International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Stereotactic Radiation Therapy in 3 Fractions for T1 Glottic Cancer.","authors":"Giuseppe Sanguineti, Pasqualina D'Urso, Marta Bottero, Alessia Farneti, Lucia Goanta, Diana Giannarelli, Valeria Landoni","doi":"10.1016/j.ijrobp.2024.09.051","DOIUrl":"10.1016/j.ijrobp.2024.09.051","url":null,"abstract":"<p><strong>Purpose/objective(s): </strong>To report the results of a phases 1 and 2 study on stereotactic body radiation therapy (SBRT) for early glottic cancer.</p><p><strong>Methods and materials: </strong>This a prospective study at a single institution enrolling patients with T1 glottic cancer. The true vocal cords (TVCs) were divided into thirds and the third(s) containing disease prescribed 36 Gy in 3 fractions. The portions of the TVCs next to the involved one were planned to receive 30 Gy in 3 fxs. SBRT was delivered by a linear accelerator-based approach using multiple arcs. Toxicity was scored by Common Terminology Criteria for Adverse Events and late events were considered those occurring 3 months after SBRT. Voice quality was investigated by the Voice Handicap Index at regular intervals. The planned sample size was 75 patients.</p><p><strong>Results: </strong>Accrual was discontinued after 33 patients because of concerns for late toxicity. T stage was as follows: T1a: 23 patients (69.7%); T1b: 10 patients (30.3%). All patients received the planned treatment and the median follow-up time was 51.5 months (IQR, 47.9-61.0 months). At last follow-up, all patients were alive and without evidence of disease but 2 patients who died for intercurrent causes. The local control rate was 100% at 4 years. Six patients (18.2%) developed soft tissue necrosis (N = 4) or cartilage necrosis (N = 2) after a median time of 14.9 months from SBRT. Five out of 6 necrotic events were observed in patients who kept smoking and/or had a recent COVID infection. All 4 soft tissue events healed with conservative therapy. After an initial deterioration, the average Voice Handicap Index score significantly improved at 6 months over baseline.</p><p><strong>Conclusions: </strong>SBRT to 36 Gy in 3 fractions is highly effective in controlling T1 TVC carcinoma, but necrosis, although mostly transient, is a concern. On the basis of the present results, a reduction in total dose and a more accurate patient selection are warranted.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"145-152"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypofractionated Preoperative Radiation Therapy for Soft Tissue Sarcoma: A Systematic Review.","authors":"Ronan Joyce, Emer Herlihy, Naomi Lavan, Charles Gillham","doi":"10.1016/j.ijrobp.2024.07.2151","DOIUrl":"10.1016/j.ijrobp.2024.07.2151","url":null,"abstract":"<p><strong>Purpose: </strong>Hypofractionated radiation therapy is being used more frequently for many common cancer sites. Conventionally fractionated radiation therapy treatment regimens have remained the standard of care when radiation therapy is indicated for soft tissue sarcoma (STS). The aim of this study was to systematically review published data on the use of preoperative hypofractionated radiation therapy as part of a curative treatment paradigm in patients with STS. Herein, we summarize current evidence for the use of hypofractionated radiation therapy in the preoperative treatment of STS.</p><p><strong>Methods and materials: </strong>We conducted a database search for prospectively or retrospectively collected data on patients with a diagnosis of STS treated with hypofractionated radiation therapy. Studies evaluating STS of all histologic subtypes affecting extremities or trunks were included in the search. Articles were screened by 2 independent reviewers for inclusion in this review. Patient, treatment, toxicity, and outcome data were recorded and collated from selected studies.</p><p><strong>Results: </strong>Twenty-five articles are included in this review. Nine prospective trials have been published since 2020. Dose fractionations range from 25 to 40 Gy in 5 fractions or 28-42.75 Gy in 8-15 fractions. Local control and overall survival outcomes are consistent with historical data for conventionally fractionated radiation therapy. Acute toxicity and wound complication rates are in keeping with acceptable results. Late toxicity data are limited and require longer follow-up. Rates of pathologic complete response are promising across all studies.</p><p><strong>Conclusions: </strong>There is a growing body of evidence supporting hypofractionation as safe and effective in the preoperative treatment of STS. This review highlights potential areas that could be further investigated to optimize preoperative treatment for STS.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"13-27"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901724","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":"Bladder Tumor-Focused Adaptive Radiation Therapy: Clinical Outcomes of a Phase I Dose Escalation Study.","authors":"Shaista Hafeez, Karole Warren-Oseni, Kelly Jones, Kabir Mohammed, Amir El-Ghzal, David Dearnaley, Victoria Harris, Atia Khan, Pardeep Kumar, Susan Lalondrelle, Fiona McDonald, Melissa Tan, Karen Thomas, Alan Thompson, Helen A McNair, Vibeke N Hansen, Robert A Huddart","doi":"10.1016/j.ijrobp.2024.07.2317","DOIUrl":"10.1016/j.ijrobp.2024.07.2317","url":null,"abstract":"<p><strong>Purpose: </strong>We determine the maximum tolerated tumor-focused dose (MTD) for the radical treatment of muscle invasive bladder cancer enabled by image guided adaptive radiation therapy and long-term clinical outcomes.</p><p><strong>Methods and materials: </strong>Fifty-nine patients with T2 to T4aN0M0 unifocal urothelial muscle invasive bladder cancer suitable for daily radical radiation therapy were recruited prospectively to an ethics-approved protocol (NCT01124682). The uninvolved bladder (PTV_bladder) was planned to 52 Gy in 32 fractions. The bladder tumor (PTV_tumor) was planned to an assigned dose level of 68, 70, 72, or 74 Gy. If organ at risk dose constraints were violated, then PTV_tumor was planned to 64 Gy. Dose level allocation was determined by concurrent toxicity assessment of all previous patients recruited. Acute toxicity was evaluated using Common Terminology Criteria for Adverse Events v3.0; late toxicity was evaluated using Radiation Therapy Oncology Group criteria. The MTD was predefined as the highest dose level with an estimated probability of ≤ 15% ≥ G3 late toxicity and an observed rate of <50% acute G3 and <10% acute G4 toxicity.</p><p><strong>Results: </strong>Twenty-six patients were assigned to 68 Gy, of whom 6 were planned to 64 Gy; 29 patients were assigned to 70 Gy of whom 1 was planned to 68 Gy, 2 patients were assigned and planned to 72 Gy; no patients were assigned to 74 Gy. Three patients did not complete the treatment as planned, of whom only 1 patient stopped treatment because dose-limiting toxicity occurred. The MTD was 70 Gy. Acute genito-urinary and gastro-intestinal G3 acute toxicity was seen in 19% and 7% of patients, respectively. No acute G4 genito-urinary or gastro-intestinal toxicity was seen. Late toxicity (any) G3 and G4 was seen in 14% and 2% of patients, respectively. The 5-year overall survival was 58% (95% CI, 44%-71%). The bladder preservation rate was 89% (95% CI, 88%-96%) with 6 patients not retaining native bladder function.</p><p><strong>Conclusions: </strong>Bladder tumor-focused dose escalation to 70 Gy using image guided adaptive radiation therapy is feasible with acceptable toxicity. This dose level has been evaluated in a phase II randomized control trial (RAIDER NCT02447549).</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"165-175"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787980","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":"Analgesia and Anesthesia Practice Patterns for Gynecologic Brachytherapy Procedures and Potential Impact on Women's Procedural Experience: A National Survey.","authors":"Amanda Rivera, Dulce M Barrios, Emma Herbach, Jenna M Kahn, Vonetta M Williams, Keyur J Mehta, Aaron Wolfson, Lorraine Portelance, Mitchell Kamrava","doi":"10.1016/j.ijrobp.2024.07.2150","DOIUrl":"10.1016/j.ijrobp.2024.07.2150","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine the current U.S. practice patterns of analgesia (AG) and anesthesia (AS) for gynecologic brachytherapy (BT) procedures.</p><p><strong>Methods and materials: </strong>A 27-item survey created with expertise from 5 brachytherapists was distributed electronically to 90 U.S. radiation oncology academic programs and publicized on social media and at 2 national meetings from June to October 2023.</p><p><strong>Results: </strong>Forty-one responses were received (46%). Fifty-four percent identified as female, 66% as Caucasian, and 85% as non-Hispanic/Latino ethnicity. Forty-nine percent use a BT suite ± computed tomography (CT) simulator alone, 39% the operating room ± BT suite or CT simulator or other location, 10% CT simulation room alone, and 2% clinic examination room. Thirty-four percent use general anesthesia alone (GA) for intracavitary BT (n = 41), 20% conscious sedation (CS) alone, 10% oral analgesia (OA) alone, 9% spinal or epidural AS alone, and 27% combination. Among those performing hybrid BT (n = 25), 40% use GA alone, 16% use CS alone, 12% epidural or spinal AS alone, 4% OA alone, and 28% combination. For template interstitial BT (n = 25), 44% use GA alone, 48% epidural alone or in combination with other AS, and 8% CS alone. Twenty-two percent of respondents provide AG or AS during applicator placement only, whereas 32% provide it during placement, planning, treatment, and removal. The most common reasons for not using CS or GA were the lack of AS resources and clinician preference. Seventy-three percent reported the belief that patients suffer from post-traumatic stress disorder symptoms after BT. However, 68% reported not using techniques to alleviate BT-related emotional distress.</p><p><strong>Conclusions: </strong>Many U.S. brachytherapists report using GA, CS, or epidural AS; however, 10% are using only OA, and 22% offer AG/AS only during applicator placement. Furthermore, a majority of respondents believe post-traumatic stress disorder symptoms can occur after BT, but few offer any intervention. AS resources and clinician preferences should be targeted for the expansion of higher-quality care.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"118-127"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787978","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":"NAD+ Metabolism Reprogramming Mediates Irradiation-Induced Immunosuppressive Polarization of Macrophages.","authors":"Wanrong Meng, Ling Li, Yaying Hao, Miaomiao Tang, Chang Cao, Jialu He, Linlin Wang, Bangrong Cao, Yongqing Zhang, Longjiang Li, Guiquan Zhu","doi":"10.1016/j.ijrobp.2024.07.2327","DOIUrl":"10.1016/j.ijrobp.2024.07.2327","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation therapy stands as an important complementary treatment for head and neck squamous cell carcinoma (HNSCC), yet it does not invariably result in complete tumor regression. The infiltration of immunosuppressive macrophages is believed to mediate the radiation therapy resistance, whose mechanism remains largely unexplored. This study aimed to elucidate the role of immunosuppressive macrophages during radiation therapy and the associated underlying mechanisms.</p><p><strong>Methods and materials: </strong>Male C3H mice bearing syngeneic SCC-VII tumor received irradiation (2 × 8 Gy). The impact of irradiation on tumor-infiltrating macrophages was assessed. Bone marrow-derived macrophages were evaluated in differentiation, proliferation, migration, and inflammatory cytokines after treatment of irradiated tumor culture medium and irradiated tumor-derived extracellular vesicles (irTEVs). A comprehensive metabolomics profiling of the irTEVs was conducted using liquid chromatography-mass spectrometry, whereas key metabolites were investigated for their role in the mechanism of immunosuppression of macrophages in vitro and in vivo.</p><p><strong>Results: </strong>Radiation therapy on SCC-VII syngeneic graft tumors increased polarization of both M1 and M2 macrophages in the tumor microenvironment and drove infiltrated macrophages toward an immunosuppressive phenotype. Irradiation-induced polarization and immunosuppression of macrophages were dependent on irTEVs which delivered an increased amount of niacinamide (NAM) to macrophages. NAM directly bound to the nuclear factor kappa-B transcriptional activity regulator USP7, through which NAM reduced translocation of nuclear factor kappa-B into the nucleus, thereby decreasing the release of cytokines interleukin 6 and interleukin 8. Increased enzyme activity of NAM phosphoribosyl transferase which is the rate-limiting enzyme of NAD+ metabolism, contributed to the irradiation-induced accumulation levels of NAM in irradiated HNSCC and irTEVs. Inhibition of NAM phosphoribosyl transferase decreased NAM levels in irTEVs and increased radiation therapy sensitivity by alleviating the immunosuppressive function of macrophages.</p><p><strong>Conclusions: </strong>Radiation therapy could induce NAD+ metabolic reprogramming of HNSCC cells, which regulate macrophages toward an immunosuppressive phenotype. Pharmacologic targeting of NAD+ metabolism might be a promising strategy for radiation therapy sensitization of HNSCC.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"176-190"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912737","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":"Reduction of Postradiation Therapy Urinary Toxicity Via Intrafractional Megavoltage-Kilovoltage Prostate Location Monitoring.","authors":"Pengpeng Zhang, Laura Happersett, Sarah Burleson, Jung Hun Oh, Ahmed Elsayegh, Brian Leong, Maria Thor, Antonio Damato, Andrew Jackson, Laura Cervino, Joseph O Deasy, Michael Zelefsky","doi":"10.1016/j.ijrobp.2024.07.2325","DOIUrl":"10.1016/j.ijrobp.2024.07.2325","url":null,"abstract":"<p><strong>Purpose: </strong>We hypothesized that an in-house developed system using megavoltage and kilovoltage image guidance (MKIG) to ensure correct prostate positioning during stereotactic body radiation therapy (SBRT) could potentially avoid unwanted doses to nontarget tissues, leading to reduced toxicities.</p><p><strong>Methods and materials: </strong>We built a 3-dimensional MKIG platform that accurately tracks prostate implanted fiducials in real time and clinically translated the system to replace a commercial approach, intrafraction motion review (IMR), which only tracks fiducials in the 2-dimensional kilovoltage views. From 2017 to 2019, 150 patients with prostate cancer were treated with SBRT and monitored using MKIG. The motion trace of the fiducials alerts therapists to interrupt and reposition the prostate when displacement exceeds a 1.5 mm threshold. A comparison cohort of 121 patients was treated with the same dose regimen and treatment technique but managed by IMR. Statistics of intrafractional patient shifts and delivery time were collected to evaluate the workflow efficacy. The incidence of grade ≥2 urinary toxicities was analyzed to assess clinical complications. The median follow-up time was 3.7 years (0.2-8.2 years).</p><p><strong>Results: </strong>MKIG treatments had more treatment shifts (1.09 vs 0.28) and a longer average delivery time per fraction (579 ± 205 seconds vs 357 ± 117 seconds) than IMR treatments. Three-quarters (75%) of shifts resulting from MKIG were ≤3 mm, versus 51% in IMR, indicating that MKIG detected and corrected smaller deviations. The incidence of grade ≥2 urinary toxicity was lower in the MKIG than the IMR cohort: 10.7% versus 19.8% (P = .047). On multivariate analysis of late urinary toxicity, only high (>7) preradiation therapy international prostate symptom score (P < .043) and the use of MKIG were selected (P < .029).</p><p><strong>Conclusions: </strong>Automated and quantitative MKIG introduced minimal workflow impact and was superior to IMR in localizing the prostate during SBRT, which correlated with a clinically significant reduction in late urinary toxicity. Further clinical testing using randomized trials will be required to validate the impact on outcomes.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"261-268"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987971","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":"Cost-Utility Analysis of Stereotactic Body Radiation Therapy Versus Surgery for Patients With Stage I Non-small Cell Lung Cancer in Japan.","authors":"Ataru Igarashi, Hiroshi Onishi, Yoshiyuki Shioyama, Yasuo Matsumoto, Kenji Takayama, Yukinori Matsuo, Hideomi Yamashita, Akifumi Miyakawa, Haruo Matsushita, Masahiko Aoki, Keiji Nihei, Tomoki Kimura, Ritsuko Koba, David W Lee, Kaoru Ito","doi":"10.1016/j.ijrobp.2024.07.2328","DOIUrl":"10.1016/j.ijrobp.2024.07.2328","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic body radiation therapy (SBRT) for patients with operable stage I non-small cell lung cancer (NSCLC) is less invasive than surgery. However, differences in lifetime costs and patient outcomes remain unclear. In this study, a cost-utility analysis of SBRT compared with surgery for Japanese patients with operable stage I NSCLC was conducted.</p><p><strong>Methods and materials: </strong>A partitioned survival model was constructed using each treatment arm's overall survival (OS) and progression-free survival (PFS) data. The data for the SBRT arm were extracted from the Japanese multicenter cohort study, which enrolled 678 medically operable patients with stage I NSCLC, and patient registry data were used for the surgery arm. The 5-year OS rate was 78.2% for SBRT and 74.8% for surgery from both studies. The 5-year PFS rate was 57.0% for SBRT and 63.4% for surgery. The quality of life values of PFS and progressive disease were obtained from domestic and overseas literature (PFS: 0.74, progressive disease: 0.65). The time horizon was set to 10 years. The expected costs and quality-adjusted life years for each treatment group were calculated. All costs are expressed in Japanese yen converted to US dollars (USD).</p><p><strong>Results: </strong>SBRT was the dominant strategy, reducing treatment costs by 4,443.8 USD and increasing quality-adjusted life years by 0.131 compared with surgery. According to probabilistic sensitivity analysis, the probability of SBRT being dominant and cost-effective was 50.6% and 72.4%, respectively. Under the budget impact analysis, the total savings for the patients with stage I NSCLC in Japan was 6,252,870.0 USD (n = 1,407).</p><p><strong>Conclusions: </strong>SBRT is a more cost-effective option than surgery in patients with medically operable stage I NSCLC in Japan. Large-scale epidemiologic studies that reflect the latest clinical realities, such as OS/PFS, will be needed to validate this study's robustness.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"56-67"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346572","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":"Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non-Small Cell Lung Cancer: Long-Term Clinical Outcomes.","authors":"Vivian S Tan, Rohann J M Correa, Timothy K Nguyen, Alexander V Louie, Richard A Malthaner, Dalilah Fortin, George B Rodrigues, Brian P Yaremko, Joanna M Laba, Keith Kwan, Stewart Gaede, Ting Lee, Aaron D Ward, Andrew Warner, Richard I Inculet, David A Palma","doi":"10.1016/j.ijrobp.2024.07.2332","DOIUrl":"10.1016/j.ijrobp.2024.07.2332","url":null,"abstract":"<p><strong>Purpose: </strong>For early-stage non-small cell lung cancer, surgery is the preferred approach in operable patients, whereas SABR is preferred for patients who are medically inoperable. The combination of neoadjuvant SABR followed by surgery was tested in the Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non-Small Cell Lung Cancer (MISSILE) phase 2 trial. We report long-term outcomes beyond 5 years of follow-up.</p><p><strong>Methods and materials: </strong>Patients diagnosed with T1-2N0M0 non-small cell lung cancer with good performance status and adequate lung function were enrolled. Patients underwent neoadjuvant SABR followed by lobectomy/wedge resection. Forty enrolled patients received SABR, of which 36 patients proceeded to surgery.</p><p><strong>Results: </strong>The pathologic and major complete response rates were 60% and 63%, respectively. Median follow-up was 6.6 years following surgery. Five-year overall, disease-free, and cancer-specific survival were 66.7% (95% CI, 48.8%-79.5%), 58.3% (95% CI, 40.7%-72.4%), and 76.4% (95% CI, 58.2%-87.4%), respectively. Five-year local, regional, and distant control were 93.5% (95% CI, 76.3%-98.4%), 80.1% (95% CI, 62.7%-90.0%), and 82.4% (95% CI, 64.9%-91.7%), respectively. After SABR and surgery, 16.7% (n = 6) of patients experienced related grade ≥3 adverse events, and there were no grade 5 events.</p><p><strong>Conclusions: </strong>The combined approach of SABR and surgery was safe and demonstrated reasonable long-term clinical outcomes, but similar to surgery alone.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"39-44"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371820","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":"Comparison of the Long-term Survival Outcome of Surgery versus Stereotactic Body Radiation Therapy as Initial Local Treatment for Pulmonary Oligometastases from Colorectal Cancer: A Propensity Score Analysis.","authors":"Yaqi Wang, Xin Dong, Shi Yan, Bing Liu, Xiang Li, Shaolei Li, Chao Lv, Xinrun Cui, Ye Tao, Rong Yu, Nan Wu","doi":"10.1016/j.ijrobp.2024.07.2324","DOIUrl":"10.1016/j.ijrobp.2024.07.2324","url":null,"abstract":"<p><strong>Purpose: </strong>Optimal local treatment for pulmonary oligometastases from colorectal cancer (CRC) remains unclear. We aimed to compare the long-term survival outcomes between surgery and stereotactic body radiation therapy (SBRT) as the initial local treatment for CRC pulmonary oligometastases.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 335 consecutive patients who initially underwent surgery or SBRT for CRC pulmonary metastases from 2011 to 2022, and 251 patients (173 surgery and 78 SBRT) were ultimately included. Freedom from intrathoracic progression (FFIP), progression-free survival (PFS), and overall survival (OS) were compared using stabilized inverse probability of treatment weighting (sIPTW) analysis. In addition, patterns of intrathoracic progression and subsequent treatment were analyzed.</p><p><strong>Results: </strong>Median follow-up was 61.6 months for surgery and 54.4 months for SBRT. After sIPTW adjustment, significant differences emerged in both FFIP and PFS between surgery and SBRT (FFIP: hazard ratio [HR] = 0.50, 95% confidence interval [CI], 0.31-0.79; PFS: HR = 0.56, 95% CI, 0.36-0.87). The 3- and 5-year FFIP rates were 58.6% and 54.8%, respectively, after surgery, and 34.6% and 31.3%, respectively, after SBRT (P = .006). The 3- and 5-year PFS rates were 49.4% and 45.2%, respectively, after surgery, and 28.8% and 26.1%, respectively, after SBRT (P = .010). However, OS was not significantly affected by treatment approach (HR = 0.93, 95% CI, 0.49-1.76). The 3- and 5-year OS rates were 85.9% and 73.1%, respectively, after surgery, and 78.9% and 68.7%, respectively, after SBRT (P = .849). Recurrence at the treated site was more prevalent after SBRT than after surgery (33.3% vs 16.9%), whereas new intrathoracic tumors occurred more frequently after surgery than after SBRT (71.8% vs 43.1%). Both groups chose radiation therapy as the primary local salvage treatment.</p><p><strong>Conclusions: </strong>Notwithstanding the significant differences in FFIP and PFS between surgery and SBRT, the long-term survival of patients with CRC pulmonary oligometastases did not depend on the initial choice of the local treatment approach.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"45-55"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic Ablative Radiotherapy for T1 to T2 Glottic Larynx Cancer: Mature Results From the Phase 2 GLoTtic Larynx-SABR Trial.","authors":"David J Sher, Vladimir Avkshtol, Dominic Moon, Dat Vo, Ted Mau, Lesley Childs, Mu-Han Lin, Jeffrey Dubas, Chul Ahn, Baran D Sumer","doi":"10.1016/j.ijrobp.2024.07.2147","DOIUrl":"10.1016/j.ijrobp.2024.07.2147","url":null,"abstract":"<p><strong>Purpose: </strong>Traditional radiation therapy for early-stage larynx cancer irradiates the whole larynx over 5.5 to 6 weeks. Phase 1 data suggest that stereotactic ablative radiotherapy (SABR) is a viable strategy to reduce the irradiated volume and compress treatment time. This phase 2 study evaluated the efficacy of gLoTtic larynx-SABR in 5 or 16 fractions.</p><p><strong>Methods and materials: </strong>Eligibility required stage 0 to II squamous cell carcinoma of the glottic larynx. The arytenoid cartilage could not be involved beyond the vocal process, and patients smoking more than one pack per day were excluded. The treatment volume consisted of the gross tumor volume, with a 3 mm margin (5 mm craniocaudal) to create the planning target volume. Patients without active smoking and planning target volume <10 cc received 4250 cGy in 5 fractions, twice per week; other patients received 58.08 Gy in 16 daily fractions. The primary endpoint was the 2-year incidence of local failure.</p><p><strong>Results: </strong>Twenty-five patients were accrued to this study, with 21 and 4 treated with 5 and 16 fractions, respectively. The stage distribution was in situ (n = 1, 4%), T1a/b (n = 16/5, 64%/20%), and T2 (n = 3, 12%). The median age was 72 years, with a prior smoking history in 16 (64%) and active smoking in 1 (4%). At a median follow-up for surviving patients of 3.7 years (IQR, 3.1-4.4 years), there have been 2 in-field recurrences (1 in each dose cohort). The cumulative incidences of local failure were 4% (90% CI, 0.8%-20%) and 8% (90% CI, 3%-24%) at 1 and 2 years, respectively. There have been no acute or late grade 3+ toxicities in disease-free patients. The median baseline, 1, 6, 12, and 24 months Voice Handicap Index scores were 57 (IQR, 32-69), 28.5 (8-48), 4 (0-12), 7.5 (0-12), and 5 (0-24), respectively.</p><p><strong>Conclusions: </strong>Highly conformal stereotactic radiation therapy appears safe and efficacious for early-stage glottic larynx cancer, with encouraging patient-reported outcomes. These results need to be interpreted with caution given the small sample size and large noninferiority margin. Additional follow-up and ultimately comparative studies are necessary to validate this paradigm.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"137-144"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748070","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}