Clinical and Translational Radiation Oncology最新文献

{"title":"Clinical implementation of RTT-only CBCT-guided online adaptive focal radiotherapy for bladder cancer","authors":"K. Goudschaal ,&nbsp;S. Azzarouali ,&nbsp;J. Visser ,&nbsp;M. Admiraal ,&nbsp;J. Wiersma ,&nbsp;N. van Wieringen ,&nbsp;A. de la Fuente ,&nbsp;M. Piet ,&nbsp;L. Daniels ,&nbsp;D. den Boer ,&nbsp;M. Hulshof ,&nbsp;A. Bel","doi":"10.1016/j.ctro.2024.100884","DOIUrl":"10.1016/j.ctro.2024.100884","url":null,"abstract":"<div><h3>Purpose</h3><div>The study assesses the clinical implementation of radiation therapist (RTT)-only Conebeam CT (CBCT)-guided online adaptive focal radiotherapy (oART) for bladder cancer, by describing the training program, analyzing the workflow and monitoring patient experience.</div></div><div><h3>Materials and methods</h3><div>Bladder cancer patients underwent treatment (20 sessions) on a ring-based linac (Ethos, Varian, a Siemens Healthineers Company, USA). Commencing April 2021, 14 patients were treated by RTTs supervised by the Radiation Oncologist (RO) and Medical Physics Expert (MPE) in a multidisciplinary workflow. From March 2022, 14 patients were treated solely by RTTs. RTT training included target delineation lessons and practicing oART in a simulation environment. We analyzed the efficiency of the RTT-only workflow regarding session time, adjustments by RTTs, attendance of the RO and MPE at the linac, and qualitative assessment of gross tumor volume (GTV) delineation. Patient experience was monitored through questionnaires.</div></div><div><h3>Results</h3><div>A training program resulted in a skilled team of RTTs, ROs and MPEs.</div><div>The RTT-only workflow demonstrated shorter session times compared to the multidisciplinary approach. Among 14 patients treated using the RTT-only workflow, RTTs adjusted 99% of bladder volumes and 44% of GTV. 79% of the sessions proceeded without MPEs and ROs. All GTV delineations were RO-approved, thus considered clinically acceptable, and 87% required minor or no adjustments. Patient satisfaction was reported in 18 of 21 cases.</div></div><div><h3>Conclusions</h3><div>The RTT-only oART workflow for bladder cancer, complemented by a training program and on-call support from ROs and MPEs, demonstrated success. Patient experience is positive. It is currently introduced as standard in our clinic.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100884"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142578563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current status of brachytherapy in Europe − A GEC-ESTRO Brachy-HERO survey","authors":"J.G. Johansen ,&nbsp;I.M. Jürgenliemk-Schulz ,&nbsp;H. Haddad ,&nbsp;J.M. Hannoun-Levi ,&nbsp;T.P. Hellebust ,&nbsp;B. Guix ,&nbsp;K. Loessl ,&nbsp;B. Pieters ,&nbsp;C. Rao ,&nbsp;V. Strnad ,&nbsp;A.E. Sturdza ,&nbsp;L. Tagliaferri ,&nbsp;Z. Takacsi-Nagy ,&nbsp;E. Villafranca ,&nbsp;P. Wojcieszek ,&nbsp;A. Rembielak ,&nbsp;P. Niehoff","doi":"10.1016/j.ctro.2024.100883","DOIUrl":"10.1016/j.ctro.2024.100883","url":null,"abstract":"<div><div>A survey regarding utilisation of brachytherapy was distributed to European brachytherapy professionals. Eighty replies from 26 countries were received, two of which were outside Europe. The replies showed that brachytherapy is still widely used. The main indications for brachytherapy are gynaecological and prostate cancer, with &gt;80 % of the responding countries performing brachytherapy for these indications. There is on average one brachytherapy centre per 0.8 million inhabitants, ranging from 0.4 per million to 2.3 per million inhabitants. The organisation of brachytherapy on national levels also varies from country to country, with less than half of the countries having a central brachytherapy registry. All in all, the survey shows that brachytherapy still plays a role on modern radiotherapy, but the field could benefit from a stronger collaboration both nationally and internationally.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100883"},"PeriodicalIF":2.7,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142652812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI guided online adaptive radiotherapy and the dosimetric impact of inter- and intrafractional motion in patients with cervical cancer","authors":"Shouliang Ding ,&nbsp;Zun Piao ,&nbsp;Meining Chen ,&nbsp;Fanghua Li ,&nbsp;Yongbao Li ,&nbsp;Biaoshui Liu ,&nbsp;Hongdong Liu ,&nbsp;Xiaoyan Huang ,&nbsp;Junyun Li","doi":"10.1016/j.ctro.2024.100881","DOIUrl":"10.1016/j.ctro.2024.100881","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to evaluate the inter- and intrafractional organs motions and dosimetric advantages of MRI guided online adaptive radiotherapy for cervical cancer.</div></div><div><h3>Methods</h3><div>A total of 150 fractions treated on the 1.5 T Unity MR-Linac were included in this study. Each fraction, pre-treatment, position validation and post-treatment MRI scans were obtained. Structures including CTV, rectum and bladder were delineated by the same radiation oncologists on each MRI. The inter- and intrafractional changes of contours were assessed by Hausdorff distance (HD), dice similarity coefficient (DSC), relative volume difference (ΔV) and the relative positions of the geometric center. The non-ART plans and online adaptive plans were obtained by recalculating or re-optimizing from reference plans on daily MRI, respectively. CTV coverage and OARs constraints were evaluated between ART and non-ART plans.</div></div><div><h3>Results</h3><div>For each fraction, the interfractional changes of HD, ΔV and DSC for CTV, bladder and rectum were significant. Our study also examined the relationship of bladder and rectum filling on CTV position. For 150 non-ART plans, CTV coverage constraints (D_98% ≥ 45 Gy) were not met by 45 %, while 15 % were not covered by more than 5 % of the prescribed dose. Compared to the non-ART plans, the ART plans had higher CTV coverage and lower dose to the bladder and rectum (P &lt; 0.05). During the treatment, the intrafractional changes of bladder, rectum and CTV may affect actual dose delivery. And we observed an intrafractional time trend in the motion of the CTV. There were 15 % fractions failing the CTV coverage constraints in post-MRI due to intrafractional motion. The adaptive plans optimized with 3 mm margin could cover CTV of post-MRI in 98 % fractions.</div></div><div><h3>Conclusions</h3><div>Considerable inter- and intrafractional CTV and OARs changes were observed in cervical cancer patients treated on MR-Linac. MRI guided online ART has significant dosimetric advantages in cervical cancer and is an ideal approach for achieving individualized and precise radiotherapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100881"},"PeriodicalIF":2.7,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142571611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to brachytherapy treatment for cervical cancer management in Africa","authors":"Emmanuel Fiagbedzi ,&nbsp;Vivian Della Atuwo-Ampoh ,&nbsp;Ishmael Nii Ofori ,&nbsp;Savanna Nyarko ,&nbsp;Asare Adomako ,&nbsp;Francis Hasford ,&nbsp;Jeffrey Gameli Amlalo ,&nbsp;Philip Narteh Gorleku","doi":"10.1016/j.ctro.2024.100880","DOIUrl":"10.1016/j.ctro.2024.100880","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Cervical cancer is an important public health issue with a high incidence and death rate in Africa. It is mostly treated with Brachytherapy as the gold standard but its access is limited. This study set out to investigate the distribution and accessibility of brachytherapy units in Africa for the treatment of cervical cancer, and to provide some recommendations for increasing the quantity and accessibility of such equipment throughout the continent.</div></div><div><h3>Materials and methods</h3><div>The International Atomic Energy Agency’s Division of Human Health’s Directory for radiotherapy Centers (DIRAC) was the principal source of data for this study. The number of brachytherapy equipment in the 54 African countries was obtained from the DIRAC database. The number of cervical cancer cases was obtained from the GLOBOCAN 2022 database, and country’s income was calculated using the Gross Domestic Product (GDP) per capita from the global economics database. All of these searches were conducted in February 2024.</div></div><div><h3>Results</h3><div>Africa exhibited a greater number of cervical cancer cases. A total of one hundred (100) brachytherapy units were present across 84 radiotherapy centres spanning 20 African countries. Egypt and South Africa each possess 23 units, which accounts for 46% of the overall quantity. With just two brachytherapy facilities, Nigeria had the most cervical cancer cases. A significant quantity of brachytherapy unit was situated in countries of northern Africa. The quantity of these units varied among countries, from those without any to those with many, and was not only influenced by GDP per capita.</div></div><div><h3>Conclusion</h3><div>Due to the rising incidence of cervical cancer in Africa, the number of brachytherapy equipment was woefully inadequate. Consequently, Africa requires partnerships and financial support to facilitate the quantity and accessibility of brachytherapy services. This will enable the provision of thorough and holistic care to patients and enhance their quality of life.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100880"},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary site stereotactic ablative body radiotherapy in localized, recurrent, and metastatic renal cell carcinoma","authors":"Daniel Huang ,&nbsp;Connor Lynch ,&nbsp;Lucas M. Serra ,&nbsp;Randy F. Sweis ,&nbsp;Paul J. Chang ,&nbsp;Walter M. Stadler ,&nbsp;Russell Z. Szmulewitz ,&nbsp;Peter H. O’Donnell ,&nbsp;Abhinav Sidana ,&nbsp;Scott E. Eggener ,&nbsp;Arieh L. Shalhav ,&nbsp;Stanley L. Liauw ,&nbsp;Sean P. Pitroda","doi":"10.1016/j.ctro.2024.100879","DOIUrl":"10.1016/j.ctro.2024.100879","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Stereotactic ablative body radiotherapy (SABR) is an effective treatment for localized renal cell carcinoma (RCC). However, the role of primary site SABR for locally recurrent or metastatic RCC is unclear. Here, we report outcomes of primary SABR across a diverse cohort of localized, recurrent, and metastatic RCC patients treated at our institution.</div></div><div><h3>Materials and methods</h3><div>RCC patients treated with SABR to lesions of the kidney or nephrectomy bed at our institution with at least 6 months of follow-up were included for analysis. Local control, overall survival, and freedom from distant failure were estimated using the Kaplan-Meier method. Estimated glomerular filtration rate (eGFR) was assessed at baseline and following SABR.</div></div><div><h3>Results</h3><div>Fifty-three patients received primary site SABR. Thirty-seven (70 %) patients had localized RCC, and 16 (30 %) had metastatic RCC. Seven (13 %) had locally recurrent RCC after prior surgery or ablation. The median tumor size was 4.5 cm (IQR 3.7–6.3). At a median follow-up of 23 months (IQR 12–35), 2-year local control was 100 %, and 3-year local control was 94.4 % (95 % CI 84.4 %–100 %). Among patients with initially localized disease, the 2-year freedom from distant failure was 94.6 % (95 % CI 87.6 %–100 %), and the 2-year overall survival was 66.5 % (95 % CI 51.9 %–85.2 %). Twelve (23 %) patients experienced acute grade 1–2 treatment-related toxicity (nausea, vomiting, or small bowel). There were no acute grade 3–4 toxicities. Two (3.8 %) patients developed late grade 3 gastrointestinal toxicity. The median baseline eGFR was 51 mL/min/1.73 m² (IQR 38–77). At 1-year post-SABR, the median eGFR decline was 5 mL/min/1.73 m² (IQR −3 to 9). One patient required dialysis following SABR.</div></div><div><h3>Conclusion</h3><div>This analysis demonstrates excellent local control rates across patients with localized, recurrent, and metastatic RCC treated with SABR. Treatment was associated with minimal eGFR decline.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100879"},"PeriodicalIF":2.7,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-mastectomy hypofractionated versus conventionally fractionated radiation therapy for patients receiving immediate breast reconstruction: Subgroup analysis of a phase III randomized trial","authors":"Xiaomeng Zhang ,&nbsp;Xiaofang Wang ,&nbsp;Yajuan Chu ,&nbsp;Li Zhang ,&nbsp;Jin Meng ,&nbsp;Wei Shi ,&nbsp;Xingxing Chen ,&nbsp;Zhaozhi Yang ,&nbsp;Xin Mei ,&nbsp;Xiaoli Yu ,&nbsp;Miao Mo ,&nbsp;Zhen Zhang ,&nbsp;Guangyu Liu ,&nbsp;Jiong Wu ,&nbsp;Zhimin Shao ,&nbsp;Xiaomao Guo ,&nbsp;Jinli Ma","doi":"10.1016/j.ctro.2024.100882","DOIUrl":"10.1016/j.ctro.2024.100882","url":null,"abstract":"","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100882"},"PeriodicalIF":2.7,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the gross tumor volume for hepatocellular carcinoma radiotherapy based on multi-phase contrast-enhanced magnetic resonance imaging","authors":"Kangning Meng ,&nbsp;Guanzhong Gong ,&nbsp;Rui Liu ,&nbsp;Shanshan Du ,&nbsp;Ruozheng Wang ,&nbsp;Yong Yin","doi":"10.1016/j.ctro.2024.100877","DOIUrl":"10.1016/j.ctro.2024.100877","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to quantitatively analyze of the differences in determining the gross tumor volume (GTV) for hepatocellular carcinoma (HCC) radiotherapy using multi-phase contrast-enhanced magnetic resonance imaging (CE-MRI) and provide a reference for determining the GTV for radiotherapy of HCC.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 99 HCC patients (145 lesions) who underwent MR simulation. T₁-weighted imaging (T₁WI), contrast-enhanced T₁WI (CE-T₁WI) at 15 s, 45 s, 75 s, 150 s, and 20 min after contrast agent injection were performed, comprising a total of six imaging sequences. The GTVs identified on different sequences were grouped and fused in various combinations. The internal GTV (IGTV), which was the reference structure, was obtained by the fusion of all six sequences. Mean signal intensity (SI), volume, shape, and fibrous capsule (FC) thickness among GTVs were compared.</div></div><div><h3>Results</h3><div>(1) The mean SI value of GTV_-T1WI, GTV_-15s-GTV_-20min in patients with transarterial chemoembolization (TACE) was lower by 14.09 % (GTV_-T1WI) to 31.31 % (GTV_-15s) compared with that in patients without TACE. Except for GTV_-T1WI, the differences in SI values between the two groups for other GTVs were statistically significant (<em>p</em> &lt; 0.05). (2) The volumes of GTV_-T1WI, GTV_-15s-GTV_-20min ranged from 32.66-34.99 cm³. The volume differences between GTV_-45s and the other GTVs were statistically significant (<em>p</em> &lt; 0.05), excluding the GTV_-T1WI. (3) Compared with the IGTV, the change trend of GTV volume reduction rate is consistent with that of dice similarity coefficients (DSC). (4) In the CE-T₁WI sequences (except for CE-T₁WI_-15s), FC measurement was possible in 39.31 % of lesions (57/145), with the largest mean thickness observed at 75 s.</div></div><div><h3>Conclusion</h3><div>Although single-phase CE-MRI introduces uncertainty in HCC GTV determination, combining different phases CE-MRI can enhance accuracy. The CE-T₁WI_-45s should be routinely included as a necessary scanning sequence.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100877"},"PeriodicalIF":2.7,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of more than a decade treating patients with stereotactic body radiation therapy for hepatocellular carcinoma","authors":"Wilhelm den Toom ,&nbsp;Eva M. Negenman ,&nbsp;Francois E.J.A. Willemssen ,&nbsp;Erik van Werkhoven ,&nbsp;Robert J. Porte ,&nbsp;Roeland F. de Wilde ,&nbsp;Dave Sprengers ,&nbsp;Imogeen E. Antonisse ,&nbsp;Ben J.M. Heijmen ,&nbsp;Alejandra Méndez Romero","doi":"10.1016/j.ctro.2024.100878","DOIUrl":"10.1016/j.ctro.2024.100878","url":null,"abstract":"<div><h3>Purpose/Objective(s)</h3><div>To evaluate if stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) has a durable effect on tumor control and can be delivered safely.</div></div><div><h3>Materials/Methods</h3><div>Patients included in this retrospective study have been treated at our institution from January 2008 to December 2022. Eligibility criteria were diagnosis of HCC, BCLC stage 0-A-B, non-cirrhotic liver or liver with cirrhosis Child-Pugh class A, and a maximum of three lesions with a cumulative diameter of ≤ 6 cm. Patients with relapses after surgery, thermal ablation or TACE or patients awaiting transplant were also candidates for SBRT. SBRT was delivered in 6 fractions of 8 or 9 Gy. The primary endpoint was local (target) control (LC). Secondary endpoints were time to progression (TTP), overall survival (OS), response rate (RR) and toxicity.</div></div><div><h3>Results</h3><div>A total of 52 patients received SBRT at our institution and 51 were included in this study. One patient objected and was excluded. Median follow-up was 2.1 years for LC and 2.3 years for OS. Median tumor size was 26 mm. LC rates at 1, 2, and 5 years were 100 %, 95 % and 95 % respectively. Median TTP was 45.6 months. Median OS was 7.1 years. RR was 96 %. No patients in this study have experienced SBRT related CTC AE grade ≥ 3 toxicity.</div></div><div><h3>Conclusion</h3><div>SBRT resulted in excellent long-term local control rates and absence of severe toxicity in a group of HCC patients. The reported outcomes compare favorably with other local therapies. SBRT should be considered as one of the available local treatment options for HCC.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100878"},"PeriodicalIF":2.7,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhibition of OXPHOS induces metabolic rewiring and reduces hypoxia in murine tumor models","authors":"Daan F. Boreel ,&nbsp;Anne P.M. Beerkens ,&nbsp;Sandra Heskamp ,&nbsp;Milou Boswinkel ,&nbsp;Johannes P.W. Peters ,&nbsp;Gosse J. Adema ,&nbsp;Paul N. Span ,&nbsp;Johan Bussink","doi":"10.1016/j.ctro.2024.100875","DOIUrl":"10.1016/j.ctro.2024.100875","url":null,"abstract":"<div><h3>Introduction</h3><div>Tumor hypoxia is a feature of many solid malignancies and is known to cause radio resistance. In recent years it has become clear that hypoxic tumor regions also foster an immunosuppressive phenotype and are involved in immunotherapy resistance. It has been proposed that reducing the tumors’ oxygen consumption will result in an increased oxygen concentration in the tissue and improve radio- and immunotherapy efficacy. The aim of this study is to investigate the metabolic rewiring of cancer cells by pharmacological attenuation of oxidative phosphorylation (OXPHOS) and subsequently reduce tumor hypoxia.</div></div><div><h3>Material and methods</h3><div>The metabolic effects of three OXPHOS inhibitors IACS-010759, atovaquone and metformin were explored by measuring oxygen consumption rate, extra cellular acidification rate, and [¹⁸F]FDG uptake in 2D and 3D cell culture. Tumor cell growth in 2D cell culture and hypoxia in 3D cell culture were analyzed by live cell imaging. Tumor hypoxia and [¹⁸F]FDG uptake <em>in vivo</em> following treatment with IACS-010759 was determined by immunohistochemistry and <em>ex vivo</em> biodistribution respectively.</div></div><div><h3>Results</h3><div><em>In vitro</em> experiments show that tumor cell metabolism is heterogeneous between different models. Upon OXPHOS inhibition, metabolism shifts from oxygen consumption through OXPHOS towards glycolysis, indicated by increased acidification and glucose uptake. Inhibition of OXPHOS by IACS-010759 treatment reduced diffusion limited tumor hypoxia in both 3D cell culture and <em>in vivo</em>. Although immune cell presence was lower in hypoxic areas compared with normoxic areas, it is not altered following short term OXPHOS inhibition.</div></div><div><h3>Discussion</h3><div>These results show that inhibition of OXPHOS causes a metabolic shift from OXPHOS towards increased glycolysis in 2D and 3D cell culture. Moreover, inhibition of OXPHOS reduces diffusion limited hypoxia in 3D cell culture and murine tumor models. Reduced hypoxia by OXPHOS inhibition might enhance therapy efficacy in future studies. However, caution is warranted as systemic metabolic rewiring can cause adverse effects.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100875"},"PeriodicalIF":2.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health care system factors associated with receipt of treatment and treatment intent in stage III non-small cell lung cancer: A population-based study in Ontario","authors":"Stephane Thibodeau ,&nbsp;Paul Nguyen ,&nbsp;Andrew Robinson ,&nbsp;Fabio Ynoe de Moraes ,&nbsp;Jason Pantarotto ,&nbsp;Timothy P. Hanna","doi":"10.1016/j.ctro.2024.100873","DOIUrl":"10.1016/j.ctro.2024.100873","url":null,"abstract":"<div><h3>Purpose</h3><div>Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease, with a spectrum of anatomic extent, health status, and treatment approaches. Receipt of treatment and its intent should be independent of health system factors where care quality is optimal. We investigated the degree that modifiable health system factors are associated with receipt of treatment and treatment intent in stage III NSCLC in a large, universal health system.</div></div><div><h3>Methods</h3><div>This was a population-based, retrospective cohort study with health administrative data from Ontario, Canada, 2010–2018 for those aged ≥ 20 years, with AJCC 7 or 8 stage III NSCLC. We explored health system factors associated with NSCLC treatment: region of residence, diagnostic interval, travel distance, advanced radiation (e.g. IMRT, VMAT) and systemic therapy treatment volumes, and year of treatment (treatment era). The relative risk (RR) of (1) any treatment versus no treatment, and (2) palliative versus non-palliative treatment was determined, using multivariable stepwise Poisson regression models. We adjusted for patient, disease, and treatment factors.</div></div><div><h3>Results</h3><div>We identified 7,093 people with stage III NSCLC between 2010 and 2018. There were no health system factors associated with receipt of treatment versus no treatment in adjusted analysis. The major health system factor associated with palliative intent was region of residence (RR: Region ranges from 0.88 to 1.67, p &lt; 0.001). Stratifying by era (2010–2012 vs. 2013–2015 vs. 2016–2018), there was an increase in receipt of curative treatment and use of advanced radiotherapy techniques and immunotherapy over time, but regional variation of treatment intent was similar.</div></div><div><h3>Conclusions</h3><div>Region of residence emerged as the major health system factor associated with treatment intent for stage III NSCLC. This variation remained, even as advances in radiotherapy and systemic therapy were adopted. Our study suggests possible opportunities to improve care outcomes by addressing unexplained regional variation in care.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100873"},"PeriodicalIF":2.7,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}