Clinical and Translational Radiation Oncology最新文献

{"title":"Position in proton Bragg curve influences DNA damage complexity and survival in head and neck cancer cells","authors":"Tim Heemskerk ,&nbsp;Celebrity Groenendijk ,&nbsp;Marta Rovituso ,&nbsp;Ernst van der Wal ,&nbsp;Wouter van Burik ,&nbsp;Konstantinos Chatzipapas ,&nbsp;Danny Lathouwers ,&nbsp;Roland Kanaar ,&nbsp;Jeremy M.C. Brown ,&nbsp;Jeroen Essers","doi":"10.1016/j.ctro.2024.100908","DOIUrl":"10.1016/j.ctro.2024.100908","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Understanding the cellular and molecular effect of proton radiation, particularly the increased DNA damage complexity at the distal end of the Bragg curve, is current topic of investigation. This work aims to study <em>in vitro</em> clonogenic survival and DNA damage foci kinetics of a head and neck squamous cell carcinoma cell line at various positions along a double passively scattered Bragg curve. Complementary <em>in silico</em> studies are conducted to gain insights into the link between cell survival variations, experimentally yielded foci and the number and complexity of double strand breaks (DSBs).</div></div><div><h3>Materials and methods</h3><div>Proton irradiations are performed at the HollandPTC R&amp;D proton beamline, using a double passively scattered setup. A custom water phantom setup is employed to accurately position the samples within the Bragg curve. FaDu cells are irradiated at the proximal 36 % point of the Bragg peak, (P36), proximal 80 % point of the Bragg peak (P80) and distal 20 % point of the Bragg peak (D20), with dose-averaged mean lineal energies (<span><math><mover><mrow><msub><mi>y</mi><mi>D</mi></msub></mrow><mrow><mo>¯</mo></mrow></mover></math></span>) of 1.10 keV/μm, 1.80 keV/μm and 7.25 keV/μm, respectively.</div></div><div><h3>Results</h3><div>Clonogenic survival correlates strongly with <span><math><mover><mrow><msub><mi>y</mi><mi>D</mi></msub></mrow><mrow><mo>¯</mo></mrow></mover></math></span>, showing similar survival for P36 (D_37%=3.0 Gy) and P80 (D_37%=2.9 Gy), but decreased survival for D20 (D_37% = 1.6 Gy). D20 irradiated samples exhibit increased 53BP1 foci shortly after irradiation, slower resolution of the foci, and larger residual 53BP1 foci after 24 h, indicating unrepaired complex breaks. These experimental observations are supported by the <em>in silico</em> study which demonstrates that irradiation at D20 leads to a 1.7-fold increase in complex DSBs with respect to the total number of strand breaks compared to P36 and P80.</div></div><div><h3>Conclusions</h3><div>This combined approach provides valuable insights into the cellular and molecular effect of proton radiation, emphasizing the increased DNA damage complexity at the distal end of the Bragg curve, and has the potential to enhance the efficacy of proton therapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100908"},"PeriodicalIF":2.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058131","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":"Corrigendum to “Image-guided superficial radiation therapy has superior 2-year recurrence probability to Mohs micrographic surgery” [Clin. Transl. Radiat. Oncol. 43 (2023) 100678]","authors":"Erin M. McClure ,&nbsp;Geoffrey Sedor ,&nbsp;Yuxuan Jin ,&nbsp;Michael W. Kattan","doi":"10.1016/j.ctro.2024.100876","DOIUrl":"10.1016/j.ctro.2024.100876","url":null,"abstract":"","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100876"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143165952","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":"Elective pelvic nodal irradiation for elderly patients with high-risk prostate cancer: A more patient-oriented approach","authors":"Federico Iori ,&nbsp;Matteo Augugliaro ,&nbsp;Emanuele Alì ,&nbsp;Cinzia Iotti","doi":"10.1016/j.ctro.2024.100909","DOIUrl":"10.1016/j.ctro.2024.100909","url":null,"abstract":"<div><div>The role of elective pelvic nodal irradiation (EPNI) for high-risk prostate cancer (hrPC) management is still an open issue, especially for the elderly patients. It is unclear whether older patients can experience the same benefit from the treatment strategies used for younger men. Hence, in absence of solid data, it appears reasonable to pursuit a shared decision-making process so that older patients can express their informed preferences about the different treatment options. In this letter, we discuss why caution appears reasonable on EPNI<!--> <!-->trade-off in hrPC patients aged 75 years or more.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100909"},"PeriodicalIF":2.7,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021650","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":"Urethra-sparing prostate cancer radiotherapy: Current practices and future insights from an international survey","authors":"Jennifer Le Guévelou ,&nbsp;Paul Sargos ,&nbsp;Piet Ost ,&nbsp;Filippo Alongi ,&nbsp;Stefano Arcangeli ,&nbsp;Alejandro Berlin ,&nbsp;Pierre Blanchard ,&nbsp;Anna Bruynzeel ,&nbsp;Olivier Chapet ,&nbsp;Alan Dal Pra ,&nbsp;Robert T. Dess ,&nbsp;Matthias Guckenberger ,&nbsp;Andrew Loblaw ,&nbsp;Amar U. Kishan ,&nbsp;Barbara Alicja Jereczek-Fossa ,&nbsp;David Pasquier ,&nbsp;Mohamed Shelan ,&nbsp;Shankar Siva ,&nbsp;Alison C. Tree ,&nbsp;Costantinos Zamboglou ,&nbsp;Thomas Zilli","doi":"10.1016/j.ctro.2024.100907","DOIUrl":"10.1016/j.ctro.2024.100907","url":null,"abstract":"<div><h3>Purpose</h3><div>In prostate cancer patients, high radiation doses to the urethra have been associated with an increased risk of severe genitourinary toxicity following dose-escalated radiotherapy. Urethra-sparing techniques have emerged as a promising approach to reduce urinary toxicity. This international survey aims to evaluate current global practices in urethra-sparing and explore future directions for the implementation of this technique in external beam radiotherapy (EBRT) for prostate cancer.</div></div><div><h3>Methods and materials</h3><div>In April 2024, a survey consisting of 20 questions was distributed to 26 international radiation oncology experts in prostate cancer EBRT, with 23 experts participating. The survey focused on clinical scenarios which might take benefit from urethra-sparing, the definition of the urethra and urinary organs-at-risk, and urethral dose constraints.</div></div><div><h3>Results</h3><div>Magnetic resonance imaging with T2-weighted sequences is the preferred method for urethra contouring (83 % consensus). Based on the experts opinion, urethra-sparing should be considered for prostate cancer EBRT, regardless of pelvic irradiation, except in cases where the tumor is located within 2 mm of the urethra and/or transitional zone, or in T4 disease. Most experts would not apply specific dose constraints to the urethra for either conventional or moderate hypofractionation regimens. When delivering stereotactic body radiotherapy (SBRT), urethra-sparing with dose hotspot limitation (urethra steering) is recommended by 70 % of the experts, in particular when combined with focal boosting (91 %). Urethra dose-reduction is also the favored approach for salvage prostate reirradiation with SBRT (70 % agreement). Large variations exists regarding urethral dose constraints.</div></div><div><h3>Conclusions</h3><div>Urethra-sparing is a promising technique for the mitigation of urinary toxicity in prostate cancer patients undergoing EBRT, particularly recommended for ultra-hypofractionation and reirradiation with SBRT. The lack of consensus on specific urethral dose constraints and optimal sparing techniques underscores the need for further research to standardize practices in this field.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100907"},"PeriodicalIF":2.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021576","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":"E_N_T_R_O_P_Y: Monocentric analysis of rectal cancer radio-chemotherapy treatment in patients of young age","authors":"E. Meldolesi ,&nbsp;A. Nicolì ,&nbsp;N. Dinapoli ,&nbsp;G. Chiloiro ,&nbsp;A. Romano ,&nbsp;R. Menghi ,&nbsp;R. Persiani ,&nbsp;F. Pacelli ,&nbsp;C. Coco ,&nbsp;C. Ratto ,&nbsp;S. Manfrida ,&nbsp;L. Boldrini ,&nbsp;B. Corvari ,&nbsp;M.A. Gambacorta","doi":"10.1016/j.ctro.2024.100905","DOIUrl":"10.1016/j.ctro.2024.100905","url":null,"abstract":"<div><h3>Purpose//objectives</h3><div>A disproportionate incidence‘s increase of rectal cancer in patients younger than 50 years of age. The ESMO and NCCN recommendations are not age-specific and the literature is poor and conflicting. We decided to examine patients with rectal cancer treated in our centre in the last 15 years with curative neoadjuvant radiochemotherapy comparing outcomes in the two groups under and over 55 years old.</div></div><div><h3>Materials/methods</h3><div>788 rectal cancer patients were enrolled in this monocentric retrospective observational study (523 =&gt;55 years and 265 &lt; 55). All patients received neoadjuvant chemoradiation treatment. R statistical software v.4.1.3 was used for the entire analysis. The outcomes were death, local recurrence, and new distant metastases. Survival analysis was performed using the Kaplan-Meier method and the Log-rank was used to compare the two groups.</div></div><div><h3>Results</h3><div>All patients were classified in different risk groups, according to the ESMO 2017 rectal cancer clinical practice guidelines. 88 % of patients under 55 years old at the diagnosis belonged to the bad or advanced risk groups with an equal division. In patients over 55 years old, there was a clear dominance of the advanced risk class (62 % of the total). In multivariate analysis, OS and DFS decrease with increasing age and ESMO risk group. The other variables in multivariate were not significant. For Both OS, DFS and MFS, the curves separated significantly at 55 years of age, with a prevalence of metastasis development in the older group.</div></div><div><h3>Conclusion</h3><div>Elderly patients have a prevalence of advanced disease. Younger patients seem having a better OS at 3 and 5 years. ESMO risk group and age were the only variables affecting OS and DFS. Young patients have better MFS and DFS at 2 and 5 years than patients older than 55 years. The addition of oxaliplatin to fluoropyrimidine-based neoadjuvant chemotherapy resulted not significant in both groups.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100905"},"PeriodicalIF":2.7,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064299","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":"Neoadjuvant chemoradiotherapy up-regulates PD-L1 in radioresistant colorectal cancer","authors":"Sung Uk Bae ,&nbsp;Hye Won Lee ,&nbsp;Jee Young Park ,&nbsp;Incheol Seo ,&nbsp;Jae-Min Cho ,&nbsp;Jin Young Kim ,&nbsp;Ju Yup Lee ,&nbsp;Yoo Jin Lee ,&nbsp;Seong Kyu Baek ,&nbsp;Nam Kyu Kim ,&nbsp;Sang Jun Byun ,&nbsp;Shin Kim","doi":"10.1016/j.ctro.2024.100906","DOIUrl":"10.1016/j.ctro.2024.100906","url":null,"abstract":"<div><h3>Background</h3><div>Combining radiotherapy (RT) with immune checkpoint inhibitors (ICIs) is a promising strategy that can enhance the therapeutic efficacy of ICIs. However, little is known about RT-induced changes in the expression of immune checkpoints, such as PD-L1, and their clinical implications in colorectal cancer (CRC). This study aimed to investigate the association between responsiveness to RT and changes in PD-L1 expression in human CRC tissue and cell lines.</div></div><div><h3>Methods</h3><div>Tissue specimens from preoperative biopsy via sigmoidoscopy and surgical resection were obtained from 24 patients with locally advanced rectal cancer (LARC) who underwent neoadjuvant chemoradiation therapy (CRT) between August 2016 and December 2017. Immunohistochemistry for PD-L1 in formalin-fixed paraffin-embedded tissue was performed from the endoscopic biopsy and surgical specimens. RNA sequencing was performed using 11 pairs of human LARC tissues before and after irradiation. After exposing human CRC cells to radiation, we investigated changes in the expression levels of PD-L1 and its regulatory signaling pathways.</div></div><div><h3>Results</h3><div>Patients were classified by tumor regression grade into responders (grade 2; 9 patients, 37.5 %) and non-responders (grades 3, 4, or 5; 15 patients, 62.5 %). In the non-responder group, 13 patients had low PD-L1 expression, but neoadjuvant CRT increased PD-L1 expression in 7 patients (53.9 %) (McNemar’s test, p=0.034). CRT up-regulated PD-L1 in non-responder LARC tissues. Similarly, radiation increased PD-L1 in radioresistant DLD-1 cells more than in radiosensitive HCT116 cells, also affecting PD-L1-regulating genes and immune checkpoints in CRC cells. Conventional fractionated radiation treatment further increased PD-L1 in DLD-1 cells compared to HCT116 cells.</div></div><div><h3>Conclusions</h3><div>This study demonstrated that radiation induces an increase in PD-L1 expression, which is more pronounced in radioresistant CRC, proving the theoretical framework for a combined treatment strategy with a PD-L1 blockade for locally advanced rectal cancer.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100906"},"PeriodicalIF":2.7,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982967","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":"Cardiorespiratory-gated cardiac proton radiotherapy using a novel ultrasound guidance system","authors":"Keith A Cengel ,&nbsp;Zayne Belal ,&nbsp;Michele M Kim ,&nbsp;Sarah Hagan ,&nbsp;Saskia Camps ,&nbsp;Alexander Kalinin ,&nbsp;Weihow Hsue ,&nbsp;Eric Diffenderfer ,&nbsp;Adriano Garonna ,&nbsp;Cory Tschabrunn","doi":"10.1016/j.ctro.2024.100904","DOIUrl":"10.1016/j.ctro.2024.100904","url":null,"abstract":"<div><div>Cardiac stereotactic body radiotherapy is a promising noninvasive treatment for patients with refractory ventricular tachycardia. With the aim to prove feasibility of a novel image guided radiotherapy and heart motion gating device, cardiac proton radiotherapy was performed using a porcine model. Using a novel adaptation of γ − H2AX tissue staining techniques, we have been able to localize a radiation beam in large animal tissue to assess targeting accuracy within a defined field. Cardiorespiratory-gated irradiations of the animals were successfully completed and analysis of the γ-H2AX staining intensity of the excised heart after radiation demonstrated radiotherapy was delivered close to or within the expected region. We simulated the irradiated volumes under different gating scenarios, showing significant reduction when using combined cardiorespiratory gating. The results of this study show the feasibility of proton irradiation of the heart left ventricle with a novel ultrasound based cardiorespiratory gating technology with the benefit of reduced irradiation volumes and increased healthy tissue sparing.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100904"},"PeriodicalIF":2.7,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11764844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045701","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":"Brain radiotherapy and dorsal vagal complex irradiation: A new organ at risk to decrease radiation-induced nausea and vomiting?","authors":"Valentine Caspar ,&nbsp;Nicolas Giraud ,&nbsp;Thomas Charleux ,&nbsp;Arnaud Beddok ,&nbsp;Brieuc Bernard ,&nbsp;Maelle Martin ,&nbsp;Juliette Thariat ,&nbsp;Aymeri Huchet ,&nbsp;Véronique Vendrely ,&nbsp;Charles Dupin","doi":"10.1016/j.ctro.2024.100902","DOIUrl":"10.1016/j.ctro.2024.100902","url":null,"abstract":"<div><h3>Purpose</h3><div>Nausea is a common symptom in patients irradiated for benign brain tumors. The dorsal vagal complex (DVC) located in the brainstem (BS) has been identified as the center of nausea and vomiting. The objective of our study was to determine an association between mean dose to the DVC and nausea.</div></div><div><h3>Material</h3><div>Details of consecutive patients treated for benign brain tumors at the Bordeaux University Hospital using normofractionated intensity modulated radiotherapy technique, without chemotherapy, were accessed. DVC delineation was performed on MRI T1 sequences with gadolinium injection using a reference atlas.</div></div><div><h3>Results</h3><div>Among 102 patients, 68 were women, and median age was 61.5 years. The tumors treated were primarily meningiomas (80 %) and neurinomas (17 %). The median dose was 54 Gy [48.6–57.6 Gy]. In the overall population, 40 (39.2 %) had nausea, requiring anti-nausea treatment for 23 (57.5 %). Patients with nausea were significantly younger (45.5 versus 63.2 years, p = 0.014).</div><div>For patients without and with nausea, the mean DVC dose was 8.9 Gy versus 21.6 Gy (p &lt; 10^-4), respectively, and the mean brainstem dose was 16.9 Gy versus 27.1 Gy (p &lt; 10^-3). The optimal threshold for mean DVC dose was 8.82 Gy (AUC = 0.731, p &lt; 10^-4). Patients with DVC receiving less than 8.82 Gy had a 16 % risk to have nausea versus 62 % for patients receiving more than 8.82 Gy (p &lt; 10^-4). The optimal threshold for mean brainstem dose was 24 Gy (AUC = 0.715p &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>The mean DVC dose is significantly associated with radiation-induced nausea. A dose constraint below 8.82 Gy to decrease the incidence of radiation-induced nausea needs to be validated by a prospective study.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100902"},"PeriodicalIF":2.7,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982966","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":"Treatment time and learning curve analysis of 1.5 T MR-Linac workflows led by radiation oncologists or therapists","authors":"J.M. Westerhoff ,&nbsp;F.J. Raaijmakers ,&nbsp;L.A. Daamen ,&nbsp;E.N. de Groot-van Breugel ,&nbsp;L.T.C. Meijers ,&nbsp;J.R.N. van der Voort van Zyp ,&nbsp;J.J.C. Verhoeff ,&nbsp;S. Mook ,&nbsp;H.M. Verkooijen ,&nbsp;M.P.W. Intven","doi":"10.1016/j.ctro.2024.100901","DOIUrl":"10.1016/j.ctro.2024.100901","url":null,"abstract":"<div><h3>Background and purpose</h3><div>This study assessed the treatment time of online adaptive (i.e. Adapt-to-Shape, ATS) and virtual couch shift (i.e. Adapt-to-Position, ATP) magnetic resonance guided radiotherapy (MRgRT) on a 1.5 Tesla MR-Linac. Additionally, the transition from a radiation oncologists (RO)-led to a radiation therapist (RTT)-led workflow, and the presence of a learning curve were assessed.</div></div><div><h3>Materials and methods</h3><div>This study was conducted utilizing the prospective Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-Linac study (MOMENTUM, <span><span>NCT04075305</span><svg><path></path></svg></span>). Mean (±standard deviation) online adaptation time and total treatment time were collected from MR-Linac log files. Learning and proficiency phases were defined using a cumulative sum (CUSUM) analysis. Independent T-tests were performed. A p-value &lt; 0.01 was considered statistically significant.</div></div><div><h3>Results</h3><div>In total, 4942 fractions of 645 patients were included. Mean total treatment time was 39 (±7), 15 (±2), 34 (±8), 41 (±11), and 40 (±7) minutes for ATS-treated prostate cancer, ATP-treated prostate cancer, ATS-treated pelvic lymph node metstasis (LNM), ATS-treated abdominal LNM and ATS-treated rectal cancer, respectively. Mean online adaptation time of RO-led and RTT-led treatment was 28 (±6) and 25 (±6) minutes (p &lt; 0.001) for ATS-treated prostate cancer. No significant differences in the remaining subgroups were found. In subgroups with a learning curve, mean online adaptation time of learning and proficiency phase were 30 (±6) and 26 (±5) minutes (p &lt; 0.001) for ATS-treated prostate cancer, 27 (±8) and 19 (±7) minutes for pelvic LNM (p &lt; 0.001), and 29 (±7) and 25 (±7) minutes (p &lt; 0.001) for rectal cancer, respectively.</div></div><div><h3>Conclusion</h3><div>The transition from RO-led to RTT-led workflows did not significantly increase total treatment time. The online adaptation time reduced after a learning curve for ATS-treated prostate cancer, pelvic LNM and rectal cancer.</div><div><strong>Keywords</strong>; MRgRT, MR-Linac, time, prostate cancer, oligolymphnode metastasis, rectal cancer.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100901"},"PeriodicalIF":2.7,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045718","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":"Radiotherapy-induced Hypothalamic-Pituitary axis dysfunction in adult Brain, head and neck and skull base tumor patients – A systematic review and Meta-Analysis","authors":"J.M.J. Paulissen ,&nbsp;C.M.L. Zegers ,&nbsp;R.M. Houben ,&nbsp;D. Hofstede ,&nbsp;M. Kars ,&nbsp;H.M. van Santen ,&nbsp;F.J.P. Hoebers ,&nbsp;D.K.M. De Ruysscher ,&nbsp;D.B.P. Eekers","doi":"10.1016/j.ctro.2024.100900","DOIUrl":"10.1016/j.ctro.2024.100900","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background and purpose&lt;/h3&gt;&lt;div&gt;Radiotherapy for brain, head &amp; neck (HN), and skull base (SB) tumors may deliver significant radiation dose to the hypothalamic-pituitary axis (HPA), leading to impaired functioning of this region and hence, to endocrine disorders. The purpose of this systematic review and &lt;em&gt;meta&lt;/em&gt;-analysis is to investigate literature on HP dysfunction after radiation for non-pituitary brain, HN, or SB tumors at adult age, aiming to give insight in the prevalence of HP dysfunction related to radiation dose.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;Literature search of the PubMed database was performed for HP dysfunction after radiotherapy in adult patients. A risk of bias assessment was performed to rate the quality of the included papers. Besides clinical and treatment variables, reported insufficiencies for adrenocorticotrophic hormone, thyroid stimulating hormone, growth hormone, prolactin and follicle stimulating hormone and luteinizing hormone and for insufficiency of any axis were extracted. The prevalence for hormonal insufficiency per axis and for multiple axes was calculated using a random effects &lt;em&gt;meta&lt;/em&gt;-regression with a random effect at the study level.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;The literature selection process resulted in a total of 22 original papers, suitable for full assessment (n = 1,462 patients). Literature showed a wide variation in HP dysfunction, along with wide dose ranges given to the hypothalamus and pituitary, with varying follow-up times. The calculated prevalence for any pituitary insufficiency was on average 0.61 (95 % CI 0.44–0.75). For growth hormone the mean prevalence was 0.40 (95 % CI 0.22–0.61), for prolactin 0.22 (95 % CI 0.17–0.28), for gonadotropin 0.20 (95 % CI 0.14–0.28), for adrenocorticotropic hormone 0.16 (95 % CI 0.08–0.30) and for thyroid stimulating hormone 0.16 (95 % CI 0.11–0.23). The prevalence for any insufficiency of 1 axis was 0.19 (95 % CI 0.11–0.30), of 2 axes 0.22 (95 % CI 0.12–0.38), of 3 axes 0.05 (95 % CI 0.03–0.09) and of panhypopituitarism 0.17 (95 % CI 0.08–0.32). Patients irradiated for nasopharyngeal carcinoma (NPC) seemed to be at highest risk for developing any endocrine insufficiency with a mean prevalence of 0.68 (95 % CI 0.45–0.85). A significant correlation between any endocrine insufficiency and follow-up time was observed (p = 0.015). A correlation between dose to the pituitary and occurrence of insufficiency on the hormonal axes could not be observed.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Endocrine insufficiency is reported in over half of the patients irradiated for brain, HN and SB malignancies. The hypothalamus is likely to be more vulnerable to radiation dose compared to the pituitary gland. More research is needed to establish dose thresholds for the hypothalamus and the pituitary to minimize the risk for pituitary insufficiency. Based on this knowledge, radiotherapy and follow-up of these patient groups shou","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100900"},"PeriodicalIF":2.7,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969877","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}