International Journal of Radiation Oncology Biology Physics最新文献

{"title":"FLASH Bragg-Peak Irradiation With a Therapeutic Carbon Ion Beam: First In Vivo Results.","authors":"Walter Tinganelli, Anggraeini Puspitasari-Kokko, Olga Sokol, Alexander Helm, Palma Simoniello, Christoph Schuy, Sylvie Lerchl, Denise Eckert, Julius Oppermann, Anna Rehm, Stefan Janssen, Denise Engel, Ralf Moeller, Rossana Romano, Felix Horst, Daria Boscolo, Claudia Fournier, Marco Durante, Uli Weber","doi":"10.1016/j.ijrobp.2024.11.089","DOIUrl":"10.1016/j.ijrobp.2024.11.089","url":null,"abstract":"<p><strong>Purpose: </strong>In recent years, ultra-high dose rate (UHDR) irradiation has emerged as a promising innovative approach to cancer treatment. Characteristic feature of this regimen, commonly referred to as FLASH effect, demonstrated primarily for electrons, photons, or protons, is the improved normal tissue sparing, whereas the tumor control is similar to the one of the conventional dose-rate (CDR) treatments. The FLASH mechanism is, however, unknown. One major question is whether this effect is maintained when using densely ionizing (high-LET) heavy nuclei.</p><p><strong>Methods materials: </strong>Here, we report the effects of 20 Gy UHDR heavy ion irradiation in clinically relevant conditions, ie, at high-LET in the spread-out Bragg peak of a ¹²C beam using an osteosarcoma mouse model.</p><p><strong>Results: </strong>We show that UHDR irradiation was less toxic in the normal tissue compared with CDR while maintaining tumor control. The immune activation was also comparable in UHDR and CDR groups. Both UHDR and CDR exposures steered the metagenome toward a balanced state.</p><p><strong>Conclusions: </strong>These results suggest that the UHDR irradiations can improve the safety and effectiveness of heavy ion therapy, and provide a crucial benchmark for current mechanistic FLASH models. However, additional experiments are needed to validate these findings across other animal and tumor models.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750841","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":"Evaluating the impact of liver vasculature model complexity for estimating dose to circulating blood during radiotherapy.","authors":"Shu Xing, Camilo M Correa-Alfonso, Jungwook Shin, Jennifer Pursley, Nicolas Depauw, Sean Domal, Julia Withrow, Wesley Bolch, Clemens Grassberger, Harald Paganetti","doi":"10.1016/j.ijrobp.2024.11.087","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2024.11.087","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the impact of liver model complexity on the estimated radiation dose to circulating blood during radiotherapy.</p><p><strong>Methods: </strong>Six hepatocellular carcinoma patients were selected covering a range of clinical treatment volume (CTV) sizes and locations. Photon and proton treatment plans were generated for each patient. Planning CT, CTV contours and dose distributions were deformably registered to the ICRP reference livers. Three vasculature models were considered including (1) major vascular tree (MVT), (2) coarse vascular tree (CVT) of 1045 vessels, and (3) detailed vascular tree (DVT) of 2041 vessels. Blood dose-volume histograms (bDVH_MVT, bDVH_CVT, bDVH_DVT) and the mean circulating blood dose (μ_b,MVT, μ_b,CVT, μ_b,DVT) were estimated using Monte Carlo simulations for all three models. The effect of varying blood velocity (v_b) in HCC tumors on dose estimation was also evaluated through increasing the tumor v_b by 1.5, 2 and 4.2 times.</p><p><strong>Results: </strong>For the three lesions located in the left lobe, the estimated μ_b,MVT was lower than μ_b,DVT by an average ± standard deviation of (6±4) % and (17±7) % for photon and proton treatments, respectively. Smaller differences were found for lesions in the right lobe, where μ_b,MVT was on average (2±1) % lower than μ_b,DVT for photon and (3±1) % lower for proton treatments. More pronounced difference between μ_b,MVT and μ_b,DVT was seen in lesions with smaller CTV sizes. We also found that considering the elevated tumor v_b led to a reduction of estimated dose to circulating blood, with a maximum reduction in the estimated μ_b of 39% and 8% for CTV of 603 mL and 249 mL, respectively.</p><p><strong>Conclusion: </strong>Our study revealed that the impact of liver vasculature model complexity on the estimated dose to blood depended on lesion-specific characteristics. For lesions with larger CTV size on the right liver lobe treated with photons, modeling only major vessels could generate bDVHs that are dosimetrically comparable to bDVHs of more complex vascular models. Increased tumor v_b resulted in a reduction of the estimated blood dose.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750837","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":"Spine Stereotactic Body Radiation Therapy in Geriatric Patients: Implications of Age and Dose on Iatrogenic Vertebral Compression Fracture Risk.","authors":"Adrian Wai Chan, Kang Liang Zeng, Daniel Moore-Palhares, Eshetu G Atenafu, Hanbo Chen, Sten Myrehaug, Mark Ruschin, Hany Soliman, Chia-Lin Tseng, Bei-Bei Zhang, Cari Whyne, Pejman Maralani, Arjun Sahgal, Jay Detsky","doi":"10.1016/j.ijrobp.2024.11.082","DOIUrl":"10.1016/j.ijrobp.2024.11.082","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic body radiation therapy (SBRT) is an effective treatment for spinal metastases; however, outcomes specific to a geriatric population have not been described. This study aims to investigate the efficacy and safety of spine SBRT, in particular the rate of iatrogenic vertebral compression fracture (VCF), in patients aged 70 and older.</p><p><strong>Patients and methods: </strong>From a prospectively maintained single-institutional database of 976 patients and 2407 spinal segments treated with SBRT for vertebral metastases between 2008 and 2021, all patients aged 70 or above were retrospectively reviewed. The primary outcome is the risk of VCF. Secondary outcomes included magnetic resonance imaging-based local failure and overall survival.</p><p><strong>Results: </strong>A total of 252 consecutive patients with 580 spinal segments treated with spine SBRT were reviewed. The median age was 75.8 (range: 70-90.3) years and the median (interquartile range) follow-up duration was 16.9 (6.4-41.3) months. The median overall survival of the entire cohort was 20.3 months and the 2-year local failure rate was 14.3%. The cumulative risk of VCF at 12 and 24 months were 8.4% and 12.3%, respectively. Significant predictors of VCF on multivariable analyses included greater biologically equivalent dose, baseline fracture, and increasing age. In particular, the 2-year VCF rate and median time to VCF were 30.3% and 3.4 months for those 86 and older, compared with 11.2% and 12.8 months for those younger than 86, respectively (P = .0011).</p><p><strong>Conclusion and relevance: </strong>Spine SBRT should be considered in a geriatric population; however, for those 86 and older, we suggest caution due to the significant risk of VCF.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695402","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 Association of Linear Energy Transfer and Dose With Radiation Necrosis After Pencil Beam Scanning Proton Therapy in Pediatric Posterior Fossa Tumors.","authors":"Jarey H Wang, Ryan Oglesby, Anh Tran, Melike Guryildirim, Mattea Miller, Khadija Sheikh, Heng Li, Matthew Ladra, William T Hrinivich, Sahaja Acharya","doi":"10.1016/j.ijrobp.2024.11.086","DOIUrl":"10.1016/j.ijrobp.2024.11.086","url":null,"abstract":"<p><strong>Purpose: </strong>Proton therapy is the preferred treatment modality for most pediatric central nervous system tumors. The risk of radiation necrosis may be increased at the distal end of the beam because of an increase in linear energy transfer (LET) and relative biological effectiveness (RBE) dose. We report on the association of LET and dose with radiation necrosis after pencil beam scanning proton therapy in pediatric posterior fossa tumors using a case-control framework.</p><p><strong>Materials and methods: </strong>From 2019 to 2022, 33 patients less than or equal to 18 years of age treated with first-line proton therapy for primary tumors in the posterior fossa and with 6 or more months of follow-up magnetic resonance imaging were retrospectively identified. Nine patients with imaging changes consistent with necrosis were matched with controls in a 1:2 fashion based on age, sex, dose, and follow-up time from proton therapy. Dose (Gy [RBE]) and dose-averaged LET (LETd) values for target structures and organs at risk were computed and compared between cases and controls.</p><p><strong>Results: </strong>Within the whole cohort, the mean age was 6.6 years (SD, 4.77) with a median follow-up time of 24.1 months. Within the case-control matched cohort (18 controls and 9 cases), there were no significant differences in age, sex, time to follow-up, tumor location, dose, and use of concurrent chemotherapy. The mean time to necrotic imaging finding was 4.47 months (SD, 2.03). Cases demonstrated significantly higher brainstem D50 (P = .02). LETd was not different between cases and controls. However, when using a combined metric of higher brainstem dose {>47.5 (Gy [RBE])} and higher LETd (>3.5 keV/µm), a greater proportion of cases compared with controls met this metric (89% vs 39%, P = .02).</p><p><strong>Conclusions: </strong>Combined effects of intermediate-to-high dose and LETd in the brainstem may contribute to greater necrosis risk after pencil beam scanning proton therapy in children with posterior fossa tumors.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695474","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":"Phase 2 Trial of Consolidative Stereotactic Body Radiation Therapy in Patients With Metastatic Oncogene-driven Non-small Cell Lung Carcinoma Treated With Tyrosine Kinase Inhibitors.","authors":"Florence K Keane, Beow Y Yeap, Melin J Khandekar, Jessica J Lin, Ibiayi Dagogo-Jack, Lecia V Sequist, Zofia Piotrowska, Henning Willers","doi":"10.1016/j.ijrobp.2024.10.022","DOIUrl":"10.1016/j.ijrobp.2024.10.022","url":null,"abstract":"<p><strong>Purpose: </strong>The role of stereotactic body radiation therapy (SBRT) in the management of advanced EGFR/ALK/ROS1-driven non-small cell lung carcinoma (NSCLC) remains undefined. In EGFR-mutant NSCLC, 50-60% of recurrences on first-line tyrosine kinase inhibitors (TKIs) occur in originally involved sites and may lead to subsequent distant failures (DFs). We sought to determine whether consolidative SBRT to residual sites reduces DF.</p><p><strong>Methods and materials: </strong>This is a single-arm, phase 2 trial of SBRT to residual sites of disease in patients with metastatic oncogene-driven NSCLC with stable or responding disease to TKI within 12 months of treatment start. The primary endpoint was DF frequency at 12 months after SBRT.</p><p><strong>Results: </strong>The median follow-up was 57.1 months. The trial enrolled 27 of 30 planned patients between 2015 and 2021, stopping early caused by slow accrual. Most (n = 22) had EGFR driver mutations. The majority (59.5%) were treated with later-generation TKIs. The median time from TKI start to SBRT was 6.4 months. Twenty-five patients (92.6%) received SBRT to the residual lung primary only. The 12-month DF rate was 19% (95% CI, 7%-36%). Median progression-free survival from SBRT was 15.0 months (95% CI, 8.6-46.7). The 2-year local failure rate of irradiated sites was 11% (95% CI, 3%-27%). Two-year and median overall survival were 88% (95% CI, 68%-96%) and 59.6 months (95% CI, 42.3-NR), respectively. There were no grade ≥3 adverse events related to SBRT.</p><p><strong>Conclusions: </strong>In patients treated with first-line TKIs, consolidative SBRT was associated with improvement in distant disease control compared with historical controls, supporting ongoing randomized trials.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692923","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":"Robust Optimization for Spot-Scanning Proton Therapy based on Dose-Linear-Energy-Transfer Volume Constraints.","authors":"Jingyuan Chen, Yunze Yang, Hongying Feng, Lian Zhang, Zhengliang Liu, Tianming Liu, Carlos E Vargas, Nathan Y Yu, Jean-Claude M Rwigema, Sameer R Keole, Samir H Patel, Sujay A Vora, Jiajian Shen, Wei Liu","doi":"10.1016/j.ijrobp.2024.11.068","DOIUrl":"10.1016/j.ijrobp.2024.11.068","url":null,"abstract":"<p><strong>Purpose: </strong>Historically, spot-scanning proton therapy (SSPT) treatment planning uses dose-volume constraints and linear-energy-transfer (LET) volume constraints separately to balance tumor control and organs-at-risk (OARs) protection. We propose a novel dose-LET-volume constraint (DLVC)-based robust optimization (DLVCRO) method for SSPT in treating prostate cancer to obtain a desirable joint dose and LET distribution to minimize adverse events.</p><p><strong>Methods and materials: </strong>DLVCRO treats DLVC as soft constraints that control the shapes of the dose-LET volume histogram (DLVH) curves. It minimizes the overlap of high LET and high dose in OARs and redistributes high LET from OARs to targets in a user-defined way. Ten patients with prostate cancer were included in this retrospective study. Rectum and bladder were considered as OARs. DLVCRO was compared with the conventional robust optimization (RO) method. Plan robustness was quantified using the worst-case analysis method. Besides the dose-volume histogram indices, the analogous LET-volume histogram, extrabiological dose (the product of per voxel dose and LET) volume histogram (xBDVH) indices characterizing the joint dose/LET distributions and DLVH indices were also used. The Wilcoxon signed-rank test was performed to measure statistical significance.</p><p><strong>Results: </strong>In the nominal scenario, DLVCRO significantly improved joint distribution of dose and LET to protect OARs compared with RO. The physical dose distributions in targets and OARs are comparable. In the worst-case scenario, DLVCRO markedly enhanced OAR protection (more robust) while maintaining almost the same plan robustness in target dose coverage and homogeneity.</p><p><strong>Conclusions: </strong>DLVCRO upgrades 2D DVH-based to 3D DLVH-based treatment planning to adjust dose/LET distributions simultaneously and robustly. DLVCRO is potentially a powerful tool to improve patient outcomes in SSPT.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647654","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":"Exploratory Evaluation of Personalized Ultrafractionated Stereotactic Adaptive Radiation Therapy (PULSAR) With Central Nervous System-Active Drugs in Brain Metastases Treatment.","authors":"Michael Dohopolski, Luiza Giuliani Schmitt, Soummitra Anand, Haozhao Zhang, Strahinja Stojadinovic, Michael Youssef, Nawal Shaikh, Toral Patel, Ankur Patel, Sam Barnett, Dong Soo Lee, Chul Ahn, MinJae Lee, Robert Timmerman, Hao Peng, Xin Cai, Tu Dan, Zabi Wardak","doi":"10.1016/j.ijrobp.2024.11.067","DOIUrl":"10.1016/j.ijrobp.2024.11.067","url":null,"abstract":"<p><strong>Purpose: </strong>Brain metastases (BMs) affect an increasing number of cancer patients and are typically managed with stereotactic radiosurgery (SRS). Our institution advocates the use of Personalized Ultrafractionated Stereotactic Adaptive Radiation Therapy (PULSAR), where radiation is delivered in high-dose pulses at extended intervals allowing for treatment adaptation and easy concurrent systemic therapy integration. We explore the integration of PULSAR with central nervous system (CNS)-active drugs (CNS-aDs).</p><p><strong>Methods and materials: </strong>This study involved a retrospective evaluation of patients treated with PULSAR using Gamma Knife from 2018 to 2024. We collected demographic, clinical, and specific treatment details, as well as outcomes such as local failure (LF) and toxicity rates. Cumulative incidence analysis for LF and toxicity, considering death a competing risk, and Kaplan-Meier survival analysis for overall survival (OS) were conducted.</p><p><strong>Results: </strong>Analysis included 109 lesions treated with PULSAR, predominantly in patients with lung and breast cancer. The median follow-up was 1.72. The median OS was not reached. The 1- and 2-year LF rates were 5% and 8.9%, respectively, and 3.4% and 5.5% with concurrent CNS-aDs (cCNS-aDs). BMs >2 cm had LF rates of 9.4% at 2 years. No LFs were observed in BMs >2 cm treated with the combined PULSAR+CNS-aDs approach at 2.5 years. Univariate analysis indicated CNS-aD and radioresponsive histologies were associated with decreased LF rates. The 2-year grade 3+ toxicity rate for PULSAR was 8.7%, with no increase in toxicity with cCNS-aDs.</p><p><strong>Conclusions: </strong>The integration of PULSAR with CNS-aDs appears to offer excellent local control for larger BMs with limited toxicity. These promising results merit further prospective investigation to validate the findings and potentially establish new treatment protocols.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667321","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":"Inappropriate Denials for Radiation Therapy in Medicare Advantage Plans.","authors":"Jared Pasetsky, Kishan Bhatt, Lisa A Kachnic, James B Yu, David P Horowitz","doi":"10.1016/j.ijrobp.2024.11.063","DOIUrl":"10.1016/j.ijrobp.2024.11.063","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation oncologists are known to be burdened with prior authorization and insurance denials more than other medical specialties. This analysis sought to use publicly available data and determine whether Medicare Advantage plans are inappropriately denying radiation therapy (RT) services more than other health services.</p><p><strong>Methods and materials: </strong>Data from the Appeals Decision Search on the Centers for Medicare & Medicaid Services website were extracted from 2022 through June 2024. The data contain appeal decisions from a third-party independent review entity, which uses Medicare coverage guidelines to determine the appropriateness of a denial. Percentages of inappropriate denials were calculated for RT services and all health services. A chi-square test was used to compare inappropriate denial levels between RT and everything else. Decisions were also filtered by \"keyword\" and \"condition\" to analyze trends in treatment modalities and diagnosis, respectively.</p><p><strong>Results: </strong>RT services were inappropriately denied in 15.04%, 18.69%, and 16.01% of cases for 2022, 2023, and 2024, respectively, while inappropriate denials for all health services were only 4.69%, 5.28%, and 3.44%, respectively. Overall, since 2022, 274 out of 1576 RT appeals were inappropriately denied (17.39%), while only 20,195 out of 433,788 total appeals were inappropriately denied for all health services (4.66%). The difference was statistically significant for all 3 years and for the entire time period, with all P values < .00001. Using keywords brachytherapy, stereotactic body radiation therapy, proton, and intensity-modulated RT, inappropriate denial rates varied at 12.75%, 26.11%, 13.02%, and 41.06%, respectively, from 2022 to 2024. Prostate cancer appeals for protons had particularly low rates of inappropriate denial at 3.45%, while breast cancer appeals for intensity-modulated RT had particularly high rates of inappropriate denial at 82.14%.</p><p><strong>Conclusions: </strong>Medicare Advantage plans are inappropriately denying RT services more than non-RT services. These data warrant urgent policy changes to prevent Medicare-eligible patients from being inappropriately denied access to cancer treatments.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647644","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":"Docetaxel/Cisplatin Chemotherapy Followed by Pelvic Radiation Therapy in Patients With High-risk Endometrial Cancer After Staging Surgery: A Phase 2 Study.","authors":"Ok-Ju Kang, Yoon-Jung Cho, Myong Cheol Lim, Yeon Jee Lee, Sang Soo Seo, Sokbom Kang, Sang-Yoon Park, Young Seok Kim, Joo-Hyun Nam, Jeong-Yeol Park","doi":"10.1016/j.ijrobp.2024.11.071","DOIUrl":"10.1016/j.ijrobp.2024.11.071","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy and safety of docetaxel/cisplatin chemotherapy followed by pelvic radiation therapy after staging surgery in patients with high-risk endometrial cancer.</p><p><strong>Methods and materials: </strong>In this open-label, single-arm, phase 2 trial conducted at 2 South Korean centers, we enrolled patients with histologically confirmed endometrial cancer who had undergone staging surgery. Inclusion criteria were based on International Federation of Gynecology and Obstetrics (FIGO) Staging 2009: stage I patients with ≥2 risk factors (grade 3, positive lymphovascular invasion, more than half of myometrium invasion); stage IB and II patients with clear cell or serous adenocarcinoma; stage II patients post-type 1 hysterectomy; and patients at stage III. Patients underwent 3 cycles of chemotherapy with docetaxel (70 mg/m²) and cisplatin (60 mg/m²) followed by pelvic radiation therapy ranging from 45 to 50.4 Gy. Disease status and adverse events were evaluated using RECIST 1.1 and Common Terminology Criteria for Adverse Events 4.0, respectively, with scheduled imaging and assessments throughout the study.</p><p><strong>Results: </strong>A total of 62 patients were included in this study and were followed for a median duration of 65 months (IQR, 48-86 months). The progression-free survival rates at 1, 3, and 5 years were 98.4%, 86.9%, and 79.1%, respectively. The overall survival rates at 1, 3, and 5 years were 98.4%, 96.4%, and 96.4%, respectively. After chemotherapy, 62.9% of patients experienced severe neutropenia, with 3.2% having grade 3 or 4 anemia. Common mild side effects included nausea (58.1%) and alopecia (38.7%). Postradiation, 16.7% experienced grade 3 neutropenia, and a few had grade 1 or 2 anemia (3.3%), with most other side effects being mild and no critical toxicities reported.</p><p><strong>Conclusions: </strong>Patients with endometrial cancer with high-risk factors could benefit from adjuvant chemotherapy using docetaxel/cisplatin, followed by radiation therapy, with manageable toxicities.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667304","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":"Generalizable Magnetic Resonance Imaging-based Nasopharyngeal Carcinoma Delineation: Bridging Gaps Across Multiple Centers and Raters With Active Learning.","authors":"Xiangde Luo, Hongqiu Wang, Jinfeng Xu, Lu Li, Yue Zhao, Yuan He, Hui Huang, Jianghong Xiao, Tao Song, Shichuan Zhang, Shaoting Zhang, Guotai Wang, Wenjun Liao","doi":"10.1016/j.ijrobp.2024.11.064","DOIUrl":"10.1016/j.ijrobp.2024.11.064","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a deep learning method exploiting active learning and source-free domain adaptation for gross tumor volume delineation in nasopharyngeal carcinoma (NPC), addressing the variability and inaccuracy when deploying segmentation models in multicenter and multirater settings.</p><p><strong>Methods and materials: </strong>One thousand fifty-seven magnetic resonance imaging scans of patients with NPC from 5 hospitals were retrospectively collected and annotated by experts from the same medical group with consensus for multicenter adaptation evaluation. One data set was used for model development (source domain), with the remaining 4 for adaptation testing (target domains). Meanwhile, another set of 170 patients with NPC, with annotations delineated by 4 independent experts, was created for multirater adaptation evaluation. We evaluated the pretrained model's migration ability to the 4 multicenter and 4 multirater target domains. Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and other metrics were used for quantitative evaluations.</p><p><strong>Results: </strong>In the adaptation of dataset5 to other data sets, our source-free active learning adaptation method only requires limited labeled target samples (only 20%) to achieve a median DSC ranging from 0.70 to 0.86 and a median HD95 ranging from 3.16 to 7.21 mm for 4 target centers, and 0.78 to 0.85 and 3.64 to 6.00 mm for 4 multirater data sets. For DSC, our results for 3 of 4 multicenter data sets and all multirater data sets showed no statistical difference compared to the fully supervised U-Net model (P values > 0.05) and significantly surpassed comparison models for 3 multicenter data sets and all multirater data sets (P values < 0.05). Clinical assessment showed that our method-generated delineations can be used both in multicenter and multirater scenarios after minor refinement (revision ratio <10% and median time <2 minutes).</p><p><strong>Conclusions: </strong>The proposed method effectively minimizes domain gaps and delivers encouraging performance compared with fully supervised learning models with limited labeled training samples, offering a promising and practical solution for accurate and generalizable gross tumor volume segmentation in NPC.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667329","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}