International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Implementing Image-Guided Brachytherapy (IGBT) For Cervical Cancer in Resource-Limited Settings: An International Multicentric Cross-Sectional Study of Resource and Workflow Impact.","authors":"Varsha Hande, Sandra Ndarukwa, Alfredo Polo Rubio, Daniel Berger, Yavuz Anacak, Maria Sucharski, Jerickson Abbie S Flores, Jai Prakash Agarwal, Susan Chitonje Msadabwe, Eugenia Gamboa, Julius David Mwaiselage, Enkhtsetseg Vanchinbazar, El Majjaoui Sanaa, Chynara Batyrkanova, Amira Shami, Senem Alanyali, Nigar Aliyeva Sabaddin, Vladyslav Sukhin, Blanka Jaksic, Tomoaki Tamaki, Supriya Chopra","doi":"10.1016/j.ijrobp.2026.10.028","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.028","url":null,"abstract":"<p><strong>Background: </strong>Use of image-guided brachytherapy (IGBT) in cervical cancer improves patient outcomes. However, implementation in resource-limited settings is challenging due to limited capacity upscale, absence of workflow enhancement strategies, and financial barriers. Optimizing workflows is essential, yet the relationship between workflow efficiency and IGBT uptake remains unclear.</p><p><strong>Methods: </strong>This cross-sectional study examined brachytherapy (BT) workflows across 14 nationally representative centers. Standardized forms collected data on infrastructure, treatment workflows ((A): Conventional two-dimensional (2D) X-Ray-Guided BT, with point-A-based fractions planned using 2D X-ray imaging, (B): Standard intracavitary (IC) three-dimensional (3D) IGBT, with fractions planned using computed tomography (CT)- or magnetic resonance (MR)-based imaging with volume-based prescriptions, (C): Advanced 3D IGBT, with fractions delivered using advanced IC or intracavitary-interstitial (IC-IS) techniques and planned using CT- or MR-based imaging with volume-based prescriptions.)), procedural times, anesthesia, imaging, and treatment planning. National BT resource data was also collected. Recommendations were developed to optimize workflows and facilitate IGBT transition.</p><p><strong>Findings: </strong>A total of 365 workflows were analyzed, wherein workflow B was most common (51%). Median procedure times were 2 hours 08 minutes (Interquartile range (IQR) 1 hour and 7 minutes), 2 hours 35 minutes (IQR 1 hour and 51 minutes), and 4 hours 16 minutes (IQR 2 hours and 33 minutes) for workflows A, B, and C, respectively. Using sedation instead of full anesthesia shortened workflows by a median of 35 minutes. BT machine demand, based on national cervical cancer incidence, ranged from 0.2 to 9.5; four countries had low (< 0.5), two moderate (0.5 - 1.0), and eight high demand (>1.0). Resource- and context-specific recommendations for IGBT transition were provided.</p><p><strong>Interpretation: </strong>BT workflows varied widely. Substantially increased procedure times and resource use were observed with advanced workflows. Findings highlight opportunities to improve efficiency through anesthesia choice, imaging strategy, and planning workflow optimization. Implementing context-specific strategies will be crucial for IGBT transition.</p><p><strong>Funding: </strong>Funding from the XXXX, in collaboration with XXXX and participating sites.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meeting the Need: Development of a Theranostics-Focused Nuclear Oncology Physics Fellowship.","authors":"Yohan A Walter, Hsinshun T Wu, Stephen Lokitz, Adam Springer, Chiachien J Wang, Grant Stec, Joseph Dugas, Lane Rosen","doi":"10.1016/j.ijrobp.2026.10.027","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.027","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>With the emergence of radiotheranostics, radiation oncology practices are adapting to offer new radiopharmaceutical therapies (RPTs), while qualified medical physicists (QMPs) support these programs. However, RPT-specific medical physics training is variable, and heavily dependent on the clinical setting. QMPs may therefore be tasked with supporting RPT programs without adequate training in the subject matter. In 2025, the Nuclear Oncology Division of the Department of Radiation Oncology at Willis Knighton Cancer Center launched a first-of-kind, one-year Nuclear Oncology Physics Fellowship. Here, we detail our program structure and provide a framework for further expansion of nuclear oncology medical physics training.</p><p><strong>Methods: </strong>The fellowship is offered in partnership with three institutions: a large, tertiary community cancer center (hub site), a radiopharmaceutical research institution encompassing GMP isotope and radiopharmaceutical production and clinical and pre-clinical imaging, and a medical physics consulting group. The curriculum is split into twelve rotations covering the core competencies outlined by major certifying bodies. Primary mentors hold board certifications in diagnostic, nuclear medicine, or therapeutic medical physics.</p><p><strong>Results: </strong>The fellowship may be completed before or after physics residency training, and culminates in a final project, in which the trainee designs a mock theranostics department. The program was verified to meet current training requirements for board certification in nuclear medicine physics. At the time of writing, the program enrolled its first fellow (pre-residency) and recruited its second trainee (post-residency).</p><p><strong>Conclusion: </strong>The fellowship provides a pathway for QMPs to gain the necessary training to support new theranostics programs. The curriculum may be adapted to accommodate the interests of each trainee and extended to support individuals in other crucial professions within the theranostics space. Future development of RPT-specific training guidelines may influence adjustments to the curriculum and certification processes; however, the current model provides a robust template for necessary QMP training.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Lenalidomide-Dexamethasone in Combination With Radiotherapy in Solitary Plasmacytoma.","authors":"Pierre Loap, Sebastien Laroze, Didier Bouscary, Marguerite Vignon, Youlia Kirova","doi":"10.1016/j.ijrobp.2026.10.030","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.030","url":null,"abstract":"<p><strong>Introduction: </strong>Radiotherapy achieves excellent local control in solitary plasmacytoma, but systemic progression remains a major limitation. We evaluated the long-term association between lenalidomide-dexamethasone combined with radiotherapy and disease outcomes.</p><p><strong>Materials and methods: </strong>This retrospective analysis of a prospectively maintained database included 75 consecutive patients with solitary plasmacytoma treated between 2004 and 2025. All patients underwent bone marrow assessment, serum free light-chain testing, and magnetic resonance imaging, with PET/CT routinely incorporated into staging from late 2008 onward. Patients received radiotherapy alone (n=42) or radiotherapy combined with lenalidomide-dexamethasone (n=33). Primary endpoints were progression-free survival and multiple myeloma-free survival. Systemic progression-free survival, defined by progression to multiple myeloma, multiple plasmacytomas, or distant solitary plasmacytoma, was additionally evaluated.</p><p><strong>Results: </strong>Median follow-up was 6.31 years. Only three local recurrences occurred. Lenalidomide-dexamethasone was associated with longer progression-free survival (HR, 0.315; 95% CI, 0.128-0.775; p=0.012), with 10-year rates of 71.8% versus 26.7% after radiotherapy alone. Among the six patients progressing after combined treatment, three (50.0%) developed multiple myeloma and three (50.0%) developed multiple plasmacytomas. Multiple myeloma-free survival did not differ significantly between groups (10-year rates, 86.6% vs 65.9%; p=0.19).</p><p><strong>Conclusion: </strong>Lenalidomide-dexamethasone combined with radiotherapy was associated with sustained improvement in progression-free survival in solitary plasmacytoma. These long-term findings support prospective evaluation of upfront lenalidomide-dexamethasone in combination with radiotherapy for solitary plasmacytoma.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global greenhouse gas emissions from external beam radiotherapy: a population-based study.","authors":"Hongcheng Zhu, Icro Meattini, Lixiao Zhang, Antonin Levy, Minsong Cao, Susannah Stanway, Fanxin Meng, Eleonor Rivin de Campo, Kevin Lee Min Chua, Zhen Zhang, May Abdel-Wahab","doi":"10.1016/j.ijrobp.2026.10.029","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.029","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the global and country-level greenhouse gas emissions implications of external beam radiotherapy (EBRT) scale-up to 2050.</p><p><strong>Methods and materials: </strong>We conducted a country-level, scenario-based study across 181 countries to estimate EBRT-associated greenhouse gas emissions in 2022 and project emissions to 2050 under utilisation benchmarks of 50% and 64%, uniform schedules of 25, 15, and 5 fractions per course, and prespecified income-stratified Moderate and Ambitious hypofractionation pathways. Country-specific utilisation was examined as an access-constrained sensitivity scenario.</p><p><strong>Results: </strong>Across all scenarios, global EBRT-associated emissions increased from 2022 to 2050. With 25-fraction delivery, emissions rose from 43.02 to 67.94 MtCO₂e under the 50% utilisation and from 55.06 to 86.96 MtCO₂e under the 64% utilisation. Under the 50% benchmark, 15- and 5-fraction schedules reduced 2050 emissions to 40.76 and 13.59 MtCO2e, respectively. Emissions shifted towards middle-income settings: the high-income share declined from 42.9% to 36.5%, while the 10 countries with the largest modelled EBRT-associated emissions still accounted for 64.5% of global emissions in 2022 and 60.6% in 2050. Compared with a uniform 25-fraction baseline, the Moderate pathway reduced global emissions by 23.3% in 2022 and 21.9% in 2050, while the Ambitious pathway reduced emissions by 36.5% and 34.7%, respectively. The largest absolute reductions occurred in high-income and upper-middle-income settings.</p><p><strong>Conclusion: </strong>Global EBRT-associated emissions are projected to rise substantially by 2050. Clinically appropriate hypofractionation offers a high-leverage mitigation opportunity, with priorities differing between decarbonising established high-volume systems and embedding low-carbon delivery during capacity expansion.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149297314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Artificial Intelligence in Radiation Oncology: A Missed Opportunity for LMICs?","authors":"Hiba Siddiqui, Turkan Aliyeva, Agha Muhammad Hammad Khan, Laraib Khan, Abdul Qadir Jangda, Atif Mansha, Derek S Tsang","doi":"10.1016/j.ijrobp.2026.10.022","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.022","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial Intelligence (AI) and Machine Learning (ML) are driving a major shift in modern medicine, particularly within radiation oncology. AI in radiation oncology offers low- and middle-income countries (LMICs) a way to offset critical shortages of oncologists and physicists by automating segmentation, planning, and quality checks, improving efficiency, and expanding equitable access to care. Its actual value depends on validation against LMICs' infrastructure and patient populations, an area where current evidence remains limited. This review aims to comprehensively summarize the current evidence on AI and ML applications across key domains of radiotherapy, while highlighting global disparities in adoption, particularly in LMICs.</p><p><strong>Methodology: </strong>This critical review conducted a comprehensive literature search across PubMed, Embase, and the Cochrane Library for studies published between 2010 and April 2026. Only relevant studies emphasizing the efficiency of AI in radiation workflow and the existing gaps in its adoption within LMICs were included in this review.</p><p><strong>Results: </strong>Eleven studies published between 2019 and 2025 were included. Study designs comprised original research (n=5), reviews (n=4), a survey (n=1), and a study protocol (n=1). Studies were conducted across multiple LMICs in Africa, Asia, and Latin America, predominantly evaluating AI-based contouring and treatment-planning tools, with Radiation Planning Assistant (RPA) being the most frequently reported platform. AI tools demonstrated comparable performance in LMICs relative to High-Income Countries (HICs), particularly with regard to time efficiency and the quality of target volume contouring. Yet the majority of LMICs still don't have AI tools in their radiation centers to work efficiently.</p><p><strong>Conclusion: </strong>The current literature reveals a gap between the need for AI in radiation oncology in LMICs and the available evidence supporting its implementation. LMICs could benefit substantially from AI-enabled improvements in radiation oncology. Several conclusions about the applicability of these findings in LMIC settings were drawn by extrapolation from studies conducted in HIC contexts, which substantially limits their direct generalizability to lower-resource environments. Cost-effective and accessible AI models hold promise to address workforce shortages, improve efficiency, and expand equitable access to quality radiotherapy services.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149266859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A senescence-driven fibroblast-macrophage feed-forward circuit promotes radiation induced cutaneous fibrosis.","authors":"Eun Joo Chung, Santwana Kc, Seokjoo Kwon, Ayla White, Joon-Yong Chung, Youngjoo Jung, Heesu Ahn, Hong Zhang, Edmund Cauley, Deborah E Citrin","doi":"10.1016/j.ijrobp.2026.10.013","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.013","url":null,"abstract":"<p><strong>Purpose: </strong>Therapeutic radiation for superficial tumors may cause cutaneous fibrosis, a late side effect with limited treatment options. Here, we investigated the underlying mechanisms driving radiation-induced cutaneous fibrosis.</p><p><strong>Methods and materials: </strong>C3H/HeN mice received 35 Gy unilateral hind limb irradiation. Cutaneous tissues from irradiated and contralateral unirradiated legs were analyzed by spatial whole transcriptome profiling using the GeoMx Digital Spatial Profiler platform. Beginning at 5 weeks after irradiation, mice received the senolytic agent ABT-263 (50 mg/kg/day) or vehicle (n ≥ 10/group) by oral gavage (5 consecutive days followed by 2-week rest for 3 cycles). Hind limb contracture was assessed at 150 days after irradiation. Senescence and macrophage markers were evaluated by immunohistochemistry and quantitative PCR. Cellular senescence and senescence-associated secretory phenotype (SASP) factors were evaluated in irradiated fibroblasts and their culture media using senescence-associated β-galactosidase activity assays and multiplex immunoassays. The senolytic activity of ABT-263 in irradiated primary fibroblasts and effects of ABT-263 on primary macrophage cultures were evaluated in vitro.</p><p><strong>Results: </strong>Spatial whole-transcriptomic analysis of irradiated murine dermis identified expression patterns consistent with macrophage activation, extracellular matrix remodeling, and a senescence-associated secretory phenotype (SASP)-rich environment. In vitro studies identified that the irradiated fibroblast-derived SASP induced a senescent phenotype in unirradiated fibroblasts and macrophages. SASP-induced senescent-like macrophages acquired a CD206⁺ profibrotic phenotype and in concert with activated fibroblasts, initiated a feed-forward loop amplifying IL-6 and collagen production. SASP exposure increased expression of Bcl-2 family proteins in macrophages and fibroblasts, rendering both populations susceptible to clearance by the senolytic agent ABT-263. In vivo, ABT-263 effectively mitigated radiation-induced dermal fibrosis, depleted senescent fibroblasts and CD206⁺ macrophages, and reduced IL-6 expression CONCLUSION: Our findings identify senescence-driven reciprocal macrophage-fibroblast interactions as key mediators of cutaneous fibrosis and demonstrate the therapeutic potential of senolytic interventions for treating late radiation-induced skin injury.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149267429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harmonizing Radiotherapy Data Standards: A Comparative Analysis of OMOP, CDISC, FHIR, NAACCR, and OBO Foundry with an O3-Anchored Mapping Framework.","authors":"Ying Xiao, Georgina Kennedy, Rebecca L Baker, Kari J Brewer Savannah, Kristy K Brock, Elizabeth L Covington, Peter E Gabriel, Asieh Golozar, Michael Gurley, Chen Hu, Denise Manfredi, Martha M Matuszak, Katherine Mayo, Jennifer Moughan, Elizabeth A O'Meara, Christian Reich, Lois Holloway, Charles S Mayo","doi":"10.1016/j.ijrobp.2026.10.018","DOIUrl":"10.1016/j.ijrobp.2026.10.018","url":null,"abstract":"<p><strong>Purpose: </strong>This Special Report analyzes current radiotherapy data standards, determines which radiotherapy data elements should propagate between them, and identifies the barriers to that propagation to improve interoperability and data utilization in clinical care and research.</p><p><strong>Methods: </strong>We compared five data standards-OMOP, CDISC SDTM, FHIR, NAACCR, and the Operational Ontology for Oncology (O3)-and one ontology framework, the OBO Foundry, for radiotherapy data representation, strengths, limitations, and implementation maturity, and examined harmonization initiatives including NRG's O3-based conversion frameworks, CodeX mCODE, and ESTRO and IAEA efforts. We then scored a 90-item benchmark drawn from radiotherapy operational and trial-reporting requirements, partitioned the radiotherapy items by whether and where they should propagate, and matched each barrier to a remediation route and owning body.</p><p><strong>Results: </strong>Counting only unqualified matches, O3 covered 46 of 62 radiotherapy-specific items (74%) versus 15 (24%) for OMOP, 12 (19%) for NAACCR, 11 (18%) for FHIR, and none for OBO Foundry; on the 28 general clinical items the ordering reversed (OMOP 79%, FHIR 71%, NAACCR 46%, O3 25%, OBO Foundry 4%). Each standard is strongest on the items its target function was built to serve. Wholesale propagation is therefore unwarranted: 20 course-summary elements should converge across standards, 26 planning and adaptive elements warrant selective adoption, and 16 voxel- and machine-level artifacts should be referenced by DICOM unique identifier rather than replicated.</p><p><strong>Conclusions: </strong>Harmonization requires ontology-driven approaches using O3 as the semantic backbone with mappings to FHIR, OMOP and CDISC, applied to a defined tier of elements rather than the full element set. The principal barriers are process barriers-structural, terminological, burden-related and tooling-related-each with a named owner and an existing route. Standardized formats alone are insufficient; they require robust information systems, validation, and governance. Harmonization improves real-world data utility but cannot resolve biases inherent to nonrandomized data. Coordinated international collaboration remains critical for advancing precision radiation oncology.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PET-Guided Dose Escalation for Stage III Non-Small Cell Lung Cancer: A Randomized Clinical Trial.","authors":"Srinivas Raman, Jean-Pierre Bissonnette, David A Palma, Andrew Warner, Harroun Wong, Mojgan Taremi, Andrea Bezjak, Sergio Faria, Anne Dagnault, Marc-Emile Plourde, Myriam Bouchard, Benjamin H Lok, X Melody Qu, Guy-Anne Turgeon, George B Rodrigues, Brian P Yaremko, Edward Yu, Caroline Lavoie, Allison Ashworth, Stewart Gaede, Alexander Sun","doi":"10.1016/j.ijrobp.2026.10.017","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.017","url":null,"abstract":"<p><strong>Purpose: </strong>Uniform radiation dose escalation has not improved outcomes in locally advanced non-small cell lung cancer (NSCLC), and locoregional failure remains common despite multimodal therapy. We evaluated whether fluorodeoxyglucose positron emission tomography (FDG-PET)-guided dose escalation to metabolically active tumor subvolumes reduces locoregional failure compared with standard chemoradiation.</p><p><strong>Methods and materials: </strong>PET-BOOST was a multi-institutional, open-label, phase 2 randomized trial conducted at 7 Canadian centers (January 2017-May 2022). Eligible patients had inoperable, FDG-avid stage IIIA/IIIB NSCLC and an achievable boost dose of at least 65 Gy. Patients were randomized 1:1 to standard chemoradiation with 60 Gy in 30 fractions or metabolically adaptive radiotherapy with an integrated boost to FDG-avid subvolumes to a maximum of 85 Gy in 30 fractions. Concurrent platinum-based chemotherapy was planned, and consolidation durvalumab was permitted after 2018. The primary endpoint was 2-year locoregional failure; secondary endpoints included overall survival (OS), progression-free survival (PFS), grade ≥3 treatment-related toxicity, and quality of life (QOL).</p><p><strong>Results: </strong>Seventy-eight patients were randomized: 40 to standard radiotherapy and 38 to dose escalation, with a median follow-up of 5.0 years. Median age was 64.4 years; 53% were male, 62% had stage IIIA disease, and 76% received consolidation durvalumab. Median prescription boost dose was 75 Gy. Two-year locoregional failure was 27.5% with standard radiotherapy versus 18.4% with dose escalation (P=.13). Two-year OS (72.5% vs. 73.7%; P=.91) and PFS (52.5% vs. 57.9%; P=.74) did not differ between arms. Grade ≥3 treatment-related toxicities occurred in 25% versus 37% of patients (P=.26), with one grade 5 pulmonary hemorrhage in the dose-escalation arm. QOL did not differ between arms.</p><p><strong>Conclusions: </strong>Metabolically adaptive PET-guided radiotherapy dose escalation was feasible in the context of consolidation immunotherapy and resulted in a numerically lower rate of locoregional failure, but did not significantly improve locoregional control or survival. The lower-than-anticipated event rate may have limited statistical power, and larger studies would be required to determine whether selective dose escalation provides a clinically meaningful improvement in locoregional control.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-Dose Radiotherapy for Benign Osteoarticular Disorders: Balancing Efficacy, Competing Risks, and Long-Term Surveillance.","authors":"Aurelia Alati","doi":"10.1016/j.ijrobp.2026.10.016","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.016","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Escalation of Resting Heart Rate and Tachycardia as a Response to Thoracic Radiotherapy: Implications for Cardiovascular Outcomes after Radiotherapy.","authors":"Ali Ajdari, Mislav Bobic, Cosmin Ciausu, Alissa J Cooper, Christian Guthier, Thomas Bortfeld, Oreoluwa Owoseeni, Melin J Khandekar, Tomas G Neilan, Justin Gainor, Henning Willers, Rachel B Jimenez, Florence K Keane","doi":"10.1016/j.ijrobp.2026.10.020","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2026.10.020","url":null,"abstract":"<p><strong>Background: </strong>Cardiac toxicity is a well-recognized, but poorly understood complication of radiotherapy (RT). In non-oncological settings, there is an established relationship between resting heart rate and cardiovascular health.</p><p><strong>Objectives: </strong>To study the incidence and pattern of resting heart rate (rHR) as an early sign of cardiotoxicity among patients with non-metastatic non-small cell lung cancer (NSCLC) treated with RT.</p><p><strong>Methods: </strong>We retrospectively analyzed serial rHR measurements of consecutive patients with locally advanced NSCLC treated with definitive chemoradiation (CRT) over 6-7 weeks of daily radiation treatments followed by immunotherapy (durvalumab) between 2017-2022. Radiation dose to the heart and 17 cardiac substructures were extracted. Associations between heart rate elevation, tachycardia, cardiac substructure dose and outcomes were evaluated using generalized additive mixed models (GAMMs) and regression analysis.</p><p><strong>Results: </strong>We identified 110 patients, 56.4% with pre-existing heart disease. Median follow-up was 33.6 months. Median age was 70.4 years. Median rHR increased significantly during RT, rising from 81.5 bpm to 93 bpm at end of RT (p < 0.0001), remaining elevated in 30.6% of patients 12 months post-RT. Tachycardia incidence rose from 11.2% at baseline to 36.5% at 1-month post-RT (p < 0.0001). After adjusting for comorbidities, higher mean sinoatrial node (SAN) dose was associated with higher rHR elevation, delayed HR recovery and persistent tachycardia (all p < 0.05). Higher rHR during and after RT (β = 0.23, p = 0.005, and β = 13.49, p = 0.049, respectively), as well as the incidence of tachycardia episodes during RT were associated with increased odds of developing an arrhythmia (OR, 2.97, 95% CI, 1.17-7.52, p = 0.022).</p><p><strong>Conclusions: </strong>Elevated rHR and tachycardia are observed during and after RT for NSCLC and are associated with higher mean SAN dose. HR elevation was associated with increased risk of de novo arrhythmias, suggesting that heart rate may represent a non-invasive biomarker of subclinical cardiac injury. Prospective studies might be warranted to test the potential of routine HR monitoring and proactive dose reductions to the SAN to enable early detection and help mitigate the risk of post-treatment arrhythmia.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149244372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}