International Journal of Radiation Oncology Biology Physics最新文献

{"title":"NRG Oncology White Paper on the Relative Biological Effectiveness in Proton Therapy.","authors":"Harald Paganetti, Charles B Simone, Walter R Bosch, Daphne Haas-Kogan, David G Kirsch, Heng Li, Xiaoying Liang, Wei Liu, Anita Mahajan, Michael D Story, Paige A Taylor, Henning Willers, Ying Xiao, Jeffrey C Buchsbaum","doi":"10.1016/j.ijrobp.2024.07.2152","DOIUrl":"10.1016/j.ijrobp.2024.07.2152","url":null,"abstract":"<p><p>This position paper, led by the NRG Oncology Particle Therapy Work Group, focuses on the concept of relative biologic effect (RBE) in clinical proton therapy (PT), with the goal of providing recommendations for the next-generation clinical trials with PT on the best practice of investigating and using RBE, which could deviate from the current standard proton RBE value of 1.1 relative to photons. In part 1, current clinical utilization and practice are reviewed, giving the context and history of RBE. Evidence for variation in RBE is presented along with the concept of linear energy transfer (LET). The intertwined nature of tumor radiobiology, normal tissue constraints, and treatment planning with LET and RBE considerations is then reviewed. Part 2 summarizes current and past clinical data and then suggests the next steps to explore and employ tools for improved dynamic models for RBE. In part 3, approaches and methods for the next generation of prospective clinical trials are explored, with the goal of optimizing RBE to be both more reflective of clinical reality and also deployable in trials to allow clinical validation and interpatient comparisons. These concepts provide the foundation for personalized biologic treatments reviewed in part 4. Finally, we conclude with a summary including short- and long-term scientific focus points for clinical PT. The practicalities and capacity to use RBE in treatment planning are reviewed and considered with more biological data in hand. The intermediate step of LET optimization is summarized and proposed as a potential bridge to the ultimate goal of case-specific RBE planning that can be achieved as a hypothesis-generating tool in near-term proton trials.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"202-217"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141766103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the 3-Dimensional Dose Distribution of Multilesion Lung Stereotactic Ablative Radiation Therapy With Generative Adversarial Networks.","authors":"Edward Wang, Hassan Abdallah, Jonatan Snir, Jaron Chong, David A Palma, Sarah A Mattonen, Pencilla Lang","doi":"10.1016/j.ijrobp.2024.07.2329","DOIUrl":"10.1016/j.ijrobp.2024.07.2329","url":null,"abstract":"<p><strong>Purpose: </strong>Because SABR therapy is being used to treat greater numbers of lung metastases, selecting the optimal dose and fractionation to balance local failure and treatment toxicity becomes increasingly challenging. Multilesion lung SABR therapy plans include spatially diverse lesions with heterogeneous prescriptions and interacting dose distributions. In this study, we developed and evaluated a generative adversarial network (GAN) to provide real-time dosimetry predictions for these complex cases.</p><p><strong>Methods and materials: </strong>A GAN was trained to predict dosimetry on a data set of patients who received SABR therapy for lung lesions at a tertiary center. Model input included the planning computed tomography scan, the organs at risk (OARs) and target structures, and an initial estimate of exponential dose fall-off. Multilesion plans were split 80/20 for training and evaluation. Models were evaluated on voxel-voxel, clinical dose-volume histogram, and conformality metrics. An out-of-sample validation and analysis of model variance were performed.</p><p><strong>Results: </strong>There were 125 multilesion plans from 102 patients with 357 lesions. Patients were treated for 2 to 7 lesions, with 19 unique dose-fractionation schemes over 1 to 3 courses of treatment. The out-of-sample validation set contained an additional 90 plans from 80 patients. The mean absolute difference and gamma pass fraction between the predicted and true dosimetry was <3 Gy and >90% for all OARs. The absolute differences in lung V20 and CV14 were 1.40% ± 0.99% and 75.8 ± 42.0 cc, respectively. The ratios of predicted to true R50%, R100%, and D2cm were 1.00 ± 0.16, 0.96 ± 0.32, and 1.01 ± 0.36, respectively. The out-of-sample validation set maintained mean absolute difference and gamma pass fraction of <3 Gy and >90%, respectively for all OARs. The median standard deviation of variance in V20 and CV14 prediction was 0.49% and 22.2 cc, respectively.</p><p><strong>Conclusions: </strong>A GAN for predicting the 3-D dosimetry of complex multilesion lung SABR therapy is presented. Rapid dosimetry prediction can be used to assess treatment feasibility and explore dosimetric differences between varying prescriptions.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"250-260"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999890","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":"Sparing of the Heart Facilitates Recovery From Cardiopulmonary Side Effects After Thoracic Irradiation.","authors":"Julia Wiedemann, Sai K Paruchuru, Lisette E den Boef, Uilke Brouwer, Herman H W Silljé, Elisabeth M Schouten, Michael G Dickinson, Marc-Jan van Goethem, Robert P Coppes, Peter van Luijk","doi":"10.1016/j.ijrobp.2024.07.2330","DOIUrl":"10.1016/j.ijrobp.2024.07.2330","url":null,"abstract":"<p><strong>Purpose: </strong>When irradiating thoracic tumors, dose to the heart or lung has been associated with survival. We previously showed in a rat model that in addition to known side effects such as pericarditis, pneumonitis and fibrosis, heart and/or lung irradiation also impaired diastolic function and increased pulmonary artery pressure. Simultaneous irradiation of both organs strongly intensified these effects. However, the long-term consequences of these interactions are not yet known. Therefore, here, we investigated the long-term effects of combined heart and lung irradiation.</p><p><strong>Methods and materials: </strong>Different regions of the rat thorax containing the heart and/or 50% of the lungs were irradiated with protons. Respiratory rate (RR) was measured biweekly as an overall parameter for cardiopulmonary function. Echocardiography of the heart was performed at 8, 26, and 42 weeks after irradiation. Tissue remodeling and vascular changes were assessed using Masson trichrome and Verhoeff-stained lung and left ventricle tissue collected at 8 and 42 weeks after irradiation.</p><p><strong>Results: </strong>During the entire experimental period RR was consistently increased after combined heart/lung irradiation. This coincided with persistent effects on lung vasculature and reduced right-ventricle (RV) contraction. In contrast, recovery of RR, pulmonary remodeling and RV contraction was observed after sparing of the heart. These corresponding temporal patterns suggest that the reduction of RV function is related to vascular remodeling in the lung.</p><p><strong>Conclusions: </strong>Combined irradiation of lung and heart leads to an intensified, persistent reduction of cardiopulmonary function. Recovery of the pulmonary vasculature and RV function requires heart sparing.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"191-201"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995673","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":"Refining Treatment Planning in STereotactic Arrhythmia Radioablation: Benchmark Results and Consensus Statement From the STOPSTORM.eu Consortium.","authors":"Valeria Trojani, Melanie Grehn, Andrea Botti, Brian Balgobind, Alessandro Savini, Judit Boda-Heggemann, Marcin Miszczyk, Olgun Elicin, David Krug, Nicolaus Andratschke, Daniel Schmidhalter, Wouter van Elmpt, Marta Bogowicz, Javier de Areba Iglesias, Lukasz Dolla, Stefanie Ehrbar, Enric Fernandez-Velilla, Jens Fleckenstein, Domingo Granero, Dominik Henzen, Coen Hurkmans, Anne Kluge, Lukas Knybel, Sandy Loopeker, Alfredo Mirandola, Veronica Richetto, Gianluisa Sicignano, Veronique Vallet, Bram van Asselen, Esben Worm, Etienne Pruvot, Joost Verhoeff, Martin Fast, Mauro Iori, Oliver Blanck","doi":"10.1016/j.ijrobp.2024.07.2331","DOIUrl":"10.1016/j.ijrobp.2024.07.2331","url":null,"abstract":"<p><strong>Purpose: </strong>STereotactic Arrhythmia Radioablation (STAR) showed promising results in patients with refractory ventricular tachycardia. However, clinical data are scarce and heterogeneous. The STOPSTORM.eu consortium was established to investigate and harmonize STAR in Europe. The primary goal of this benchmark study was to investigate current treatment planning practice within the STOPSTORM project as a baseline for future harmonization.</p><p><strong>Methods and materials: </strong>Planning target volumes (PTVs) overlapping extracardiac organs-at-risk and/or cardiac substructures were generated for 3 STAR cases. Participating centers were asked to create single-fraction treatment plans with 25 Gy dose prescriptions based on in-house clinical practice. All treatment plans were reviewed by an expert panel and quantitative crowd knowledge-based analysis was performed with independent software using descriptive statistics for International Commission on Radiation Units and Measurements report 91 relevant parameters and crowd dose-volume histograms. Thereafter, treatment planning consensus statements were established using a dual-stage voting process.</p><p><strong>Results: </strong>Twenty centers submitted 67 treatment plans for this study. In most plans (75%) intensity modulated arc therapy with 6 MV flattening filter free beams was used. Dose prescription was mainly based on PTV D_95% (49%) or D_96%-100% (19%). Many participants preferred to spare close extracardiac organs-at-risk (75%) and cardiac substructures (50%) by PTV coverage reduction. PTV D_0.035cm3 ranged from 25.5 to 34.6 Gy, demonstrating a large variety of dose inhomogeneity. Estimated treatment times without motion compensation or setup ranged from 2 to 80 minutes. For the consensus statements, a strong agreement was reached for beam technique planning, dose calculation, prescription methods, and trade-offs between target and extracardiac critical structures. No agreement was reached on cardiac substructure dose limitations and on desired dose inhomogeneity in the target.</p><p><strong>Conclusions: </strong>This STOPSTORM multicenter treatment planning benchmark study not only showed strong agreement on several aspects of STAR treatment planning, but also revealed disagreement on others. To standardize and harmonize STAR in the future, consensus statements were established; however, clinical data are urgently needed for actionable guidelines for treatment planning.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"218-229"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912738","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":"Chemoradiation Therapy for Nonmetastatic Muscle-Invasive Bladder Cancer: Still the Only Bladder Preservation Treatment in 2024.","authors":"Vérane Achard, Robert Huddart","doi":"10.1016/j.ijrobp.2024.09.003","DOIUrl":"10.1016/j.ijrobp.2024.09.003","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"162-164"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545406","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":"Concerning Safety and Efficacy of Concurrent and Consolidative Durvalumab With Thoracic Radiation Therapy in PDL1-Unselected Stage III Non-Small Cell Lung Cancer: Brief Report.","authors":"Yuanyuan Zhang, Puneeth Iyengar, Steven Montalvo, Kenneth D Westover, Sawsan Rashdan, Kavitha Donthireddy, James Kim, Jonathan E Dowell, Benjamin Drapkin, Sheena Bhalla, Christian Chukwuma, Urooba Nadeem, Chul Ahn, Robert D Timmerman, David E Gerber","doi":"10.1016/j.ijrobp.2024.07.2333","DOIUrl":"10.1016/j.ijrobp.2024.07.2333","url":null,"abstract":"<p><strong>Purpose: </strong>Consolidative durvalumab, an anti-programmed death ligand 1 (PDL1) immune checkpoint inhibitor, administered after concurrent chemoradiation improves outcomes of patients with locally advanced non-small cell lung cancer (NSCLC) without substantially increasing toxicities. We studied a chemotherapy-free regimen of thoracic radiation therapy (RT) with concurrent and consolidative durvalumab.</p><p><strong>Methods and materials: </strong>This single-arm phase 2 trial enrolled patients with stage III NSCLC (regardless of tumor PDL1 expression), Eastern Cooperative Oncology Group (ECOG) performance status 0-1, adequate pulmonary function, and RT fields meeting standard organ constraints. Participants received 2 cycles of durvalumab (1500 mg every 4 weeks) concurrently with thoracic RT (60 Gy in 30 fractions), followed by up to 13 cycles of consolidative durvalumab.</p><p><strong>Results: </strong>After 10 patients were enrolled, the trial was closed because of poor clinical outcomes. With a median follow-up of 12 months, 5 patients had disease progression and 8 patients died. Six patients experienced 15 treatment-related, grade ≥3 events, including 1 grade 4 acute kidney injury during consolidation and 2 fatal pulmonary events. One fatal pulmonary event occurred during the concurrent phase in an active smoker; the other occurred after the first cycle of consolidative durvalumab. The primary endpoint of progression-free survival at 12 months was 20% (50% for PDL1≥1% vs 0% for PDL1 unavailable or <1%). Median overall survival was not reached, 10.5 months, and 7 months, for PDL1 ≥1%, <1%, and unavailable, respectively.</p><p><strong>Conclusions: </strong>In PDL1 unselected stage III NSCLC, thoracic RT plus concurrent and consolidative durvalumab is associated with high-grade toxicity and early disease progression.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"68-74"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987960","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":"Pelvic Bone Marrow Sparing Intensity Modulated Radiation Therapy Reduces the Bone Mineral Density Loss of Patients With Cervical Cancer.","authors":"Jin Huang, Jianyao Gao, Fan Zhang, Fei Gu, Silu Ding, Qingyu Yang, Yanfeng Bai, Guang Li","doi":"10.1016/j.ijrobp.2024.07.2314","DOIUrl":"10.1016/j.ijrobp.2024.07.2314","url":null,"abstract":"<p><strong>Purpose: </strong>To test the efficacy and feasibility of pelvic bone marrow sparing intensity modulated radiation therapy (PBMS-IMRT) in reducing bone density loss for patients with cervical cancer undergoing pelvic radiation therapy (RT).</p><p><strong>Methods and materials: </strong>Patients with nonsurgical cervical cancer with stage Ib2-IIIc cancer were randomly allocated into the PBMS group or the control group. The PBMS group additionally received pelvic bone marrow dose constraint. Computed tomography (CT) imaging sets were acquired at baseline and at 1, 3, 6, 9, and 12 months after treatment. Radiation dose and Hounsfield unit were registered. Bone density loss rates and fracture events at different follow-up time points were recorded.</p><p><strong>Results: </strong>Data from 90 patients in the PBMS group and 86 patients in the control group were used for statistical analysis, which included 30 and 26 patients with extended-field radiation therapy (EFR), respectively. The median follow-up for all patients was 12 months. Compared with baseline, the bone density of all bones at the last follow-up decreased by 43% and 53% in the PBMS and control groups, respectively, with the most significant decline at 1 month after treatment. Although patients without EFR received minimal irradiation in the upper lumbar spine, a 22.33% decrease in bone density was detected. In the group of patients with EFR, the decrease was 51.18% (P < .01). Lumbar or pelvic fracture incidence rates of patients in the PBMS and control groups were 7.8% and 12.79%, respectively. Among the dosimetric parameters, mean dose had the strongest correlation with bone density loss.</p><p><strong>Conclusions: </strong>In patients undergoing pelvic RT, the loss of bone density can begin to appear early after RT, and it can occur either inside or outside of the irradiation field. Results of this study showed that PBMS-IMRT reduced bone mineral density loss compared with IMRT alone.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"107-117"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792436","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 Results of Bladder Preservation With Twice-Daily Radiation Plus 5-Fluorouracil/Cisplatin or Daily Radiation Plus Gemcitabine for Muscle-Invasive Bladder Cancer-Updated Report of NRG/RTOG 0712: A Randomized Phase 2 Trial.","authors":"John J Coen, Joseph P Rodgers, Philip J Saylor, Cheryl T Lee, Chin-Lee Wu, William Parker, Tim Lautenschlaeger, Anthony L Zietman, Jason Efstathiou, Ashesh B Jani, Omer Kucuk, Luis Souhami, Stephanie L Pugh, Howard M Sandler, William U Shipley","doi":"10.1016/j.ijrobp.2024.08.007","DOIUrl":"10.1016/j.ijrobp.2024.08.007","url":null,"abstract":"<p><strong>Purpose: </strong>For bladder-sparing treatment of muscle-invasive bladder cancer, 5-fluorouracil/cisplatin with twice-daily radiation (FCT) or gemcitabine plus daily radiation (GD) are effective chemoradiation (CRT) regimens. This trial evaluated these regimens and demonstrated efficacy with either regimen at 3 years. With further follow-up, longer-term results are reported here.</p><p><strong>Methods and materials: </strong>Patients with cT2 to cT4a muscle-invasive bladder cancer were randomized to FCT or GD. Patients had a transurethral resection and induction CRT to 40 Gy. Patients with a complete response received consolidation CRT to 64 Gy. Others had cystectomy. Adjuvant gemcitabine/cisplatin chemotherapy was administered. The primary endpoint was freedom from distant metastasis (FDM). This updated analysis reports 7-year data. Toxicity and efficacy endpoints, including bladder-intact distant metastasis-free survival (BI-DMFS) were also assessed.</p><p><strong>Results: </strong>From December 2008 to April 2014, 70 patients were enrolled; 66 were eligible for analysis, 33 per arm. Median follow-up was 9.1 years for eligible living patients. At 7 years, FDM was 65% and 73% for FCT and GD, respectively. Bladder-intact distant metastasis-free survival was 58% (95% CI, 41-76) and 68% (95% CI, 51-84), respectively. The post hoc hazard ratio of 0.75 (95% CI, 0.37-1.55) showed no difference between treatments (P = .44). Overall survival at 7 years was 48% and 59%. There were 4 and 5 cystectomies performed for FCT and GD, respectively. In the FCT arm, there were 5 (16%), 1 (3%), and 0 grade 3, 4, and 5 late toxicities reported, respectively. In the GD arm, there were 7 (23%), 0, and 0 grade 3, 4, and 5 late toxicities reported, respectively.</p><p><strong>Conclusions: </strong>Both regimens maintained high FDM rates at 7 years. Cystectomy rates were low and overall survival rates were high on both arms. Late toxicity rates were low. Either gemcitabine and daily radiation or a cisplatin-based regimen are effective bladder-sparing therapies.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"153-161"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987961","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":"Extended nnU-Net for Brain Metastasis Detection and Segmentation in Contrast-Enhanced Magnetic Resonance Imaging With a Large Multi-Institutional Data Set.","authors":"Youngjin Yoo, Eli Gibson, Gengyan Zhao, Thomas J Re, Hemant Parmar, Jyotipriya Das, Hesheng Wang, Michelle M Kim, Colette Shen, Yueh Lee, Douglas Kondziolka, Mohannad Ibrahim, Jun Lian, Rajan Jain, Tong Zhu, Dorin Comaniciu, James M Balter, Yue Cao","doi":"10.1016/j.ijrobp.2024.07.2318","DOIUrl":"10.1016/j.ijrobp.2024.07.2318","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate an extended self-adapting nnU-Net framework for detecting and segmenting brain metastases (BM) on magnetic resonance imaging (MRI).</p><p><strong>Methods and materials: </strong>Six different nnU-Net systems with adaptive data sampling, adaptive Dice loss, or different patch/batch sizes were trained and tested for detecting and segmenting intraparenchymal BM with a size ≥2 mm on 3 Dimensional (3D) post-Gd T1-weighted MRI volumes using 2092 patients from 7 institutions (1712, 195, and 185 patients for training, validation, and testing, respectively). Gross tumor volumes of BM delineated by physicians for stereotactic radiosurgery were collected retrospectively and curated at each institute. Additional centralized data curation was carried out to create gross tumor volumes of uncontoured BM by 2 radiologists to improve the accuracy of ground truth. The training data set was augmented with synthetic BMs of 1025 MRI volumes using a 3D generative pipeline. BM detection was evaluated by lesion-level sensitivity and false-positive (FP) rate. BM segmentation was assessed by lesion-level Dice similarity coefficient, 95-percentile Hausdorff distance, and average Hausdorff distance (HD). The performances were assessed across different BM sizes. Additional testing was performed using a second data set of 206 patients.</p><p><strong>Results: </strong>Of the 6 nnU-Net systems, the nnU-Net with adaptive Dice loss achieved the best detection and segmentation performance on the first testing data set. At an FP rate of 0.65 ± 1.17, overall sensitivity was 0.904 for all sizes of BM, 0.966 for BM ≥0.1 cm³, and 0.824 for BM <0.1 cm³. Mean values of Dice similarity coefficient, 95-percentile Hausdorff distance, and average HD of all detected BMs were 0.758, 1.45, and 0.23 mm, respectively. Performances on the second testing data set achieved a sensitivity of 0.907 at an FP rate of 0.57 ± 0.85 for all BM sizes, and an average HD of 0.33 mm for all detected BM.</p><p><strong>Conclusions: </strong>Our proposed extension of the self-configuring nnU-Net framework substantially improved small BM detection sensitivity while maintaining a controlled FP rate. Clinical utility of the extended nnU-Net model for assisting early BM detection and stereotactic radiosurgery planning will be investigated.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"241-249"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141766102","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":"PRECISE: Preoperative Radiation Therapy to Elicit Critical Immune Stimulating Effects-A Phase 2 Clinical Trial.","authors":"Simona F Shaitelman, Huong Le-Petross, Maria G Raso, David M Swanson, Aislyn P Schalck, Alejandro Contreras, Fei Yang, Manickam Muruganandham, George Z Zhao, Gabriel O Sawakuchi, Leonard H Kim, Harsh Batra, Benjamin D Smith, Michael C Stauder, Wendy A Woodward, Jay P Reddy, Jennifer K Litton, Alastair Thompson, Isabelle Bedrosian, Elizabeth A Mittendorf","doi":"10.1016/j.ijrobp.2024.08.008","DOIUrl":"10.1016/j.ijrobp.2024.08.008","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation therapy is an underinvestigated tool for priming the immune system in intact human breast cancers. We sought here to investigate if a preoperative radiation therapy boost delivered was associated with a significant change in tumor-infiltrating lymphocytes (TILs) in the tumor in estrogen receptor positive, HER2Neu nonamplified breast cancers.</p><p><strong>Methods and materials: </strong>A total of 20 patients were enrolled in a phase 2 clinical trial and received either 7.5 Gy × 1 fraction or 2 Gy × 5 fractions, completed 6 to 8 days before surgery. Percent stromal TILs were evaluated on hematoxylin and eosin-stained samples. Short-term safety was assessed based on time to surgery, toxicities, and cosmesis up to 6 months after boost.</p><p><strong>Results: </strong>Stromal TIL increased 6 to 8 days after completion of boost radiation therapy (median 3.0 [IQR, 1.0-6.5]) before radiation therapy versus median 5.0 (IQR, 1.5-8.0) after radiation therapy, P = .0037. Zero grade ≥3 toxicities up to 6 months after boost were experienced. In all, 94% (16/17) patients with 6-month follow-up cosmetic assessment after breast conservation had good-excellent cosmesis by physician assessment.</p><p><strong>Conclusion: </strong>In this phase 2 trial, preoperative radiation therapy boost resulted in a short-term increase in stromal TIL with minimal toxicities. Preoperative breast radiation therapy appears to be safe and may be a feasible means for priming the tumor microenvironment.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"90-96"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987962","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}