Previously published studies combined external beam radiotherapy (EBRT) treatments with different activities of ²²³Ra. The data of two-year overall survival (2y-OS) and neutropenia (TOX) incidence when combining EBRT and ²²³Ra are not homogeneous in literature. We adapted the linear–quadratic model (LQ) to ²²³Ra therapy using brachytherapy formalism for a mixture of radionuclides, considering the contribution of all daughter isotopes in the decay chain. A virtual cohort of patients undergoing ²²³Ra therapy was derived using data from the literature. The doses delivered using ²²³Ra and EBRT were converted into biologically equivalent doses. Fixed-effect logistic regression models were derived for both the 2y-OS and TOX and compared with available literature. Based on the literature search, four studies were identified to have reported the ²²³Ra injection activity levels varying from the placebo (0) to 80 kBq/kg, associated or not with EBRT. Logistic regression models revealed a dose-dependent increase in both the 2y-OS (intercept = −1.364; slope = 0.006; p-value ≤ 0.05) and TOX (−5.035; 0.018; ≤0.05) using the EBRT schedule of 8 Gy in 1 fr. Similar results were obtained for other schedules. Discrepancies between our TOX model and those derived for EBRT combined with chemotherapy are discussed. Radiobiological models allow us to estimate dose-dependent relationships, to predict the OS and TOX following combined ²²³Ra + EBRT treatment, which will guide future treatment optimization.

The DirectDensity^® CT reconstruction algorithm provides a reconstruction approach independent of the tube voltage, directly reconstructing the CT projection data into CT numbers related to the electron densities of the materials. This work examines the efficacy of DirectDensity^® in the treatment planning process with both tissues and metallic materials. CT scans of a Cheese phantom were acquired at 80, 100, 120 and 140 kVp and reconstructed with different algorithms. Calibration curves were built for each kVp and reconstruction technique. To evaluate the flexibility of the DirectDensity^® in dose calculations, a prostate cancer treatment plan was simulated on phantom images with and without metal inserts. Moreover, the robustness of the algorithm was tested by simulating a possible error in the selection of the calibration curve. As expected, the calibration curves related to DirectDensity^® showed a tube voltage dependence only for densities above 1.82 g/cm³. The maximum percentage differences in dose distributions comparations never exceeded the 3% of tolerance and the 3D gamma analysis always returned indices greater than 90%. The results suggest that the DD reconstruction algorithm can be employed in most clinical cases and allows for a personalized radiotherapy cancer treatment workflow, maintaining its robustness and simplicity.

The increasing use of ¹⁷⁷Lu-labelled agents for targeted radionuclide cancer therapy highlights the radiation protection challenges in the management of radioactive waste due to ^177mLu impurities. To ensure safe disposal, compliance with clearance criteria must be verified using calibrated systems, such as Hyper Pure Germanium (HPGe) spectrometers. This work aims to validate a customized GEANT4 model of our HPGe system in Marinelli beaker geometry to propose an operational approach properly quantifying ¹⁷⁷Lu and ^177mLu in waste samples. The system's efficiency curve was calculated by modelling gamma sources in the energy range of interest and validated by spectra measurements of ¹⁷⁷Lu and ^99mTc sources. Correction factors accounting for true coincidence summing (TCS) effect were simulated for ¹⁷⁷Lu, ^177mLu and ^99mTc and they were applied to the spectrum measurement of a waste sample model with known activities of ¹⁷⁷Lu and ^177mLu. Thus, an operational approach for activities quantification was tested comparing the results with the nominal values. No significant differences were observed between simulated and measured efficiency values. TCS correction factors are significant only for ^177mLu (1.6 at 112.95 keV and 204.11 keV). Eventually, the proposed framework to quantify ¹⁷⁷Lu in a waste sample allowed to estimate the ¹⁷⁷Lu and ^177mLu component activities within a maximum 16% uncertainty. Results show that the HPGe model could be a powerful resource for a wide range of applications in daily clinical routine and it could be used to build a simple quality assurance program to monitor the detector response constancy in time.

The study aimed to generate a local failure (LF) risk map in resected pancreatic cancer (PC) and validate the results of previous studies, proposing new guidelines for PC postoperative radiotherapy clinical target volume (CTV) delineation. Follow-up computer tomography (CT) of resected PC was retrospectively reviewed by two radiologists identifying LFs and plotting them on a representative patient CT scan. The percentages of LF points randomly extracted based on CTV following the RTOG guidelines and based on the LF database were 70% and 30%, respectively. According to the Kernel density estimation, an LF 3D distribution map was generated and compared with the results of previous studies using a Dice index. Among the 64 resected patients, 59.4% underwent adjuvant treatment. LFs closer to the root of the celiac axis (CA) or the superior mesenteric artery (SMA) were reported in 32.8% and 67.2% cases, respectively. The mean (± standard deviation) distances of LF points to CA and SMA were 21.5 ± 17.9 mm and 21.6 ± 12.1 mm, respectively. The Dice values comparing our iso-level risk maps corresponding to 80% and 90% of the LF probabilistic density and the CTVs-80 and CTVs-90 of previous publications were 0.45–0.53 and 0.58–0.60, respectively. According to the Kernel density approach, a validated LF map was proposed, modeling a new adjuvant CTV based on a PC pattern of failure.