Radiotherapy and Oncology最新文献

{"title":"Impact of estimated dose of radiation to immune cells (EDRIC) in locally advanced Non-Small-Cell lung Cancer: A secondary analysis of the multicenter randomized PET-Plan trial","authors":"Cas Stefaan Dejonckheere ,&nbsp;Younèss Nour ,&nbsp;Jörg Sahlmann ,&nbsp;Michael Tobias Engelhart ,&nbsp;Abdelkhalek Hammi ,&nbsp;Simeon Ari Barth ,&nbsp;Tanja Schimek-Jasch ,&nbsp;Sonja Adebahr ,&nbsp;Markus Hecht ,&nbsp;Cornelius Waller ,&nbsp;Severin Schmid ,&nbsp;Matthias Miederer ,&nbsp;Alexander Brose ,&nbsp;Harald Binder ,&nbsp;Jochem König ,&nbsp;Andreas Rimner ,&nbsp;Anca-Ligia Grosu ,&nbsp;Ursula Nestle ,&nbsp;Eleni Gkika","doi":"10.1016/j.radonc.2025.110907","DOIUrl":"10.1016/j.radonc.2025.110907","url":null,"abstract":"<div><h3>Purpose</h3><div>A higher estimated dose of radiation to immune cells (EDRIC) has been proposed as an explanation for failed attempts at thoracic radiation intensification as a part of concurrent chemoradiotherapy (cCRT) for locally advanced non-small-cell lung cancer (NSCLC), as lymphopenia in particular is a negative prognostic factor in this context. We studied the impact of EDRIC on survival in this secondary analysis of the prospective PET-Plan trial (ARO-2009–09; NCT00697333). Considering the immune system as an organ at risk for radiotherapy is of major importance in the current era of consolidation immunotherapy.</div></div><div><h3>Methods</h3><div>Eligible patients had previously received chemoradiotherapy up to 60–74 Gy with radiation treatment planning based on an ¹⁸F-FDG PET/CT targeting all CT positive lymph nodes plus 50 Gy elective nodal irradiation (arm A) versus targeting only PET-positive nodes (arm B). EDRIC was calculated with the original model by Jin <em>et al.</em> in addition to a modified score with cohort-specific weight parameters.</div></div><div><h3>Results</h3><div>Sufficient data were available in 153 patients with a median follow-up time (95 % confidence interval [CI]) of 41.6 (34.6 − 53.7) months. Using the original model, the mean EDRIC (range) was 5.70 (3.23 − 8.44) Gy and showed a strong inverse correlation with PFS (hazard ratio [HR] = 1.77; 95 % CI 1.23–2.54; <em>p</em> = 0.002) and OS (HR = 1.72; 95 % CI 1.12–2.65; <em>p</em> = 0.01). The mean modified EDRIC (range) was 5.30 (3.01 − 8.38) Gy, again with a strong inverse correlation with PFS (HR = 1.66; 95 % CI 1.16–2.38; <em>p</em> = 0.006) but not OS (HR = 1.40; 95 % CI 0.91–2.15; <em>p</em> = 0.122). Neither radiation treatment allocation (arm A vs. B) nor technique (3D-CRT vs. IMRT) influenced EDRIC (<em>p</em> = 0.889 and <em>p</em> = 0.958, respectively) and EDRIC did not influence the rate of early or delayed hematological toxicity. On multivariate analysis, mean body dose (MBD) was the main contributing factor of the EDRIC equation to PFS and OS.</div></div><div><h3>Conclusion</h3><div>Higher doses of radiation to the immune system were associated with worse PFS in this secondary analysis of the PET-Plan trial. The omission of elective nodal irradiation did not influence EDRIC. MBD could potentially suffice as a surrogate for EDRIC, as it is more readily available and requires fewer calculations. Future trials should aim to refine existing models and investigate ways to reduce EDRIC to limit its effects in patients undergoing cCRT for locally advanced NSCLC.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110907"},"PeriodicalIF":4.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886757","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":"Personalized radiotherapy doses from the integration of mathematical oncology and machine learning","authors":"Mohammad U. Zahid,&nbsp;Heiko Enderling","doi":"10.1016/j.radonc.2025.110902","DOIUrl":"10.1016/j.radonc.2025.110902","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110902"},"PeriodicalIF":4.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886758","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 radiotherapy in older patients with high-risk prostate cancer: Age should not be a barrier","authors":"Cem Onal ,&nbsp;Birhan Demirhan ,&nbsp;Aysenur Elmali ,&nbsp;Ozan Cem Guler","doi":"10.1016/j.radonc.2025.110904","DOIUrl":"10.1016/j.radonc.2025.110904","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110904"},"PeriodicalIF":4.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890626","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 the commentary on “Optimizing fractionation schedules for de-escalation radiotherapy in head and neck cancers using deep reinforcement learning” by Mohammad Zahid, and Heiko Enderling","authors":"Yongheng Yan ,&nbsp;Feng Zhao","doi":"10.1016/j.radonc.2025.110903","DOIUrl":"10.1016/j.radonc.2025.110903","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110903"},"PeriodicalIF":4.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143890625","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":"Stereotactic reirradiation for in-field lung cancer recurrence after stereotactic ablative radiotherapy: A systematic review and meta-analysis","authors":"Kevin Jang ,&nbsp;Shamira Cross ,&nbsp;Roland Yeghiaian-Alvandi","doi":"10.1016/j.radonc.2025.110898","DOIUrl":"10.1016/j.radonc.2025.110898","url":null,"abstract":"<div><h3>Purpose</h3><div>There is paucity of data for thoracic in-field reirradiation with two courses of stereotactic ablative radiotherapy (SABR). This meta-analysis evaluates the safety and efficacy of repeat SABR as salvage therapy for in-field failures after definitive SABR.</div></div><div><h3>Materials and Methods</h3><div>A systematic search of PubMed, Cochrane Library, MEDLINE, and EMBASE databases was conducted in accordance with PRISMA guidelines. Studies were included if they involved adult patients treated with salvage SABR for in-field recurrences of lung cancer following prior SABR. To address varying definitions of local failure, studies were included if recurrence occurred within the original planning target volume (PTV). Studies with out-of-field failures (&gt;1 cm from PTV) or those using non-SABR techniques were excluded. Pooled 1- and 2-year local control (LC) rates, overall survival (OS), and toxicities were calculated using a random-effects model. Population-weighted linear regression was employed to assess the relationship between dosimetric and clinico-pathologic variables and patient outcomes.</div></div><div><h3>Results</h3><div>Twelve studies involving 197 patients were included in the quantitative analysis. All patients received two courses of SABR, with a median total dose of 50 Gy in 5 fractions. Pooled 1- and 2-year LC rates were 78.2 % (95 % CI: 66–87 %) and 68.0 % (95 % CI: 55–79 %), respectively. Patients receiving a cumulative biologically effective dose (BED) ≥ 200 Gy had significantly higher LC rates (84.9 %, 95 % CI: 70–93 %) vs (64.9 %, 95 % CI: 54–75 %, p = 0.02). Median OS did not significantly differ between low and high BED groups, though there was a trend toward improved survival with higher BED (21.4 vs 32.6 months). The pooled median OS across all studies was 26.3 months (95 % CI: 25.4–27.1). Improved LC rates were associated with smaller tumours (&lt;2 cm), higher BED from the initial treatment and longer interval (&gt;12 months) between initial and repeat SABR (p &lt; 0.01). Toxicities were minimal, with a pooled incidence of ≥ grade 2 pneumonitis at 6.4 % and only 0.10 % reporting ≥ grade 3 toxicity.</div></div><div><h3>Conclusions</h3><div>Salvage in-field reirradiation with SABR achieves high local control and low toxicity, particularly in patients receiving higher cumulative BED (≥200 Gy) and with longer intervals (≥12 months) between treatments. These results suggest that repeat SABR is a viable salvage option for selected patients. Further prospective studies are needed to optimise dosing and patient selection for safe and effective reirradiation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110898"},"PeriodicalIF":4.9,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870345","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":"DAHANCA19: A randomized phase III study of primary curative (chemo)-radiotherapy and the EGFR-inhibitor zalutumumab for squamous cell carcinoma of the head and neck","authors":"Jesper Grau Eriksen ,&nbsp;Christian Maare ,&nbsp;Jørgen Johansen ,&nbsp;Hanne Primdahl ,&nbsp;Åse Bratland ,&nbsp;Claus Andrup Kristensen ,&nbsp;Maria Andersen ,&nbsp;Jan Alsner ,&nbsp;Jens Overgaard ,&nbsp;on behalf of DAHANCA","doi":"10.1016/j.radonc.2025.110899","DOIUrl":"10.1016/j.radonc.2025.110899","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Antibodies against the Epidermal Growth Factor receptor is suggested to decrease tumour failure and increase survival rates of patients (pts) with Head and Neck Squamous Cell Carcinomas (HNSCC) when combined with radiotherapy. This study aimed to evaluate if concurrent treatment with the EGFR inhibitor zalutumumab during (chemo-)radiotherapy improved outcome in pts with HNSCC.</div></div><div><h3>Materials and methods</h3><div>Overall, 608 eligible pts with biopsy-verified HNSCC of the oral cavity, pharynx and larynx were accrued November 2007 to June 2012. Pts were randomized to a control-arm of primary accelerated radiotherapy predominantly 66–68 Gy, 2 Gy/fraction, 6fx/week and concomitant daily hypoxic radiosensitisation with nimorazole. St. III-IV carcinomas received weekly cisplatin 40 mg/m² in addition to nimorazole. The zalutumumab-arm was identical to the control-arm plus zalutumumab 8 mg/kg. First dose was given the week before start of treatment and continued weekly during radiotherapy. Analyses were performed as intention-to-treat. Primary endpoint was loco-regional failure. Secondary endpoints were disease-specific survival and overall survival.</div></div><div><h3>Results</h3><div>In total, 307 pts were in the control-arm and 301 in the zalutumumab-arm. Median follow-up was 59 months. Patient and tumour parameters were well balanced. The 5-year loco-regional failure rate was 24 % in the zalutumumab-arm and 18 % in the control-arm; Hazard Ratio (HR) 1.16 (95 % CI 0.84–1.59); disease-specific survival; HR 1.04 (95 % CI 0.73–1.50) and overall survival; HR 1.21, (0.91–1.61). Effect of zalutumumab was not influenced by HPV/p16 status.</div></div><div><h3>Conclusion</h3><div>Addition of concomitant zalutumumab to primary (chemo-)radiotherapy and concomitant nimorazole for HNSCC did not increase loco-regional control nor disease-specific or overall survival.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110899"},"PeriodicalIF":4.9,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876843","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":"Postoperative radiotherapy for oral cavity cancer with or without elective neck radiotherapy of the pN0 en bloc dissected neck: oncologic outcomes and late toxicity","authors":"B. Kreike ,&nbsp;A. Al-Mamgani ,&nbsp;E. van Werkhoven ,&nbsp;M. Beugeling ,&nbsp;J.H.A.M. Kaanders ,&nbsp;M. van Ruler ,&nbsp;P.A.H. Doornaert ,&nbsp;M.A. de Jong ,&nbsp;M.S. Koedijk ,&nbsp;M.R. Vergeer ,&nbsp;H.H.G. Verbeek ,&nbsp;F.W.R. Wesseling ,&nbsp;Joris B.W. Elbers ,&nbsp;on behalf of the Dutch Head and Neck Radiation Oncology Society","doi":"10.1016/j.radonc.2025.110896","DOIUrl":"10.1016/j.radonc.2025.110896","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The benefit of elective postoperative radiotherapy (PORT) to the pN0 neck after en bloc primary tumor with neck dissection in patients with oral cavity cancer remains unclear. This nationwide multicenter retrospective observational study investigates the effect of adding or omitting elective neck irradiation to PORT of the primary tumor bed.</div></div><div><h3>Materials and Methods</h3><div>Treatment data from 12 head and neck cancer centers in the Netherlands was pooled to compare oncologic outcomes and long-term toxicity between 2 groups of patients, i.e. in whom the PORT volume involved the primary tumor bed only (PORT-T, 118 patients) and in whom the pN0 neck was also irradiated, along with the primary tumor bed (PORT-TN, 146 patients).</div></div><div><h3>Results</h3><div>After a median follow-up of 60 months, 5-year regional control was 96 % in both groups. The 5-year local control was 92 % vs 91 % and the 5-year overall survival was 80 % vs 78 % for the PORT-T and PORT-TN group, respectively (p-value &gt; 0.05 for all). Multivariable analyses showed that elective irradiation of pN0 neck was significantly associated with late grade 2–3 xerostomia (OR 4,93, p &lt; 0.01) and dysphagia (OR 5.29, p &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>The omission of elective radiotherapy to the pN0 en bloc dissected neck in patients with oral cavity cancer resulted in comparable regional control rate to those who received elective irradiation of the neck along with the primary tumor bed with a significant reduction of late grade 2–3 radiation-related xerostomia and dysphagia. Therefore, elective irradiation of the pN0 en bloc dissected neck can safely be omitted.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110896"},"PeriodicalIF":4.9,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870344","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":"Pain response to palliative radiotherapy in bone metastases vs. non-bone lesions: Prospective study","authors":"Yutaro Koide,&nbsp;Masamune Noguchi,&nbsp;Yurika Shindo,&nbsp;Tomoki Kitagawa,&nbsp;Takahiro Aoyama,&nbsp;Shingo Hashimoto,&nbsp;Hiroyuki Tachibana,&nbsp;Takeshi Kodaira","doi":"10.1016/j.radonc.2025.110901","DOIUrl":"10.1016/j.radonc.2025.110901","url":null,"abstract":"<div><h3>Background</h3><div>This study compared the pain response to palliative radiotherapy for bone metastases and non-bone lesions based on the International Consensus on Palliative Radiotherapy Effectiveness (ICPRE) criteria.</div></div><div><h3>Methods</h3><div>This two-cohort study used data from a prospective cohort of 867 registered lesions from 500 patients conducted between August 2021 and September 2023. Pain responses were assessed using the ICPRE criteria at prespecified timings of 2, 4, 12, 24, 36, and 52 weeks. The primary outcome was the pain response rate within 12 weeks, comparing two groups of patients with bone and non-bone lesions. A multivariate logistic regression analysis was conducted to adjust for confounding covariates based on opioid use, irradiation history, performance status, NRS, primary disease, and radiation dose.</div></div><div><h3>Results</h3><div>Among 678 lesions from 440 patients who met the criteria, 541 (80 %) and 137 (20 %) were in the bone and non-bone cohort, including primary tumors, lymph node metastases, and others. The mean age was 63 years, and 45 % were female. Treatment included conventional radiotherapy of a single 8 Gy dose, 20 Gy in 5 fractions, and 30 Gy in 10 fractions, used in 89 % of lesions. While opioid use (67 %) and re-irradiation rates (22 %) were not different between cohorts, the non-bone cohort had shorter median survival (4.9 months vs. 6.3 months, P = 0.017) and more frequently fractionated irradiation (85 % vs. 67 %, P &lt; 0.001). No differences were observed in pain response rates between the two groups (57 % vs. 62 %, P = 0.33), which remained consistent after adjusting covariates. Re-irradiation and opioid were associated with negative impacts on pain response in the bone cohort. In contrast, the increased irradiation dose was identified as potentially affecting the non-bone cohort.</div></div><div><h3>Conclusions</h3><div>This study suggested palliative radiotherapy is effective for painful non-bone lesions and potential dose-dependency for pain response, highlighting the need for future randomized controlled trials to determine the optimal radiation dose.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110901"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869572","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 role of prophylactic cranial irradiation in patients with limited-stage small cell lung cancer at different risks of brain metastasis: A multicenter retrospective study","authors":"Xingyue Li ,&nbsp;Shuangqing Lu ,&nbsp;Jingli Lv ,&nbsp;Song Guan ,&nbsp;Meng Yan ,&nbsp;Hui Zhu ,&nbsp;Jianzhong Cao ,&nbsp;Lujun Zhao","doi":"10.1016/j.radonc.2025.110897","DOIUrl":"10.1016/j.radonc.2025.110897","url":null,"abstract":"<div><h3>Background and purpose</h3><div>To evaluate the value of prophylactic cranial irradiation (PCI) in patients with limited-stage small cell lung cancer (LS-SCLC) at different risks of brain metastasis (BM).</div></div><div><h3>Materials and methods</h3><div>A retrospective study included 498 LS-SCLC patients from three centers who achieved complete or partial response (CR/PR) after radical chemoradiotherapy. A nomogram was developed using significant factors associated with BM, identified through univariate and multivariate analyses. Patients were stratified into high- and low-risk groups based on risk scores. The incidence of BM was compared between patients with and without PCI in different risk-stratified populations using the log-rank test.</div></div><div><h3>Results</h3><div>The nomogram included age, start of treatment to the end of radiotherapy (SER), hemoglobin, prognostic nutritional index (PNI), ProGRP, and NSE. The area under the receiver operating characteristics (AUC) of the nomogram for predicting the 2-year probability of intracranial progression-free survival (IPFS) were 0.738, 0.811, and 0.726 in the training, internal validation, and external validation cohorts, respectively. In the low-risk group, no significant differences were observed in BM incidence (<em>p</em> = 0.220), OS (<em>p</em> = 0.679), or PFS (<em>p</em> = 0.616) between PCI and non-PCI groups. In the high-risk group, PCI significantly reduced BM incidence (<em>p</em> &lt; 0.0001) and improved PFS (<em>p</em> = 0.032), while no significant differences were found in OS (<em>p</em> = 0.778). Propensity score-matching analysis showed similar results.</div></div><div><h3>Conclusion</h3><div>PCI did not improve OS in patients regardless of high or low risk of BM. However, PCI did significantly reduce the incidence of BM and prolong PFS in patients at a high risk of BM.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110897"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143873991","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":"Prognostic gene expression signatures for HPV-negative head and neck squamous cell carcinoma","authors":"Stefano Cavalieri ,&nbsp;Ruud H. Brakenhoff ,&nbsp;C. René Leemans ,&nbsp;Frank J.P. Hoebers ,&nbsp;Tito Poli ,&nbsp;Kathrin Scheckenbach ,&nbsp;Nicola Alessandro Iacovelli ,&nbsp;Marzia Franceschini ,&nbsp;Ester Orlandi ,&nbsp;Lisa Licitra ,&nbsp;Loris De Cecco","doi":"10.1016/j.radonc.2025.110900","DOIUrl":"10.1016/j.radonc.2025.110900","url":null,"abstract":"<div><h3>Background</h3><div>Head and neck squamous cell carcinoma (HNSCC) is a leading cause of cancer-related deaths worldwide, with HPV-negative cases being particularly aggressive. These cases often show poor prognosis and low responsiveness to radiotherapy. Improved prognostic tools and treatment strategies are needed to enhance outcomes.</div></div><div><h3>Aim</h3><div>To evaluate the prognostic value of various gene expression signatures in predicting survival outcomes in HPV-negative HNSCC patients receiving radiotherapy and to compare their accuracy against the current TNM staging system.</div></div><div><h3>Methods</h3><div>This observational cohort study used data from the European BD2Decide project, systematically analyzing gene expression in loco-regionally advanced, non-metastatic HPV-negative HNSCC patients (stage III-IVa/b) treated with curative radiotherapy (post-operative or definitive) between 2008 and 2017. The primary outcome was overall survival (OS), with secondary outcomes including disease-free survival (DFS), distant metastasis-free survival (DMFS), and loco-regional recurrence-free survival (LRRFS). The prognostic performance of selected gene expression signatures was evaluated using receiver operating characteristic (ROC) curves and hazard ratios (HR) from Cox models.</div></div><div><h3>Results</h3><div>The study included 783 patients, with a median age of 63 years, mostly male (68 %), with significant tobacco (84 %) and alcohol (69 %) exposure. The 172-gene signature (172GS) showed the highest prognostic accuracy, outperforming the TNM system in predicting OS, DFS, DMFS, and LRRFS. Multivariable analysis confirmed its independent prognostic value.</div></div><div><h3>Conclusions</h3><div>The 172GS gene signature offers superior prognostic information compared to TNM staging, supporting its potential use for better risk stratification and personalized treatment planning in HPV-negative HNSCC. Future trials should consider tumor biology and gene signatures for better patient selection.</div><div><em>Trial Registration:</em> NCT02832102.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 110900"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870343","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}