Background/Objectives: Squamous cell carcinoma (SCC) of the lip occupies an ambiguous position between cutaneous and oral-cavity oncology and lacks dedicated radiotherapy guidelines, resulting in considerable practice variability. We systematically reviewed the reported radiotherapy practices, clinical outcomes and gaps in consensus at this site. Methods: Following PRISMA 2020 and prospectively registered in PROSPERO (CRD420261349994), we searched PubMed/MEDLINE, Scopus, the Cochrane Library (Trials) and ClinicalTrials.gov (20 March 2026). Studies of at least ten patients with lip SCC treated with external beam radiotherapy or brachytherapy were eligible. Risk of bias was assessed with ROBINS-I; the synthesis was narrative, following the Synthesis Without Meta-analysis (SWiM) reporting framework. Results: Nine studies (approximately 3904 patients; 1964–2021; six countries) met the criteria. Interstitial brachytherapy was the dominant modality (seven studies), with high local control (approximately 93–97% in modern actuarial series), favourable toxicity and good functional/aesthetic outcomes; external beam radiotherapy served mainly as adjuvant treatment. Doses, fractionation, nodal management and outcome reporting were markedly heterogeneous, and eight of nine studies were at serious risk of bias. Conclusions: Radiotherapy—in the identified literature, in effect, largely historical interstitial brachytherapy—appears to be an effective, organ-preserving option in early-stage lip SCC; no conclusions can be drawn for modern external beam techniques such as IMRT. The limited, brachytherapy-dominated evidence warrants cautious interpretation and justifies protocol standardisation, a core outcome set with validated quality-of-life instruments, and multi-institutional prospective registries.

Background: Guidelines recommend the early integration of palliative care in advanced cancer; however, “earliness” remains heterogeneously defined, with no temporal consensus, and timing studies are vulnerable to immortal-time bias and do not model competing risks. Objective: To evaluate a pre-specified three-month threshold as a prognostic marker of cancer-specific survival (CSS) and as a potential auditable indicator of timely access to palliative care. Methods: A retrospective observational cohort study of 147 consecutive adults with advanced locoregional or metastatic cancer, admitted to a Romanian palliative care center (2018–2022; median follow-up 26 months), was conducted. The six-stratum analytical framework comprised multivariable Cox regression, Fine–Gray models, Grambsch–Therneau coefficients, Imai–Keele–Tingley mediation, restricted mean survival time (RMST) with inverse probability of censoring weighting, and validation through landmark and left-truncation analyses. Results: Fifty-nine patients (40.1%) were referred within the first three months. Referral within three months was independently associated with a reduced risk of cancer-specific death in locoregional disease (adjusted hazard ratio [HR], 0.49; 95% confidence interval, 0.28–0.86) and metastatic disease (HR, 0.58). Fine–Gray models confirmed the association (subdistribution HR 0.52). The RMST benefit was + 18.7 months (locoregional) and + 4.3 months (metastatic), persisting across landmark and truncation analyses. Conclusion: The three-month threshold is independently associated with significantly better CSS and is robust across six analytical approaches. As the design is observational, the findings remain associative and hypothesis-generating. Relevance for patients: The proportion of patients referred within the first three months can be computed from routine documentation and, subject to external validation, could serve as an auditable indicator of access to palliative care.

Background/Objectives: Inter-platform variability in beam characteristics and low-dose exposure may arise from differences in linear accelerator head design, multileaf collimator geometry, and dose calculation algorithms. This study aimed to evaluate system-level dosimetric differences between two widely used linear accelerator platforms under clinically commissioned conditions. Methods: A comparative dosimetric analysis was performed between Elekta Synergy and Varian TrueBeam linear accelerators. Beam data were acquired using a SunSCAN™ 3D water phantom, and patient-specific quality assurance was conducted with the Octavius^® 4D system. Treatment plans were generated for left-sided breast, prostate, and head and neck cases using clinically commissioned treatment planning systems. Beam flatness, symmetry, penumbra width, low-dose exposure, conformity, homogeneity, and organ-at-risk dose metrics were evaluated. Results: Platform-dependent differences were observed in penumbra behavior and out-of-field dose, primarily attributable to intrinsic linac head design and collimation characteristics. These differences propagated into clinical plans, with greater variability observed for breast and head and neck cases, while prostate plans showed higher consistency between platforms. Algorithm-dependent trends were noted for conformity and homogeneity indices; however, all plans met institutional clinical acceptance criteria during quality assurance. Stricter gamma evaluation criteria revealed systematic but limited inter-platform deviations. Conclusions: Elekta Synergy and Varian TrueBeam demonstrated clinically acceptable dosimetric performance, with modest platform-dependent differences. While target coverage and overall plan quality were comparable, these variations were primarily observed in peripheral dose regions and may be relevant for platform-specific planning optimization and quality assurance. This supports the importance of comprehensive commissioning and QA procedures in both mixed- and single-platform clinical settings, particularly for highly modulated techniques.