Exploring the artificial intelligence "Trust paradox": Evidence from a survey experiment in the United States.

Advances in Artificial Intelligence (AI) are poised to transform society, national defense, and the economy by increasing efficiency, precision, and safety. Yet, widespread adoption within society depends on public trust and willingness to use AI-enabled technologies. In this study, we propose the possibility of an AI "trust paradox," in which individuals' willingness to use AI-enabled technologies exceeds their level of trust in these capabilities. We conduct a two-part study to explore the trust paradox. First, we conduct a conjoint analysis, varying different attributes of AI-enabled technologies in different domains-including armed drones, general surgery, police surveillance, self-driving cars, and social media content moderation-to evaluate whether and under what conditions a trust paradox may exist. Second, we use causal mediation analysis in the context of a second survey experiment to help explain why individuals use AI-enabled technologies that they do not trust. We find strong support for the trust paradox, particularly in the area of AI-enabled police surveillance, where the levels of support for its use are both higher than other domains but also significantly exceed trust. We unpack these findings to show that several underlying beliefs help account for public attitudes of support, including the fear of missing out, optimism that future versions of the technology will be more trustworthy, a belief that the benefits of AI-enabled technologies outweigh the risks, and calculation that AI-enabled technologies yield efficiency gains. Our findings have important implications for the integration of AI-enabled technologies in multiple settings.

Resistance to COVID-19 vaccination and the social contract: evidence from Italy.

Confronted with stalled vaccination efforts against COVID-19, many governments embraced mandates and other measures to incentivize vaccination that excluded the unvaccinated from aspects of social and economic life. Even still, many citizens remained unvaccinated. We advance a social contract framework for understanding who remains unvaccinated and why. We leverage both observational and individual-level survey evidence from Italy to study the relationship between vaccination status and social context, social trust, political partisanship, and adherence to core institutional structures such as the rule of law and collective commitments. We find that attitudes toward the rule of law and collective commitments outside the domain of vaccination are strongly associated with compliance with vaccine mandates and incentives. Partisanship also corresponds with vaccine behaviors, as supporters of parties whose leaders criticized aggressive policies to incentivize or mandate vaccination and emphasized individual liberty are least likely to comply. Our findings suggest appeals emphasizing individual benefits may be more effective than appeals emphasizing collective responsibility.

The impact of sarcopenia on survival and treatment tolerance in patients with head and neck cancer treated with chemoradiotherapy.

BACKGROUND: Sarcopenia appears to be a negative prognostic factor for poor survival outcomes and worse treatment tolerance in patients with head-and-neck squamous cell carcinoma (HNSCC). We evaluated sarcopenia's impact on overall survival (OS), disease-free survival (DFS) and chemo-radiation tolerance in patients with head-and-neck cancer (HNC) treated with chemoradiotherapy (CRT) from a monocentric observational study. METHODS: We identified patients with HNC treated by CRT between 2009 and 2018 with pretreatment imaging using positron emission tomography-computed tomography scans (PET/CT). Sarcopenia was measured using the pretreatment PET/CT at the L3 vertebral body using previously published methods. Clinical variables were retrospectively retrieved. RESULTS: Of 216 patients identified, 54 patients (25.47%) met the criteria for sarcopenia. These patients had a lower mean body mass index before treatment (21.92 vs. 25.65 cm/m2 , p < 0.001) and were more likely to have a history of smoking (88.89% vs. 71.52%, p = 0.01), alcohol use (55.56% vs. 38.61%, p = 0.03) and positive human papilloma virus status (67.74% vs. 41.75%, p = 0.011). At 3 years of follow-up, OS and DFS were 75% and 70% versus 82% and 85% for sarcopenic and non-sarcopenic patients, respectively (p = 0.1 and p = 0.00015). On multivariate analysis, sarcopenia appeared as a pejorative factor on DFS (hazard ratio 2.174, p = 0.0001) in the overall cohort. Sarcopenic patients did not require more chemotherapy and radiation-treatment interruptions and did not suffer from more chemo-induced and radiation-induced grade 3-4 toxicities than their non-sarcopenic counterparts. CONCLUSION: Sarcopenia in HNSCC patients is an independent adverse prognostic factor for DFS after definitive chemoradiotherapy.

(Mis)Information on Digital Platforms: Quantitative and Qualitative Analysis of Content From Twitter and Sina Weibo in the COVID-19 Pandemic.

Background: Misinformation about COVID-19 on social media has presented challenges to public health authorities during the pandemic. This paper leverages qualitative and quantitative content analysis on cross-platform, cross-national discourse and misinformation in the context of COVID-19. Specifically, we investigated COVID-19-related content on Twitter and Sina Weibo-the largest microblogging sites in the United States and China, respectively. Objective: Using data from 2 prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, we compared the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. Methods: A total of 3,579,575 posts were scraped from both Sina Weibo and Twitter, focusing on content from January 30, 2020, within 24 hours of when WHO declared COVID-19 a "public health emergency of international concern," and a week later, on February 6, 2020. We examined how the use and engagement measured by keyword frequencies and hashtags differ across the 2 platforms. A 1% random sample of tweets that contained both the English keywords "coronavirus" and "covid-19" and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags and the Viterbi algorithm. We manually coded a random selection of 5%-7% of the content to identify misinformation on each platform and compared posts using the WHO fact-check page to adjudicate accuracy of content. Results: Both platforms posted about the outbreak and transmission, but posts on Sina Weibo were less likely to reference topics such as WHO, Hong Kong, and death and more likely to cite themes of resisting, fighting, and cheering against coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Sina Weibo content-almost 4 times as much on Twitter compared to Sina Weibo. Conclusions: Quantitative and qualitative analysis of content on both platforms points to lower degrees of misinformation, more content designed to bolster morale, and less reference to topics such as WHO, death, and Hong Kong on Sina Weibo than on Twitter.

COVID-19 booster uptake among US adults: Assessing the impact of vaccine attributes, incentives, and context in a choice-based experiment.

OBJECTIVE: Evidence shows that booster shots offer strong protection against the Omicron variant of COVID-19. However, we know little about why individuals would receive a booster compared to the initial decision to vaccinate. We investigate and assess the factors that affect individuals' reported willingness to receive the COVID-19 vaccine booster. This information can aid in tailoring public health messaging to communicate attributes that are associated with individuals' attitudes toward the COVID-19 booster. RATIONALE: Existing research provides little insight into whether the same factors that affect Americans' likelihood of accepting initial vaccination against COVID-19 also affect booster uptake. Our experiment also examines the influence of contextual information about a novel variant on willingness to receive a booster. METHODS: We administered a conjoint experiment (N = 2740 trials) in a survey of fully vaccinated US adults that had not yet received a COVID-19 booster (N = 548) to assess the impact of varied vaccine attributes on willingness to receive a booster. RESULTS: The most important factors associated with higher willingness to receive a booster were efficacy, manufacturer, and the size of a financial incentive. Protection duration and protection against future variants vs. only current variants had modest influence. A contextual prime reporting that some public health experts believe the Omicron variant is more contagious, but less lethal than those previously seen, significantly increased favorability toward boosters. This provides potential motivation and guidance for vaccination campaigns to emphasize these variant-specific traits. CONCLUSION: With several vaccines with varying degrees of efficacy available to consumers, emphasizing boosters with a high efficacy would likely improve attitudes toward boosters. Financial incentives and predispositions toward manufacturers also matter. Concerns about more contagious variants may spur uptake, even if such variants are less lethal.

Bladder preservation in older adults with muscle-invasive bladder cancer: A retrospective study with concurrent chemotherapy and twice-daily hypofractionated radiotherapy schedule.

INTRODUCTION: Bladder cancer occurs mainly in older adults and surgery is not always possible when there are geriatric conditions and comorbidities. Trimodal treatment (TMT) combining trans-urethral resection of bladder tumour (TURBT) followed by concurrent chemoradiation (CRT) would be a curative alternative in such patients. MATERIALS AND METHODS: All consecutive patients 75 years of age and older with non-metastatic muscle-invasive bladder cancer (MIBC) treated with TMT by Georges Pompidou European Hospital team were retrospectively analysed. Induction CRT combined hypofractionated twice-daily radiotherapy targeting bladder and pelvis to a total dose of 24 Gy (Gy) with concurrent platinum salt and 5-fluorouracil. Consolidation CRT to a total dose of 44 Gy was proposed to patients with biopsy-proven complete response after induction phase and those with persistent tumour underwent salvage cystectomy. We assessed using Kaplan-Meier method overall survival (OS), cancer specific survival (CSS), invasive recurrence-free survival (IRFS), metastasis-free survival (MFS), survival with bladder preserved (SBP), and toxicities. With a Cox model for OS and the Fine Gray method of competing risk for secondary endpoints, we analysed in univariate (u) and multivariate (m) analysis the impact of tumour characteristics and patient profiles: gender, age, age-adjusted Charlson comorbidity index, polypharmacy, and malnutrition. RESULTS: From 1988 to 2017, 85 patients were included. After induction, complete response rate was 83.5%. With a median follow-up of 63 months, 5 year-OS, CSS, IRFS, MFS and SBP were 61.0%, 77.6%, 71%, 82.9%, and 70.2% respectively. A persistent tumour after induction impacted SBP (SHRm 3.61; p = 0.004), CSS (SHRm 3.27; p = 0.023), and MFS (SHRm 3.68; p = 0.018). Late grade 3 urinary and gastrointestinal toxicities were 3.5% and 1.2%. DISCUSSION: We report here the largest series of bladder preservation over 75 years in a curative intent. Outcomes and tolerance in selected older adults compared favourably with surgical series and with CRT studies using classical fractionation.

Communication about vaccine efficacy and COVID-19 vaccine choice: Evidence from a survey experiment in the United States.

While mass vaccination campaigns against COVID-19 have inoculated almost 200 million Americans and billions more worldwide, significant pockets of vaccine hesitancy remain. Research has firmly established that vaccine efficacy is an important driver of public vaccine acceptance and choice. However, current vaccines offer widely varying levels of protection against different adverse health outcomes of COVID-19. This study employs an experiment embedded on a survey of 1,194 US adults in June 2021 to examine how communications about vaccine efficacy affect vaccine choice. The experiment manipulated how vaccine efficacy was defined across four treatments: (1) protection against symptomatic infection; (2) protection against severe illness; (3) protection against hospitalization/death; (4) efficacy data on all three metrics. The control group received no efficacy information. Subjects were asked to choose between a pair of vaccines-a one-dose viral vector vaccine or two-dose mRNA vaccine-whose efficacy data varied across the four experimental treatment groups. Efficacy data for each vaccine on each dimension were adapted from clinical trial data on the Johnson & Johnson/Janssen and Pfizer/BioNTech vaccines. Among all respondents, only modest preference gaps between the two vaccines emerged in the control group and when the two vaccines' roughly equivalent efficacy data against hospitalization and death were reported. Strong preferences for a two-dose mRNA vaccine emerged in treatments where its higher efficacy against symptomatic or severe illness was reported, as well as in the treatment where data on all three efficacy criteria were reported. Unvaccinated respondents preferred a one-dose viral vector vaccine when only efficacy data against hospitalization or death was presented. Black and Latino respondents were significantly more likely to choose the one-shot viral vector vaccine in the combined efficacy treatment than were whites. Results speak to the importance of understanding how communications about vaccine efficacy affect public preferences in an era of increasing uncertainty about efficacy against variants.

The Relationship between US Adults' Misconceptions about COVID-19 Vaccines and Vaccination Preferences.

While mass vaccination has blunted the pandemic in the United States, pockets of vaccine hesitancy remain. Through a nationally representative survey of 1027 adult Americans conducted in February 2021, this study examined individual misconceptions about COVID-19 vaccine safety; the demographic factors associated with these misconceptions; and the relationship between misconceptions and willingness to vaccinate. Misconceptions about vaccine safety were widespread. A sizeable minority (40%) believed that vaccine side effects are commonly severe or somewhat severe; 85% significantly underestimated the size and scale of the clinical trials; and a sizeable share believed either that the vaccines contain live coronavirus (10%) or were unsure (38%), a proxy for fears that vaccination itself may cause infection. These misconceptions were particularly acute among Republicans, Blacks, individuals with lower levels of educational attainment, and unvaccinated individuals. Perceived side effect severity and underestimating the size of the clinical trials were both significantly associated with vaccine hesitancy.

COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries.

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation.

While efficacious vaccines have been developed to inoculate against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; also known as COVID-19), public vaccine hesitancy could still undermine efforts to combat the pandemic. Employing a survey of 1096 adult Americans recruited via the Lucid platform, we examined the relationships between vaccine attributes, proposed policy interventions such as financial incentives, and misinformation on public vaccination preferences. Higher degrees of vaccine efficacy significantly increased individuals' willingness to receive a COVID-19 vaccine, while a high incidence of minor side effects, a co-pay, and Emergency Use Authorization to fast-track the vaccine decreased willingness. The vaccine manufacturer had no influence on public willingness to vaccinate. We also found no evidence that belief in misinformation about COVID-19 treatments was positively associated with vaccine hesitancy. The findings have implications for public health strategies intending to increase levels of community vaccination.

Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer.

PURPOSE: To evaluate trimodal conservative treatment as an alternative to radical surgery for urothelial muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS: This retrospective study reported the carcinologic and functional results of patients (pts) presenting a cT2/T3 N0M0 operable MIBC and fit for surgery, treated by a conservative strategy. Treatment consisted of a transurethral resection (TURB) followed by concomitant bi-fractionated split-course radiochemotherapy (RCT) with 5FU-Cisplatine. A control cystoscopy was performed six weeks after the induction RCT (eq45Gy) with systematic biopsies. Patients with complete histologic response achieved RCT protocol. Salvage surgery was proposed to pts with persistent tumor. RESULTS: 313 pts (83% cT2 and 17% cT3) treated between 1988 and 2013 were included, with a median follow-up of 59 months and 67-year mean age. After the induction RCT, the histologic response rate was 83%. After five years, overall, disease-free, and functional bladder-intact survival rates were respectively 69%, 61%, and 69%, significantly better for pts in complete response after induction RCT. Late urinary and digestive toxicities were limited, with respective rates of 4% and 1.5% of grade 3 toxicity. CONCLUSION: Trimodal strategy with RCT after TURB showed interesting functional and oncologic results and should be considered as an alternative to surgery in well-selected pts.

Americans' perceptions of privacy and surveillance in the COVID-19 pandemic.

OBJECTIVE: To study the U.S. public's attitudes toward surveillance measures aimed at curbing the spread of COVID-19, particularly smartphone applications (apps) that supplement traditional contact tracing. METHOD: We deployed a survey of approximately 2,000 American adults to measure support for nine COVID-19 surveillance measures. We assessed attitudes toward contact tracing apps by manipulating six different attributes of a hypothetical app through a conjoint analysis experiment. RESULTS: A smaller percentage of respondents support the government encouraging everyone to download and use contact tracing apps (42%) compared with other surveillance measures such as enforcing temperature checks (62%), expanding traditional contact tracing (57%), carrying out centralized quarantine (49%), deploying electronic device monitoring (44%), or implementing immunity passes (44%). Despite partisan differences on a range of surveillance measures, support for the government encouraging digital contact tracing is indistinguishable between Democrats (47%) and Republicans (46%), although more Republicans oppose the policy (39%) compared to Democrats (27%). Of the app features we tested in our conjoint analysis experiment, only one had statistically significant effects on the self-reported likelihood of downloading the app: decentralized data architecture increased the likelihood by 5.4 percentage points. CONCLUSION: Support for public health surveillance policies to curb the spread of COVID-19 is relatively low in the U.S. Contact tracing apps that use decentralized data storage, compared with those that use centralized data storage, are more accepted by the public. While respondents' support for expanding traditional contact tracing is greater than their support for the government encouraging the public to download and use contact tracing apps, there are smaller partisan differences in support for the latter policy.

Factors Associated With US Adults' Likelihood of Accepting COVID-19 Vaccination.

Importance: The development of a coronavirus disease 2019 (COVID-19) vaccine has progressed at unprecedented speed. Widespread public uptake of the vaccine is crucial to stem the pandemic. Objective: To examine the factors associated with survey participants' self-reported likelihood of selecting and receiving a hypothetical COVID-19 vaccine. Design, Setting, and Participants: A survey study of a nonprobability convenience sample of 2000 recruited participants including a choice-based conjoint analysis was conducted to estimate respondents' probability of choosing a vaccine and willingness to receive vaccination. Participants were asked to evaluate their willingness to receive each hypothetical vaccine individually. The survey presented respondents with 5 choice tasks. In each, participants evaluated 2 hypothetical COVID-19 vaccines and were asked whether they would choose vaccine A, vaccine B, or neither vaccine. Vaccine attributes included efficacy, protection duration, major adverse effects, minor adverse effects, US Food and Drug Administration (FDA) approval process, national origin of vaccine, and endorsement. Levels of each attribute for each vaccine were randomly assigned, and attribute order was randomized across participants. Survey data were collected on July 9, 2020. Main Outcomes and Measures: Average marginal component effect sizes and marginal means were calculated to estimate the relationship between each vaccine attribute level and the probability of the respondent choosing a vaccine and self-reported willingness to receive vaccination. Results: A total of 1971 US adults responded to the survey (median age, 43 [interquartile range, 30-58] years); 999 (51%) were women, 1432 (73%) White, 277 (14%) were Black, and 190 (10%) were Latinx. An increase in efficacy from 50% to 70% was associated with a higher probability of choosing a vaccine (coefficient, 0.07; 95% CI, 0.06-0.09), and an increase from 50% to 90% was associated with a higher probability of choosing a vaccine (coefficient, 0.16; 95% CI, 0.15-0.18). An increase in protection duration from 1 to 5 years was associated with a higher probability of choosing a vaccine (coefficient, 0.05 95% CI, 0.04-0.07). A decrease in the incidence of major adverse effects from 1 in 10 000 to 1 in 1 000 000 was associated with a higher probability of choosing a vaccine (coefficient, 0.07; 95% CI, 0.05-0.08). An FDA emergency use authorization was associated with a lower probability of choosing a vaccine (coefficient, -0.03; 95% CI, -0.04 to -0.01) compared with full FDA approval. A vaccine that originated from a non-US country was associated with a lower probability of choosing a vaccine (China: -0.13 [95% CI, -0.15 to -0.11]; UK: -0.04 [95% CI, -0.06 to -0.02]). Endorsements from the US Centers for Disease Control and Prevention (coefficient, 0.09; 95% CI, 0.07-0.11) and the World Health Organization (coefficient, 0.06; 95% CI, 0.04-0.08), compared with an endorsement from President Trump were associated with higher probabilities of choosing a vaccine. Analyses of participants' willingness to receive each vaccine when assessed individually yielded similar results. An increase in efficacy from 50% to 90% was associated with a 10% higher marginal mean willingness to receive a vaccine (from 0.51 to 0.61). A reduction in the incidence of major side effects was associated with a 4% higher marginal mean willingness to receive a vaccine (from 0.54 to 0.58). A vaccine originating in China was associated with a 10% lower willingness to receive a vaccine vs one developed in the US (from 0.60 to 0.50) Endorsements from the Centers for Disease Control and Prevention and World Health Organization were associated with increases in willingness to receive a vaccine (7% and 6%, respectively) from a baseline endorsement by President Trump (from 0.52 to 0.59 and from 0.52 to 0.58, respectively). Conclusions and Relevance: In this survey study of US adults, vaccine-related attributes and political characteristics were associated with self-reported preferences for choosing a hypothetical COVID-19 vaccine and self-reported willingness to receive vaccination. These results may help inform public health campaigns to address vaccine hesitancy when a COVID-19 vaccine becomes available.

Radiomics and Machine Learning for Radiotherapy in Head and Neck Cancers.

Introduction: An increasing number of parameters can be considered when making decisions in oncology. Tumor characteristics can also be extracted from imaging through the use of radiomics and add to this wealth of clinical data. Machine learning can encompass these parameters and thus enhance clinical decision as well as radiotherapy workflow. Methods: We performed a description of machine learning applications at each step of treatment by radiotherapy in head and neck cancers. We then performed a systematic review on radiomics and machine learning outcome prediction models in head and neck cancers. Results: Machine Learning has several promising applications in treatment planning with automatic organ at risk delineation improvements and adaptative radiotherapy workflow automation. It may also provide new approaches for Normal Tissue Complication Probability models. Radiomics may provide additional data on tumors for improved machine learning powered predictive models, not only on survival, but also on risk of distant metastasis, in field recurrence, HPV status and extra nodal spread. However, most studies provide preliminary data requiring further validation. Conclusion: Promising perspectives arise from machine learning applications and radiomics based models, yet further data are necessary for their implementation in daily care.

Higher complications after previous external beam radiation for extremity soft-tissue sarcoma in the surgical treatment of a local recurrence: a comparative retrospective study of one hundred and three patients.

PURPOSE: The use of adjuvant radiation in the treatment of soft-tissue sarcoma (STS) is equivocal in selected cases. Our objective was to compare the short-term outcomes in patients operated on for a local recurrence who had radiation for the primary tumour to those who were spared radiation. METHODS: This was a retrospective study of 103 patients treated for a local recurrence: 48 (47%) with previous radiation and 55 (53%) without. Our primary outcome criterion was to identify the differences in the local treatment provided. Secondary outcomes were the cumulative incidence of a surgical site infection/wound complication (SSI/WC), variables associated with SSI/WC, and local recurrence. RESULTS: Amputation and the incidence of re-operation were significantly more frequent in patients who received previous radiation compared to patients without previous radiation (27% vs 9%, p = 0.02, for amputation; 26% vs 36% at 2 years for SSI/WC, p = 0.049). Multivariable regression models found previous radiation (p = 0.049), arteriopathy (p = 0.012), location at lower limb (p = 0.09), and use of a flap (0.0048) associated with the risk of SSI/WC. CONCLUSIONS: Previous radiation is associated with an increased risk of amputation and reoperation for SSI/WC when treating a local recurrence. This information should be accounted for when deciding for the use of radiation.

Automatic Intracranial Segmentation: Is the Clinician Still Needed?

INTRODUCTION: Stereotactic hypofractionated radiotherapy is an effective treatment for brain metastases in oligometastatic patients. Its planning is however time-consuming because of the number of organs at risk to be manually segmented. This study evaluates 2 automated segmentation commercial software. METHODS: Patients were scanned in the treatment position. The computed tomography scan was registered on a magnetic resonance imaging and volumes were manually segmented by a clinician. Then 2 automated segmentations were performed (with iPlan and Smart Segmentation). RT STRUCT files were compared with Aquilab's Artistruct segment comparison module. We selected common segmented volume ratio as the main judging criterion. Secondary criteria were Dice-Sørensen coefficients, overlap ratio, and additional segmented volume. RESULTS: Twenty consecutive patients were included. Agreement between manual and automated contouring was poor. Common segmented volumes ranged from 7.71% to 82.54%, Dice-Sørensen coefficient ranged from 0.0745 to 0.8398, overlap ratio ranged from 0.0414 to 0.7275, and additional segmented volume ranged from 9.80% to 92.25%. Each software outperformed the other on some organs while performing worse on others. CONCLUSION: No software seemed clearly better than the other. Common segmented volumes were much too low for routine use in stereotactic hypofractionated brain radiotherapy. Manual editing is still needed.

Optimal post-operative radiation after soft-tissue sarcoma resection is achieved in less than two thirds of cases.

PURPOSE: Local control of soft tissue sarcomas frequently involves adjuvant radiation to the surgical resection. When opting for post-operative radiation, care should be taken that radiation is started within some reasonable time after the surgery. We were interested to the proportion of patients who did not recieve optimal post-operative radiation and the variables associated. METHODS: We retrospectively analyzed a series of 77 patients operated on for an extremity soft-tissue sarcoma and due for post-operative radiotherapy. Patients were considered to have received radiation optimally if radiation was started within 12 weeks of surgery. Variables associated with not receiving radiation optimally were looked for using univariable and multivariable regression models. RESULTS: Overall, 26 patients (34%; 95% CI: 23-45%) did not receive radiation optimally. Twenty (26%) did not start radiation within the 12-weeks mark and six (8%) could not have radiation at all. The main reason identified for not receiving radiation on time was the occurrence of a wound complication (14 (54%) patients). An increased body mass index (OR: 1.14; 95% CI: 1.02-1.26; p = 0.02) and an older age (OR: 1.55; 95% CI: 1.18-2.14; p = 0.04; of note, the OR are for a 10 year change) were significantly associated with not receiving radiation optimally. Patients with a social fragility (p = 0.04), metastatic spread at presentation (p = 0.04), and increased duration of surgery (p = 0.02) were more likely to develop a wound complication. CONCLUSIONS: About 34% of patients do not receive optimal post-operative radiation treatment. Older and obese patients have a higher risk of not receiving radiation optimally. The decision for pre- or post-operative radiation should account for these findings.

Adaptive radiation therapy in head and neck cancer for clinical practice: state of the art and practical challenges.

Modern radiation therapy techniques are characterized by high conformality to tumor volumes and steep dose gradients to spare normal organs. These techniques require accurate clinical target volume definitions and rigorous assessment of set up uncertainties using image guidance, a concept called image-guided radiation therapy. Due to alteration of patient anatomy, changes in tissue density/volumes and tumor shrinkage over the course of treatment, treatment accuracy may be challenged. This may result in excessive irradiation of organs at risk/healthy tissues and undercoverage of target volumes with a significant risk of locoregional failure. Adaptive radiation therapy (ART) is a concept allowing the clinician to reconsider the planned dose based on potential changes to accurately delivering the remaining radiation dose to the tumor while optimally minimizing irradiation of healthy tissues. There is little consensus on how to apply this concept in clinical practice. The current review investigates the current ART issues, including patient selection, clinical/dosimetric criteria and timing for re-planning, and practical technical issues. A practical algorithm is proposed for patient management in cases where ART is required.

[Post-radiotherapy care and monitoring of head and neck cancers]. / Soins et surveillance post-radiothérapie des cancers ORL.

Radiotherapy performed to treat head and neck cancer results in considerable side effects and the patient must be provided with all the necessary information and regular monitoring. From the announcement of the diagnosis, during and after the radiotherapy, the nurse coordinator identifies and assesses the needs, expectations and concerns of the patients. Their role helps to simplify and personalise the care pathway, providing a liaison between the different professionals and offering support for the patient.