Clinical and Translational Radiation Oncology最新文献

{"title":"Clinical and treatment-related predictors of complete response after total neoadjuvant therapy for rectal cancer in a large multicenter analysis","authors":"Georg W. Wurschi ,&nbsp;Melanie Schneider ,&nbsp;Jan-Niklas Becker ,&nbsp;Bernd Frerker ,&nbsp;Samuel M. Vorbach ,&nbsp;Felix Ehret ,&nbsp;Markus Diefenhardt ,&nbsp;Fabian Schunn ,&nbsp;Maria-Elena von Gruben ,&nbsp;Marcel Büttner ,&nbsp;Elgin Hoffmann ,&nbsp;Alexander Rühle ,&nbsp;Josephine Beier ,&nbsp;Simone Ferdinandus ,&nbsp;Maike Trommer ,&nbsp;Ezgi Ceren Sahin ,&nbsp;Julian Hlouschek ,&nbsp;Kynann Aninditha ,&nbsp;Daphne Schepers von Ohlen ,&nbsp;Justus Kaufmann ,&nbsp;Klaus Pietschmann","doi":"10.1016/j.ctro.2026.101120","DOIUrl":"10.1016/j.ctro.2026.101120","url":null,"abstract":"<div><h3>Introduction</h3><div>Complete response (CR) after total neoadjuvant therapy (TNT) in rectal cancer is linked to favorable local control and enables non-operative management (NOM). Achieving high CR rates is crucial. As no standard TNT protocol exists, we aimed to assess the impact of clinical factors and different protocols on CR rates.</div></div><div><h3>Methods</h3><div>Rectal cancer patients undergoing TNT with curative intent between 2015 and 2024 were included in this retrospective multicenter analysis (DRKS00033000). The primary endpoint was CR. Predefined clinical and therapeutic variables were treated as covariates and evaluated as potential predictors of CR in a multivariable logistic regression model.</div></div><div><h3>Results</h3><div>Among 245 included patients (181 men) with a median age of 62 (Q1-Q3: 54–67) years, 113 (46.1%) reached a CR. Of those, 69 (28.2%) were active smokers. Short-course radiotherapy (SCRT) was applied in 107 (43.7%) patients. Chemoradiotherapy with pyrimidine-based monotherapy or concomitant oxaliplatin was used in 65 (26.5%) and 73 (29.8%) of patients, respectively. A median of 8 (Q1-Q3: 6–9) cycles of consolidation chemotherapy was administered. The CR likelihood increased with each additional chemotherapy cycle (OR 1.19, 95%-CI: 1.04–1.38). SCRT was associated with lower CR rates (OR 0.34, 95%-CI: 0.16–0.74) compared with concomitant pyrimidine-based chemoradiotherapy. Adding concomitant oxaliplatin to 5-FU did not further increase CR rates (OR 1.06, 95%-CI: 0.50–2.27). CR was more likely in non-smokers (OR 1.92, 95%-CI: 1.03–3.57). ESMO tumor classification and treatment duration were not associated with CR.</div></div><div><h3>Conclusion</h3><div>More intensive TNT protocols were associated with higher CR rates. Smoking cessation may be beneficial but requires external validation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101120"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186099","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":"MR-guided stereotactic radiosurgery of an intracardiac tumoral thrombus using comprehensive motion management","authors":"Shaïma El Chammah ,&nbsp;Mickael Bendahman ,&nbsp;Sarah Ghandour ,&nbsp;Olivier Pisaturo ,&nbsp;Marc Pachoud ,&nbsp;Asteria Nikolopoulou ,&nbsp;Mahmut Ozsahin","doi":"10.1016/j.ctro.2026.101118","DOIUrl":"10.1016/j.ctro.2026.101118","url":null,"abstract":"<div><div>Lung cancer is often complicated by hypercoagulability, with intracardiac thrombi not an uncommon consequence. While radiotherapy can be a treatment option, effective intracardiac irradiation can be technically challenging. We present the case of a 54-year-old non-small-cell lung cancer (NSCLC) patient treated for a recurrent left atrial tumoral thrombus. The patient responded well after a first course of chemo-immuno radiotherapy. Follow up imaging showed a metabolic reactivation of the left atrial thrombus. The patient subsequently underwent an 18 Gy stereotactic radiosurgery using a 1.5 T Unity MR-Linac (Elekta AB, Sweden, Stockholm) using comprehensive motion management (CMM) to account for respiratory motion. Treatment was well tolerated. Complete metabolic response was observed 2 months after treatment. This case represents the first ever reported use of CMM on a 1.5 T MR-Linac to target an intracardiac lesion.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101118"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186089","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":"Timing, fractionation, and dose of thoracic radiotherapy in patients with extensive-stage small cell lung cancer undergoing first-line Chemo-Immunotherapy","authors":"Hao Zhou ,&nbsp;Huan Zhao ,&nbsp;Shuming Shi ,&nbsp;Tao Hu ,&nbsp;Li Li ,&nbsp;Shuai Wang ,&nbsp;Zhe Zhang ,&nbsp;Shuanghu Yuan","doi":"10.1016/j.ctro.2026.101114","DOIUrl":"10.1016/j.ctro.2026.101114","url":null,"abstract":"<div><h3>Objective</h3><div>This study investigates the optimal timing, fractionation, and dose of thoracic radiotherapy (RT) in extensive-stage small cell lung cancer (ES-SCLC) patients responsive to first-line Chemo-Immunotherapy (CIT), and evaluates efficacy and safety.</div></div><div><h3>Materials and methods</h3><div>In this multicenter retrospective analysis, 280 ES-SCLC patients receiving both CIT and TRT between January 2020 and July 2024 were included. Patients were stratified by TRT timing into Concurrent Chemo-Immuno-Radiotherapy (CCIRT, during CIT) or Sequential CIRT (SCIRT, after CIT) groups. We also evaluated the differences among various prescribed radiation doses and fractionation regimens. To avoid selection bias, we conducted Propensity Score Matching (PSM) for patients. Overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (TRAEs) were assessed and compared.</div></div><div><h3>Results</h3><div>The median PFS and OS in the study were 8.7 months and 20.6 months, respectively. The SCIRT group demonstrated superior PFS (p = 0.008) and OS (p = 0.048) compared with the CCIRT group, and additionally with a lower incidence of TRAEs. In the CCIRT group, a low time-corrected biological effective dose (tBED) (≤50 Gy) was associated with better OS (p = 0.028) and PFS (p = 0.014). Sex, KPS, tBED, brain metastasis status, and other indicators were independent influencing factors for TRAEs. Age, KPS, tBED, and distant metastasis status were independent prognostic factors.</div></div><div><h3>Conclusion</h3><div>Based on the efficacy and safety profile, sequential TRT after first-line chemoimmunotherapy is superior to concurrent administration. The exploratory conclusions regarding the optimal dose and fractionation regimen require confirmation through further research.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101114"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186091","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":"Late toxicity after peposertib-enhanced chemoradiation in rectal cancer patients managed with organ preservation","authors":"W. Zambare ,&nbsp;R. Ravella ,&nbsp;C. Li ,&nbsp;C.H. Crane ,&nbsp;J.J. Cuaron ,&nbsp;I.H. Wei ,&nbsp;A. Wu ,&nbsp;D. Rao ,&nbsp;G.M. Nash ,&nbsp;E. Pappou ,&nbsp;V.M. Williams ,&nbsp;M. Reyngold ,&nbsp;P.B. Paty ,&nbsp;M. Zinovoy ,&nbsp;D. Roth O’Brien ,&nbsp;L.B. Saltz ,&nbsp;A. Cercek ,&nbsp;M.R. Weiser ,&nbsp;J. Garcia-Aguilar ,&nbsp;R. Yaeger ,&nbsp;P.B. Romesser","doi":"10.1016/j.ctro.2026.101109","DOIUrl":"10.1016/j.ctro.2026.101109","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Combining peposertib, a DNA-PK inhibitor, with capecitabine-based chemoradiation may improve tumor response and organ preservation in rectal cancer. We assessed how adding peposertib to chemoradiation impacts organ preservation-specific outcomes and toxicities.</div></div><div><h3>Materials and methods</h3><div>In a recent phase Ib trial, rectal cancer patients underwent neoadjuvant capecitabine-based chemoradiation with peposertib. Patients were then restaged: those with clinical complete responses (cCRs) were offered “watch-and-wait” (WW), while those with non-cCRs (near complete and incomplete responses) were recommended surgery, although most opted for consolidation chemotherapy. Six patients were selected for this post-hoc analysis with primary endpoints of organ preservation rate, tumor response rates, and characterization of late grade 3 + toxicities.</div></div><div><h3>Results</h3><div>Tumor response rates showed 50 % of patients (3/6) achieved cCR and entered WW. Additionally, the frequency of late grade 3 + toxicity was 50 % (3/6). Late grade 3 + toxicity was exclusively observed in patients with cCR entering WW, and all toxicities were specific to the rectum (severe proctitis and bowel fistulization). In contrast, no late grade 3 + toxicities were seen when disease was managed by oncologic surgical resection. Finally, while overall three-year organ preservation rate was 60 % (3/5), patients with organ preservation also had increased rates of late grade 3 + rectal toxicities (66 %, 2/3).</div></div><div><h3>Conclusion</h3><div>Combining peposertib with capecitabine-based chemoradiation was associated with disproportionately high risks of severe late rectal toxicities, particularly in patients entering WW. Thus, careful assessment of the toxicity and response profiles of novel neoadjuvant regimens is critically important in future clinical trials focused on organ preservation and the nonoperative management of rectal cancer.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101109"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186088","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":"Dynamic immune changes after bone marrow sparing VMAT in women with locally advanced cervical cancer treated with chemoradiotherapy","authors":"Anouk Corbeau ,&nbsp;Marij J.P. Welters ,&nbsp;Sanne Boekestijn ,&nbsp;Jan Willem M. Mens ,&nbsp;Henrike Westerveld ,&nbsp;Mila Donker ,&nbsp;Laura A. Velema ,&nbsp;Hélène van Meir ,&nbsp;Mariëtte I.E. van Poelgeest ,&nbsp;Judith R. Kroep ,&nbsp;Ingrid A. Boere ,&nbsp;Sander C. Kuipers ,&nbsp;Jeremy Godart ,&nbsp;Mischa S. Hoogeman ,&nbsp;Hein Putter ,&nbsp;Carien L. Creutzberg ,&nbsp;Remi A. Nout ,&nbsp;Sjoerd H. van der Burg ,&nbsp;Stephanie M. de Boer","doi":"10.1016/j.ctro.2026.101107","DOIUrl":"10.1016/j.ctro.2026.101107","url":null,"abstract":"<div><h3>Background</h3><div>Chemoradiotherapy is immunosuppressive in women with locally advanced cervical cancer (LACC). Both advanced external-beam radiation therapy (EBRT) and bone marrow sparing (BMS) radiotherapy techniques might lower bone marrow dose and therefore reduce the impact on the immune system. In this study, immune composition and function changes in the blood of women with LACC were evaluated for BMS volumetric-modulated arc therapy (VMAT) and exploratively compared with a historical cohort of women with LACC who underwent non-BMS radiotherapy (RT) with older EBRT techniques.</div></div><div><h3>Methods</h3><div>Women were treated with chemoradiotherapy followed by brachytherapy according to EMBRACE-II protocol (BMS VMAT) or with 46–52.5 Gy in 23–30 fractions (non-BMS RT). Blood samples for immunomonitoring were collected at set timepoints. Statistical analyses were performed using linear mixed-effects models.</div></div><div><h3>Results</h3><div>Eighteen and eleven women received BMS VMAT and non-BMS RT, respectively. Although BMS VMAT reduced mean pelvic bone dose by 8.1 Gy, it did not prevent treatment-induced leukopenia and lymphopenia. Chemoradiotherapy mainly reduced CD4+ T helper cells and B cells, leaving CD8+ T-cell and natural killer-cell frequencies untouched. T-cell reactivity to common pathogens was decreased, despite sustained T-cell proliferative capacity, and coincided with increased numbers of regulatory T cells. The potential to activate immune cells remained intact, with small increases in dendritic cells, decreases in myeloid-derived suppressor cells, and preserved capacity of myeloid cells to present antigen and activate T cells.</div></div><div><h3>Conclusion</h3><div>Our study provided insight in the dynamic immune changes following chemoradiotherapy in LACC. As immunosuppression occurred with BMS VMAT, optimizing BMS and exploring other techniques is warranted.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101107"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076946","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":"Preoperative hypofractionated radiotherapy in soft tissue sarcomas: institutional experience and clinical implications","authors":"Laura Guzmán-Gómez ,&nbsp;Cristina Morón ,&nbsp;Javier Martín-Broto ,&nbsp;Nadia Hindi ,&nbsp;José Ángel Merino-García ,&nbsp;Celia Viejo Martínez ,&nbsp;César García Mauriño ,&nbsp;Felipe López Oliva ,&nbsp;Leticia del Campo ,&nbsp;Carolina M. Cantemir-González ,&nbsp;Ignacio Azinovic","doi":"10.1016/j.ctro.2026.101112","DOIUrl":"10.1016/j.ctro.2026.101112","url":null,"abstract":"<div><h3>Background</h3><div>Conventional preoperative radiotherapy (RT) with 50 Gy in 25 fractions improves local control in soft tissue sarcomas (STS) but entails prolonged treatment and high rates of wound complications. Hypofractionated regimens may offer a shorter, more patient-convenient alternative while maintaining comparable outcomes, although they are not yet standard.</div></div><div><h3>Materials and methods</h3><div>We conducted an observational study of a prospective cohort of 24 patients with localized STS of the extremities or superficial trunk treated with preoperative hypofractionated RT between December 2021 and January 2025. Two regimens were used: moderately hypofractionated RT (MHFRT, 42.75 Gy/15 fx) and ultra-hypofractionated RT (UHFRT, 30 Gy/5 fx). Outcomes included acute toxicity, wound complications, pathological response, local control, and postoperative limb function using the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) scales.</div></div><div><h3>Results</h3><div>The median age was 68 years, and median tumor size 11.6 cm. All patients completed RT without interruption. A favorable pathological response (≥90% necrosis and/or ≤ 10% viable tumor) was achieved in 66.7%. Grade 1–2 dermatitis occurred in 66.7%, with no grade ≥ 3 toxicity. Major wound complications developed in 29.2%. Median MSTS and TESS scores were 26/30 (86.7%) and 88%, respectively. At 18 months median follow-up, 1- and 2-year local control rates were 100%.</div></div><div><h3>Conclusions</h3><div>Preoperative hypofractionated RT demonstrated excellent tolerance, high pathological response, and outstanding local control with acceptable wound-complication rates. Functional outcomes were favorable, supporting hypofractionated RT as a safe, efficient, and function-preserving alternative for localized STS in experienced centers. These findings provide real-world evidence supporting shorter preoperative RT schedules as a feasible and function-preserving approach in multidisciplinary sarcoma care.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101112"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071140","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":"HYpofractionated, dose-redistributed RAdiotherapy (HYDRA) versus conventional radiotherapy for head and neck cancer: planned interim analysis and dosimetric comparison from the phase I HYDRA trial","authors":"Pascal A. Gunsch ,&nbsp;Michiel Kroesen ,&nbsp;Reno Debets ,&nbsp;Stijn Keereweer ,&nbsp;Esther van Meerten ,&nbsp;Jaap Zindler ,&nbsp;Erik van Werkhoven ,&nbsp;Mischa Hoogeman ,&nbsp;Gerda M. Verduijn ,&nbsp;Remi A. Nout ,&nbsp;Joris B.W. Elbers","doi":"10.1016/j.ctro.2026.101113","DOIUrl":"10.1016/j.ctro.2026.101113","url":null,"abstract":"<div><h3>Purpose</h3><div>(Chemo)radiotherapy for squamous cell carcinoma of the oropharynx, hypopharynx, and larynx results in significant treatment burden and may cause radiation-induced lymphopenia (RIL), which is associated with worse survival. We aim to reduce treatment burden and RIL using HYpofractionation and Dose-redistribution in patients treated with proton or photon RAdiotherapy (HYDRA, NCT05364411).</div></div><div><h3>Methods</h3><div>Patients receiving curative (chemo)radiotherapy for cT1-4 N0-3bM0 oropharyngeal and hypopharyngeal carcinomas are eligible. Referral for proton therapy is determined by model-based selection (MBS) according to Dutch protocols, resulting in a HYDRA-proton and HYDRA-photon cohort. HYDRA in 20 fractions constitutes 40 Gy to the elective volume, 55 Gy to gross tumour volume (GTV) + 5 mm and 59 Gy to GTV − 3 mm. Safety interim analyses are conducted in each cohort when ten patients complete 6 months follow-up. The interim results determine trial continuation and expansion to inclusion of laryngeal carcinomas according to predefined dose limiting toxicities (DLT). Per included HYDRA-patient, we perform an intra-patient plan comparison of the HYDRA plan versus the conventional treatment plan that was used for MBS.</div></div><div><h3>Results</h3><div>The HYDRA-photon interim analysis (reached in March 2024, <em>n</em> = 10) showed one DLT (osteoradionecrosis), with no other late grade ≥ 3 toxicity after a median follow-up of 10.6 months. Among all enrolled HYDRA-patients (photons: <em>n</em> = 14; protons: <em>n</em> = 5), intra-patient plan comparison showed that HYDRA delivered a focal boost of Dmean 59.6 Gy (range 59.0–60.1 Gy) to the GTV, while on average, organs at risk received a reduced dose (HYDRA-photons: 0.4–4.5 Gy EQD2; HYDRA-protons: 2.1–5.0 GyE EQD2).</div></div><div><h3>Conclusions</h3><div>The predefined interim analysis of HYDRA-photons showed one DLT. Per protocol, inclusion of laryngeal carcinomas in the photon cohort is now possible. The 20 fraction HYDRA schedule delivers a focal boost to the tumour with reduced dose to all organs at risk.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101113"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146178179","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":"Association between dose to specific pelvic substructures and urinary and sexual dysfunction following Single-Dose ablative radiotherapy for prostate Cancer: A post hoc analysis from the ABRUPT trial","authors":"Stefano Arcangeli ,&nbsp;Valeria Faccenda ,&nbsp;Federica Ferrario ,&nbsp;Chiara Chissotti ,&nbsp;Lorenzo De Sanctis ,&nbsp;Giulia Rossano ,&nbsp;Elena Arcieri ,&nbsp;Valerio Pisoni ,&nbsp;Riccardo Ray Colciago ,&nbsp;Elena De Ponti ,&nbsp;Denis Panizza","doi":"10.1016/j.ctro.2026.101127","DOIUrl":"10.1016/j.ctro.2026.101127","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the association between radiation dose to pelvic functional substructures and the incidence of urinary and sexual side-effects following single-dose ablative radiotherapy (SDRT) for localized prostate cancer.</div></div><div><h3>Methods and Materials</h3><div>A post hoc analysis was conducted on the 30 patients from the prospective ABRUPT trial (NCT04831983). Functional substructures, including the bladder trigone, urogenital diaphragm, neurovascular bundles (NVB), penile bulb (PB), internal pudendal arteries (IPA), and crura, were contoured by an experienced radiation oncologist. Maximum and mean doses were extracted from planning dose-volume histograms. Adverse events (AEs) were assessed using CTCAE and patient-reported outcomes (PRO). Logistic regression, Wilcoxon-Mann-Whitney, and ROC analyses were used to explore dose-toxicity associations and predictive thresholds, with cross-validation for robustness.</div></div><div><h3>Results</h3><div>Late urinary dysfunction correlated with bladder trigone D1cc ≥ 20.3 Gy (cross-validated AUC = 0.80; PPV = 64.3%; NPV = 75.0%), consistent across physician- and patient-reported endpoints. Larger bladder volumes (&gt;166.8 cc) were also associated with urinary PRO deterioration (p = 0.030). Among 22 patients (76% of 29) who recovered testosterone (median = 10 months post ADT completion), erectile dysfunction showed a suggestive association with NVB D0.035 cc ≥ 23.6 Gy (apparent AUC = 0.98), although based on a limited number of events. Trends toward higher IPA and crura doses were observed in patients with sexual dysfunction, while no relationship was observed for PB dose.</div></div><div><h3>Conclusions</h3><div>This exploratory analysis highlights the bladder trigone as potential predictor of urinary morbidity in SDRT. Incorporating substructure-sparing into treatment planning could improve functional preservation and reduce late toxicity, pending prospective validation in larger trials.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101127"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186092","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":"Effect of dose escalation in neoadjuvant chemoradiotherapy of locally advanced rectal cancer on clinical and pathologic Response: A Systematic review and meta-analysis of randomized controlled trials","authors":"Kasra Kolahdouzan ,&nbsp;Sepehr Nayebi Rad ,&nbsp;Reza Ghalehtaki ,&nbsp;Romina Abyaneh ,&nbsp;Forouzan Nourbakhsh ,&nbsp;Ehsan Saraee","doi":"10.1016/j.ctro.2026.101123","DOIUrl":"10.1016/j.ctro.2026.101123","url":null,"abstract":"<div><div>Management of locally advanced rectal cancer (LARC) increasingly highlights necessity of organ functionality preservation, with the achievement of a complete clinical or pathological response (CR) regarded as a fundamental treatment target. While established concurrent chemoradiation (CRT) is effective, it often results in only modest complete response rates, thus prompting exploration into the possible benefits of raising radiation dosages to boost clinical results. This <em>meta</em>-analysis of randomized controlled trials sought to elucidate whether dose-escalated neoadjuvant CRT augments tumor response and to evaluate its accompanying toxicity profile. By extracting data from 12 trials encompassing 1,803 patients, we discerned that the overall effect on a composite CR endpoint—incorporating both pathological and clinical complete responses—did not achieve statistical significance (RR 1.26, 95% CI: 0.95–1.68). Notably, the subgroup evaluation showed that in clinical trials with a uniform chemotherapy strategy for both control and experimental populations, raising the dosage led to an elevation in CR rates which was not statistically significant (RR 1.46, 95% CI: 1.00–2.12). Conversely, studies that altered concurrent chemotherapy did not show these benefits. Also, the assessment showed that raised radiation doses did not independently result in a marked rise in severe acute toxicity (RR 0.92, 95% CI: 0.53 – 1.59); instead, the gravity of toxicity appeared to be more directly associated with the chemotherapy methods used. These findings suggest that increasing radiation dose may modestly enhance tumor response in LARC. This technique corresponds with the progressing framework towards preserving organ function in rectal cancer.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101123"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186098","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":"Response to “comment on a submandibular gland-sparing radiotherapy study: a methodological and analytical perspective”","authors":"Prasoon Garg ,&nbsp;S. Shyama Prem ,&nbsp;Madhusudhanan Ponnusamy ,&nbsp;Muthuveerappan Sathappan ,&nbsp;K. Saravanan ,&nbsp;N. Sreekumaran Nair ,&nbsp;R. Anusuya","doi":"10.1016/j.ctro.2026.101119","DOIUrl":"10.1016/j.ctro.2026.101119","url":null,"abstract":"<div><div>We thank the authors for their interest and constructive comments on our study. This response clarifies methodological aspects and the scope of our work evaluating scintigraphic assessment of irradiated submandibular glands. The study was initiated during the COVID-19 pandemic, resulting in patient dropouts and limiting stratified analyses due to small subgroup sizes. Nevertheless, our cohort includes scintigraphy data from 27 spared and 53 unspared submandibular glands, representing a comparatively large dataset for long-term functional evaluation. Scintigraphy protocols were standardized to minimize technical variability, although unavoidable physiological and patient-related factors may have influenced measurements. The primary aim was to characterize scintigraphic parameters following irradiation; analyses of dose–response relationships, temporal modeling, and correlations with patient-reported xerostomia outcomes are ongoing. With a median follow-up of three years, no locoregional recurrences were observed near spared glands, supporting the oncological safety of submandibular gland sparing.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"58 ","pages":"Article 101119"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146186090","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}