A Systematic Review on the Impact of Hypofractionated and Stereotactic Radiotherapy on Immune Cell Subpopulations in Cancer Patients

FLIP: a novel method for patient-specific dose quantification in circulating blood in large vessels during proton or photon external beam radiotherapy treatments

Purpose.To provide a novel and personalized method (FLIP, FLowand Irradiation Personalized) using patient-specific circulating blood flows and individualized time-dependent irradiation distributions, to quantify the dose delivered to blood in large vessels during proton or photon external beam radiotherapy.Methods.Patient-specific data were obtained from ten cancer patients undergoing radiotherapy, including the blood velocity field in large vessels and the temporal irradiation scheme using photons or protons. The large vessels and the corresponding blood flow velocities are obtained from phase-contrast MRI sequences. The blood dose is obtained discretizing the fluid into individual blood particles (BPs). A Lagrangian approach was applied to simulate the BPs trajectories along the vascular velocity field flowlines. Beam delivery dynamics was obtained from beam delivery machine measurements. The whole IS is split into a sequence of successive IEs, each one with its constant dose rate, as well as its corresponding initial and final time. Calculating the dose rate and knowing the spatiotemporal distribution of BPs, the dose is computed by accumulating the energy received by each BP as the time-dependent irradiation beams take place during the treatment.Results.Blood dose volume histograms from proton therapy and photon radiotherapy patients were assessed. The irradiation times distribution is obtained for BPs in both modalities. Two dosimetric parameters are presented: (i)D3%, representing the minimum dose received by the 3% of BPs receiving the highest doses, and (ii)V0.5 Gy, denoting the blood volume percentage that has received at least 0.5 Gy.Conclusion.A novel methodology is proposed for quantifying the circulating blood dose along large vessels. This methodology involves the use of patient-specific vasculature, blood flow velocity field, and dose delivery dynamics recovered from the irradiation machine. Relevant parameters that affect the dose received, as the distance between large vessels and CTV, are identified.

Financial Toxicity in Radiation Oncology

Financial toxicity details the financial burden patients face due to a variety of medical costs. Cancer patients, especially those receiving radiation therapy, are at a much higher risk of experiencing economic hardships than healthy people or people with other conditions. There are a variety of risk factors associated with financial toxicity as well as numerous tools to assess the toxicity experienced by patients. In this review article, we present a concise overview of contributors, risk factors, case studies, tools, impacts, and potential interventions of financial toxicity.

Kaplan lecture 2023: lymphopenia in particle therapy

PURPOSE

Lymphopenia is now generally recognized as a negative prognostic factor in radiotherapy. Already at the beginning of the century we demonstrated that high-energy carbon ions induce less damage to the lymphocytes of radiotherapy patients than X-rays, even if heavy ions are more effective per unit dose in the induction of chromosomal aberrations in blood cells irradiated ex-vivo. The explanation was based on the volume effect, i.e. the sparing of larger volumes of normal tissue in Bragg peak therapy. Here we will review the current knowledge about the difference in lymphopenia between particle and photon therapy and the consequences.

CONCLUSIONS

There is nowadays an overwhelming evidence that particle therapy reduces significantly the radiotherapy-induced lymphopenia in several tumor sites. Because lymphopenia turns down the immune response to checkpoint inhibitors, it can be predicted that particle therapy may be the ideal partner for combined radiation and immunotherapy treatment and should be selected for patients where severe lymphopenia is expected after X-rays.