International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Principal Strain Analysis for Early Detection of Radiation-Induced Cardiotoxicity in a Mouse Model.","authors":"Tanmay Mukherjee, Sarah Elliott, Nandhini Manikandan, Taylor-Jade Higgins, Yuncheng Zhong, Steven Montalvo, Debabrata Saha, Janaka Wansapura, Reza Avazmohammadi, Prasanna Alluri","doi":"10.1016/j.ijrobp.2025.03.029","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.029","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation-induced cardiotoxicity (RIC) is common in patients receiving thoracic radiation and a major risk factor for morbidity and mortality. The development of novel approaches for early detection and mitigation of RIC remains an acute unmet need. The objective of this study is to develop a mouse model of RIC that recapitulates the progression of cardiac dysfunction seen in patients receiving thoracic radiation and to develop novel cardiac strain markers that exhibit higher sensitivity in detecting subclinical RIC over existing approaches.</p><p><strong>Methods: </strong>We developed a mouse model of RIC through image-guided whole heart irradiation of male C57BL/6J mice using two radiation regimens (8Gy × 5 and 24Gy × 1). We developed a pipeline for analyzing anatomical and principal strains derived from cardiac magnetic resonance (CMR) imaging obtained at baseline and at 3-months and 6-months following radiation.</p><p><strong>Results: </strong>Both radiation regimens used for whole heart irradiation caused a progressive decline in both anatomical and principal cardiac strains over time. The minimum principal cardiac strain detected subclinical decline in cardiac contractility at an earlier time point than the traditional anatomical cardiac strains. We also observed asymmetric changes in contractility at the epicardium and endocardium relative to averaged cardiac strain across the full thickness of the left ventricle following cardiac irradiation, further reinforcing the limitations of existing methods that do not capture the heterogeneity in cardiac strain changes along the transmural axis.</p><p><strong>Conclusion: </strong>We have developed a mouse model of RIC that recapitulates time-dependent deterioration in myocardial contractility noted in patients receiving thoracic radiation. We also developed CMR imaging-derived novel principal strain cardiac markers that detect subclinical deterioration in cardiac contractile function earlier than traditional anatomic cardiac strain markers. If successfully translated into patients, our novel approach of measuring CMR imaging-derived cardiac principal strain analysis may enhance detection of subclinical RIC in patients receiving thoracic radiation.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772300","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":"Contrast-enhancing Lesions Induced by Central Nervous System-directed Intensity Modulated Proton Therapy: Distribution Patterns, Kinetics, Risk Factors, and Outcomes.","authors":"Omer Gal, Jen Yu, Minesh P Mehta, Matthew D Hall, Robert H Press, Yazmin Odia, Michael W McDermott, Zachary Fellows, Andrew Wroe, Alonso N Gutierrez, Rupesh Kotecha","doi":"10.1016/j.ijrobp.2025.03.025","DOIUrl":"10.1016/j.ijrobp.2025.03.025","url":null,"abstract":"<p><strong>Purpose: </strong>Patients treated with intensity modulated proton therapy (IMPT) may develop intracranial radiation-induced contrast enhancement (RICE). The incidence, distribution, kinetics, predisposing factors, linear energy of transfer (LET) associations, and clinical outcomes of RICE are inadequately defined.</p><p><strong>Methods and materials: </strong>The incidence and characteristics of RICE were analyzed in brain tumor patients treated with at least 50 Gy IMPT, 1-year follow-up, and 3 posttreatment magnetic resonance imaging scans. RICE distribution was classified as overlapping with tumor/tumor bed (A), inside or marginal to high-dose region (≤5 mm from the 95% isodose line [IDL]) (B), or distant (>5 mm from 95% IDL) (C). Voxelized dose and LET were computed for each RICE lesion. Risk factors were assessed using binary logistic regression.</p><p><strong>Results: </strong>With a median follow-up of 3 years, 73 RICE lesions were observed in 36 of 137 patients (26%), appearing at a median of 11 months post-IMPT. Group-wise distribution demonstrated 10 (28%), 24 (67%), and 2 (5%) lesions in groups A, B, and C, respectively. Ten (7% overall) patients were symptomatic. After a median of 5 months, most lesions (78%) improved or resolved. Median dose and LET in RICE lesions were 50.4 Gy and 3.1 keV/µm. RICE risk increased with age as a continuous variable (0.4%/year), age ≥18 years (odds ratio [OR], 5.4), tumor volume >30 cc (OR, 2.8), and 95% IDL overlapping the ventricles (OR, 3.8).</p><p><strong>Conclusions: </strong>RICE is a common radiographic finding after IMPT, primarily occurring in the periventricular and high-dose regions, but is infrequently symptomatic. Periventricular-sparing treatment may be considered to minimize the risk of RICE.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742858","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":"Multidisciplinary consensus prostate contours on magnetic resonance imaging: educational atlas and reference standard for artificial intelligence benchmarking.","authors":"Yuze Song, Anna Dornisch, Robert T Dess, Daniel Ja Margolis, Eric P Weinberg, Tristan Barrett, Mariel Cornell, Richard E Fan, Mukesh Harisinghani, Sophia C Kamran, Jeong Hoon Lee, Cynthia Xinran Li, Michael A Liss, Mirabela Rusu, Jason Santos, Geoffrey A Sonn, Igor Vidic, Sean A Woolen, Anders M Dale, Tyler M Seibert","doi":"10.1016/j.ijrobp.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.024","url":null,"abstract":"<p><strong>Introduction: </strong>Evaluation of artificial intelligence (AI) algorithms for prostate segmentation is challenging because ground truth is lacking. We aimed to (1) create a reference standard dataset with precise prostate contours by expert consensus and (2) evaluate various AI tools against this standard.</p><p><strong>Materials and methods: </strong>We obtained prostate MRI cases from XXX. A panel of four experts (two genitourinary radiologists, two prostate radiation oncologists) meticulously developed consensus prostate segmentations on axial T₂-weighted series. We evaluated the performance of six AI tools (three commercially available, three academic) using Dice scores, distance from reference contour, and volume error.</p><p><strong>Results: </strong>The panel achieved consensus prostate segmentation on each slice of all 68 patient cases included in the reference dataset. We present two patient examples to serve as contouring guides. Depending on the AI tool, median Dice scores (across patients) ranged from 0.80 to 0.94 for whole prostate segmentation. For a typical (median) patient, AI tools had a mean error over the prostate surface ranging from 1.3 to 2.4 mm. They maximally deviated 3.0 to 9.4 mm outside the prostate and 3.0 to 8.5 mm inside the prostate for a typical patient. Error in prostate volume measurement for a typical patient ranged from 4.3% to 31.4%.</p><p><strong>Discussion: </strong>We established an expert consensus benchmark for prostate segmentation. The best-performing AI tools have typical accuracy greater than that reported for radiation oncologists using CT scans (most common clinical approach for radiotherapy planning). Physician review remains essential to detect occasional major errors.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742882","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":"Temporal Apparent Diffusion Coefficient (ADC) Changes During Chemoradiation: An Imaging Biomarker for Tumour Response Monitoring and Spatial Recurrence Prediction in Glioblastoma.","authors":"Daniel Moore-Palhares, Liam Sp Lawrence, Sten Myrehaug, James Stewart, Jay Detsky, Chia-Lin Tseng, Hanbo Chen, Deepak Dinakaran, Pejman Maralani, Mark Ruschin, Beibei Zhang, James Perry, Mary Jane Lim-Fat, Arjun Sahgal, Hany Soliman, Angus Z Lau","doi":"10.1016/j.ijrobp.2025.03.028","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.028","url":null,"abstract":"<p><strong>Background: </strong>Apparent diffusion coefficient (ADC) from diffusion-weighted imaging (DWI) has been shown to detect early treatment response in glioblastoma. This prospective observational serial imaging study aimed to compare apparent diffusion coefficient (ADC) changes in gross tumour volume (GTV) regions that developed recurrence versus those that remained recurrence-free.</p><p><strong>Methods: </strong>Patients with glioblastoma underwent DWI at radiation planning (baseline, Fx0), fraction 10 (Fx10), fraction 20 (Fx20), and 1 month after completing a 6-week course of chemoradiation (P1M). Recurrence was contoured at the earliest magnetic resonance imaging (MRI) showing progression. The intersection of the GTV and recurrence was labelled resistant-GTV, while non-intersecting GTV was labelled sensitive-GTV. ADC values and percentage changes from Fx0 were compared between these regions.</p><p><strong>Results: </strong>Eighty patients were analyzed. Median absolute ADC values for resistant (0.94 μm²/ms, interquartile range [IQR]: 0.84, 1.08) and sensitive GTV (0.93 μm²/ms, IQR: 0.87, 1.13) were similar at baseline (P=0.193), but statistically significant differences were observed from the start of radiotherapy. Median ADC changes from baseline for resistant- and sensitive-GTV were +2.5% vs. +15.1% at Fx10 (P<0.001), +8.1% vs. +23.1% at Fx20 (P<0.001), and +21.2% vs. +36.4% at P1M (P<0.001), respectively. Smaller ADC changes at Fx10 (odds ratio [OR] 0.95, P=0.005) and Fx20 (OR 0.95, P=0.010) were independent predictors of increased risk of GTV failure, adjusting for MGMT promoter methylation and extent of surgical resection.</p><p><strong>Conclusions: </strong>Temporal ADC changes are promising imaging biomarkers for treatment response and spatial recurrence prediction, and may provide a target for MRI-guided biologically adapted radiation clinical trials.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742946","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 Magnetic Resonance Guided Adaptive Radiation Therapy for Infradiaphragmatic Oligometastatic Disease: Disrupting the One-Size-Fits-All Paradigm.","authors":"Eyub Y Akdemir, Robert Herrera, Selin Gurdikyan, Lydia C Hodgson, Sreenija Yarlagadda, Adeel Kaiser, Robert H Press, Kathryn E Mittauer, Nema Bassiri-Gharb, Ranjini Tolakanahalli, Alonso N Gutierrez, Minesh P Mehta, Michael D Chuong, Rupesh Kotecha","doi":"10.1016/j.ijrobp.2025.03.031","DOIUrl":"10.1016/j.ijrobp.2025.03.031","url":null,"abstract":"<p><strong>Purpose: </strong>Although recent studies have demonstrated the benefits of stereotactic ablative radiotherapy (SABR) in the treatment of oligometastatic (OM) disease, toxicity remains a concern in the infradiaphragmatic region. This is largely because of challenges in soft tissue visualization, motion management, and the proximity of gastrointestinal organs at risk. Stereotactic magnetic resonance guided adaptive radiation therapy (SMART) may enhance the safety and efficacy of SABR in abdominopelvic targets.</p><p><strong>Methods and materials: </strong>Patients with infradiaphragmatic OM disease, including up to 5 lesions treated with SMART between May 2018 and September 2023, were evaluated. Progression-free survival, overall survival, and local control (LC) were analyzed using Kaplan-Meier and Fine and Gray proportional subhazards models, whereas treatment-related toxicities were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events v4.0 criteria.</p><p><strong>Results: </strong>One hundred eighty-three targets in 138 patients with primarily lung, colorectal, and noncolorectal gastrointestinal cancers were prescribed a median dose of 50 Gy in 5 fractions on a 0.35-T magnetic resonance-Linac. Overall, 62.8% of treated metastases were within 5 mm of a dose-limiting organs at risk, necessitating online adaptive planning in 670 of 875 (76.6%) delivered SABR fractions. The 1-year progression-free survival rate was 35.8% for the entire population and significantly differed between OM and oligoprogressive patients (42.4% vs 25.4%, P = .03). There was a trend toward lower LC in colorectal versus noncolorectal histology in the definitive dose group (biologically effective dose₁₀ ≥ 75 Gy) with 2-year LC rates of 74.0% versus 86.0%, respectively, P = .08. Acute and late grade ≥3 toxicities were 0% and 2.2%, respectively.</p><p><strong>Conclusions: </strong>SMART is feasible and effective for treating OM disease lesions in proximity to dose-limited organs at risk. Safe dose escalation is facilitated by online adaptive radiation therapy and is associated with long-term LC. Patient selection is key to identifying which patients with OM or oligoprogressive disease should be considered most appropriate for SMART.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742943","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 the 2020-2023 Association of Residents in Radiation Oncology Graduating Resident Survey: Job Search Experience and Satisfaction.","authors":"Michael C LeCompte, Austin J Sim, Chelain R Goodman, Amishi Bajaj, Abhishek Kumar, Emily MacDuffie, Kelsey K Corrigan, Idalid Franco, Bailey A Nelson, Sarah Dooley, Justin D Anderson, Elizabeth B Jeans, Karen Tye, Dakim K Gaines, Gabriel Vidal, Ankit Agarwal, Ashley A Albert, Shauna R Campbell","doi":"10.1016/j.ijrobp.2025.02.050","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.050","url":null,"abstract":"<p><strong>Purpose: </strong>To better understand radiation oncology (RO) resident experiences navigating the job market, responses from the 2020-2023 ARRO Graduating Resident Surveys were analyzed and compared.</p><p><strong>Methods/materials: </strong>All identified postgraduate year five (PGY5) RO residents in the United States were sent a 50-58 question survey in May of their respective graduating year. Responses were collected in a de-identified database. Descriptive statistics were generated. Univariable and Multivariable (MVA) logistic regressions were performed to identify predictors of overall satisfaction/dissatisfaction with accepted position and agreement that the job market was tough.</p><p><strong>Results: </strong>The aggregate response rate was 86.9%. Very few (0-1.8%) respondents did not have a signed offer at survey completion. The percentage who strongly agreed or agreed that the job market was \"tough\" was 39.3% in 2020, 69.9% in 2021, 25.7% in 2022, and 16.2% in 2023. The percentage of respondents who were strongly dissatisfied or dissatisfied with their accepted job position was 6.2% in 2020, 3.6% in 2021, 1.4% in 2022, and 0.6% in 2023. On MVA, significant predictors of feeling that the job search was not tough included year of job search (2020 [reference]; 2021 [OR 0.31, CI 0.17-0.57, p < 0.01]; 2022 [OR 2.68, CI 1.66-4.33, p < 0.01]; 2023 [OR 3.23, CI 2.02-5.17, p < 0.01) and satisfaction with one's residency program's mentorship in the job search (OR 1.69, CI 1.08-2.64, p = 0.02). On MVA, predictors of overall satisfaction with an accepted position included mentorship during the job search (OR 4.93, CI 2.45-9.93, p < 0.01) and practice setting (urban [reference]; rural [OR 0.29, CI 0.11-0.74, p < 0.01).</p><p><strong>Conclusions: </strong>The vast majority of graduating RO residents from 2020-2023 were satisfied with their accepted job offer. Perceptions of job market toughness declined precipitously over time after 2021. Residents who have strong mentorship and accepted positions in urban settings were the more likely to report accepted position satisfaction.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729568","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":"Computed Tomography Guided Online Adaptive Stereotactic Body Radiation Therapy for Lymph Node Oligometastases: Impact on Dose to Target and Organs at Risk.","authors":"Lucy A van Werkhoven, Maaike T W Milder, Wilco Schillemans, Mischa S Hoogeman, Remi A Nout, Joost J Nuyttens","doi":"10.1016/j.ijrobp.2025.03.020","DOIUrl":"10.1016/j.ijrobp.2025.03.020","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the radiation dose in abdominal and pelvic lymph node oligometastases (A-P LN) and gastrointestinal organs (GIOs) of patients undergoing computed tomography (CT) guided online adaptive stereotactic body radiation therapy in a phase 2 study. The study aimed to increase the dose to the target iso-toxically.</p><p><strong>Methods and materials: </strong>Patients with oligometastatic A-P LN received 45 Gy in 5 fractions on the CyberKnife. Each patient had 3 plans created using a pretreatment planning CT scan: plan A, standard of care (SOC) plan based on the planning CT; plan B, adaptive plan with GIO contours from a diagnostic CT; plan C, adaptive plan with 45 Gy prescribed to the 80% isodose-line. After a prefraction in-room CT scan, the radiation therapy technologist used a decision tree to select the plan with the highest target coverage without exceeding organs at risk constraints. Dose volume histogram parameters were extracted from the original planning CT, the fraction CT with the selected library plan and the fraction CT with the SOC plan.</p><p><strong>Results: </strong>In total, 52 patients were included, and 55 online adaptive treatments were performed. An adaptive plan was chosen in 58% of fractions and in 78% of the patients and resulted in a significant higher D_mean compared with the planned dose (100.6 biologically effective dose (BED₁₀) vs 95 BED₁₀; P < .001). The GIO D_0.5cc was 2.7 Gy EQD₂³ higher for the SOC plan on the fraction CT compared with the SOC on the original planning CT (P = .009). There was no significant difference in GIO D_0.5cc between the SOC plan on the fraction CT and the selected plan on the fraction CT.</p><p><strong>Conclusions: </strong>CT-based online adaptive stereotactic body radiation therapy for A-P LN oligometastases, using a library of plans, led to an adaptive plan selection in the majority of patients. This workflow enabled a mean BED₁₀ 5 Gy isotoxic dose escalation to the gross tumor volume.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692000","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":"Online Adaptive Radiotherapy for Bladder Preservation: Transitioning to Hypofractionation.","authors":"Anuradha Krishnan, Priyamvada Maitre, Sheetal Kashid, Namrata Pansande, Maneesh Singh, Pallavi Singh, Sakshi Dubey, Reena Phurailatpam, Divya Patil, Amit Joshi, Ankit Misra, Amandeep Arora, Mahendra Pal, Gagan Prakash, Vedang Murthy","doi":"10.1016/j.ijrobp.2025.03.018","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.018","url":null,"abstract":"<p><strong>Purpose: </strong>To present the clinical experience of bladder preservation with adaptive radiotherapy (ART) in conventionally fractionated RT (ConvRT) and discuss the challenges in transitioning to hypofractionated RT (HypoRT) METHODS AND MATERIALS: Consecutive patients from a prospectively maintained institutional database with histologically proven urothelial carcinoma, staged T1-T4, N0-N3, M0, treated with curative intent chemoradiotherapy from January 2014 to December 2023 were included. Patients from 2014 were treated with a dose of 64Gy/32# to the bladder and 55Gy/32# to the pelvis. From 2021 onwards, most patients received 55Gy/20# to the bladder and 44Gy/20# to the pelvis. Suitable patients received neoadjuvant and concurrent chemotherapy. All patients were treated with the \"plan of the day\" adaptive radiotherapy (POD-ART) technique. Acute (within 3 months of radiotherapy) and late urinary and gastrointestinal toxicity were assessed using the CTCAE criteria. Overall survival (OS), bladder cancer-specific survival (BCSS), disease-free survival (DFS) and local control (LC) were analysed.</p><p><strong>Results: </strong>About 221 patients treated with POD-ART were analysed, 146 with ConvRT and 75 with HypoRT. Most treatment and clinical characteristics were comparable between groups. In HypoRT, the gemcitabine dose was capped at 75 mg/m². Acute GU toxicity rates were similar between ConvRT and Hypo RT cohorts. Acute Grade 2 GI toxicity was higher in the Hypo RT cohort (26.7%) compared to the Conv RT cohort (13.7%, p = 0.02). There were no ≥Grade 3 acute GU or GI toxicity in the Hypo RT cohort. On multivariable analysis, age > 60 years and use of concurrent gemcitabine were statistically significant for acute ≥Grade 2 GI toxicity. Late GU and GI toxicity rates at 15 months were similar in both cohorts. The 2-year OS, BCSS, DFS, and LC rates of patients in the ConvRT cohort were 85.9% (95% CI: 79.6% - 92.1%), 88.2% (95% CI: 82.3% - 94.0%), 83.4% (95% CI: 76.7% - 90.0%) and 89.0% (95% CI: 83.3% - 94.6%) and HypoRT cohort was 85.3% (95% CI: 74.7% - 95.8%), 90.2% (95% CI: 80.7% - 99.6%), 80.4% (95% CI: 69.6% - 91.1%) and 89.6% (95% CI: 81.3% - 97.8%) respectively.</p><p><strong>Conclusion: </strong>POD-ART allows safe treatment transition from ConvRT to HypoRT for bladder preservation. It mitigates some of the treatment-related toxicity during HypoRT, even with concurrent gemcitabine and pelvic radiotherapy.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700445","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":"Structural network hubs as potential organs at risk in glioma patients after radiotherapy.","authors":"Laurien De Roeck, Jeroen Blommaert, Patrick Dupont, Stefan Sunaert, Lieselotte Lauwens, Paul M Clement, Steven De Vleeschouwer, Charlotte Sleurs, Maarten Lambrecht","doi":"10.1016/j.ijrobp.2025.03.019","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.019","url":null,"abstract":"<p><strong>Background: </strong>Cognitive sequelae are a concern in glioma patients post-radiotherapy. As there is uncertainty regarding which brain regions to spare during radiotherapy to preserve cognition, we explored structural brain network hubs as potential organs at risk.</p><p><strong>Methods: </strong>We conducted a cross-sectional study, involving 39 irradiated adult WHO grade 2 and 3 gliomas along with 50 healthy controls. Cognitive domains (language, memory, attention, motor-, executive functioning) were assessed ≥1-year post-radiotherapy. Using multi-shell diffusion-weighted imaging, weighted structural graphs were constructed, and graph measures calculated to define hubs. The association between mean RTdose in each region and 1) nodal strength and 2) cognitive domains were tested with a linear regression model and Spearman's rho correlations, respectively.</p><p><strong>Results: </strong>Lower nodal strength was significantly associated with increasing RTdose in nine brain regions, significantly (Mc Nemar's test, p<.001) impacting hubs more often than non-hubs (58% vs. 7%). Executive performance (r(37)≥-.474, p_FDR≤.045) and attention (r(37)≥-.471, p_FDR≤.045) were significantly correlated with RTdoses to the left pre- and postcentral gyrus and right posterior cingulate cortex, while poorer language outcomes were observed in patients receiving higher doses to the left insula, superior frontal, and precentral gyrus (r(37)≥-.460, pFDR.≤.045). These correlations were more prevalent in hubs than non-hubs (p=.033), and higher than those between memory and left (r(37)=-.359) and right (r(37)=.059) hippocampal dose.</p><p><strong>Conclusion: </strong>Higher RTdoses to specific brain regions, particularly left-sided hubs, were associated with reduced nodal strength (i.e., lower network centrality) and poorer cognitive performance. While baseline cognitive testing is unavailable and cognitive functioning is influenced by multiple factors, this study highlights the potential value of network- or hub-sparing RT dose planning. Future longitudinal studies are needed to validate these findings before clinical implementation.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692017","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":"Safety and Efficacy of Unresectable Malignant Cardiac Tumors Treated with Concurrent Chemoradiation Therapy Using a 1.5T MR-Linac (GASTO-1078).","authors":"ShiYang Zheng, ShouLiang Ding, QiaoTing Luo, YiXin Xiong, DaQuan Wang, BiaoShui Liu, YueMing Peng, XiaoYan Huang, Bo Qiu, YiShan Lin, Hui Liu, Mai Xiong","doi":"10.1016/j.ijrobp.2025.01.018","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.01.018","url":null,"abstract":"<p><strong>Purpose: </strong>This trial aimed to investigate the safety and efficacy of treating malignant cardiac tumors with hypofractionated radiation therapy and concurrent chemotherapy (hypo-CCRT) using a 1.5T MR-Linac.</p><p><strong>Methods and material: </strong>Patients with both primary and secondary malignant cardiac tumors underwent split-course hypo-CCRT on a 1.5T MR-Linac, receiving 30 Gy/6 fractions initially, followed by a boost course of 20 to 30 Gy/4 to 6 fractions, totaling 50 to 60 Gy. Concurrent chemotherapy (docetaxel and nedaplatin) was administered weekly. The primary endpoint was local recurrence-free survival (LRFS). Secondary endpoints included objective response rate, progression-free survival (PFS), overall survival (OS), toxicity, and quality of life.</p><p><strong>Results: </strong>From October 2021 to October 2023, 7 patients were enrolled in the study and received split-course hypo-CCRT on the 1.5T MR-Linac. The median follow-up was 26 months (range, 8.3-36.3 months). The objective response rate was 85.7% (6/7). The 2-year LRFS rate was 71.4%, with the median LRFS not reached. The 2-year PFS rate was 38.1%, with a median PFS of 20.1 months (95% CI, 8.8-31.5 months). The 2-year OS rate was 71.4%, with the median OS yet to be determined. No patients experienced acute or late toxicity above grade 2. Three months posttreatment, the ejection fraction percentage increased from 63.43% ± 7.21% to 68.57% ± 4.28% (P = .02), and the internal diameter of the right ventricle decreased from 24.43 ± 2.99 to 18.86 ± 3.13 mm (P < .01). The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 scores were significantly improved at 6 months posttreatment (P < .05).</p><p><strong>Conclusions: </strong>Split-course hypo-CCRT on MR-Linac for malignant cardiac tumors was feasible, generally well-tolerated, and showed promising oncologic as well as patient-reported outcomes in this small prospective cohort. Further study is warranted for the long-term effects.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656962","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}