We reported the clinical and radiological outcome of an aggressive dural arteriovenous fistula (DAVF) after combined glue embolization and hypofractionated helical TomoTherapy (Hypo-HT).

Eleven patients whose radiological examinations are consistent with aggressive DAVF were treated with combined glue embolization and Hypo-HT 30–36 Gy in 5–6 fractions. The dosimetric analysis, clinical response and radiological imaging obliteration rate by magnetic resonance angiography or computed tomography angiography were investigated.

There were eight males and three females with a male and female ratio of 2·67. The mean age was 51·2 years old (range 37–69). Anatomical imaging sites of disease included transverse-sigmoid sinuses (n = 7), superior sagittal sinus (n = 3) and tentorium cerebelli (n = 1). The mean pitch and MF of treatment plans were 0·273 ± 0·032 and 1·70 ± 0·31, respectively. The average size of PTV were 15·39 ± 7·74 cc whereas the Reff,PTV was 1·50 ± 0·25 cm. The average Dmax and Dmin were 37·52 ± 3·34 and 31·77 ± 2·64 Gy, respectively. HI, CI and CI50 were 0·16 ± 0·06, 1·80 ± 0·56 and 7·85 ± 4·16, respectively. The Reff,Rx and Reff,50%Rx were 1·80 ± 0·24 and 2·90 ± 0·45 cm, respectively. The Reff between 50%Rx and 100%Rx was 1·10 ± 0·28 cm on average. With a mean follow up of 28·5 months (range 9–48), the complete recovery of symptoms was found in 72·7 % (eight patients) within 2–12 months after completion Hypo-HT. Partial recovery was reported in 18·2% (two patients). No clinical response was found in 9·1% (one patient). The total radiographic obliteration rate was 27·3% (three patients), subtotal obliteration was 27·3% (three patients) and partial obliteration was 45·4% (five patients).

Satisfactory clinical response of aggressive DAVF was found in all treated patients by combining glue embolization and Hypo-HT. All dosimetric parameters were acceptable. We still need an extended follow up time to assess further radiographic obliteration rate and late side effects of the treatment.

Radiation exposure to the thyroid gland during breast irradiation can lead to hypothyroidism and this can impact on the quality of life. The aim of this study was to analyse if there is any difference in the radiation dose received by the thyroid gland during supraclavicular irradiation for breast cancer, with two different neck positions—straight or when the head is turned to the contralateral side to the breast being treated, when using a conformal technique.

All patients who received chest wall/breast and supraclavicular irradiation for breast cancer in 2019 in our department were divided into two groups based on the neck position as SN (neck positioned straight) and TN (neck tilted to contralateral side). The volume of thyroid gland, the radiation dose and volume parameters for Dmax, Dmean, and V5 to V40 of the thyroid were tabulated.

There were 72 patients included in the study with a mean age of 59 years, with 39 in the SN group and 33 in the TN group. There was no significant difference in thyroid volume between the two groups. Dmean, V15, V20, V25, V30 and V35 were significantly lower in tilted neck patients as compared to straight neck patients.

Neck positioned to the contralateral side of the breast primary may be recommended for conformal CT-based radiation planning.

The aim was to evaluate the feasibility of an intraoral stent (10 and 20 mm thickness) in radiotherapy of tongue cancer, and to measure the reduction in acute mucositis in the palate.

There were six patients in the intervention group, and seven patients in the control group. Target coverage was measured by the minimum dose covering 98% of the clinical target volume (CTV). Data were collected from the planning CT and daily cone-beam computer tomography (CBCT).

The 10 and 20 mm stent yielded a mean distance of 26 and 36 mm, respectively, between the tongue and the hard palate. We found comparable dose coverage of the CTV in the treatment plan, and on the CBCT. The stent reduced mean dose to the hard palate by 61.0% (p = 0.002). Dose to the soft palate was not reduced (p = 0.18). Average Common Terminology Criteria for Adverse Events (CTCAE) mucositis scores of the hard palate were 0 and 0.8 in the intervention and control group, respectively. The mucositis scores of the soft palate were 1.2 and 1.8.

Use of an intraoral stent substantially reduced the dose to the hard palate. CTV coverage was maintained. We did not find any significant reduction in visually scored radiation-induced mucositis.

To evaluate clinically pertinent skin dose and volume parameters for the development of toxicities following accelerated partial breast irradiation (APBI).

Three skin structures of various thicknesses inside the body (2 mm, 3 mm, 4 mm) were contoured over the treated breast retrospectively in a cohort of 62 women who underwent APBI using multi-catheter interstitial brachytherapy. The correlation statistics between the various skin structures and acute and late skin sequelae were evaluated using the Mann–Whitney U test and receiver-operating characteristic analysis. A p-value of <0·05 was considered significant.

At a median follow-up period of 54 months (range: 28–86), a significant correlation was seen between dose received by 0·2 (D0·2) cc of skin 4 mm inside the body as well as volume receiving 100% dose (V100) of skin 3 mm inside the body with cosmesis at 2 years and at last follow-up. The threshold for the two parameters for prediction of excellent or good cosmesis was 90% of the prescribed dose and 0·05 cc, respectively. No significant dosimetric or volumetric correlation was seen with other sequelae like wound dehiscence, fat necrosis, telangiectasia and atrophy.

The results of this study support the use of dose and volumetric indices of the sub-volumes of the skin for correlation with clinical endpoints. However, the same should be validated prospectively in a larger cohort of women undergoing breast brachytherapy.

This study aimed to evaluate and compare simultaneous integrated boost-based volumetric modulated arc therapy (SIB-VMAT) of head-and-neck plans optimised using segmented and non-segmented intermediate-risk target volumes.

CT data of 20 patients with locally advanced laryngeal cancer treated with radical chemoradiation were included retrospectively. Both segmented [planning target volume (PTV) IR!] and non-segmented PTV (PTV IR) volumes were created for the intermediate-risk volume. Correspondingly, two VMAT plans were generated for every CT dataset. Dosimetry parameters obtained from cumulative dose volume histogram and the quality indices such as conformity and homogeneity indices were evaluated for both plans and were statistically analysed.

Maximum dose of PTV IR! was observed to be higher in the non-segmented plans (7281·45 versus 7075·75 cGy) and was statistically significant (p = 0·002). Homogeneity index (HI) of PTV IR! in segmented plans fared better compared to non-segmented plans (0·1 versus 0·12, p = 0·01). All other dosimetry parameters were found to be similar in both plans.

This study shows that using segmented volumes for planning will lead to more homogenous plans with regard to intermediate- and low-risk volumes, especially under controlled settings.

This study aimed to evaluate acute and late toxicities in nasopharyngeal cancer (NPC) patients who were treated between split-field (SF) and extended-field (EF) step-and-shoot intensity-modulated radiotherapy (IMRT) techniques.

Between January 2011 and October 2011, 21 NPC patients with stage I-IVB (7th edition American Joint Committee on Cancer Staging) were randomly assigned to undergo radiotherapy with SF or EF step-and-shoot IMRT technique.

At a median follow-up time of 60 months (range 3–77), we reported the comparable acute and late toxicities between the two techniques. One patient (9%) in SF-IMRT arm developed grade 3 acute skin toxicity.

Both SF and EF step-and-shoot IMRT techniques for NPC patients did not produce any statistically significant differences in both acute and late toxicities. Although no difference in toxicity was observed, technical problems due to field matching management were the obstacles in utilisation of SF-IMRT in our routine practice.

To evaluate the efficacy of concurrent chemotherapy and high-dose (≥55 Gy) intensity-modulated radiotherapy (CCIMRT) in comparison with chemotherapy alone and intensity-modulated radiotherapy (IMRT) alone for unresectable locally advanced or metastatic pancreatic cancer.

Forty-six patients with pancreatic cancer undergoing CCIMRT (n = 17), chemotherapy alone (n = 16) or IMRT alone (n = 13) were analysed. Overall survival (OS), locoregional progression-free survival (LRPFS) and gastrointestinal toxicities were evaluated. The median radiation dose was 60 Gy (range, 55–60) delivered in a median of 25 fractions (range, 24–30). Gemcitabine (GEM) alone, GEM + S-1, S-1 alone, FOLFIRINOX and GEM + nab-paclitaxel were used in CCIMRT and chemo-monotherapy.

The 1-year OS rate was 69% in the CCIMRT group, 27% in the chemotherapy group and 38% in the IMRT group (p = 0·12). The 1-year LRPFS rate was 73, 0 and 40% in the 3 groups, respectively (p = 0·012). Acute Grade ≥ 2 gastrointestinal toxicity (nausea, diarrhea) was observed in 12% (2/17) in the CCIMRT group, 25% (4/16) in the chemotherapy group and 7·7% (1/13) in the IMRT group (p = 0·38). Late Grade 3 gastrointestinal bleeding was observed in 6·3% (1/16) in the chemotherapy group.

High-dose CCIMRT yielded acceptable toxicity and favorable OS and LRPFS.

This study aims to compare the gating signals of patients with lung cancer recorded during the planning computed tomography scan with the ones recorded during treatment fractions. The results provide insights into how representative the respiratory signals from the planning scan are for radiation dose partitioning.

The amplitude and frequency of the respiratory signals of 29 patients with lung carcinoma were analysed and compared with the amplitude and frequency of those recorded during their planning scans. Moreover, a cross-correlation analysis was performed between the difference between the planning scan and fractions and features from the planning scan.

Two patients showed significantly different amplitude and frequency during treatment fractions compared to those from the planning scan. These patients showed low variances in frequency and amplitude during the different fractions. The difference between planning scan and fractions is correlated with the variances within the planning scan.

Respiratory signals can differ between the planning scan and the fractions. In this case, a new planning scan may be beneficial. The respiratory signals from the planning scan may be predictive of whether the planning scan will be representative and usable as a control measure during radiotherapy fractions.

Breast cancer is the most commonly diagnosed malignancy among women and accounts for about 25% of all new cancer cases and 13% of all cancer deaths in Canadian women. It is a highly heterogeneous disease, encompassing multiple tumour entities, each characterised by distinct morphology, behaviour and clinical implications. Moreover, different breast tumour subtypes have different risk factors, clinical presentation, histopathological features, outcome and response to systemic therapies. Therefore, any strategies capable of the stratification of breast cancer by clinically relevant subtypes are an important requirement for personalised and targeted treatment. Therefore, in the advancement towards the concept of precision medicine that takes individual patient variability into account, several investigators have focused on the identification of effective clinical breast cancer biomarkers that interrogate key aberrant pathways potentially targetable with molecular targeted or immunological therapies.

This paper reports on a review of 11 current clinical and emerging biomarkers used in screening for early detection and diagnosis, to stratify patients by disease subtype, to identify patients’ risk for metastatic disease and subsequent relapse, to monitor patient response to specific treatment and to provide clinicians the possibility of prospectively identifying groups of patients who will benefit from a particular treatment.

The future holds promising for the use of effective clinical breast cancer biomarkers for early detection and personalised patient-specific targeted treatment and increased patient survival. Breast cancer biomarkers can potentially assist in early-staged, non-invasive, sensitive and specific breast cancer detection and screening, provide clinically useful information for identification of patients with a greater likelihood of benefiting from the specific treatment, offer a better understanding of the metastatic process in cancer patients, predict disease and for patients with the established disease can assist define the nature of the disease, monitor the success of treatment and guide the clinical management of the disease.

Previous studies showed that replacing conventional flattened beams (FF) with flattening filter-free (FFF) beams improves the therapeutic ratio in lung stereotactic body radiation therapy (SBRT), but these findings could have been impacted by dose calculation uncertainties caused by the heterogeneity of the thoracic anatomy and by respiratory motion, which were particularly high for target coverage. In this study, we minimised such uncertainties by calculating doses using high-spatial-resolution Monte Carlo and four-dimensional computed tomography (4DCT) images. We aimed to evaluate more reliably the benefits of using FFF beams for lung SBRT.

For a cohort of 15 patients with early-stage lung cancer that we investigated in a previous treatment planning study, we recalculated dose distributions with Monte Carlo using 4DCT images. This included 15 FF and 15 FFF treatment plans.

Compared to Monte Carlo, the treatment planning system (TPS) over-predicted doses in low-dose regions of the planning target volume (PTV). For most patients, replacing FF beams with FFF beams improved target coverage, tumour control, and uncomplicated tumour control probabilities.

Monte Carlo tends to reveal deficiencies in target coverage compared to coverage predicted by the TPS. Our data support previously reported benefits of using FFF beams for lung SBRT.

The aim of this systematic review was to synthesise and summarise evidence surrounding the clinical use of fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI) for target volume delineation (TVD) in rectal cancer radiotherapy planning.

PubMed, EMBASE, Cochrane library, CINAHL, Web of Science and Scopus databases and other sources were systematically queried using keywords and relevant synonyms. Eligible full-text studies were assessed for methodological quality using the QUADAS-2 tool.

Eight of the 1448 studies identified met the inclusion criteria. Findings showed that MRI significantly delineate larger tumour volumes (TVs) than FDG-PET/CT while diffusion-weighted magnetic resonance imaging (DW-MRI) defined smaller gross tumour volumes (GTVs) compared to T2 weighted-Magnetic Resonance Image. CT-based GTVs were found to be larger compared to FDG-PET/CT. FDG-PET/CT also identified new lesions in 15–17% patients and TVs extending outside the routinely used clinical standard CT TV in 29–83% patients. Between observers, delineated volumes were similar and consistent between MRI sequences, whereas interobserver agreement was significantly improved with FDG-PET/CT than CT.

FDG-PET/CT and DW-MRI appear to delineate smaller rectal TVs and show improved interobserver variability. Overall, this study provides valuable insights into the amount of attention in the research literature that has been paid to imaging for TVD in rectal cancer.

This National Cancer Database (NCDB) analysis was performed to evaluate the outcomes of adjuvant chemotherapy (AC) versus observation for resected pancreatic adenocarcinoma treated with neoadjuvant therapy (NT).

The NCDB was queried for primary stages I–II cT1-3N0-1M0 resected pancreatic adenocarcinoma treated with NT (2004–2015). Baseline patient, tumour and treatment characteristics were extracted. The primary end point was overall survival (OS). With a 6-month conditional landmark, Kaplan–Meier analysis, multivariable Cox proportional hazards method and 1:1 propensity score matching was used to analyse the data.

A total of 1,737 eligible patients were identified, of which 1,247 underwent post-operative observation compared to 490 with AC. The overall median follow-up was 34·7 months. The addition of AC showed improved survival on the multivariate analysis (HR 0·78, p < 0·001). AC remained statistically significant for improved OS, with a median OS of 26·3 months versus 22·3 months and 2-year OS of 63·9% versus 52·9% for the observation cohort (p < 0·001). Treatment interaction analysis showed OS benefit of AC for patients with smaller tumours.

Our findings suggest a survival benefit for AC compared to observation following NT and surgery for resectable pancreatic adenocarcinoma, especially in patients with smaller tumours.

The complexity associated with the treatment planning and delivery of stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) volumetric modulated arc therapy (VMAT) plans which employs continuous dynamic modulation of dose rate, field aperture and gantry speed necessitates diligent pre-treatment patient-specific quality assurance (QA). Numerous techniques for pre-treatment VMAT treatment plans QA are currently available with the aid of several different devices including the electronic portal imager (EPID). Although several studies have provided recommendations for gamma criteria for VMAT pre-treatment QA, there are no specifics for SRS/SRT VMAT QA. Thus, we conducted a study to evaluate intracranial SRS/SRT VMAT QA to determine clinical action levels for gamma criteria based on the institutional estimated means and standard deviations.

We conducted a retrospective analysis of 118 EPID patient-specific pre-treatment QA dosimetric measurements of 47 brain SRS/SRT VMAT treatment plans using the integrated Varian solution (RapidArcTM planning, EPID and Portal dosimetry system) for planning, delivery and EPID QA analysis. We evaluated the maximum gamma (γmax), average gamma (γave) and percentage gamma passing rate (%GP) for different distance-to-agreement/dose difference (DTA/DD) criteria and low-dose thresholds.

The gamma index analysis shows that for patient-specific SRS/SRT VMAT QA with the portal dosimetry, the mean %GP is ≥98% for 2–3 mm/1–3% and Field+0%, +5% and +10% low-dose thresholds. When applying stricter spatial criteria of 1 mm, the mean %GP is >90% for DD of 2–3% and ≥88% for DD of 1%. The mean γmax ranges: 1·32 ± 1·33–2·63 ± 2·35 for 3 mm/1–3%, 1·57 ± 1·36–2·87 ± 2·29 for 2 mm/1–3% and 2·36 ± 1·83–3·58 ± 2·23 for 1 mm/1–3%. Similarly the mean γave ranges: 0·16 ± 0·06–0·19 ± 0·07 for 3 mm/1–3%, 0·21 ± 0·08–0·27 ± 0·10 for 2 mm/1–3% and 0·34 ± 0·14–0·49 ± 0·17 for 1 mm/1–3%. The mean γmax and mean γave increase with increased DTA and increased DD for all low-dose thresholds.

The establishment of gamma criteria local action levels for SRS/SRT VMAT pre-treatment QA based on institutional resources is imperative as a useful tool for standardising the evaluation of EPID-based patient-specific SRS/SRT VMAT QA. Our data suggest that for intracranial SRS/SRT VMAT QA measured with the EPID, a stricter gamma criterion of 1 mm/2% or 1 mm/3% with ≥90% %GP could be used while still maintaining an in-control QA process with no extra burden on resources and time constraints.

Head and neck cancer (HNC) accounts for 5% of all new cancer cases and most were locally advanced. Positron emission tomography/computed tomography (PET/CT) in radiotherapy practice in locally advanced head and neck squamous cell carcinoma (HNSCC) is being used in staging and proper contouring. Proper staging is essential for accurate treatment decision.

This is a prospective phase II study conducted as a single institute centre to evaluate the role of PET/CT-treatment in staging, contouring and response evaluation of 30 patients with locally advanced HNSCC in contrast to CT scan. Our cases did not undergo radical surgery for the primary tumour, and biopsy was taken with PET/CT post-treatment to evaluate response.

Median age of patients was 49·4 years (minimum age of 32 years and maximum of 68 years). Males were predominant 22 (73·3%). Nasopharynx was the predominant site 16/30 (53·3%). PET/CT changed the overall staging in 40% of the patients (upstaged in 36·7% and downstaged in 3·3%). Gross tumour volume (GTV) of PET/CT was smaller in 23 patients (76·7%) and larger in 5 (16·7%) than the GTV of conventional CT, whereas GTV of lymph nodes of PET/CT was larger in 20 patients (67·7%) and smaller in 4 (13·3%). PET/CT study detected bone metastasis in two nasopharyngeal carcinoma patients and two cases of 2nd primary tumours which were not detected using conventional CT. The Cox-regression model showed that the median standardised uptake volume (SUV) of the initial tumour had been a dependent predictor of death in patients with HNSCC (p-value = 0·033) where the risk of death was 0·725 times among patients with high SUV of the initial tumour. Consequently, the size of GTV of the tumour was significant in the prediction of death (p = 0·018).

18F-FDG-PET/CT is useful for staging, radiotherapy delineation as well as aiding proper decision making, in addition to assessment of treatment response in HNSCC patients.

The overall aim of this study was to evaluate the use of Virtual Environment for Radiotherapy Training Image-Guided Radiotherapy (VERT™IGRT) as a teaching and assessment tool for 3D image matching competency within the radiotherapy clinical setting and explore radiographer perceptions, experiences and integration of VERT™IGRT as an imaging tool.

A mixed-methods study was utilised to measure clinical image matching competencies in the first quantitative phase through means of a workbook and imaging assessment. Phase II used qualitative semi-structured interviews to explore radiographer perceptions.

Workbooks enabled participants to prepare for image assessments. Interview findings were highlighted in three distinctive themes: (1) The need for supervision, guidance and feedback; (2) Experience and practice leads to confidence and competence and (3) Technology supports process but not evaluation.

VERT™IGRT provides a sound platform for training therapeutic radiographer image matching skills, but needs to be delivered with continuous feedback to develop individual decision-making skills. The technology provides opportunities for staff to increase confidence in utilsing image matching technology, but analytical and evaluation skills require supervision and continuous feedback which should be embedded in any educational training programme.

The objective of this study has been to identify monitor unit (MU) and treatment time variations, volume coverage dissimilarity among 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) treatment plans for head and neck cancer (HNC) based on literature review.

A number of HNC cases were studied with the investigation of conformity and homogeneity index.

When high-dose modulation was required around small organs at risk (OARs), a clinically acceptable IMRT plan was achieved as VMAT usually required longer dose optimisation time. The greatest benefit of VMAT has been rapid treatment delivery allowing improved patient comfort, reduced intra-fraction motion and increased patient throughput. In some papers, 3D-CRT was shown not to meet well the requirements on parotid glands. One paper showed that cerebellum dose was lower for 3D-CRT than IMRT. However, it was found in other papers that OAR sparing with 3D-CRT was reasonable but in complex cases not enough.

IMRT usually consists of several treatment fields with different directions, hundreds of beam lets with modulated intensity, an advantage over 3D-CRT, whereas VMAT has advantage over IMRT due to rotating beam utilisation. VMAT has lower total MU and treatment times than IMRT and 3D-CRT, while maintaining similar dosimetric endpoints.

Induction chemotherapy (iC) followed by concurrent chemoradiation has been shown to improve overall survival (OS) for locally advanced pancreatic cancer (LAPC). However, the survival benefit of stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation therapy (CFRT) following iC remains unclear.

The National Cancer Database (NCDB) was queried for primary stage III, cT4N0-1M0 LAPC (2004–15). Kaplan–Meier analysis, Cox proportional hazards method and propensity score matching were used.

Among 872 patients, 738 patients underwent CFRT and 134 patients received SBRT. Median follow-up was 24·3 and 22·9 months for the CFRT and SBRT cohorts, respectively. The use of SBRT showed improved survival in both the multivariate analysis (hazards ratio 0·78, p = 0·025) and 120 propensity-matched pairs (median OS 18·1 versus 15·9 months, p = 0·004) compared to the CFRT.

This NCDB analysis suggests survival benefit with the use of SBRT versus CFRT following iC for the LAPC.

We have investigated the influence in volumetric-modulated arc therapy (VMAT) plans by a sequence of increment of gantry angle (IGA) in definitive radiotherapy treatment for cervical cancer. The plans are quantitatively analysed in terms of conformity index (CI), heterogeneity index (HI), dose–gradient index (DGI), target coverage (TC) by prescription dose, monitor unit (MU) usage, control points (CPs) and dose to organs.

In this retrospective study, we selected 27 patients with cervical cancer having aged between 54 and 69. All the patients enrolled in this study were at T3N1M0 stage of cervical cancer. The prescription dose to planning target volume (PTV) was 50 Gy and was administered in 2 Gy/fraction through VMAT technique. VMAT plans were optimised by varying the parameter ‘IGA’ as 10, 20, 30 and 40°.

Homogenous dose distribution within PTV and TC by prescription dose was significantly enhanced (p < 0·05) with larger IGA. The difference between volume receiving 15 Gy (V15Gy) in bowel was up to 10% with larger IGA (30 and 40°) and V25Gy in femoral head was up to 3% with smaller IGA (10 and 20°). CPs were enhanced and MU usage was reduced with larger IGA (30 and 40°). IGA 40° had reduced the MU usage than IGA 30° but the CI and DGI were compromised due to large MLC field segments.

This study recommends that the larger IGA could yield better results when the number of sectors is even, for a cervical cancer patient. However, more data from more patients need to be obtained and analysed to make this an evidence-based hypothesis.

The Coronavirus disease 2019 (COVID-19) is spreading rapidly throughout the world. Lung is the primary organ which the COVID-19 virus affects and leads to pneumonia, an acute respiratory distress syndrome. COVID-19 infects the lower respiratory system, and the lung’s response to this infection is recruiting macrophages and monocytes leading to inflammation, this response causes widespread damage to the lung’s airways.

The purpose of this study is to review studies of using low-dose radiation as a treatment for the inflammation of the tissue and pneumonia resulting from COVID-19. These studies were compared with the risk of developing lung cancer during performed dose for the treatment of COVID-19 in radiation therapy.

Our study focused on in vitro, in vivo and clinical reports of using low-dose radiation for the treatment of inflammation, pneumonia and COVID-19. The risk of lung cancer resulting from suggested dose in these studies was also evaluated.

From the review of articles, we have found that low-dose radiation can lead to improvement in inflammation in different line cells and animals; in addition, it has been effective in treating inflammation and pneumonia caused by COVID-19 in human up to 80%. Since suggested doses do not remarkably increase the lung cancer risk, low-dose radiation can be an adjuvant treatment for COVID-19 patients.

Little is known about how integrated positron emission tomography-computed tomography (IPET-CT), both imaging tools and not methods of treatment, contributes to head and neck cancer patients’ outcomes. We analysed the clinical PET-CT findings and their correlation to the effects of applied contemporary disease management.

A retrospective analysis of 29 individuals who underwent treatment planning fusion of PET-CT for radiochemotherapy of locally advanced head and neck cancer between 2010 and 2016 was undertaken. Gross tumour volumes were categorised as small (≤36 cm3) or large (>36 cm3), and tumour responses to therapy were classified as complete or incomplete.

The overall rates of complete tumour response (CTR), 3-year crude survival and failure (all types included) were 80%, 41% and 55%, respectively. Comparative analysis of tumour volume subsets revealed no significant differences in the rates of CTR (p > 0.80), 3-year survival (p > 0.30) and locoregional recurrence (p > 0.70). CTR was associated with improved prognosis (p > 0.05) and fewer tumour relapses (p < 0.02).

Our findings, although not truly conclusive, appear in line with those in the literature. Smaller tumour volumes and CTRs shown on integrated PET-CT are likely to play important roles in the promotion of better prognosis, but further study with larger patient numbers and more data are needed.