Radiotherapy and Oncology最新文献

{"title":"Deep learning dosiomics for the pretreatment prediction of radiation dermatitis in nasopharyngeal carcinoma patients treated with radiotherapy","authors":"Ziqing Xiang ,&nbsp;Xianwen Yu ,&nbsp;Sunzhong Lin ,&nbsp;Dong Wang ,&nbsp;Weiqian Huang ,&nbsp;Wen Fu ,&nbsp;Xuanxuan Zhu ,&nbsp;Li Shao ,&nbsp;Jianping Wu ,&nbsp;Qiao Zheng ,&nbsp;Yao Ai ,&nbsp;Xujing Yang ,&nbsp;Mingrou Guo ,&nbsp;Xiance Jin","doi":"10.1016/j.radonc.2025.110951","DOIUrl":"10.1016/j.radonc.2025.110951","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Materials and methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 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 ,&nbsp;Eva Samsøe ,&nbsp;Birgitte Vrou Offersen ,&nbsp;Ebbe Laugaard Lorenzen ,&nbsp;Gitte Persson ,&nbsp;Hanna Rahbek Mortensen ,&nbsp;Henrik Dahl Nissen ,&nbsp;Ivan Richter Vogelius ,&nbsp;Jesper Folsted Kallehauge ,&nbsp;Ludvig Paul Muren ,&nbsp;Mads Brincker ,&nbsp;Mette van Overeem Felter ,&nbsp;Rikke Hedegaard Dahlrot ,&nbsp;Steffen Bjerre Hokland ,&nbsp;Tine Schytte ,&nbsp;Birgitte Mayland Havelund ,&nbsp;Britta Weber ,&nbsp;Ditte Sloth Møller ,&nbsp;Eva Serup-Hansen ,&nbsp;Kenneth Jensen ,&nbsp;Christian Rønn Hansen","doi":"10.1016/j.radonc.2025.110950","DOIUrl":"10.1016/j.radonc.2025.110950","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 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":"Design and pre-trial dose planning quality assurance of the Nordic trial of inhomogeneous dose escalated radiotherapy for patients with limited disease small cell lung cancer: NIELS","authors":"Sara Linde ,&nbsp;Ditte S. Møller ,&nbsp;Mai-Britt Linaa ,&nbsp;Ane Appelt ,&nbsp;Erik Almhagen ,&nbsp;Kenneth F. Hofland ,&nbsp;Marianne M. Knap ,&nbsp;Charlotte Kristiansen ,&nbsp;Lotte H. Land ,&nbsp;Christina Larsen ,&nbsp;Nina Levin ,&nbsp;Karin Lindberg ,&nbsp;Mikkel D. Lund ,&nbsp;Lars Merring-Mikkelsen ,&nbsp;Tine B. Nielsen ,&nbsp;Wiviann Ottosson ,&nbsp;Gitte F. Persson ,&nbsp;Hella M.B. Sand ,&nbsp;Morten H. Suppli ,&nbsp;Fernanda Villegas ,&nbsp;Lone Hoffmann","doi":"10.1016/j.radonc.2025.110946","DOIUrl":"10.1016/j.radonc.2025.110946","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The NIELS trial will examine if inhomogeneous dose-escalated radiotherapy up to a mean dose of 80 Gy in 40 fractions (fx), twice-daily delivered (BID), for patients with limited disease small cell lung cancer can improve overall survival. Because of the inherent risks of dose-escalation, pre-trial QA is particularly important. This study aims to examine the feasibility of the NIELS trial planning approach in a multicenter setting.</div></div><div><h3>Materials and methods</h3><div>The NIELS trial will randomize patients between standard dose radiotherapy (60 Gy/40fx BID) and inhomogeneous dose-escalated radiotherapy (up to 80 Gy/40fx BID). Five representative patient cases were distributed to seven Nordic centers for pre-trial QA planning of a standard and an escalated dose plan. Targets for escalation were primary tumor (GTVp) and involved lymph nodes (GTVn). We evaluated inter-center variation in achievable dose-escalation and doses to organs at risk (OAR).</div></div><div><h3>Results</h3><div>All targets could be escalated beyond the standard dose, with a median mean dose of 79.6 Gy [76.9–81.0] and 75.8 Gy [68.3–81.1] for GTVp and GTVn. Some targets could not be fully escalated due to OAR proximity. Three separate breaches of mandatory OAR constraints were observed in 35 escalated dose plans. There was a statistical difference in mean lung dose between standard and escalated plans, though clinically small, with a median inter-patient difference of 0.3 Gy. There were no differences in mean doses to the heart and esophagus.</div></div><div><h3>Conclusion</h3><div>Inhomogeneous dose-escalation as planned in the NIELS trial is feasible, and the dose-escalation can be performed respecting the OAR constraints in a multi-center setting.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110946"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132871","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":"Investigating the therapeutic potential of FLASH radiotherapy – a treatment planning study","authors":"Filip Hörberger ,&nbsp;Kristoffer Petersson ,&nbsp;Sofie Ceberg ,&nbsp;Sven Bäck ,&nbsp;Gabriel Adrian ,&nbsp;Crister Ceberg","doi":"10.1016/j.radonc.2025.110947","DOIUrl":"10.1016/j.radonc.2025.110947","url":null,"abstract":"<div><h3>Purpose/Background</h3><div>Ultra-high dose rate radiotherapy (RT) has shown potential for differential normal tissue (NT) sparing (a phenomenon termed the “FLASH effect”), particularly for larger fraction doses (&gt;5 Gy). However, transitioning to hypofractionation may increase late-reacting NT toxicity, counteracting the FLASH effect. This study evaluates whether FLASH-RT can provide netsparing for organs at risk (OARs) and NT within the PTV under the assumption of standard-of-care dose-conformity.</div></div><div><h3>Material/Methods</h3><div>Five patients per tumor-site (breast, head-and-neck, prostate, and glioblastoma) were analyzed. Using the Linear-Quadratic model, dose-distributions with higher dose per fraction were derived from standard schedules while maintaining tumor control efficacy. FLASH-modified dose-distributions were simulated voxel-by-voxel using logistic regression-based dose-modifying factors modeled from preclinical data. These plans were converted to standard fractionation equivalents for radiobiological comparisons of NT damage. Netsparing was defined as the difference in OAR dose-volume histogram parameters between standard and FLASH-modified plans, normalized to the prescribed dose. Commonly used <em>α/β</em>-ratios for tumors and late-reacting NT were applied.</div></div><div><h3>Results</h3><div>The netsparing for OARs and PTV varied strongly by tumor location. Breast and prostate cases showed positive netsparing, indicating that the FLASH effect outweighed increased toxicity. Even under a conservative scenario (higher <em>α/β</em>_T vs. <em>α/β</em>_NT), most OARs showed positive netsparing. In glioblastoma and head-and-neck cases, no netsparing was observed, indicating increased toxicity even with FLASH induced NT-sparing.</div></div><div><h3>Conclusion</h3><div>FLASH-RT appears to be beneficial for tumor sites where <em>α/β</em>_T ≲ <em>α/β</em>_NT, such as breast and prostate. However, not all tumor sites may benefit from FLASH-RT, highlighting the need for site-specific consideration for FLASH-RT implementation.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110947"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132882","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 ,&nbsp;Xiaoyan Yin ,&nbsp;Yuhao Lin ,&nbsp;Xiyi Liao ,&nbsp;Lisha Chen ,&nbsp;Jiabiao Hong ,&nbsp;Linghui Yan ,&nbsp;Sijia Chen ,&nbsp;Xueting Yan ,&nbsp;Zirong Li ,&nbsp;Kai Hu ,&nbsp;Ruiping Zhai ,&nbsp;Chuanben Chen ,&nbsp;Zhaodong Fei","doi":"10.1016/j.radonc.2025.110943","DOIUrl":"10.1016/j.radonc.2025.110943","url":null,"abstract":"<div><h3>Purpose</h3><div>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.</div></div><div><h3>Methods and Materials</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"208 ","pages":"Article 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}

{"title":"Intrafraction motion stability of open vs. closed facemasks in head and neck radiotherapy: Insights from the OPEN phase III trial","authors":"Ciaran Malone ,&nbsp;Samantha Ryan ,&nbsp;Jill Nicholson ,&nbsp;Roisin O ’Maolalai ,&nbsp;Rebecca O’Donovan ,&nbsp;Orla McArdle ,&nbsp;Frances Duane ,&nbsp;John Armstrong ,&nbsp;Lorna Keenan ,&nbsp;Aisling Glynn ,&nbsp;Ruth Woods ,&nbsp;Brendan McClean ,&nbsp;Sinead Brennan","doi":"10.1016/j.radonc.2025.110941","DOIUrl":"10.1016/j.radonc.2025.110941","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;div&gt;This OPEN (Optimising Patient Experience in Head and Neck Radiotherapy) phase III trial sub-study, aimed to evaluate intrafraction motion in head and neck (H&amp;N) cancer patients using three different facemask designs. Specifically, we compared intrafraction motion among patients immobilized with a closed facemask or one of two open-face designs, utilizing pre-/post-cone-beam computed tomography (CBCT) and surface-guided radiation therapy (SGRT).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A pre-planned interim analysis on the first 56 patients enrolled in the OPEN trial was conducted as a safety checkpoint. In the OPEN trial, patients are randomised into three arms: closed facemask, 3-point open facemask, or 5-point open facemask. Intrafraction motion was assessed using both CBCT and SGRT. CBCT provided deviations in translational and rotational dimensions based on bony alignment, while SGRT offered continuous monitoring of surface motion. Intrafraction motion metrics, (i.e. mean, standard deviation, maximum absolute deviation, and the 95th percentile of surface motion) were recorded for each open mask patient using SGRT data to fully quantify motion variation during treatment. The 95th percentile of SGRT deviations was used for direct comparison with CBCT motion data. Bayesian analysis was conducted to determine the equivalence of motion across mask types and measurement techniques. Margins to account for intrafraction motion were calculated across mask types using Van Herk’s formulism.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Mean CBCT deviations were less than 0.4 mm and 0.2 degrees, while SGRT recorded 95th percentile deviations of 0.4 mm and 0.8 degrees over all patients. SGRT detected transient maximum deviations not captured by CBCT, particularly in the yaw axis. However, these differences were transient. Bayesian analysis showed no clinically significant differences in intrafraction motion between mask types or measurement methods. No correlation was found between SGRT and CBCT measured motion within the small range of motion recorded. No difference in intrafraction margin requirements were found between arms. Based on CBCT-measured intrafraction motion, margins of 1.8 mm, 1.7 mm, and 1.3 mm were calculated for the vertical (VRT), lateral (LAT), and longitudinal (LNG) directions, respectively, to account for intrafraction motion for all mask types, with SGRT confirming that patient motion during treatment remained within these margins.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Intrafraction motion, as measured by both CBCT and SGRT, remains within clinically acceptable limits and yields similar PTV margins across both open and closed mask types. Intrafraction PTV margins were found to be comparable across all mask types. The use of SGRT allowed for the detection of transient deviations and rotational differences that were not detected using CBCT alone. Overall, these findings confirm that both 3-point and 5-point open-fac","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110941"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131182","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 Radiopathomics based on pretreatment MRI and whole slide images for predicting overall survival in locally advanced nasopharyngeal carcinoma","authors":"Xiaochun Yi ,&nbsp;Xiaoping Yu ,&nbsp;Congrui Li ,&nbsp;Junjian Li ,&nbsp;Hui Cao ,&nbsp;Qiang Lu ,&nbsp;Junjun Li ,&nbsp;Jing Hou","doi":"10.1016/j.radonc.2025.110949","DOIUrl":"10.1016/j.radonc.2025.110949","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop an integrative radiopathomic model based on deep learning to predict overall survival (OS) in locally advanced nasopharyngeal carcinoma (LANPC) patients.</div></div><div><h3>Materials and methods</h3><div>A cohort of 343 LANPC patients with pretreatment MRI and whole slide image (WSI) were randomly divided into training (n = 202), validation (n = 91), and external test (n = 50) sets. For WSIs, a self-attention mechanism was employed to assess the significance of different patches for the prognostic task, aggregating them into a WSI-level representation. For MRI, a multilayer perceptron was used to encode the extracted radiomic features, resulting in an MRI-level representation. These were combined in a multimodal fusion model to produce prognostic predictions. Model performances were evaluated using the concordance index (C-index), and Kaplan-Meier curves were employed for risk stratification. To enhance model interpretability, attention-based and Integrated Gradients techniques were applied to explain how WSIs and MRI features contribute to prognosis predictions.</div></div><div><h3>Results</h3><div>The radiopathomics model achieved high predictive accuracy in predicting the OS, with a C-index of 0.755 (95 % CI: 0.673–0.838) and 0.744 (95 % CI: 0.623–0.808) in the training and validation sets, respectively, outperforming single-modality models (radiomic signature: 0.636, 95 % CI: 0.584–0.688; deep pathomic signature: 0.736, 95 % CI: 0.684–0.810). In the external test, similar findings were observed for the predictive performance of the radiopathomics, radiomic signature, and deep pathomic signature, with their C-indices being 0.735, 0.626, and 0.660 respectively. The radiopathomics model effectively stratified patients into high- and low-risk groups (<em>P</em> &lt; 0.001). Additionally, attention heatmaps revealed that high-attention regions corresponded with tumor areas in both risk groups.</div></div><div><h3>Conclusion</h3><div>The radiopathomics model holds promise for predicting clinical outcomes in LANPC patients, offering a potential tool for improving clinical decision-making.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"209 ","pages":"Article 110949"},"PeriodicalIF":4.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132775","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}