Clinical and Translational Radiation Oncology最新文献

{"title":"Impact of deep learning on CT-based organ-at-risk delineation for flank irradiation in paediatric renal tumours: a SIOP-RTSG radiotherapy committee study","authors":"Mianyong Ding ,&nbsp;Matteo Maspero ,&nbsp;Semi Harrabi ,&nbsp;Emmanuel Jouglar ,&nbsp;Sabina Vennarini ,&nbsp;Timothy Spencer ,&nbsp;Britta Weber ,&nbsp;Henriette Magelssen ,&nbsp;Karen Van Beek ,&nbsp;Remus Stoica ,&nbsp;Simonetta Saldi ,&nbsp;Tom Boterberg ,&nbsp;Patrick Melchior ,&nbsp;Marry M. van den Heuvel-Eibrink ,&nbsp;Geert O. Janssens","doi":"10.1016/j.ctro.2025.101051","DOIUrl":"10.1016/j.ctro.2025.101051","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Integrating deep learning (DL) for auto-contouring has significantly improved organ-at-risk (OAR) delineation in adult radiotherapy. However, its application in paediatric radiotherapy remains limited. This study evaluates DL-based auto-contouring of OARs, followed by manual revisions, for paediatric flank irradiation, focusing on delineation time, accuracy, and inter-observer variability (IOV).</div></div><div><h3>Materials and methods</h3><div>Twelve paediatric radiation oncologists from nine countries affiliated with the SIOP Renal Tumour Study Group participated in a two-day workshop. Participants were randomly divided into two groups: one performed manual delineation first, followed by DL-based revision, while the other group performed in reverse order. Eight thoracoabdominal OARs were delineated on non-contrast CTs of renal tumour patients (ages 1–6). DL-based contours were generated using a model for paediatric abdominal cases. Delineation time was recorded, accuracy and IOV were assessed using the Dice similarity coefficient (DSC), 95th percentile Hausdorff distance, mean surface distance against a STAPLE consensus (threshold = 0.95), and an expert reference.</div></div><div><h3>Results</h3><div>In total, 122 manual delineations and 254 DL-based revisions were collected. DL-based auto-contouring reduced delineation time by 59 %, from 25.5 to 10.2 min. The mean DSC of all eight OARs improved from 0.91 to 0.97 using STAPLE reference and from 0.89 to 0.93 using expert reference. The pancreas exhibited the largest gain, with mean DSC increases ranging from 0.18 to 0.25. Delineation accuracy was significantly improved for seven OARs (p &lt; 0.05), while IOV significantly decreased for the pancreas and heart in both references (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Manually revising DL-based auto-contouring reduces delineation time, enhances accuracy, and reduces inter-observer variability in paediatric CT-based OAR delineation.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101051"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324843","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":"Radiation-induced lymphopenia: A data compilation to unveil relevant factors and mitigation strategies","authors":"Vladislav Sandul ,&nbsp;Sarah Salih Al-Hamami ,&nbsp;Jiří Kubeš ,&nbsp;Marco Durante ,&nbsp;Thomas Friedrich","doi":"10.1016/j.ctro.2025.101071","DOIUrl":"10.1016/j.ctro.2025.101071","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation-induced lymphopenia (RIL) is a common complication of radiation therapy (RT) that can undermine antitumor immunity and diminish the efficacy of immunotherapy. While RIL is a known predictor of poor outcomes, its underlying mechanisms and key determinants remain poorly characterized.</div></div><div><h3>Materials and Methods</h3><div>We systematically compiled and quantitatively analyzed published data on absolute lymphocyte count (ALC) dynamics during and after RT. A total of 142 ALC curves from 52 publications were digitized and integrated into a standardized database. This database encompasses various RT modalities, including therapy with X-rays or charged particles, as well as extracorporeal irradiation of blood (ECIB).</div></div><div><h3>Results</h3><div>Analysis revealed consistent lymphocyte depletion during treatment. By the end of RT, median ALCs declined to 24% (range: 1.5–78%) of baseline for intracorporeal exposure and 10% (range: 1–60%) for ECIB. Recovery was incomplete and cancer-type-dependent, reaching only a median of 55% (range: 33–90%) of baseline within one year. We identified baseline ALC, planning target volume (PTV), and dosimetric parameters as key predictors of severe lymphopenia. A low rate of lymphocyte depletion during treatment was frequently associated with impaired long-term recovery. Particle therapy was associated with an average 11% higher end-of-treatment ALC compared to photon therapy, underscoring the lymphocyte-sparing benefit of reduced integral dose.</div></div><div><h3>Conclusions</h3><div>This work establishes a comprehensive, quantitative foundation for understanding RIL. The developed ALC database supports mechanistic investigation and enables model-based approaches to predict lymphocyte dynamics, guiding the design of lymphocyte-sparing treatment strategies, including particle therapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101071"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516670","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":"Daily adaptive MR-guided stereotactic ablative re-irradiation (re-SABR) in oligometastatic liver disease: A single-institution retrospective analysis","authors":"Elena Moreno-Olmedo ,&nbsp;Dan Murray ,&nbsp;Ben George ,&nbsp;Paul Bassett ,&nbsp;Andy Gaya ,&nbsp;Veni Ezhil ,&nbsp;Somnath Mukherjee ,&nbsp;Rebecca Muirhead ,&nbsp;Ramanivas Sundareyan ,&nbsp;Peter Dickinson ,&nbsp;James Good ,&nbsp;Kasia Owczarczyk","doi":"10.1016/j.ctro.2025.101082","DOIUrl":"10.1016/j.ctro.2025.101082","url":null,"abstract":"<div><h3>Objective</h3><div>Stereotactic ablative body radiotherapy (SABR) is an established treatment option in oligometastatic liver disease. Limited data exist on liver SABR re-irradiation (re-SABR). MR-guided SABR with daily plan adaptation and deformable image registration (DIR) allows organ-at-risk (OAR) sparing and dose accumulation in a re-irradiation setting. We report the safety and efficacy of MR-guided re-SABR in oligometastatic liver disease, alongside a DIR-based workflow for cumulative OAR dose calculation.</div></div><div><h3>Methods</h3><div>MR-guided re-SABR to oligometastatic liver disease was retrospectively analysed. Key inclusion criteria included: prior liver SABR, MR-guided re-SABR to ≤ 4 liver metastases, Child Pugh Score (CPS) ≤ B7, and a minimum prescribed dose of 30 Gy in 5 fractions. Lesions were classified according to the ESTRO-EORTC re-irradiation consensus. Acute and delayed toxicity, local control (LC), local progression-free survival (LPFS), and overall survival (OS) were reported, overall and by primary tumour type. Cumulative OAR doses were estimated using a DIR-based as compared to a non-DIR-based workflow.</div></div><div><h3>Results</h3><div>Between October 2020 and April 2024, twelve patients underwent MR-guided re-SABR to 18 liver metastases. While the majority (12/18) were colorectal in origin, other primaries included pancreas, breast, oesophagogastric, and ovary. 50% of lesions were type-1 re-irradiation (including 3 repeated target irradiations).</div><div>Median prescription BED₁₀ was 100 Gy (range 72–151 Gy) for initial SABR and 100 Gy (range 48–132 Gy) for re-SABR. 50 Gy in 5 fractions (BED10 100 Gy) was delivered in 8 out of 12 re-SABR cases. With a median follow-up of 10 months (range 3–33) from re-SABR, no acute ≥ G2 toxicity was seen. 12-month PFS was 92 % (95 % CI 54–99).</div><div>Median, 1-year, and 2-year OS were 36 months (range 12–37), 100 % (95 % CI 54–99) and 91 % (95 % CI 51–99) for SABR and 22 months, 68 % (95 %CI 28–89) and 34 % (95 % CI 5–67) for re-SABR. DIR-based workflow estimates predicted significantly higher MLD and D700cc (p &lt; 0.01) and smaller uninvolved liver volumes (p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>With the limitation of relatively low patient numbers and mixed tumour histology, MR-guided re-SABR to oligometastatic liver disease appeared well tolerated, achieving high LC rates. DIR-based workflow predicted higher cumulative OAR doses, potentially further improving the safety of liver re-SABR.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101082"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145681364","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":"Radiotherapy access in Latin America: Socio-economic determinants and equity challenges socio-economic determinants in Latin America for radiotherapy","authors":"Gustavo R. Sarria ,&nbsp;Santiago Torales ,&nbsp;Florencia Rossi ,&nbsp;Leandro Ricagni ,&nbsp;Dante Baldeon ,&nbsp;Armando Felix ,&nbsp;Benjamin Li ,&nbsp;Eleni Gkika ,&nbsp;Gustavo Ferraris ,&nbsp;Gustavo J. Sarria","doi":"10.1016/j.ctro.2025.101062","DOIUrl":"10.1016/j.ctro.2025.101062","url":null,"abstract":"<div><h3>Introduction</h3><div>Radiotherapy (RT) is essential for cancer treatment, yet access in Latin America remains highly unequal due to socio-economic and systemic disparities. This study aims to identify and analyze the key socio-economic determinants influencing RT access, infrastructure, and workforce distribution across 11 Latin American countries.</div></div><div><h3>Methods</h3><div>A comprehensive database was created using 29 demographic, economic, and healthcare-related variables from public sources and expert input. Countries included were Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Mexico, Paraguay, Peru, Uruguay, and Venezuela. Variables were categorized under access, demand, and supply of RT services. Correlation analyses and linear/exponential regression models were applied in an exploratory way to evaluate relationships between socio-economic indicators and RT availability<strong>.</strong></div></div><div><h3>Results</h3><div>Higher GDP per capita and adjusted GDP (PPP) correlated significantly with better RT infrastructure, including EBRT and megavoltage units (r &gt; 0.68, p &lt; 0.05). Urban population percentage strongly correlated with RT access (r = -0.77, p = 0.005), while social security coverage was linked to lower inhabitants per RT center (r = -0.67, p = 0.025). Notably, the number of radiation oncologists correlated perfectly with patients requiring EBRT (r = 1.0, p &lt; 0.001), but showed no correlation with poverty or urbanization, highlighting workforce capacity constraints. Rural areas were underserved due to infrastructure centralization in urban zones. High out-of-pocket expenditure and low public health investment would be associated with limited access to these treatments.</div></div><div><h3>Conclusion</h3><div>Socio-economic disparities—particularly GDP, healthcare coverage, and urbanization—are strongly associated with RT access inequities in Latin America. For the medical community and public policymakers, confirming these assumptions requires a different scope about discussions regarding access to these highly complex services, when they are not associated with the population’s health needs but rather with the countries’ mere organizational and financial capabilities. Some possible formats require the definition of new clinical and financial management models. Our findings underscore the need for targeted health policies, investment in infrastructure and workforce, and decentralized care models. Expanding RT services beyond urban centers and improving funding models are critical to ensuring equitable cancer treatment across the region.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101062"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462760","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":"Simulation-free palliative radiotherapy using diagnostic CT scans– is less more? A systematic review","authors":"Daniel R. Zwahlen ,&nbsp;Stefan Brodmann ,&nbsp;Robert Förster ,&nbsp;Paul Windisch ,&nbsp;Elena Hofmann ,&nbsp;André Buchali ,&nbsp;Christina Schröder","doi":"10.1016/j.ctro.2025.101053","DOIUrl":"10.1016/j.ctro.2025.101053","url":null,"abstract":"<div><h3>Background</h3><div>Cancer incidence continues to rise globally, with nearly half of patients requiring radiotherapy. Simulation-free radiotherapy (SFRT) using diagnostic CT scans instead of dedicated planning CTs is a streamlined alternative that may reduce patient visits and shorten time to treatment without impacting quality of care. This systematic review evaluates the practical aspects, dosimetric accuracy, and clinical outcomes of SFRT in palliative radiotherapy.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, PubMed and Embase were searched for publications on SFRT using multiple search terms. Included studies reported clinical or logistical endpoints such as treatment timing, toxicity, dosimetric errors, and patient-reported outcomes.</div></div><div><h3>Results</h3><div>Eleven studies met inclusion criteria, comprising retrospective and prospective cohorts with patient numbers ranging from 10 to 1000. SFRT was associated with significantly reduced intervals from consultation to treatment start compared to conventional workflows. Dosimetric uncertainties using diagnostic CT scans were generally low, with higher variability observed in thoracic cases. Patient selection typically excluded treatments involving steep dose gradients, reirradiation, or requiring immobilization devices. Limited clinical outcome data showed favourable toxicity profiles and effective symptom relief.</div></div><div><h3>Conclusions</h3><div>SFRT offers a practical, efficient alternative for palliative radiotherapy, enabling faster treatment initiation and optimized resource use without compromising safety or efficacy in selected patients. The overall dosimetric accuracy appears acceptable for most cases, though caution is advised for thoracic lesions and complex treatment plans. Additional prospective studies with robust clinical endpoints are needed to further validate the role of SFRT in palliative radiotherapy.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101053"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217972","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":"Response to the Comment on “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;Péter Ágoston","doi":"10.1016/j.ctro.2025.101055","DOIUrl":"10.1016/j.ctro.2025.101055","url":null,"abstract":"<div><div>First of all, we would like to sincerely thank the colleagues who authored the commentary on our article. It is encouraging to see that this complex and difficult-to-study field stimulates high-level academic discourse. Precisely for this reason, we are pleased to address the questions they have raised.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101055"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145217974","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":"Reduction of bowel loop motion during radiotherapy for gynaecological cancer assessed by 3D cine-MRI","authors":"J.J. Laan ,&nbsp;D.L.J. Barten ,&nbsp;Z. van Kesteren ,&nbsp;L.J.S. Ewals ,&nbsp;A. Bel ,&nbsp;K.A. Hinnen ,&nbsp;B.R. Pieters ,&nbsp;L.J.A. Stalpers ,&nbsp;H. Westerveld","doi":"10.1016/j.ctro.2025.101075","DOIUrl":"10.1016/j.ctro.2025.101075","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastrointestinal toxicity is a major concern after radiotherapy for gynaecologic cancer. Strong dose–effect relationships for the bowel and individual loops are lacking, which might be explained by challenges in accurate radiation dose estimation due to continuous motion of the bowel loops. The objective of this study was to evaluate whether changes in bowel loop motion occur over the course of radiotherapy, with the use of three-dimensional (3D) cine-MRI.</div></div><div><h3>Methods and Materials</h3><div>This study prospectively enrolled patients with gynaecologic cancer undergoing primary radiotherapy with curative intent. To measure bowel loop motion, three 3D cine-MRI scans were acquired: before external beam radiotherapy (EBRT), in the last week of EBRT, and on the day of brachytherapy. A MR image was acquired every 3.7 s during a 10-minute scan. Deformable image registration was used to generate a motion map and a motion volume histogram. Changes in bowel loop motion over the course of treatment were assessed by the Wilcoxon signed-rank test using the median bowel loop motion in millimetres per 3.7 s of 50% of all voxels.</div></div><div><h3>Results</h3><div>For 15 of the 22 patients, 3D cine-MR scans were available at all three time points. Median bowel loop motion per 3.7 s was 1.8 mm (range 0.6–3.3 mm) before EBRT, 1.0 mm (range 0.6–2.3 mm) in the last week of EBRT, and 0.7 mm (range 0.4–1.1 mm) at brachytherapy. Most patients (14 out of 15) showed reduced bowel loop motion in the last week of EBRT compared to the first MR, with the lowest motion at brachytherapy in 13 patients (87 %). Median bowel loop motion decreased significantly with each subsequent MRI scan (<em>p</em> = 0.005 and <em>p</em> = 0.020, respectively).</div></div><div><h3>Conclusions</h3><div>The results of this study demonstrate a statistically significant decrease in bowel loop motion over the course of primary radiotherapy for gynaecological cancer.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101075"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145516671","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":"Challenges in recurrent head and neck squamous cell cancer treatment: systematic review and meta-analysis comparing efficacy and toxicity between post-operative and definitive IMRT-based reirradiation","authors":"Lukas Grajewski ,&nbsp;Alicia Greiner ,&nbsp;Georg Wurschi ,&nbsp;Orlando Guntinas-Lichius ,&nbsp;Alexander Rühle ,&nbsp;Klaus Pietschmann ,&nbsp;Maximilian Römer","doi":"10.1016/j.ctro.2025.101061","DOIUrl":"10.1016/j.ctro.2025.101061","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Treatment of patients with recurrent head and neck squamous cell cancer in a previously irradiated field remains challenging. We performed a <em>meta</em>-analysis, comparing the efficacy and safety of definitive and post-operative intensity-modulated radiotherapy (IMRT) based reirradiation.</div></div><div><h3>Material and methods</h3><div>MEDLINE, Cochrane Library, Web of Science, SCOPUS and PsycINFO were systematically searched. The Newcastle-Ottawa Scale was used to assess the risk of bias. A <em>meta</em>-analysis was performed using the random-effects model.</div></div><div><h3>Results</h3><div>10 eligible studies with a median follow up of 24.9 months (9.6–78.1) and a total of 958 patients were identified, two of which are prospective trials. 455 were patients treated with post-operative/ adjuvant IMRT (aIMRT), while 503 patients received definitive IMRT (dIMRT). Median age was 62 years (48–63), 78 % were males and the rate of concomitant systemic therapy varied between 0 and 100 %.</div><div>Post-operative IMRT showed significantly higher 1-year overall survival of 68 %, compared to 55 % for dIMRT, with a risk reduction (RR) of 0.84 (95 % CI: 0.76–0.93). aIMRT achieved superior 1-year locoregional control (65 %) in comparison to dIMRT (58 %) with an RR of 0.89 (95 % CI: 0.798 to 0.997). All other endpoints did not reach statistical significance. The certainty of our findings was low, due to limitations in the included studies. Radiotoxicity was insufficiently reported and does not allow any conclusions.</div></div><div><h3>Conclusion</h3><div>Post-operative IMRT achieves superior survival and tumor control and should be the preferred option for patients eligible for surgery. Careful patient evaluation and selection are fundamental to maximizing therapeutic efficacy while minimizing treatment-related toxicities.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101061"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462762","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":"Radiotherapy and survival in elderly grade 4 glioma patients: The prognostic value of onco-functional outcome","authors":"Helen X. Hou ,&nbsp;Sophia M. Leiss ,&nbsp;Daniel Schmottermeyer ,&nbsp;Christian Diehl ,&nbsp;Benedikt Wiestler ,&nbsp;Jan Peeken ,&nbsp;Kai Borm ,&nbsp;Chiara Negwer ,&nbsp;Arthur Wagner ,&nbsp;Igor Yakushev ,&nbsp;Claire Delbridge ,&nbsp;Meike Mitsdoerffer ,&nbsp;Friederike Schmidt-Graf ,&nbsp;Bernhardt Meyer ,&nbsp;Stephanie Combs ,&nbsp;Denise Bernhardt","doi":"10.1016/j.ctro.2025.101085","DOIUrl":"10.1016/j.ctro.2025.101085","url":null,"abstract":"<div><h3>Purpose</h3><div><strong>/Objectives:</strong> Older adults with WHO grade 4 glioma face distinct therapeutic challenges due to age-related comorbidities, treatment intolerance and tumor aggressiveness. This retrospective study evaluates the prognostic value of the Onco-Functional Outcome (OFO) classification, which integrates extent of resection and postoperative functional status, in the context of radiotherapy (RT) for patients with grade 4 glioma.</div></div><div><h3>Materials</h3><div><strong>/Methods:</strong> 139 patients aged ≥ 60 years treated between 2001 and 2021 were included. Patients were grouped into four OFO categories based on Karnofsky Performance Status, National Institutes of Health Stroke Scale, and resection extent. Survival outcomes were assessed using Kaplan-Meier and compared by log-rank test. Univariate and multivariable analyses were performed using Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Median OS decreased across OFO groups (OFO1-4: 22.6, 20.5, 12.6, and 11.2 months respectively, log-rank, p = 0.0026). PFS followed a similar pattern (12.2, 9.3, 6.7, and 5.7 months respectively; p = 0.0030). Among 119 patients with known MGMT status, methylation (n = 49) was associated with significantly prolonged OS (36.3 vs. 12.6 months, p &lt; 0.00001) and PFS (14.1 vs 5.9 months, p &lt; 0.00001). Survival advantage of NF–RT showed a a strong trend in both univariate (OS HR = 0.47, 95 % CI 0.28–0.82; p = 0.007) and multivariate models (OS HR = 0.57, 95 % CI 0.33–1.00, 0.051). In multivariable analysis, the OFO classification retained independent prognostic value, with OFO Group 4 associated with a significantly increased risk of both death (OS: HR = 2.91, p = 0.003) and disease progression (PFS: HR = 3.08, p = 0.0005) compared to OFO Group 1.</div></div><div><h3>Conclusions</h3><div>OFO classification effectively stratifies survival in elderly grade 4 glioma patients. Its integration with MGMT methylation status and RT regimen refines risk assessment, supporting personalized treatment strategies in this vulnerable patient group.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101085"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145614551","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":"Deep learning [18F]-FDG-PET/CT‑based algorithm for tumor burden estimation in metastatic melanoma patients under immunotherapy","authors":"Lorenzo Lo Faro ,&nbsp;Hubert S. Gabryś ,&nbsp;Simon Burgermeister ,&nbsp;Daniel Abler ,&nbsp;Maksym Fritsak ,&nbsp;Maiwand Ahmadsei ,&nbsp;Ciro Franzese ,&nbsp;Adrien Depeursinge ,&nbsp;Michel A. Cuendet ,&nbsp;Stephanie Tanadini-Lang ,&nbsp;Panagiotis Balermpas ,&nbsp;Marta Scorsetti ,&nbsp;Matthias Guckenberger ,&nbsp;Sebastian M. Christ","doi":"10.1016/j.ctro.2025.101063","DOIUrl":"10.1016/j.ctro.2025.101063","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Artificial intelligence is increasingly used in radiation oncology, yet its application for tumor burden (TB) estimation remains limited. This study evaluated the performance of a [¹⁸F]-fluorodeoxyglucose positron emission tomography/computerized tomography ([¹⁸F]-FDG-PET/CT)-based deep learning model, PET-Assisted Reporting System (“PARS”, <em>Siemens Healthineers</em>), for lesion detection, segmentation, and TB estimation in patients with metastatic melanoma undergoing immunotherapy.</div></div><div><h3>Materials and methods</h3><div>This retrospective study included 165 stage IV melanoma patients who underwent [¹⁸F]-FDG-PET/CT imaging prior to immunotherapy. Gross tumor volumes were segmented using PARS and compared with manual delineations performed by radiation oncologists. Performance was assessed through lesion detection metrics (precision and recall), individual lesion volume agreement, and overall TB estimation accuracy.</div></div><div><h3>Results</h3><div>PARS demonstrated an overall recall (sensitivity) of 68.9 %, though with modest precision (46.8 %). Performance was location-dependent, with highest precision observed for lung lesions (74.0 %) and lowest for bone lesions (32.9 %). For lesions detected by both methods, PARS tended to underestimate lesion volumes by an average (median) of 0.9 cc (median relative percentage difference (MRPD) =  −34.3 %), with a good agreement (intraclass correlations coefficient (ICC) = 0.77). The global TB in the whole cohort was overestimated by 28.3 %, but patient-level TB was on average (median) underestimated by 1.1 cc (MRPD =   −18.4 %) with high variability with a median absolute relative percentage difference (MARPD) = 68.6 %) and poor agreement (intraclass correlation coefficient (ICC) = 0.28).</div></div><div><h3>Conclusions</h3><div>PARS shows potential for treatment decision support with moderate accuracy in lesion detection and lesion volume estimation, but demonstrates significant variability in TB estimation, highlighting the need for further model refinements before clinical adoption.</div></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"56 ","pages":"Article 101063"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145462758","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}