Radiotherapy and Oncology最新文献

{"title":"HORMONE CHANGES ASSOCIATED WITH METFORMIN TREATMENT IN PROSTATE CANCER PATIENTS INITIATING ANDROGEN DEPRIVATION THERAPY: A CORRELATIVE ANALYSIS OF THE RANDOMIZED, PLACEBO-CONTROLLED PRIME STUDY","authors":"Mathew Gorman ,&nbsp;Bernhard J. Eigl ,&nbsp;Nawaid Usmani ,&nbsp;Michael Pollak ,&nbsp;Myriam Bouchard ,&nbsp;John Thoms ,&nbsp;Julian O. Kim ,&nbsp;Arun Elangovan ,&nbsp;Sunita Ghosh ,&nbsp;Ye Wang ,&nbsp;Eric Vigneault ,&nbsp;Michael Peacock ,&nbsp;Neil Fleshner ,&nbsp;Holly Campbell ,&nbsp;Francois Vincent ,&nbsp;Alan So ,&nbsp;Fabio L. Cury ,&nbsp;Harvey Quon ,&nbsp;Ryan Carlson ,&nbsp;Carole Lambert ,&nbsp;Kerry S. Courneya","doi":"10.1016/S0167-8140(25)04668-7","DOIUrl":"10.1016/S0167-8140(25)04668-7","url":null,"abstract":"<div><h3>Purpose:</h3><div>To determine if prostate cancer (PCa) patients (pts) receiving androgen deprivation therapy (ADT) will have predictable changes in laboratory biomarkers associated with metabolic syndrome and type II diabetes, that can be mitigated with Metformin.</div></div><div><h3>Materials and Methods:</h3><div>PRIME is Phase III multicentre double-blind, randomized controlled trial in which 166 normoglycemic pts with PCa receiving at least 9 months ADT were randomized 2:1 to receive metformin 850 mg or placebo BID orally for 18 months (NCT03031821). For this correlative analysis, 47 pts from the metformin arm and 32 pts from the placebo arm underwent optional serum collection and analysis. Fasting (F) and post-prandial (PP) serum samples of the following analytes were collected at baseline, 9, and 12 months: IGF, IGFBP1, IGFBP2, IGFBP3, IGFBP7, leptin, adiponectin, GDF15, insulin, C-peptide, GLP-1, and IL-6. Two-tailed paired t-tests were used to determine if significant changes in laboratory values were evident in pts receiving metformin versus placebo; paired t-tests were conducted to evaluate analytes between timepoints for the metformin and placebo groups separately.</div></div><div><h3>Results:</h3><div>Mean leptin values increased markedly in the placebo group and significantly less in the metformin group at 9-months F (p=4.98x10-5), 12-months F (p=9.20x10-4), 9-months PP (p=5.37x10-6), and 12-months PP (p=4.02x10-4). Mean IGFBP1 values increased more with metformin compared to placebo at all time-points (all p≤0.05). Mean IL-6 values decreased with metformin compared to placebo at 9-months F (p=0.06), 12-months F (p=0.04), 9-months PP (p=0.04), and 12-months PP (p=0.03). C-peptide and GLP-1 showed statistically significant changes with metformin versus placebo only at 9-months F. Some favourable but insignificant trends in mean changes were observed at other time points with C-peptide, GLP-1, insulin, adiponectin, and IGFBP2. No significant changes were observed in other analytes.</div></div><div><h3>Conclusions:</h3><div>This study demonstrates that metformin can mitigate changes induced by ADT in biomarkers (leptin, IGFBP1, IL-6) associated with an increased risk of type 2 diabetes and metabolic syndrome. Additionally, the attenuated increase in leptin with metformin signals a potential for improved PCa outcomes, as high leptin values have been correlated with aggressive disease and worse prognosis.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S6"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100182","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":"INTERDISCIPLINARY 3D SPECIMEN MAPPING TO OPTIMIZE RADIATION THERAPY FOR HEAD AND NECK CANCER","authors":"Jamie J.Y. Kwon ,&nbsp;Sarah Hamilton ,&nbsp;Matthew Chan ,&nbsp;Brad Gill ,&nbsp;Samantha Lloyd ,&nbsp;Joel Howlett ,&nbsp;Cornelius Kürten ,&nbsp;Tony Ng ,&nbsp;Carl Ren ,&nbsp;Eitan Prisman","doi":"10.1016/S0167-8140(25)04734-6","DOIUrl":"10.1016/S0167-8140(25)04734-6","url":null,"abstract":"<div><h3>Purpose:</h3><div>Radiation therapy (RT) planning for head and neck cancer (HNC) relies on accurate delineation of surgical margins, yet traditional pathology reports and imaging methods often fail to capture the spatial complexity of tumour resection. This study evaluates the feasibility and impact of integrating three-dimensional specimen maps (3DSM) into RT planning to enhance margin visualization and improve target delineation.</div></div><div><h3>Materials and Methods:</h3><div>Ten resected specimens from locally advanced HNC cases underwent 3D scanning. 3DSM were generated and annotated for positive and close margins, then registered to preoperative and pre-radiation CT scans to assess volume overlap with the clinical target volume (CTV) and planning target volume (PTV) from existing RT plans, and positive margin coverage within target volumes. A survey of institutional HNC radiation oncologists (ROs) compared the clinical utility of 3DSM to traditional written reports and verbal communication.</div></div><div><h3>Results:</h3><div>Retrospective analysis showed a mean volume overlap of 70.6±21.8% between 3DSM and CTV, and 86.9±14.7% between 3DSM and PTV. In 33% of cases, positive or close margins were not encompassed within the CTV. ROs consistently rated 3DSM as more informative than traditional methods in all survey categories (p&lt;0.01), particularly in communication of margin location and interpretation of postoperative changes.</div></div><div><h3>Conclusions:</h3><div>This proof-of-concept study demonstrates the potential of 3D specimen maps to improve RT planning for head and neck cancer, particularly in enhancing margin visualization and targeting of areas at high risk of local recurrence. Survey feedback and volume overlap data indicate that 3D models may offer significant clinical value by improving anatomical clarity and supporting high-precision RT delivery. While future studies will be needed to confirm these findings in larger cohorts, early results are promising for integration into standard practice.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S33"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099953","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":"ULTRA-HYPOFRACTIONATED RADIOTHERAPY FOR NON-MELANOMA SKIN CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS","authors":"Jaehyeong Yang ,&nbsp;Grace Xiong ,&nbsp;Shaheer Shahhat ,&nbsp;Andrew Arifin ,&nbsp;Adam Mutsaers","doi":"10.1016/S0167-8140(25)04735-8","DOIUrl":"10.1016/S0167-8140(25)04735-8","url":null,"abstract":"<div><h3>Purpose:</h3><div>Radical intent ultra-hypofractionated radiotherapy (UHRT) to treat non-melanoma skin cancer (NMSC) is increasingly used to decrease treatment time. Limited prospective data exists on the efficacy and safety of different regimens, particularly in comparison to more fractionated regimens. A systematic review and pooled analysis was done to synthesize best available evidence.</div></div><div><h3>Materials and Methods:</h3><div>Cochrane, Medline and Embase databases were queried from inception to July 2024 for studies evaluating patients with NMSC treated with UHRT. Studies with fractionation schedules of doses-per-fraction greater than 5 Gy and biologically equivalent dose (BED10) greater than 45 Gy were included. Nonquantitative primary endpoints, mixed cohorts failing to report fractionation separately, and other definitive treatments (brachytherapy, conventional radiotherapy, surgery) were excluded. Results for 12- and 24-month local control (LC), response rate, overall survival (OS), cosmesis and toxicity were examined, and weighted-mean and confidence intervals were calculated.</div></div><div><h3>Results:</h3><div>Seventeen studies met inclusion criteria (6087 lesions, 4192 patients), with fifteen studies eligible for quantitative analysis of common endpoints. Fourteen studies were retrospective and three were prospective. Study size varied, with a median of 38 patients (range:12-1149) and 112 lesions (range:15-1715). Radiation was delivered in 1-12 fractions with doses-per-fraction of 5-30 Gy. Radiation schedule and technique were heterogeneous across studies. One-year LC (LC1) reported in three studies was 89.6% (n=3, 325 lesions, 95%CI: 77.7-101.5%) and LC2 was 95.5% (n=6, no overlapping studies with LC1 justifying higher LC, 2098 lesions, 95%CI: 89.0-102.0%). In 8 studies with 432 lesions, complete response was 78.6% and partial response was 12.0%. One-year OS (OS1) was 58.4% (n=4, 170 patients, 95%CI: 46.0-70.7%) and OS2 was 46.0% (n=4, 184 patients, 95%CI: 21.0-70.9%). In 11 studies reporting toxicity, treatment was well tolerated with a single study reporting 2.5% (n=6) incidence of acute Grade 4 toxicity. Cosmesis was reported in 6 studies with 2097 lesions, with 78.2% reporting fair to excellent grades.</div></div><div><h3>Conclusions:</h3><div>In a heterogeneous cohort of radiation treatments for NMSC, ultra-hypofractionation offers excellent LC, modest toxicity and acceptable cosmesis. Further prospective evaluation is warranted.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S33"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100109","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":"DID THE SARS-COV-2 PANDEMIC PROVIDE A UNIQUE OPPORTUNITY TO DETERMINE THE MAXIMUM PROPORTION OF SINGLE FRACTION RADIOTHERAPY (SFRT) DELIVERABLE AT THE POPULATION LEVEL FOR UNCOMPLICATED PAINFUL BONE METASTASES (UPBM)?","authors":"Justina Machnee ,&nbsp;James Beck ,&nbsp;Nikesh Hanumanthappa ,&nbsp;Aldrich Ong ,&nbsp;Bindu Venugopal ,&nbsp;Rashmi Koul ,&nbsp;Arbind Dubey ,&nbsp;Bashir Bashir ,&nbsp;Saranya Kakumanu ,&nbsp;Julian Kim","doi":"10.1016/S0167-8140(25)04747-4","DOIUrl":"10.1016/S0167-8140(25)04747-4","url":null,"abstract":"<div><h3>Purpose:</h3><div>SFRT is recommended over multiple fraction radiotherapy (MFRT) for the palliative management of UPBM as supported by level 1 evidence. In routine clinical practice, barriers to SFRT use arise, leading to suboptimal SFRT utilization. The maximum proportion of SFRT achievable at the population level is currently unknown. We conducted a retrospective population-based analysis of SFRT utilization of a provincial cancer program during post-lockdown 2020 and assessed factors associated with receipt of MFRT.</div></div><div><h3>Materials and Methods:</h3><div>The SARS-COV-2 pandemic led to critical radiation oncology (RO) resource shortages after the first pandemic lockdowns in March 2020. In response, CancerCare Manitoba, a provincial cancer program, asked all ROs to conserve limited RT resources by prioritizing SFRT for UPBM. MFRT was permitted for individual cases if the treating RO felt a given bone metastasis did not meet criteria as an UPBM. Between 20 March 2020 to 31 December 2020, all patients treated in Manitoba with palliative RT for bone metastases were identified using the ARIA electronic medical record and patient, tumour, and treatment variables were extracted. The proportions of patients treated with SFRT and MFRT were tabulated. Univariable and multivariable logistic regression assessed factors associated with receipt of MFRT.</div></div><div><h3>Results:</h3><div>Following the March 2020 lockdowns, 878 bone metastases received palliative RT with a mean age of 67.5 years and the most common primary sites were lung (27.6%), prostate (22.9%), and breast (15.2%). Amongst the whole cohort, Spinal cord compression was present in 9.9%, and 36.2% of bone metastases were complicated. SFRT was used in 85.7% of uncomplicated bone metastases and 81.3% of all bone metastases. On multivariable analysis, factors associated with increased odds of MFRT included spinal cord compression (OR 2.2, p=0.005), soft tissue extension (OR 2.9, p&lt;0.000), primary tumour types including hematologic (OR 2.8, p=0.013), non-prostate GU (OR 3.3, p=0.006), and GI (OR 2.6, p=0.020).</div></div><div><h3>Conclusions:</h3><div>This study found that the maximum proportion of SFRT that can be utilized for the palliation of uncomplicated bony metastases at the population level is 85.7%. Knowledge translation campaigns aimed at maximizing SFRT utilization now have an upper asymptote upon which reasonable SFRT benchmark goals can be derived.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S38"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100112","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":"COGNITIVE OUTCOMES FOLLOWING PROTON VERSUS PHOTON RADIOTHERAPY FOR CNS NON-GERMINOMATOUS GERM CELL TUMOURS: A CHILDREN’S ONCOLOGY GROUP STUDY","authors":"David Mak ,&nbsp;Yu Wang ,&nbsp;Sunita Patel ,&nbsp;Girish Dhall ,&nbsp;Arzu Onar-Thomas ,&nbsp;Erin Murphy ,&nbsp;Shannon MacDonald ,&nbsp;Ute Bartels ,&nbsp;Jason Fangusaro ,&nbsp;Christine Trask ,&nbsp;Leanne Embry ,&nbsp;Hitesh Dama ,&nbsp;Kenda Oribhabor ,&nbsp;Derek S. Tsang","doi":"10.1016/S0167-8140(25)04666-3","DOIUrl":"10.1016/S0167-8140(25)04666-3","url":null,"abstract":"<div><h3>Purpose:</h3><div>The Children’s Oncology Group (COG) study ACNS1123 (stratum 1) treated children with localized non-germinomatous germ cell tumours (NGGCT) of the brain with chemotherapy followed by whole ventricular (WV) radiotherapy (RT, 30.6 Gy) followed by a focal tumour bed boost (54 Gy total dose). Previous work has shown that WVRT with proton therapy, compared to photon RT, resulted in lower RT doses to the brain. However, it was unclear whether this dosimetric difference led to superior cognitive outcomes.</div></div><div><h3>Materials and Methods:</h3><div>The ACNS1123 study was a prospective, Phase II trial conducted by the COG that enrolled 107 patients. Evaluation of cognitive functioning of children was a co-primary objective of the study. Cognition was prospectively examined at 9-, 30- and 60-months post-diagnosis, using the COG Standard Neuropsychological and Behavioral Battery. The primary endpoints were attention/concentration, estimated intelligence quotient (IQ), and processing speed. Linear mixed-effect models were created to model cognitive endpoints with treatment exposures, including RT modality (proton versus photon RT) or RT dose to brain structures. Cognitive evaluations completed post-recurrence were excluded.</div></div><div><h3>Results:</h3><div>Seventy patients were evaluable and received WVRT followed by RT boost, of which 20 received proton therapy. Mean age of all patients was 11.8 ± 4.3 years old at the start WVRT and were predominantly male (n=52). Mean doses to the brain were significantly lower with proton versus photon RT (means 18.8 ± 1.8 [SD] versus 24.7 ± 3.7 Gy, p&lt;0.0001), left hippocampus (41.1 ± 5.2 versus 46.2 ± 5.3 Gy, p=0.0005), and right hippocampus (41.8 ± 5.1 versus 46.0 ± 5.3 Gy, p=0.0038). A total of 56, 60 and 61 patients were evaluable for attention/concentration, estimated IQ and processing speed, respectively, with 1 or more evaluation. Nine, 20 and 20 patients had data at all 3 time points for attention/concentration, estimated IQ and processing speed, respectively. Multivariable modelling demonstrated that photon therapy was associated with a decline in IQ over time (p=0.0401), as compared with proton RT, adjusted for age at RT and gender. In a separate multivariable model, higher mean brain dose was also associated with poorer recovery of IQ over time (p=0.0216), adjusted for gender. There were no identified associations between use of proton RT or hippocampal dose with processing speed or attention/concentration.</div></div><div><h3>Conclusions:</h3><div>Compared to proton therapy, WVRT delivered with photons was associated with a significant decline in IQ and adverse recovery of IQ over time. To our knowledge, this data is the first to demonstrate such an association for children with NGGCT.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S5"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STEREOTACTIC BODY RADIATION THERAPY (SBRT) FOR RENAL TUMOURS: A PROSPECTIVE PHASE II STUDY","authors":"Katelyn Wang ,&nbsp;Joelle Helou ,&nbsp;Andrew McPartlin ,&nbsp;Anna T. Santiago ,&nbsp;Jamie Bernstein ,&nbsp;Jennifer Dang ,&nbsp;Grace Tsui ,&nbsp;Peter Chung ,&nbsp;Aruz Mesci ,&nbsp;Enrique Gutierrez ,&nbsp;Srinivas Raman ,&nbsp;Alejandro Berlin ,&nbsp;Charles Catton ,&nbsp;Andrew Bayley ,&nbsp;Padraig Warde ,&nbsp;Satheesh Krishna ,&nbsp;Antonio Finelli ,&nbsp;Robert J. Hamilton ,&nbsp;Kenneth T. Pace ,&nbsp;Jeff Winter ,&nbsp;Rachel M. Glicksman","doi":"10.1016/S0167-8140(25)04670-5","DOIUrl":"10.1016/S0167-8140(25)04670-5","url":null,"abstract":"<div><h3>Purpose:</h3><div>Stereotactic body radiotherapy (SBRT) represents a novel, efficacious treatment for patients with kidney tumours who are medically inoperable or decline surgery. There is limited prospective data on the impact of kidney SBRT on renal function. Herein, we present the primary endpoint of a prospective trial of kidney-directed SBRT.</div></div><div><h3>Materials and Methods:</h3><div>This is a prospective single-arm Phase II trial of renal-directed SABR including patients with solid kidney mass(es) (primary or metastatic) amenable to SBRT, and who were medically inoperable or declined surgery. Key exclusion criteria included prior kidney radiation exposure, recent nephrotoxic systemic therapy, or end-stage renal failure. SBRT was delivered as 27.5-40 Gy in 5 fractions, delivered on alternate days. Primary endpoint was nephron toxicity, measured by the change in eGFR over 2 years. Secondary endpoints included oncologic endpoints, toxicity, and quality-of-life (QOL), measured by NFKSI-19. The a priori null hypothesis was that eGFR does not decrease over time and was analyzed using a null hypothesis significance test (NHST) Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario and two one-sided tests (TOST) of equivalence for the paired t-test at α=0.05.</div></div><div><h3>Results:</h3><div>Thirty patients with 32 renal tumours enrolled, with median (IQR) age 76 years (73-86), Charlson comorbidity index 8 (7-9), 93% had chronic kidney disease Stage &gt;2, and the majority had cT1b disease. Twenty-six patients (87%) had primary kidney cancer, and the remainder had non-kidney cancer metastatic lesions. Median radiation dose was 35 Gy in 5 fractions. Median follow-up was 24.5 months (IQR 20-36.2). Median (IQR) eGFR levels (mL/min/1.73m2) were 47.5 (37.8-64.0) at baseline, 42.0 (35.2-54.2) at 1-year and 39.5 (25.5-54.8) at 2-years. The null hypothesis was rejected (mean difference=8.7, 90% CI [3.4, 14.1]; NHST p=0.011; TOST p=0.71). Local control was 96.7% at 2 years. The cumulative incidence of Grade &gt;2 toxicity was 4.3% (95% CI 0.3, 18.7). There were no acute or late Grade 3+ toxicities. QOL scores did not significantly change following treatment.</div></div><div><h3>Conclusions:</h3><div>Kidney-directed SBRT results in minimal loss of renal function, comparable to that expected from other treatment options, with high rates of local control, low rates of toxicity, and preservation of QOL. Kidney SBRT should be tested in large, randomized trials to evaluate its outcomes, including efficacy and impact on renal function, relative to other standard-of-care therapies.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S7"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100184","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":"DYING ALONE? INVESTIGATING LONELINESS AS A RISK FACTOR FOR CANCER MORTALITY","authors":"Samantha Cheng ,&nbsp;Joshua Yi ,&nbsp;Keiran Pace ,&nbsp;Anna Santiago ,&nbsp;John-Jose Nunez ,&nbsp;Jane Jomy ,&nbsp;Srinivas Raman","doi":"10.1016/S0167-8140(25)04698-5","DOIUrl":"10.1016/S0167-8140(25)04698-5","url":null,"abstract":"<div><h3>Purpose:</h3><div>Loneliness and social isolation can adversely affect the cancer patient journey with profound emotional and psychological impact. Accruing evidence suggests loneliness also has adverse effects on cancer outcomes and survival in this vulnerable population. This may be due to a variety of biological, psychological, and social factors, from impaired ability to access treatment to effects of loneliness on the immune system. We conducted the first systematic review and meta-analysis to date to investigate mortality in relation to loneliness and social isolation among cancer populations.</div></div><div><h3>Materials and Methods:</h3><div>We systematically searched MEDLINE, Embase, and PsycINFO from inception to September 13, 2024, for studies that report on the impact of loneliness or social isolation on all-cause and cancer mortality in cancer patients. Three reviewers independently screened titles, abstracts, and full texts using predefined eligibility criteria, with discrepancies resolved by consensus. Data extraction and risk of bias assessment was conducted using a standardized form. Random-effects meta-analysis was used to examine the association between loneliness/ social isolation with all-cause and cancer mortality.</div></div><div><h3>Results:</h3><div>Of 12,602 citations, 16 studies met eligibility criteria and 13 were included in the meta-analysis. Of these, 8 were prospective while 8 were retrospective, and 9 studies assessed cancer mortality while 12 examined all-cause mortality. Social isolation and loneliness were most commonly measured using the Social Network Index, Social Integration Index, and UCLA Loneliness Scale. The median sample size was 6,249, and the mean age of participants was 63 years. Meta-analysis demonstrated loneliness/social isolation may increase the risk of all-cause mortality with low certainty of evidence (hazard ratio [HR] [95% CI] = 1.34 [1.26–1.42], p&lt;0.001). Similarly, we found loneliness/social isolation may increase the risk of cancer-specific mortality with low certainty of evidence (HR [95% CI] = 1.14 [1.04–1.25], p=0.005).</div></div><div><h3>Conclusions:</h3><div>Our review provides evidence that among cancer patients, loneliness and social isolation may be associated with increased risk in all-cause and cancer-specific mortality. These findings support the need to incorporate psychosocial assessments and targeted interventions into cancer care to improve patient outcomes.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S18"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100188","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":"DOES LIMITING HOTSPOTS OUTSIDE THE GTV DECREASE THE RISK OF VERTEBRAL COMPRESSION FRACTURE IN PATIENTS BEING TREATED WITH SPINE SBRT? A SINGLE INSTITUTION EXPERIENCE","authors":"Zhang Hao (Jim) Li ,&nbsp;Adrian Wai Chan ,&nbsp;Alanah M. Bergman ,&nbsp;Haley Patrick ,&nbsp;Mitchell Liu ,&nbsp;Emma M. Dunne","doi":"10.1016/S0167-8140(25)04755-3","DOIUrl":"10.1016/S0167-8140(25)04755-3","url":null,"abstract":"<div><h3>Purpose:</h3><div>Vertebral compression fracture (VCF) is one of the most common and challenging adverse events following stereotactic body radiation (SBRT) to the spine. Among the many possible predictive factors for VCF, radiation dose per fraction has consistently been found to increase the risk. In response to this, our institution has recently adopted a new constraint to limit dose in the PTV – (GTV+2mm) region to &lt;110% under the hypothesis that limiting the hotspots (HS) outside the GTV will decrease the risk of VCF. This study aims to test this hypothesis and evaluate the effects of this new constraint on VCF rates and local control.</div></div><div><h3>Materials and Methods:</h3><div>A retrospective review was conducted of all patients treated with SBRT between October 2014 and December 2022 for de novo spinal metastases. Patients with pre- and post-treatment MRIs were selected for the study cohort. Clinical, dosimetric, and survival data were collected, and survival analyses were performed using the Kaplan-Meier method to compare outcomes between plans that respected and exceeded the HS constraint.</div></div><div><h3>Results:</h3><div>80 patients underwent SBRT treatment to 117 spine segments, 35 of which respected the PTV-(GTV+2mm) HS constraint. The median age was 64 (range: 28-83). At a median follow up of 33 months, 36 patients died. The mean overall survival was 60 months (95% CI: 50-69 months). The cumulative risk of VCF at 24 months was 6% (95% CI: 0-15%) for segments treated with the HS-limiting constraint and 19% (95% CI: 9-28%) for those without (p=0.10). Local control at 24 months was 88% (95% CI: 76%-99%) and 82% (95% CI: 73-91%), respectively (p=0.31).</div></div><div><h3>Conclusions:</h3><div>Although our small sample size did not show any significant differences, the lower VCF rates observed suggest a potential benefit of applying the PTV – (GTV+2mm) &lt;110% constraint in reducing VCF rates associated with SBRT. Future prospective studies could be performed to further evaluate this.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S41"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100203","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":"FEASIBILITY AND SAFETY OF ORGAN PRESERVING THERAPY FOR EARLY STAGE OR INDUCED EARLY-STAGE ESOPHAGEAL CANCER USING ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AND ADJUVANT IMMUNORADIOTHERPY WITH DURVALUMAB (OPERA-RADIO): A PHASE 1 CLINICAL TRIAL","authors":"Julian Kim ,&nbsp;Shantanu Banerji ,&nbsp;James Paul ,&nbsp;Rebekah Rittberg ,&nbsp;Bashir Bashir ,&nbsp;Amitava Chowdhury ,&nbsp;William Hunter ,&nbsp;Ahmet Leylek ,&nbsp;Shantanu Banerji ,&nbsp;Biniam Kidane","doi":"10.1016/S0167-8140(25)04688-2","DOIUrl":"10.1016/S0167-8140(25)04688-2","url":null,"abstract":"<div><h3>Purpose:</h3><div>OPERA-RADIO (NCT05667298) is a phase I prospective study investigating organ preservation therapy for patients with early stage esophageal cancer (EC) who decline or are ineligible for esophagectomy. We report the feasibility and safety up front organ preserving therapy with ESD followed by adjuvant concurrent immunoradiotherapy (IORT) or adjuvant immunotherapy (IO) alone (in patients with prior neoadjuvant intent chemoradiotherapy).</div></div><div><h3>Materials and Methods:</h3><div>Patients with de novo early-stage (high risk pT1b/pT2N0M0) EC received upfront ESD followed by adjuvant IORT consisting of 41.4-45 Gy/23-25# with concurrent and consolidation durvalumab every 4 weeks x 13 cycles. The protocol was amended to also include patients with locally advanced EC who received neoadjuvant concurrent chemoradiotherapy (CROSS Regimen) with complete clinical response amenable to ESD (induced early stage disease) and declined esophagectomy. These patients received adjuvant durvalumab only (13 cycles). Patient, disease, and treatment characteristics were tabulated for descriptive purposes. Acute and late toxicities are reported using CTCAE V5.0.</div></div><div><h3>Results:</h3><div>From Feb 2023 until Apr 2024, 11 patients were enrolled with a mean follow-up of 2.0 years (range 1.2 to 2.5) with a mean age of 68 (range 54-78), of whom 4 (36%) were female. Ten (91%) patients had adenocarcinoma, and 1 (9%) had squamous cell carcinoma. Most tumours (91%) were located in the lower third of the esophagus/GEJ, while 1 (9%) was located in the middle third of the esophagus. Ten patients (91%) received durvalumab, of whom 4 received it as part of concurrent IORT and consolidation following ESD, while 6 patients received neoadjuvant CROSS followed by ESD and adjuvant durvalumab. The mean number of cycles of durvalumab received was 10. Reasons for early discontinuation of durvalumab (all of which occurred in patients with induced early stage post-CROSS) included: disease progression (n=1), and grade 2 arthralgias which resolved with cessation of durvalumab (n=2). Amongst patients receiving concurrent IORT, no grade 3 or higher toxicity occurred during follow-up. One patient treated with adjuvant durvalumab had grade 2 weight loss following endoscopic resection which resolved prior to receipt of adjuvant durvalumab. No unexpected safety signal with durvalumab was identified.</div></div><div><h3>Conclusions:</h3><div>This phase I study demonstrates that an organ preservation approach with ESD followed by radioimmunotherapy for esophageal cancer patients who are ineligible or declining esophagectomy is safe and feasible to deliver. There are ongoing plans to develop this approach into a randomized Phase 2/3 study.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Page S14"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100238","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":"RADIOTHERAPY FOR THE MANAGEMENT OF BONE METASTASES IN DIFFERENTIATED THYROID CANCER","authors":"Colin Faulkner ,&nbsp;Aruz Mesci ,&nbsp;Faisal Alfadli ,&nbsp;James Brierley ,&nbsp;Richard Tsang ,&nbsp;Xiang Ye ,&nbsp;Osgur Mete ,&nbsp;Lucy Ma ,&nbsp;Carly Barron ,&nbsp;Monika Krzyzanowska ,&nbsp;Jelena Lukovic","doi":"10.1016/S0167-8140(25)04696-1","DOIUrl":"10.1016/S0167-8140(25)04696-1","url":null,"abstract":"<div><h3>Purpose:</h3><div>Bone metastases are observed in over 50% of patients with differentiated thyroid cancer (DTC) who develop metastatic disease. Local treatments including external beam radiation therapy (RT) may be used for radioactive iodine-refractory, progressive, or symptomatic disease. The purpose of this study was to evaluate the efficacy of radiotherapy doses and techniques for DTC bone metastases.</div></div><div><h3>Materials and Methods:</h3><div>This retrospective study included all patients with DTC who received RT for bone metastases. The primary outcome was treated metastasis control (TMC), calculated from the date of radiotherapy completion to the date of lesion progression, death, or last follow-up. The biological effective dose (BED, α/β=10) was used to compare radiotherapy regimens. The dose-response relationship was evaluated using BED₁₀ as a continuous variable in increments of 10. Subsequently, the group was divided into low dose radiation (BED₁₀&lt;40) and high dose radiation (BED₁₀&gt;=40). The cumulative incidence of TMC was estimated using the Aalen-Johansen method and compared between two BED groups using the Gray test. Univariate and multivariate models were performed to assess for predictors of TMC. A two-sided p-value of &lt;0.05 was considered statistical significance.</div></div><div><h3>Results:</h3><div>In total, 107 patients with DTC were treated for 280 bone metastases between 2003 and 2023. Patients were stratified into two groups: high BED₁₀≥40 (n=35) and low BED₁₀&lt;40 (n=72). Our results demonstrated that high BED treatment was associated with significantly lower cumulative incidence of progression (HR 0.50, p=0.003), with a median progression time of 3.3 years for low BED and not reached for high BED groups. In total 55/107 patients had molecular profiling, but no mutations were found to predict TMC.</div></div><div><h3>Conclusions:</h3><div>In this retrospective cohort study, a clear dose-response relationship was identified for patients with DTC bone metastases. When suitable, treatment of these patients should include a higher dose exceeding BED₁₀=40.</div></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"210 ","pages":"Pages S17-S18"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145100252","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}