Clinical and Translational Radiation Oncology最新文献

{"title":"ACO/ARO/AIO-22 – External beam radiotherapy combined with endorectal high-dose-rate brachytherapy in elderly and frail patients with rectal cancer: A prospective multicentre trial of the German Rectal Cancer Study Group","authors":"Hendrik Dapper ,&nbsp;Maximilian Fleischmann ,&nbsp;Nikolaos Tselis ,&nbsp;Markus Diefenhardt ,&nbsp;Ralf-Dieter Hofheinz ,&nbsp;Christian Weiß ,&nbsp;Gerhard G. Grabenbauer ,&nbsp;Ricarda Merten ,&nbsp;Anca-Ligia Grosu ,&nbsp;Simon Kirste ,&nbsp;Stefan Rieken ,&nbsp;Johannes Claßen ,&nbsp;Christian Langer ,&nbsp;Thomas Kuhnt ,&nbsp;Heinz Schmidberger ,&nbsp;Michael Ghadimi ,&nbsp;Frank Giordano ,&nbsp;Ursula Nestle ,&nbsp;Stefan A. Koerber ,&nbsp;Felix Bock ,&nbsp;Emmanouil Fokas","doi":"10.1016/j.ctro.2025.100958","DOIUrl":"10.1016/j.ctro.2025.100958","url":null,"abstract":"<div><h3>Purpose</h3><div>Rectal cancer disproportionately affects the elderly population, with more than half of cases diagnosed in individuals aged 70 years or older. Frail patients in this group often face significant challenges tolerating the standard treatment of total mesorectal excision (TME), due to elevated risks of surgical complications and perioperative morbidity. Advances in radiotherapy techniques offer a viable alternative, providing effective tumor control while minimizing treatment-related toxicity. Recent clinical trials, including OPERA and MORPEUS, have demonstrated that dose-escalated radiotherapy, which integrates external beam (chemo)radiotherapy (EBRT) with high-dose-rate endorectal brachytherapy (HDR-BT) or contact X-ray brachytherapy (CXB), can achieve high clinical response rates and facilitate organ preservation in younger, healthier patient cohorts. Building on these findings, the ACO/ARO/AIO-22 study seeks to adapt these innovative approaches to meet the needs of elderly and frail patients with rectal cancer.</div></div><div><h3>Methods/Design</h3><div>The ACO/ARO/AIO-22 trial is a prospective multicentre controlled trial. Elderly (age ≥70 years) and/or frail patients with non-metastatic rectal adenocarcinoma (cT1-3d N0/+ M0, mrCRM − / +) localized 0–16 cm from the ano-cutaneous line, unable to undergo radical surgery can be included. The initial treatment comprises an external beam radiation (EBRT) regime with 13 × 3 Gy (total: 39 Gy) over a period of two and a half weeks. Following initial restaging 6.5 weeks after completion of EBRT, endorectal HDR-BT will be delivered with 3 weekly fractions of 8 Gy to a total dose of 24 Gy (prescribed at the radial margin of the tumor; with a maximum prescription depth of 10 mm); alternatively, with CXB with 90 Gy in 3 weekly fractions. The primary objective is complete or near complete clinical response (cCR or ncCR) and the second primary endpoint is quality of life (QoL) measured with the EORTC QLQ-ELD14, both at 12 months after treatment start.</div></div><div><h3>Discussion</h3><div>The ACO/ARO/AIO-22 prospective multicentre trial will evaluate organ preservation rates and QoL after combining EBRT with endorectal HDR-BT in elderly and/or frail patients with rectal cancer.</div><div><strong>Trial Registration:</strong> <span><span>Clinicialtrials.gov</span><svg><path></path></svg></span> number: NCT06729645.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100958"},"PeriodicalIF":2.7,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833244","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":"Impact of hypoxic versus oxic conditions on local tumor control after proton irradiation in a rat prostate carcinoma","authors":"Michaela Schmitt ,&nbsp;Christin Glowa ,&nbsp;Ina Kurth ,&nbsp;Peter Peschke ,&nbsp;Stephan Brons ,&nbsp;Christian P. Karger","doi":"10.1016/j.ctro.2025.100957","DOIUrl":"10.1016/j.ctro.2025.100957","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Hypoxia in tumors significantly contributes to radiation resistance, often leading to poor treatment outcomes. <em>In vitro</em> studies demonstrated that proton irradiation not only exhibits an increased relative biological effectiveness (RBE), but also a lower oxygen enhancement ratio (OER). This study explored the impact of hypoxic and oxic conditions on local tumor control after proton irradiation in a rat prostate carcinoma.</div></div><div><h3>Material and methods</h3><div>Subcutaneously transplanted Dunning R3327-HI rat prostate carcinomas were irradiated with varying single doses of protons under oxic or hypoxic conditions. Hypoxia was induced by clamping the tumor-supplying vessels. The biological endpoint was local tumor control assessed 300 days after irradiation. Dose-response curves were determined and based on the doses required for 50 % tumor control probability (TCD₅₀), the RBE and OER were calculated.</div></div><div><h3>Results</h3><div>The TCD₅₀ value was significantly higher under hypoxic than under oxic conditions (73.4 ± 1.9 Gy vs. 50.5 ± 1.6 Gy), resulting in an OER of 1.45 ± 0.06 for proton irradiation. Compared to photon irradiation, the RBE for protons was of 1.23 ± 0.07 under oxic and 1.30 ± 0.04 under hypoxic conditions.</div></div><div><h3>Conclusion</h3><div>Proton irradiations showed a 5 % reduction in OER compared to the previously measured photon value of 1.53 ± 0.08, suggesting a slightly higher effectiveness of protons in hypoxic tumors as compared to photons.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100957"},"PeriodicalIF":2.7,"publicationDate":"2025-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839629","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":"Examining the role of elective pelvic radiotherapy in patients Diagnosed with high- and very High-Risk Non-Metastatic prostate cancer","authors":"István Nahaji ,&nbsp;Zsuzsa S. Kocsis ,&nbsp;Andrea Kovács ,&nbsp;Levente Varga ,&nbsp;László Gesztesi ,&nbsp;Kliton Jorgo ,&nbsp;Zoltán Takácsi-Nagy ,&nbsp;Csaba Polgár ,&nbsp;Péter Ágoston","doi":"10.1016/j.ctro.2025.100960","DOIUrl":"10.1016/j.ctro.2025.100960","url":null,"abstract":"<div><h3>Introduction</h3><div>In the treatment of node-negative, non-metastatic high-risk (HR) and very high-risk (VHR) prostate cancer, the necessity of elective pelvic irradiation is controversial. According to our in-house treatment protocol − elective pelvic irradiation is generally omitted for HR and VHR patients over the age of 70 or those in poor general health due to its toxicity.</div></div><div><h3>Objective</h3><div>To retrospectively examine the outcome for HR and VHR prostate cancer patients treated with elective whole pelvic radiotherapy (WPRT) versus prostate-only radiotherapy (PORT).</div></div><div><h3>Materials and Methods</h3><div>The study included 434 patients treated with definitive radiotherapy, 203 patients received PORT (HR: 127, VHR: 76) and 231 WPRT (HR: 113, VHR: 118) with a boost to the prostate. Patients also received 2–3 years of androgen deprivation. Patients’ average age who received PORT vs. WPRT was 73.9 ± 4.3 years vs. 66.4 ± 5.4 years respectively. An inverse propensity score weighting method was utilized to create homogeneous WPRT and PORT treatment groups that are balanced for T stage, PSA, and Gleason score, but not for age. The survival outcomes for HR and VHR subgroups were examined depending on whether they received WPRT or PORT. Biochemical- (BRFS), local- (LRFS) and regional relapse-free survival (RRFS), distant metastasis-free- (DMFS), disease-free- (DFS), failure-free- (FFS), and overall survival (OS) were compared using the Kaplan −Meier method and Cox regression analysis.</div></div><div><h3>Results</h3><div>The median follow-up time was 76 months (3–134 months). In the VHR subgroup five-year outcomes showed a significant advantage for patients receiving WPRT vs. PORT in BRFS (82.2 % vs. 73 %; p = 0.028), in DMFS (87.5 % vs. 73.6 %; p = 0.025), in DFS (86.1 % vs. 70.5 %; p = 0.012), and in FFS (82.3 % vs. 68.9 %; p = 0.005), respectively. The OS (92.8 % vs. 81.8 %; p = 0.056) showed a trend favoring the WPRT group. There was no significant difference between WPRT vs. PORT in LRFS (95.8 % vs. 96.4 %; p = 0.763) and RRFS (95.8 % vs. 89.9 %; p = 0.099). On the contrary, in the HR group, no significant survival differences were observed between WPRT vs. PORT groups: BRFS 93.0 % vs. 93.3 % (p = 0.978), LRFS 99.0 % vs. 100 % (p = 0.120), RRFS 98.2 % vs. 95.1 % (p = 0.813), DMFS 93.5 % vs. 95.5 % (p = 0.793), DFS 91.7 % vs. 92.9 % (p = 0.691), FFS 89.5 % vs. 90.9 % (p = 0.853), OS 91.0 % vs. 87.7 % (p = 0.407).</div></div><div><h3>Conclusion</h3><div>Based on our retrospective data elective pelvic irradiation can be omitted in HR patients, especially over the age of 70. For VHR patients, elective pelvic irradiation should be considered even for the subgroup of elderly patients.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100960"},"PeriodicalIF":2.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826478","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":"Rectal stenosis after immunotherapy in a mismatch repair deficient rectal cancer. Case report and review of literature","authors":"Marcel Büttner ,&nbsp;Ulrike Schempf ,&nbsp;Robert Bachmann ,&nbsp;Rüdiger Hoffmann ,&nbsp;Christopher Schroeder ,&nbsp;Sven Mattern ,&nbsp;Stephan Singer ,&nbsp;Marc Steinle ,&nbsp;Maximilian Niyazi ,&nbsp;Michael Bitzer ,&nbsp;Cihan Gani","doi":"10.1016/j.ctro.2025.100953","DOIUrl":"10.1016/j.ctro.2025.100953","url":null,"abstract":"<div><div>We report the case of a 57-year-old male patient who presented with a circumferential cT3 cN1 rectal adenocarcinoma in the mid rectum. The tumor was found to be mismatch repair deficient/microsatellite instable (dMMR/MSI). Instead of multimodality treatment with chemoradiotherapy immunotherapy with Dostarlimab was initiated. Treatment was well-tolerated in general and endoscopy and MRI showed early signs of treatment response. Despite this, the patient developed intestinal obstruction due to scarring that required repeat balloon dilations. In contrast to other oncological treatments, obstructions may worsen during immunotherapy in dMMR rectal cancers. This information has to be considered when patients are consulted regarding the optimal treatment after disease.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100953"},"PeriodicalIF":2.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143863558","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":"A pattern of local failure after preoperative 5 × 5 Gy in soft tissue sarcomas: A long-term real-world experience","authors":"Konrad Zasadziński ,&nbsp;Aneta Borkowska ,&nbsp;Tadeusz Morysiński ,&nbsp;Hanna Koseła-Paterczyk ,&nbsp;Piotr Rutkowski ,&nbsp;Mateusz Jacek Spałek","doi":"10.1016/j.ctro.2025.100954","DOIUrl":"10.1016/j.ctro.2025.100954","url":null,"abstract":"<div><h3>Introduction</h3><div>Preoperative radiotherapy (RT) is used to improve local control (LC) and facilitate limb-sparing procedures in patients with localized soft tissue sarcomas (STS). While conventional preoperative RT delivers 50–50.4 Gy in 25–28 fractions, alternative hypofractionated regimens are under investigation. A 5x5 Gy regimen has been investigated in STS, but its long-term LC rates appear suboptimal. The aim of this study is to analyze the characteristics of patients with local recurrence (LR) after 5x5 Gy and to identify potential RT-related factors affecting efficacy.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients who received 5x5 Gy and underwent surgery for localized extremity and truncal STS in three clinical trials and institutional records. Patient, tumor, and treatment characteristics were evaluated. We assessed the quality of RT plans and recurrence patterns.</div></div><div><h3>Results</h3><div>Among 174 patients who experienced LR after 5x5 Gy, pleomorphic sarcoma (23 %), myxofibrosarcoma (17.8 %), and malignant peripheral nerve sheath tumor (12 %) were the most common pathologic diagnoses. No LR was observed in patients with myxoid liposarcoma. Almost all analyzed plans met the quality criteria. Most patients (86.2 %) had in-volume recurrences, suggesting inadequate tumor cell eradication rather than insufficient margins or poor target coverage. Dose equivalence analysis suggested that 5x5 Gy (EQD2 = 37.5 Gy for STS, assuming alpha/beta ratio of 4 Gy) may be insufficient, especially for radioresistant subtypes.</div></div><div><h3>Conclusions</h3><div>The primary factor contributing to LR after 5x5 Gy appears to be insufficient total dose. Future clinical trials should explore dose escalation beyond 5 Gy per fraction, except in myxoid liposarcoma where 5x5 Gy remains effective.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100954"},"PeriodicalIF":2.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800581","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":"Challenges and opportunities to minimize the dose in the neurovascular bundles during prostate radiotherapy","authors":"Victor J. Brand ,&nbsp;Linda Rossi ,&nbsp;Maaike T.W. Milder ,&nbsp;Femke E. Froklage ,&nbsp;Alison C. Tree ,&nbsp;Mischa S. Hoogeman ,&nbsp;Luca Incrocci","doi":"10.1016/j.ctro.2025.100959","DOIUrl":"10.1016/j.ctro.2025.100959","url":null,"abstract":"<div><div>Background and purpose: Radiation damage to the neurovascular bundles (NVB) has been linked to erectile dysfunction after prostate cancer radiotherapy (PCa). NVB sparing using coplanar and non-coplanar automated treatment planning is presented here in two settings: (1) without compromising target coverage, (2) allowing target coverage compromise. Material and methods: 20 previously treated patients with localized PCa. Based on a MRI-CT match, the NVB were retrospectively delineated. All treatment plans (5 × 7.25 Gy) were automatically generated using Erasmus-iCycle (in-house automated treatment planning algorithm). Non-NVB sparing (non-NVBsparing) plans and NVB sparing plans in two settings were generated: (1) uncompromised NVB sparing (u-NVBsparing; maintaining target coverage) (2) and compromised NVB sparing (c-NVBsparing; allowing target underdosage). Coplanar and non-coplanar beam arrangements were compared. U-NVBsparing was compared to non-NVBsparing. C-NVBsparing plans were visualized in Pareto fronts. Statistical significance (p-value &lt; 0.05) was determined by Wilcoxon signed-rank test. Results: u-NVBsparing compared to non-NVBsparing plans showed statistically significant median reductions in NVB D0.1 cc (38.9 vs 42.6 Gy for coplanar; 38.9 vs 43.3 Gy for non-coplanar) and Dmean (25.6 vs 30.0 Gy for coplanar; 24.7 vs 30.2 Gy for noncoplanar). Further lowering NVB D0.1 cc in c-NVBsparing plans clearly correlated to lower target coverage. Non-coplanar c-NVBsparing plans maintained significantly higher target coverages for similar NVB D0.1 cc values, compared to coplanar plans. Conclusion: NVB sparing without compromising target coverage is feasible. No clinically relevant benefit was found for non-coplanar compared to coplanar NVB sparing plans, although overall statistically superior. Further sparing of the NVB comes at the cost of target coverage, for which a Pareto front could be used as a tool in clinical practise.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100959"},"PeriodicalIF":2.7,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821207","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":"Post-treatment changes in bowel and urinary function in prostate cancer patients treated with moderate or ultra-hypofractionation: A prospective cohort study","authors":"W.D. Heemsbergen,&nbsp;F. Sinzabakira,&nbsp;K.C. de Vries,&nbsp;M. Franckena,&nbsp;M.E.M.C. Christianen,&nbsp;F.E. Froklage,&nbsp;H. Westerveld,&nbsp;L. Incrocci","doi":"10.1016/j.ctro.2025.100955","DOIUrl":"10.1016/j.ctro.2025.100955","url":null,"abstract":"<div><h3>Objective/Purpose</h3><div>Hypofractionation (HF) has been established as safe in prostate cancer (PCa) trial populations. We evaluated post-treatment changes in health-related quality of life (HRQoL) outcomes after moderate (MHF) or ultra-hypofractionated (UHF) radiotherapy in a real-world PCa patient population.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, T1-4N0M0 PCa patients receiving MHF (20x3/3.1 Gy, n = 140) or UHF (7x6.1 Gy, n = 138) were assessed. UHF was not prescribed in case of T3b/T4 disease or an impaired baseline urinary function. Patients completed the EPIC urinary and bowel domains and the EQ-5D-5L (general HRQoL) at baseline and 6 months post-treatment. Thresholds for minimal clinically important differences (MCID) were defined at 8 %. Prognostic factors were assessed using regression models.</div></div><div><h3>Results</h3><div>Proportion of the total cohort with MCID deterioration for bowel and urinary function was 20 % and 17 %, respectively. Deteriorations in bladder and bowel function significantly correlated with declined scores for general health, usual activities, pain/discomfort, and depression/anxiety. Predictive factors for urinary function deterioration at multivariable analysis were androgen deprivation therapy, age ≥ 75 year, MHF, and grade ≥ 2 acute urinary toxicity. For bowel function deterioration, no factors were identified.</div></div><div><h3>Conclusion</h3><div>We assessed post-treatment changes in HRQoL in a clinical PCa patient population treated with MHF and UHF, and observed changes comparable to previous trial reports. Deteriorations in bowel and urinary function correlated with worse general health scores. Results for urinary function loss suggested a consequential effect of acute urinary toxicity.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100955"},"PeriodicalIF":2.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791977","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":"Assessment of the impact of age on DIBH in radiotherapy based on the prospective GATTUM and B-REST trials","authors":"Rebecca Moser ,&nbsp;Lena Marie Buchecker ,&nbsp;Jantje M. Bohlen ,&nbsp;Mathias Düsberg ,&nbsp;Maximilian Aigner ,&nbsp;Nina A. Mayr ,&nbsp;Jana Nano ,&nbsp;Sophie T. Behzadi ,&nbsp;Sophia Kiesl ,&nbsp;Marciana-Nona Duma ,&nbsp;Markus Oechsner ,&nbsp;Stephanie E. Combs ,&nbsp;Kai J. Borm","doi":"10.1016/j.ctro.2025.100956","DOIUrl":"10.1016/j.ctro.2025.100956","url":null,"abstract":"<div><h3>Background</h3><div>Adjuvant radiotherapy (RT) of left sided breast cancer is increasingly performed in deep inspiration breath hold (DIBH). This technique requires active involvement and compliance of patients as well as pulmonary endurance. Since previous studies focused on female patients with a median age under 65 years to test practicability of DIBH and advantages in comparison to free breathing (FB), DIBH in elderly patients over 65 years remains mostly underexplored. This study aims to evaluate attitudes and feasibility of DIBH in elderly breast cancer patients.</div></div><div><h3>Methods</h3><div>First a 14-item survey of 100 female breast cancer patients aged ≥65 years was conducted to assess their attitudes toward DIBH and their breath-hold capability. Secondly, we performed a matched-pair analyses using pooled data from the prospective GATTUM and B-REST trials to compare respiratory and dosimetric parameters during DIBH between patients aged ≥65 years (n = 30) and &lt;65 years (n = 30).</div></div><div><h3>Results</h3><div>According to the survey large majority of patients were interested in DIBH: 98 % stated that age should not be a criterion when selecting patients for DIBH, and 66 were able to hold their breath &gt; 20 s. Based on the matched-pair analyses of the GATTUM and B-Rest trials, no significant differences were observed regarding breath hold amplitude, duration and stability, and in DIBH-induced dose reduction to organs at risk between elderly (≥65) (n = 30) and younger patients (n = 30).</div></div><div><h3>Conclusion</h3><div>Based on our results age alone should not be used as a criterion for excluding patients from DIBH in the treatment of left-sided breast cancer.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100956"},"PeriodicalIF":2.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143839641","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":"Prediction for cardiac and pulmonary toxicity in a multicentric cohort of advanced stage NSCLC patients using sub-regions of the heart","authors":"Albrecht Weiß ,&nbsp;Steffen Löck ,&nbsp;Ting Xu ,&nbsp;Zhongxing Liao ,&nbsp;Miguel Garrett Fernandes ,&nbsp;René Monshouwer ,&nbsp;Johan Bussink ,&nbsp;Esther G.C. Troost","doi":"10.1016/j.ctro.2025.100952","DOIUrl":"10.1016/j.ctro.2025.100952","url":null,"abstract":"<div><h3>Purpose</h3><div>Follow-up investigations in locally advanced stage non-small cell lung cancer (NSCLC) patients treated with radiochemotherapy (RCHT) regularly focus around lung toxicity. However, Cardiac Adverse Events (CAE) can occur much earlier in patients than originally anticipated with serious repercussions for patient quality-of-life and survival.</div><div>Therefore, here we investigated spatial dependencies of dose within the heart and their correlation with toxicity, with dosimetric parameters of sub-regions of the heart at the focus of this analysis.</div><div>Additionally, we aimed to explore the connection between cardiac toxicity and pulmonary toxicity.</div></div><div><h3>Methods</h3><div>Patient treatment plans with dosimetric data for the lungs and the heart, as well as toxicity data for 502 NSCLC patients treated with either passively scattered proton therapy (PSPT), intensity modulated radiation therapy (IMRT), three-dimensional conformal radiation therapy (3DCRT) or volumetric arc therapy (VMAT) with or without chemotherapy was retrospectively retrieved from prospective clinical studies of three international centers. Cardiac toxicity data was not available for all patients. Data was randomly split into a training set (336) and validation set (166). Statistical analyses were performed using binomial logistic regression.</div></div><div><h3>Results</h3><div>In univariate modeling, the Mean Lung Dose (MLD) significantly predicted CAE grade ≥ 3 in the training-set (p_MLD = 0.02, AUC_train = 0.69), which was confirmed in validation (AUC_val, = 0.77). No suitable candidates for the construction of multivariate models could be identified. Parameters of the heart and its subregions did not significantly predict CAE grade ≥ 3 in the investigated cohorts. No parameters were found to significantly predict CAE grade ≥ 2 or RP. Finally, no spatial dependency was found in the investigated toxicity data.</div></div><div><h3>Conclusion</h3><div>The pulmonary dosimetric parameter MLD successfully predicted CAE grade ≥ 3 in a cohort treated with either photons or protons. Cardiac dosimetric parameters as well as spatial parameters did not perform similarly. No parameters were found to significantly predict RP in the investigated cohorts.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100952"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786153","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":"Multidisciplinary approach to target volume delineation in locally recurrent rectal cancer: An explorative study","authors":"F. Piqeur ,&nbsp;D.S.C. van Gruijthuijsen ,&nbsp;J. Nederend ,&nbsp;H. Ceha ,&nbsp;T. Stam ,&nbsp;M. Dieters ,&nbsp;P. Meijnen ,&nbsp;M. Bakker-van der Jagt ,&nbsp;M. Intven ,&nbsp;A.E. Verrijssen ,&nbsp;J.S. Cnossen ,&nbsp;M. Berbee ,&nbsp;M. den Hartogh ,&nbsp;E.J. Bantema-Joppe ,&nbsp;M. De Kroon ,&nbsp;G. Paardekooper ,&nbsp;M.P.M. Gielens ,&nbsp;A.W. Daniels-Gooszen ,&nbsp;M.J. Lahaye ,&nbsp;D.M.J. Lambregts ,&nbsp;H. Peulen","doi":"10.1016/j.ctro.2025.100948","DOIUrl":"10.1016/j.ctro.2025.100948","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Interobserver variation (IOV) in locally recurrent rectal cancer (LRRC) delineations is large, possibly because of different interpretations of imaging. An explorative study was performed to investigate the benefit of additional delineations by expert radiologists.</div></div><div><h3>Materials and methods</h3><div>14 cases of LRRC were delineated on planning CT by 8 radiologists (RADs) to construct a median and total radiology contour, followed by 12 radiation oncologists (ROs), without (GTV−) or with (GTV+) the additional contours. IOV was calculated separately for RADs, GTV− and GTV+. The following metrics were used: the Surface Dice Similarity Coefficient (SDSC), Dice similarity coefficient (DSC), and Hausdorff Distance at the 98th percentile (HD98%). The median SDSC, DSC, and HD98% of GTV− and GTV+ were compared. Sub-analyses of IOV in different recurrence types were performed.</div></div><div><h3>Results</h3><div>Median SDSC significantly improved from GTV− to GTV+ overall, but a significant benefit could not be proven in individual cases. Additional radiological input consistently improved all parameters in 4/14 cases (29 %). Geographical miss occurred after radiological input in 7 %. Subgroup analyses show large IOV in mainly fibrotic and intraluminal recurrences. Little IOV is seen in solitary nodal recurrences.</div></div><div><h3>Conclusion</h3><div>This study highlights target volume delineation challenges in LRRC. Overall, radiological input reduced IOV amongst ROs in target volume delineation for LRRC. Large differences do however exist amongst recurrence types. A standard terminology for LRRC and close collaboration between radiologists and radiation oncologists seems necessary to reduce IOV and improve quality of care.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"53 ","pages":"Article 100948"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816681","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}