Radiotherapy and Oncology最新文献

{"title":"Enhancing IMRT/VMAT Competencies in LMICs globally within radiation physicists through remote training.","authors":"Sierra M Silverwood, Caroline M Carlson, Hong Zhu, Cesar Della Biancia, Claire Dempsey, Adam Shulman, Timothy D Keiper, Sharareh Koufigar, Afua Yorke, Bilal Jalal, Cenji Yu, Doris Dimitriadou, Lydia Wilson, Tomi Nano, Benjamin Li","doi":"10.1016/j.radonc.2025.110957","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110957","url":null,"abstract":"<p><strong>Background and purpose: </strong>High-quality intensity-modulated radiation therapy (IMRT)/volumetric modulated arc therapy (VMAT) is necessary to drive positive patient outcomes, yet gaps in staff training hinder its implementation in low-to-middle-income countries (LMICs). This work aimed to evaluate a large-scale remote training curriculum for medical physicists and clinicians with existing IMRT infrastructure in LMICs.</p><p><strong>Materials and methods: </strong>A 15-week free, virtual course with weekly live sessions incorporating didactics and case-based learning led by expert volunteers was conducted. The first 500 registrants were accepted into the program. Participants' confidence and knowledge was evaluated via pre- and post-course surveys on a 1-5 Likert scale across seven IMRT/VMAT domains and through 11 multiple-choice questions. Participants also created treatment plans for standardized bilateral head-and-neck cancer cases, assessed by eight expert volunteers using qualitative rubrics and quantitative scorecards on the ProKnow DS platform. Performances were compared using Wilcoxon signed-rank tests.</p><p><strong>Results: </strong>A total of 240 medical physicists, medical physics residents, and dosimetrists responded to both the pre- and post-course surveys. Mean confidence scores increased from 3.00/5 (SD: 1.04) to 3.80/5 (0.87) (p < 0.001). Knowledge scores improved from 4.16/11 (SD: 1.77) to 5.98/11 (SD: 2.11) (p < 0.001). Additionally, 33 participants completed both the pre-course and post-course treatment planning assignments. Automated scorecard performance significantly improved from 12.64/25 (SD: 7.50) to 17.74/25 (SD: 6.74) (p = 0.0004). Grading rubric scores did not significantly change, from 9.15/14 (SD: 3.33) to 9.76/14 (SD: 2.65) (p = 0.4).</p><p><strong>Conclusion: </strong>The virtual IMRT/VMAT curriculum significantly enhanced knowledge, confidence, and treatment planning skills among participants, demonstrating a scalable, low-cost intervention for improving IMRT/VMAT implementation in LMICs.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110957"},"PeriodicalIF":4.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151543","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":"Estimating the carbon footprint of an international radiation oncology conference and modelling reduction strategies.","authors":"Robert Chuter, Frank Brewster, Kari Tanderup","doi":"10.1016/j.radonc.2025.110956","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110956","url":null,"abstract":"<p><strong>Background and purpose: </strong>Healthcare professionals attend international meetings to network, disseminate science and update practice. Conferences have large carbon footprints, and this study aimed to estimate the carbon footprint of an ESTRO conference and potential reduction strategies while balancing needs of international networking.</p><p><strong>Materials and methods: </strong>The geographical distribution of ESTRO23 attendees was used. The Climatiq API was utilised to determine the carbon footprint, in kg CO₂ equivalent (CO₂e), of venue, accommodation and travel. The impact of venue location and train travel on total CO₂e was estimated as well as impact of online attendance. The amount and impact of in-person networking was assessed through a post conference survey.</p><p><strong>Results: </strong>The carbon footprint of ESTRO 2023 was 1.4 tCO₂e per attendee. Centrally located venues had lowest travel carbon footprint, e.g. Frankfurt with 8,873 tCO₂e was 28 % lower than Lisbon. Hotel and venue accounted for < 5 % of the footprint. Train travel could reduce total CO₂e by on average 17 % if all Europeans travelled by train. If all non-Europeans joined the conference online, CO₂e would drop by 81 %. International networking of ≤ 2 h, 3-6 h and ≥ 7 h was seen in 45 %, 35 % and 20 % of attendees, respectively.</p><p><strong>Conclusion: </strong>The ESTRO conference has a significant carbon footprint, with travel accounting for > 95 % (81 % from long-haul flights). Centrally located venues and train travel are important means of reducing CO₂e. The amount of international networking varies considerably across attendees, and regional or online participation can potentially reduce CO₂e without compromising conference output for some attendees.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110956"},"PeriodicalIF":4.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151544","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":"Second primary cancer risks in seminoma patients treated with current and previous radiotherapy protocols: a systematic literature review.","authors":"Wilma D Heemsbergen, Sofia Spampinato, Maarten Dirkx, Marie C Jahreiß, Joost L Boormans, Martine Franckena, Liesbeth J Boersma","doi":"10.1016/j.radonc.2025.110955","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110955","url":null,"abstract":"<p><strong>Background and purpose: </strong>Postoperative radiotherapy (RT) with para-aortal (PAO) +/- para-iliac (dog-leg) fields in seminoma patients is an effective treatment, associated with a lifetime risk of developing infra-diaphragmatic radiation-induced second primary cancers (SPC). We performed a systematic review to investigate dose to organs at risk (OAR), associated SPC risks, and landmark changes in RT-protocols, with a special interest in proton therapy.</p><p><strong>Methods: </strong>A systematic literature search (1990-2024) was conducted using PRISMA guidelines.</p><p><strong>Results: </strong>We identified eleven cohort studies reporting consistently excess SPC risks for pancreas, kidney, stomach, and (for dog-leg field) bladder, and colorectum after RT. Important RT-landmarks during the past 60 years were: abandoning mediastinal and inguinal RT, PAO only in stage I, prescription-dose reductions from 30-40 Gy to 20-26 Gy, largely abandoning elective PAO for stage I seminoma in favour of active surveillance, and introduction of proton therapy. RT remains an option in stage II (dog-leg with boosting) and high-risk stage I seminoma. Two studies estimated the dose-response-relationship for pancreas and stomach. Five planning studies showed consistent OAR dose reductions with proton versus photon therapy. Similar or higher OAR doses were observed with intensity-modulated versus conventional RT, due to larger low-dose baths.</p><p><strong>Conclusions: </strong>Established SPC risks have changed clinical practice in seminoma patients, and remain relevant for current RT practice. Proton therapy has the potential to reduce dose in relevant OARs at risk for SPCs. Further research on dose-response relationships for SPCs with fractionated RT and protons is needed to improve SPC risk assessment.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110955"},"PeriodicalIF":4.9,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144151545","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":"Standardized anesthetic protocol in pediatric Radiotherapy: A retrospective analysis of clinical efficacy and outcomes","authors":"S. Palmese ,&nbsp;C. Secondulfo ,&nbsp;V. Caterino ,&nbsp;G. Santaniello ,&nbsp;A. Siglioccolo ,&nbsp;M. Cascella ,&nbsp;R. Gammaldi ,&nbsp;G. Bilancio","doi":"10.1016/j.radonc.2025.110952","DOIUrl":"10.1016/j.radonc.2025.110952","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Radiotherapy plays a critical role in the treatment of pediatric cancers; however, the need for absolute immobilization during treatment necessitates the use of general anesthesia or deep sedation.</div></div><div><h3>Materials and methods</h3><div>In this retrospective observational study conducted at Salerno University Hospital between 2022 and 2024, we evaluated a standardized anesthetic protocol based on the exclusive use of a laryngeal mask airway (LMA) in pediatric patients undergoing radiotherapy. Data were collected from 420 anesthesia sessions performed in 22 patients under 14 years of age with solid or hematological tumors. The protocol involved premedication with midazolam when indicated, induction with either intravenous propofol (administered in 77.3 % of sessions with a mean dose of 1.64 mg/kg) or inhalational sevoflurane (in 22.7 % of sessions), and maintenance with sevoflurane at a mean minimum alveolar concentration of 2.2. Continuous monitoring of vital parameters was ensured via advanced remote systems, while airway management was successfully maintained with LMA in all sessions.</div></div><div><h3>Results</h3><div>The overall complication rate was low (1.9%), with laryngospasm (0.95%), postoperative delirium (0.71%), and a single episode of tachycardia/hypotension (0.24%) observed; importantly, no major adverse events occurred. The median time to awakening was 3 min, and full recovery in the post-anesthesia care unit was achieved within 35 min.</div></div><div><h3>Conclusion</h3><div>These findings suggest that the standardized anesthetic protocol is both safe and effective, ensuring rapid recovery and minimal complications, thereby optimizing the management of pediatric radiotherapy sessions.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110952"},"PeriodicalIF":4.9,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143447","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":"Deep learning dosiomics for the pretreatment prediction of radiation dermatitis in nasopharyngeal carcinoma patients treated with radiotherapy.","authors":"Ziqing Xiang, Xianwen Yu, Sunzhong Lin, Dong Wang, Weiqian Huang, Wen Fu, Xuanxuan Zhu, Li Shao, Jianping Wu, Qiao Zheng, Yao Ai, Xujing Yang, Mingrou Guo, Xiance Jin","doi":"10.1016/j.radonc.2025.110951","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110951","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a combined dosiomics and deep learning (DL) model for predicting radiation dermatitis (RD) of grade ≥ 2 in patients with nasopharyngeal carcinoma (NPC) after radiation therapy (RT) based on radiation dose distribution.</p><p><strong>Materials and methods: </strong>A retrospective study was performed with 290 NPC patients treated with RT from two medical centers. The patients were categorized into three groups: a training set (n = 167), an internal validation set (n = 72), and an external validation set (n = 51), respectively. Dosiomic features, in conjunction with DL features derived from convolutional neural networks, were extracted and analyzed from the radiation dose distribution to construct an end-to-end model and facilitate the prediction of RD. The efficacy of the developed models was assessed and compared using the area under curve (AUC) of the receiver operating characteristic (ROC) curves.</p><p><strong>Results: </strong>The XGBoost model with finally screened 25 dosiomic features achieved the best AUC of 0.751 and 0.746 in the internal and external validation sets, respectively. DL model with ResNet-34 achieved the best AUC of 0.820 and 0.812 in the internal and external validation sets, respectively. Combining DL and dosiomic features improved the AUC to 0.863 and 0.832 in the internal and external validation sets, respectively. Nomogram integrating DL, dosiomic features, and clinical factors achieved an AUC of 0.945, 0.916, and 0.832 in the training, internal, and external validation sets, respectively.</p><p><strong>Conclusion: </strong>The integration of DL, dosiomics and clinical features is feasible and effective for predicting RD, thereby enhancing the management of NPC patients treated with RT.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110951"},"PeriodicalIF":4.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143442","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":"Daily proton dose re-calculation on deep-learning corrected cone-beam computed tomography scans","authors":"Casper Dueholm Vestergaard ,&nbsp;Ludvig Paul Muren ,&nbsp;Ulrik Vindelev Elstrøm ,&nbsp;Liliana Stolarczyk ,&nbsp;Ole Nørrevang ,&nbsp;Stine Elleberg Petersen ,&nbsp;Vicki Trier Taasti","doi":"10.1016/j.radonc.2025.110953","DOIUrl":"10.1016/j.radonc.2025.110953","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Synthetic CT (sCT) generation from cone-beam CT (CBCT) must maintain stable performance and allow for accurate dose calculation across all treatment fractions to effectively support adaptive proton therapy. This study evaluated a 3D deep-learning (DL) network for sCT generation for prostate cancer patients over the full treatment course.</div></div><div><h3>Material and methods</h3><div>Patient data from 25/6 prostate cancer patients were used to train/test the DL network. Patients in the test set had a planning CT, 39 CBCT images, and at least one repeat CT (reCT) used for replanning. The generated sCT images were compared to fan-beam planning and reCT images in terms of i) CT number accuracy and stability within spherical regions-of-interest (ROIs) in the bladder, prostate, and femoral heads, ii) proton range calculation accuracy through single-spot plans, and iii) dose trends in target coverage over the treatment course (one patient).</div></div><div><h3>Results</h3><div>The sCT images demonstrated image quality comparable to CT, while preserving the CBCT anatomy. The mean CT numbers on the sCT and CT images were comparable, e.g. for the prostate ROI they ranged from 29 HU to 59 HU for sCT, and from 36 HU to 50 HU for CT. The largest median proton range difference was 1.9 mm. Proton dose calculations showed excellent target coverage (V95%≥99.6%) for the high-dose target.</div></div><div><h3>Conclusion</h3><div>The DL network effectively generated high-quality sCT images with CT numbers, proton range, and dose characteristics comparable to fan-beam CT. Its robustness against intra-patient variations makes it a feasible tool for adaptive proton therapy.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110953"},"PeriodicalIF":4.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144134089","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":"Recommendations for radiotherapy quality assurance in clinical trials.","authors":"Camilla Panduro Nielsen, Eva Samsøe, Birgitte Vrou Offersen, Ebbe Laugaard Lorenzen, Gitte Persson, Hanna Rahbek Mortensen, Henrik Dahl Nissen, Ivan Richter Vogelius, Jesper Folsted Kallehauge, Ludvig Paul Muren, Mads Brincker, Mette van Overeem Felter, Rikke Hedegaard Dahlrot, Steffen Bjerre Hokland, Tine Schytte, Birgitte Mayland Havelund, Britta Weber, Ditte Sloth Møller, Eva Serup-Hansen, Kenneth Jensen, Kirsten Legård Jakobsen, Mirjana Josipovic, Simon Long Krogh, Slávka Lukacova, Lone Hoffmann, Christian Rønn Hansen","doi":"10.1016/j.radonc.2025.110950","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110950","url":null,"abstract":"<p><p>Robust quality assurance (QA) of clinical trials in radiotherapy (RT) is paramount for minimising uncertainties in treatment delivery, thereby strengthening the statistical power of the study and increasing the likelihood of accurately answering the research question. As RT techniques evolve and become more complex, establishing an appropriate QA program for a specific clinical trial becomes increasingly challenging, highlighting the importance of clear and standardised recommendations. This study provide such recommendations for Principal Investigators (PIs) to consider when planning and conducting RT Quality Assurance (RTQA) for clinical trials. They arise from experiences with RTQA in the clinical trials conducted in the Danish Multidisciplinary Cancer Groups (DMCGs). The recommendations include a checklist to guide PIs in developing an effective RTQA program.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110950"},"PeriodicalIF":4.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143445","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":"Presentation and outcomes of second primary malignancies (SPMs) in locally advanced oral cavity squamous carcinoma (LA-OSCC): Secondary analysis of a phase III randomised control trial (NCT00193843)","authors":"Sarbani Ghosh Laskar ,&nbsp;Sahil Sood ,&nbsp;Abhishek Chatterjee ,&nbsp;Shwetabh Sinha ,&nbsp;Shilpi Sharma ,&nbsp;Devendra Chaukar ,&nbsp;Jai Prakash Agarwal ,&nbsp;Tejpal Gupta ,&nbsp;Ashwini Budrukkar ,&nbsp;Vedang Murthy ,&nbsp;Monali Swain ,&nbsp;Anuj Kumar ,&nbsp;Samarpita Mohanty ,&nbsp;Pankaj Chaturvedi ,&nbsp;Prathamesh Pai ,&nbsp;Gouri Pantvaidya ,&nbsp;Anuja Deshmukh ,&nbsp;Deepa Nair ,&nbsp;Sudhir Nair ,&nbsp;Vidisha Tuljapurkar ,&nbsp;Anil K. Dcruz","doi":"10.1016/j.radonc.2025.110944","DOIUrl":"10.1016/j.radonc.2025.110944","url":null,"abstract":"<div><h3>Background</h3><div>Second Primary Malignancies (SPMs) are a common cause of morbidity and mortality in Head &amp; Neck Squamous Carcinoma (HNSCC). Prospective data on incidence, outcomes and prognostic factors is sparse. The current publication summarizes data on 83 SPMs which developed on follow up among patients accrued on a Phase III Randomized Controlled Trial testing treatment intensification in Oral Cavity Squamous Carcinoma (OSCC).</div></div><div><h3>Patients and Methods</h3><div>Nine hundred patients of OSCC accrued between 2005–2013 were followed up as part of the trial protocol. Standard clinical criteria were used to determine SPM occurrence. Clinicopathological and demographic variables were summarized using descriptive statistics and analysed using measures of central tendency and dispersion. Outcomes of interest included Overall-Survival (OS) and Progression-Free-Survival (PFS) post SPM diagnosis and were analysed using the Kaplan-Meier method and factors of prognostic significance were compared using the log-rank test and multivariate analysis thereafter.</div></div><div><h3>Results</h3><div>The median follow-up of surviving patients was 95.9 months {(IQR) = 76.1–122.4 months}. A total of 83 SPMs were detected at a median time-to-occurrence of 48 months (IQR-20–87 months) (Cumulative Incidence −11 % at 5 years). The Head &amp; Neck was the most common site of SPM. The 2-year Kaplan Meier estimates of OS and PFS post diagnosis of SPM were 30.3 % (95 %CI-20.9 %-43.9 %) and 21.6 % (95 %CI-13.8 %-34 %) respectively. Multivariate analysis revealed time-to-development of SPM more than 2 years and surgical management of SPM to be associated with superior PFS.</div></div><div><h3>Conclusions</h3><div>SPMs can cause major morbidity and mortality in OSCC survivors. Strategies need to be developed to gear towards early detection and aggressive salvage.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110944"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131127","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":"Impact of clinical target volume utilization on outcomes in patients with non-spine bone oligometastases treated with stereotactic ablative radiation therapy","authors":"Emily O’Reilly ,&nbsp;Eshawn Johal ,&nbsp;Haley Clark ,&nbsp;Benjamin Mou ,&nbsp;Reno Eufemon Cereno ,&nbsp;Mitchell Liu ,&nbsp;Devin Schellenberg ,&nbsp;Will Jiang ,&nbsp;Tanya Berrang ,&nbsp;Abraham Alexander ,&nbsp;Hannah Carolan ,&nbsp;Siavash Atrchian ,&nbsp;Emma M. Dunne ,&nbsp;Scott Tyldesley ,&nbsp;Robert Olson ,&nbsp;Sarah Baker","doi":"10.1016/j.radonc.2025.110948","DOIUrl":"10.1016/j.radonc.2025.110948","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare local failure, marginal failure, and toxicity in non-spine bone metastases (NSBMs) treated with versus without a CTV for stereotactic ablative radiotherapy (SABR).</div></div><div><h3>Methods</h3><div>The study included all patients in British Columbia treated with SABR for NSBMs on the SABR-5 trial (November 2016 – July 2020) and on the BC Oligometastases Registry (August 2020- October 2022). NSBMs were stratified based on CTV use for treatment planning.</div></div><div><h3>Results</h3><div>148 patients with 183 NSBMs were included. 145 (79 %) NSBMs were treated with a CTV. Most lesions received 35 Gy in 5 fractions (80 %) or 24 Gy in 2 fractions (15 %). Local failure rates did not differ, with a 2-year local failure of 8.6 % (95 % confidence interval [CI] 3.9–13.2) with a CTV and 8.1 % (95 % CI 0–16.8) without a CTV (p = 0.53). Marginal failure did not differ (6.4 % [95 % CI 2.3–10.5] and 2.6 %, [95 % CI 0–7.7], respectively [p = 0.23]). 2-year cumulative incidence of grade ≥ 2 toxicity did not differ (15.8 %, 95 % CI 9.7–21.9 and 16.2 %, 95 % CI 4.2–28.2 respectively; p = 1.00). On multivariable regression, use of a CTV was not associated with the risk of local-marginal failure (hazard ratio [HR] 1.81, 95 % CI 0.62–5.31, p = 0.28). Extraosseous extension (HR 2.59, 95 % CI 1.2–5.7, p = 0.02) and lack of receipt of systemic therapy (HR 0.27, 95 % CI 0.1–0.5, p = 0.0002) were associated with higher risk.</div></div><div><h3>Conclusions</h3><div>Use of a CTV was not associated with local or marginal failure or toxicity. Extraosseous extension and lack of receipt of systemic therapy were associated with higher risk of local-marginal failure.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110948"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132876","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":"Transforming the management of radiotherapy-induced hypothyroidism in nasopharyngeal carcinoma through an Innovative individualized radiation dosage model: A multicenter retrospective analysis.","authors":"Jianming Ding, Xiaoyan Yin, Yuhao Lin, Xiyi Liao, Lisha Chen, Jiabiao Hong, Linghui Yan, Sijia Chen, Xueting Yan, Zirong Li, Kai Hu, Ruiping Zhai, Chuanben Chen, Zhaodong Fei","doi":"10.1016/j.radonc.2025.110943","DOIUrl":"https://doi.org/10.1016/j.radonc.2025.110943","url":null,"abstract":"<p><strong>Purpose: </strong>Current guidelines for thyroid radiation dose prescription lack uniformity and fail to consider the unique characteristics of individual patients. This study aimed to develop an individualized thyroid dosing regimen to enhance thyroid protection during radiotherapy.</p><p><strong>Methods and materials: </strong>In this study, we enrolled 621 patients with nasopharyngeal carcinoma (NPC) across four distinct cancer centers, stratifying the data into a training cohort and two external validation cohorts. The specific clinical characteristic-matched tolerated dose values were fitted using binary logistic regression and time-to-event Cox methods in the training cohort. The TSH-volume index (TVI), calculated as thyroid-stimulating hormone (TSH) level divided by thyroid volume (TV), was introduced as a novel parameter. A radiation-induced hypothyroidism (RIHT) parameter was developed using the volume of thyroid spared at the tolerated dose (VStd) and compared with classical normal tissue complication probability (NTCP) and machine learning models using the area under the curve (AUC) and concordance index (C-index).</p><p><strong>Results: </strong>The follow-up periods spanned 28 (range, 1-66), 33.5 (range, 3-82), and 17 months (range, 2-56), respectively, across these cohorts. RIHT was observed in 27.7 % and 35.3 % of patients at 2 and 3 years in the training cohort, respectively; 30.0 % and 41.5 % in the external validation cohort 1; and 27.2 % and 38.0 % in the external validation cohort 2. Univariable analysis identifies sex, equivalent uniform dose (EUD), TV, TSH, and the TVI as predictors of RIHT, while multivariable analysis confirms EUD and TVI as independent prognostic factors. The TVI-based VStd parameter outperformed the VS40, VS45, and VS50 indices (representing volumes spared at 40 Gy, 45 Gy, and 50 Gy, respectively), classical NTCP models, and even machine learning models in predictive performance. To enhance clinical applicability, we have developed a thyroid dose prescription table based on TVI.</p><p><strong>Conclusions: </strong>We developed a high-accuracy model for individualized thyroid dosing in NPC radiotherapy. The model, supported by a clinically relevant table, offers a customized approach to thyroid protection, enhancing both predictive accuracy and clinical utility.</p>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":" ","pages":"110943"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132897","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}