International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Do Not Be Shy When It Comes to the Spine: The Importance of Craniospinal Irradiation in High-risk Ependymoma","authors":"Raj Singh MD, Joshua D. Palmer MD","doi":"10.1016/j.ijrobp.2025.01.001","DOIUrl":"10.1016/j.ijrobp.2025.01.001","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":"121 4","pages":"Pages 853-854"},"PeriodicalIF":6.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453297","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":"In Reply to Luh","authors":"Fiona Hegi-Johnson MBBS Hons, PhD, FRANZCR, Farhannah Aly MBChB (Hons), MPhil, FRANZCR, Nicholas Bucknell MBBS Hons, PhD, FRANZCR, Liz Kenny AO, FRANZCR, Salma K. Jabbour MD, Thomas J. Dilling MD","doi":"10.1016/j.ijrobp.2024.11.110","DOIUrl":"10.1016/j.ijrobp.2024.11.110","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":"121 4","pages":"Pages 1090-1091"},"PeriodicalIF":6.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143453305","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 matched case-control study of the relationship between radiation dose to the internal mammary lymph nodes and clinical outcomes in patients with and without internal mammary lymph node relapses.","authors":"Alan Nichol, Louise Wade, Lovedeep Gondara, Richard Musoke, Jee Suk Chang, Carrie-Lynne Swift, Nicholas Chng, Dylan Narinesingh, Caroline Speers, Caroline Lohrisch","doi":"10.1016/j.ijrobp.2025.02.007","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.007","url":null,"abstract":"<p><strong>Purpose: </strong>The Early Breast Cancer Trialists' Collaborative Group's 2023 meta-analysis of radiotherapy to regional nodes in early breast cancer demonstrated a significant improvement in overall survival (OS) without an associated improvement in locoregional recurrence in the trials comparing internal mammary node (IMN) irradiation versus none. We aimed to study cases with IMN relapse (IMNR) and controls without IMNR to examine the link between IMNR and OS.</p><p><strong>Materials and methods: </strong>Patients treated curatively between 2005 and 2014, who subsequently developed IMNR, were identified in a population-based database. The IMNR cases were matched 1:2 to controls without IMNR using patient and tumor characteristics. The internal mammary vessels in the first three intercostal spaces were outlined on planning CTs as the IMN clinical target volume, and the mean equivalent doses in 2 Gy fractions to the IMNs were calculated. Multivariable Fine and Gray competing-risk regression and Cox regression were used to evaluate the effect of the baseline patient, tumor and treatment variables, including therapeutic IMN irradiation with ≥40 Gy on IMNR and OS.</p><p><strong>Results: </strong>Seventy cases were matched with 140 controls. Median follow-up was 9.1 years, median tumor size was 25 mm, and N-stages were: 37% N0, 33% N1, and 30% N2-3. The medians of the IMN doses were 4.1 Gy for cases and 13.7 Gy for controls (p<0.001). On multivariable analysis, worse IMNR was associated with mastectomy (HR=2.11, p=0.02), and better IMNR was associated with therapeutic IMN irradiation (HR=0.36, p=0.009); worse OS was associated with larger tumor size (HR=1.02, p=0.006), ≥10 positive axillary nodes (HR=3.15, p=0.04), and triple-negative subtype (HR=2.92, p=0.03), and better OS was associated with therapeutic IMN irradiation (HR=0.49, p=0.02).</p><p><strong>Conclusions: </strong>We demonstrated that therapeutic IMN irradiation with ≥40 Gy was associated with a lower risk of internal mammary node relapse and improved overall survival.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476617","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":"Challenges in interpreting survival metrics in clinical trials: the utility of restricted mean survival analyses.","authors":"Itamar Averbuch, Avital Bareket-Samish, Daniel A Goldstein, Sapir Eizenstein, Gal Markel, Eli Rosenbaum, Dror Limon, David Bomze, Ethan B Ludmir, Tomer Meirson","doi":"10.1016/j.ijrobp.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.006","url":null,"abstract":"<p><p>A 75-year-old man enters your clinic with a new diagnosis of high-risk localized prostate cancer. You suggest to him a state-of-the-art treatment plan: radiotherapy to the prostate and lymph nodes, and hormonal therapy. The man expresses a concern about urinary leakage and wonders if nodal irradiation will be worthwhile. To address his concerns, you describe the recent POP-RT trial, which compared whole pelvic radiotherapy to prostate-only radiotherapy. Indeed, whole pelvic radiotherapy increased the risk of genitourinary toxicity, but the improved disease-free survival appears impressive with a hazard ratio (HR) of 0.4. The patient looks confused, so you try communicating using simpler terms: \"Fear not, with whole pelvic radiotherapy, you'll enjoy a 60% lower rate of disease progression or death compared to prostate radiotherapy\" (more statistically-minded folks will say this through gritted teeth, as HR 0.4 does not mean a 60% reduced risk of the endpoint; more on this later). Despite your efforts, the patient's gaze remains confused, and you realize that a more straightforward way to explain the treatment benefit with respect to delay in disease progression would be helpful. Thus, you try to find the median disease-free survival for both arms in the POP-RT study, but the medians are nowhere to be found in the entire POP-RT publication. On the verge of giving up, you recall that lunchtime chat with your center's statistician-the one where he went on and on about this \"game-changing\" metric, restricted mean survival time (RMST), insisting it is more intuitive and patient-friendly. And, of course, he even followed up with an email detailing different clinical trial results with RMST, including the POP-RT. After a quick search in your inbox, you confidently tell the patient, \"Adding pelvic RT will, on average, delay progression by over 11 months.\" After a moment of silence, the patient nods and says, \"Let's go for it.\"</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467936","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":"Final results from a longitudinal observation study evaluating sexual health and facial appearance and distress in human papillomavirus-associated oropharyngeal cancer survivors treated with chemoradiotherapy: Sexual health and facial appearance in HPV OPC.","authors":"Lachlan McDowell, Karla Gough, Tsien Fua, Andrew Coleman, Allison Drosdowsky, Danny Rischin, June Corry","doi":"10.1016/j.ijrobp.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.004","url":null,"abstract":"<p><strong>Purpose: </strong>This communication reports on the complete results of a prospective study evaluating sexual health and appearance-related outcomes in human papillomavirus-associated oropharyngeal cancer (HPVOPC) survivors treated with (chemo)radiotherapy ((C)RT).</p><p><strong>Methods and materials: </strong>One hundred HPVOPC patients scheduled to receive curative-intent (C)RT were enrolled onto a longitudinal observational study between October 2020 and November 2021. Sexual health was measured using the EORTC Sexual Health Questionnaire (QLQ-SHQ22) and appearance-related issues were measured using FACE-Q Appearance and Appearance distress modules. Questionnaires were administered before (C)RT, in the last week of treatment (week 7), and 3, 12 and 24 months after (C)RT. Linear mixed models estimated mean differences at follow-up assessments compared to before (C)RT.</p><p><strong>Results: </strong>Global tests of differences across time provided moderate to strong evidence against the null hypothesis of no differences for all QLQ-SHQ22 scales/items, apart from sexual pain and insecurity with partner (both P > .10). Compared to before (C)RT, the remainder of item/scale scores indicated worse sexual health in the last week of treatment, convalescing to pretreatment levels by 3 months (importance of sexual activity, worry incontinence), 12 months (sexual satisfaction, libido, fatigue affecting sex life) or 24 months (treatment affecting sex life, confidence in erection) after treatment. On average, feeling less masculine scores did not return to pretreatment levels by the final assessment. Appearance distress, but not facial appearance, was worse in the last week of treatment but improved by 3 months post-treatment.</p><p><strong>Conclusions: </strong>Most sexual health outcomes impacted by (C)RT return to pretreatment levels by 3, 12 or 24 months. Temporary appearance distress was reported at the end of treatment. This communication provides multidimensional sexual health data to strengthen counselling of HPVOPC patients.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143458013","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":"Analysis of the lnfluence of Boron Distribution on CBE Values in Boron Neutron Capture Therapy.","authors":"Zhiyuan Lin, Zuokang Lin, Zijian Zhang, Guanchao Wu, Yinan Zhu, Yuchen Liu, Ye Dai, Zhimin Dai","doi":"10.1016/j.ijrobp.2025.02.005","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.005","url":null,"abstract":"<p><p>Boron Neutron Capture Therapy (BNCT) is an innovative cancer treatment that employs the ¹⁰B(n,α)⁷Li reaction to selectively destroy cancer cells at the cellular level. In BNCT, the biological effectiveness of boron doses is typically assessed using the Compound Biological Effectiveness (CBE) factor. This study analyzes the impact of boron distribution on CBE values based on the Microdosimetric Kinetic Model (MKM) and Monte Carlo simulations. Simulations were conducted on both macroscopic and microscopic scales. At the macroscopic level, the average dose absorbed by cells within tissues was modeled, while at the microscopic level, the microdosimetric lineal energy spectra and the microscopic dose absorbed by cell nuclei were simulated. The CBE values for various cells during BNCT were then derived from the Monte Carlo simulation data. Results indicate that while macroscopic boron concentrations had no significant impact on CBE values, the distribution of boron at the cellular level played a crucial role; CBE values increased as boron moved closer to the cell nucleus. This study proposes a method for calculating CBE values using Monte Carlo simulations, providing insights for evaluating CBE values and developing novel boron agents for BNCT.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440767","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":"Trajectories of Cortical Atrophy Differ According to Cognitive Phenotype in Adults With Primary Brain Tumors.","authors":"Jiwandeep S Kohli, Anny Reyes, Austin Hopper, Alena Stasenko, Natalia Menendez, Kathryn R Tringale, Mia Salans, Roshan Karunamuni, Jona Hattangadi-Gluth, Carrie R McDonald","doi":"10.1016/j.ijrobp.2025.01.036","DOIUrl":"10.1016/j.ijrobp.2025.01.036","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated patterns of cortical atrophy longitudinally in a prospective cohort of well-characterized patients with primary brain tumors before radiation therapy (RT) and at discrete time points up to 1-year post-RT. Patients with more impaired profiles were hypothesized to show greater and more widespread atrophy post-RT than patients with minimally impaired profiles.</p><p><strong>Methods and materials: </strong>Adults (aged 20-72 years) with primary brain tumors were enrolled in a prospective, observational study examining the effects of fractionated, partial brain RT on brain structure and cognition (n = 85). Cortical atrophy rates were compared using multilevel modeling across 4 different time points (baseline, 3, 6, and 12 months after RT) between minimal, generalized, and isolated verbal memory impairment phenotypes taken from a previous study's latent profile analysis.</p><p><strong>Results: </strong>The minimal impairment phenotype showed no regions of significant change in cortical thickness across the 4 time points analyzed. The generalized impairment phenotype showed bihemispheric, multilobar cortical atrophy, with the greatest changes observed in the left precentral gyrus, lateral occipital cortex, and frontal pole. The verbal memory impairment phenotype demonstrated less extensive atrophy focally in the left superior temporal and superior parietal cortices. Annualized atrophy rates in regions of significant cortical thinning in the generalized and verbal memory impairment phenotypes ranged from 3.5% to 8.7% compared with baseline.</p><p><strong>Conclusions: </strong>In patients with primary brain tumors, the cognitive profile before RT informs the pattern and risk for RT-related cortical atrophy. Cognitive profiles may aid in identifying patients at greater risk for RT-related atrophy and accelerated cognitive decline.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425442","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":"Protons versus Photons Postmastectomy Radiotherapy Effects on Breast Reconstruction Outcomes and Dosimetry Analysis.","authors":"George E Naoum, Katrina Dobinda, Amulya Yalamanchili, Alexander Ho, Poonam Yadav, Eric Nesbit, Eric Donnelly, Masha Kocherginsky, Jonathan Strauss","doi":"10.1016/j.ijrobp.2025.01.034","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.01.034","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the impact of proton versus photon postmastectomy radiation (PMRT) on implant related complications.</p><p><strong>Materials: </strong>The records of breast cancer patients treated with mastectomy and expander and/or implant reconstruction followed by PMRT at our institution between 2011-2022 were reviewed. Patients were divided into two groups by treatment modality: proton and photon. All identified proton patients were treated using conventional fractionation and radiobiological effectiveness (RBE) was set to 1.1 compared to photons x-rays. Recorded complications included infection/skin necrosis (I/N) requiring operative debridement, capsular contracture (CC) necessitating capsulotomy, absolute reconstruction failure (ARF) implying complete loss of reconstruction, and overall reconstruction failure (ORF) defined as multiple revisions leading to replacement of the implant or salvage autologous reconstruction. Subgroup analysis for proton patients explored correlation between dosimetric parameters and complications using logistic regression and Cox proportional hazards regression models.</p><p><strong>Results: </strong>203 patients with an overall median follow-up of 4.7 years were identified. Among those 203 patients, 50 patients (25%) received protons while 153 patients (75%) received photons. The complication rates for protons vs photons were: Infection/necrosis (20% vs 13%, OR:1.6, p=0.2), capsular contracture (30% vs 10%, OR:3.9, p<0.001), Absolute Reconstruction Failure (16% vs 12%, OR:1.4, p=0.4) and Overall Reconstruction Failure (56% vs 36%, OR: 2.2, p=0.01). Sensitivity analyses and time-to-event models yielded similar results. The median (Dmean) for CTV, implant and skin was 50.6, 50.8, and 6.7 Gy (RBE), respectively. The median hot spot (D1cc) for CTV (clinical-target-volume), implant and skin was 52.8, 52.7, and 49.8 Gy (RBE) respectively. None of these parameters were significantly correlated with complications. The 5-year local failure cumulative incidence was 0% vs 4% (p=0.13) for protons and photons, respectively.</p><p><strong>Conclusions: </strong>Proton PMRT was associated with higher rates of implant capsular contracture and reconstruction failures compared to photons with equivalent local-control. No dosimetric parameter correlated with reconstruction complications.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414284","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":"Intracranial Disease Control and Survival among Patients with KRAS-mutant Lung Adenocarcinoma and Brain Metastases Treated with Stereotactic Radiosurgery.","authors":"Benjamin Gaeta, Jordan E Eichholz, Henry Walch, Ahmet T Ilica, Lillian Boe, Leah Kratochvil, Yao Yu, Daniel R Gomez, Brandon S Imber, Bob T Li, Yonina R Murciano-Goroff, Kathryn C Arbour, Nikolaus Schultz, Emily S Lebow, Luke R G Pike","doi":"10.1016/j.ijrobp.2025.01.033","DOIUrl":"10.1016/j.ijrobp.2025.01.033","url":null,"abstract":"<p><strong>Purpose: </strong>Precision medicine according to molecularly defined subgroups offers great potential to improve outcomes for patients with metastatic lung adenocarcinoma. This study describes clinical outcomes and the impact of co-occurring genetic alterations on outcomes following stereotactic radiosurgery (SRS) among patients with Kirsten rat sarcoma viral oncogene homolog (KRAS)-mutant lung adenocarcinoma.</p><p><strong>Methods and materials: </strong>A total of 195 patients with KRAS-mutant lung adenocarcinoma were treated with SRS for brain metastases (BMs) between 2014 and 2018 with follow-up until 2022 or death. Coprimary outcomes were median overall survival (OS) and intracranial progression-free survival (iPFS); univariable and multivariable Cox regression models and Kaplan-Meier survival analysis were used.</p><p><strong>Results: </strong>Median follow-up from the date of BM diagnosis was 11 months. Median OS and iPFS for the cohort were 27.7 months (95% CI, 19.7-36.8) and 22.1 months (95% CI, 16.8-48.9), respectively. Lesion-level local control at 12 and 24 months was 89.9% and 87.5%, respectively. In a multivariable Cox regression model, inferior OS was associated with coalterations in KEAP1 and STK11 (hazard ratio [HR], 1.94; 95% CI, 1.04-3.62; q = 0.087), progressive (HR, 3.41; 95% CI, 1.38-8.39; q = 0.087), and mixed response (HR, 3.52; 95% CI, 1.2-10.3; q = 0.092) extracranial disease, and 6 or more BMs at time of diagnosis (HR, 2.58; 95% CI, 1.22-6.63; q = 0.087). Positive programmed death ligand 1 status was associated with improved OS (HR, 0.57; 95% CI, 0.37-0.87; P = .01). Inferior iPFS was associated with chemotherapy before SRS (HR, 2.69; 95% CI, 1.42-5.09; q = 0.04) and age >65 years (HR, 2.21; 95% CI, 1.25-3.93; q = 0.055). KRAS G12C was not associated with differences in iPFS, OS, or type of intracranial progression event following SRS.</p><p><strong>Conclusions: </strong>Coalteration of KRAS and KEAP1/STK11 was associated with inferior OS, but not iPFS. Similar outcomes were found in patients harboring KRAS G12C and non-G12C mutant non-small cell lung cancer BMs. Further understanding of molecularly characterized subgroups will be critical in driving personalized radiation therapy for patients with lung cancer BMs.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390913","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 Phase 2 Trial of Radium²²³ and Stereotactic Ablative Radiation Therapy in Hormone-Naïve Men with Oligometastatic Prostate Cancer to Bone: The RadSABR Study.","authors":"Jonathan Tward, Shane Lloyd, Skyler Johnson, Christopher Dechet, Brock O Nei, Benjamin Maughan, Umang Swami, Sumati Gupta, Alejandro Sanchez, Kristine Kokeny, Neeraj Agarwal","doi":"10.1016/j.ijrobp.2025.01.025","DOIUrl":"10.1016/j.ijrobp.2025.01.025","url":null,"abstract":"<p><strong>Purpose: </strong>We hypothesized that treatment with Radium²²³ (Ra²²³) and Stereotactic ablative radiotherapy (SABR) in patients with bone-only metachronous oligometastastic hormone-sensitive prostate cancer (moHSPC) could safely delay the start of androgen deprivation therapy (ADT) and maintain quality of life (QoL).</p><p><strong>Methods and materials: </strong>This prospective trial included 20 men with moHSPC and ≤5 bone-only metastases who previously had definitive treatment to the prostate and pelvic lymph nodes. Eligibility criteria were testosterone ≥ 100 ng/dL and metastases validated by conventional imaging. Exclusion criteria were postinitial treatment (LHRH) therapy or N1 disease at bone metastasis diagnosis. Treatment included 6 cycles of Ra²²³ and SABR (30 Gy in 5 fractions). Bone scans and Prostate Specific Antigen (PSA) levels were monitored regularly. The primary endpoint was freedom from ADT use at 15 months in ≥20% of patients. Patients were followed for 2 years, with clinically significant patient-reported outcome changes defined as >1/2 standard deviation from baseline. Statistical analyses used Wilcoxon rank sum, Pearson's χ² tests, and univariate Cox regression, with significance set at P < .05 RESULTS: The median number of Ra²²³ cycles was 6. Freedom from ADT at 15 and 24 months was 50.0% and 40.0%, respectively (P < .001). Eleven (55%) and 5 (25%) patients had PSA declines exceeding 50% and 90%, respectively, with 2 patients achieving undetectable PSA levels (<0.01) at 2 years. No significant changes were observed in any patient-reported outcome QoL domains. Two patients had grade 3 skeletal-related events, and grade 2+ events attributed to Ra²²³ and SABR were observed in 4 and 2 patients, respectively.</p><p><strong>Conclusions: </strong>In this phase 2 trial, the initial use of Ra²²³ and SABR for moHSPC significantly delayed ADT use compared with historical controls. The therapy is well tolerated, preserves QoL, and can lead to undetectable PSA levels at 2 years.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374055","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}