Clinical and Translational Radiation Oncology最新文献

{"title":"Combining CAR-T therapy with radiotherapy or not in refractory/relapsed diffuse large B-cell lymphoma: A comparative study","authors":"Yun Yang ,&nbsp;Bichun Xu ,&nbsp;Hong Zhu ,&nbsp;Weikai Sun ,&nbsp;Aibin Liang ,&nbsp;Judong Luo","doi":"10.1016/j.ctro.2025.101041","DOIUrl":"10.1016/j.ctro.2025.101041","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy and Chimeric Antigen Receptor(CAR)-T therapy may exhibit a synergistic effect, suggesting that incorporating radiotherapy into CAR-T could improve the prognosis for patients with refractory/relapsed diffuse large B-cell lymphoma (R/R DCBCL). A lack of standardized treatment protocols and relevant guidelines in bridging radiotherapy(BRT) prior to CAR-T therapy still exists. Consequently, we retrospectively analyzed the outcomes of R/R DLBCL patients treated with BRT prior to CAR-T therapy or not, aiming to evaluate the efficacy and satety of BRT as well as the impact of radiotherapy dose on prognosis.</div></div><div><h3>Methods</h3><div>Between December 2017 and January 2025, 80 patients diagnosed with R/R DLBCL were treated with CAR-T. Thirty-five of them received BRT during leukapheresis and lymphodepletion. The primary endpoint of this study was progression free survival(PFS), and secondary endpoints included overall survival(OS), disease-specific survival(DSS), in-field PFS, best objective response rate(ORR), and complete response rate(CRR). PFS and OS of CAR-T were compared between BRT group and no BRT group. In the subgroup of radiotherapy patients, PFS, OS and in-field PFS were compared between the low-Equivalent dose to 2 Gy per fraction(EQD₂) subgroup and the high-EQD₂ subgroup.</div></div><div><h3>Results</h3><div>BRT group showed obviously longer PFS and OS than no BRT group(p = 0.001, p = 0.043). In addition, BRT did not increase the incidence of CAR-T toxicities during follow-up (median:35.27 months). Comprehensive BRT subgroup improved prognosis in PFS(p = 0.015) and OS(p = 0.029) when compared with focal BRT subgroup, no significant effect on DSS was noted(p = 0.109). High-EQD2 subgroup did not significantly improve PFS(p = 0.181) and OS(p = 0.665) except for local control(p = 0.079) especially in patients with high tumor burden(p = 0.005). There is no impact on prognosis between early salvage radiotherapy(SRT) and salvage chemotherapy(SCT) cohorts in patients with PR response to CAR-T therapy.</div></div><div><h3>Conclusions</h3><div>Our analysis demonstrated that BRT is a effective and safe approach for patients with R/R DLBCL preparing for CAR T-cell therapy, which indicated that BRT may enhance the anti-tumor effect of CAR T-cells.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"55 ","pages":"Article 101041"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004047","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":"Overexpression of JAML in colorectal cancer cells predicts higher radiosensitivity by inactivating ATR pathway","authors":"Mingyan Zhang ,&nbsp;Wenhui Shi ,&nbsp;Yanan Liu ,&nbsp;Yufeng Wang ,&nbsp;Yinying Dong ,&nbsp;Chunsheng Yang ,&nbsp;Yawen Zheng ,&nbsp;Ning Liu ,&nbsp;Yan Zheng ,&nbsp;Meili Sun","doi":"10.1016/j.ctro.2025.101016","DOIUrl":"10.1016/j.ctro.2025.101016","url":null,"abstract":"<div><h3>Background</h3><div>Junctional adhesion molecule–like protein (JAML) is highly expressed in cancer tissues of patients with colorectal cancer (CRC) and promotes cancer proliferation. However, the relationship between JAML expression and radiosensitivity of CRC remains unclear.</div></div><div><h3>Methods</h3><div>Stable CRC cell lines with knocked down or overexpressed JAML were used to evaluate the effects of irradiation on cell viability and cell proliferation using Cell Counting Kit-8 (CCK8) and cell clone formation assay, respectively. Cellular immunofluorescence, flow cytometry, and western blotting were used to determine the mechanism. Tumor-bearing nude mouse models were established to verify the relationships between the expression of JAML and the radiosensitivity of CRC.</div></div><div><h3>Results</h3><div>The results of CCK8 and cell clone formation assay showed that the viability and proliferation of CRC cells with JAML overexpression were significantly inhibited after exposure to irradiation compared with those of CRC cells with low expression of JAML. DNA damage and cell apoptosis were significantly increased in the JAML-overexpression group compared with the JAML-low-expression group after exposure to irradiation. The phosphorylation of the ataxia telangiectasia and Rad3-related protein (ATR)-checkpoint kinase 1 (CHK1)-mediated DNA damage repair pathway was inhibited in the JAML-overexpression group compared with the JAML-low-expression CRC cells after irradiation. Similar results were observed in CRC xenografts <em>in vivo</em>.</div></div><div><h3>Conclusions</h3><div>CRC cells with JAML overexpression are more sensitive to radiotherapy of X-rays because of the decreased phosphorylation of the ATR-CHK1-mediated DNA damage repair pathway. The expression of JAML in CRC cells could be used as a predictive biomarker of radiosensitivity in patients with CRC.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101016"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631330","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":"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":"Wang-Jian Li ,&nbsp;Li-Ting Ling ,&nbsp;Yue Yao ,&nbsp;Kai-Qing Tan ,&nbsp;Bo-Lin Zhu ,&nbsp;Li-Qing Zhou ,&nbsp;Song Qu ,&nbsp;Ling Li ,&nbsp;Ying Guan ,&nbsp;Ling-Hui Pan ,&nbsp;Xiao-Dong Zhu ,&nbsp;Zhong-Guo Liang","doi":"10.1016/j.ctro.2025.101006","DOIUrl":"10.1016/j.ctro.2025.101006","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate 10-year survival outcomes of intensity-modulated radiotherapy (IMRT)-era locoregionally advanced nasopharyngeal carcinoma (NPC) treated with concurrent chemoradiotherapy (CCRT) ± adjuvant chemotherapy (AC), and assess the impact of AC on survival in high-risk and low-risk patients.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 477 non-metastatic NPC patients (2009–2012) treated with CCRT + AC (n = 315) or CCRT alone (n = 162). Risk stratification into high-/low-risk subgroups utilized a published prognostic model. Kaplan-Meier estimates compared 10-year overall survival (OS), locoregional failure-free survival (LFFS), distant metastasis-free survival (DMFS), and failure-free survival (FFS).</div></div><div><h3>Results</h3><div>The 10-year OS, DMFS, LFFS, and FFS rates for the entire cohort were 71.7 %, 81.4 %, 87.9 %, and 68.1 %, respectively. Compared to CCRT alone, CCRT + AC demonstrated no significant improvement in OS (70.9 % vs. 73.4 %; HR = 1.036, 95 % CI: 0.717–1.497, P = 0.849), LFFS (87.5 % vs. 88.7 %; HR = 1.176, 95 % CI: 0.642–2.154, P = 0.598), DMFS (79.4 % vs. 85.3 %; HR = 1.356, 95 % CI: 0.839–2.191, P = 0.211), or FFS (66.4 % vs. 71.5 %; HR = 1.133, 95 % CI: 0.803–1.599, P = 0.477). In high-risk patients, AC failed to enhance OS (62.7 % vs. 57.5 %; HR = 0.755, 95 % CI: 0.511–1.115, P = 0.156) or other survival endpoints. Notably, AC was associated with reduced OS (84.8 % vs. 94.1 %; HR = 3.319, 95 % CI: 0.966–11.401, P = 0.043) and FFS (77.8 % vs. 92.0 %; HR = 2.596, 95 % CI: 1.064–6.332, P = 0.029) in low-risk patients, while showing no benefit in LFFS or DMFS.</div></div><div><h3>Conclusion</h3><div>The addition of AC to CCRT did not improve 10-year survival outcomes in locoregionally advanced NPC. Moreover, AC may adversely impact survival in low-risk patients, highlighting the need for risk-adapted therapeutic strategies.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101006"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510939","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":"Optimizing predictive accuracy of the two-component repair model for pediatric TBI: Pediatric-specific parameters, toxicity endpoint harmonization, and dose-rate safeguards","authors":"Ruijie Meng","doi":"10.1016/j.ctro.2025.101004","DOIUrl":"10.1016/j.ctro.2025.101004","url":null,"abstract":"<div><div>In response to the innovative two-component repair model for pediatric TBI renal toxicity prediction, this letter proposes three key refinements to enhance clinical translation: adopting pediatric-specific radiobiological parameters (e.g., DNA-PKcs dynamics, α/β ratios) to address systematic overestimation of radiation tolerance; harmonizing toxicity endpoints to CTCAE v5.0 ≥Grade 3 criteria to strengthen doseresponse associations and enable precise risk stratification; and implementing institution-specific minimum dose-rate thresholds to mitigate unmodeled vascular susceptibility during low-dose-rate TBI. Collectively, these optimizations will improve predictive accuracy and support personalized radiotherapy for high-risk pediatric cohorts.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101004"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144501201","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":"Palliative expeditiously adaptive quad shot radiotherapy for head and neck cancers (PEAQ-RT)","authors":"Weiren Liu ,&nbsp;Joshua P. Schiff ,&nbsp;Comron Hassanzadeh ,&nbsp;Karen Miller ,&nbsp;Casey Hatscher ,&nbsp;Robbie Beckert ,&nbsp;Alex Price ,&nbsp;Mackenzie Daly ,&nbsp;Randall Brenneman ,&nbsp;Lauren Henke ,&nbsp;Anthony Apicelli ,&nbsp;Michael Moravan ,&nbsp;Wade Thorstad ,&nbsp;Eric Laugeman","doi":"10.1016/j.ctro.2025.101012","DOIUrl":"10.1016/j.ctro.2025.101012","url":null,"abstract":"<div><h3>Purpose/objective</h3><div>Quad shot radiotherapy (QS-RT) is integral to head and neck cancer palliative care, but multiple CT-simulations for QS-RT cycles can be burdensome for patients. We evaluated the ability of an online adaptive radiotherapy (ART) workflow (PEAQ-RT) to eliminate extra CT simulations in QS-RT and reduce treatment related burdens.</div></div><div><h3>Materials/methods</h3><div>Ten patients with head and neck malignancies were enrolled in this prospective study receiving QS-RT for up to three cycles, each comprising four fractions of 350 cGy delivered twice daily, with a total dose of 1400 cGy per cycle. QS-RT could be delivered up to three cycles, spaced three to four weeks apart. Patients underwent standard CT simulation, and the simulation plan served as the treatment plan for the first QS-RT cycle. For subsequent QS-RT cycles, patients proceeded directly to adaptive treatment via institutional online ART protocol. Feasibility was defined as completing this expedited adaptive QS-RT workflow in at least 80 % of attempted adapted fractions.</div></div><div><h3>Results</h3><div>Ten patients aged 56–89 were enrolled. Eight patients received a second cycle of QS-RT and four patients received a third cycle. PEAQ-RT workflow was feasible in 87.5% (7/8) of patients who received at least one adapted cycle and was feasible in 86% (12/14) of attempted adapted fractions. For the second and third cycles, average total workflow time for the adaptive treatments was 28 min (14–38). All constraint violations were resolved with the use of online adaptation. The PEAQ-RT workflow eliminated a median of 2 (range: 0–2) simulation visits with additional QS-RT cycles. This resulted in a median travel distance savings of 50.8 miles (range: 40.6–848 miles) and a median reduction of 3.5 h in travel time per patient.</div></div><div><h3>Conclusion</h3><div>PEAQ-RT enabled QS-RT while eliminating the need for additional CT simulation appointments for subsequent cycles.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101012"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654358","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":"2025-09-01","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":"Reirradiation with stereotactic radiosurgery for vestibular schwannomas – a systematic review and meta-analysis","authors":"Noel-Adrian Hollosi ,&nbsp;Julie Luise Reimers ,&nbsp;Antonio Santacroce ,&nbsp;Christoph Fürweger ,&nbsp;Markus Kufeld ,&nbsp;Anna M.E. Bruynzeel ,&nbsp;Joost J.C. Verhoeff ,&nbsp;Alexander Muacevic ,&nbsp;Helen A. Shih ,&nbsp;Felix Ehret","doi":"10.1016/j.ctro.2025.100989","DOIUrl":"10.1016/j.ctro.2025.100989","url":null,"abstract":"<div><h3>Introduction</h3><div>Stereotactic radiosurgery (SRS) is a widely used treatment modality for vestibular schwannomas due to its non-invasive nature and high tumor control rates. However, some patients experience tumor progression after treatment. In this setting, reirradiation with SRS represents a potential treatment option. This systematic review and meta-analysis evaluates the evidence for reirradiation of vestibular schwannomas with SRS.</div></div><div><h3>Methods</h3><div>This systematic literature review and meta-analysis investigates the efficacy and safety of reirradiation with SRS for vestibular schwannoma and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).</div></div><div><h3>Results</h3><div>A total of 806 studies were screened and 35 included, comprising 394 reirradiated patients. The median time from first treatment to reirradiation was 45 months (range: 12 – 65 months). Reirradiation with SRS, applying a median marginal/prescription dose of 12 Gy, achieved an estimated local control of 95% (95% confidence interval (CI): 92 – 97%, I² = 29.62%, p = 0.10). Trigeminal and facial nerve deterioration rates after repeat SRS were 7% (95% CI: 4 – 10%, I² = 0.0%, p = 0.44) and 6% (95% CI: 3 – 8%, I² = 0.0%, p = 0.53), respectively. Serviceable hearing after reirradiation with SRS was rare (5%, 95% CI: 2 – 8%, I² = 0.0%, p = 0.46). Among patients with serviceable hearing before reirradiation, 43% maintained it after treatment (95% CI: 29 – 57%, I² = 65.71%, p = 0.00). The risk of bias across all studies was high.</div></div><div><h3>Conclusion</h3><div>Reirradiation with SRS appears to be a safe and effective salvage treatment for progressive vestibular schwannomas. Prospective studies are warranted to define the optimal dose, timing, and dose constraints for reirradiation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 100989"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144704413","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":"Efficacy and safety of the pudendal nerve block as a component of multimodal analgesia for cervical brachytherapy","authors":"Matthew Charles Knox ,&nbsp;Niluja Thiruthaneeswaran ,&nbsp;George Zhong ,&nbsp;Alison Brand ,&nbsp;Unine Herbst ,&nbsp;Emily Flower ,&nbsp;Jennifer Chard ,&nbsp;Alison Salkeld","doi":"10.1016/j.ctro.2025.101001","DOIUrl":"10.1016/j.ctro.2025.101001","url":null,"abstract":"<div><h3>Introduction</h3><div>Whilst an essential component of curative management, cervical brachytherapy is associated with considerable pain and discomfort, with analgesic protocols varying between institutions. We present the first series on adjunctive pudendal nerve block (PNB) in addition to routine anaesthesia.</div></div><div><h3>Methods</h3><div>Retrospective review of patients receiving brachytherapy for cervical malignancies across two time periods, correlating to the institutional introduction of PNB. Technically, bilateral PNB was performed using 1 % ropivacaine under general anaesthesia and intravenous patient-controlled analgesia (PCA) was used post-operatively. Median pain scores (11-point numeric rating scale), acceptability of pain (&lt;20 % of recorded scores ≥ 4), opioid requirement and adverse events are reported. Intracavitary with or without interstitial brachytherapy was performed as per EMBRACE-2 protocol.</div></div><div><h3>Results</h3><div>78 patients receiving 149 brachytherapy episodes were included, of which 95 episodes (64%) utilised PNB. 48% of cases required interstitial needles in both cohorts, with no significant differences in demographics.</div><div>Median pain scores were lower in the PNB cohort (1 vs. 2.5; p = 0.003). PNB was associated with less episodes of unacceptable pain, as defined above (33 % vs. 63 %; p &lt; 0.001). This benefit was sustained on binomial logistic regression, including such factors as number of interstitial needles, baseline opioid use and applicator model choice.</div><div>PNB use was also associated with reduced opioid requirement via PCA (p &lt; 0.001) and there were no differences in the incidence of hypotension, respiratory depression or nausea between cohorts.</div></div><div><h3>Conclusions</h3><div>PNB is an effective and safe adjunct to general anaesthesia and intravenous PCA for cervical brachytherapy, with improved pain and reduced opioid requirements. We advocate for routine use of PNB in addition to multimodal analgesic regimens.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101001"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517635","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":"Acute toxicity and quality of life in dose-escalated proton reirradiation for locally recurrent rectal cancer: The prospective ReRad II trial","authors":"Truelsen C.G ,&nbsp;Rønde H.S ,&nbsp;Kallehauge J.F ,&nbsp;Szpejewska J.E ,&nbsp;Bahij R ,&nbsp;Diness L.V ,&nbsp;Skriver S.K ,&nbsp;Poulsen L.Ø ,&nbsp;Havelund B.M ,&nbsp;Pedersen B.G ,&nbsp;Iversen L.H ,&nbsp;Spindler K.G ,&nbsp;Kronborg C.S","doi":"10.1016/j.ctro.2025.100999","DOIUrl":"10.1016/j.ctro.2025.100999","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Locally recurrent rectal cancer (LRRC) in pre-irradiated patients remains a clinical challenge. Intensity-Modulated Proton Therapy (IMPT) enables dose escalation with potential for improved tumour control without compromising dose to organs at risk (OAR). However, prospective data on toxicity and patient-reported outcomes (PROs) with quality of life (QoL) are limited.</div></div><div><h3>Materials and Methods</h3><div>This planned interim analysis from the prospective phase II ReRad II trial (NCT04695782) reports acute toxicity and PROs in the first 25 patients treated with dose-escalated IMPT for LRRC. Patients received either 55 Gy (relative biological effectiveness (RBE)) in 44 fractions (neoadjuvant) or 57.5–65 Gy (RBE) in 46–52 fractions (definitive). Acute toxicity was graded using NCI-CTCAE. PROs were assessed using EORTC QLQ-C30 and −CR29 questionnaires at pretreatment, during treatment, and at 3-month follow-up. A linear mixed model evaluated longitudinal PRO trajectories.</div></div><div><h3>Results</h3><div>Among 25 patients, 49 gross tumour volumes resulted in 29 clinical target volumes (median: 84.2 cm³). Median D_mean to bladder, bowel bag, and bowel loops were 7.5, 1.8, and 11.5 Gy(RBE); corresponding D_0.03cc were 58.1, 59.9, and 59.3 Gy(RBE). Grade ≥3 acute toxicity (ileus) occurred in 2 patients with pre-existing ileus episodes. Urinary retention was associated with bladder D_0.03cc(Gy). PROs showed stable global health scores over time, with improvements in emotional and cognitive function.</div></div><div><h3>Conclusion</h3><div>Interim results support the feasibility of dose-escalated IMPT reirradiation for LRRC, with manageable acute toxicity and preserved QoL. Continuance of the trial will inform long-term outcomes and guide future treatment strategies for LRRC management.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 100999"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491078","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":"Changes in prostate volume during prostate SBRT delivered on an MR-Linac and correlation with acute toxicity","authors":"Jason Gurewitz ,&nbsp;Cheongeun Oh ,&nbsp;Sungmin Woo ,&nbsp;Jiyu Kim ,&nbsp;Adam Bruzzese ,&nbsp;Ting Chen ,&nbsp;Hesheng Wang ,&nbsp;David Byun ,&nbsp;Michael J. Zelefsky","doi":"10.1016/j.ctro.2025.101007","DOIUrl":"10.1016/j.ctro.2025.101007","url":null,"abstract":"<div><h3>Purpose</h3><div>We evaluated prostate volume changes during stereotactic body radiation therapy (SBRT) using serial MRI, identifying variables associated with prostatic swelling and their correlation with acute toxicity.</div></div><div><h3>Methods</h3><div>Fifty-two patients with localized prostate cancer, androgen deprivation therapy naive, underwent SBRT to 40 Gy in five fractions on an MRI-Linear Accelerator with dominant intraprostatic lesion boosts to 45 Gy when present. Whole prostate (WP) and transition zone (TZ) measurements were assessed on the pre-treatment T2 MRI obtained for daily adaptation. Volumes were calculated using the ellipsoid formula. Non-transition zone (nonTZ) measures = WP values − TZ values. Transition zone index (TZI) = TZ volume/WP volume. Acute toxicity and International Prostate Symptom Scores (IPSS) were recorded.</div></div><div><h3>Results</h3><div>Prostate volume increased significantly over the first four fractions, peaking at fraction 4 with mean percent and absolute changes of 21 % and 7.8 cc, respectively. Standardized TZ measures were strongly associated with WP volume (β per SD 10.60–12.78; all p &lt; 0.001), whereas the only nonTZ dimension weakly associated was anteroposterior (β per SD 1.78). Each standard deviation increase in baseline TZ parameters doubled to tripled the odds of significant swelling (≥10 cc) (all p ≤ 0.011). The interaction of baseline TZI with later fractions was significantly associated with swelling (fraction 4: β = 12.06, p = 0.020; fraction 5: β = 10.96, p = 0.036), but not baseline TZI alone. Neither Grade 2+ genitourinary toxicity nor IPSS changes were associated with prostate measures or TZI.</div></div><div><h3>Conclusions</h3><div>Prostate volume significantly increases during SBRT, primarily corresponding with TZ volumetric changes. Baseline TZ measurements most strongly predict high-volume swelling. Acute toxicity was not associated with volumetric change.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101007"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144517634","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}