International Journal of Radiation Oncology Biology Physics最新文献

{"title":"Primary Tumor Failure After Definitive Chemoradiation in Locally Advanced Non-Small Cell Lung Cancer: A Brief Report on the Implications for NRG LU-008.","authors":"Cole Friedes, Nikhil Yegya-Raman, Michelle Iocolano, William P Levin, Keith A Cengel, Jeffrey D Bradley, Steven J Feigenberg","doi":"10.1016/j.ijrobp.2025.09.016","DOIUrl":"10.1016/j.ijrobp.2025.09.016","url":null,"abstract":"<p><strong>Purpose: </strong>Locoregional failure (LRF) after definitive chemoradiation for locally advanced non-small cell cancer is suboptimal. LU-008 aims to improve local control through an stereotactic body radiation therapy boost. We quantified first-failure patterns after modern chemoradiation and determined whether patients with LRF had LU-008 eligibility.</p><p><strong>Methods and materials: </strong>Consecutive adults treated with definitive chemoradiation (>60 Gy, 1.8-2 Gy/fraction ± immunotherapy) from 2011 to 2021 at a single institution were reviewed. First progression was classified as isolated LRF, isolated distant failure (DF), or synchronous LRF + DF; LRF was subclassified as primary tumor failure (PTF), regional failure (RF), or PTF + RF. PTF was defined radiographically within the 90% isodose of the primary tumor gross tumor volume. LU-008 eligibility (tumor <7 cm, ≥1 node, primary >2 cm from nodal clinical tumor volume) was applied retrospectively. Cumulative incidence functions used Fine-Gray models with death as a competing risk.</p><p><strong>Results: </strong>Among 786 patients (median follow-up 66.9 months), 484 first failures occurred: 109 isolated LRF, 122 synchronous LRF + DF, and 253 isolated DF. Isolated PTF occurred in 40 patients (5.1%); PTF + RF in 29 (3.7%). Five-year cumulative incidence was 52% for any DF, 42% for any LRF, 25% for any isolated LRF (DF-free), 17% for any PTF (PTF + RF, DF-free), and 10% for isolated PTF. Only 28 of 69 PTF-containing LRFs (41%) met LU-008 criteria. Failure patterns were similar for patients who received immunotherapy consolidation. Overall, 129 of 231 patients with any LRF (56%) were LU-008-ineligible, commonly due to central or ultracentral primaries, and experienced earlier PTF (median, 12.1 vs 22.4 months; P = .002). PTF risk increased steeply with primary tumor gross tumor volume up to ∼200 cm².</p><p><strong>Conclusions: </strong>Although DF is the most common site of failure, LRF remains a problem. Many PTFs after chemoradiation occur in patients who would be excluded from LU-008, mainly because of central-tumor location. This high-risk subset of central primaries may require alternative escalation or combined modality strategies beyond the proposed LU-008 paradigm.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085950","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":"Grid Spatially Fractionated Radiation Therapy for Bulky Tumors: A Large Single Institution Experience.","authors":"Kaidi Wang, Pouya Sabouri, Adam Wolfe, Eric Siegel, John Marrufo, Canon Cothran, Paula McClain, Gary Lewis, Jose Penagaricano, Robert J Griffin, Fen Xia","doi":"10.1016/j.ijrobp.2025.08.013","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.08.013","url":null,"abstract":"<p><strong>Purpose: </strong>Spatially fractionated radiation therapy, specifically grid radiation therapy (grid-RT), is a treatment option for bulky tumors (≥6 cm). However, its modern use for locally advanced or metastatic disease remains limited. We evaluated outcomes in patients treated with grid-RT at our institution.</p><p><strong>Methods and materials: </strong>We retrospectively reviewed patients with locally advanced or metastatic bulky tumors treated with grid-RT from December 2013 to June 2022. Patient and treatment characteristics, response rates, survival outcomes, and toxicity were analyzed.</p><p><strong>Results: </strong>Eighty patients underwent 82 grid-RT treatments. Median age was 58.5 years. The head and neck region was the most frequently treated site (40/82, 49%). The most common grid-RT dose was 20 Gy in a single fraction (78/82, 95%; range, 15-20). Median gross tumor volume was 364 cm³ (range, 46-3860). Most treatment courses (51/82, 62%) used a Cerrobend grid block, whereas 31 of 82 (38%) treatments used intensity modulated radiation therapy (IMRT) via tomotherapy. Median follow-up was 8 months (range, 1-100). Seventeen patients were lost to follow-up before imaging response assessment. Among 65 evaluable treatments, 53 demonstrated an objective response (82%). Definitive treatment intent and definitive RT dose were associated with improved response. Cumulative locoregional recurrences at 1, 2, and 3 years were 21% (95% CI, 11.1%-31.4%), 24% (95% CI, 12.7%-34.4%), and 26% (95% CI, 14.5%-37.9%), respectively. Median time to progression was 11.7 months (IQR, 5.9-35.8 months). Median progression-free survival was 5.7 months (95% CI, 3.3-6.9). Median overall survival was 7.9 months (95% CI, 5.1-11.6). Common acute toxicities included grade-2 radiation dermatitis (14/102, 14%) and grade-2 oral mucositis (13/102, 13%). Late toxicities (>30 days post-RT) included grade-1 fatigue (4/43, 10%), grade-2 pain (5/43, 12%), and grade-2 dry mouth (4/43, 10%). Grid block was associated with higher acute xerostomia than IMRT.</p><p><strong>Conclusions: </strong>Grid-RT appears to be an effective treatment for bulky tumors, either standalone or as a boost to palliative or definitive radiation. Grid block and IMRT have comparable short- and long-term toxicity profiles.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069681","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":"Defining the Supply of Radiation Oncologists in the United States: An American Society for Radiation Oncology Workforce Report.","authors":"Michael Weisman, James E Bates, J Isabelle Choi, Pranshu Mohindra, Mudit Chowdhary, Joseph Salama, John Shumway, Andrew Hoover, Zhong Su, Austin J Sim, Chirag Shah","doi":"10.1016/j.ijrobp.2025.09.012","DOIUrl":"10.1016/j.ijrobp.2025.09.012","url":null,"abstract":"<p><p>An accurate accounting of the current number of practicing radiation oncologists (ROs) is critical to the complete understanding of the workforce dynamics of the field. At present, there is no clear standard on how to assess this, with multiple approaches available. Therefore, the American Society for Radiation Oncology (ASTRO) Workforce Committee reviewed and evaluated multiple approaches in assessing the radiation oncology (RO) workforce supply, including the pros and cons of each approach, while comparing supply estimates in order to define a recommended standard for assessing the RO workforce supply in the United States. Most methods use data from the Centers for Medicare & Medicaid Services (CMS), the American Medical Association, and/or the American Association of Medical Colleges. The ASTRO-sponsored Health Management Associates Workforce Analysis and the American Society of Clinical Oncology (ASCO) approach used multiple data sources, with the ASCO approach including the American Medical Association and CMS data sources. Limitations of each approach are reflective of the data sources used and include an inability to capture all physicians, a lack of routine updating, and/or a lag-time in incorporating entrants to and exits from the workforce. Overall, the assessments across methods demonstrated substantial consistency in results (range of maximum difference, 2.2%-5.0%; mean, 3.0%), with unfiltered data sets consistently reporting higher estimates, likely due to inclusion of ROs not actively practicing. For example, in 2023, filtered estimates ranged from 4935 (ASCO) to 5072 (American Association of Medical Colleges), whereas in 2024, the estimates ranged from 4992 (ASCO) to 5103 (CMS) ROs. Using the ASCO model, we estimate a total of 5100 ROs in 2024, accounting for Veterans Affairs and pediatric-only ROs, understanding this may not account for nonclinical ROs. Additionally, these methods capture \"head counts\" of the number of ROs, but not their clinical capacity. After reviewing the various approaches, the ASTRO Workforce Committee recommends applying a similar methodology to that in use by ASCO for RO workforce supply assessments. This would allow subsequent workforce models to be compared with a consistent methodology to prevent erroneous conclusions when comparing across methodologies.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080696","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":"Tumor-infiltrating lymphocytes and preoperative partial breast irradiation in early-stage breast cancer: insights from the prospective PAPBI cohort.","authors":"Jetske L B Gunster, Emma J Groen, Roberto Salgado, Corrie A M Marijnen, Astrid N Scholten","doi":"10.1016/j.ijrobp.2025.08.058","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.08.058","url":null,"abstract":"<p><strong>Purpose: </strong>Current understanding of the interaction between radiation therapy (RT) and tumor-infiltrating lymphocytes (TILs) is limited. We investigated the impact of preoperative accelerated partial breast irradiation (PAPBI) on TILs in early-stage breast cancer patients. Additionally, we evaluated whether baseline TILs were associated with pathologic response to RT.</p><p><strong>Methods: </strong>In the prospective PAPBI trial, early-stage breast cancer patients received preoperative RT (10 × 4 Gy or 5 × 6 Gy), followed by a wide local excision after six weeks. Matched control patients who underwent postoperative RT were retrospectively collected for validation. Stromal TILs (sTILs) were manually scored on hematoxylin- and eosin-stained slides from diagnostic biopsy and resection specimens, following established guidelines. Baseline differences in sTILs between patients with and without a pathologic complete response (pCR) were analyzed using the Mann-Whitney U test, and longitudinal changes in sTILs were evaluated with a linear mixed model.</p><p><strong>Results: </strong>A total of 72 PAPBI patients and 68 matched controls were included. In the PAPBI cohort, baseline sTILs were generally low, with a median of 2% (IQR 1 - 2%). Eight patients (11%) achieved a pCR, and these patients had significantly higher baseline sTILs compared to patients without a pCR (p = 0.021). Among the 64 PAPBI patients with evaluable pre- and post-irradiation samples, a minimal, non-significant increase in sTILs was observed following RT. Control patients had similarly low baseline sTILs (median 2%, IQR 1 - 2%), with no significant changes over time.</p><p><strong>Conclusion: </strong>In this cohort of early-stage breast cancer patients receiving preoperative partial breast irradiation, longitudinal assessment showed minimal changes in sTILs after RT. In patients who achieved a pCR, we observed significantly higher baseline sTILs compared to those without a pCR.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058439","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":"Red Journal Reviews: Typology, Methodology, and Standards.","authors":"Justin Smith, Daniel R Dickstein, Alekhya Mitta, David Sher, Sue S Yom, Lachlan McDowell","doi":"10.1016/j.ijrobp.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.08.004","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033212","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":"Missing the Target: Radiation, \"Toxicity,\" and Public Fear.","authors":"Drew Moghanaki, Sue S Yom, Neha Vapiwala","doi":"10.1016/j.ijrobp.2025.08.003","DOIUrl":"https://doi.org/10.1016/j.ijrobp.2025.08.003","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006138","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":"Radiotherapy Deserves the Spotlight: The First World Radiotherapy Awareness Day.","authors":"Pat Price, Sandra Lynne Turner, Katie Wakeham, Mary Gospodarowicz","doi":"10.1016/j.ijrobp.2025.09.001","DOIUrl":"10.1016/j.ijrobp.2025.09.001","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023238","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":"Can Radiation Therapy Quality Assurance Improve Nasopharyngeal Cancer Outcomes in Low and Middle-Income Countries-Reporting the Technical Component of the Second Phase of a Prospective International Atomic Energy Agency study (E33039).","authors":"June Corry, Wai Tong Ng, Alisha Moore, Horace C W Choi, Quynh-Thu Le, Sofee Holmes, Arie Munandar, Shengzi Wang, Angela Camacho, Jiraporn Setakornnukul, Chuleeporn Jiarpinitnun, Pham N Hiep, Sarbani Ghosh Laskar, Mohammad Faheem, Chiraz Nasr Ben Ammar, Elena Fidarova, Kirsten Hopkins, Eduardo Rosenblatt, May Abdel-Wahab, Anne W M Lee","doi":"10.1016/j.ijrobp.2025.08.057","DOIUrl":"10.1016/j.ijrobp.2025.08.057","url":null,"abstract":"<p><strong>Purpose: </strong>Most of new nasopharyngeal cancer (NPC) cases occur in low- and middle-income countries (LMICs), but these patients experience poorer survival than new NPC cases in high income countries. This study seeks to determine whether a radiation therapy quality assurance (RT QA) program can improve patients with NPC outcomes in LMICs. Here we report the technical results of the second phase of the International E33039 study.</p><p><strong>Methods and materials: </strong>Phase 1 of this study included an audit by an expert panel of 134 NPC patients' RT plans from LMICs. It was previously reported and showed a 64% rate of unacceptable plans. Detailed RT QA reports was given to each center, followed by an educational face-to-face workshop discussing the results and improvement plans. Thereafter accrual for phase 2 commenced. The primary endpoint of the technical component of phase 2 is the number of major deviations in priority 1 parameters as compared with phase 1.</p><p><strong>Results: </strong>A total of 153 patients accrued from 9 centers between April 2020 and April 2023 in phase 2. Notably, 105 (68.6%) were reviewed pretreatment as per protocol, and 48 (31.4%) were reviewed after treatment (not per protocol, because of technical reasons). Of the plans reviewed pretreatment, 31 of 105 (29.5%) were unacceptable because of major deviations in priority one structures. Thirty cases (30/31, 96.8%) were resubmitted and 20 were deemed acceptable (an improvement of 20/30, 66.7%). Of the plans reviewed posttreatment, 6/48 (12.5%) were unacceptable. The overall rate of unacceptable plan was 11% (17/153) in phase 2 compared with 64% in phase 1.</p><p><strong>Conclusions: </strong>This prospective study shows that RT QA and education for NPC RT plans in LMICs can dramatically reduce major RT protocol deviations. This will hopefully translate into improved patient outcomes.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015329","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":"Accelerated Patient-specific Non-Cartesian Magnetic Resonance Imaging Reconstruction Using Implicit Neural Representations.","authors":"Di Xu, Hengjie Liu, Xin Miao, Daniel O'Connor, Jessica E Scholey, Wensha Yang, Mary Feng, Michael Ohliger, Hui Lin, Dan Ruan, Yang Yang, Ke Sheng","doi":"10.1016/j.ijrobp.2025.08.059","DOIUrl":"10.1016/j.ijrobp.2025.08.059","url":null,"abstract":"<p><strong>Purpose: </strong>Accelerating magnetic resonance acquisition is essential for image guided therapeutic applications. Compressed sensing (CS) has been developed to minimize image artifacts in accelerated scans, but the required iterative reconstruction is computationally complex and difficult to generalize. Convolutional neural networks (CNNs)/Transformers-based deep learning methods emerged as a faster alternative but face challenges in modeling continuous k-space, a problem amplified with non-Cartesian sampling commonly used in accelerated acquisition. In comparison, implicit neural representations (INRs) can model continuous signals in the frequency domain and thus are compatible with arbitrary k-space sampling patterns. The current study developed novel k-space generative-adversarially trained INRs (k-GINR) for de novo undersampled non-Cartesian k-space reconstruction.</p><p><strong>Methods and materials: </strong>k-GINR consists of 2 stages: 1) supervised training on an existing patient cohort; 2) self-supervised patient-specific optimization. The StarVIBE T1-weighted liver data set, consisting of 118 prospectively acquired scans and corresponding coil data, was employed for testing. k-GINR is compared with 2 INR-based methods, Neural Representation learning methodology with Prior embedding (NeRP) and k-space NeRP, an unrolled deep learning method, Deep Cascade CNN, and CS.</p><p><strong>Results: </strong>k-GINR consistently outperformed the baselines with a larger performance advantage observed at very high accelerations (peak-signal-to-noise ratio: 6.8%-15.2% higher at 3 times, 15.1%-48.8% at 10 times, and 29.3%-60.5% higher at 20 times). The reconstruction times for k-GINR, NeRP, k-NeRP, CS, and Deep Cascade CNN were approximately 3 minutes, 4-10 minutes, 3 minutes, 4 minutes and 3 second, respectively.</p><p><strong>Conclusions: </strong>k-GINR, an innovative 2-stage INR network incorporating adversarial training, was designed for direct non-Cartesian k-space reconstruction for new incoming patients. It demonstrated superior image quality compared to CS and Deep Cascade CNN across a wide range of acceleration ratios.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015334","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":"Less Is More: Current Trials Redefining Locoregional Therapy in Breast Cancer","authors":"Jean L. Wright ,&nbsp;Jennifer Croke ,&nbsp;Youlia Kirova ,&nbsp;Lior Z. Braunstein MD","doi":"10.1016/j.ijrobp.2025.07.046","DOIUrl":"10.1016/j.ijrobp.2025.07.046","url":null,"abstract":"","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":"123 2","pages":"Pages 323-327"},"PeriodicalIF":6.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144997482","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}