Clinical and Translational Radiation Oncology最新文献

{"title":"Evaluating the radiosensitivity of the oral microbiome to predict radiation-induced mucositis in head and neck cancer patients: A prospective trial","authors":"Andreas R. Thomsen ,&nbsp;Elsa Beatriz Monroy Ordonez ,&nbsp;Michael Henke ,&nbsp;Benedikt Luka ,&nbsp;Jörg Sahlmann ,&nbsp;Henning Schäfer ,&nbsp;Vivek Verma ,&nbsp;Nadine Schlueter ,&nbsp;Anca-Ligia Grosu ,&nbsp;Tanja Sprave","doi":"10.1016/j.ctro.2025.100915","DOIUrl":"10.1016/j.ctro.2025.100915","url":null,"abstract":"<div><h3>Background</h3><div>Predicting the occurrence and/or severity of oral mucositis (OM) before commencing radiotherapy (RT) remains very difficult. The aim of this prospective trial was to investigate whether the <em>ex-vivo</em> radiation sensitivity of oral keratinocytes from head and neck (H&amp;N) cancer patients correlates with severe OM.</div></div><div><h3>Methods</h3><div>Oral microbiopsies of healthy gingival mucosa were collected from 63H&amp;N cancer patients undergoing (chemo)RT, of which 58 samples were useable. Keratinocytes from these microbiopsies underwent <em>ex-vivo</em> proliferation, irradiation, and subsequently the cell spreading assay. Tubes with the cell suspension were placed within the irradiation chamber of a ¹³⁷Cs Gammacell 40 Exactor (Best Theratronics, Canada) and exposed to 0, 2, 4, 6, or 8 Gy at a dose rate of 0.63 Gy min⁻¹. Cell suspension was then immediately pipetted into custom-made polydimethylsiloxane (PDMS) rings.</div><div>The effect of demographic and clinical parameters on the cell spreading assay were also analyzed. Systematic clinical recording of OM was conducted twice a week by a specially trained examiner.</div></div><div><h3>Results</h3><div>Most patients had node-positive disease and cancer of the oropharynx or oral cavity. The vast majority of patients received adjuvant RT and concurrent chemotherapy. Overall, 34 (58.6 %) participants developed grade 3 OM after a median dose of 32 Gy. No patient experienced a grade ≥ 4 event. There was a correlation between the cell spreading assay area and grade 3 OM (p &lt; 0.05), equivalent to approximately 0.5 Gy dose. Demographic and clinical parameters had no significant impact on the cell spreading assay (p &gt; 0.05 for all).</div></div><div><h3>Conclusions</h3><div>It is necessary to establish reliable predictors of severe OM before treatment in H&amp;N cancer to allow early management of treatment-related sequelae. This prospective trial illustrates that the intrinsic <em>ex-vivo</em> radiosensitivity of oral keratinocytes could be correlated with RT-induced OM in patients with H&amp;N cancer. This novel predictor requires validation in larger prospective cohorts.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100915"},"PeriodicalIF":2.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078714","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":"Real-world outcomes of prophylactic cranial irradiation utilization and efficacy for patients with extensive-stage small cell lung cancer treated with consolidative thoracic radiotherapy","authors":"Abdul H. Lone ,&nbsp;Rohan Salunkhe ,&nbsp;Vijithan Sugumar ,&nbsp;Luna J. Zhan ,&nbsp;Xiang Y. Ye ,&nbsp;Andrea Bezjak ,&nbsp;John Cho ,&nbsp;Meredith E. Giuliani ,&nbsp;Andrew J. Hope ,&nbsp;Alexander Sun ,&nbsp;Srinivas Raman ,&nbsp;Penelope A. Bradbury ,&nbsp;Lawson Eng ,&nbsp;Natasha B. Leighl ,&nbsp;Frances A. Shepherd ,&nbsp;Adrian Sacher ,&nbsp;Geoffrey Liu ,&nbsp;Benjamin H. Lok","doi":"10.1016/j.ctro.2025.100917","DOIUrl":"10.1016/j.ctro.2025.100917","url":null,"abstract":"<div><h3>Background</h3><div>The role of prophylactic cranial irradiation (PCI) is not well-defined in extensive-stage SCLC (ES-SCLC), with conflicting results from randomized trials and a lack of relevant data for patients who received consolidative thoracic radiotherapy (CTRT). We sought to evaluate the impact of PCI on the outcomes of ES-SCLC patients who were all treated with CTRT.</div></div><div><h3>Methods</h3><div>A retrospective analysis of ES-SCLC patients without brain metastases who were all treated with CTRT between 2013–2021 at our institution was conducted. Overall survival (OS) and incidence of brain failure (BFR) were estimated using Kaplan-Meier estimation and cumulative incidence function. Multivariable Cox or Fine-Gray’s proportional hazard regression analysis (MVA) were performed to determine association between PCI and OS.</div></div><div><h3>Results</h3><div>47 patients met inclusion criteria and were theoretically eligible for PCI, 27 (57.4 %) received PCI and CTRT while 20 (42.6 %) received CTRT alone. Baseline characteristics were similar except for age, where patients receiving PCI were younger (median age 62) compared to patients who did not receive PCI (median age 72). Median OS with PCI was 19.2 months, compared to 10.8 months without PCI (<em>P =</em> 0.0334). This improved OS remained apparent in patients who received post-chemotherapy MRI restaging (<em>P =</em> 0.0245). BFR was reduced with PCI (HR = 0.22 [0.09–0.52], <em>P</em> = 0.0004). On MVA, PCI was significantly and independently associated with improved OS (HR = 0.39 [0.19–0.80], <em>P</em> = 0.01) and reduced BFR (HR = 0.20 [0.09–0.44], <em>P</em> = &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This real-world study found PCI was independently associated with improved OS and reduced BFR in ES-SCLC patients treated with CTRT compared to patients treated with CTRT not receiving PCI, including after post-chemotherapy brain MRI. The role of PCI with CTRT should be evaluated in prospective studies.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100917"},"PeriodicalIF":2.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078717","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":"Large language models for pretreatment education in pediatric radiation oncology: A comparative evaluation study","authors":"Dominik Wawrzuta ,&nbsp;Aleksandra Napieralska ,&nbsp;Katarzyna Ludwikowska ,&nbsp;Laimonas Jaruševičius ,&nbsp;Anastasija Trofimoviča-Krasnorucka ,&nbsp;Gints Rausis ,&nbsp;Agata Szulc ,&nbsp;Katarzyna Pędziwiatr ,&nbsp;Kateřina Poláchová ,&nbsp;Justyna Klejdysz ,&nbsp;Marzanna Chojnacka","doi":"10.1016/j.ctro.2025.100914","DOIUrl":"10.1016/j.ctro.2025.100914","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Pediatric radiotherapy patients and their parents are usually aware of their need for radiotherapy early on, but they meet with a radiation oncologist later in their treatment. Consequently, they search for information online, often encountering unreliable sources. Large language models (LLMs) have the potential to serve as an educational pretreatment tool, providing reliable answers to their questions. We aimed to evaluate the responses provided by generative pre-trained transformers (GPT), the most popular subgroup of LLMs, to questions about pediatric radiation oncology.</div></div><div><h3>Materials and methods</h3><div>We collected pretreatment questions regarding radiotherapy from patients and parents. Responses were generated using GPT-3.5, GPT-4, and fine-tuned GPT-3.5, with fine-tuning based on pediatric radiotherapy guides from various institutions. Additionally, a radiation oncologist prepared answers to these questions. Finally, a multi-institutional group of nine pediatric radiotherapy experts conducted a blind review of responses, assessing reliability, concision, and comprehensibility.</div></div><div><h3>Results</h3><div>The radiation oncologist and GPT-4 provided the highest-quality responses, though GPT-4′s answers were often excessively verbose. While fine-tuned GPT-3.5 generally outperformed basic GPT-3.5, it often provided overly simplistic answers. Inadequate responses were rare, occurring in 4% of GPT-generated responses across all models, primarily due to GPT-3.5 generating excessively long responses.</div></div><div><h3>Conclusions</h3><div>LLMs can be valuable tools for educating patients and their families before treatment in pediatric radiation oncology. Among them, only GPT-4 provides information of a quality comparable to that of a radiation oncologist, although it still occasionally generates poor-quality responses. GPT-3.5 models should be used cautiously, as they are more likely to produce inadequate answers to patient questions.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100914"},"PeriodicalIF":2.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045716","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":"Detection of alteration in carotid artery volumetry using standard-of-care computed tomography surveillance scans following unilateral radiation therapy for early-stage tonsillar squamous cell carcinoma survivors: a cross-sectional internally-matched carotid isodose analysis","authors":"Efstratios Koutroumpakis ,&nbsp;Mohamed A. Naser ,&nbsp;Abdallah Sherif Radwan Mohamed ,&nbsp;Salman A. Eraj ,&nbsp;Andrea Jarre ,&nbsp;Jay C. Shiao ,&nbsp;Mona Kamal ,&nbsp;Subha Perni ,&nbsp;Jack P. Phan ,&nbsp;William H. Morrison ,&nbsp;Steven J. Frank ,&nbsp;G.Brandon Gunn ,&nbsp;Adam S. Garden ,&nbsp;Anita Deswal ,&nbsp;Jun-ichi Abe ,&nbsp;David I. Rosenthal ,&nbsp;Elie Mouhayar ,&nbsp;Clifton D. Fuller","doi":"10.1016/j.ctro.2025.100912","DOIUrl":"10.1016/j.ctro.2025.100912","url":null,"abstract":"<div><h3>Aim</h3><div>This study leveraged standard-of-care CT scans of patients receiving unilateral radiotherapy (RT) for early tonsillar cancer to detect volumetric changes in the carotid arteries, and determine whether there is a dose–response relationship.</div></div><div><h3>Methods</h3><div>Disease-free cancer survivors (&gt;3 months since therapy and age &gt; 18 years) treated with intensity modulated RT for early (T1-2, N0-2b) tonsillar cancer with pre- and post-therapy contrast-enhanced CT scans available were included. Patients treated with definitive surgery, bilateral RT, or additional RT before the post-RT CT scan were excluded. Isodose lines from treatment plans were projected onto both scans, facilitating the delineation of carotid artery subvolumes in 5 Gy increments (i.e. received 50–55 Gy, 55–60 Gy, etc.). The percent-change in sub-volumes across each dose range was examined.</div></div><div><h3>Results</h3><div>Among 46 patients, 72 % received RT alone, 24 % induction chemotherapy followed by RT, and 4 % concurrent chemoradiation. The median interval from RT completion to the latest, post-RT CT scan was 43 months (IQR 32–57). A decrease in the volume of the irradiated carotid artery was observed in 78 % of patients, while there was a statistically significant difference in mean %-change (±SD) between the total irradiated and spared carotid volumes (−7.0 ± 9.0 vs. + 3.5 ± 7.2, respectively, p &lt; 0.0001). Chemotherapy use, in addition to RT, was associated with a significant mean %-decrease in carotid artery volume compared to RT alone. No significant dose–response trend was observed in the carotid artery volume change within 5 Gy ranges.</div></div><div><h3>Conclusions</h3><div>Our data show that standard-of-care oncologic surveillance CT scans can effectively detect reductions in carotid volume following RT for oropharyngeal cancer. Changes were equivalent between studied dose ranges, denoting no further dose–response effect beyond 50 Gy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100912"},"PeriodicalIF":2.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045703","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 first evaluation of the efficacy of minibeam radiation therapy combined with an immune check point inhibitor in a model of glioma-bearing rats","authors":"Lorea Iturri ,&nbsp;Emmanuel Jouglar ,&nbsp;Cristèle Gilbert ,&nbsp;Julie Espenon ,&nbsp;Marjorie Juchaux ,&nbsp;Yolanda Prezado","doi":"10.1016/j.ctro.2025.100911","DOIUrl":"10.1016/j.ctro.2025.100911","url":null,"abstract":"<div><div>Glioblastoma multiforme (GBM) continues to be a hopeless case today. Its treatment involves the use of multiple modalities. One of them is radiation therapy (RT), that is limited by normal tissue tolerances in GBM patients. GBM is widely recognized to induce local and systemic immunosuppression, which is a hindrance to the use of immune-modulating therapies. One possible strategy is to ally immunotherapy (IT) with novel RT approaches able to revert the immunosuppressive nature of GBM. One example is minibeam radiation therapy (MBRT). Preclinical experiments have shown that MBRT leads to a remarkable widening of the therapeutic window for GBM and elicits an effective immune priming. The main hypothesis of this study is that the activation of the immune system by MBRT would synergize with IT enhancing tumour control and minimizing toxicities. To validate it, <em>in vivo</em> experiments in a glioma rat model were performed. The goal was to assess the gain in survival of animals treated with MBRT, MBRT plus an immune check point inhibitor (ICI) versus conventional RT (CRT) or ICI alone. All treatments (ICI alone, CRT, CRT + ICI, MBRT and MBRT + ICI) increased survival with respect to the non-irradiated controls. However, the high radiation dose (30 Gy) delivered in one fraction in CRT is highly detrimental for normal tissues contrary to MBRT. The combination of CRT plus ICI appeared to be toxic. MBRT + ICI surpassed the survival rate with respect to ICI alone. When ICI was used with high-dose conventional irradiation, tumor eradication was observed in 6 out 8 animals. However, the survival was statistically equivalent to MBRT plus ICI, with a tendency to reduce survival in comparison with CRT alone, suggesting acute toxicity associated with this multimodal treatment.</div><div>In conclusion, our results suggest some advantages for MBRT in combination with ICI. We need to conduct further work to determine the optimal RT-IT combination and schedule for ICI injection and MBRT irradiation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"51 ","pages":"Article 100911"},"PeriodicalIF":2.7,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078640","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":"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}