International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Changes in Employment and Practice Locations Among Radiation Oncologists: 2015-2023.","authors":"Sifan Grace Lu, Kunal K Sindhu, Jared P Rowley","doi":"10.1016/j.ijrobp.2025.02.036","DOIUrl":"10.1016/j.ijrobp.2025.02.036","url":null,"abstract":"<p><strong>Purpose: </strong>Previous population-based studies of practice patterns among radiation oncologists (ROs) have focused on the overall supply of ROs rather than rates of job entry, turnover, and retirement, and have been limited to survey-based data. In this study, we aimed to examine trends in practice consolidation, characterize the frequency with which ROs have been entering and leaving the workforce, and quantify the proportion of ROs who have changed jobs.</p><p><strong>Methods and materials: </strong>We used the Medicare Doctors and Clinicians National Downloadable File to evaluate the employers and practice locations of ROs who practiced between 2015 and 2023. Employers were identified using tax identification numbers and organization names. In addition, we determined the number of ROs who entered, stayed in, and left practice from year to year, and the number of ROs who changed employers and zip code. Solo and large practices were defined as employing 1 RO and ≥10 ROs, respectively.</p><p><strong>Results: </strong>The number of large practices increased by 51% and the number of solo practices decreased by 27% between 2015 and 2023, resulting in a 13% decrease in the number of organizations that employed ROs. In addition, ROs retired (2.5% per year) and entered the workforce (4.1% per year) at steady rates, resulting in a 16% increase in the size of the RO workforce. Lastly, ROs changed jobs at a mean annual rate of 4.2%; female ROs, early career physicians, solo-practitioners, and ROs from rural practices were most likely to undergo job changes.</p><p><strong>Conclusions: </strong>ROs are increasingly working in fewer and larger practices, indicative of a trend in practice size consolidation between 2015 and 2023. Rates of entry into and retirement from the workforce among ROs have been consistent, resulting in a steady and gradual increase in the number of practicing radiation oncologists. Lastly, ROs changed jobs at relatively consistent rates over the study period.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572825","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":"Toward the Use of Implanted Cardiac Leads or the Diaphragm for Active Respiratory Motion Management in Stereotactic Arrhythmia Radioablation.","authors":"Jakob Marshall, Alanah Bergman, Tania Karan, Marc W Deyell, Devin Schellenberg, Steven Thomas","doi":"10.1016/j.ijrobp.2025.02.035","DOIUrl":"10.1016/j.ijrobp.2025.02.035","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the utility of implanted cardiac leads or the diaphragm for active respiratory motion management in stereotactic arrhythmia radioablation by quantifying the relationship between their motions.</p><p><strong>Methods and materials: </strong>Seven patients treated with stereotactic arrhythmia radioablation were imaged using 5-Hz biplanar, kV x-ray fluoroscopy for 15-20 seconds under both abdominal compression (AC) and free breathing (FB) conditions. Three-dimensional motion traces for different regions of the heart were acquired by tracking and triangulating the position of all implanted cardiac leads. The heart's respiratory motion was extracted from the total motion (respiratory + cardiac) using a low-pass filter and described in optimized coordinates using principal component analysis. The existence of a relationship between the respiratory motion of different cardiac leads or the diaphragm was quantified using the Spearman rank correlation coefficient. Polynomial correlation models relating PC1 cardiac lead motion to the diaphragm were created and evaluated on the resultant errors.</p><p><strong>Results: </strong>Eighty-one respiratory motion correlations between different positions of the heart or diaphragm were calculated under both AC and FB. Consistently strong correlations between the respiratory motion of different positions in the heart and the diaphragm required accounting for phase shifts between motions. When accounting for phase shifts, the proportion of strong (>0.7) PC1 respiratory motion correlations was 100% under FB and 92.6% under AC. Linear fitting of cardiac lead motion with the diaphragm resulted in mean absolute PC1 tracking errors of (1.0 ± 0.6) mm under FB and (0.7 ± 0.4) mm under AC.</p><p><strong>Conclusions: </strong>The respiratory motion of all combinations of implanted cardiac leads and the diaphragm are moderately to strongly correlated after accounting for phase shifts between motion traces. These phase shifts should be carefully considered to ensure patient safety during respiratory tracking or gating during stereotactic arrhythmia radioablation using cardiac leads or the diaphragm as internal surrogates.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566569","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":"Moving from the background towards the spotlight: A critical review of radiation therapy for locally advanced pancreas cancer.","authors":"Michael D Chuong, Jonathan Ashman, Krishan Jethwa, Jordan Kharofa, Eugene Koay, Ethan Ludmir, Eric Miller, Bailey Nelson, Marsha Reyngold, Nina Sanford, Daniel Chang","doi":"10.1016/j.ijrobp.2025.02.022","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.02.022","url":null,"abstract":"<p><p>Radiation therapy for locally advanced pancreatic cancer (LAPC) continues to be controversial. Advances in both systemic therapy and radiation therapy techniques have changed the landscape of LAPC management in recent years. Clinical outcomes of ablative radiation therapy have been encouraging and randomized clinical trials may clarify the role of radiation therapy for LAPC. We present a contemporary critical review of key aspects regarding optimal patient selection, radiation dose escalation techniques, novel radiosensitizers and radioprotectors, and treatment response assessment for LAPC.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541948","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 Pilot Study of Computed Tomography Simulator Downtime at an African Cancer Conference: Survey Results From AORTIC 2023.","authors":"Michael P Dykstra, Tucker J Netherton, Nwamaka N Lasebikan, Diane A Ndoli, Solomon Kibudde, Bello A Mohammed, Peter Balter, Adam D Melancon, Donald Roberts, Jeniffer L Shah, Julianna Coleman, Mercy N Kitonyi, Abba Mallum, Graeme L Lazarus, Angela K Waweru, William Shaw, Sarah T Hawley, Lauren P Wallner, Laurence E Court","doi":"10.1016/j.ijrobp.2025.02.019","DOIUrl":"10.1016/j.ijrobp.2025.02.019","url":null,"abstract":"<p><strong>Purpose: </strong>Computed tomography (CT) simulation is required for centers performing 3-dimensional conformal radiation therapy and intensity modulated radiation therapy. Therefore, CT simulator downtime is likely to lead to delays in patient care. We sought to characterize CT simulator downtime within the African context.</p><p><strong>Methods and materials: </strong>A pilot clinician survey was developed to evaluate CT simulator downtime frequency, causes, and workflow impact over the last year. It was distributed to African Organization for Research and Training in Cancer Conference attendees in November 2023 and through radiation therapy networks on the African continent. Descriptive statistics were used to summarize data.</p><p><strong>Results: </strong>Responses were obtained for 22 CT scanners in 16 centers across 9 African countries. Nigeria (n = 6) and South Africa (n = 3) had the most centers represented. Most centers (n = 10, 63%) had a single CT scanner capable of simulation, 5 (31%) had 2, and 1 (6%) had 3 scanners. For the 19 CT simulators with downtime information available, 11 (58%) were down for at least 15 days in the last year. Median downtime per episode was 3.5 days (IQR, 1-9.75 days). Three CT simulators were down all year, 2 of which were the only CT simulator at their respective centers. CT simulators were down because of intrinsic causes for median 8 days (IQR, 3-37.5 days) and extrinsic causes for median 1 day (IQR, 0-7.5 days). Most machines (n = 17, 77%) were under an active maintenance contract. Most centers (n = 11, 69%) lacked access to an alternate CT scanner for simulation during downtime, whereas 3 (19%) maintained normal workflow.</p><p><strong>Conclusions: </strong>CT simulator downtime is highly variable across the African continent and can cause significant disruptions in radiation therapy treatment at some centers. Intrinsic causes led to most downtime. These results suggest reducing CT simulator downtime frequency and duration or implementing simulation-free workflows may decrease patient delays.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530985","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":"Regional Near-Surface Dose Predicts Moist Desquamation and Implant Failure in Patients Receiving Radiation Therapy for Breast Cancer.","authors":"Kamran Salari, Joseph S Lee, Derek A Mumaw, Muayad F Almahariq, Thomas J Quinn, Alicia Bui, Veronica Abbott, Julie Kroetsch, Joshua T Dilworth","doi":"10.1016/j.ijrobp.2025.02.010","DOIUrl":"10.1016/j.ijrobp.2025.02.010","url":null,"abstract":"<p><strong>Purpose: </strong>We correlated regional near-surface dose with toxic effects and implant complications in patients receiving breast or chest wall irradiation. We also compared toxic effects and implant complications between patients receiving photon or proton irradiation with prospective near-surface dose optimization.</p><p><strong>Methods and materials: </strong>Patients at a single institution who received conventionally fractionated breast or chest wall and regional nodal irradiation from 2017 to 2022 were included. Near-surface rinds (SR3, defined as the volume bound by the breast or chest wall planning target volume and 3 mm in from the skin) were generated for all patients for analysis. SR3 volumes were used prospectively during proton treatment. SR3 volumes were retrospectively subdivided into axillary SR3, nonaxillary SR3, and inframammary SR3 regions. The discrimination performance of near-surface dosimetry for skin and implant toxicity was evaluated using the area under the receiver operating curve (AUC). National Cancer Institute Common Terminology Criteria for Adverse Events toxicity was compared between patients receiving photon versus proton irradiation using the Pearson χ² test.</p><p><strong>Results: </strong>Of 223 patients, 157 and 66 received photon and proton irradiation, respectively. Axillary SR3 D2cc was the strongest dosimetric predictor of moist desquamation (AUC = 0.657, P = .007) and implant failure (AUC = 0.880, P = .017), driven by a stronger predictive ability for moist desquamation in the axillary fold (AUC = 0.728, P < .001). With axillary SR3 D2cc ≤48 Gy versus >48 Gy, rates of moist desquamation were 25.8% versus 48.5% (P < .001), respectively, and rates of implant failure were 0% versus 20% (P = .006). Rates of moist desquamation (38.2% vs 27.3%, P = .12), unplanned reconstructive surgery (35.1% vs 18.8%, P = .21), and implant failure (8.8% vs 6.3%, P > .99) were similar between patients receiving photon versus proton irradiation.</p><p><strong>Conclusions: </strong>Near-surface dose predicts moist desquamation and implant failure in patients receiving either photon or proton irradiation of the breast or chest wall. Consideration should be given to limit axillary SR3 D2cc ≤48 Gy in appropriately selected patients considered low-risk of skin involvement of cancer.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515582","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":"Boswellia Serrata for Cerebral Radiation Necrosis After Radiosurgery for Brain Metastases.","authors":"Rituraj Upadhyay, Ahmed Nader Mohammed Elguindy, Laura Salts, Kari Donovan, Soma Sengupta, Kyle Wang, Pierre Giglio, Samuel Chao, Arnab Chakravarti, Raj Singh, Sasha Beyer, Raju R Raval, Evan M Thomas, Joshua D Palmer","doi":"10.1016/j.ijrobp.2025.02.016","DOIUrl":"10.1016/j.ijrobp.2025.02.016","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation necrosis (RN) is a dose-limiting toxicity of stereotactic radiosurgery (SRS) for brain metastases. Oral corticosteroids are not optimal for long-term management, given multiple side effects. Boswellia serrata (BS) is an over-the-counter supplement traditionally known for its anti-inflammatory properties and has recently been shown to reduce cerebral edema. We evaluated the response rates of BS in a series of patients with RN after SRS for brain metastases.</p><p><strong>Methods and materials: </strong>We identified patients who developed any grade RN after SRS and received BS for ≥2 months at a target dose of 4050 to 4500 mg daily. The primary endpoint was objective response rate (ORR), including complete response (CR) or partial response (PR), defined as ≥30% decrease in edema volume on T2-fluid-attenuated inversion recovery magnetic resonance imaging from baseline.</p><p><strong>Results: </strong>A total of 100 patients received BS, of which 94 patients with adequate follow-up were included. The median SRS dose was 24 Gy in 3 fractions, and 44%, 47%, and 9% of patients had grade 1, 2, and 3 RN, respectively. The best response was CR in 12% and PR in 48%, while 28% had stable edema and 12% had progression of edema. The overall ORR was 59.6% (95% CI, 48.9%-69.6%). ORR was 62%, 63%, and 33% for grade 1, 2, and 3 RN, respectively. The median duration of response in patients with CR or PR was 13.9 months (IQR, 9-23). Among 69 patients (73%) who never received steroids, received prior steroids only, or had a stable or decreasing steroid requirement of ≤4 mg per day of dexamethasone for at least >1 week prior to starting Boswellia, the ORR was 63.8%. Fourteen percent of patients had National Cancer Institute Common Terminology Criteria for Adverse Events grade 1, and 2% had grade 2 gastrointestinal toxicity. A total of 67% of patients remained on BS at the last follow-up.</p><p><strong>Conclusions: </strong>Our study suggests that BS is a safe and feasible treatment option for grade 1 to 3 RN after SRS. Further prospective studies comparing BS with a placebo are warranted.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491943","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":"Magnetic Resonance Imaging Relaxometry for Glioblastoma Response Assessment During Radiation Therapy on a 0.35 T Magnetic Resonance Imaging Linear Accelerator.","authors":"Natalia Lutsik, Siamak P Nejad-Davarani, Alessandro Valderrama, Janette Herr, Kaylie Cullison, Danilo Maziero, Macarena I de la Fuente, Gregory J Kubicek, Jessica J Meshman, Gregory A Azzam, Tess Armstrong, Radka S Stoyanova, Eric A Mellon","doi":"10.1016/j.ijrobp.2025.02.008","DOIUrl":"10.1016/j.ijrobp.2025.02.008","url":null,"abstract":"<p><strong>Purpose: </strong>The integration of magnetic resonance imaging (MRI) and linear accelerator (MRI-Linac) enables daily imaging during radiation therapy (RT). This study implements MRI-Linac relaxometry to evaluate quantitative imaging changes in patients with glioblastoma during RT and identify associations with disease progression and survival outcomes.</p><p><strong>Methods and materials: </strong>Thirty-eight patients with glioblastoma were treated on a 0.35 T MRI-Linac with Strategically Acquired Gradient Echo and T2 multiecho acquisitions every other day. Per voxel changes in tumor T2, T2*, and T1 values were assessed by parametric response mapping comparing each treatment fraction with pre-RT baselines. Statistical analyses included the Wilcoxon test for group comparisons and Cox proportional hazards models for survival associations.</p><p><strong>Results: </strong>Progressors had higher proportions of voxels with increased T2 values at week 2 (49% vs 40%, P = .008) and week 6 (58% vs 43%, P = .012) and higher T2* values at week 1 (47% vs 43%, P = .016), week 2 (48% vs 43%, P = .016), week 3 (50% vs 44%, P = .012), and the final week (53% vs 43%, P = .021). Cox modeling linked increased T2 values at week 4 with overall survival (hazard ratio [HR], 4.72; 95% CI, 1.24-12.9) and progression-free survival (HR, 9.26; 95% CI, 1.88-24.5). Increased T2* values at weeks 2 and 3 correlated with progression-free survival (HR, 5.02; 95% CI, 1.44-17.6; HR, 6.04; 95% CI, 1.59-22.9) and overall survival at week 3 (HR, 3.09; 95% CI, 0.94-10.1).</p><p><strong>Conclusions: </strong>Quantitative changes in T2 and T2* values during RT, particularly in weeks 3 to 4, were associated with progression and survival outcomes. Early detection of poor responders may enable therapy adaptation, improving glioblastoma treatment outcomes.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491950","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":"Development and Validation of a Prediction Model for Cardiac Events in Patients With Hepatocellular Carcinoma Undergoing Stereotactic Body Radiation Therapy.","authors":"Hye In Lee, Jaeman Son, Byungchul Cho, Youngmoon Goh, Jinhong Jung, Jin-Hong Park, Eui Kyu Chie, Kyung Su Kim, Young-Hak Kim, Hyun-Cheol Kang, Sang Min Yoon","doi":"10.1016/j.ijrobp.2025.02.013","DOIUrl":"10.1016/j.ijrobp.2025.02.013","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate a prediction model for major adverse cardiac events (MACEs) in hepatocellular carcinoma patients treated with stereotactic body radiation therapy (SBRT).</p><p><strong>Methods and materials: </strong>We retrospectively identified 1893 hepatocellular carcinoma patients who received SBRT at 2 institutions, with one serving as the development cohort (n = 1473) and the other as the validation cohort (n = 420). A MACE was defined as any cardiac event classified as grade 3 or higher according to the Common Terminology Criteria for Adverse Events, version 5.0. We evaluated 15 clinical and 88 dosimetric parameters using bootstrapped forward selection and area under the curve (AUC) to identify significant predictors for MACEs. Based on these factors, we constructed the Cardiac Event Index (CEI) model, categorizing patients into distinct risk groups. Model performance was assessed for discrimination, efficiency, and calibration.</p><p><strong>Results: </strong>The MACE occurrence rate was 5.8% in the development cohort and 6.7% in the validation cohort. Five parameters were selected for predicting MACEs and were incorporated into the CEI model using the following equation: CEI = age score + hypertension + current smoking + (2 × history of cardiac disease) + (0.05 × heart-V5 [%]), which yielded an AUC of 0.770 for MACEs and 0.750 for coronary artery disease. The CEI model stratified patients into low-, intermediate-, and high-risk groups that had MACE incidence rates of 0.4%, 4.9%, and 22.8%, respectively. The impact of heart-V5 on MACEs was minimal in low- and intermediate-risk groups but pronounced in the high-risk group. In the validation cohort, the CEI model yielded an AUC of 0.809 for MACEs and 0.793 for coronary artery disease.</p><p><strong>Conclusions: </strong>The CEI model demonstrated robust performance in predicting MACEs, revealing the significant influence of clinical factors and the minimal impact of SBRT. This model can inform evidence-based decisions regarding cardiac dose optimization in SBRT planning.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Update of a Phase 2 Study of Dose-Reduced Radiation in Diffuse Large B-Cell Lymphoma.","authors":"Christina C Huang, Zihan Wan, Donna Niedzwiecki, Leonard R Prosnitz, Anne W Beaven, Chris R Kelsey","doi":"10.1016/j.ijrobp.2025.02.009","DOIUrl":"10.1016/j.ijrobp.2025.02.009","url":null,"abstract":"<p><strong>Purpose: </strong>Consolidation radiation therapy (RT) is often recommended in diffuse large B-cell lymphoma. The current recommended dose of 30 Gy was established in the pre-rituximab and PET-CT era. We hypothesized that following a complete response to modern systemic therapy, as determined by PET-CT, a lower dose of RT would be equally effective.</p><p><strong>Methods and materials: </strong>Patients with diffuse large B-cell lymphoma or primary mediastinal B-cell lymphoma achieving a complete response by PET-CT (Deauville score 1-3) after ≥4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone or rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin were eligible. Consolidation RT dose was 19.5-20 Gy. The primary endpoint of the original study was 5-year freedom from local recurrence.</p><p><strong>Results: </strong>From 2010 to 2016, 62 patients were enrolled. The stage distribution was as follows: I-II (n = 49, 79%) and III-IV (n = 13, 21%). Bulky disease (≥7.5 cm) was present in 24 patients (39%). Most (n = 58, 94%) received rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone. Four cycles were administered to 34% of patients, whereas 66% received 5-6 cycles. A median follow-up was 9 years. Overall, 1 patient experienced local recurrence with freedom from local recurrence of 98% at both 5 and 10 years (95% CI, 88%-99%). Seven patients progressed outside of the RT field. Progression-free survival and overall survival at 10 years were 77% (95% CI, 62%-87%) and 80% (95% CI, 64%-89%), respectively.</p><p><strong>Conclusions: </strong>Long-term results of this phase 2 study, with a median follow-up of 9 years, did not demonstrate late local failures when patients received ∼20 Gy consolidation RT. A larger (n = 240) confirmatory study from the International Lymphoma Radiation Oncology Group evaluating ∼20 Gy of RT after ≥3 cycles of chemoimmunotherapy completed accrual in 2023.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491949","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":"Preoperative Single Fraction Stereotactic Partial Breast Irradiation for Early-Stage Breast Cancer Patients With GammaPod Technology: Pathologic Findings and Ki-67 Evaluation.","authors":"Chiara Reverberi, Giuseppe Facondo, Agnese Prisco, Tino Ceschia, Eugenia Moretti, Paolo Scalchi, Enrico Pegolo, Maria Orsaria, Chiara Zuiani, Luca Seriau, Serena Bertozzi, Yvonne Beorchia, Luigi Castriotta, Carla Cedolini, Carla Di Loreto, Marco Trovò","doi":"10.1016/j.ijrobp.2025.02.012","DOIUrl":"10.1016/j.ijrobp.2025.02.012","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this phase 2 clinical study is to investigate the safety and feasibility of a single fraction stereotactic partial breast irradiation (S-PBI) for early-stage breast cancer in the preoperative setting and to evaluate tumor response to a single large radiation dose through pathologic examination and immunohistochemistry analysis of the surgical specimen.</p><p><strong>Methods and materials: </strong>This single arm, phase 2 clinical trial includes patients in postmenopausal status, over the age of 50 years, with early-stage (cT1-T2 cN0) breast cancer, luminal type, any grade, unifocal tumor, and suitable for breast conserving surgery. The gross tumor volume includes the tumor. The clinical target volume corresponds to gross tumor volume. The planning target volume is created by adding 3 mm symmetrical margins from the clinical target volume. Treatment is delivered through GammaPod technology as single fraction radiosurgery, to a total dose of 30 to 36 Gy. Surgery is performed 8 to 28 weeks after S-PBI. Pathologic response is classified as pathologic complete response (pCR), near complete response with <10% of residual disease, pathologic partial response with 10% to 90% of residual disease, or stable disease with >90% of residual disease. We further group pCR and near complete response together as \"Major Response.\"</p><p><strong>Results: </strong>From January 2022 to November 2023, 49 patients were enrolled and underwent S-PBI followed by breast conserving surgery. The rate of Major Response was 37%, including pCR in 18% of cases. The mean Ki-67 index was reduced from 9.5% pre-S-PBI to 2% post-S-PBI.</p><p><strong>Conclusions: </strong>Preoperative single fraction S-PBI appears to be associated with a promising rate of \"Major Response,\" including cases of complete response.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491952","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}