Radiation

Purpose: Uterine carcinosarcomas are highly aggressive tumors of the endometrium and are associated with a poor prognosis. The optimal adjuvant treatment for both early and advanced-stage patients remains unclear. Methods: Cases of uterine carcinosarcoma were identified in our institution’s pathology database between 2000 and 2022. Kaplan–Meier estimates were calculated for the local and distant recurrence-free, disease-free and overall survival; hazard ratios were calculated using Cox proportional hazards modelling for independent prognostic factors including the stage and treatment. Results: A total of 48 patients were identified as having uterine carcinosarcoma, of whom 70.8% were surgically staged. In total, 43 patients had pelvic-confined disease, while five had positive omental or peritoneal biopsies at surgery. There were 10 pelvic (20.8%) and 19 (39.6%) distant recurrences. None of the patients with stage IA disease who received chemotherapy and brachytherapy experienced disease recurrence. The local recurrence-free survival was 54.95%, the distant recurrence-free survival was 44.7%, and the overall survival was 59.6% at 5 years. Local recurrence-free survival and overall survival were inversely associated with advanced-stage OR 1.23 (p = 0.005) and OR 1.28 (p = 0.017), respectively, and no chemotherapy was associated with OR 1.96 (p = 0.06) and OR 2.08 (p = 0.056), respectively. Conclusion: The local and distant recurrence rates were high for advanced=stage patients even when treated with aggressive adjuvant therapy regimens. Chemotherapy may improve recurrence and survival. Early-stage patients may perform well with vaginal vault brachytherapy and chemotherapy. Further prospective comparisons are required between sequential, sandwich, and concurrent approaches to chemotherapy and radiotherapy, to optimize outcomes in this high-risk population. Full article

The combination of an ultra-low-loss optical fiber sensitive to ionizing radiation and an optical time domain reflectometer (OTDR) is investigated to explore the feasibility of a single-ended distributed radiation detector. The peculiarity of the tested fiber resides in its regenerative high radiation-induced attenuation (RIA) response in the infrared spectrum (1310 nm), which returns to a low value once the irradiation has ended, combined to its sensitivity, highly increasing with the dose rate. In this work, only some sections of the fiber line were irradiated with 100 kV X-rays at room temperature, to prove the spatially resolved radiation detection capabilities of the system. The transient RIA response of the fiber was characterized at different pre-irradiation doses. A pre-irradiation treatment was shown to stabilize the optical fiber response, improving its RIA vs. dose rate linearity and repeatability. This improved response, in terms of radiation quantification, comes at the cost of a lower detection threshold. This work lays the bases for a distributed radiation detector, with some capabilities in dose rate evaluation. Full article

The physiological process of iodine uptake in the thyroid is used for ¹³¹I treatment of thyroid diseases. Children are more sensitive to radiation compared to adults and may react differently to ¹³¹I exposure. The aims of this study were to evaluate the effects on thyroid protein expression in young and adult rats one year after ¹³¹I injection and identify potential biomarkers related to ¹³¹I exposure, absorbed dose, and age. Twelve Sprague Dawley rats (young and adults) were i.v. injected with 50 kBq or 500 kBq ¹³¹I and killed twelve months later. Twelve untreated rats were used as age-matched controls. Quantitative proteomics, statistical analysis, and evaluation of biological effects were performed. The effects of irradiation were most prominent in young rats. Protein biomarker candidates were proposed related to age, absorbed dose, thyroid function, and cancer, and a panel was proposed for ¹³¹I exposure. In conclusion, the proteome of rat thyroid was differentially regulated twelve months after low-intermediate dose exposure to ¹³¹I in both young and adult rats. Several biomarker candidates are proposed for ¹³¹I exposure, age, and many of them are known to be related to thyroid function or thyroid cancer. Further research on human samples is needed for validation. Data are avaiable via ProteomeXchange with identifier PXD024786. Full article

PET/CT scans are being used to assess patients who have experienced biochemical failure following surgery or radiation therapy for localized prostate cancer. We aimed to evaluate the language used in report impressions and to determine the level of confidence that radiologists have when reporting on lesions in various anatomic sites. Between 2015 and 2021, 295 F18-fluciclovine PET/CT scan reports were identified. Thirteen phrases commonly used by radiologists in the report impression section to describe a lesion of interest were identified and categorized into three confidence categories: definitive (positive and negative), likely (consistent with, most likely, favors, probable), and unsure (suspicious for, concerning for, non-specific, conspicuous, compatible with, borderline, unknown). The use of definitive language varied depending on the anatomic site, with the highest use in bone (87.1%) and the lowest use in the intact prostate (34.6%). In patients with a PSA < 0.5, there was the highest degree of definitive certainty (89.2%), whereas in patients with a PSA > 1, there was the least definitive certainty (66.2%). The language used in these reports has not been standardized, with definitive, likely, and unsure findings reported in 68.6%, 9.7%, and 21.7% of scans, respectively. Full article

For patients with recurrent brain metastases, there is an urgent need for a more effective and less toxic treatment approach. Accumulating evidence has shown that spatially fractionated radiation therapy (SFRT) is able to provide a significantly higher therapeutic ratio with lower toxicity compared to conventional radiation using a uniform dose. The purpose of this study was to explore the potential low toxicity benefit of mini-beam radiotherapy (MBRT), a form of SFRT, for whole-brain re-irradiation in a healthy mouse model. Animals first received an initial 25 Gy of uniform whole-brain irradiation. Five weeks later, they were randomized into three groups to receive three different re-irradiation treatments as follows: (1) uniform irradiation at 25 Gy; (2) MBRT at a 25 Gy volume-averaged dose (106.1/8.8 Gy for peak/valley dose, 25 Gy-MBRT); and (3) MBRT at a 43 Gy volume-averaged dose (182.5/15.1 Gy for peak/valley dose, 43 Gy-MBRT). Animal survival and changes in body weight were monitored for signs of toxicity. Brains were harvested at 5 weeks after re-irradiation for histologic evaluation and immunostaining. The study showed that 25 Gy-MBRT resulted in significantly less body weight loss than 25 Gy uniform irradiation in whole-brain re-irradiation. Mice in the 25 Gy-MBRT group had a higher level of CD11b-stained microglia but also maintained more Ki67-stained proliferative progenitor cells in the brain compared to mice in the uniform irradiation group. However, the high-dose 43 Gy-MBRT group showed severe radiation toxicity compared to the low-dose 25 Gy-MBRT and uniform irradiation groups, indicating dose-dependent toxicity. Our study demonstrates that MBRT at an appropriate dose level has the potential to provide less toxic whole-brain re-irradiation. Future studies investigating the use of MBRT for brain metastases are warranted. Full article

Background: Stereotactic body radiotherapy (SBRT) targeted at metastatic sites of disease progression is emerging as a potential therapeutic approach for managing oligoprogressive prostate cancer. However, a definitive benefit has yet to be demonstrated. Herein, we present our institution’s experience with this treatment approach. Methods: From April 2018 to March 2023, 11 patients affected by oligoprogressive prostate cancer were treated with SBRT targeting the nodal or bone sites of progression while maintaining the ongoing systemic therapy. Three patients were undergoing single-agent ADT (Androgen Deprivation Therapy), while the remaining eight were receiving a subsequent line of systemic therapy. All patients were evaluated with a pre-treatment 68Ga-PSMA-11 or 18F-fluorocholine PET/CT, which demonstrated between one and five localizations of disease. All the active sites were treated with SBRT in one (15–24 Gy) or three (21–27 Gy) fractions, except for one patient, who was treated in five fractions (35 Gy). PSA serum levels were tested at baseline, one month after RT and at least every three months; all patients underwent a post-treatment 68Ga-PSMA-11 or 18F-fluorocholine PET/CT. The evaluated endpoints were PSA response, defined as a post-treatment decrease >50% from baseline measured within 6 months, time to next-line systemic treatment (NEST), local control (LC), biochemical progression-free survival (bPFS), radiological progression-free survival (rPFS) and freedom from polymetastatic progression (FPP). Results: Nineteen lesions were treated (seven nodal and twelve bone). At a median follow-up of 19 months (7–63), 9 of the 11 patients had a PSA response; all patients had local control of the treated metastases. A total of six patients switched to a next-line systemic treatment, with a median NEST of 13 months. Six patients had polymetastatic progression with an FPP median time of 19 months. No patients died during the follow-up period. The SBRT-related toxicity was negligible. Conclusions: Our data support the use of SBRT targeting the sites of oligoprogressive disease before moving to a subsequent line of systemic treatment in patients with metastatic prostate cancer. Prospective studies to evaluate the potential impact of this approach on overall survival are warranted. Full article

Space exploration introduces astronauts to challenges, such as space radiation and microgravity. Researchers have investigated vitamin C as a potential radiation mitigator, as well as antioxidants for sustaining astronaut health. Our own studies demonstrate vitamin C’s life-saving radioprotective effects and its potential as a radiation mitigator, thus highlighting promise, even when administered 24 h post-exposure. This is particularly relevant in scenarios where astronauts may be exposed to sudden large solar particle events, potentially resulting in lethal doses of space radiation. The success of vegetable cultivation on the International Space Station using NASA’s Veggie system offers fresh, vitamin C-rich food. While approved supplements address somatic function, further research is needed to optimize vitamin C’s efficacy in humans, and to develop appropriate antioxidant cocktails for space missions. The variable vitamin C content in vegetables underscores the necessity for the utilization of artificial intelligence (AI) to assist astronauts in selecting and cultivating the vitamin C-rich vegetables best-suited to combat high levels of space radiation and microgravity. Particularly, AI algorithms can be utilized to analyze various factors, such as nutritional content, growth patterns, and cultivation methods. In conclusion, vitamin C shows significant potential for mitigating space radiation, and ongoing research aims to enhance astronaut health through optimal dietary strategies. Full article

Background: Our study aimed to assess the radiation sensitivity of BT20, a human breast tumor cell line, using the laser-trap** technique and compare it with N2a and 4T1 cells. Additionally, we investigated the impact of the antitumor compound 2-Dodecyl-6-methoxycyclohexa-2,5-diene-1,4-dione (DMDD) on radiation sensitivity. Methods and Materials: We employed laser trap** to calculate both the threshold ionization energy (TIE) and threshold radiation dose (TRD) for BT20, N2a, and 4T1 cells. We assessed the effect of DMDD on BT20 cells’ radiosensitivity and conducted comparisons across these cell lines. Results: Our findings reveal that DMDD significantly enhances the radiosensitivity of BT20 breast carcinoma cells. Moreover, we observed distinct trends in TIE and TRD across the three cell lines, with differences attributed to variations in cell size and composition. When multiple cell ionizations were considered, a notable reduction in TRD was observed, implicating factors such as the chain effect of ionizing radiation and the influence of DMDD. The study found that TIE increased with the number of cells in the trap while TRD consistently decreased across all three cell lines, suggesting comparable radiation sensitivity, and oligostilbene treatment further reduced TRD, presenting the potential for enhancing therapeutic ratios in cancer treatment. Conclusion: The antitumor compound DMDD enhances the radiosensitivity of BT20 breast carcinoma cells, highlighting its potential in cancer treatment. Furthermore, our study underscores the impact of cell size and multiple-cell ionizations on TRD. Leveraging laser trap** techniques, biocompatible nanoparticles, and advanced optical tweezers opens promising avenues for personalized and effective cancer therapy approaches. Full article

To date, the radiation-adaptive response has been reported as a low-dose-related phenomenon and has been associated with radiation hormesis. Well-known cancers are caused by non-radiation active reactants, in addition to radiation. A model of suppression for radiation-specific cancers was previously reported, but the model did not target radiation-nonspecific cancers. In this paper, we describe kinetic models of radiation-induced suppressors for general radiation non-specific cancers, estimating the dose M that induces the maximum hormesis effect while satisfying the condition that the risk is approximately proportional to a dose above NOAEL (No Observed Adverse Effect Level). The radiation hormesis effect is maximal when the rate constant for generation of a risk-reducing factor is the same as the rate constant for its decomposition. When the two rate constants are different, the dose M at which the radiation hormesis effect is maximized depends on both rate constants, but the dose M increases as the two rate constants approach each other, reaching a maximum dose. The theory proposed in this paper can only explain existing experiments with extremely short error bar lengths. This theory may lead to the discovery of unknown risk-reducing factor at low doses and the development of risk-reducing methods in the future. Full article

(1) Background: Some cancer patients do not experience tumour shrinkage but are still at risk of experiencing unwanted treatment side effects. Radiomics refers to mining biomedical images to quantify textural characterization. When radiomics features are labelled with treatment response, retrospectively, they can train predictive machine learning (ML) models. (2) Methods: Radiomics features were determined from lymph node (LN) segmentations from treatment-planning CT scans of head and neck (H&N) cancer patients. Binary treatment outcomes (complete response versus partial or no response) and radiomics features for n = 71 patients were used to train support vector machine (SVM) and k-nearest neighbour (k-NN) classifier models with 1–7 features. A deep texture analysis (DTA) methodology was proposed and evaluated for second- and third-layer radiomics features, and models were evaluated based on common metrics (sensitivity (%S_n), specificity (%S_p), accuracy (%Acc), precision (%Prec), and balanced accuracy (%Bal Acc)). (3) Results: Models created with both classifiers were found to be able to predict treatment response, and the results suggest that the inclusion of deeper layer features enhanced model performance. The best model was a seven-feature multivariable k-NN model trained using features from three layers deep of texture features with %S_n = 74%, %S_p = 68%, %Acc = 72%, %Prec = 81%, %Bal Acc = 71% and with an area under the curve (AUC) the receiver operating characteristic (ROC) of 0.700. (4) Conclusions: H&N Cancer patient treatment-planning CT scans and LN segmentations contain phenotypic information regarding treatment response, and the proposed DTA methodology can improve model performance by enhancing feature sets and is worth consideration in future radiomics studies. Full article

A new physics-based compact model, which makes it possible to simulate in a unified way the neutrons and protons of cosmic ray-induced SEU cross-sections, including the effects from nuclear reaction products and from direct ionization by low-energy protons, has been proposed and validated. The proposed approach is analytical and based on explicit analytical relationships and approximations with physics-based fitting parameters. GEANT4 or SRIM numerical calculations can be used as an aid to adjust or refine the phenomenological parameters or functions included in the model, taking into account real geometrical configurations and chemical compositions of the devices. In particular, explicit energy dependencies of the soft error cross-sections for protons and neutrons over a wide range of nucleon energies were obtained and validated. The main application areas of the developed model include space physics, accelerator studies high energy physics and nuclear experiments. Full article

Utilizing Monte Carlo multi-track chemistry simulations along with a cylindrical instantaneous pulse (Dirac) irradiation model, we assessed the initial acidic response in both subcritical and supercritical water under high radiation dose rates. This investigation spans a temperature range of 300 to 500 °C at a nominal pressure of 25 MPa, aligning with the operational conditions anticipated in proposed supercritical water (SCW)-cooled small modular reactors (SCW-SMRs). A pivotal finding from our study is the observation of a significant ‘acid spike’ effect, which shows a notable intensification in response to increasing radiation dose rates. Our results bring to light the potential risks posed by this acidity, which could potentially foster a corrosive environment and thereby increase the risk of accelerated material degradation in reactor components. Full article

We investigated imaging conditions for the distribution of lutetium oxodotreotide (Lu-177 DOTATATE) in the body during peptide receptor radionuclide therapy for neuroendocrine tumor (NET). We investigated imaging conditions using gamma rays emitted from the radionuclide. The gamma rays had energy peaks at 113 and 208 keV and characteristic X-rays at 56 keV. Image quality was compared by utilizing a combination of low–medium-energy general-purpose (LMEGP) and medium-energy general-purpose (MEGP) collimators. This study included the measurement of total spatial resolution (Full Width at Half Maximum) using a line source phantom. We compared the image quality of static images using a plane phantom and SPECT images using a cylindrical phantom. This comparison involved assessing recovery coefficient curves, count ratio, and %CV. Imaging evaluation was also performed on one NET patient. In phantom studies and the clinical study, comparing the combination of the three energy peaks (56 + 113 + 208 keV) using the LMEGP collimator and the conventional combination (113 + 208 keV) using the MEGP collimator revealed a count ratio of 1.9 times the maximum, stable %CV, and the best image quality. Full article

Cetaceans are cast to shore for a large number of reasons, although sometimes it is not clear why. This paper reviews the types and causes of cetacean strandings, focusing on mass strandings that lack a direct scientific explanation. Failure of cetacean orientation due to radiofrequency radiation and alterations in the Earth’s magnetic field produced during solar storms stand out among the proposed causes. This paper proposes the possibility that anthropogenic radiofrequency radiation from military and meteorological radars may also cause these strandings in areas where powerful radars exist. A search of accessible databases of military and meteorological radars in the world was carried out. Research articles on mass live strandings of cetaceans were reviewed to find temporal or spatial patterns in the stranding concentrations along the coast. The data showed certain patterns of spatial and temporal evidence in the stranding concentrations along the coast after radar setup and provided a detailed description of how radars may interfere with cetacean echolocation from a physiological standpoint. Plausible mechanisms, such as interference with echolocation systems or pulse communication systems, are proposed. This work is theoretical, but it leads to a hypothesis that could be empirically tested. Further in-depth studies should be carried out to confirm or reject the proposed hypothesis. Full article

Nuclear sites require regular measurements of the air, soil, and groundwater to ensure the safety of the surrounding environment from potentially hazardous levels of contamination. Although high-energy beta and gamma emitters can often be detected instantly using fixed dosimeters, the detection of low-energy beta emitters is a difficult challenge, especially in groundwater, as its radiation is easily self-absorbed by the surrounding medium. Therefore, it is common practice to sample groundwater and transfer it to a laboratory for analysis using Liquid Scintillation Counting. This work demonstrates a new detector design for the real-time monitoring of tritiated water, a weak beta emitter. This design utilizes a flow cell filled with a granulated scintillator to maximize the surface area of the sample. The cavity is made from plastic sheets, which allow rapid manufacture using readily available lamination sheets. A column of SiPMs in coincidence counting mode has been implemented to reduce noise and allow future extensions to the flow cell for greater detection rates while allowing the detector to fit within limited spaces such as groundwater monitoring boreholes. Using multiple concentrations of tritiated water, this detector has been validated and calibrated, obtaining a minimum detection activity of 26.356 ± 0.889 Bq/mL for a 1-day counting period. Full article

Background: The Chernobyl nuclear disaster is still considered the worst nuclear accident in history. The particles were dispersed over the former USSR and large parts of Western Europe, leading to radioactive exposure to more than 10 million people. Radioactivity is a risk factor for the development of basal cell carcinoma (BCC), since radiation-induced mutations in both Sonic hedgehog (Shh) signaling pathway genes and TP53 have been described. Methods: We present the case of a patient with a history of radiation exposure following the 1986 Chernobyl accident who presented to our outpatient clinic with recurrent basal cell carcinoma in the facial region. Case: The patient presented to our clinic with two facial lesions suspicious for BCC. Although there were no typical risk factors, 11 BCCs had previously been removed. The patient had been building shelters for the construction workers working on the sarcophagus around the destroyed reactor immediately after the 1986 accident. Staging using an 18F-FDG-PET/CT as well as ultrasound of the abdomen revealed no other tumor manifestations. Diagnostic excision of the two facial lesions was performed, and a histopathological workup revealed BCC at the right temporal region and acanthopapillomatosis with no sign of malignancy at the corner of the mouth. After presentation to the tumor board, complete resection of the BCC was initiated. Conclusions: This case demonstrates the value of early use of 18F-FDG-PET/CT in staging/restaging to visualize BCC location, local spread and potential metastases or secondary tumors and to aid in the decision for therapeutic management. Full article

Synchrotron Microbeam Radiation Therapy (MRT) is an innovative technique that spatially segments the synchrotron radiation field for cancer treatment. A microbeam peak dose is often hundreds of times the dose in the valley (the sub-millimeter region between the peaks of the microbeams). Peak and valley doses vary with increasing depth in tissue which effects tumor dose coverage. It remains to be seen whether the peak or valley is the primary factor in MRT cancer control. This study investigates how unilateral MRT doses can be modulated using a bolus, and identifies the valley dose as a primary factor in MRT cancer control. Fischer rats bearing 9 L gliosarcoma tumors were irradiated with MRT at the Imaging and Medical Beam Line of the Australian Synchrotron. MRT valley doses of 8–15 Gy (250–1040 Gy peak doses) were used to treat tumors with and without a 5 mm dose-modulating bolus. Long-term survival depended on the valley dose primarily (92% correlation), and the use of the bolus reduced the variance in animal survival and improved to the mean survival of rats treated with MRT by 47% and 18% using 15 Gy and 8 Gy valley doses, respectively. Full article

(1) Background: Water radiolysis leads to the formation of hydronium ions H₃O⁺ in less than 50 fs, resulting in the formation of transient acidic pH spikes in the irradiated water. The purpose of this study is to examine the time evolution of these spikes of acidity under irradiation conditions combining both high absorbed dose rate and high-LET radiation. (2) Methods: The early space–time history of the distributions of the various reactive species was obtained using our Monte Carlo multitrack chemistry simulation code IONLYS-IRT. To simulate different LETs, we used incident protons of varying energies as radiation sources. The “instantaneous pulse” (or Dirac) model was used to investigate the effect of dose rate. (3) Results: One major finding is that the combination of high dose rates and high LETs is clearly additive, with a very significant impact on the pH of the solution. For example, at 1 ns and for a dose rate of ~10⁷ Gy/s, the pH drops from ~4.7 to 2.7 as the LET increases from ~0.3 to 60 keV/μm. (4) Conclusions: Confirming previous work, this purely radiation chemical study raises the question of the possible importance and role of these spikes of acidity in underpinning the physical chemistry and biology of the “FLASH effect”. Full article

Background: Ultrasound-stimulated microbubbles (USMB) have shown potential for enhancing radiation treatment via cavitation and sonoporation mechanisms. However, in vitro studies have produced inconsistent results, with adherent cells demonstrating no radioenhancement. This study aims to investigate the effect of cell adherence on in vitro radioenhancement using USMB and radiation. Method: Lung metastases of follicular thyroid carcinoma cells (FTC-238) and non-small cell lung carcinoma cells (NCI-H727) were treated, both when adhered and in suspension, using 1.6% (v/v) Definity™ microbubbles, ~90 s of 2 MHz ultrasound with mechanical index 0.9, and either 3 Gy or 6 Gy of megavoltage (MV) X-rays. The cell viability was measured using an MTS assay 72 h post-treatment, and statistical analysis was conducted using a three-way analysis of variance. Results: Statistically significant differences were observed for cells treated when adherent compared to suspended. An additive effect was detected in NCI-H727 cells treated in suspension, but not while adherent, while no enhancement was observed for FTC-238 cells in either culture state. Conclusions: To the best of our knowledge, this is the first study to directly compare the effect of cell adherence on the radioenhancement potential of USMB in vitro, and the first to do so using a metastatic cell line. Full article