Clinical and Translational Radiation Oncology最新文献

{"title":"Comment on “Ten-year survival outcomes of concurrent chemoradiotherapy with or without adjuvant chemotherapy for locoregionally advanced nasopharyngeal carcinoma in the IMRT era: A retrospective cohort study stratified by high- and low-risk profiles”","authors":"Erkan Topkan , Efsun Somay , Duriye Ozturk , Ugur Selek","doi":"10.1016/j.ctro.2025.101025","DOIUrl":"10.1016/j.ctro.2025.101025","url":null,"abstract":"","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101025"},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining radiological and radiation oncology expertise in the delineation of hypopharyngeal tumours: potential effects on treatment volumes and patterns of failure","authors":"Gabriella Alexandersson von Döbeln ,&nbsp;Eva Onjukka ,&nbsp;Halla Sif Ólafsdóttir ,&nbsp;Sara Jonmarker Jaraj ,&nbsp;Mattias Hedman","doi":"10.1016/j.ctro.2025.101022","DOIUrl":"10.1016/j.ctro.2025.101022","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Target definition is one of the greatest uncertainties in the radiotherapy process. We aimed to investigate whether a radiologist specialized in head and neck can improve the target definition of hypopharyngeal cancers.</div></div><div><h3>Materials and methods</h3><div>We retrospectively identified 54 patients with hypopharyngeal cancer who received curative-intent radiotherapy between 2009–2015. New target structures were defined incorporating head and neck radiology expertise and updated delineation guidelines. The new structures were subsequently compared both quantitively and qualitatively to the original delineations. Loco-regional failures were analyzed in relation to radiotherapy dose and target volumes.</div></div><div><h3>Results</h3><div>There was a significant reduction in gross tumour volume (GTV) for the primary tumour, decreasing from 14.4 to 9.2 cm³ (−47 %), and in clinical target volume (CTV), decreasing from 203.7 to 93.8 cm³ (−54 %). Mean quantitative values indicated a large overestimation of the original GTV (Dice Coefficient 0.58 ± 0.2 SD, Jaccard index 0.44 ± 0.19 SD, Positive predictive value 0.53 ± 0.24 SD). Only 39 % of the original primary tumour GTV and 19 % of the original lymph node GTV were assessed as acceptable. Twelve patients (22 %) had a locoregional recurrence. In relation to both the original radiation dose and the updated dose distribution, nine recurrences were classified as in field, two as marginal, and one could not be evaluated. The 3-year and 5-year locoregional progression free survival (PFS) was 75.5 % and 66.6 % respectively.</div></div><div><h3>Conclusion</h3><div>Incorporating radiological expertise in the delineation of hypopharyngeal tumours leads to large changes in tumour volumes and possibly a decrease in radiation volumes which may lead to reduced side effects.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101022"},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lattice radiotherapy for extensive liver metastases in synchronous EGFR-mutant lung adenocarcinoma and small cell lung cancer","authors":"Shaïma El Chammah ,&nbsp;Mickael Bendahman ,&nbsp;Sarah Ghandour ,&nbsp;Loris Fuchs ,&nbsp;Rémy Kinj ,&nbsp;Gian Guyer ,&nbsp;Mahmut Ozsahin","doi":"10.1016/j.ctro.2025.101023","DOIUrl":"10.1016/j.ctro.2025.101023","url":null,"abstract":"<div><div>We report the case of exceptional response of massive liver metastases of a patient with synchronous lung adenocarcinoma and small cell lung cancer following lattice radiotherapy (L-RT). After a single irradiation of 16 Gy to 1 % of the metastatic liver burden, the patient reported improved abdominal symptoms within a week. Within two weeks liver volume decreased by 50 %, and liver enzyme levels stabilized or improved. This case highlights L-RT as a novel and effective approach to treat symptomatic liver metastases.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101023"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PSMA response evaluation in follow-up PSMA-PET/CT after stereotactic ablative body radiotherapy (SABR) for oligometastases in prostate cancer","authors":"Anna-Lena Zang ,&nbsp;Timo Maier ,&nbsp;Sandra Freitag-Wolf ,&nbsp;Alexander Fabian ,&nbsp;Severin Rodler ,&nbsp;Jürgen Dunst ,&nbsp;David Krug ,&nbsp;Ulf Lützen ,&nbsp;Olaf Wittenstein","doi":"10.1016/j.ctro.2025.101021","DOIUrl":"10.1016/j.ctro.2025.101021","url":null,"abstract":"<div><h3>Purpose</h3><div>PSMA-PET/CT is frequently used for staging patients with de-novo or recurrent prostate cancer (PCa). In patients with oligometastatic PCa PSMA-PET/CT guided stereotactic ablative body radiotherapy (SABR) is a common treatment option. Follow-up is regularly performed via measurement of prostate-specific-antigen (PSA) level. Response assessment based on follow-up PSMA-PET/CTs is poorly studied. Therefore, we report on long-term local tumor response using repeated PSMA-PET/CTs of patients with oligometastatic PCa after PSMA-PET/CT guided SABR.</div></div><div><h3>Methods/Patients</h3><div>Patients with de-novo oligometastatic or oligoprogressive PCa who received PSMA-PET/CT-directed SABR with 5 × 7 Gy of at least one bone or lymph node lesion between 2015 and 2019 and had one or more follow-up PSMA-PET/CT were included in this retrospective single center analysis. PSMA response was evaluated by visual and quantitative assessment of local PSMA uptake pre- and post-SABR.</div></div><div><h3>Results</h3><div>Overall, 48 patients with 97 irradiated lesions and a total of 145 PSMA-PET/CT-scans were analyzed. 26 patients received androgen-deprivation-therapy (ADT) at any time. Median SUV_max per lesion was 10.88 (range 1.59–122.11) before SABR with a median CTV of 4.75 cm³ (Range 0.68–60.4 cm³). In the first follow-up PET/CT after a median of 13 months (range 3–42) after SABR, median SUV_max per lesion declined to 2.2 (range 0.13–26.09). Complete remission (CR) was observed in 49 lesions, partial remission in 32 and stable disease in 12 lesions. Four lesions were non-responders. Over the course of up to five follow-up PSMA-PET/CTs a maximum of 90 % of the lesions showed CR. Median time to SUV_min was 19 months (range 3–50). 5-year local control was 86 %. No short-term or long-term toxicities were reported.</div></div><div><h3>Conclusion</h3><div>PSMA-PET/CT directed SABR provides excellent long-term local tumor control of 90% in bone and lymph node metastasis of oligometastatic PCa and is well tolerated. PSMA activity may further decrease after initial re-imaging with PSMA-PET/CT.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101021"},"PeriodicalIF":2.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normal tissue outlining guidelines development for soft tissue sarcoma of the extremities","authors":"Rita Simões ,&nbsp;Sarah Gulliford ,&nbsp;Punita Shah ,&nbsp;Eve McAtavey ,&nbsp;Elizabeth Richardson ,&nbsp;Umme Chowdhury ,&nbsp;Laura Fray ,&nbsp;Roeum Butt ,&nbsp;Yolanda Augustin ,&nbsp;Ruqayyah Sarang ,&nbsp;Refia Kilinc ,&nbsp;Maryam Iqbal ,&nbsp;Hakim Moulay-Dehbi ,&nbsp;Elizabeth Miles ,&nbsp;Peter Hoskin ,&nbsp;Shane Zaidi ,&nbsp;Kevin J Harrington ,&nbsp;Aisha B. Miah","doi":"10.1016/j.ctro.2025.101020","DOIUrl":"10.1016/j.ctro.2025.101020","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiotherapy (RT) plans for soft tissue sarcoma of the extremities (STSE) are optimised to achieve maximum target coverage whilst avoiding high doses to weight-bearing bones and intermediate doses to the normal tissue (NT) limb corridor. Within this study, novel lower extremity NT outlining guidelines and atlas were developed based on the hypothesis that using these for RT planning may reduce RT toxicity. Usability and applicability of the guidance were also investigated.</div></div><div><h3>Methods</h3><div>Guidelines for NT outlining were developed. Two STSE cases were selected and a set of reference volumes was outlined on each case by one Therapeutic Radiographer/Radiation Therapist (RTT) and peer-reviewed by a consultant radiation oncologist (RO). NTs were then outlined following the guidelines by 11 (8 RTT and 3 RO) and 12 (9 RTT and 3 RO) additional observers, respectively for cases 1 and 2. Dice coefficient (DICE), Maximum Hausdorff distance (maxHD) and mean surface distance (MSD) were calculated for individual NT volumes against the reference volumes. The Kruskal-Wallis test was performed. Analysis of interobserver variability was then used to inform guidance improvement.</div></div><div><h3>Results</h3><div>Good agreement and reproducibility were observed in DICE, MSD and maxHD for the anterior, posterior, adductor and gluteal muscle compartments, femur and femoral head and neck, knee and hip joints. Moderate agreement was observed for the lateral rotator and iliopsoas muscle compartments, and the femoral and inguinofemoral neurovascular bundle. Poor agreement was observed for the deep thigh neurovascular bundle.</div></div><div><h3>Conclusion</h3><div>Our results identify that the new NT outlining guidance for STSE is reproducible between observers and within a multi-professional environment, with consistent RTT and RO scores. This reproducibility is attributed to the use of guidelines. This study has also identified areas for refinement of the guidelines, particularly for the deep thigh neurovascular bundle.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101020"},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision regret after reirradiation of the primary site in patients with prostate cancer","authors":"Alexander Fabian ,&nbsp;Bilgesu Sahin Öztürk ,&nbsp;Lars Haack ,&nbsp;Severin Rodler ,&nbsp;Christof van der Horst ,&nbsp;Christian Schulz ,&nbsp;Claudia Schmalz ,&nbsp;Stefan Huttenlocher ,&nbsp;Olaf Wittenstein ,&nbsp;Oliver Blanck ,&nbsp;Frank-André Siebert ,&nbsp;David Krug","doi":"10.1016/j.ctro.2025.101019","DOIUrl":"10.1016/j.ctro.2025.101019","url":null,"abstract":"<div><h3>Purpose</h3><div>A subset of prostate cancer patients develops local relapse at the primary site after radiotherapy. The optimal local salvage strategy is unknown. Therefore, we aimed to explore prevalence and determinants of decision regret among patients after reirradiation of the primary site.</div></div><div><h3>Materials and methods</h3><div>We surveyed 31 patients in a cross-sectional bi-centre exploratory study. Reirradiation was high dose-rate brachytherapy (HDR-BT) in 21 and stereotactic body radiotherapy (SBRT) in 10 patients. Decision regret (DR) was measured using the Decision Regret Scale (DRS) (range: 0–100; higher values higher regret). Further patient-reported outcomes (PRO) included the EPIC-26, EORTC QLQ-C30, PRO-CTCAE, and PSCC questionnaires. Univariable associations of decision regret and potential determinants were assessed by one-way ANOVA or Pearson’s correlation.</div></div><div><h3>Results</h3><div>Median age at reirradiation was 75 years. Median time intervals from initial radiotherapy to reirradiation was 8 years and 4 years from reirradiation to survey. The mean DRS score was 10 (SD: 14). No (0 points), mild (1–25 points), or strong regret (&gt;25 points) was reported by 45 % (14/31), 48 % (15/31), and 7 % (2/31) of the patients, respectively. DR was significantly associated with PRO of urinary symptom burden and toxicity as well as levels of shared-decision making and patient satisfaction. HDR-BT vs. SBRT, further local relapse, and progression-free survival were not associated with DR.</div></div><div><h3>Conclusions</h3><div>DR was mild among prostate cancer patients after reirradiation to the primary site. PRO on symptom burden and shared decision making may be associated with DR. These findings should be validated and may inform treatment decisions on local salvage therapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101019"},"PeriodicalIF":2.7,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CD8-positive lymphocyte infiltration as a marker of anti-tumor immune response in rectal cancer: pre- and post-neoadjuvant radiotherapy comparison","authors":"Samaneh Salarvand ,&nbsp;Romina Abyaneh ,&nbsp;Abdorreza Raee ,&nbsp;Mahdieh Yaghooti-Khorasani ,&nbsp;Fariba Mohammadjani ,&nbsp;Fatemeh Nili ,&nbsp;Mahdi Aghili ,&nbsp;Reza Ghalehtaki","doi":"10.1016/j.ctro.2025.101018","DOIUrl":"10.1016/j.ctro.2025.101018","url":null,"abstract":"<div><h3>Background</h3><div>Antitumor immunity, exerted by CD8+ cytotoxic T lymphocytes, plays a vital role in tumor control. Therefore, the present study was conducted to compare the amount of CD8+ tumor-infiltrating lymphocytes (TILs) before and after either long- (LCRT) or short-course radiotherapy (SCRT) in rectal cancer.</div></div><div><h3>Methods</h3><div>This study retrospectively assessed rectal cancer patients treated by neoadjuvant radiotherapy between 2019 and 2021. Biopsy and surgical samples were subjected to immunohistochemical staining to count CD8+ TILs. The association between the post-to-pre-treatment CD8+ count ratio and treatment groups, histopathological factors, and response to treatment was assessed.</div></div><div><h3>Results</h3><div>A total of 34 patients were included, with 23 (67.6 %) receiving LCRT and 11 (32.4 %) receiving SCRT. The mean age was 58.56 ± 13.59 years. The number and percentage of CD8+ TILs increased significantly after radiotherapy in all patients (P &lt; 0.001). An increase in CD8+ TILs was observed in both groups, with LCRT showing a median post-to-pre-treatment count ratio of 2.77 and SCRT showing 3.1 (P = 0.127). A generalized linear multivariate model adjusting for mucinous histology, surgical grade, and pathological stages revealed that SCRT was associated with a significantly higher post-to-pre-treatment CD8+ count ratio compared to LCRT (P = 0.03).</div></div><div><h3>Conclusion</h3><div>Our study highlights that both SCRT and LCRT significantly increase CD8+ TIL count and percentage, reflecting robust immune activation after radiotherapy in rectal cancer, with SCRT showing a higher relative increase, though not statistically significant in unadjusted analyses. After adjusting for histopathological variables, SCRT was independently associated with a greater increase in CD8+ T cells.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101018"},"PeriodicalIF":2.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing patient comfort in palliative radiotherapy with a newly developed mattress: a nonrandomized clinical trial","authors":"Nienke Hoffmans-Holtzer,&nbsp;Britt Kunnen,&nbsp;Olijn Tims,&nbsp;Ilse de Pree,&nbsp;Cleo Slagter,&nbsp;Manouk Olofsen-van Acht,&nbsp;Mischa Hoogeman,&nbsp;Steven Petit","doi":"10.1016/j.ctro.2025.101017","DOIUrl":"10.1016/j.ctro.2025.101017","url":null,"abstract":"<div><h3>Background</h3><div>In palliative radiotherapy, many patients experience discomfort and pain during treatment, particularly while lying on flat, hard treatment couches that are considered essential for accurate treatment delivery. Thin foam matts, often used for palliative treatments, can somewhat reduce discomfort, but they are frequently insufficient.</div></div><div><h3>Aim</h3><div>In this study a mattress was developed and investigated, with the aim to reduce pain during radiotherapy treatments without affecting treatment quality.</div></div><div><h3>Methods</h3><div>A nonrandomized clinical trial compared the newly designed RTComfort mattress with a standard thin foam matt. The primary endpoint was mattress preference, while secondary endpoints included experienced pain, positioning stability, and dosimetric effects. Included patients tested both the mat and mattress for one minute each in the treatment position before planning-CT acquisition, scoring their preference and pain on a Numerical Rating Scale (NRS, 0–10). Subsequently, patients were scanned and treated on their preferred option. Positioning stability during treatment was evaluated using optical surface scanning and dosimetric effects were evaluated through dose calculations with the treatment planning system.</div></div><div><h3>Results</h3><div>Out of 45 patients, 44 (98 %) preferred the RTComfort mattress, with 35 patients showing a strong preference (p &lt; 0.0001). The median pain score on the RTComfort mattress decreased from 4.8 (IQR: 2.0–6.1) to 2.0 (IQR: 0.4 to 4.0 NRS) (p &lt; 0.0001). Both options showed negligible patient sagging, with marginally less on the RTComfort mattress (p &lt; 0.0001). No relevant dosimetric effects were observed.</div></div><div><h3>Conclusions</h3><div>This prospective clinical trial highlights the need for more comfortable radiotherapy treatments. Compared to the standard thin foam matt, 98% of patients preferred the RTComfort mattress. The RTComfort mattress provided clinically significant reduction in pain associated with lying on flat, hard treatment couches. The mattress is safe for clinical use and shows potential beyond palliative radiotherapy settings.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101017"},"PeriodicalIF":2.7,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144665472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate 2-Stage breast reconstruction outcomes after proton or photon postmastectomy radiotherapy","authors":"Robert W. Gao ,&nbsp;William S. Harmsen ,&nbsp;Na L. Smith ,&nbsp;Trey C. Mullikin ,&nbsp;Adam C. Amundson ,&nbsp;Feven Abraha ,&nbsp;Kimberly G. Gergelis ,&nbsp;Arslan Afzal ,&nbsp;Christin A. Harless ,&nbsp;Aparna Vijayasekaran ,&nbsp;Minh-Doan T. Nguyen ,&nbsp;Judy C. Boughey ,&nbsp;Nicholas B. Remmes ,&nbsp;Hok S. Wan Chan Tseung ,&nbsp;May Elbanna ,&nbsp;Allison E. Garda ,&nbsp;Mark R. Waddle ,&nbsp;Safia K. Ahmed ,&nbsp;Sean S. Park ,&nbsp;Kimberly S. Corbin ,&nbsp;Dean A. Shumway","doi":"10.1016/j.ctro.2025.101015","DOIUrl":"10.1016/j.ctro.2025.101015","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of postmastectomy radiotherapy (PMRT) on immediate breast reconstruction (IBR) outcomes among patients treated with proton or photon radiotherapy.</div></div><div><h3>Material and Methods</h3><div>Patients who had undergone mastectomy, immediate breast reconstruction, and PMRT at our institution were included in a retrospective analysis of risk factors for surgical site infection (SSI), unplanned reoperation, and reconstruction failure. Univariate Cox models were used to examine associations of variables with reconstruction outcomes.</div></div><div><h3>Results</h3><div>Two-hundred thirty-one women were included, of whom 224 (97.0 %) underwent two-stage IBR with placement of a tissue expander and 7 (3 %) had direct-to-implant IBR. One-hundred sixty-five patients (71.4 %) received proton and 65 (28.6 %) received photon therapy. Twenty-nine patients (12.6 %) received hypofractionation. Median follow-up was 1.8 years. Two-year cumulative risk of SSI was 17.83 % (95 % CI 12.27–24.41 %); unplanned reoperation was 16.19 % (95 % CI 10.06–22.10 %); and reconstruction failure was 7.60 % (95 % CI 3.55–12.11). On multivariable analysis, prophylactic use of Mepitel Film reduced the risk of SSI [HR: 0.35 (95 % CI: 0.18–0.69), <em>p</em> = 0.002] and unplanned reoperation [HR: 0.39 (95 % CI: 0.20–0.79), <em>p</em> = 0.008]. The small number of events (n = 16) precluded multivariable analysis of reconstruction failure; on univariate analysis, receipt of a chest wall boost [HR: 4.98 (95 % CI: 1.12–22.10), <em>p</em> = 0.035] and/or lymph node boost [HR: 3.66 (95 % CI: 1.25–10.73), <em>p</em> = 0.018] were associated with reconstruction failure.</div></div><div><h3>Conclusions</h3><div>Although approximately one-fifth of women experienced SSI or unplanned reoperation, the rate of reconstruction failure was low (7.6%) and most women achieved a successful reconstruction outcome with PMRT using photons or protons. The lower rate of SSI and unplanned reoperation with use of Mepitel Film highlights the need for further evaluation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101015"},"PeriodicalIF":2.7,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiotherapy boost to the primary tumour in locally advanced rectal cancer: Systematic review of practices and meta-analysis","authors":"Julien Pierrard ,&nbsp;Lorraine Donnay ,&nbsp;Alix Collard ,&nbsp;Geneviève Van Ooteghem","doi":"10.1016/j.ctro.2025.101014","DOIUrl":"10.1016/j.ctro.2025.101014","url":null,"abstract":"<div><h3>Introduction</h3><div>In locally advanced rectal cancer (LARC), increasing the complete response (CR) rate after total neo-adjuvant treatment may increase the patient eligibility for non-operative management (“watch and wait”, W&amp;W). Although a radiotherapy (RT) boost to the primary tumour may enhance CR rates, clear guidelines are currently lacking. This systematic review and <em>meta</em>-analysis investigate the technical parameters used for rectal boost RT and assess their impact on oncological outcomes.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, the terms “rectum,” “radiotherapy,” and “boost” were searched in PubMed and EMBASE (PROSPERO: CRD42023444685). Studies reporting on external beam RT boost to the primary tumour in LARC and meeting quality criteria were included. Descriptive analyses extracted data on RT technique, preparation, boost delineation, dose, chemotherapy, and follow-up. A mixed-effects <em>meta</em>-analysis model evaluated the impact of selected parameters on CR and local recurrence rate (LRR). Studies were analysed separately based on treatment intent: planned surgery or W&amp;W.</div></div><div><h3>Results</h3><div>Out of 3904 references, 83 were included in the descriptive analysis and 78 in the <em>meta</em>-analysis. Substantial variability in RT parameters was observed across studies. Pathologic CR rates were significantly higher with intensity-modulated/volumetric-modulated arc RT (IMRT/VMAT, p = 0.007), simultaneous boost (p = 0.020), dose escalation (Biological equivalent dose &gt; 74 Gy, p = 0.035), and the combination of induction and consolidation chemotherapy (p = 0.023). No significant associations were found for clinical CR or LRR.</div></div><div><h3>Conclusion</h3><div>While rectal RT boost is already part of real-world practices, the wide heterogeneity in techniques highlights the urgent need for standardisation. Our <em>meta</em>-analysis suggests that IMRT/VMAT, simultaneous boost, and dose escalation are associated with higher pathological CR rates and should be considered in future rectal boost guidelines. These findings, however, warrant careful interpretation due to the absence of adjustments for clinical, tumoral, or patient-related parameters that may also influence response rate and oncological outcomes.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101014"},"PeriodicalIF":2.7,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}