International Journal of Radiation Oncology Biology Physics最新文献

{"title":"5-5-5 ABRT (Dose of 5 Gy per Fraction for up to 5 Fractions Over 5 Weeks Adaptive Bridging Radiation Therapy)-Artificial Intelligence Enters the CAR (-T) (Chimeric Antigen Receptor-T) in Relapsed/Refractory Large B Cell Lymphoma.","authors":"Hazim S Ababneh, Andrea K Ng, Joshua Wan, Tyler Walburn, Lin Zhu, Mislav Bobić, Patrick Connor Johnson, Jeremy Bredtfeld, Jonathan Leeman, Jacob Soumerai, Jeremy S Abramson, Jeffrey Barnes, Ronald Takvorian, Matthew J Frigault, Jennifer Pursley, Chirayu G Patel","doi":"10.1016/j.ijrobp.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.023","url":null,"abstract":"<p><strong>Purpose: </strong>Bridging radiation therapy (BRT) is effective for local control in patients with relapsed or refractory large B cell lymphoma who are undergoing chimeric antigen receptor (CAR) T cell therapy. We hypothesized that adaptive BRT (ABRT), which can be used to personalize the radiation dose, fractionation, and volume based on real-time lymphoma target volume, is feasible, safe, and effective for local control.</p><p><strong>Methods and materials: </strong>We conducted a pilot study to investigate, once weekly, computed tomography-based adaptive radiation therapy (Varian Ethos) at a dose of 5 Gy per fraction for up to 5 fractions over 5 weeks in patients referred for BRT (NCT06004167).</p><p><strong>Results: </strong>Ten patients were enrolled. Eleven sites were irradiated for palliative purposes, achieving an overall symptomatic response rate of 100%. Of the 40 total ABRT sessions, 26 fractions were delivered (65%). For 8 of the 11 target volumes treated, ABRT was held after the first 1 or 2 fractions. The in-field responses during ABRT pre-CAR T were: complete response (n = 3, 30%), partial response (n = 6, 60%), and in-field progression (n = 1, 10%). After CAR T cell infusion, the best overall response rate was 70% (n = 7), all of whom achieved complete response. Among all 10 patients, 3 experienced in-field recurrence after start date of BRT. Among those with immune effector cell-associated neurotoxicity syndrome (n = 6), grade 3 immune effector cell-associated neurotoxicity syndrome occurred in 50% (n = 3). No grade 3 or higher cytokine release syndrome events were reported. At the time of the last follow-up, 9 patients (90%) were still alive, and 1 patient (10%) died due to disease progression.</p><p><strong>Conclusions: </strong>We demonstrate the safety and feasibility of ABRT at a dose of 5 Gy per fraction for up to 5 fractions over 5 weeks in this highly relapsed/refractory population, even in patients with high-volume disease, with the vast majority responding to 1 to 2 fractions of 5 Gy. All patients achieved symptomatic relief and were able to proceed to CAR T cell infusion.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772202","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":"Feasibility and Impact of an RTT-Driven Workflow for CBCT-Guided Partial Breast Adaptive Radiotherapy.","authors":"David Parsons, Sean Domal, Eric Chambers, Denise Salazar, Justin Visak, Mona Arbab, Francis Holgado, Dillon Li, Chinasa Okoro, Narine Wandrey, Zohaib Iqbal, Prasanna Alluri, Bin Cai, Hannah Keen, Jennifer Cleaton, Andrew Godley, David Sher, Shahed Badiyan, Asal Rahimi, Mu-Han Lin","doi":"10.1016/j.ijrobp.2025.03.055","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.055","url":null,"abstract":"<p><strong>Purpose: </strong>Cone-beam computed tomography (CBCT)-based online adaptive radiotherapy (ART) allows significantly smaller planning target volume (PTV) margins for patients treated with adaptive stereotactic partial breast irradiation (A-SPBI). However, this approach places increased demands on the treatment team, especially physicians. We hypothesize that with appropriate training, physicians' involvement at the treatment console can be reduced by delegating contouring and planning tasks to radiation therapy technologists (RTTs) with a physicist co-pilot without reducing treatment quality.</p><p><strong>Materials and methods: </strong>In this prospective study designed to evaluate an RTT-driven workflow, 23 patients undergoing A-SPBI were included, with two treatment plans generated per adaptive fraction. The first plan used contours edited by RTTs under physicist supervision (without physician oversight), and the second plan used contours edited by physicians. RTT-modified plans were compared with physician-edited contours for target coverage (V_100% and V_95%) and organ-at-risk (OAR) constraints. Dice coefficient and Hausdorff distance were calculated for target volumes. Following confirmation of RTT contour quality, we initiated the 'remote physician' workflow to further reduce physician demand in the on-couch process. Physician review time was recorded to estimate the reduction in time required for ART. The number of treated fractions before and after implementation was also tracked.</p><p><strong>Results: </strong>Analysis of 103 adaptive fractions showed mean Dice coefficient 0.96 for the tumor bed. Mean Hausdorff distance was 0.6 mm. Differences in planning target volume coverage were -1.0 ± 2.2% and -0.6 ± 1.3% for V_100% and V_95%, respectively. Similar metrics for the tumor bed and clinical target volume had differences <0.4%. Physician time for ART was reduced by 12.3 ± 1.0 minutes per fraction, leading to a 224% increase in ART breast volume at our institution.</p><p><strong>Conclusions: </strong>Training experienced radiation therapists to perform contouring and planning tasks reduces physician workload without compromising treatment quality during online A-SPBI. Remote contour review ensures ongoing quality and consistency.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780072","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":"Differentiation stage predicts radiosensitivity in mesenchymal-like pancreatic cancer.","authors":"Tingshi Su, Xinjian Yu, Mojtaba Hoseini-Ghahfarokhi, David B Flint, Scott J Bright, Joana Antunes, David K J Martinus, Mandira Manandhar, Mariam Ben Kacem, Poliana C Marinello, Eurico Pereira, Hua-Sheng Chiu, Uwe Titt, David R Grosshans, Jan Schuemann, Henning Willers, Harald Paganetti, Pavel Sumazin, Gabriel O Sawakuchi","doi":"10.1016/j.ijrobp.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.034","url":null,"abstract":"<p><strong>Purpose: </strong>To derive a genomic classifier to predict radiosensitivity of pancreatic cancer cell lines and pancreatic cancer patients to allow genomic-guided radiotherapy.</p><p><strong>Methods and materials: </strong>We collected a comprehensive dataset of full clonogenic cell survival curves of 45 pancreatic cancer cell lines irradiated with clinical photon and proton beams. We derived classifiers based on data from human embryonic and fetal pancreas single-cell RNA-sequencing (scRNA-seq) to distinguish between epithelial and mesenchymal cells and to predict pancreas cell-line differentiation stage. Independent testing was done with an embryonic mouse pancreas scRNA-seq dataset. We then used bulk RNA-seq profiles from the Cancer Cell Line Encyclopedia (CCLE) to classify our pancreatic cancer cell lines using our epithelial-mesenchymal and differentiation stage classifiers. We then correlated the differentiation stage classifier with the radiosensitivity of the pancreatic cancer cell lines as well as with pancreatic cancer patient data from The Cancer Genome Atlas.</p><p><strong>Results: </strong>We found wide variability in radiosensitivity to both photons and protons among pancreatic cancer cell lines. We showed that the differentiation stage is predictive of radiosensitivity of mesenchymal pancreatic cancer cell lines but not epithelial pancreatic cancer cell lines. We found that chromatin compaction is associated with the differentiation stage and showed that the less differentiated mesenchymal pancreatic cancer cell lines tend to be radioresistant and with more compact chromatin than the radiosensitive differentiated cell lines. Patients with more differentiated tumors exhibit better overall survival.</p><p><strong>Conclusions: </strong>We found that mesenchymal-like undifferentiated pancreatic cancer cell lines are more radioresistant than mesenchymal-like differentiated ones and that pancreatic cancer patients with mesenchymal-like undifferentiated tumors treated with radiotherapy tend to have lower overall survival compared to patients with mesenchymal-like differentiated tumors. We show that it is feasibility to use the differentiation stage of mesenchymal pancreatic cancer cells to predict tumor specific radiosensitivity.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780071","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":"Quality of life and toxicity in patients with pancreatic ductal adenocarcinoma treated with online adaptive stereotactic MR-guided radiotherapy.","authors":"J M Westerhoff, J C M Scheepens, F F van Wolffelaar, U Bernchou, R Bahij, B Erickson, J P Christodouleas, S S W Ng, C Gani, A Choudhury, F Alongi, P Renz, A T Colonias, G J Meijer, T Schytte, M P W Intven, H M Verkooijen, L A Daamen, W A Hall","doi":"10.1016/j.ijrobp.2025.03.046","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.046","url":null,"abstract":"<p><strong>Introduction: </strong>Online adaptive magnetic resonance guided radiotherapy (MRgRT) using a hybrid MRI and linear accelerator (MR-Linac) enables stereotactic ablative radiation doses to pancreatic tumors. We evaluated patient-reported quality of life (QoL) and clinician-reported toxicity in patients with pancreatic ductal adenocarcinoma (PDAC) following stereotactic MRgRT.</p><p><strong>Method: </strong>Patients with non-metastatic PDAC treated with stereotactic MRgRT on a 1.5T MR-Linac according to local standard practices between May 2019 and December 2023 were identified using the international, prospective observational XXX study. Patient-reported QoL and clinician-reported toxicity were assessed using the EORTC QLQ-C30 and Common Terminology Criteria for Adverse Events (CTCAE) at baseline, 3, 6, and 12 months of follow-up. Patients with new systemic therapy or resection were censored. Patients with disease progression were additionally censored for a sensitivity analysis. Mean difference (MD) QoL scores from baseline were estimated using a linear mixed model, which were evaluated for clinical relevance (MD≥10) and statistical significance (p≤0.05). Acute (≤3 months follow-up) and late (3 to 12 months follow-up) toxicity was captured if grade ≥3.</p><p><strong>Results: </strong>Included were 127 patients from eight centers. Treatment dose ranged from 30-50 Gy in five fractions. Functional QoL domains remained stable over time. Statistically significant and clinically relevant improvement was found for nausea and vomiting (MD -10, 95%CI -17 to -3; p<0.001), and in the sensitivity analysis for nausea and vomiting (MD -11, 95%CI -18 to -3; p<0.001) and appetite (MD -14, 95%CI -28 to 0; p=0.05), all at six months follow-up. No clinically relevant and statistically significant deterioration was found in other domains. Acute and late grade 3 toxicity occurred in 2 patients and 1 patient, respectively.</p><p><strong>Conclusion: </strong>Stereotactic MRgRT for patients with non-metastatic PDAC was associated with stable functioning, improved disease-related symptoms, and minimal toxicity up to 12 months following treatment.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780003","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":"Standardisation of radiotherapy to inguinal and pelvic lymph nodes in locally-advanced cancer of the penis, as defined by the International Penile Advanced Cancer Trial (InPACT).","authors":"S Cooper, S Nicholson, J Crook, N Watkin, C Pettaway, J Barber, A V Mitra, O Woodley, A Millin, E Hall, A Pathmanathan, S Penegar, S Burnett, P E Spiess, E Miles, K Hoffman, H Yang, A Tree","doi":"10.1016/j.ijrobp.2025.03.022","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.022","url":null,"abstract":"<p><p>InPACT addresses the optimal management of locally advanced penile cancer, aiming to prospectively evaluate the relative benefits and sequencing of surgery, chemotherapy, and chemoradiotherapy. At trial inception, radiotherapy protocols for this rare cancer lacked consistency and standardisation, necessitating multi-centre, international collaboration to develop comprehensive Radiotherapy Planning, Delivery and Quality Assurance Guidelines.</p><p><strong>Methods: </strong>InPACT has two main aims; to establish the efficacy of neoadjuvant chemotherapy or chemoradiotherapy in patients with macroscopically-involved inguinal nodes. Secondly, to compare prophylactic pelvic lymph node dissection (PLND) plus chemoradiation to the inguinal and pelvic fields versus chemoradiation alone in patients whose inguinal node histology predicts a high risk of occult pelvic node involvement. The primary outcome measure for the trial is survival time. An international group was convened to achieve consensus on radiotherapy contouring, planning, dose, fractionation and delivery for this rare cancer. These guidelines have been used throughout the conduct of the trial to date and form part of the radiotherapy quality assurance for each participating centre.</p><p><strong>Results: </strong>International consensus radiotherapy guidelines were established, encompassing risk status assessment and indications for each treatment region based on radiological and pathological risk status of nodal basins. Guidance provides a nodal contouring atlas, addresses prepubic fat coverage, and specifies dose fractionation for both neoadjuvant and adjuvant settings, including recommendations for macroscopic disease. Trial recruitment is ongoing. Oncological and toxicity outcomes will be reported in due course.</p><p><strong>Conclusion: </strong>The InPACT radiotherapy guidelines offer a step towards international consensus on contouring for inguino-pelvic radiotherapy in penile cancer.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780004","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 prospective single-arm study of daily online adaptive radiotherapy for cervical cancer with reduced PTV margin: acute toxicity and dosimetric outcomes.","authors":"Guangyu Wang, Yining Chen, Zhiqun Wang, Zheng Zeng, Yuliang Sun, Bing Zhou, Bo Yang, Jie Qiu, Junfang Yan, Ke Hu, Fuquan Zhang","doi":"10.1016/j.ijrobp.2025.03.051","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.051","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate acute toxicity and dosimetric outcomes in cervical cancer treated with daily iterative cone-beam computed tomography (iCBCT)-guided online adaptive radiotherapy (oART) using reduced planning target volume (PTV) margin.</p><p><strong>Methods and materials: </strong>From February 2023 to November 2023, 27 patients with stage I-III cervical cancer were prospectively enrolled in this study. All patients received daily iCBCT-guided oART (prescribed 50.4Gy in 28fractions) with concurrent weekly chemotherapy followed by brachytherapy. A uniform 10 mm margin was used to cover more variable uterus (PTV-U), and 5 mm margin was used for other PTV. The dosimetric results for each oART fraction were recorded. Both clinician- and patient-reported acute toxicities were assessed before treatment, weekly during treatment, 1 month and 3 months after treatment.</p><p><strong>Results: </strong>The average total treatment time was 22 minutes and 54 seconds, and the adapted plan was selected for all fractions. The adapted plans showed superior coverage for the target volume and dosimetric improvement of organs at risk compared with the scheduled plan. Overall, no patient had Grade ≥ 4 acute toxicities. Grade 1, 2 and 3 acute gastrointestinal toxicity were 26%, 19%, and 4%, respectively, among which diarrhea was the most common. Only Grade 1 acute genitourinary toxicity was observed in 2 cases (7%). The low incidence of acute toxicity was supported by patient-reported outcome data, which showed significant decreases in mean standard scores on function subscales and significant increases on symptom subscales/items following the initiation of oART. Most of these scales returned to baseline average scores by the 1-month follow-up.</p><p><strong>Conclusions: </strong>This prospective study of daily oART in patients with cervical cancer observed dosimetric benefits and a low incidence of acute toxicity, both in clinician- and patient-reported outcome measurements.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780070","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":"Requirements and study design for the next proton FLASH clinical trials: an international multidisciplinary Delphi consensus.","authors":"Yvonne Lb Klaver, Mischa S Hoogeman, Q Richard Lu, Jeffrey D Bradley, J Isabelle Choi, Matthew J Ferris, Cai Grau, Chandan Guha, Haibo Lin, Liyong Lin, Anthony E Mascia, Astrid M Moerman, Per R Poulsen, Lewis Z Shi, Brita Singers Sørensen, Sibo Tian, Marie-Catherine Vozenin, Christopher D Willey, Sumin Zhou, Richard A Amos, Maria Hawkins, Charles B Simone","doi":"10.1016/j.ijrobp.2025.03.047","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.047","url":null,"abstract":"<p><strong>Purpose: </strong>The FLASH effect, defined as normal tissue sparing while maintaining tumor control with ultra-high dose rate (UHDR) irradiation, has been demonstrated preclinically in different tumors and tissues. Although biological mechanisms are unclear, there is a need for clinical trials investigating the value of proton FLASH irradiation (pFLASH). The purpose of this study was to establish an expert consensus regarding prerequisites, study design and endpoints for next clinical trials exploring the clinical potentials of pFLASH.</p><p><strong>Methods and materials: </strong>Delphi methodology was used to develop a systematic expert consensus. An international expert panel was composed of 21 clinicians, physicists and biologists, well-balanced in expertise and geography, using predefined inclusion criteria. Statements were scored on a 5-point Likert scale in 2 rounds of online questionnaire voting. Definition of consensus was set a priori.</p><p><strong>Results: </strong>Response rate was 100% in both rounds. Preclinical in vivo demonstration of the FLASH effect in normal tissue while maintaining tumor response is deemed essential before starting a clinical trial in a specific tumor site. The next clinical pFLASH trials are advised to include adult patients only, with a minimal expected overall survival of 1 year for palliative settings or, preferably, oligometastatic disease in the ablative setting. The pFLASH effect should be studied in a single treatment modality setting with toxicity reduction as the primary endpoint. Recommendations are described on the use of clinical targets and organs at risk constraints, requirements for evaluation and reporting and accuracy levels and pretreatment verification of dose rates. No consensus was reached on the use of multiple beams, multiple fractions and fraction dose.</p><p><strong>Conclusions: </strong>There is a need for additional data regarding influence of fractionation and multiple beam planning. Results of this study can be used to develop roadmaps to guide future clinical trial design.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772301","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":"Magnetic Resonance-Guided Stereotactic Body Radiotherapy (MRgSBRT) with Daily Online Plan Adaptation for Reirradiation in the Abdomen.","authors":"Thomas P Howard, Dianne Ferguson, Zhaohui Han, Harvey J Mamon, Jonathan E Leeman, Ritchell van Dams","doi":"10.1016/j.ijrobp.2025.03.042","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.042","url":null,"abstract":"<p><strong>Purpose: </strong>Reirradiation in the abdomen poses a challenge due to both interfraction and intrafraction motion of the target and nearby organs at risk (OARs). We hypothesized that magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) with daily online adaptation allows for safe and effective dose-escalated treatment by minimizing grade 3+ gastrointestinal (GI) toxicities.</p><p><strong>Materials/methods: </strong>We performed a single-institution retrospective review of 38 patients who received a total of 44 courses of MRgSBRT reirradiation within the abdomen. Clinical outcomes included local control, overall survival, and GI toxicities assessed using CTCAE v5. OAR metrics of original and adapted plans were compared to assess the added value of daily adaptation.</p><p><strong>Results: </strong>Fourteen different primary histologies were treated, with the most common including pancreatic (18.2%), renal (18.2%), and prostate (15.9%) cancers. The most common site for reirradiation was abdominal lymph nodes (61.3%). A majority (70.4%) of MRgSBRT courses were preceded by prior SBRT. The median and modal prescribed dose of MRgSBRT reirradiation was 40 Gy in 5 fractions (BED₁₀=72); 87% of courses were treated to a BED₁₀ of at least 59.5. Across 218 total fractions, daily adaptation improved PTV coverage by a mean of 4.1% (95% CI: 3.1 - 5.1%, p<0.0001) and met 100% of hard luminal GI OAR 0.03cc constraints that would have been exceeded without adaptation in 53.2% of fractions. The median follow-up after MRgSBRT reirradiation was 15.8 months. One-year local control and overall survival were 89.5% and 74.9%, respectively. Grade 3+ toxicity possibly related to MRgSBRT reirradiation was observed following two (4.5%) courses.</p><p><strong>Conclusion: </strong>MRgSBRT allows for dose escalation and good local control in cases of abdominal reirradiation with acceptable toxicity. Daily adaptation provided substantial benefit in meeting safety goals and improving coverage. This retrospective study supports the development of a prospective clinical trial of MRgSBRT reirradiation in the abdomen.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772299","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":"TREATMENT OF OLIGOMETASTATIC PARENCHYMAL LESIONS IN OVARIAN CANCER WITH STEREOTACTIC ABLATIVE RADIOTHERAPY: A MULTICENTER PROSPECTIVE PHASE II TRIAL (MITO RT3/RAD).","authors":"Gabriella Macchia, Donato Pezzulla, Maura Campitelli, Simona Lucci, Lorena Draghini, Donatella Russo, Andrei Fodor, Giuseppe Roberto D'Agostino, Vittoria Balcet, Marinella Tamburo, Lucia Giaccherini, Francesca Tortoreto, Antonietta Augurio, Edy Ippolito, Aida Di Stefano, Mara Fanelli, Lella Petrella, Savino Cilla, Francesco Cosentino, Claudia Marchetti, Vanda Salutari, Alessio Giuseppe Morganti, Maria Antonietta Gambacorta, Anna Fagotti, Sandro Pignata, Giovanni Scambia, Gabriella Ferrandina, Francesco Deodato","doi":"10.1016/j.ijrobp.2025.03.032","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.032","url":null,"abstract":"<p><strong>Purpose: </strong>The results of stereotactic body radiotherapy (SBRT) for parenchymal lesions in the setting of oligometastatic ovarian cancer are reported in the context of the prospective multicenter Phase II MITO-RT3/RAD trial (NCT04593381).</p><p><strong>Methods: </strong>The primary endpoint was the complete response (CR) rate, secondary endpoints included local control (LC), progression-free survival (PFS), overall survival (OS), treatment-free interval (TFI), and toxicity rates. Sample size was based on a previous study reporting an average 40.0% CR with SBRT. The study was powered to detect an improvement in the CR rate from 40.0% to 55.0%, with an α error of 0.05 (one-side) and a β error of 0.1.</p><p><strong>Results: </strong>The study met its primary endpoint of a statistically significant improvement of CR. 88 patients with 127 lesions were enrolled across fifteen Institutions from May 2019 to November 2023. CRs were observed in 71 lesions (55.9%), partial response in 37 (29.1%), stable disease in 14 (11.0%), and progressive disease in five lesions (4.0%). The objective response rate was 85.0%, with an overall clinical benefit rate of 96.0%. The overall 12-month LC was 81.6%, with CR lesions exhibiting a significantly higher rate than partial or not responding lesions (12-month LC: 96.3% versus 61.4%, p<0.001). The 12-month actuarial rates for PFS and for OS were 34.9% and 91.5%, respectively. The median actuarial Treatment-free interval was 9 months (range 2.5-15.4 months), while the 12-month actuarial rate was 44.1%. No Grade 3 or higher toxicity was reported. In particular, 15 (20.5%) patients experienced mild acute toxicity (≤ Grade 2). There were 12 Grade 1 events and 6 Grade 2 events, the latter mostly represented by pain flare (N=2). Late toxicity was reported in 4 patients (4.5%) accounting for 4 events, mostly Grade 1, except for one case of moderate asthenia (Grade 2).</p><p><strong>Conclusions: </strong>Parenchymal oligometastatic lesions showed a high rate of complete response and encouraging long-term outcomes for patients achieving CR, including a substantial period of systemic therapy-free survival after radiotherapy. The observed toxicity was minimal, strengthening the safety of ablative SBRT as a non-invasive alternative to surgical resection for parenchymal metastases in high-risk areas.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772303","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":"Establishing a Safety Net in X-Ray-Based Online Adaptive Radiation Therapy: Early Detection of Planning Deficiencies Through Upstream Physics Plan Review.","authors":"Zohaib Iqbal, Yang Kyun Park, David Parsons, Andrew Godley, Steve Jiang, David Sher, Shahed Badiyan, Robert Timmerman, Mu-Han Lin","doi":"10.1016/j.ijrobp.2025.03.041","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.041","url":null,"abstract":"<p><strong>Purpose: </strong>Online adaptive radiation therapy (oART) is increasingly adopted in clinics worldwide, making robust error mitigation essential to deliver high-quality treatment. This study reports on a one-year experience with an upstream physics plan review process aimed at early error detection and prevention of x-ray-based oART planning deficiencies.</p><p><strong>Method/materials: </strong>An upstream plan review process was implemented, enabling physicists to evaluate adaptive plans before physician approval, with a focus on identifying deficiencies early and allowing time for corrective modifications. This process was facilitated by an ESAPI script, which recorded timestamps and comments in a central database. The review checklist, optimized through FMEA analysis and clinic-specific insights, was used for all oART plans. A total of 732 cases were reviewed prospectively and categorized into three groups-proceed, minor revisions necessary, and major revisions necessary-based on the type of errors found. Errors were further classified into sub-groups and reported. These findings were compared to events in the clinic's incident learning system to determine the impact of errors on treatment.</p><p><strong>Results: </strong>Of the 732 cases (totaling 2437 oART deliveries), only 2 errors (0.3% of cases; 0.08% of deliveries) affected patient treatment, with no dosimetric consequences. The review process saved the clinic a net total of 160.3 hours over the year by reducing the need for last-minute re-plans. Approximately 29% of cases required minor or major revisions, largely due to contouring errors. Revision probability and upstream plan review time was significantly negatively correlated with the normalized planning workload (p < 0.001).</p><p><strong>Conclusions: </strong>Upstream physics plan review enables early detection of planning deficiencies in oART, providing a critical safety net that prevents last-minute re-plans and enhances adaptive therapy reliability. Moving plan review earlier in the workflow supports quality assurance, workload efficiency, and error reduction, making it a valuable model for other treatment planning workflows.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752659","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}