Clinical and Translational Radiation Oncology最新文献

{"title":"Selection criteria and method for deep inspiration breath-hold in patients with left breast cancer undergoing PMRT/IMRT","authors":"Yingying Zhou ,&nbsp;Jinfeng Xu ,&nbsp;Fumin Xu ,&nbsp;Yanning Li ,&nbsp;Huali Li ,&nbsp;Lisheng Pan ,&nbsp;Yang Li ,&nbsp;Shuyi Cao ,&nbsp;Longmei Cai ,&nbsp;Lin Yang ,&nbsp;Bo Chen ,&nbsp;Hongmei Wang","doi":"10.1016/j.ctro.2024.100812","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100812","url":null,"abstract":"<div><h3>Purpose</h3><p>This study explored whether a free-breathing mean heart dose (FB-MHD) of 4 Gy is a reliable dose threshold for selecting left breast cancer patients after modified radical mastectomy suitable for deep inspiration breath-hold (DIBH) and developed anatomical indicators to predict FB-MHD for rapid selection.</p></div><div><h3>Materials and methods</h3><p>Twenty-three patients with left breast cancer treated with DIBH were included to compare FB and DIBH plans. The patients were divided into the high-risk (FB-MHD ≥ 4 Gy) and low-risk (FB-MHD &lt; 4 Gy) groups to compare dose difference, normal tissue complication probability (NTCP) and the DIBH benefits. Another 30 patients with FB only were included to analyze the capacity of distinguishing high-risk heart doses patients according to anatomical metrics, such as cardiac-to-chest Euclidean distance (CCED), cardiac-to-chest gap (CCG), and cardiac-to-chest combination (CCC).</p></div><div><h3>Results</h3><p>All heart doses were significantly lower in patients with DIBH plans than in those with FB plans. Based on FB-MHD of 4 Gy cutoff, the heart dose, NTCP for cardiac death, and benefits from DIBH were significantly higher in the high-risk group than in the low-risk group. The CCED was a valid anatomical indicator with the largest area under the curve (AUC) of 0.83 and maintained 95 % sensitivity and 70 % specificity at the optimal cutoff value of 2.5 mm.</p></div><div><h3>Conclusions</h3><p>An FB-MHD of 4 Gy could be used as an efficient dose threshold for selecting patients suitable for DIBH. The CCED may allow a reliable prediction of FB-MHD in left breast cancer patients at CT simulation.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"48 ","pages":"Article 100812"},"PeriodicalIF":2.7,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000892/pdfft?md5=0d5516f40ba3ab24dd8a634cb1fae08f&pid=1-s2.0-S2405630824000892-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485829","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":"Repeated HyperArc radiosurgery for recurrent intracranial metastases and dosimetric analysis of recurrence pattern to account for diffuse dose effect on microscopical disease","authors":"Luca Nicosia ,&nbsp;Andrea Gaetano Allegra ,&nbsp;Niccolò Giaj-Levra ,&nbsp;Reyhaneh Bayani ,&nbsp;Nima Mousavi Darzikolaee ,&nbsp;Rosario Mazzola ,&nbsp;Edoardo Pastorello ,&nbsp;Paolo Ravelli ,&nbsp;Francesco Ricchetti ,&nbsp;Michele Rigo ,&nbsp;Ruggero Ruggieri ,&nbsp;Davide Gurrera ,&nbsp;Riccardo Filippo Borgese ,&nbsp;Simona Gaito ,&nbsp;Giuseppe Minniti ,&nbsp;Pierina Navarria ,&nbsp;Marta Scorsetti ,&nbsp;Filippo Alongi","doi":"10.1016/j.ctro.2024.100811","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100811","url":null,"abstract":"<div><h3>Aims</h3><p>Evaluate effectiveness and safety of multiple HyperArc courses and patterns of progression in patients affected by BMs with intracranial progression.</p></div><div><h3>Methods</h3><p>56 patients were treated for 702 BMs with 197 (range 2–8) HyperArc courses in case of exclusive intracranial progression. Primary end-point was the overall survival (OS), secondary end-points were intracranial progression-free survival (iPFS), toxicity, local control (LC), neurological death (ND), and whole-brain RT (WBRT)-free survival. Site of progression was evaluated against isodoses levels (0, 1, 2, 3, 5, 7, 8, 10, 13, 15, 20, and 24 Gy.).</p></div><div><h3>Results</h3><p>The 1-year OS was 70 %, and the median was 20.8 months (17–36). At the univariate analysis (UVA) biological equivalent dose (BED) &gt; 51.3 Gy and non-melanoma histology significantly correlated with OS. The median time to iPFS was 4.9 months, and the 1-year iPFS was 15 %. Globally, 538 new BMs occurred after the first HA cycle in patients with extracranial disease controlled. 96.4 % of them occurred within the isodoses range 0–7 Gy as follows: 26.6 % (0 Gy), 16.5 % (1 Gy), 16.5 % (2 Gy), 20.1 % (3 Gy), 13.1 % (5 Gy), 3.4 % (7 Gy) (p = 0.00). Radionecrosis occurred in 2 metastases (0.28 %). No clinical toxicity of grade 3 or higher occurred during follow-up. One- and 2-year LC was 90 % and 79 %, respectively. At the UVA BED &gt; 70 Gy and non-melanoma histology were significant predictors of higher LC. The 2-year WBRT-free survival was 70 %. After a median follow-up of 17.4 months, 12 patients deceased by ND.</p></div><div><h3>Conclusion</h3><p>Intracranical relapses can be safely and effectively treated with repeated HyperArc, with the aim to postpone or avoid WBRT. Diffuse dose by volumetric RT might reduce microscopic disease also at relatively low levels, potentially acting as a <em>virtual CTV</em>. Neurological death is not the most common cause of death in this population, which highlights the impact of extracranial disease on overall survival.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"48 ","pages":"Article 100811"},"PeriodicalIF":2.7,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000880/pdfft?md5=ee6e240f6a223d2da0816f6494e7ab35&pid=1-s2.0-S2405630824000880-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485827","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":"Salvage low-dose-rate brachytherapy for locally recurrent prostate cancer after definitive irradiation","authors":"Y. Meraouna ,&nbsp;P. Blanchard ,&nbsp;S. Losa ,&nbsp;A. Labib ,&nbsp;S. Krhili ,&nbsp;P. Pommier ,&nbsp;G. Crehange ,&nbsp;T. Flam ,&nbsp;J-M. Cosset ,&nbsp;M. Kissel","doi":"10.1016/j.ctro.2024.100809","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100809","url":null,"abstract":"<div><h3>Purpose</h3><p>The optimal management of locally recurrent prostate cancer after definitive irradiation is still unclear but local salvage treatments are gaining interest. A retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity after salvage I-125 low-dose-rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer was conducted in a Comprehensive Cancer Center.</p></div><div><h3>Patients and methods</h3><p>A total of 94 patients treated with salvage LDR-BT between 2006 and 2021 were included. The target volume was either the whole-gland +/- a boost on the GTV, the hemigland, or only the GTV. The prescribed dose ranged from 90 to 145 Gy. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0.</p></div><div><h3>Results</h3><p>Median follow-up was 34 months. Initial radiotherapy was external beam radiotherapy in 73 patients (78 %) with a median dose of 76 Gy and I-125 BT in 21 patients (22 %) with a prescribed dose of 145 Gy. Median PSA at salvage was 3.75 ng/ml with a median interval between first and salvage irradiation of 9.4 years. Salvage brachytherapy was associated with androgen deprivation therapy for 32 % of the patients. Only 4 % of the patients were castrate-resistant. Failure free survival was 82 % at 2 years and 66 % at 3 years. The only factors associated with failure-free survival on multivariate analysis were hormonosensitivity at relapse and European Association of Urology (EAU) prognostic group. Late grade 3 urinary and rectal toxicities occurred in 12 % and 1 % of the patients respectively.</p><p>No significant difference in toxicity or efficacy was observed between the three implant volume groups.</p></div><div><h3>Conclusion</h3><p>The efficacy and toxicity results are consistent with those in the LDR group of the MASTER <em>meta</em>-analysis. Salvage BT confirms to be an effective and safe option for locally recurrent prostate cancer. A focal approach could be interesting to reduce late severe toxicities, especially urinary.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"48 ","pages":"Article 100809"},"PeriodicalIF":2.7,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000867/pdfft?md5=444fc93d95f08cc67bd70058a5389543&pid=1-s2.0-S2405630824000867-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141444407","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":"Re-irradiation to the prostate using stereotactic body radiotherapy (SBRT) after initial definitive radiotherapy – A systematic review and meta-analysis of recent trials","authors":"Christina Schröder ,&nbsp;Hongjian Tang ,&nbsp;Bianca Lenffer ,&nbsp;André Buchali ,&nbsp;Daniel Rudolf Zwahlen ,&nbsp;Robert Förster ,&nbsp;Paul Windisch","doi":"10.1016/j.ctro.2024.100806","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100806","url":null,"abstract":"<div><h3>Background</h3><p>There is increasing data on re-irradiation to the prostate using stereotactic body radiotherapy (SBRT) after definitive radiotherapy for prostate cancer, with increasing evidence on prostate re-irradiation using a C-arm LINAC or an MR LINAC in recent years. We therefore conducted this systematic review and <em>meta</em>-analysis on prostate re-irradiation including studies published from 2020 to 2023, to serve as an update on existing <em>meta</em>-analysis.</p></div><div><h3>Methods</h3><p>We searched the PubMed and Embase databases in October 2023 with queries including combinations of “repeat”, “radiotherapy”, “prostate”, “re-irradiation”, “reirradiation”, “re treatment”, “SBRT”, “retreatment”. Publication date was set to be from 2020 to 2023. There was no limitation regarding language. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. After data extraction, heterogeneity testing was done by calculating the I². A random effects model with a restricted maximum likelihood estimator was used to estimate the combined effect. Funnel plot asymmetry was assessed visually and using Egger’s test to estimate the presence of publication and/or small study bias.</p></div><div><h3>Results</h3><p>14 publications were included in the systematic review. The rates of acute ≥ grade 2 (G2) genitourinary (GU) and gastrointestinal (GI) toxicities reported in the included studies ranged from 0.0-30.0 % and 0.0–25.0 % respectively. For late ≥ G2 GU and GI toxicity, the ranges are 4.0–51.8 % and 0.0–25.0 %. The pooled rate of acute GU and GI toxicity ≥ G2 were 13 % (95 % CI: 7–18 %) and 2 % (95 % CI: 0–4 %). For late GU and GI toxicity ≥ G2 the pooled rates were 25 % (95 % CI: 14–35 %) and 5 % (95 % CI: 1–9 %). The pooled 2-year biochemical recurrence-free survival was 72 % (95 % CI: 64–92 %).</p></div><div><h3>Conclusions</h3><p>SBRT in the re-irradiation of radiorecurrent prostate cancer is safe and effective. Further prospective data are warranted.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"48 ","pages":"Article 100806"},"PeriodicalIF":2.7,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000831/pdfft?md5=e16d1d76635dd6c9db3e3618043bcaeb&pid=1-s2.0-S2405630824000831-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141485826","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":"Implementation of ultra-hypofractionated radiotherapy schedules for breast cancer during the COVID-19 pandemic in the Netherlands","authors":"Anouk H. Eijkelboom ,&nbsp;Marcel R. Stam ,&nbsp;Desirée H.J.G. van den Bongard ,&nbsp;Margriet G.A. Sattler ,&nbsp;Enja J. Bantema-Joppe ,&nbsp;Sabine Siesling ,&nbsp;Marissa C. van Maaren","doi":"10.1016/j.ctro.2024.100807","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100807","url":null,"abstract":"<div><h3>Background and purpose</h3><p>The COVID-19 pandemic resulted in an accelerated recommendation to use five-fraction radiotherapy schedules, according to the FAST- and FAST-Forward trial. In this study, trends in the use of different radiotherapy schedules in the Netherlands were studied, as well as the likelihood of receiving five fractions.</p></div><div><h3>Materials and methods</h3><p>Data from the NABON Breast Cancer Audit-Radiotherapy and Netherlands Cancer Registry was used. Women receiving radiotherapy for their primary invasive breast cancer or DCIS between 01–01-2020 and 31–12-2021 were included. Logistic regression was used to investigate the association between patient-, tumour-, treatment-, and radiotherapy institution-related characteristics and the likelihood of receiving five fractions in tumours meeting the FAST and FAST-Forward criteria.</p></div><div><h3>Results</h3><p>Detailed information about radiotherapy treatment was available for 9,392 tumours. Shortly after the start of the COVID-19 pandemic, i.e. April 2020, 19% of the tumours being treated with radiotherapy received five fractions of 5.2 or 5.7 Gray (Gy). While only 3% of the tumours received five fractions in March 2020. The usage of five fractions increased to 26% in December 2021. Partial breast irradiation, compared to whole breast irradiation, was significantly associated with the administration of five fractions, as well as radiotherapy delivered in an academic radiotherapy institution compared to an independent institution.</p></div><div><h3>Conclusion</h3><p>The start of the COVID-19 pandemic was associated with the early use of ultra-hypofractionated radiotherapy schedules. After publication of the trials, and mainly after the recommendation by the national radiotherapy society, the implementation further increased. These schedules were not yet used in all patients meeting the eligibility criteria for the FAST- or FAST-Forward trial.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"47 ","pages":"Article 100807"},"PeriodicalIF":3.1,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000843/pdfft?md5=2abce41e37991a3ecc0fb6c15eea2758&pid=1-s2.0-S2405630824000843-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141333202","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":"Uterus motion analysis for radiotherapy planning optimization. The innovative contribution of on-board hybrid MR imaging","authors":"Angela Romano ,&nbsp;Claudio Votta ,&nbsp;Matteo Nardini ,&nbsp;Giuditta Chiloiro ,&nbsp;Giulia Panza ,&nbsp;Luca Boldrini ,&nbsp;Davide Cusumano ,&nbsp;Elena Galofaro ,&nbsp;Lorenzo Placidi ,&nbsp;Marco Valerio Antonelli ,&nbsp;Gabriele Turco ,&nbsp;Rosa Autorino ,&nbsp;Maria Antonietta Gambacorta","doi":"10.1016/j.ctro.2024.100808","DOIUrl":"10.1016/j.ctro.2024.100808","url":null,"abstract":"<div><h3>Introduction</h3><p>Organ motion (OM) and volumetric changes pose challenges in radiotherapy (RT) for locally advanced cervical cancer (LACC). Magnetic Resonance-guided Radiotherapy (MRgRT) combines improved MRI contrast with adaptive RT plans for daily anatomical changes. Our goal was to analyze cervico-uterine structure (CUS) changes during RT to develop strategies for managing OM.</p></div><div><h3>Materials and methods</h3><p>LACC patients received chemoradiation by MRIdian system with a simultaneous integrated boost (SIB) protocol. Prescription doses of 55–50.6 Gy at PTV1 and 45–39.6 Gy at PTV2 were given in 22 and 25 fractions. Daily MRI scans were co-registered with planning scans and CUS changes were assessed.</p><p>Six PTVs were created by adding 0.5, 0.7, 1, 1.3, 1.5, and 2 cm margins to the CUS, based on the simulation MRI. Adequate margins were determined to include 95 % of the CUSs throughout the entire treatment in 95 % of patients.</p></div><div><h3>Results</h3><p>Analysis of 15 LACC patients and 372 MR scans showed a 31 % median CUS volume decrease. Asymmetric margins of 2 cm cranially, 0.5 cm caudally, 1.5 cm posteriorly, 2 cm anteriorly, and 1.5 cm on both sides were optimal for PTV, adapting to CUS variations. Post-14th fraction, smaller margins of 0.7 cm cranially, 0.5 cm caudally, 1.3 cm posteriorly, 1.3 cm anteriorly, and 1.3 cm on both sides sufficed.</p></div><div><h3>Conclusion</h3><p>CUS mobility varies during RT, suggesting reduced PTV margins after the third week. MRgRT with adaptive strategies optimizes dose delivery, emphasizing the importance of streamlined IGRT with reduced PTV margins using a tailored MRgRT workflow with hybrid MRI-guided systems.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"47 ","pages":"Article 100808"},"PeriodicalIF":3.1,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000855/pdfft?md5=8d5d8f5f369dcb47b5b52c7bdcb99807&pid=1-s2.0-S2405630824000855-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141393097","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":"Remineralization of lytic spinal metastases after radiation therapy – A retrospective cohort study comparing conventional external beam radiation therapy with stereotactic ablative body radiation","authors":"Ruben Van den Brande ,&nbsp;Maxim Van den Kieboom ,&nbsp;Marc Peeters ,&nbsp;Charlotte Billiet ,&nbsp;Erik Van de Kelft","doi":"10.1016/j.ctro.2024.100805","DOIUrl":"10.1016/j.ctro.2024.100805","url":null,"abstract":"<div><h3>Introduction</h3><p>Osteolytic spinal metastases (SM) have a higher risk of fracture. In this study we aim to confirm the remineralization of lytic SM after radiation therapy. Secondary the influence of SBRT compared to cEBRT and tumor type will be analyzed.</p></div><div><h3>Methods</h3><p>A retrospective cohort study was performed.</p></div><div><h3>Results</h3><p>87 patients, 100 SM were included. 29 received SBRT, 71 cEBRT. Most common primary tumors were breast (35 %), lung (26 %) and renal (11 %). Both cEBRT and SBRT resulted in a significant increase of bone mineral density (BMD) (83.76 HU ± 5.72 → 241.41 HU ± 22.58 (p &lt; 0.001) and 82.45 ± 9.13 → 179.38 ± 47.83p = 0.026). There was a significant increase in absolute difference of BMD between the SM and reference vertebrae (p &lt; 0.001). There was no significant difference between SBRT and cEBRT. There was no increase of BMD in renal lytic SM after radiation therapy (pre-treatment: 85.96 HU ± 19.07; 3 m 92.00 HU ± 21.86 (p = 0.882); 6 m 92.06 HU ± 23.94 (p = 0.902); 9 m 70.44 HU ± 7.45 (p = 0.213); 12 m 98.08 HU ± 11.24 (p = 0.740)). In all other primary tumors, a significant increase of BMD after radiation therapy was demonstrated (p &lt; 0,05).</p></div><div><h3>Conclusion</h3><p>We conclude that the BMD of lytic SM increases significantly after radiation therapy. Lytic SM of primary renal tumors are the exception; there is no significant remineralization of renal lytic SM after radiation therapy. There is no benefit of SBRT over cEBRT in this remineralization. These findings should be taken into account when deciding on surgery in the potentially unstable group defined by the spinal instability neoplastic score.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"48 ","pages":"Article 100805"},"PeriodicalIF":2.7,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240563082400082X/pdfft?md5=4f8ef0023f8c09ab89107f6ffeef76aa&pid=1-s2.0-S240563082400082X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141407944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant radiotherapy combined with fluorouracil-cisplatin plus cetuximab in operable, locally advanced esophageal carcinoma: Results of a phase I-II trial (FFCD-0505/PRODIGE-3)","authors":"Bernadette de Rauglaudre ,&nbsp;Guillaume Piessen ,&nbsp;Marine Jary ,&nbsp;Karine Le Malicot ,&nbsp;Antoine Adenis ,&nbsp;Thibault Mazard ,&nbsp;Xavier Benoît D’Journo ,&nbsp;Caroline Petorin ,&nbsp;Joelle Buffet-Miny ,&nbsp;Thomas Aparicio ,&nbsp;Rosine Guimbaud ,&nbsp;Véronique Vendrely ,&nbsp;Côme Lepage ,&nbsp;Laetitia Dahan","doi":"10.1016/j.ctro.2024.100804","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100804","url":null,"abstract":"<div><h3>Background</h3><p>Radiotherapy combined with fluorouracil (5FU) and cisplatin for locally advanced esophageal cancer is associated with a 20–25% pathologic complete response (pCR) rate. Cetuximab increases the efficacy of radiotherapy in patients with head and neck carcinomas. The aim of this phase I/II trial was to determine the optimal doses and the pCR rate with chemoradiotherapy (C-RT) plus cetuximab.</p></div><div><h3>Methods</h3><p>A 45-Gy radiotherapy regimen was delivered over 5 weeks. The phase I study determined the dose-limiting toxicity and the maximum tolerated dose of 5FU-cisplatin plus cetuximab. The phase II trial aimed to exhibit a pCR rate &gt; 20 % (25 % expected), requiring 33 patients (6 from phase I part plus 27 in phase II part). pCR was defined as ypT0Nx.</p></div><div><h3>Results</h3><p>The phase I study established the following recommended doses: weekly cetuximab (400 mg/m² one week before, and 250 mg/m² during radiotherapy); 5FU (500 mg/m²/day, d1-d4) plus cisplatin (40 mg/m², d1) during week 1 and 5. In the phase II part, 32 patients received C-RT before surgery, 31 patients underwent surgery, and resection was achieved in 27 patients. A pCR was achieved in five patients (18.5 %) out of 27. After a median follow-up of 19 months, the median progression-free survival was 13.7 months, and the median overall survival was not reached.</p></div><div><h3>Conclusions</h3><p>Adding cetuximab to preoperative C-RT was toxic and did not achieve a pCR &gt; 20 % as required. The recommended doses, determined during the phase I part, could explain these disappointing results due to a reduction in chemotherapy dose-intensity.</p></div><div><h3>Trial registration</h3><p>This trial was registered with EudraCT number 2006-004770-27.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"47 ","pages":"Article 100804"},"PeriodicalIF":3.1,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000818/pdfft?md5=716549578a37ddc7e68d6c0bff3e5e7c&pid=1-s2.0-S2405630824000818-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141325691","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":"Effect of palliative radiation dose on symptom response in metastatic sarcomas","authors":"Jennifer K. Matsui ,&nbsp;Scott Jackson ,&nbsp;Judy Fang ,&nbsp;Lynn Million ,&nbsp;Alexander L. Chin ,&nbsp;Susan M. Hiniker ,&nbsp;Anusha Kalbasi ,&nbsp;Everett J. Moding","doi":"10.1016/j.ctro.2024.100803","DOIUrl":"10.1016/j.ctro.2024.100803","url":null,"abstract":"<div><h3>Purpose</h3><p>Palliative radiotherapy (RT) plays a crucial role in alleviating symptoms associated with metastatic sarcoma. However, there is a lack of consensus on the optimal palliative radiation dose and fractionation for metastatic sarcomas. We analyzed the association between biologically effective radiation dose and symptom response for patients who underwent palliative RT for metastatic sarcomas</p></div><div><h3>Methods and materials</h3><p>We retrospectively identified patients with metastatic sarcoma treated with palliative RT between 1999 and 2021 at our institution. We assessed the association between equivalent dose in 2 Gy fractions (EQD2) with an α/β of three and symptom relief or overall survival (OS) using univariable and multivariable analyses.</p></div><div><h3>Results</h3><p>Of the 198 metastatic sites treated, the most common indications for palliative radiation were pain (n = 181, 91 %) and compression of adjacent structures (n = 16, 8 %). In our analysis, an EQD2 of &gt; 20 Gy was associated with greater rates of short-term symptom relief (n = 143, 85 %) at the RT site compared to an EQD2 of ≤ 20 Gy (n = 14, 54 %, P = 0.001) with no reports of grade 3 or higher toxicity. However, there was no significant improvement in short-term symptom relief for higher radiation doses. Patients treated with an EQD2 of ≤ 20 Gy had a significantly worse performance status, but there was no significant difference in overall survival based on EQD2 on multivariable analysis.</p></div><div><h3>Conclusions</h3><p>An EQD2 ≤ 20 Gy (e.g., 8 Gy in 1 fraction) provided inadequate palliative benefit in this series. An EQD2 &gt; 20 Gy resulted in greater rates of symptom palliation in metastatic sarcomas, but further dose escalation did not improve symptom response or durability. These findings suggest standard palliative regimens such as 20 Gy in 5 fractions (EQD2 of 28 Gy) are effective for patients with metastatic sarcomas.</p></div>","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"48 ","pages":"Article 100803"},"PeriodicalIF":2.7,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2405630824000806/pdfft?md5=03750ab3ed91089b900384b2208b54da&pid=1-s2.0-S2405630824000806-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141416442","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":"Setting the stage: The opening act of preoperative SRS for brain metastases","authors":"Cristian Udovicich ,&nbsp;Arjun Sahgal ,&nbsp;Hany Soliman ,&nbsp;Neda Haghighi","doi":"10.1016/j.ctro.2024.100802","DOIUrl":"https://doi.org/10.1016/j.ctro.2024.100802","url":null,"abstract":"","PeriodicalId":10342,"journal":{"name":"Clinical and Translational Radiation Oncology","volume":"47 ","pages":"Article 100802"},"PeriodicalIF":2.7,"publicationDate":"2024-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S240563082400079X/pdfft?md5=d3387fe7fcb5df517e2a36b1bc4fe71d&pid=1-s2.0-S240563082400079X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141438639","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}