Background:The role of systemic tumor immune environment(STIE)is unclear in hepatocellular carcinoma(HCC).This study aimed to exam the cells in the STIE,their changes after transarterial chemoembolisation(TACE),stereo...Background:The role of systemic tumor immune environment(STIE)is unclear in hepatocellular carcinoma(HCC).This study aimed to exam the cells in the STIE,their changes after transarterial chemoembolisation(TACE),stereotactic body radiotherapy(SBRT),and immunotherapy(IO)and explore their significance in the treatment response of patients with unresectable HCC.Methods:This is a prospective biomarker study of patients with unresectable HCC.The treatment was sequential TACE,SBRT(27.5-40 Gy/5 fractions),and IO.The treatment response was assessed according to modified Re-sponse Evaluation Criteria in Solid Tumors(mRECIST)by magnetic resonance imaging(MRI)after 6 months of treatment.Longitudinal data of STIE cells was extracted from laboratory results of complete blood cell counts,in-cluding leukocytes,lymphocytes,neutrophils,monocytes,eosinophils,basophils,and platelets.Peripheral blood samples were collected at baseline and after TACE,SBRT,and IO for T-lymphocyte subtyping by flow cytometry.Generalized estimation equation was employed for longitudinal analyses.Results:A total of 35 patients with unresectable HCC were enrolled:23 patients in the exploratory cohort and 12 in the validation cohort.STIE circulating cells,especially lymphocytes,were heterogenous at baseline and changed differentially after TACE,SBRT,and IO in both cohorts.SBRT caused the greatest reduction of 0.7×10^(9)/L(95%CI:0.3×10^(9)/L-1.0×10^(9)/L,P<0.001)in lymphocytes;less reduction was associated with significantly better treatment response.The analysis of T-lymphocyte lineage revealed that the baseline levels of CD4+T cells(P=0.010),type 1 T helper(Th1)cells(P=0.007),and Th1/Th17 ratios(P=0.001)were significantly higher in responders,while regulatory T(Treg)cells(P=0.002),Th17 cells(P=0.047),and Th2/Th1 ratios(P=0.028)were significantly higher in non-responders.After treatment with TACE,SBRT and IO,T-lymphocyte lineage also changed differentially.More reductions were observed in CD25^(+)CD8^(+)T cells and CD127^(+)CD8^(+)T cells after SBRT in non-responders,while increases in natural killer T(NKT)cells after SBRT(10.4%vs.3.4%,P=0.001)and increases in the lymphocyte counts were noted during IO in responders.Conclusions:STIE cells are significant for treatment response,can be reshaped differentially after TACE,SBRT,and IO.The most significant changes of T-lymphocyte lineage are SBRT associated modulations in CD25^(+)CD8^(+)T cells,CD127^(+)CD8^(+)T cells,and NKT cells,which also have significant effects on the ultimate treatment response after TACE-SBRT-IO(ClinicalTrails.gov identifier:GCOG0001/NCT05061342).展开更多
Background:Indoleamine 2,3-dioxygenase(IDO1)activity,measured by kynurenine/tryptophan(K:T)ratio,is known for its association with distant metastasis and overall survival(OS)in patients with non-small cell lung cancer...Background:Indoleamine 2,3-dioxygenase(IDO1)activity,measured by kynurenine/tryptophan(K:T)ratio,is known for its association with distant metastasis and overall survival(OS)in patients with non-small cell lung cancer(NSCLC).Here,we aimed to examine whether IDO1 activity is correlated with OS in NSCLC patients with brain metastasis(Bramet)and has negative effect on modulating the anti-tumor functions of immune cells.Methods:This study was a part of a prospective clinical trial in circulating biomarkers.Blood or tissues from eligible participants were collected for measurement of kynurenine,tryptophan,immune cell subtype,scRNA-seq analysis,and untargeted metabolomics analysis.Results:A total of 195 patients were enrolled.The median kynurenine to tryptophan(K:T)ratio was 0.18,with consistent values observed among patients with NSCLC Bramet and those without(0.18 and 0.11,respectively).Notably,student’s t-test analysis revealed significantly higher kynurenine concentrations in stage IV patients compared to those in stage I(2.3 vs 1.7μM,P<0.001).In patients with Bramet,both kynurenine concentrations and K:T ratios were significantly elevated in comparison with those of extra-cerebral metastasis(2.7 vs 1.9μM,P<0.001;0.12 vs 0.095,P=0.028;respectively).Single-cell analysis further validated a high level of IDO1 expression in stage IV tumors or Bramet lesions,particularly in macrophages,regulated by chemokines such as CXCL11.Additionally,K:T ratios exhibited significant associations with Treg cell percentages and OS in patients with Bramet(P=0.039).Treatment with kynurenine led to the upregulation of immune-suppressive molecules,including PD-1,in T cells.Finally,untargeted metabolomics analysis further identified that,apart from the IDO1 metabolic pathway,other metabolites,such as those involved in phospholipid pathways,were also implicated in Bramet.展开更多
Hepatocellular carcinoma(HCC)is a common malignancy with high mortality rates.While surgery can be curative in early-stage disease,80% of patients cannot undergo surgical resection.Stereotactic body radiotherapy(SBRT)...Hepatocellular carcinoma(HCC)is a common malignancy with high mortality rates.While surgery can be curative in early-stage disease,80% of patients cannot undergo surgical resection.Stereotactic body radiotherapy(SBRT),an emerging,non-invasive,precision treatment,has shown promising results across various stages of HCC and has thus been adopted in practice to varying degrees around the world.This article aims to review current guideline recommendations on SBRT,clinical evidence,and outcome comparisons with other local treatment modalities.Attempts are also made to compare the differences in clinical trials between Asian and Western countries.展开更多
Purpose:This study aimed to examine the effect of radiation esophagitis(RE)and the dynamics of RE on subse-quent survival in non-small cell lung cancer(NSCLC)patients who underwent radiotherapy.Experimental Design:Pat...Purpose:This study aimed to examine the effect of radiation esophagitis(RE)and the dynamics of RE on subse-quent survival in non-small cell lung cancer(NSCLC)patients who underwent radiotherapy.Experimental Design:Patients with NSCLC treated with fractionated thoracic radiotherapy enrolled in prospective trials were eligible.RE was graded prospectively according to Common Terminology Criteria for Adverse Events(CTCAE)v3.0 per protocol requirement weekly during-RT and 1 month after RT.This study applied conditional survival assessment which has advantage over traditional survival analysis as it assesses the survival from the event instead of from the baseline.P-value less than 0.05 was considered to be significant.The primary endpoint is overall survival.Results:A total of 177 patients were eligible,with a median follow-up of 5 years.The presence of RE,the maximum RE grade,the evolution of RE and the onset timing of RE events were all correlated with subsequent survival.At all conditional time points,patients first presented with RE grade1(initial RE1)had significant inferior subsequent survival(multivariable HRs median:1.63,all P-values<0.05);meanwhile those with RE progressed had significant inferior subsequent survival than those never develop RE(multivariable HRs median:2.08,all P-values<0.05).Multivariable Cox proportional-hazards analysis showed significantly higher C-indexes for models with inclusion of RE events than those without(all P-values<0.05).Conclusion:This study comprehensively evaluated the impact of RE with conditional survival assessment and demonstrated that RE is associated with inferior survival in NSCLC patients treated with RT.展开更多
The current standard of cancer care is combined multimodality ther-apy,including surgery,radiation therapy,chemotherapy,target ther-apy,and immune therapy.Radiation therapy,as one of these five major cancer modalities...The current standard of cancer care is combined multimodality ther-apy,including surgery,radiation therapy,chemotherapy,target ther-apy,and immune therapy.Radiation therapy,as one of these five major cancer modalities,has a significant contribution to the cure of cancer patients.According to the 2006 data of the Surveillance,Epidemiology,and End Results(SEER)Program,an estimated 3.05 million cancer sur-vivors received radiation therapy,accounting for 29%of all 5-year can-cer survivors.1 The number of radiation-treated cancer survivors is pro-jected to 4.17 million by 2030.The radiation-treated female survivors were at 58%and projected to increase to 66%in 2030.1 It was estimated that about 50%of cancer patients in developed countries such as Aus-tralia indicated for radiation therapy,2,3 while less than 10%patients in low-income countries had access to such a life-saving treatment.4,5 Interestingly,the availability of radiation therapy has direct correlation with the survival of the cancer patients 6 or the mortality to incidence ra-tio(MIR)of cancer.7 The high-income countries have lower MIRs than many low/middle income countries where over 50%and 90%of pa-tients requiring radiotherapy do not have access to this life saving treat-ment.7 While the reason of such discrepancy is multifactorial,limited knowledge on the role of radiation therapy is an important reason.In-vesting in radiation therapy was associated with more life-saving and economic benefit,as presented in a special issue in Lancet Oncology.8 This highlights the importance of promoting the data and evidence in radiation therapy,justifying this very first special issue of the Journal of the National Cancer Center(JNCC)to promote the research and clinical activity on the role of radiation therapy.展开更多
Introduction:Accurate contouring of thoracic organs at risk(OARs)is essential for minimizing complications in radiation treatment.Manual contouring of thoracic OARs is not only time-consuming but also prone to substan...Introduction:Accurate contouring of thoracic organs at risk(OARs)is essential for minimizing complications in radiation treatment.Manual contouring of thoracic OARs is not only time-consuming but also prone to substantial user variation.To enhance the efficiency and consistency,we developed a unified deep learning(DL)OAR contouring model,DeepOAR,that was trained using multiple partially labeled datasets for segmenting a comprehensive set of thoracic OARs following the Radiation Therapy Oncology Group(RTOG)-guided OAR atlas.This DL model supports the segmentation of six required and eight optional OARs guided by the NRG-RTOG 1106 trial,providing precise and reproducible OARs contouring that are ready to be used in radiotherapy practice.Materials and methods:Following the OAR contouring recommendation of the NRG-RTOG 1106 trial,we collected and curated three private datasets and two public datasets,comprising a total of 531 patients with partially annotated thoracic OARs.These partially annotated datasets were utilized to develop DeepOAR,which consisted of a shared encoder and 14 separate decoders,with each decoder dedicated to one specific OAR.For model training,we utilized all patients from the two public datasets and 75%of the patients from the private datasets.We reserved the remaining 25%of the private datasets for independent testing.A multi-user study involving 21 radiation oncologists was conducted on 40 randomly selected patients from the independent testing dataset to evaluate the clinical applicability of DeepOAR.The Dice coefficient score(DSC)and average surface distance(ASD)were computed to evaluate the quantitative delineation performance of the model.Results:DeepOAR outperformed nnUNet(the benchmark medical segmentation model)across all 14 OARs,achieving mean DSC and ASD values of 88.4%and 1.0 mm,respectively,in the independent testing set.Multi-user validation demonstrated that 89.7%of DeepOAR-generated OARs were clinically acceptable or required only minor revisions.A comparison using two randomly selected patients showed that the delineation variability of DeepOAR was significantly smaller than the inter-user variation among radiation oncologists.Human editing of DeepOAR’s predictions could further improve OAR delineation accuracy by an average of 3%increase in DSC and 40%reduction in ASD while significantly reducing the workload of radiation oncologists for contouring 14 thoracic OARs by an average of 77.0%.Conclusion:We developed DeepOAR,a DL-based unified contouring model trained using multiple partially labeled datasets,to delineate a comprehensive set of 14 thoracic OARs following the RTOG-guided OAR atlas.Both qualitative and quantitative results demonstrated the strong clinical applicability of DeepOAR for the OAR delineation process in thoracic cancer radiotherapy workflows,along with improved efficiency,comprehensiveness,and quality.展开更多
Cancer remains a substantial global health challenge,with steadily increasing incidence rates.Radiotherapy(RT)is a crucial component in cancer treatment.Nevertheless,due to limited resources,there is an urgent need to...Cancer remains a substantial global health challenge,with steadily increasing incidence rates.Radiotherapy(RT)is a crucial component in cancer treatment.Nevertheless,due to limited resources,there is an urgent need to enhance both its efficiency and therapeutic efficacy.The integration of Artificial Intelligence(AI)into RT has proven to significantly improve treatment efficiency,especially in time-consuming tasks.This perspective demonstrates how AI enhances the efficiency of target delineation and treatment planning,and introduces the concept of All-in-One RT,which may greatly improve RT efficiency.Furthermore,the concept of Radiotherapy Digital Twins(RDTs)is introduced.By integrating patient-specific data with AI,RDTs enable personalized and precise treatment,as well as the evaluation of therapeutic efficacy.This perspective highlights the transformative impact of AI and digital twin technologies in revolutionizing cancer RT,with the aim of making RT more accessible and effective on a global scale.展开更多
基金supported by the Shenzhen Science and Technology Program(grant number:KQTD20180411185028798).
文摘Background:The role of systemic tumor immune environment(STIE)is unclear in hepatocellular carcinoma(HCC).This study aimed to exam the cells in the STIE,their changes after transarterial chemoembolisation(TACE),stereotactic body radiotherapy(SBRT),and immunotherapy(IO)and explore their significance in the treatment response of patients with unresectable HCC.Methods:This is a prospective biomarker study of patients with unresectable HCC.The treatment was sequential TACE,SBRT(27.5-40 Gy/5 fractions),and IO.The treatment response was assessed according to modified Re-sponse Evaluation Criteria in Solid Tumors(mRECIST)by magnetic resonance imaging(MRI)after 6 months of treatment.Longitudinal data of STIE cells was extracted from laboratory results of complete blood cell counts,in-cluding leukocytes,lymphocytes,neutrophils,monocytes,eosinophils,basophils,and platelets.Peripheral blood samples were collected at baseline and after TACE,SBRT,and IO for T-lymphocyte subtyping by flow cytometry.Generalized estimation equation was employed for longitudinal analyses.Results:A total of 35 patients with unresectable HCC were enrolled:23 patients in the exploratory cohort and 12 in the validation cohort.STIE circulating cells,especially lymphocytes,were heterogenous at baseline and changed differentially after TACE,SBRT,and IO in both cohorts.SBRT caused the greatest reduction of 0.7×10^(9)/L(95%CI:0.3×10^(9)/L-1.0×10^(9)/L,P<0.001)in lymphocytes;less reduction was associated with significantly better treatment response.The analysis of T-lymphocyte lineage revealed that the baseline levels of CD4+T cells(P=0.010),type 1 T helper(Th1)cells(P=0.007),and Th1/Th17 ratios(P=0.001)were significantly higher in responders,while regulatory T(Treg)cells(P=0.002),Th17 cells(P=0.047),and Th2/Th1 ratios(P=0.028)were significantly higher in non-responders.After treatment with TACE,SBRT and IO,T-lymphocyte lineage also changed differentially.More reductions were observed in CD25^(+)CD8^(+)T cells and CD127^(+)CD8^(+)T cells after SBRT in non-responders,while increases in natural killer T(NKT)cells after SBRT(10.4%vs.3.4%,P=0.001)and increases in the lymphocyte counts were noted during IO in responders.Conclusions:STIE cells are significant for treatment response,can be reshaped differentially after TACE,SBRT,and IO.The most significant changes of T-lymphocyte lineage are SBRT associated modulations in CD25^(+)CD8^(+)T cells,CD127^(+)CD8^(+)T cells,and NKT cells,which also have significant effects on the ultimate treatment response after TACE-SBRT-IO(ClinicalTrails.gov identifier:GCOG0001/NCT05061342).
基金supported in parts by the Shenzhen Science and Technology Program(grant num-ber:KQTD20180411185028798)the National Natural Science Foun-dation of China(grant number:8187110989)+1 种基金the China Postdoctoral Science Foundation(grant number:2021M693291)High Level-Hospital Program,Health Commission of Guangdong Province,China(grant number:HKUSZH201901038).
文摘Background:Indoleamine 2,3-dioxygenase(IDO1)activity,measured by kynurenine/tryptophan(K:T)ratio,is known for its association with distant metastasis and overall survival(OS)in patients with non-small cell lung cancer(NSCLC).Here,we aimed to examine whether IDO1 activity is correlated with OS in NSCLC patients with brain metastasis(Bramet)and has negative effect on modulating the anti-tumor functions of immune cells.Methods:This study was a part of a prospective clinical trial in circulating biomarkers.Blood or tissues from eligible participants were collected for measurement of kynurenine,tryptophan,immune cell subtype,scRNA-seq analysis,and untargeted metabolomics analysis.Results:A total of 195 patients were enrolled.The median kynurenine to tryptophan(K:T)ratio was 0.18,with consistent values observed among patients with NSCLC Bramet and those without(0.18 and 0.11,respectively).Notably,student’s t-test analysis revealed significantly higher kynurenine concentrations in stage IV patients compared to those in stage I(2.3 vs 1.7μM,P<0.001).In patients with Bramet,both kynurenine concentrations and K:T ratios were significantly elevated in comparison with those of extra-cerebral metastasis(2.7 vs 1.9μM,P<0.001;0.12 vs 0.095,P=0.028;respectively).Single-cell analysis further validated a high level of IDO1 expression in stage IV tumors or Bramet lesions,particularly in macrophages,regulated by chemokines such as CXCL11.Additionally,K:T ratios exhibited significant associations with Treg cell percentages and OS in patients with Bramet(P=0.039).Treatment with kynurenine led to the upregulation of immune-suppressive molecules,including PD-1,in T cells.Finally,untargeted metabolomics analysis further identified that,apart from the IDO1 metabolic pathway,other metabolites,such as those involved in phospholipid pathways,were also implicated in Bramet.
基金supported in part by Shenzhen Science and Technol-ogy Program(grant number KQTD20180411185028798)a Varian Medical Systems Research Grant.
文摘Hepatocellular carcinoma(HCC)is a common malignancy with high mortality rates.While surgery can be curative in early-stage disease,80% of patients cannot undergo surgical resection.Stereotactic body radiotherapy(SBRT),an emerging,non-invasive,precision treatment,has shown promising results across various stages of HCC and has thus been adopted in practice to varying degrees around the world.This article aims to review current guideline recommendations on SBRT,clinical evidence,and outcome comparisons with other local treatment modalities.Attempts are also made to compare the differences in clinical trials between Asian and Western countries.
基金supported by Shenzhen Fundamental Research Program(JCYJ2020109150427184)Shenzhen Science and Technology Program(KQTD20180411185028798)Shenzhen Fun-damental Research Program(JCYJ20180508153249223).
文摘Purpose:This study aimed to examine the effect of radiation esophagitis(RE)and the dynamics of RE on subse-quent survival in non-small cell lung cancer(NSCLC)patients who underwent radiotherapy.Experimental Design:Patients with NSCLC treated with fractionated thoracic radiotherapy enrolled in prospective trials were eligible.RE was graded prospectively according to Common Terminology Criteria for Adverse Events(CTCAE)v3.0 per protocol requirement weekly during-RT and 1 month after RT.This study applied conditional survival assessment which has advantage over traditional survival analysis as it assesses the survival from the event instead of from the baseline.P-value less than 0.05 was considered to be significant.The primary endpoint is overall survival.Results:A total of 177 patients were eligible,with a median follow-up of 5 years.The presence of RE,the maximum RE grade,the evolution of RE and the onset timing of RE events were all correlated with subsequent survival.At all conditional time points,patients first presented with RE grade1(initial RE1)had significant inferior subsequent survival(multivariable HRs median:1.63,all P-values<0.05);meanwhile those with RE progressed had significant inferior subsequent survival than those never develop RE(multivariable HRs median:2.08,all P-values<0.05).Multivariable Cox proportional-hazards analysis showed significantly higher C-indexes for models with inclusion of RE events than those without(all P-values<0.05).Conclusion:This study comprehensively evaluated the impact of RE with conditional survival assessment and demonstrated that RE is associated with inferior survival in NSCLC patients treated with RT.
基金Shenzhen Science and Technology Commission KQTD20180411185028798.
文摘The current standard of cancer care is combined multimodality ther-apy,including surgery,radiation therapy,chemotherapy,target ther-apy,and immune therapy.Radiation therapy,as one of these five major cancer modalities,has a significant contribution to the cure of cancer patients.According to the 2006 data of the Surveillance,Epidemiology,and End Results(SEER)Program,an estimated 3.05 million cancer sur-vivors received radiation therapy,accounting for 29%of all 5-year can-cer survivors.1 The number of radiation-treated cancer survivors is pro-jected to 4.17 million by 2030.The radiation-treated female survivors were at 58%and projected to increase to 66%in 2030.1 It was estimated that about 50%of cancer patients in developed countries such as Aus-tralia indicated for radiation therapy,2,3 while less than 10%patients in low-income countries had access to such a life-saving treatment.4,5 Interestingly,the availability of radiation therapy has direct correlation with the survival of the cancer patients 6 or the mortality to incidence ra-tio(MIR)of cancer.7 The high-income countries have lower MIRs than many low/middle income countries where over 50%and 90%of pa-tients requiring radiotherapy do not have access to this life saving treat-ment.7 While the reason of such discrepancy is multifactorial,limited knowledge on the role of radiation therapy is an important reason.In-vesting in radiation therapy was associated with more life-saving and economic benefit,as presented in a special issue in Lancet Oncology.8 This highlights the importance of promoting the data and evidence in radiation therapy,justifying this very first special issue of the Journal of the National Cancer Center(JNCC)to promote the research and clinical activity on the role of radiation therapy.
基金Xianghua Ye,Zhejiang Provincial Science and Technology Project,2024-KY1-001-105.This funding is intended to support the training of organ auto-segmentation models.
文摘Introduction:Accurate contouring of thoracic organs at risk(OARs)is essential for minimizing complications in radiation treatment.Manual contouring of thoracic OARs is not only time-consuming but also prone to substantial user variation.To enhance the efficiency and consistency,we developed a unified deep learning(DL)OAR contouring model,DeepOAR,that was trained using multiple partially labeled datasets for segmenting a comprehensive set of thoracic OARs following the Radiation Therapy Oncology Group(RTOG)-guided OAR atlas.This DL model supports the segmentation of six required and eight optional OARs guided by the NRG-RTOG 1106 trial,providing precise and reproducible OARs contouring that are ready to be used in radiotherapy practice.Materials and methods:Following the OAR contouring recommendation of the NRG-RTOG 1106 trial,we collected and curated three private datasets and two public datasets,comprising a total of 531 patients with partially annotated thoracic OARs.These partially annotated datasets were utilized to develop DeepOAR,which consisted of a shared encoder and 14 separate decoders,with each decoder dedicated to one specific OAR.For model training,we utilized all patients from the two public datasets and 75%of the patients from the private datasets.We reserved the remaining 25%of the private datasets for independent testing.A multi-user study involving 21 radiation oncologists was conducted on 40 randomly selected patients from the independent testing dataset to evaluate the clinical applicability of DeepOAR.The Dice coefficient score(DSC)and average surface distance(ASD)were computed to evaluate the quantitative delineation performance of the model.Results:DeepOAR outperformed nnUNet(the benchmark medical segmentation model)across all 14 OARs,achieving mean DSC and ASD values of 88.4%and 1.0 mm,respectively,in the independent testing set.Multi-user validation demonstrated that 89.7%of DeepOAR-generated OARs were clinically acceptable or required only minor revisions.A comparison using two randomly selected patients showed that the delineation variability of DeepOAR was significantly smaller than the inter-user variation among radiation oncologists.Human editing of DeepOAR’s predictions could further improve OAR delineation accuracy by an average of 3%increase in DSC and 40%reduction in ASD while significantly reducing the workload of radiation oncologists for contouring 14 thoracic OARs by an average of 77.0%.Conclusion:We developed DeepOAR,a DL-based unified contouring model trained using multiple partially labeled datasets,to delineate a comprehensive set of 14 thoracic OARs following the RTOG-guided OAR atlas.Both qualitative and quantitative results demonstrated the strong clinical applicability of DeepOAR for the OAR delineation process in thoracic cancer radiotherapy workflows,along with improved efficiency,comprehensiveness,and quality.
基金The National Natural Science Foundation of China(grant no.12375334)National Key Research and Development Program of China(grant nos.2023YFC2413200/2023YFC2413201 and 2019YFF01014402)Shenzhen Science and Technology Program,(grant no.KQTD20180411185028798)。
文摘Cancer remains a substantial global health challenge,with steadily increasing incidence rates.Radiotherapy(RT)is a crucial component in cancer treatment.Nevertheless,due to limited resources,there is an urgent need to enhance both its efficiency and therapeutic efficacy.The integration of Artificial Intelligence(AI)into RT has proven to significantly improve treatment efficiency,especially in time-consuming tasks.This perspective demonstrates how AI enhances the efficiency of target delineation and treatment planning,and introduces the concept of All-in-One RT,which may greatly improve RT efficiency.Furthermore,the concept of Radiotherapy Digital Twins(RDTs)is introduced.By integrating patient-specific data with AI,RDTs enable personalized and precise treatment,as well as the evaluation of therapeutic efficacy.This perspective highlights the transformative impact of AI and digital twin technologies in revolutionizing cancer RT,with the aim of making RT more accessible and effective on a global scale.
