Radiotherapy and Oncology最新文献

{"title":"Long-term trends in the burden of nasopharyngeal carcinoma in China: A comprehensive analysis from 1990 to 2021 and projections to 2030 based on the global burden of disease study 2021","authors":"","doi":"10.1016/j.radonc.2024.110613","DOIUrl":"10.1016/j.radonc.2024.110613","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Nasopharyngeal carcinoma (NPC) is a significant public health issue in China, with distinctive epidemiological characteristics and evolving trends. This study aims to analyze long-term trends in NPC burden from 1990 to 2021 and provide projections.</div></div><div><h3>Materials and Methods</h3><div>Data from the Global Burden of Disease (GBD) database (1990–2021) was utilized to evaluate NPC metrics, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs). Joinpoint regression identified significant changes over time. Age-period-cohort (APC) analyses assessed the effects of age, period, and cohort. A decomposition analysis identified factors influencing changes in NPC incidence, prevalence, and DALYs. Projections were made for future trends up to 2030.</div></div><div><h3>Results</h3><div>In 2021, NPC significantly impacted China, with males experiencing higher incidence (5.16 per 100,000) and mortality rates (2.32 per 100,000) than females. NPC prevalence was 342,477 cases, with males accounting for 260,164. DALYs totaled 982,657, predominantly affecting males. From 1990 to 2021, the age-standardized incidence rate (ASIR) in China decreased from 4.64 to 3.42 per 100,000, while globally it declined from 1.74 to 1.38 per 100,000. Between 1990 and 2021, trends showed an initial decline in ASIR and age-standardized prevalence rate (ASPR), followed by a steady increase from 2006 onwards, with males experiencing more significant rises. Mortality rates showed a general downward trend, yet males remained disproportionately affected. Comparative global data indicated that while NPC metrics are declining worldwide, the burden remains higher in China. Decomposition analysis highlighted aging and population growth as major contributors to the NPC burden. Bayesian age-period-cohort (BAPC) projections indicated a continuing rise in age-standardized incidence and prevalence rates for both males and females up to 2030.</div></div><div><h3>Conclusions</h3><div>The burden of NPC in China remains significant, particularly among the male population. Despite declining mortality rates, the increasing prevalence suggests that more people are living with NPC. Targeted public health interventions are urgently needed to address these gender-specific trends and reduce the disease burden.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569412","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":"Boron neutron capture therapy for cutaneous angiosarcoma and malignant melanoma: First in-human phase I clinical trial","authors":"","doi":"10.1016/j.radonc.2024.110607","DOIUrl":"10.1016/j.radonc.2024.110607","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Definitive radiotherapy for patients with scalp angiosarcoma has a poor prognosis, often resulting in severe skin adverse events. Additionally, malignant melanoma is known for its radioresistant nature. Boron neutron capture therapy (BNCT) may address these challenges due to the high uptake capacity of boron drugs in these cancer types. We aimed to determine the treatment dose for BNCT and evaluate the incidence of acute adverse events AEs following BNCT in patients with primary or recurrent angiosarcoma/malignant melanoma of the skin.</div></div><div><h3>Materials and methods</h3><div>This was a single-center, non-randomized clinical trial with a three-step dose escalation plan, involving maximum skin doses of 12, 15, and 18 Gy-Eq following a 3 + 3 design. The patients underwent BNCT between November 2019 and April 2022. The primary endpoint was to evaluate the incidence of acute adverse events.</div></div><div><h3>Results</h3><div>Ten patients (scalp angiosarcomanine, forefinger malignant melanoma: one) were included. The median target lesion size was 46.5 (range: 20–145) mm. A transient asymptomatic increase in serum amylase level was the only grade 3 adverse event. The best overall response rate within 180 days was 70 % (median tumor shrinkage rate: 77.5 % [4.9–100 %]).</div></div><div><h3>Conclusions</h3><div>BNCT with a dose of 18 Gy-Eq is a feasible treatment option, demonstrating a favorable safety profile and a high response rate in patients with primary or recurrent angiosarcoma or malignant melanoma of the skin.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of loco-regional progression and patient outcomes after definitive-dose radiation therapy for anaplastic thyroid cancer.","authors":"Julianna K Bronk, Alexander Augustyn, Abdallah S R Mohamed, C David Fuller, Adam S Garden, Amy C Moreno, Anna Lee, William H Morrison, Jack Phan, Jay P Reddy, David I Rosenthal, Michael T Spiotto, Steven J Frank, Ramona Dadu, Naifa Busaidy, Mark Zafereo, Jennifer R Wang, Anastasios Maniakas, Renata Ferrarotto, Priyanka C Iyer, Maria E Cabanillas, G Brandon Gunn","doi":"10.1016/j.radonc.2024.110602","DOIUrl":"https://doi.org/10.1016/j.radonc.2024.110602","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to characterize the patterns of loco-regional progression (LRP) and outcomes after definitive-dose intensity modulated radiation therapy (IMRT) for anaplastic thyroid cancer (ATC) with macroscopic neck disease at the time of IMRT.</p><p><strong>Methods: </strong>Disease/treatment characteristics and outcomes for patients with unresected or incompletely resected ATC who received IMRT (≥45 Gy) were retrospectively reviewed. For those with LRP after IMRT, progressive/recurrent gross tumor volumes (rGTV) were contoured on diagnostic CTs and co-registered with initial planning CTs using deformable image registration. rGTVs were classified based on established spatial/dosimetric criteria.</p><p><strong>Results: </strong>Forty patients treated between 2010-2020 formed the cohort. Median IMRT dose was 66 Gy (45-70 Gy); altered fractionation (AF) was used in 24 (60 %). All received concurrent chemotherapy. In addition to areas of gross disease, target volumes (TVs) commonly included: central compartment/upper mediastinum (levels VI/VII), neck levels II-V in an involved, and levels III-IV in an uninvolved lateral neck. Median overall survival was 7.1 m. Median progression free survival was 7.4 m for patients with locoregional disease and 1.8 m for patients with distant metastasis at the time of IMRT. Twenty-one patients (53 %) developed LRP at median of 10.9 m; freedom from LRP at 3 m and 12 m was 71 % (95 %CI 58-87 %) and 47 % (95 %CI 32-68 %). Forty-one individual rGTVs were identified and most occurred within the high dose (HD) TVs: Type A/central HD (n = 29, 71 %) and B/peripheral HD (n = 3, 7 %).</p><p><strong>Conclusions: </strong>Despite an intensive treatment schedule, including AF and concurrent chemotherapy, classic radio-resistant and rapid Type A failures predominated; isolated extraneous dose failures were rare. While these findings support the IMRT and TV delineation strategies described herein, they highlight the importance of identifying novel strategies to further improve LRC for patients with unresectable disease without targetable mutations for contemporary neo-adjuvant strategies.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569418","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":"Auto-contouring of cardiac substructures for Stereotactic arrhythmia radioablation (STAR): A STOPSTORM.eu consortium study","authors":"","doi":"10.1016/j.radonc.2024.110610","DOIUrl":"10.1016/j.radonc.2024.110610","url":null,"abstract":"<div><h3>Background/Purpose</h3><div>High doses to healthy cardiac substructures (CS) in stereotactic arrhythmia radioablation (STAR) raise concerns regarding potential treatment-induced cardio-toxicity. However, CS contours are not routinely created, hindering the understanding of the CS dose–effect relationships. To address this issue, the alignment of CS contouring was initiated within the STOPSTORM consortium. In this study, we developed and evaluated auto-contouring models trained to delineate CS and major vessels in ventricular tachycardia (VT) patients.</div></div><div><h3>Methods</h3><div>Eight centres provided standard treatment planning computed tomography (CT) and/or contrast-enhanced CT datasets of 55 VT patients, each including 16 CS. Auto-contouring models were trained to contour either large structures or small structures. Dice Similarity Coefficient (DSC), 95 % Hausdorff distance (HD95) and volume ratio (VR) were used to evaluate model performance versus inter-observer variation (IOV) on seven VT patient test cases. Significant differences were tested using the Mann-Whitney <em>U</em> test.</div></div><div><h3>Results</h3><div>The performance on the four chambers and the major vessels (median DSC: 0.88; HD95: 5.8–19.4 mm; VR: 1.09) was similar to the IOV (median DSC: 0.89; HD95: 4.8–14.0 mm; VR: 1.20).</div><div>For the valves, model performance (median DSC: 0.37; HD95: 11.6 mm; VR: 1.63) was similar to the IOV (median DSC: 0.41; HD95: 12.4 mm; VR: 3.42), but slightly worse for the coronary arteries (median DSC: 0.33 vs 0.42; HD95: 24.4 mm vs 16.9 mm; VR: 1.93 vs 3.30). The IOV for these small structures remains large despite using contouring guidelines.</div></div><div><h3>Conclusion</h3><div>CS auto-contouring models trained on VT patient data perform similarly to IOV. This allows for time-efficient evaluation of CS as possible organs-at-risk.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A feasibility study of dose-band prediction in radiation therapy: Predicting a spectrum of plan dose","authors":"","doi":"10.1016/j.radonc.2024.110593","DOIUrl":"10.1016/j.radonc.2024.110593","url":null,"abstract":"<div><h3>Purpose</h3><div>The current deep learning-based dose prediction methods only predict one dose distribution. If the predicted dose is inaccurate, no additional options can be selected. To overcome this limitation, we propose a novel dose prediction method called “dose-band prediction,” which provides a spectrum of predicted dose distributions for planning and quality assurance (QA) purposes.</div></div><div><h3>Material and methods</h3><div>We utilized Upper/Lower-band losses in 3D neural networks to establish the Upper/Lower-band models (UBM/LBM). The maximum/minimum rational dose predicted in UBM/LBM defined the ideal dose spectrum for each voxel. We enrolled 104 nasopharyngeal carcinoma cases with tomotherapy (dataset 1), 54 cervical carcinoma cases with IMRT (dataset 2), and 37 cervical carcinoma cases with VMAT (dataset 3) in the study. Moreover, a dose band-based auto planning (Auto-plan_dose-band) attempt was carried out in dataset 3, compared with the MSE model (Auto-plan_MSE).</div></div><div><h3>Results</h3><div>The UBM/LBM doses tend to be higher/lower than the clinical dose, forming a predicted dose spectrum. The Middle-line dose represents the average of the Upper/Lower-band, which was consistent with the clinical dose. The mean differences of the planning target volumes (PTVs) and organs at risk (OARs) for the Upper-band, Middle-line, and Lower-band in Dataset 1 were 3.66 %, −0.40 %, and −4.48 % in Dataset 2, they were 2.40 %, −1.62 %, and −5.57 %; in Dataset 3, they were 2.18 %, −0.59 %, and −3.31 %. When PTVs meet prescription, the mean difference between Auto-plan_dose-band and Auto-plan_MSE in OARs was −2.67 %.</div></div><div><h3>Conclusion</h3><div>The dose-band prediction successfully predicted a spectrum of doses, making auto-planning and QA flexible and high quality.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569369","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":"Automated segmentation in planning-CT for breast cancer radiotherapy: A review of recent advances","authors":"","doi":"10.1016/j.radonc.2024.110615","DOIUrl":"10.1016/j.radonc.2024.110615","url":null,"abstract":"<div><div>Postoperative radiotherapy (RT) has been shown to effectively reduce disease recurrence and mortality in breast cancer (BC) treatment. A critical step in the planning workflow is the accurate delineation of clinical target volumes (CTV) and organs-at-risk (OAR). This literature review evaluates recent advancements in deep-learning (DL) and atlas-based auto-contouring techniques for CTVs and OARs in BC planning-CT images for RT. It examines their performance regarding geometrical and dosimetric accuracy, inter-observer variability, and time efficiency. Our findings indicate that both DL- and atlas-based methods generally show comparable performance across OARs and CTVs, with DL methods slightly outperforming in consistency and accuracy. Auto-segmentation of breast and most OARs achieved robust results in both segmentation quality and dosimetric planning. However, lymph node levels (LNLs) presented the greatest challenge in auto-segmentation with significant impact on dosimetric planning. The translation of these findings into clinical practice is limited by the geometric performance metrics and the lack of dose evaluation studies. Additionally, auto-contouring algorithms showed diverse structure sets, while training datasets varied in size, origin, patient positioning and imaging protocols, affecting model sensitivity. Guideline inconsistencies and varying definitions of ground truth led to substantial variability, suggesting a need for a reliable consensus training dataset. Finally, our review highlights the popularity of the U-Net architecture. In conclusion, while automated contouring has proven efficient for many OARs and the breast-CTV, further improvements are necessary in LNL delineation, dosimetric analysis, and consensus building.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EGCG protects intestines of mice and pelvic cancer patients against radiation injury via the gut microbiota/D-tagatose/AMPK axis","authors":"","doi":"10.1016/j.radonc.2024.110608","DOIUrl":"10.1016/j.radonc.2024.110608","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Radiation-induced intestinal injury (RIII) compromises the clinical utility of pelvic radiotherapy (RT). We aimed to explore the protective effect and underlying mechanism of (−)-epigallocatechin-3-gallate (EGCG) on RIII.</div></div><div><h3>Materials and methods</h3><div>We evaluated the protective effect of EGCG on intestine in RIII mouse model and pelvic cancer patients, while explored the underlying mechanism through (1) 16S rRNA sequencing, (2) metabolomic profiles, (3) fresh sterile fecal filtrate (SFF) transplantation, and (4) transcriptome sequencing.</div></div><div><h3>Results</h3><div>EGCG efficiently prevented RIII in mouse, as reflected by improved survival, alleviated intestinal structure damage, promoted intestinal regeneration, and ameliorated gut microbiota dysbiosis. Prophylactic EGCG intervention reduced the severity of RIII in patients receiving pelvic RT. Mechanistically, the protective effect of EGCG could be transferred to other mice by SFF transplantation. EGCG enriched gut microbiota-derived metabolite D-tagatose, and oral administration of D-tagatose reproduced the radio-protective effect of EGCG via activating AMPK.</div></div><div><h3>Conclusion</h3><div>Oral EGCG may be a promising strategy for preventing RIII clinically, and warrant further investigation in prospective randomized phase III trials.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564868","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":"Knowledge-based planning for fully automated radiation therapy treatment planning of 10 different cancer sites","authors":"","doi":"10.1016/j.radonc.2024.110609","DOIUrl":"10.1016/j.radonc.2024.110609","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiation treatment planning is highly complex and can have significant inter- and intra-planner inconsistency, as well as variability in planning time and plan quality. Knowledge-based planning (KBP) is a tool that can be used to efficiently produce high-quality, consistent, clinically acceptable plans, independent of planner skills and experience. In this study, we created and validated multiple clinically acceptable and fully automatable KBP models, with the goal of creating VMAT plans without user intervention.</div></div><div><h3>Methods</h3><div>Ten KBP models were configured using high quality clinical plans from a single institution. They were then honed to be part of a fully automatable system by incorporating scriptable planning structures, plan creation, and plan optimization. These models were verified and validated using quantitative (model statistics) and qualitative (dose-volume histogram estimation review) analysis. The resulting KBP-generated plans were reviewed by physicians and rated for clinical acceptability.</div></div><div><h3>Results</h3><div>Autoplanning models were created for anorectal, bladder, breast/chest wall, cervix, esophagus, head and neck, liver, lung/mediastinum, prostate, and prostate with nodes treatment sites. All models were successfully created to be part of a fully automated system without the need for human intervention to create a fully optimized plan. The physician review indicated that, on average, 88% of all KBP-generated plans were “acceptable as is” and 98% were “acceptable after minor edits.”</div></div><div><h3>Conclusion</h3><div>KBP models for multiple treatment sites were used as a basis to generate fully automatable, efficient, consistent, high-quality, and clinically acceptable plans. These plans do not require human intervention, demonstrating the potential this work has to significantly impact treatment planning workflows.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of dynamic blood dose with clinical outcomes in radiotherapy for head-and-neck cancer","authors":"","doi":"10.1016/j.radonc.2024.110603","DOIUrl":"10.1016/j.radonc.2024.110603","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Radiation-induced lymphopenia (RIL) during cancer radiotherapy is receiving growing attention due to its association with adverse clinical outcomes. Correlations between RIL and poorer locoregional control (LRC), distant-metastasis-free survival (DMFS), and overall survival (OS) have been demonstrated across multiple treatment sites. Estimates of radiation delivered to circulating blood or lymphocytes have been shown to be correlated with severe RIL. This study aims to evaluate whether blood dose estimates are equally correlated with patient outcomes directly.</div></div><div><h3>Materials and methods</h3><div>For 298 head-and-neck cancer patients, blood dose was estimated via the total body dose (D_body), a static blood dose model considering the mean dose to relevant organs and tissues (D_static), and a dynamic model which further included temporal aspects such as blood flow and treatment delivery time (D_dynamic). The latter utilized hematological dose (HEDOS), an open-source computational tool for blood dose simulations. Survival analysis was performed to evaluate potential correlations between blood dose and LRC, DMFS, and OS.</div></div><div><h3>Results</h3><div>Multivariable Cox regression analysis found a statistically significant (p &lt; 0.05) correlation between various dynamic blood dose metrics and clinical outcomes. D_body and D_static did not correlate with any of the outcomes considered.</div></div><div><h3>Conclusion</h3><div>A statistically significant correlation between the dynamic blood dose model and adverse clinical outcomes was observed. During multivariable regression analysis, neither static blood dose model exhibited a statistically significant correlation with any of the outcomes studied.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558630","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":"Climate impact of early-stage NSCLC treatment: A comparison between radiotherapy and surgery using Life Cycle Assessment.","authors":"Jochem Kaas, Marit Verbeek, Wilson W L Li, Stefan M van der Heide, Ad F T M Verhagen, René Monshouwer, Hugo R W Touw, Johan Bussink, Erik van der Bijl, Tim Stobernack","doi":"10.1016/j.radonc.2024.110601","DOIUrl":"10.1016/j.radonc.2024.110601","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare systems contribute significantly to CO₂ emissions, accounting for 7 % of emissions in the Netherlands. Understanding the environmental footprint of medical treatments can help identify opportunities for reducing climate impact. We evaluated the climate impact of stereotactic body radiotherapy (SBRT) and Video-Assisted Thoracic Surgery (VATS) when treating T1-2N0M0 Non-Small Cell Lung Cancer (NSCLC).</p><p><strong>Materials and methods: </strong>We used life cycle assessment (LCA) to evaluate climate impact in emissions of kilograms of CO₂ equivalent. Care trajectories were inventoried for both VATS and SBRT with the same entry and end point of the paths. We analyzed a range of factors contributing to climate impact, such as patient and staff travel, energy consumption, disposables and medication using direct measurements: questionnaires and waste audits, or retrospective record analysis. As is common in LCA, existing infrastructure was excluded from the analysis. Reductions that can be influenced by individual departments were also modeled.</p><p><strong>Results: </strong>Using LCA we calculated the impact of all categorized contributions for two treatments for NSCLC. In total, VATS generates approximately 547 kg CO₂ equivalent (CO₂e), whereas SBRT generates 172 kg CO₂e per treatment. For SBRT, the largest contributors were energy use in the hospital (52 % of total), of which 22 % is from the linac, and patient travel (23 %). For VATS, major contributions were hospital energy use (52 %) and disposables (23 %). Climate impact could be reduced by 20 % (SBRT) by hypofractionation, reduced linac idle time and patient travel impact, and 13 % (VATS) with fast track recovery and a reduction of disposables.</p><p><strong>Conclusion: </strong>When treating T1-2N0M0 NSCLC, surgery has a larger climate impact than SBRT. For both modalities reductions are possible.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558629","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}