Proton therapy facilities: an overview of the development in recent years

Since its discovery in 1946, Proton therapy has continued to overgrow from the number of units installed in various countries and the technology used. This paper aims to provide an overview of the development of proton therapy facilities to date based on a literature review. The results are discussed in several aspects, including its distribution across the globe, beam delivery techniques, dose verification, room layout, and shielding design considerations.

Improving Outcomes of Tyrosine Kinase Inhibitors in Hepatocellular Carcinoma: New Data and Ongoing Trials

Targeted therapies such as oral tyrosine kinase inhibitors (TKIs) are the main therapeutic strategy effective for advanced hepatocellular carcinoma (HCC). Currently six tyrosine kinase inhibitors for HCC therapy have been approved. The newly approved first-line drug donafenib represent the major milestones in HCC therapeutics in recent years. However, drug resistance in HCC remains challenging due to random mutations in target receptors as well as downstream pathways. TKIs-based combinatorial therapies with immune checkpoint inhibitors such as PD-1/PD-L1 antibodies afford a promising strategy to further clinical application. Recent developments of nanoparticle-based TKI delivery techniques improve drug absorption and bioavailability, enhance efficient targeting delivery, prolonged circulation time, and reduce harmful side effects on normal tissues, which may improve the therapeutic efficacy of the TKIs. In this review, we summarize the milestones and recent progress in clinical trials of TKIs for HCC therapy. We also provide an overview of the novel nanoparticle-based TKI delivery techniques that enable efficient therapy.

Nanomedicine potential for endometriosis treatment

Contraception has previously provided alternative medication delivery techniques for the treatment of endometriosis. Only LNG-IUSs and depot formulation (DMPA), however, have been studied in numerous RCTs to treat patients. These approaches tend to enhance patient compliance and satisfaction when compared to other conventional treatment alternatives. Nanotechnologies are potential new drug delivery techniques that have been shown to deliver compounds with a particular therapeutic impact. However, the information is limited and preliminary. Endometriosis research has identified the patients who could benefit most from this kind of medication administration. No one has ever been used in a clinical study to treat endometria. Alternative medication delivery techniques may help to enhance compliance, effectiveness, and the development of novel treatment approaches. The use of vaginal rings as a unique and alternative medication delivery route for AIs, as well as the experience with danazol, are examples. The vaginal ring has been studied as a new medication delivery mechanism for danazol and aromatase inhibitors. Nanotechnologies are made up of bioconjugates that deliver anti-inflammatory, antioxidant, anti-angiogenic, and immunomodulating chemicals directly to the illness site. At this early stage of proof-of-concept, the evidence is limited and tentative. Clinical effectiveness can not be predicted using mouse models.

Current Perspective on the Natural Compounds and Drug Delivery Techniques in Glioblastoma Multiforme

Glioblastoma multiforme (GBM) is one of the debilitating brain tumors, being associated with extremely poor prognosis and short median patient survival. GBM is associated with complex pathogenesis with alterations in various cellular signaling events, that participate in cell proliferation and survival. The impairment in cellular redox pathways leads to tumorigenesis. The current standard pharmacological regimen available for glioblastomas, such as radiotherapy and surgical resection following treatment with chemotherapeutic drug temozolomide, remains fatal, due to drug resistance, metastasis and tumor recurrence. Thus, the demand for an effective therapeutic strategy for GBM remains elusive. Hopefully, novel products from natural compounds are suggested as possible solutions. They protect glial cells by reducing oxidative stress and neuroinflammation, inhibiting proliferation, inducing apoptosis, inhibiting pro-oncogene events and intensifying the potent anti-tumor therapies. Targeting aberrant cellular pathways in the amelioration of GBM could promote the development of new therapeutic options that improve patient quality of life and extend survival. Consequently, our review emphasizes several natural compounds in GBM treatment. We also assessed the potential of drug delivery techniques such as nanoparticles, Gliadel wafers and drug delivery using cellular carriers which could lead to a novel path for the obliteration of GBM.

Estimating Cancer Risks Due to Whole Lungs Low Dose Radiotherapy With Different Techniques for Treating COVID-19 Pneumonia

Background: Low dose radiotherapy (LDRT) of whole lungs with photon beams is a novel under evaluation method for treating COVID-19 pneumonia. The purpose of this study was to estimate the cancer risks induced by lung LDRT as the only radiation side effects at low doses for different radiotherapy delivery techniques.Method: Four different radiotherapy techniques including 3D-conformal with anterior and posterior fields (3D-CRT AP-PA), 3D-conformal with 8 coplanar fields (3D-CRT 8 fields), 8 fields intensity modulated radiotherapy (IMRT), and volumetric modulated arc therapy using 2 full arcs (VMAT) were planned on the CT images of 32 COVID-19 patients. Organ average and maximum doses, and PTV dose distribution indexes were calculated and compared between different techniques. The radiation induced cancer and mortality risks were estimated and compared for the assessed techniques.Results: In IMRT and VMAT techniques, heart (mean, and max), breast (mean, and max), and stomach (mean) doses and also maximum dose in the body were significantly lower compared to 3D-CRT techniques. The calculated conformity indexes were similar in all the techniques. However, the homogeneity indexes were lower (i.e. better) in intensity modulated techniques (P<0.03) with no significant differences between IMRT and VMAT plans. Lifetime lung cancer incident risks for all the delivery techniques were statistically similar (P>0.4). Cancer risks for organs located closer to lung like breast, and stomach were significantly higher in 3D-CRT techniques compared to IMRT or VMAT techniques (for a 30 years old man: 2.041±0.237% Vs 1.560±0.210%; and woman: 6.624±0.548% Vs 4.963±0.462%) (P<0.03). However, 8 fields 3D-conformal had significantly lower breast cancer risk compared to the 3D-CRT AP-PA technique (P<0.01).Conclusion: Although all the radiotherapy techniques had low cancer risks, the overall risks induced by IMRT and VMAT radiotherapy techniques were lower than the 3D-CRT techniques and can be used clinically in younger patients or patients having higher concerns about future cancers. Higher cancer risks except the lungs are related to breast, and stomach which must be considered for lung LDRT.