International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Reirradiation Special Medical Physics Consultations: Lessons Learned from Nearly 3000 Courses of Treatment.","authors":"Kelly C Paradis, Charles Mayo, Charles K Matrosic, Joann I Prisciandaro, Benjamin S Rosen, Steven G Allen, Alex K Bryant, Enid Choi, Kyle Cuneo, Robert Dess, Alek Dragovic, Joseph R Evans, James A Hayman, Jason Hearn, Elizabeth M Jaworski, Shruti Jolly, Michelle M Kim, Theodore S Lawrence, Sean Miller, Grace Sun, Daniel R Wahl, Martha M Matuszak, Daniel T Chang","doi":"10.1016/j.ijrobp.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.002","url":null,"abstract":"<p><strong>Introduction: </strong>Reirradiation (reRT) has become increasingly prevalent due to an aging population and advancements in cancer detection and treatment. However, the field is still lacking standardized dosimetric evaluation methods and reRT workflows, which leads to difficulty in correlating clinical outcomes with delivered dose. This study reports on the implementation and evolution of a standardized reRT workflow in the Department of Radiation Oncology at [redacted], describing insights gained from nearly 3000 external beam reirradiation courses delivered since 2017.</p><p><strong>Materials and methods: </strong>A systematic workflow for reRT special medical physics consultations (SMPCs) was established in 2017. Patient SMPC records from the past seven years were reviewed, with an additional more in-depth review of the past one year, to report on course characteristics including treatment sites, where prior treatment was delivered (in-house vs an outside institution), whether institutional dose limits were met and the associate reasoning, time intervals between RT, the type of dose summation method used (rigid image registration-based vs point dose-based), as well as the evolution of this workflow.</p><p><strong>Results: </strong>Of the 2929 SMPCs conducted from 2017 to mid-2024, the most common treatment sites for reRT were the pelvis, brain, and thorax. About a third of patients had prior treatments at outside institutions. Of the 427 courses treated in the past year, institutional reirradiation dose limits were met in 82.2%. Rigid image registration was most successful for calculating composite dose in the brain (93.8% of cases) and least successful in the abdomen and pelvis (53.1% and 51.2%, respectively), and most reRT cases (80.3%) had a single prior course of treatment. Several updates were made to our institutional reRT dosimetric evaluation template, including increasing some time-dependent tissue recovery factors, adding and removing some OARs, and adding new point-based and volumetric dose objectives.</p><p><strong>Conclusion: </strong>Via our seven-year experience with nearly 3,000 courses of reRT, we highlight the critical need for standardized reirradiation workflows, improved tools for cumulative dose assessment, and standardized reporting. These efforts will facilitate cross-institutional data sharing to enhance data-driven clinical decision-making and improve patient outcomes in reRT. As the prevalence of reRT rises, these efforts are vital for advancing safe and effective cancer care.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605045","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":"Modeling the effect of daughter migration on dosimetry estimates for [²²⁵Ac]Ac-DOTATATE.","authors":"Stephen Tronchin, Jake Forster, Kevin Hickson, Eva Bezak","doi":"10.1016/j.ijrobp.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.004","url":null,"abstract":"<p><strong>Purpose: </strong>[²²⁵Ac]Ac-DOTATATE is a promising treatment option for patients with neuroendocrine tumors. A concern with ²²⁵Ac is that the decay energy can break the bond to the targeting vehicle, producing free daughter radionuclides in the body. Daughter migration is generally not considered in clinical dosimetry, and therefore its effect needs to be studied.</p><p><strong>Methods: </strong>A compartment model for ²²⁵Ac and its daughters was developed, where each daughter isotope is assigned unique transfer coefficients. The model was applied to [²²⁵Ac]Ac-DOTATATE. Computer simulations were performed in Python for two scenarios: a) the daughters decay at the site of [²²⁵Ac]Ac-DOTATATE decay, and b) the daughters have unique biokinetics, where each decay of [²²⁵Ac]Ac-DOTATATE releases ²²¹Fr off the DOTATATE peptide. Two extreme cases concerning intra-cellular degradation of [²²⁵Ac]Ac-DOTATATE were also examined: one in which it remains intact inside the tumor cells, and one with complete degradation followed by free ²²⁵Ac released back to plasma. Normal organ and tumor absorbed doses were determined in each case. In addition, the model-calculated cumulated activities of ²²¹Fr and ²¹³Bi were compared to recent measurements from a clinical trial.</p><p><strong>Results: </strong>When modelling the unique daughter kinetics, the average absorbed dose to the kidneys and tumor was 517 (95% CI: 413-622) and 577 (95% CI: 134-1020) mGy/MBq, respectively, with daughter migration resulting in an average increase in the kidney dose of 10.2% (95% CI: 7.9%-12.5%), and an average decrease in the tumor dose of 22.9% (95% CI: 16.3%-29.4%). The model scenario including free ²²⁵Ac showed improved agreement with clinical trial data, specifically for the liver, suggesting a fraction of free ²²⁵Ac is produced in patients following the administration of [²²⁵Ac]Ac-DOTATATE.</p><p><strong>Conclusion: </strong>When performing dosimetry for [²²⁵Ac]Ac-DOTATATE, our study found that if daughter migration is ignored, the kidney dose is underestimated by approximately 10%, and the tumor dose is overestimated by approximately 23%. For accurate dosimetry, daughter biokinetics should be considered.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605040","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":"Direct-to-treatment adaptive radiotherapy: live planning of spine metastases using novel CBCT.","authors":"K Maiti McGrath, Robert Lee MacDonald, James L Robar, Amanda Cherpak","doi":"10.1016/j.ijrobp.2025.02.045","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.045","url":null,"abstract":"<p><strong>Purpose: </strong>CBCT-based online adaptive radiation therapy is carried out using a synthetic CT, sCT, created through deformable registration between the patient-specific fan-beam CT, FBCT, and daily CBCT. Ethos 2.0 allows for plan calculation directly on HyperSight CBCT and uses AI-informed tools for daily contouring without the use of a priori information. This breaks an important link between daily adaptive sessions and initial reference plan preparation. This work explores adaptive radiation therapy for spine metastases without prior patient-specific imaging or treatment planning. We hypothesize that adaptive plans can be created when patient-specific positioning and anatomy is incorporated only once the patient has arrived at the treatment unit.</p><p><strong>Methods and materials: </strong>An Ethos 2.0 emulator was used to create initial reference plans on ten patient-specific FBCTs. Reference plans were also created using FBCTs of i) a library patient with clinically acceptable contours and ii) a water-equivalent phantom with placeholder contours. Adaptive sessions were simulated for each patient using the three different starting points. Resulting adaptive plans were compared to determine the significance of patient-specific information prior to the start of treatment.</p><p><strong>Results: </strong>The library patient and phantom reference plans did not generate adaptive plans that differed significantly from the standard workflow for all clinical constraints for target coverage and organ at risk sparing (p>0.2). Gamma comparison between the three adaptive plans for each patient (3%/3 mm) demonstrated overall similarity of dose distributions (pass rate >95%), for all but two cases. Failures occurred mainly in low-dose regions, highlighting difference in fluence used to achieve the same clinical goals.</p><p><strong>Conclusions: </strong>This study confirmed feasibility of a procedure for treatment of spine metastases that does not rely on previously acquired patient-specific imaging, contours or plan. Reference-free direct-to-treatment workflows are possible and can condense a multi-step process to a single location with dedicated resources.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605035","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 body radiotherapy for oligoprogressive disease in androgen suppressed prostate cancer: Primary endpoint analysis of the TRAP trial.","authors":"Priyanka Patel, Sabine Dreibe, Gerhardt Attard, Aidan Cole, Patricia Diez, John Frew, Jeane Guevara, Daniel Levine, Fiona McDonald, Vinod Mullassery, Julia Murray, Chris Parker, Nachi Palaniappan, Angela Pathmanathan, Alison Reid, Yae-Eun Suh, Isabel Syndikus, Angelie Tirona, Amina Tran, Nina Tunariu, Nicholas J van As, James Wylie, Alison C Tree","doi":"10.1016/j.ijrobp.2025.02.046","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.046","url":null,"abstract":"<p><strong>Purpose: </strong>Optimal management of oligoprogressive prostate cancer whilst on androgen receptor pathway inhibitors (ARPi) is not known. The **** trial tests the role of stereotactic body radiotherapy (SBRT) in this setting. The objective of this Phase II prospective, non-randomised, single arm trial was to determine if local control of oligoprogressive disease with SBRT can delay further progression by more than four months, postponing time to next therapy.</p><p><strong>Methods: </strong>Men with castration resistant prostate cancer with ≤ 2 oligoprogressive sites developing on treatment with an ARPi, after initial response to therapy, were recruited. All patients were treated to a dose of 30 Gy in 5 fractions (alternate days) or 36 Gy in 6 fractions weekly (prostate only).</p><p><strong>Results: </strong>86 men were recruited between October 2018 and February 2023. SBRT was delivered to 81 men. Mean age was 74 years. Most patients (67%) had 1 OPD lesion. Sites irradiated were bone (59%), lung (1%), lymph node (32%) and prostate (7%). Median follow-up was 22.9 months at the time of analysis. Fifty-five (68%) patients had progressed, 33 (41%) of patients progressed within 6 months of radiotherapy. Median progression free survival (PFS) was 6.4 months (95% CI 5.9-11.4). An estimated 39% (95% CI 29-49) of patients have a prolonged PFS of > 12 months. Thirty-three (41%) of patients had started new treatment or died. Median time to either next treatment or death was 27 months (95% CI 14.9-29.6). Median overall survival was 27.2 months (95% CI 24.7-36.6). Four deaths occurred within 6 months of SBRT; none were related to radiotherapy treatment.</p><p><strong>Conclusions: </strong>The **** trial has demonstrated a median PFS of 6.4 months after SBRT for oligoprogression of prostate cancer, meeting the primary endpoint. Further analysis of biomarker panel including circulating DNA and whole-body magnetic resonance imaging will promote better patient selection.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605048","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":"Skin Microbiome, Inflammation, and Skin Toxicities in Women With Breast Cancer Receiving Moderately Hypofractionated Radiation Therapy.","authors":"Jinbing Bai, Claire Gong, Yi-Juan Hu, Deborah W Bruner, Mylin A Torres, Zachary S Buchwald, Jolinta Y Lin","doi":"10.1016/j.ijrobp.2025.02.044","DOIUrl":"10.1016/j.ijrobp.2025.02.044","url":null,"abstract":"<p><strong>Purpose: </strong>Up to 95% of women during and after radiation therapy (RT) for breast cancer have reported cutaneous toxicity. However, the biologic link between skin microbiome and skin toxicities from RT remains largely unknown. This study aimed to assess the associations of skin microbiome with clinician- and patient-reported skin toxicities and inflammatory markers in women with breast cancer receiving RT.</p><p><strong>Methods and materials: </strong>A prospective, longitudinal study was conducted at a single institution. Thirty-two women with breast cancer undergoing moderately hypofractionated RT for 3 to 4 weeks after breast conserving surgery were enrolled and 30 of them were analyzed. A total of 240 swabs for skin microbiome and 120 plasma samples were collected pre-RT baseline (T₁), week-1 of RT (T₂), week-3 of RT (T₃), and 3 months post-RT (T₄), from the cancer-affected and contralateral healthy breasts. Skin microbiome specimens were processed using 16S V1-V3 sequencing.</p><p><strong>Results: </strong>Differences in skin microbiome of the treated breasts during RT (T₂ and T₃) were observed compared with the skin microbiome of pre-RT baseline breasts (T₁) and contralateral, healthy breasts, with the affected breasts having an increased abundance of pathogenetic Finegoldia (P = .001), Dermacoccus (P = .01), and Variovorax (P = .003) during RT. Longitudinal analysis showed that decreased Variovorax but increased Staphylococcus were associated with increased clinician-reported grade 2 pruritus (P = .002) and dermatitis (P = .012), and increased patient-reported moderate or severe darkened skin (P = .002) and itchy skin (P = .012). Additionally, the plasma interferon gamma was associated with changes in skin microbiome in women with breast cancer undergoing RT.</p><p><strong>Conclusions: </strong>This study shows changes in the skin microbiome during well-tolerated moderately hypofractionated breast RT. The skin microbiome return toward baseline appears to associate with improvement of clinician- and patient-reported skin toxicities post-treatment. Although there were few high-grade toxicities observed among frequently prescribed courses of hypofractionated whole breast RT, changes in skin microbiome may be of interest as further targets of symptomatic relief or intervention as ultrahypofractionated courses become more common.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585680","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":"A Phase 2 Study of Multiparametric Magnetic Resonance Imaging-Guided High-Dose Response-Adaptive Radiation Therapy With Concurrent Temozolomide in Patients With Newly Diagnosed Glioblastoma: Results From an Interim Analysis.","authors":"Michelle M Kim, Madhava P Aryal, Krithika Suresh, Benjamin S Rosen, Hemant Parmar, Daekeun You, Denise Leung, Nathan Clarke, John Fortunato, Wajd Al-Holou, Jason Heth, David Altshuler, Todd Hollon, Donna M Edwards, Daniel R Wahl, Theodore S Lawrence, Yue Cao","doi":"10.1016/j.ijrobp.2025.02.020","DOIUrl":"10.1016/j.ijrobp.2025.02.020","url":null,"abstract":"<p><strong>Purpose: </strong>Biologically-informed radiation therapy (RT) targeting an adversely prognostic hypercellular/hyperperfused imaging phenotype in patients with newly diagnosed glioblastoma (GBM) may improve outcomes by identifying emerging regions of treatment resistance associated with overall survival, and is under investigation in an ongoing phase 2 trial (NCT04574856) of individualized, response-adaptive RT.</p><p><strong>Methods and materials: </strong>In this single-arm phase 2 study, patients with newly diagnosed GBM after resection undergo dose-intensified chemoradiation targeting the residual hypercellular (TV_HCV, 2 SD above mean intensity contralateral normal brain) and hyperperfused tumor volume (TV_CBV, 1 SD above contralateral normal frontal lobe gray matter) identified using high b-value diffusion-weighted and dynamic contrast-enhanced perfusion magnetic resonance imaging. The combination of TV_HCV and TV_CBV (TV_HCV/TV_CBV) is treated to 50 Gy in 20 fractions (2.5 Gy/fraction), and after mid-RT reassessment, the persistent and developing TV_HCV/TV_CBV is treated to 30 Gy in 10 fractions (3 Gy/fraction). The primary endpoint is improvement in overall survival, with planned interim safety analysis.</p><p><strong>Results: </strong>At interim analysis, 16 of 30 patients were enrolled. Median age was 58 years (range, 29-75) and 69% were male. No patient underwent biopsy only, and 50% had gross total resection; 19% had O⁶-methylguanine-DNA methyltransferase methylated tumors. Median TV_HCV/TV_CBV was 6.9 cc (range, 1.9-42.8) pre-RT and 30% (range, 1%-72%) was nonenhancing. By mid-RT, TV_HCV/TV_CBV was reduced to 4.2 cc (range, 0.8-34.3) and 47% (range, 3%-74%) was nonenhancing. The TV_HCV/TV_CBV persisting from pre-RT to mid-RT was 2.3 cc (range, 0-24.2), with an additional 1.8 cc (range, 0.3-20.6) newly developing outside of the initial region. All patients underwent adaptive replanning for boost without interruption. Planned interim analysis determined an acceptable rate of neurologic toxicity and safety to continue enrollment.</p><p><strong>Conclusions: </strong>Individualized, response-adaptive chemoradiation using an advanced imaging biomarker to assess emerging and especially nonenhancing regions of treatment resistance in patients with GBM is feasible, with short-term safety and longer-term efficacy outcomes anticipated with completion of accrual.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585652","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 Probability of Locoregional Control in Patients With Locoregional Recurrent Breast Cancer Treated With Postoperative Reirradiation and Hyperthermia (RADHY): A Continuous Thermal Dose-effect Relationship.","authors":"C Paola Tello Valverde, Akke Bakker, H Petra Kok, M Willemijn Kolff, Geertjan van Tienhoven, Polychronis Kostoulas, Ben J Slotman, Konstantinos Pateras, Hans Crezee","doi":"10.1016/j.ijrobp.2025.02.040","DOIUrl":"10.1016/j.ijrobp.2025.02.040","url":null,"abstract":"<p><strong>Purpose: </strong>Mild hyperthermia (HT) (39-43 °C) combined with reirradiation is considered for patients with locoregional recurrent (LRR) breast cancer. Studies analyzing dichotomized HT thermal dose (TD) parameters suggest that higher TD correlates with better response rates, but evidence quantifying optimal TD levels needed to achieve locoregional control (LRC) is limited. We investigated the continuous TD-effect relationship of LRC in patients with LRR breast cancer treated with postoperative reirradiation and HT.</p><p><strong>Methods and materials: </strong>In this historical cohort study, 112 patients with LRR breast cancer were treated in 2010-2017 with postoperative reirradiation 8 × 4 Gy (n = 34) or 23 × 2 Gy (n = 78) and 4 to 5 weekly HT sessions, TD was measured using invasive thermometry in the target region. Primary endpoint was the estimated probability of LRC at 5-years. The logarithm of highest (\"Best\") CEM43T50 (median cumulative equivalent minutes at 43 °C) of all HT sessions was analyzed as TD parameter based on Weibull univariate and stepwise multivariate regression analyses. Additionally, the best fitted Bayesian LRC survival model was analyzed assuming 3 informative priors: age, tumor location (breast/chest wall), and lymph node involvement.</p><p><strong>Results: </strong>Twenty-four patients developed an infield recurrence; median time to recurrence was 3.4 years (interquartile range, 2.7-4.6 years). Increasing median Best session CEM43T50 TD range from 0.08 to 101.9 minutes was associated with increasing probability of LRC from ∼44% to 94% at 5-years, and over this range a 2-fold TD increase resulted in ∼5% to 10% increasing LRC. The hazard ratio for a subsequent recurrence decreased 48% (95% confidence interval, 18%-84%) with a 2-fold increase in TD over the TD range, P = .001. This effect was confirmed in Weibull multivariate regression analysis and in Bayesian LRC survival regression analysis.</p><p><strong>Conclusions: </strong>Increasing TD was strongly associated with an improved LRC, showing that adequate TD must be ensured and confirming that HT is essential for strongly sensitizing efficacy of postoperative reirradiation for patients with LRR breast cancer.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585689","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":"Sexual Health Outcomes in Sexual Minority and Heterosexual Men After Prostate Radiation Therapy.","authors":"Daniel R Dickstein, Thodori Kapouranis, Keith Sigel, Christopher W Wheldon, Eva Nvepu, Noelle Marie Javier, Robert Stewart, Matthew Galsky, John Sfakianos, Joshua D Safer, Richard Stock, Karyn Goodman, B R Simon Rosser, Kathryn E Flynn, Deborah C Marshall","doi":"10.1016/j.ijrobp.2025.01.023","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.01.023","url":null,"abstract":"<p><strong>Purpose/objectives: </strong>To characterize the effects of prostate radiation therapy on sexual health outcomes in sexual minority men (SMM), particularly those engaging in receptive anal intercourse (RAI), and compare them with heterosexual men (HET).</p><p><strong>Methods and materials: </strong>This retrospective cohort study included patients with intact prostates, ≥6 months after radiation therapy and androgen deprivation therapy (ADT), seen between June 2022 and August 2023, and sexually active with a partner in the prior 30 days. Patients self-reported sexual orientation, gender identity, sexual behaviors, and health outcomes using select items from Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction, Sexual Health Inventory for Men, and American Urological Association questionnaires. P values <.05 were considered statistically significant; mean differences (MD) ≥3 were considered clinically meaningful.</p><p><strong>Results: </strong>Of eligible participants, 39% HET (n = 57/145) and 68% SMM (n = 21/31) were sexually active with a partner in the last 30 days (P = .005); including 15 (71%) SMM engaging in RAI. Overall, 9% received brachytherapy, 46% external beam radiation therapy, 45% both; 14% received ADT. The cohort reported worse orgasm ability (3.3, P < .01), orgasm pleasure (MD: 7.2, P < .001), and sexual satisfaction (MD: 3.4, P < .001) compared with US general population normative scores for sexually active adult men. SMM were more likely to be single (72% vs 33%, P < .001) and have higher prostate-specific antigen at diagnosis than HET (P = .031). SMM engaging in RAI reported worse orgasm ability (MD: 3.5), orgasm pleasure (MD: 6.3, P < .05), and anal discomfort (MD: 9.0) compared with norms. For SMM engaging in RAI, brachytherapy with/without external beam radiation therapy was associated with worse orgasm pleasure (MD: 3.1), yet less anal pain (MD: 5.2) compared with external beam radiation therapy alone; the addition of ADT was associated with worse orgasm ability (MD: 14.1, P < .05), orgasm pleasure (MD: 10.7, P < .05), anal pain (MD: 6.8), and sexual satisfaction (MD: 6.1).</p><p><strong>Conclusions: </strong>Prostate cancer treatments uniquely affect sexual health in SMM, particularly those engaging in RAI. Clinicians should inquire about sexual orientation, gender identity, and sexual behaviors when discussing treatments to align care with individual preferences.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585675","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 Importance of Multi-parametric MRI, PET/CT, and Biopsy for Identifying and Delineating the Extent of Intraprostatic Radiorecurrent Prostate Cancer: A Secondary Analysis of the F-SHARP Clinical Trial.","authors":"Bhanu Prasad Venkatesulu, William Adams, Rebecca Joel, Dylan Ross, Ryan Yoo, Carly Quick, Kristin G Baldea, Guliz Barkan, Alec Block, Davide Bova, Ahmer Farooq, Aurelie Garant, Gopal Gupta, Steven M Shea, Timothy N Showalter, William Small, James S Welsh, Matthew M Harkenrider, Abhishek A Solanki","doi":"10.1016/j.ijrobp.2025.02.042","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.042","url":null,"abstract":"<p><strong>Background: </strong>Up to 50% of clinical recurrences after curative-intent prostate cancer radiation are intraprostatic radiorecurrences (IPRR). Salvage local therapy (SLT) is increasingly offered, particularly as focal SLT, to reduce toxicity due to prior radiation. Limited data exist on the relative value of MRI, PET/CT, and biopsy on SLT target delineation.</p><p><strong>Objective: </strong>Compare MRI, PET/CT, and biopsy in patients with IPRR and the impact each modality has on identifying IPRR and defining the extent of prostatic involvement.</p><p><strong>Design, setting, and participants: </strong>Secondary analysis of 62 patients enrolled in phase I/II clinical trial of salvage high-dose-rate brachytherapy.</p><p><strong>Outcome measurements and statistical analysis: </strong>The IPRR was delineated using each imaging modality and by defining the involved regions of the prostate on biopsy. The exact binomial distribution was used to estimate the sensitivity of MRI and PET/CT to detect IPRR. Exact conditional logistic regression was used to compare the tumor identified by MRI and PET/CT with the areas of biopsy involvement (gold standard) and estimate the proportion of patients with prostatic involvement outside of the image-defined targets.</p><p><strong>Results and limitations: </strong>The sensitivity for detecting the IPRR was 91.8% for MRI and 85.5% for PET/CT. Most patients had biopsy-proven cancer outside of the MRI-defined (70.5%) and PET/CT-defined target (73.8%). Delineating the brachytherapy target using imaging only would have missed the full extent of recurrence in 63.9%.</p><p><strong>Conclusion: </strong>Although MRI and PET/CT are valuable, a thorough biopsy is a mandatory tool to avoid missing areas of imaging-occult prostatic involvement when delivering focal SLT.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585698","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 Different Mediastinal Staging Modalities on Target Volume Delineation in Locally Advanced Non-Small Cell Lung Cancer: A Secondary Analysis of the Multicenter Randomized PET-Plan Trial.","authors":"Andreas Rimner, Cas Stefaan Dejonckheere, Jörg Sahlmann, Simeon Ari Barth, Tanja Schimek-Jasch, Sonja Adebahr, Markus Hecht, Cornelius F Waller, Severin Schmid, Daiana Stolz, Matthias Miederer, Alexander Brose, Harald Binder, Jochem König, Anca-Ligia Grosu, Ursula Nestle, Eleni Gkika","doi":"10.1016/j.ijrobp.2025.02.041","DOIUrl":"10.1016/j.ijrobp.2025.02.041","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the role of different invasive and noninvasive mediastinal staging methods in patients with locally advanced non-small cell lung cancer treated with definitive chemoradiation therapy in the prospective PET-Plan trial (ARO-2009-09; NCT00697333) and to evaluate the impact of endobronchial ultrasound-guided transbronchial needle aspiration and mediastinoscopy on target volume definition.</p><p><strong>Methods and materials: </strong>Patients treated per protocol (n = 172), all receiving isotoxically dose-escalated chemoradiation therapy, were included in this unplanned secondary analysis. Radiation treatment planning was based on an ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) targeting all CT-positive lymph nodes (ie, short-axis diameter > 10 mm), even if PET-negative, plus elective nodal irradiation (arm A) or targeting only PET-positive nodes (arm B). The concordance rate between different staging modalities and their impact on target volume delineation was calculated.</p><p><strong>Results: </strong>The median follow-up time (95% confidence interval) was 41.1 (33.8-50.4) months. A total of 2752 lymph node stations were evaluated noninvasively, whereas 330 were examined invasively. Of 172 patients, 87 (50.6%) underwent ≥1 invasive staging modality. The number of different staging procedures per patient did not correlate with any of the primary endpoints (overall survival, progression-free survival, or freedom from local progression). The sensitivity of ¹⁸F-FDG PET/CT was 89.7% (78/87) and the specificity was 67.5% (112/166) based on histology as assessed by endobronchial ultrasound. When using the results from mediastinoscopy, the sensitivity of PET was 82.6% (19/23) and the specificity was 66.7% (36/54). On the basis of invasive staging methods, 13 lymph node stations in 9 patients (10.3%) were PET-negative while positive on invasive staging, thus leading to a significant adjustment in the target volume.</p><p><strong>Conclusions: </strong>In this unplanned secondary analysis of the PET-Plan trial, the additional use of invasive staging resulted in relevant changes to the target volume in a tenth of patients. Invasive staging did not, however, have an effect on outcome in this trial, with a low rate of isolated out-of-field recurrences (6 in arm A vs 3 in arm B). Radiation treatment planning can thus be based on invasive staging in addition to noninvasive PET in patients undergoing definitive chemoradiation therapy for locally advanced non-small cell lung cancer. Prospective randomized data are required to confirm these findings.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585656","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}