherapy) with pathological staging ranging from IIa – IVb disease. Patients were planned for adjuvant radiotherapy followed by chemotherapy; however, one developed liver metastases prior to initiating radiotherapy and was therefore treated with palliative chemotherapy alone. A second patient was non-compliant with radiation treatments and was considered as treated with palliative chemotherapy alone. Of the seven patients who completed definitive treatment, median time to progression and overall survival has yet to be reached. Only one of these patients developed progressive disease 10 months after completing treatment and eventually succumbed to disease 41 months after completing definitive therapy. With a median follow up of 30 months, two year overall survival is 67% for all patients. Conclusion: Resection with an emphasis on best possible oncologic margins, followed by radiation and chemotherapy remains an effective treatment strategy for advanced stage thymic carcinoma. In patients who present with unresectable tumors, neoadjuvant chemotherapy or definitive chemo-radiation therapy may also be considered as viable treatment strategies.

The Linear Quadratic (LQ) survival relation is presented along with its derivation from the Theory of Dual Radiation Action (TDRA) and the related Microdosimetric Kinetic (MK) model. The role of the LQ model in the reporting and interpretation of experimental and clinical studies of the effects of ionizing radiation exposure is discussed. The definition of a Biological Effective Dose (BEDa/ß) based on the LQ model is given and its use to compare fractionated radiation treatment courses is described. The implications of heterogeneity of radio sensitivity among the cells of an irradiated cell population with regard to the LQ survival relation and the calculation of the BEDa/ß are described. The results of important early studies reported using survival constants defined by the target model are reviewed and related to the survival constants of the LQ survival relation. The dependence of the relative biological effectiveness (RBE) on the linear energy transfer (LET) is presented.

For decades, the standard of care for radiation treatment of early larynx cancers has been conventional treatment using opposed lateral fields encompassing the larynx and overlying neck structures, including the adjacent carotid arteries. The relative simplicity of the 3D technique and the excellent outcomes were shown in several series [1-4]. The ultimate local control is even higher if we take into account the availability of surgical salvage using hemilaryngectomy or total laryngectomy.