International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Comparison of Metastasectomy and Stereotactic Body Radiation Therapy for Pulmonary Oligometastasis From Hepatocellular Carcinoma: A Propensity Score-Weighted Analysis.","authors":"Young Seob Shin, Jae Kwang Yun, Jinhong Jung, Jin-Hong Park, Si Yeol Song, Eun Kyung Choi, Sehoon Choi, Hyeong Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Geun Dong Lee, Sang Min Yoon","doi":"10.1016/j.ijrobp.2024.09.022","DOIUrl":"10.1016/j.ijrobp.2024.09.022","url":null,"abstract":"<p><strong>Purpose: </strong>Although there is a growing role for local therapy in patients with hepatocellular carcinoma (HCC) and pulmonary oligometastasis, it remains unclear whether metastatectomy or stereotactic body radiation therapy (SBRT) is the more effective treatment for these patients. We aimed to compare the oncologic outcomes of metastasectomy and SBRT for HCC with pulmonary oligometastasis.</p><p><strong>Methods and materials: </strong>We retrospectively analyzed 209 patients with HCC with 322 metastatic lung lesions who underwent either metastasectomy (150 patients with 241 lesions) or SBRT (59 patients with 81 lesions) between January 2008 and December 2018. Propensity score-based inverse probability of treatment weighting was used to minimize potential bias between the 2 groups.</p><p><strong>Results: </strong>The median follow-up duration was 39.8 months (range, 2.3-166.9 months). The 2-year rate of freedom from local progression was 98.2% in the metastasectomy group and 97.0% in the SBRT group (P = .197). The 2-year rates of overt systemic progression-free survival (PFS) (51.0% vs 46.1%; P = .274), PFS (26.3% vs 9.1%; P = .074), and overall survival (OS, 74.0% vs 57.6%; P = .006) were higher in the metastasectomy group. After the probability of treatment weighting adjustment, the 2-year rates of overt systemic PFS (50.8% vs 52.7%; P = .396), PFS (23.0% vs 24.7%; P = .478), and OS (72.6% vs 83.0%, P = .428) were not significantly different between the 2 groups. In multivariate analysis, viable intrahepatic lesions and the number of prior liver-directed therapies were found to be significant prognostic factors for OS and PFS. The time interval between HCC diagnosis and the development of pulmonary metastases was also significantly associated with OS.</p><p><strong>Conclusions: </strong>Both metastasectomy and SBRT demonstrated excellent local control and comparable oncologic outcomes in patients with pulmonary oligometastasis from HCC. The treatment modality for these patients could be determined based on the individual patient's condition and intrahepatic disease status.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"432-441"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287106","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":"Phase 1 Trial of Total Neoadjuvant Therapy With Short-Course Chemoradiotherapy Followed by Chemotherapy for Patients With Potentially Resectable Gastric Cancer.","authors":"Brian Badgwell, Naruhiko Ikoma, Mariela Blum Murphy, Jenny Li, Xuemei Wang, Bruce D Minsky, Jeannelyn Estrella, Paul Mansfield, Jaffer Ajani, Prajnan Das","doi":"10.1016/j.ijrobp.2024.08.042","DOIUrl":"10.1016/j.ijrobp.2024.08.042","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this phase 1 trial was to evaluate the safety and toxicity of preoperative short-course chemoradiotherapy (CRT) as part of total neoadjuvant therapy (TNT) for patients with potentially resectable gastric or gastroesophageal adenocarcinoma.</p><p><strong>Methods and materials: </strong>Patients were enrolled between March 2021 and December 2022 and received CRT (30 Gy radiation in 10 fractions with concurrent capecitabine or 5-fluorouracil), then received systemic therapy for 2 months, and then underwent surgery. The primary endpoint was CRT safety; secondary endpoints were pathologic complete response, perioperative complications, and overall survival (OS).</p><p><strong>Results: </strong>Of the 24 patients enrolled in the trial, 10 (42%) had bleeding, 3 (13%) had gastric outlet obstruction, and 2 (8%) had cirrhosis. Twelve patients (50%) had clinical nodal involvement. Twenty patients (83%) had poorly differentiated tumors, and 13 (54%) had signet ring cell histology. All patients completed CRT. CRT treatment-related toxic effects included grade 3 lymphopenia in 7 patients (29%), grade 4 lymphopenia in 1 (4%), and grade 3 anemia in 1 (4%). After CRT, 22 patients (92%) received chemotherapy, 1 patient (4%) with a microsatellite instability-high tumor received immunotherapy, and 1 patient (4%) underwent resection without systemic therapy. All patients underwent attempted resection, and gastrectomy was performed in 20 (83%). The R0 resection rate was 95%. Two patients had pathologic complete response, and an additional 5 had ≤1% viable tumor. Three patients had surgical complications [grade 1 in 1 patient (4%), grade 3b in 1 (4%), and grade 4a in 1 (4%)]; no patients died within 90 days. The median follow-up time was 28 months, and median OS was not reached. The 1- and 3-year OS rates were 96% and 85%, respectively.</p><p><strong>Conclusion: </strong>Short-course CRT may be safely used as part of planned TNT for patients with potentially resectable gastric or gastroesophageal adenocarcinoma. The promising rates of treatment completion, pathologic response, and OS support further research of TNT for gastric cancer.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"423-431"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140035","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":"Evolving Paradigms in Prostate Cancer: The Integral Role of Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography in Primary Staging and Therapeutic Decision-Making.","authors":"Cristian Udovicich, Angela Y Jia, Andrew Loblaw, Renu Eapen, Michael S Hofman, Shankar Siva","doi":"10.1016/j.ijrobp.2024.08.045","DOIUrl":"10.1016/j.ijrobp.2024.08.045","url":null,"abstract":"<p><p>Prostate-specific membrane antigen (PSMA) positron emission tomography or computed tomography (PET/CT) has emerged as a superior imaging option to conventional imaging for prostate cancer. The majority of early evidence and prospective trials evaluated PSMA PET/CT in the biochemical recurrence or metastatic setting. However, there has been an increasing number of prospective trials in the primary setting. The purpose of this narrative review was to describe the role of PSMA PET/CT in localized primary prostate cancer. This narrative review focuses on the prospective evidence available in this setting. We detail the current practice and future potential for PSMA PET/CT to be used in multiple stages of localized primary prostate cancer. The most common practice currently for PSMA PET/CT is in the primary nodal and metastatic staging of high-risk prostate cancer. We describe other roles of PSMA PET/CT, including in intermediate-risk prostate cancer as well as local staging and the impact on radiation therapy and surgical management. We also discuss the potential future roles of PSMA PET/CT in prediagnosis such as risk stratification for biopsy, prognosis, and specific surgical roles. Potential pitfalls of PSMA PET/CT are also addressed. PSMA PET/CT has already had a significant influence on prostate cancer, and there will continue to be a greater role for this imaging modality in localized primary prostate cancer.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"307-316"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287110","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":"Proton-Based Radiation Therapy for Skull Base Chondrosarcomas in Children and Adolescents: 40-Year Experience From the Massachusetts General Hospital.","authors":"Myrsini Ioakeim-Ioannidou, Saveli Goldberg, Tobias Urell, Athena Tejada, G Petur Nielsen, Yin P Hung, Judith Adams, Barbara Fullerton, Paul Caruso, Manuel Patino, Karen Buch, Sandra Rincon, Osamu Sakai, Maria Tolia, David Ebb, Gregory Cote, William Curry, Drosoula Giantsoudi, Shannon M MacDonald","doi":"10.1016/j.ijrobp.2024.09.030","DOIUrl":"10.1016/j.ijrobp.2024.09.030","url":null,"abstract":"<p><strong>Purpose: </strong>The literature on skull base chondrosarcoma (CHS) is scarce. We report outcomes for pediatric and young patients ≤22 years with base of skull CHSs treated with proton-based radiation therapy (PBRT).</p><p><strong>Methods and materials: </strong>We retrospectively reviewed all patients treated with PBRT between 1981 and 2023. Primary endpoints were overall survival (OS), chondrosarcoma-specific survival (CSS), progression-free survival (PFS), local control, and distal control.</p><p><strong>Results: </strong>Eighty-four patients were identified. Median age at diagnosis was 19 years (range, 6-22). Most patients (n = 79, 94%) had conventional CHS, whereas 5 (6%) had mesenchymal CHS. Nine patients (11%) underwent gross total resection, 64 (76%) subtotal resection, and 11 patients (13%) underwent biopsy. Twenty-four (29%) patients progressed before radiation therapy. The median prescription dose was 70 Gy (relative biological equivalent) (range, 50-79.7). At a median follow-up of 18.0 years (IQR, 9.2-26.2) from diagnosis, 11 patients recurred (7 local, 4 distant). Six patients died of disease. Five patients died of other causes. Ten-year OS, CSS, and PFS rates for all patients were 93.3%, 94.7%, and 88%, respectively. Twenty-year OS, CSS, and PFS rates for conventional CHS (n = 79) were 93.1%, 97.1%, and 89.2%, respectively. Mesenchymal histology was significantly associated with worse OS and PFS. Preradiation therapy tumor progression portended worse OS and CSS. Eight patients (9.9 %) experienced a late toxicity grade 3 or greater.</p><p><strong>Conclusions: </strong>This is the largest cohort of pediatric base of skull CHSs in literature to date. High-dose PBRT after surgical resection achieves excellent disease control with minimal toxicity.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"403-413"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287194","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":"Whole Abdominal Pencil Beam Scanned Proton FLASH Increases Acute Lethality.","authors":"Brett I Bell, Christian Velten, Michael Pennock, Minglei Kang, Kathryn E Tanaka, Balaji Selvaraj, Alexander Bookbinder, Wade Koba, Justin Vercellino, Jeb English, Beata Małachowska, Sanjay Pandey, Phaneendra K Duddempudi, Yunjie Yang, Shahin Shajahan, Shaakir Hasan, J Isabelle Choi, Charles B Simone, Weng-Lang Yang, Wolfgang A Tomé, Haibo Lin, Chandan Guha","doi":"10.1016/j.ijrobp.2024.09.006","DOIUrl":"10.1016/j.ijrobp.2024.09.006","url":null,"abstract":"<p><strong>Purpose: </strong>Ultrahigh dose-rate FLASH radiation therapy has emerged as a modality that promises to reduce normal tissue toxicity while maintaining tumor control. Previous studies of gastrointestinal toxicity using passively scattered FLASH proton therapy (PRT) have, however, yielded mixed results, suggesting that the requirements for gastrointestinal sparing by FLASH are an open question. Furthermore, the more clinically relevant pencil beam scanned (PBS) FLASH PRT has not yet been assessed in this context, despite differences in the spatiotemporal dose-rate distributions compared with passively scattered PRT. Here, to our knowledge, we provide the first report on the effects of PBS FLASH PRT on acute gastrointestinal injury in mice after whole abdominal irradiation.</p><p><strong>Methods and materials: </strong>Whole abdominal irradiation was performed on C57BL/6J mice using the entrance channel of the Bragg curve of a 250 MeV PBS proton beam at field-averaged dose rates of 0.6 Gy/s for conventional (CONV) and 80 to 100 Gy/s for FLASH PRT. A 2D strip ionization chamber array was used to measure the dose and dose rate for each mouse. Survival was assessed at 14 Gy. Intestines were harvested and processed as Swiss rolls for analysis using a novel artificial intelligence-based crypt assay to quantify crypt regeneration 4 days after irradiation.</p><p><strong>Results: </strong>Survival was significantly reduced after 14 Gy FLASH PRT compared with CONV (P < .001). Our artificial intelligence-based crypt assays demonstrated no significant difference in intestinal crypts/cm or crypt depth between groups 4 days after irradiation. Furthermore, we found no significant difference in 5-ethynyl-2'-deoxyuridine⁺ cells/crypt or Olfactomedin4⁺ intestinal stem cells with FLASH relative to CONV PRT.</p><p><strong>Conclusions: </strong>Overall, our data demonstrate significantly impaired survival after abdominal PBS FLASH PRT without apparent differences in intestinal histology 4 days after irradiation.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"493-505"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287197","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":"An Exploratory Analysis of the Conditional Neurocognitive Function Failure Risk in Patients Receiving Whole Brain Radiation Therapy for Brain Metastases on NRG Oncology CC001.","authors":"Hua-Ren R Cherng, Kai Sun, Soren M Bentzen, Mark V Mishra","doi":"10.1016/j.ijrobp.2024.09.029","DOIUrl":"10.1016/j.ijrobp.2024.09.029","url":null,"abstract":"<p><strong>Purpose: </strong>We sought to estimate the conditional risk of development of neurocognitive function failure (NCFF) after whole brain radiation therapy (WBRT) for patients with brain metastases on NRG Oncology CC001. In addition, we aimed to determine if factors prognostic of NCFF at time of treatment remained relevant over time.</p><p><strong>Methods and materials: </strong>We performed a post hoc analysis of 518 patients enrolled on NRG-CC001 in which patients with brain metastases were randomly assigned to WBRT + memantine or hippocampal avoidant (HA-WBRT) + memantine. Life table method was used to calculate conditional monthly hazard rates and cumulative incidence was used to estimate rates of NCFF. Risk factors associated with NCFF were analyzed using cause-specific multivariable Cox proportional hazards modeling.</p><p><strong>Results: </strong>The cumulative risk of development of NCFF by 6 months was 64.0% for the entire cohort. The greatest conditional monthly hazard rate of development of neurocognitive toxicity was 2 to 3 months postradiation (0.97; 95% CI, 0.85-1.10); this rate significantly declined and then plateaued to 0.036 (95% CI, 0-0.11) by 8 months posttreatment. For 2-month survivorship without cognitive failure, HA-WBRT (HR, 0.74; P = .033) and age ≤61 years (HR, 0.62; P = .003) continued to be protective against cognitive toxicity. In addition, conditional cumulative incidence of development of NCFF was significantly reduced with HA techniques for patients living ≥2 months free of cognitive dysfunction (P = .047).</p><p><strong>Conclusions: </strong>Our data highlight that the greatest risk of development of neurocognitive toxicity is within the first 3 months after treatment, and therefore strategies to mitigate toxicities should focus on this initial period. Moreover, the conditional risk of neurocognitive impairment significantly declines the longer patients live with preserved cognition. Importantly, these data can be used to inform patients on how their risks of development of NCFF can change over time.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"475-480"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346661","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":"Dose-Response Relationships Between Radiation Exposure, Bone Marrow Function as Measured by ¹⁸F-Fluorothymidine Positron Emission Tomography, and Lymphocyte Counts During Chemoradiation for Non-Small Cell Lung Cancer.","authors":"Michael P MacManus, Elizabeth Prins, Jing Xie, Tim Akhurst, Rodney J Hicks, Jason Callahan, Fiona Hegi-Johnson, Nicholas Hardcastle, Sarah Everitt","doi":"10.1016/j.ijrobp.2024.08.035","DOIUrl":"10.1016/j.ijrobp.2024.08.035","url":null,"abstract":"<p><strong>Purpose: </strong>¹⁸F-fluorothymidine (FLT) positron emission tomography (PET) enables sensitive imaging of bone marrow (BM) proliferation. Sequential FLT-PET/computed tomography scans before and during chemoradiation therapy (CRT) for non-small cell lung cancer were repurposed to investigate the dose-response effects of radiation on BM proliferation.</p><p><strong>Methods and materials: </strong>Twenty-six non-small cell lung cancer patients underwent platinum-based CRT to 60 Gy in 30 fractions with FLT-PET/computed tomography scans at baseline, week 2 (20 Gy), and week 4 (40 Gy). FLT uptake in BM was isolated using Medical Image Merge software. Weeks 2 and 4 FLT-PET BM scans were fused with contemporaneous radiation isodose distributions. Relationships between radiation dose and FLT BM uptake (highest standardized uptake values within the volume and visual parameters) were analyzed using generalized linear and restricted cubic spline models. Percentage volumes of total BM without appreciable FLT uptake (\"ablated\") on weeks 2 and 4 FLT-PET scans were calculated by comparisons with baseline scans.</p><p><strong>Results: </strong>Thoracic FLT uptake was ablated in BM regions exposed to cumulative radiation doses ≥3 Gy by week 2. In all cases, BM FLT's highest standardized uptake values within the volume declined rapidly as the radiation dose increased. BM proliferation significantly decreased by >95% after ≥3 to 4 Gy at 2 weeks and ≥4 to 5 Gy at 4 weeks. The ablated BM volume increased from week 2 to week 4 as BM in the penumbra accumulated radiation dose. The median percentage of total BM ablated was 13.1% (range, 5.6%-20.3%) at 2 weeks and 15.7% (range, 9.2%-24.1%) at 4 weeks. Mean lymphocyte counts fell from a baseline of 2.01 × 10⁹/L to 0.77 at week 2 and 0.60 at week 4. Lymphocyte decline strongly correlated with the percentage of total BM ablated by week 4 (y = -46 to 1.64x; R²_adj = 0.34; P = .001).</p><p><strong>Conclusions: </strong>BM ablation associated with low-dose radiation exposure during CRT correlated significantly with lower week 4 lymphocyte counts. BM is a potential organ at risk, and reducing the BM volume exposed to ≥3 Gy may help preserve lymphocytes, which is essential for effective adjuvant immunotherapy.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"375-387"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132687","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":"The Impact of Radiation Therapy on Metastatic Rhabdomyosarcoma: Results From the EpSSG MTS 2008 Study.","authors":"Alison L Cameron, Henry Mandeville, Beatrice Coppadoro, Manivannan Periasamy, Raquel Davila Fajardo, Andrea Ferrari, Mark N Gaze, Sylvie Helfre, Henriette Magelssen, Veronique Minard-Colin, Monica Ramos, Reineke Schoot, Illaria Zanetti, Gianni Bisogno, Julia C Chisholm, Johannes H M Merks","doi":"10.1016/j.ijrobp.2024.08.039","DOIUrl":"10.1016/j.ijrobp.2024.08.039","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation oncologists use radiation variably for children with metastatic rhabdomyosarcoma (RMS). Data from the European paediatric Soft tissue sarcoma Study Group (EpSSG) MTS 2008 study were retrospectively analyzed to validate the previous observation that the use of radiation is associated with improved outcomes and guide future recommendations on radiation use in this patient group.</p><p><strong>Methods and materials: </strong>The radiation delivered to 216 patients aged 0 to 21 years with metastatic RMS was retrospectively reviewed and classified as radical (all sites of disease irradiated within the protocol parameters), partial (some sites irradiated within the protocol parameters), and none (no radiation or delivered outside the protocol parameters). Landmark analysis excluded those with an event before day 221. Overall survival (OS) and progression-free survival were modeled using the Kaplan-Meier method to investigate the impact of radiation. The joint effect of treatment and known prognostic factors was examined using the Cox regression model.</p><p><strong>Results: </strong>Overall, 56 patients received radical, 104 partial, and 56 no radiation therapy per protocol. Owing to nonrandomized data, the groups were heterogeneous, particularly fewer sites of metatatic disease and less with bone metatases in those receiving radical radiation. The 3-year progression-free survival was 62.0% (95% CI, 47.9-73.4), 39.5% (95% CI, 29.8-49.1), 30.1% (95% CI, 18.7-42.3) for radical, partial, and no radiation therapy groups (P = .002), respectively, and the 3-year OS was 70.1% (95% CI, 55.8-80.6), 53.1% (95% CI, 42.6-62.5), and 52.3% (95% CI, 38.3-64.5; P = .019), respectively. Multivariable analysis confirmed incremental improvement in OS with additional radiation, with hazard ratio of 1, 1.8, and 2.4 (P = .022) for radical, partial, and no radiation therapy per protocol, respectively.</p><p><strong>Conclusions: </strong>Radiation to all sites of disease seems to improve outcomes for children with metastatic RMS and should be considered when feasible. If not feasible, radiation is still recommended to the primary site and involved regional lymphadenopathy. Randomized clinical trials are required to confirm these findings, given the heterogeneity between the groups and potential confounding factors in this analysis.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"388-402"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119782","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":"Multimodal Image Confidence: A Novel Method for Tumor and Organ Boundary Representation.","authors":"Liang Yang, Xiao Liu, Zirong Li, Zimeng Li, Zhenjiang Li, Xiaoyan Yin, X Sharon Qi, Qichao Zhou","doi":"10.1016/j.ijrobp.2024.09.020","DOIUrl":"10.1016/j.ijrobp.2024.09.020","url":null,"abstract":"<p><p>The indistinct boundaries of tumors and organs at risk in medical images present significant challenges in treatment planning and other tasks in radiation therapy. This study introduces an innovative analytical algorithm called multimodal image confidence (MMC), which leverages the complementary strengths of various multimodal medical images to assign a confidence measure to each voxel within the region of interest (ROI). MMC enables the generation of modality-specific ROI-enhanced images, providing a detailed depiction of both the boundaries and internal features of the ROI. By employing an interpretable mathematical model that propagates voxel confidence based on intervoxel correlations, MMC circumvents the need for model training, distinguishing it from deep learning-based methods. The alogorithm was evaluated qualitatively and quantitatively on 156 nasopharyngeal carcinoma cases and 1251 glioma cases. Qualitative assessments demonstrated MMC's accuracy in delineating lesion boundaries as well as capturing internal tumor characteristics. Quantitative analyses further revealed strong concordance between MMC and manual delineations. This study presents a cutting-edge algorithm for identifying and illustating ROI boundaries using multimodal 3D medical images. The versatility of the proposed method extends to both targets and organs at risk across various anatomic sites and multiple image modalities, enhancing its potential for accurate delineation of critical structures andmany image-related tasks in radiaton therapy and other fields.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"558-569"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287113","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":"Visual Dose Monitoring for Whole Breast Radiation Therapy Treatments via Combined Cherenkov Imaging and Scintillation Dosimetry.","authors":"Savannah M Decker, Petr Bruza, Rongxiao Zhang, Brian W Pogue, David J Gladstone, Lesley A Jarvis","doi":"10.1016/j.ijrobp.2024.08.033","DOIUrl":"10.1016/j.ijrobp.2024.08.033","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates scintillation dosimetry coupled with Cherenkov imaging for in vivo dose monitoring during whole breast radiation therapy (WBRT). Given recent observations of excess dose to the contralateral breast (CB), in vivo dosimetry (IVD) could help ensure accurate dose delivery and decrease risks of secondary cancer. This work presents a rapid, streamlined alternative to traditional IVD, providing direct visualization of measurement location relative to the treatment field on the patient.</p><p><strong>Methods and materials: </strong>Ten WBRT patients consented under an institutional review board-approved protocol were monitored with scintillation dosimetry and always-on Cherenkov imaging, on both their treated and CB for 1 to 3 fractions. Scintillator dosimeters, small plastic discs 1 mm thick and 15 mm in diameter, were calibrated against optically stimulated luminescent dosimeters (OSLDs) to generate an integral output-to-dose conversion, where integral output is measured in postprocessing through a custom fitting algorithm. The discs have been extensively characterized in a previous study for various treatment conditions including beam energy and treatment geometry.</p><p><strong>Results: </strong>A total of 44 dosimetry measurements were evaluated, including 22 treated breast and 22 CB measurements. After integral output-to-dose calibration, in vivo scintillator dosimeters exhibited high linearity (R² = 0.99) with paired OSLD readings across all patients. The difference between scintillation and OSLD dose measurements averaged 2.8% of the prescribed dose, or an absolute dose difference of approximately 7 cGy.</p><p><strong>Conclusions: </strong>Integration of scintillation dosimetry with Cherenkov imaging offers an accurate, rapid alternative for in vivo dose verification in WBRT, circumventing the limitations of conventional point dosimeters. The additional benefit of visualizing measurement locations relative to the treatment field provides users an enhanced understanding of results and allows for detection of high dose gradients. Future work will explore the applicability of this technique across a broader range of radiation therapy treatments, aiming to streamline IVD practices.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"365-374"},"PeriodicalIF":6.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055572","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}