Radiotherapy and Oncology最新文献

{"title":"Physical activity at diagnosis is associated with tumor downstaging after neoadjuvant chemoradiotherapy in patients with rectal cancer","authors":"I.H. Mast ,&nbsp;J.H.W. de Wilt ,&nbsp;B. Duman ,&nbsp;K.C. Smit ,&nbsp;E.C. Gootjes ,&nbsp;P.A.J. Vissers ,&nbsp;H. Rütten ,&nbsp;I.D. Nagtegaal ,&nbsp;M.T.E. Hopman ,&nbsp;A.M. May ,&nbsp;L.M. Buffart","doi":"10.1016/j.radonc.2024.110523","DOIUrl":"10.1016/j.radonc.2024.110523","url":null,"abstract":"<div><h3>Background</h3><p>Patients with rectal cancer are often treated with neoadjuvant chemoradiotherapy, followed by a waiting period and surgical resection. Good or complete response to neoadjuvant chemoradiotherapy might enable organ preservation, which highlights the need to increase response rates. Pre-clinical studies suggest that physical activity during neoadjuvant chemoradiotherapy may improve tumor downstaging.</p></div><div><h3>Purpose</h3><p>To investigate whether physical activity and physical functioning of patients with rectal cancer at diagnosis are associated with tumor downstaging after neoadjuvant chemoradiotherapy.</p></div><div><h3>Materials and methods</h3><p>Patients were included if they participated in the Dutch Prospective ColoRectal Cancer Cohort, a nationwide cohort providing an infrastructure for scientific research, and received neoadjuvant chemoradiotherapy for rectal cancer. Tumor downstaging was dichotomized into good/complete or moderate/poor downstaging. Physical activity (total physical activity, moderate-to-vigorous physical activity (MVPA), and Dutch physical activity guideline adherence) and physical functioning were assessed using questionnaires. Logistic regression analyses were performed to examine associations of physical activity and physical functioning with tumor downstaging, adjusted for relevant confounders.</p></div><div><h3>Results</h3><p>268 patients (aged 62 ± 11 years, 33 % female) with rectal cancer were included. Patients with moderate (OR = 2.07; 95%CI = 1.07 – 4.07; <em>p</em> = 0.03) or high (OR = 2.05; 95%CI = 1.05 – 4.07; <em>p</em> = 0.04) levels of MVPA were more likely to have good/complete tumor downstaging than patients with low levels. No significant associations with tumor downstaging were found for total physical activity, Dutch physical activity guideline adherence, and physical functioning.</p></div><div><h3>Conclusions</h3><p>We found augmented tumor downstaging in patients with rectal cancer with moderate or high levels of self-reported MVPA before the start of neoadjuvant chemoradiotherapy compared to patients with low levels.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110523"},"PeriodicalIF":4.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167814024035011/pdfft?md5=81a910f7b38cc7ee18724bd1be0d6e79&pid=1-s2.0-S0167814024035011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238046","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":"Brachial plexopathy following stereotactic body radiation therapy in apical lung malignancies: A dosimetric pooled analysis of individual patient data","authors":"Hui Bai ,&nbsp;Xiao-Feng Wang ,&nbsp;Yi-Han Xu ,&nbsp;Nicholas G Zaorsky ,&nbsp;Huan-Huan Wang ,&nbsp;Geng-Min Niu ,&nbsp;Jia-Cheng Li ,&nbsp;Yang Dong ,&nbsp;Jun-Yi Li ,&nbsp;Lu Yu ,&nbsp;Mei-Feng Chen ,&nbsp;Xiao-Tong Lu ,&nbsp;Zhi-Yong Yuan ,&nbsp;Ji-Long Yang ,&nbsp;Mao-Bin Meng","doi":"10.1016/j.radonc.2024.110529","DOIUrl":"10.1016/j.radonc.2024.110529","url":null,"abstract":"<div><h3>Background and objectives</h3><p>The aim of this study is to establish dosimetric constraints for the brachial plexus at risk of developing grade ≥ 2 brachial plexopathy in the context of stereotactic body radiation therapy (SBRT).</p></div><div><h3>Patients and Methods</h3><p>Individual patient data from 349 patients with 356 apical lung malignancies who underwent SBRT were extracted from 5 articles. The anatomical brachial plexus was delineated following the guidelines provided in the atlases developed by Hall, <em>et al</em>. and Kong, <em>et al</em>.. Patient characteristics, pertinent SBRT dosimetric parameters, and brachial plexopathy grades (according to CTCAE 4.0 or 5.0) were obtained. Normal tissue complication probability (NTCP) models were used to estimate the risk of developing grade ≥ 2 brachial plexopathy through maximum likelihood parameter fitting.</p></div><div><h3>Results</h3><p>The prescription dose/fractionation schedules for SBRT ranged from 27 to 60 Gy in 1 to 8 fractions. During a follow-up period spanning from 6 to 113 months, 22 patients (6.3 %) developed grade ≥2 brachial plexopathy (4.3 % grade 2, 2.0 % grade 3); the median time to symptoms onset after SBRT was 8 months (ranged, 3–54 months). NTCP models estimated a 10 % risk of grade ≥2 brachial plexopathy with an anatomic brachial plexus maximum dose (D_max) of 20.7 Gy, 34.2 Gy, and 42.7 Gy in one, three, and five fractions, respectively. Similarly, the NTCP model estimates the risks of grade ≥2 brachial plexopathy as 10 % for BED D_max at 192.3 Gy and EQD₂ D_max at 115.4 Gy with an <em>α/β</em> ratio of 3, respectively. Symptom persisted after treatment in nearly half of patients diagnosed with grade ≥2 brachial plexopathy (11/22, 50 %).</p></div><div><h3>Conclusions</h3><p>This study establishes dosimetric constraints ranging from 20.7 to 42.7 Gy across 1–5 fractions, aimed at mitigating the risk of developing grade ≥2 brachial plexopathy following SBRT. These findings provide valuable guidance for future ablative SBRT in apical lung malignancies.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110529"},"PeriodicalIF":4.9,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142167688","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":"RSPO3 regulates the radioresistance of Non-Small cell lung cancer cells via NLRP3 Inflammasome-Mediated pyroptosis","authors":"Hongbin Li ,&nbsp;Jialin Zhang ,&nbsp;Boyi Yu ,&nbsp;Tiantian Yang ,&nbsp;Bingtao Liu ,&nbsp;Feifei Li ,&nbsp;Xiaodong Jin ,&nbsp;Qiang Li","doi":"10.1016/j.radonc.2024.110528","DOIUrl":"10.1016/j.radonc.2024.110528","url":null,"abstract":"<div><h3>Purpose</h3><p>Radioresistance is a significant challenge in the radiotherapy of non-small cell lung cancer (NSCLC). This study aimed to investigate the role of R-spondin 3 (RSPO3) in regulating NSCLC radioresistance.</p></div><div><h3>Methods and Materials</h3><p>RNA sequencing was performed to analyze genes that are differentially expressed in radioresistant NSCLC cell lines. RSPO3 overexpression and knockdown experiments were conducted to assess its impact on radiosensitivity. The involvement of the β-catenin-NF-κB signaling pathway and the NLRP3 inflammasome in RSPO3-mediated radiosensitivity was also evaluated. In vivo experiments were conducted using a clinical-grade anti-RSPO3 antibody (OMP-131R10/rosmantuzumab) to assess its impact on radiation-induced pyroptosis and subsequent anti-tumor immunity.</p></div><div><h3>Results</h3><p>RSPO3 expression was downregulated in radioresistant NSCLC cells. Overexpression of RSPO3 increased NSCLC radiosensitivity through the induction of pyroptosis, which was mediated by the β-catenin-NF-κB signaling pathway and the NLRP3 inflammasome. The anti-RSPO3 antibody effectively blocked radiation-induced pyroptosis and anti-tumor immunity in vivo. Conversely, upregulation of RSPO3 enhanced NSCLC tumor radiosensitivity.</p></div><div><h3>Conclusions</h3><p>The findings demonstrated that RSPO3 plays a crucial role in regulating NSCLC radioresistance via NLRP3 mediated pyroptosis. Targeting the RSPO3-NLRP3 inflammasome axis may offer a potential therapeutic strategy to enhance the efficacy of radiotherapy for NSCLC patients.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110528"},"PeriodicalIF":4.9,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154908","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":"Association of the combined stereotactic radiosurgery and embolization strategy and long-term outcomes in brain arteriovenous malformations with a volume >10 ml: A nationwide multicenter observational prospective cohort study","authors":"Zhipeng Li ,&nbsp;Jun Zhang ,&nbsp;Heze Han ,&nbsp;Dezhi Gao ,&nbsp;Hengwei Jin ,&nbsp;Li Ma ,&nbsp;Ruinan Li ,&nbsp;Anqi Li ,&nbsp;Haibin Zhang ,&nbsp;Kexin Yuan ,&nbsp;Ke Wang ,&nbsp;Qinghui Zhu ,&nbsp;Chengzhuo Wang ,&nbsp;Debin Yan ,&nbsp;Junlin Lu ,&nbsp;Yukun Zhang ,&nbsp;Yang Zhao ,&nbsp;Youxiang Li ,&nbsp;Shibin Sun ,&nbsp;Yuanli Zhao ,&nbsp;Xiaolin Chen","doi":"10.1016/j.radonc.2024.110530","DOIUrl":"10.1016/j.radonc.2024.110530","url":null,"abstract":"<div><h3>Background</h3><p>To assess the long-term outcome of large brain arteriovenous malformations (AVMs) (volume &gt; 10 ml) underwent combined embolization and stereotactic radiosurgery (E+SRS) versus SRS alone.</p></div><div><h3>Methods</h3><p>Patients were recruited from a nationwide multicenter prospective collaboration registry (MATCH study, August 2011–August 2021) and categorized into E+SRS and SRS alone cohorts. Propensity score-matched survival analysis was employed to control for potential confounding variables. The primary outcome was a composite event of non-fatal hemorrhagic stroke or death. Secondary outcomes were favorable patient outcomes, AVM obliteration, favorable neurological outcomes, seizure, worsened mRS score, radiation-induced changes (RIC), and embolization complications. Furthermore, the efficacy of distinct embolization strategies was evaluated. Hazard ratios (HRs) were computed utilizing Cox proportional hazard models.</p></div><div><h3>Results</h3><p>Among 1063 AVMs who underwent SRS with or without prior embolization, 176 patients met the enrollment criteria. Following propensity score matching, the final analysis encompassed 98 patients (49 pairs). Median (interquartile range) follow-up duration for primary outcomes spanned 5.4 (2.7–8.4) years. Overall, the E+SRS strategy demonstrated a trend toward reduced incidence of primary outcomes compared to the SRS alone strategy (1.44 vs 2.37 per 100 patient-years; HR, 0.58 [95 % CI, 0.17–1.93]). Regardless of embolization degree or strategy, stratified analyses further consistently revealed a similar trend, albeit without achieving statistical significance. Secondary outcomes generally exhibited equivalence, but the combined approach showed potential superiority in most measures.</p></div><div><h3>Conclusions</h3><p>This study suggests a trend toward lower long-term non-fatal hemorrhagic stroke or death risks with the E+SRS strategy when compared to SRS alone in large AVMs (volume &gt; 10 ml).</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110530"},"PeriodicalIF":4.9,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A patient-specific auto-planning method for MRI-guided adaptive radiotherapy in prostate cancer","authors":"Xiaonan Liu ,&nbsp;Xinyuan Chen ,&nbsp;Deqi Chen ,&nbsp;Yuxiang Liu ,&nbsp;Hong Quan ,&nbsp;Linrui Gao ,&nbsp;Lingling Yan ,&nbsp;Jianrong Dai ,&nbsp;Kuo Men","doi":"10.1016/j.radonc.2024.110525","DOIUrl":"10.1016/j.radonc.2024.110525","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Fast and automated generation of treatment plans is desirable for magnetic resonance imaging (MRI)-guided adaptive radiotherapy (MRIgART). This study proposed a novel patient-specific auto-planning method and validated its feasibility in improving the existing online planning workflow.</p></div><div><h3>Materials and methods</h3><p>Data from 40 patients with prostate cancer were collected retrospectively. A patient-specific auto-planning method was proposed to generate adaptive treatment plans. First, a population dose-prediction model (<em>M₀</em>) was trained using data from previous patients. Second, a patient-specific model (<em>M_ps</em>) was created for each new patient by fine-tuning <em>M₀</em> with the patient’s data. Finally, an auto plan was optimized using the parameters derived from the predicted dose distribution by <em>M_ps</em>. The auto plans were compared with manual plans in terms of plan quality, efficiency, dosimetric verification, and clinical evaluation.</p></div><div><h3>Results</h3><p>The auto plans improved target coverage, reduced irradiation to the rectum, and provided comparable protection to other organs-at-risk. Target coverage for the planning target volume (+0.61 %, <em>P</em> = 0.023) and clinical target volume 4000 (+1.60 %, <em>P</em> &lt; 0.001) increased. V_2900cGy (−1.06 %, <em>P</em> = 0.004) and V_1810cGy (−2.49 %, <em>P</em> &lt; 0.001) to the rectal wall and V_1810cGy (−2.82 %, <em>P</em> = 0.012) to the rectum were significantly reduced. The auto plans required less planning time (−3.92 min, <em>P</em> = 0.001), monitor units (−46.48, <em>P</em> = 0.003), and delivery time (−0.26 min, <em>P</em> = 0.004), and their gamma pass rates (3 %/2 mm) were higher (+0.47 %, <em>P</em> = 0.014).</p></div><div><h3>Conclusion</h3><p>The proposed patient-specific auto-planning method demonstrated a robust level of automation and was able to generate high-quality treatment plans in less time for MRIgART in prostate cancer.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110525"},"PeriodicalIF":4.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154896","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":"Clinical implementation of deep learning robust IMPT planning in oropharyngeal cancer patients: A blinded clinical study","authors":"Ilse G. van Bruggen ,&nbsp;Marije van Dijk ,&nbsp;Minke J. Brinkman-Akker ,&nbsp;Fredrik Löfman ,&nbsp;Johannes A. Langendijk ,&nbsp;Stefan Both ,&nbsp;E.W. Korevaar","doi":"10.1016/j.radonc.2024.110522","DOIUrl":"10.1016/j.radonc.2024.110522","url":null,"abstract":"<div><h3>Background and purpose</h3><p>This study aimed to evaluate the plan quality of our deep learning-based automated treatment planning method for robustly optimized intensity-modulated proton therapy (IMPT) plans in patients with oropharyngeal carcinoma (OPC). The assessment was conducted through a retrospective and prospective study, blindly comparing manual plans with deep learning plans.</p></div><div><h3>Materials and methods</h3><p>A set of 95 OPC patients was split into training (n = 60), configuration (n = 10), test retrospective study (n = 10), and test prospective study (n = 15). Our deep learning optimization (DLO) method combines IMPT dose prediction using a deep learning model with a robust mimicking optimization algorithm. Dosimetrists manually adjusted the DLO plan for individual patients. In both studies, manual plans and manually adjusted deep learning (mDLO) plans were blindly assessed by a radiation oncologist, a dosimetrist, and a physicist, through visual inspection, clinical goal evaluation, and comparison of normal tissue complication probability values. mDLO plans were completed within an average time of 2.5 h. In comparison, the manual planning process typically took around 2 days.</p></div><div><h3>Results</h3><p>In the retrospective study, in 10/10 (100%) patients, the mDLO plans were preferred, while in the prospective study, 9 out of 15 (60%) mDLO plans were preferred. In 4 out of the remaining 6 cases, the manual and mDLO plans were considered comparable in quality. Differences between manual and mDLO plans were limited.</p></div><div><h3>Conclusion</h3><p>This study showed a high preference for mDLO plans over manual IMPT plans, with 92% of cases considering mDLO plans comparable or superior in quality for OPC patients.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110522"},"PeriodicalIF":4.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S016781402403500X/pdfft?md5=756f01872c837c89ad1fdbd1c8e8830f&pid=1-s2.0-S016781402403500X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146126","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":"Concerns regarding the use of only phase 2 study to Justify palliative radiotherapy vs. Palliative chemo-radiotherapy in unresectable head and neck cancer","authors":"Jay Dave","doi":"10.1016/j.radonc.2024.110526","DOIUrl":"10.1016/j.radonc.2024.110526","url":null,"abstract":"","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110526"},"PeriodicalIF":4.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154897","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":"Recording and reporting of ultra-high dose rate “FLASH” delivery for preclinical and clinical settings","authors":"Till Tobias Böhlen ,&nbsp;Serena Psoroulas ,&nbsp;Jack D Aylward ,&nbsp;Sam Beddar ,&nbsp;Alexandros Douralis ,&nbsp;Grégory Delpon ,&nbsp;Cristina Garibaldi ,&nbsp;Alessia Gasparini ,&nbsp;Emil Schüler ,&nbsp;Frank Stephan ,&nbsp;Raphaël Moeckli ,&nbsp;Anna Subiel","doi":"10.1016/j.radonc.2024.110507","DOIUrl":"10.1016/j.radonc.2024.110507","url":null,"abstract":"<div><p>Treatments at ultra-high dose rate (UHDR) have the potential to improve the therapeutic index of radiation therapy (RT) by sparing normal tissues compared to conventional dose rate irradiations. Insufficient and inconsistent reporting in physics and dosimetry of preclinical and translational studies may have contributed to a reproducibility crisis of radiobiological data in the field. Consequently, the development of a common terminology, as well as common recording, reporting, dosimetry, and metrology standards is required. In the context of UHDR irradiations, the temporal dose delivery parameters are of importance, and under-reporting of these parameters is also a concern.This work proposes a standardization of terminology, recording, and reporting to enhance comparability of both preclinical and clinical UHDR studies and and to allow retrospective analyses to aid the understanding of the conditions which give rise to the FLASH effect.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110507"},"PeriodicalIF":4.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142154907","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":"Analysis of re-recurrent rectal cancer after curative treatment of locally recurrent rectal cancer","authors":"F. Piqeur ,&nbsp;L. Coolen ,&nbsp;S. Nordkamp ,&nbsp;D.M.J. Creemers ,&nbsp;R.H.N. Tijssen ,&nbsp;A.G.J. Neggers-Habraken ,&nbsp;H.J.T. Rutten ,&nbsp;J. Nederend ,&nbsp;C.A.M. Marijnen ,&nbsp;J.W.A. Burger ,&nbsp;H.M.U. Peulen","doi":"10.1016/j.radonc.2024.110520","DOIUrl":"10.1016/j.radonc.2024.110520","url":null,"abstract":"<div><h3>Purpose</h3><p>Substantiating data guiding clinical decision making in locally recurrent rectal cancer (LRRC) is lacking, specifically in target volume (TV) definition for chemoradiotherapy (CRT). A case-by-case review of local re-recurrences (re-LRRC) after multimodal treatment for LRRC was performed, to determine location of re-LRRC and assess whether treatment could have been improved.</p></div><div><h3>Methods</h3><p>All patients treated with curative intent for LRRC at the Catharina Hospital Eindhoven from October 2016 onwards, in whom complete imaging of (re-)LRRC and radiotherapy was available, were retrieved. Patients were discussed in plenary meetings with expert colorectal surgeons, radiation oncologists and radiologists. Each case was classified based on re-LRRC location, whether it was in accordance with the (current) radiotherapy protocol, and whether multimodal management would have been different in retrospect.</p></div><div><h3>Results</h3><p>Thirty-three cases were discussed. LRRC treatment was deemed suboptimal in 17/33 patients, due to different target volumes (13/17) and/or different surgery (9/17). 15/33 (46 %) of re-LRRC developed in-field of the prior radiotherapy TV, possibly showing RT-resistant disease. Other re-LRRCs developed out-field (n = 5, 15 %), marginally (n = 6, 18 %), or in a combined fashion (n = 7, 21 %). In retrospect, 48 % of cases were irradiated in line with current TV recommendations. TVs of 13/33 cases would have been altered if irradiated today.</p></div><div><h3>Conclusion</h3><p>This study highlights room for improvement within current standard-ofcare treatment for LRRC. Different surgical management or TVs may have improved outcome in up to half of discussed cases. Further delineation guideline development, incorporating the results from this study, may improve oncological outcome, specifically local control, for LRRC patients.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110520"},"PeriodicalIF":4.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146125","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":"Adapting outside the box: Simulation-free MR-guided stereotactic ablative radiotherapy for prostate cancer","authors":"Jeremiah de Leon ,&nbsp;Urszula Jelen ,&nbsp;Madeline Carr ,&nbsp;David Crawford ,&nbsp;Maddison Picton ,&nbsp;Charles Tran ,&nbsp;Laura McKenzie ,&nbsp;Valery Peng ,&nbsp;Tania Twentyman ,&nbsp;Michael G. Jameson ,&nbsp;Vikneswary Batumalai","doi":"10.1016/j.radonc.2024.110527","DOIUrl":"10.1016/j.radonc.2024.110527","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Magnetic resonance (MR)-guided radiotherapy (MRgRT) enhances treatment precision and adaptive capabilities, potentially supporting a simulation-free (sim-free) workflow. This work reports the first clinical implementation of a sim-free workflow using the MR-Linac for prostate cancer patients treated with stereotactic ablative radiotherapy (SABR).</p></div><div><h3>Materials and methods</h3><p>Fifteen patients who had undergone a prostate-specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scan as part of diagnostic workup were included in this work. Two reference plans were generated per patient: one using PSMA-PET/CT (sim-free plan) and the other using standard simulation CT (simCT plan). Dosimetric evaluations included comparisons between simCT, sim-free, and first fraction plans. Timing measurements were conducted to assess durations for both simCT and sim-free pre-treatment workflows.</p></div><div><h3>Results</h3><p>All 15 patients underwent successful treatment using a sim-free workflow. Dosimetric differences between simCT, sim-free, and first fraction plans were minor and within acceptable clinical limits, with no major violations of standardised criteria. The sim-free workflow took on average 130 min, while the simCT workflow took 103 min.</p></div><div><h3>Conclusion</h3><p>This work demonstrates the feasibility and benefits of sim-free MR-guided adaptive radiotherapy for prostate SABR, representing the first reported clinical experience in an ablative setting. By eliminating traditional simulation scans, this approach reduces patient burden by minimising hospital visits and enhances treatment accessibility.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":"200 ","pages":"Article 110527"},"PeriodicalIF":4.9,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0167814024035059/pdfft?md5=aec6cfd6f46613eaf3f01ef7120b1d00&pid=1-s2.0-S0167814024035059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146109","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}