Clinical and Translational Radiation Oncology最新文献

{"title":"How to protect the proximal bronchial tree during stereotactic radiotherapy of ultracentral lung tumors: Lessons from MR-guided treatment","authors":"Sebastian Regnery ,&nbsp;Efthimios Katsigiannopulos ,&nbsp;Hin Lau ,&nbsp;Philipp Hoegen-Saßmannshausen ,&nbsp;Fabian Weykamp ,&nbsp;Claudia Katharina Renkamp ,&nbsp;Carolin Rippke ,&nbsp;Fabian Schlüter ,&nbsp;Sophia Albert ,&nbsp;Jan Meis ,&nbsp;Marietta Kirchner ,&nbsp;Alexandra Balzer ,&nbsp;Nicolaus Andratschke ,&nbsp;Matthias Guckenberger ,&nbsp;Jürgen Debus ,&nbsp;Sebastian Klüter ,&nbsp;Juliane Hörner-Rieber","doi":"10.1016/j.ctro.2024.100899","DOIUrl":"10.1016/j.ctro.2024.100899","url":null,"abstract":"<div><h3>Purpose</h3><div>To use imaging data from stereotactic MR-guided online adaptive radiotherapy (SMART) of ultracentral lung tumors (ULT) for development of a safe non-adaptive approach towards stereotactic body radiotherapy (SBRT) of ULT.</div></div><div><h3>Patients and Methods</h3><div>Analysis is based on 19 patients with ULT who received SMART (10 × 5.0–5.5 Gy) on a 0.35 T MR-Linac (MRIdian®) in the prospective MAGELLAN trial. 4D-planning CT data of six patients served to quantify proximal bronchial tree (PBT) breathing motion. Daily fraction MRIs are used to calculate interfractional translations (mediolateral (ML), anterior-posterior (AP), superior-inferior (SI)) and their dosimetric consequences for the PBT. A planning risk volume (PRV) is calculated for an assumed non-adaptive SBRT in deep-inspiration breath hold (DIBH) with surface-guidance (AlignRT®). Finally, non-adaptive volumetric modulated arc (VMAT) SBRT is simulated with and without a PRV for N = 10 patients (10 × 5.5 Gy).</div></div><div><h3>Results</h3><div>The PBT shows relevant breathing motion, especially in superior-inferior direction (median ML: 2.5 mm, AP: 1.9 mm and SI: 9.2 mm). Furthermore, moderate interfractional translations are observed (mean absolute translation ML: 1.3 mm, AP: 1.3 mm, SI: 1.1 mm), with an estimated 2 mm PRV margin for interfractional changes alone. Simulated non-adaptive SBRT leads to PBT overdoses in 60 % of patients (median overdosed fractions VMAT: 2.5, predicted MR-linac plans 4). Both MR-guided online plan adaptation (SMART) and PRV-based non-adaptive VMAT prevent PBT overdoses, but SMART yields significantly higher planning target volume (PTV) coverage (SMART: median 96 % [IQR 95–96], VMAT: median 89 % [IQR 77–94], p = 0.014).</div></div><div><h3>Conclusions</h3><div>Both intrafractional breathing motion and interfractional translations may impact doses to the PBT during SBRT of ULT. SMART protects the PBT from overdoses while maintaining high PTV coverage. Non-adaptive SBRT appears safe with advanced breathing motion management and PRV, but yields inferior PTV coverage.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100899"},"PeriodicalIF":2.7,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142945741","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":"Enhanced radiosensitivity of head and neck cancer cells to proton therapy via hyperthermia-induced homologous recombination deficiency","authors":"Tim Heemskerk ,&nbsp;Gerarda van de Kamp ,&nbsp;Marta Rovituso ,&nbsp;Roland Kanaar ,&nbsp;Jeroen Essers","doi":"10.1016/j.ctro.2024.100898","DOIUrl":"10.1016/j.ctro.2024.100898","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Radiotherapy induces tumor cell killing by generating DNA double strand breaks (DSBs). The effectiveness of radiotherapy is significantly influenced by the repair of DSBs, which counteracts this lethal effect. Current investigations are focused on determining whether non-homologous end joining (NHEJ) or homologous recombination is the predominant repair pathway following proton and photon radiation.</div></div><div><h3>Materials and methods</h3><div>In this study, we examined the response of FaDu cells, a head and neck squamous cell carcinoma model, to spread-out Bragg peak (SOBP) proton and photon radiation combined with mild hyperthermia (42 °C for one hour) to induce homologous recombination deficiency or NHEJ inhibition by AZD7648.</div></div><div><h3>Results</h3><div>Hyperthermia resulted in stronger radiosensitization after proton radiation (SR = 1.53) compared to photon radiation (SR = 1.32). Conversely, NHEJ inhibition did not produce a significant differential effect between photon and proton radiation. This indicates a greater reliance on homologous recombination following proton radiation compared to photon radiation. We found that the number of DSBs formed after photon versus proton irradiation is comparable. Interestingly, the homologous recombination protein Rad51 accumulated more frequently at DSBs following proton irradiation than photon irradiation.</div></div><div><h3>Conclusions</h3><div>These findings support the hypothesis that cells rely more on homologous recombination to repair proton-induced DNA damage compared to photon-induced DNA damage. As clinically applied hyperthermia enhances the therapeutic effect of photon irradiation by, among other factors, inducing homologous recombination deficiency, our results suggests that hyperthermia could be more effective in combination with proton irradiation than photon irradiation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100898"},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11665703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885235","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":"Avoiding prostate bed radiation for the PSMA-PET detected nodal recurrence patient post prostatectomy","authors":"Benjamin Challis ,&nbsp;Andrew Kneebone ,&nbsp;Thomas Eade ,&nbsp;Lesley Guo ,&nbsp;John Atyeo ,&nbsp;Chris Brown ,&nbsp;George Hruby","doi":"10.1016/j.ctro.2024.100896","DOIUrl":"10.1016/j.ctro.2024.100896","url":null,"abstract":"<div><h3>Background</h3><div>Nodal only recurrence post radical prostatectomy (RP) is increasingly recognised in the PSMA scan era. Management is controversial with a curative approach usually incorporating prostate bed and nodal irradiation (PB + NRT) in combination with long-term hormonal therapy. It is unknown whether omitting prostate-bed irradiation (PBRT) is safe in a subgroup of these patients.</div></div><div><h3>Purpose</h3><div>To document the outcomes for pelvic nodal only salvage radiation therapy (NRT) plus concurrent androgen deprivation therapy (ADT) for patients with PSMA PET documented nodal relapses.</div></div><div><h3>Methods and materials</h3><div>Eligible patients included PSMA PET documented nodal only relapses post RP who received NRT with or without PBRT at Royal North Shore Hospital (NSCC), Gosford Hospital (CCCC) or Genesis Care (GC) between January 2015 and December 2021. Baseline demographics, surgical pathology, radiation details, ADT use and outcomes were documented.</div></div><div><h3>Results</h3><div>Forty-six patients were identified, 22 in the PB + NRT cohort and 24 in the NRT cohort. Compared to the PBRT + NRT group, the NRT cohort had lower stage disease (pT2 = 7 (29 %), pT3a = 15 (63 %), pT3b = 1 (4 %) vs pT2 = 0, pT3a = 10 (45 %), pT3b = 12 (55 %)) (p=&lt;0.001) and lower rates of R1 resection (0 % vs 63.6 % (n = 14)) (p &lt; 0.001) respectively. The median follow-up from radiotherapy was 3.9 years.</div><div>Four-year biochemical failure- free survival (BFFS) was 64 % in the NRT group vs 67 % in the PB + NRT group. Of the ten (41.6 %) failures in the NRT group, 1 (4 %) was a biochemical failure only, 2 (8 %) recurred in the PB and received further salvage treatment, 4 (17 %) had nodal failure outside the pelvis and 3 (13 %) had distant metastases.</div><div>One patient (4 %) in the NRT group recorded late grade ≥2 GU toxicity compared with 7 (32 %) in the PB + NRT. No patients in the NRT group recorded late grade ≥2 GI toxicity compared with 2 (9 %) in the PB + NRT cohort.</div></div><div><h3>Conclusion</h3><div>This study provides early evidence for the feasibility of PBRT sparing to avoid local toxicity. Most patients in this cohort failed distantly. This data suggests that for selected men PB-avoidance may be considered given informed consent.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100896"},"PeriodicalIF":2.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722736","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":"ESTRO guidelines for developing questionnaires in survey-based radiation oncology research","authors":"Amanda Webster ,&nbsp;Lotte S. Fog ,&nbsp;Emma Hall ,&nbsp;Peter S.N. van Rossum ,&nbsp;Daan Nevens ,&nbsp;Pierre Montay-Gruel ,&nbsp;Pierfrancesco Franco ,&nbsp;Elizabeth Joyce ,&nbsp;Nuria Jornet ,&nbsp;Catharine H. Clark ,&nbsp;Jenny Bertholet","doi":"10.1016/j.ctro.2024.100895","DOIUrl":"10.1016/j.ctro.2024.100895","url":null,"abstract":"<div><div>Survey-based research is increasingly used in radiation oncology, yet survey-based research methodology is often unfamiliar in the field. This guideline offers comprehensive instructions for conducting survey-based research in radiation oncology, covering critical aspects such as survey design, validation, dissemination, analysis, and reporting. Tailored to professionals, it emphasizes the importance of methodological rigour to ensure reliable and actionable data collection. Dissemination strategies are highlighted to maximize response rates and enhance data completeness across diverse clinical, research and industrial settings. Rigorous analysis techniques are discussed to uncover insights that optimize operational efficiencies and inform evidence-based practices. Transparent reporting is underscored as crucial for enhancing the credibility and applicability of findings. This guideline aims to be a practical resource for enhancing research standards in survey-based research for researchers and practitioners in radiation oncology.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100895"},"PeriodicalIF":2.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078712","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":"Bridging the care gap: patients’ needs and experiences regarding shared decision-making in radiotherapy","authors":"A.R. van Hienen ,&nbsp;C.J.W. Offermann ,&nbsp;L.J. Boersma ,&nbsp;M.J.G. Jacobs ,&nbsp;R.R.R. Fijten","doi":"10.1016/j.ctro.2024.100897","DOIUrl":"10.1016/j.ctro.2024.100897","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Shared decision-making (SDM), a collaborative process in which patients and physicians jointly determine further treatment, has been associated with numerous positive effects. However, its implementation into routine clinical practice faces challenges. In radiotherapy (RT) it may have additional challenges, since patients are referred from another oncologist, often “to undergo RT”. The aim of this study is to understand patients’ preferences and experiences regarding SDM at an academic RT clinic, and to identify targets for SDM implementation in RT.</div></div><div><h3>Materials and methods</h3><div>We adapted an earlier survey sent out by the Dutch Cancer Patient Organizations Federation to fit the RT setting. The survey was distributed via letters and social media to (former) patients who had their intake between 2020 and 2022.</div></div><div><h3>Results</h3><div>1799 participants completed the survey, of whom 88,3% mentioned to always or often prefer SDM. 23,1% of participants reported experiencing a choice, and 50% of these participants experienced multiple options. The most commons reason for preferring SDM was bodily autonomy (n = 1114) and against SDM was wanting to decide themselves instead (n = 11). Participants with a higher educational attainment were more likely to prefer and experience SDM. Older participants were more likely to experience multiple options.</div></div><div><h3>Conclusion</h3><div>Our findings reaffirm that most cancer patients prefer SDM, and extend these findings to RT. However, we found a large gap between patients’ desire for SDM, and the SDM experienced in our RT institute. SDM implementation strategies are needed and should focus on overcoming RT-specific and patient-reported barriers and opportunities.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100897"},"PeriodicalIF":2.7,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722737","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":"Tumor sequencing before and after neoadjuvant chemoradiotherapy in locally advanced rectal cancer: Genetic tumor characterization and clinical outcome","authors":"Kerstin Clasen ,&nbsp;Nadja Ballin ,&nbsp;Leon Schütz ,&nbsp;Irina Bonzheim ,&nbsp;Olga Kelemen ,&nbsp;Michael Orth ,&nbsp;Cihan Gani ,&nbsp;Olaf Rieß ,&nbsp;Stephan Ossowski ,&nbsp;Maximilian Niyazi ,&nbsp;Christopher Schroeder","doi":"10.1016/j.ctro.2024.100894","DOIUrl":"10.1016/j.ctro.2024.100894","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Neoadjuvant chemoradiotherapy (NCRT) is a standard treatment option for locally advanced rectal cancer. However, there is still conflicting data about the genetic landscape and potential dynamics during and after NCRT. This study evaluated oncogenic driver mutations before NCRT and investigated corresponding resection samples after treatment.</div></div><div><h3>Materials and methods</h3><div>In 17 patients the pre-therapeutic biopsy and in ten cases the related resection specimen were investigated by next-generation sequencing using a dedicated cancer panel (708 genes). Oncogenic driver mutations and tumor mutational burden (TMB) were compared pre- and post NCRT to evaluate stability of the genomic landscape. TMB and frequently detected driver mutations were correlated with outcome parameters.</div></div><div><h3>Results</h3><div>In our corresponding tumor samples before and after NCRT 95.2 % of the oncogenic driver mutations could be found in both specimens whereas one <em>ATM</em> and one <em>RYR1</em> mutation were not detectable after NCRT. TMB decreased in all patients after neoadjuvant treatment. <em>KRAS</em> ± <em>TP53</em> mutations and TMB ≥ 5 were associated with impaired outcome.</div></div><div><h3>Conclusion</h3><div>Most oncogenic driver mutations investigated persisted after neoadjuvant treatment. At the same time, we did not observe ascending TMB after treatment but decline. Thus, NCRT does not seem to induce a relevant number of new driver mutations or mutational burden. Genetic profiling implies the potential to support tumor-informed approaches and outcome estimation in future.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100894"},"PeriodicalIF":2.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722738","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":"Stereotactic ablative radiotherapy for primary kidney cancer – An international patterns of practice survey","authors":"Katherine Taplin ,&nbsp;Raquibul Hannan ,&nbsp;Simon S. Lo ,&nbsp;Scott C. Morgan ,&nbsp;Muhammad Ali ,&nbsp;Samantha Sigurdson ,&nbsp;Matthias Guckenberger ,&nbsp;Anand Swaminath","doi":"10.1016/j.ctro.2024.100891","DOIUrl":"10.1016/j.ctro.2024.100891","url":null,"abstract":"<div><h3>Purpose</h3><div>To conduct an international survey of radiation oncologists treating primary renal cell carcinoma (RCC) with SABR to ascertain the general patterns of SABR use, common dose/treatment/follow-up details, and expected outcomes.</div></div><div><h3>Materials and methods</h3><div>A 51-question survey was created containing the following themes: prevalence and clinical scenarios in which RCC SABR is used, dose-fractionation schedules, treatment delivery details, follow-up/outcome assessments, and implementation barriers. The survey was distributed widely across multiple influential radiation oncology societies and social media, and ran from January to April 2023.</div></div><div><h3>Results</h3><div>A total of 255 respondents participated, mostly from academic centers within Europe/North America. Of these, 40 % (n = 102) currently offer SABR (50 % having begun within the last 3 years). Common barriers in non-users included lack of referrals by urologists and lack of supportive practice guidelines. Of respondents who do offer SABR, 77 % treat both small (4 cm or less) and large (&gt;4 cm) renal masses. Dose-fractionation strategies varied from 27-52 Gy (3–5 fractions) for multifraction regimens, and 15–34 Gy for single fractions. Apart from treatment for medically inoperable disease, scenarios in which SABR was likely to be offered were for recurrence post surgery/thermal ablation and for oligometastatic kidney lesions. Uncommon scenarios included RCC with renal vein/inferior vena cava thrombosis, and as cytoreductive therapy in metastatic RCC. Expected local control outcomes were generally above 70 %, higher for small versus large renal masses.</div></div><div><h3>Conclusions</h3><div>SABR is a relatively newer indication for primary RCC, offered by less than 50% of respondents, with both consistent and variable practice patterns observed.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100891"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142744634","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":"Fractionated stereotactic radiotherapy of brainstem metastases – Clinical outcome and prognostic factors","authors":"Anna Krämer ,&nbsp;Laura Hahnemann ,&nbsp;Fabian Schunn ,&nbsp;Christoph A. Grott ,&nbsp;Michael Thomas ,&nbsp;Petros Christopoulos ,&nbsp;Jonathan W. Lischalk ,&nbsp;Juliane Hörner-Rieber ,&nbsp;Philipp Hoegen-Saßmannshausen ,&nbsp;Tanja Eichkorn ,&nbsp;Maximilian Y. Deng ,&nbsp;Eva Meixner ,&nbsp;Kristin Lang ,&nbsp;Angela Paul ,&nbsp;Fabian Weykamp ,&nbsp;Jürgen Debus ,&nbsp;Laila König","doi":"10.1016/j.ctro.2024.100893","DOIUrl":"10.1016/j.ctro.2024.100893","url":null,"abstract":"<div><h3>Introduction</h3><div>Brain metastases (BM) are the most common malignancy in the central nervous system (CNS) and observed in approximately 30% of cancer patients. Brainstem metastases (BSM) are challenging because of their location and the associated neurological risks. There are still no general therapeutic recommendations in this setting. Stereotactic radiosurgery (SRS) is one of few possible local therapy options but limited due to the tolerance dose of the brainstem. There is still no standard regarding the optimal dose und fractionation.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 65 patients with fractionated stereotactic radiotherapy (fSRT) for 69 BSM. FSRT was delivered at a dose of 30 Gy in six fractions prescribed to the 70 % isodose performed with Cyberknife. Overall survival (OS), local control (LC) and total intracranial brain control (TIBC) were analyzed via Kaplan-Meier method. Cox proportional hazards models were used to identify prognostic factors.</div></div><div><h3>Results</h3><div>Median follow-up was 27.3 months. One-year TIBC was 35.0 % and one-year LC was 84.1 %. Median OS was 8.9 months. In total, local progression occurred in 7.7 % and in 8.2 % symptomatic radiation-induced contrast enhancements (RICE) were diagnosed. In univariate analysis the Karnofsky performance scale index (KPI) (p = 0,001) was an independent prognostic factor for longer OS. Acute CTCAE grade 3 toxicities occurred in 18.4 %.</div></div><div><h3>Conclusion</h3><div>FSRT for BSM is as an effective and safe treatment approach with high LC rates and reasonable neurological toxicity despite the poor prognosis in this patient cohort is still very poor. Clinical and imaging follow-up is necessary to identify cerebral progression and adverse toxicity including RICE.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100893"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698206","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":"Stereotactic body radiation therapy in primary liver tumor: Local control, outcomes and toxicities","authors":"Ludovic Hernandez ,&nbsp;Laure Parent ,&nbsp;Victoire Molinier ,&nbsp;Bertrand Suc ,&nbsp;Françoise Izar ,&nbsp;Elisabeth Moyal ,&nbsp;Jean-Marie Peron ,&nbsp;Philippe Otal ,&nbsp;Amélie Lusque ,&nbsp;Anouchka Modesto","doi":"10.1016/j.ctro.2024.100892","DOIUrl":"10.1016/j.ctro.2024.100892","url":null,"abstract":"<div><h3>Objective</h3><div>Stereotactic body radiation therapy (SBRT) is a therapeutic option in the guidelines for liver primaries after standard strategies like surgery or thermoablation have failed. To assess its efficacy and safety, we reviewed all patients treated by SBRT for a hepatocellular carcinoma (HCC) over a six-year period.</div></div><div><h3>Methods and materials</h3><div>The study included all patients treated by SBRT for HCC between April 2015 and November 2021 in the University Cancer Institute at Toulouse-Oncopole. All patients were inoperable and not eligible for thermoablation, or after a failure. All tumor sizes were included and cirrhosis up to Child-Pugh B was accepted. Local control (LC), overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Treatment response was assessed using mRECIST criteria. Toxicity was graded using CTCAE (v4.0).</div></div><div><h3>Results</h3><div>One hundred and nine patients with 118 lesions were treated. Half underwent prior standard treatment. Median dose was 50 Grays in five fractions for most patients. Chronic liver disease represented 90.8 % of cases with a median age of 69 years. Median tumor size was 4.0 cm. Median follow-up was 22.2 months [95 %CI: 15.1–30.4]. LC, OS and PFS at two years were 82.4 % [95 %CI: 71.3; 89.5], 73.2 % [95 %CI: 61.5; 81.8] and 35.8 % [95 %CI: 25.1; 46.7], respectively. Acute toxicities occurred in 20.2 % of patients, including 10.1 % grade 3–4 and 1.8 % grade 5. Late toxicities occurred in 5.5 % of patients including 4.6 % grade 3–4. Grade ≥ 3 toxicity was related to digestive perforation or liver failure.</div></div><div><h3>Conclusion</h3><div>SBRT provides good LC with an acceptable safety profile. It can be used in several settings such as salvage therapy or in combination with validated treatment. Prospective randomized trials are needed to validate SBRT as a standard alternative.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100892"},"PeriodicalIF":2.7,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698207","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":"Is postoperative radiotherapy effective in patients with completely resected pathologic stage IIIA(N2) non-small cell lung cancer? High-risk populations should consider it","authors":"Shu-Xian Zhang ,&nbsp;Chen-Chen Zhang ,&nbsp;Run-Ping Hou ,&nbsp;Xu-Wei Cai ,&nbsp;Jun Liu ,&nbsp;Wen Yu ,&nbsp;Qin Zhang ,&nbsp;Jin-Dong Guo ,&nbsp;Chang-Lu Wang ,&nbsp;Hong-Xuan Li ,&nbsp;Zheng-Fei Zhu ,&nbsp;Xiao-Long Fu ,&nbsp;Wen Feng","doi":"10.1016/j.ctro.2024.100889","DOIUrl":"10.1016/j.ctro.2024.100889","url":null,"abstract":"<div><h3>Background and purpose</h3><div>We aimed to assess the benefits of postoperative radiotherapy (PORT) in completely resected patients with pathologic stage IIIA(N2) non-small cell lung cancer (NSCLC) with a high risk of locoregional recurrence (LRR).</div></div><div><h3>Materials and methods</h3><div>A prospective, randomized trial was conducted starting in July 2016 to explore the optimal timing of PORT in high-LRR-risk patients with completely resected IIIA(N2) NSCLC (NCT02974426). Patients were identified as high-LRR-risk patients via the prognostic index (PI) model and were randomly assigned to PORT-first or PORT-last treatment. To evaluate PORT for high-LRR-risk patients, all patients in this trial constituted the PORT cohort, whereas high-LRR-risk patients without PORT were selected from a retrospective cohort as the non-PORT cohort. Propensity score-matched (PSM) analyses were conducted to compare overall survival (OS), disease-free survival (DFS), locoregional recurrence-free survival (LRFS) and distant metastasis-free survival (DMFS).</div></div><div><h3>Results</h3><div>Between 2016 and 2022, 132 patients were included in the trial, with a median follow-up of 49.3 months. The 3-year OS rate was 83.2 %, and the 3-year DFS rate was 35.0 %. Among these patients, 122 patients (92 %) received planned PORT. For 132 intention-to-treat patients, PSM analysis with the non-PORT cohort (n = 307) resulted in 130 matched pairs. The results revealed that PORT improved LRFS (3-year LRFS, 77.6 % vs. 57.3 %; p = 0.00014), DFS (3-year DFS, 35.2 % vs. 28.6 %; p = 0.038), and OS (3-year OS, 83.0 % vs. 60.7 %; p = 0.00017), with no difference in DMFS (p = 0.17).</div></div><div><h3>Conclusion</h3><div>PORT could increase local control, DFS, and OS in high-LRR-risk patients with completely resected IIIA(N2) NSCLC. Future research should utilize multidimensional data to pinpoint more precise subgroups benefiting from PORT, with prospective trials validating these findings.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"50 ","pages":"Article 100889"},"PeriodicalIF":2.7,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142698209","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}