International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Second Generation Gd-Bi Ultrasmall Nanoparticles Amplify the Effects of Clinical Radiation Therapy and Provide Clinical MRI Contrast.","authors":"Toby Morris, Zeinaf Muradova, Needa Brown, Léna Carmès, Romy Guthier, Meghna Iyer, Léa Seban, Arianna Liles, Stephanie Bennett, Mileni Isikawa, Michael Lavelle, Guillaume Bort, François Lux, Olivier Tillement, Sandrine Dufort, Geraldine LeDuc, Ross Berbeco","doi":"10.1016/j.ijrobp.2025.04.032","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.04.032","url":null,"abstract":"<p><strong>Purpose: </strong>AGuIX nanoparticles consisting of Gd atoms chelated to a polysiloxane matrix are under clinical evaluation as theranostic agents with radiation therapy. A new generation, AGuIX-Bi, replaces 70% of the Gd atoms in AGuIX with Bi atoms, improving radiation dose amplification while maintaining MRI contrast. The therapeutic efficacy of AGuIX-Bi was investigated under clinical megavoltage and MRI conditions in two of non-small cell lung cancer (NSCLC) models.</p><p><strong>Methods and materials: </strong>Murine (LLC) and human (A549) NSCLC were studied in mice, with animals inoculated and divided into cohorts for control (saline, AGuIX, AGuIX-Bi) and irradiation (saline+RT, AGuIX+RT, AGuIX-Bi+RT). Nanoparticle cohorts were injected 24-hours prior to delivering 10 Gy of irradiation using a 6 MV flattening-filter-free (FFF) beam. Tumors were measured until euthanasia was necessary, taken as time-to-tumor doubling (TTD). Additionally, AGuIX and AGuIX-Bi phantoms were constructed with T1-weighted images and maps taken using a 3T clinical MRI scanner. T1-images of A549 inoculated mice were obtained on the same scanner with injection of AGuIX or AGuIX-Bi 2- and 24-hrs prior to imaging.</p><p><strong>Results: </strong>No toxicity was observed due to nanoparticle injection, anaesthesia, or irradiation. In both LLC and A549 models, AGuIX-Bi+RT significantly outperformed both saline+RT and AGuIX+RT in reducing tumor growth (p<0.05). Median TTD for AGuIX-Bi+RT compared to AGuIX+RT groups was increased by 160% for A549, and by 60% for LLC models (p<0.05). Longitudinal relaxivity constants (r₁) derived from phantom T1-mapping were 6.9 mM^-1 s^-1 for AGuIX and 8.4 mM^-1 s^-1 for AGuIX-Bi. Additionally, T1-weighted mouse tumor imaging showed contrast-to-noise (CNR) of AGuIX-Bi to be roughly half that of AGuIX.</p><p><strong>Conclusions: </strong>AGuIX-Bi nanoparticles proved more effective than AGuIX at delaying tumor growth for both NSCLC models while maintaining sufficient MRI contrast at 3T. Replacing some Gd atoms with bismuth improves the efficacy of AGuIX nanoparticles under clinical megavoltage energies without compromising imaging.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002123","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":"Understanding hydronephrosis occurrence by an individual-kidney level analysis of all events post-chemoradiotherapy for locally advanced cervical cancer.","authors":"Lucas Gomes Sapienza, Christina Hunter Chapman, Samyukta Jhavar, Vinícius Fernando Calsavara, Michelle Suzanne Ludwig, Maria José Leite Gomes, Emanuel de Freitas Carvalho","doi":"10.1016/j.ijrobp.2025.04.033","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.04.033","url":null,"abstract":"<p><strong>Purpose: </strong>Hydronephrosis is a complex renal abnormality that requires assessment of individual-kidney status at different times for correct interpretation of the mechanism of damage. This study analyzes all hydronephrosis events in women with locally advanced cervical cancer (LACC).</p><p><strong>Methods: </strong>The status of 449 kidneys from 225 women treated with external beam radiotherapy (EBRT) with concurrent cisplatin and image-guided adaptive brachytherapy (IGABT) were retrospectively reviewed. Hydronephrosis incidence, causes (including radiation-induced hydronephrosis [RIH]), associated factors, and resolution rates were analyzed. Univariable and multivariable analyses were performed at the individual-kidney level, clustered by individual patient.</p><p><strong>Results: </strong>At baseline, 10.9% (49/449) of the kidneys were affected by hydronephrosis, which resolved in 38.8% (19/49) after RT. During follow-up, new hydronephrosis occurred in 15.8% (71/419) of the kidneys, caused more frequently by cancer recurrence than by RIH (2:1 ratio). The overall RIH incidence per kidney was 5.7% (95% CI, 3.2-8.1) and 7.2% (95% CI, 3.8-10.4) at 3 years and 5 years, respectively. The rates of type A RIH (ureteral stenosis) at 3 years and 5 years were 1.9% (95% CI, 0.5-3.3) and 3.5% (95% CI, 0.8-6.2). Both 3- and 5-year rates of type B RIH (damage to structures other than ureter) were 3.8% [95% CI, 1.7-5.9]. Point A dose (p=0.01; EQD2₃), bladder D_2.0cc (p=0.03; EQD2₃), and CTV_HR volume (p<0.01; cm³) were associated with overall hydronephrosis incidence in the multivariable model. Point A dose was associated with type A RIH (p<0.01) but not with type B (p=0.74). At last follow-up, 19.6% (88/449) of kidneys had unresolved hydronephrosis.</p><p><strong>Conclusion: </strong>Persistent hydronephrosis is not uncommon after definitive RT for LACC (20%), with RIH being a relevant etiology (5y: 7%). In contrary to type B RIH (damage to other structures), type A (ureteral damage) is usually unilateral, associated with dose to the ipsilateral point A, and its incidence does not plateau over time.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018320","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":"Association of Multi-Kingdom Skin Microbiota With Radiation Dermatitis in Patients With Breast Cancer After Reconstructive Surgery: A Prospective, Longitudinal Study.","authors":"Wei Shi, Li Zhang, Zhiming Li, Xu Zhao, Wailok Lui, Jin Meng, Xingxing Chen, Xin Mei, Jinli Ma, Zhaozhi Yang, Jingjing Xia, Jiucun Wang, Zhen Zhang, Zhimin Shao, Xiaoli Yu, Xiaomao Guo","doi":"10.1016/j.ijrobp.2025.03.077","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.077","url":null,"abstract":"<p><strong>Background: </strong>The clinical significance of multi-kingdom skin microbiota in acute radiation dermatitis (ARD) is not well understood. We hypothesized that skin microbiota is associated with ARD in patients with breast cancer (BC) undergoing radiation therapy (RT) after reconstructive surgery.</p><p><strong>Methods and materials: </strong>A total of 412 skin microbiota samples from 103 patients, taken before and after RT, from both the treated and contralateral healthy sides, were analyzed using bacterial 16S ribosomal RNA (rRNA) V3-V4 region and fungal rRNA internal transcribed spacer (ITS) sequencing. ARD was graded using the Toxicity Criteria of the Radiation Therapy Oncology Group (RTOG). Patients were divided into 2 groups: no or mild ARD subgroup (N_MD, RTOG grade 0-1) and significant ARD subgroup (SD, RTOG grade ≥ 2).</p><p><strong>Results: </strong>Significant differences in skin microbiota were observed between the N_MD and SD subgroups, with Staphylococcus, Cutibacterium, and Malassezia genera enriched in SD and Ralstonia and Methyloversatilis enriched in N_MD. Network analysis revealed that interkingdom and intrakingdom ecological interactions were more notable and stable in N_MD than SD over the course of RT. Importantly, 2 dermotypes with robust patterns of microbial networks were identified, with the \"D-dermotype\" (highly diversified and dominated by Devosiaceae) composing entirely of N_MD. Dermatitis-prediction classifiers were constructed. Classifiers I and III, which included bacterial variables with or without fungal variables, performed significantly better than classifier II, which relied solely on fungal variables. Bacteria-based classifier I yielded the best area under the curve in the test set of 94.64% (95% confidence interval, 83.58%-100%).</p><p><strong>Conclusions: </strong>This prospective longitudinal study indicated an association between multi-kingdom skin microbiota and the development of significant ARD in patients with BC undergoing RT after reconstructive surgery, implying the possible application of skin microbiota in the prediction of ARD and microbial therapy in the management of ARD.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009653","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":"Critical Review: Real-Time Dose-Guided Radiation Therapy.","authors":"Paul J Keall, Issam El Naqa, Martin F Fast, Emily A Hewson, Nicholas Hindley, Per Poulsen, Chandrima Sengupta, Neelam Tyagi, David E J Waddington","doi":"10.1016/j.ijrobp.2025.04.019","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.04.019","url":null,"abstract":"<p><p>Dramatic strides have been made in real-time adaptive radiation therapy, where treating single tumors as dynamic but rigid bodies has demonstrated a halving of toxicities for prostate cancer. However, the human body is much more complex than a rigid body. This review explores the ongoing development and future potential of dose-guided radiation therapy, where the three core process steps of volumetric imaging of the patient, dose accumulation, and dose-guided treatment adaptation occur quasi-continuously during treatment, fully accounting for the complexity of the dynamic human body. The clinical evidence supporting real-time adaptive radiation therapy was reviewed. The foundational studies, status, and potential of real-time volumetric imaging using both x-ray and magnetic resonance imaging technology were described. The development of real-time dose accumulation to the dynamic patient was evaluated, and a method to measure real-time dose delivery was assessed. The growth of real-time treatment adaptation was examined. Literature demonstrates continued improvements in patient outcomes because the treatment becomes more conformal to the dynamic patient. Real-time volumetric imaging using both x-ray and magnetic resonance imaging technology is poised for broader implementation. Real-time dose accumulation has demonstrated clinical feasibility, with approximations made to achieve real-time operation. Real-time treatment adaptation to deforming targets and multiple targets has been experimentally demonstrated. Tying together the inputs of the real-time volumetric anatomy and dose accumulation is real-time treatment adaptation that uses the available degrees of freedom to optimize the dose delivered to the patient, maximizing the treatment intent. Opportunities exist for artificial intelligence to accelerate the application of dose-guided radiation therapy to broader patient use. In summary, the emerging field of real-time dose-guided radiation therapy has the potential to significantly improve patient outcomes. The advances are primarily software-driven and therefore could be widely available and cost-effective upgrades to improve imaging and targeting cancer.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010135","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 REIRRADIATION: FINAL RESULTS FROM A PHASE I DOSE ESCALATION TRIAL (DESTROY-1).","authors":"Francesco Deodato, Donato Pezzulla, Savino Cilla, Carmela Romano, Alessia Re, Mara Fanelli, Marica Ferro, Milly Buwenge, Gian Carlo Mattiucci, Alessio Giuseppe Morganti, Gabriella Macchia","doi":"10.1016/j.ijrobp.2025.04.025","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.04.025","url":null,"abstract":"<p><strong>Purpose: </strong>The final results of the DESTROY-1 arms focusing on stereotactic radiotherapy (SBRT) retreatment of recurrences occurring >4 months after prior in-field radiotherapy (RT) are reported.</p><p><strong>Methods: </strong>In the DESTROY-1 trial, a phase I multi-arm SBRT study, arms (d) and (e) focused on retreatment of recurrences after prior RT. Arm (d) included recurrences with doses >60 Gy or in locations with previous small intestinal irradiation, while arm (e) included recurrences with doses ≤60 Gy. The dose was escalated up to 45 Gy (arm d) or 50 Gy (arm e). All treatments were performed in 5 fractions. Each cohort of 6 patients was monitored for dose-limiting toxicity (DLT), defined as any ≥Grade 3 toxicity within 6 months after SBRT.</p><p><strong>Results: </strong>From September 2004 to August 2023, 121 lesions (74 in the \"d\" arm, 47 in the \"e\" arm) in 97 patients were treated. Acute toxicity included 20 cases in the \"d\" arm and 6 in the \"e\" arm, all low-grade except for one G4 soft tissue toxicity in the \"d\" arm. Regarding late toxicity, with a median follow-up of 18 months in the \"d\" arm and 17 months in the \"e\" arm, we registered 5 G1 in the d arm and 7 events in the e arm, all G1-2, except one G4 skin toxicity. We registered 65 complete responses (53.7%), 35 partial responses (28.9%), and 19 stable diseases (15.7%), leading to a disease control rate of 98.3%. Progression was registered only in 2 cases (1.7%). The overall local control at 1-year was 87.6%, while it was 84.7% and 92.0% for the \"d\" and \"e\" arms, respectively. Overall, the one-year Distant Metastasis Free Survival, Disease Free Survival, and Overall Survival were 54.5%, 46.7%, and 78.1%, respectively.</p><p><strong>Conclusion: </strong>The reRT doses of 45 Gy for the \"d\" arm and 50 Gy for the \"e\" arm were delivered with acceptable toxicity and achieved local control rates consistent with existing literature.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035373","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":"NOVEMBER, A Phase 2 Trial of a 9-Day Course of Whole Breast Radiation Therapy With a Simultaneous Lumpectomy Boost for Early-Stage Breast Cancer.","authors":"Matthew M Poppe, Kenneth Boucher, David K Gaffney, Kirstyn E Brownson, Gina Smith, Jackson N Howell, Federico F Ticona, Jaewhan Kim, Lindsay Burt, Donald Cannon, Kristine Kokeny","doi":"10.1016/j.ijrobp.2025.03.078","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.078","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>A phase 2 prospective noninferiority trial evaluating a novel 9 fraction course of whole breast radiation and simultaneous lumpectomy boost.</p><p><strong>Materials and methods: </strong>Tis and T1-3N0 patients enrolled to receive 3420 cGy radiation to the breast with 3960 cGy to the lumpectomy cavity. The primary endpoint was averaged photographic cosmetic scores at 24 months with a hypothesis of >70% good to excellent cosmetic breast scoring 24 months after completing radiation, assuming a baseline excellent/good cosmetic scoring of 80% with an 80% power, α = 0.1.</p><p><strong>Results: </strong>From 2018 to 2020, with institutional review board approval, 103 patients were enrolled. Patients had mostly invasive ductal carcinoma (75%), tumor size ≤ 2cm (88%), negative margins (92%), no lympho-vascular invasion (80%), and estrogen receptor positive (85%). Patients had a mean age of 59.5 years (33-82). With a mean follow-up of 51 months, there were no local recurrences and 1 patient with both regional (axilla) and distant (brain) recurrence. Twenty-four-month post-radiation therapy (RT) cosmetic photos were 68% excellent/good, and 32% fair/poor. The null hypothesis was not rejected with one-sided 95% exact binomial confidence interval of 59.1% (59.1%-100%). There were no reported late ≥grade 3 radiation toxicity events and only 4 patients with late grade 2 events. Patient-reported outcomes utilizing the Breast-Q survey revealed breast satisfaction in 85% of women.</p><p><strong>Conclusions: </strong>We demonstrate an effective novel 9 fraction whole breast + lumpectomy boost radiation schedule. This trial uses one of the shortest published radiation schedules for a lumpectomy boost. Although we did not meet our prespecified cosmetic endpoint, no significant cosmetic change from baseline was seen in 80% of patients. We demonstrate excellent local control, and patient-reported satisfaction with low RT-related toxicity. We hope to move this concept forward in a randomized trial against the 5-day United Kingdom (UK) Fast Forward regimen, inclusive of a simultaneous lumpectomy cavity boost.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988707","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":"Average Dose Rate is the Major Temporal Beam Structure Parameter for Preserving Murine Intestines with Pulsed Electron FLASH-RT.","authors":"Veljko Grilj, Anet Valdes Zayas, Anouk Sesink, Preethi Devanand, David Repáraz, Ryan Paisley, K Sprengers, Katiuska Passelli, Julie Pernot, Till T Böhlen, Reiner W Geyer, Raphael Moeckli, Claude Bailat, Jean-Francois Germond, Julien Dagher, Francois Bochud, Jean Bourhis, Fernanda G Herrera","doi":"10.1016/j.ijrobp.2025.04.021","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.04.021","url":null,"abstract":"<p><strong>Purpose: </strong>The relationship between physical parameters of pulsed beams and the FLASH effect remains largely unexplored. Our research aimed to investigate systematically the beam requirements necessary for pulsed-electron FLASH radiotherapy (FLASH-RT), which is characterized by high average dose rates (DR_av) and large doses-per-pulse (DPP).</p><p><strong>Materials and methods: </strong>The abdominal cavity of tumor free C57BL/6 mice was irradiated with a pulsed electron beam at 17 Gy, generated by an prototype electron LINAC. The time structure of the applied beams was varied by adjusting the pulse repetition frequency (PRF) and the DPP. The overall survival was assessed for each group irradiated with different configurations of beam parameters. For some groups, jejunum samples were harvested at 96 h post-irradiation and the number of regenerating crypts per unit length was evaluated.</p><p><strong>Results: </strong>Decreasing both DPP and DR_av led to an increase in side effects and reduced overall survival. The observed toxicity was reduced by increasing DR_av while maintaining a constant DPP, achieving a maximum FLASH sparing effect at a minimum DR_av of 100 Gy/s. Conversely, lowering the DR_av while maintaining a high DPP (> 1 Gy/pulse) increased side effects with the subsequent reduction in overall survival.</p><p><strong>Conclusions: </strong>This research provides evidence that the DR_av is the major temporal beam parameter for reproducing the FLASH normal tissue sparing effect even in the case of pulsed radiation beams. A minimum dose rate of 100 Gy/s is necessary to maximize the sparing effect for intestines irradiated with 17 Gy.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063758","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":"Neoadjuvant Immunochemoradiation Therapy Versus Chemoradiation Therapy in Esophageal Cancer: A Systematic Review and Meta-Analysis of Reconstructed Individual Patient Data.","authors":"Yunsong Liu, Yu Men, Yongxing Bao, Zeliang Ma, Jun Wang, Qingsong Pang, Jianjun Qin, Liyan Xue, Chen Hu, Zhouguang Hui","doi":"10.1016/j.ijrobp.2025.04.020","DOIUrl":"10.1016/j.ijrobp.2025.04.020","url":null,"abstract":"<p><p>Neoadjuvant immunochemoradiation therapy (nICRT) is emerging as a promising treatment for resectable esophageal cancer, but comprehensive analyses comparing it with standard neoadjuvant chemoradiation therapy (nCRT) are limited. This meta-analysis aimed to evaluate the efficacy, safety, and survival outcomes of nICRT versus nCRT. A systematic search of PubMed, Embase, the Cochrane Library, and major conference proceedings up to October 30, 2024, identified studies involving resectable esophageal cancer treated with nICRT or nCRT. Data on pathologic complete response, major pathologic response, treatment-related adverse events, overall survival (OS), and progression-free survival were extracted. A one-stage meta-analysis using reconstructed individual patient data was performed, calculating hazard ratios with 95% CIs. Thirty-seven studies were included, comprising 811 patients treated with nICRT and 1796 with nCRT. nICRT demonstrated significantly longer OS than nCRT (hazard ratio, 0.714; 95% CI, 0.550-0.926; P = .011). The 1-, 2-, and 3-year OS rates were 89.9%, 76.0% and 66.4%, respectively, for nICRT, compared with 85.0%, 66.5%, and 57.3% for nCRT. The pathologic complete response rate was significantly higher in nICRT (50% vs 38%; P = .040) for squamous cell carcinoma. Safety profiles were comparable, with no significant differences in grades 3 and 4 treatment-related adverse events or postoperative complications between the groups. nICRT showed potential for superior survival compared with standard nCRT in resectable esophageal cancer and showed enhanced pathologic response in squamous cell carcinoma, with a possibly acceptable safety profile. These findings support future trials integrating immunotherapy into neoadjuvant treatment regimens for esophageal cancer.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966279","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":"Cone Beam Computed Tomography-Guided Online Adaptive Radiation Therapy: Clinical Insights From a Nationwide Staffing Survey.","authors":"Ti Bai, Xenia Ray, David Parsons, Mu-Han Lin","doi":"10.1016/j.ijrobp.2025.03.070","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.070","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to provide insights into the staffing and workflow requirements for cone beam computed tomography (CBCT)-guided online adaptive radiation therapy (ART) systems to guide institutions in optimizing staffing strategies and to promote broader ART adoption.</p><p><strong>Methods and materials: </strong>We conducted a nationwide survey to collect data on ART program metrics, clinician roles during online treatment, and physicist staffing models, along with free-text feedback for sharing of insights and challenges. Additionally, we reviewed 26 published articles describing ART workflows across various anatomic sites and performed a literature-based timing analysis to provide further context on workflow efficiency.</p><p><strong>Results: </strong>We received 19 responses from a range of institutions. Medical schools and university hospitals reported the highest ART patient throughput, averaging 4 patients per machine per day. Overall, most institutions treat 1 to 2 ART patients per machine daily, with average session duration of 1 hour. Therapists are primarily responsible for CBCT scans, whereas physicists oversee almost all ART stages. The physicians are mainly responsible for on-treatment contouring and plan selection/approval. As ART cases increase, more full-time equivalent (FTE) physicists are needed, with >5 cases per day typically requiring an additional FTE. The online adaptive workflow adds about 20 minutes to treatment time compared with image guided radiation therapy, resulting in a total on-table time of ∼40 minutes.</p><p><strong>Conclusions: </strong>Implementing ART programs requires careful planning and flexible staffing models to balance resource availability with treatment quality. The findings from this survey highlight the importance of interdisciplinary collaboration, defined clinician roles, and evolving staffing solutions for ART implementation. Medical physicists are essential in all stages of the ART process, with higher adaptive case volumes directly driving the need for additional FTEs to maintain effective workflow and treatment quality. This study's insights can guide health care facilities in establishing efficient and sustainable ART workflows, ultimately enhancing patient care outcomes.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010134","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":"Adaptive Radiation Therapy in Lymphomas: Indications, Early Experiences, and Future Directions.","authors":"Kiran A Kumar, Xinran Zhong, Zohaib Iqbal, Praveen Ramakrishnan Geethakumari, Farrukh T Awan, Elif Yilmaz, Heather Wolfe, Mohammad Faizan Zahid, Hsiao-Ching Li, Alka Mallik, David Parsons, Neil B Desai, Shahed N Badiyan, Mu-Han Lin, Robert D Timmerman, Margaret M Kozak","doi":"10.1016/j.ijrobp.2025.03.063","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.063","url":null,"abstract":"<p><strong>Purpose: </strong>Adaptive radiation therapy (RT) allows for smaller treatment volumes and adaptation to shrinking tumors, which is particularly intriguing in lymphomas that are radiosensitive and sometimes in difficult to target locations. We hypothesize that adaptive RT may be beneficial in a variety of lymphoma cases and describe our early experience to outline indications for adaptive RT in lymphomas.</p><p><strong>Methods and materials: </strong>An institutional review board-approved prospective registry was reviewed to identify patients with lymphoma who were treated with cone-beam computed tomography-based online adaptive RT (oART) at our institution from 2021 to 2024. Patients were categorized by lymphoma type, rationale for adaptation was elicited, and adaptive data were collected and analyzed.</p><p><strong>Results: </strong>Seventy-two radiation treatment courses from 67 unique patients were identified, with 26 low-grade (14 gastric mucosal associated lymphoid tissue, 8 follicular, and 4 other) and 46 high-grade (33 diffuse large B-cell, 5 mantle cell, and 8 other) lymphomas. Seventy-one percent of patients were treated with daily oART, whereas the remaining had adapt-on-demand. The main indications for oART were better targeting (69%) in locations with high interfraction motion (eg, stomach, mesentery) and/or abutting critical structures, gross disease (69%) that may change during treatment, desire for hypofractionation (38%) and planned target volume (PTV) margin reduction, and complicated treatment plans with multitargets and/or simultaneous integrated boosts (14%). On average, adaptation led to improved PTV coverage from 72.2% ± 22.7% (\"scheduled plan\") to 95.2% ± 1.2% (\"adapted plan\") (P < .001). For cases with gross disease, PTV size reduced on average 24.6% ± 21.6% from first to last fraction.</p><p><strong>Conclusions: </strong>We demonstrated that oART can be successfully implemented in a variety of lymphoma cases to reduce treatment volume while maintaining PTV coverage, allowing RT to be used more safely, with shorter treatment courses, and in scenarios where it previously may have been avoided. Future studies are needed to further elicit the clinical benefit of oART in lymphomas.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008954","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}