Radiotherapy and Oncology最新文献

{"title":"Acknowledgement of Reviewers","authors":"","doi":"10.1016/j.radonc.2025.110870","DOIUrl":"10.1016/j.radonc.2025.110870","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"206 ","pages":"Article 110870"},"PeriodicalIF":4.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735148","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":"Improved NTCP model for late radiation-induced aspiration based on dose delivered to specific aspiration-related OARs.","authors":"Agata Gawryszuk, Hans Paul van der Laan, Marije R Vergeer, Martijn Veening, Irma M Verdonck-de Leeuw, Rico N Rinkel, Roel J H M Steenbakkers, Johanna G M van den Hoek, Jan Wedman, Arjen van der Schaaf, Johannes A Langendijk","doi":"10.1016/j.radonc.2025.110871","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110871","url":null,"abstract":"<p><strong>Background and purpose: </strong>Radiation-induced aspiration is a serious complication following (chemo)radiation for head and neck cancer. The standard set of swallowing organs at risk (SWOARs) does not include all aspiration-related organs (OARs). An alternative proposed in earlier work includes a definition and delineation atlas for additional OARs, called Functional Swallowing Units (FSU). The purpose of this study was to compare two NTCP models for late aspiration, based on either SWOARs only or the FSU concept.</p><p><strong>Methods and materials: </strong>Data from 189 patients were analysed. Aspiration at baseline (Asp_T0) and 6 months after treatment (Asp_T6) were scored according to Penetration Aspiration Scale (PAS). All SWOARs and FSUs were delineated and the DVH was recorded. Clinical factors and average dose (Dmean) to all aspiration-related OARs were included in multivariable analysis. Two models were built, model 1: including clinical factors and SWOARs only and model 2: including clinical factors, SWOARs and FSUs.</p><p><strong>Results: </strong>Both final models included Asp_T0 and Dmean to the supraglottic larynx as predictors. Model 2 included the dose to three additional OARs as a predictor: 1) Anterior Segment (floor of mouth/ thyrohyoid muscles) 2) hyoglossus/styloglossus muscles complex (HSG) 3) upper oesophageal sphincter (UES). Adding FSUs to model 1 resulted in significant model updates and model 2 performed better than model 1 (AUC 0.79 vs. 0.75).</p><p><strong>Conclusion: </strong>NTCP models for late aspiration may be improved by including the dose to aspiration-related OARs, defined by the FSU concept. In addition to the supraglottic larynx, sparing of the Anterior Segment, HSG and UES could further decrease the risk of radiation-induced aspiration, but this remains to be confirmed in clinical studies.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110871"},"PeriodicalIF":4.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743539","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":"Control of dental calculus Prevents severe Radiation-Induced oral mucositis in patients undergoing radiotherapy for nasopharyngeal carcinoma.","authors":"Yu Zeng, Yue Hu, Linjing Wang, Zhiwei Liao, Jianming Tan, Yanhao Kuang, Pan Gong, Bin Qi, Xin Zhen","doi":"10.1016/j.radonc.2025.110872","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110872","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to develop an artificial intelligence model to predict severe radiation-induced oral mucositis (RIOM) in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) and verify the risk factors associated with severe RIOM.</p><p><strong>Methods and materials: </strong>A total of 578 patients diagnosed with LA-NPC and undergoing radiotherapy were enrolled in this study. This cohort comprised 430 retrospective patients used for model development/validation, and 148 patients for the prospective verification study. Multifaceted data related to RIOM were collected to build an explainable multi-classifier fusion (MCF) model to identify severe RIOM associated risk factors. A prospective study was designed to validate the key risk factors.</p><p><strong>Results: </strong>The MCF model demonstrated satisfactory performance in severe RIOM prediction when integrating all dosimetric, clinical, and oral features, with an AUC of 0.904, ACC of 0.849, SEN of 0.853 and SPE of 0.846 on the independent testing set. The dental calculus index of 2 was identified as a significant key risk factor for developing RIOM. The severe RIOM rate in the prospective intervention cohort was 8.1 % (95 % CI:4.3 %∼13.7 %), lower than that in the model development cohort, with a decrease of 31 % (95 % CI23.9 %∼36.8 %, p < 0.0001).</p><p><strong>Conclusions: </strong>The developed model can serve as a valuable tool for providing timely alerts for high-risk patients with the severe RIOM and assisting physicians in optimizing treatment management. The dental calculus index is a key independent risk factor for severe RIOM. The effective control of the dental calculus can significantly mitigate the onset of severe RIOM.</p><p><strong>Clinicaltrials: </strong>gov: NCT05858385.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110872"},"PeriodicalIF":4.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743534","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-irradiation for children with diffuse intrinsic pontine glioma and diffuse midline glioma","authors":"Nisha Shariff ,&nbsp;Alejandro S. Moreno ,&nbsp;Julie Bennett ,&nbsp;Vijay Ramaswamy ,&nbsp;Anirban Das ,&nbsp;Anthony P. Liu ,&nbsp;Annie Huang ,&nbsp;Uri Tabori ,&nbsp;Cynthia Hawkins ,&nbsp;Peter Dirks ,&nbsp;Eric Bouffet ,&nbsp;Dana M. Keilty ,&nbsp;Barbara-Ann Millar ,&nbsp;David C. Hodgson ,&nbsp;Derek S. Tsang","doi":"10.1016/j.radonc.2025.110865","DOIUrl":"10.1016/j.radonc.2025.110865","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Diffuse intrinsic pontine glioma (DIPG) and diffuse midline glioma (DMG) are incurable brain malignancies. In this study, we report one of the largest known single-institution cohorts of DIPG/DMG patients undergoing re-irradiation (RT2) to evaluate its effect on survival.</div></div><div><h3>Materials and methods</h3><div>Children aged less than 18 years treated for DIPG/DMG with initial fractionated photon radiotherapy (RT1) and had subsequent recurrence were retrospectively reviewed. Patients treated with or without RT2 were compared. The primary outcomes were overall survival (OS) from time of recurrence after RT1, and from start of RT2 (for the RT2 group).</div></div><div><h3>Results</h3><div>A total of 118 children were included, 39 of whom received RT2. Children treated with RT2 had superior OS, with 6-month OS of 66 % vs 22 % in those who did not undergo RT2 (p &lt; 0.0001). Median survivals were 6.9 months for the RT2 group vs 2.7 months for RT1 only. Median time from RT1 to RT2 was 7.7 months; patients with a greater than 1-year latent time between RT1 and RT2 had longer OS from start of RT2 (median 10.9 months vs 5.5 months, p = 0.023). 61 % of those treated with RT2 experienced improvement of neurologic symptoms post-RT2. Multivariate analysis identified younger age, adverse imaging findings on the 4-week post-RT1 reassessment MRI (including pseudoprogression), and the absence of RT2 as poor prognostic factors for OS.</div></div><div><h3>Conclusion</h3><div>Re-irradiation was associated with improved survival and neurological recovery in children with recurrent DIPG and DMG. There is a need to identify novel biomarkers to better select patients who respond best to RT2.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110865"},"PeriodicalIF":4.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704509","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":"Kinetics of PSMA PET signal after radiotherapy in prostate cancer lesions: A single-center retrospective study","authors":"Masatoshi Hotta ,&nbsp;Kathleen Nguyen ,&nbsp;Pan Thin ,&nbsp;Wesley R. Armstrong ,&nbsp;Ida Sonni ,&nbsp;Andrea Farolfi ,&nbsp;Michael Steinberg ,&nbsp;Johannes Czernin ,&nbsp;Nicholas G. Nickols ,&nbsp;Amar U. Kishan ,&nbsp;Jeremie Calais","doi":"10.1016/j.radonc.2025.110869","DOIUrl":"10.1016/j.radonc.2025.110869","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the kinetics of prostate-specific membrane antigen (PSMA) PET uptake in irradiated lesions using serial PSMA PET/CT scans.</div></div><div><h3>Methods</h3><div>Patients with prostate cancer who underwent ⁶⁸Ga-PSMA-11 PET/CT before (PET1) and after radiotherapy (PET2) were retrospectively included. Percentage changes in SUVmax (ΔSUVmax) of the irradiated lesion were measured. The presence of residual uptake was visually assessed on PET2. When available, follow-up imaging was used for lesion validation. Morphologic or uptake disappearance on follow-up scans was defined as loco-regional complete response (L-CR). Clinical and PET characteristics were compared between lesions with and without residual uptake. An optimal timing for response assessment was calculated by receiver-operating-curve analysis.</div></div><div><h3>Results</h3><div>Eighty-nine patients with 217 irradiated lesions (106 lymph nodes, 85 bone, 21 prostate/prostate bed) receiving ablative radiotherapy were included. Lesion uptake was lower at later time points and was lowest at 9–12 months after radiotherapy. Sixty-eight lesions showed residual uptake on PET2. Residual uptake was more common in lesions imaged at an earlier time point after radiotherapy (median: 7.9 vs. 13.0 months, p = 0.001), lesions in the prostate/prostate bed (p &lt; 0.001), and lesions with higher baseline SUVmax (p = 0.001). Thirty-one residual uptake-positive lesions had available follow-up imaging, of which 24 lesions were confirmed to be L-CR. Risk factors for not achieving L-CR were lesions with prolonged uptake (p = 0.002) and those in the prostate/prostate bed (p = 0.003). The optimal time point for predicting L-CR was 8.6 months.</div></div><div><h3>Conclusions</h3><div>Timing and tumor site affect the PSMA PET signal after radiotherapy, and should be considered when assessing response on post-radiotherapy PSMA PET.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110869"},"PeriodicalIF":4.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692986","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":"Clinical outcomes of proton beam therapy for inoperable stage I-IIA non-small cell lung cancer: Japanese nationwide registry study","authors":"Masaki Nakamura ,&nbsp;Kazushi Maruo ,&nbsp;Masao Murakami ,&nbsp;Takashi Ogino ,&nbsp;Hiromitsu Iwata ,&nbsp;Masatoshi Nakamura ,&nbsp;Hitoshi Tatebe ,&nbsp;Takahiro Waki ,&nbsp;Sunao Tokumaru ,&nbsp;Miyako Satouchi ,&nbsp;Kimihiro Shimizu ,&nbsp;Takayuki Hashimoto ,&nbsp;Hidefumi Aoyama ,&nbsp;Hideyuki Harada","doi":"10.1016/j.radonc.2025.110868","DOIUrl":"10.1016/j.radonc.2025.110868","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiotherapy is the standard treatment for unresectable stage I-IIA non-small cell lung cancer (NSCLC). One treatment option within radiotherapy is proton beam therapy (PBT). Currently, a prospective observational study is being conducted at all proton therapy centers in Japan as part of a proton beam all-case registry. This study aimed to evaluate the outcomes of PBT for inoperable stage I-IIA NSCLC.</div></div><div><h3>Methods</h3><div>We included patients with stage I-IIA (UICC 8th) NSCLC who had started PBT between May 2016 and June 2020. Overall survival (OS), progression-free survival (PFS), cumulative incidence of local failure (LF), and adverse events were evaluated. Prognostic factors were compared using log-rank test and Cox proportional hazards model. The cumulative incidence curves were compared using Gray’s test.</div></div><div><h3>Results</h3><div>A total of 309 patients were evaluated. The median follow-up period was 47 months, calculated using the reverse Kaplan–Meier method. The 3/5-year OS was 62.7 %/47.7 %, PFS was 52.9 %/40.0 %, and LF was 14.4 %/22.1 %. According to the stage, 3-year OS, PFS, and LF were 69.6 %, 58.7 %, 13.3 %, respectively, for stage IA; 55.3 %, 41.6 %, 15.6 %, respectively, for stage IB; 33.9 %, 41.5 %, 25.6 %, respectively, for stage IIA. Female sex and good performance status, absence of interstitial pneumonia, absence of double cancer, and T1 stage were favorable prognostic factors for OS in a multivariate analysis. Grade ≥ 4 adverse events were not observed.</div></div><div><h3>Conclusion</h3><div>This study provided real-world treatment outcomes of PBT for inoperable stage I-IIA NSCLC in Japan.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110868"},"PeriodicalIF":4.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692867","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":"Determining the optimal radiation dose for locally advanced esophageal cancer: A pooled analysis of reconstructed individual patient data from randomized clinical trials","authors":"Rui Li ,&nbsp;Xiaofeng Wang ,&nbsp;Junxiang Luo ,&nbsp;Hui Bai ,&nbsp;Yanling Wu ,&nbsp;Wei Tian ,&nbsp;Yihan Xu ,&nbsp;Jiacheng Li ,&nbsp;Yang Dong ,&nbsp;Minglei Yang ,&nbsp;Guofang Zhao ,&nbsp;Cihui Yan ,&nbsp;Wencheng Zhang ,&nbsp;Zhiyong Yuan","doi":"10.1016/j.radonc.2025.110867","DOIUrl":"10.1016/j.radonc.2025.110867","url":null,"abstract":"<div><h3>Background</h3><div>The optimal radiation dose of definitive concurrent chemoradiotherapy (dCCRT) for esophageal cancer (EC) has always been a concern in radiation oncology and has remained controversial for several decades, we performed a <em>meta</em>-analysis based on individual patient data (IPD) to explore the optimal dose.</div></div><div><h3>Methods</h3><div>Randomized clinical trials (RCTs) comparing high-dose radiotherapy (HD-RT,≥59.4 Gy) with standard-dose radiotherapy (SD-RT, 50 Gy/50.4 Gy) were identified. Graphical reconstructive algorithms were employed to extract time-to-event outcomes from Kaplan-Meier curves presented in the original RCTs. Using reconstructed individual patient data, summary overall survival (OS), progression-free survival (PFS) and locoregional progression-free survival (LRPFS) for HD-RT versus SD-RT were recalculated. Hazard Ratios (HRs) of OS, PFS and LRPFS reported were also pooled by the fixed or random effects model.</div></div><div><h3>Results</h3><div>Six RCTs, including 1722 patients, were included. IPD for OS, PFS, and LRPFS were from 1287, 462, and 722 patients, respectively. Overall, HD-RT had no significant benefits in 3-year OS (RR = 1.00, P = 0.990), 3-year progression-free survival (PFS) (RR = 0.96, P = 0.320) and 3-year locoregional progression-free survival (LRPFS) (RR = 0.88, P = 0.204), compared with SD-RT. Consistent with above results, the pooled HRs of OS, PFS and LRPFS for HD-RT versus SD-RT were 0.99 (P = 0.854), 0.94 (P = 0.628) and 0.91 (P = 0.410), respectively. However, HD-RT had higher grade ≥ 3 treatment-related adverse effects (TRAEs) (OR = 1.26, P = 0.025). Subgroup analyses were also performed based on the RT techniques, histology, size of the RT target, dose-escalation mode, and stage editions. We found that dose escalation, even in subgroups, did not benefit long-term survival but resulted in a higher incidence of grade ≥ 3 TRAEs.</div></div><div><h3>Conclusion</h3><div>The results provide robust evidence that corroborates current guidelines and supports the clinical practice of employing SD-RT. Additionally, it provides implications for the feasibility of further research into novel drug combinations (e.g., immunotherapy) rather than radiation dose escalation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110867"},"PeriodicalIF":4.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692962","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 the prognostic significance of artificial intelligence-delineated gross tumor volume and prostate volume measurements for prostate radiotherapy.","authors":"Jenna Adleman, Pierre-Yves McLaughlin, James M G Tsui, Ivan Buzurovic, Thomas Harris, Julie Hudson, Jaime Urribarri, Daniel W Cail, Paul L Nguyen, Peter F Orio, Leslie K Lee, Martin T King","doi":"10.1016/j.radonc.2025.110866","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110866","url":null,"abstract":"<p><strong>Background and purpose: </strong>Artificial intelligence (AI) may extract prognostic information from MRI for localized prostate cancer. We evaluate whether AI-derived prostate and gross tumor volume (GTV) are associated with toxicity and oncologic outcomes after radiotherapy.</p><p><strong>Materials and methods: </strong>We conducted a retrospective study of patients, who underwent radiotherapy between 2010-2017. We trained an AI segmentation algorithm to contour the prostate and GTV from patients treated with external-beam RT, and applied the algorithm to those treated with brachytherapy. AI prostate and GTV volumes were calculated from segmentation results. We evaluated whether AI GTV volume was associated with biochemical failure (BF) and metastasis. We evaluated whether AI prostate volume was associated with acute and late grade 2+ genitourinary toxicity, and International Prostate Symptom Score (IPSS) resolution for monotherapy and combination sets, separately.</p><p><strong>Results: </strong>We identified 187 patients who received brachytherapy (monotherapy (N = 154) or combination therapy (N = 33)). AI GTV volume was associated with BF (hazard ratio (HR):1.28[1.14,1.44];p < 0.001) and metastasis (HR:1.34[1.18,1.53;p < 0.001). For the monotherapy subset, AI prostate volume was associated with both acute (adjusted odds ratio:1.16[1.07,1.25];p < 0.001) and late grade 2 + genitourinary toxicity (adjusted HR:1.04[1.01,1.07];p = 0.01), but not IPSS resolution (0.99[0.97,1.00];p = 0.13). For the combination therapy subset, AI prostate volume was not associated with either acute (p = 0.72) or late (p = 0.75) grade 2 + urinary toxicity. However, AI prostate volume was associated with IPSS resolution (0.96[0.93, 0.99];p = 0.01).</p><p><strong>Conclusion: </strong>AI-derived prostate and GTV volumes may be prognostic for toxicity and oncologic outcomes after RT. Such information may aid in treatment decision-making, given differences in outcomes among RT treatment modalities.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110866"},"PeriodicalIF":4.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701369","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":"Definitive IMRT in older men with high-risk prostate cancer: Additional considerations and future directions","authors":"Yuekun Fang ,&nbsp;Shengyi Chen ,&nbsp;Bin Cheng","doi":"10.1016/j.radonc.2025.110843","DOIUrl":"10.1016/j.radonc.2025.110843","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110843"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The prognostic and predictive value of pre-treatment hematologic markers for oropharyngeal carcinoma stratified by HPV status and treated with definitive (chemo) radiation","authors":"A. Hughes ,&nbsp;Ca Johnny ,&nbsp;SH. Huang ,&nbsp;J. Su ,&nbsp;S. Bratman ,&nbsp;J. Cho ,&nbsp;E. Hahn ,&nbsp;A. Hosni ,&nbsp;A. Hope ,&nbsp;J. Kim ,&nbsp;J Tsai ,&nbsp;B. O’Sullivan ,&nbsp;JG. Ringash ,&nbsp;J. Waldron ,&nbsp;A. Spreafico ,&nbsp;L. Eng ,&nbsp;E.Sanz Garcia ,&nbsp;J. DeAlmeida ,&nbsp;L. Tong ,&nbsp;Wei Xu ,&nbsp;A. McPartlin","doi":"10.1016/j.radonc.2025.110851","DOIUrl":"10.1016/j.radonc.2025.110851","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The literature of hematological biomarker performance in oropharynx cancer is conflicted, likely due to heterogeneity of the cohorts studied, limiting clinical application. To resolve this, we analyze the predictive and prognostic power of the pre-treatment hematologic markers total lymphocyte count (TLC), total neutrophil count (TNC), total monocyte count (TMC), and neutrophil–lymphocyte ratio (NLR), for a large oropharynx cohort receiving definitive (chemo)radiotherapy ((C)RT).</div></div><div><h3>Materials and methods</h3><div>All OPC patients treated at a single academic center with definitive (C)RT between 2005–2018 were included. The actuarial rates of locoregional control (LRC) and distant control (DC) were calculated using competing risks methods, while overall survival (OS) was estimated using the Kaplan-Meier method. Multivariable analysis (MVA) was applied to assess the prognostic and predictive value of the TLC, TMC, TNC, and NLR, adjusted for known prognostic factors. A Bonferroni correction was applied with a significance threshold of p &lt; 0.01, due to consideration of multiple markers.</div></div><div><h3>Results</h3><div>A total of 1,515 OPC patients were included (HPV-positive 1,151; HPV-negative 364). The median follow-up was 5.5 years, and 469 deaths were recorded. A significant interaction between the association of TLC and overall survival (OS) and the use of chemotherapy was identified for HPV-positive disease (p &lt; 0.001). Hence, analysis was performed separately to determine the association of TLC with the outcome for the CRT and RT alone cohorts for HPV-positive OPC. On MVA, TLC was only prognostic for HPV-positive OPC when receiving CRT (OS adjusted HR (aHR) 0.51 (0.35–0.74), p &lt; 0.001), with improved outcomes seen with higher TLC. TLC was also predictive for HPV-positive OPC, with a larger benefit to OS from the addition of concurrent cisplatin seen as TLC increased. On MVA, NLR, TNC, and TMC did not show a significant prognostic value in HPV-positive or HPV-negative OPC (p &gt; 0.01 for all markers).</div></div><div><h3>Conclusion</h3><div>In this large and homogenous cohort of OPC patients receiving definitive (C)RT, TLC was found to be a prognostic and predictive biomarker for patients with HPV-positive OPC receiving CRT, but not RT alone nor in HPV-negative disease. No other assessed marker was prognostic. TLC may inform the stratification of patients for investigation of novel treatment strategies in HPV-positive OPC. Prospective validation of this finding is required.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"207 ","pages":"Article 110851"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674520","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}