Radiotherapy and Oncology最新文献

{"title":"Response to letter to editor \"Re-evaluating 'Prospective evaluation of AI-based BiCycle autoplanning for advanced cervical cancer brachytherapy': The silent cumulative CTVIR deficit\".","authors":"Linda Rossi, Remi Nout, Ben Heijmen","doi":"10.1016/j.radonc.2025.111217","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111217","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111217"},"PeriodicalIF":5.3,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145355760","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":"Regarding Dähler K et al. '' Evaluation of the prognostic value of the ESTRO/EORTC classification of reirradiation in patients with non-small cell lung cancer\".","authors":"Wen-Chien Cheng, Hung-Jen Chen, Chun-Ru Chien","doi":"10.1016/j.radonc.2025.111213","DOIUrl":"10.1016/j.radonc.2025.111213","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111213"},"PeriodicalIF":5.3,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337602","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":"Re-evaluating 'Prospective evaluation of AI-based BiCycle autoplanning for advanced cervical cancer brachytherapy': The silent cumulative CTVIR deficit.","authors":"Shengquan Fang, Min Gao","doi":"10.1016/j.radonc.2025.111216","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111216","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111216"},"PeriodicalIF":5.3,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346937","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":"Multicenter deep Learning-Based automatic delineation of CTV and PTV in uterine malignancy CT imaging.","authors":"Bichun Xu, Jun Liu, Mingming Fang, Hong Zhu, Yichi Zhang, Hongwei Zhang, Xujing Lu, Judong Luo","doi":"10.1016/j.radonc.2025.111212","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111212","url":null,"abstract":"<p><strong>Background and purpose: </strong>Accurate delineation of the clinical target volume (CTV) and planning target volume (PTV) is essential for effective radiotherapy in uterine malignancies. Manual contouring is laborious, time-consuming, and subjective, and current automatic methods often focus on a single cancer type with limited external validation. To address this, we developed a deep-learning model capable of accurately delineating both CTV and PTV across multiple uterine malignancies using CT imaging.</p><p><strong>Materials and methods: </strong>We retrospectively collected 602 contrast-enhanced CT scans, comprising 302 cases (cervical and endometrial cancers) from our institution and an additional 300 cervical cancer scans from external centers. Expert radiation oncologists manually delineated the CTV and PTV on each image. Among the 302 internal cancer cases, 177 cervical cancer cases were used for model training with five-fold cross-validation. Additionally, 41 cervical cancer cases were reserved as an internal testing cohort, while 84 endometrial cancer cases constituted the first external testing cohort to assess the model's generalizability across cancer types. The remaining 300 cervical cancer scans from external centers formed a second external testing cohort to assess model robustness across institutions. We evaluated three segmentation architectures-2D, full-resolution 3D, and cascaded 3D networks-and measured their performance using three standard metrics: Dice Similarity Coefficient (DSC), 95 % Hausdorff Distance (HD95), and Average Surface Distance (ASD).</p><p><strong>Results: </strong>The model-generated segmentations demonstrated strong concordance with the expert contours. In the internal testing cohort with the same cancer type, performance metrics (DSC, HD95, ASD) were consistently high. Similarly, the external testing cohort with different cancer types showed robust performance, indicating effective generalizability. On the internal testing cohort, the model demonstrated strong performance, achieving mean DSCs of 83.42 % for PTV and 81.23 % for CTV, with low spatial errors (PTV: ASD 2.01 mm, HD95 5.71 mm; CTV: ASD 1.35 mm, HD95 4.75 mm). In the endometrial cancer cohort, PTV segmentation achieved a DSC of 82.88 %, while CTV segmentation yielded an HD95 of 5.85  mm and an ASD of 1.34  mm. Additionally, clinical evaluation revealed that approximately 90 % of the model-generated contours required no or only minor revision.</p><p><strong>Conclusions: </strong>We present a multicenter-validated deep-learning based framework for automatic CTV and PTV delineation across diverse uterine malignancies on CT. Our model offers a scalable, generalized solution with the potential to reduce the workload in radiation oncology, improve consistency, and streamline clinical workflows.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111212"},"PeriodicalIF":5.3,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346922","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":"Response to \"Regarding Dähler K et al. '' Evaluation of the prognostic value of the ESTRO/EORTC classification of reirradiation in patients with non-small cell lung cancer\".","authors":"Jonas Willmanna, Nicolaus Andratschke","doi":"10.1016/j.radonc.2025.111214","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111214","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111214"},"PeriodicalIF":5.3,"publicationDate":"2025-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346873","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":"Patterns of relapse and outcomes following Single-Fraction High-Dose-Rate brachytherapy monotherapy for Intermediate-Risk prostate cancer.","authors":"Constanza Martinez, Jayson Paragas, Leticia Alvarado, Fabio Cury, Luis Souhami, Simon Gauvin, Richard Sioufi, Sergio Faria, James M G Tsui, Gabriela Stroian, Doris Marti, Marie Duclos","doi":"10.1016/j.radonc.2025.111211","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111211","url":null,"abstract":"<p><strong>Introduction: </strong>High-dose rate brachytherapy (HDRB) monotherapy has proven effective in managing low- and intermediate-risk prostate cancer (IRPC). This study aims to evaluate patterns of relapse, treatment-related toxicity, and tumor control in patients with IRPC treated with a single fraction of HDRB monotherapy.</p><p><strong>Methodology: </strong>We reviewed IRPC patients treated with HDRB monotherapy delivered as a single 21 Gy fraction between January 2015 and December 2021. Clinical data, treatment parameters, and outcomes were extracted from medical records. Radiological local recurrences diagnosed by a blinded genitourinary radiologist were confirmed by biopsy. We performed dosimetric analysis of recurrent intraprostatic nodules. Toxicities were graded using CTCAE v4. We report 3- and 5-year biochemical relapse-free survival (bRFS), locoregional relapse-free survival (LRRFS), and overall survival (OS).</p><p><strong>Results: </strong>87 patients were included (median follow-up: 51.1 months). Biochemical failure occurred in 24.1 % of patients, including local relapse in 16.1 %. Using Cox proportional-hazards model, higher baseline PSA and unfavorable intermediate-risk (UIR) category were associated with an increased local relapse risk (HR 1.2 [95 % CI 1.0-1.42], p = 0.013; HR 4.52 [95 % CI 1.4-14.1], p = 0.01, respectively), whereas a greater prostatic volume receiving 100 % of the prescription dose was protective (HR 0.85 [95 % CI 0.75-0.96]). Dosimetric analyses of recurrences (D98% = 21.6 Gy, D90% = 23.7 Gy, Dmean = 30.6 Gy) showed no association with failure. The 5-year bRFS rate for favorable intermediate-risk (FIR) patients was 83.4 %, and for UIR patients 59.3 %. The 5-year LRRFS rate was 82.6 % for FIR and 76.9 % for UIR patients. The 5-year OS was 96.6 %. Acute grade ≥ 3 genitourinary toxicities occurred in 5.7 % of patients, and late grade ≥ 3 toxicity in 1.1 %. No grade ≥ 2 gastrointestinal toxicity was observed.</p><p><strong>Conclusion: </strong>A single 21 Gy fraction of HDR brachytherapy monotherapy for IRPC appears feasible and safe, yielding a 5-year bRFS of 83.4 % for FIR and 59.3 % for UIR patients. Patterns of failure were not attributable to inadequate dosimetric coverage. Higher baseline PSA levels and UIR classification were associated with an increased risk of local failure.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111211"},"PeriodicalIF":5.3,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337586","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":"CT online adaptive radiotherapy is associated with dosimetric and acute toxicity improvements in prostate cancer treatment.","authors":"Lin L Zhu, Jeremy S Bredfeldt, Yue-Houng Hu, Cindy Hancox, Christian V Guthier, Sarah Quirk, Jennifer Pursley, Sophia C Kamran, David McClatchy, Paul L Nguyen, Anthony V D'Amico, Mutlay Sayan, Ellen Kim, Kent W Mouw, Martin T King, Neil E Martin, Jonathan E Leeman","doi":"10.1016/j.radonc.2025.111207","DOIUrl":"10.1016/j.radonc.2025.111207","url":null,"abstract":"<p><strong>Background and purpose: </strong>CT online adaptive (COA) radiotherapy allows for daily personalization of radiotherapy plans based on cone-beam CT imaging. Presently, the impact of COA on prostate cancer outcomes remains unknown.</p><p><strong>Materials and methods: </strong>Records of 158 prostate cancer patients treated to 60 Gy/20 fractions in a single department with either COA with daily plan adaptation (n = 81) or non-adaptive radiotherapy (n = 77) were analyzed. Dosimetric changes resulting from COA were assessed. Short-term gastrointestinal (GI) and genitourinary (GU) toxicities were graded and logistic regression analyses with inverse probability treatment weighting (IPTW) were performed to assess the effect of COA on toxicities. The length of seminal vesicle tissue treated (LSV) was assessed as a predictor of COA outcomes.</p><p><strong>Results: </strong>On multivariate analysis, COA was significantly associated with reduced GI toxicity (OR 0.45 95 %CI 0.27-0.73, p = 0.001) but not GU toxicity (OR 0.65 95 %CI 0.40-1.03, p = 0.07). Of 1620 COA fractions, 48.4 % demonstrated a clinically beneficial dosimetric change (63.7 %, 20.0 %, 15.1 % and 2.3 % for target coverage, rectum, small bowel and bladder, respectively) and 79/81 (97.5 %) of COA patients experienced at least one fraction exceeding a pre-defined threshold for clinical benefit. LSV was positively correlated with dosimetric benefit from COA (r = 0.42, p < 0.001). In non-adaptive patients, the LSV was associated with short-term GI toxicity (r = 0.30, p = 0.009) whereas this association was abolished with COA.</p><p><strong>Conclusions: </strong>COA is associated with dosimetric improvements and decreased short-term GI toxicity. Accounting for daily variation in seminal vesicle position is a primary mechanism by which COA improves outcomes.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111207"},"PeriodicalIF":5.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329790","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 II study of salvage HDR brachytherapy combined with external beam radiotherapy for isolated prostate bed relapse after radical prostatectomy: preliminary clinical results.","authors":"Luis Fuertes Vallés, Maite Echeveste, Marcos Torres, Javier Ancizu-Marckert, Luis Labairu Huerta, Marian Aristu Mendioroz, Sara Fadrique, Benigno Barbés, Alberto Benito, Macarena Rodríguez Fraile, Adriana Ayestarán, Rafael Martínez-Monge","doi":"10.1016/j.radonc.2025.111215","DOIUrl":"10.1016/j.radonc.2025.111215","url":null,"abstract":"<p><strong>Background: </strong>Biochemical recurrence after radical prostatectomy is common, and conventional salvage external beam radiotherapy (EBRT) achieves suboptimal control with significant late morbidity. Advances in PSMA PET/CT and multiparametric MRI enable precise detection of isolated prostate bed relapse (IPBR) at low PSA values. High-dose-rate (HDR) brachytherapy offers focal dose escalation with steep gradients, potentially improving control while sparing organs at risk (OARs).</p><p><strong>Methods: </strong>We conducted a prospective phase I-II study (NCT06982469) of combined salvage high-dose-rate (HDR) brachytherapy followed by external beam radiotherapy (EBRT) for patients with IPBR. HDR was delivered as 19 Gy in two fractions prescribed to the clinical target volume (CTV) with strict organ-at-risk (OAR) constraints. EBRT to the whole prostate bed and elective pelvic lymph nodes followed combined with 6-month ADT. Toxicity was assessed using CTCAE v5.0 and quality of life with EORTC QLQ-PR25.</p><p><strong>Results: </strong>Sixteen patients were enrolled between 2020 and 2024. Median PSA at salvage was 0.36 ng/mL. After HDR planning, all dosimetric objectives were met. At a median follow-up of 3.7 years (range, 2.3 - 5.2), 15 out of 16 patients (93.8 %) remained biochemically controlled, with no local failures. Grade 2 late urinary toxicity was documented in one case and no grade 3 late toxicites occurred. Patient-reported urinary and bowel domains showed only minor, non-significant changes at 6 months from baseline.</p><p><strong>Conclusions: </strong>Combined salvage HDR brachytherapy followed by EBRT for PSMA-detected IPBR is feasible, achieves excellent early biochemical control, and preserves quality of life with favorable toxicity. The trial was closed without completing the target size due to slow accrual although these results warrant confirmation in larger multicenter trials.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111215"},"PeriodicalIF":5.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329827","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":"Fractionation increasingly reduces FLASH sparing for acute murine skin damage.","authors":"Line Kristensen, Sky Rohrer, Jacob Graversen Johansen, Lone Hoffmann, Lars Hjorth Præstegaard, Anna Holtz Hansen, Per Rugaard Poulsen, Brita Singers Sørensen","doi":"10.1016/j.radonc.2025.111209","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111209","url":null,"abstract":"<p><strong>Background and purpose: </strong>Preclinical studies report a favourable normal tissue-sparing FLASH effect. Most studies report single-fraction irradiations. The interplay between fractionation and FLASH sparing is highly relevant for clinical translation but is scarce in the literature. This study compared the tissue-sparing effect of FLASH on acute skin toxicity with single-fraction, four-fraction and eight-fraction schemes.</p><p><strong>Materials and methods: </strong>Acute skin toxicity after conventional dose rate (CONV, 0.16 Gy/s) and FLASH (mean ± sd 251 ± 12 Gy/s) irradiation was assessed in female CDF1 mice. The right hindleg of unanaesthetised mice was irradiated using a single dose (1 fraction), one daily dose for four consecutive days (4 fractions) or two daily doses with a 6-hour interval for four consecutive days (8 fractions). The study had 4-12 mice per dose group. The total dose per group ranged from 24.5 to 89.9 Gy. A FLASH-enabled accelerator (TrueBeam, Varian) delivered irradiation with a 16 MeV electron beam. Acute skin toxicity was quantified daily from 9 to 28 days post-treatment.</p><p><strong>Results: </strong>Single-fraction irradiation had a tissue-sparing FLASH effect, which was halved for four fractions and markedly reduced for eight fractions. The dose modification ratio was 1.41 for a single fraction, 1.18 for four fractions, and nonsignificantly 1.05 for eight fractions.</p><p><strong>Conclusion: </strong>Fractionation increasingly reduced the acute skin-sparing effect seen in single-fraction FLASH studies. However, a tissue-sparing effect of 18 % was still present at four fractions, while eight fractions provided a nonsignificant 5 % FLASH skin-sparing. Clinical implementation of FLASH may work best in highly hypofractionated settings.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111209"},"PeriodicalIF":5.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329753","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":"Proseven trial: MR-guided prostate stereotactic body radiotherapy in seven days - First results.","authors":"Benjamin Vanspeybroeck, Jacques Bezuidenhout, Guy Soete, Tim Everaert, Anne-Sophie Bom, Jens Van Loon, Sven Van Laere, Thierry Gevaert, Mark De Ridder","doi":"10.1016/j.radonc.2025.111208","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.111208","url":null,"abstract":"<p><strong>Background and purpose: </strong>Reducing the overall treatment duration of prostate SBRT has the potential to improve patient comfort and treatment compliance. Additionally, focal boosting to the gross tumor volume (GTV) is of interest to enhance oncologic outcomes. The phase II PROSEVEN trial (MR-guided prostate stereotactic body radiotherapy in seven days) combined both strategies, utilizing MR-guided radiotherapy (MRgRT) to deliver treatment.</p><p><strong>Materials and methods: </strong>Treatment delivered 36 Gy in five fractions to the planning target volume (PTV), 40 Gy to the clinical target volume (CTV), and up to 42 Gy as a simultaneous integrated boost (SIB) to the intraprostatic tumor (GTV). This was administered using a 0.35-Tesla MR-Linac over a seven-day period. The primary endpoint was the incidence of clinician-reported acute GU and GI toxicity of grade 2 or higher, assessed using CTCAE v5.0. Secondary endpoints included patient-reported outcomes (PROMs). This phase II Proseven trial, approved by the Ethics Committee of UZ Brussels, has completed recruitment with five-year follow-up ongoing.</p><p><strong>Results: </strong>A total of 132 patients with low (12.1 %), intermediate (66.6 %), and limited high-risk (21.2 %) prostate cancer (Pca) were included. The median PSA at diagnosis was 9.43 ng/ml. SIB to the GTV was performed in 85 % of patients, and 64.4 % completed the treatment within the specified 7 days OTT. No grade 3 acute GU or GI toxicity was observed. Acute Grade 2 GU toxicity occurred in 35 %. Acute Grade 2 GI toxicity occurred in 5 %.</p><p><strong>Conclusion: </strong>Prostate SBRT with SIB to the GTV in seven days using MRgRT demonstrated acceptable acute GU toxicity rates and low acute GI toxicity.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111208"},"PeriodicalIF":5.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329795","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}