International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Hypofractionated Versus Single-Session Radiosurgery to Preserve Hearing in Patients Affected by Sporadic Vestibular Schwannoma: The ACOUNEU Randomized Clinical Trial.","authors":"Marcello Marchetti, Valentina Pinzi, Marco Gemma, Valeria Cuccarini, Riccardo Pascuzzo, Irene Cane, Aurora Romeo, Sara Morlino, Elena De Martin, Laura Fariselli","doi":"10.1016/j.ijrobp.2025.03.081","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.081","url":null,"abstract":"<p><strong>Purpose: </strong>During the last decades, in addition to tumor control, hearing preservation has become an important priority in the treatment of vestibular schwannoma (VS). Given that the potential advantages of hypofractionated radiosurgery (hRS) over single-session radiosurgery (RS) in terms of improved hearing outcomes remain unclear, this randomized trial aims to provide a robust answer to this question.</p><p><strong>Methods and materials: </strong>The present is a double-arm randomized clinical trial. The study started in 2011 and the last patient was enrolled in 2020. The minimum follow-up was 36 months. The trial involved patients with a diagnosis of sporadic VS with preserved hearing. One hundred and eight patients were enrolled. Participants were randomized to receive either hRS (18 Gy/3 consecutive fractions) or RS (most commonly 12 Gy/1 fraction). At each follow-up, clinical assessment, volumetric magnetic resonance imaging, and audiometry were evaluated. The primary endpoint was hearing sparing 36 months after RS or hRS. The maintenance of a serviceable hearing was defined according to the American Academy of Otorhinolaryngology Head and Neck Surgery classification.</p><p><strong>Results: </strong>Of the 108 randomized patients, 100 (47 RS and 53 hRS) were included in the analysis (mean age, 55 years; 56% female). No significant differences between hRS and RS were found in terms of hearing preservation (hazard ratio, 1.083; [95% CI, 0.603-1.946], and P = .789), with pretreatment hearing status, age, and dose to cochlea being the only significant predictors. No other parameters, including tumor volume, were associated with hearing preservation. At a median follow-up of 62 months, local control was 92% (95% CI, 84.8%-96.5%). Treatment-related toxicity was mild or moderate, in general not exceeding National Cancer Institute Common Terminology Criteria for Adverse Events grade 2.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first randomized clinical trial comparing 2 different radiosurgical regimens while focusing on hearing preservation. The study failed to demonstrate the potential advantages of hRS over RS with respect to hearing preservation. The volumetric analysis confirmed an excellent postradiosurgery tumor control rate for both RS and hRS groups. These results may guide the clinicians in the treatment schedule choice to preserve hearing in patients with VS.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Toxicity and Interaction Outcomes of Systemic Therapy and Stereotactic Ablative Radiation Therapy for Oligometastatic Disease: A Secondary Analysis of the Phase 2 SABR-5 Trial.","authors":"Aiden Kooyman, Jee Suk Chang, Mitchell Liu, Will Jiang, Alanah Bergman, Devin Schellenberg, Benjamin Mou, Abraham Alexander, Hannah Carolan, Fred Hsu, Stacy Miller, Siavash Atrchian, Elisa Chan, Clement Ho, Islam Mohamed, Angela Lin, Tanya Berrang, Andrew Bang, Nick Chng, Quinn Matthews, Vicky Huang, Ante Mestrovic, Derek Hyde, Chad Lund, Howard Pai, Boris Valev, Shilo Lefresne, Scott Tyldesley, Robert Olson, Sarah Baker","doi":"10.1016/j.ijrobp.2025.03.079","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.079","url":null,"abstract":"<p><strong>Purpose: </strong>Although stereotactic ablative radiation therapy (SABR) is known for low toxicity and safety, its combined use with specific systemic therapies requires further investigation. This study aims to evaluate the toxicity of SABR in combination with various systemic therapies.</p><p><strong>Materials and methods: </strong>A secondary analysis of the SABR-5 trial evaluated grade 2+ and 3+ toxicities post-SABR in patients who had received high-risk or non-high-risk systemic therapies before SABR at 4 predefined intervals: concurrent with SABR, 1 day to 1 week prior, 1 to 2 weeks prior, or 2 to 12 weeks prior. High-risk systemic therapy was a priori defined as drugs that may increase treatment toxicity when delivered in close proximity to SABR. This category encompasses cytotoxic chemotherapy, multitargeted tyrosine kinase inhibitors, CDK 4/6 inhibitors, EGFR inhibitors, anti-VEGF agents, and anti-CTLA-4 agents.</p><p><strong>Results: </strong>Among 380 patients, grade 2+ toxicity rates were 17.3% (35/202) off systemic therapy, 19.2% (19/99) on non-high-risk therapy, and 42.9% (3/7) on high-risk therapy concurrent with SABR. Grade 3+ rates were 3.5% (7/202), 4.0% (4/99), and 28.6% (2/7), respectively. On multivariable analysis, concurrent use of high-risk systemic therapy was associated with a higher risk of grade 3+ toxic effects (OR, 14.88; P = .009). No significant risk was noted when high-risk drugs were used within 1 week, 2 weeks, or 2 to 12 weeks of SABR or with any non-high-risk drugs. Grade 2+ toxic effects associated with concurrent high-risk systemic therapy were primarily bone/pain related. Increased tumor diameter also elevated grade 2+ toxicity risk (per 1 cm increment; G2+ OR, 1.19; P < .001).</p><p><strong>Conclusion: </strong>Concurrent use of high-risk drugs has demonstrated a potential of increased SABR-related toxicity, warranting caution in their concurrent use with SABR. In contrast, combining non-high-risk drugs (eg, hormonal therapy) with SABR did not increase risk. Further research is essential to identify risks associated with this therapeutic combination.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063759","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 Outcomes Following Proton-based Radiation Therapy for Pediatric Chordomas and Chondrosarcomas of the Mobile Spine and the Sacrum.","authors":"Myrsini Ioakeim-Ioannidou, Andrzej Niemierko, Timur Mukhammadov, Drosoula Giantsoudi, David J Konieczkowski, Daniel W Kim, Athena Tejada, Maria Tolia, G Petur Nielsen, Yin P Hung, Gregory Cote, Daniel G Tobert, John Shin, Thomas F DeLaney, Yen-Lin Chen, Fantine Giap, Shannon M MacDonald","doi":"10.1016/j.ijrobp.2025.03.075","DOIUrl":"10.1016/j.ijrobp.2025.03.075","url":null,"abstract":"<p><strong>Purpose: </strong>To report the first cohort of children with spinal and sacrococcygeal chordomas (CH) and chondrosarcomas (CHS) treated with proton-based radiation therapy (PRT).</p><p><strong>Materials and methods: </strong>Between 1989 and 2019, 52 pediatric patients ≤22 years old with spinal CH (n = 43) or CHS (n = 9) were treated with PRT at a single institution. The primary tumor originated in the C-spine (n = 37, 71%), T-spine (n = 6, 12%), L-spine (n = 7, 14%), or sacrum (n = 2, 3%). The CH group included 33 conventional and 10 atypical/poorly differentiated CH. The CHS group included 5 conventional and 4 mesenchymal CHS. Pre-RT chemotherapy was administered to 13 (25%) patients. Salvage radiation was delivered to 13 (25%) patients with progressive disease. The median total dose was 74.5 Gy (RBE) [IQR, 69.8-76 Gy (RBE)], delivered in 1.8 to 2.5 Gy (RBE) daily fractions. Primary endpoints were overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS). A univariate and multivariable Cox regression analysis was performed to identify prognostic and predictive factors.</p><p><strong>Results: </strong>At a median follow-up of 11.4 years (IQR, 5.7-19.8) from the date of diagnosis, 17 (32.7%) patients recurred (8 local, 7 distant, and 2 iatrogenic). Fifteen of these patients died of disease. The 5-, 10-, and 20-year OS were 82.7%, 72.3% and 72.3%, respectively. The 5-, 10-, and 20-year DSS were 86.1%, 77.5%, and 77.5%, respectively. The 5-, 10-, and 20-year PFS were 72.3%, 70.1% and 70.1%, respectively. The 20-year OS, DSS, and PFS for conventional CH were 93.9%, 97%, and 87.9%, respectively. Factors significantly associated with worse outcomes were poorly differentiated CH subtype, pre-RT chemo, and low KPS (P < .05). Pre-RT tumor progression was found to be a significant prognostic factor for PFS (P = .02). Two patients developed late grade 3 toxicities.</p><p><strong>Conclusions: </strong>This is the largest study of pediatric spinal and sacrococcygeal CH/CHS to date. High-dose PRT following surgical resection offers high disease control rates for conventional CH/CHS.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964898","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":"Plasma Epstein-Barr Virus DNA Temporal Clearance Pattern During Induction-Concurrent (Chemo)Radiation Therapy for Risk Stratification in Nasopharyngeal Carcinoma.","authors":"Zongwei Huang, Ying Li, Wenxi Wu, Lishui Wu, Zihan Chen, Siqi Xu, Yi Li, Jinghua Lai, Sufang Qiu, Jun Lu","doi":"10.1016/j.ijrobp.2025.03.076","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.076","url":null,"abstract":"<p><strong>Purpose: </strong>Plasma Epstein-Barr virus (EBV) DNA is a widely used biomarker for nasopharyngeal carcinoma (NPC). Prior investigations predominantly assessed EBV DNA at a single time point, thus neglecting the differential prognostic implications of the temporal clearance pattern of EBV DNA during induction-concurrent (chemo)radiation therapy (RT).</p><p><strong>Methods and materials: </strong>We retrospectively reviewed EBV DNA clearance patterns during induction-concurrent chemoRT in newly diagnosed patients with nonmetastatic NPC. EBV DNA was tested at 3 time points (baseline [T0], end of induction chemotherapy [T1], and end of RT [T2]) and recorded as detectable (D) and undetectable (U). The association between EBV DNA pattern and progression-free survival was analyzed.</p><p><strong>Results: </strong>A total of 2203 NPCs were included. Five distinct EBV DNA trajectory patterns were identified: type Ⅰ (negative-stable, U-U-U, 7.3%), type Ⅱ (induction chemotherapy-elimination, D-U-U, 42.8%), type Ⅲ (RT-elimination, D-D-U, 35.0%), type Ⅳ (persistent-positive, D-D-D, 11.7%), and type Ⅴ (resurgence, D-U-D [1.5%], U-D-U [1.2%], U-D-D [0.4%], or U-U-D [0.2%]). The median follow-up was 53.5 months (IQR, 43.1-66.9). Type Ⅱ patients displayed superior 5-year progression-free survival (82.9% [95% CI, 80.4%-85.5%]) versus type Ⅲ (75.9% [72.8%-79.1%], P < .001), type Ⅳ (52.5% [46.4%-59.5%], P < .001), and type Ⅴ (72.5% [62.2%-84.6%], P = .028). The 5-year progression-free survival for type V patients with \"D-U-D,\" \"U-D-U,\" \"U-D-D,\" and \"U-U-D\" patterns was 62.4% (46.2%-84.3%), 78.6% (63.1%-97.8%), 85.7% (63.3%-100.0%), and 75.0% (42.6%-100.0%), respectively. All 33 patients with the \"D-U-D\" pattern had stage Ⅲ-Ⅳ disease at diagnosis.</p><p><strong>Conclusions: </strong>Temporal EBV DNA clearance patterns during induction-concurrent chemoRT provide valuable prognostic insights, enabling the identification of patients with high-risk NPC and informing personalized treatment strategies. Resurgence of EBV DNA may occur occasionally (3.3%). Caution is required when considering reduced-intensity therapy in patients with locoeregionally advanced disease when EBV DNA becomes U after induction chemotherapy.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999736","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 Mevalonate Pathway in the Radiation Response of Cancer.","authors":"Linda Azizi, Hannah Hausman, Alexandra K Meyer, Matthew Wong, Frank Pajonk","doi":"10.1016/j.ijrobp.2025.03.059","DOIUrl":"10.1016/j.ijrobp.2025.03.059","url":null,"abstract":"<p><p>The mevalonate (MVA) pathway plays a critical role in cholesterol biosynthesis, protein prenylation, and metabolic reprogramming, all of which contribute to cancer progression and therapy resistance. Targeting the MVA pathway with statins and other inhibitors has shown promise in preclinical studies; however, clinical outcomes remain controversial, raising concerns about translating these findings into effective treatments. Additionally, the interaction between the MVA pathway and radiation therapy (RT) is not yet fully understood, as RT upregulates the pathway, which can enhance tumor cell survival. This review summarizes the current literature on MVA pathway inhibition in cancer therapy, focusing on its potential to enhance the efficacy of RT. A better understanding of the pathway's role in radiation responses will be essential to translate combination therapies that target this pathway.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803212","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":"Computed Tomography-Guided Online Adaptive Stereotactic Body Radiation Therapy for Liver Tumors: A Retrospective Study.","authors":"Alexander Lukez, Li Zhang, Eric M Horwitz, Thomas J Galloway, Mark A Hallman, Jessica K Wong, Sameera S Kumar, Rebecca M Shulman, Chang-Ming Charlie Ma, Ahmed Eldib, Joseph Panetta, Zachary Kiss, Robert H Freeman, Joshua E Meyer","doi":"10.1016/j.ijrobp.2025.03.061","DOIUrl":"10.1016/j.ijrobp.2025.03.061","url":null,"abstract":"<p><strong>Purpose: </strong>We present a computed tomography-guided online adaptive radiation therapy (CT-ART) experience in liver stereotactic body radiation therapy (SBRT).</p><p><strong>Methods and materials: </strong>A retrospective registry study evaluated patients with hepatocellular carcinoma or liver metastasis treated with CT-ART. Physicians were offered 2 plans, the original plan transposed onto the cone beam CT with adapted contours and a new plan generated with updated contours. Treatment distance from planning target volume (PTV) to nearest organ at risk (OAR) was determined by calculating the distance from PTV to nearest OAR on cone beam CT for simulation and each fraction.</p><p><strong>Results: </strong>Thirteen patients received SBRT 45 to 60 Gy (median, 50 Gy) in 5 fractions. Median PTV was 98.6 cc. Of 65 fractions, 77% (50) were adapted. Distance from PTV to nearest OAR over the course of treatment varied for 10 of 13 patients (range, 0-1.1 cm). Three patients without change in PTV-OAR distance all had PTV-OAR overlap at simulation. Despite having no PTV-OAR overlap at time of simulation, during treatment, 3 patients developed an overlap between PTV and nearest OAR. PTV V100% ≥ 95% criteria were met in 92% of adapted and 64% of scheduled plans (P = .042) and among fractions with PTV and OAR overlap, 87% of adapted and 33% of scheduled plans met PTV V100% goal (P = .045). For fractions with PTV-OAR overlap, maximum dose (Dmax) to nearest OAR was lower with adapted plan (P = .026). Adapted plans had lower mean stomach Dmax (P = .012) and lower mean duodenum Dmax (P = .05).</p><p><strong>Conclusions: </strong>We demonstrate the distance between PTV and nearest OAR varies throughout a course of CT-ART SBRT for liver tumors. Overlap between the PTV and OAR during treatment emerged in half of patients with separation between 0.1 and 1.5 cm at time of simulation. Among fractions with PTV-OAR overlap, adapted plans improved ability to meet PTV V100% goal while reducing Dmax to nearest OAR.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795484","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":"In Silico Evaluation of Direct-to-Unit, Single-Visit Celiac Plexus Pain Ablation Using Computed Tomography Guided Adaptive Radiation Therapy.","authors":"Beatriz Guevara, Atefeh Rezaei, Atallah Baydoun, Qing Li, Stephen Layng, Kenneth W Gregg, Theodore Arsenault, Gisele Pereira, Nathaniel Butka, Breanna Peyton, Rojano Kashani, Alex Price, Lauren E Henke","doi":"10.1016/j.ijrobp.2025.03.060","DOIUrl":"10.1016/j.ijrobp.2025.03.060","url":null,"abstract":"<p><strong>Purpose: </strong>Celiac plexus stereotactic body radiation therapy (CP-SBRT) using 25 Gy in a single fraction is an effective method of palliative pain relief for patients suffering from celiac axis tumor invasion. Standard complex stereotactic body radiation therapy workflows for simulation and planning result in delays in pain relief during end-of-life care. We propose a simulation-free, direct-to-unit (DTU) adaptive radiation therapy (ART) approach, using a diagnostic computed tomography (CT) preplan and online adaptation for final plan construction to enable the same-day radiation oncology consult and CP-SBRT. We aimed to demonstrate that this advanced imaging has increased electron density accuracy which enables the test of this DTU, adaptive CP-SBRT workflow in silico.</p><p><strong>Methods and materials: </strong>Ten patients with abdominal malignancies were imaged on a HyperSight Cone Beam Computed Tomography (CBCT) solution on a C-arm linear accelerator as part of a prospective imaging clinical trial (NCT05975619). These patients' existing diagnostic CT scans were used to generate CP-SBRT preplans. To simulate a simulation-free, DTU workflow, HyperSight CBCT images were injected into a CT guided ART treatment planning system environment as the primary data set, with target contours propagated from the registered diagnostic CT. Contours were updated as needed to reflect the treatment anatomy and positioning. A standard online ART workflow was used for the predicted and final adaptive plan calculation. Dose-volume values for each clinical goal were compared between predicted and final plans. Timing and measured quality assurance data were also collected.</p><p><strong>Results: </strong>DTU adaptive CP-SBRT plans were successfully created for all 10 patients and met all clinical goals. Without adaptation, predicted plans were infeasible for clinical use; 9 of 10 patients had nondeliverable predicted plans. The average time to complete ART contouring was 6 minutes. The average gamma passing rate for 3%/2 mm was 92.6%.</p><p><strong>Conclusion: </strong>DTU ART for CP-SBRT is dosimetrically feasible. Adaptation is a critical component for DTU CP-SBRT to achieve deliverable plans. This approach could reduce treatment delay for cancer-related celiac pain.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795490","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 Randomized Comparison of High-Dose-Rate and Low-Dose-Rate Prostate Brachytherapy Combined With External Beam Radiation Therapy for Unfavorable Prostate Cancer: Efficacy Results After Median Follow-up of 74 Months.","authors":"Juanita Crook, Jui-Chi Cheng, Gregory Arbour, Cynthia Araujo, Deidre Batchelar, David Kim, David Petrik, Tracey Rose, Francois Bachand","doi":"10.1016/j.ijrobp.2025.03.053","DOIUrl":"10.1016/j.ijrobp.2025.03.053","url":null,"abstract":"<p><strong>Purpose: </strong>This single-center randomized trial compared health-related Quality of Life for men with unfavorable localized prostate cancer treated with combined pelvic external beam radiation therapy (EBRT) and prostate brachytherapy, randomly assigned to high-dose rate (HDR) or low-dose rate (LDR). We now report efficacy outcomes with a minimum 5-year follow-up.</p><p><strong>Materials and methods: </strong>Consenting patients receiving pelvic EBRT combined with prostate brachytherapy were randomized to either LDR (110 Gy) or HDR (15 Gy). Androgen deprivation was used in 76% of patients. EBRT delivered 46 Gy/23 using intensity modulated radiation therapy or volumetric-modulated arc therapy (68%) or 3-dimensional conformal radiotherapy (32%). Follow-up up was 1, 3, and 6 months, then every 6 months to 3 years, and then annually. Prostate-specific antigen (PSA) ≤0.2 ng/mL at 4 years defined cure. Biochemical failure-free survival (bFFS) and overall survival were calculated by Kaplan-Meier methods. All failures were investigated by imaging (computed tomography, bone scan, and/or Prostate Specific Membrane Antigen- Positron Emission Tomography (PET) ± biopsy if PET was not available.</p><p><strong>Results: </strong>From January 2014 to December 2019, 195 men (42% intermediate risk/58% high risk) were randomly assigned: 108 to HDR and 87 to LDR. The median age was 71 years. Median PSA was 11.6 ng/mL (mean, 27.0 ng/mL). Median follow-up was 74 months (43-116 m). The median PSA nadirs were 0.07 and 0.08 in HDR and LDR (P = .16), and time to nadir was 13.8 and 14.1 months, respectively (P = .87). Four-year PSA ≤0.2 was maintained in 81% and 83% of HDR and LDR (P = .91). Eight-year bPFS (nadir + 2) was 86% and 85%, respectively. Eighteen of 22 biochemical failures have been identified; 3 are isolated local failures, whereas 14 are distant failures (isolated 11; 3 combined).</p><p><strong>Conclusions: </strong>In this small, randomized comparison, efficacy analysis shows no difference between LDR and HDR boost in bPFS at 5 and 8 years and confirms the excellent efficacy of dose escalation using prostate brachytherapy as documented in Ascende-RT for unfavorable localized prostate cancer.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787892","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":"5-5-5 ABRT (Dose of 5 Gy per Fraction for up to 5 Fractions Over 5 Weeks Adaptive Bridging Radiation Therapy)-Artificial Intelligence Enters the CAR (-T) (Chimeric Antigen Receptor-T) in Relapsed/Refractory Large B Cell Lymphoma.","authors":"Hazim S Ababneh, Andrea K Ng, Joshua Wan, Tyler Walburn, Lin Zhu, Mislav Bobić, Patrick Connor Johnson, Jeremy Bredtfeld, Jonathan Leeman, Jacob Soumerai, Jeremy S Abramson, Jeffrey Barnes, Ronald Takvorian, Matthew J Frigault, Jennifer Pursley, Chirayu G Patel","doi":"10.1016/j.ijrobp.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.03.023","url":null,"abstract":"<p><strong>Purpose: </strong>Bridging radiation therapy (BRT) is effective for local control in patients with relapsed or refractory large B cell lymphoma who are undergoing chimeric antigen receptor (CAR) T cell therapy. We hypothesized that adaptive BRT (ABRT), which can be used to personalize the radiation dose, fractionation, and volume based on real-time lymphoma target volume, is feasible, safe, and effective for local control.</p><p><strong>Methods and materials: </strong>We conducted a pilot study to investigate, once weekly, computed tomography-based adaptive radiation therapy (Varian Ethos) at a dose of 5 Gy per fraction for up to 5 fractions over 5 weeks in patients referred for BRT (NCT06004167).</p><p><strong>Results: </strong>Ten patients were enrolled. Eleven sites were irradiated for palliative purposes, achieving an overall symptomatic response rate of 100%. Of the 40 total ABRT sessions, 26 fractions were delivered (65%). For 8 of the 11 target volumes treated, ABRT was held after the first 1 or 2 fractions. The in-field responses during ABRT pre-CAR T were: complete response (n = 3, 30%), partial response (n = 6, 60%), and in-field progression (n = 1, 10%). After CAR T cell infusion, the best overall response rate was 70% (n = 7), all of whom achieved complete response. Among all 10 patients, 3 experienced in-field recurrence after start date of BRT. Among those with immune effector cell-associated neurotoxicity syndrome (n = 6), grade 3 immune effector cell-associated neurotoxicity syndrome occurred in 50% (n = 3). No grade 3 or higher cytokine release syndrome events were reported. At the time of the last follow-up, 9 patients (90%) were still alive, and 1 patient (10%) died due to disease progression.</p><p><strong>Conclusions: </strong>We demonstrate the safety and feasibility of ABRT at a dose of 5 Gy per fraction for up to 5 fractions over 5 weeks in this highly relapsed/refractory population, even in patients with high-volume disease, with the vast majority responding to 1 to 2 fractions of 5 Gy. All patients achieved symptomatic relief and were able to proceed to CAR T cell infusion.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772202","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":"Radiation Therapy Dose Escalation Failed to Improve Local Control for Intermediate-Risk Rhabdomyosarcoma on ARST1431: A Report From the Children's Oncology Group.","authors":"Christopher B Jackson, Wei Xue, Abha A Gupta, Amira Qumseya, Roshni Dasgupta, Christine E Hill-Kayser, Aaron C Spalding, David A Rodeberg, Douglas J Harrison, Rajkumar Venkatramani, Suzanne L Wolden","doi":"10.1016/j.ijrobp.2025.03.038","DOIUrl":"10.1016/j.ijrobp.2025.03.038","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate local failure (LF) rates for patients with intermediate-risk rhabdomyosarcoma treated on the Children's Oncology Group ARST1431 clinical trial, the first and largest international, phase 3 randomized study to use FOXO1 fusion status for risk stratification. To improve local control, radiation therapy (RT) dose was increased to 59.4 Gy for patients with tumors >5 cm and residual gross disease at the time of RT.</p><p><strong>Methods and materials: </strong>For the 297 patients included, LF was defined as progression or relapse at the primary site. The rate of LF was calculated 3-years after enrollment.</p><p><strong>Results: </strong>LF for group 3, FOXO1 fusion-positive patients (n = 58) compared with fusion-negative patients (n = 175) was 10.7% versus 21.5%, respectively (P = .08). The LF rate for patients with tumors >5 cm at diagnosis (n = 180; 24.4%) was higher than that of patients with tumors ≤5 cm at diagnosis (n = 117; 9.8%), P = .002. The risk of LF for patients who received proton (n = 99) versus photon RT (n = 126) was not different (16.1% vs 15.9%, P = .8). For the 75 patients with tumors >5 cm at diagnosis and gross disease at the time of RT, the boost to 59.4 Gy did not improve the 3-year LF rate compared with that of patients who did not receive the boost (29.7% vs 16.1%, P = .6). For patients with group 3/4 disease, those who underwent delayed primary excision (n = 72) had a lower LF rate compared with those who had RT alone (n = 151) (5.8% vs 19.7%, P < .01).</p><p><strong>Conclusions: </strong>On ARST1431, tumors >5 cm at diagnosis had poor local control despite dose escalation to 59.4 Gy. Proton and photon RT had equivalent local control. For select patients, delayed primary excision significantly improved local control.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788192","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}