Radiotherapy and Oncology最新文献

{"title":"Hypofractionated accelerated radiation dose-painting (HARD) improves outcomes in unresected soft-tissue sarcoma.","authors":"John Michael Bryant, Matthew N Mills, Casey Liveringhouse, Russell Palm, Mihaela Druta, Andrew Brohl, Damon R Reed, Peter A Johnstone, Justin T Miller, Kujtim Latifi, Vladimir Feygelman, George Q Yang, Arash O Naghavi","doi":"10.1016/j.radonc.2024.110644","DOIUrl":"https://doi.org/10.1016/j.radonc.2024.110644","url":null,"abstract":"<p><p>Soft tissue sarcomas (STS) are radioresistant with a low α/β, which may have a biologic benefit with hypofractionation. For unresectable STS, the dose escalation required to achieve durable control is often limited by long-term toxicity risk. We sought to compare an isotoxic approach utilizing hypofractionated accelerated radiation dose-painting (HARD) versus standard fractionated radiation therapy (SFT) in patients with unresected STS. We conducted a retrospective analysis of patients with unresected STS who received either HARD (n = 49) or SFT (n = 43) with photon-based therapy between 1990 and 2022. The 2 HARD regimens each use 3 dose levels based on risk of disease burden. The gross disease, intermediate risk and low-risk clinical target volumes were treated with either 20-22 fractions of 3/2.5/2-2.2 Gy or 28 fractions of 2.5/2.2/1.8 Gy. SFT included patients treated with definitive intent, receiving ≥ 50 Gy in 1.8-2 Gy per fraction. Clinical endpoints included 3-year local control (LC), overall survival (OS), and progression-free survival (PFS), along with treatment-related toxicity. With a median age of 67 and tumor size of 7 cm, most patients were stage IV (37 %), grade 3 (67 %), had no concurrent systemic therapy (70 %), and were lower extremity tumors (24 %). HARD cohort consisted of higher age, stage, recurrent disease, and median BED₄ (p < 0.05), when compared to SFT. With a median follow-up of 35.9 months, HARD demonstrated significant improvement in 3-year LC (96.4 % vs. 48.4 %, p < 0.001), compared to SFT overall, with a median PFS benefit (16 vs. 10 months, p = 0.037) for non-distantly metastatic patients at baseline. On multivariate analysis, HARD was significantly associated with improved LC (HR 0.058, 95 % CI 0.005-0.682, p = 0.024). The HARD regimen found no significant increase in toxicity, with limited acute grade 3 (24 %, all dermatitis) and late grade 3 toxicity (6 %) observed, with no grade 4 or 5 events. HARD regimen significantly improves LC for unresectable STS without a significant increase in toxicity, when compared to a standard fractionated approach, supporting further prospective investigation of this treatment approach.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110644"},"PeriodicalIF":4.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688670","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 ChatGPT's competency in radiation oncology: A comprehensive assessment across clinical scenarios.","authors":"Sherif Ramadan, Adam Mutsaers, Po-Hsuan Cameron Chen, Glenn Bauman, Vikram Velker, Belal Ahmad, Andrew J Arifin, Timothy K Nguyen, David Palma, Christopher D Goodman","doi":"10.1016/j.radonc.2024.110645","DOIUrl":"https://doi.org/10.1016/j.radonc.2024.110645","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial intelligence (AI) and machine learning present an opportunity to enhance clinical decision-making in radiation oncology. This study aims to evaluate the competency of ChatGPT, an AI language model, in interpreting clinical scenarios and assessing its oncology knowledge.</p><p><strong>Methods and materials: </strong>A series of clinical cases were designed covering 12 disease sites. Questions were grouped into domains: epidemiology, staging and workup, clinical management, treatment planning, cancer biology, physics, and surveillance. Royal College-certified radiation oncologists (ROs) reviewed cases and provided solutions. ROs scored responses on 3 criteria: conciseness (focused answers), completeness (addressing all aspects of the question), and correctness (answer aligns with expert opinion) using a standardized rubric. Scores ranged from 0 to 5 for each criterion for a total possible score of 15.</p><p><strong>Results: </strong>Across 12 cases, 182 questions were answered with a total AI score of 2317/2730 (84 %). Scores by criteria were: completeness (79 %, range: 70-99 %), conciseness (92 %, range: 83-99 %), and correctness (81 %, range: 72-92 %). AI performed best in the domains of epidemiology (93 %) and cancer biology (93 %) and reasonably in staging and workup (89 %), physics (86 %) and surveillance (82 %). Weaker domains included treatment planning (78 %) and clinical management (81 %). Statistical differences were driven by variations in the completeness (p < 0.01) and correctness (p = 0.04) criteria, whereas conciseness scored universally high (p = 0.91). These trends were consistent across disease sites.</p><p><strong>Conclusions: </strong>ChatGPT showed potential as a tool in radiation oncology, demonstrating a high degree of accuracy in several oncologic domains. However, this study highlights limitations with incorrect and incomplete answers in complex cases.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110645"},"PeriodicalIF":4.9,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688667","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":"Efficacy of radiotherapy for bone metastasis in breast cancer patients treated with cyclin-dependent kinase 4/6 inhibitors.","authors":"Marcin Kubeczko, Dorota Gabryś, Justyna Rembak-Szynkiewicz, Donata Gräupner, Anna Polakiewicz-Gilowska, Michał Jarząb","doi":"10.1016/j.radonc.2024.110639","DOIUrl":"https://doi.org/10.1016/j.radonc.2024.110639","url":null,"abstract":"<p><strong>Background: </strong>In patients diagnosed withestrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer, bone metastasesemerge as theprimary siteofsignificant tumor burden. Cyclin-dependent kinase 4/6 (CDK4/6i) inhibitorsare thegold standard in this clinical scenario, while radiotherapy (RT) represents a valuable addition. However, data on the efficacy of this combination remain scarce. We aimed to evaluate efficacy of RT in bone metastatic breast cancer patients treated with CDK4/6 inhibitors.</p><p><strong>Materials and methods: </strong>398 patients (pts) with ER-positive HER2-negative breast cancer with bone metastases treated with CDK4/6i between 2018-2024 were analyzed. A total of 114 pts received 177 bone RT concurrently with CDK4/6i or within 6 months before CDK4/6i initiation, including 34 courses of stereotactic-body RT and 143 courses of conventional RT.</p><p><strong>Results: </strong>The median progression-free survival (PFS) in pts who received bone RT was 31.0 months, compared to 26.3 months in pts without bone RT. The 2-y PFS for pts with bone RT was 57.1 % [95 % CI: 46.3-66.6 %] vs. 53.2 % [95 % CI: 46.3-59.6 %] for patients without bone RT (p = 0.51). The median overall survival (OS) for pts who received bone RT was 49.1 months, compared to 40.5 months for pts without bone RT. The 3-y OS for pts with bone RT was 63.7 % [95 % CI: 51.5-73.5 %] vs. 55.0 % [95 % CI 46.6-62.6 %] for pts without bone RT (p = 0.50). The 3-y local control for irradiated patients was 86.9 % [95 % CI 72.2-94.1 %].</p><p><strong>Conclusions: </strong>In this study, we present the largest cohort published to date of breast cancer patients who received CDK4/6i alongside bone-directed RT. Although the observed differences in survival were not statistically significant, RT remains a viable treatment modality in metastatic breast cancer in some patients.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110639"},"PeriodicalIF":4.9,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682315","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":"Prostate-specific antigen kinetics after stereotactic body radiotherapy for localized prostate cancer: A scoping review and meta-analysis.","authors":"Cas Stefaan Dejonckheere, Lara Caglayan, Andrea Renate Glasmacher, Shari Wiegreffe, Julian Philipp Layer, Younèss Nour, Davide Scafa, Gustavo Renato Sarria, Simon Spohn, Markus Essler, Stefan Hauser, Manuel Ritter, Marit Bernhardt, Glen Kristiansen, Anca-Ligia Grosu, Constantinos Zamboglou, Eleni Gkika","doi":"10.1016/j.radonc.2024.110642","DOIUrl":"10.1016/j.radonc.2024.110642","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic body radiotherapy (SBRT) is emerging as a valuable treatment modality for localized prostate cancer, with promising biochemical progression-free survival rates. Longitudinal assessment of prostate-specific antigen (PSA) is the mainstay of follow-up after treatment. PSA kinetics and dynamics are well-established in the context of brachytherapy and conventionally fractionated radiotherapy, yet little is known in the context of prostate SBRT.</p><p><strong>Methods: </strong>A review of available literature in MEDLINE, Scopus, and Embase was performed, focusing on studies reporting PSA slope, nadir, bounce, and biochemical failure after prostate SBRT.</p><p><strong>Results: </strong>Thirty-three records (45 % prospective) encompassing 9,949 patients were included. SBRT dose ranged from 32-50 Gy in 4-5 fractions and overall median follow-up time (range) was 41 (15-74) months. Use of androgen deprivation therapy ranged from 0-38 %. SBRT was characterized by a steep initial decline of PSA, slowing down over time and ultimately yielding a lower nadir in comparison with conventional radiotherapy, with a median value (range) of 0.24 (0.1-0.6) ng/mL after a median time (range) of 33.1 (6-54) months. There was an inverse correlation between the highest SBRT dose in a trial and PSA nadir (r = - 0.59; p < 0.001). Benign PSA bounce occurred in 30 % of patients across all studies, after a median time (range) of 14.8 (9-36) months and with a median size (range) of 0.5 (0.3-1.1) ng/mL. There was no significant correlation between bounce and dose, nadir nor biochemical failure. There was, however, a significant inverse correlation between ADT use and PSA bounce frequency (r = -0.49; p = 0.046).</p><p><strong>Conclusion: </strong>PSA kinetics and dynamics after SBRT for localized prostate cancer are different from those in other established radiotherapy modalities. Benign PSA bounce is very common. Clinicians should be aware of these factors and patients should be counseled accordingly, preventing unnecessary distress or salvage treatment.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110642"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668798","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":"Population based audit of heart radiation doses in 6925 high-risk breast cancer patients from the Danish breast cancer group RT Nation study.","authors":"Emma Skarsø Buhl, Lasse Hindhede Refsgaard, Sami Aziz-Jowad Al-Rawi, Karen Andersen, Martin Berg, Kristian Boye, Ingelise Jensen, Ebbe Laugaard Lorenzen, Else Maae, Maja Vestmø Maraldo, Louise Wichmann Matthiessen, Marie Louise Milo, Mette Holck Nielsen, Abhilasha Saini, Esben Yates, Birgitte Vrou Offersen, Stine Sofia Korreman","doi":"10.1016/j.radonc.2024.110643","DOIUrl":"10.1016/j.radonc.2024.110643","url":null,"abstract":"<p><strong>Background and purpose: </strong>In this study, we conducted a population-based retrospective audit of heart doses for high-risk breast cancer (BC) over a nine-year period in patients treated with adjuvant CT-based radiotherapy in a comprehensive and homogenized national BC cohort. Additionally, this serves as a demonstration of performing large scale audits with consistent delineations created by an auto-segmentation tool.</p><p><strong>Materials and methods: </strong>High-risk BC patients treated with adjuvant radiotherapy in the period 2008-2016 from all seven radiotherapy centres in Denmark were included. A homogenized cohort was created using an inhouse developed auto-segmentation tool. The homogenized cohort volume and planned doses (mean heart dose (MHD), V20Gy and V40Gy) were evaluated. Volumes and dose metrics were compared for clinical delineations and homogenized heart volumes.</p><p><strong>Results: </strong>Among 6925 patients, 5589(81 %) had a clinical heart delineation. The median delineated heart volume increased from 531.9 ml (2008) to 635.5 ml (2016) (p < 0.01). The median MHD for the homogenized cohort was 1.58 Gy (2008-2016) with an overall decreasing trend, 2.14 Gy in left- and 1.08 Gy in right-sided patients. The median MHD in the clinically delineated hearts was 0.01 Gy lower than the planned median MHD in the homogenized cohort.</p><p><strong>Conclusion: </strong>During 2008-2016 the planned heart dose has been low across the population. A volume increase was observed in the clinically delineated hearts, however the median MHD in the homogenized cohort was low, with 1.58 Gy. The study demonstrated the possibilities for full population-based and consistent dose audit by using auto-segmentation tools.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110643"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668789","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":"An update to the American Radium Society's appropriate use criteria of lower grade Gliomas: Integration of IDH inhibitors.","authors":"Martin C Tom, Seema Nagpal, Joshua D Palmer, William G Breen, Erqi L Pollom, Eric J Lehrer, Tresa M McGranahan, Kevin Shiue, Anupama Chundury, Shearwood McClelland Iii, Hina Saeed, Eric L Chang, Veronica L S Chiang, Tony J C Wang, Jonathan P S Knisely, Samuel T Chao, Michael T Milano","doi":"10.1016/j.radonc.2024.110640","DOIUrl":"10.1016/j.radonc.2024.110640","url":null,"abstract":"<p><p>The ARS brain committee recommends that vorasidenib may be appropriate for recurrent or residual IDH-mutant grade 2 oligodendroglioma or astrocytoma. Vorasidenib is usually not appropriate for completely resected grade 2 oligodendroglioma or astrocytoma, any grade 3 oligodendroglioma or astrocytoma, or combined with radiotherapy and/or chemotherapy for any grade 2-3 glioma.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110640"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668786","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 for stage IIA/IIB seminomas: Back to the future?","authors":"Jennifer Le Guévelou, Luca Nicosia, Pierre Blanchard, Flavien Ralite, Xavier Durand, Vincent Marchesi, Guilhem Roubaud, Paul Sargos","doi":"10.1016/j.radonc.2024.110626","DOIUrl":"10.1016/j.radonc.2024.110626","url":null,"abstract":"<p><p>Seminoma is a highly curable disease; therefore, long-term morbidity of oncological treatment represents a crucial stake. In view of the considerable advances made in radiotherapy in the past decade, we aim to shed light on current and future strategies that hold promises for the management of stage II seminoma.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110626"},"PeriodicalIF":4.9,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668800","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":"Comment on \"Analysis of re-recurrent rectal cancer after curative treatment of locally recurrent rectal cancer\".","authors":"Chong-Jie Zhang","doi":"10.1016/j.radonc.2024.110625","DOIUrl":"10.1016/j.radonc.2024.110625","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110625"},"PeriodicalIF":4.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639670","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 systematic review and meta-analysis on the impact of institutional peer review in radiation oncology.","authors":"Jane Jomy, Rachel Lu, Radha Sharma, Ke Xin Lin, David C Chen, Jeff Winter, Srinivas Raman","doi":"10.1016/j.radonc.2024.110622","DOIUrl":"10.1016/j.radonc.2024.110622","url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy peer review is recognized as a key component of institutional quality assurance, though the impact is ill-defined. We conducted the first systematic review and meta-analysis to date to quantify the impact of institutional peer review on the treatment planning workflow including radiotherapy contours, prescription and dosimetry.</p><p><strong>Methods: </strong>We searched several medical and healthcare databases from January 1, 2000, to May 25, 2024, for papers that report on the impact of institutional radiotherapy peer review on treatment plans. We conducted random-effects meta-analyses of proportions to summarize the rates of any change recommendation and major change recommendation (suggesting re-planning or re-simulation due to safety concerns) following peer review processes. To explore differences in change recommendations dependent on location, radiotherapy intent, technique, and peer review structure characteristics, we conducted analyses of variance.</p><p><strong>Results: </strong>Of 9,487 citations, we identified 55 studies that report on 96,444 case audits in 10 countries across various disease sites. The pooled proportion of any change recommendation was 28 % (95 %CI = 21-35) and major change recommendation was 12 % (95 %CI = 7-18). Proportions of change recommendation were not impacted by any treatment characteristics. The most common reasons for change recommendation include target volume delineation (25/55; 45 %), target dose prescription (18/55; 33 %), organ at risk dose prescription (5/55; 9 %), and organ at risk volume delineation (3/55; 5 %).</p><p><strong>Conclusions: </strong>Our review provides evidence that peer review results in treatment plan change recommendations in over one in four patients. The results suggest that some form of real-time, early peer review may be beneficial for all cases, irrespective of treatment intent or RT technique.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110622"},"PeriodicalIF":4.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639669","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":"Role of consolidative thoracic and prophylactic cranial radiation in extensive stage small cell lung cancer in chemo-immunotherapy era","authors":"J. Varlotto ,&nbsp;R. Voland ,&nbsp;M. DeCamp ,&nbsp;J. Khatri ,&nbsp;Y. Shweihat ,&nbsp;K. Nwanwene ,&nbsp;M. Tirona ,&nbsp;T. Wright ,&nbsp;T. Pacioles ,&nbsp;M. Jamil ,&nbsp;K. Anwar ,&nbsp;J. Bastidas ,&nbsp;N. Chowdhury ,&nbsp;D. Zander ,&nbsp;D. Silbermins ,&nbsp;M. Abdallah ,&nbsp;J. Flickinger","doi":"10.1016/j.radonc.2024.110619","DOIUrl":"10.1016/j.radonc.2024.110619","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of consolidative thoracic and prophylactic brain radiation for extensive stage small cell lung cancer patients is controversial. We investigated the factors associated with the use of any radiation therapy (RT) and whether RT has a benefit to overall survival (OS) in patients receiving any systemic therapy and whether this benefit is the same if Chemotherapy (CT) or chemo-immunotherapy (CT-IO) is used.</div></div><div><h3>Material/Methods</h3><div>The NCDB database was queried from years 2017–2019. Patients receiving systemic therapy- STX (CT or CT-IO) had to have at least 6 months of follow-up and have no brain metastases at diagnosis. All RT patients had to receive upfront systemic therapy, be treated 2–6 months from diagnosis, and if treated to the brain received 25 Gy in 10 fractions only. Multi-variable analyses (MVA) were used to determine factors associated with OS and selection for any radiation. Propensity matching for factors affecting OS were used to generate Kaplan-Meier OS curves. Log-rank tests were used to determine differences in Kaplan Meier survival curves for the effects of RT on OS.</div></div><div><h3>Results</h3><div>The total number of patients receiving RT/STX or STX alone as well as their median follow-up (months) were (890, 17.0 mn) and (6898, 14.0mn). The median time to the start of STX and RT were 22.9 days and 152 days, respectively. MVA noted that RT had a greater effect on OS (Thorax, Brain, Both Brain/Thorax – HRs = 0.80, 0.77, 0.70) than other interventions including IO (HR 0.87) and palliative care without RT (HR 1.06). Selection for radiation depended significantly upon factors affecting OS (HR) including lack of liver metastases, females, age and Charlson co-morbidity index, but did not depend upon insurance status, race, or county income/high school graduation rates. Propensity-score matched OS curves noted the same significant effects of RT on OS in those receiving CT +/- IO, CT-IO, and CT alone with HRs of 0.68/0.68/0.68 for thoracic RT, 0.72/0.72/0.70 for brain RT, and 0.60/0.60/0.60 for brain/thoracic RT, respectively.</div></div><div><h3>Conclusions</h3><div>The patient with extensive stage small cell lung cancer who reach candidacy and receive RT may have a significant improvement in OS compared to the patients treated only with CT or CT-IO. Combined thoracic and prophylactic brain RT seems to be better than either one alone. The impact of radiation whether given to one or two sites may be more beneficial than immunotherapy added to chemotherapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"202 ","pages":"Article 110619"},"PeriodicalIF":4.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626026","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}