Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Journal of neuro-oncology
Feasibility evaluation of tumor treating fields for brainstem gliomas
PURPOSE: Tumor treating fields (TTFields) are FDA-approved for supratentorial glioblastoma, but feasibility in infratentorial tumors remains poorly defined. This simulation study evaluated TTFields dose in brainstem gliomas using patient-specific modeling with scalp-only transducer arrays. METHODS: MRI and CT imaging from seven patients with brainstem gliomas were used for TTFields planning with MAXPOINT® (Novocure, Switzerland). Clinical target volume (CTV) was defined as enhancing tumor on T1 post-contrast MRI (Gross tumor volume, GTV) plus a 3 mm peritumoral expansion. The platform optimized scalp-only array layouts, and finite element calculations generated maps of local minimum field intensity (LMiFI, V/cm) and local minimum power density (LMiPD, mW/cm³). Values were compared against a standard, unplanned layout using one-sided paired t-tests, with LMiFI ≥ 1.0 V/cm as a therapeutic reference. RESULTS: MAXPOINT-optimized layouts achieved significantly higher LMiFI than the standard layout across all regions (all p ≤ 0.019). GTV median LMiFI was 1.1 vs. 1.0 V/cm (p = 0.019). CTV median LMiFI was 1.1 vs. 1.0 V/cm (p = 0.002). Brainstem median LMiFI was 1.3 vs. 1.1 V/cm (p = 0.002). Posterior fossa showed the largest difference: median LMiFI 1.5 vs. 1.2 V/cm (p < 0.001). All optimized LMiFI values met or exceeded the therapeutic reference. LMiPD was also significantly higher with MAXPOINT® across all regions (all p ≤ 0.006). CONCLUSION: This simulation study demonstrates that patient-specific modeling can achieve favorable TTFields intensities in brainstem gliomas using scalp-only arrays, supporting prospective clinical evaluation for infratentorial tumors.
8 July 2026
Read appraisal →Biomedical physics & engineering express
A verification-oriented review of reaction-enhanced radiotherapy: linking nuclear data, transport modeling, and measurable observables
Reaction-enhanced radiotherapy (RER) aims to improve the therapeutic ratio of particle therapy by exploiting isotope-specific nuclear reactions that generate localized high-linear energy transfer secondary radiation. Absorbed dose remains the central metric for radiotherapy planning and evaluation; however, RER introduces additional verification requirements related to nuclear-reaction data, mixed-field transport, isotope delivery, and measurable secondary-field observables. This review frames RER as a verification-oriented physics problem built on three interdependent pillars: covariance-aware nuclear data, high-fidelity Monte Carlo transport, and reaction-specific secondary-field monitoring. Boron neutron capture therapy (BNCT) is treated as the clinically mature benchmark for RER, whereas PBCT and the emerging15N(p,α)12C-based proton-carbon-alpha therapy (Proton-CAT) are discussed as early-stage comparative cases. BNCT has the strongest clinical evidence base, while PBCT remains constrained by narrow resonances, low reaction yield, and limited observability. Proton-CAT provides a candidate 4.439 MeV prompt-γobservable whose verification value still requires detector-level validation and delivery/selectivity assessment. Overall, clinically credible RER requires coordinated progress in uncertainty-aware nuclear data, detector-integrated transport modeling, isotope delivery and tumor-to-normal biodistribution assessment, and high-sensitivity radiation monitoring for therapy verification.
7 July 2026
Read appraisal →Journal of neuro-oncology
Endovascular treatment of tumor-related dural sinus stenosis, venous outflow obstruction, and secondary intracranial hypertension: a systematic review of the literature.
INTRODUCTION: Tumors involving dural venous sinuses can lead to venous outflow obstruction and secondary intracranial hypertension. While surgical resection can decompress the sinus, such procedures carry significant risks. With the success of endovascular interventions for idiopathic intracranial hypertension (IIH), venous sinus stenting (VSS) and angioplasty have emerged as potential treatments for tumor-related sinus stenosis. However, evidence remains limited and dispersed. This systematic review aimed to synthesize the available literature on the safety and efficacy of endovascular treatment for tumor-related venous sinus obstruction. METHODS: A systematic search of PubMed, Embase, and Web of Science was conducted from database inception to November 2025. Eligible studies included any report describing endovascular treatment (VSS and/or angioplasty) for tumor-related venous sinus obstruction, whether due to tumor invasion or compression, or even stenosis following surgery or radiotherapy. Data on patient demographics, tumor characteristics, procedural details, and outcomes were extracted and summarized descriptively. RESULTS: Twenty studies comprising 57 patients were included. Most patients were female (65%) with a mean age of 48 years. Meningioma represented the most common underlying tumor (75%). The majority of obstructions resulted from tumor compression or invasion (86%), and most patients underwent VSS alone (74%), while the rest underwent VSS and angioplasty (23%). No periprocedural complications were reported. Mean trans-stenotic pressure gradient decreased by 10 ± 9 mmHg post-treatment and mean lumbar opening pressure decreased by 11 ± 12 cmH2O. Clinical improvement was reported in 63% of patients, including resolution or improvement of papilledema in 94% and vision changes in 94%. Repeat intervention was required in 28% of cases, and only about half of patients achieved further improvement after reintervention. CONCLUSION: Endovascular therapy for tumor-related venous sinus stenosis appears safe and effective, leading to meaningful pressure reduction and symptomatic improvement in two-thirds of patients. These findings support VSS as a viable adjunct or alternative to surgery in selected patients. Nonetheless, the certainty of evidence remains very low, and current data cannot establish definitive conclusions.
28 June 2026
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