eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 833 838 article L.P. Zhou 1 L.M. Chang 240612799@qq.com 2 H. Zhao 3 X.Y. Yang 4 L.L. Shi 5 Department of Function, The Fifth Hospital of Tangshan (CT/DR Room), Tangshan, China Department of Medical Imaging, Tangshan Gongren Hospital, Tangshan, China Department of Medical Imaging, Tangshan Gongren Hospital, Tangshan, China Department of Medical Imaging, Tangshan Gongren Hospital, Tangshan, China Department of Radiology, Tangshan Maternal and Child Health Hospital, Tangshan, 063000, China Background: To analyze the correlation between epidermal growth factor receptor (EGFR) gene mutations and clinical as well as computed tomography (CT) signs in minimally invasive adenocarcinoma (MIA). Materials and Methods: A total of 118 patients with MIA treated at the Department of Thoracic Surgery, Tangshan Gongren Hospital, from December 2018 to December 2021 were included in this study. Patients were categorized into two groups based on their Epidermal Growth Factor Receptor(EGFR) mutation status: a mutation group and a wild-type group. Differences in clinical and CT features between the two groups were recorded and statistically analyzed. Results: Among the 118 patients, 69 were in the mutation group, while 49 were in the wild-type group. No significant differences were observed in gender, smoking history, age, mean nodule diameter, peripheral emphysema, air bronchogram, lobulation sign, pleural indentation sign, morphology, tumor-lung interface, peripheral fibrosis, and density between the two groups (P>0.05). However, significant differences were noted in the spiculation sign, vacuole sign, and vascular convergence sign between the groups (P<0.05). Logistic regression analysis identified the vacuole sign with an odds ratio (OR) of 0.410 (P>0.05) and the spiculation sign and vascular convergence sign with ORs of 1.498 and 2.262, respectively (P<0.05), as independent risk factors for predicting EGFR mutations. The areas under the ROC curves (AUC) for the spiculation sign and vascular convergence sign were 0.634 and 0.735, respectively, in distinguishing EGFR gene mutations in MIA. Conclusion: CT imaging demonstrated that MIA patients presenting with spiculation, vacuole, and vascular convergence signs had a higher likelihood of EGFR gene mutations. Among these, the spiculation and vascular convergence signs are critical, independent risk factors for predicting EGFR gene mutations in MIA patients. http://ijrr.com/article-1-6691-en.pdf Lung adenocarcinoma CT signs epidermal growth factor receptor tomography X-ray computed. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 839 845 article J. Wei 1 P. Gao 2 Z. Wang 3 L. Fan 4 J. Zhao zhaojin8490@dingtalk.com 5 Department of Nephrology, Zibo First Hospital, Zibo Shandong, China Department of Nephrology, Zibo First Hospital, Zibo Shandong, China Department of Chinese Medicine, Zibo First Hospital, Zibo Shandong, China Hemodialysis Center, Zibo First Hospital, Zibo Shandong, China Department of Nephrology, Zibo First Hospital, Zibo Shandong, China Background: To explore the key targets and regulatory mechanisms affecting the efficacy of radiotherapy (RT) in patients with renal carcinoma (RCC) complicated by renal failure. Materials and Methods: Differentially expressed genes (DEGs)(|log2FC|>2) in TCGA (n=537) and GEO data set (n=215) were screened by limma package in R software. Intersecting genes were accessed through the online site (InteractiVenn). The STRING and MCODE module of the Metascape website were used for key target screening and enriched pathway analysis. The preprocessCore R package was used for data normalization and batch effect processing. The survival/survminer R package was used to analyze the relationship between gene expression and patient survival. Results: High expression of ACADM, DLAT, SUCLA2 and SUCLG2 genes were all associated with significantly improved prognosis in renal cancer patients. The mOS time in the ACADM high expression group was 7.10 years [Hazard Ratio (HR) = 0.466, 95% Confidence Interval (CI): 0.353-0.615). The mOS time in the DLAT high expression group was 7.10 years (HR=0.489, 95% CI: 0.372-0.642). The mOS time in the SUCLA2 high expression group was 7.30 years (HR=0.458, 95% CI: 0.346-0.606). The mOS time in the SUCLG2 group was 7.00 years (HR=0.544, 95% CI: 0.415-0.715). Conclusion: The suppression of ACADM, DLAT, SUCLA2, and SUCLG2 can regulate fatty acid metabolism and tricarboxylic acid cycle-related pathways, which provides ideas for the prognosis of patients with RCC complicated by renal failure. http://ijrr.com/article-1-6721-en.pdf Prognosis radiotherapy renal carcinoma renal failure. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 847 853 article D. An 1 Z. Zou 2 J. An 3 Y. Tian tianye0917@163.com 4 Department of Medical Imaging Center, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China Department of Interventional Treatment, First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China Background: Distinguishing focal interstitial fibrosis from pulmonary adenocarcinoma based on computed tomography characteristics is challenging. We investigated the computed tomography features of part-solid lung nodules to identify characteristics useful for differentiating focal interstitial fibrosis from pre-invasive lesions or invasive pulmonary adenocarcinomas. Materials and Methods: Our research analyzed 182 part-solid lung nodules from 177 patients, comparing the computed tomography characteristics of focal interstitial fibrosis, pre-invasive lesions, and invasive pulmonary adenocarcinomas. Predictive factors for focal interstitial fibrosis were determined via binary logistic regression analysis. Predictive capability of the logistic regression model was assessed utilizing receiver operating characteristic curves. Results: Invasive pulmonary adenocarcinoma was seen in 124 part-solid lung nodules, while 21 nodules showed focal interstitial fibrosis. Binary logistic regression analysis between focal interstitial fibrosis and pre-invasive lesions revealed that irregular shape and concentrated distribution of the solid portion were significantly associated with focal interstitial fibrosis. Binary logistic regression analysis between focal interstitial fibrosis and invasive pulmonary adenocarcinomas revealed that smaller lesion size, ill-defined lesion borders, and solid portion’s well-defined borders were notable independent factors linked to focal interstitial fibrosis. The model using these three predictors to distinguish focal interstitial fibrosis from invasive pulmonary adenocarcinomas achieved a high receiver operating characteristic curve area of 0.845. Conclusion: Focal interstitial fibrosis exhibited distinct computed tomography features compared to pre-invasive lesions or invasive pulmonary adenocarcinomas; the solid portion of part-solid lung nodules might serve as a valuable distinguishing feature. http://ijrr.com/article-1-6722-en.pdf Tomography X-Ray computed solitary pulmonary nodule pulmonary fibrosis adenocarcinoma of lung. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 855 864 article L. Ji 1 L. Wang 2 S. Qin 3 Y. Fan yifan.suda@vip.163.com 4 J. Zhou zhoujuyingsy@163.com 5 Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Soochow, China Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Soochow, China Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Soochow, China Department of Hematology, the First Affiliated Hospital of Soochow University, Soochow, China Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Soochow, China Background: Nasopharyngeal carcinoma (NPC) is commonly treated with radiotherapy, which can induce systemic and local metabolic changes. Saliva, as a non-invasive biofluid, provides a valuable medium for monitoring such alterations. This study aimed to investigate salivary metabolic changes in NPC patients before and after radiotherapy using an untargeted metabolomics approach. Materials and Methods: Saliva samples were collected from 23 NPC patients both prior to and following radiotherapy. An untargeted metabolomics analysis was performed using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Multivariate statistical analysis was employed to identify differential metabolites, and pathway enrichment analysis was conducted to elucidate the affected biological processes. Key metabolic features were selected using least absolute shrinkage and selection operator (LASSO) regression. Results: A total of 110 differential metabolites were identified, comprising 64 in positive ion mode (30 upregulated, 34 downregulated) and 46 in negative ion mode (31 upregulated, 15 downregulated). LASSO analysis highlighted four key metabolites: L-Carnitine and Kanosamine were significantly upregulated post-radiotherapy, whereas Phloroglucinol and Dibutyl phthalate were significantly downregulated. Pathway enrichment analysis revealed five significantly affected pathways: arginine biosynthesis, central carbon metabolism in cancer, arginine and proline metabolism, HIF-1 signaling pathway, and protein digestion and absorption. Conclusion: Salivary metabolomics revealed notable metabolic adaptations in NPC patients following radiotherapy, reflecting tissue repair and compensatory responses. These findings provide new insights into the metabolic impact of radiotherapy and may help identify potential therapeutic targets for optimizing treatment outcomes. http://ijrr.com/article-1-6723-en.pdf Nasopharyngeal neoplasms radiotherapy metabolomics saliva metabolic networks and pathways. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 865 871 article D.A. Mohamed Shaban daliaashaban@gmail.com 1 A.A. Ghaffar Boraei 2 N.A.E. Tawfik Chalabi 3 M.A.M. Ali Nagi 4 Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt Background: Breast cancer stands out as a major health issue globally, being the most common type of cancer diagnosed in women around the world. Its impact in Egypt is particularly pronounced, accounting for a substantial proportion of new cancer cases. Contrast-Enhanced Spectral Mammography (CESM) has emerged as a promising diagnostic tool for breast tumors. By visualizing tumor angiogenesis, CESM offers improved accuracy compared to traditional mammography with or without ultrasound. Its ability to depict tumor neovascularity parallels that of breast magnetic resonance imaging (MRI). This study was done to assess how well CESM can accurately identify the nature of unclear breast lesions in patients who have had breast-conserving surgery (BCS). Materials and Methods: We carried out a retrospective study with 30 women who had breast-conserving surgery due to ambiguous breast lesions found by traditional mammography. Their ages varied between 32 and 77, averaging 50.07 years. Each patient received dual-energy contrast-enhanced spectral mammography. The definitive diagnosis was confirmed by examining tissue samples from surgery or biopsy through histopathology. Results: Examination of the 30 patients showed that 23 had benign lesions (69.7%) while 10 were malignant (30.3%). The diagnostic performance character of CESM was improved with the use of the malignancy potential score (MPS) in distinguishing between benign and malignant breast lesions. Conclusion: The results indicate that CESM serves as an effective supplement to traditional mammography for evaluating unclear breast lesions after breast-conserving surgery. Its enhanced sensitivity and accuracy could lead to better patient management and improved health outcomes. http://ijrr.com/article-1-6724-en.pdf Comprehensive Diagnostic accuracy breast cancer contrast-enhanced spectral mammography breast lesions breast-conserving surgeries. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 873 879 article H. Takano hirokazu.takano.a1@tohoku.ac.jp 1 Y. Kondo 2 Y. Ishizawa 3 S. Onodera 4 M. Saito 5 H. Ota 6 Department of Radiological Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan Graduate School of Health Sciences, Niigata University, 746 Asahimachidori 2bancho, Chuo-ku, Niigata City, Niigata, 951-8518, Japan Department of Radiological Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan Department of Radiological Technology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan Graduate School of Health Sciences, Niigata University, 746 Asahimachidori 2bancho, Chuo-ku, Niigata City, Niigata, 951-8518, Japan Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan Background: Single-energy computed tomography (SECT) requires different energies for disease diagnosis and detection. The patient must be scanned again after the CT scan to obtain other tube-voltage images, causing increased radiation exposure. One method for avoiding rescanning is virtual monochromatic images (VMI) by dual-energy computed tomography (DECT). However, VMI has not proven superior to SECT. Moreover, DECT is not available at all facilities. This study used generative adversarial networks to generate 120 kVp and Sn140 kVp CT images from 80 kVp CT images. Material and Methods: This study involved 35 patients with pulmonary hypertension who underwent CT scans with DECT. The peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) were calculated to evaluate the difference between the real and pseudo images. Furthermore, the mean CT values of the pulmonary arteries (PA) were compared. Results: The SSIM was 0.99 ± 9.15×10-5 and 0.99 ± 3.38×10-3 at 120 kVp and Sn140 kVp, respectively. The PSNR was 69.1 ± 1.29 and 66.5 ± 5.40 at 120 kVp and Sn140 kVp, respectively. Additionally, no significant differences were observed in the mean CT values of PA (p > 0.05) between the real and pseudo images. Conclusion: The proposed model accurately generated 120 kVp and Sn140 kVp CT images from 80 kVp CT images. http://ijrr.com/article-1-6725-en.pdf Deep learning medical image processing dual-energy scanned projection radiography pulmonary artery. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 881 887 article Z. Cao 1 W. Xu 2 J. Shen 3 L. Li Lilinjun00417@126.com 4 H. Liu hbzkznyy@163.com 5 C. Chen chenc20022002@163.com 6 Department of Oncology, Maternal and Child Health Hospital of Hubei Province, Hubei, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China Department of Oncology, Maternal and Child Health Hospital of Hubei Province, Hubei, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, China Background: This study evaluates the impact of body contouring changes on delivered dose and proposes a method to identify target dose deviations exceeding 5%. Materials and Methods: Five CT datasets were created by simulating body contouring reductions of 3mm, 6mm, 9mm, 12mm, and 15mm from the original planning CT. Using the same iso-center and Volumetric Modulated Arc Therapy (VMAT) plan, new plans (P3, P6, P9, P12, P15) were generated for new five CT datasets (body contouring reductions of 3mm, 6mm, 9mm, 12mm, and 15mm) respectively. Dose distributions and changes in dosimetric parameters for the Planning Target Volume (PTV) and Organs at Risk (OARs), including the small intestine, rectum, bone marrow, femoral head, and bladder, were analyzed. Results: Progressive weight loss increased doses to PTVs and OARs. PTV D50 increased by 1.32%, 2.35%, 3.62%, 5.18%, and 6.24% for 3mm, 6mm, 9mm, 12mm, and 15mm reductions, respectively. The small intestine V45 exceeded 195cc and the rectum V50 surpassed 50% at 12mm and 15mm. Bone marrow doses remained below the V40 threshold of 37%. When reductions reached 12mm and 15mm, regions with dose deviations >5% (250cGy) covered 31.81% and 178.08% of the PTV. Conclusion: Weight loss-induced body contouring reductions significantly affect PTV and OAR doses. Re-scanning and re-planning are recommended when contour reductions exceed 12mm or waist circumference decreases by >75mm. http://ijrr.com/article-1-6726-en.pdf Radiotherapy volumetric modulated arc therapy weight loss dosimetry cervical neoplasms. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 889 894 article F. Peng 1 J. Song 2 Y. Zhang 3 Q. Peng jack6558@163.com 4 Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China Department of Radiology, the Second Affiliated Hospital Of Hainan Medical University, Hainan Haikou 570311, China Department of Breast Armor Surgery, the Second Affiliated Hospital Of Hainan Medical University Hainan Haikou 570311, China Large aperture CT room, Shandong Cancer Hospital, Jinan City, Shandong Province, 250117 China Background: Globally, gastric cancer (GC) continues to be a primary driver of cancer deaths, as delayed diagnoses frequently lead to unfavorable clinical outcomes. Accurate preoperative assessment is critical for optimizing treatment strategies and enhancing patient outcomes. This research analyzed the preoperative evaluation value of multi-slice spiral computed tomography (MSCT) perfusion imaging in GC. Material and Methods: A cohort of 112 GC patients was recruited between January 2022 and April 2024 for quantification of MSCT perfusion metrics, including blood flow (BF), blood volume (BV), permeability surface (PS), and mean transit time (MTT). Results: Advanced-stage GC exhibited significantly higher BF, BV, and PS than early-stage disease (P<0.05). TNM stage progression (Ia+Ib → III+IIIa → III+IV) correlated with increasing BF, BV, and PS (P<0.05), while tumor location showed no significant parameter differences. Well-differentiated tumors had higher BF and PS but lower MTT than poorly differentiated cases (P<0.05). Patients without lymph node metastasis (LNM) or distant metastasis demonstrated reduced perfusion parameters, with BF and PS being statistically lower in non-metastatic groups (P<0.05). Conclusion: These findings suggest that MSCT perfusion imaging effectively reflects hemodynamic changes and provides valuable insights into tumor staging, differentiation, and metastasis, supporting its clinical utility in preoperative GC evaluation. http://ijrr.com/article-1-6770-en.pdf Stomach neoplasms multidetector computed tomography perfusion imaging preoperative period neoplasm staging hemodynamics. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 895 900 article L. Xu 1 Q. Ge geqin.kelley@163.com 2 Cancer Research Center Nantong, Affiliated Tumor Hospital of Nantong University, and Medical School of Nantong University, Nantong, China Department of Radiation Oncology, Nantong Tumor Hospital, Affiliated Tumor Hospital of Nantong University, Nantong, China Background: As the predominant malignant embryonal liver tumor in children, hepatoblastoma (HB) demonstrates rising incidence rates. While surgical resection and chemotherapy remain primary treatments, radiation therapy emerges as a potential adjuvant option for refractory cases. However, clinical evidence supporting its application remains scarce. To address this knowledge gap, we investigated the radiobiological response of HB cell line Huh-6 through systematic in vitro analyses. Materials and Methods: The proliferation, morphology change, cell apoptosis and cell cycle of Huh-6 cells received gradient X-ray irradiation were systemically conducted with CCK-8 assay, microscopy, Annexin V/7-ADD and PI single staining, respectively. Results: Irradiation induced dose-dependent suppression of Huh-6 cell proliferation. Morphological assessment demonstrated escalating cytopathic effects with increasing radiation doses, characterized by cytoplasmic vacuolization in the early stage progressing to membrane disintegration and cytosolic debris formation in morphologically aberrant cells during the late stage. Cell apoptosis was enhanced with the increment of irradiation dose. The percentage of cells arrested in G2/M phase increased and meanwhile the proportion of cells in G0/G1 phase decreased with the rising dose gradient. Conclusion: Our findings demonstrate marked radiosensitivity in Huh-6 cells characterized by dose-responsive growth inhibition, cell apoptosis and cell morphological changes. These experimental results provide preliminary biological validation for considering radiotherapy in HB management protocols, particularly for treatment-resistant cases. http://ijrr.com/article-1-6771-en.pdf Hepatoblastoma radiosensitivity Huh-6 cell line in vitro. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 901 906 article G. Wang wangguozhong8268@163.com 1 P. Liu 2 X. Qubie 3 C. Fan 4 Y. Fang 5 Thoracic Surgery, Huoshan County Hospital, Anhui Province, China 237200 Medical imaging department, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan province Medical imaging department, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan province Medical imaging department, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan province Medical imaging department, Armed Police Force Hospital of Sichuan, Leshan 614000, Sichuan province Background: This investigation explores the effectiveness and physiological consequences of CT-guided percutaneous lung biopsies, a common technique for analysing pulmonary nodules. Materials and Methods: The study involved a paired comparison involving 211 patients who received CT-guided lung biopsies and an equal number of matched controls who did not undergo the procedure. Variables such as demographic and baseline health characteristics, changes in cardiorespiratory parameters, and patient outcomes were meticulously recorded and analysed. Results: Both groups exhibited comparable baseline demographics and health statuses. The procedure confirmed the presence of malignancy or other diseases in 90% of cases (190 out of 211 patients). Significant physiological responses post-biopsy included elevated heart rate, increased systolic and diastolic blood pressure, enhanced respiratory rate, and reduced oxygen saturation levels, all statistically significant compared to controls. However, metrics such as hospital stay duration, rate of readmission within 30 days, and survival after one year showed no statistical difference between the groups. The incidence of complications following the biopsies was calculated at 15%. Conclusion: CT-guided percutaneous lung biopsy is a reliable diagnostic tool for pulmonary nodules, as evidenced by its high diagnostic yield. The procedure, however, leads to noticeable transient cardiorespiratory changes, underscoring the necessity for vigilant monitoring and supportive care during and after the procedure. Long-term patient outcomes did not differ significantly between the groups, indicating the procedure’s safety profile in a clinical setting. http://ijrr.com/article-1-6772-en.pdf CT-guided percutaneous lung biopsy diagnostic yield cardiorespiratory changes patient outcomes. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 907 912 article Y. Hu 1 C. Hou 2 M. Wen mingwen_dc@163.com 3 Department of Radiology,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China Department of Oncology, The First Hospital of Neijiang, Neijiang, Sichuan, China Department of Radiology,The First Affiliated Hospital of Chongqing Medical University, Chongqing, China Background: Prostate cancer (PCa) and benign prostatic hyperplasia (BPH) present with similar clinical symptoms, particularly in patients with borderline prostate-specific antigen (PSA) levels (4–10 ng/mL), making accurate diagnosis challenging. MRI-based radiomics enables non-invasive extraction of quantitative imaging features that may aid in differentiating these conditions. Materials and Methods: In this retrospective study, 150 patients (56 PCa, 94 BPH) underwent prostate MRI including T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). Radiomics features were extracted from manually segmented lesions using PyRadiomics. Logistic regression was used for feature selection and model construction. Three predictive models were developed based on T2WI, DWI, and combined T2WI+DWI features. Model performance was assessed using receiver operating characteristic (ROC) analysis, evaluating area under the curve (AUC), sensitivity, and specificity on training and validation sets. Results: The combined T2WI+DWI model showed the best diagnostic performance with an AUC of 0.942 in the validation set, sensitivity of 0.821, and specificity of 1.000. This outperformed model based on T2WI or DWI alone, as well as the clinical model using PSA and prostate volume. Conclusion: Dual-parameter MRI-based radiomics enhances the non-invasive differentiation of PCa from BPH. The combined T2WI and DWI model offers superior diagnostic accuracy and may reduce unnecessary biopsies in patients with indeterminate PSA levels. http://ijrr.com/article-1-6773-en.pdf Prostatic neoplasms radiomics diffusion magnetic resonance imaging computer-assisted machine learning. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 913 919 article Z.H. Zhang 1 Y.Y. Li 2 Z.Y. He hezhy2253@163.com 3 Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, P. R. China Background: Inflammatory breast cancer (IBC) is an aggressive subtype of breast carcinoma for which radiotherapy (RT) is a recommended treatment. This retrospective analysis aimed to clarify the impact of RT on survival outcomes among patients with IBC, stratified by molecular subtype. Materials and Methods: Data concerning IBC patients diagnosed from 2010 through 2015 was based on the SEER (Surveillance, Epidemiology, and End Results) database. To evaluate survival differences among women with diverse molecular subtypes, comparisons were drawn between those treated with RT and those untreated, employing Cox proportional hazards modeling, Kaplan-Meier (KM) curves, and chi-square analysis. Results: The cohort included 532 female patients, of whom 263 (49.4%) received radiotherapy. Nodal involvement, metastatic status, and chemotherapy use were each significantly correlated with the likelihood of receiving RT (all P < 0.05). Longer survival was exhibited in overall molecular subtypes who received RT(P<0.001). RT significantly improved outcomes in IBC cases of the hormone receptor (HR)-/human epidermal growth factor (HER2)- phenotype (OR, odds ratio = 0.525 [0.334–0.823], P = 0.005), whereas those with HR+/HER2-, HR+/HER2+ or HR-/HER2+ subtypes had a comparable prognosis between the RT cohort and non-RT cohort. HR-/HER2- patients with pathologic stage N0-2M0 had longer survival with RT (OR=0.354 [0.178-0.704], P=0.003), whereas those with N3M0 stage (P=0.880) or M1 stage (P=0.443) derived no benefit. Conclusion: Marked improvements in survival following RT were noted for HR−/HER2− IBC with pathologic N0–2M0 staging. http://ijrr.com/article-1-6774-en.pdf Inflammatory breast neoplasms radiotherapy survival analysis retrospective studies SEER program. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 921 926 article A. Kasić amela.dedic@untz.ba 1 Z. Sakić 2 A. Kasumović 3 Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Urfeta Vejzagića 4, 75 000 Tuzla, Bosnia and Herzegovina Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Urfeta Vejzagića 4, 75 000 Tuzla, Bosnia and Herzegovina Department of Physics, Faculty of Natural Sciences and Mathematics, University of Tuzla, Urfeta Vejzagića 4, 75 000 Tuzla, Bosnia and Herzegovina Background: All generations of living beings have been and will be exposed to ionizing radiation. Until the discovery of radioactivity, man was not aware that ionizing radiation was a part of him and his environment. Humans are mainly exposed to gamma and beta radiation from terrestrial radionuclides, which represent the main source of irradiation of the human body. Materials and Methods: This paper presents the research overview of the dose rates of gamma and beta radiation, measured outdoors in the research locations by the Gamma–Scout device. The measurements were performed at fifteen locations in the area of Tuzla Canton, Bosnia and Herzegovina. The Gamma–Scout device was mounted outside on the table, at a height of 50 cm above ground in the vicinity of residential buildings in periods of 30 minutes. Results: The results presented include gamma, gamma+beta, and beta dose rate measurements. Based on these results, the annual effective doses originating from gamma and beta radiation were estimated. Results of measurements taken by this method showed that the values of the annual effective dose of gamma and gamma+beta radiation were in the interval of (0.21-0.32) mSv and (0.22-0.33) mSv, respectively. The estimated annual effective dose received by beta radiation was in the interval of (0-0.04) mSv. Conclusion: For all investigated locations, excess lifetime cancer risk (ELCR) was below the recommended risk value. http://ijrr.com/article-1-6775-en.pdf Radiation exposure gamma radiation beta radiation annual effective dose risk assessment. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 927 934 article L. Liu 1 Z. Fei 2 X. Pei 3 Q. Ren 4 J. Li 5 X. Cui xlcui@cmpt.ac.cn 6 H. Wang wanghz@hfcas.ac.cn 7 University of Science and Technology of China, Hefei, 230026, Anhui, China Department of Radiation Oncology, The 901st Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei, 230031, Anhui, China Technology Development Department, Anhui Wisdom Technology Company Limited, Hefei, 230000, Anhui, China Technology Development Department, Anhui Wisdom Technology Company Limited, Hefei, 230000, Anhui, China University of Science and Technology of China, Hefei, 230026, Anhui, China Hefei Cancer Hospital of CAS, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, Anhui, China University of Science and Technology of China, Hefei, 230026, Anhui, China Background: Simultaneous integrated boost-stereotactic body radiotherapy (SIB-SBRT) is an effective technique for lung cancer treatment but is significantly affected by respiratory motion. This study employed a four-dimensional (4D) dose calculation method to evaluate the impact of respiratory motion on dose delivery. Materials and Methods: Retrospective analysis was performed on data from 17 lung cancer patients who underwent four-dimensional computed tomography (4DCT). Volumetric modulated arc therapy (VMAT) plans, referred to as the original plans, were designed with dose prescriptions of 6 Gy per fraction for the internal target volume (ITV) and 5 Gy per fraction for the planning target volume (PTV). Control points (CPs) and monitor units (MUs) from the original plans were mapped onto ten respiratory phases of the 4DCT to generate sub-plans. These sub-plans were combined to form a 4D dose plan, followed by evaluation of physical and biological dose effects. Results: Compared to the original plans, respiratory motion reduced V100 by 1.4% for the ITV and 3.5% for the PTV. Additionally, it decreased the tumor control probability (TCP) by 0.1% for the ITV and 4.2% for the PTV. Gamma analysis revealed hot spots at the target periphery and cold spots within the target. Conclusion: Respiratory motion has a greater impact on PTV than ITV in SIB-SBRT. Dose deviations and distribution should be considered to enhance treatment accuracy. http://ijrr.com/article-1-6776-en.pdf Lung neoplasms stereotactic body radiotherapy four-dimensional computed tomography respiratory motion. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 935 943 article A.R.W. Wicaksana 1 A. Muharini 2 Y. Sardjono 3 G.S. Wijaya 4 Z. Ismail 5 I.M. Triatmoko 6 S. Ulya syar015@brin.go.id 7 H. Prasetio 8 N. Nuraeni 9 N.R. Hidayati 10 F. Fendinugroho 11 Y. Kasesaz 12 Department of Nuclear Engineering and Engineering Physics, Faculty of Engineering, Universitas Gadjah Mada, 2 Grafika Street, Yogyakarta 55281, Indonesia Department of Nuclear Engineering and Engineering Physics, Faculty of Engineering, Universitas Gadjah Mada, 2 Grafika Street, Yogyakarta 55281, Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Research Center for Safety, Metrology, and Nuclear Quality Technology, Research Organization for Nuclear Energy, National Research and Innovation Agency Indonesia Background: Effective radiation shielding in Boron Neutron Capture Therapy (BNCT) facilities is essential to protect patients, staff, and the environment from secondary radiation. This study aims to determine the optimal thickness of Portland, boron, and barite concretes for shielding the Beam Shaping Assembly (BSA) in BNCT facilities, ensuring compliance with International Atomic Energy Agency (IAEA) and Indonesia’s BAPETEN (Nuclear Energy Regulatory Agency of Indonesia) safety standards. Materials and Methods: Monte Carlo simulations were performed using the Particle and Heavy Ion Transport Code System (PHITS) to model radiation interactions. The shielding performance of the three concretes was evaluated across five critical areas of the BSA: front, left side, external labyrinth, top, and bottom, utilizing 100,000,000 particles for statistical accuracy. Results: Barite concrete required the least thickness due to its high density and superior photon attenuation, with optimal thicknesses of 0.56 m, 0.4 m, 1.0 m, 0.4 m, and 0.32 m in the respective areas. Boron concrete provided enhanced neutron protection with thicknesses of 0.79 m, 0.35 m, 1.0 m, 0.45 m, and 0.32 m. Portland concrete, while needing greater thickness for gamma shielding, remained cost-effective and accessible with thicknesses of 0.7 m, 0.5 m, 1.0 m, 0.5 m, and 0.37 m. Conclusion: All three concretes met IAEA and BAPETEN safety standards. Barite concrete was most effective for photon attenuation, boron concrete excelled in neutron protection, and Portland concrete offered a practical balance between effectiveness and cost. These findings aid in designing safe and efficient BNCT facilities, especially in resource-limited settings. http://ijrr.com/article-1-6777-en.pdf BNCT radiation shielding Monte Carlo simulation PHITS concrete materials. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 945 951 article J. Gao 1 H.C. Li 2 Z.J. Ruan 3 J. Liu 4 T.T. Yang 5 K.L. Lin 6 K.J. Chen chenkejie1@126.com 7 C.L. Liao 597326974@qq.com 8 Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China Breast and Thyroid Surgery, Shanghai First Hospital Ningde City Hospital, Ningde, Fujian, China Department of Radiation Oncology, Mengchao Hepatobiliary Hospital, Fujian Medical University, Ningde, Fujian, China School of Medicine, Ningde Normal University, Ningde, Fujian, China Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China Department of Gastrointestinal Surgery Zone 1,Ningde Municipal Hospital of Ningde Normal University, Ningde, Fujian, China Background: To investigate the correlation between immune gene expression patterns and radiotherapy (RT) response, aiming to identify novel biomarkers for personalized rectal cancer treatment. Materials and Methods: Data from rectal cancer patients were clustered into two subgroups based on immune gene expression. Differentially expressed genes (DEGs) between subgroups were identified by using the limma package, and survival analysis was conducted with the Kaplan-Meier (KM) method. ClusterProfiler was used to conduct GO and KEGG pathway enrichment analyses on the DEGs. Protein-protein interaction (PPI) networks were utilized to pinpoint key modules or hub genes through interaction scores. In the TCGA rectal cancer dataset, 165 samples were divided into high (n=39) and low (n=126) immune gene expression groups based on the expression of 1,959 immune-related genes. Results: Between the two groups, 775 DEGs were up-regulated and 35 were down-regulated. Analysis of the GSE35452 dataset revealed 308 up-regulated and 209 down-regulated DEGs between the RT-responsive group (n=24) and the non-responsive group (n=22). PPI analysis showed that PLA2G2A and PLA2G4A exhibited the highest interaction score (value = 0.918). Conclusion: Through gene enrichment and PPI network analysis, potential core targets PLA2G2A and PLA2G4A were identified, providing new biomarkers for personalized treatment in rectal cancer. http://ijrr.com/article-1-6778-en.pdf Immunotherapy PLA2G2A PLA2G4A rectal cancer radiotherapy. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 953 958 article J. Zheng 1 J. Zhu 2 J. Sun sunjiafengntyy@163.com 3 Department of Anesthesiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, China Department of Anesthesiology, Haimen District Peoples Hospital, Nantong, Jiangsu 226000, China Department of Anesthesiology, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, China Background: To assess the clinical benefits of intravenous dexmedetomidine infusion administered before radiotherapy in patients with lung cancer, focusing on hemodynamic stability, stress response modulation, and pulmonary protection. Materials and Methods: A total of 120 lung cancer patients scheduled for thoracic radiotherapy (6 MV linear accelerator, Varian Clinac iX, USA; 2 Gy/fraction, 30 fractions, total dose 60 Gy) between April 2022 and January 2024 were divided into the control group (n = 60) and dexmedetomidine group (n = 60). Prior to each radiotherapy session, the control group received intravenous 0.6 μg/kg normal saline, while the study group received 0.6 μg/kg dexmedetomidine. Hemodynamic parameters, oxidative stress markers, and stress hormone levels were recorded at baseline (T0), midway (T1), end of session (T2), and 24 hours post-radiotherapy (T3). Pulmonary complications, cognitive impairment, and adverse reactions were documented. Results: The dexmedetomidine group maintained significantly more stable mean arterial pressure, heart rate, arterial oxygen partial pressure (PaO₂), and oxidative stress profiles (P < 0.05). Compared to controls, they showed lower arterial carbon dioxide partial pressure (PaCO₂), malondialdehyde, cortisol, and adrenocorticotropic hormone (ACTH) levels. Pulmonary injury occurred in 5.0% vs. 16.7% (P = 0.041), and cognitive impairment in 6.7% vs. 20.0% (P = 0.031). Adverse reaction rates were similar between groups (P > 0.05). Conclusion: Pre-radiotherapy dexmedetomidine stabilizes hemodynamics, attenuates oxidative and neuroendocrine stress responses, and reduces pulmonary and cognitive complications without increasing adverse events, suggesting a valuable role in peri-radiotherapy management of lung cancer patients.   http://ijrr.com/article-1-6779-en.pdf Dexmedetomidine lung neoplasms radiotherapy hemodynamics oxidative stress cognitive dysfunction. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 959 965 article X. Peng 1 X. Xiong 2 J. Wang m13576064516@163.com 3 Department of Ultrasound, Affiliated Rehabilitation Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China Department of Ultrasound, Affiliated Rehabilitation Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China Department of Ultrasound, Affiliated Rehabilitation Hospital of Nanchang University, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi Province, China Background: Radiotherapy (RT) for thoracic malignancies, such as breast and lung cancer, can induce cardiac injury, leading to ventricular remodeling and heart failure (HF), which negatively impacts long-term health outcomes. This study aimed to evaluate the effectiveness of color Doppler echocardiography in detecting early signs of ventricular remodeling and cardiotoxicity in patients undergoing thoracic RT. Materials and Methods: A retrospective analysis was performed on 80 patients with thoracic cancers who underwent RT between June 2022 and December 2024. Patients were divided into high-dose RT (n=49) and standard-dose RT groups (n=31). Serial color Doppler echocardiography was conducted before, immediately after, and at a 6-month follow-up to assess changes in cardiac structure and function. Results: Post-RT, both groups showed an increase in left ventricular end-diastolic volume index (LVEDVI), with the high-dose group showing significantly greater changes (P<0.05). Eleven patients in the high-dose group showed signs of HF, including increased left ventricular diameters and reduced ejection fraction (LVEF) (P<0.05). Color Doppler echocardiography demonstrated high sensitivity and specificity in detecting RT-related cardiotoxicity. Conclusion: Color doppler echocardiography is a valuable, non-invasive tool for monitoring ventricular remodeling and detecting early cardiotoxic effects of RT in thoracic cancer patients, enabling timely interventions and improved cardiac outcomes. http://ijrr.com/article-1-6780-en.pdf Radiotherapy color doppler echocardiography cardiotoxicity ventricular remodeling heart failure thoracic cancer. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 967 972 article B. Xia 1 M. Qiu 15980276855@163.com 2 Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of PLA Joint Logistics Support Force, Fuzhou City, Fujian Province, China Department of Gastroenterology, Fuzong Clinical Medical College of Fujian Medical University, 900TH Hospital of PLA Joint Logistics Support Force, Fuzhou City, Fujian Province, China Background: To investigate the host anti-tumor immune response induced by the combination of endoscopic mucosal resection (EMR) and photodynamic therapy (PDT) in patients with early gastrointestinal cancer (EGIC), and its impact on recurrence and immune modulation. Materials and Methods: A total of 120 patients diagnosed with EGIC were enrolled and divided into EMR-only (n=60) and EMR+PDT (n=60) groups. Peripheral blood samples were taken before treatment, and on days 7 and 30 post-treatment. Immune markers (CD4+, CD8+ T cells, NK cells) were measured by flow cytometry. Serum cytokines (IL-2, IL-6, IFN-γ, TNF-α, IL-10) were assessed using ELISA. Recurrence was tracked over 6 months using endoscopic follow-up. Results: At day 30, the EMR+PDT group showed significantly elevated CD8+ T cell counts (P<0.01), IFN-γ levels (P<0.01), and NK cell activity (P<0.05) compared to EMR-only. There was a marked decrease in Treg cells and IL-10 in the EMR+PDT group (P<0.05). Recurrence rate was 5% in the PDT group versus 18% in EMR-only (P=0.01). Conclusion: PDT combined with EMR enhances host immune responses against tumor cells via immunogenic cell death, improving clinical outcomes in early gastrointestinal cancers. http://ijrr.com/article-1-6794-en.pdf Photodynamic therapy endoscopic mucosal resection T cell response gastrointestinal cancer host immune modulation. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 973 977 article R. Kojima 1 Y. Tanaka 2 N. Irie 3 H. Sasaki 4 T. Morishita 5 A. Nakamoto 6 K. Nishioka 7 S. Takahashi 8 Y. Tanabe tanabey@okayama-u.ac.jp 9 Facilty of Health Sciences, Okayama University Medical School, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan Department of Radiological Technology, Graduate School of Health Sciences, Okayama University, 2-5-1, Shikata, Kita, Okayama, Japan Facilty of Health Sciences, Okayama University Medical School, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan Facilty of Health Sciences, Okayama University Medical School, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan Facilty of Health Sciences, Okayama University Medical School, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan Department of Radiology, Tokuyama Central Hospital, 1-1 Kodacho, Shunan, Yamaguchi, Japan Faculty of Medicine, Graduate School of Health Sciences, Okayama University, 2-5-1 Shikata, Kita-ku, Okayama, Japan Background: Predicting the direction and amount of movement of the patient-specific prostate at an early stage of treatment is important for estimating systematic errors and avoiding large dose differences between planning and actual treatment. This study aimed to evaluate a two-plane analysis of prostate movement for multiple-image matching and examine the accuracy of predicting the amount of prostate movement for inter- and intra-fraction setup errors at the early stage of treatment. Materials and Methods: Sixty-five patients who underwent prostate intensity-modulated rotating radiotherapy with fiducial markers were examined for setup errors in bone matching and inter- and intra-marker matching. The two-plane setup errors in the anterior-posterior (AP), left-right (LR), and superior-inferior (SI) directions were analyzed. Correlation analysis was performed by calculating the relationship between the total average setup error and each average setup error (2‒5 fractions), increasing from the first to the sixth fraction. Results: The inter- and intra-fraction setup errors between the AP and SI directions of prostate movement were moderately correlated (r: 0.63, r =0.58, respectively). The average setup error of >4 fractions was strongly correlated (r >0.7), and the standard deviation of the >3 fraction setup errors was moderately correlated (r >0.4) with total and early setup errors. Conclusions: Prostate movement during radiotherapy was linear in the AP-SI direction. The evaluation of early fraction setup errors may be used to predict prostate movement in individual patients during the treatment period. http://ijrr.com/article-1-6795-en.pdf Prostate cancer two-plane analysis prostate movement setup errors adaptive radiation therapy. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 979 986 article S. Huang 1 J. Miao 2 Y. Gu guyyjiaxing@163.com 3 Department of Thoracic Surgery, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, China The Yangtze River Delta Biological Medicine Research and Development Center of Zhejiang Province, Yangtze Delta Region Institution of Tsinghua University, Hangzhou, Zhejiang, China Department of Respiratory and Critical Care Medicine, Jiaxing Second Hospital, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China Background: Lung adenocarcinoma (LUAD), a subtype of non-small cell lung cancer, has a poor prognosis in patients undergoing radiotherapy. M2 macrophage polarization and their derived exosomes play key roles in tumor progression, but their impact on LUAD prognosis remains unclear. This study aims to identify M2 macrophage-derived exosome-related genes associated with prognosis in radiotherapy-treated LUAD patients. Materials and Methods: Transcriptomic data from TCGA-LUAD, ExoRBase, ExoCarta, and GEO were analyzed. The CIBERSORT algorithm quantified immune cell infiltration, and differentially expressed genes (DEGs) were identified. Prognostic genes were screened via univariate Cox regression, LASSO regression, and Kaplan–Meier survival analysis. Gene function was explored using enrichment analysis and immune infiltration correlation. Results: A total of 2,592 DEGs were identified in LUAD, of which 17 were exosome-related and associated with M2 macrophages. Among these, FGR and MNDA emerged as key prognostic markers. High expression levels of both genes were associated with better outcomes: median overall survival of 45.2 months versus 28.7 months in the low-expression group. Improved progression-free interval and disease-specific survival were also observed. Multivariate analysis confirmed FGR and MNDA as independent prognostic indicators. Their high expression correlated with favorable radiotherapy response and enhanced immune infiltration, particularly of CD8⁺ T cells. Conclusion: FGR and MNDA, as M2 macrophage-derived exosome-related genes, are associated with favorable prognosis and enhanced radiotherapy response in LUAD. These biomarkers may offer novel insights into tumor immunity and therapeutic targeting in LUAD patients receiving radiotherapy. http://ijrr.com/article-1-6796-en.pdf Lung neoplasms exosomes macrophages biomarkers radiotherapy gene expression profiling. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 987 994 article S.M.J. Mortazavi 1 M. Arshadi 2 B.F. Baha'addini Baigy Zarandi 3 J.S. Welsh 4 H. Mozdarani 5 M. Haghani 6 N. Jooyan 7 S. Nematollahi 8 A.A. Fallah 9 A. Mortazavi 10 Z. Farshidfar 11 N. Azarpira azarpiran@sums.ac.ir 12 L. Sihver 13 Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Department of, Pharmacology School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Department of Radiation Oncology, Edward Hines Jr VA Hospital, Hines, IL, United States Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Ionizing and Non-Ionizing Radiation Protection Research Center (INIRPRC), Shiraz University of Medical Sciences, Shiraz, Iran Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran MVLS College, The University of Glasgow, Glasgow, Scotland, UK Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Department of Informatics and Engineering Systems, College of Engineering and Computer Science, University of Texas Rio Grande Valley, TX, USA Background: Natural background radiation varies geographically and has potential implications for cancer development. High-level natural radiation areas (HLNRAs), like Ramsar, Iran, offer unique opportunities to study the biological effects of radiation exposure. This study investigates the relationship between high background radiation and tumor progression in a murine model. Materials and Methods: Thirty-two C57BL/6 mice were exposed to varying levels of natural radiation (0.097 μSv/h to 9.24 μSv/h) for two months, simulating conditions in Ramsar. Mice were divided into four groups based on radiation intensity. After exposure, 1106 B16-F10 melanoma cells were injected subcutaneously, and tumor growth was monitored for 24 days. Tumor morphology was assessed using Magnetic Resonance Imaging (MRI), and survival rates were recorded. Statistical analyses included mixed-model and Kaplan-Meier methods. Results: Tumor volume and growth rates were significantly reduced in groups exposed to the highest radiation levels (100X Bkg). Mice in this group also exhibited the highest survival rates (100%) compared to the control group (55.6%). Tumor reduction and disintegration were observed, especially in female mice, suggesting a potential protective effect of elevated radiation exposure against melanoma progression. Conclusion: Findings challenge the Linear No-Threshold (LNT) model by demonstrating that high background radiation may not correlate with increased cancer risk. Instead, elevated radiation levels appear to confer protective effects against tumor growth in this murine model. These results highlight the need to reassess radiation safety standards and explore the complex interplay between radiation and cancer biology. http://ijrr.com/article-1-6797-en.pdf Background radiation Radioactivity Melanoma Mice. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 995 1001 article M. Marashdeh mwmarashdeh@imamu.edu.sa 1 M.J. Aljaafreh 2 Department of Physics, College of Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia Department of Physics, College of Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia Background: This study aims to understand the impact of material composition on radiation attenuation by integrating polystyrene (PS) composites with a conjugated hole transport material (MADN) and zinc oxide (ZnO). The high atomic number of zinc is expected to enhance photon interactions, making ZnO a promising additive for radiation shielding applications. Materials and Methods: PS composites with varying concentrations of MADN (1.3%–4.5%, denoted as PM0–PM5) and ZnO (PMZnO1–PMZnO5) were prepared. Linear and mass attenuation coefficients were measured at photon energies of 59.5 keV, 661.7 keV, 1173.2 keV, and 1332.5 keV. Furthermore, the half value layer (HVL) and mean free path (MFP) were evaluated to assess the attenuation behavior at these energy levels. Results: The PM0–PM5 samples exhibited similar mass attenuation coefficients, which is attributed to the predominant presence of carbon and hydrogen atoms. The addition of ZnO significantly increased the mass attenuation coefficient, especially at lower photon energies, owing to the higher atomic number of zinc, which enhances photoelectric absorption and photon interactions. ZnO addition also reduced the HVL, particularly at 59.5 keV, where composites with higher ZnO concentrations exhibited significantly lower HVL values, indicating stronger attenuation. Conclusion: The findings highlight the crucial roles of atomic number and material density in radiation attenuation, with ZnO effectively enhancing photon attenuation in PS composites. This effect is particularly significant at lower photon energies, validating ZnO’s potential as a useful additive for improved radiation shielding in PS composites. http://ijrr.com/article-1-6798-en.pdf Polystyrenes zinc oxide half-value layer (HVL) mean free path (MFP) radiation attenuation. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1003 1007 article M. Pinkawa michael.pinkawa@post.rwth-aachen.de 1 H. Haddad 2 A. Rashid 3 S. Temming 4 H. Hermani 5 M. Schlenter 6 Department of Radiation Oncology, Wege Klinik, Bonn, Germany Department of Radiation Oncology, Wege Klinik, Bonn, Germany Department of Radiation Oncology, Wege Klinik, Bonn, Germany Department of Radiation Oncology, Wege Klinik, Bonn, Germany Department of Radiation Oncology, Wege Klinik, Bonn, Germany Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany Background: Perirectal spacers are injected to decrease the dose to the rectum and prevent rectal toxicity in prostate cancer radiotherapy. Advantages of a radiopaque viscous hydrogel spacer are a good visibility in computed tomography and improved placement control. The aim of this study was to demonstrate unaffected long-term bowel quality of life (QoL) in comparison to baseline levels, independently from radiotherapy (RT) treatment technique. Materials and Methods: Patients responded to the EPIC (Expanded Prostate Cancer Index Composite) questionnaire before RT, at the last day of RT, 3 months, >12 months and >60 months after RT (n=27). A significant QoL change was defined as a statistically significant mean change >5 points in comparison to baseline. Results: The largest mean bowel domain changes were found at the end of RT (>10 points in the function and bother subdomains, respectively). Function subdomain changes remained without a significant difference in comparison to baseline at all later points in time (<3 points, respectively). In the bother subdomain, changes remained >5 points and statistically significant (8 and 6 points after >12 and >60 months, repsectively). In contrast to patients after pelvic node RT, the difference after >60 months was <5 points for patients after prostate only RT (12 vs. 4 points with vs. without pelvic node RT). Conclusion: The first QoL analysis after RT with a radiopaque viscous hydrogel spacer showed unaffected long-term bowel QoL in patients with limitation of the target volume to the prostate.  http://ijrr.com/article-1-6799-en.pdf Prostate cancer radiotherapy brachytherapy hydrogel quality of life. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1009 1015 article R.S. Ahmed rasha.sabeeh.ahmed@colmed-alnahrain.edu.iq 1 Y.M. Hassen 2 F.H. Hameed 3 S.A. Abd El-Azeem 4 M.Y.A. Mostafa Mostafa.youness@mu.edu.eg 5 Department of Physiology and Medical Physics, College of Medicine, Al-Nahrain University, Baghdad, Iraq Department of Surgery, College of Medicine, Al-Nahrain University, Baghdad, Iraq Department of Physiology and Medical Physics, College of Medicine, Al-Nahrain University, Baghdad, Iraq Physics Department, College of Sciences and Humanities, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia Physics Department, Faculty of Science, Minia University, El-Minia, Egypt Background: Gamma Knife Radiosurgery is a type of radiation therapy that uses a very intense beam of gamma rays that is used in destroying brain tumors like meningiomas without the need to make a surgical interface. The current study aims to assess the impact of Gamma Knife Radiosurgery in meningioma treatment by estimating the changes in meningioma volumes after six months of follow-up. Materials and Methods: 43 participants' data was collected at the Saad Al-Watari Gamma Knife Center in Baghdad, Iraq. The data was gathered from June 2022 to December 2022, and each patient followed after 6 months after the gamma knife surgery. Results: The outcomes show a decrease in meningioma volumes of 83.7% of patients. Only 2.3% of the patients recorded no change in meningioma size. Also, 9.3% of the patients recorded an increase in meningioma size. And finally, the tumor completely disappeared in 4.7% of the patients. Conclusion: Gamma knife treatment is a beneficial option for reducing the meningioma volume. The study demonstrated a significant decrease in tumor size for most patients. Furthermore, a small percentage of patients reported no change or an increase in tumor size, indicating that gamma knife treatment may not be equally effective for all individuals. However, it is essential to mention that two patients reported the complete disappearance of their tumors, suggesting a potential for successful tumor eradication with this treatment. http://ijrr.com/article-1-6800-en.pdf Meningioma gamma knife radiosurgery Iraq tumor. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1017 1022 article B. Xie 18058445771@163.com 1 X. Ma 2 Zhejiang 1Class 2, Nursing, 21st Batch, Equal Academic Qualification Program, Zhejiang Chinese Medical University, Hangzhou, 310002, Zhejiang Province, China Department of Medical Engineering, Hangzhou First People's Hospital, Hangzhou, 310000, Zhejiang Province, China Background: This study aimed to evaluate the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) in improving self-efficacy, quality of life, and mental health outcomes in patients with lung cancer undergoing radiotherapy. Materials and Methods: A randomized controlled trial was conducted involving 60 patients diagnosed with lung cancer and scheduled to receive radiotherapy between January 2024 and February 2025. Patients were randomly assigned to either the intervention group (IG, n=30), which received MBCT in addition to standard oncological care, or the control group (CG, n=30), which received standard oncological care alone. The MBCT program was delivered over eight weekly sessions during the radiotherapy course. Outcome measures included quality of life (QoL), self-efficacy (SE), cancer-related fatigue, and levels of depression and anxiety. Assessments were conducted at baseline, one day after completing radiotherapy, and seven days post-treatment. Results: Compared to baseline, patients in the intervention group showed significant improvements in QoL, self-relaxation, positive attitude, decision-making confidence, and overall self-efficacy (P<0.05). These improvements were significantly greater than those observed in the control group at both follow-up points. Furthermore, the intervention group exhibited markedly reduced symptoms of depression, anxiety, and cancer-related fatigue-particularly emotional and cognitive fatigue-seven days post-treatment (P<0.05). Conclusion: MBCT significantly enhances self-efficacy and mental health outcomes in lung cancer patients undergoing radiotherapy. These findings support the integration of MBCT as a complementary psychosocial intervention in radiotherapy care to improve patients’ psychological resilience and quality of life. http://ijrr.com/article-1-6801-en.pdf Mindfulness-based cognitive therapy (MBCT) lung cancer radiotherapy self-efficacy mental health quality of life. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1023 1027 article L. Suncak lxleyla@hotmail.com 1 C.K. Akbas 2 G.U. Alveroglu 3 S. Özkurt 4 K.A. İbiş 5 S. Küçücük 6 H.B. Becerir 7 The Institute of Health Sciences at Istanbul University, Istanbul, Turkey Division of Medical Physics, Istanbul University Oncology Institute, Istanbul, Turkey Division of Medical Physics, Istanbul University Oncology Institute, Istanbul, Turkey Division of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey Division of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey Division of Radiation Oncology, Istanbul University Oncology Institute, Istanbul, Turkey Division of Medical Physics, Istanbul University Oncology Institute, Istanbul, Turkey Background: The purpose of our study was to investigate the doses received by critical organs, namely the bladder, rectum, and sigmoid colon, in the treatment plans using single-channel (SC) or multi-channel (MC) applicators in high dose rate (HDR) brachytherapy treatments for vaginal cancer patients. Materials and Methods: We established treatment plans for 10 patients received 45Gy (1.8Gy×25fractions) external radiotherapy and then subsequently treated with HDR brachytherapy using MC applicators in the Oncentra Brachytherapy Treatment Planning System (OBTPS). These plans, originally created with MC applicator in the OBTPS, were redefined to simulate an SC applicator, where only the central channel active was kept active. To compare the doses to critical organs, new plans were generated with a prescribed dose of 5Gy to the clinical target volume (CTV). During optimization, it was ensured that 90% of the CTV received the prescribed dose (5Gy), in accordance with Groupe Européen de Curiethérapie and the European SocieTy for Radiotherapy and Oncology (GEC-ESTRO) criteria. The doses received by critical organs were analyzed for volumes of 0.1, 1, and 2cc in both SC and MC applicator plans. Results: A significant difference was found in rectal doses at 1cc and 2cc (p=0.022 and p=0.022, respectively); bladder doses at 0.1cc 1cc and 2cc (p=0.013 for all); and sigmoid colon dose at 1cc (p=0.012). Conclusion: HDR brachytherapy plans using MC applicators delivered lower doses to critical organs compared to SC applicators. Thus, MC applicators are preferable for better organ sparing in vaginal cancer treatment. http://ijrr.com/article-1-6802-en.pdf Brachytherapy rectum sigmoid colon urinary bladder applicators. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1029 1036 article S. Bagherzadeh 1 H. Rajabi hrajabi@modares.ac.ir 2 Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Background: The advent of Magnetic Resonance-guided (MR-guided) radiotherapy, facilitated by MR-guided linear accelerators (MR-LINACs), has significantly enhanced the availability of online adaptive radiotherapy treatments. Research indicates that a static magnetic field influences the amount of radiation absorbed by patients undergoing MR-guided radiotherapy. This study employed Monte Carlo simulations to assess the dose distribution of Photon, Proton, and Carbon ion beams in the absence and presence of magnetic fields. Materials and Methods: All simulations were performed using version 9.1 of the GATE software. The experimental configuration consisted of a water phantom equipped with a one mm-thick air slit oriented parallel to the x-y plane. Energy and dose measurements from both the primary beam and secondary electrons were conducted using DoseActor. Results: The observed magnetic field shifted the Bragg peak for both proton and carbon ion beams, with an increasing displacement correlating to higher primary beam energy levels. Furthermore, there was a positive correlation between secondary electron doses and magnetic field intensity; in scenarios involving a 7 Tesla magnetic field, photon doses at the water-air interface increased considerably. Additionally, at the air slit location, doses from photon-induced secondary electrons markedly increased at this interface. Conclusion: The Electron Return Effect (ERE) influences dose distribution at water-air boundaries. Increased initial energies and more robust magnetic fields exacerbate these phenomena, emphasizing the critical importance of rigorous deliberation in the treatment planning process. http://ijrr.com/article-1-6803-en.pdf Comprehensive Magnetic Fields Carbon-Ion Therapy Monte Carlo Method Proton Therapy Protons. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1037 1042 article S. Bargh 1 C. Ozkul 2 S.S. Timur 3 V.C. Ozalp 4 S. Erdogan serdogan@hacettepe.edu.tr 5 Department of Radiopharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye Department of Pharmaceutical Technology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye Department of Biology, Faculty of Medicine, Atılım University, Ankara, Turkiye Department of Radiopharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye Background: Staphylococcus aureus (S. aureus) is the most common causative pathogen associated with a wide range of infections, from mild to life-threatening conditions such as osteomyelitis, endocarditis, and pneumonia. Early detection and reliable differentiation between infection and sterile inflammation are essential for accurate diagnosis and effective treatment. However, most radiopharmaceuticals currently available fail to discriminate between these conditions, underscoring the need for infection-specific imaging agents. Materials and Methods: In this study, a Gallium-68 (Ga-68)-labeled S. aureus-specific aptamer was developed as a potential PET infection imaging probe. Aptamers were selected using the cell- systematic evolution of ligands by exponential enrichment (SELEX) method, and their specificity was verified by fluorescence-based binding assays. Radiolabeling was achieved via DOTA chelation, and radiochemical purity was determined. Additionally, in vitro binding assays were performed with S. aureus, while Escherichia coli (E. coli) served as a control. Results: The aptamer exhibited an affinity constant (Kₐ) of 2260 ± 634 CFU/mL and a linear detection range of 250-2×10⁴ CFU/mL, with a limit of detection of 171 CFU/mL for S. aureus. The Ga-68-labeled aptamer demonstrated radiochemical purity greater than 99%. In vitro binding increased linearly with rising S. aureus concentrations (10³-2×10⁴ CFU/mL), while minimal binding to E. coli confirmed its specificity. Conclusion: These results demonstrate that the Ga-68-labeled S. aureus-specific aptamer holds promise as an infection-targeted PET imaging agent. Although currently limited to in vitro evaluation, such aptamer-based radiopharmaceuticals may contribute to improved diagnosis and imaging of infectious diseases. http://ijrr.com/article-1-6804-en.pdf Aptamer gallium-68 Staphylococcus aureus PET agent for infection imaging. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1043 1049 article C. Barlas dr.cerencicibiyik@gmail.com 1 T.K. Çatal 2 H.C. Yıldırım 3 E.S. Akovalı 4 S.Ç. Karaçam 5 Ş.A. Ergen 6 D.Ç. Öksüz 7 Department of Radiation Oncology, Sivas Numune Hospital, Sivas, Turkey Department of Radiation Oncology, Kahramanmaraş Necip Fazil City Hospital, Kahramanmaraş, Turkey Department of Radiation Oncology, Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey Department of Radiation Oncology, Sakarya Training and Research Hospital, Sakarya, Turkey Istanbul University-Cerrahpaşa, Vocational School of Health Services, Radiotherapy Program, Turkey Department of Radiation Oncology, Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey Department of Radiation Oncology, Istanbul University- Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey Background: To investigate the effect of radiation dose to thoracic vertebrae (TV) on the development of hematologic toxicity in esophageal cancer patients treated with intensity-modulated radiotherapy. Materials and Methods: We identified 28 patients with esophageal cancer treated with chemoradiotherapy between 2014-2021.Vertebral volumes receiving 5-50 Gy (TV5-50) and the mean vertebral and thoracic blood pool dose were collected from the dose-volume-histogram. Complete blood cell counts were analyzed and hematologic toxicities were graded according to the Common Terminology Criteria for Adverse Events version5.0 (CTCAE v5.0). Results: TV50 was negatively linearly associated with mean lymphocyte nadir by percentage. TV20 was negatively linearly associated with mean platelet nadir by cc. Planning Target Volume (PTV) length was negatively linearly associated with mean hemoglobin nadir. The optimal threshold dose values for avoiding grade ≥4 lymphopenia was TV40 of <22.3%, TV50 of <9.09%, mean thoracic blood pool dose of < 16.9 Gy, PTV volume of <652 cc and PTV length of <16.7 cm. The optimal threshold dose values for avoiding grade ≥3 leukopenia were TV10 of <47.6%, TV20  of <39.7%, TV30 of< 34.69%,and mean vertebral dose of <17.7Gy. Conclusion: This study demonstrated a statistically significant negative correlation between vertebral doses and hematologic parameters. The optimal threshold dose values for avoiding grade ≥3 leukopenia were TV10 of <47.6% and mean vertebral dose of <17.7Gy. http://ijrr.com/article-1-6805-en.pdf Esophageal neoplasms chemoradiotherapy hematologic toxicity complete blood cell counts dosimetry parameter. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1051 1056 article H. Amiri 1 K. Rakhshan 2 F. Shabkhiz 3 R. Zeighami fard 4 N. Aboutaleb dr.nabotaleb@gmail.com 5 Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Department of Physiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran Background: The effects of electromagnetic radiation (EMR) on the body are an emerging field of research. The evidence supports the production of oxidative stress (OS) through EMR and the positive role of exercise in reducing liver damage. The evidence supports the production of OS through EMR and the positive role of exercise in reducing liver damage. Materials and Methods: 32 Wistar male rats were randomly divided into four groups: control, EMR, endurance training (ET), and EMR+ET. The ET and EMR+ET groups ran on the treadmill with the maximum speed and duration of 30 m/ min and 35 min, respectively (5 sessions/weeks, during four weeks). The ET and EMR+ ET groups were exposed to a 2.45GHZ Wi-Fi router for four weeks (4 h/day, 7days/weeks). Forty-eight hours after the last training session, the blood and liver tissue of the animals were sampled for histological, biochemical evaluations and measurement of oxidative stress markers. Results: Histopathological findings confirmed the protective role of ET in rats exposed to EMR. The results showed that in the EMR group, the concentration of malondialdehyde (MDA) and the serum levels of liver enzymes (AST, ALT, and ALP) increased significantly, and the activity of antioxidant enzymes decreased significantly (P<0.05). In the ET and EMR+ET groups, compared to the EMR group, the concentration of MDA and the serum levels of liver enzymes significantly decreased, and the activity of antioxidant enzymes increased significantly (P<0.05). Conclusion: Our findings show that ET can improve the state of OS and liver damage caused by EMR. http://ijrr.com/article-1-6806-en.pdf Endurance training electromagnetic radiation oxidative stress transaminases pathology. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1057 1063 article Y. Wang 1 W. Cui ssamsca2001@163.com 2 Department of Neurology, Jingxian Hospital, Xuancheng, Anhui 242500, China Department of Neurology, Shahe Hospital Changping District, Beijing 102206, China Background: This study investigated the relationship between extracranial internal carotid artery (EICA) and extracranial carotid artery (ECA) tortuosity and clinical prognosis in acute anterior circulation ischemic stroke (AIS). Materials and Methods: We retrospectively analyzed 201 patients with anterior circulation AIS who underwent head and neck CT angiography (CTA) between January–December 2023.CTA was performed using a Discovery CT750 HD scanner (GE Medical Systems), with scanning extending from the aortic arch to the skull vertex. Iopromide contrast agent (37g iodine/100ml) was administered intravenously. Images were reconstructed at 0.63-mm slice thickness using multiplanar reformation (MPR) and 3D volume rendering (VR). Results: Tortuosity Index (TI) of EICA and ECA were independent predictors of poor 90-day prognosis (modified Rankin Scale [mRS] ≥3) in multivariate regression (Model I: EICA OR=1.038, P=0.007.ECA OR=1.052, P=0.015). ROC analysis showed ECA-TI≥12.5 predicted poor prognosis with higher specificity (AUC=0.623,sensitivity 55.6%,specificity 68.3%) than EICA-TI ≥14.5 (AUC=0.601,sensitivity 61.9%,specificity60.7%). Conclusions: Increased EICA/ECA tortuosity independently correlates with poor AIS outcomes, with ECA-TI being a superior prognostic indicator. http://ijrr.com/article-1-6807-en.pdf Carotid arteries stroke prognosis intracranial arteriosclerosis x-ray computed risk factors. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1065 1070 article T. Runwei 1 L. Chaoran 2 Z. Yinghui postop.tsin@foxmail.com 3 General Surgery Department, Liqun Hospital, Putuo District, Shanghai, China Breast Surgery/Medical Department, Baoshan District Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China Breast Surgery Department, Jiading Maternal and Child Health Hospital, Shanghai, China Background: Chemotherapy resistance has become a problem for the treatment of breast cancer patients. This study aimed to investigate whether astragaloside IV (AS-IV) has synergistic effects to enhance Paclitaxel (PTX) chemosensitivity in breast cancer cells. Materials and Methods: CCK-8 assays were performed to evaluate the sensitivity of the cell to AS-IV and PTX. The flow cytometric analysis of Annexin-V-fluoresceine isothiocyanate (FITC)/propidium iodide (PI) staining was carried out to evaluate cell apoptosis. The western blotting assay was used to measure the apoptosis-related proteins and Nrf-2 levels. ROS levels were measured using Dichlorofluorescein (DCF) assay. Results: AS-IV enhances PTX chemosensitivity in MDA-MB-231 and MCF-7 cells by enhancing the inhibitory effect of cell viability and promotion effect on cell apoptosis of PTX. The synergistic effects of AS-IV to PTX could decrease the Nrf-2 expression and increase the ROS levels. Nrf-2 signaling was related to ROS generation. Conclusion: AS-IV may enhance PTX chemosensitivity in breast cancer via regulating Nrf-2 signaling. AS-IV might be used as a potential adjuvant drug to increase PTX sensitivity in breast cancer cells. http://ijrr.com/article-1-6810-en.pdf Astragaloside IV breast cancer chemosensitivity nuclear factor erythroid 2-related factor 2 reactive oxygen species. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1071 1077 article F. Yang 1 W. Qi 793219993@qq.com 2 F. Zhou 3 S. Li 4 M. Zhang 5 Y. Zong 6 H. Yang 7 X. Hu 8 Qingdao Huanghai University, Qingdao, Shandong, China School of Nursing, Qingdao Binhai University, Qingdao, Shandong, China; Department of Pathology, Chengdu Medical College, Sichuan, 610500, China; Philippine Women's University, 1743 Taft Avenue, Malate, Manila 1004 Sichuan Medical College, Nanchong, Sichuan, China Department of Pathology, Chengdu Medical College, Sichuan, China Department of Pathology, Chengdu Medical College, Sichuan, China Department of Pathology, Chengdu Medical College, Sichuan, China Department of Pathology, Chengdu Medical College, Sichuan, China Department of Pathology, Chengdu Medical College, Sichuan, China Background: Cranial radiotherapy (RT), while critical for treating brain tumors, often leads to delayed cognitive dysfunction due to neuronal damage and Tau protein accumulation. Remote ischemic post-conditioning (RIPC) has emerged as a potential strategy to mitigate RT-induced neurotoxicity. This study explores the neuroprotective role of RIPC in modulating hippocampal autophagy and phospho-Tau (P-Tau) expression through the Nrf2-antioxidant response element (ARE) signaling pathway following cranial irradiation. Materials and Methods: Male Sprague-Dawley rats were subjected to focal cranial RT to induce radiation-associated hippocampal injury. A subgroup received RIPC through intermittent limb ischemia. Behavioral evaluations, including Morris water maze, elevated plus maze, and novel object recognition tests, were conducted at weeks 4 and 8 post-irradiation. Hippocampal expression levels of Nrf2, HO-1, SOD2, Tau, and P-Tau were assessed via qPCR and ELISA. Immunohistochemistry and immunofluorescence were employed to localize and quantify neuronal changes and autophagy markers. Results: Rats receiving RIPC demonstrated significant improvements in memory and spatial learning compared to non-conditioned controls. RIPC upregulated hippocampal Nrf2, HO-1, and SOD2, while decreasing Tau and P-Tau accumulation. Additionally, increased neuronal autophagy and reduced oxidative stress were observed, correlating with better cognitive outcomes. Conclusion: RIPC exerts neuroprotective effects in a RT-induced brain injury model by activating the Nrf2-ARE pathway, promoting autophagy, and reducing Tau pathology. These findings support the therapeutic potential of RIPC as an adjunct to RT for preserving cognitive function in cancer patients. http://ijrr.com/article-1-6815-en.pdf Radiotherapy cognitive dysfunction ischemic preconditioning hippocampus Tau proteins autophagy. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1079 1084 article C. Chen 1 W. Xu 2 J. Shen 3 C. Xie 4 Y. Zhou 5 X. Wang 6 J. Zhang 7 D. Jiang 8 Y. Zhong doctorzyh73@163.com 9 H. Liu liuhui69_wh@hotmail.com 10 H. Yu haijunyu@whu.edu.cn 11 Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Department of Radiation and Medical Oncology, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, 169 Donghu Street, Wuhan, China Background: Traditionally, volumetric modulated arc therapy (VMAT) plans have depended on a predefined gantry range and a fixed collimator angle. Herein, we develop a novel sub-arc collimator angle optimization (SACAO) method for VMAT in cervical cancer. Materials and Methods: Twenty patients with cervical cancer were retrieved in the retrospective planning study. Two plans for traditional optimization were generated using dual arcs with two static collimator angles of 0˚ and 45˚ (named VMAT_0 and VMAT_45, respectively). A new plan was also developed using SACAO (named VMAT_SACAO). The dynamic gantry range segmentation of the full arc was calculated according to the continuity of the best conformity index (CI). The dose-volumetric parameters, average x-jaw size, and total monitor units (MUs) were compared. Results: The HI (uniformity index) and CI (conformity index) were improved in VMAT_SACAO compared to VMAT_0 and VMAT_45. The average x-jaw size of VMAT_SACAO was lower than VMAT_0 and VMAT_45 (18.7 ± 0.9 cm2, 20.7 ± 1.1 cm2, and 20.2 ± 1.0 cm2), as well as the total MUs (402 ± 19.0, 450 ± 18.8, and 432 ± 18.5). The average low-dose delivered to normal tissue was lowest in VMAT_SACAO compared to VMAT_0 and VMAT_45 (15.8 ± 0.4 Gy, 18.6 ± 0.3 Gy, and 17.0 ± 0.4 Gy). Conclusion: Compared to the two VMAT plans, the VMAT_SACAO improved the HI and CI, decreased the low-dose delivered to normal tissue, the V50, V45, and V15 of the small bowel, and the total MUs when applied in treating cervical cancer patients. http://ijrr.com/article-1-6818-en.pdf Radiotherapy cervical cancer volumetric modulated arc therapy collimator angle optimization normal tissue protection. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1085 1090 article Q. Wei 1 Z. Zhang 406262711@qq.com 2 Electrocardiogram room, Zibo First Hospital, Zibo City, Shandong Province, China Electrocardiogram room, Zibo First Hospital, Zibo City, Shandong Province, China Background: Radiotherapy, an essential treatment for numerous malignancies, can lead to radiation-induced heart disease (RIHD), including pericarditis, coronary artery disease, cardiomyopathy, valvular dysfunction, or arrhythmias. Early cardiac monitoring is crucial for timely interventions. Electrocardiography (ECG), a widely available, non-invasive diagnostic tool, provides real-time insights into cardiac electrical activity. However, its utility in detecting and managing RIHD remains underexplored. Materials and Methods: A systematic literature search was performed using PubMed, Embase, and Web of Science, focusing on studies published in English up to 2025 in order to evaluate the role of ECG in monitoring cardiac function in patients undergoing radiotherapy, its diagnostic potential, limitations, and emerging advancements. Results: ECG can detect early signs of RIHD, including ST-segment changes, QT interval prolongation, T-wave abnormalities, and conduction disturbances. While ECG is useful for baseline assessment and ongoing surveillance, its specificity for RIHD-related structural and functional changes is limited. Clinical guidelines recommend ECG as part of routine cardio-oncology care, particularly for high-risk patients. Advancements in wearable devices, such as smartwatches that can measure ECG and artificial intelligence-driven ECG interpretation, may improve early detection, enabling real-time monitoring and improving patient outcomes. Conclusions: ECG allows for early detection and monitoring of RIHD in patients undergoing radiotherapy. Integrating ECG with multimodal imaging and biomarkers can enhance diagnostic accuracy. Future research should focus on refining ECG-based risk stratification models, improving detection algorithms, and optimizing clinical guidelines for cardio-oncology surveillance. Emerging technologies, including AI and remote monitoring, can advance the utility of ECG. http://ijrr.com/article-1-6819-en.pdf Electrocardiography radiotherapy cardiotoxicity heart diseases arrhythmias. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1091 1099 article X. Zhang 1 J. Liu 2 Y. Fu 13388266807@163.com 3 Department of Oncology and Hematology, People's Hospital of Leshan, Leshan, 614000, China Department of Oncology and Hematology, People's Hospital of Leshan, Leshan, 614000, China Department of Oncology and Hematology, People's Hospital of Leshan, Leshan, 614000, China Background: Gynecological cancers-including cervical, ovarian, endometrial, vulvar, vaginal, and gestational trophoblastic neoplasms-pose significant global health challenges, particularly in low- and middle-income countries (LMICs). Radiotherapy is a cornerstone of treatment, yet access remains limited in under-resourced regions, contributing to poor outcomes. This systematic review investigates the epidemiology and disease burden of gynecological cancers, focusing on incidence trends, risk factors, geographical variation, histopathological subtypes, and tumor mutational burden (TMB). It also evaluates the effectiveness of radiotherapy and the potential of personalized approaches guided by molecular profiling. Materials and Methods: A systematic search following PRISMA guidelines was conducted across PubMed, Scopus, Web of Science, and Embase for studies published between 2000 and 2023. Study quality was assessed using the QUADAS-2 tool. Results: Nine studies met the inclusion criteria. Cervical cancer showed the highest incidence, with increasing trends in some regions. High TMB was associated with aggressive histological subtypes and poorer survival, highlighting its value as a predictive biomarker. Radiotherapy significantly improved outcomes, especially when integrated into personalized treatment plans based on molecular characteristics. Conclusion: The global burden of gynecological cancers is rising, with substantial disparities in diagnosis and treatment access, especially in LMICs. Radiotherapy remains vital, but outcomes may be further improved through TMB-guided personalization. Expanding radiotherapy infrastructure and integrating molecular diagnostics are crucial for addressing global inequities and enhancing treatment efficacy. http://ijrr.com/article-1-6820-en.pdf Gynecologic neoplasms radiotherapy tumor mutational burden precision medicine uterine cervical neoplasms. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1101 1114 article Sh. Chen 1 Sh. Wei 2 Y. Wang 3 L. Chen 4 Zh. Lin hxsf803@163.com 5 Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China Department of Urological Oncology Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Province, China Predictive models have become essential tools in modern oncology, significantly advancing gastric cancer management—one of the most prevalent and lethal cancers worldwide. This systematic review investigates the application of predictive models derived from public databases, emphasizing their role in improving radiotherapy outcomes. Various modeling techniques are explored, including statistical methods like logistic regression and Cox proportional hazards models, machine learning approaches such as random forests and support vector machines, and deep learning models like convolutional and recurrent neural networks. These models contribute to early detection, prognosis estimation, treatment response prediction, and tumor classification. Notably, in the context of radiotherapy, predictive models enhance tumor delineation, assist in selecting optimal radiation doses, and forecast individual treatment responses, reducing toxicity and improving precision. Other key clinical applications include molecular subtyping, biomarker discovery, and image-based diagnostics, especially through endoscopic and histopathological image analysis. These applications support the development of personalized treatment regimens and improve long-term patient outcomes. Despite their promise, several challenges remain, including inconsistent or imbalanced data, limited interpretability of complex algorithms, and concerns regarding clinical trust and AI transparency. Addressing these issues requires the development of high-quality standardized databases, stronger data-sharing frameworks, the adoption of federated learning methods, and the integration of explainable AI models into clinical workflows. This review concludes that predictive models, when properly validated and implemented, hold substantial potential to transform gastric cancer radiotherapy by enabling more tailored, data-driven treatment strategies, ultimately improving survival rates and quality of life for patients. http://ijrr.com/article-1-6821-en.pdf Stomach neoplasms radiotherapy predictive value of tests machine learning clinical decision-making. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1115 1118 article Y. Zhang m18331591022@163.com 1 Department of Ultrasound, Tangshan Maternal and Child Health Hospital, Tangshan, Hebei, China Background: To explore the value of transvaginal ultrasonography (TVUS) combined with abdominal ultrasonography (AUS) in gynecological acute abdomen diagnosis. Materials and Methods: One hundred patients with gynecological acute abdomen admitted to our hospital from January 2022 to January 2023 were enrolled in this study. Patients were separated into observation group (OG, n=50) and control group (CG, n=50). The OG underwent routine abdominal ultrasound examination. On the basis of the OG, the CG received transvaginal ultrasound examination. The diagnosis of all patients was confirmed by pathological examination after ultrasound examination. The detection rate of diseases (acute pelvic inflammatory disease, ectopic pregnancy, rupture of ovarian cyst, and torsion of the pedicle of ovarian cyst) as well as the coincidence rate of ultrasonic diagnosis with pathological examination were assessed in the two groups. Results: OG showed significantly higher disease detection rate relative to CG (P<0.01). The total coincidence rate of diagnosis of gynecological acute abdomen in the OG was 96.00%, which was also higher than that of 74.00% in the CG (P<0.01). Conclusion: Transvaginal ultrasonography combined with abdominal ultrasonography can improve the overall diagnostic coincidence rate of gynecological acute abdomen. http://ijrr.com/article-1-6822-en.pdf Acute abdomen ultrasonography diagnosis. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1119 1123 article Y. Fan FanYaoq998@hotmail.com 1 J. Niu 2 Q. Lu 3 Department of Critical Care Medicine, Shaoxing Second Hospital Department of Critical Care Medicine, The First Affiliated Hospital, Medical College, Zhejiang University Department of Critical Care Medicine, Shaoxing Second Hospital Background: Severe traumatic brain injured (STBI) is a leading reason for death and long-term disabilities, and improved real-time management of intracranial pressure (ICP) is necessary. This study evaluated the efficacy of drug therapy with ultrasound-guided in patients with STBI by measuring optic nerves sheath diameters (ONSD). Materials and Methods: This retrospective case-control study involved 263 patients with STBI who were treated between March 2019 and June 2021. Patients were categorized in an ultrasound group (n=125), which received ONSD-guided therapy, and a regular group (n=138), which received conventional treatment. Neurogenic and inflammatory markers, clinical scales, and functional recovery metrics were assessed. Results: The ultrasound group showed remarkably improved early-treatment outcomes, such as decreased abnormal breathing (27.20% vs. 40.58%, P=0.022) and lower ICP (54.40% < 350 mmHg vs. 40.58%, P=0.025). This group also showed increased neurogenic factors (brain-derived neurotrophic factors (BDNF) and nerve growth factors (NGF)) and notable decreases in inflammatory indicators like tumor necrosis factor α (TNF-α) (P<0.05). Post-treatment neurological scores were better in the ultrasound group (National Institutes of Health Stroke Scale (NIHSS): 18.32 vs. 18.96 (P=0.018); Glasgow Coma Scale (GCS): 11.19 vs. 10.54 (P=0.007)). Functional assessments (Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Modified Barthel Indexs (MBI)) and quality of life (Simplified Form of Health Questionnaire-36 (SF-36)) indices also favored the ultrasound group. Conclusion: Ultrasound-guided ONSD measurement enhances real-time ICP management in drug therapy for patients with STBI. The measurement has positive effects on neurogenic and inflammatory profiles, functional recoveries, and quality of life. http://ijrr.com/article-1-6823-en.pdf Severe traumatic brain injury ultrasound measurement optic nerve sheath diameter neurogenic markers functional recovery. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1125 1129 article Z.P. Koç zehrapinarkoc@gmail.com 1 P.P. Özcan 2 E. Reyhan 3 M. Yaldız 4 E. Üçbilek 5 Nuclear Medicine Department, Mersin University, Mersin, Turkey Nuclear Medicine Department, Mersin University, Mersin, Turkey Surgical Oncology Department, Mersin University, Mersin, Turkey Pathology Department, Mersin University, Mersin, Turkey Gastroenterology Department, Mersin University, Mersin, Turkey Background: Our investigation employed a retrospective methodological approach, examining a sample of 45 participants (55.6% male, 44.4% female). The average age was 64 years. All participants presented clinical manifestations suggestive of malignant biliary obstruction. Initial diagnoses were established through advanced imaging techniques, specifically endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP). The study design involved a retrospective analysis of data obtained from the entire cohort to ascertain the diagnostic precision of FDG-PET imaging protocol in this specific clinical context. We also conducted a comparative analysis between the imaging results and the definitive findings from surgical interventions and pathological examinations. To quantitatively assess the diagnostic efficacy of FDG-PET scans, we employed ROC curve analysis as our primary statistical instrument. Results: Imaging studies through FDG-PET scans yielded a sensitivity value at 86.1% with a relatively lower specificity level standing at around 66.7%. These diagnostic parameters underscore the FDG-PET modality's particular strength in precise lesion localization. The imaging technique exhibited marked efficacy in delineating areas of concern, proving especially valuable in guiding targeted diagnostic sampling procedures. Conclusion: Despite exhibiting only moderate specificity, integrating FDG-PET imaging into surgical planning protocols afforded significant alterations in patient treatment plans. The modality’s value manifests in two critical domains: detection and localization of malignant biliary obstructions and informing the subsequent management approach. It represents a valuable diagnostic and prognostic tool in the clinical context. http://ijrr.com/article-1-6824-en.pdf Biliary stasis 18F-FDG positron emission tomography. eng Dr. Hossein Mozdarani International Journal of Radiation Research 2322-3243 2345-4229 2025-10 23 4 1131 1135 article Z. Zhang 1 W. Wang 2 H. Wang wanghui201@163.com 3 Department II of Gynecology, Affiliated Hospital of Shandong Second Medical University,School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, China Department II of Gynecology, Affiliated Hospital of Shandong Second Medical University,School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, China Department II of Gynecology, Affiliated Hospital of Shandong Second Medical University,School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong Province, China Ewing's sarcoma (EWS) is a rare malignant tumour that is more likely to occur in children and young people, especially in people of European ancestry, with an annual incidence rate of one in a million, and the incidence of extra-skeletal EWS is even lower, among which retroperitoneal EWS is advanced once detected because of the deep location of the lesion and other characteristics, which makes treatment difficult. The following case report describes an EWS in the retroperitoneal region in a young healthy female patient. A 28-year-old young female patient with a negative family history underwent gynaecologic ultrasound examination for difficulty in defaecation and lower abdominal pain, which revealed a solid cystic mass behind the cervix, tenderness of the mass, and compression of the vagina and rectum. Therefore, surgery was recommended. A retroperitoneal tumour was found during intraoperative exploration, and laparoscopic surgery was changed to open surgery. Postoperative pathology suggested EWS. After postoperative radiation therapy and close follow-up, tumour recurrence occurred six months after surgery, and bone metastasis occurred one year after surgery. Retroperitoneal EWS is a rare and poorly documented disease. Radical surgery remains the first-line treatment of this disease. http://ijrr.com/article-1-6825-en.pdf Ewing sarcoma retroperitoneal space primary neoplasms radiotherapy case report.