Radiotherapy and Oncology最新文献

{"title":"Efficacy of local–regional radiotherapy in de novo metastatic nasopharyngeal carcinoma patients receiving chemo-immunotherapy: A multicenter, propensity score matching study","authors":"Shui-Qing He ,&nbsp;Guo-Ying Liu ,&nbsp;Ya-Hui Yu ,&nbsp;Lin Wang ,&nbsp;Guo-Yi Zhang ,&nbsp;Ding-Sheng Peng ,&nbsp;Wei-Xin Bei ,&nbsp;Chun-Lan Chen ,&nbsp;Shu-Hui Lv ,&nbsp;Ze-Yu Zhao ,&nbsp;Ying Huang ,&nbsp;Yan-Qun Xiang","doi":"10.1016/j.radonc.2024.110687","DOIUrl":"10.1016/j.radonc.2024.110687","url":null,"abstract":"<div><h3>Background</h3><div>To evaluate the efficacy of local–regional radiotherapy (LRRT) in de novo metastatic nasopharyngeal carcinoma (dm NPC) patients receiving chemo-immunotherapy as first-line treatment and select the beneficiaries from LRRT.</div></div><div><h3>Methods and materials</h3><div>M1-NPC patients receiving platinum-based chemo-immunotherapy with or without LRRT from four centers were included in this study. The propensity score matching (PSM) analysis was employed to balance the baseline characteristics between the LRRT and non-LRRT groups.</div></div><div><h3>Results</h3><div>546 dm NPC patients (140 patients in the non-LRRT group and 406 patients in the LRRT group) were incorporated. Patients receiving LRRT demonstrated significantly improved progression-free survival (3-year PFS rate, 53.2 % vs 31.2 %, p &lt; 0.001). After PSM analysis, there were 244 patients in the LRRT group and 122 patients in the non-LRRT group. Multivariable analysis indicated that LRRT was not an independent prognostic factor in the matched cohort (HR, 1.25, 95 % CI, 0.92–1.69, p = 0.156). Subgroup analysis among the matched cohort showed a significant increase in PFS for patients with oligo metastatic disease (OMD) who received LRRT (3-year PFS rate, 70.6 % vs 49.3 %, p = 0.043). In contrast, no such benefit was observed in patients with poly metastatic disease (PMD, 3-year PFS rate, 35.8 % vs 27.8 %, p = 0.17). Furthermore, LRRT significantly enhanced survival in patients with undetectable EBV DNA_{2-6 cycles} (3-year PFS rate, 57.9 % vs. 43.4 %, p = 0.043), whereas no survival improvement was noted in patients with detectable EBV DNA_{2-6 cycles} (16.2 % vs. 20.3 %, p = 0.21).</div></div><div><h3>Conclusion</h3><div>LRRT could prolong PFS in M1-NPC patients. OMD and undetectable EBV DNA_{2-6 cycles} are potential indicators for selecting beneficiaries from LRRT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110687"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872758","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":"Modulation of the local angiotensin II: Suppression of ferroptosis and radiosensitivity in nasopharyngeal carcinoma via the HIF-1α-HILPDA axis","authors":"Xiuting Huang ,&nbsp;Kehai Lin ,&nbsp;Weirui Chen ,&nbsp;Donghui Zhang ,&nbsp;Muhammad Khan ,&nbsp;Xiaoxin Ye ,&nbsp;Baiyao Wang ,&nbsp;Chengcong Chen ,&nbsp;Yunhong Tian ,&nbsp;Yawei Yuan ,&nbsp;Jie Lin","doi":"10.1016/j.radonc.2024.110686","DOIUrl":"10.1016/j.radonc.2024.110686","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiotherapy presents a curative approach for nasopharyngeal carcinoma (NPC); however, the cellular radiosensitivity heterogeneity limits its efficacy. Thus, investigating the specific mechanisms of radioresistance in NPC is crucial for identifying and employing effective radiosensitizing agents to enhance treatment success.</div></div><div><h3>Methods and Materials</h3><div>Radioresistant NPC cell lines HONE1-RR and SUNE1-RR were established. Quantitative reverse transcription-PCR (qRT-PCR), western blot, and enzyme-linked immuno sorbent assay (ELISA) were employed to detect the activation of the angiotensinogen (AGT) and local angiotensin II (Ang II). Transmission electron microscopy, ferrous ion detection, and lipid oxidation levels were utilized to detect radiation-induced ferroptosis in NPC. Bioinformatics analysis, along with qRT-PCR, western blotting, co-immunoprecipitation, and dual-luciferase assays were employed to explore downstream mechanisms. Colony formation assay, Cell Counting Kit-8 (CCK-8) assay, and a nude mouse xenograft model were utilized to assess NPC radiosensitivity. The expression of AGT, hypoxia-inducible factor-1 alpha (HIF-1α), hypoxia-inducible lipid droplet-associated protein (HILPDA), and glutathione peroxidase 4 (GPX4) in NPC tissues was detected through immunohistochemistry.</div></div><div><h3>Results</h3><div>Activation of local Ang II was revealed to play a critical role in driving radioresistance in NPC cells modulating ferroptosis. This local Ang II established a positive feedback loop with HIF-1α through two parallel pathways; Ang II stabilizes HIF-1α by activating the MAPK pathway, and AGT directly binds HIF-1α to prevent its degradation. This AGT-HIF-1α loop regulated NPC cell ferroptosis via transcriptional regulation of HILPDA expression. Moreover, the co-administration of Ang II receptor antagonist (ARB) and ferroptosis inducers markedly increased NPC radiosensitivity.<!--> <!-->Additionally, the expression of AGT, HIF-1α, and HILPDA was closely correlated with the intensity of ferroptosis, radiosensitivity, and prognosis in NPC.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that the AGT-HIF-1α-HILPDA pathway promotes radioresistance in NPC by enhancing lipid droplet accumulation, thereby suppressing ferroptosis. Targeting local Ang II alongside ferroptosis induction offers a promising strategy to improve radiosensitivity in NPC.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110686"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872759","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 proton RBE and the distal edge effect for acute and late normal tissue damage in vivo","authors":"Cathrine Bang Overgaard ,&nbsp;Fardous Reaz ,&nbsp;Christina Ankjærgaard ,&nbsp;Claus E. Andersen ,&nbsp;Mateusz Sitarz ,&nbsp;Per Poulsen ,&nbsp;Harald Spejlborg ,&nbsp;Jacob G. Johansen ,&nbsp;Jens Overgaard ,&nbsp;Cai Grau ,&nbsp;Niels Bassler ,&nbsp;Brita Singers Sørensen","doi":"10.1016/j.radonc.2024.110668","DOIUrl":"10.1016/j.radonc.2024.110668","url":null,"abstract":"<div><h3>Background and purpose</h3><div>In proton therapy, a relative biological effectiveness (RBE) of 1.1 is used to<!--> <!-->reach an isoeffective biological response between photon and proton doses. However, the RBE varies with biological endpoints and linear energy transfer (LET), two key parameters in radiotherapy. Few <em>in vivo</em> studies have investigated the increasing RBE with increasing LET. This study aims to test the hypothesis that the RBE varies between endpoints and has a distal edge effect <em>in vivo</em>.</div></div><div><h3>Materials and methods</h3><div>Unanesthetized mice<!--> <!-->were restrained<!--> <!-->in jigs where their right hind legs were irradiated with a single dose of protons at the center (LET, _all = 5.3 keV/μm) and distal edge (LET, _all = 7.6 keV/μm) of a spread-out Bragg peak (SOBP). 6 MV photons were used as reference. The acute damage and skin toxicity were scored daily until day 30, and the late damage was evaluated using a joint contracture assay for one year after treatment.</div></div><div><h3>Results</h3><div> <!-->An acute damage RBE of 1.06 ± 0.02(1.02–1.10) and late damage RBE of 1.16 ± 0.08(1.00–1.32) were found, displaying an enhanced RBE for late damage in the center SOBP. The distal edge RBE for acute and late damage was 1.15 ± 0.02(1.10–1.19) and 1.26 ± 0.09(1.07–1.43), showing a similar center-to-distal edge RBE enhancement of 8 % and 9 % for acute and late damage.</div></div><div><h3>Conclusion</h3><div>The findings demonstrate an increased RBE for late damage than acute damage and the distal edge effect is evident with increased RBE at the distal end of the proton SOBP <em>in vivo</em>.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110668"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829755","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":"Predictive biomarkers of radiotherapy- related dermatitis, xerostomia, mucositis and dysphagia in head and neck cancer: A systematic review","authors":"Alexander Koch ,&nbsp;Philipp Reinhardt ,&nbsp;Olgun Elicin ,&nbsp;Daniel M. Aebersold ,&nbsp;Daniel H. Schanne","doi":"10.1016/j.radonc.2024.110689","DOIUrl":"10.1016/j.radonc.2024.110689","url":null,"abstract":"<div><h3>Background</h3><div>Radiotherapy is essential for treating head and neck cancer but often leads to severe toxicity. Traditional predictors include anatomical location, tumor extent, and dosimetric data. Recently, biomarkers have been explored to better predict and understand toxicity. This review aims to summarize the current literature, assess data quality, and guide future research.</div></div><div><h3>Methods</h3><div>Two reviewers independently screened EMBASE and PubMed for studies published between 2010 and 2023. Endpoints were dermatitis, mucositis, sticky saliva/xerostomia, and dysphagia. Statistical analysis was performed using R, and bias assessed via a modified QUIPS questionnaire. Pathway analysis was conducted using gProfiler. The study adhered to PRISMA and COSMOS-E guidelines and was registered in the PROSPERO database (#CRD42023361245).</div></div><div><h3>Results</h3><div>Of 2,550 abstracts, 69 publications met the inclusion criteria. These studies involved a median of 81 patients, primarily male (75 %), with common primary tumors in the nasopharynx (32 %) and oropharynx (27 %). Most patients (84 %) had advanced disease (stage III/IV). The most frequently studied biomarkers were DNA-based single-nucleotide polymorphisms (SNPs, 59 %), salivary proteins (13 %), and bacteria (10 %). Ten statistically-significant biomarkers (all SNPs) in low-bias publications were identified, particularly in DNA repair and cell detoxification pathways. Data quality was often poor and few validation studies were present in the dataset.</div></div><div><h3>Conclusion</h3><div>This review provides an overview of the research landscape, highlights research gaps and provides recommendations for future research directions. We identified several potential biomarkers, particularly in DNA repair pathways, that align with current understanding of radiation-induced cell damage. However, the overall data quality was poor, with key clinical variables often missing. Overall, rigorous standardization of reporting, validation studies and multi-center collaborations to increase study power and sample sizes are necessary to build high-level evidence for clinical application.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110689"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872760","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":"Aims+Scope/Editorial Board/ Publication information","authors":"","doi":"10.1016/S0167-8140(25)00025-8","DOIUrl":"10.1016/S0167-8140(25)00025-8","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110730"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143132449","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":"Prolonged interval hypofractionated radiotherapy facilitates better antitumor immunity","authors":"Jie Xiao ,&nbsp;Shilong Shao ,&nbsp;Yue Deng ,&nbsp;Dan Wang ,&nbsp;Yi Liu ,&nbsp;Shanshan He ,&nbsp;Yue Zhao ,&nbsp;Wenjun Liao ,&nbsp;Jun Zhang ,&nbsp;Mu Yang ,&nbsp;Shichuan Zhang","doi":"10.1016/j.radonc.2024.110664","DOIUrl":"10.1016/j.radonc.2024.110664","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of hypofractionated radiotherapy (Hypo-RT) with different interfraction intervals on tumor growth, immune response, and synergistic effects with anti-PD-1 immunotherapy.</div></div><div><h3>Methods</h3><div>The mouse MC38 colon cancer model was utilized. Various radiation regimens were designed to investigate the effects of fraction interval and fraction size on tumor growth, immune mobilization, and combination effects with anti-PD-1 immunotherapy.</div></div><div><h3>Results</h3><div>For a fixed-dose experiment, the 6 × 5 Gy for every other day (qod) regimen demonstrated an equivalent effect on tumor growth compared to the 6 × 5 Gy once daily (qd) regimen, while the 6 × 5 Gy for twice weekly (biw) regimen failed to inhibit tumor growth. Both qod and biw regimens induced an enhanced immune response, unlike the qd regimen. For a fixed biologically equivalent dose experiment, 6 × 5 Gy qod, 4 × 7 Gy biw, and 2 × 11 Gy once weekly (qw) regimens exhibited similar tumor suppression to the 12 × 3 Gy qd regimen. The long-interval Hypo-RT regimens significantly mobilized host immunity, whereas 12 × 3 Gy qd did not. The peripheral and intratumoral T cells increased as the fraction interval and size increased. All Hypo-RT regimens combined with anti-PD-1 immunotherapy demonstrated higher intratumoral CD8 + T cells and more effective tumor growth delay compared to the 12 × 3 Gy qd regime.</div></div><div><h3>Conclusions</h3><div>The current study suggested that a prolonged inter-fraction interval with an increased fraction size in Hypo-RT may be a promising option to balance the therapeutic effect on tumor and immune activation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110664"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795088","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 significance of sarcopenia in patients treated with definitive radiotherapy: A systematic review","authors":"Alexander J. Vickers ,&nbsp;Dónal M. McSweeney ,&nbsp;Ananya Choudhury ,&nbsp;Jamie Weaver ,&nbsp;Gareth Price ,&nbsp;Alan McWilliam","doi":"10.1016/j.radonc.2024.110663","DOIUrl":"10.1016/j.radonc.2024.110663","url":null,"abstract":"<div><div>Sarcopenia describes the degenerative loss of muscle mass and strength, and is emerging as a pan-cancer prognostic biomarker. It is linked with increased treatment toxicity, decreased survival and significant healthcare financial burden. Systematic analyses of sarcopenia studies have focused on outcomes in patients treated surgically or with systemic therapies. There are few publications concerning patients treated with radiotherapy. This manuscript presents a pan-cancer systematic review of the association between sarcopenia and survival outcomes in patients treated with definitive (chemo-)radiotherapy. A literature search was performed, with 26 studies identified, including a total of 5,784 patients. The prognostic significance of sarcopenia was mixed. This may reflect lack of consensus in methods used to measure skeletal muscle mass and define sarcopenia. Many papers analyse small samples and present sarcopenia cutoffs optimised on the local population, which may not generalise to external populations. Recent advances in artificial intelligence allow for automatic measurement of body composition by segmenting the muscle compartment on routinely collected imaging. This provides opportunity for standardisation of measurement methods and definitions across populations. Adopting sarcopenia diagnosis into clinical workflows could reduce futile treatments and associated financial burden, by reducing treatment toxicities, and improving treatment completion, patient survival, and quality-of-life after cancer.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110663"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795089","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":"Cost-effectiveness of a nurse-led sexual rehabilitation intervention for women treated with radiotherapy for gynaecological cancer in a randomized trial","authors":"Isabelle Suvaal ,&nbsp;Wilbert B. van den Hout ,&nbsp;Susanna B. Hummel ,&nbsp;Jan-Willem M. Mens ,&nbsp;Charlotte C. Tuijnman-Raasveld ,&nbsp;Laura A. Velema ,&nbsp;Henrike Westerveld ,&nbsp;Jeltsje S. Cnossen ,&nbsp;An Snyers ,&nbsp;Ina M. Jürgenliemk-Schulz ,&nbsp;Ludy C.H.W. Lutgens ,&nbsp;Jannet C. Beukema ,&nbsp;Marie A.D. Haverkort ,&nbsp;Marlies E. Nowee ,&nbsp;Remi A. Nout ,&nbsp;Cor D. de Kroon ,&nbsp;Helena C. van Doorn ,&nbsp;Carien L. Creutzberg ,&nbsp;Moniek M. ter Kuile","doi":"10.1016/j.radonc.2024.110683","DOIUrl":"10.1016/j.radonc.2024.110683","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the cost-effectiveness of a nurse-led sexual rehabilitation intervention with standard care in women treated with external beam radiotherapy, with or without brachytherapy, for gynaecological cancers.</div></div><div><h3>Methods</h3><div>Eligible women were randomly assigned to the intervention (n = 112) or standard care (n = 117). Primary endpoint was sexual functioning at 12-months post-radiotherapy, assessed by the Female Sexual Function Index (FSFI). Nurses documented frequency and duration of intervention sessions, patients reported sexual healthcare and functioning at 1, 3, 6, and 12-months. Costs were related to quality-adjusted-life-years (QALYs) using the EuroQol-5 Dimensions and visual analogue scale, and to sexual functioning improvement at 12-months. T-tests compared mean QALYs and costs, with multiple imputation for missing data.</div></div><div><h3>Results</h3><div>The nurse-led intervention added €172 per patient, including training costs and 4–5 sessions. Other sexual rehabilitation costs were higher in the standard care group (€107 versus €141, p = 0.02). Total costs were €478 for the intervention group and €357 for standard care (p = 0.03). Valued at €20.000 per QALY, the intervention was 60 %–70 % likely to be cost-effective and less than 50 % likely to be cost-effective in terms of improved sexual functioning.</div></div><div><h3>Conclusion</h3><div>The nurse-led sexual rehabilitation intervention is not more cost-effective than standard care, however with low costs in both groups. Since costs for standard care were slightly lower, it is preferred from a health-economic perspective. It includes detailed patient education and a dedicated sexual rehabilitation session within the first three months post-radiotherapy, which is better provided at lower cost by a trained nurse.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110683"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829752","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":"Deep learning dose prediction to approach Erasmus-iCycle dosimetric plan quality within seconds for instantaneous treatment planning","authors":"Joep van Genderingen ,&nbsp;Dan Nguyen ,&nbsp;Franziska Knuth ,&nbsp;Hazem A.A. Nomer ,&nbsp;Luca Incrocci ,&nbsp;Abdul Wahab M. Sharfo ,&nbsp;András Zolnay ,&nbsp;Uwe Oelfke ,&nbsp;Steve Jiang ,&nbsp;Linda Rossi ,&nbsp;Ben J.M. Heijmen ,&nbsp;Sebastiaan Breedveld","doi":"10.1016/j.radonc.2024.110662","DOIUrl":"10.1016/j.radonc.2024.110662","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Fast, high-quality deep learning (DL) prediction of patient-specific 3D dose distributions can enable instantaneous treatment planning (IP), in which the treating physician can evaluate the dose and approve the plan immediately after contouring, rather than days later. This would greatly benefit clinical workload, patient waiting times and treatment quality. IP requires that predicted dose distributions closely match the ground truth. This study examines how training dataset size and model size affect dose prediction accuracy for Erasmus-iCycle GT plans to enable IP.</div></div><div><h3>Materials and methods</h3><div>For 1250 prostate patients, dose distributions were automatically generated using Erasmus-iCycle. Hierarchically Densely Connected U-Nets with 2/3/4/5/6 pooling layers were trained with datasets of 50/100/250/500/1000 patients, using a validation set of 100 patients. A fixed test set of 150 patients was used for evaluations.</div></div><div><h3>Results</h3><div>For all model sizes, prediction accuracy increased with the number of training patients, without levelling off at 1000 patients. For 4–6 level models with 1000 training patients, prediction accuracies were high and comparable. For 6 levels and 1000 training patients, the median prediction errors and interquartile ranges for PTV <em>V</em>_95%, rectum <em>V</em>₇₅<em>_Gy</em> and bladder <em>V</em>₆₅<em>_Gy</em> were 0.01 [-0.06,0.15], 0.01 [-0.20,0.29] and −0.02 [-0.27,0.27] %-point. Dose prediction times were around 1.2 s.</div></div><div><h3>Conclusion</h3><div>Although even for 1000 training patients there was no convergence in obtained prediction accuracy yet, the accuracy for the 6-level model with 1000 training patients may be adequate for the pursued instantaneous planning, which is subject of further research.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110662"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795086","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":"Prediction of the need of enteral nutrition during radiation therapy for head and neck cancers","authors":"Paul Giraud ,&nbsp;Sebastien Guihard ,&nbsp;Sebastien Thureau ,&nbsp;Philippe Guilbert ,&nbsp;Amandine Ruffier ,&nbsp;Remi Eugene ,&nbsp;Assia Lamrani-Ghaouti ,&nbsp;Cyrus Chargari ,&nbsp;Xavier Liem ,&nbsp;Jean Emmanuel Bibault","doi":"10.1016/j.radonc.2024.110693","DOIUrl":"10.1016/j.radonc.2024.110693","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with a head and neck (HN) cancer undergoing radiotherapy risk critical weight loss and oral intake reduction leading to enteral nutrition. We developed a predictive model for the need for enteral nutrition during radiotherapy in this setting. Its performances were reported on a real-world multicentric cohort.</div></div><div><h3>Material and Methods</h3><div>Two models were trained on a prospective monocentric cohort of 230 patients. The first model predicted an outcome combining severe or early fast weight loss, or severe oral intake impairment (grade 3 anorexia or dysphagia or the prescription of enteral nutrition). The second outcome only combined oral intake impairment criteria. We trained a gradient boosted tree with a nested cross validation for Bayesian optimization on a prospective cohort and predictive performances were reported on the external multicentric real-world cohort of 410 patients from 3 centres. Predictions were explainable for each patient using Shapley values.</div></div><div><h3>Results</h3><div>For the first and second outcome, the model yielded a ROC curve AUC of 81 % and 80%, an accuracy of 77 % and 77 %, a positive predictive value of 77 % and 72 %, a specificity of 78 % and 79 % and a sensitivity of 75 % and 73 %. The negative predictive value was 80 % and 80 %. For each patient, the underlying Shapley values of each clinical predictor to the prediction could be displayed. Overall, the most contributing predictor was concomitant chemotherapy.</div></div><div><h3>Conclusion</h3><div>Our predictive model yielded good performance on a real life multicentric validation cohort to predict the need for enteral nutrition during radiotherapy for HN cancers.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"203 ","pages":"Article 110693"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882682","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}