Radiotherapy and Oncology最新文献

{"title":"From code to clinic: advancing source code availability in radiation oncology research.","authors":"Wouter van Elmpt, Kareem A Wahid, William H Nailon, Stephanie Tanadini-Lang, Steffen Löck","doi":"10.1016/j.radonc.2026.111755","DOIUrl":"https://doi.org/10.1016/j.radonc.2026.111755","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111755"},"PeriodicalIF":5.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892422","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":"Spatial mapping of cardiac dose-survival associations in oesophageal radiotherapy.","authors":"Tom Marchant, Ganesh Radhakrishna, Hamid Sheikh, Corinne Faivre-Finn, Gareth Price, Alan McWilliam","doi":"10.1016/j.radonc.2026.111770","DOIUrl":"https://doi.org/10.1016/j.radonc.2026.111770","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate spatial associations between cardiac radiation dose and survival following radiotherapy for oesophageal cancer, and to assess whether a previously defined Cardiac Avoidance Area (CAA) from lung radiotherapy is relevant in this patient population.</p><p><strong>Materials and methods: </strong>Patients treated with curative-intent radiotherapy for middle or lower oesophageal cancer between 2009 and 2024 were identified from a large institutional database. Planning CT images and dose distributions were deformably registered to a common reference anatomy for voxel-based analysis. Dose-survival associations were assessed voxel-wise by comparing dose between patients alive and deceased at 12 months, with permutation testing for multiple comparisons. Dose to the CAA was quantified, and survival was evaluated using Kaplan-Meier analysis and multivariable Cox regression including clinical covariates.</p><p><strong>Results: </strong>A total of 452 patients were included. Voxel-based analysis identified a spatially localised heart region where higher radiation dose was significantly associated with poorer 12-month survival, exceeding the 99th percentile of permutation-derived significance. This region partially overlapped with the lung-derived CAA and the left atrium. A maximum CAA dose threshold of 43.5 Gy produced significant survival stratification, with improved median survival in patients receiving lower doses. Maximum CAA dose remained an independent predictor of survival on multivariable analysis.</p><p><strong>Conclusion: </strong>Image-based data mining identified a radiosensitive cardiac region associated with survival after oesophageal radiotherapy, overlapping the established CAA from lung cancer. These findings support the relevance of spatially defined cardiac dose metrics and suggest a potential role for targeted cardiac avoidance in oesophageal radiotherapy planning.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111770"},"PeriodicalIF":5.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892499","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":"Position paper: how to treat more patients per professional without sacrificing job satisfaction and treatment quality.","authors":"Tomas Janssen, Wouter van Elmpt, Bartlomiej Tomasik, Elizabeth Forde, Dylan Callens, Steven Petit","doi":"10.1016/j.radonc.2026.111748","DOIUrl":"https://doi.org/10.1016/j.radonc.2026.111748","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111748"},"PeriodicalIF":5.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892345","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":"Metastatic patterns, outcomes, and prognostic factors in de novo metastatic head and neck cancer by tumor HPV status.","authors":"Alexander Rühle, Enrique Sanz-Garcia, Jie Su, Brian O'Sullivan, John N Waldron, Anna Spreafico, Lillian Siu, Lawson Eng, Andrew McPartlin, Andrew Bayley, Scott V Bratman, Ezra Hahn, Andrew Hope, Ali Hosni, Nauman Malik, Jillian Tsai, John de Almeida, Wei Xu, John Kim, Shao Hui Huang","doi":"10.1016/j.radonc.2026.111769","DOIUrl":"https://doi.org/10.1016/j.radonc.2026.111769","url":null,"abstract":"<p><strong>Objectives: </strong>To describe metastatic characteristics and outcomes in patients with de novo metastatic (cM1) head and neck squamous cell carcinoma (HNSCC).</p><p><strong>Methods: </strong>cM1 HNSCC patients diagnosed between 2001 and 2024 were reviewed. Metastatic characteristics and management patterns were collected, including the timing of locoregional radiotherapy (LR-RT) relative to first-line systemic therapy. Overall survival (OS) was estimated using the Kaplan-Meier method, and multivariable Cox regression analyses (MVA) identified prognostic factors.</p><p><strong>Results: </strong>Among 10,273 newly diagnosed HNSCC cases, 222 (2.2%) had cM1 disease (HPV-associated: 48/2593 [1.9%]; HPV-independent: 174/7680 [2.3%]). cM1 characteristics were similar between HPV-associated and HPV-independent disease, including oligometastatic presentation (1-5 lesions; 31% vs 43%, p = 0.21) and frequency of lung-only metastases (83% vs 77%, p = 0.46), although mediastinal involvement was more common in HPV-associated disease (40% vs 23%, p = 0.034). LR-RT was delivered to 191 (86%) patients: 127 (57%) as sole treatment, 55 (25%) before, and 9 (4%) after first-line systemic therapy. After median follow-up of 25 months, median OS was 7 months (6.0-8.8). On MVA, LR-RT (HR 0.49 [0.32-0.75]), HPV-associated disease (HR 0.62 [0.43-0.88]), ECOG 0-1 (HR 0.63 [0.47-0.86]), first-line immunotherapy (HR 0.52 [0.33-0.82]), and lung-only metastases (HR 0.67 [0.48-0.95]) were associated with longer OS. Among patients receiving LR-RT, a radiation dose ≥ 50 Gy was associated with improved OS (HR 0.53 [0.34-0.83]).</p><p><strong>Conclusions: </strong>cM1 HNSCC has a poor prognosis, highlighting a substantial unmet need. First-line immunotherapy and LR-RT, particularly with ≥ 50 Gy, were associated with improved OS and warrant prospective evaluation.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111769"},"PeriodicalIF":5.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892425","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":"Parametric delineation of the clinical target volume for glioma: Model-based approach that tailors to physician contouring practices.","authors":"Gregory Buti, Ali Ajdari, Christopher Bridge, Ariel E Marciscano, Gregory C Sharp, Kevin Oh, Fredrik Löfman, Helen A Shih, Thomas Bortfeld","doi":"10.1016/j.radonc.2026.111753","DOIUrl":"10.1016/j.radonc.2026.111753","url":null,"abstract":"<p><strong>Background and purpose: </strong>Delineating the clinical target volume (CTV) is an essential part of a radiation oncologist's practice. However, this process is subject to variability due to factors such as clinical experience, institutional standards, and contouring guidelines being followed. We propose a parameterized CTV delineation model for glioma tumors that can tailor to CTV delineation practices. The model is validated based on its ability to replicate different physician-delineated CTVs within our institution.</p><p><strong>Material and methods: </strong>Five delineation parameters define the model-based CTV for glioma: CTV margin expansion, reduction of CTV margins in the brainstem and optic structures for reduced likelihood of tumor infiltration or preferential sparing, and increase of CTV margins at the ventricles and falx cerebri to account for positional uncertainties. Parameters are fitted by matching the model CTV to the manually-delineated CTVs for patients, maximizing the Dice score. The model is developed using 93 retrospectively collected glioma cases treated by three physicians in our institution. The parameter values for different physicians provide CTV delineation starting points, which was tested by training a classification model using fitted CTV parameters.</p><p><strong>Results: </strong>Physician quality assessments showed no statistically significant difference in quality ratings between model-generated and physician-delineated CTVs (p > 0.05), with both groups achieving an average quality rating of 2.3 (0: unusable, 1: major edits, 2: minor edits, 3: acceptable). The distribution of the fitted delineation parameters varied systematically across physicians, especially in the CTV contours near the brainstem and ventricles. The best-performing classification model identified physician-specific CTV delineation starting points with 80% accuracy and Cohen's Kappa score of 0.68.</p><p><strong>Conclusion: </strong>Our parametric CTV delineation system effectively captures and quantifies physician contouring practices. The model can be used in a contour quality assurance program to promote consensus-building and CTV standardization across physician practices.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111753"},"PeriodicalIF":5.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888393","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":"When progression-free survival fails to inform: the need for event-level reporting in oligometastatic radiotherapy trials.","authors":"Cole Friedes, David Palma, Nina N Sanford","doi":"10.1016/j.radonc.2026.111754","DOIUrl":"10.1016/j.radonc.2026.111754","url":null,"abstract":"<p><p>Progression-free survival treats biologically and clinically distinct progression events equivalently, limiting its interpretability in oligometastatic radiotherapy trials. Across 21 randomized trials, event-level reporting was frequently absent, and none described how post-radiotherapy imaging was adjudicated within PFS. Pragmatic reporting standards could improve interpretation without requiring new endpoints or altered trial design.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111754"},"PeriodicalIF":5.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment to letter to the editor: Patient selection for proton therapy in lung cancer: Nationwide external validation and model update of a prognostic model for 2-year mortality including mean heart dose.","authors":"Judith van Loon, Robin Wijsman, L Boersma, J A Langendijk, S Krol, E Schuit","doi":"10.1016/j.radonc.2026.111750","DOIUrl":"10.1016/j.radonc.2026.111750","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111750"},"PeriodicalIF":5.8,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860317","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":"Letter to the editor regarding 'Patient selection for proton therapy in lung cancer: Nationwide external validation and model update of a prognostic model for 2-year mortality including mean heart dose'.","authors":"Max Peters, Peter S N van Rossum, Cornelis P J Raaijmakers, André W Minken, Karin Muller, Helena M Verkooijen","doi":"10.1016/j.radonc.2026.111751","DOIUrl":"10.1016/j.radonc.2026.111751","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111751"},"PeriodicalIF":5.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857687","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":"Survival impact of pelvic radiotherapy plus chemotherapy in newly diagnosed stage IVB cervical cancer in Japan (JROSG22-1/JGOG1088S).","authors":"Keisuke Tsuchida, Kazunari Ogawa, Takafumi Toita, Hitoshi Ikushima, Taichi Mizushima, Shin Nishio, Kenta Murotani, Rie Okuya, Takashi Uno, Chika Eto, Tetsuo Nishimura, Haruya Saji, Yumi Ishidera, Chisato Tonoiso, Munetaka Takekuma, Aikou Okamoto, Tatsuya Ohno","doi":"10.1016/j.radonc.2026.111752","DOIUrl":"https://doi.org/10.1016/j.radonc.2026.111752","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the survival benefit of adding pelvic radiotherapy (RT) to chemotherapy and to identify patient subgroups most likely to benefit from pelvic RT.</p><p><strong>Materials and methods: </strong>A multicentre retrospective study was conducted in Japan and included patients with newly diagnosed stage IVB (FIGO 2018) cervical cancer treated with chemotherapy alone or chemotherapy plus pelvic RT between 2016 and 2020. Patients were classified into the CT group (chemotherapy-alone) or PRT group (chemotherapy plus pelvic RT). Propensity score matching (PSM) was applied using age, histology, T stage, N stage, metastatic pattern, and number of metastatic lesions. Overall survival (OS) represented the primary endpoint; progression-free survival (PFS) and late adverse events constituted the secondary endpoints.</p><p><strong>Results: </strong>Among 343 patients, the PRT group showed significantly longer OS than the CT group following PSM (median OS: 25.0 vs. 18.0 months; hazard ratio [HR], 0.58; 95% confidence intervals [CI], 0.42-0.79; p < 0.001). PFS was also significantly improved in the PRT group (HR, 0.65; 95% CI, 0.48-0.87; p = 0.002). The longer OS in the PRT group was seen across metastatic patterns, although this was less evident in early T stages (≤ T2). Brachytherapy was independently associated with improved OS in the PRT group. Grade ≥ 3 gastrointestinal toxicity was more frequent in the PRT group.</p><p><strong>Conclusion: </strong>In this nationwide, real-world study, definitive-dose pelvic RT combined with chemotherapy was associated with improved survival in selected patients with stage IVB cervical cancer. Prospective randomised trials are warranted to validate these findings.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111752"},"PeriodicalIF":5.8,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A versatile phantom-based framework for end-to-end testing of (online) adaptive proton therapy in the head-and-neck region.","authors":"Jacob Brunner, Francesca Albertini, Giuliano Perotti Bernardini, Stefanie Bertschi, Stefan Both, Evangelia Choulilitsa, Dietmar Georg, Stine Korreman, Gabriel Guterres Marmitt, Kenneth Poels, Christian Richter, Edmond Sterpin, Markus Stock, Kristin Stützer, Nadine Vatterodt, Barbara Knäusl","doi":"10.1016/j.radonc.2026.111749","DOIUrl":"10.1016/j.radonc.2026.111749","url":null,"abstract":"<p><strong>Background and purpose: </strong>Clinical implementation of online adaptive proton therapy requires rigorous testing of all facility-specific components. This work aimed to develop a multi-purpose phantom-based framework capable of testing the efficacy of diverse adaptive proton therapy workflows.</p><p><strong>Materials and methods: </strong>A custom-built, 3D-printed phantom mimicking different cavity fillings and swelling in the head-and-neck region was designed. The baseline scenario was compared with the anatomically altered scenario employing an initial and an adapted treatment plan. Across six institutes, dose deterioration and recovery were measured using an ionisation chamber and radiochromic films. Tools supporting adaptive proton therapy, i.e. log-file-based dose reconstruction, cone-beam computed tomography (CBCT)-based synthetic CTs, prompt- gamma imaging and proton radiography were included depending on their availability to demonstrate the framework's versatility.</p><p><strong>Results: </strong>Median dose deviation between ionisation chamber measurements and calculation was -0.7%[IQR=1.2%] averaged over all institutes and scenarios without significant differences. Not adapting to the anatomical change led to a 13.9%[IQR=1.5%] median dose decrease inside the target and 169.2%[IQR=11.7%] in the buildup region. Adapting to the changed anatomy, a median 0.2%[IQR=0.8 %] difference in the target and maximum 3.3% in the buildup could be achieved. Gamma-pass-rate (2%, 2mm) analysis of the radiochromic film measurements revealed a comparable trend. Institute-specific tests showed good compatibility with the various adaptive workflows tools.</p><p><strong>Conclusions: </strong>The combination of the developed multi-purpose phantom and the end-to-end testing framework could reliably detect dosimetric effects of anatomical changes and provided comparable results across six institutes.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"111749"},"PeriodicalIF":5.8,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148831769","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}