International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Constructing Surrogate Lung Ventilation Maps From 4-Dimensional Computed Tomography-Derived Subregional Respiratory Dynamics.","authors":"Yu-Hua Huang, Zihan Li, Tianyu Xiong, Zhi Chen, Bing Li, Zhaoyang Lou, Yanjing Dong, Xinzhi Teng, Zongrui Ma, Hong Ge, Ge Ren, Jing Cai","doi":"10.1016/j.ijrobp.2024.11.074","DOIUrl":"10.1016/j.ijrobp.2024.11.074","url":null,"abstract":"<p><strong>Purpose: </strong>To present a 2-stage framework that robustly extracts and maps reliable lung ventilation surrogates based on subregional respiratory dynamics (SRDs) measured from 4-dimensional computed tomography (4DCT) images, with comprehensive consideration of spatial and temporal heterogeneity in the ventilation process over the respiratory cycle.</p><p><strong>Methods and materials: </strong>We retrospectively analyzed 3 subject cohorts from the Ventilation and Medical Pulmonary Image Registration Evaluation challenge containing 4DCT and reference ventilation imaging (RefVI) scans. Lung subregions were partitioned on the 4DCT end-of-exhale base phase using anatomically constrained simple linear iterative clustering, whereas sliding-preserved interphase image registrations were performed between the base and other phases. SRDs of breathing-induced volume and intensity changes were tracked across phases utilizing the displacement fields. Voxel-level representations integrating mechanical collapsibility and physiological tissue density (V_SRD) were accordingly constructed from SRDs. Imaging performance of V_SRD as the proposed surrogate ventilation map was studied against RefVI scans and compared with classical biphasic Jacobian maps. The dosimetric performance evaluation was also conducted to assess the clinical benefits of incorporating V_SRD maps into functional lung avoidance radiation therapy (FLA-RT) planning.</p><p><strong>Results: </strong>The extracted SRD highlighted temporally varying subregional volume and computed tomography intensity changes related to underlying functional physiology and pathologies. For imaging performance, the median Spearman correlation coefficients between V_SRD and RefVI scans were 0.600, 0.582, and 0.561 for the 3 cohorts, whereas median Dice similarity coefficients against RefVI scans showing the high (low)-functioning lung regions' concordances were 0.611 (0.626), 0.592 (0.620), and 0.601 (0.611), superior to biphasic Jacobian maps for both metrics. For dosimetric performance, V_SRD-guided FLA-RT plans achieved significantly better dose sparing of high-functioning lung regions compared with FLA-RT plans based on biphasic Jacobian maps.</p><p><strong>Conclusions: </strong>V_SRD maps captured spatial and temporal heterogeneity in the ventilation process, providing improved ventilation representations compared with classical algorithms. The capability to extract multidimensional ventilation-correlated image information from widely available 4DCT images showed promise in enhancing personalized FLA-RT implementations.</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":"142647627","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":"Ten-Year Outcomes of a Phase 3, Multicenter, Randomized Controlled Trial (SHIP0804) With 3-Month Neoadjuvant Androgen Deprivation Prior to ¹²⁵I-Seed Transperineal Prostate Brachytherapy Followed by Nil Versus 9-Month Adjuvant Hormonal Therapy in Patients With Intermediate-Risk Prostate Cancer.","authors":"Wataru Fukuokaya, Kenta Miki, Manabu Aoki, Hiroyuki Takahashi, Shiro Saito, Atsunori Yorozu, Takashi Kikuchi, Takushi Dokiya, Shin Egawa","doi":"10.1016/j.ijrobp.2024.11.010","DOIUrl":"10.1016/j.ijrobp.2024.11.010","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the effects of adjuvant hormonal therapy (AHT) on time to event after neoadjuvant androgen deprivation therapy (ADT) and ¹²⁵I-transperineal prostate brachytherapy (TPPB), compared with neoadjuvant ADT and TPPB only, in patients with intermediate-risk prostate cancer (IRPC).</p><p><strong>Methods and materials: </strong>In this multicenter, open-label, phase 3 randomized controlled trial (SHIP0804), 421 patients with IRPC were randomly assigned to either 9-month AHT (AHT arm) or no AHT (non-AHT arm) after 3 months of neoadjuvant ADT and TPPB. The primary endpoint was biochemical progression-free survival, and secondary endpoints included overall survival and clinical progression-free survival. Prostatic biopsy results 36 months after treatment were evaluated in a correlative investigation (SHIP36B).</p><p><strong>Results: </strong>With a median follow-up of over 11 years, the 10-year biochemical progression-free survival rates were comparable: 82.9% in the AHT group and 78.4% in the non-AHT group (P = .51). Results were consistent across key prognostic indicators such as age at randomization, baseline prostate-specific antigen level, clinical stage, Gleason grade group, number of National Comprehensive Cancer Network intermediate-risk factors, and prostatic volume. The secondary endpoints, including overall survival and clinical progression-free survival, were also comparable between the 2 arms. Grade 3 or higher adverse events occurred in 5.4% and 1.4% of patients in the AHT and non-AHT arms, respectively. At 36-month post-TPPB prostate biopsy, only 3.1% of biopsied patients tested positive for residual tumors. There were no deaths due to prostate cancer in either group.</p><p><strong>Conclusions: </strong>Adding 9-month AHT to TPPB after 3-month neoadjuvant ADT did not improve long-term outcomes in patients with IRPC. These findings suggest that moderate-term AHT may not offer substantial benefits and thus should not be considered a standard treatment in this population with IRPC.</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":"142647576","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":"Assessment of Photon-Counting Computed Tomography for Quantitative Imaging in Radiation Therapy.","authors":"Jens Zimmerman, Gavin Poludniowski","doi":"10.1016/j.ijrobp.2024.11.069","DOIUrl":"10.1016/j.ijrobp.2024.11.069","url":null,"abstract":"<p><strong>Purpose: </strong>To test a first-generation clinical photon-counting computed tomography (PCCT) scanner's capabilities to characterize materials in an anthropomorphic head phantom for radiation therapy purposes.</p><p><strong>Methods and materials: </strong>A CIRS 731-HN head-and-neck phantom (CIRS/SunNuclear) was scanned on a NAEOTOM Alpha PCCT and a SOMATOM Definition AS+ with single-energy and dual-energy CT techniques (SECT and DECT, respectively), both scanners manufactured by Siemens (Siemens Healthineers). A method was developed to derive relative electron density (RED) and effective atomic number (EAN) from linear attenuation coefficients (LACs) of virtual mono-energetic images and applied for the PCCT and DECT data. For DECT, Siemens' syngo.via \"Rho/Z\"-algorithm was also used. Proton stopping-power ratios (SPRs) were calculated based on RED/EAN with the Bethe equation. For SECT, a stoichiometric calibration to SPR was used. Nine materials in the phantom were segmented, excluding border pixels. Distributions and root-mean-square deviations within the material regions were evaluated for LAC, RED/EAN, and SPR, respectively. Two example ray projections were also examined for LAC, SPR, and water-equivalent thickness, for illustrations of a more treatment-like scenario.</p><p><strong>Results: </strong>There was a tendency toward narrower distributions for PCCT compared with both DECT methods for the investigated quantities, observed across all materials for RED only. Likewise the scored root-mean-square deviations showed overall superiority for PCCT with a few exceptions: for water-like materials, EAN and SPR were comparable between the modalities; for titanium, the RED and SPR estimates were inferior for PCCT. The PCCT data gave the smallest deviations from theoretic along the more complex example ray profile, whereas the more standard projection showed similar results between the modalities.</p><p><strong>Conclusions: </strong>This study shows promising results for tissue characterization in a human-like geometry for radiation therapy purposes using PCCT. The significance of improvements for clinical practice remains to be demonstrated.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643968","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 Myc-Altered Pathology on Radiation Therapy Efficacy Among Patients With Relapsed/Refractory Large-B Cell Lymphoma: A Collaborative Study by ILROG.","authors":"Yolanda D Tseng, Phil Stevenson, Bachviet Nguyen, Davey C Li, Daniel Y Lee, Ima Paydar, Justyn Nakashima, Alex Balogh, Revathi Ravella, Andrew B Barbour, Carl Post, Hazim Ababneh, Chelsea C Pinnix, Leslie K Ballas, Michael S Binkley, Katerina Dedeckova, Richard T Hoppe, Chirayu Patel, Nima Nabavizadeh, Christopher R Kelsey, Kiran A Kumar, Daniel Landsburg, Nicholas B Figura, Andrea C Lo, John P Plastaras","doi":"10.1016/j.ijrobp.2024.11.072","DOIUrl":"10.1016/j.ijrobp.2024.11.072","url":null,"abstract":"<p><strong>Purpose: </strong>The presence of MYC and BCL2 translocations (ie, double-hit lymphoma, DHL) in large B-cell lymphoma (LBCL) is associated with reduced chemosensitivity, but less is known on its impact on radiotherapy (RT) efficacy.</p><p><strong>Methods and materials: </strong>Patients with LBCL who received their first course of RT for relapsed/refractory disease between 2008 and 2020 were eligible if there was adequate pathologic evaluation to be categorized as DHL versus non-DHL as per the World Health Organization (fifth edition). Separate analyses were conducted by treatment intent. Predictors for response (complete and partial) and local recurrence (LR) were evaluated using Cox regression analysis. LR analysis was restricted to curative-intent patients to ensure adequate follow-up.</p><p><strong>Results: </strong>Three hundred and eighty-three patients (102 DHL, 281 non-DHL, and 44% curative) were treated at 447 sites. Median time from diagnosis to RT was 11.6 months, with 38.7% of patients having primary chemorefractory disease, 37.4% having received >2 lines of systemic therapy, and 24% status post-stem cell transplant. Median biological equivalent dose (alpha/beta: 10) was 28 Gy (range: 3.2-60.0) for palliative and 46.9 Gy (range: 6.4-84.0) for curative-intent patients. With a median follow-up of 41.1 and 41.5 months among curative and palliative patients, respectively, the response was high (81.1% curative, 60.1% palliative). On univariate analysis, DHL pathology was not associated with RT response in either curative or palliative patients. Among curative patients, 2-year LR rate was 38.8%. On multivariable analysis, DHL pathology was associated with a 2 times higher risk of LR (95% CI: 1.05-3.67, P = .03), with a crude LR rate of 42.9% (DHL) versus 28.9% (non-DHL). RT was well tolerated with low rates of grade 3 or higher acute toxicity (1.8% curative, 2.9% palliative).</p><p><strong>Conclusions: </strong>Relapsed/refractory LBCL remains radioresponsive with a 60%-80% response rate to RT. Although DHL pathology does not appear to influence RT response, its presence is associated with higher rates of LR, suggesting that it may be more radioresistant.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton FLASH Irradiation Using a Synchrotron Accelerator: Differences by Irradiation Positions.","authors":"Hiromitsu Iwata, Toshiyuki Toshito, Chihiro Omachi, Masumi Umezawa, Masashi Yamada, Kenichiro Tanaka, Koichiro Nakajima, Yusuke Tsuzuki, Kazuhisa Matsumoto, Tatsuya Kawai, Yasuhiro Shibata, Shinya Ugawa, Hiroyuki Ogino, Akio Hiwatashi","doi":"10.1016/j.ijrobp.2024.11.066","DOIUrl":"10.1016/j.ijrobp.2024.11.066","url":null,"abstract":"<p><strong>Purpose: </strong>To establish an ultra-high dose-rate (UHDR) radiation system using a synchrotron proton beam accelerator and to compare the effects by irradiation positions on cultured cells and chick embryos.</p><p><strong>Methods and materials: </strong>Protons for UHDR were obtained by applying high-frequency power at much higher levels than usual to extract all protons within approximately 50 ms. Subsequently, monitoring with a Faraday cup was performed immediately after synchrotron extraction and the waveform was adjusted accordingly. Four cultured tumor lines, 2 normal cell lines, and chick embryos were used. UHDR radiation therapy (UHDR-RT) at 6 to 18 Gy (200-300 Gy/s, single exposure) and conventional dose-rate radiation therapy (Conv-RT) at 6 to 18 Gy (3 Gy/s) were administered to the 1-cm spread-out Bragg peak (SOBP) and the plateau region preceding SOBP. After irradiation, disparities in cell growth rates and cell cycle progression were assessed, and cell survival was evaluated via colony assay. Chick embryos were also examined for survival.</p><p><strong>Results: </strong>UHDR-RT was achieved at a range of 40 to 800 Gy/s, encompassing both plateau and peak phases. In vitro studies demonstrated similar cell-killing effects between UHDR-RT and Conv-RT in cancer cells. Significant apoptotic effects and G2 arrest were observed during the cell cycle under peak UHDR-RT conditions. The FLASH effect was not observed in normal single cells under normal atmospheric conditions. Stronger cell-killing effects were noted in V79 spheroids exposed to peak UHDR-RT than peak Conv-RT. Moreover, in chick embryos, an increase in survival rate, indicative of the FLASH effect, was observed.</p><p><strong>Conclusions: </strong>The FLASH effect was also achieved with UHDR-RT using a synchrotron proton beam accelerator in chick embryos. The cell-killing effects in cancer cells were higher with peak UHDR-RT that may be due to the higher linear energy transfer at the SOBP.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644015","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":"Outcomes After Palliative Radiation Therapy in Patients With Symptomatic Locoregionally Advanced Breast Cancer.","authors":"Luisa E Jacomina, David M Swanson, Melissa P Mitchell, Wendy A Woodward, Benjamin D Smith, Karen E Hoffman, Chelain R Goodman, Haven R Garber, Susie X Sun, Timothy A Yap, Funda Meric-Bernstam, Isidora Y Arzu, Elizabeth S Bloom, Pamela J Schlembach, Eric A Strom, Michael C Stauder, Simona F Shaitelman","doi":"10.1016/j.ijrobp.2024.11.065","DOIUrl":"10.1016/j.ijrobp.2024.11.065","url":null,"abstract":"<p><strong>Purpose: </strong>Symptomatic locoregionally advanced breast cancer (SLABC) can cause troublesome pain or wound complications that negatively impact quality of life. Although palliative radiation therapy (RT) can minimize tumor-related symptoms, how best to tailor RT to achieve the most meaningful and durable response is not well defined.</p><p><strong>Methods and materials: </strong>This is a single institution, multi-site retrospective review of patients with SLABC treated between 2016 and 2023 with palliative RT to symptomatic disease in the breast, chest wall, and/or regional lymph node basins. Overall survival (OS), locoregional control (LC), clinical and radiographic treatment response, overall pain scores, and treatment-related toxicities were analyzed.</p><p><strong>Results: </strong>A total of 164 patients with a median age of 57 years were analyzed with a median follow-up time of 4.97 months. In total, 86% had distant metastases. The most common presenting symptom was pain (87%), followed by ulcerating or fungating lesion (76%) and discharge (45%). The median cumulative biologically effective dose to the gross tumor volume (BED_GTV) was 69 Gy. The 1-year OS and LC rates were 37% and 63%, respectively. Eighty-one percent experienced improvement in symptoms within 3 months after RT, the odds of which increased per Gy BED_GTV (odds ratio, 1.029; P = .003). Acute toxicities were associated with number of fractions and BED_GTV (both P < .001), but not with concurrent systemic therapy or reirradiation (both P > .05). Trends in pain scores showed a significant change in pain trajectory that was sustained during the first year after RT. OS and LC were not different among patients who received 1 versus 2 to 10 versus >10 fractions, and between ≤70 and >70 Gy BED_GTV.</p><p><strong>Conclusions: </strong>In this large series of patients with SLABC, palliative RT was effective at relieving locoregional symptoms with acceptable toxicity, with the likelihood of symptom improvement associated with radiation dose. Survival of these patients remains poor, highlighting the importance of palliative care strategies that minimize overall symptom burden while maximizing quality of life.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644012","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":"Significant Influence of Cardiac Radiation Dose on the Risk of Cardiotoxicity in Patients Receiving Adjuvant Trastuzumab and Radiation Therapy for Breast Cancer.","authors":"Tae Hoon Lee, Nalee Kim, Eun Kyoung Kim, Jin Seok Ahn, Yeon Hee Park, Seok Won Kim, Jeong Eon Lee, Jonghan Yu, Byung Joo Chae, Se Kyung Lee, Won Kyung Cho, Won Park, Tae Gyu Kim, Jee Suk Chang, Haeyoung Kim","doi":"10.1016/j.ijrobp.2024.11.009","DOIUrl":"10.1016/j.ijrobp.2024.11.009","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to analyze the incidence of cancer therapy-related cardiovascular toxicity (CTRCVT) and identify the radiation dosimetric and clinical risk factors for these events in patients with human epidermal growth factor receptor 2-positive breast cancer.</p><p><strong>Methods and materials: </strong>Data from 1378 patients who were treated with curative surgery and adjuvant trastuzumab for breast cancer were retrospectively analyzed. A total of 959 patients underwent postoperative radiation therapy (RT), whereas 419 patients were managed without RT (no-RT). CTRCVT were categorized according to the time of occurrence in relation to trastuzumab as follows: during trastuzumab cycles (CTRCVT-during T) or after completing trastuzumab (CTRCVT-after T). The cardiac radiation dose was extracted from the RT plan of each individual patient. The incidence of and contributing factors for CTRCVT-during T and -after T were evaluated.</p><p><strong>Results: </strong>After a median follow-up of 95.8 months (range, 4.3-181.1 months), 69 patients (5.0%) had experienced CTRCVT. CTRCVT-during T was detected in 41 patients (3.0%), and the 8-year rate of CTRCVT-after T was 2.2%. Of the patients developing CTRCVT-during T, 27 (2.0%) discontinued trastuzumab. The cardiac radiation doses were significantly associated with the risk of both CTRCVT-during T (odds ratio, 1.087; P = .001) and -after T (hazard ratio, 1.177; P < .001). The 8-year rates of CTRCVT-after T were not significantly different between the no-RT and RT groups (2.0% vs 2.4%, P = .956). However, the rate was significantly higher in patients with heart V_25Gy ≥3% compared with those with heart V_25Gy <3% (5.7% vs 1.5%, P = .019). Patients who received <17 cycles of trastuzumab had worse oncological outcomes than those who received ≥17 cycles.</p><p><strong>Conclusions: </strong>Both CTRCVT-during T and -after T were associated with the cardiac radiation dose. Therefore, evaluation of the cardiac radiation dose is necessary to prevent early termination of trastuzumab treatment, which could lead to worse outcomes.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644024","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":"Honing Locoregional Therapy for Breast Cancer: Refinement of Surgical and Radiotherapeutic Management","authors":"Pierre Loap MD ,&nbsp;Youlia Kirova MD ,&nbsp;Lior Z. Braunstein MD","doi":"10.1016/j.ijrobp.2024.09.004","DOIUrl":"10.1016/j.ijrobp.2024.09.004","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":"120 5","pages":"Pages 1199-1204"},"PeriodicalIF":6.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644035","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 1 Study of Adjuvant Allogeneic Granulocyte-Macrophage Colony-Stimulating Factor-Transduced Pancreatic Tumor Cell Vaccine, Low-Dose Cyclophosphamide, and Stereotactic Body Radiation Therapy Followed by FOLFIRINOX in High-Risk Resected Pancreatic Ductal Adenocarcinoma.","authors":"Colin S Hill, Rose Parkinson, Elizabeth M Jaffee, Elizabeth Sugar, Lei Zheng, Beth Onners, Matthew J Weiss, Christopher L Wolfgang, John L Cameron, Timothy M Pawlik, Lauren Rosati, Dung T Le, Amy Hacker-Prietz, Eric R Lutz, Richard Schulick, Amol K Narang, Daniel A Laheru, Joseph M Herman","doi":"10.1016/j.ijrobp.2024.10.039","DOIUrl":"10.1016/j.ijrobp.2024.10.039","url":null,"abstract":"<p><strong>Purpose: </strong>Local and distant progression remains common following resection of resectable pancreatic ductal adenocarcinoma (PDAC) despite adjuvant multiagent chemotherapy. We report a prospective institutional phase 1 trial incorporating adjuvant GVAX vaccine, low-dose cyclophosphamide (Cy), and stereotactic body radiation therapy (SBRT) followed by FOLFIRINOX (FFX) among patients who underwent resection of high-risk PDAC.</p><p><strong>Patients and methods: </strong>The study design was a modified 3+3. Cohort 1 received 5-fraction SBRT to 33 Gy to the tumor bed and 25 Gy to elective nodes followed by 6 cycles of full-dose FFX. After toxicity review, cohort 2 had SBRT and was switched to modified FFX (mFFX). Cohort 3 had 1 cycle of Cy/GVAX followed by SBRT, mFFX, and 4 cycles of maintenance Cy/GVAX with 6-month Cy/GVAX boosts until progression.</p><p><strong>Results: </strong>Nineteen patients were enrolled with a median follow-up of 36.2 months. To be eligible, patients were required to have close/positive margins (within ≤1 mm) (71%) and/or lymph node metastasis (79%). Overall, 63% of patients had both. In cohort 1, 67% of patients received 6 cycles of FFX; in cohort 2, 75% received 6 cycles of modified FFX. In cohort 3, 12 patients received the first dose of Cy/GVAX and SBRT with 10 individuals (83%) receiving 6 cycles of mFFX. Cohort 3 had acceptable levels of grade ≥3 thrombocytopenia, neutropenia, and diarrhea after 2 cycles of mFFX. Median overall survival (OS)/disease-free survival (DFS) for the overall cohort and cohort 3 was 36.2/18.2 months and 61.3/24.1 months, respectively. One- and 2-year OS for cohort 3 was 83%/75%, respectively. At the last follow-up (median = x), 5 patients were alive (42%) in cohort 3.</p><p><strong>Conclusions: </strong>This is the first prospective trial to evaluate adjuvant GVAX, Cy, SBRT, and mFFX in resected PDAC patients with high-risk features. This combination regimen was well tolerated with limited toxicity and promising survival outcomes, warranting future studies to validate this regimen in the adjuvant setting.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638956","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":"Real-World Pattern-of-Care Analysis of Primary Cutaneous Lymphomas Radiation Therapy Among European Organisation for Research and Treatment of Cancer Members.","authors":"Khaled Elsayad, Emmanuella Guenova, Beatrice Fournier, Carolina Fernandes, Enrico Clementel, Evangelia Papadavid, Marie Beylot Barry, Felix Pavlotsky, Chalid Assaf, Pablo L Ortiz-Romero, Vassilis Kouloulias, Adele de Masson, Stephane Dalle, Pierre Clavère, Max Schlaak, Nina Booken, Marion Wobser, Christina Mitteldorf, Barzilai Aviv, Virgínia Mareco, Fernando Gallardo, Reinhard Dummer, Markus Gross, Felix Ehret, Andrea Lancia, Bartłomiej Tomasik, Lorna Hawley, Vincent Rermouchamps, Mona Abdel-Halim Ibrahim, Ahmed Gawish, Mohamed Abouegylah, Martin Stuschke, Adinda Baten, Hans Theodor Eich, Lena Specht, Mario Levis, Stephen Morris, Belinda Campbell, Jan P Nicolay, Richard Cowan, Dora Correia","doi":"10.1016/j.ijrobp.2024.11.011","DOIUrl":"10.1016/j.ijrobp.2024.11.011","url":null,"abstract":"<p><strong>Purpose: </strong>We aim to determine the current treatment patterns and recommendations among physicians for cutaneous lymphomas and to identify the types of skin lymphomas for which existing radiation regimens need improvement.</p><p><strong>Methods and materials: </strong>A questionnaire from the European Organisation for Research and Treatment of Cancer was distributed to all members of the Cutaneous Lymphoma Tumour Group and Radiation Oncology Scientific Council. This online survey included 13 questions regarding treatment practices for patients with cutaneous lymphoma. The survey was conducted from August 21 to December 18, 2023. Frequency distributions and subgroup comparisons were calculated and analyzed.</p><p><strong>Results: </strong>We collected 51 completed questionnaires from investigators from 19 countries specializing in cutaneous lymphoma treatment. Radiation doses varied significantly (range, 4-60 Gy). Based on the histologic entity, up to one-third of the investigators delivered hypofractionated regimens (range, 14%-35%). Reduced-dose radiation therapy (RT) was considered by 27% to 63% of investigators. Meanwhile, 18 (35%) investigators considered adapting the radiation dose to the response to immunochemotherapy when treating primary cutaneous diffuse large B cell lymphoma-leg type. Regarding total skin electron beam therapy, 91% of centers delivered reduced-dose regimens, and 18% of investigators applied ultrahypofractionated protocols.</p><p><strong>Conclusions: </strong>RT in patients with cutaneous lymphoma is highly heterogeneous among the European Organisation for Research and Treatment of Cancer centers. The development of evidence-based recommendations for RT dose, fractionation, and technique for cutaneous lymphomas is required for optimization and standardization of treatment.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644018","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}