International Journal of Radiation Oncology Biology Physics最新文献

{"title":"A Randomized Study of Consolidation Chemoradiation (CTRT) versus Observation after first line chemotherapy (CT) in Advanced Gall bladder Cancers (GBC):RACE-GB study.","authors":"Sushma Agrawal, Vishwas Kapoor, Rahul Rahul, Ashish Singh, Prabhakar Mishra, Rajan Saxena","doi":"10.1016/j.ijrobp.2024.11.099","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.099","url":null,"abstract":"<p><strong>Purpose: </strong>CT is the standard of care for patients presenting with unresectable advanced GBC but their prognosis remains poor. The value of consolidation CTRT after initial CT is uncertain. We therefore conducted a single centre open label randomised trial evaluating consolidation CTRT versus Observation after four cycles of CT in patients whose disease did not progress during CT (partial responders/stable disease).</p><p><strong>Materials & methods: </strong>Responders to 4 cycles of CT were randomised (1:1) to CTRT versus Observation (n=135). CTRT was delivered by 3D-Conformal Radiation Therapy (Field in field when required) along-with concurrent capecitabine. The dose of RT was 45 Gy in 25 fractions to GBC and lymphatics followed by a boost of 9 Gy in 5 fractions to the GBC. The primary endpoint was overall survival which was calculated from the date of randomisation.</p><p><strong>Results: </strong>67 patients were randomized to observation and 68 to CTRT. Consolidation CTRT led to an improvement in median overall survival from 4 months to 10 months (HR 0.43; 95% CI, 0.32 to 0.62; P < 0.001). The actual median OS from accrual was 7 months (95%CI 6.114 to 7.88) versus 13 months (95% CI 11.13 months to 14.84 months). Adverse events (grade 3 or higher) due to CTRT were nausea: 3%, anaemia: 9%, GI bleed: 5.8%, hepatotoxicity:13%. FACT G score and FACT Hep score did not deteriorate due to CTRT as compared to observation (p value 0.053 and 0.097).</p><p><strong>Conclusion: </strong>To our knowledge, this is the first-ever randomized study in LMIC setting to demonstrate that consolidation CTRT significantly prolonged overall survival without deterioration in QOL and should be the alternative standard of care in advanced unresectable GBC.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828551","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 outcome in cervical lymph node-positive nasopharyngeal carcinoma following IMRT with one-step cervical nodal CTV delineation by geometric-anatomic expansion from nodal GTV: A double-center experience.","authors":"Qiaojuan Guo, Jing Huang, Nan Xiao, Fangyuan Zhou, Wanfang Huang, Shuhan Zhao, Jihong Chen, Hanchuan Xu, Ziyi Wu, Yahan Zheng, Xinlan Chen, Jianji Pan, Kunyu Yang, Shaojun Lin","doi":"10.1016/j.ijrobp.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.12.002","url":null,"abstract":"<p><strong>Background: </strong>To report long-term results of cervical node-positive (CLN+) nasopharyngeal carcinoma (NPC) patients treated with IMRT with one-step nodal clinical target volume (CTVn) delineation by geometric-anatomic expansion from the nodal gross target volume (GTVn).</p><p><strong>Materials: </strong>CLN+ NPC treated with the same one-step-CTVn delineation in two Chinese academic centers were pooled for this study. GTVn was prescribed to 70 Gy equivalent, CTVn1 was omitted, CTVn2 was prescribed to 45-55 Gy equivalent and defined as GTVn + 3 mm geometric expansion (5 mm if radiological extranodal extension-positive, rENE+) + elective nodal regions defined by anatomic boundary of cervical nodal levels. Regional-control (RC) and overall survival (OS) were analyzed. Fifteen randomly selected cases were recontoured for CTVn according to 2018 International Guidelines (2018-IG). Dose/volume was compared between the two CTV delineation methods.</p><p><strong>Results: </strong>A total of 807 patients were included (Center 1, n=459; Center 2, n=348). Five-year RC and OS were 95.8% and 86.2%, respectively. Thirty-four patients developed regional failure, and 13/34 (38%) were outside CTVn2: level VIII (parotid node) (9/13), Ib (4/13), and IV (2/13). Seven out of these 9 level VIII failures had preexisting \"equivocal\" nodes. All 4 level 1b failures had \"equivocal\" nodes with very advanced rENE or large (>5 cm) nodal mass in level II. Compared with the 2018-IG, our strategy resulted in significant reduction in nodal volumes received therapeutic (V70) (mean: 100.7 vs 27.5 cc, p<0.001) and prophylactic (V45) (mean: 343.5 vs 261.2 cc, p<0.001) doses, and further dose reduction in surrounding organs-at-risks.</p><p><strong>Conclusion: </strong>Our one-step-CTVn delineation by geometric-anatomic expansion from GTVn appears to be a safe and efficient approach in CLN+ NPC with excellent RC and potential dosimetric benefit in selected patients. Caution is needed for parotid sparing in patients with preexisting \"equivocal\" nodes or level Ib sparing in cases with advanced rENE or large (>5 cm) nodal mass in level II.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824047","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":"Contact X-ray Brachytherapy (CXB) as a boost therapy after neoadjuvant (chemo)radiation in high-risk locally advanced rectal cancer.","authors":"Ngu Wah Than, D Mark Pritchard, David M Hughes, Carrie A Duckworth, Helen Wong, Muneeb Ul Haq, Rajaram Sripadam, Arthur Sun Myint","doi":"10.1016/j.ijrobp.2024.11.113","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.113","url":null,"abstract":"<p><strong>Background and purpose: </strong>Radical surgery following neoadjuvant therapy is the standard of care for locally advanced rectal cancer. A Contact X-ray Brachytherapy (CXB) boost can alternatively be used to treat residual disease post neoadjuvant (chemo)radiation, especially in patients who are not suitable for or do not wish to have surgery. Its role has mostly been studied to date in low to intermediate-risk patients. We have now evaluated the utility of CXB-boost in high-risk rectal cancers after their tumours have been significantly downstaged by neoadjuvant (chemo)radiation.</p><p><strong>Materials and methods: </strong>Oncological outcomes and treatment tolerability were evaluated in 328 patients based on rectal cancer treatment risk stratification: low/intermediate risk (cT1-3ab, N0-1, M0, no extramural invasion (EMVI), mesorectal fascia (MRF) involvement >1mm) and high-risk (cT3cd-4/N2, M0, MRF≤1mm and/or EMVI positive).</p><p><strong>Results: </strong>With median follow-up of 33(IQR:15-54) months and median age of 73(IQR:62-80) years, no significant differences were found between low/intermediate and high-risk groups in clinical complete response (78% vs 73%, p=0.32), local regrowth (16.6% vs 22.4%, p=0.41), nodal (1.8% vs 5.8%, p=0.051) or regional (1.3% vs 2.9%, p=0.33) relapse, or post-radiation toxicities (p=0.16). However, the high-risk group had a higher distant relapse rate (21.2% vs 10.7%, p=0.01), with no significant differences in 3-year organ preservation (80% vs 87%, p=0.25), 5-year disease-free (DFS) (62% vs 64%, p=0.46), or overall (OS) survivals (67% vs 64%, p=0.88). Longer treatment time, treatment gap >24 weeks between therapies, and administration of a higher than standard CXB dose were newly identified factors that negatively impacted outcomes.</p><p><strong>Conclusions: </strong>High-risk rectal cancer patients treated with CXB-boost had more distant relapses, but comparable locoregional tumour control, organ preservation, DFS and OS to lower-risk patients, with acceptable toxicities. CXB-boost is therefore a viable option for selected high-risk rectal cancer patients. Timely reassessment, prompt referral, and CXB dose optimisation are crucial for improving outcomes.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824046","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":"Osteoradionecrosis in Pediatric Patients Treated with Proton Therapy for Head and Neck Malignancies.","authors":"Adam Grippin, Andy Kim, Yufei Liu, Sage Copling, Ansel Nalin, Katina Crabtree, Hunter Cheng, Zhe Zhang, Mary Fran McAleer, David Grosshans, Susan McGovern, Arnold C Paulino","doi":"10.1016/j.ijrobp.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.12.001","url":null,"abstract":"<p><strong>Purpose: </strong>Osteoradionecrosis (ORN) is a feared complication after head and neck radiation, but the incidence and radiotherapy risk factors for ORN in children are unknown. In this retrospective analysis of a prospectively collected dataset, we evaluated the incidence and factors associated with development of ORN in children treated with proton therapy for head and neck malignancies.</p><p><strong>Methods and materials: </strong>We reviewed records from patients treated at a single institution between December 2006 and February 2020 including demographic data, tumor, and treatment details, ORN occurrence, and dosimetry. Differences between groups and the predictive value of dosimetric characteristics were assessed with Mann-Whitney U tests, simple linear regression, and Fisher's exact tests.</p><p><strong>Results: </strong>We identified 117 pediatric patients treated with proton therapy for head and neck malignancies. The most common histology was rhabdomyosarcoma (46%), and the most common involved sites were the parameningeal sites (44%) and the orbit (32%). The majority received passive scatter (n=81, 69%) and the remainder IMPT (n=36, 31%). Only two (1.7%) developed ORN. Age, mean mandible doses, and radiation technique (3D vs. IMPT) did not predict for ORN. Patients with ORN had higher doses to the mandible than those without ORN, including Dmax (p=0.029), D0.5cc (p=0.039), D1cc (p=0.036), V60Gy (p=0.01), V55Gy (p=0.02), and V50Gy (p=0.048). The most significant predictors of ORN by linear regression were mandible V50Gy (r²=0.053, p=0.01), V55Gy (r²=0.094, p<0.01), and V60Gy (r²=0.17, p<0.001). Dosimetric characteristics associated with development of ORN included Dmax>60Gy (p=0.037), D0.5cc>60Gy (p=0.031), D1cc>59Gy (p=0.028), and V55Gy>2cc (p=0.034).</p><p><strong>Conclusions: </strong>ORN is uncommon in pediatric patients treated with proton therapy for head and neck malignancies, occurring in 1.7% of patients in our cohort. Patients with mandible Dmax>60Gy, D0.5cc>60Gy, D1cc>59Gy, and V55Gy>2cc are at greatest risk for ORN.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824048","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":"Concurrent vs. Sequential Adjuvant Capecitabine-Based Chemoradiation in Residual TNBC after neoadjuvant-chemotherapy: A Multicenter comparative Study.","authors":"Nalee Kim, Su Ssan Kim, Won Kyung Cho, Won Park, Ji Hyun Chang, Yong Bae Kim, Ah Ram Chang, Tae Hyun Kim, Jongmoo Park, Jin Hee Kim, Kyubo Kim, Yu Jin Lim, Tae Gyu Kim, Jin Hwa Choi, Jeanny Kwon, Sungmin Kim, Kyung Hwan Shin, Haeyoung Kim","doi":"10.1016/j.ijrobp.2024.11.109","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.109","url":null,"abstract":"<p><strong>Purpose: </strong>Given the aggressive nature and poor prognosis of triple-negative breast cancer (TNBC), adjuvant capecitabine has been the standard therapy for residual disease after preoperative systemic therapy (PST). However, the optimal sequence of postoperative radiation therapy (RT) and capecitabine remains unclear. This study evaluated the efficacy and safety of concurrent RT and capecitabine (RT+CAP) versus sequential RT followed by capecitabine (RT→CAP) in patients with residual TNBC after PST.</p><p><strong>Materials and methods: </strong>In this multicenter retrospective study, data from 491 patients treated at 14 tertiary hospitals were analyzed. The patients received either postoperative RT→CAP (n=255) or RT+CAP (n=236). Survival outcomes were analyzed using the Kaplan-Meier method, and multivariable Cox regression was used to adjust for potential confounders.</p><p><strong>Results: </strong>There were no significant differences in the baseline characteristics between the two groups. With a median follow-up of 41.8 months, the 4-year rates of disease-free survival (DFS) and overall survival (OS) were 68.8% and 82.4%, respectively. The RT+CAP group demonstrated improvements in DFS (74.6% vs. 63.7%, p=0.045) and OS (86.8% vs. 78.3%, p=0.006) compared to the RT→CAP group. Specifically, RT+CAP showed superior DFS and OS outcomes in patients with a low disease burden (ypT0-1, ypN0/axillar level I only, or Ki67 <15%). Additionally, the incidence of ≥grade 2 toxicities and discontinuation of capecitabine due to toxicity did not differ, indicating that RT+CAP was well tolerated.</p><p><strong>Conclusions: </strong>RT+CAP offers improvements in oncologic outcomes without an increase in adverse events compared to RT→CAP, suggesting it is a promising treatment option for patients with residual TNBC after PST.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822145","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":"Interleukin-13 receptor subunit alpha 2 (IL-13Rα2) induces chemokine expression and macrophage polarization to promote inflammation and fibrosis.","authors":"Seokjoo Kwon, Eun Joo Chung, Santwana Kc, Ayla O White, Su I Chung, Jason A Horton, Hong Shik Yun, Heesu Ahn, Uma Shankavaram, Joon-Yong Chung, Joon Seon Song, Deborah E Citrin","doi":"10.1016/j.ijrobp.2024.11.103","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.103","url":null,"abstract":"<p><strong>Purpose: </strong>Interleukin-13 (IL-13) is a known mediator of radiation induced lung injury (RILI). IL-13Rα2 has an accepted role in antagonizing IL-13 signaling by acting as a decoy receptor. We sought to understand the role of IL-13Rα2 in the progression of RILI.</p><p><strong>Methods and materials: </strong>Mice deficient in IL-13Rα2 (Ra2 KO) and wild type mice (WT) were exposed to thoracic irradiation (IR) in 5 daily fractions of 6 Gy and followed for survival (n>15 per group) and tissue collection (n>5 per group). Collagen accumulation in the lung was evaluated with Masson's trichrome staining and hydroxyproline content. Gene expression was evaluated by RNA Sequencing. Expression of IL-13Rα2 and macrophage markers in murine lung and human lung tissue (n=63) was assessed with immunohistochemistry. The role of IL-13Rα2 in IL-13 mediated macrophage polarization was determined in primary macrophage cultures from Ra2 KO mice and after RNA silencing of a human monocyte cell line (THP-1).</p><p><strong>Results: </strong>Membrane-bound IL-13Rα2 expression in murine lung was increased after IR and localized to macrophages. Irradiated Ra2 KO mice exhibited reduced sensitivity to thoracic IR compared to WT mice as measured by median survival (19 vs 21 weeks, p<0.05), histology, hydroxyproline content, TGF-β expression and macrophage accumulation. Gene sets linked to cytokine signaling and macrophage recruitment were enriched in irradiated WT compared to Ra2 KO lung tissue. IL-13 mediated expression of CCL2 and M2 markers was reduced in murine and human macrophages deficient in IL-13Rα2. Increased expression of in IL-13Rα2 and co-localization with CD163 was confirmed in irradiated fibrotic human lung.</p><p><strong>Conclusions: </strong>IL-13Rα2 is predominantly expressed in macrophages within irradiated lung and plays a crucial role in CCL2 expression,macrophage polarization, and TGF-β expression in response to IL-13. These studies demonstrate an unexpected profibrotic role of IL-13Rα2 in RILI and suggest that strategies targeting IL-13Rα2 may ameliorate chronic inflammation and fibrosis.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life Report Associated with Pain Response and Patient Classification System for Palliative Radiotherapy: A prospective observational study.","authors":"Yutaro Koide, Yurika Shindo, Masamune Noguchi, Tomoki Kitagawa, Takahiro Aoyama, Hidetoshi Shimizu, Shingo Hashimoto, Hiroyuki Tachibana, Takeshi Kodaira","doi":"10.1016/j.ijrobp.2024.11.102","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.102","url":null,"abstract":"<p><strong>Purpose: </strong>A novel classification system has been proposed to stratify patients undergoing palliative radiotherapy based on their pain response and time to progression. This study used prospective observational data to quantify quality-of-life (QoL) changes associated with pain response and the classification system.</p><p><strong>Methods and materials: </strong>Between August 2021 and September 2022, 366 painful lesions with an NRS of 2 or more from the 261 eligible patients underwent palliative radiotherapy. Patients were followed up prospectively at 2, 4, 12, 24, 36, and 52 weeks post-radiotherapy, with EORTC QLQ-C15-PAL and QLQ-BM22 questionnaires obtained simultaneously with pain response assessments. The primary endpoint was defined as the global health status (GHS/QoL) improvements at 12 weeks based on minimally clinically important differences and compared by the pain response (responders vs. non-responders) and by class 1 (no opioids, no re-irradiation, n = 89), 2 (neither class 1 nor 3, n = 211), and 3 (opioids and re-irradiation, n = 66).</p><p><strong>Results: </strong>With a median follow-up time of 21 weeks for pain response and 13 weeks for QoL assessment, 1773 pairs of QLQ-C15-PAL and QLQ-BM22 questionnaires were collected. The QoL assessment at baseline was covered with 97% (355/366) of lesions and 67% (183/273) at 12 weeks: this compliance was lower in non-responders than in responders (57% vs. 72%, p=.004) and highest in class 1, followed by classes 2 and 3 (70% vs. 44% vs. 39%, p=.001). The improvement rate was significantly different by class, with class 3 having the lowest in all subscales except nausea and psychosocial aspects: the improvement rate of GHS/QoL was 33% in class 1, 31% in class 2, and 20% in class 3, p=.001).</p><p><strong>Conclusions: </strong>The QoL changes associated with pain response and the classification system were identified, suggesting that the classification system may help identify populations more or less likely to improve QoL, in addition to separating pain response rates.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822148","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":"Five-year outcomes of moderately hypofractionated proton therapy incorporating elective pelvic nodal irradiation for high-risk prostate cancer.","authors":"Richard Choo, Kimberly Corbin, Kenneth Merrell, Bradley Stish, Thomas M Pisansky, Brian J Davis, Adam Amundson, David W Hillman, Cecilia Mitchell, William Wong, Carlos Vargas, Jean Claude Rwigema, Sameer Keole, Sujay Vora, Thomas Daniels","doi":"10.1016/j.ijrobp.2024.11.115","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.115","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the efficacy of moderately hypofractionated intensity-modulated proton therapy (IMPT) targeting the prostate/seminal vesicles and pelvic lymph nodes for high-risk (HR) or unfavorable intermediate-risk (UIR) prostate cancer (PCa) MATERIALS/METHODS: A prospective study (ClinicalTrials.gov: NCTXXX) of moderately hypofractionated IMPT accrued a target sample size of 56 patients with HR or UIR-PCa . The prostate/seminal vesicles and pelvic lymph nodes were treated simultaneously with 67.5 Gy and 45 Gy, respectively, in 25 daily fractions. All received androgen deprivation therapy (ADT). Its primary objective was late gastrointestinal (GI) and genitourinary (GU) adverse events (AEs), and secondary objectives were a recurrence-free rate (RFR) including freedom from PSA relapse and disease-free survival (DFS) at 5 years. PSA and AEs were evaluated at 3, 6, and 12 months post-IMPT, then every 6 months for 5 years and then yearly thereafter. The actuarial rates of late GI and GU AEs, RFR, and DFS were estimated with Kaplan-Meier method.</p><p><strong>Results: </strong>Median age was 75 years. Median PSA was 10.5 ng/mL. Fifty-three patients had HR-PCa; 2 had UIR-PCa. Median ADT duration was 18 months. Median follow-up was 62 months. Late grade ≥ 2 and 3 GI AEs at 5 years were 16% and 4%, respectively. Late grade ≥ 2 and 3 GU AEs at 5 years were 41% and 0%, respectively. None had a grade ≥ 4 late AE. At 5 years, RFR and DFS were 90% and 89%, respectively. Seven patients had PCa recurrence, all detected by PSA relapse initially. Three patients died with PSA < 0.1 ng/mL at last follow-up. None died of PCa or treatment-related AEs.</p><p><strong>Conclusions: </strong>This regimen of moderately hypofractionated IMPT for HR or UIR-PCa yielded encouraging 5-year RFR, DFS, and late AE outcomes. A phase III study is needed to assess any therapeutic gain of IMPT compared with photon-based radiotherapy.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822146","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":"Radiation-induced nephrotoxicity: Role of SMPDL3b.","authors":"Ahmad Anis, Kumar Mallela Shamroop, Ansari Saba, Alnukhali Mohammed, Ali Misha, Merscher Sandra, Pollack Alan, H Zeidan Youssef, Fornoni Alessia, Marples Brian","doi":"10.1016/j.ijrobp.2024.11.105","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.105","url":null,"abstract":"<p><strong>Background: </strong>Radiation nephropathy (RN) can be a significant late complication after radiotherapy for abdominal and paraspinal tumors. The mechanisms for the development of RN are thought to involve disruption of podocyte function, leading to podocyte cell death and, finally, impaired renal function. This study investigated the mechanistic role of SMPDL3b in regulating podocyte injury and renal function after irradiation. The aim of the study was to investigate the potential linkage between (1) RT-induced renal dysfunction and podocyte SMPDL3b expression and (2) RT-induced podocyte injury and expansion of the glomerular basement membrane (GBM).</p><p><strong>Methods: </strong>SMPDL3b WT, siSMPDL3b, and SMPDL3b-overexpressing podocytes were irradiated in cell culture, and cell death was assessed. SMPDL3b WT and podocyte-specific SMPDL3b KO (pSMPDL3b KO) mice were treated with focal bilateral kidney X-irradiation (14 Gy, or 6 × 5Gy), and podocyte apoptosis, renal function parameters, glomerular filtration rate (GFR), glomerular histology, and GBM ultrastructural changes via transmission electron microscopy were assessed.</p><p><strong>Results: </strong>Following RT treatment, a notable decrease in SMPDL3b expression was observed, accompanied by heightened levels of DNA damage, cytoskeletal alterations, and apoptotic events in cultured podocytes. SMPDL3b overexpression notably prevented DNA damage and apoptosis in cultured podocytes. Additionally, in vivo, RT exposure led to a significant decline in SMPDL3b expression, podocyte count, and renal function while concomitantly elevating glomerular basement membrane (GBM) thickness, mesangial expansion, and renal fibrosis at the 20-week post-RT. Furthermore, in vivo, rituximab pretreatment before RT prevented SMPDL3b downregulation, podocyte loss, mesangial expansion, GBM expansion, and renal fibrosis and ultimately enhanced renal function post-RT.</p><p><strong>Conclusion: </strong>Our findings collectively suggest a novel function for SMPDL3b in orchestrating the DNA damage response triggered by radiation. This study proposes that SMPDL3b exerts a regulatory influence on the repair of double-strand breaks (DSBs) within podocytes, consequently averting podocyte loss, glomerular basement membrane (GBM) expansion, and the onset of radiation nephropathy.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817818","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":"Prior Knowledge-Guided U-Net for Automatic CTV Segmentation in Postmastectomy Radiotherapy of Breast Cancer.","authors":"Xiu-Wen Deng, Hong-Mei Zhao, Le-Cheng Jia, Jin-Na Li, Ziquan Wei, Hang Yang, Ang Qu, Wei-Juan Jiang, Run-Hong Lei, Hai-Tao Sun, Jun-Jie Wang, Ping Jiang","doi":"10.1016/j.ijrobp.2024.11.104","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.104","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to design and evaluate a prior-knowledge-guided U-Net (PK-UNet) for automatic clinical target volume (CTV) segmentation in postmastectomy radiotherapy for breast cancer.</p><p><strong>Methods and materials: </strong>A total of 102 computed tomography (CT) scans from breast cancer patients who underwent postmastectomy were retrospectively collected. Of these, 80 scans were used for training with 5-fold cross-validation, and 22 scans for independent testing. The CTV included the chest wall, supraclavicular region, and axillary group III. The proposed PK-UNet method employs a two-stage auto-segmentation process. Initially, the localization network categorizes CT slices based on the anatomical information of the CTV and generates prior knowledge labels. These outputs, along with the CT images, were fed into the final segmentation network. Quantitative evaluation was conducted using the mean Dice similarity coefficient (DSC), 95% Hausdorff distance (95HD), average surface distance (ASD), surface Dice similarity coefficient (sDSC). A four-level objective scale evaluation was performed by two experienced radiation oncologists in a randomized, double-blind manner.</p><p><strong>Results: </strong>Quantitative evaluations revealed that PK-UNet significantly outperformed state-of-the-art (SOTA) segmentation methods (P < 0.01), with a mean DSC of 0.90 ± 0.02 and a 95HD of 2.82 ± 1.29 mm. The mean ASD of PK-UNet was 0.91 ± 0.22 mm and the sDSC was 0.84 ± 0.07, significantly surpassing the performance of AdwU-Net (P < 0.01) and showing comparable results to other models. Clinical evaluation confirmed the efficacy of PK-UNet, with 81.8% of the predicted contours being acceptable for clinical application. The advantages of the auto-segmentation capability of PK-UNet were most evident in the superior and inferior slices and slices with discontinuities at the junctions of different subregions. The average manual correction time was reduced to 1.02 min, compared to 18.20 min for manual contouring leading to a 94.4% reduction in working time.</p><p><strong>Conclusion: </strong>This study introduced the pioneering integration of prior medical knowledge into a deep learning framework for postmastectomy radiotherapy. This strategy addresses the challenges of CTV segmentation in postmastectomy radiotherapy and improves clinical workflow efficiency.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817587","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}