Clinical and Translational Radiation Oncology最新文献

{"title":"Physician reported toxicities and patient reported quality of life of transperineal ultrasound-guided radiotherapy of prostate cancer","authors":"Jing Ma ,&nbsp;Paul Rogowski ,&nbsp;Christian Trapp ,&nbsp;Farkhad Manapov ,&nbsp;Bin Xu ,&nbsp;Alexander Buchner ,&nbsp;Shun Lu ,&nbsp;Nina Sophie Schmidt-Hegemann ,&nbsp;Xuanbin Wang ,&nbsp;Cheng Zhou ,&nbsp;Christian Stief ,&nbsp;Claus Belka ,&nbsp;Minglun Li","doi":"10.1016/j.ctro.2024.100868","DOIUrl":"10.1016/j.ctro.2024.100868","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to address therapy-related toxicities and quality of life in prostate cancer patients undergoing transperineal ultrasound (TPUS) guided radiotherapy (RT).</div></div><div><h3>Methods</h3><div>Acute and late gastrointestinal (GI) and genitourinary (GU) toxicities were assessed by physicians using CTCAE v5.0. Patient-reported quality of life outcomes were evaluated using EORTC QLQ-C30, -PR25 and IPSS. We utilized Volumetric Modulated Arc Therapy (VMAT) or intensity modulated radiation therapy (IMRT) as the RT technique for this study. The assessments were carried out before RT, at RT end, 3 months after RT and subsequently at 1-year intervals. Prostate-specific antigen (PSA) was also evaluated at each follow-up.</div></div><div><h3>Results</h3><div>In this study, a total of 164 patients were enrolled, while among them, 112 patients delivered quality-of-life data in a prospective evaluation. The median pre-treatment PSA was 7.9 ng/mL (range: 1.8–169 ng/ml). At the median follow-up of 19 months (3–82 months), the median PSA decreased to 0.22 ng/ml. Acute grade II GI and GU toxicities occurred in 8.6 % and 21.5 % patients at RT end. Regarding late toxicities, 2.2 % patients experienced grade II GI toxicities at 27 months and only one patient at 51 months, whereas no grade II GU late toxicities were reported at these time points. Quality of life scores also indicated a well-tolerated treatment. Patients mainly experienced acute clinically relevant symptoms of fatigue, pain, as well as deterioration in bowel and urinary symptoms. However, most symptoms normalized at 3 months and remained stable thereafter. Overall functioning showed a similar decline at RT end but improved over time.</div></div><div><h3>Conclusion</h3><div>The outcomes of TPUS-guided RT demonstrated promising results in terms of minimal physician-reported toxicities and satisfactory patient-reported QoL.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100868"},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001459/pdfft?md5=8cd8a86c88fe85607a2c0f9d58438f7f&pid=1-s2.0-S2405630824001459-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315817","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":"Immunological responses to brain metastasis stereotactic radiosurgery in patient-matched longitudinal blood and tumour samples","authors":"Joseph Sia ,&nbsp;Criselle D’Souza ,&nbsp;Rebecca Castle ,&nbsp;Yu-Kuan Huang ,&nbsp;Han Xian Aw Yeang ,&nbsp;Rejhan Idrizi ,&nbsp;Metta Jana ,&nbsp;Shankar Siva ,&nbsp;Claire Phillips ,&nbsp;Paul Neeson","doi":"10.1016/j.ctro.2024.100863","DOIUrl":"10.1016/j.ctro.2024.100863","url":null,"abstract":"<div><h3>Background</h3><div>Stereotactic radiosurgery (SRS) is highly effective as focal treatment for brain metastases (BrMs), but whether it can promote anti-tumour immune responses that synergise with immunotherapy remains unclear. We investigated this by examining blood samples from a clinical trial for HER2-amplified breast cancer (HER2-BC) BrMs, matched with longitudinal HER2-BC BrM samples resected from the same location in the same patient.</div></div><div><h3>Methods</h3><div>Blood samples from 10 patients taken pre- and 7–14 days post-SRS were analysed by mass and flow cytometry. One patient received pre-operative SRS for a BrM that recurred 7 months after resection, followed by planned re-resection 8 days post-SRS. Pre- and post-SRS tumours from this patient were analysed by bulk RNAseq, multiplex immunohistochemistry (mIHC), and TCR sequencing.</div></div><div><h3>Results</h3><div>Monocytes, central memory CD8+ T and regulatory T cells were enriched in blood post-SRS, together with increased MHC-II expression on monocytes, conventional DCs, and monocytic MDSCs. In tumour, SRS upregulated antigen presentation, T cell proliferation and T cell co-stimulation signatures, alongside an influx of tumour-associated macrophages (TAMs) and CD4+ T cells. Specifically, TAMs and CD4+ T cells, but not CD8+ T cells, demonstrated spatial co-localisation post-SRS. These TAMs were lowly PD-L1 expressing, but CD4+ T cells showed increased PD-1 expression. A sizeable proportion of T cell clonotypes were retained post-SRS, and four clones demonstrated significant, non-stochastic expansion.</div></div><div><h3>Conclusion</h3><div>Systemic and local immunological changes in this homogenous patient cohort suggest that SRS may facilitate MHC-II-restricted T cell priming responses involving the monocyte-macrophage lineage and CD4+ T cells, which should be further explored.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100863"},"PeriodicalIF":2.7,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240563082400140X/pdfft?md5=12649680110201c143c95f7fd3305912&pid=1-s2.0-S240563082400140X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142315816","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 oxygen puzzle in FLASH radiotherapy: A comprehensive review and experimental outlook","authors":"Andrea Scarmelotto ,&nbsp;Victor Delprat ,&nbsp;Carine Michiels ,&nbsp;Stéphane Lucas ,&nbsp;Anne-Catherine Heuskin","doi":"10.1016/j.ctro.2024.100860","DOIUrl":"10.1016/j.ctro.2024.100860","url":null,"abstract":"<div><div>FLASH radiotherapy is attracting increasing interest because it maintains tumor control while inflicting less damage to normal tissues compared to conventional radiotherapy. This sparing effect, the so-called FLASH effect, is achieved when radiation is delivered at ultra-high dose rates (≥40 Gy/s). Although the FLASH effect has already been demonstrated in several preclinical models, a complete mechanistic description explaining why tumors and normal tissues respond differently is still missing. None of the current hypotheses fully explains the experimental evidence. A common point between many of these is the role of oxygen, which is described as a major factor, either through transient hypoxia in the form of dissolved molecules, or reactive oxygen species (ROS). Therefore, this review focuses on both forms of this molecule, retracing old and more recent theories, while proposing new mechanisms that could provide a complete description of the FLASH effect based on preclinical and experimental evidence. In addition, this manuscript describes a set of experiments designed to provide the FLASH community with new tools for exploring the post-irradiation fate of ROS and their potential biological implications.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100860"},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240563082400137X/pdfft?md5=b43eb0285d3f5ab4366e1ffa3994ed62&pid=1-s2.0-S240563082400137X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311304","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":"A pilot study to evaluate the combination of surgery and brachytherapy for local tumor control in young children with perianal rhabdomyosarcoma","authors":"Andreas Schmidt ,&nbsp;David Baumann ,&nbsp;Ulf Lamprecht ,&nbsp;Benjamin Mayer ,&nbsp;Cristian Urla ,&nbsp;Benjamin Bender ,&nbsp;Jürgen Schäfer ,&nbsp;Frank Fideler ,&nbsp;Maximilian Niyazi ,&nbsp;Frank Paulsen ,&nbsp;Jörg Fuchs","doi":"10.1016/j.ctro.2024.100862","DOIUrl":"10.1016/j.ctro.2024.100862","url":null,"abstract":"<div><h3>Background</h3><div>Perianal rhabdomyosarcoma ((P)RMS) are rare and have a poor prognosis. Data in young children are limited and local therapy is not well defined. Combined brachytherapy and surgery is routinely being used for RMS at other sites in children as it provides good oncologic outcomes and allows for organ-sparing surgery. The objective of this study was to evaluate this combination treatment for local tumor control and organ-sparing surgery in young children with (P)RMS.</div></div><div><h3>Methods</h3><div>A retrospective review of the medical records of all children who underwent surgery and brachytherapy for (P)RMS at our institution since 2009 was conducted.</div></div><div><h3>Results</h3><div>Surgery for (P)RMS was performed in 6 patients at a median age of 19 months (range 8–50). Embryonal RMS was diagnosed in 4 patients and alveolar RMS in 2 patients, of which 1 patient had FOXO1 fusion-positive RMS. All patients underwent postoperative high-dose rate (HDR) brachytherapy. Organ-preserving surgery was achieved in 5 of 6 patients (83 %). In 1 patient, the entire sphincter was infiltrated, making organ-preserving resection impossible. 5 of 6 patients (83 %) exhibited an event-free and overall survival at a median follow-up of 26 months (range 8–107). One patient died due to locoregional recurrence. Complications were urethral leakage in 1 patient followed by urethral stenosis and delayed wound healing and vaginal stenosis in another patient. No patient reported fecal incontinence.</div></div><div><h3>Conclusions</h3><div>Combined treatment with surgery and HDR brachytherapy is feasible in very young children with (P)RMS and leads to a favorable oncologic outcome. Preliminary data show a good functional preservation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100862"},"PeriodicalIF":2.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001393/pdfft?md5=1fd57689573a1c5819dc75c26422ac7d&pid=1-s2.0-S2405630824001393-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311168","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":"Anatomical and dosimetric variations during volumetric modulated arc therapy in patients with locally advanced nasopharyngeal carcinoma after induction therapy: Implications for adaptive radiation therapy","authors":"Shuhan Zhao ,&nbsp;Jun Han ,&nbsp;Zhiyong Yang ,&nbsp;Xi Chen ,&nbsp;Xixi Liu ,&nbsp;Fangyuan Zhou ,&nbsp;Yajie Sun ,&nbsp;Ye Wang ,&nbsp;Gang Liu ,&nbsp;Bian Wu ,&nbsp;Sheng Zhang ,&nbsp;Jing Huang ,&nbsp;Kunyu Yang","doi":"10.1016/j.ctro.2024.100861","DOIUrl":"10.1016/j.ctro.2024.100861","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate anatomical and dosimetric changes during volumetric modulated arc therapy (VMAT) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) after induction therapy (IT) and explore characteristics of patients with notable variations.</div></div><div><h3>Materials and methods</h3><div>From July 2021 to June 2023, 60 LA-NPC patients undergoing VMAT after IT were retrospectively recruited. Adaptive computed tomography (aCT), reconstructed from weekly cone-beam computed tomography(CBCT), facilitates recontouring and planning transplantation. Volume, dice similarity coefficients, and dose to target volumes and organs at risk(OARs) on planning CT(pCT) and aCT were compared to identify changing patterns. Multivariate logistic regression was used to investigate risk factors.</div></div><div><h3>Results</h3><div>The volumes of PGTVnasopharynx (PGTVp), PGTVnode (PGTVn), ipsilateral and contralateral parotid glands decreased during VMAT, with reductions of 2.25 %, 6.98 %, 20.09 % and 18.00 %, respectively, at 30 fractions from baseline (P &lt; 0.001). After 25 fractions, D99 and D95 of PGTVn decreased by 7.94 % and 4.18 % from baseline, respectively, while the Dmean of ipsilateral and contralateral parotid glands increased by 7.80 % and 6.50 %, marking the peak rates of dosimetric variations (P &lt; 0.001). The dosimetric fluctuations in PGTVp, the brainstem, and the spinal cord remained within acceptable limits. Furthermore, an initial BMI ≥ 23.5 kg/m² and not-achieving objective response (OR) after IT were regarded as risk factors for a remarkable PGTVn dose reduction in the later stages of VMAT.</div></div><div><h3>Conclusions</h3><div>Replanning for post-IT LA-NPC patients appears reasonable at 25F during VMAT. Patients with an initial BMI ≥ 23.5 kg/m² and not-achieving OR after IT should be considered for adaptive radiation therapy to stabilize the delivered dose.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100861"},"PeriodicalIF":2.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001381/pdfft?md5=5553e3b11f7deb51687a0068a8493f3b&pid=1-s2.0-S2405630824001381-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311165","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":"Feasibility of using contrast-free quantitative magnetic resonance imaging for liver sparing stereotactic ablative body radiotherapy","authors":"Frank Brewster ,&nbsp;Zoe Middleton ,&nbsp;Alan McWilliam ,&nbsp;Andrew Brocklehurst ,&nbsp;Ganesh Radhakrishna ,&nbsp;Robert Chuter","doi":"10.1016/j.ctro.2024.100859","DOIUrl":"10.1016/j.ctro.2024.100859","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Tumours in the liver often develop on a background of liver cirrhosis and impaired liver function. As a result, radiotherapy treatments are limited by radiation-induced liver disease, parameterised by the liver mean dose (LMD). Liver function is highly heterogeneous, especially in liver cancer, but the use of LMD does not take this into account. One possible way to improve liver treatments is to use quantitative imaging techniques to assess liver health and prioritise the sparing of healthy liver tissue.</div></div><div><h3>Materials and methods</h3><div>Anatomical T2 and quantitative iron-corrected T1 (cT1) images were made available for 10 patients with liver metastases. Functional liver volumes were automatically segmented on the quantitative images using a threshold. Liver stereotactic ablative body radiotherapy (SABR) plans were made using a departmental protocol. Liver-sparing plans were then made by reducing the dose to the functional sub-volume.</div></div><div><h3>Results</h3><div>The sparing plans achieved a statistically significant (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0.002</mn></mrow></math></span>) reduction in the functional liver mean dose, with a mean reduction of 1.4 Gy. The LMD was also significantly different (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0.002</mn></mrow></math></span>) but had a smaller magnitude with a mean reduction of 0.7 Gy. There were some differences in the planning target volume D_99% (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0.04</mn></mrow></math></span>) but the sparing plans remained within the optimal tolerance and the D_95% was not significantly different (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0.2</mn></mrow></math></span>).</div></div><div><h3>Conclusions</h3><div>This study has, for the first time, demonstrated the use of cT1 maps in radiotherapy showing significant reductions in dose to the healthy liver. Further work is needed to validate this in liver cancer patients, who would likely benefit most.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100859"},"PeriodicalIF":2.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001368/pdfft?md5=de1ba350da198b0fb5d222e61232e6e2&pid=1-s2.0-S2405630824001368-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311169","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":"Prognostic value of pretreatment radiological MRI variables and dynamic contrast-enhanced MRI on radiotherapy treatment outcome in laryngeal and hypopharyngeal tumors","authors":"Hilde J.G. Smits ,&nbsp;Saskia J. Vink ,&nbsp;Mischa de Ridder ,&nbsp;Marielle E.P. Philippens ,&nbsp;Jan W. Dankbaar","doi":"10.1016/j.ctro.2024.100857","DOIUrl":"10.1016/j.ctro.2024.100857","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to determine the prognostic value of radiological magnetic resonance imaging (MRI) variables and dynamic contrast enhanced (DCE)-MRI for local control (LC), disease control (DC), and overall survival (OS) in laryngeal and hypopharyngeal cancer patients after radiotherapy.</p></div><div><h3>Methods</h3><p>320 patients treated with radiotherapy were retrospectively included. Pretreatment MRIs were evaluated for the following anatomical tumor characteristics: cartilage invasion, extralaryngeal spread, and involvement of the anterior commissure, pre-epiglottic space, and paralaryngeal space.</p><p>Pretreatment DCE-MRI was available in 89 patients. The median and 95th percentile of the 60-second area under the contrast-distribution-curve (AUC60_median and AUC60_p95) were determined in the tumor volume.</p></div><div><h3>Results</h3><p>Univariable log-rank test determined that extralaryngeal spread, tumor volume and T-stage were prognostic for worse LC, DC, and OS. A low AUC60_p95 (&lt;31.7 mmol·s/L) and thyroid cartilage invasion were prognostic for worse OS.</p><p>In multivariable analysis, a Cox proportional hazard model showed that a AUC60_p95 ≥ 31.7 mmol·s/L was prognostic for better OS (HR=0.25, <em>P</em>&lt;.001). Tumor volume was prognostic for DC (HR=3.42, <em>P</em>&lt;.001) and OS (HR=3.27, <em>P</em>&lt;.001). No anatomical MRI variables were significantly prognostic for LC, DC, or OS in multivariable analysis when corrected for confounders.</p></div><div><h3>Conclusion</h3><p>Low pretreatment AUC60_p95 is prognostic for a worse OS, suggesting that poor tumor perfusion leads to worse survival. Large tumor volume is also prognostic for worse DC and OS. Anatomical MRI parameters are not prognostic for any of the evaluated treatment outcomes when corrected for confounders like age, T-stage, N-stage, and tumor volume.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100857"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001344/pdfft?md5=3576162bf3ca34d1fb03a6dac0e6488b&pid=1-s2.0-S2405630824001344-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142233887","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":"Complications leading to hospitalisation 12 months after brachytherapy or high-intensity focused ultrasound for localized prostate cancer: French national from the PMSI-MCO data, 2019 and 2020","authors":"Timothée Bourgarit ,&nbsp;Clément Larose ,&nbsp;Andrea Dagry ,&nbsp;Nicolas Martz ,&nbsp;Beverley Balkau ,&nbsp;Pascal Eschwège ,&nbsp;Charles Mazeaud","doi":"10.1016/j.ctro.2024.100854","DOIUrl":"10.1016/j.ctro.2024.100854","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Prostate cancer can be treated using either brachytherapy or high-intensity focused ultrasound (HIFU), which are less invasive than surgery. Although both approaches have proved effective, few studies have looked at the specific causes of hospitalisation due to complications, following these treatments. The aim of this study was to compare the causes of hospitalisation.</div></div><div><h3>Methods</h3><div>A retrospective study was carried out examining the records of patients who had undergone brachytherapy or HIFU treatment for localized prostate cancer in 2019 and 2020, using the French national database: Programme de Médicalisation du Système d’Information − Médecine, Chirurgie, Obstétrique (PMSI-MSO). Data on post-treatment hospitalisations were analyzed.</div></div><div><h3>Results</h3><div>3090 patients were included in the study, of whom 1699 underwent brachytherapy and 1391 HIFU procedures. The incidence of hospitalisation was much higher after HIFU than after brachytherapy, notably due to a higher rate of obstructive complications (12.94% vs 2.77%). Large differences were also found for infections (8.20% vs 1.47%) and bleeding (6.76% vs 2.18%) leading to hospitalisation. Most of the complications occurred at the initial hospitalization: 12% for HIFU, and 1.4% for brachytherapy.</div></div><div><h3>Conclusion</h3><div>Complications were more frequent after treatment with HIFU than with brachytherapy in the year following treatment for localized prostate cancer. Further the causes of hospitalisation differed between the two treatments. These differences need to be taken into account in the therapeutic strategy, as well as in post-treatment management.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100854"},"PeriodicalIF":2.7,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001319/pdfft?md5=426becff83aad519aa6fcdbbde932394&pid=1-s2.0-S2405630824001319-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311226","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":"Temporary halo fixation and radiotherapy as alternative to long-construct spondylodesis in patients with multiple unstable cervical metastases","authors":"E.H. Huele ,&nbsp;J.M. van der Velden ,&nbsp;H.M. Verkooijen ,&nbsp;N. Kasperts ,&nbsp;J.J. Verlaan","doi":"10.1016/j.ctro.2024.100858","DOIUrl":"10.1016/j.ctro.2024.100858","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Currently no minimally invasive surgical treatment exists to provide immediate stability for unstable cervical/cervicothoracic metastases. Long-construct spondylodesis carries a high complication risk and has severe impact on residual range of motion. This study explores temporary halo fixation and radiotherapy as an alternative to long-construct cervical spondylodesis.</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort study included twenty patients with multiple unstable cervical metastases treated between 2013–2023. All patients underwent halo fixation for an intended duration of three months to allow for safe reossification of lytic lesions following radiotherapy, with a dose fractionation scheme best suited to the histological origin of the tumor.</div></div><div><h3>Results</h3><div>Immobilization with halo fixation lasted a median 83 days (range, 41–132 days). Radiotherapy started on average 7 days after halo fixation (range, −35–118 days). The median pain score at baseline was 8, and was 0 at halo removal and at last follow-up. All patients had no or minor neurological deficits at baseline and did not develop new neurological deficits. At halo removal, 17/18 patients showed radiographic evidence of reossification. The majority of patients experienced minor limitations or had full range of motion of the neck at last follow-up.</div></div><div><h3>Conclusion</h3><div>Patients with multiple unstable cervical metastases treated with halo fixation and radiotherapy showed complete pain response or substantial pain reduction, reossification of the vertebrae and a, mostly, preserved range of motion. In selected neurologically intact patients, this treatment might be a patient-friendly alternative to fixation. Prospective evaluation of this treatment combination is needed.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100858"},"PeriodicalIF":2.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001356/pdfft?md5=3c9454ee7e9131e52349a2d5b13d869d&pid=1-s2.0-S2405630824001356-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142311164","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":"Durable local control with hypofractionated radiation therapy for unresectable or metastatic melanoma","authors":"Sydney A. Keatts ,&nbsp;Aya F. Salem ,&nbsp;David M. Swanson ,&nbsp;Ahsan S. Farooqi ,&nbsp;Andrew J. Bishop ,&nbsp;Rodabe N. Amaria ,&nbsp;Jennifer L. McQuade ,&nbsp;Isabella C. Glitza Oliva ,&nbsp;Adi Diab ,&nbsp;Roi Weiser ,&nbsp;Sarah B. Fisher ,&nbsp;Ryan P. Goepfert ,&nbsp;Merrick I. Ross ,&nbsp;B. Ashleigh Guadagnolo ,&nbsp;Devarati Mitra","doi":"10.1016/j.ctro.2024.100856","DOIUrl":"10.1016/j.ctro.2024.100856","url":null,"abstract":"<div><h3>Background and purpose</h3><p>As patients with advanced melanoma live longer in the context of systemic therapy advancements, better strategies for durable control of bulky tumors are needed. In this study, we evaluated if dose-escalated hypofractionated radiation therapy (HFRT) can provide durable local control and improve tumor-associated symptoms in patients with unresectable or bulky metastatic melanoma for whom stereotactic ablative radiotherapy (RT) approaches are not feasible due to tumor size or location.</p></div><div><h3>Materials and methods</h3><p>We retrospectively reviewed 49 patients with unresectable or bulky metastatic melanoma who were treated to a total of 53 tumor targets with 12–17 fractions HFRT at our institution between 2015–2022. Clinical scenarios included: unresectable, locoregional only disease (26 %); oligometastatic disease (&lt;3 total sites, 17 %); oligoprogressive disease (&lt;3 sites progressing, 17 %); and aggressive palliation (&gt;5 known sites of disease or with at least 3 sites progressing, 40 %).</p></div><div><h3>Results</h3><p>Of the 53 HFRT targets, 91 % (n = 48) had radiographic evidence of response as defined by either stabilization (6 %, n = 3), decreased size (74 %, n = 39), or decreased FDG avidity (11 %, n = 6). Of the 43 symptomatic patients, 98 % (n = 42) had symptomatic improvement. One −year local control was 79 %, with 2-year progression-free and overall survival of 33 % and 39 % respectively. The most common acute toxicities were radiation dermatitis (16 %, n = 8) or a pain flare (14 %, n = 7). Late toxicities were uncommon and typically grade 1.</p></div><div><h3>Conclusion</h3><p>HFRT provides favorable local control and symptomatic relief with limited toxicity in tumors not amenable to surgical resection or stereotactic ablative RT.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"49 ","pages":"Article 100856"},"PeriodicalIF":2.7,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824001332/pdfft?md5=cf6d774fdeacb5d0ed0a81599e6d8483&pid=1-s2.0-S2405630824001332-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229532","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}