International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Clinically Interpretable Survival Risk Stratification in Head and Neck Cancer Using Bayesian Networks and Markov Blankets.","authors":"Keyur D Shah, Ibrahim Chamseddine, Xiaohan Yuan, Sibo Tian, Richard Qiu, Jun Zhou, Anees Dhabaan, Hania Al-Hallaq, David S Yu, Harald Paganetti, Xiaofeng Yang","doi":"10.1016/j.ijrobp.2025.09.063","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.09.063","url":null,"abstract":"<p><strong>Purpose: </strong>To identify a clinically interpretable subset of survival-relevant features in head and neck (H&N) cancer using Bayesian Network (BN) and evaluate its prognostic and causal utility.</p><p><strong>Methods and materials: </strong>We used the RADCURE dataset, consisting of 3,346 patients with H&N cancer treated with definitive (chemo)radiotherapy. A probabilistic BN was constructed to model dependencies among clinical, anatomical, and treatment variables. The Markov Blanket (MB) of two-year survival (SVy2) was extracted and used to train a logistic regression model. After excluding incomplete cases, a temporal split yielded a train/test (2,174/820) dataset using 2007 as the cutoff year. Model performance was assessed using area under the receiver operating characteristic (ROC) curve (AUC), concordance index (C-index), and Kaplan-Meier (KM) survival stratification. Model fit was further evaluated using a log-likelihood ratio (LLR) test. Causal inference was performed using do-calculus interventions on MB variables.</p><p><strong>Results: </strong>The MB of SVy2 included 6 clinically relevant features: Eastern Cooperative Oncology Group (ECOG) performance status, T-stage, HPV status, disease site, the primary gross tumor volume (GTVp), and treatment modality. The model achieved an AUC of 0.65 and C-index of 0.78 on the test dataset, significantly stratifying patients into high- and low-risk groups (log-rank p < 0.01). Model fit was further supported by a log-likelihood ratio of 70.32 (p < 0.01). Subgroup analyses revealed strong performance in HPV-negative (AUC = 0.69, C-index = 0.76), T4 (AUC = 0.69, C-index = 0.80), and large-GTV (AUC = 0.67, C-index = 0.75) cohorts, each showing significant KM separation. Causal analysis further supported the positive survival impact of ECOG 0, HPV-positive status, and chemoradiation.</p><p><strong>Conclusions: </strong>A compact, MB-derived BN model can robustly stratify survival risk in H&N cancer. The model's structure enables explainable prognostication and supports individualized decision-making across key clinical subgroups.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286210","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":"Radiobiology and Radioresistance in High-Dose Radiosurgery for Brain Tumors: A Hypothesis-Generating Study Using an Intracranial Glioma Mouse Model.","authors":"Anastasia Janas, Carolin Senger, Kiril Krantchev, Susan Brandenburg, Wenying Zhang, Anne Kluge, Sanaria Al-Rubaiey, Jan Bukatz, Chiara Eitner, Melina Nieminen-Kelhä, Philipp Boehm-Sturm, Ingeborg Tinhofer, Daniel Zips, Peter Vajkoczy, Gueliz Acker","doi":"10.1016/j.ijrobp.2025.09.061","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.09.061","url":null,"abstract":"<p><strong>Introduction: </strong>Stereotactic radiosurgery (SRS) is a precise, non-invasive treatment for brain tumors, yet underlying radiobiological mechanisms remain unclear. This study explored long-term dose-dependent tumor response to high-dose SRS in a murine glioma model, focusing on tumor-associated macrophages (TAMs) as key regulators of tumor microenvironment and immune modulation.</p><p><strong>Methods: </strong>Using the intracranial GL261-glioma mouse model, single-dose SRS was administered at either 20-Gy (clinically prescribed dose) or 40-Gy as a dose-escalation approach (n=24/dose). Tumor response was assessed longitudinally using 7T MRI at predefined intervals (d7, d30, d90, and d180) post-SRS or earlier upon symptom onset. Histological analyses performed at each timepoint evaluated cell proliferation, apoptosis, vascular morphology, blood-brain/tumor-barrier integrity, hypoxia, TAM recruitment, and polarization. Immune cell populations within tumor microenvironment were characterized using flow cytometry. Statistical analyses included a T-test and one-way ANOVA with Bonferroni or Dunnett correction.</p><p><strong>Results: </strong>SRS efficacy was dose-dependent: 40-Gy suppressed tumor growth, while 20-Gy led to regrowth in 29% of cases between d30-51 post-SRS, necessitating stratification into responders and non-responders. Responders demonstrated reduced cell proliferation, sustained apoptosis, and vascular remodeling indicative of vessel normalization. Non-responders exhibited up to 94.5% increased hypoxia and up to 300-fold increased CXCR4 expression compared to responders. TAM recruitment inversely correlated with tumor volume (r=-0.8619, p=0.0056). The M1/M2 ratio in non-responders was similar to that of matched controls, but 3.8-fold and 4.8-fold lower than in responders at d30 and d90 post-SRS, respectively. FACS analysis confirmed an increased M1/M2 ratio by d30 in responders.</p><p><strong>Discussion: </strong>This study offers key insights into longitudinal SRS radiobiology, highlighting the dynamic role of TAMs in sustaining long-term tumor control. Our findings support an association between hypoxia, CXCL12/CXCR4 signaling, and treatment resistance, and suggest a potential SRS-induced vascular normalization that may support improved therapeutic outcomes. While not designed to establish causality, the data provide a spatially and temporally resolved framework to guide future mechanistic studies and inform more effective SRS-based combination strategies.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280164","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":"Investigating the FLASH Effect in a Rat Brain Organotypic Model with a Novel High Energy Electron Beam.","authors":"Tyler V Kay, Anna L Price, Markus Sprenger, Victoria J P Radosova, Andrew Thompson, Eric L Martin, Denise Dunn, Victor Popov, Stepan Mikhailov, Zachary J Reitman, Ying K Wu, Scott R Floyd, Mark Oldham","doi":"10.1016/j.ijrobp.2025.09.057","DOIUrl":"10.1016/j.ijrobp.2025.09.057","url":null,"abstract":"<p><strong>Purpose: </strong>Ultra-high dose rate (FLASH) radiation therapy is reported to reduce normal tissue toxicity while maintaining tumor control, however mechanism(s) remain obscure. To study FLASH mechanisms in brain tissue, we developed a novel experimental platform featuring a specialized high-energy electron linear accelerator, HIGS (High Intensity Gamma Ray Source), paired with an organotypic ex vivo brain metastasis model.</p><p><strong>Methods: </strong>We varied inter-pulse spacing to modulate the mean dose rate (MDR) of our unique 35 MeV electron beam, while maintaining extremely high instantaneous dose rate (IDR). We characterized dosimetry and targeting accuracy of the FLASH beam with film dosimetry. We combined this FLASH beam with an organotypic rat brain slice/breast carcinoma co-culture model of brain metastasis to assess effects on normal and neoplastic tissues. Live cell and bioluminescence imaging demonstrated cancer cell growth effects, while normal tissue responses and immune activation were assessed using live cell imaging, cytokine profiles, and confocal microscopy. We performed comparison experiments with 20 MeV electrons from a Varian clinical linear accelerator (VCLA) using conventional dose rates.</p><p><strong>Results: </strong>The highest IDR of the FLASH beam to date was 20.7 ± 0.6 MGy/s, with maximum MDR of 20.7 MGy/s delivered in one pulse of 1 µs duration. Beam targeting was accurate to < 1 mm and reproducible. HIGS-FLASH and VCLA dose rates equivalently decreased cell growth. HIGS-FLASH irradiation significantly increased TNFα and fractalkine levels and confocal microscopy revealed distinct changes in microglial morphology slices suggesting microglia activation.</p><p><strong>Conclusions: </strong>Our novel experimental platform produces extremely high dose rates and rapid normal/neoplastic tissue readouts for mechanistic research into the effects of FLASH radiation in the brain. HIGS-FLASH irradiation induces comparable cancer cell growth inhibition but differential effects on cytokines and microglial morphology, suggesting that acute innate immune responses may be involved in FLASH normal tissue effects in the brain.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280125","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":"Impact of Palliative Radiotherapy on Quality of Life in Patients with Bone vs. Non-Bone Lesions: Secondary Analysis of a Prospective Study.","authors":"Yutaro Koide, Kenta Nimura, Masamune Noguchi, Tomoki Kitagawa, Takahiro Aoyama, Shingo Hashimoto, Hiroyuki Tachibana, Takeshi Kodaira","doi":"10.1016/j.ijrobp.2025.09.055","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.09.055","url":null,"abstract":"<p><strong>Purpose: </strong>This study compared quality-of-life (QoL) changes following palliative radiation therapy (RT) between patients with painful bone metastases and those with painful non-bone lesions.</p><p><strong>Methods and materials: </strong>A total of 440 patients with 678 lesions (541 bone metastases and 137 non-bone lesions) who underwent palliative RT between 2021 and 2023 were included, using the same cohort as a previous study assessing pain response. From 2756 QLQ-C15-PAL/BM22 questionnaires collected simultaneously with pain assessments, mean scores for each C15-PAL subscale at baseline and 2, 4, and 12 weeks post-RT were analyzed. The primary endpoint was the difference in mean change in GHS/QoL scores from baseline to 12 weeks between the groups. Secondary endpoints included the differences in other subscales and the improvement rates in each subscale.</p><p><strong>Results: </strong>The median follow-up time was 21 weeks for pain response and 13 weeks for QoL. Baseline QoL data were available for 97% (656/678) of lesions and 74% (338/458) at 12 weeks, with no significant difference between the groups. At baseline, the non-bone group had better GHS/QoL (45 vs. 39, P = .015) and physical functioning (76 vs. 67, P = .02), but slightly worse scores in the pain subscale (52 vs. 51, P = .005). At 12 weeks, no significant differences were observed between the groups across all QoL subscales, including GHS/QoL (52 vs. 49, P = .41). Regarding changes over time, dyspnea worsened in the bone metastasis group (+9 vs. +1, P = .017), while changes in GHS/QoL (+5 vs. +1, P = .27) and other subscales were not significantly different. Improvement rates across all subscales, including GHS/QoL (39% vs. 48%, P = .44), were not significantly different between groups.</p><p><strong>Conclusions: </strong>The results of this study indicate that QoL changes after palliative RT for non-bone lesions are comparable to those for bone metastases, providing a basis for future development in this underexplored area.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280219","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":"Timescale of FLASH sparing effect determined by varying temporal split of dose delivery in mice.","authors":"Jacob P Sunnerberg, David I Hunter, Austin M Sloop, Armin D Tavakkoli, Petr Bruza, Rongxiao Zhang, Jiang Gui, Lesley A Jarvis, Harold M Swartz, David J Gladstone, P Jack Hoopes, Brian W Pogue","doi":"10.1016/j.ijrobp.2025.09.052","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.09.052","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the timescale for ultra-high dose rate (UHDR) radiation delivery that dictates FLASH normal-tissue sparing and elucidate its relationship to in vivo oxygen dynamics. A split-dose experiment was used to determine the transition time below which the observation of the FLASH sparing effect is preserved.</p><p><strong>Methods and materials: </strong>A 25 Gy dose was split into two deliveries (12.5 Gy), with varied interruption times. Albino B6 mice received flank skin irradiation in eight groups: single-beam UHDR (25 Gy at 415 Gy/s), single-beam conventional dose rate (CDR) (25 Gy at 0.15 Gy/s), or split-beam delivery with two lower-dose UHDR beams (12.5 Gy at 415 Gy/s) separated by 0.1, 1, 5, 15, 25, or 120 seconds. Skin damage was scored daily for 31 days, with mixed-effects analysis comparing damage progression across cohorts. Real-time tissue pO₂ was monitored using the phosphorescence-lifetime probe Oxyphor PdG4. Radiolytic oxygen consumption per unit dose (g_O2) and reoxygenation rates were quantified.</p><p><strong>Results: </strong>Single-beam UHDR significantly spared skin versus CDR. In split-dose groups, this sparing effect showed a transition at longer inter-beam intervals. Damage progression remained significantly lower than CDR and comparable to single-beam UHDR (p>0.16) for interruptions < 15 seconds. Longer intervals progressively lost tissue sparing. Oximetry indicated an average tissue reoxygenation lifetime of 7.7 ± 1.1 s. At the delivery of the second beam, pO₂ remained lower when inter-beam times were shorter than the reoxygenation period but recovered fully for longer interruptions. g_O2 values correlated with baseline tissue pO₂.</p><p><strong>Conclusions: </strong>Observation of the FLASH sparing effect requires delivery within a critical temporal window that is similar timescale to tissue reoxygenation kinetics. The transition time for loss of the FLASH sparing effect in skin roughly corresponds to a diffusion timescale for oxygen, from capillaries to the cells. While not conclusively demonstrating a mechanism, this unique finding supports the likelihood that local oxygen depletion or consumption underlies the FLASH tissue sparing effect observed in vivo, with important implications for clinical implementation and the timescale needed for multi-beam FLASH-RT.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228456","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":"Prospective Trial Evaluating Post-operative Human Papilloma Virus Circulating Tumor DNA Guided Adjuvant Therapy for Human Papilloma Virus-related Oropharyngeal Carcinoma (PATH study): HPV ctDNA Guided Adjuvant therapy in OPC.","authors":"Linda Chen, Marc Cohen, Vaios Hatzglou, Zhigang Zhang, Nadeem Riaz, Achraf A Shamseddine, Luc G T Morris, Sean M McBride, Daphna Y Gelblum, Kaveh Zakeri, Yao Yu, Ian Ganly, Jennifer Cracchiolo, Richard J Wong, Noah S Kalman, Andrew B Tassler, David Kutler, Winston Wong, Anuja Kriplani, Lara Dunn, Alan L Ho, Loren S Michel, James Fetten, David G Pfister, Nora Katabi, Eric J Sherman, Nancy Y Lee","doi":"10.1016/j.ijrobp.2025.09.044","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.09.044","url":null,"abstract":"<p><p>Human papillomavirus circulating tumor DNA (HPV ctDNA) is a biomarker which detects minimal residual disease (MRD) for HPV-associated oropharyngeal carcinoma (HPV+ OPC).</p><p><strong>Purpose: </strong>We conducted the first prospective study using HPV ctDNA as an integral biomarker to select patients for post-operative radiotherapy omission. We tested the hypothesis that undetectable post-operative HPV ctDNA can be used to omit or delay adjuvant radiation until patients develop detectable HPV ctDNA using the NavDx (Naveris, Inc.) tumor-tissue-modified viral (TTMV) HPV DNA score. Eligible HPV+ OPC patients had a preoperative TTMV-HPV DNA Score of ³50 and at least one pathologic risk factor to warrant standard adjuvant radiotherapy.</p><p><strong>Methods and materials: </strong>Post-operatively, eligible patients had no evidence of disease on post-operative MRI and two negative TTMV-HPV DNA test results. Patients with non-HPV-16 genotype, positive margins, and extranodal extension were excluded. Patients were monitored with TTMV-HPV DNA testing, imaging, and physical exams. Delayed adjuvant radiation was initiated if patients developed detectable TTMV-HPV DNA without radiographic recurrence. The primary endpoint was the proportion of patients without gross recurrent disease.</p><p><strong>Results: </strong>Fifty-five HPV+ OPC patients were screened; 12 patients were enrolled. The median follow-up was 26.6 months (Range: 18.3-40.3). One patient (8%) developed detectable HPV ctDNA 6 months after surgery without evidence of recurrence and was treated with delayed adjuvant radiotherapy. Three additional patients (25%) developed radiographic recurrence 6 months after surgery. Radiographic recurrence was not preceded by detectable TTMV-HPV DNA. TTMV-HPV DNA detection was synchronous with radiographically evident disease in 2 of 3 patients. Recurrence was associated with N2b disease pre-treatment (p=0.01). The high gross recurrence rate (3 of 12 patients) led to closure of this cohort due to a pre-specified stopping rule.</p><p><strong>Conclusion: </strong>Deferring adjuvant radiotherapy based on HPV ctDNA using NavDx TTMV-HPV DNA testing resulted in a high rate of disease recurrence.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225396","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":"The Ongoing Challenge of Radiation-Immunotherapy Optimization: From Preclinical Insights to Clinical Practice.","authors":"Ryan J Park, Jonathan D Schoenfeld","doi":"10.1016/j.ijrobp.2025.08.044","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.08.044","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206513","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":"Electrifying Results? Tumor Treating Fields Reduce Intracranial Relapse of Non-Small Cell Lung Cancer Brain Metastasis Following Radiosurgery in the METIS Trial.","authors":"Martin C Tom, Kyle Wang, Donna M Edwards, Jiayi Huang","doi":"10.1016/j.ijrobp.2025.09.007","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.09.007","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274536","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":"Proton therapy may reduce the risk of cancer progression during immune checkpoint inhibitor therapy: a propensity score-matched analysis of intensity-modulated proton versus photon radiotherapy.","authors":"Cong Bo, Zhenhuan Lv, Hong Zhang, Xianmin Hou, Yinxin Wang, Jing Liu, Xue Meng","doi":"10.1016/j.ijrobp.2025.09.042","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.09.042","url":null,"abstract":"<p><strong>Purpose: </strong>Intensity-modulated proton radiotherapy (IMPT) may preserve the immune response more effectively than intensity-modulated photon radiotherapy (IMRT) owing to its dosimetric advantages, making it a potentially superior modality in immunotherapy. This study aimed to evaluate the clinical benefits of IMPT versus IMRT during immune checkpoint inhibitors (ICIs) treatment.</p><p><strong>Methods and materials: </strong>We retrospectively analyzed the data of 466 patients (IMPT group, n=109; IMRT group, n=357) who received radiotherapy (RT) during ICI therapy between July 2022 and September 2024. Propensity score matching (PSM) was applied to balance clinical characteristics. The primary endpoint was the duration of response (DoR). Secondary endpoints included progression-free survival (PFS) and post-RT adverse events. Kaplan-Meier and Cox proportional hazards regression were used to calculate survival curves and identify independent prognostic factors. The threshold used to dichotomize post-RT lymphocyte count was 0.5 × 10⁹/L.</p><p><strong>Results: </strong>Baseline clinical characteristics were balanced after PSM. The IMPT group showed significantly longer median DoR (17.7 vs. 5.7 months, p=0.0001) and PFS (18.8 vs. 6.8 months, p<0.0001) than the IMRT group. Multivariable regression revealed IMPT to be an independent predictor of improved DoR (hazard ratio [HR] 0.34; 95% confidence interval [CI]: 0.21-0.55; p<0.0001) and PFS (HR 0.36; 95% CI: 0.25-0.52; p<0.0001). Subgroup analyses suggested greater benefit of IMPT over IMRT in patients with a Charlson Comorbidity Index ≥4, lung cancer, advanced-stage disease, or those receiving palliative, thoracic, or abdominal/pelvic RT. Higher post-RT lymphocyte counts in the IMPT group showed potential correlation with improved DoR and PFS. Additionally, the IMPT group had fewer grade ≥2 post-RT adverse events (p=0.012).</p><p><strong>Conclusions: </strong>IMPT is linked to enhanced efficacy of ICIs, compared to IMRT, by improving DoR and PFS with tolerable adverse effects. Higher post-RT lymphocyte counts may be associated with improved survival in patients receiving IMPT during ICI therapy. These findings suggest that IMPT may be a preferable option for preserving immune function, thereby optimizing outcomes during immunotherapy.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225461","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":"Is Stereotactic Arrhythmia Radiotherapy (STAR) a valid alternative to repeated invasive ablation for refractory ventricular tachycardia?","authors":"Francesco Cellini, Judit Boda-Heggemann, Oliver Blanck","doi":"10.1016/j.ijrobp.2025.09.047","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.09.047","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225366","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}