Background: This study aimed to propose a machine learning model to predict the local response of resectable locally advanced esophageal squamous cell carcinoma (LA-ESCC) treated by neoadjuvant chemoradiotherapy (NCRT) using pretreatment 18-fluorodeoxyglucose positron emission tomography (FDG PET) images. Methods: The local responses of 98 patients were categorized into two groups (complete response and noncomplete response). We performed a radiomics analysis using five segmentations created on FDG PET images, resulting in 4250 features per patient. To construct a machine learning model, we used the least absolute shrinkage and selection operator (LASSO) regression to extract radiomics features optimal for the prediction. Then, a prediction model was constructed by using a neural network classifier. The training model was evaluated with 5-fold cross-validation. Results: By the LASSO analysis of the training data, 22 radiomics features were extracted. In the testing data, the average accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve score of the five prediction models were 89.6%, 92.7%, 89.5%, and 0.95, respectively. Conclusions: The proposed machine learning model using radiomics showed promising predictive accuracy of the local response of LA-ESCC treated by NCRT.

This study aimed to evaluate the relationship between chronic kidney disease (CKD) after radiation therapy for gastric/duodenal mucosa-associated lymphoid tissue lymphoma and dose-volume histogram of the kidneys. We retrospectively reviewed 40 patients who received 3-dimensional conformal radiation therapy. CKD was evaluated using the Common Terminology Criteria for Adverse Events version 5.0. The mean dose of bilateral kidneys/right kidney/left kidney (D_{mean of b-kidneys}) (D_{mean of r-kidney}) (D_{mean of l-kidney}), bilateral kidneys/right kidney/left kidney volume receiving ≥ x Gy (V_{x of b-kidneys}) (V_{x of r-kidney}) (V_{x of l-kidney}), and patients’ baseline clinical characteristics were analyzed. The median radiation therapy dose was 28 (range, 24-44.8) Gy in 14 fractions. The median follow-up period was 63.1 months, and the 5-year cumulative incidence of grade 2 CKD rate was 14.8%. Among several factors, V_{5 of b-kidneys} was most strongly associated with grade 2 or worse CKD, with an area under the curve of 0.81 in the receiver operating characteristic curve. The 5-year incidence rate in patients with V_{5 of b-kidneys} ≥ 58% was significantly higher than that in other patients (24.5% and 9.8%, respectively; P < .05). In this study using 3-dimensional conformal radiation therapy, the rate of adverse events at 5 years was low, many patients showed toxicity after 5 years; thus, continuous follow-up is necessary to detect potential nephrotoxicity. Our data demonstrate that V_{5 of b-kidneys} was most strongly associated with the risk of CKD. With lower doses and more advanced techniques in recent years, the incidence of CKD may be further reduced.

Self-care demonstrated efficacy in preventing severe acute radiation dermatitis among patients with head and neck squamous cell carcinoma undergoing chemoradiotherapy (CRT). This prospective trial aimed to confirm the feasibility and safety of transcutaneous electrical sensory stimulation while examining the relationship between changes in self-care behavior through supportive care interventions and the severity of acute radiation dermatitis during CRT. Patients underwent assessments for dermatitis grading (Grades 1 to ≥3) and were interviewed regarding self-care practices. The self-care questionnaires comprised six items, and a point was deducted for each task that the patient could not perform independently. Statistical analysis was performed to determine the association between G3 radiation dermatitis and the lowest self-care behavior scores. Of the 10 patients enrolled, three experienced G3 dermatitis. During CRT, six patients maintained their initial scores and did not develop ≥G3 dermatitis. Meanwhile, three of four patients with decreased scores exhibited ≥G3 dermatitis. The group with ≥G3 dermatitis had significantly lower scores than those with ≤G2 dermatitis, suggesting that the inability of patients to perform self-care routinely may lead to severe acute radiation dermatitis. Further prospective studies are needed to confirm the potential of self-care interventions in preventing severe dermatitis.

Purpose: Self-care during radiotherapy (RT) is crucial for managing mucositis and dermatitis in patients with head and neck squamous cell carcinomas (HNSCC). However, elderly patients often struggle with self-care. This study examined the relationship between self-care decline and the Geriatric 8 (G8) score. Methods: A retrospective analysis was conducted on 66 patients (≥ 65 years) with HNSCC who met the inclusion and exclusion criteria and received definitive RT between December 2018 and February 2023. Self-care activities—medication adherence, oral care, grooming, skin ointment application, and gauze dressing—were assessed during definitive RT on a 0–5 scale. Patients were first grouped by initial self-care independence, and their G8 scores were compared. Among initially independent patients, those with self-care score changes were further analyzed based on their G8 scores. A threshold value was also determined to differentiate between the groups. Results: The initially independent group exhibited significantly higher G8 scores than non-independent group (median G8 score: 14 vs. 9.75, P = 0.0067). Among the initially independent patients, 15 (24.2%) experienced self-care decline, and lower baseline G8 scores significantly predicted this deterioration (median G8 score: 12 vs. 15; P = 0.011). Multivariate analysis identified G8 scores as a significant predictor of self-care decline (odds ratio = 6.53, P = 0.0074). Receiver operating characteristic (ROC) analysis determined a G8 cutoff of 12 (area under the curve = 0.72) with 53.3% sensitivity and 85.1% specificity. Conclusion: These findings indicate a possible coherence between the absence of frailty and maintenance of self-care in elderly patients undergoing RT. Further, prospectively designed research is needed to confirm these findings in a larger cohort.

To compare the efficacy and safety of stereotactic body radiation therapy (SBRT) with or without transcatheter arterial chemoembolization (TACE) for patients with small hepatocellular carcinoma (HCC) who were ineligible for resection or ablation therapies.