radiation

The first randomised comparison of protons with modern photon radiotherapy for lung cancer. Protons spared the heart but not the lung overall, and neither severe lung inflammation nor local failure was reduced: 10.5 per cent against 6.5 per cent for lung inflammation, 10.5 against 10.9 per cent for local failure.

A French trial of 470 men compared checking the prostate's position with imaging before every radiotherapy session against checking weekly. Daily imaging lowered rectal side effects and PSA-defined progression, but the main endpoint, recurrence-free survival, did not differ, and overall survival was worse in the daily group.

Brain metastases treated with radiosurgery were randomly given a 1 millimetre or a 3 millimetre margin. Control of the treated tumours was similar, the larger margin irradiated more healthy brain, and five of the six biopsy-proven cases of radiation damage were in the 3 millimetre group.

Transplant conditioning, and total body irradiation in particular, usually ends natural fertility and in children slows growth. The decisions that preserve the most are made before conditioning starts. A randomised trial in children with leukaemia tested replacing the radiation with chemotherapy and found the radiation worked better.

A trial of 571 men with intermediate or high-risk prostate cancer gave half of them an extra dose, up to 95 Gy, to the tumour visible on MRI inside the prostate. After five years 92 per cent of the boosted group were free of PSA relapse against 85 per cent, with no measurable increase in side effects and no difference in survival.

Nanobiotix is the Paris nanomedicine company behind NBTXR3, hafnium oxide nanoparticles injected into a tumour to make radiotherapy deposit more energy inside it.

People having radiotherapy for head and neck cancer were randomly given the standard closed face mask or one of two open masks, with cameras tracking the face during treatment. The open masks were set up as accurately and were significantly better tolerated.

A proton beam stops at a depth that cannot be predicted exactly, so planners deliberately aim it a few millimetres past the tumour. At one leading centre the allowance is 3.5 per cent of the beam's range plus 1 millimetre, which for a beam reaching 20 centimetres into soft tissue means overshooting by about 8 millimetres.

A review of why the depth at which a proton beam stops cannot be predicted exactly, and how much margin centres add for it. One common recipe, 3.5 per cent of the range plus 1 millimetre, overshoots by about 8 millimetres for a beam reaching 20 centimetres into soft tissue.

A review of ten studies comparing radiotherapy plans for left breast cancer made in deep breath-hold and in free breathing. Breath-hold cut the average heart dose by up to 3.4 Gy, which on published dose-risk estimates corresponds to a 13.6 per cent smaller projected rise in heart disease risk.

The paper behind the margin most radiotherapy departments add around a target. It showed that errors repeated every day matter far more than errors that vary day to day, and turned that into a formula: a margin of 2.5 times the systematic error plus 0.7 times the random error.

In ten UK centres, women having radiotherapy for left breast cancer were taught to hold a deep breath during treatment without any machine to help. Ninety-five per cent had a lower heart dose as a result, and the average heart dose fell from 1.8 to 1.1 Gy.

The mouse study that started modern FLASH research. Radiation given in a fraction of a second spared the lungs of mice from scarring at doses that scarred them when given at the usual rate, while controlling tumours just as well. It was in mice, and the effect in people has not been shown.

A review of 119 studies in which several clinicians drew the same radiotherapy targets. The studies measured the disagreement in so many different ways that they could not be combined, and only 21 per cent checked what it did to the dose.

Before a radiotherapy plan can be made, a doctor draws the tumour and the organs around it on the planning scan, and two doctors given the same scan do not draw the same outline. A 2016 review found 119 studies measuring this across every major cancer site, and only one in five checked what the differences did to the dose.