International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Relationship of Immediate Breast Reconstruction and the Development of Lymphedema in Breast Cancer Patients with Radiotherapy.","authors":"Soon Woo Hong, Eun-Kyu Kim, Hee-Chul Shin, Jaewon Beom, Jae-Young Lim, Koung Jin Suh, Jee Hyun Kim, Kyubo Kim, In Ah Kim","doi":"10.1016/j.ijrobp.2025.05.062","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.062","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer-related lymphedema (BCRL) is often challenging to manage, and knowledge of how to prevent it is limited. There are several well-known risk factors, but recent studies have also suggested the potential association of immediate breast reconstruction with lower incidence, albeit with inconclusive results. Thus, we explored the impact of immediate breast reconstruction on lymphedema incidence in breast cancer patients who underwent a mastectomy and adjuvant radiation therapy (RT).</p><p><strong>Methods and materials: </strong>We retrospectively reviewed 440 breast cancer patients who underwent a mastectomy with adjuvant RT from 2012 to 2020. Of these, 229 underwent immediate breast reconstruction (IR group), and 211 underwent no reconstruction (NR group). BCRL events were defined and graded on a scale of 0 to 3 following the International Society of Lymphology (ISL) staging system. After excluding patients who experienced BCRL before radiotherapy (n=30), with propensity score matching, we utilized log-rank analysis and multivariate Cox regression models to identify associated factors. Then, the clinical course of BCRL was explored with flow diagrams.</p><p><strong>Results: </strong>After a median follow-up period of 35 months, 116 patients (26%) developed BCRL, with 74% classified as ISL stage 2-3. 2-year actuarial rate of BCRL was 16.3% for the IR group, and 28.9% for the NR group (p=0.020). In a multivariate Cox regression of propensity score-matched (PSM) cohort (n=180), patients were more likely to develop stage ≥2 BCRL if 15 or more axillary lymph nodes were resected (p=0.035), or intensity-modulated radiotherapy (IMRT) was given (p=0.004). However, immediate breast reconstruction was associated with a lower incidence of BCRL (p=0.022). Regarding patients with initial stage 0 or 1 BCRL, the IR group showed a lower rate of progression during follow-up compared with the NR group (33% vs. 60%).</p><p><strong>Conclusions: </strong>In postmastectomy breast cancer patients, resection of 15 or more axillary lymph nodes, as well as IMRT, were found to be significantly associated with lymphedema occurrence. Notably, immediate breast reconstruction may be associated with a lower incidence of lymphedema.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159007","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":"International Consensus Guideline on Delineation of the Clinical Target Volumes (CTV) at Different Dose Levels for Nasopharyngeal Carcinoma (2024 Version).","authors":"Shao-Jun Lin, Qiao-Juan Guo, Qin Liu, Wai-Tong Ng, Yong Chan Ahn, Hussain AlHussain, Annie W Chan, James Chow, Melvin Chua, June Corry, Fei Han, Vincent Grégoire, Kevin J Harrington, Chao-Su Hu, Kenneth Jensen, Johannes A Langendijk, Quynh Thu Le, Nancy Y Lee, Victor Lee, Jin-Ching Lin, Jun Ma, William M Mendenhall, Brian O'Sullivan, Enis Ozyar, David I Rosenthal, Yun-Gan Tao, Ren-Sheng Wang, Joseph Wee, Zhi-Yuan Xu, Jun-Lin Yi, Sue S Yom, Dai-Ming Fan, Hai-Qiang Mai, Jian-Ji Pan, Anne W M Lee","doi":"10.1016/j.ijrobp.2025.05.019","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.019","url":null,"abstract":"<p><strong>Background and purpose: </strong>Radiotherapy planning for nasopharyngeal carcinoma (NPC) is one of the most challenging tasks for radiation oncologists due to the notoriously narrow therapeutic margin. The first International Guideline (IG-2018 Version) has served as a practical guide for contouring clinical target volumes (CTV). With increasing data on locoregional extension patterns and outcomes from studies on optimizing CTV and doses, an updated International Guideline is pressingly needed to provide a reference for enhancing precision.</p><p><strong>Methods and materials: </strong>A comprehensive literature review was conducted to assess existing guidelines and emerging data related to contouring. A preliminary questionnaire was distributed to 30 international experts (from 26 centers in 14 countries/regions) with extensive experience in NPC treatment, aiming to capture diverse practices and opinions. Following initial voting and iterations, a comprehensive survey was prepared for consensus building.</p><p><strong>Results: </strong>The initial questionnaire revealed marked variations in clinical practices related to CTV contouring and prescribed doses among experts. The final Delphi survey consisted of 58 questions: 20 (34%) parameters attained consensus (≥ 75% agreement) and 32 (55%) attained agreement (60-74% agreement). In the current guideline (IG-2024), 36 parameters involved changes/clarifications compared to IG-2018. The major differences focus on the use of post-induction chemotherapy GTV (except in patients with advanced extranodal extension) for CTV(p/n) to 70 Gy equivalent, stepwise refinement of elective coverage to ipsilateral anatomical structures for eccentric primary tumor, selective coverage of nodal levels, and a lower elective dose of 50 Gy equivalent.</p><p><strong>Conclusion: </strong>Midst the challenges of diverging practices, a comprehensive consensus guideline is devised based on updated evidence and collective agreement among international experts. This serves as a practical reference for optimal target coverage at different dose levels to maximize locoregional control while minimizing toxicities, and guiding principles for generating automated contouring programs to enhance standardization.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150444","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 after two sequences of total neoadjuvant treatment in patients with locally advanced rectal cancer in the randomized CAO/ARO/AIO-12 phase 2 trial.","authors":"Rebekka Kosmala, Adriana Salazar Hammann, Patrick Paulus, Marcus Zimmermann, Andrea Wittig-Sauerwein, Christoph-Thomas Germer, Michael Ghadimi, Ralf-Dieter Hofheinz, Markus Diefenhardt, Emmanouil Fokas, Claus Rödel, Bülent Polat","doi":"10.1016/j.ijrobp.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.018","url":null,"abstract":"<p><strong>Background and purpose: </strong>In a multicenter phase 2 trial the sequence of chemoradiotherapy (CRT) followed by consolidation chemotherapy (CT) prior to total mesorectal excision demonstrated higher pathological complete response rates than induction CT before CRT. Here, we present findings on quality of life (QoL).</p><p><strong>Materials and methods: </strong>Patients with rectal carcinoma (cT3-4 cN0-2) were randomly assigned to group A (CT+CRT; N=156) or group B (CRT+CT; N=150). This is a secondary QoL analysis (EORTC QLQ-C30+CR29, Wexner) before and during treatment and of disease-free patients during follow-up.</p><p><strong>Clinicaltrials: </strong>gov identifier: XXXX.</p><p><strong>Results: </strong>At baseline, completed questionnaires were available for 86% (N=134/156; group A) and 89% (N=133/150; group B) of participants, with availability decreasing to 73% versus 64% at 1 year, 61% versus 59% at 2 years, and 51% versus 47% at 3 years. Global health status remained stable in both groups (range 0-100) with baseline scores of 65.2 (mean, SD=21.5; N=133; group A) and 64.7 (SD=23.2; N=131; group B) and with scores of 67.6 (SD=18.4; N=52) and 65.4 (SD=22.2; N=46), respectively, at 3 years. No statistically or clinically relevant differences were observed between groups in any QoL scale upon treatment completion or during follow-up. Both groups experienced declines in role functioning, body image, male impotence, and stool incontinence (Wexner), which did not fully recover over the follow-up period. Rectal blood/mucus discharge and anxiety improved during treatment.</p><p><strong>Conclusions: </strong>QoL did not differ between the two total neoadjuvant treatment sequences. QoL domains with long lasting deterioration may serve as endpoints in future studies focused on organ preservation.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132389","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":"Stereotactic radiotherapy in children and young adults: Can we apply adult treatment paradigms?","authors":"Derek S Tsang, Erin Murphy, Kilian E Salerno, Jeannette Parkes, Susan M Hiniker, Steve Braunstein","doi":"10.1016/j.ijrobp.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.011","url":null,"abstract":"<p><p>The use of stereotactic radiation therapy (RT) in the treatment of children and young adults with malignancies and benign conditions has been increasing. However, the evidence guiding stereotactic RT in this population is in a nascent phase as compared to adult-derived data. In this critical review, the authors discuss some of the adult evidence behind stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS), and how it can be applied to children with cancer. An overview of pediatric-specific evidence and guidelines for SBRT and SRS are discussed, including indications, treatment approaches, outcomes, and future directions for research.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132390","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":"HERMES: Randomised trial of 2-fraction or 5-fraction MRI-guided adaptive prostate radiotherapy.","authors":"Sian Cooper, Rosalyne L Westley, Katie Biscombe, Alex Dunlop, Adam Mitchell, Uwe Oelfke, Simeon Nill, Georgina Manning, Stephanie Burnett, Julia Murray, Anna Wilkins, Nina Tunariu, Derek Price, Aidan Adkins, Angela Pathmanathan, Greta Bucinskaite, Shaista Hafeez, Chris Parker, Ragu Ratnakumaran, Helena Verkooijen, Sophie Alexander, Trina Herbert, Emma Hall, Alison C Tree","doi":"10.1016/j.ijrobp.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.008","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate safety and feasibility of 2-fraction stereotactic body radiotherapy (SBRT) for prostate cancer.</p><p><strong>Methods: </strong>This single centre, non-comparative, phase II/R-IDEAL2b trial randomised 46 patients with intermediate/lower high-risk prostate cancer with visible gross tumour volume (GTV) on multiparametric magnetic resonance imaging (MRI) to receive 36.25Gy in 5 fractions over 10 days or 24Gy in 2 fractions with a GTV boost up to 27Gy over 8 days. All treatment was delivered on an MR-linac with daily adaptive replanning. The primary endpoint was acute grade ≥2 (G2+) genitourinary (GU) toxicity (CTCAEv5). Secondary endpoints include gastrointestinal (GI) toxicity and patient reported outcomes.</p><p><strong>Results: </strong>G2+GU acute toxicity was observed in 6/22 (27.3%; 95% CI (0.11-0.50) of patients in the 2-fraction group and 7/24 (29.2%; 95% CI (0.13-0.50) in the 5-fraction group. There were no grade 3(G3) GU toxicities. G2+ urinary frequency rose from 4.5% (1/22) at week 2 to 13.6% (3/22) at week 4 in 2-fraction SBRT. G2+ urinary frequency peaked earlier in 5-fraction SBRT at 16.7% (4/24) in week 2, falling to 12.5% (3/24) at week 4. At 12 weeks, median EPIC-26 urinary-incontinence score was 85.5, IQR 75-100) for 2-fraction SBRT and 100, IQR 93.8-100) for 5-fraction SBRT. Urinary irritative-obstructive scores were higher at 12 weeks in the 2-fraction group (93.8, IQR 87.5-100) and 87.5, IQR 81.3-93.8 in the 5-fraction group. Peak IPSS score was lower in the 2-fraction group (8, IQR 4-11) and 13.5, IQR 10-17) in the 5-fraction group. G2+ GI acute toxicity occurred in 3/24 (6.8%) after 5-fraction SBRT, but none after 2-fraction SBRT.</p><p><strong>Conclusions: </strong>Acceptable acute GU toxicity was seen after 2-fraction SBRT. Acute GI toxicity was low. Randomised trials are warranted to explore late toxicity and biochemical control.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127608","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":"Safety and potential radiosensitizing effect of Olaparib in combination with breast radiotherapy for TNBC patients with residual disease: long-term results from the RADIOPARP Phase I Trial: Safety and Radiosensitization of Olaparib with Radiotherapy in TNBC.","authors":"Pierre Loap, Delphine Loirat, Marc-Henri Stern, Jean-Yves Pierga, Kim Cao, Anne Vincent -Salomon, Frederique Berger, Alain Fourquet, Youlia Kirova","doi":"10.1016/j.ijrobp.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.013","url":null,"abstract":"<p><strong>Introduction: </strong>Triple-negative breast cancer (TNBC) patients with residual disease after neoadjuvant therapy face a high risk of locoregional recurrence, particularly when homologous recombination deficiency (HRD) is present. HRD tumors, characterized by impaired double-strand break repair, are theoretically sensitive to PARP inhibitors through synthetic lethality. This phase I trial (XXXXX) evaluated the long-term safety and potential radiosensitizing effects of Olaparib combined with breast radiotherapy in TNBC patients.</p><p><strong>Materials and methods: </strong>This dose-escalation trial enrolled 24 non-metastatic TNBC patients treated between 2015 and 2019. Patients had either residual disease after neoadjuvant therapy (n=21, adjuvant setting) or unresectable tumors (n=3, preoperative setting). Olaparib was administered at escalating doses (50-200 mg BID) for seven days before normofractionated radiotherapy (50-50.4 Gy in 25-28 fractions). HRD status was determined using genomic analyses. Safety was assessed through dose-limiting toxicities (DLTs) and long-term adverse events, while secondary endpoints included locoregional recurrence-free survival (LRRFS), metastasis-free survival (MFS), and overall survival (OS).</p><p><strong>Results: </strong>Median follow-up was 59 months. No grade ≥3 toxicities were reported, and grade 2 toxicities (fibrosis and telangiectasias) were rare. Among HRD patients (n=13), no locoregional recurrences were observed, while three of eight homologous recombination proficient (HRP) patients experienced recurrences (p=0.024). Five-year LRRFS was 100% for HRD patients and 60.0% for HRP patients. MFS was 69.8%, and OS was 73.5%, with no significant differences by HRD status.</p><p><strong>Conclusion: </strong>The XXXXX trial demonstrates the long-term safety of combining Olaparib with radiotherapy and suggests its potential to enhance locoregional control in HRD tumors. Further studies are warranted to confirm these findings and refine treatment strategies for high-risk TNBC patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: XXXXXXX.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110339","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":"Machine Learning-Based Dose Prediction in [¹⁷⁷Lu]Lu-PSMA-617 Therapy by Integrating Biomarkers and Radiomic Features from [⁶⁸Ga]Ga-PSMA-11 PET/CT.","authors":"Elmira Yazdani, Mahdi Sadeghi, Najme Karamzade-Ziarati, Parmida Jabari, Payam Amini, Habibeh Vosoughi, Malihe Shahbazi Akbari, Mahboobeh Asadi, Saeed Reza Kheradpisheh, Parham Geramifar","doi":"10.1016/j.ijrobp.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.014","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to develop machine learning (ML) models for pretherapy prediction of absorbed doses (ADs) in kidneys and tumoral lesions for metastatic castration-resistant prostate cancer (mCRPC) patients undergoing [¹⁷⁷Lu]Lu-PSMA-617 (Lu-PSMA) radioligand therapy (RLT). By leveraging radiomic features (RFs) from [⁶⁸Ga]Ga-PSMA-11 (Ga-PSMA) PET/CT scans and clinical biomarkers (CBs), the approach has the potential to improve patient selection and tailor dosimetry-guided therapy.</p><p><strong>Methods: </strong>Twenty patients with mCRPC underwent Ga-PSMA PET/CT scans prior to the administration of an initial 6.8±0.4 GBq dose of the first Lu-PSMA RLT cycle. Post-therapy dosimetry involved sequential scintigraphy imaging at approximately 4, 48, and 72 h, along with a SPECT/CT image at around 48 h, to calculate time-integrated activity (TIA) coefficients. Monte Carlo (MC) simulations, leveraging the Geant4 application for tomographic emission (GATE) toolkit, were employed to derive ADs. The ML models were trained using pretherapy RFs from Ga-PSMA PET/CT and CBs as input, while the ADs in kidneys and lesions (n=130), determined using MC simulations from scintigraphy and SPECT imaging, served as the ground truth. Model performance was assessed through leave-one-out cross-validation (LOOCV), with evaluation metrics including R² and root mean squared error (RMSE).</p><p><strong>Results: </strong>The mean delivered ADs were 0.88 ± 0.34 Gy/GBq for kidneys and 2.36 ± 2.10 Gy/GBq for lesions. Combining CBs with the best RFs produced optimal results: the extra trees regressor (ETR) was the best ML model for predicting kidney ADs, achieving an RMSE of 0.11 Gy/GBq and an R² of 0.87. For lesion ADs, the gradient boosting regressor (GBR) performed best, with an RMSE of 1.04 Gy/GBq and an R² of 0.77.</p><p><strong>Conclusion: </strong>Integrating pretherapy Ga-PSMA PET/CT RFs with CBs shows potential in predicting ADs in RLT. To personalize treatment planning and enhance patient stratification, it is crucial to validate these preliminary findings with a larger sample size and an independent cohort.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110380","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":"Examining recent employment outcomes for graduating radiation oncologists across and within the metropolitan/non-metropolitan continuum: 2015-2022.","authors":"Catherine Yu, Kristin Hsieh, Daniel R Cherry, Juliana Runnels, Jared P Rowley, Kunal K Sindhu","doi":"10.1016/j.ijrobp.2025.05.017","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.017","url":null,"abstract":"<p><strong>Purpose: </strong>In recent years, fewer than 5% of radiation oncology (RO) residents have accepted permanent positions in nonmetropolitan (nonmetro) areas immediately after graduation. In this study, we sought to identify factors associated with practice location and examine the county-level parameters of these communities.</p><p><strong>Materials and methods: </strong>Using multiple sources of publicly available data, we built a database of United States RO residents who graduated between 2015-2022. We subsequently determined the first permanent job accepted by each graduate and identified its rural-urban continuum code (RUCC). A logistic regression model was used to identify predictors of accepting a first job in a nonmetro county. Using the Area Health Resource Files (AHRF), we performed a secondary analysis to determine county characteristics associated with an increased geographic density of recent graduates in both metropolitan (metro) and nonmetro cohorts.</p><p><strong>Results: </strong>Among 2015-2022 RO graduates, 60/1396 (4.3%) accepted first jobs in a nonmetro county, and 24/60 (40.0%) of these graduates were located in a nonmetro county not adjacent to a metro area. On multivariable analysis, graduates of larger residency programs (defined by the total number of graduates between 2015-2022) were less likely to accept a first job in a nonmetro county (odds radio [OR], 0.96; 95% CI, 0.94-0.99; P < .01). Within both metro and nonmetro cohorts, recent graduates' first jobs were located in counties with higher population (P <.01), higher population density (P < .01), higher median household income (P< .01), more hospital care access (P < .01), and more primary care physicians per 10,000 individuals (P < .01).</p><p><strong>Conclusion: </strong>The geographic distribution of recent RO graduates appears to correlate with several indicators of population and healthcare resources, even when accounting for metro and nonmetro communities separately. These findings suggest that future efforts aimed at improving equitable access to RO services throughout the United States may prove more challenging than simply addressing disparities across the metro/nonmetro divide.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110079","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":"Hypofractionated Preoperative Radiation Therapy for Extremity and Superficial Trunk Soft Tissue Sarcomas: Results of a Prospective, Phase II Trial.","authors":"Safia K Ahmed, Meng Xu-Welliver, Madeline Dorr, Kimberly O Steinert, Matthew T Houdek, Peter S Rose, S Mohammed Karim, Jonathan B Ashman, Krista A Goulding, Brittany L Siontis, Michael G Haddock, Ivy A Petersen","doi":"10.1016/j.ijrobp.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.006","url":null,"abstract":"<p><strong>Background: </strong>Preoperative radiation therapy (RT) for resectable extremity soft tissue sarcomas (STS) has historically been delivered over 5 weeks and associated with a 35% major wound complication (WC) rate. We investigated the rate of WC in a cohort of STS patients treated with a moderately hypofractionated course of preoperative RT.</p><p><strong>Patients and methods: </strong>MC1973 was a single-arm, prospective, phase 2, non-inferiority trial completed at Mayo Clinic in Minnesota and Arizona. We administered preoperative RT to 42.75 Gy in 15 fractions. Patients underwent standard of care tumor resection afterwards. The primary endpoint was a major WC occurring within 120 days of surgery. Wilcoxon Rank Sum tests, Fisher Exact tests, and Conchran-Armitage Trend tests were used to evaluate associations with WC. Kaplan-Meier analysis was used to report early survival-associated outcomes.</p><p><strong>Results: </strong>Between November 24, 2020 and January 30, 2024, 120 patients enrolled on trial. One patient withdrew prior to receiving treatment. Most common tumor location was proximal lower extremity (48.7%). After RT, 117 patients (97.5%) underwent tumor resection. Two patients treated with RT came off study prior to surgery due to death. A major WC developed in 27/117 patients (23.1%). Median time to WC resolution was 17.4 weeks. The rate of persistent WC at 6 months was 26%. On univariate analysis, leiomyosarcoma histology (n=5) correlated with a higher WC rate (60%). Median follow up was 21.1 months. Fourteen patients experienced acute grade 3 adverse events. One-year disease-free survival was 86.0% (95% CI, 79.7-92.9%). Two patients developed local recurrence. One fracture was observed.</p><p><strong>Conclusions: </strong>The major WC rate was 23.1% with a preoperative regimen of 42.75 Gy in 15 fractions. This suggests moderate hypofractionation is not inferior compared to historical standards of major WC rate. Additional follow-up will allow evaluation of oncologic outcomes, long-term treatment-associated adverse events, and patient reported outcomes.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144101812","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":"HYHOPE: A phase I study of de-intensified hypofractionated radiation therapy for human papillomavirus-associated oropharynx cancer.","authors":"Dominic H Moon, Vladimir Avkshtol, Randall S Hughes, Chul Ahn, Baran D Sumer, Andrew T Day, Brittny N Tillman, Larry L Myers, John M Truelson, David J Sher","doi":"10.1016/j.ijrobp.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.05.009","url":null,"abstract":"<p><strong>Background: </strong>Various de-escalation strategies for human papillomavirus-associated oropharynx cancers are under investigation. We have incorporated hypofractionated radiotherapy (RT) in a phase I study to assess the tolerability of dose and volume de-intensified RT completed in 3 weeks with weekly cisplatin.</p><p><strong>Methods: </strong>Patients with favorable oropharynx cancer, defined as T1-3, N0-2, p16 positive, and ≤10 pack-years, were enrolled using a rolling 6 design with 46.5 Gy in 15 fractions as level 0 and 52 Gy in 20 fractions as level -1. The elective neck was restricted to the involved plus adjacent nodal levels. The primary endpoint was the maximum tolerated dose/fractionation (MTD) of hypofractionated RT. Additional patients were enrolled at the MTD on the dose expansion cohort. All patients received three weekly doses of cisplatin (40 mg/m²).</p><p><strong>Results: </strong>Six patients were treated on level 0 with no dose limiting toxicity, and thus 46.5 Gy in 15 fractions was deemed the MTD. On the dose expansion cohort, 18 additional patients were enrolled for a total of 24 patients. Acute grade 3 toxicity occurred in 7 (29%) patients including oral mucositis, dysphagia, and weight loss. One patient experienced an acute grade 4 toxicity of lymphopenia, which resolved with time. Late toxicity consisted of one grade 2 xerostomia and one grade 2 dysphagia, with no late grade 3+ toxicity. Mean (standard deviation) MD Anderson Dysphagia Inventory composite score at baseline, 3 and 12 months were 86.5 (13.7), 85.5 (11.3), and 89.4 (9.4), respectively. With a median follow-up of 26.6 months, the 2-year cumulative incidence of locoregional recurrence was 13.8% (95% confidence interval 3.2-32%).</p><p><strong>Conclusion(s): </strong>De-intensified hypofractionated RT with weekly cisplatin completed in 3 weeks is well-tolerated with excellent toxicity profile and patient-reported swallow function warranting further investigation to assess efficacy.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093683","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}