International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Biomarker Expression and Clinical Outcomes in International Study of Chemoradiation and Magnetic Resonance Imaging-Based Image-Guided Brachytherapy for Locally Advanced Cervical Cancer: BIOEMBRACE.","authors":"Supriya Chopra, Tjalling Bosse, Nanda Horeweg, Kedar Deodhar, Santosh Menon, Tynisha Rafael, Venkatesh Pai, Lucia Rijstenberg, Folkert van Kemenade, Sadhana Kannan, Umesh Mahantshetty, Barbara Segedin, Fleur Huang, Kjersti Bruheim, Margarita Perez, Bhavana Rai, Li Tee Tan, Nadia Giannakopoulos, Maximilian Schmid, Kari Tanderup, Richard Pötter, Remi A Nout","doi":"10.1016/j.ijrobp.2024.07.2316","DOIUrl":"10.1016/j.ijrobp.2024.07.2316","url":null,"abstract":"<p><strong>Purpose: </strong>BIOEMBRACE was designed to study the impact of biomarkers in addition to clinicopathological factors on disease outcomes in patients treated with chemoradiation and magnetic resonance imaging (MRI)-guided brachytherapy (BT) for locally advanced cervical cancer in the EMBRACE study.</p><p><strong>Methods and materials: </strong>Between 2018 and 2021, 8 EMBRACE-I sites contributed tumor tissue for the immunohistochemistry of p16, PD-L1, and L1CAM. These biomarkers and clinicopathological factors (International Federation of Gynecology and Obstetrics 2009 stage, nodal status, histology, and necrosis on MRI) were analyzed to predict poor response at BT (high-risk clinical target volume [HR-CTV] ≥ 40 cc) at BT) and 5-year local control, pelvic control, and disease-free survival. Interaction between p16, PD-L1, radiation therapy dose (HR-CTV D90), and disease outcomes was investigated. Univariable and multivariable analyses were performed.</p><p><strong>Results: </strong>Two hundred sixty-four patients were included. The median HR-CTV D90 was 89 Gy (86-95). P-16 positive status, PD-L1 > 1%, and L1CAM ≥ 10% was noted in 86.6%, 20.1%, and 17.8% of patients, respectively. P16 negative status (odds ratio, 2.0; 95% CI, 1.0-5.7; P = .04) and necrosis on MRI (odds ratio, 2.1; 95% CI, 1.1-4.3; P < .02) independently predicted for HR-CTV ≥ 40 cc, as did the International Federation of Gynecology and Obstetrics stage and tumor width >5 cm. PD-L1 > 1% was associated with reduced local (82% vs 94%; P = .02) and pelvic control (79% vs 89%; P = .02). HR-CTV D90 < 85 Gy was associated with inferior 5-year local control in p16-positive patients, especially if PD-L1 was coexpressed. On multivariable analysis, PD-L1 > 1% was the only independent factor for 5-year local control (hazard ratio, 3.3; P = .04) and L1CAM ≥ 50% for pelvic control (hazard ratio, 5.5; 95% CI, 1.3-23.3; P = .02).</p><p><strong>Conclusions: </strong>P16 negative status and tumor necrosis on MRI are independently associated with poor response to chemoradiation, whereas PD-L1 > 1% and L1CAM ≥ 50% have an independent impact on local and pelvic control, suggesting an impact of biomarker expression on outcomes. Further validation is needed.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"97-106"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Update of a Phase 3 Randomized Study Comparing Once-a-Week Versus Once-Every-3-Weeks Cisplatin Along With Radiation in Head and Neck Cancer.","authors":"Vanita Noronha, Vijay Patil, Nandini Menon, Ajaykumar Singh, Minit Shah, Ankush Shetake, Zoya Peelay, Vijayalakshmi Mathrudev, Kavita Nawale, Srushti Shah, Kumar Prabhash","doi":"10.1016/j.ijrobp.2024.07.2315","DOIUrl":"10.1016/j.ijrobp.2024.07.2315","url":null,"abstract":"<p><strong>Purpose: </strong>In the weekly-3-weekly study, cisplatin at 100 mg/m² once-every-3-weeks led to superior locoregional control compared with cisplatin 30 mg/m² once-a-week in combination with radical radiation for locally advanced head and neck squamous cell carcinoma (LAHNSCC). We report the updated analysis of the study.</p><p><strong>Methods and materials: </strong>In this phase 3 open-label noninferiority study conducted between 2013 and 2017, 300 patients with LAHNSCC were randomly assigned to receive cisplatin 100 mg/m² once-in-every-weeks or cisplatin 30 mg/m² once-a-week, concurrently with radiation. The primary endpoint was locoregional control. Secondary outcomes were overall survival, progression-free survival, and late adverse events.</p><p><strong>Results: </strong>The median follow-up was 6.91 years (95% CI, 6.12-7.36). The updated 2-year and 5-year locoregional control rates for the once-a-week cisplatin arm were 58.75% (95% CI, 51.08-67.58) and 48.09% (95% CI, 40.26-57.43), whereas for the once-every-3-weeks, cisplatin arm were 73.95% (95% CI, 66.93-81.70) and 56.76% (95% CI, 48.46-66.48), respectively, hazard ratio = 1.44 (95% CI, 1.03-2.03), P = .034. The 5-year overall survival was 43.60% (95% CI, 36.29-52.37) in the once-a-week cisplatin arm and 50.55% (95% CI, 43.06-59.35) in the once-every-3-weeks cisplatin arm; P = .19. There was no difference in any grade or grade ≥3 late adverse events between the 2 arms, except for hearing dysfunction, which was significantly more common in patients who received high-dose cisplatin.</p><p><strong>Conclusions: </strong>Long-term follow-up confirms that cisplatin at 100 mg/m² administered once-every-3-weeks concurrently with radical radiation for LAHNSCC leads to superior locoregional control compared with cisplatin 30 mg/m² once-a-week and should remain one of the standard treatment options.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"128-136"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792435","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":"Autodelineation of Treatment Target Volume for Radiation Therapy Using Large Language Model-Aided Multimodal Learning.","authors":"Praveenbalaji Rajendran, Yizheng Chen, Liang Qiu, Thomas Niedermayr, Wu Liu, Mark Buyyounouski, Hilary Bagshaw, Bin Han, Yong Yang, Nataliya Kovalchuk, Xuejun Gu, Steven Hancock, Lei Xing, Xianjin Dai","doi":"10.1016/j.ijrobp.2024.07.2149","DOIUrl":"10.1016/j.ijrobp.2024.07.2149","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial intelligence-aided methods have made significant progress in the auto-delineation of normal tissues. However, these approaches struggle with the auto-contouring of radiation therapy target volume. Our goal was to model the delineation of target volume as a clinical decision-making problem, resolved by leveraging large language model-aided multimodal learning approaches.</p><p><strong>Methods and materials: </strong>A vision-language model, termed Medformer, has been developed, employing the hierarchical vision transformer as its backbone and incorporating large language models to extract text-rich features. The contextually embedded linguistic features are seamlessly integrated into visual features for language-aware visual encoding through the visual language attention module. Metrics, including Dice similarity coefficient (DSC), intersection over union (IOU), and 95th percentile Hausdorff distance (HD95), were used to quantitatively evaluate the performance of our model. The evaluation was conducted on an in-house prostate cancer data set and a public oropharyngeal carcinoma data set, totaling 668 subjects.</p><p><strong>Results: </strong>Our Medformer achieved a DSC of 0.81 ± 0.10 versus 0.72 ± 0.10, IOU of 0.73 ± 0.12 versus 0.65 ± 0.09, and HD95 of 9.86 ± 9.77 mm versus 19.13 ± 12.96 mm for delineation of gross tumor volume on the prostate cancer dataset. Similarly, on the oropharyngeal carcinoma dataset, it achieved a DSC of 0.77 ± 0.11 versus 0.72 ± 0.09, IOU of 0.70 ± 0.09 versus 0.65 ± 0.07, and HD95 of 7.52 ± 4.8 mm versus 13.63 ± 7.13 mm, representing significant improvements (P < 0.05). For delineating the clinical target volume, Medformer achieved a DSC of 0.91 ± 0.04, IOU of 0.85 ± 0.05, and HD95 of 2.98 ± 1.60 mm, comparable with other state-of-the-art algorithms.</p><p><strong>Conclusions: </strong>Auto-delineation of the treatment target based on multimodal learning outperforms conventional approaches that rely purely on visual features. Our method could be adopted into routine practice to rapidly contour clinical target volume/gross tumor volume.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"230-240"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906598","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 Radiation for Oligoprogressive Cancers: Results of the Randomized Phase 2 STOP Trial.","authors":"Devin Schellenberg, Zsolt Gabos, Adele Duimering, Brock Debenham, Alysa Fairchild, Fleur Huang, Lindsay S Rowe, Diane Severin, Meredith E Giuliani, Andrea Bezjak, Benjamin H Lok, Srinivas Raman, Peter Chung, Yizhou Zhao, Clement K Ho, Michael Lock, Alexander V Louie, Shilo Lefresne, Hannah Carolan, Mitchell Liu, Vivian Yau, Allison Ye, Robert A Olson, Benjamin Mou, Islam G Mohamed, David W Petrik, Maryam Dosani, Howard Pai, Boris Valev, Stewart Gaede, Andrew Warner, David A Palma","doi":"10.1016/j.ijrobp.2024.08.031","DOIUrl":"10.1016/j.ijrobp.2024.08.031","url":null,"abstract":"<p><strong>Purpose: </strong>This trial examined if patients with ≤5 sites of oligoprogression benefit from the addition of SABR to standard of care (SOC) systemic therapy.</p><p><strong>Methods and materials: </strong>We enrolled patients with 1 to 5 metastases progressing on systemic therapy, and after stratifying by type of systemic therapy (cytotoxic vs noncytotoxic), randomized 1:2 between continued SOC treatment versus SABR to all progressing lesions plus SOC. The trial was initially limited to non-small cell lung cancer but was expanded to include all nonhematologic malignancies to meet accrual goals. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), lesional control, quality of life, adverse events, and duration of systemic therapy postrandomization.</p><p><strong>Results: </strong>Ninety patients with 127 oligoprogressive metastases were enrolled across 8 Canadian institutions, with 59 randomized to SABR and 31 to SOC. The median age was 67 years, and 39 (43%) were women. The most common primary sites were lung (44%), genitourinary (23%), and breast (13%). Protocol adherence in the SOC arm was suboptimal, with 11 patients (35%) either receiving high-dose/ablative therapies (conflicting with trial protocol) or withdrawing from the study. The median follow-up was 31 months. There was no difference in PFS between arms (median PFS 8.4 months in the SABR arm vs 4.3 months in the SOC arm, but curves cross and 2-year PFS was 9% vs 24%, respectively; P = .91). The median OS was 31.2 months versus 27.4 months, respectively (P = .22). Lesional control was superior with SABR (70% vs 38%, respectively; P = .0015). There were 2 (3.4%) grade 3 and no grade 4/5 adverse events attributable to SABR.</p><p><strong>Conclusions: </strong>SABR was well-tolerated with superior lesional control but did not improve PFS or OS. Accrual to this study was difficult, and the results may have been impacted by an unwillingness to forgo ablative treatments on the SOC arm. (NCT02756793).</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"28-38"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017346","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":"Three-Dimensional Deep Learning Normal Tissue Complication Probability Model to Predict Late Xerostomia in Patients With Head and Neck Cancer.","authors":"Hung Chu, Suzanne P M de Vette, Hendrike Neh, Nanna M Sijtsema, Roel J H M Steenbakkers, Amy Moreno, Johannes A Langendijk, Peter M A van Ooijen, Clifton D Fuller, Lisanne V van Dijk","doi":"10.1016/j.ijrobp.2024.07.2334","DOIUrl":"10.1016/j.ijrobp.2024.07.2334","url":null,"abstract":"<p><strong>Purpose: </strong>Conventional normal tissue complication probability (NTCP) models for patients with head and neck cancer are typically based on single-value variables, which, for radiation-induced xerostomia, are baseline xerostomia and mean salivary gland doses. This study aimed to improve the prediction of late xerostomia by using 3-dimensional information from radiation dose distributions, computed tomography imaging, organ-at-risk segmentations, and clinical variables with deep learning (DL).</p><p><strong>Methods and materials: </strong>An international cohort of 1208 patients with head and neck cancer from 2 institutes was used to train and twice validate DL models (deep convolutional neural network, EfficientNet-v2, and ResNet) with 3-dimensional dose distribution, computed tomography scan, organ-at-risk segmentations, baseline xerostomia score, sex, and age as input. The NTCP endpoint was moderate-to-severe xerostomia 12 months postradiation therapy. The DL models' prediction performance was compared with a reference model: a recently published xerostomia NTCP model that used baseline xerostomia score and mean salivary gland doses as input. Attention maps were created to visualize the focus regions of the DL predictions. Transfer learning was conducted to improve the DL model performance on the external validation set.</p><p><strong>Results: </strong>All DL-based NTCP models showed better performance (area under the receiver operating characteristic curve [AUC]_test, 0.78-0.79) than the reference NTCP model (AUC_test, 0.74) in the independent test. Attention maps showed that the DL model focused on the major salivary glands, particularly the stem cell-rich region of the parotid glands. DL models obtained lower external validation performance (AUC_external, 0.63) than the reference model (AUC_external, 0.66). After transfer learning on a small external subset, the DL model (AUC_{tl, external}, 0.66) performed better than the reference model (AUC_{tl, external}, 0.64).</p><p><strong>Conclusion: </strong>DL-based NTCP models performed better than the reference model when validated in data from the same institute. Improved performance in the external data set was achieved with transfer learning, demonstrating the need for multicenter training data to realize generalizable DL-based NTCP models.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"269-280"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanistic Insights and Knowledge Gaps in the Effects of Radiation Therapy on Cardiac Arrhythmias.","authors":"Poornima Balaji, Xingzhou Liulu, Sonaali Sivakumar, James J H Chong, Eddy Kizana, Jamie I Vandenberg, Adam P Hill, Eric Hau, Pierre C Qian","doi":"10.1016/j.ijrobp.2024.08.040","DOIUrl":"10.1016/j.ijrobp.2024.08.040","url":null,"abstract":"<p><p>Stereotactic body radiation therapy (SBRT) is an innovative modality for the treatment of refractory ventricular arrhythmias (VAs). Phase 1/2 clinical trials have demonstrated the remarkable efficacy of SBRT at reducing VA burden (by >85%) in patients with good short-term safety. SBRT as an option for VA treatment delivered in an ambulatory nonsedated patient in a single fraction during an outpatient session of 15 to 30 minutes, without added risks of anesthetic or surgery, is clinically relevant. However, the underlying mechanism remains unclear. Currently, the clinical dosing of SBRT has been derived from preclinical studies aimed at inducing transmural fibrosis in the atria. The propitious clinical effects of SBRT appear earlier than the time course for fibrosis. This review addresses the plausible mechanisms by which radiation alters the electrophysiological properties of myocytes and myocardial conduction to impart an antiarrhythmic effect, elucidate clinical observations, and point the direction for further research in this promising area.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":"75-89"},"PeriodicalIF":6.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119780","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":"Consensus Radiation Treatment Planning Guidelines Utilizing (68)Ga-DOTATATE PET/CT for Resected Meningiomas.","authors":"Haley K Perlow, David R Raleigh, Tony J C Wang, Erqi L Pollom, Michael T Milano, William G Breen, Jay Detsky, Eric L Chang, Martin C Tom, Kevin R Shiue, Eric J Lehrer, Hina Saeed, Luke R G Pike, Simon S Lo, Mark V Mishra, Jonathan P S Knisely, Samuel T Chao, Arjun Sahgal, Joshua D Palmer","doi":"10.1016/j.ijrobp.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.12.003","url":null,"abstract":"<p><strong>Background: </strong>Meningiomas are the most common primary intracranial tumor. Somatostatin receptor 2 (SSTR 2) is almost universally expressed in meningioma tissue. For patients who require adjuvant radiation, SSTR based (68)Ga-DOTATATE positron emission tomography (PET) imaging can detect additional or residual disease not discernible on magnetic resonance imaging (MRI). PET-guided radiation treatments may improve local control, minimize toxicity by allowing for more precise radiotherapy plans, and allow for more precise dose escalation to maximize local control. The aim of this study was to develop consensus PET-guided treatment planning guidelines for common meningioma presentations.</p><p><strong>Methods: </strong>Five post-operative clinically relevant meningioma cases were selected from a prospective single-institutional registry of patients. Each patient had a preoperative and post-operative contrast enhanced T1-weighted volumetric MRI, and a post-operative (68)Ga-DOTATATE PET/CT, to assist with target delineation. The full treatment scenario including clinical history, histology, surgical history, and imaging were provided for each patient. Nineteen international experts who have published on the treatment and management of meningiomas, and who utilize (68)Ga-DOTATATE PET/CT in their practice, evaluated each case. Individual prescription recommendations were created, pooled, and discussed to create consensus recommendations.</p><p><strong>Results: </strong>Consensus recommendations were created for each case. In most cases, PET-based contouring allowed for more precise-dose escalation to 66-70Gy targeting residual disease. When compared to RTOG 0539 and modern clinical trial contouring guidelines, a smaller CTV expansion from the surgical cavity was recommended using PET-guided radiation plans in the absence of radiographic or pathologic evidence of brain or bone invasion.</p><p><strong>Conclusion: </strong>This report provides consensus target volume delineation guidelines for meningiomas receiving postoperative radiation in common clinical situations. Integration of these guidelines into clinical practice may allow for more precise biomarker-guided radiation treatments and standardize radiotherapy on future meningioma clinical trials.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Outcomes Following Individualized Elective Primary Tumor CTV Delineation Based on Stepwise Spread Patterns of Nasopharyngeal Carcinoma Treated with Intensity-modulated Radiotherapy.","authors":"Rui Guo, Wei-Wei Zhang, Jia-Wei Lv, Jia-Yi Lin, Cheng Xu, Jing Li, Yan-Ling Wu, Xiao-Min Zhang, Ling-Long Tang, Ying Sun, Jun Ma","doi":"10.1016/j.ijrobp.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.12.006","url":null,"abstract":"<p><strong>Purpose: </strong>Our institution has developed an individualized elective primary tumor clinical target volume (CTVp) delineation protocol for nasopharyngeal carcinoma (NPC) based on stepwise tumor spread patterns in intensity-modulated radiotherapy (IMRT) for over ten years. Herein, we report the long-term efficacy and toxicities in NPC patients treated under this protocol.</p><p><strong>Methods and materials: </strong>A total of 7,262 histologically proven, nonmetastatic NPC patients treated with IMRT following this individualized delineation protocol were retrospectively evaluated. The 5-year rates for local relapse-free survival (LRFS), regional relapse-free survival (RRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) were estimated. Dose-volume histogram (DVH) parameters for patients with local relapse were compared to those of propensity score-matched (PSM) without local relapse. Dosimetric comparisons of our delineation protocol with the 2018 International Guideline (2018-IG) were conducted on representative early- and advanced-stage NPC cases.</p><p><strong>Results: </strong>The 5-year LRFS, RRFS, DMFS, PFS and OS were 93.6%, 94.4%, 86.8%, 77.8%, and 86.0%, respectively. 92.3% of local relapses and 86.0% of regional relapses occurred within the 95% isodose lines and were considered GTV in-field failures. No significant differences in DVH parameters were observed between the local relapse group and the propensity score-matched non-relapse group. Compared with the 2018-IG, our contouring protocol resulted in a 58.4% and 48.3% reduction in PTV70, and an 80.8% and 62.8% reduction in PTV60 for early and advanced-stage disease, respectively. Late grade 3 toxicities included ototoxicity (1.8%), xerostomia (0.2%), dysphagia (0.2%), temporal lobe injury (0.2%), and trismus (0.1%).</p><p><strong>Conclusion: </strong>Individualized elective CTVp delineation based on the stepwise spread patterns of nasopharyngeal carcinoma achieved excellent long-term outcomes and reduced the irradiated volumes at equivalent dose levels compared to the 2018-IG.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864151","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":"Results of a single arm phase II clinical trial: online-adaptive stereotactic body radiotherapy of abdominal-pelvic oligometastases.","authors":"Lucy A van Werkhoven, Maaike T W Milder, Mischa S Hoogeman, Erik van Werkhoven, Remi A Nout, Joost J Nuyttens","doi":"10.1016/j.ijrobp.2024.11.106","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.106","url":null,"abstract":"<p><strong>Purpose: </strong>This study reports on the clinical outcomes of the single arm phase-II STEAL trial investigating online adaptive stereotactic body radiotherapy (SBRT) for abdominal-pelvic lymph node (A-P LN) oligometastases.</p><p><strong>Methods: </strong>Patients with oligometastatic A-P LN were enrolled and treated to a total dose of 45 Gy in five fractions on the CyberKnife. For each patient, a library of three plans was created using a pre-treatment diagnostic CT scan and the treatment planning CT scan. Following a decision tree, the radiotherapy technologist (RTT) selected the best plan of the day, i.e. the plan with the highest target coverage without exceeding OAR constraints. The primary endpoint was local control (LC), and secondary endpoints were toxicity and overall survival (OS).</p><p><strong>Results: </strong>In total, 52 patients were included, and 55 online adaptive treatments were performed. The primary tumor was prostate adenocarcinoma in 19 patients (37 %), colorectal in 17 (33%) and 16 patients (31%) had a different origin. After a median follow-up of 38.5 months, local control at one year was 96% and 80% at three years; 20 patients had died, resulting in a median OS of 4.1 years. No grade ≥ 4 toxicity was observed. One patient (2%) developed a grade 3 ureter stenosis.</p><p><strong>Conclusion: </strong>CT-guided online adaptive SBRT for A-P LN oligometastases using a RTT only library of plans strategy is feasible, safe, and resulted in an excellent local control with a low rate of toxicity.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854177","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":"First Retrospective QA of FAST-01 Clinical Treatment Fields Using High-Speed Quantitative Scintillation Imaging.","authors":"Megan Clark, Zhiyan Xiao, Austin Sloop, Yongbin Zhang, Eunsin Lee, Roman Vasyltsiv, David Gladstone, Rongxiao Zhang, Petr Bruza, Anthony E Mascia","doi":"10.1016/j.ijrobp.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.12.005","url":null,"abstract":"<p><strong>Purpose: </strong>To retrospectively validate the dose and dose rates delivered in XXX clinical trial fields via sub-millimeter spatial and <0.25 ms temporal resolution scintillation imaging.</p><p><strong>Methods: </strong>An ultra-fast intensified CMOS camera (4.5-12 kHz sampling rate) imaged the light response of a scintillator sheet at treatment isocenter and irradiated by pencil beam scanning proton fields, including XXX clinical fields. Dose and dose rate linearity studies were performed, followed by camera calibration, via EBT3 film. An EDGE diode detector was placed directly under the scintillator at the surface and at 5cm depth, for comparison with the imaging data and log files. Frame-by-frame analysis of image stacks yielded dose and dose-rate maps for each delivery at the surface. Using the percent depth dose curves and 3D spot profiles, the surface images were projected to 5 cm depth for comparison with a secondary diode and log file recordings.</p><p><strong>Results: </strong>Camera response was linear with dose (R² =0.9998) and beam current (R²=0.9883) from 2-12Gy and 20-210nA, respectively. Gamma analysis of the cumulative dose maps at 3%/2mm indicated a mean passing rate of 100% compared with film. Total irradiation time agreed with the log file recordings with an average deviation of 0.20±0.07ms. At the surface, the average imaged dose rate across the seven fields was 114±1Gy/s, agreeing with the diode within 1±1%. The dose at 5cm depth from the projected images (mean 8.4 Gy) agreed with the reported dose (log files) within 0.13±0.03 Gy (2±1%). The average dose rate from projected images at 5 cm depth was 62±1 Gy/s which agreed with the reported and diode values within 2±3%.</p><p><strong>Conclusion: </strong>This study provides the first independent validation of dose and dose rate for clinical proton XXX fields at unprecedented spatiotemporal resolution. Owing to the non-trivial dose rate distributions in PBS fields, such direct 2D dose rate mapping will be important in future pre-treatment plan quality assurance.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854093","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}