Clinical and Translational Radiation Oncology最新文献

{"title":"Volumetric and spatial changes in brain metastases during stereotactic radiosurgery: a case for off-line adaptive planning","authors":"Menekse Turna ,&nbsp;Hale Başak Çağlar","doi":"10.1016/j.ctro.2025.101000","DOIUrl":"10.1016/j.ctro.2025.101000","url":null,"abstract":"<div><div>Stereotactic radiosurgery is a widely used treatment modality for brain metastases, particularly in cases with a limited number and volume of lesions. While adaptive strategies have gained prominence in the stereotactic treatment of extracranial, their application in intracranial SRS remains largely unexplored. This case study presents a 45-year-old female with multiple brain metastases and significant perilesional edema, treated with fractionated stereotactic radiotherapy. Due to tumor displacement during the treatment course, adaptive SRS was implemented after the third fraction, utilizing an updated MRI scan to account for changes in tumor volume and midline shift. The total GTV decreased by 34.2 %, and five lesions were found to be partially outside the prescribed treatment target. Based on this MRI, an offline adaptive SRS plan was generated, and the remaining two fractions were delivered according to the updated plan. This case underscores the potential for significant changes in target volume and spatial displacement during FSRT in patients with brain metastases exhibiting extensive edema and emphasizes the importance of mid-treatment imaging and the potential role of offline adaptive SRS strategies in managing intracranial tumors.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 101000"},"PeriodicalIF":2.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144472372","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":"IORT for early-stage, low-risk breast cancer: Outcomes from a prospective, observational study","authors":"Amalia Palacios-Eito ,&nbsp;María del Carmen Moreno-Manzanaro ,&nbsp;María Espinosa-Calvo ,&nbsp;Fátima Ginés-Santiago ,&nbsp;Juan Adrián Camús-Martínez ,&nbsp;Ángel Calvo-Tudela ,&nbsp;Pilar Rioja-Torres ,&nbsp;Sara Romero-Martín ,&nbsp;José Antonio Miñano-Herrero ,&nbsp;Gustavo R. Sarria ,&nbsp;Sonia García-Cabezas","doi":"10.1016/j.ctro.2025.100998","DOIUrl":"10.1016/j.ctro.2025.100998","url":null,"abstract":"<div><h3>Introduction</h3><div>Treatment of early-stage, low-risk breast cancer (BC) has undergone significant de-escalation during the past years. The TARGIT-A trial provided information on intraoperative radiotherapy (IORT) as a convenient, single-fraction modality. Nevertheless, significant discussion regarding different aspects of the trial continues. This study reports on oncological outcomes in a real-world clinical setting and contributes to the understanding of its optimal indication.</div></div><div><h3>Methods</h3><div>Five-hundred patients planned for breast-conserving surgery (BCS) were screened for IORT between June 2017 and December 2023, within this prospective, observational, single-center. The treatment protocol replicated the experimental arm of the TARGIT-A trial, implementing stricter inclusion criteria and maintaining a risk-adapted approach. The primary endpoint was ipsilateral breast recurrence rates (IBR). Secondary endpoints included local recurrence-free survival, progression-free survival, overall survival, and patient-reported cosmesis. The Kaplan-Meier method was used to analyze survival and recurrence risk, and risk factors for IBR were assessed through Cox regression analysis.</div></div><div><h3>Results</h3><div>After screening and recruiting, IORT was performed in 464 patients. The median follow-up was 45.3 (8–89) months. The estimated 5-year IBR risk in the entire cohort was 1.7 % (95 % CI: 0.7 %–2.8 %), decreasing to 1 % (95 % CI: 0.3 %–2.4 %) in the IORT + whole breast irradiation (WBI) cohort. In the IORT-only cohort, the risk was 2.1 % (95 % CI: 0.6 %–3.7 %). No significant differences were observed among the three subgroups. The 5-year overall survival and breast cancer-specific survival rates were 97.6 % (95 % CI: 96.0 %–99.1 %) and 99.5 % (95 % CI: 98.5 %–100 %), respectively. Two independent significant risk factors for IBR were identified: age &lt; 50 years (HR = 0.138, 95 % CI: 0.032–0.597, p = 0.008) and close or affected surgical margins (HR = 5.8, 95 % CI: 1.5–22.5, p = 0.011). No grade 3–4 toxicity events were reported. Patient-reported cosmesis was excellent/good in 84 % of cases.</div></div><div><h3>Conclusions</h3><div>Local recurrence rates were low amongst all groups. Superior control outcomes could be obtained by applying more restrictive criteria than the TARGIT A trial. Longer follow-up is needed to confirm our findings.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 100998"},"PeriodicalIF":2.7,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144366491","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":"Evaluation of therapeutic radiographer target volume contouring for magnetic resonance image guided online adaptive bladder radiotherapy","authors":"Bethany Williams ,&nbsp;Jonathan Mohajer ,&nbsp;Sophie E. Alexander ,&nbsp;Helen Barnes ,&nbsp;Francis Casey ,&nbsp;Joan Chick ,&nbsp;Alex Dunlop ,&nbsp;Ryan Fullerton ,&nbsp;Trina Herbert ,&nbsp;Robert Huddart ,&nbsp;Sarah A. Mason ,&nbsp;Adam Mitchell ,&nbsp;Jayde Nartey ,&nbsp;Simeon Nill ,&nbsp;Priyanka Patel ,&nbsp;Shaista Hafeez ,&nbsp;Helen A. McNair","doi":"10.1016/j.ctro.2025.100994","DOIUrl":"10.1016/j.ctro.2025.100994","url":null,"abstract":"<div><h3>Background and purpose</h3><div>One barrier to wider clinical implementation of online MRI-guided radiotherapy (MRIgRT) on the MR Linac (MRL) is resource intensity. Specifically, the requirement for a clinical oncologist/radiation oncologist (CO/RO) to perform online contouring each fraction. We report an evaluation of therapeutic radiographer (RTT) online contouring for patients receiving whole bladder MRIgRT.</div></div><div><h3>Materials and methods</h3><div>RTTs undertook a contouring training programme. RTT and CO/RO clinical target volume (CTV) contours from 95 fractions were assessed using dice similarity coefficient (DSC), hausdorff distance (HD), mean distance to agreement (MDA), sensitivity and specificity volume metrics on the Raystation treatment planning system (TPS) (RaySearch Laboratories). Additionally, CTV DSC was evaluated with respect to a simultaneous truth and performance level estimation (STAPLE) generated in ADMIRE (Elekta AB, Stockholm, Sweden). In dosimetric analysis (Monaco, Elekta AB), online adaptive treatment plans, which had been generated using RTT-defined contours, were evaluated using contours delineated offline by CO/ROs.</div></div><div><h3>Results</h3><div>Comparison of RTT versus CO/RO contours found the CTV median (interquartile range) (IQR) for DSC was 0.92 (0.91–0.94), MDA was 0.11 (0.09–0.12) cm, and HD was 0.63 (0.53–0.72) cm, sensitivity and specificity were 0.94 (0.90–0.96) and 0.95 (0.92–0.97) respectively. In dosimetric analysis, 65 % (30/46) plans met optimal PTV coverage of V52.25 Gy &gt; 98 % and all plans met mandatory PTV coverage of V52.25 Gy &gt; 95 %.</div></div><div><h3>Conclusion</h3><div>Following effective training, evaluation results demonstrate RTT whole bladder CTV contours to be comparable to CO/RO contours. Clinical implementation will release CO/ROs from MRL bladder treatments, reducing resource intensity of online workflows.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 100994"},"PeriodicalIF":2.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314496","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":"Urethral and bladder dosimetry and urinary toxicity in prostate cancer patients undergoing SBRT with and without intra-prostatic boost","authors":"Nisha Bhargava ,&nbsp;Martina Hurwitz ,&nbsp;Josephine Levey ,&nbsp;Lily Bennett ,&nbsp;Joseph A. Aronovitz ,&nbsp;Daniel R. Schmidt ,&nbsp;Jonathan W. Lischalk ,&nbsp;Irving D. Kaplan ,&nbsp;Nima Aghdam","doi":"10.1016/j.ctro.2025.100993","DOIUrl":"10.1016/j.ctro.2025.100993","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To evaluate the dosimetric and toxicity profiles of stereotactic body radiotherapy (SBRT) for prostate cancer, comparing cohorts with and without intraprostatic boost (IPB) to assess feasibility and safety of IPB, with particular attention to urethral and bladder dose and toxicity.</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort study analyzed 349 patients with localized prostate cancer treated between 2018 and 2023. Of these, 266 received SBRT with IPB, and 83 received SBRT without IPB. Patients were treated using a robotic SBRT platform with fiducial tracking. Dosimetric parameters for the urethra, including D0.03cc, D0.3cc, and V40Gy, and for the bladder, including D0.03cc, D5cc, D10cc, and V37Gy, were evaluated. Acute and late toxicities were assessed using CTCAE criteria.</div></div><div><h3>Results</h3><div>For the urethra, median values for D0.03cc, D0.3cc, and V40Gy, and for the bladder, median values D0.03cc, D5cc, D10cc, and V37Gy were compared and no statistically significant differences were observed between the two cohorts. Late urinary toxicity of grade 3 or higher occurred in 2.25 % of patients in the IPB group and 2.47 % in the no IPB group, with no grade 3 acute toxicities reported.</div></div><div><h3>Discussion</h3><div>These findings support the use of SBRT using an IPB as a feasible and safe approach to achieve focal dose escalation to dominant intra-prostatic lesions (DILs) without significantly increasing urethra or bladder dose or toxicity. Future research should focus on standardizing DIL contouring, exploring adaptive planning techniques to increase accuracy, and prospectively studying toxicity and quality of life in patients treated with IPB with SBRT.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 100993"},"PeriodicalIF":2.7,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307589","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":"Online CBCT-based adaptive radiation with reduced PTV margins for prostate cancer: Does reference plan comparison tell the whole story?","authors":"Margaret L. Dahn ,&nbsp;R.Lee MacDonald ,&nbsp;Amanda Cherpak ,&nbsp;Stefan Allen ,&nbsp;Hannah M. Dahn","doi":"10.1016/j.ctro.2025.100992","DOIUrl":"10.1016/j.ctro.2025.100992","url":null,"abstract":"<div><h3>Background</h3><div>Online adaptive radiation (ART) is a novel treatment approach that allows for a new daily treatment plan based on cone beam CT (CBCT) imaging. This daily adaptation facilitates precise tumor and organ-at-risk (OAR) localization and minimizes the impact of interfractional motion, allowing for planning target volume (PTV) margin reduction. Isotropic PTV margins for localized non-stereotactic adaptive prostate radiation performed on an ETHOS linear accelerator with HyperSight have been reduced from standard 7 mm to 5 mm. This study assesses the impact of margin reduction by evaluating the dose metrics of patient reference plans, as well as daily treated plans, for 7 mm vs 5 mm PTV margins.</div></div><div><h3>Methods</h3><div>Patients with prostate cancer receiving moderately hypofractionated adaptive radiation were initially treated with a 7 mm PTV margin (n = 10). This retrospective study generated 5 mm PTV margin treatment plans (n = 10) for these patients for comparison. In addition, a full adaptive 20 fraction treatment course was simulated with margin reduction to identify differences not recognized with reference plan comparison alone.</div></div><div><h3>Results</h3><div>Bladder V40.8 and V48.6 but not V60 were significantly reduced in 5 mm treatment plans compared to 7 mm treatment plans. However, when daily treated plan data was examined bladder V60 was lower for the 5 mm PTV case. Similarly, rectum doses V24.6-V57 but not V60 were significantly reduced in 5 mm PTV margin treatment plans. Further differences were identified when looking at the daily treated plan data as opposed to simply comparing reference plans.</div></div><div><h3>Significance</h3><div>In the era of online ART, with significant data available, such as daily treated plan dosimetry, analysis of reference plans alone may not be sufficient. PTV margin reduction, made possible due to the use of online ART, reduced the volume of bladder and rectum receiving &lt;60 Gy, which may reduce toxicity and secondary malignancy risk.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"54 ","pages":"Article 100992"},"PeriodicalIF":2.7,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307590","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":"Head and neck and skin (HNS) GEC-ESTRO and BRAPHYQS working groups joint critical review of the use of Rhenium-188 in dermato-oncology","authors":"Sergio Lozares ,&nbsp;Paula Tur ,&nbsp;Facundo Ballester ,&nbsp;Ralph Alexander Bundschuh ,&nbsp;Víctor González-Pérez ,&nbsp;Ramin Jaberi ,&nbsp;Javier Vijande ,&nbsp;Renate Walter ,&nbsp;Åsa Carlsson Tedgren ,&nbsp;Luca Tagliaferri ,&nbsp;Frank-André Siebert ,&nbsp;Agata Rembielak","doi":"10.1016/j.ctro.2025.100991","DOIUrl":"10.1016/j.ctro.2025.100991","url":null,"abstract":"<div><div>Non-melanoma skin cancers are increasing globally, prompting the need for innovative, non-invasive treatment approaches. Radioactive rhenium (¹⁸⁸Re) paste has emerged as an open-source radiation-based modality in dermato-oncology, offering a novel alternative to conventional radiotherapy and brachytherapy. In this review, a systematic literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar for studies published over the past 20 years. Data were extracted from case series, pilot studies, and clinical trials, with particular emphasis on response rates, dosimetric parameters, and treatment-associated toxicity. Findings from approximately 240 patients demonstrated complete response rates ranging from 86 % to 100 % after one or two treatment applications, while dosimetric analyses revealed a rapid dose fall-off that effectively confines the therapeutic effect to a tissue depth of 2–3  mm, with most adverse effects being mild and transient. Notably, ¹⁸⁸Re differs from conventional brachytherapy (specifically high-dose-rate modality) due to its open-source application and unique dosimetric profile. The use of ¹⁸⁸Re in clinical practice mandates a highly specialized, multidisciplinary team, including radiation oncologists, nuclear medicine specialists, and experienced medical physicists, and strict quality assurance protocols, thereby limiting its application to carefully selected cases.</div><div>Although ¹⁸⁸Re therapy offers a promising alternative for the treatment of superficial skin cancers, its distinct clinical and dosimetric characteristics warrant further randomized studies with extended follow-up to validate its efficacy and refine patient selection criteria under rigorous multidisciplinary oversight.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100991"},"PeriodicalIF":2.7,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263232","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":"Ultrahypofractionated radiotherapy for localised prostate cancer: The impact of daily MRI-guided adaptive radiotherapy on delivered dose","authors":"S.E. Alexander ,&nbsp;R.A. Mitchell ,&nbsp;A. Dunlop ,&nbsp;T. Herbert ,&nbsp;K. Morrison ,&nbsp;J. Nartey ,&nbsp;U. Oelfke ,&nbsp;H.A. McNair ,&nbsp;A.C. Tree","doi":"10.1016/j.ctro.2025.100985","DOIUrl":"10.1016/j.ctro.2025.100985","url":null,"abstract":"<div><h3>Introduction</h3><div>Magnetic resonance image-guided adaptive radiotherapy (MRIgART) reduces uncertainties by correcting for day-to-day target and organ-at-risk deformation and motion. This is the first study to examine the dosimetric impact of MRIgART for ultrahypofractionated prostate cancer treatment, compared to standard-of-care image-guided non-adapted radiotherapy.</div></div><div><h3>Methods</h3><div>Twenty patients with localised prostate cancer, who received ultrahypofractionated MRIgART on the Unity MR linac (Elekta, Sweden) were retrospectively analysed. Online daily MRI was acquired for replanning (MRI_session) and a second for position verification before treatment (MRI_verification). To compare delivered dose with and without adaptation, three plans were generated offline per fraction; a session plan (reference plan adapted to MRI_session anatomy), a verification plan (session plan recalculated on MRI_verfication anatomy), and a non-adapted plan (reference plan recalculated on MRI_verfication anatomy). Target and organ-at-risk doses were calculated, and dose difference evaluated.</div><div>Secondary analysis, using deformable dose accumulation, estimated verification and non-adapted dose to primary target (CTVpsv) substructures; prostate, gross tumour volume (GTV) and proximal 1 cm of seminal vesicles (1cmSV). Impact of prostate, rectum and bladder volume changes on dose were evaluated.</div></div><div><h3>Results</h3><div>Median dose to 95 % of the CTVpsv was significantly higher with adaptation; 40.3, 40.0 and 38.2 Gy for session, verification, and non-adapted plans. Adaptation achieved a lower median urethra V42Gy dose but bladder V37Gy dose was lower when not adapting. Rectum V36Gy dose was similar for adapted and non-adapted plans.</div><div>CTVpsv substructure dose difference was greatest for 1cmSV; 40.0 versus 37.5 Gy for verification/non-adapted plans. Adaptation achieved significantly higher prostate only, but not GTV doses. Prostate and rectal volume changes had a negative impact on non-adapted dose only.</div></div><div><h3>Conclusion</h3><div>MRIgART, offers significant dosimetric benefit for ultrahypofractionated prostate cancer compared to non-adapted strategies. Greatest benefit is expected for those with SV or high-risk of SV involvement, persistent rectal gas, prostate swelling and for the application of novel dose strategies including GTV dose escalation and non-involved prostate dose de-escalation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100985"},"PeriodicalIF":2.7,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255148","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":"Bulky non-small cell lung cancer treated with two-field robust proton lattice boost followed by conventional chemoradiation","authors":"Matthew J. Ferris,&nbsp;Sina Mossahebi,&nbsp;Jenna Jatczak,&nbsp;Jason K. Molitoris,&nbsp;Zaker H. Rana,&nbsp;Katarina J. Steacy,&nbsp;William F. Regine,&nbsp;Byong Yong Yi","doi":"10.1016/j.ctro.2025.100987","DOIUrl":"10.1016/j.ctro.2025.100987","url":null,"abstract":"<div><div>Despite advances in outcomes for non-small cell lung cancer (NSCLC) with the establishment of adjuvant immunotherapy as the standard of care, locoregional recurrence is still experienced by half of patients with progressive disease. We sought to integrate a novel pencil beam scanning (PBS) spatially fractionated approach into definitive management of bulky non-small cell lung cancer cases. Spatial fractionation via lattice or more commonly GRID has long been of interest as supplement to more conventional radiation regimens for bulky tumors, though requirements for plan robustness and concerns about single-field approaches have previously limited their integration into proton therapy practice. Here we present two cases of bulky NSCLC treated with a novel two-field partially robust PBS lattice boost of 12 Gy followed by standard conventional chemoradiation. Both patients experienced usual mild treatment related toxicities and remain with their bulky lesions controlled in field at more than a year out from treatment.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100987"},"PeriodicalIF":2.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289027","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":"Tumor control and survival after postoperative radiotherapy for high-risk oral cavity cancer: A retrospective cohort study","authors":"Pepijn B Bolleurs ,&nbsp;Brend P Jonker ,&nbsp;Joris BW Elbers ,&nbsp;Gerda M Verduijn ,&nbsp;Atilla Gül ,&nbsp;Aniel Sewnaik ,&nbsp;Wilma D Heemsbergen","doi":"10.1016/j.ctro.2025.100988","DOIUrl":"10.1016/j.ctro.2025.100988","url":null,"abstract":"<div><h3>Background</h3><div>We evaluated locoregional failure (LRF) and survival after postoperative radiotherapy (PORT) in selected high-risk oral squamous cell carcinoma (OSCC) patients.</div></div><div><h3>Methods</h3><div>In a retrospective OSCC cohort (n = 219) treated with local (n = 216) and/or regional (n = 87) PORT in 2011–2018, we determined the first location of tumor recurrence or progression, survival, and cause of death. Tumor control and survival was calculated using Kaplan Meier method. Prognostic factors were evaluated in Cox regression models.</div></div><div><h3>Results</h3><div>Main subsites were oral tongue (34 %), gingiva (32 %), and floor of mouth (27 %). Eight percent also received chemotherapy. Median follow-up was five year for tumor control and eight year for survival. Tumor progression was observed in 47 patients (n = 31 LRF). Nine patients had salvage treatment. Locoregional control was 87 % and 84 % at 2 and 5 years, respectively. Significant prognostic factors for local failure (LF) were T4 stage, bone invasion, and subsite gingiva; 12 of 18 LF concerned a T4 gingiva tumor with bone invasion. For regional failure (RF), pN1 (vs pN0) was prognostic, mainly concerning solitary contralateral RFs. Overall survival was 63 % and 48 % at 5 and 8 year, respectively. Main causes of death (104 events) were the index tumor (n = 42) and a post-treatment second primary tumor (n = 37).</div></div><div><h3>Conclusion</h3><div>A locoregional control of 84 % was achieved after PORT for high-risk OSCC with only 8 % receiving additional chemotherapy. Overall survival was 48 % at 8 years, with a large proportion of cancer-related deaths related to the index tumor and other subsequent tumor diagnoses. Risk of LF was increased for gingiva tumors with bone invasion. N1 stage was associated with a risk of solitary contralateral RFs in non-irradiated neck areas.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100988"},"PeriodicalIF":2.7,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190366","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":"Automated segmentation of target volumes in breast cancer radiotherapy, impact on target size and dose to organs at risk","authors":"Vivi Tang ,&nbsp;Elinore Wieslander ,&nbsp;Mahnaz Haghanegi ,&nbsp;Elisabeth Kjellén ,&nbsp;Sara Alkner","doi":"10.1016/j.ctro.2025.100986","DOIUrl":"10.1016/j.ctro.2025.100986","url":null,"abstract":"<div><h3>Introduction</h3><div>Target volume delineation is crucial in breast cancer radiotherapy planning but involves significant interobserver variability. Deep learning (DL) models may reduce this variability, saving time and costs. However, current DL-models do not consider clinical data, such as tumor location and patient comorbidity, to adjust the target and reduce dose to organs at risk (OAR). This study compares clinically defined target volumes to those generated by a DL-model in terms of size, geometric overlap, and dose to OAR.</div></div><div><h3>Method</h3><div>For a hypothetical breast cancer patient, we compared target volumes constructed by Swedish radiotherapy clinics and two DL-models, Raystation and MVision. Geometrical overlap was evaluated, as well as the impact of differences in target delineation on dose to OAR. Treatment plans for locoregional vs. breast-only 3D-conformal radiotherapy were generated.</div></div><div><h3>Results</h3><div>CTV-structures for the breast, lymph nodes level I-IV, and internal mammary nodes were available for 10, 11, and 14 centers respectively. Volume of the CTV-breasts varied between 770–890cc, and the total CTV-volumes (breast + lymph nodes) between 875–1003cc. The DL-models did not constitute the largest nor smallest breast or total CTV-volumes, and geometric overlap between structures was relatively good. Evaluating dose to OAR from dose plans based on the respective CTV-volumes for locoregional radiotherapy, this was comparable between the DL-models and the mean of the CTVs generated by the clinics. In radiotherapy of only the breast, the CTV-breasts constructed by the DL-models gave the highest heart doses due to their proximity to the chest wall, affecting field angle choices. No difference was seen in dose to the ipsilateral lung, thyroid gland, or humeral head.</div></div><div><h3>Conclusion</h3><div>DL-models for target delineation have great potential. However, their introduction must be closely monitored since even small differences compared to clinical standards may affect doses to OAR in 3D conformal breast cancer radiotherapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100986"},"PeriodicalIF":2.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230362","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}