International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Development of Multiparametric Prognostic Models for Stereotactic Magnetic Resonance Guided Radiation Therapy of Pancreatic Cancers.","authors":"Morgan Michalet, Gladis Valenzuela, Stéphanie Nougaret, Marion Tardieu, David Azria, Olivier Riou","doi":"10.1016/j.ijrobp.2025.03.039","DOIUrl":"10.1016/j.ijrobp.2025.03.039","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic magnetic resonance guided adaptive radiation therapy (SMART) is a new option for local treatment of unresectable pancreatic ductal adenocarcinoma, showing interesting survival and local control (LC) results. Despite this, some patients will experience early local and/or metastatic recurrence leading to death. We aimed to develop multiparametric prognostic models for these patients.</p><p><strong>Methods and materials: </strong>All patients treated in our institution with SMART for an unresectable pancreatic ductal adenocarcinoma between October 21, 2019, and August 5, 2022 were included. Several initial clinical characteristics as well as dosimetric data of SMART were recorded. Radiomics data from 0.35-T simulation magnetic resonance imaging were extracted. All these data were combined to build prognostic models of overall survival (OS) and LC using machine learning algorithms.</p><p><strong>Results: </strong>Eighty-three patients with a median age of 64.9 years were included. A majority of patients had a locally advanced pancreatic cancer (77%). The median OS was 21 months after SMART completion and 27 months after chemotherapy initiation. The 6- and 12-month post-SMART OS was 87.8% (IC95%, 78.2%-93.2%) and 70.9% (IC95%, 58.8%-80.0%), respectively. The best model for OS was the Cox proportional hazard survival analysis using clinical data, with a concordance index inverse probability of censoring weighted of 0.87. Tested on its 12-month OS prediction capacity, this model had good performance (sensitivity 67%, specificity 71%, and area under the curve 0.90). The median LC was not reached. The 6- and 12-month post-SMART LC was 92.4% [IC95%, 83.7%-96.6%] and 76.3% [IC95%, 62.6%-85.5%], respectively. The best model for LC was the component-wise gradient boosting survival analysis using clinical and radiomics data, with a concordance index inverse probability of censoring weighted of 0.80. Tested on its 9-month LC prediction capacity, this model had good performance (sensitivity 50%, specificity 97%, and area under the curve 0.78).</p><p><strong>Conclusions: </strong>Combining clinical and radiomics data in multiparametric prognostic models using machine learning algorithms showed good performance for the prediction of OS and LC. External validation of these models will be needed.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788064","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":"Minimizing Bowel Gas Artifact in Computed Tomography Guided Online Adaptive Radiation Therapy With Prolonged Supine Positioning.","authors":"Kendall Kiser, Eric Laugeman, Robbie Beckert, Minji Kwon, Allen Mo, Eric Morris, Justin Barnes, Geoffrey Hugo, Clifford Robinson, Pamela Samson, Hyun Kim","doi":"10.1016/j.ijrobp.2025.03.058","DOIUrl":"10.1016/j.ijrobp.2025.03.058","url":null,"abstract":"<p><strong>Purpose: </strong>Abdominal computed tomography guided online adaptive SABR treatments can be complicated by bowel gas artifact. We investigated whether prolonged patient supine positioning decreases bowel gas artifact.</p><p><strong>Methods and materials: </strong>Three radiation oncologists, a physicist, and an advanced practice radiation therapist scored bowel gas artifact in 1644 images from 104 cone beam computed tomography (CBCT) data sets acquired in 52 fractions delivered to 26 pancreatic adenocarcinoma patients with a Halcyon/Ethos online adaptive SABR platform. Bowel gas artifact scoring followed an ordinal rubric from 1 (best) to 4 (worst). Ten patients were imaged with HyperSight CBCTs and 16 with an earlier CBCT imager, Halcyon v3.0.</p><p><strong>Results: </strong>Four-hundred forty-four CBCT images (27%) had bowel gas artifact that at least minimally obscured organ-at-risk borders. Artifact was worse in initial CBCTs than subsequent verification CBCTs (mean scores 2.26 vs 2.15, P = .006). The proportion of images scored 4 was significantly greater in Halcyon initial CBCTs (0.25) compared to verification CBCTs (0.16; P < .001). For HyperSight, this proportion was low in initial CBCTs (0.03) and lower in verification CBCTs (0.01; P = .09).</p><p><strong>Conclusions: </strong>Clinically impactful bowel gas artifact in online adaptive SABR CBCT data sets was better in verification CBCTs than in initial CBCTs, potentially due to bowel settling during prolonged supine positioning.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788190","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 Magnetic Resonance Guided Radiation Therapy.","authors":"Jasmijn M Westerhoff, Jacobien C M Scheepens, Fernanne F van Wolffelaar, Uffe Bernchou, Rana Bahij, Beth A Erickson, John P Christodouleas, Sylvia S W Ng, Cihan Gani, Ananya Choudhury, Filippo Alongi, Paul Renz, Athanasios T Colonias, Gert J Meijer, Tine Schytte, Martijn P W Intven, Helena M Verkooijen, Lois A Daamen, William A Hall","doi":"10.1016/j.ijrobp.2025.03.046","DOIUrl":"10.1016/j.ijrobp.2025.03.046","url":null,"abstract":"<p><strong>Purpose: </strong>Online adaptive magnetic resonance guided radiation therapy (MRgRT) using a hybrid magnetic resonance imaging and linear accelerator 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 after stereotactic MRgRT.</p><p><strong>Method: </strong>Patients with nonmetastatic pancreatic ductal adenocarcinoma treated with stereotactic MRgRT on a 1.5-Tesla magnetic resonance imaging and linear accelerator according to local standard practices between May 2019 and December 2023 were identified using the international, prospective observational Multi-OutcoMe EvaluatioN of radiation Therapy Using the MR-Linac study (MOMENTUM, NCT04075305). Patient-reported QoL and clinician-reported toxicity were assessed using the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaires and National Cancer Institute Common Terminology Criteria for Adverse Events 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 ≤ .05). Acute (≤3 months follow-up) and late (3-12 months follow-up) toxicity was captured if grade ≥3.</p><p><strong>Results: </strong>A total of 127 patients were included from 8 centers. Treatment dose ranged from 30 to 50 Gy in 5 fractions. Functional QoL domains remained stable over time. A statistically significant and clinically relevant improvement was found for nausea and vomiting (MD -10; 95% CI, -17 to -3; P < .001), and in the sensitivity analysis for nausea and vomiting (MD -11; 95% CI -18 to -3; P < .001) and appetite (MD -14; 95% CI -28 to 0; P = .05), all at 6 months follow-up. No clinically relevant and statistically significant deterioration was found in other domains. New-onset acute and late grade 3 toxicity occurred in 2 patients and 1 patient, respectively.</p><p><strong>Conclusion: </strong>Stereotactic MRgRT for patients with nonmetastatic pancreatic ductal adenocarcinoma was associated with stable functioning, improved disease-related symptoms, and minimal toxicity up to 12 months after treatment.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-02","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":"Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy.","authors":"Alden D'Souza, Kylie H Kang, John E Lattin, Bita Kalaghchi, John S Ginn, Alex T Price, David S Lakomy, Michael R Waters, Joshua P Schiff, Yi Huang, Richard Tsai, Pamela P Samson, Carl J DeSelm, Lauren E Henke, Farnoush Forghani, Xiaodong Zhao, Eric Morris, Geoffrey D Hugo, Tong Zhu, Allen Mo, Eric Laugeman, Hyun Kim","doi":"10.1016/j.ijrobp.2025.03.049","DOIUrl":"10.1016/j.ijrobp.2025.03.049","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic body radiation therapy (SBRT) has historically been contraindicated in patients with tumors abutting gastrointestinal (GI) organs due to risk of toxicity. Adaptive magnetic resonance (MR) guided SBRT (MRgSBRT) is an increasingly used treatment paradigm to prescribe ablative doses to pancreatic tumors. Here we present our institutional experience of adaptive MRgSBRT for pancreatic tumors abutting or invading GI organs at risk (OARs).</p><p><strong>Methods and materials: </strong>Forty-eight patients with pancreatic adenocarcinoma tumors abutting or invading GI OARs who received MRgSBRT to 50 Gy in 5 fractions at our institution between 2018-2019 were reviewed. Dosimetric variables were compared pre- and postadaptation to determine adequacy of target coverage, reasons for online adaptation, and resulting changes in GI OAR and constraints.</p><p><strong>Results: </strong>Patients' mean age was 67 years, 50% female, 63% with ECOG 0-1, and with majority of tumors being locally advanced (52%) and located in the pancreatic head, uncinate process, or neck (92%). Tumors abutted or invaded GI OARs in 100% and 21% of cases, respectively. Of the 240 fractions evaluated, 99% required online adaptation and 77% underwent normalization. The mean PTV_opt (PTV minus a 5mm-expansion of GI OAR contours as the plan optimization structure) receiving prescription dose was 93%. The predicted and adapted critical volume (V36Gy ≤0.5 cc) for OARs were found to be statistically significantly different (P < .001). The duodenum had the highest volume receiving 36 Gy for both preadapted (mean 3.4 cc) and postadapted (mean 0.33 cc) plans. Plans for pancreatic head, uncinate process, or neck tumors frequently exceeded duodenum dose constraints and plans for pancreatic body or tail tumors more often exceeded stomach constraints (P < .001).</p><p><strong>Conclusions: </strong>Adaptive MR guidance may permit SBRT for pancreatic tumors abutting or invading OARs with minimal toxicity.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788187","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":"American Radium Society Appropriate Use Criteria Systematic Review and Guidelines on Reirradiation for Non-Small Cell Lung Cancer Executive Summary.","authors":"Charles B Simone, Arya Amini, Indrin J Chetty, J Isabelle Choi, Stephen G Chun, Jessica Donington, Martin J Edelman, Kristin A Higgins, Larry L Kestin, Pranshu Mohindra, Benjamin Movsas, George B Rodrigues, Kenneth E Rosenzweig, Igor I Rybkin, Annemarie F Shepherd, Ben J Slotman, Andrea Wolf, Joe Y Chang","doi":"10.1016/j.ijrobp.2025.03.056","DOIUrl":"10.1016/j.ijrobp.2025.03.056","url":null,"abstract":"<p><p>Definitive thoracic reirradiation can improve outcomes for select patients with non-small cell lung cancer (NSCLC) with locoregional recurrences. To date, there is a lack of systematic reviews on safety or efficacy of NSCLC reirradiation and dedicated guidelines. This American Radium Society Appropriate Use Criteria Systematic Review and Guidelines provide practical guidance on thoracic reirradiation safety and efficacy and recommends consensus of strategy, techniques, and composite dose constraints to minimize risks of high-grade/fatal toxicities. Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review assessed all studies published through May 2020 evaluating toxicities, local control and/or survival for NSCLC thoracic reirradiation. Of 251 articles, 52 remained after exclusions (3 prospective) and formed the basis for recommendations on the role of concurrent chemotherapy, factors associated with toxicities, and optimal reirradiation modalities and dose-fractionation schemas. Stereotactic body radiation therapy improves conformality/dose escalation and is optimal for primary-alone failures, but caution is needed for central lesions. Concurrent chemotherapy with definitive reirradiation improves outcomes in nodal recurrences but adds toxicity and should be individualized. Hyperfractionated reirradiation may reduce long-term toxicities, although data are limited. Intensity modulated reirradiation is recommended over 3D conformal reirradiation. Particle therapy may further reduce toxicities and enable safer dose escalation. Acute esophagitis/pneumonitis and late pulmonary/cardiac/esophageal/brachial plexus toxicities are dose limiting for reirradiation. Recommended reirradiation composite dose constraints (2 Gy equivalents): esophagus V60 <40%, maximum point dose (Dmax) < 100 Gy; lung V20 <40%; heart V40 <50%; aorta/great vessels Dmax < 120 Gy; trachea/proximal bronchial tree Dmax < 110 Gy; spinal cord Dmax < 57 Gy; brachial plexus Dmax < 85 Gy. Personalized thoracic reirradiation approaches and consensus dose constraints for thoracic reirradiation are recommended and serve as the basis for ongoing Reirradiation Collaborative Group and NRG Oncology initiatives. As very few prospective and small retrospective studies formed the basis for generating the dose constraint recommended in this report, further prospective studies are needed to strengthen and improve these guidelines.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788075","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 a Radiation Therapy Technologist-Driven Workflow for Cone Beam Computed Tomography Guided Partial Breast Adaptive Radiation Therapy.","authors":"David Parsons, Sean Domal, Eric Chambers, Denise Salazar, Justin Visak, Mona Arbab, Francis Holgado, Xingzhe 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":"10.1016/j.ijrobp.2025.03.055","url":null,"abstract":"<p><strong>Purpose: </strong>Cone beam computed tomography-based online adaptive radiation therapy (ART) allows significantly smaller planning target volume margins for patients treated with adaptive stereotactic partial breast irradiation. However, this approach places increased demands on the treatment team, particularly 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 copilot 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 adaptive stereotactic partial breast irradiation were included, with 2 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 constraints. The 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 a mean Dice coefficient of 0.96 for the tumor bed. The 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 of <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 adaptive stereotactic partial breast irradiation. 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 I D S Antunes, David K J Martinus, Mandira Manandhar, Mariam Ben Kacem, Poliana C Marinello, Eurico J G 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":"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 patients with pancreatic cancer to allow genomic-guided radiation therapy.</p><p><strong>Methods and materials: </strong>We collected a comprehensive data set 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 to distinguish between epithelial and mesenchymal cells and to predict pancreas cell-line differentiation stage. Independent testing was done with an embryonic mouse pancreas single-cell RNA-sequencing data set. We then used bulk RNA-seq profiles from the Cancer Cell Line Encyclopedia 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 patients with pancreatic cancer with mesenchymal-like undifferentiated tumors treated with radiation therapy tend to have lower overall survival compared with 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":"A Prospective Single-Arm Study of Daily Online Adaptive Radiation Therapy for Cervical Cancer with Reduced Planning Target Volume 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":"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 radiation therapy (oART) using reduced planning target volume (PTV) margin.</p><p><strong>Methods and materials: </strong>From February 2023 to November 2023, 27 patients with stages I to III cervical cancer were prospectively enrolled in this study. All patients received daily iCBCT guided oART (prescribed 50.4 Gy in 28 fractions) 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. Grades 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":"Standardization of radiation therapy to Inguinal and Pelvic Lymph Nodes in Locally Advanced Cancer of the Penis, as Defined by the International Penile Advanced Cancer Trial (InPACT).","authors":"Sian Cooper, Steve Nicholson, Juanita Crook, Nick Watkin, Curtis Pettaway, Jim Barber, Anita Mitra, Owain Woodley, Anthony Millin, Emma Hall, Angela Pathmanathan, Steven Penegar, Stephanie Burnett, Philippe Spiess, Elizabeth Miles, Karen Hoffman, Huiqi Yang, Alison C Tree","doi":"10.1016/j.ijrobp.2025.03.022","DOIUrl":"10.1016/j.ijrobp.2025.03.022","url":null,"abstract":"<p><strong>Purpose: </strong>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, radiation therapy protocols for this rare cancer lacked consistency and standardization, necessitating multicenter, international collaboration to develop comprehensive radiation therapy planning, delivery, and quality assurance guidelines.</p><p><strong>Methods and materials: </strong>InPACT has 2 main aims; to establish the efficacy of neoadjuvant chemotherapy or chemoradiotherapy in patients with macroscopically-involved inguinal nodes. Second, to compare prophylactic pelvic lymph node dissection 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 radiation therapy 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 radiation therapy quality assurance for each participating center.</p><p><strong>Results: </strong>International consensus radiation therapy guidelines were established, encompassing risk status assessment and indications for each treatment region based on radiological and pathologic 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>Conclusions: </strong>The InPACT radiation therapy guidelines offer a step toward international consensus on contouring for inguino-pelvic radiation therapy 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":"Global Longitudinal Strain: A Potential Noninvasive Tool for Early Detection of Radiation-Induced Cardiac Dysfunction in Patients With Lung Cancer Receiving Thoracic Radiation Therapy.","authors":"Steven K Montalvo, Brian Lue, Eugenia Kakadiaris, Chul Ahn, Elizabeth Zhang-Velten, Maureen Aliru, Weiguo Lu, Kenneth D Westover, Puneeth Iyengar, Robert D Timmerman, Vlad G Zaha, Srilakshmi Vallabhaneni, Kathleen Zhang, Alvin Chandra, Prasanna G Alluri","doi":"10.1016/j.ijrobp.2025.03.027","DOIUrl":"10.1016/j.ijrobp.2025.03.027","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation-induced cardiac dysfunction (RICD) is a competing cause of morbidity and mortality in patients receiving thoracic radiation therapy (RT). Currently, there are no clinically-validated approaches for early detection of RICD at a time point that affords the potential for mitigation. The goal of this study was to evaluate the potential of global longitudinal strain (GLS) derived from standard-of-care echocardiogram (ECHO) for the early detection of RICD and to assess the association between adverse GLS changes and survival in patients receiving thoracic RT.</p><p><strong>Methods and materials: </strong>A retrospective review of changes in GLS was carried out in patients with primary or secondary lung cancer who received standard-of-care thoracic RT with a mean heart dose of ≥5 Gy and had measurable GLS on ECHOs performed before and after RT. Changes in 2-chamber (2C), 3-chamber (3C), and 4-chamber (4C) GLS and peak average GLS after RT (relative to pre-RT baseline) were quantified. Survival probabilities were estimated in patients with normal versus abnormal GLS.</p><p><strong>Results: </strong>Thirty-eight patients had measurable GLS before and after RT. Abnormal GLS (defined as <18% or >15% relative decline in GLS after RT from a normal baseline value) was present in 31.6% of patients before RT and 57.9% of patients after RT (P = .012). On paired comparisons, the absolute median reduction (IQR) in 2-chamber, 3-chamber, 4-chamber, and average GLS after RT relative to pre-RT baseline was 1.90 (4.43), 3.00 (3.83), 2.50 (3.63), and 2.25 (3.53), respectively, all P < .001. No statistically significant change in left ventricular ejection fraction was noted after RT. Patients with abnormal GLS after RT had significantly worse survival than those with normal GLS on univariable analysis (P = .049). Despite the small sample size of the study, the survival detriment in patients with abnormal GLS after RT strongly trended toward significance on multivariable analysis (P = .063).</p><p><strong>Conclusions: </strong>Adverse changes in GLS are detectable on standard-of-care ECHOs and precede significant changes in left ventricular ejection fraction in this cohort of high-risk patients with primary and secondary lung cancer receiving thoracic RT. Thus, ECHO-derived GLS has the potential to serve as an early and noninvasive marker of RICD in this patient population and may enable early adoption of GLS-guided cardioprotective therapy, which has been shown to mitigate cardiac dysfunction in patients with cancer receiving cardiotoxic treatments.</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":"143772298","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}