SummaryThe lack of specific treatment planning tools limits the spread of Intraoperative Electron Radiation Therapy. An innovative simulation and planning tool is presented. Applicator positioning, isodose curves, and dose volume histograms can be estimated for previously segmented regions to treat/protect. Evaluation by three radiation oncologists on 15 patients showed high parameter agreement in nine cases, demonstrating the possibilities in cases involving different anatomical locations, and Purpose: Intraoperative electron beam radiation therapy (IOERT) involves a modified strategy of conventional radiation therapy and surgery. The lack of specific planning tools limits the spread of this technique. The purpose of the present study is to describe a new simulation and planning tool and its initial evaluation by clinical users. Methods and Materials: The tool works on a preoperative computed tomography scan. A physi cian contours regions to be treated and protected and simulates applicator positioning, calcu lating isodoses and the corresponding doseevolume histograms depending on the selected electron energy. Three radiation oncologists evaluated data from 15 IOERT patients, including different tumor locations. Segmentation masks, applicator positions, and treatment parameters were compared. Results: High parameter agreement was found in the following cases: three breast and three rectal cancer, retroperitoneal sarcoma, and rectal and ovary monotopic recurrences. All radiation oncologists performed similar segmentations of tumors and high risk areas. The average appli cator position difference was 1.2 AE 0.95 cm. The remaining cancer sites showed higher devia tions because of differences in the criteria for segmenting high risk areas (one rectal, one pancreas) and different surgical access simulated (two rectal, one Ewing sarcoma). Conclusions:The results show that this new tool can be used to simulate IOERT cases involving different anatomic locations, and that preplanning has to be carried out with specialized surgical input.

A modest surgical interval delay (≥6 weeks) did not increase postoperative complications and was identified as a favorable prognostic factor for OS, although no differences were observed in pCR, LC, or DFS. Innovative multidisciplinary strategies incorporating further time extension of the surgical interval can be safely explored.

No significant differences were seen in DP and QLQ between intermittent (6 months) and continuous (36 months) ADT in patients with BF after EBRT.

Background: Plastic scintillators have been used as radiation detectors for the past few years, as they are water-equivalent and independent of the dose, dose rate, and angle of incidence. In addition, they are also independent of the presence of a magnetic field and could be used for in vivo dosimetry in an MR-Linac. With the advent of a new commercial scintillation detector, Blue Physics Model 10,its characterization has been performed on an MR-Linac with a view to future applications. Purpose: To perform the dosimetric characterization and study potential applications of a novel commercial plastic scintillation detector in a MR-Linac. Methods: Scintillation detector description, calibration procedure, short-term repeatability, dose-response linearity, dose-rate dependence, angular dependence, and temperature dependence have been studied. Percent-depth-dose (PDD) and beam profiles were measured for small fields and a standard field, as well as output factors, for comparison with other PTW detectors: a diamond diode and PinPoint and Semiflex 3D ionization chambers. The suitability of the plastic scintillator for in vivo dosimetry in a magnetic field has also been studied measuring the dose to a point in an anthropomorphic phantom while acquiring MR imaging. This measured dose was compared with that calculated with Monaco planning system and with that measured with a PTW Semiflex 3D chamber, the latter without acquiring MR images. Results: Short-term repeatability presented negligible variations (<0.4%) for 100 and 20 MU. Similar results were obtained for dose-response linearity and dose-rate dependence. A small angular dependence was determined, while the scintillator resulted practically independent of the temperature. PDDs showed excellent agreement except in the build-up region, and calculated penumbras with the profiles given by the scintillator were between the ones obtained with the diamond detector and the PinPoint ionization chamber. Measured OF with the scintillator were the highest between all detectors, 1.26% higher than the value obtained with the microdiamond for the smallest field measured, 0.5 × 0.5 cm 2 . Finally, the total dose to a point measured with the scintillator was 0.51% higher compared to that calculated by the planning system. Conclusion:The Blue Physics model 10 scintillation system showed excellent dosimetric characteristics. Its response independent of the temperature and the presence of a magnetic field make it suitable for in vivo dosimetry in an MR-Linac while acquiring MR images, which could solve the impossibility of performing a dosimetric QA for each adapted plan. Furthermore, its temporalThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

The reality of intraoperative radiation therapy (IORT) practice is consistent with an efficient and highly precise radiation therapy technique to safely boost areas at risk for local recurrence. Long-term clinical experience has shown that IORT-containing multi-modality regimens appear to improve local disease control, if not survival in many diseases. Research with IORT is a multidisciplinary scenario that covers knowledge from radiation beam adapted development to advance molecular biology for bio-predictability of outcome. The technical parameters employed in IORT procedures are important information to be recorded for quality assurance and clinical results analysis. In addition, specific treatment planning systems for IORT procedures are available, to help in the treatment decision-making process. A systematic revision of opportunities for research and innovation in IORT is reported including radiation beam modulation, delivery, dosimetry and planning; infrastructure and treatment factors; experimental and clinical radiobiology; clinical trials, innovation and translational research development.