Advanced Radiation Therapy (United States)

Diagnosing cardioembolic stroke/transient ischemic attack (TIA) rapidly remains a major challenge. Current emergency cardiac assessments often provide insufficient data. This study tests whether bolus tracking, a readily available technique during brain CTA, can be leveraged to quickly identify reduced ejection fraction (EF) and potential cardioembolic etiology in acute stroke patients. We retrospectively analyzed CTA and echocardiography data from acute ischemic stroke/TIA patients across two comprehensive stroke centers. We measured total transit time (TTT) based on aortic attenuation values of 40 Hounsfield Units (T40HU) and 100 HU (T100HU) obtained during routine CTA. ΔT100-T40HU, representing the time difference required for aortic contrast enhancement to increase from 40 to 100 HU, was also calculated as a key parameter. EF was measured by transthoracic echocardiography using the Simpson biplane method. In a cohort of 443 patients, we found a statistically significant inverse correlation between EF and T40HU, T100HU, and ΔT100-T40HU. Notably, ΔT100-T40HU demonstrated good discriminatory ability for identifying heart failure (AUROC = 0.88) and poor discriminatory ability for cardioembolic stroke (AUROC = 0.66). Multivariate analysis further confirmed that T40HU, T100HU, and ΔT100-T40HU were independent predictors of both heart failure and cardioembolic stroke based on the TOAST classification criteria. Bolus tracking during CTA provides a reliable and easily accessible radiological tool for the identification of heart failure and cardioembolic stroke, enabling a faster diagnostic workup and facilitating appropriate selection of further diagnostic investigations within the acute emergency setting.

Abstract Background Sarcopenia is defined as a quantitative and qualitative reduction of muscle mass. Recent evidence suggests that in Crohn’s disease (CD), muscle depletion may increase the risk of postoperative complications and disease recurrence. Sarcopenia can be assessed using indices derived from CT or MRI, such as the Total Psoas Area Index (TPAI), calculated at the level of the third lumbar vertebra on radiologic scans. The study aims to evaluate the prognostic role of preoperative sarcopenia on surgical outcomes and on endoscopic recurrence at 6–12 months in CD patients after ileocolic resection. Methods CD patients undergoing ileocolic resection between 2017 and 2024 were enrolled. Sarcopenia was defined as TPAI lower than 5.4 cm²/m² for men and 3.56 cm²/m² for women, assessed on MRI or CT scans performed within 3 months prior to surgery. Postoperative complications were evaluated using the Clavien–Dindo classification (CDs ≥2). Endoscopic recurrence (ER) was assessed using the Rutgeerts score (RS ≥ i2) at 6–12 months after surgery. Results We retrospectively enrolled 152 patients, with a preoperative prevalence of sarcopenia of 40.1%. The mean BMI was 22.26 kg/m² (±3.63). The mean age at surgery was 43.24 years (±15). Early postoperative complications (PC) occurred in 25.7% of cases, while ER at 6–12 months was observed in 50.7%. The presence of sarcopenia was significantly associated with PC (39% vs 16, p = 0.002) and with ER(62% vs 42% p = 0.019). In multivariate logistic regression, the factors independently associated with ER were: Sarcopenia: OR 2.26 (95% CI 1.06–4.85, p = 0.036); Active smoking: OR 2.32 (95% CI 1.12–4.81, p = 0.024); Previous surgeries: OR 2.21 (95% CI 1.01–4.86, p = 0.047) Conclusion In our study, preoperative sarcopenia emerged as a potentially predictor of both early surgical complications and postoperative disease recurrence in Crohn’s disease. Conflict of interest: Dr. Del Gaudio, Angelo: No Di Vincenzo, Federica: No conflict of interest Murgiano, Marco: No conflict of interest Cascella, Fabio: No conflict of interest Becherucci, Guia: No conflict of interest Parello, Simone: No conflict of interest Fiaccavento, Flavio: No conflict of interest Di Certo, Teodoro Pietro: No conflict of interest Massimo, Musumeci: No conflict of interest Coppola, Gaetano: No conflict of interest Mignini, Irene: No conflict of interest Foscarini, Elisa: No conflict of interest Francesca, Profeta: No conflict of interest Puca, Pierluigi: No conflict of interest Laterza, Lucrezia: No conflict of interest Napolitano, Daniele: No conflict of interest Schiavoni, Elisa: No conflict of interest Sacchetti, Franco: No conflict of interest Caprino, Paola: No conflict of interest Sofo, Luigi: No conflict of interest Gasbarrini, Antonio: No conflict of interest Pugliese, Daniela: No conflict of interest Lopetuso, Loris Riccardo: Personal Fees: none Minordi, Laura Maria: No conflict of interest Scaldaferri, Franco: Consultancy fee/board for Janseen, Takeda, Pfizer, MSD, Sandoz, Galapagos, Celltrion, Ferring, Abbvie, Lilly, Alfasigma, Abivax

Background/Objectives: The anatomical complexity of the auricular region poses a unique challenge for contact interventional radiotherapy (IRT, modern brachytherapy), especially in maintaining close conformity between the applicator and skin surface. Air gaps can arise due to the irregular shape of the ear, potentially compromising dose coverage. This study evaluates the dosimetric impact of air gaps in HDR IRT for non-melanoma skin cancer (NMSC) of the ear. Methods: Ten patients treated with contact IRT using alginate as supporting material were retrospectively analyzed. Treatment plans were recalculated using both the TG-43 and the TG-186 formalism. CTV coverage and organ-at-risk dose parameters were evaluated within the two formalisms. Results: CTV coverage was comparable between algorithms (mean V95% 96.2% vs. 94.4%, V100% 89.6% vs. 86.7%, and V150% 2.6% vs. 2.5% for TG-43 vs. TG-186; p > 0.05), while the ipsilateral eye D2cc decreased from 4.0% (TG-43) to 3.2% (TG-186). In silico simulations showed that increasing air gaps reduced skin dose progressively (up to ~15% at 5 mm), whereas alginate thickness produced only a mild dose increase (<5%) across the tested range. Overall, small air pockets (<1 mm) did not substantially alter global dosimetric metrics, although local underdosage may occur at gap locations. Conclusions: This study underscores the importance of accounting for material heterogeneities and geometric uncertainties in anatomically complex regions through advanced dose calculation algorithms.

PurposeInterventional radiotherapy (IRT, brachytherapy) for perineal malignancies, such as anal canal cancer, is challenged by complex pelvic anatomy and procedural limitations. Therefore, TIMER® applicator was developed to address these issues, offering innovative and adaptable design, compatible with multimodal imaging (MRI, CT, PET/CT, US).Material and methodsTIMER® applicator features MRI/CT compatibility, dual anchoring options, and optimized needle layout to improve dose distribution and anatomical conformity. A dosimetric comparison with two commercial applicators was conducted, evaluating dose non-homogeneity ratio (DNR) across varying clinical target volumes (CTVs).ResultsThe TIMER® applicator demonstrated superior dose uniformity, achieving lower DNR values across most configurations and depths. It outperformed both commercially available templates, except for shallow posterior CTVs, where one applicator showed slightly better performance.ConclusionsThe TIMER® applicator enhances dose precision and adaptability in IRT for perineal cancers, outperforming commercial devices in most scenarios. Further refinements and clinical validation will establish its role in advancing IRT protocols.

BackgroundHereditary Hemorrhagic Telangiectasia (HHT) is a rare, hereditary, autosomal dominant vascular disease, characterized by visceral arteriovenous malformations (AVMs), mucocutaneous telangiectasias and epistaxis. While symptomatic medical and surgical therapies are used in the management of pediatric patients, data comparing phenotypic presentation between genetically related individuals (e.g., parent-child pairs) remain limited.Aims and MethodsWe conducted a single-center retrospective study involving pediatric patients with genetically confirmed HHT and their affected parents at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome, Italy. The aim of our study was to assess genotype-phenotype correlation and intrafamilial HHT-phenotypic variability. Clinical, laboratory, imaging, and therapeutic data were collected between May 2022 and May 2023. Variables including presence of AVMs, epistaxis, telangiectasias, anemia, and need for interventions were compared between children and their parents.ResultsThe study included 11 children (mean age 11.8 years) and 9 adults (mean age 47 years), all exhibiting ENG or ACVRL1 variants. While epistaxis was common in both cohorts (91% in children vs. 100% in adults), mucocutaneous telangiectasias and AVMs were more prevalent in adults. AVMs were more frequently detected in adults, especially among ENG carriers. Notably, phenotype concordance between parent-child pairs with the same mutation was observed in only 3 up to 9 families (33.3%), with substantial intrafamilial variability in AVM distribution and disease severity.ConclusionsOur findings confirm the variable expressivity of HHT, even among first-degree relatives sharing the same pathogenic variant. No consistent overlap was observed between parent and child phenotypes, reinforcing the need for individualized pediatric screening and follow-up. Early genetic testing remains essential to prevent complications and guide appropriate management.

Elderly LBCL patients have unfavorable clinical and biological features, leading to higher relapse rates. While CD19 CAR-T therapy offers a curative option in second-line, access remains limited by clinical criteria in pts aged ≥ 65 years. In our real-world study, we evaluated 232 LBCL pts ≥ 65 years focusing on first line outcomes and potential CAR-T eligibility. Sixty-four patients progressed or relapsed. Applying AIFA criteria, only 9/37 (24%) R/R LBCL pts aged 65-75 years would have been CAR-T eligible. Among those > 75 years, excluded from CAR-T in Italy, only 3/27 (11%) met eligibility criteria. The main exclusion criteria were ECOG ≥ 2 (34 pts, 53%), CNS involvement (14 pts, 22%) and rapidly progressive disease with life expectancy < 12 weeks (12 pts, 19%) The majority of pts who would have been excluded from CAR-T therapy had multiple criteria (32/52, 61%). Pts not receiving full-dose anthracyclines would have been seldom candidates for CAR-T (only 2/12, 16.5%). This study provides an estimate of the potential eligibility to CAR-T cell therapy in an elderly population of R/R LBCL in a real world setting of a CAR-T center. These findings highlight the urgent need for improved first-line therapies for elderly R/R LBCL pts.

Multiplexed assays of variant effect (MAVEs) are a critical tool for researchers and clinicians to understand genetic variants. Here we describe the 2024 update to MaveDB (https://www.mavedb.org/) with four key improvements to the MAVE community’s database of record: more available data including over 7 million variant effect measurements, an improved data model supporting assays such as saturation genome editing, new built-in exploration and visualization tools, and powerful APIs for data federation and streamlined submission and access. Together these changes support MaveDB’s role as a hub for the analysis and dissemination of MAVEs now and into the future.